CHEMOTHERAPY TREATMENTS 02/22/16 - 07/05/16

Monday, February 22, 2016

Cycle #17 of Folfiri.   The doctor reviewed Mike's x-rays taken during his recent hospital stay and stated it show sign of bowel obstruction.  There was just some fecal matter in the colon.  Due to scheduled labrectomy in 2 weeks by Mike's dentist to deal with his eroding gums, there was a hold placed on the Bevacuzumab.   The doctor ordered his treatment with a 20-30% dose reduction.  He scheduled Mike to return in 3 weeks instead of the usual 2 weeks due to the planned dental procedure for cycle #18.

Weight:  182 lbs/83 kg


DENTAL PROCEDURE:  This labrectomy was performed on March 7, 2016


Monday, March 14, 2016

Cycle #18 (rescheduled)  Due to Mike having laser surgery to repair his gumline one week ago, his appointment was rescheduled to Monday, March 21, 2016.  The doctor stated this area was granulating. There were no signs of infection.  Mike denied any uncontrolled pain, fevers, chills, diarrhea, or oral ulcers.  The surgical area is healing.  Denied any oral pain. Mild leukopenia and thrombocytopenia secondary to treatment.  He is to return in 2 weeks for palliative chemotherapy.  Continue daily activities.

Weight:  187 lbs/85 kg

Mike and I hiking Ryder Park trails outside of Montoursville, PA

Monday, March 28, 2016

Cycle #18 Bevacizumab held today to allow the gumline to heal for a good 4-6 weeks.    The doctor stated that Mike may be progressing despite the present regimen, and he may need a complete overall of his chemotherapy.  His plan was to simply readmit the Bevacizumab for a few cycles and then repeat the CEA.  
Mike was sick this week with a head cold along with the nausea from his treatment.

Weight: 188 lbs/85.5 kg


Monday, April 11,2016

Cycle #19.  Return for palliative treatment with Bevacizumab added.  The doctor will treat Mike with approximately 4 cycles, and then reassess his CEA and scan.

Weight:  190 lbs/86.4 kg


Monday, April 25, 2016

Cycle #20.  They proceeded with cycle #20.  Remain active and continue with oral care.  Report any uncontrolled diarrhea, oral ulceration, or pain. After completing cycle #21, he should be reassessed  to see what his response to this therapy is due to his increasing CEA level.  Return in 2 weeks.  

Weight:  186 lbs/84.7 kg


Monday, May 9, 2016

Cycle #21.  Mike continues to be fully active ad able to carry on all predisease activities without restriction.  Advised to remain active and continue his routine medication.  Return in 2 weeks, repeating a CEA, CT scan of the chest, abdomen, and pelvis to reassess the diease.

Weight:  187 lbs/85.1 kg


Monday, May 16, 2016               CT scan & CEA

CT Chest/Abdomen/Pelvis -  Worsening pulmonary metastases noted since last exam.  These have increased slightly in size and number when compared with prior exam,  Slight increase in size of hepatic metastases in the dome of the liver when compared to prior exam.  No retroperitoneal or pelvis lymphadenopathy seen.

CEA - 568.9.  This is up from 142.0 done on March 14, 2016.


Monday, May 23, 2016

Mike returns for results of his CEA and CT scan.   Due to the progression shown in his recent testing, the doctor suggested FOLFIRI/zaltrap.  This will need to be authorized through his insurance.  Appointment scheduled to start this regimen next week.


Tuesday, May 31, 2016

Cycle #1 FOLFIRI/zaltrap.  Risks and benefits discussed.  Return in 2 weeks for cycle #2.

Weight:  186 lbs/84.4 kg


Monday, June 13, 2016

Cycle #2.  Mike's upper quadrant discomfort has resolved which the doctor felt may be a good sign.  He has no evidence of active infection at this time.  Zaltrap can cause significant  neutropenia.  The doctor felt if he proceeded with cycle #2,  Mike would become significantly neutropenic and at risk for infection.  He decided to delay the chemotherapy 1 week and allow Mike's white cells to have a better recovery.  His WBC was 2.50 (normal 4.5-9.1).  His Platelets were 104 (normal 150-330).

