Change of pace - I’m going to begin this update to coincide with the start of therapy treatment cycle two which started Tuesday, January 6. The idea is to give a better "feel" of how the cycle progresses from start to finish, although it will probably be subdivided into smaller parts.

Day one - The cycle kicks off with morning and evening doses of dexamethasone taken as pills. The steroid's purpose is to prepare the body for the onslaught of the next-day's chemotherapy. A principal goal is anti-nausea. It is also taken with the chemicals the next day in the infusion liquids and again by pills on the third day. On the infusion day, an additional anti-nausea compound is administered.

So much attention may be paid to suppressing nausea as it is the number-one reason patients bow out of treatment.

While Tuesday would have typically been a relatively quiet day, this one was anything but.

Doering meeting - At around 11 a.m., we met with Dr. Doering, "our" surgeon. The purpose was a follow-up to see how well the healing following the bilateral mastectomy was progressing.

He was very happy with what he saw. While we talked for perhaps 15 minutes or so, it was along the line of his asking how the chemotherapy was going and I asked if he had heard about CCK’s software problem. While he had heard, he didn't have any details.

There would be another check-up much later - months - that would be scheduled later.

Koeneke meeting - We ate lunch at Culver's before the 1 p.m. appointment with Dr. Koeneke.

He first looked over Gloria's labs and declared then all to be well within the range he'd expect to see.

A discussion covering the details of the ER visit of December 8 followed. It was one of the things that prompted him to modify Gloria's therapy by reducing the amount of Taxotere she was getting. Another was a loss of 7 lbs and the colitis brought on by the drugs. He was also giving her a prescription for Dicyclomine. It is to be taken as needed to reduce intestinal cramping. It works to slow contractions in the intestines.

We discussed the problem with the bloody nose and not finding anything that sounds appealing to eat. He said those were common problems and said about all than can be done is to experiment and see if something proves effective.

A considerable amount of discussion followed relating to the importance - or not - of keeping strictly with a three-week cycle. He said that varying from that is not a big deal, but they have people who are repeatedly calling a day before a session and cancelling, creating havoc with their scheduling. He suggested that if there was some good reason to delay a week, just call as studies have not shown any significant impact on outcomes.

The discussion then shifted to the scheduling software. It also came up during the treatment session the next day with nurse Sydnee. I will combine their comments. We learned that CCK had contracted with Centricity, a health software provider, to handle the scheduling. Apparently Centricity had been planning on leaving this market and when the CCK system went down, Centricity decided to exit at that point and refused to fix the problem, leaving many health-care related businesses with no recourse but to locate a new provider and wait for the customized software to be completed. In brief, not much CCK could do about any of it. Koeneke was very forthcoming.

Gloria spoke a bit about her anxiety going into the treatments. These concluded with the idea that: "Before the first treatment, you are anxious because you don't know what's coming; after, you are anxious because you do know!"

Sydnee noted that the Sustol anti-nausea medication injected into her belly fat in December had left a lump that was still not fully absorbed. It was decided to use an alternate in the third cycle of treatments.

We shared the treatment room with two different couples at separate times. The first two were a farmer and his wife from Seneca. We had a lively conversation. The wife had even chaperoned a bunch of girls to soccer matches and had even visited Klagenfurt, a place we recall fondly in southern Austria.

The second couple was the opposite. I heard them speak about being from Clay Center, but they spent most of the time with earbuds in.

We finished at 2:15 p.m. and then stopped at Culver's on the way home for lunch.

When we returned home, we moved Mr. Philips into the van. That evening, we watched the "Great Canal Journeys" with Tim West and Prudence Scales and were particularly intrigued about the one involving the Llangollen Canal.

Day Three - As before, the infusion didn't start taking hold yet, so Gloria was feeling good and being energetic. We first went to the CCK office to get the blood-boosting shot. Then it was off to Howie's to dump the recyclables.

We stopped by Walmart for an optical cable, but they only had the more expensive one, so I passed and would later order from Amazon. We ate at home, but do not recall what.

