Well
I was sitting down to write all of you about what my first day at chemo
was like when i realized that my day started out long before chemo
therapy was hooked up-
so i am debating- should I write the long version with details? or shorter version- going straight to chemo experience?
long version with details? straight to chemo experience?
Eureka! -----("Eureka" (/jʊərˈriːkə/) is an interjection used to celebrate a discovery or invention)
Straight
to chemo experience! for everyone who wants this they can read this and
go to bed! I can add the other information later. I am getting tired
myself.
Arrived at the facility around 10:20 am-
taken promptly for a blood draw- weight check in ( 262 lbs) - amazing
right!?! blood pressure check -117/82 - amazing right?!??!!?!
Met
with the doctor substituting for Dr. Gor- He is Dr. Guggenheim- He was
very kind and soft spoken and started to give me the run down on what
was going to happen- i interrupted him and said I am up to date and
besides, I am a medical social worker working at the former UMDNJ SOM,
now Rowan SOM- - He then told he went to UMDNJ but not SOM which he
added he would not hold it against me that I work at SOM - MD are still
snobs over DO ! Likely he thought he was being cute and joking- (OK- so
this statement might not be as snobby as I thought) ha ha - He added
that she at the top of her field in all of South Jersey and reassured me
that I was in good hands- He indicated that she is smarter than he is
because she went to PENN-She has scholarly published research and he
does not yet.----She did put a note in my chart that I have a trip
planned and he expects that she will approve my earlier next chemo if
all goes well with this one. He was pleasant and easy to talk- she was
not- you tell me who is the better physician. I was interested if they had a Dietitian or Nutritionist on staff for their cancer patients- he said no.
I
explained that I am accustomed for the jury to be out as far as
diseases of the brain and especially dementia are concerned but I
thought we had come further when it comes to cancer-He agreed-
treatment has come further and the science behind the cancer treatment
is far more advanced but as far as nutrition- we still do not know- it
is being studied aggressively now as the public wants that and at one
time he thought he knew the role nutrition that played but he is no
longer sure. WOW what a fabulous doctor he truly is.
Then
he told me about the toy I was going to go home with which I am
currently wearing. It saves me from having to go back to the center for
this injection. Then he tells me to go pick a chair that I like and my
nurse will be over shortly.- which I do and then I go get Janet who has
been in waiting area. So far so good- Right?!?
Neulasta
is a single subcutaneous injection of 6 mg administered once per
chemotherapy cycle in adults. Do not administer Neulasta between 14 days
before and 24 hours after administration of cytotoxic chemotherapy.
So my sister Janet is a little uncertain of where she should sit. Chairs for companions are not placed in very convenient places. She starts out in one and then needs to spread out because we Altermans travel with stuff- I have my purse (aka pocketbook) a bag of my stuff and a pillow- My first nurse was Chris- lovely young lady that had to read to me each and every possible side effect before she started my IV. Which went in the hand so I could bend my elbow. Unfortunately it was in my right hand ( which it had to be because my dirty lymph node was in my left arm pit so they can not use that side!) So I signed consent form and off we went- Janet agreed with my assessment of the aesthetics of the place and she proceeded to tell each nurse that was involved with me. Neither of them really wanted to hear her opinion but one was a little more receptive as I was curious who designed the place. Virtua built it as offices PERIOD. Center For Cancer and Hematologic Disease became Regional Cancer Care Associates LLC (RCCA), they are only renting the space..(one of the largest oncology physician networks in the United States, is transforming oncology care by ensuring that cancer patients have access to the highest- quality, most-comprehensive, cutting edge treatments in a compassionate and community-based setting. Patients can now receive this high-quality cancer care in convenient locations close to home, in New Jersey, Maryland and Washington D.C. through our network of expert physicians.) AND they are renting the space but landlord and renters are not working together to improve the atmosphere- Renters are just making due with what they got there which is pretty awful.
When 2nd nurse came over- "This place is ugly" was Janet's greeting- oh well- so much for not talking. She went on to explain that she has an ulterior motive- then proceeded to go into her explanation of her son's business- she is, after-all, a very proud Mama- but no one was really interested.
Janet came prepared and brought with her some of the fabulous home made vegetable soup. I had 2 bowls of it as my lunch- packed in a thermos -it stayed warm enough to really enjoy. There was a big story there too- She got it at the Melitta Company for a just a little more than dollar cuz it had a dent- she doesn't' think they have sales there anymore yada yada yada. Yes I am sending this out because it happened like this and I love Janet very much and she has a strong desire to express her thoughts- in many ways-- at various times ---in public ----to whoever is interested in listening---- You know- she knows many things - she even beat the pants off of me, Charlie and Cassie in Trivial pursuit.
Our first nurse was knowledgeable about good nutrition just a little and she was able to sneak out some information to Janet and about Bone Marrow soups, raw honey- etc... - She was very clear that she could get into trouble is they knew she gave that to us- "The information IS NOT endorsed by my employer. " ( Been there - Done that) Janet sat and took lots of her own notes from the cook book that Harold gave me for fighting cancer, while I talked on the phone.