Neutropenia, pronounced noo-troh-PEE-nee-uh, is a decrease in the number of white blood cells. These cells are the body’s main defense against infection. Neutropenia is common after receiving chemotherapy and increases your risk for infections.

Weight:  185 lbs/84 kg


Monday, June 20, 2016

Cycle #2.  WBC were 2.60 which is up from last week.  His platelets were 98 which is lower,    Mike was advised of the risks and benefits of further therapy including infection and prolonged neutropenia.  They decided to proceed with cycle #2.  He is to return in 2 weeks for potential cycle 3.  Mike's abdominal discomfort has resolved, so the doctor thought he that he may be having a response to the treatment. 

Weight 187 lbs/85.2 kg


Tuesday, July 5, 2016

We had a relaxing and quiet Fourth of July.  Mike returned for Cycle #3.    Neutropenia seconday to therapy, white count adequate.  Mike complaining of sore spots in his mouth again.  The doctor put Mike on Penicillin for his oral pain and dental infection,   He was advised to contact his dentist.  Cycle #3 was completed.  CT scan of chest/abdomen/pelvis to assess response to therapy scheduled as well as a CEA.  Mike is to return in 2 weeks for further palliative treatment.  Cycle #4 will be initiated provided his scans demonstrate improvement,   We await the results of these tests.

Weight:  186 lbs.84.3 kg

WEAR BLUE FOR COLON CANCER

March 2, 2016





March is Colon Cancer Awareness month.   Please wear blue on Friday. March 6, 2016 to
show your support of the 2nd leading cause of death from cancer in the United States as reported by www.cancer.gov.





I will add an update on what has been going on with Mike soon. Sorry I have not posted in awhile.

MIKE ENDS UP IN HOSPITAL FEBRUARY 13-15, 2016

Saturday, February 13, 2016

Mike as usual has not been feeling the greatest since his last chemo treatment on 02/02/16.  He has not been eating either.  Usually by today, he is coming out of his response to the chemo and starting to feel better.  He was having terrible pain in his right side with nausea and inability to move his bowels.   He could not get comfortable sitting, lying down, or moving around.  Just before 8:00 PM, Mike made the decision that we needed to go to the ER.  This experience was better than previous visits to the ER.   Mike was taken to an exam room in the treatment area of the ER by 9:00.    An IV was started, he was given Reglan every 6 hours and Zofran  as needed for nausea. He also ordered Mike to be kept n.p.o.

The doctor ordered an x-ray of his mid-section.  This came back showing an obstruction in stomach/colon area.  The decision was made to put an NG tube down to Mike's stomach to empty this out. Watching them insert this tube into Mike's nostril was excruciating to watch.  I cannot even imagine what Mike was feeling at this point.  I just know that he had a tight grip on the sides of the bed. Placement of the tub was confirmed by return of gastric content,  He was actively vomiting at this time.  It just kept coming and coming. I felt so bad for what he was going through.  They added another bag of fluids

 At this point, our family doctor was notified, and he gave the instructions for Mike to be admitted.   The doctor placed orders for gastroenterology and surgical consults.  His diagnosis was listed as bowel obstruction.

Shortly after Mike was admitted, a wonderful friend from church called to find out what was happening with Mike.   Lisa stated she was coming out to sit with me.  It was now almost midnight.  She came and stayed with us until around 1:30.  I told her at that time, she needed to go home and get some sleep because she needed to be at church yo play the organ for service at 8:30.

The nurses turned the couch in Mike's room into a bed for me to stay with him.  We both slept off and on during the night.  Mike got up numerous times having to go to the bathroom.   Each time we had to call the nurse to come in and disconnect tubing so he could wheel his IV holder into the restroom.  Then we had to call the nurse to come back to hook his suction tubing back up.

