Tuesday, May 27, 2008

live from palo alto, its tuesday afternoon

so another long day is almost in the books...

trish and i arrived at stanford at 10am this morning for her blood draw up at the infusion center. this was the first time we have watched as her mediport was accessed, but aside from a little pinch (ok... trish said it felt like a knife going through her chest), nurse pat had the keg tapped, and the beer flowing... err... port tapped and blood flowing, in no time.
i think next week, we will have trish put the numbing cream on a little earlier..

we then headed down to dr. carlson's waiting room at 10:40am for our 11:00am appointment. trish early for something... (insert your own sarcastic comment here)

at 12:30pm we got into an exam room and met with nurse jan, reviewing the previous 7 days of trish's reaction to her new treatment.

dr. carlson and dr. telli came in around 1pm to examine trish, and outlined the coming weeks. they are pleased with trish's response to the chemo, and we will now only see them on a once a month basis (or unless we feel a need to meet with them).

by 2pm trish and i were seated in her patient station, #B6...
around 2:20pm nurse mary had trish's three pre-drugs flowing:

decadron: steroid to hinder any allergic reactions
diphenhydramine: a antihistamine also known as benedryl (makes trish a little loopy and sleepy)
famotidine: an antacid, also known as pepcid

around 3:40pm trish began on her taxol and herceptin drips... both were flowing at the same time, but the herceptin was flowing at about 1/12th the full rate..
once the taxol finished around 5pm, the herceptin was pumped up to its full 500ml an hour and we should be done within the next 15 minutes..

everything is going good, and trish seems to be handing this new treatment really great. she has not experienced any nausea this past week, although she did have some achiness but nothing that kept her and caden from going camping with trish's parents saturday-monday. trish and caden got home monday morning, and come evening time, we headed down to san jose for a bbq at my coworker kevran's house to celebrate the completion of my project at work...

this was the first time trish had a chance to meet my boss, jane, who introduced us to the Healing Touch program at stanford. kevran cooked us a great dinner of bbq'd steak, chicken and veggies.. and caden had a great time exploring the palatial play structure Kevran has in her backyard, as well as playing with her daughter, kiley..

anyhow... thats the report from chair B6... her treatment is done, nurse mary just flushed trish's port with heparin and its time to go home and see caden...

10am - 6pm ugghhh... i hope the valet parking is still open..

Wednesday, May 21, 2008

tales, continued...

so wednesday morning, its back to stanford we go...

9:30am chemo appointment to pick up where we left off on tuesday night.

julie came along to keep trish company, as i had to do some work while we were there.
(hospitals with wifi, its a beautiful thing)

the nurses left the needle in trish's port from the night before, no blood tests were needed and we didn't meet with dr. carlson...
so we were already three steps ahead of the game

as with yesterday, the nurses started off the treatment with the 3 "pre-drugs" of benadryl, decadrone (i think) and something else i dont recal.

about an hour later, it was time for the Taxol. Taxol can sometimes cause allergic reactions, but trish experienced nothing of the sort.
again, the nurses took it slow, about 90 minutes... but everything went smoothly.

next tuesday trish will get back on the normal track of herceptin and taxol on the same day... about 45 minutes each...
plus the 45 minutes of the 3 other drugs, so it will be a 3-4 hour process.

the stanford cancer center is a really, really nice place in many ways.
the doctors offices and blood lab are on the street level, chemo is upstairs, radiation is downstairs. there is a pharmacy, boutique and cafe on site.

its a new building, so its bright, open, cheery and clean, and they will even valet park you car (but not free)

upstairs in the chemo rooms, there are large picture windows looking out to a grove of redwoods..
each patient station has a flat screen tv to watch (and hook our portable dvd player to)

all the people... employees, nurses and patients/families alike, are all there for the same reason and are really cordial and accommodating.
mark and pablo handle all the scheduling that comes out of dr. calrson's office. when you are planning months and months of chemo, blood tests, ekg's, etc..
its really nice to have a couple of guys that go out of their way to help you out. they know who to talk with and what strings to pull.

