Onwards and Upwards - Let's Start Chemo!

Zee plan is now for chemo to start tomorrow - Monday January 31, 2011. At 10AM my fiance will call the hospital to see if they have a bed available. Does this seem odd to you? It seems odd to me. It seems like a lot of responsibility is put on the patient for making things happen...

Regardless, my fiance will call and they will tell him what time the bed is ready for him. I will have gone to work and when I get a call from my fiance I will zip home to pick him up and take him to the hospital.

From this point things should happen quickly (according to Nurse Scott). The pick line will be put in his vein right away and they'll start chemo right then. Chemo delivery is not painful. Dr. Webster will be there once my fiance is admitted so we can ask any questions.

On the top of my fiance's question list so far are:

1. Will I have my own room?
2. Will I have a TV?
   

What's that You Say? - Hearing Test - Jan. 26, 2011

Because my fiance's nasopharyngeal cancer is blocking the Eustachian tube that lets air into his right eardrum so it's filled with fluid (at least that's how I understand it), his hearing in his right ear is impaired.

For him, his right ear feels like it's in a bubble. His left ear is fine though.

The good news from the hearing test was that after treatment, it's likely that the liquid can be drained and his hearing should return to normal.

Little Soldiers

Another topic Dr. Webster brought up was infertility. I'm not going to get into it too much because it's pretty personal, so I'll just mention that a side-effect of chemo can be infertility.

Roadblock - Hello Dentist... Goodbye to 8 Teeth - Jan. 20, 2011

Alright, so, let's recap. On Jan. 19th there was a very wonderful meeting with Dr. Webster. He wanted to start chemo right away.

There was a great sense of urgency to start the chemo as soon as possible. Dr. Webster said start on Monday at the latest. My fiance and I discussed this. He wanted to wait till Monday at first so he could have time to mentally prepare for the chemo, but in the end decided that starting Friday would be best.

So Dr. Webster requested a bed in the hospital so chemo could start on Friday the 21st.

All seemed to be well. But then...

An innocent trip to the dentist at the Tom Baker turned into a rushed trip to an oral surgeon to have 8 teeth removed. I was in shock. When I first found out that 8 teeth had to be removed I couldn't understand why. Why couldn't it wait till after the treatment?

Everything happened so fast. Before I could even talk to the nurse on the phone to get an explanation the teeth were already out. This was hard to deal with because now not only was chemo delayed, my fiance was in a ton of pain and he couldn't eat anything to get his weight up for chemo.

I was also frustrated that they hadn't made the dental appointment as soon as he was diagnosed with cancer. Why was it scheduled for 2.5 weeks after he was diagnosed? This was another time when the Cancer VIP Card would have come in handy.

He had his 4 wisdom teeth removed and the 4 molars beside the wisdom teeth. The bottom wisdom teeth were growing sideways into the molars causing cavities, so the molars had to be removed too since they were resting on the wisdom teeth. And since the bottom molars were removed the top molars would have nothing to bite down on so they had to be removed too.

Why, oh why couldn't this wait? Well, apparently all dental work has to be done before chemo and radiation start. For chemo, there can be no risk of infection while having treatments. For radiation, it decreases blood flow to the jaw so any dental work done after has a risk of causing osteoradionecrosis.

Wow, I just googled that word for the first time and the images that came up were nasty! Ok, now I truly understand why it had to be done.

So ya, my fiance had issues getting the bleeding to stop. He pretty much drank Ensures for the next 3 days after surgery. He was not a happy camper!

On the bright side though - it was amazing how quickly he got in to see the dental surgeon. It was only a few hours after the initial dentist appointment that he was driven downtown by his brother to see the dental surgeon.

Chemo Fever = Danger!

The most important thing to remember with this chemo is:

If you develop a fever over 30 degrees Celsius you must go to the hospital emergency RIGHT away. Pack an overnight bag, go to the triage nurse and tell her you're on chemo.

If you ignore a fever for 24 hours it is VERY dangerous. You need to see a physician within 8 hours of getting a fever.

There is a 10-15% chance a fever will occur in the first round of chemo.

