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Breast Cancer - Rosemary Gallagher's Story

Chemotherapy Treatment   -  - -   Page 2  of 3 

Reports prepared by Mark Gallagher  e-mail: mark@gallagher.com

Summary of diagnosis: stage 2 breast cancer, invasive lobular carcinoma, one tumor 1.8cm, four lymph nodes positive, hormone receptive, and favorable pathology.

Summary of treatment: lumpectomy, six-months of chemotherapy (four treatments of Andriamycin / Cytoxin and four of Taxol), 28 treatments of radiation followed by Tamoxifen taken daily for 5 years.

February 11, 2000 - First Chemo Treatment

Ro and I went to the oncology office today for Ro's first treatment of chemotherapy. So far, everything is going well.

Ro is scheduled for six months of chemotherapy. The purpose of this treatment is to kill any cancer cells that may be in Ro's body. The fact that the doctors found breast cancer cells in four of Ro's lymph nodes makes them concerned that cancer cells may have spread to other parts of her body, so they want the best drugs that are proven to kill the type of cancer cells found in Ro.  For Ro this means three months of Adriamycin and Cyclophosphamide (Cytoxin), followed by three months of Taxol (abbreviated AC followed by T).  These are pretty heavy duty chemo drugs.

For the first three months of AC, Ro is given the drugs once every three weeks. So she gets four treatments of AC over 12 weeks (three months) and four treatments of T over 12 weeks (three months). The first treatment of AC was this morning at 9a at the oncologist's office. This is all given by the oncology nurse (Julie). It took about two and a half hours. See the attached
picture of Ro getting the Andriamycin by Julie using a large syringe inserted into a tube that  is connected to Ro's port-a-cath.

This port-a-cath was surgically implanted in Ro's upper chest last Wednesday (same day surgery). This device is an alternative to administering drugs by inserting an IV into your arm or hand. Your arm has narrow veins and the chemo drugs can damage small veins, so they developed this port-a-cath to allow drugs to be inserted into the large veins in your chest or neck. The port-a-cath was inserted by the surgeon in Ro's neck and the day after the surgery we were concerned that Ro seemed to lose some mobility moving her head around. But today this seemed to be better and the port-a-cath did its job well.

Ro had no discomfort during the administration of the chemo drugs this morning. Prior to the chemo drugs they gave Ro an IV of saline and an anti-nausea drug - Zofran. The first day of getting AC is usually no problem, but the second and third day after can be tougher with typical side effects of nausea, fatigue and fuzziness (also called chemo-head). The side effects normally lessen after three or four days following a treatment. Ro has Zofran and Compazine ready to counter the nausea. So we are hoping these drugs do their job this weekend. Zofran is a newer drug that has been a great help to chemo patients that have strong reactions to the chemo drugs. Ro has been advised to take Compazine for nausea and if this is not effective with the nausea - add Zofran.

For the next six months, Ro has to go into the oncologist office twice a week for quick visits to draw a little blood for testing. They track blood counts very closely during the entire period of chemo treatments.

At the oncology office today we saw two other patients that offered both hope and perspective. A woman stopped by for a quick blood test that was half way through the same chemo treatment Ro is just starting. She was younger than Ro, had on a wig (no hair) and was generally in very good spirits. She said she did not wear her wig at home and her kids said she looked like Uncle Fester. She said this laughing with the oncology nurse. She seemed very positive about moving into the next phase of the Taxal treatment. So for Ro and I, seeing this woman was encouraging.

The second patient we saw was a thirty something guy and his wife that walked quickly to a private room in the office. Later we heard the oncology nurse talking to the Doctor on the phone with some urgency in her voice. From what we could tell, the guy had a bone marrow procedure the day before and he had some type of incision that was bleeding and would not stop bleeding. She said they went to the ER at the hospital last night and they gave him a couple stitches, but as of this morning it was still bleeding and would not clot to stop the bleeding. After talking to the Doctor, the nurse called the hospital to arrange some type of procedure that stops bleeding in these circumstances. I observed his wife momentarily and could see the concern in her face.  So this offered some perspective on our situation.

So Ro and I are feeling pretty good about where we are today. Ro exhibited no fear going into today's first treatment.  Excuse all the details, but it helps me to write these things and family and friends have sent feedback that they prefer to know the details as opposed to worrying about what might be happening. We will be home this weekend and Ro really enjoys any e-mail or calls.

