Saturday, February 26, 2011

Day O Nothing

I had an old familiar feeling today.  A feeling I have not had since the days when I worked ridiculous hours.  I used to work 50 to 60 hours a week and usually worked six days.  When Saturday afternoon would hit and it was quitting time I would smile and remark that it was "Day O Nothing" time. 

Actually, it was a day and a half, but it sounds better the other way.  It was my time to do as I pleased, which was usually nothing, and that was just fine with me.  Nowadays, I have my son and my husband to do things with, and these days that suits me just fine.  My work weeks are much shorter now, which feels nice, because I have the best of both worlds.  Soul satisfying work and plenty of time with my son.

I guess it just feels extra nice when you have a stretch of time that is just yours and you can do with it what you please.  I have been feeling better lately, which is no doubt what brought about this Day O Nothing memory and the smile on my face today.  It is a little phrase which reminds me to have a mini celebration each week.  I am glad that I remembered it. Since my cancer diagnosis I have appreciated any opportunity to celebrate good things in my life.  I hope that as you read this post you are enjoying a "Nothing" time of your own.  Cheers!


If you needed me.

If you needed a shoulder to cry on would you call me?  If you had a question about my experience that you thought might help you but it regarded a sensitive subject would you find the courage to ask me? Have you convinced yourself that I have too much on my plate and decide instead to let your need go unmet?  Have you made up your mind that I am suffering too much and that you must not impose?

I am sure that there are many of my friends and acquaintances out there that think just this.  They don't trust that I still have the ability to say no if I cannot help.  It might not occur to them that I am feeling so very blessed that I would cherish an opportunity to give back out of what has been measured to me.

I have not died yet.  I am far from it.  I have not been quoted any numbers on my life expectancy.  I expect that I will love to see my son grow to be a man.  I believe that I will be in attendance at his college graduation.  This is a few years away yet.  I have so much life to live before I have to think about that.

I do not know how long my life will be but I intend to make it as full as possible.  I want to hug and hold my friends.  I want to take phone calls late at night.  I want coffee dates, lunch dates and to schedule vacation dates and while I am at it to plan some romantic dates with my husband.  I want to cuddle with my baby and I want to take an active role in teaching him and guiding him. 

I want to feel like a real live alive woman.  I want to fully participate in my life and to interact with those who choose to be part of my life.  Call me.  Stop by unannounced for a visit.  Bring me chocolates and then help me eat them.  There are so many nice things to experience and I want company while I do them.

If you are sitting at home worried about me, afraid to call me and feeling guilty because we haven't see each other in awhile then stop.  Pick up the phone and I will do the rest.  I miss you.  I miss me and my life.  I am getting it back.  It feels good.  There are a lot of you who are AWOL.  ;)  Don't be surprised if you hear from me and I invite you to get together.


Thursday, February 24, 2011

Has This Ever Happened To You?

My father watches my son overnights Sunday through Thursday so that I can try and get as much sleep as I can which is important for someone with cancer.  Tonight as I was returning home from dropping off my son I gave myself quite a scare.  As I was getting out of the car I inadvertantly squeezed my key fob and set off my car alarm.

This is startling enough as it is but my door was open and it occurred as I was getting out so the sound was absolutely deafening.  First, I had the confused frightened jolt and then as I figured out what was happening I clumsily scrambled around with my keys fumbling to turn it off.  Finally, came the moment of wondering how many people were having a good laugh at my expense which brought an smile of chagrin to my face as I walked down the sidewalk to my condo.

At any rate, when my sense of humor returned to me I thought I would share it with the rest of you in the hopes that you may also share a snicker.

Roxanne's Post To Assist Me In Getting Away, Having Fun and Making A Memory

Susan and Roxanne
Many of you asked me (Roxanne Ashey) how you could help or to please let you know if there was anything you could do when my husband died 20 months ago...well now I am coming and asking for your help and letting you know what you can do…but it isn’t for me.

Since about the age of 13, I have had an amazing friend named Susan. She has laughed with me, cried with me, helped me get through some of the worst times in my life ( a divorce, a house fire that occurred while I was a single mom to 2 small children, and the death of the love of my life…and everything in between.

Susan is 39 years old. She met and married her husband at the age of 37, followed less than a year later by the birth of her one and only child at age 38, but 6 months after he was born she was having back issues and was diagnosed with stage 4 breast cancer that had already spread to her spine.