In the morning I ran home to tend to our three dogs.  After I returned to the hospital, our family doctor came in to see Mike. He seemed to think that his intestine had been somewhat twisted.  Mike was feeling better at this point.  However, he had not yet had any solid food.  The doctor was going to put in an order for Mike to slowly be given liquids and progress him to solid foods.   He felt Mike should be able to be discharged on Monday.   I left in the afternoon to go home to get some sleep.  While I was gone, our associate pastor came in to see Mike.  He also has a visit from a childhood friend and her two sons who we mentored for their confirmation at church.   A fellow member of the choir also was visiting Mike when I came back around suppertime.  She is the choir's ray of sunshine and cheer.  She brought Mike magazines, magazines for me, crackers, bottles of water, truffles, a hand made afghan, granola, and gift cards Panera Bread, Subway, and  Crazy Tomato (sandwich/wrap/pizza establishment).  Vickie just makes you laugh and feel good.  Before she left, she prayed for Mike's healing.

Mike's repeat x-ray showed the bowel now to be normal with no blockage.  Mike was told he would be discharged on Monday.   I left for the night to go home to get a good night's sleep before work the next day.

I got up in thr morning and went to work in a doctor's office next door to the hospital.  I called Mike to see how he was doing.  He was waiting on the doctor to come in to see him to be discharged.  I told Mike to give me a call when that happened so I could leave work to pick him up and take him home.   I called Mike a little bit later to find out when he was going to be discharged. That was when he told me he was already home.  I asked how this happened because they usually do not allow you to leave the hospital without a driver.  He said they just asked him if he was ready to go, he said yes and they gave him the OK.  I asked who he called to pick him up.  That is when he informed me that he walked across the street and "stole" my car to drive himself home,  He made it home OK and spent the rest of the day resting with our dogs.

CHEMOTHERAPY TREATMENTS JANUARY 11 - FEBRUARY 08, 2016

Monday, January 11, 2016

Cycle #14

Monday, January25, 2016

Cycle #15.   Return for FOLFIRI treatment #15.  Mike has not had bevacizumab the last few cycles due to oral ulceration of his gumline.  The lower jaw incisors are somewhat eroded.  Continue with cheotherapy at 30% dose reduction. Recent CEA improved to 54.8.   Return in 2 weeks for cycle for cycle #16.


Monday, February 8, 2016

Cycle #16.  Disease is stable.  He is adequately palliated with minimal toxicity.  Gumline is improved.  Has follow up with his dentist 02/09/16.  Received cycle #16 of FOLIRI, but continue to hold the Avastin.   Reassess his CEA and scans again in March.  Return in 2 weeks for further chemotherapy cycle #17.

CHEMOTHERAPY VISITS SEPTEMBER 8, 2015 - DECEMBER 28, 2015

Tuesday, September 8, 2015

Cycle #5.  Tolerating the dose reduction.  Tolerating chemotherapy well.  Liver enzymes continue to improve.  He has mild nausea from the chemotherapy which is being controlled with Zofran.  Return in 2 weeks for cycle #6.


Monday, September 21, 2015

Cycle #6.  Tolerating chemotherapy well.   He was advised to remain active and continue his routine medications.  Mike had a 5 mm ulcer on the left side of his tongue.  He was advised to use soda bicarbonate as a mouth rinse.  He is to also add nystatin for this ulcer.   Return in 2 weeks for reassessment and a CEA.


Monday, October 5, 2015

Cycle #7.    Tolerated the last cycle reasonably well.   Mike did report that he did have around 8 episodes of diarrhea with some minor abdominal cramping the day after the last infusion which resolved without any intervention.  No blood or mucus in the stools and no nausea or vomiting.  No issues with fever or chills.  After starting the nystatin swish and swallow for mucositis, the lesions cleared after 2 days.    Cycle #7  was initiated.    Imodium  as needed for diarrhea if this becomes an issue.  Restart the mystatin should any further mouth sores develop.   A CEA was drawn at this visit to be reviewed at the next visit.


Monday, October 19, 2015

Cycle #8.   CEA 274.3.   No toxicity from treatment.   Performance status has improved.    Return in 2 weeks for  Cycle #9.