That's the report.  Love,  Mark

Friday, 10pm

February 13, 2000 - Two Days After First Chemo Treatment:

Ro and I were waiting for the big chemo side effects to kick in this weekend, but nothing bad happened with this first treatment so far. Ro felt tired today (Sunday), her arms felt heavy, but no bad nausea or other bad stuff. So we are feeling pretty fortunate so far.  :-)

That's the quick report.

Love,

Mark

Sunday, 8:20p

February 17, 2000 - A Bad Day For RoRo

Well, Ro is fine, but had a difficult day on Wednesday. Earlier in the week we were feeling pretty lucky that there was no big reaction to the first chemo treatment on Friday. I'll spare you the details (and no pictures this time), but one of the many side effects of these chemo drugs you need to watch out for has to do with your digestive system. The chemo drugs can speed this process up or slow it down.

In Ro's case it slowed it down, big time. And we really did not determine this until Tuesday night and Ro took some meds they give you for this. But it was too late and poor Ro Ro had a very bad Wed morning where several things were attempted with coaching on the phone from Ro's sister Jane (a nurse) and a lot of help from our neighbor and friend, Mary Kay, running to the drug store and talking to the doctors office. I left for work early Wednesday morning, thinking things would be OK, but they were not. Ro experienced tremendous discomfort and was taken to the emergency room of the hospital by Mary Kay later that morning. At the hospital they were able to address the problem and Ro was released from the hospital at about 3p.

I picked-up Ro at the hospital, and I have never seen RoRo so exhausted (partly because of a shot they gave her for the pain). I have to be honest, it was very sad and difficult to see Ro this tired and hear what had happened.

Ro is feeling much better today. Ro had a meeting with the oncology nurse today and they will watch this very closely in the future and there are drugs they will give her prior to the next chemo treatment that should manage this. Ro also has a little whiteness in her mouth and they have given her some anti-fungal medications to control this. This is also a common side-effect of chemo and not unexpected.

So the trick to the next six months of chemo is to watch for any number of side effects and get the right medications for these - but not spend all your time worrying about what is next and try to live as normal a life as possible. Not so easy, but it seems like all the bad things come unexpectedly and the things you worry about turn out to be no big deal.

When RoRo dropped me off at the train this morning, she said she would try to stay out of the emergency room today. So RoRo is feeling much better today.  :-)

That's the quick report.

Love,

Mark

Thursday, 9:45p

February 23, 2000 - Ro Learns to do Self-Injections

Hi Rosemary Fans,

Ro and I had a nice, quiet weekend - decided to skip our regular visits to the ER. ;-)

We went out to our favorite Outback restaurant Saturday night and on Sunday we were in Rockford with Ro's family.

Ro's latest medical report is her blood test on Monday showed her white blood cell count was very low. This is an expected side effect of the chemo drugs. The drugs kill cancer cells, but they also kill some good cells you need. The blood count was low enough that they put Ro on Neupogen starting yesterday. Neupogen is a new drug that stimulates your bone marrow to make more white blood cells. You need these guys to fight infections - maintain your immune system.

The tricky part of taking this drug is you need to take it by "self-injection". Ro was trained by the nurse yesterday to stick the needle of a syringe in a small vile of Neupogen (we store in the fridge next to the ketchup), load the syringe with the drug and then stick the needle into her leg to inject the drug. Yes, I had the same reaction when Ro called me at work and told me about this plan.....you have to be kidding. But Ro has now done this twice with great success. No big deal for RoRo. The needle is fairly short and you just stick it into the fleshy part of your thigh and push it in. Ro needs to do this once a day for about ten days until her counts get back up. She may have to repeat this treatment after each chemo session if her blood count drops as it has after the first session.

Ro has been advised that while her blood count is so low (should go up in a week or so) that she is at risk of getting an infection and should avoid "people". I have been avoiding people my entire life so now Ro needs to follow my lead. Ro is suppose to stay away from restaurants, stores and any other public places. As long as I am not exposed to a cold or flu, I can hang around the house and bug Rosemary.

Ro actually looks very good, is eating pretty well and we are both feeling pretty good about things. One side-effect of Neupogen is you get sort of a dull ache in your bones and Ro has a little of this in her legs, but says it is no big deal. They also put Ro on an anti-biotic as a precaution.

These drugs are kind of scary sounding, but also kind of interesting. Neupogen is a product of genetic engineering by a company named Amgen, that found a way to create a hormone-like substance that tricks your body into thinking you have an infection and it needs to produce more white blood cells in your bones to fight the infection. It is a very expensive drug, we have heard it is over $100 per injection, but I just picked up a vile at Walgreen's and they charged us our regular $10 co-pay with our health insurance, so Ro and I are high-fiving that kind of deal.