She is a therapist who specializes in PTSD and more specifically in cases of children and women who have experienced sexual abuse. She didn’t start out in this field and worked for years on her masters degree, paying her own way and working several jobs and studying hard to be able to help others. In spite of her illness and going through painstaking treatments she has continued to work, even though at times it has been very physically hard on her, so that she may help others.

She went through 6 months of chemo, and not long after her cancer tumor markers were back up, she just finished the most aggressive form of chemo in her second round of it. Continuing to try to be a wife, a mother to a toddler and help her clients.

She has started a blog of her jouney…please read it so you can see what an amazing woman she is. It can be found at

It is my hope to help Susan take a trip of a lifetime, to celebrate her 40th birthday, coming up the beginning of April. I have provided the place for her to stay in Cancun (part of my timeshare and doesn't include food or drink) and a rental car but am hoping to raise whatever funds possible to take care of the rest of her trip, allow her to do as many activities as possible while she is there and not have the worry of anything and to possibly even send her home with a little extra money to allow her to spend more time with her husband and child doing something to create a few more memories.

A week after her last chemo treatment, her cancer tumor markers had gone back up. Considering this was the most aggressive form of chemo there is, this is not a good sign. To lay it out frankly, which is the only way Susan and I have every been with each other and why she is one of my oldest and dearest friends, I am thankful that she will see 40 but it is a very real probability she won't see 41.

She has given so much to so many people and it is my wish to be able to give something back to someone so worthy.

It is more than I can do as one person, but with your help and the help of anyone you know who might like to do a little something for someone else, I know her dream can be made possible. My goal is to raise $2000.00 This seems like a lot but if each person I know just donates $5 or $10 (the price of a Starbucks coffee, or a 6 pack of beer, or a movie ticket) I think this goal can be accomplished.

I am not one to ever ask of anything for myself and I have never asked for anything like this before but knowing how short and precious life is, I feel very compelled and moved to do this. Anything you can do is appreciated more than I can say. One person cant always make a huge difference alone but many people doing something small can.

Here is the link to her donation page and you can donate any amount at all…
Click HERE to help Susan - Please Go To

Thank you again, for reading this, and for helping my dear friend to have this opportunity to have one week in her life that wasn’t about anyone else but her.

God Bless


Tuesday, February 22, 2011

Radiation Therapy

Today I went to Rocky Mountain Cancer Center for my monthly Zomeda treatment.  I have been receiving this treatment monthly to help build bone density which is very necessary since the cancer weakened my bones and caused a compression fracture.  Incidentally, I lost an inch and a half off my height. 

While I was at Rocky Mountain I asked my Doctor if we should consider radiation to the rib that showed some activity on the PET scan.  I did receive some radiation to my right hip as I was having some difficulty walking and pain.  Radiation therapy is a breeze as it takes only a few minutes and is virtually painless.  There can be some side effects but I did not experience any that were bothersome. 

My Doctor did not feel that radiation would be a good idea right now unless I was having pain.  I have had some occasional cramping in this area but no real pain.  I do not see my Doctor again for a month which will give us time to see if the hormone therapy is working.  I will address the question of radiation therapy again with her at this time and take labs.  I am very hopeful that this treatment will work as my hair is beginning to grow back and having hair again will be nice.  I lost all of my hair on this last round of chemotherapy and it is just now starting to come back in.  The hair on my legs has NOT yet started to grow back and I am keeping my fingers crossed that it will not.  I have heard from other cancer survivors who have been on chemotherapy that they got so lucky.  That would be a nice silver lining.

For the record, I do not count the free tattoos that came with the radiation treatment as a silver lining.  ;)


Sunday, February 20, 2011

Off Chemotherapy and back on Hormone Therapy

I last met with Dr. Matei on Valentine's Day to discuss the PET scan results and decide on a plan for my treatment at Rocky Mountain Cancer Center.  I was not in a good mood as I had learned that my tumor markers had gone up from 346 to 376.  This was after my last chemotherapy, which I found very displeasing, because for all that chemotherapy entails I would have expected and appreciated a drop, even a little drop.

Dr. Matei reminded me that it is more important to pay attention to the overall trend and not to get upset over a single rise in tumor markers.  She felt that overall, Adriamycin and Cytoxan had done a good job for me and that we had enjoyed good results.  She suggested that I take a few months off to recover and give Aromasin a try.  Aromasin is an aromatase inhibitor and can only be used for women who are post menopausal. Last year, something suspect showed up on my PET scan in one of my ovaries so I had them removed which is called an oophorectomy.  For this round she promised that we would keep an eye on things and take action if I didn't respond well to this hormone therapy. 