All you Star War Fans- you have heard of the Force- Well I then spent about an hour plus with the Source -I made some notes which Shari is cleaning up for me- it was hard to take notes because the IV was in my right hand. So writing was a challenge. She sent me 4 videos / websites for me to review as soon as i can(very excited) BUT I LEARNED SO MUCH FROM HER! Excellent Teacher for sure. What was also lovely is that she and I have never met face to face and we feel close to one another because of her Mom Carol always filling us in on one another over the years. (lots of years) So, 2 bags of killer kemo later, they were ready to cut me loose and after kisses good-bye to Janet, by 2:20 pm, I was out the door, heading to work at NJISA ( New Jersey Institute for Successful Aging )
So far I feel fine- a little bad taste in my mouth and I have had bad taste in my mouth before so I know it is nothing to be concerned about- ( I once walked into a client's house and saw a bowl of tan curved things sitting in a bowl on the kitchen counter ( his name was Hal and i sometimes drove him back and forth to the day center) - they sure looked like cashews to me. So I reach in a took a handful as Hal was adjusting himself at the kitchen table. He saw on my face that "I had a bad taste in my mouth" and started to laugh but not before he told me that I was eating their Dog's food. And no, I did not swallow- I spit it out in the kitchen sink!
Dr. Douglas E. Guggenheim, MD
What is this drug used for?
- This medicine is used to stimulate the growth of "healthy" white blood cells in the bone marrow, once chemotherapy is given. White blood cells help the body to fight infection. This is not a chemotherapy drug.
- This medication is usually given at least 24 hours after chemotherapy to stimulate the growth of new, healthy, white blood cells (WBC).
- Pegfilgrastim is a longer acting form of filgrastim and the manufacturer recommends that it should not be given within 14 days prior to chemotherapy.
- Pegfilgrastim is given as a single injection.
So my sister Janet is a little uncertain of where she should sit. Chairs for companions are not placed in very convenient places. She starts out in one and then needs to spread out because we Altermans travel with stuff- I have my purse (aka pocketbook) a bag of my stuff and a pillow- My first nurse was Chris- lovely young lady that had to read to me each and every possible side effect before she started my IV. Which went in the hand so I could bend my elbow. Unfortunately it was in my right hand ( which it had to be because my dirty lymph node was in my left arm pit so they can not use that side!) So I signed consent form and off we went- Janet agreed with my assessment of the aesthetics of the place and she proceeded to tell each nurse that was involved with me. Neither of them really wanted to hear her opinion but one was a little more receptive as I was curious who designed the place. Virtua built it as offices PERIOD. Center For Cancer and Hematologic Disease became Regional Cancer Care Associates LLC (RCCA), they are only renting the space..(one of the largest oncology physician networks in the United States, is transforming oncology care by ensuring that cancer patients have access to the highest- quality, most-comprehensive, cutting edge treatments in a compassionate and community-based setting. Patients can now receive this high-quality cancer care in convenient locations close to home, in New Jersey, Maryland and Washington D.C. through our network of expert physicians.) AND they are renting the space but landlord and renters are not working together to improve the atmosphere- Renters are just making due with what they got there which is pretty awful.
When 2nd nurse came over- "This place is ugly" was Janet's greeting- oh well- so much for not talking. She went on to explain that she has an ulterior motive- then proceeded to go into her explanation of her son's business- she is, after-all, a very proud Mama- but no one was really interested.
Janet came prepared and brought with her some of the fabulous home made vegetable soup. I had 2 bowls of it as my lunch- packed in a thermos -it stayed warm enough to really enjoy. There was a big story there too- She got it at the Melitta Company for a just a little more than dollar cuz it had a dent- she doesn't' think they have sales there anymore yada yada yada. Yes I am sending this out because it happened like this and I love Janet very much and she has a strong desire to express her thoughts- in many ways-- at various times ---in public ----to whoever is interested in listening---- You know- she knows many things - she even beat the pants off of me, Charlie and Cassie in Trivial pursuit.
Our first nurse was knowledgeable about good nutrition just a little and she was able to sneak out some information to Janet and about Bone Marrow soups, raw honey- etc... - She was very clear that she could get into trouble is they knew she gave that to us- "The information IS NOT endorsed by my employer. " ( Been there - Done that) Janet sat and took lots of her own notes from the cook book that Harold gave me for fighting cancer, while I talked on the phone.
All you Star War Fans- you have heard of the Force- Well I then spent about an hour plus with the Source -I made some notes which Shari is cleaning up for me- it was hard to take notes because the IV was in my right hand. So writing was a challenge. She sent me 4 videos / websites for me to review as soon as i can(very excited) BUT I LEARNED SO MUCH FROM HER! Excellent Teacher for sure. What was also lovely is that she and I have never met face to face and we feel close to one another because of her Mom Carol always filling us in on one another over the years. (lots of years) So, 2 bags of killer kemo later, they were ready to cut me loose and after kisses good-bye to Janet, by 2:20 pm, I was out the door, heading to work at NJISA ( New Jersey Institute for Successful Aging )
So far I feel fine- a little bad taste in my mouth and I have had bad taste in my mouth before so I know it is nothing to be concerned about- ( I once walked into a client's house and saw a bowl of tan curved things sitting in a bowl on the kitchen counter ( his name was Hal and i sometimes drove him back and forth to the day center) - they sure looked like cashews to me. So I reach in a took a handful as Hal was adjusting himself at the kitchen table. He saw on my face that "I had a bad taste in my mouth" and started to laugh but not before he told me that I was eating their Dog's food. And no, I did not swallow- I spit it out in the kitchen sink!