Monday, November 2, 2015


Cycle #9.  Some pus was extracted along the gumline.  There may be some periodontal disease along the left lower molar.  Given Penicillin VK 500 to take for the abscessed tooth.  If no improvement, Mike was instructed to seek a dental consult.  Continue the bicarbonate mouth rinse.  Given cycle #9.  Return in 2 weeks for Cycle #10.


Monday, November 16, 2015

Cycle #10.   Occasional mild, intermittent nausea.  No oral ulcers noted.  Abnormal molar loos improved.  Does have a follow up scheduled with the dentist.  Return in 2 weeks for cycle #11.


Monday, November 30, 2015

Cycle #11.  Since last visit, Mike developed an upper respiratory infection with postnasal drip, sore throat, right ear pressure, and rhinorrhea over the past 4 days.  Mike has been taking Vitamin C to help resolve the infection.  He has been to the dentist where he was told his gingiva has receded and have become very sensitive.  Nasal mucous positive for erythema and congestion.  Oral mucus clear.  No lesions or ulcers.  Gingiva of the anterior teeth of the lower jaw noted to be receded - no bone visualized.  

Proceed with Folfiri cycle 11.  The Avastin is withheld from the infusion due to the gingival recession and tenderness in the mouth.  Osteonecrosis of the jaw is a concern with Avastin.  However this was not noted on his exam today.   Mike was advised that manipulation of the gums while on chemotherapy is contraindicated.   Symptomatic care was encouraged.  Mike was also informed that large amounts of vitamin C can interfere with chemotherapy mechanism of action and possibly decrease effectiveness.  Mike was instructed not t take more than 500 ng daily of vitamin C.  He was to contact the office if he developed progressive respiratory symptoms or fever.  He is return in 2 weeks for a complete blood count, chemistry profile, and hepatic function test prior to reassessment for cycle #12.


Monday, December 14, 2015

Cycle #12.  No ulcers noted.  Sinus infection improved with a Z-pak.    Irritation of the gumline noted in the anterior jaw in the area of the incisors.  Recommended that Mike use biotin mouth rinse.  The Avastin is still held.  Proceed with #12 FOLFIRI at 30% dose reduction.  Return in 2 weeks for potential FOLFIRI.  CEA and a CT scan of the chest, abdoment, and pelvis to be done to reassess his disease.



Monday, December 21, 2015       CT SCAN


Multiple bilateral pulmonary nodule consistent with metastatic disease.   However, there has been a               definite decrease in size of the numerous lower lobe nodules compared to the prior exam.  Multiple hepatic lesions present consistent with metastatic disease.  These are also decreased in size compared to the previous study.No new suspicious signs of metastatic disease currently identified.


Monday, December 28, 2015

Cycle #13.  Scans indicated good partial response and CEA is also improved. Continue biotin mouth rinse,  Hold further Avastin because of the gum recession and lower jaw pain. Proceed with Cycle #13 at 30% dose reduction because of prior toxicity.  After 3 further cycles, repeat CEA will be done.

ONCOLOGY VISITS AFTER TRIP TO EMERGENCY ROOM JULY 13, 2015 - AUGUST 24, 2015

Monday, July 13, 2015

Mike had another CEA test done on July 8th following his visit to the Emergency Room.   This showed his level to now be at 4635.8 which has increased since the last time this was done.   Mike return to the cancer center for reassessment.  The doctor stated he was showing scleral icterus which is when the normally white area (sclera) of the eye is yellow because the patient has jaundice, and he had dark urine.  He was also experiencing itching over his body and was complaining of right upper quadrant pain.

Due to this, Mike has decided to reinitiate chemotherapy. Because of Mike's mild jaundice and his bilirubin of 3, the doctor decided to reduce the chemotherapy by 25-30%.  He was started on cycle #1 of palliative FOLFIRI plus Avastin.   He was advised to take his Phenergan every 6 hours a needed for nausea.

