Anyone else having a hard time believing it’s November???

Anyway, I’m over due for a longer, detailed update, so here it is. If you just want the takeaway….
Maggie is much better after her a round of chemo with some annoying side effects and an unexpected (though not really) trip to the clinic Monday for suspected C-Diff. Our next planned appointment is Thursday (16th) for a chemo admission.

Now for the details….

Last Thursday, Maggie entered Batson for her 46th round of chemo. Each round starts with having her port accessed. The port is located under the skin in her upper left chest area. It is a small device, hers is PowerPort, for delivery of IV fluids directly into the heart via a catheter OR for removing blood samples. Before access, the skin surrounding the target area is scrubbed with an alcohol prep sponge. Once the needle is in, the area is covered with a sterile bandage to minimize the risk of infection. The plastic bandage stays in place until the port is de-accessed when the infusion is completed. For Maggie, this is 48 hours. Because her targeted therapy (one drug of four) attacks skin cells (colon cancer is a mutation arising from epithelial or skin cells), the main side effect is skin irritation which is progressively worse with each round. You can imagine what happens when irritated skin is scrubbed with alcohol and immediately covered with something like Saran wrap. Within several hours Thursday, she was in agony with painful itching. Oral Benadryl was not enough. Two dressing changes of different materials was not enough. She finely had some relief with application of a cream. (Steroids would only be administered as a last resort due to their possible interruption of chemotherapy acting on the cell cycle, so we couldn’t use those). Her skin remains irritated. Otherwise, her admission/infusion was without incident and we were able to discharge Saturday evening.

We had made plans to go to Birmingham Monday morning for a quick visit to our friends at UAB in the Phase I program. We haven’t seen them since Spring and our difficult time with two ER visits resulting in two hospitalizations and multiple procedures. We have a “thank you” gift for them and have been anxious to deliver it. We also planned to hang around for shopping (of course). Well, early Sunday morning, Maggie began running fever. Our initial thought was C-Diff (antibiotic use + a round of Irinotecan = C Diff) but we hadn’t seen the upset tummy part yet, so we were hopeful it would pass. When fever didn’t resolve by Monday, we called the clinic and were told to come in for blood work and cultures. Prior to leaving, the diarrhea started. She was starting to get dehydrated as evidenced by her pulse rate of 150+. One good thing to come out of having her port accessed for blood (for cultures) is a better, less irritating prep method (thank you Nikki). Her blood counts looked good and after an hour of IV fluids we decided to go home – no admission. We still didn’t have confirmation of C-Diff because, quiet honestly, she couldn’t produce a stool sample while there. With a home sampling kit in hand, we left for the drive home. When her upset tummy resumed at home with a vengeance, we made the decision to forego the official testing and start a course of Vancomycin we had on standby). I’m happy to report she is much better this morning after one full day of drugs and rest. I think we caught it early by being proactive and spared her the horrible ordeal with hospitalization that we experienced during the summer. We’ll reschedule the Birmingham trip when she feels stronger. We’re ever so thankful the fever (if it had to come) started Sunday BEFORE we made our trip.

God’s mercies are new every morning. Maggie’s CEA (tumor marker) continues falling with a reading of 4.3 last week. The skin irritation carries its own mercy with it. In my online search to find advice for relieving her distress, I came across a medical journal article reporting a direct correlation between severity of skin symptoms and the effectiveness of Panitumumab (targeted therapy). No skin breakout = no cancer cell death. Major skin breakout = better treatment outcomes. We’re praying for the ability to relieve the discomfort while hoping it continues. We find ourselves in strange places on this journey. As in our spiritual life, we know death in one sense allows us to live. We’re extremely thankful for signs of success. In the clinic last Thursday, we heard a bit more about Maggie’s scan report. The reduction in tumor size and metabolic activity was described as moderate. As our special UMMC resident Katye said, “Moderate is a big word!”

Until next Thursday, we’re home for rest and recovery. I’ll check in before that with a reminder. As always, thank you for your time in reading and your commitment to pray.