the nurses in dr. carlson's office and the chemo center are all really nice, sharing experiences and answering all our questions.

but the the people who really stand out are the volunteers..
there is always someone coming around with a cart of snacks, drinks, blankets, magazines, books, games, etc.
just trying to do whatever they can to make it easier on the patients.

today, we had a guy come in with a guitar and just sit down in the middle of the chemo room and strum some tunes..
another volunteer had an 'art cart' with plenty of pencils, paints, crafts, etc...

julie kinda got strong armed by the art cart lady, but she wound up tapping her inner jewlery making abilities, and created a couple fashionable bracelets that would look great on any tennis court.
maybe next time jules will conquer the more advanced necklace..

down the hall from the chemo rooms, there is a mediation room where you can go relax and find some peace and quiet.

so for a place that has all the reasons to be on the depressing side, its really quite the opposite.

our 'chemo neighbor' was a guy who looked to be in his mid 20's, and this was his first chemo treatment. he seemed a bit nervous to say the least, but trish, the veteran, chatted it up with the guy and shared her 'expertise'

typical trish, putting some good thoughts in his head and trying to make him feel better... all while she is going through the same thing.

here are some crappy cell phone pics...
but you can get an idea of what the stations look like, what the view from trish's chair.

Tuesday, May 20, 2008

tales from chemo land...

on tuesday 5/20, trish jumped back up on that chemo bandwagon.

it was long day...

trish, cerena and i arrived at stanford around 9am for her blood work, then headed to dr. carlson's office.
dr. carlson, dr. telli and nurse jan explained to trish what the coming weeks will bring in terms of side effects of the Herceptin / Taxol combo.
trish may feel achy for a few days, but she shouldn't experience any nausea from here on out..
we will meet with the doctors again next week, but the future schedule will be once every four weeks.

one less stop = shorter day (hopefully)

dr. carlson examined trish and seemed pleased with the progression of the treatment.

he could not feel trish's lump :)

this was really good news.

it makes you feel better knowing all the crap trish has been put through is working. this by no means affects how we will continue to battle this, but its sure a helluva lot better than hearing the doc say "the dang thing seems to have doubled".

a little positive news every once in while is kinda nice.

after our visit with dr. carlson, it was about 11am and we headed over to the ambulatory surgery department for trish's appointment to get her mediport installed.

a mediport is a little doohicky that is implanted beneath the skin, near the collarbone with a tube connecting to one of trish's veins.
basically, trish will no longer have needles inserted directly into her veins. needles will now go into the mediport, which is already connected to a vein.
its one of those rare times where a middleman is actually a good thing.. think of it as a dartboard under the skin, the nurse just needs to hit the dartboard, not even a bullseye.

the mediport is completely under her skin, and the only thing visible will be any residual scarring from the stitches.
trish's surgeon assured her that he was pretty anal about the quality of his stitches, so scarring should be limited.

since trish wasn't getting much luck from the nurses when it came time to find her veins, this will help out a lot.
her skin will still need to be punctured at the mediport location, but no more hunting for veins.
trish was given a numbing cream that she will put on her skin above the port prior to arriving for chemo, and this will help with any pain of getting pricked in the same spot week after week.

another nice thing about the port is that we no longer need to go to the blood lab prior to each chemo visit. trish can just head up to the chemo clinic, and they tap her, draw blood themselves, then give her the IV's

one less stop = shorter day (hopefully)

here are pictures of what a port looks like, and the special needles used to access it...

trish was awake during surgery, which lasted about 90 minutes, but was pretty loopy from the sedatives they gave her.

we left the ambulatory surgery center at 4:30pm...
we got there at 11am...

surgery was 90 minutes...

im still trying to figure out that math..

so we arrived back at the cancer center 5 1/2 hours after we left it, and a little late for trish's chemo appointment.
because we were so late, they decided to only administer the herceptin, and have us come back wednesday for the taxol.

