Time for a Paracentesis...catheter to the belly!

I first want to say thanks to those of you who have donated to my cause.  Any little amount helps me out with my co-pays and medical expenses.  From the bottom of my heart, I truly thank you.

After my eventful week of a trip to the ER and having to visit Kaiser on Tuesday and Thursday for IV fluids and IV anti-nausea, I decided to also get a paracentesis done Thursday afternoon.  Paracentesis is very similar to the thoracentesis I have had to my pleural cavity except this is for my belly.  I have been able to manage the fluid build up in my belly by using Lasix but I was just so exhausted and afraid of taking any pills by mouth that I just gave in.  I was very afraid to have this done because I thought that they were going to pick the fattest part of my tummy and shove a catheter through it.  This is not the case at all.  I had asked my oncologist about how the procedure is performed at my last visit with her on July 31st and she told me that they usually go in on either the right or left lower quadrant of the belly.  I can usually tell when I have a lot of fluid build up by monitoring my weight. It's amazing how fast the belly fluid collects.  It was making me feel like I was walking around with a pregnant belly.  When I lay on my back, it also makes it hard for me to breathe.  And lastly, my clothes don't fit right.  Makes me feel like I should be shopping the maternity section.

My Thursday started at Kaiser at 10:45am when I had to go in for more fluids.  I had been throwing up the day before and so I had called just before closing to speak with nurse Jennifer about setting me up for fluids since I knew I was very dehydrated. It's nice that when I walk into the oncology department, the receptionists know my name and are already to register me in.  Nurse Elsie called me to the back and I asked her if I could hop on the scale real quick to see how my belly fluid was doing.  It was amazing that I was weighing more than I usually do when I had not eaten anything since Sunday.  Elsie led me to the back of the infusion center where there is a private room with two chairs.  Luckily, I was the only one in there.  I asked Elsie if I could speak with my oncologist, Dr. R, so I can let her know how I was doing.  Moments later she appeared.  I told her about how I was having major bouts of nausea, vomiting, and diarrhea.  The pain seemed to be control by the fentanyl patches but I was having more frequent break through pain.  She suggested that I take Decadron, which is a steroid I normally take during chemo only, for my nausea in addition to my Zofran or Compazine.  She told me it was ok to add one more fentanyl patch, and to make sure I was dating them so I wouldn't confuse them and would know exactly when to change them.  If I was still having break through pain, I could resort to taking the Dilaudid pills or liquid morphine.  I prefer Dilaudid because it's stronger and the liquid morphine tastes yucky.  Fortunately, when I have break through pain, which is about twice a day, it goes away within 15 minutes with the Dilaudid.  My pain is now managed very well.

Another round of fluids. Feeling like mush.

Elsie hooks my midline up to the IV and starts me on fluids and IV Zofran.  Because my potassium level is low, she double checks with Dr. R about giving me potassium through my IV.   Potassium infusion will take a few hours and I don't mind so they go ahead and give it to me.  It beats taking those darn horse pills that I was prescribed.  My sister decides to go do a bit of shopping and grab a bite to eat so I try to take a nap in the chair.  It's kinda noisy because I'm near the nurses station and they are discussing what they are going to have for lunch and who's going to go get it.  I don't mind though because I do enough sleeping as is and I adore the chemo nurses.  Dr. R had felt my belly earlier and said that while it felt soft, I could have a paracentesis if I was feeling uncomfortable.  I told her I was ready for it and she spoke to nurse Jennifer about having nurse practitioner Kelly do it for me.  I love Kelly.  She backs up my oncologist when she's not there and is a great woman.  By 2:30pm, I am all done with my fluids and since Jennifer is out at lunch, I'm not sure what time to come back for my paracentesis.  I tell Elsie that I'll be in the area and just have Jennifer call me.  My sister and I head on over to Costco to pick up my glasses.  We then decide to stop by Starbucks for a quick drink but Jennifer calls and asks me to head on over to radiology now for an ultrasound so that they can mark my belly with the site to where the catheter will go in.  Afterwards I am to head back to the oncology center.

My new, cool glasses!