So Ro is home most of the day (she still drives me to the train) and visits with people on the phone and e-mail.

That's the report.

Love,   Mark

Wed., 10:30p

February 27, 2000 - Third Week After First Chemo Treatment

Ro was a little tired the last couple days - the result of low blood counts. Both her white and red blood cells were low last week. The red ones carry your oxygen, so low counts for these guys kind of take the wind out of you.

Ro was better today and we took a walk around the block and were out in the car driving around most of the afternoon to Geneva and Naperville. Ro's appetite has changed a little and she finds it kind of hard to get excited about eating the normal things she enjoyed in the past. This afternoon we stopped at a place with good milk shakes and we split a chocolate malt. I am trying to think of meals that have a little bit of a surprising kick to get Ro's taste buds going.  But today, Sunday, Ro ate pretty well.

Ro gives herself an injection once a day to help boost her white cells and this is simply amazing how Ro can do this with no fear. I think I told someone that the syringes Ro uses are special, short needle type things that she pushes into her leg with no big effort. But that is wrong. These are normal syringes like the nurses give you in the hospital and it is amazing the courage Ro has to do this each day.

Ro's hair started falling out today......no big deal. We knew this was coming very soon....about two to three weeks after first chemo treatment. This was inevitable, so we are happy it has started......this means we are well into the treatment and making progress......closer to the end of the treatment.  Ro has an appointment with the hairdresser on Wednesday in Oakbrook where they will probably buzz off her hair and they have two wigs ready to go.

Ro and I enjoyed watching Felicity tonight - our favorite TV show. Ro had a glass of wine, we made some popcorn and life is good.

That's the report.  Love,  Mark

March 7, 2000 - Second of Eight Chemo Treatments

RoRo is doing well with second chemo treatment last Friday (second of eight treatments over six months). So far, Ro has avoided the bad nausea many chemo patients have the days just after getting the chemo drugs. We feel lucky about this, because the chemo drugs Ro is getting during the first three months are the heavy duty chemo drugs that can make you feel very sick. The anti-nausea drugs must be doing their jobs.

 Ro was very tired on Sunday and Monday. Ro said she took three naps on Monday and was feeling better today. The self-injections Ro takes to boost her blood counts worked well during the first cycle and the oncology nurse suggested Ro go back to daily self-injections for the next seven days during this second cycle. I asked the oncology nurse what they did before they had these new genetically engineered drugs that boost your blood counts. She said when your blood count falls to levels of Ro's, you would delay the next treatment or lower the dosage of the chemo drugs - not good options because studies show more intense chemo treatments over shorter period of time give you better shot of killing all the cancer cells and better chance of cure. So the shots Ro gives herself in the leg are allowing us to keep on track.

A quick report on the hair. Ro did not lose any hair for the first two weeks after the first treatment. But during the third week it all started to fall out over about  three days. Maureen was a big help to setup Ro at a special store in Western Springs - Naturally Yours,  that serves the needs of cancer patients. They buzzed off all of Ro's hair (about 70% was already gone) and they picked up two wigs that Maureen and Ro had ordered weeks before. The wigs look amazingly like Ro's natural hair. They also picked up several hats and in bed Ro wears a comfy cap we picked up at Target.  The short stubble was a little uncomfortable, so I helped Ro shave her head. Maureen warned me that at the first moment, both Ro and Maureen found it a bit jarring to see Ro with no hair. But after about five minutes you see it is RoRo and adjust with no problem.  As usual, Maureen and Ro made this experience full of laughs.
 
 Ro has to work to get motivated to eat food. The chemo drugs alter your taste buds and make most things taste bland. So Ro is eating OK, but it is kind of tough to get motivated to finish a meal. With the amazingly warm weather over the weekend, we cooked out on the grill a couple times. 

So that's the report. Oh, and no digestive problems so far with this second cycle. We are feeling really good about that.  :-)

Take care,

Love,

Mark

Tuesday night at 10:50p

March 12, 2000 - Good Weekend

March 24, 2000 - Third of Eight Chemo Treatments

Ro had her third chemo treatment this morning. So that is three of eight - getting close to half way done. We are coming off a very good week where Ro felt good, had her appetite back and we were able to venture out into the real world. We are high-fiving this Neupogen drug that brought Ro's blood counts back to semi-normal last week.