And a few more interesting chemo tidbits:

• Chemo takes away your taste for a week
  
  
• The first week of chemo will be very low key
  
  
• BUT - you must keep active - walking is great
  
  
• It can cause ridges in your nails and fluid retention in your legs
  

Dr. Webster Talks Chemo - Jan. 19, 2011

Everyone has seen a TV show or movie where an emaciated cancer patient getting chemo is wheel-chaired into a scene, flashes a feeble smile and obviously has no hair. But what does chemo really do? And why?

There are MANY different types of chemo drugs. Some make your hair fall out because they kill all fast growing cells, some do not.

Dr. Webster said my fiance would be treated with 3 aggressive drugs - the same regiment as is used in the East. The Chemo Cocktail for my fiance is as follows:

1. Docetaxel

• This little baby causes slow hair loss (apprx 2 weeks till follicle evacuation) - joy!
• People can have an allergic reaction their 1st or 2nd treatment cycle, after that it won't happen
• Premeds include Benadryl to handle possible allergic reaction
• Doesn't cause nausea
• Does cause flu-like symptoms like achiness, but this lasts a day at the most

2. Cisplatin

• This drug will be given with the radiation treatment too
• Given with lots of fluids because it can be hard on the liver
• Can be nauseating, but this lasts 1 week max.
  
• Patients are given a LOT of anti-nausea pills before this drug
• Typically the only feeling experienced is queasiness

3. 5-FU

• Please, hold the jokes about the FU
• This drug is given on continuous infusion
• There are no side effects!

How is chemo administered? Well...

The first time you have to be in the hospital so they can monitor you. My fiance will have to stay overnight. Usually it takes 2-3 hours for the docetaxil and Cisplatin, which are given in your vein. For this my fiance will need a vein pick. It's a tube that goes in the vein up to an artery so the doctors don't have to open the vein each time.

The 5-FU takes 48 hours to administer and is given over 2 days. For these days my fiance will get a fanny pack with the drugs in it that is hooked up to his vein pick. The pump in the fanny pack makes sure the right amount of drug goes into the vein at the right time.

Docetaxil has to be administered in the hospital each time.

And that's it for the drugs!

Dr. Webster aka Dr. Amazing - Jan. 19, 2011

On the morning of Wednesday January 19th we finally met someone who cared. His name, Dr. Marc Webster. The amount of hope this man inspired was phenomenal. Here's a link to what other patients have said about him:

Rate My MD - Dr. Marc Webster

I think I'll rate him after this is all over.

So, Dr. Webster is a medical oncologist aka chemo guy. He said he doesn't like to sugar coat things and will tell us everything if we want to hear it. Of course we said YES.

Here's what he said:

• The biopsy showed a squamous cell, looks like it came from the nasopharynx
  
  
• The cancer is wrapping itself around some blood vessels
  
  
• It is nasopharyngeal cancer Stage 4B

Stop! At this point he said something amazing. Dr. Webster said, "It is curable." Three simple words said with palpable conviction. Yipee!

And then he explained further:

• Head and neck cancers are staged differently
  
  
• Instead of just stage 1, 2, 3, 4 - at stage 4, there is also A, B and C
  
  
• Stage C means it's spread to the rest of the body, but stage B means it hasn't

Just on a side note, even if it were Stage 4C, I would still think it's curable. I started seeing a councellor and in 1996 she found out that every lymph node in her body was cancerous. She had over 100 tumors all throughout her body. The doctor said she had 2 weeks to live.

Obviously she's still here today.

Back to Dr. Amazing, I mean Webster:

• The bone scan showed 2 tiny specks in the ribs with low grade activity. This can be caused by stretching or mild bruising so could be completely benign. This needs to be followed up with a PET scan.
  
  
• Radiation is the best treatment for nasopharyngeal cancer
  
  
• Chemotherapy eliminates any micro particles of cancer throughout the body
  
  
• Radiation can't start for another 3 weeks so he wants to start chemo right now
  
  
• He will not sacrifice the radiation though
  
  
• If chemo is too hard on the body, he will stop it
  
  
• Chemo should start within the next 2 days