Thursday, April 14, 2011

Chemotherapy and IVF Treatment

I have been healing well with my surgery and Im looking forward to a few more weeks when I can do normal things again! I have started taking little morning walks without a wheelchair in the neighborhood to get some sun and to get my strength back.  I just hope my appetite will come back soon. 

We finally met with the Medical Oncologist Dr. John Glaspy on April 7, 2011.  He gave us the overview of the chemotherapy regimen I will have.  A combination of Taxotere (treatment for symptoms of locally advanced or metastatic breast cancer) and Cytoxa (which treats several types of cancer in combination with other drugs to treat breast cancer.  It will be given by infusion that will last about 4 hours through intravenous. It will be given every 3 weeks and I will be given the maximum dose of 6 cycles, which will last for six months.

To alleviate the pain of being given an intravenous line each chemotherapy session,  they will install a Port-a-Cath. It is a device that will inserted in your chest during a one hour surgery. A port is a small disc made of plastic or metal about the size of a quarter that sits just under the skin. A soft thin tube called a catheter connects the port to a large vein. Your chemotherapy medicines are given through a special needle that fits right into the port. You also can have blood drawn through the port. When all your cycles of chemotherapy are done, the port is removed during another short outpatient procedure.

Some people feel the pain when it is first installed but later on they are thankful because they do not need to get poked each time an IV line is done.  Also all the blood test will be done through the port.  They take blood test each chemotherapy session.

A day after the chemotherapy, I have to come back to the hospital to get a Neulasta injection.  It is used to reduce the chance of infection in people who have certain types of cancer and are receiving chemotherapy medications that may decrease the number of neutrophils (a type of blood cell needed to fight infection).

Unlike many years ago, the side effects of chemotherapy is vomiting, nausea, anorexia and hair loss.  They has developed many medicines that will help with nausea and vomiting.  I will be taking -Decadron twice a day before and after chemo (which may cause restlessness and insomia) . 
-Compazine every 6-8 hours but which may sleepiness
-Ativan every 4-6 hours which may cause sleepiness
-Zofran every 12 hours for vomiting

The doctor was outright in telling me that I will lose my hair about 1-2 weeks after the first chemo.

Other side effects are constipation, diarrhea, mucositis (mouth becoming tender), Neuropathy (numbness, tingling of hands and feet), Nausea, Fatigue which increases with each chemo session, bone pain within 48 hours after infusion which can last 2-3 days, weight gain.

One side effect of chemo is women can become infertile after the treament.  At the same time, pre-menoupausal women such as myself will go into early menopause.  Which is why we are in under the care of their cancer fertility clinic under the care of Dr. Mousa Shamonki for IVF or In-Vitro Fertilization.

Dr. Shamonki did an ultrasound of my ovaries and found 15 viable eggs that can be retrieved.  I haven't been ovulating since I got pregnant in June 2008 and havent mentruated since then.

They have started me on egg stimulation regimen consisting of daily injections of Menupur which is  follicle-stimulating hormone (FSH), which helps stimulate egg production; and luteinizing hormone (LH), which helps the eggs mature and release (ovulate). I also inject Gonal RFF Pen used to help ovaries make more eggs. It is used in ovulation induction.  I do this injections every night at home for 10 days.  Jim has also started taking medicines to prepare him for the sperm collection.

On the 5th day, the doctor will do an ultrasound to see the progress of the egg production.  On the 10th day or when it is determined via ultrasound that the eggs are viable for harvesting, I will undergo an IVF surgical procedure to remove the eggs from my ovaries. 

The process continues, eggs and sperms will be fertilized and become embryos, it will be frozen until the time they will be ready to be implanted in me after five years of my cancer treatment. 

I'm also under the care of a oncology gynecologist who monitors my ovaries for possible cancer every three months because I have 42% chance being BRCA 2 positive gene mutation (breast and ovarian cancer gene mutation).  After I am done with IVF, my doctor is recommending removing my ovaries to lessen the chances of ovarian cancer.  It will still be possible to get pregnant with IVF after removal because my uterus will still be normal. 

The costs of IVF treatment for cancer patients is very expensive but we were blessed to have been approved by Sharing Hope, a national organization providing reproductive information, support and hope to cancer patients and survivors whose medical treatments present the risk of infertility.  It is because of Lance Armstrong that this organization under Livestrong was made possible. He suffered cancer himself and has vowed to help cancer patients.  They are shouldering a big part of the costs of the treatments and giving the medications for free costing about $5,000.  just he medicines itself is so expensive!

My IVF treatment will be done next week hopefully by April 21 and my chemotherapy is starting on April 25. 

After chemo, I will meet with the radiation oncologist to discuss the radiation therapy treatment.  I will be getting radiation treatment everyday for about two months.

Yesterday, my sister finally went back home to Singapore and it was one of the saddest moments of my life.  She took care of me selflessly.  She came here in a week's notice. Spent more than a thousand dollars to fly out here. Gave me showers, changed my gauze dressings, dressed me up everyday, stayed with me in the hospital, took care of James all day for a month, prepared all my meals, ran errands, slept with me, woke up in the middle of the night to give me my medicines on time, tucked me in bed because i needed special bed wedges for my wounds, most of all comforted me in the most difficult time of my life dealing with cancer.  I don't know what I could have done without her.  I wish she never left.  But I know she has a life of her own to deal with too.  I couldn't stop crying for an hour when we dropped her off at the airport. I love her to the moon and back. I just wish she was here with me forever.

