From Yvonne's appointment with Dr. Kominsky, a medical
oncologist, on Wednesday, 4/15/15:
On the way in to the appointment, the nurse mentioned that Y
will need to remove shoes for every visit because the chemotherapy dosage is
determined based on weight.
We waited quite a long time for Dr. Kominsky, who finally
joined us and began the appointment with several "getting to know
you" questions, asking Y about her retirement, her kids, etc., and then
got into some family history and medical / "how are you feeling"
questions.
He mentioned that her condition is unusual because of the
size of the tumors but also because there are two of a similar size but that
they don't appear to be metastatic (my interpretation).
Adding chemotherapy to radiation treatment potentiates the
radiation, i.e., makes it stronger. (Later adds that chemo probably improves
the kill rate of the cancer by 5% to 10%.) He says "these cancers are
potentially curable. The cure rate isn't as good as with surgery for a cancer
this large." He describes cancer as one cell that's gone mad and has
forgotten how to die; it's cloning itself and dividing. "These are weeds
that tend to grow if you don't pull out every root."
He describes the treatment with radiation and chemo as
beating the cancer down and then continuing to attack it while it's down, and
this is why it's important to do the whole treatment cycle all at once, rather
than taking a break in the middle. He "recommends we treat optimally--if
you allow [the cancer] some recovery phase [treatment is] not as
successful." Says he'd rather treat it continuously (than allow Yvonne to
go on vacation in the middle of the course). She agrees this is the best course
of action.
He says it's not the standard of care to deliver this
therapy (I believe he means to give chemo during radiation) but that her
situation isn't standard.
Yvonne agrees that she will undertake the chemo at the same
time as radiation and will do the whole course all at once, postponing their
planned cruise.
Dr. K describes the process. She will receive chemo over the
first week and then again for another one-week course about halfway through the
7-week radiation course. The primary drug she will receive is cisplatin. It is
delivered via IV.
Side effects may include nausea (they will give her some
strong anti-nausea medication via IV at the same time, and also have prescribed
her some to take at home). There may be some hair loss, but not necessarily.
Sometimes sores in the mouth. There's a potential drop in blood count, they will
take labs every week to monitor. Sometimes diarrhea, they sometimes have to
hydrate patients via IV. Cisplatin causes kidney failure in less than 1% of
patients, and high-frequency hearing loss in 30%. Other side effects can
include ringing in the ear, hiccups, feeling like the ears are underwater, a
metallic taste in the mouth, "taste perversion" where you no longer
like foods you usually like, and fatigue.
Yvonne will also receive etoposide on alternating days with
the cisplatin. The delivery doesn't take as long for this drug.
Dr. K concludes the visit making sure Yvonne and we know
that this is tough, he knows it's tough, but "you can't make an omelet
without breaking some eggs." And he says "there is a significant
chance of cure."
Nurse Teresa comes in to talk to Yvonne about treatment and
scheduling. The first day will be very long because she will receive lots of
fluids, anti-nausea medicine, etc, plus both cisplatin and etoposide. Y should
wear comfortable clothes and can bring a snack or lunch. She will have access
to TV and a computer and can also bring a book or nap if she likes.
Yvonne will get a picc line inserted in her arm through
which the medicine, fluids, etc. will be delivered and blood will be
drawn--this means she won't have to keep getting "pokes" throughout
the course of treatment, but just the one time when this line is inserted. That
will be at the hospital on Thursday (this week). She should return to the
hospital Friday for a dressing change, and then subsequently the dressing will
just be changed once a week.
Cisplatin can cause you to lose magnesium and potassium;
they will check for that in the weekly blood draw and replenish via the picc
line if necessary; they will also rehydrate her via that line if necessary.
This can be helpful if she's feeling especially tired.
The chemo can cause constipation; Teresa recommends starting
Miralax the day treatment begins to get a handle on that. They can prescribe
her a sleep aid if necessary. Gatorade is a great way to keep yourself
hydrated.
Teresa or one of the other nurses are always available by
phone at 360/788-8211, Monday through Friday, 8-5.
Next steps: Yvonne will have "walk-through" of
radiation treatment on Monday (today). Get picc line on Thursday, dressing
change on Friday. First day of chemo and radiation on Monday, 4/27.
My notes:
My friend Bonnie suggests you ask for this anti-nausea
medication by name: Zophran. She says it's really good. She also recommends you
pop an anti-nausea pill in the car on the way home from treatment; that it is
important to stay ahead of it and not let the nausea creep up on you because
it's hard to make it go away once it's there.
