3/19/12 Follow Up Appointment With My Oncologist

I get chemo infusion every 3 weeks.  So the day before infusion, I do blood draws in the morning to check my liver and kidney function plus a CBC (complete blood count) and then see my oncologist.  This morning I went to Kaiser in San Mateo at about 9am and had my blood drawn.  When I arrived, I went up to the little machine that tells you to take a number.  You push the corresponding button on the screen that asks why you're there.  Blood draw, oncology, OBGYN.  I used to always push blood draw until the lady registering me told me to push oncology so that I get called quicker.  I pushed the oncology button and sat down.  There were other people waiting.  Then they called my number next.  Booyah!  I get to cut in line!  I register and then go to the chair where they will be drawing my blood.  My left arm is my preferred arm for blood draws but it's still recovering from the bruising and swelling of my last infusion so we had to go with my right arm.  My veins are small on my right arm.  I asked the lady to not to draw from median cubital vein but rather right above it more towards my elbow.  Thats where I had my blood draw in the ER and it was easy to find and painless.  She did and again it was painless and easy to find.  Just two vials of blood today.  The results were ready by 11:30am and my appointment with my oncologist was at 1:30pm.

Me waiting for my oncologist to come in.

I drove up to Kaiser South San Francisco and had valet park my car.  I love that Kaiser offers this service because parking in their garage takes forever!  I can never find a spot and always end up on the 4th floor.    Plus valet is free so why not take advantage of this service. I register and get called shortly.  Get my vitals and weight taken and fortunately I've maintained my weight.  I think I only lost 1 lb since my last visit.  Woohoo for me!  I wait for my oncologist in the exam room and she comes in.  She tells me that my liver and kidneys seem to be doing great but that my immune system is low.  It's not dangerously low but it's low enough that if I do chemo tomorrow, it will make my immune system even lower and that could be dangerous.  She told me no chemo infusion tomorrow and to stop Xeloda (oral chemo pills).  We rescheduled chemo for next Tuesday, March 27th, and I'll get my blood drawn again on Monday to see if my CBC numbers are back up to normal.  After my first infusion, my liver was not doing so well and we cancelled chemo for a week.  I took a break and let my liver recuperate.  My doctor also reduced my chemotherapy by 25%.  This time around, before I get my 3rd infusion, she is going to reduce my chemo infusion drugs (Cisplatin and Epirubicin) by 10%.  We will keep Xeloda at the same dosage.  This will hopefully bring up my immune system.

We went over a few things and I got to ask her questions.  She told me that she is going to send a referral for genetic testing.  Because I am so young and the typical stomach cancer patient is in their 60's, she wants to know if this is in my genes.  I'm happy to do this.  It will help my family know if they are at risk and this information will be helpful for future generations.

Will I get a port installed?  We are going to try infusion #3 the way we have been by just poking the veins in my arms.  If it starts to bruise, swell up, and cause me pain like the last poke did (when I had my Aredia bone treatment) then I am getting a port.  I can push for this, but I am scared.  The surgery looks scary to me.  But I've looked at what other cancer patients had to say about it and they are all giving such great reviews.  No one regrets it.  They say it is much easier.  I asked the lab tech who was drawing my blood this morning her two cents on ports and actually told me not to do it.  She said it leaves a scar and you have to get it flushed regularly.  I don't know if she has ever personally had one but I'm not concerned about scaring or flushing.  I do not want to go through my arm pain ever again! Plus, two of my old high school friends who are nurses also encouraged me to get it.  And I love nurses so I'm leaning towards getting one.

Here is a photo of my arm a couple days after my Aredia treatment.  Aredia is NOT a chemotherapy drug.  It is a bisphosphonate that works by slowly releasing calcium from bones, reducing the risk of broken bones and reducing bone pain. 

Why did she choose Cisplatin, Epirubicin, and  Xeloda as my chemo drugs?  What is the goal of treatment?  Is surgery an option in the future?  She choose these drugs because they have shown in studies to shrink cancer similar to mine.  Chemotherapy is supposed to ease my symptoms and hopefully shrink the cancer.  I have had minimal side effects so my quality of life on chemo has been outstanding.  Chemo has also prolongs my life.  Realistically, if I were to refuse treatment, I would be dead in less than a year.  She seems to think we're progressing since I feel great. Unfortunately, I am not a candidate for surgery at all.

