Drip Coffey

And back we go to chemo!

This is the tool most necessary to settle physician disputes.

Today was the fifth of Karen's six scheduled treatments and it went much better than the last one. Most probably because our oncologist pulled one of the drugs from the infusion: Avastin. It was during the Avastin portion of her treatment three weeks ago that Karen began experiencing the pain that signaled the galloping arrival of her colitis. Now, while the GI guy who treated Karen at the hospital full-on blames the Avastin for everything our oncologist, Dr. Sherman, is less definitive. And we kind of knew that was coming because Dr. GI Guy basically told us that "Your oncologist won't believe this."

And Dr. GI Guy was right. Sherman was kinda dismissive of the idea but he still pulled the Avastin because, well, it's complicated. There is no real correlation between plain old colitis and Avastin but the drug does affect your blood vessels (it fights cancer by killing off and preventing the growth of new blood vessels that spring up to keep the tumors fed with blood). Therefore, there is a slim chance it can cause ischemic colitis by killing the blood flow to the colon. Also, there's a chance that a blood clot--and Karen has a history of clots now--could have caused it as well. And thus, no more Avastin just to play it safe.

That better safe than sorry approach was just fine with Karen. While chemo is stressful under what you might laughingly call "ideal conditions" it's a lot more stressful when you're afraid it's going to knife you in the guts. Karen started dreading today's chemo a few days back, worried that she'd have a repeat performance of Treatment Number Four's ugliness. Not so today...she napped through most of it while I worked on my laptop next to her.

So now we wait. In three more weeks Karen will have that last infusion and sometime thereafter she'll have a PET scan to see if the chemo is doing any kind of good. If so, she'll transition to maintenance chemo which will be just one drug (Alimta) pumped into her every three weeks.

In anticipation of that, Karen is likely to get a port installed. There's a picture of what a port looks like just over there. Take a peek. This lovely apparatus will allow the docs to more easily deliver drugs into Karen whose veins are just about shot from all the IVs and blood draws. It will also bring her one step closer to becoming a cyborg so that's pretty awesome. Unless she goes rogue and kills us all. Less awesome, that.

Gut Response

Bright and early Saturday morning, Karen shook me awake and asked me to take her to the Emergency Room. The abdominal pain that had struck during chemo on Monday, while it had subsided in the near term, had begun to reassert itself aggressively and Karen had been unable to keep food down or in for about two days by the time Friday rolled around. Eating caused tremendous pain and even drinking a glass of water was agony, followed by near-immediate vomiting. After being up most of the night, she'd had enough and called our oncologist who told her to head to the ER.

After a CT scan it was postulated that Karen was suffering from a pretty significant case of colitis, with inflammation in both her transverse and descending colon. She was admitted to the hospital for observation and more tests, including an absolutely delightful colonoscopy Sunday morning. That confirmed the diagnosis. Karen stayed in the hospital another day and returned home Monday afternoon. Once it was clear that Karen was going to be okay and that it wasn't really necessary for me to be around, I left for a business trip and let Miranda and my parents (who were scheduled to visit already in order to care for Karen while I took this trip) collected her from the hospital.

So what does this all mean for her treatment? You got me. We'll be talking to the oncologist once I get back. But there are reasons to be concerned. This kind of inflammation and internal bleeding is associated with two of the drugs in Karen's chemo cocktail, Avastin and Carboplatin. Most likely she cannot continue with the same chemo regimen and will need to change drugs, alter dosages, suspend treatment, or outright end it. I honestly have no idea. For the moment, there's no urgency: she's not scheduled for another infusion for two more weeks so nothing is/was going to happen over those 14 days anyway (which is why I was free to travel...obviously if there were immediate concerns I would have stuck around).

This shit just never seems to stop and it is, to coin a phrase, a right fucking drag. But we soldier on and I have to say, everyone does seem to have a pretty good, resilient attitude about it. Especially Karen.

The most unsettling thing about this recent incident? Late Sunday night I headed to our bedroom, brushed and flossed, then settled into bed to watch "Girls." I laughed out loud and reflexively tried to swallow it lest I disturb Karen's sleep. And then I looked where she should have been and she wasn't there and it was incredibly unsettling. I had the bed to myself. I thought to myself, "So this is what it's going to be like" and it was like living in the present and the future simultaneously and it was just kind of awful.

We should know more about the road ahead soon, ideally sometime on Friday.