The doctor told Mike that his prognosis was extremely poor, and the chemotherapy was palliative once again.  He also said that if this was ineffective or if he developed complications, he would likely require hospice treatment.  He is to follow up in 2 weeks for reassessment.  We will wait to see how he responds to this.


Monday, July 27, 2015

Cycle #2.  The doctor noted that Mike's jaundice and itching has improved.   He stated, clinically, he had a response to cycle #1 of this chemotherapy.  Therefore, he recommended that Mike continue with cycle #2 at the same dosing.   He is to return in 2 weeks for cycle #3.


Monday, August 10, 2015

Mike returned for cycle #3 of the FOLFIRI plus Avastin.  Mike denied any fever or chills or pain.  He was experiencing some mild nausea from the treatment which was expected.

Since Mike was responding to this treatment, it was decided that Mike would proceed with cycle #3 of the FOLFIRI plus bevacizumab at a reduced dose,

Mike was advised to continue his routine medications and activity.  He was advised to avoid direct sun exposure.  The doctor stated his liver enzymes were improving.   He is to return in 2 weeks for cycle #4.


Monday, August 24, 2016

Cycle #4.  Per doctor, Mike is responding nicely,  He stated Mike had no significant toxicity and was adequately palliated.  Return in 2 weeks for cycle #5.

RESULTS OF LAST ONCOLOGY VISIT AND RECENT STATUS

Saturday, July 4th, 2015

Happy Fourth of July!  

Well........Mike's CEA level as of June were disappointing.  With everything that Mike has been doing to try to hollisticaly treat his cancer himself, his CEA level rose to 3534.  His liver profile levels have risen as well.    At that time, Mike still did not want to give into chemotherapy.   He wanted to give it another month to see if he could knock that number down himself without taking on the damaging chemotherapy.  Mike is scheduled to return for a repeat blood test on July 15th and a follow up on July 22nd with his oncologist, however, Mike has resigned to the decision that he is going to have to do chemo again to get that number down.  He has said that the only thing that will get him through this round of chemo would be knowing that he has the opportunity of returning to Germany.  So we are going to try to do our best to save as much as we can and do some fund raising to get the money for him to go to see Dr. Weber.  However, Mike has a call to his oncologist who is on vacation this week so that he can get things going to start the process to start the chemo.

About 3 weeks ago, Mike was having pain in his side that he thought was probably coming from his liver cancer.   At that time, he decided it was best to go to the Emergency Room at our local hospital. We checked in, but unfortunately after waiting 4 hours in the waiting room, Mike decided he could not wait any longer.  We left without him being seen so he could go home and lie down.  

This past week on Monday, Mike started having pain again in his stomach area.  He developed sweats but at the same time was freezing.   He sweated so much that he had to change his clothing.   As the week went on, he felt better.    Last evening after dinner, Mike decided to lie down and take a nap.  Once again, he woke up with pain in the stomach and was soaked, but yet could not get warm.    He went to bed, got up this morning with all the same symptoms and decided he needed to go back to the Emergency Room.   Luckily this time, he was taken back to the treating area right away.    He was started on fluids, had blood drawn, and a CT scan was ordered.    The doctor came in after reviewing the test results and talked to us. He said the CT scan showed the liver nodules were a little bigger and that they were probably stretching the capsule around the liver,   He said that was probably causing the pain and also causing the itching.   He said there was some fluid in his stomach which was due to some inflammation.   He said that could cause the fever.   He is discharging Mike with a pain medication and told him to take some Benadryl for the itching at night as it makes him fall asleep..  During the day, he is to take Tagamet,  Pepsid, or Zantac  which will act as an antihistamine to help his itching.    He also told Mike to call his oncologist on Monday and have him look at the scan and get things going for treatment.

I know the thought of what Mike will go through during the chemo has him dreading the upcoming days, weeks, and months as he knows how he will suffer through it.  It just breaks my heart as well knowing how much this will take out of him and watching him go through this.  My prayer is that he is able to tolerate this as best he can without too many difficulties.  I send prayers and well wishes to everyone else who is going through this awful disease.

"I can do all things through Christ, which strengthens me."   PHP 4:13