Good Things Continue 5/28/09

I have been eating (although a little at a time) and pretty much sleeping through the night since Memorial Day (Thanks Dad M.). Things seem to be on the upswing but PLEASE don't stop the thoughts and prayers.

Dan

Promising turn of things 5/25/09

We went to the movies today and I was feeling really positive so I ate some (half) of Pat's popcorn with NO PROBLEM. When we arrived home our son (Danny) was at the house. After watching the Phillies for a little, we went to an Irish restaurant and I ATE soft shell crabs with no issues. Today was the first day since March that I ate solid foods with no problems. I assume that the combination of all of the prayers being sent my way added to the chemotherapy has started shrinking the "beast".

THANKS to ALL

Home Nurse Visit 5/21/09

The nurse replaced my dressings and the needle that is inserted into the port that is under the skin in the right side of my chest. The port area is still tender from last weeks surgery to implant it, so it hurt like hell for a few seconds. At least this week the blood started to flow right away and we didn't have to resort to any tricks like reclining, turning my head, raising my right arm over my head and deep breathing.

Thanks to EVERYONE for the support and prayers..

May 19, 2009 Echo Cardiogram

A little bit of good news. The test went off without any problems.


The GOOD NEWS is that - YES - I HAVE A HEART.


God Bless All

May 14 2009 - Chemotherapy Started

All went relatively smooth.
We arrived at HMC at 8:45 Am.
Called in for blood work by 9: AM. The nurse there was the first to access the port that is implanted in my chest. She had a little bit of a problem getting blood to flow through the port.
However I was not the first with this issue and she had a few tricks up her sleeve. She reclined my chair, had me turn my head to the left and raise my right hand over my head. She got blood.

We saw an oncologist by 9:15 AM - nothing new there except a couple of prescriptions for anti nausea medications, which we had filled at the pharmacy right there in the Physicians building.

We headed to the infusion center where I was hooked up to an IV, once again through the chest port. Received two of the chemo drugs there and we left at 3:15 PM. It took so long because one of the drugs (cisplatin) can affect the kidneys, so there were hours of receiving glucose and saline to flush my kidneys both before and after receiving chemo.

The third drug (5-FU (fluorouracil) is being administered through a pump attached to the port.
This was hooked up by a nurse working for Horizon Home Care. She also used to work at the infusion center at HMC. She had a bit of a problem with seeing blood through the port, also, so we explained what we did in the morning and she added that I take deep breaths. She got blood.
Then she introduced us to my new friend that will be attached 24 hours a day and 7 days a week. The only time it isn't hooked up is once a week when the nurse comes to the house to replace the drug cartridge and the needle in the port.

Here is a picture of my little friend;

It has a belt loop and a loop that can be put over your shoulder (man bag style) or put around your waist (fanny pack style). The jury is still out on how it will be worn.

I would like to say here that ALL of the employees (nurses, doctors, surgeons, etc..) at HMC and now Horizon have been WONDERFUL. They are all pleasant, genuine and they care about you as an individual.

Peace and Love to all
Dan

Meda-Port (Mediport) Installation

All went fine today. It took a little longer that expected but all went well.
Below is a picure of what was inserted in my upper right chest.

How I will receive treatment (thanks to Veronica Lavanga for this info)

How treatment is given

Your chemotherapy treatment can be given to you as a day patient or during a short stay in hospital. The treatment is then continued at home. Before you start treatment you will need to have a blood test on the same day, or a few days beforehand. You will also be seen by a doctor, specialist nurse or pharmacist. If the results of your blood test are normal, the pharmacy will prepare your chemotherapy drugs. All of this may take a couple of hours.

Most people who have ECF will have their chemotherapy given through a thin plastic tube which is inserted under the skin into a vein near the collarbone (central line), or passed through a vein in the arm (PICC line). Your doctor or nurse will explain more about this to you.

You will be given an anti-sickness (anti-emetic) drug, either as tablets or by injection through your central line or PICC line. The chemotherapy drugs are then given separately:

• epirubicin (a red fluid) is given as an injection along with a drip of salt water (saline) into the line. It may sometimes be given as a drip
• after this you will be given cisplatin (a colourless fluid) which is given as a drip (infusion).

Before and after treatment with cisplatin, you will be given plenty of fluid through your drip to keep your kidneys working normally. This may mean that you will need to stay in hospital overnight.

Once your drip is finished you will start treatment with 5FU, which is usually given through a small portable pump. The pump is used to give a controlled amount of the drug into your bloodstream over a set period of time. There are several different sorts of pump, though all are small enough to be carried in a belt or holster so that you can continue doing the things you normally do.

Once the pump is connected to your line, you can go home with it. Before you go you should be given instructions on how to look after the pump. Your nurse should explain how to care for it and what to do if something goes wrong.

When the infusion is finished there may be some fluid left in the pump. This may be normal as some types of pump need to be overfilled to get the correct dose. You can check with your nurse or pharmacist whether you have this type of pump.