The pattern of the chemo treatments seems to be ...... get the chemo drugs on Friday morning, very tired on Sunday, Monday Tuesday, loss of appetite (no taste buds working) for about two weeks, blood counts fall, take injections of Neupogen (stay home away from people) and third week after chemo start to feel better (blood counts back up), taste buds come back and we go out to dinner as often as possible before next chemo at end of third week.

Last weekend was during the good, third week and we were able to go downtown and meet Maureen and Drew for dinner and had lots of laughs.

The Oncology office was very busy this morning. There were three other woman in the treatment room getting chemo. All were in worse shape than RoRo. Two of the woman had ovarian cancer and looked very sick. They talked a lot about managing the bad nausea (so far Ro has very little nausea). The room where they give the chemo is pretty small and you hear all the conversations between the nurses and the patients.

One woman (maybe 50ish) was there with her mother. She was just starting chemo and her blood counts had fallen and the nurse was teaching how to take Neupogen injections via self-injection. They both looked very worried about this routine (as we were). Ro told them not to worry, it's not as bad as it sounds. The mother asked Ro several questions. I also talked to the mother and said compared to some of the other difficulties of this cancer experience, the self-injections were the easy part.  After her daughter successfully gave herself the injection, her mother started to cry a little. The mother told us when her daughter left the room that her daughter had a recurrence of a pretty advanced stage of breast cancer.  It sounded like this was their first experience with chemo treatments. They both asked Ro several questions about managing the loss of hair. Ro told them where she got the wigs and how Ro uses this combination bangs and head wrap thing.  Ro had them laughing several times and the mother was amazed at Ro's attitude. So we leave the Oncology office once again feeling lucky about our situation.

That's the report.

Love,

Mark

April  16, 2000 - Fourth of Eight Chemo Treatments - Half Way Done

Ro is officially at the half way mark with her fourth chemo treatment this past Friday. The chemo room was booked with chemo patients, so the spouses got bumped to waiting room. When Ro walked out of the chemo room, she gave me a high-five.  So Ro has completed her fourth and final  treatment of Andriamycin and Cytoxin and now moves to four treatments of Taxol starting three weeks from now. So we are three months into a six month chemo treatment. Ro continues to be lucky that she has no strong nausea from the Andriamycin. Ro gets tired and her blood counts fall after each treatment, but the Neupogen self-injections bring her counts back after about a week of daily injections.  

I talked to a lady in the waiting room of the oncology office that has a similar chemo treatment to Rosemary. She completed her Andriamycin treatments and started Taxol. She said the Taxol was a little easier on her, she had some pain in her joints for a few days after a treatment, but nothing too bad. So we are going into this final round of treatments feeling pretty confident.

Ro actually looks better than me. I have been suffering with a bad cough and occasional fever for over a week. I have been to the Doctor twice and they give me antibiotics and cough medicine, hopefully I am on the upswing on this. Ro needs to stay away from me when her blood counts fall because her immune system becomes weak.

Since I sent out the last update on Ro's condition, we celebrated our 19th wedding anniversary on March 28th. This was a few days after Ro's third chemo treatment when fatigue sets in. Ro surprised me with a special dinner at home with wine and candles. In the middle of the dinner, Ro did take a few minutes to lay on her back on the floor of our dining room to recover from a feeling a little faint. It was no big deal. Ro's version of this evening was that it was kind of a disaster, but I have only fond memories of the evening and rank it among the best anniversaries we have enjoyed.

That's the report.  Love,  Mark

May 5,  2000 - Five of Eight  Chemo Treatments - First Taxol

Hey RoRo Fans,

Rosemary is doing well. Ro had her first treatment of Taxol on Friday. This went fine. Some people have an immediate allergic reaction to Taxol, so when they connect you to the Taxol, they watch you the first five minutes to see if you get a rash or shortness of breath - typical allergic reactions. Ro had no problem. They give it to you slowly over about three hours. The chemo room was full with sick people again and one young woman was also getting Taxol and was having a bad reaction with nausea. So Ro was pretty lucky.

Taxol is a newer cancer drug that was only used in very advanced ovarian and breast cancer in the past. Recent studies found Taxol improves survival rates in woman, like Rosemary, with stage II breast cancer with lymph node involvement. So Ro is getting a very modern treatment.