I'll miss you so much, May.

If you can , please help in raising funds for Krissy's Breast Cancer treatment:

Sunday, April 3, 2011

Post Surgery Updates

I'm back on the blog!  Thanks to everyone who sent their prayers and thoughts our way.  It meant a lot whenever I get to read a message from all of you.  Each one of them kept me stronger everyday.

Thanks to my better half Jim, for keeping the blog going for awhile. Despite his very busy days, he found time and stayed up till 5am to write the entries.  And still have to wake up early at 8am to attend to Jcube and me for the rest of the day.  Thanks to my sister too who's been on top of everything I need help with, from waking up to going to bed, she was like an extension of me.  Seems like she never rests.

Its been 10 days since I got out of the hospital.  Nothing is better than being home with family.  The love is overflowing and I know they are there every minute to support me. I cant thank Jim and Mhae (my sister) enough. Also baby James for the entertainment all day long. Although I have a lot of rough days physically and emotionally, they still continue to help me in every way possible. 

I can barely remember anything while I was in the hospital.  My memory seems to be from the few seconds I was in the operating table while the anesthesiologist was counting down to make me sleep then it jumped to about 5 days after the surgery.  I was told that because of the long 12 hour surgery, the anesthesia was significant and the strong pain medications given, a lot of things were blurry.  I remember though I was having rough times while I was on morphine drip.  I was having hallucinations, nightmares and chills.  My appetite was also nonexistent while I was on I.V. pain medications.  
When i got home, I had drains in my chest to get fluids out of the surgery sites, to avoid seroma.  The body tends to fill up with fluids where tissues have been removed.  I had two drains in my abdomen too but the doctors had to remove it while I was still in the hospital, way earlier than it should be, because it was pressing on nerves which were causing a lot of pain.  The fluids had to be emptied frequently and monitored in terms of volume.  The goal was to remove the drains when the output was lower than 30cc.  I had my chest drains removed on Friday, March 25, two days after I was discharged.  It was a whole lot of relief because the tubes were between the skin and chest muscles that ran across my chest to the armpit.  Everytime I moved, it gets painful.  Even turning my head became painful on the chest.  I was so afraid of getting it removed because of the thought of having tubes sliding out of my chest, awake and sitting upright without anesthesia.  But I made it!  Thanks to Jim holding my hand the whole time.

I feel lucky to have it out in 10 days after surgery because some people have it for almost a month.  The longer you have it, the more prone to infections you are, plus the irritation to the muscles is tough.

On Tuesday, March 29, I had my first follow-up visit with my breast surgeon Dr. Helena Chang and plastic surgeon Dr. Jaco Festekjian, who are both the best doctors in their fields.  They both said my wounds are so far healing good!  I was so glad to hear it.  It will take 8 weeks though before I can return to normal daily activities. 

I was also given the reports of what was done in the surgery and the surgical pathology results:
- simple mastectomy was done on the left and it was clear of cancer
- modified radical mastectomy was done on the right and two cancerous lumps were removed, one was 5cm and one was 2cm.
- 20 lymph nodes were removed from the axilla (armpit)  and 6 were cancerous with the largest cancerous deposit measuring 2.6cm.
- The cancer cells have a histologic grade of Grade 3 (out of 3)
-  The tumor biomarker Ki-67 is 50% (anything more than 20% is high)
- The hormone receptors of the cancer cells are 90% Estrogen positive, 3% progesterone positive and HER2 negative

Given all these, the cancer stage is now Stage 3  and TNM staging T2N2aMx

These results will determine the cocktail of chemotherapy drugs and radiation that I will be receiving. I will be meeting with the Oncologist - Dr. Glaspy of UCLA on April 7 to discuss these with him. 

My surgeon also ordered to get physical therapy sessions to start four weeks after surgery and lymphedema massages for the right arm. 

From now on, I will be at risk for Lymphedema of the right arm because numerous lymph nodes were removed.  The lymph nodes filter the lymph fluid, removing bacteria, viruses, cancer cells and other substances that could cause harm to the body.  Without it, fluids can start to build up in the tissues and it causes swelling, pain, numbness or infection of the arm.  There are many things I should do to avoid this such as:  not having blood drawn, IV, vaccinations, blood pressure cuffs on the right arm for the rest of my life.   I should avoid cuts, wounds, scrapes or insect bites on this arm.  No heavy or repetitive lifting on this arm.  Avoiding sunburns or burns on this arm.  Avoiding sauna or hot baths.  Wearing gloves when doing household chores like dishes, gardening etc to avoid cuts and infections.  Wearing compression sleeve and gloves in high pressure cabins or high altitude.

I just need to be aware of how to take of care of my arm from now on. It will be a bit of adjustment in my daily activities but I know its manageable. 

I am still wearing a binder on my abdomen to hold the long incision that stretches from side-to-side, where they took the fats, skin, veins and little muscle to place on my chest for the reconstruction.  I have to stand slouching to avoid stretching the sutures. 

So far, my chest is numb and it will take a while before the nerves will rebuild itself to get normal sensation.  The nerves usually grow back about 1 inch per month.  

The pain and sensation on my right armpit, shoulder and back will go back to normal in about 18 months.  

It will be quite a road to recovery but I am glad I got one step done in the list of treatments we have lined up.  I can't wait till I am up and about to hug, play rough with James and bring him to the playground again. I can't wait till I can have date nights with my honey-bunny again.

Next up..chemotherapy.

If you can , please help in raising funds for Krissy's Breast Cancer treatment: