Here We Chemo Again

Hello Everyone-

After not having chemo last week because of her neuropathy, Brooke had chemo again today.  Things have changed a bit though -- she is now having a completely different combo of chemo and, with this new regimen, will have four treatments every two weeks (instead of the three treatments every three weeks she had left on the previous drugs).  Overall, we are optimistic about both how she is doing (there has been a slight improvement in her neuropathy), and about the new treatment plan, although it comes with some pros and cons.  The driving force behind the decision to switch chemo types is the neuropathy and the concern that it could cause permanent nerve damage -- the new drugs do not have that side effect.

So here's what happened.  Yesterday Brooke went back to the doctor to consult, see how she's doing, and make a decision about chemo.  After having a rough few weeks, Brooke did some better this week.  She still felt pretty rotten, but the nausea and dizziness eased up some and, most importantly, the neuropathy started to improve slightly.  That was very encouraging news!  The neuropathy is still there and still a concern, but the fact that there was some positive movement makes us hopeful that she will not have long-term problems with it.

The doctor was quite adamant that he did not want to give Brooke any more taxotere, the drug that had brought on the neuropathy.  The best alternative then, was to go to these other chemo drugs which is what happened today.  The new drugs are adriamycin and cytoxan.  Again, these drugs are not known to cause neuropathy so that is good news.  They are, however, "harsher" drugs, to quote the doctor, meaning that the usual kind of chemo side effects can be worse on these drugs than some other types of chemo.  Adriamycin in particular is a tough drug.  Besides being worse as far as nausea, it can also cause some heart problems, though the chances of that are small.  They will be monitoring Brooke's heart function closely, and in fact first thing this morning she had an echocardiogram at American Fork hospital before her chemo treatment later in the day.

Adriamycin is sometimes called the "red devil."  It sort of looks like fruit punch and is very toxic.  It can only be administered by someone trained to do so by "pushing" it in, meaning they can't just hang an iv bag like they do with the other types of chemo.  The nurse actually has to sit there with the patient the entire time, pushing it like a giant shot slowly into the veins, regularly checking to make sure it is going into the vein and nowhere else, because of the serious damage it can cause if it's not administered properly.

It all sounds a bit scary, but we're comfortable it's the right decision for Brooke right now.  This is probably in part because we already have a history with these drugs -- adriamycin and cytoxan were the chemo drugs Brooke had in 1998.  In fact, as they considered making this change, they had to go back and look at her 1998 history because there is a lifetime limit to how much of these drugs you can tolerate.  Brooke will be okay with the dosage, but only because she is already halfway through treatment.  She could not have begun the treatment this time with adriamycin/cytoxin because it would have been too much.  But because she already had half of the taxotere/carboplatin regimen, she will now have half of the adriamycin/cytoxan regimen which will equal one whole treatment that we are told is just as effective as having the full regimen of either one (I probably managed to butcher both English and Math in one sentence here, but you get the idea -- I hope).  She does have to go every two weeks instead of every three weeks, but will still finish the chemo at the same time that she would have done with the previous drugs.

There are other pros and cons to the change.   One nice change is that it takes less time to get these drugs.  We were in and out of chemo today in about two hours, where the last treatment took almost six.  Part of the reason it doesn't take as long though, is that they can't combine the herceptin treatment with these drugs.  Herceptin is the drug she has to get for a year, so because she won't get that for these four treatments now, they will have to add on a few extra herceptin treatments on the back end, meaning her overall completion of treatment will be pushed back a couple of months, and she'll end up still having those infusions into 2014.  The adriamycin also causes a real unpleasant taste and smell that are tough to take, but worse, remind Brooke somehow of her treatments in 1998 -- not fun.  She's already experiencing the bad taste and smell  just a few hours after treatment.

On balance though, we are encouraged and optimistic and Brooke feels confident that she is getting the best treatment for her situation right now.  Brooke has had a number of nice emails, cards, messages, etc. which are very much appreciated.  Thanks for your understanding if you don't hear back right away.  Also a special thanks to ward members and neighbors who continue to bring in meals and help in other ways -- our stomachs send along their gratitude!  Brooke also wants to express special appreciation to members of the ward who fasted for her and went to the temple with her in mind last week.  It meant a great deal to us.

Best to each of you-

John