with the new herceptin/taxol regimen, trish will also get 3 other IV's of drugs prior to her chemo. they are various antihistamines and steroids to help with any allergic reactions and side effects. these take about 45 minutes.

about 6pm trish started on the herceptin. this is a clear IV drip, and technically it isn't a chemo drug, its an antibody. the IV will typically take 45 minutes, but today it took 90 minutes as this was trish's first rodeo with herceptin, the nurses wanted to slow it down and make sure trish didnt have any unexpected reactions.


a couple hours later.. around 8pm, we were heading out the door of the cancer center.

the end of an 11 hour day...

but... and there is always a but...

oh... the valet parking was closed, so we had to call security to track down our keys...

hey... whats another 15 minutes on a already long day..

Thursday, May 15, 2008

the week in review...

here is a quick update of the past week....

thursday 5/8:

trish had her first appointment with her Healing Touch partner, chanda. she really enjoyed the session, and said she was able to really relax and feel the positive energy throughout her body.
i have no doubt that this will prove to be a great program for trish.

trish's sister, yvonne, flew in from holland for a visit. trish and yvonne only see each other about once every couple of years, so this is a special time for two of them to hang out..

friday 5/9:

trish went to the movies with her sister and mom, and saw 'Forgetting Sarah Marshall'

the house cleaners came... a bunch of our friends pitched it and paid for a years worth of house cleanings... thank you very much to all of you.

jen, robert and cooper tozi stopped by for a bit and dropped off some dinner..

saturday 5/10:

trish went shopping with yvonne, as our friend jay and myself played plumber for the day.

those familiar with our 4 year long master bathroom renovation (okay, maybe 5 year) will be happy to hear that we have all our tile done (thanks whitey), but more importantly, WE HAVE A WORKING TOILET... trish was quite happy to say the least... no more trips down the hall in the middle of the night to the other bathroom..

i plan on having the sink in sometime in the next 4 years.

sunday 5/11:

we had a very nice mother's day brunch over at steve & cerena's, with all of trish's family... we ate too much as we watched caden and cousin lucas play around in the backyard...

monday 5/12:

during the morning, trish and her dad brought caden to his gymnastics class down at the rec center...

yvonne made us a nice dutch dish for dinner...

in the late afternoon, trish decided it was time for a new, new do...
trish's hair was becoming easier to pull out. she wasn't to the point of losing clumps of hair, but her scalp was constantly itchy, and she was afraid scratching her head would pull too much hair out...

so..... it was time.

she had her brother, casey (an expert with the bald head), shave all but about 1/2" off..

it turned into a head shaving party as our friend eric, trish's dad judas, our nephew trevor, and my cousin kevin took part in the shaving as well... for some reason, bella (the dog) was no where to be found during all of this...

our biggest concern was how caden would react.... so while trish was getting her haircut, caden was right in front watching as trish's hair became shorter and shorter...

he took it great... he could care less if his mom has long or short hair... that makes two of us...

tuesday 5/13:

trish and yvonne spent the day in san francisco... hitting up the ferry building, ghiradelli square and union square... they made it back to redwood city in time for the tail end of story time at the library (trish and caden have been going to this for ~ 14 months)

wednesday 5/14:

trish, along with caden, lucas, yvonne and ria went to the San Francisco Zoo.

mr. and mrs. p... ron sr. and dianne puccinelli brought by some chicken, veggies and dessert...

thursday 5/15:

trish is currently at her 2nd session with chanda of the healing touch program

whats on tap for the coming week:

friday 5/16:

trish will meet with the cardiologist and get her baseline EKG.

saturday 5/17:
the plan is for trish to head to the wine country, and spend the night up there with her girlfriends... this will be trish's first night away from caden..... ever... stay tuned..

tuesday 5/20:
trish begins her new regimen of weekly taxol and herceptin IV drips

some pics from monday...

hair falling out...

so its time to cut it...

now she is ready for the 100 degree heatwave...