Gloria attended her SCBC - Silver Creek Beneficiary Club - meeting at 1:30 p.m. and I returned at about 2:15 p.m. to take her home. By late evening her tummy was a bit upset.

Day Four - On Friday, January 9, the effects seemed to be coming on more quickly than in the previous cycle. When she awoke, she complained that she felt "achy" everywhere and lacked any appetite. She complained about her stomach bothering her, particularly so before bed. Supper was her old standby green beans and peaches. She decided to try the Dicyclomine at bed time.

Day Five - Gloria slept until 10 a.m. She felt the Dicyclomine helped. They are known for having an impact within minutes of taking, but the effect dissipates in about four hours. As usual, using half the usual dose appeals to her. I suggested cutting the pills in half and dosing up to twice as often as a way to keep the level steady in her blood stream. The idea appealed to her and I took them to work to split.

While she seemed to drop down in energy and general well-being more quickly than last cycle, today seems about the same, whereas last time she continued to decline. She had an hour-long nap mid-morning and another in the afternoon.

Day Six - Sunday, January 11 was certainly not a good day ... but far better than the equivalent day last cycle. She had a bloody nose again and very low on energy. She was really dragging and the day was largely unremarkable. She decided to do half a hydrocodone at 11 p.m. to help her sleep. She has also found that the Dicyclomine causes her to be somewhat dizzy and unsteady on her feet shortly after ingestion and the effects last for about an hour.

Day Seven - Considering the Monday after her first cycle-one treatment began in the hospital, this was a good day. And, in most regards it was. While she did use some Dicyclomine at 4 a.m. and not arise until 10 a.m., she was much more energetic. She did use half a hydrocodone late in the day, but the big surprise was she said salmon sounded good. She ate about a half of what she would normally eat, which was far beyond what she has been eating.

Day Eight - Arose about 9:30 a.m. and it was obvious she was feeling even better than the day before. We went for her labs at 11 a.m., worked on editing the annual newsletter at 9th Street and ate almost a full Butterburger at Culver's. She had a 90-minute nap in the afternoon and said that her entire alimentary canal felt as if it was on fire. She opted for some sweet potato for supper.

Day Nine - Wednesday, January 14th was a strange day. She arose at 10 a.m. and it seemed as if things would continue their upward swing. She ate well and did two loads of laundry. I went to town to complete filling cabinets for Davey, but when I called at 6 p.m. or so, I could tell by the tone of her voice it wasn't going well. When I got home, she complained her tummy hurt and after some discussion, it was decided to try some Pepto-Bismol as she felt a bit nauseous. This did not provide any relief and she said she was developing small sores in her mouth. Her tummy was really bothering her at bed time but did nothing as one is not to mix Pepto with the Dicyclomine.

She later awoke at 4 a.m. and had an urgent need to go to the bathroom. After, she felt much better and went back to sleep and slept well.

Day Ten - Again awoke about 10 a.m. In relatively short order, she requested a piece of toast with spread cheese and peach jam. That went pretty well and by afternoon we headed off to 9th Street to complete the final corrections on the newsletter, print six copies, final edit the squirrel column and then head home.

We had pot pies for supper and overall she had a good day. She seems to do better when I'm around and there seems to be several parts to that. One is she seems less inclined to "over do" it while feeling well. Another is I tend to distract her from whatever isn't going well at that time.

Jeanette C and Gloria spoke today about some history-related matters and JC shared that Shelly L is just recovering from a lumpectomy. We knew Shelly from around the time when we first met.

Day Eleven to Day Fourteen, January 16 - 19 - Slow, but steady upward trend - more energy, more foods sound good.