I have previously been on Tamoxifen and Faslodex but it did not help keep things at bay despite the fact that my cancer is ER-positive.  I asked Dr. Matei if going on Aromasin was risky with my history of anti-estrogen medications but she felt that it was not.  I have asked her if it would be unrealistic to hope that at some point I will be in remission and not on treatment and she stated that it was very unrealistic.  In fact, she stated that I will go back and forth between chemo therapies and oral medications until at some point this disease takes my life.

I realize that this is not pleasant reading material and I can tell you it is not any more pleasant to have these conversations in person.  I feel that it is important to give my readers all the information about this journey and not just the pleasant parts.  I spend a lot of time thinking about topics and trying to figure out what to blog about.  If there are things you have been wondering about please feel free to ask.  No subject is out of bounds.  I am pretty open.

Friday, February 18, 2011

The Creation of A Life

The best way to prepare for life is to begin to live.
Elbert Hubbard
Creating is such a dynamic process.  Some plan through the entire process.  Some get started and see where the creative process takes them.  I have joked with friends about not having a life and they have asked me in jest where one can be bought.  I wish I knew a place where the finest lives can be bought.  I would get one.  Fortunately you and I have the ability to invest our time on quality pursuits that feed us but we can also choose not to.

I sat with a couple this week who have been married for 12 years.  They are in their late forties.  I asked him what they did together as a couple.  He responded that they do nothing and have nearly nothing in common.  He explained that he worked 6 days a week and put in nearly 60 hours or more a week.  He is also a new grandfather and reports that he suffers from guilt because he rarely sees the baby.  He is creating a life filled with regret and he knows it.  I suggested he set up a weekly pizza date with his child and grandchild that is the same time every week at his house when he would normally come home for supper anyway.  Then we talked about planning activities they each like individually and giving to each other by sharing their company in these pursuits.

I am committed to my marriage.  The cancer and cancer treatments bring a lot of fatigue which make it really hard to actively participate in a family life.  Working can really take it out of me and by early evening I often do not have anything left.  It can be a real difficult balance to push myself to do more and enjoy my life while trying to get the rest I need for my best chance at recovery. 

My father and my son in Bar Harbor, ME

In the last 12 years the couple had not taken a vacation since their honeymoon.  I asked them what they are looking forward to and they shook their heads at me sadly.  They had accumulated some debt and were working to pay it. The husband felt especially driven to take care of this responsibility and is the busy type who enjoys working.  He said it would be nice to have something to look forward to with his wife in addition to his yearly hunting trip. I responded to them that they should go home and begin to plan something so that they would have something to look forward to.  I hope that they will.

Dost thou love life?
Then do not squander time,
for that is the stuff life is made of.
Benjamin Franklin

Life is either a daring adventure or nothing.
Helen Keller

Thanks to my friend Roxanne here is what I am looking forward to...

For all of you generous people out there who have been so kind and have contributed so that I may have this trip with Roxanne I would like to thank you from the very bottom of my heart.  I am so excited about this and am looking forward to it.  I am bursting at the seams with gratitude.

Thursday, February 17, 2011

The Sweetest Music

Today when I came home from work I opened the door to our condo and was greeted by my son who cried out "Mama".  I haven't heard him say this in so long..not since he was a small baby as these were his first words.  My heart skipped a beat.  He was in bed with his father but clearly was not sleeping yet.  He scrambled down from the bed and cried out "Mama" a second time.

Tan and his nap time pal
 I put him back in bed with his father and climbed in with them.  He smiled contentedly and enjoyed a cuddle with both of us.  In the time before I got my compression fracture he was well on his way to being an independent sleeper and then I got hurt.  You might recall that the cancer weakened my bones causing the compression fracture which led to the discovery of the cancer.

Now, a year and a half later, we have not yet re-trained the little guy to go to bed by himself.  It wasn't how we planned things but sometimes life deals you a blow you didn't expect and best laid plans are altered.  He is getting bigger and busier by the day.  We hear new words from him daily but I have to tell you that it will be some time before I hear him say sweeter words than the ones I heard him say today.  I am probably biased.

Huy is Tan's favorite nap time pal.  I get a kick out the fact that when he puts the baby down for a nap he is usually the first one to fall asleep.  The baby takes much more time tossing and turning before he settles in.  Aren't they sweet?