The 5FU treatment is given continuously over the whole time that you have your chemotherapy. You will need to have the drug reservoir or the entire pump replaced as it empties, usually on a weekly basis. This may be done at the hospital or you may be taught to change the pump yourself. Otherwise, arrangements may be made for a district nurse to come to your home to change the pump.

When you go home you will be given a supply of anti-sickness tablets to take with you. You should take these regularly if you have been told to do so, even if you are not feeling sick. This is because some medicines are much more effective at preventing sickness than stopping it once it has started. However, the 5FU in the pump is very unlikely to make you feel sick and it is unlikely that you will need anti-sickness medicines for more than a few days after your visit to the hospital.

If you do not have a central line or PICC line, 5FU can be given to you as a drip into your arm (through a small tube known as a cannula which is inserted into a vein in your arm). This is given over a shorter period, often for four days every three weeks. You will need to stay in hospital for the four days of treatment.

Hershey Medical Center Visit 5/5/09

Went for blood work and a CT Scan and was scheduled for an echo cardiogram but that was postponed. I do not have any results but these were just benchmarks for the start of chemotherapy next week. A good thing is that I have maintained my weight since the last visit.
The Clinical Trial that we were going for was closed on Friday, they met the limit of participants world wide. This is probably a good thing since the oncologist told us today that I will receive basically the same drugs that the Trial was going to use. Not being in the Trial will also cut down on trips to Hershey (35 minutes each way).

I am going on Monday the 11th for the mediport installation. When I start chemo on the 14th, I will come home wearing a pump that will inject drugs 24/7. I wear it for three (3) weeks and then it is refilled and wear it for three more weeks. They will then CT Scan me again to see the progress.

I will not try to explain the three (3) drugs that will consist of my chemo, I will let Wikipedia do that;

The chemotherapy agent 5-FU (fluorouracil), which has been in use against cancer for about 40 years, acts in several ways, but principally as a thymidylate synthase inhibitor. Interrupting the action of this enzyme blocks synthesis of the pyrimidine thymidine, which is a nucleotide required for DNA replication. Thymidylate synthase methylates deoxyuridine monophoshate (dUMP) into thymidine monophosphate (dTMP).

Like many anti-cancer drugs, 5-FU's effects are felt system wide but fall most heavily upon rapidly dividing cells that make heavy use of their nucleotide synthesis machinery, such as cancer cells (other parts of the body with rapidly dividing cells include the cells lining the digestive tract).

Some of its principal use is in colorectal cancer and pancreatic cancer, in which it has been the established form of chemotherapy for decades (platinum-containing drugs have been approved for human use in the US since 1978 are also very well established).

5-FU is also used in ophthalmic surgery, specifically to augment trabeculectomy (an operation performed to lower the intraocular pressure in patients with glaucoma) in patients deemed to be at high risk for failure. 5-FU acts as an anti-scarring agent in this regard, since excessive scarring at the trabeculectomy site is the main cause for failure of the surgery.

Fluorouracil can be used topically (as a cream) for treating actinic (solar) keratoses and some types of basal cell carcinomas of the skin. It is often referred to by its trade names Efudex, Carac or Fluoroplex.

It is a key component in Tegafur-uracil.

Epirubicin is an anthracycline drug used for chemotherapy. It is marketed by Pfizer under the trade name Ellence in the US and Pharmorubicin or Epirubicin "Ebewe" elsewhere.

Similarly to other anthracyclines, epirubicin acts by intercalating DNA strands. Intercalation results in complex formation which inhibits DNA and RNA synthesis. It also triggers DNA cleavage by topoisomerase II, resulting in mechanisms that lead to cell death. Binding to cell membranes and plasma proteins may be involved in the compound's cytotoxic effects. Epirubicin also generates free radicals that cause cell and DNA damage.

Epirubicin is favoured over doxorubicin, the most popular anthracycline, in some chemotherapy regimens as it appears to cause fewer side-effects. Epirubicin has a different spatial orientation of the hydroxyl group at the 4' carbon of the sugar, which may account for its faster elimination and reduced toxicity. Epirubicin is primarily used against breast and ovarian cancer, gastric cancer, lung cancer, and lymphomas.

Cisplatin, cisplatinum or cis-diamminedichloridoplatinum(II) (CDDP) is a platinum-based chemotherapy drug used to treat various types of cancers, including sarcomas, some carcinomas (e.g. small cell lung cancer, and ovarian cancer), lymphomas and germ cell tumors. It was the first member of its class, which now also includes carboplatin and oxaliplatin. Platinum complexes are formed in cells, which bind and cause crosslinking of DNA; ultimately triggering apoptosis(programmed cell death).

Thanks for all of the THOUGHTS, PRAYERS and LIT CANDLES. Rumor is that Notre Dame had to hire a new fireman for the Grotto based on the number of candles lit there for me...

God Bless All