Wednesday, May 7, 2008

some pics from today...

trish, caden and myself took a nice long lunch at the spot we were married three years ago today, crystal springs golf course.

i had made earlier arrangements with the wedding planning staff so we could have some private time at the gazebo area. they were more than accommodating, and even brought us a bottle of apple cider, champagne flutes and some chocolate covered strawberries.
thank you very much lindsay, liesl and tracey.

with some sandwiches from one of trish's favorite delis, alotta's, in hand, we watched as caden ran up and down the hilly acre of nicely manicured golf course grass. the time together was great, and for a couple hours any worries we had were on hold.

we decided to push the trip over the hill to the coast off until the weekend, and just hang out at home tonight. trish went out and picked up some sushi, while i worked on getting caden ready for bed.

it was a great day.


here are some pics from today
(click for bigger pics)

Tuesday, May 6, 2008

the first 14 days, the next 14 days...

today was the last days of trish's first chemo cycle!
14 days in the books...

the day was celebrated by trish taking her last 3 cytoxan pills this morning, and taking caden to the doctor in the afternoon.

this past wednesday and thursday were probably trish's worst days since beginning chemo on april 22nd, nonetheless she was out of the house and keeping busy. trish knows there is a big line between staying active and overdoing it, so she takes some extra time to relax and/or sleep, but overall the chemo has been pretty good to her. we aren't naive to the fact subsequent treatments may be tougher, but the last 14 days have been better than we both imagined them to be.

so whats next.... well, not much for the next 14 days. they will be chemo free, pill free and (almost) doctor free.

trish's next chemo appt will be tuesday may 20th, and at this time she will begin her new chemo schedule of 4 times a month, rather than twice. this regimen will consist of a combination of taxol and herceptin, both by IV... no pills :)

taxol is a drug typically administered once a week, while herceptin is every three weeks. but since trish will go in weekly for the taxol, it has been decided she will get 1/4 doses of herceptin at this time as well. the doctors believe the smaller, more frequent doses will help curb the severity of the nausea and fatigue.

the potential side effects of these drugs include damaging the heart's ability to pump blood effectively. this isn't a huge concern in trish's situation, as she is young and the owner of a healthy heart. regardless, her heart will be closely monitored throughout this treatment cycle with frequent electrocardiograms (EKG). this friday trish will visit with the cardiologist to get a baseline EKG of her heart's health. this baseline will then be compared to future EKGs she will receive during the course of her treatment.

again we feel very fortunate trish is surrounded by very knowledgeable and respected doctors in the field of oncology. Dr. Melinda Telli is a postdoctoral fellow working with Dr. Carlson in the treatment of trish. Dr. Telli was lead author of a study published in the Aug '07 Journal of Clinical Oncology discussing the effects of herceptin (trastuzumab) on the heart. It really does ease our minds knowing trish is receiving the best care available.

oddly enough, the past 14 days have been the most 'normal' we have experienced since this adventure began. we can finally relax and take a breath or two... trish isn't undergoing tests every day, we aren't waiting on the results of those tests and the visits to the doctor have become limited. we now know how she reacts to the chemo, we are getting into a solid routine and we have a very good understanding of what lies ahead of us for the coming months. trish, myself and our support system are ready to battle this together. the generosity from our families and friends continues to overwhelm us, and we can not begin to express how gracious we are.


tommorrow, may 7th, marks the 1 month anniversary of trish's diagnosis, as well as our 3 year wedding anniversary. its been an unbelievable month, but a tremendous three years. im taking trish and caden to lunch at a 'suprise' location, and later on heading over to the coast for dinner and a sunset.

trish has been dealt a crappy hand, but through all this, she has remained brave, caring and perhaps most importantly, humorous. she isn't going to let this beat her, or even get her down.

guess this just reminds me why i fell in love with the girl 8 years ago.