Dr. Douglas E. Guggenheim, MD
MEDICAL SCHOOL
- Rutgers Med Sch-Umdnj
- Graduated in 2007
INTERNSHIP HOSPITAL
- Thomas Jeff U Hosp
RESIDENCY HOSPITAL
- Thomas Jeff U Hosp
FELLOWSHIP HOSPITAL
- Weill Cornell Med Cntr
OTHER EDUCATION
- Drew U
Dr. Priya Gor
If you’ve been paying attention to the glycemic index of the foods you eat, it may be important to note that GI simply measures the overall quality of carbohydrates in a given food, according to Priya Gor, MD, MSCE, a hematologist and medical oncologist on staff at Our Lady of Lourdes Medical Center.
"By looking at glycemic load as well as GI, this research suggests that the combination of quality and quantity of carbohydrates in a woman’s diet may affect her breast cancer risk," said Dr. Gor.Learn More
Diet is just one factor that may affect your risk for breast cancer. To find out more about breast cancer, including risk factors, prevention and screening, visitwww.cancer.gov/
MEDICAL SCHOOL
- University Of Medicine and Dentistry Of New Jersey
INTERNSHIP HOSPITAL
- University Of Pennsylvania School Of Medicine Philadephia Pa
RESIDENCY HOSPITAL
- University Of Pennsylvania School Of Medicine Philadephia Pa
FELLOWSHIP HOSPITAL
- University Of Pennsylvania School Of Medicine Philadephia Pa
- Carbohydrates: Another Dietary Link for Breast Cancer? Gor PP1, Su HI, Gray RJ, Gimotty PA, Horn M, Aplenc R, Vaughan WP, Tallman MS, Rebbeck TR, DeMichele A.
- The newest research suggests yet another dietary link to breast cancer. Eating a diet rich in carbohydrates may increase a woman's risk for developing breast cancer, according to a recent study.
If you’ve been paying attention to the glycemic index of the foods you eat, it may be important to note that GI simply measures the overall quality of carbohydrates in a given food, according to Priya Gor, MD, MSCE, a hematologist and medical oncologist on staff at Our Lady of Lourdes Medical Center.
Diet is just one factor that may affect your risk for breast cancer. To find out more about breast cancer, including risk factors, prevention and screening, visitwww.cancer.gov/
Cyclophosphamide-metabolizing enzyme polymorphisms and survival outcomes after adjuvant chemotherapy for node-positive breast cancer: a retrospective cohort study.
Gor PP1, Su HI, Gray RJ, Gimotty PA, Horn M, Aplenc R, Vaughan WP, Tallman MS, Rebbeck TR, DeMichele A.
Abstract
INTRODUCTION:
Cyclophosphamide-based adjuvant chemotherapy is a mainstay of treatment for women with node-positive breast cancer, but is not universally effective in preventing recurrence. Pharmacogenetic variability in drug metabolism is one possible mechanism of treatment failure. We hypothesize that functional single nucleotide polymorphisms (SNPs) in drug metabolizing enzymes (DMEs) that activate (CYPs) or metabolize (GSTs) cyclophosphamide account for some of the observed variability in disease outcomes.METHODS:
We performed a retrospective cohort study of 350 women enrolled in a multicenter, randomized, adjuvant breast cancer chemotherapy trial (ECOG-2190/INT-0121). Subjects in this trial received standard-dose cyclophosphamide, doxorubicin and fluorouracil (CAF), followed by either observation or high-dose cyclophosphamide and thiotepa with stem cell rescue. We used bone marrow stem cell-derived genomic DNA from archival specimens to genotype CYP2B6, CYP2C9, CYP2D6, CYP3A4, CYP3A5, GSTM1, GSTT1, and GSTP1. Cox regression models were computed to determine associations between genotypes (individually or in combination) and disease-free survival (DFS) or overall survival (OS), adjusting for confounding clinical variables.RESULTS:
In the full multivariable analysis, women with at least one CYP3A4 *1B variant allele had significantly worse DFS than those who were wild-type *1A/*1A (multivariate hazard ratio 2.79; 95% CI 1.52, 5.14). CYP2D6 genotype did not impact this association among patients with estrogen receptor (ER) -positive tumors scheduled to receive tamoxifen.CONCLUSIONS:
These data support the hypothesis that genetic variability in cyclophosphamide metabolism independently impacts outcome from adjuvant chemotherapy for breast cancer.
Nancy M. Alterman
