Some Not So Good, Some Good News

Just when I thought I might be out of the woods getting ready for the next hurdle, the PET scan, I went to the hospital on Sunday for an IV fluids infusion to try and boost my severe fatigue levels of the past two weeks. They routinely draw blood to make sure nothing else is going on. Well, something else was going on, it seemed. Most of my red cell markers were very low, a sign of anemia, internal bleeding, or damage from the chemo treatments. I called the doctor on Monday.

Things are considered ok for my situation. Although red blood cell counts were low in several different categories, by the 4th chemo treatment, it is not all that uncommon to have low red cell counts, which can definitely cause significant fatigue. Of course, HOW low is the key. A transfusion would be considered if my hemoglobin count was at 8 or below. Mine was 11.1. (Normal low end range to high is 11.4 g/dL to 15.4 g/dL.) My protein levels were low...I'm to try and boost that a bit with supplements and focusing on protein intake. No wonder I have been craving burgers, lol! The office said they were more worried about watching white blood cell counts. Due to the injector shot I have gotten each time with chemo (Neulasta), my white cell counts are within acceptable ranges. So I felt much better after talking to my nurse navigator, who is a member of my treatment team, and whom I can call any time with questions about treatment, insurance, or any other concerns. A day or so after the infusion, I felt 85% better! I started taking vitamins and an iron pill as well and feel more like myself.

On to April 5th, the turning point, the PET scan....In preparation for the scan, the day before, you are to follow these directions:

*No heavy exercise for 48 hours prior. No worries there--too tired!

*Drink as much water as you can the day before and especially the day of the exam. The radioactive tracer stays in your body for a relatively short period of time....two to ten hours, so the hydration uptake is necessary the day of the test.

*a NO carbs, NO sugar preliminary diet starting at 2:00 PM the day prior to, which includes no chewing gum or mints. The objective is to keep your blood sugar as low as possible as you are going to be injected with a radioactive glucose solution/tracer that will concentrate in metabolically active cancer cell areas. Cancerous tumors use more glucose than normal tissues and those areas will be the ones to light up.

*Do not eat or drink anything except water 6 hours prior to exam. Since my exam was at 9:30, I simply did not eat breakfast when I got up that day.

*Blood sugar has to be below 200 in order to do the scan.

What CAN you eat the day before? Baked, broiled, or grilled beef, chicken, seafood (but not shrimp) or pork. Green veggies, eggs, and water. Pretty spartan diet but doable for a short time.

As I might have explained before, the PET scan involves having the technician check your blood sugar first as they will be injecting a radioactive glucose tracer. My blood sugar level was 94. We were good to go. Next, the radioactive tracer is injected through the buried port in my chest through a catheter tube that has been inserted into the port and we wait an hour for it to flow through my system. The actual scan itself was a breeze. The machine (which was very new, they said) was so quiet, NOT like the MRI machines which bang and clang and make you feel like you are in a construction zone! You lay face up, with your arms above your head (if you are able to, which is harder to do the older you get!) and the scan proceeds. The table you are on moves back and forth a bit. The tunnel you are in is open at both ends, but I always close my eyes for these tests and don't open them till I'm back out into the light of the room. I don't want to tempt claustrophobic feelings if I can help it! The actual scan was about 15 minutes. I wondered heading out the door later if I would make a Geiger counter sing!

I received my results through the portal about two hours later. I could tell from my Google doc interpretations that the numbers were very good in a positive way, I just didn't know the degree of the positivity. The doctor had previously said he's looking for a certain percentage of improvement in size, with no additional hot spots and then I would not have to have more chemo. I really wanted to hear from the doctor's office, so I called my nurse navigator, she corralled the doctor in the hall between patients and he was reported to be very happy with the results. BUT--he has to look at the scans to determine the specific degree of improvement, so he is not able to talk to me just yet. He will discuss this with me and my treatment options on April 8th at my fifth chemo infusion. It may be chemo plus immunotherapy infusion as usual, or just immunotherapy infusion and then he adds estrogen hormone blocker pills to my regimen. I'm not looking forward to taking those, there are many severe side effects for a lot of people. My thoughts are if four chemo treatments have knocked it down, but not as far as six treatments might take it, I may go with the additional treatments for insurance. If the doctor says that's not necessary, then I will trust his judgment and not take any more chemo. It's a tough decision to make. I'm not sure if just the immunotherapy and hormone blockers will be enough to hold the cancer at bay, but they might.

In the meantime, off to the podiatrist for that darn infected right toe. The left one had a slight infection as well! Two rounds of antibiotics failed to clear it up. Dr. said, "Time to cut the margins to clear the nail." He was going to slice the nail away from the side of the nail bed, and put a chemical on it so the nail would not grow back into the skin. O-o-o-o-o-kay....That involved numbing both big toes--two shots to the left and FOUR shots to the right which was a lot more infected. Twenty minutes later, I looked like this:

(the purple bandage got twisted putting on my socks) Awwww, isn't that cute? Girly colors! Forgot to ask him what color he uses for the guys, haha. Have to leave the bandages on for 24 hours, then do some soaking twice a day, and putting Betadine on it each time and then go see him back in three weeks. Honestly, I have never had so many doctor appointments in such a short period of time, it's hard to keep them all straight! The calendar gets pretty full each month.

At the time of this blog post, I have two days until I meet with the doctor about the PET scan...I will post soon with the outcome. Thank you for following along on this arduous journey!