This week has taken an unpleasant, but not unexpected twist.  Cathy seems to be developing some peripheral neuropathy.  Peripheral neuropathy is nerve damage that is the result of exposure to toxic chemicals.  There are other causes of PN, but Cathy's particular causal agent is taxotere, which is one of her chemotherapy drugs.  This is a common side effect that we'd hoped she would avoid, alas she has not!  

She feels a little tingling in her hands, especially her right hand, but her feet are the most affected.  Cathy says her feet feel like she's spent all day outside in the snow and then put her feet in warm water.  The sensation is a little numb, a little tingly, and a little burning.  The condition could get worse, stay the same, or get better.  It could go away when chemo stops or linger for a few more months to a year or more.  It's another one of those "everybody has a different experience" things.  If the pain becomes unbearable or it interferes greatly with her sleep they can prescribe some drugs for her.  Tricyclic antidepressants inhibit the nerve function that communicates PN sensations to the brain.  I think Cathy would like to avoid that if at all possible.  There are some other alternatives that may or may not be effective, like acupuncture.

Dr. Drosick said that the next chemo treatment will continue like normal, but if the PN gets really bad he can omit the taxotere in the last treatment.  It seems that these are the things that happen when poisons are placed directly into the circulatory system.

Cathy requests that if you are a praying person that you pray for the PN to improve.  

Last night I was really tired.  I don't have any good reasons or explanations, I was just dragging.  We went to bed about 10:30 and I fell asleep straight away.  Clara woke up about midnight.  I heard her cry and tried to get up, it was just so difficult.  I swung my legs out of bed and sat on the edge for a few seconds with my eyes closed, giving all my effort just to get them to open.  As they finally began to open I saw Cathy walk past and go into the bathroom.  She turned on the water and prepped a bottle.  Without a word, she walked out of the bathroom with the bottle and went to feed Clara.  I turned back to my pillow and slept until the alarm went off at 5:15.  I awoke rested and ready, feeling good.

This little episode made me happy for two reasons. (1) Cathy felt good enough to get up in the night and take care of Clara. (2) I have an awesome wife who knew I was whooped and let me sleep.

Over the course of the last twelve weeks we have been awed, humbled, and inspired by the kindness and generosity of so many people.  We feel very loved and are very grateful.  We have witnessed so much evidence of the goodness of people.  That goodness has been gifted to us over and over again.  Thank you.

This round of chemo seems to be a bit of good news/bad news with a little more emphasis on the good news.  The increased nausea that Cathy experienced in round 3 has not made an appearance this time.  In fact, I've seen Cathy eat more solid food in this round of chemo than in any of the previous three.  That's a good thing.  She will, however, need to tell the oncologist that she has lost 10% of her starting weight.  That was the magic number that when she reached he wanted to know.  I don't know if it will have any effect on her treatment, we'll have to wait and see.

This time around I think Cathy is a bit more fatigued than her other rounds, especially today.  It's hard to say if it's just the chemo or if it's because she was supermom yesterday on the first day of school.  She got up early to see the boys get on the bus and again when they got home.  She worked through all of the first day of school papers and greeted our generous meal provider.  That's much more than she would have done on a typical day 3, so I wonder if she's paying for it a little bit today.  I'm going to anticipate that tomorrow will be mostly a fatigue day with a little uptick in the late afternoon or evening.  Either way, it's been great to see her eat soup, bread, a little meat, and some fruit.  That's much better than broth or nothing at all!

Yesterday Cathy received her fourth infusion of poison, the official point of being more than halfway through chemo.  I did not accompany her for the first time.  Cathy's brother, Jonathan, went with her this time so I could do some work at school.    We've planned for her to go to chemo with other family members for the next two treatments as well.  Being at school and knowing she was at treatment was a little torturous for me, but not nearly as torturous as receiving the drugs.  The treatment room was apparently a little crowded yesterday, so she finally left at 4:00pm after arriving at 8:45am.  Jonathan sent me text updates as the day went along.  His description of events and of Cathy's poise were exactly what I've come to know from Cathy at treatment.  Those messages reassured me and helped me to visualize Cathy's positive outlook, confident patientship, and sunny disposition toward others.  Jonathan kept Cathy comfortable, double checked all of her dosages, and even remembered to give her gum before the port flush so she wouldn't taste saline.

Cathy's day 1 and day 2 have been a great improvement over the nausea that came on early with the last treatment.  She has had a pretty good appetite and higher energy level than I would expect, although as I type here on Tuesday night she is getting a little weary.  Her blood count numbers are all improved over the last treatment, as well.  Dr. Drosick told her she needs a little more protein, which is what Dr. Manders also told her will help her strengthen for surgery.  Tonight we had some tasty grassfed burgers and we'll try to have some extra salmon, beef, nuts, legumes, and protein powder in the coming weeks to get her what she needs.  Oh, that reminds me, nuts seem to be ok for Cathy now.  She has always loved nuts, but lately they have been getting lodged in the back of her throat creating what we've learned are called tonsil stones.  They aren't really stones, but instead accumulations of nut bits combined with seeds and other difficult-to-digest foods.  They aren't a big deal, just an inconvenience that is sometimes a bit smelly.  Last week she had a craving for almonds.  She ate them with no problem.  She ate them the next day and the day after that with no problems.  So nuts are back on the list of good foods for Cathy!  Maybe onions will be next?