Details

Tuesday, 6 - Cycle Day 1
-saw Doering - what a nice guy
-bought TV and installed
-saw Koeneke 1 p.m.
-went over details of response to your first cycle
-reduce Taxotere to reduce side effects
-try an anti-diarrhea medicine
-prescribed an anti-cramping agent - Dicyclomine
-nosebleed common, especially in winter
-Benadryl to help sleep
-finding a food is a problem
-much discussion about 3-5 week cycles strictness - not
-software problem - the system’s provider was Centricity
-Usystems backup - info obtained from Sydnee.
-afternoon spent setting up TV
-start Dexamethasone
- before first treatment, anxious because don’t know; after, anxious because you do know
-Culver's for lunch

Wednesday, 7 - Cycle Day 2
-no sleep until 5 a.m.
-started treatment at 11 a.m.; going until 2:15 p.m.
-changing anti-nausea from injection in tummy as is not dissipating
-moved old TV into van
-lunch at Culver's
-pick up Dicyclomine at Dillon's
-Llangollen narrow boat episode on TV

Thursday, 8 - Cycle Day 3
-day three shot to boost blood
-go to Howie’s to dump reycyclables
-SCBC meeting at 1:30 pm, back at 2:45 pm
-tummy a bit upset at bed time

Friday, 9 - Cycle Day 4
-like last time, feels “achy”
-no noon appetite
-tummy bothering her before bed time
-tried a Dicyclomine
-evening back to green beans and peaches
-cancelled Fleetwood Mac tix of Dave's

Saturday, 10, Cycle Day 5
-up about 9 a.m.
-little appetite, but had apple sauce
-new pills seem to work
-tired - napping by 10:30 a.m.
-nap in the afternoon
-little energy
-split pills -diarrhea begins

Sunday, 11, Cycle Day 6
-5 a.m., toilet and bloody nose
-little appetite
-really dragging
-low energy
-used half a hydrocodone at 11 p.m.

Monday 12, Cycle Day 7
-used half Dicyclomine at 4 a.m.
-arose at 10 a.m.
-more energetic
-half hydrocodone
-salmon ... ate about a 1/4

Tuesday 13, Cycle Day 8
-arose 9:30 a.m.
-labs at 11 a.m.
-corrections to newsletter at 9th Street
-90-minute nap in p.m.
-Butterburger at Culvers
-her entire AC feels on fire
-sweet potato for supper

Wednesday, 14, Cycle Day 9
-arose at 10 a.m.
-up twice at night
-day went well, including eating
-laundry
-significant energy/mood decline after 6 p.m.
-tummy hurt, later - 11p.m. - tried Pepto, no help
-first time some nausea
-some small mouth sores

Thursday, 15, Cycle Day 10
-no sleep until after 2 a.m. - tummy bothering
-arose at 10 a.m.
-11 a.m. toast with Cheese and peach jam
-bloody nose
-today was much better than yesterday
-does better when I'm around physically and emotionally
-pot pies for supper
-finished newsletter
-finished squirrel column
-Shelly L. had a lumpectomy

Friday, January 16, Cycle Day 11
-awoke at 5 a.m. to go to the toilet
-we were awake a while
-awaken by 8:15 a.m. to see about going to Sharp funeral
-awakened, but decided to pass ... didn’t want to get sick
-fell asleep about 10 a.m., 2 hours
-French toast didn’t do it, but pear juice did
-liked fudgesicle

Saturday, January 17, Cycle Day 12
-arose about 9:30 a.m.
-considerably more chipper, but tired due to being awake earlier
-ate spaghetti with a bit of marinara
-ate cooked cabbage I made
-ate popsicle
-was in generally good spirits all day
-worked on letter to Diana

Sunday, January 18, Cycle Day 13
-arose about 9 a.m.
-feeling pretty good, but eyes bothering, added eye drops
-supper at MnM
-worked on column
-lunch was hard-boiled-egg sandwich
-feeling good at end of the day

Monday, January 19, Cycle Day 14
-up at 8 a.m.
-good mood, slept through the night
-napping by 9:30 a.m., awake by 11:30
-pulled pork for lunch
-worked in office in early afternoon
-into town for light museum tour
-Culver’s at MnM in evening
-Did well in evening
-no diarrhea today