Not a Cup of Coffee

I've had a muga - and it doesn't have anything to do with coffee. Monday I had a MUGA scan (multiple gated acquisition scan) which is a special test of heart function, more specifically - ejection fraction. A MUGA was done to see how well blood is pushed from my heart. The test is done by obtaining a blood sample and attaching radiation to it and re-injecting the blood into the patient, then watching the blood move through the heart with a special camera. It takes about 30 minutes to complete, and the hard part is lying very still with your arms overhead. Two of the chemotherapy medications that I will be taking can have side effects on the heart. The test will be repeated periodically throughout the next few months to monitor the effect on my heart. Today the doctor called to tell me the results - and my ejection fraction is 60.8% - so students what is a "normal" ejection fraction? Okay, I give - 55-70% is considered normal.
The protocol that I will receive is a standard treatment for ER/PR negative with HER2/neu positive tumors - AC - TH protocol, which is Adriamycin and Cytoxan followed by Taxol and Herceptin. I will get AC every three weeks for 4 rounds, then TH every three weeks for 4 rounds. It is anticipated that I will receive Herceptin, which attacks the HER2/neu positive cells, every week for a year following completion of the chemotherapy. Radiation therapy is also planned following chemotherapy and I will get the Herceptin along with radiation. Herceptin is unlike other chemotherapy drugs, as there are few side effects, such as loosing hair, GI effects or fatigue. However, Herceptin is one of the drugs that has heart side effects.
I have the first round tomorrow - May 1- which will take most of the day, as the adriamycin is given over 4 hours.
I know many people will have me in their thoughts and prayers tomorrow as I begin another "leg" of my recovery journey. I am thankful for the many blessings in my life.
It is again time to put on the "warrior" armor and fight! I am ready!
Power to you and to me-
Ellen

Tender Mercies

Marlin and I traveled to St. Louis on Monday afternoon for the follow-up appointment with Dr. Margenthaler, my surgeon. The appointment was Tuesday morning. She was pleased with the healing and removed the two drains I had - which gave me much relief. She told me that I could start chemotherapy as soon as a week and that my next follow-up appointment with her would be in six months. I have some post-op exercises for the left arm and shoulder to help prevent swelling (lymphedema) in that arm. Who knew I'd be exercising 3 times a day!
While in St. Louis, I made Marlin take me to some wig shops. I wanted to try some on and see what style would look best. We had some fun - I became a brunette and a red-head for a few minutes! I even tried on a silver-gray color. The shop had some funky ones - like the pink pageboy that Brittney wears - I didn't go for it. I actually look pretty good in strawberry-blonde - so look out for me as a red-head! I once had my hair colored a light red when Lindsay was in high school. I called her from the salon to come and see me and she nixed it - so I went back to blonde that very day. I think this time, Lindsay won't protest too much. Marlin says "it really makes your eyes blue". I never got real parental when it came to my kids' hair - after all, hair is temporary - and it should be a source of fun in this situation. You have to find humor in something! I also have a nice collection of turbans and hats, thanks to my friends and family. Hair loss begins 7-14 days after the first treatment, although there is some variation depending on the medication.
I saw Dr. River, oncologist, in Pittsburg, Wednesday, April 23rd to discuss beginning chemotherapy. He confirmed that he would follow the recommendations from the specialists in St. Louis, which relieved my anxiety a great deal. He was planning to discuss the medications again with Dr. Bose in St. Louis before he would give me a definite protocol. I will see Dr. River this afternoon to confirm the plan, however we did decide "C-day" is May 1.
I am doing well, still somewhat inpatient with my recovery. I get tired in the early evening, but I am sleeping well. I appreciate all the cards, calls, packages and prayers. I know that many have me in their thoughts and I am overwhelmed with emotion, gratefulness, and thanksgiving - to have so many friends and family supporting me.
Bless the Lord, O my soul, and forget not all His benefits; who forgives all your iniquities, who heals all your diseases, who redeems your life from destruction, who crowns you with lovingkindness and tender mercies. Psalm 103: 2-4
Blessings and mercy to you -
Love, Ellen