The boys are in bed earlier than they have been in two months.  I'll get Jonah up at 5:30 (ouch) tomorrow with Aaron to follow at about 6:30.  We are praying that none of the three Ewing boys will bring any germs home from school that could cause Cathy problems.  She's making such great progress with the chemo - we would hate for that to be derailed by an infection.

Tonight I'll go to bed with a relatively good feeling wife and will likely wake up with a nauseous, fatigued wife.  We'll both remember that the chemo is working and we'll look forward to Tuesday.

Yesterday we had an appointment with Dr. Manders, a breast surgeon at Christ Hospital.  This was a consult and a second opinion and we're still yet to decide who the surgeon will be.  Cathy really liked Dr. Manders, but didn't care for the drive to Christ.  It's in Mt. Auburn, between Clifton and downtown, so it's a good bit farther away than Bethesda North.  It is, however, a really good hospital, the same hospital where I had my thyroidectomy.  At that time we were really impressed with the hospital.  Traffic was horrible on the way home and Cathy was tired.  She was too tired to really be able to think about whether or not Dr. Manders is the right surgeon for her.  I was, of course, desiring to talk it through right away, but Cathy's fatigue served as a good buffer that will allow both of us to have a clearer mind when we do talk about it.  

Dr. Manders was very thorough, spending over an hour talking with us.  We talked about the protocol for Cathy's triple negative cancer and the Plans A, B, C, etc. for attacking it surgically and otherwise.  I'll try to summarize what we learned.  Like most of our doctor appointments it was a lot to process, but it seemed to align clearly with other consults we've had and with what I've read.

Right away, triple negative and BRCA1+ meant bilateral mastectomy to Dr. Manders.  There was never any other discussion.  This was pretty comforting to us because it indicated that she understands what we're dealing with and she's aggressive in her approach to long term healing and cancer fighting for Cathy.  We talked about the mastectomy and about reconstruction options.  Dr. Manders would prefer that a consult with a radiation oncologist help us in refining Cathy's choice in reconstruction.  I have a lot more reading to do to learn about types of reconstruction, but I'll try to accurately summarize some ideas we talked about.

Reconstruction using the abdominal wall is not a good choice because it is very risky in terms of maintaining blood supply, fighting infections, and opens the door to future abdominal hernias because of a thinned abdominal wall.

Reconstruction using fatty tissue from Cathy's belly could be good, but Dr. Manders doesn't think Cathy has enough fatty tissue to make two regular sized breasts.  Further discussion of this will be had with the plastic surgeon, though.

The two best options, in Dr. Manders's mind, are expanders under the pectoral muscle to be replaced by implants later and use of the latissimus dorsi muscle with or without an implant.  

I'll go more into the reconstruction process when I learn more.  The important thing about this appointment is the strategy, though.  After meeting with the radiation oncologist it will be determined whether or not radiation will be necessary and to what extent.  A needle biopsy and/or staged sentinel node biopsy about a week prior to the mastectomy will help to confirm or change the radiation plan.  If there is no evidence of cancer in the lymph nodes, reconstruction can be done in conjunction with the mastectomy or shortly thereafter.  If there is evidence of cancer in the nodes, radiation will most likely need to come before reconstruction.  Radiation can have some adverse effects on reconstructed tissue and particularly on implants.  

Dr. Manders looked at Cathy's MRI, scans, and other films, as well as conducting her own exam.  She could see the marker left at biopsy on the MRI, but could not see the tumor.  She could also not feel the tumor, thus declaring, "Awesome."

So now we can kind of see a plan, but we know that within that plan there are many contingencies and subplans, if and if and if and if.  At least we can see a clearer picture. 

Tonight I realized that I write a lot about the times that Cathy is feeling bad, but not so much about the times that she's feeling good.  I'm not sure there is any logic behind this other than the thought that maybe most readers are concerned about her and would want to know her status as she deals with tough situations.  There are, however, many good times - like today and the last few days.  Today, Cathy has felt quite good, in fact quite good for the last three or four days.  Last night and today she ate to the point that she was really full, even uncomfortably full, because the food tasted good and she had an appetite.  This week she has been able to attend the boys school open houses and meet the teacher nights, as well as Jonah's percussion preview concert tonight.  Most times she generally avoids crowds, not because she feels bad right now, but because her white blood cell counts are low and she's susceptible to infection.  I've written about her treatment weeks and her ups and downs, but I thought maybe an overview of a three-week period might be of interest.  These descriptions may be 12-24 hours off or vary slightly, but after three treatments this is what we've come to expect - ups and downs.

Day 1-2: Slightly nauseous and body out of balance, light appetite
Day 3-5: Pretty nauseous, desperately dry mouth, unbelievably tired, achy, no appetite
Day 6-8: Moderately nauseous, dry mouth, pretty tired, slight appetite, can't digest food
Day 9: "Ah, Tuesday."
Day 10-14: Slightly nauseous, dry mouth, fatigued in the evening, appetite returning, little trouble digesting food
Day 15-21: Intermittently nauseous, sometimes fatigued in the evening, appetite good, digestion mostly good

So those first 8 days are pretty hard on Cathy, but after that the bad feelings are to a lesser degree and not constant.  The tricky part is that from day 9 to day 21 nausea, bad digestion, or extreme fatigue can just show up without warning.  For the most part, though, those days are almost like normal Cathy.  During those days (and even when she feels awful) she looks good, smiling and joking.  She's just the best.