Two days after the Taxol, today, Ro is doing fine and in very good spirits. Ro has the common side-effect of Taxol - some soreness in her joints and bones, but not too bad so far and she takes ibuprofen for this. So far the Taxol seems easier than the prior chemo drugs because Ro does not have that bad metallic taste that kills her taste buds and she feels kind of tired at times but not the bad fatigue of the andriomycin.

 Last week Ro also had a test in the hospital that scans your heart muscle to see if the chemo drugs did any damage to the heart (andriomycin can be toxic to the heart). Ro's heart is normal. Ro also had a total blood workup and this came out very nicely with a certain tumor marker back in normal range. So this was good.

 The things Ro has to watch out for are her blood counts. These are still low and Ro is taking the self-injections of medicines to get these back up. Ro also has some swelling of her left arm, this is a common side-effect of having your lymph nodes removed and you have to watch this and elevate your arm when you sleep. Ro will probably check in with her doctor to ask about the arm this coming week.

That's the report.  Love,

Mark

June 4,  2000 - Six of Eight  Chemo Treatments - Second Taxol

Hi RoRo Fans,

Well Ro is doing vey well. After 2 treatments of Taxol, Ro is feeling better compared to the 4 treatments of Andriomycin. Ro is eating well and her blood counts are better. So we have been getting out more and enjoyed a fun day at a surprise birthday party for Ro's sister Jane at the Rain Forest Cafe restaurant and we just got back from a weekend getaway to New Buffalo, Michigan. Ro feels we are on the easier, second half of the six month chemotherapy treatment. Ro has two more treatments of Taxol over the next six weeks and the chemo is complete. Then Ro has radiation treatments, but these are usually much easier compared to chemo.

One of the side-effects to watch out for with Taxol is numbness in your fingers and toes. Ro has really tolerated the Taxol very well so far, but did have one day last week with some tingling in her fingers. The oncology nurse said everyone's response is different and most people don't feel any numbness until the third or fourth treatment. The tingling only lasted for one day, so we will watch for this with the next treatments.

For the second Taxol treatment, the chemo room was packed with mostly woman being treated with ovarian cancer. Compared to RoRo, they all looked very sick with a gray complexion. Ro has a pink complexion and very positive attitude that lifts the spirits of others in the room. :-)

Love,

Mark William

July 7,  2000 - Eight of Eight  Chemo Treatments - Fourth Taxol

RoRo had a great day today - finished the eighth and final chemo treatment. The chemo nurses, Julie and Judette gave Ro a "chemo diploma", flowers (see photo below) and big hugs. RoRo is one of their favorite patients since she never complains and keeps them laughing. So this is a major accomplishment in Ro's cancer treatment. Ro was given the heavy duty chemo treatment that offers stage 2 breast cancer patients like Rosemary a very good chance of avoiding a recurrence. At the beginning of the chemo treatments, the doctor said that the bad side effects that people associate with chemotherapy are now controlled well with modern drugs for most patients. This was certainly true for Ro. The most dangerous side effect Ro experienced were big drops in her blood counts, but the self-injections of these new drugs brought these back up and Ro was able to keep on track for all scheduled treatments. 

We learned coping with chemotherapy is all a matter of watching out for all the side effects, communicating frequently with the oncology nurses and then following their directions on all these drugs. The chemo nurses need to be good communicators and the head nurse - Julie is a real take-charge person with excellent communication skills.

The last phase of Ro's cancer treatment - radiation, will start in about three weeks. This should be easy compared to the chemotherapy. Beginning in August, Ro will have daily radiation treatments (Monday through Friday) for six weeks. These treatments involve very short visits to the doctor's office in the early morning and the only side effects are usually some fatigue, but nothing like the effects of chemo. And in a month or two, Ro should start to see her hair growing back.

So we are feeling very fortunate. There is usually a lot of fear of the unknown going into chemotherapy. But RoRo had little fear because she places great trust in God and people, particularly her doctors, nurses, family and friends. Ro observed a man in the chemo room today that received his first chemo treatment a few days ago. He was not doing well. He complained of bad headaches and sickness.  He kept saying this was the worst week in his life and the chemo nurses were having difficulty getting him to follow their directions. For example, they asked him to track his temperature for fever and he refused to do this. Ro said he refused to make eye contact with anyone in the room. Ro smiles at everybody in the room.  Ro is blessed with a very positive attitude and this was a great help getting through chemo.

So that's the report.  Talk soon.  Love,

Mark

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This site published by Mark Gallagher, e-mail: mark@gallagher.com.   Last update: August 2006