Seventh day stretch

I am seven days post-op and recovery is going pretty smoothly. I continually fight with my tendencies to "get things done" in my usual efficient manner. Healing takes time! I am reading that stack of books in the corner, watching the birds at the feeder in the backyard, and learning to knit. (Okay, Faith - I'm stuck, you'll have to come and help me with the next stitch.) Two of my sisters, Nora and Carol, arrived Tuesday evening and have been wonderful company and even better house slaves. (ha-ha) I will have the cleanest house in Girard by the time they leave on Sunday. Of course, Marlin is getting used to the gourmet cooking and will soon be disappointed in the sandwich meals sure to come in the next few weeks. My third sister, Luanne, will come Friday for the day. My brother is my mail carrier and has delivered your cards and notes to me daily. I really enjoy and truly appreciate all of them. I am suddenly an old lady - looking for the mailman!
I return to St. Louis next Tuesday, April 22, for follow up with my surgeon. I have an appointment on Wednesday with the oncologist in Pittsburg to plan chemotherapy - hopefully to start by the end of April.
I continue to lean on the Lord for strength and solice during this time. I know there are hundreds on people praying for me and I feel your loving embrace.
Blessings to you all - every one.
Love to all - Ellen

Details of the day

Thank you to nurses- colleagues - who provided care during my hospital stay - my nurses were Beth Ellen (pre-op), Jeff (CRNA), Dennis & Chris (OR), Lana (recovery), Barbara (new grad, new RN), Cindy (new grad, new RN), Eileen (nursing student)and Belinda (NP). I had excellent nursing care and my anxieties about being so far from home and not personally knowing the nurses, were for no reason. I remember that He provides the care and I should not fear. My prayers (and yours!) were answered. I tried hard not to intimidate the nurses who knew I was a nursing instructor - the new grads did, however, learn a few tricks from this "old nurse" - like releasing the slide clamp allows the IV to drip (oops!). Hanging those piggyback IVs is always a challenge, at first!
My surgery went well. The surgeon, Dr. Margenthaler, had a "fellow", Dr. Dana Holwitz, who assisted with the surgery - both were very attentive and I felt confident in their care. The PET scan on Wednesday provided some positive news - the lymph node near my left collar bone is not cancer. I do have several nodes near the breast bone that will be attacked by chemotherapy and radiation.
The surgery was a left modified radical mastectomy with lymph node dissection. Dr. M. stated that she did see two lymph nodes that were cancer, and the pathologist will look through the removed tissue to find other nodes. I must wait on a pathology report to know more.
I arrived in recovery room, where I awoke following surgery, with a Q-ball (On Q). This is a round plastic reservoir filled with local anesthetic that "leaks" into the incision to provide pain relief. It is about the size of a cue ball. The reservoir slowly collapses as the bupivicaine is released through a very slim plastic tube inserted below the skin. The ball lasts about 3 days and then it is removed, by pulling the catheter out. The portion that rests under the skin is about 8 inches long! Marlin watched me as I pulled this out yesterday - I thought he might faint - but he has done very well in this crash course of nursing! According the the nurses, the Q-ball is used frequently with orthopedic surgeries, but I was only the second mastectomy patient to receive one at this surgery center. I would certainly recommend it! My pain level was never greater than 6 or 7 (out of 10) during the entire time at the hospital. Of course, I saved the Q-ball for "show and tell" with my students!
I was dismissed on Friday about noon and rode home in the Excursion on a mattress in the back. Grant drove and I was able to tolerate the trip well - of course, pain pills work great! We got home about 5:30 pm.
I have been resting at home since then. Thank you to friends from church, Fleta and Suzie, for providing meals this weekend and Brenda for staying with me while Marlin attended to business. I have been humbled by the generosity of my church friends, many blessings!!
My sisters will be arriving on Tuesday and will be a huge help in the next week. Marlin can get a break!
That's all for now - blessings and thanksgiving!
Love to you,
Ellen