My sister does a quick U-turn and we valeted the car.  I grab a wheelchair and have my sister push me to radiology.  I'm feeling exhausted.  We arrive at radiology, register and very quickly I'm called back.  The tech takes me into a dark lit room and I expose my belly.  She applies jelly on it and does her thing.  I'm watching the monitor and she tells me about how the dark spots are all fluid.  She finds two sites on my belly but goes ahead and calls a doctor back to double check her work.  They use a marker to draw two X's, one on my left side and one on my right.  I'm then let go and my sister wheels me on over to oncology.  I register and medical assistant Maria calls me on to the back procedure room.  She takes my vitals and has me sign a waiver acknowledging the procedure and risks.  I have my sister with me because I know I'll need to squeeze her hand once the needle goes in.  NP Kelly comes in and she starts getting ready.  She tells me about the risks but she's been doing these for 15 years so I know I'm in good hands. I show her the X's on my belly and she chooses the right side and has me lay down on the gurney.  She asks me if I want some Ativan and of course I do!  Nurse Elsie brings me some in and I stick them under my tongue, letting them dissolve.  I close my eyes to relax and my sister talks with Kelly, which is distracting me for the events about to happen.

At ultrasound marking the catheter site.

Medical Assistant taking my vitals

The set up!

Kelly is all set up, ready to go, and I am too.  She injects me with Lidocaine and the needle hurts.  Lidocaine stings.  I squeeze my sister's hand tightly.  Next, she takes a longer, thinner needle and injects me some more with Lidocaine.  I do some more hand torturing to my sister.  Somewhere along the line, she removes the needle and now I have this catheter in me.  Kelly hooks it up to the vacuum sealed jars waiting on the floor.  I'm fine now.  No pain.  No shock-like feeling like the thoracentesis made me feel before.  I'm ok.  I lay there relaxing and we just wait for the jars to fill up.  We all continue talking and soon I'm on the 3rd container.  I am amazed that I have that much belly fluid in me.  When I had my pleural cavity drained, that only filled about one and a third containers.  Obviously my belly is a much bigger cavity.  I can feel my belly slowly deflating and I take a peak down to where the catheter is sticking out of my body.  I don't freak out.  I look at my belly and I notice my pelvic tumor staring at me.  I give it a feel and I know it has grown.  It is definitely at least the size of a cantaloupe.  I fill up the 3 jars and a tiny bit of a fourth and Kelly tells me that we're going to stop.  I'm anxious as she pulls out the catheter but it doesn't hurt.  I made it! I survived!  There's no need to do cytology on the fluid since it's the same stuff as what was collected from my lung.  I just stare at the jars in amazement.  Paracenthesis isn't so bad.  It's actually quite easy and Kelly says I can have it done as often as I need to and like.  Before, it would take me a few days to pee all this fluid out.  Might have to rethink that now.  Kelly applies a glue to the catheter site to prevent any leaking and bandages me up.  I'm ready to go home.  I hop on the scale on the way out and see that I've lost 8 lbs, putting me back to my normal weight. Hooray!

Before: my water baby!

X marks the spot.

During.  Calm as a cucumber!

That is what came out of my belly! 3300 cc's!

By evening time, I'm feeling good.  I think it's a combination of the IV fluids and the draining of my belly.  I try to eat solids and I'm successful.  I don't vomit.  Huge victory for me.  The next morning, I'm feeling great.  There is no more nausea, vomiting, or pain.  I feel like having a solo dance party.  I can't believe how amazing I feel.  I'm so thankful for Dr. R, Kelly, and the nurses for helping me survive chemo #8.  My faith is restored that there is hope for me.  It was a horrible roller coaster ride, but I made it.  I take it easy that day as I do not want to overwhelm myself and have to put my Washington trip on hold.  I am to fly out on Tuesday and come back the following Sunday.  I lay low indoors.  At this rate, I will make my flight!  I also have my PET scan to look forward to when I return, on August 20th.  I am hoping and praying that my cancer is at the very least stable.  Better news would be that it is shrinking.  I know that sometimes it feels like chemo is about to very damn well kill me but I have to say that it is worth it.  I may have puked my guts out and felt the most excruciating pain I have ever felt, but I'm a warrior and that's part of the job.  A big hug and thank you to my sister for helping me through this roller coaster week. I know it wasn't easy watching me go through that but having her there for me really made it more manageable. I'm slowly letting her in more on my care as I realize that I can't do this by myself.  It's hard feeling like I'm losing my independence but I know that having someone else manage my care sure makes this journey a whole lot easier.

After: feeling deflated and good.

Although I am feeling good right now, I can't help but to think about the things that I won't get to do.  It seems like about every 4 weeks, my pleural cavity is filling up with fluid, causing me to be short of breath.  This means that I have to start pulling out my wheelchair whether I like it or not.  I think about the Cabo trip that I wanted to take with my sister's and how it probably won't happen just because my health is not that great.  I want to go to Disneyland so bad but I'm afraid to travel down there and wait in long lines.  I'll need my wheelchair to get me through that for sure.  But instead of focusing on the things that I feel like I'm being robbed of, I try to think of the things that I do have and what's really important.  I have my family and I have my fur babies.  I have my friends.  Really great friends.  Even if it's just a fashion show that I'm putting on for Molly and Dash, I try to make the most of my moments. I'm hoping and praying with all my heart that we find a cure.  Not just for my cancer, but for all cancers.  I won't lose that hope.  Not that easily.