How many rounds of chemo are we doing and when are we doing the next Pet scan?  I had my first Pet scan on January 25th, 2011 and this showed exactly where cancer was in my entire body.  We are doing 3 cycles and then my Pet scan has been scheduled for April 13th at Kaiser in Santa Clara.  I will then meet with my oncologist on April 16th to go over the results and see how we are progressing.  I am very anxious for this appointment.  But both my doctor and I have a good feeling about it.  She told me that we are going to shoot for 6 months of chemo and go from there.  We will see where we are at and how my quality of life is.  Some patients will do 6 cycles of chemo and then take a lil break from it then start up again, just all depending on how they are feeling.  As you know, I'm ready to dive into this and fight like the ninja I am. If the Pet scan reveals that cancer is outsmarting the chemotherapy and it's growing, we will change up the chemotherapy drugs.  With that being said, my quality of life could drastically change.  Right now I have had no vomiting and nausea but changing the drugs could mean new symptoms.  I'm crossing my fingers that it's working!

Can I get a massage and can I floss?  Simple questions but I've been getting conflicting information online so who best to ask than my doctor.  Yes and yes!  I can sure treat myself to a massage and flossing is ok as long as my gums are not bleeding too bad.  In that case, I just need to back off a little.

Will I have to start Neupogen?  Neupogen stimulates your blood system to increase your white blood cells to help fight infection.  Luckily I haven't had any infections and my white blood cells are not dangerously low, so for now we are going to hold off.  Plus we are reducing chemo by 10% on the next infusion so this should help my immune system out a bit.

What are these weird freckle like spots on my fingers?  At first I thought they were age spots but it's actually just hyper pigmentation caused by chemotherapy.  What I do need to watch out for is hand-foot syndrome which is redness and peeling of your palms.  By taking a daily dose of B6, this can help reduce my chances of getting hand-foot syndrome.  So far so good because my hands and feet are doing great!

What is up with my old friend ascites who keeps visiting me?  Ascites is swelling of the belly.  This fluid is caused by cirrhosis of the liver or cancer.  In my case, my cancer is weeping fluid which collects in my belly.  It is slowly doing this and that's why from time to time I do see an increase in my belly size.  Daily I take 20 mg of Lasix (which is a diuretic).  This helps me get rid of all this fluid.  And when my belly is really big, I can increase Lasix to twice a day so that I can urinate the fluid out faster.

Can I take a weekend trips?  Sure!  I can fly out to Seattle or LA for the weekend.  Just need to make sure I take my list of medications with me and need to stop by the doctors office to grab the notes my doctor takes of my last appointment.  This will update the doctor who is treating me about my cancer just in case I do get sick and have to been seen while on holiday.

I have no appetite and I'm getting a lot of mixed messages about what I should eat.  Should I not eat sugar? Should I juice?  My doctor flat out told me: I just want you to eat.  She agreed with me that I should enjoy life and enjoy what I eat.  I'm not going to eat the whole cake (which I couldn't even do if I tried since I have no appetite) but I'm not going to deprive myself.  Our bodies basically break down everything into sugar so have at it!  And the whole debate on whether my cancer was caused by the acidic level in my body, she wasn't sure if that applied to me and told me not to focus too much on that.

Can I get a disabled parking placard?  I get dizzy after walking around for a while and parking sucks!  Not a problem!  I can get a temporary placard for six months.  I'll be headed to DMV tomorrow to turn in my application.

That sums up my visit with my oncologist today.  I had nothing planned for this week since we were planning on doing chemo and I was planning on staying in bed for the rest of the week.  I am usually tired and dizzy after chemo and I cannot eat anything!  Now I just have to work on flushing my body of the chemo and staying hydrated.

Cross your fingers that my CBC comes back great next Monday and we can start infusion #3 on Tuesday!  My brother comes to visit next week from Seattle so I'm excited to see him and have his support!