Wrapped in love

Yesterday, my pastor's wife, Belinda, presented me with a prayer shawl that was knitted by women of the Christian Church in Topeka. It is their ministry to provide these beautiful shawls to anyone with illness and in need of prayer. Thank you, Belinda, for thinking of me. I have been wrapped in it since I received it. I am amazed by the sources of love and support that I receive.
I am preparing for the trip to St. Louis tomorrow. I will have a PET scan in the late afternoon and the surgery is scheduled for Thursday morning. I will also get a port that will provide an avenue to give chemotherapy. The port is a "cork" that goes under the skin near the collar bone that goes directly into a large vein so that I won't have to be stuck each time I get chemo - it's standard practice to have one.
Lindsay won't be making the trip to St. Louis. She has a terrible upper respiratory infection and missed work today. She needs prayer, too, to get better and because she wants to be with me for this trip. Marlin and Grant will travel with me and we plan to be back in Girard Friday evening.
Send positive thoughts and prayers for safe travel, skillful surgeon's hands and for His will be done.
Ellen

Finally --- Good News!

The MRI results are back - the right breast has been "cleared". Dr. Bose, medical oncologist, and Dr. Margenthaler, breast surgeon, both called today to tell me that the suspicious spot on the right breast was highly likely benign - and not anything to be concerned with at this time! Glory, Joy, Joy, Joy! Finally, good news.
Dr. Bose called to tell me about the discussion of my case by the "tumor board". The pathologist reviewed tissue slides from my surgery and believes it likely that I have additional tumor cells in the remaining part of the left breast (so he recommends mastectomy). The five medical oncologists on the board agreed - and of course, Dr. M. believes that additional surgery is required. I am confident that the physicians' recommendation is the right thing to do. I am scheduled for April 10th in St. Louis.
Chemotherapy will follow in about 4 weeks, lasting 3-5 months, then radiation treatments.
I am at home, resting, eating lots of fresh fruits & veggies (antioxidants)and leaning on the Lord for His continuing guidance.
Joy, joy, joy!
Love to you - Ellen

In Preparation

If you've been a frequent reader - you'll remember an early entry about "preparing" not "waiting". I received a powerful message in my devotion last night - I want to share it with you.
Do not be anxious about anything, but in everything, by prayer and petition, with thanksgiving, present your requests to God. Philippians 4:6
Thank you for your petitions.
Love to you - Ellen

A Full Day

Marlin and I traveled to St. Louis on Monday afternoon. I saw Dr. Julie Margenthaler at the Center for Advanced Medicine at Barnes-Jewish Hospital Tuesday, April 1 (no foolin'). I was her first appointment, 8 am. She is a breast surgeon and I was impressed by her confidence and interest in me. She recommended that I have a modified radical mastectomy with lymph node dissection on the left (affected side) as soon as possible. I discussed with her the suspicious lesion on the other breast. I was hoping that the biopsy could be done at the same time as the other surgery. She recommended that I get another MRI that day so she could compare the results to the one I had in Joplin. We won't make a decision about the "other" breast until the MRI results are back - hopefully tomorrow (Friday). I did ask about doing mastectomies on both, but she is not recommending that, because of the longer healing time. We briefly discussed reconstruction surgery - not to be considered until all the treatment is done. I also had blood drawn for the breast cancer gene test. Some insurance companies are covering this test - I am unsure if mine will, but the lab tech told me that the lab and the insurance company will "duke it out" about the payment. So I'll leave that for someone else to worry about.
Dr. M. has surgery scheduled for me on Thursday, April 10th. Yesterday, I was able to complete the MRI and all pre-operative preparations. Everything that needed to be done went smoothly and completed in one day. Thanksgiving! We were able to leave St. Louis by 5 pm and got home about 9:30 pm. (okay, Marlin has a radar detector)
I am in Topeka this afternoon, Thursday and Friday, trying to prepare for my absence. I am so priviledged to work with a supportive group of women at Washburn nursing - and they have offered to cover classes for me - and I will accept their offer. I am learning how to accept the generosity of others.
My daily devotions continue to "speak to me". I am touched by the cards, prayers, and kind thoughts.
Ellen