Fashion show with Dash, who loved my dress.

Precious moments, playing hide n seek with the cats.

Help the Cause

Since I've been asked about this, I'm going to post my PayPal address.  I HATE asking for money.  Since being diagnosed in January, I have never begged anyone for money.  I try to just make ends meet.  But after chemo knocked me square down on the floor this past week, I forgot to manage the paperwork side of things and lost my state disability payments.  My checking account is in the red and I am only paying whatever bills are necessary to live (credit cards can go take a hike).  Strictly optional, but if you would like to donate, my PayPal address is: TeamMartaOfficial@gmail.com.  Please feel NO pressure to donate.  If you prefer to mail me a donation or just a note to say hi (I love getting mail), email me for an address.  Thank you guys so much and I promise not to bomb my blog with this. 

Much Love, 
Marta

****Official fundraising site can be seen here:
http://www.youcaring.com/fundraiser_details?fundraiser_id=7338&url=teammarta

I am in the process of submitting paperwork to re-certify my disability so that my payments will continue, it will just take a little time. 

Trip to the ER

I like writing my blogs in order and there are a couple that I would like to write before this but it's important to me to write about what happened yesterday, so here goes.

My brother and his family left on Sunday afternoon and I was feeling fine.  I was recovering from chemo at a normal rate.  Wasn't eating much or drinking much of anything for that matter. I was just happy to keep my nausea under control and to not be throwing up.  It was in the evening when I grabbed a piece of ginger candy and took a small bite.  It didn't agree with my stomach. I made a mad dash to the bathroom as I felt the sensation to vomit come on and that was a big mistake.  Half way to the bathroom, I slipped on the carpet and face planted on the floor.  I scraped my knees and took it hard on my right cheek. I wanted to laugh and cry at the same time.  My sister watched this all happen and came to see if I was ok.  I crawled my way to the bathroom where I proceeded to spit out the ginger and vomit.  My chemo brain and dizziness were still in full effect.  Once I collected myself, I went back to my room and laid down.  I was feeling a bit of pain and nausea but I did my usual nightly morphine tablet and liquid morphine for break through pain. My stomach really wasn't having any of it so I missed my dose of Xeloda because I was afraid it would upset my stomach even more.  I did the compazine suppository since I wasn't keeping things down.

Scraped up knee. No more running!

The next morning, Monday, I woke up and wasn't feeling all that great.  I had an appointment at 12:15pm to get my dressing changed so I called up the medical assistants to see if I could also get fluids and IV Zofran.  Then things started to get worse.  I started vomiting bile and having diarrhea.  I can't take any pills or put anti-nausea up my butt at this point.  Then the pain starts to come in full force.  It's all over my stomach pain.  It starts at about a 7/10 and is working it's way up.  It comes intermittently every few minutes and it's excruciating.  There is no way I can make it to my dressing change appointment. I have not felt pain like this before.  I find myself on the floor of my bedroom, curled up into a ball crying. I tell my sister that I can't take it anymore and that I want to go to the ER now. If the rest of my cancer journey was going to be filled with this type of pain, I didn't want to do it anymore.  I was begging God to either take me away or to help me.  I didn't care what I looked like, I just put some deodorant on because I know I haven't showered since chemo which was on Wednesday.  It's 12:30pm by now and my sister takes me to the ER at Kaiser in South San Francisco.  Luckily I had grabbed a barf bag on the way out of the apartment.  I'm puking in the car and she cannot get there fast enough.  When we arrive, I had the security guard give me a wheel chair and I'm wheeled right in to check in. They check my vitals and all that good stuff and I tell them my cancer pain is horrid.  They try getting me a private room as to not expose me to other people's germs so I'm staged the hallway for a minute.  I sit there with my barf bag and I'm yacking.  It doesn't sound pretty. Especially in those hallways.  I can see the nurses working quickly to clean up room number 9 for me.  Finally I lay in the gurney in my room and nurse Henry comes in to take some blood.  Because we cannot get a blood return from my midline, he has to start an IV.  At this point, I'm in so much pain, I don't care.  On his second stick, he finally draws blood on my left hand but later I find out that the blood is no good so he sends the top notch phlebotomist who is awesome with patients with veins that are difficult to find.  I forgot her name but she is very caring and nice.  She finally finds a vein on my left hand near my thumb and gets a blood draw.  She agrees that I am a difficult draw but to remind phlebotomists in the future that the vein she used should be a good one since it's a fat vein.  Good tip.  I'm still feeling nausea and vomiting and remember now, I have diarrhea, too.  I couldn't control it.  I felt it.  I pooped my pants.  I have my barf bag in front of me and my sis standing next to me trying to comfort me and I tell her, "Great, I just pooped my pants."  We start to laugh.  The force from the vomiting caused me to not be able to control my bowels.  I'm actually quite surprised this didn't happen sooner. I ask my sister to let Henry know that my linens will need to be changed.  In the mean time, I have my sis take me to the bathroom so I can clean up and throw away my undies.  When I get back in the room, Henry has removed my old linens and hands me a bag for my pants and top since I'm now wearing a hospital gown.  I ask my sister to grab me a piece of gum from my purse as my mouth tastes like utter hell vomiting all that bile.  I take a few quick chews before I spit that out.

