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Or, the Adventures of Chemo-Sabe and Tomto.


Wednesday, April 15, 2015

Meeting with the Medical Oncologist

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.

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