Trying to sleep after getting pain meds.

I'm laying in my bed in pain and I ask them to get me something ASAP.  We start out with morphine through my IV and that seems to work for about 10 minutes.  The pain is less now but it is coming back more frequently.  My ER doctor, Dr. Ma, decides it's time to try Dilaudid which is about 7-10x more stronger than morphine.  The pain is finally gone.  And it doesn't have me falling asleep or feeling loopy.  I really like Dr. Ma.  There is a gentle warmth about her and she tells me that she wants to send me to x-ray to see if there is anything blocking my intestines.  The tech comes over to wheel me to x-ray and I ask if I can get some pants or something to cover my butt since I'm naked under my gown.  They hand me another gown and I wear it backwards so that it looks like I'm wearing a muumuu type gown.  I just don't want to flash anyone. I take 3 x-rays and I hear the tech say that I'm completely empty.  Doesn't surprise me as I have not had anything to eat in 24 hours and I've been vomiting everything.   I head on over back to room number 9 and Henry is now gone for the day.  I have a new nurse named Julie and she turned out to be a real gem.  Dr. Ma enters the room and tells me that my x-rays look clean and that there were no blockages which is what she was looking for.  This is a good thing.  She continues to tell me that my potassium is low and that they will be hooking it up to me via IV.  I'll also be taking home a prescription where I'll be taking one tablet of potassium twice daily.  If you've ever seen potassium pills, they are huge!  At this point, I'm taking fluids, Zofran, and potassium through the IV in my hand and Julie asked if we could use the midline on my arm to speed things up and with Dr. Ma's permission, she switched the infusion from my hand to my arm.

I'm smiling but I'm not feeling chipper!

I've lost track of how long I've been in the ER by now, I think it was now 4pm and it didn't seem like it to me.  Julie brought me some ice chips to work on ingesting something by mouth and then later I could try saltine crackers.  The Dilaudid seemed to be my miracle drug.  I lay in my bed relaxing and trying to get some sleep.  I am really glad I had a nurse like Julie.  She was just absolutely amazing.  She was very knowledgeable in pain meds and answered all my questions.  Dr. Ma came in to give me my paper prescription for the Dilaudid that I will take home and she gives it to my "mom." Inside my head I am cracking up that she has called my sister my "mom."  She then says that Dr. Dilda will be my new doctor.  Again, I think I am hearing things and I am holding back chuckles in my head.  I thank her for all she has done for me and she leaves.  When Julie comes back into the room to check on me, I ask her to clarify the name of the next doctor. She looks into the computer and says, "Oh, you dirty birds."  My sister and I start cracking up.  Just wanted to make sure the pain meds weren't making me loopy and hearing things.  Dr. Dilda comes into the room to introduce himself but pretty much Dr. Ma has controlled the situation and nurse Julie is driving the ship.  I don't really need him, he's just the one who will give the ok to discharge me.  He says I'll finish my bag of fluid and if I'm feeling good, then I can go home.  I try eating 2 saltine crackers and they seem to go down ok.  I'm feeling proud of myself for a couple of minutes and then the stomach pain returns and I realize that I'm just not quite ready for solids yet.  Now I know that I'll be on a liquid diet.

It's about 6:30pm when I am finally discharged and I can't believe that I've been in the ER for about 6 hours.  It really didn't seem like it.  Not when you're in that much pain.  My sister had gone to the pharmacy for me to pick up all my meds (the Dilaudid, potassium, and also sublingual Zofran). She also picked me up some Pedialyte popsicles. Nurse Julie handed me some disposable paper pants that I get to wear home since my undies are now in the garbage from my pooing incident earlier.  I check out and I wait by the door for my sister to pull the car up front.  The wheelchair is now my friend.  I'm very exhausted and weak and all I want to do is get home to rest.  Part of me wanted to remain in the hospital where they can take care of me but then part of me wanted to go home.  I'm much more comfortable at home and I'm not exposed to all those germs that a hospital has.

I slowly walk up the two flights of stairs it is to get to my apartment.  That's going to be a problem if I plan on using my wheelchair more often.  I change into my pajamas and hop into bed.  I set up my nightstand with an assortment of fluids I can drink and all my meds.  I'm concerned that I haven't taken my Xeloda for the past 2 doses and manage to get it down.  I still have to take my chemo pill and fight cancer even though I may not feel up to it.

I'm hoping that this has just been a yucky reaction to chemo #8 that I had on August 1st.  I don't want to believe that my cancer is getting worse or growing but I know that it is a possibility.  Just a week ago I was feeling great and eating.  Things can change in the blink of an eye.  I have my PET scan scheduled for August 20th and I'm very anxious for it.  This will tell us if the chemo is working or not.  If it's not working, we will switch to another regimen.  If it is working, we will continue.  And I'm afraid to continue.  This is so hard on my body.  It just seems like it's getting worse and worse.  I am putting my body through hell and I don't know if it's worth it or not.  There is no cure.  There is no guarantee that this chemo will buy me more time.  I have to think about what I'm doing here. I won't give up but at some point, the chemo will no longer work and I will have to choose quality of life over beating up my body with treatment that I'm not responding to.  I've thought about hospice care.  Just living my life out.  But I know what makes me want to throw in the towel is the side effects.  The one thing I cannot stand is the pain.  I am a tough cookie and will endure it till I am on my last leg but I know there are tons of drugs out there that can help me manage it.  Same thing with the nausea and vomiting.  I'd rather be cooped up in a hospital managing those side effects than to be at home enduring the pain.  I'm not going to give up that easily.  And I feel so bad for my sister.  She has to watch me go through this and there isn't a damn thing she can do for me.  I never want to feel that pain again.

The next day, Tuesday, I went in to the infusion center to get my dressing changed.  I couldn't even stand in line.  I was so weak.  Luckily, the medical assistant, Latishma, saw me and told me to sit while she took my Kaiser card and checked me in.  I couldn't help but to break down and cry.  I was so exhausted.  I had thrown up that morning and I knew I was dehydrated.  I asked her if my oncologist was in (because she had taken a few days off) and luckily she was back in the office.  I saw my doctor first and told her how I was now on Dilaudid but I was getting break through pain and that I was really tired.  She decided to put me on the fentanyl patch now which is a patch that I change every 3 days.  I hear it's strong stuff but I'm still getting some intermittent pain where I have to resort to the Dilaudid.  She also set me up with some fluids and IV Zofran while I got my dressing changed.  I can feel the fluid in my belly starting to collect.  I haven't been eating anything in days and yet I'm gaining weight.  I'm too afraid to take anything by mouth, which included Lasix, so I'm thinking paracentesis might be a good option for me later on this week.

Nurse Pauline changing my dressing.

My mind is exhausted. I try to sleep if off only to have these crazy dreams and breakthrough pain.  I am really praying that this is a bad reaction to the chemo. I don't want this to be a sign that I am dying. That chemo is not working, and that cancer is winning.  I'll never lose my battle with cancer because I did get those precious moments with my family and friends.  My life just wasn't meant to be lived as long as everyone else's.  And I don't know why I got chosen to get cancer.  Why God thought that I was strong enough to endure this roller coaster that cancer is.  I think the sucky part is that my mind and major organs are all running in tip top shape.  Before I decided to go to the ER, I knew I wasn't dying.  My brain was 100% coherent.  I was just having a lot of pain.  And after the labs, I found out my kidneys and liver are doing great.  Basically I'm physically not dying but part of me wishes that we could just get this over with because I'm so tired.  I really do not know how much more I can take.  It is draining me to my core.  I've already asked God for forgiveness and to heal my body.  But yet, I still feel pain.  I still throw up.  I don't know what it all means.  What works and what doesn't.  I try and take suggestions from my fellow warriors and caregivers and I'm still miserable.  Something has got to give.  I go in for more IV fluids and Zofran tomorrow.  I hope this does the trick.  I really need to start feeling good or this chemo #8 in addition to my next PET Scan results will weigh heavily in my decision to continue treatment or not.