Monday, February 14, 2011

PET Scan From 2-10-11

Findings: Imaging through the head and neck shows no findings suggestive for malignancy.  Imaging through the chest shows no evidence of hypermetabolic lung parenchymal disease, hilar, or mediastinal adenopathy.  There is no hypermetabolic activity in the breast tissues.  Imaging through the abdomen and pelvis continues to show normal physiologic distribution of radiopharmaceutical.  Imaging of musculoskeletal structures show massive improvement of the hypermetabolic osseous metastatic disease.  The vast majority of lesions are well visualized on the mapping CT, but no longer measurably hypermetabolic.  The only area of residual hypermetabolic activity is in the left sixth rib laterally.  Even this area shows less hypermetabolic activity than on the previous exam.

1.  Marked improvement in the osseous metastatic disease when compared to the previous study.
2.  The only residual hypermetabolic bone lesion is in approximate the left sixth rib laterally.  Even this area has improved from the prior exam.
3.  No hypermetabolic soft tissue disease noted.

Honor Roll Additions

Please check out the two latest editions to the Pay it Forward Honor Roll.

Saturday, February 12, 2011

Happy Valentine's Day

Dear Huy,

I love you.  I looked a long time to find you.  I guess I was looking in all the wrong places or I needed to wait on God's timing.  I want to take this opportunity to tell you how glad I am that I finally found you.  I spent a lot of time thinking that I needed to be perfect before someone would love me.  I spent years trying to lose weight and somehow only managed to gain it.  I didn't think anyone would love me unless I was thin. I underestimated how you would be able to love me because of my heart and not because of my appearance.

When we began to date and eventually fell in love I could see this love in your eyes.  Even then as I was overjoyed to see the love from your heart reflected in your eyes I still could not begin to grasp the depth of that love.  These days when I have grown too warm from a hot flash or the temperature to have my head covered and you look at me with my bald head I can still see the same love in your eyes.  I cry tears of gratitude and I am filled with love for you and joy. I feel like a lucky, lucky woman to have the honor of being your wife.

I know that I get after you about some things.  I have high expectations and at times I can be quite demanding.  I do not let you off the hook but you are a strong man who is able to admit when you are wrong and to hold your own.  I find that to be a very admirable trait.  I love your sense of humor.  I love that you are independent and allow me to be independent.  We each have our own space, our own past times and when we come together as a couple it is very meaningful.  It was the kind of marriage I would dream about when I was single and lonely and afraid that I wouldn't find someone to call my own.  
This is me trying to figure
 out sleeping with a nursing
schedule, a husband who
needed to sleep and trying to
read the baby books to ensure I
knew what I needed to know.

Speaking of dreams, I want you to know Huy, that you have made so many of my dreams come true.  I wanted to be married to a man that loves me.  I wanted a child and to parent that child with a husband.  You have made these dreams come true and so many more.  It means so much to me that you allowed Tan to be born at home.  I could feel in the depths of my being that I wanted a home birth for my son.  You were afraid and felt it would be safer for us in the hospital.  As long as I live, I will remember how great you were the night he was born.  You took such great care of me and followed the plan for Tan that we made with the doula.  Thank you for giving in and letting me have the birth experience that I wanted.  Since I cannot have another child naturally it means so much more to me.

I continue to have dreams and you continue to give in and help me make them come true.  I have not made it easy on you.  My dreams are sometimes bigger than your comfort zone and nearly always bigger than what you can fathom.  I am sorry that this process has not been comfortable for you.  I do not intend to stop dreaming and I know that because you love me you do not want me to.  I love my kitchen.  I love the way that our home is shaping up.  I feel more and more that it is our home.  I am proud of how beautiful, safe and cozy it feels.  I am happy to live here with you.

I am aware that you need us to concentrate on getting the loan paid off for our project.  I commit to that.  I would like to have a nice dinner with you this week and talk about working on a dream that you might have.  I think that this would be a nice way to celebrate Valentine's Day.  I know that you don't do things the way other people do.  It may not be your first impulse buy big gifts on February 14 but you make sure that we have food to eat every day and many times when I come home from work you are cooking dinner.  I love the easy relationship that you and I have together.  I love that we go to bed laughing and talking nearly every night.  Our son loves you and loves to hold and cuddle with you. It fills my heart to see you and him together.

Anyway, I wanted to let you know that I love you very much.  Happy Valentine's Day!


Huy's Gift

Thursday, February 10, 2011

Finding Your Inspiration

Do you remember the last time that you felt inspired?  How about the last time that you were moved to tears?  I wonder what gets you out of bed in the morning.  Is it a burning desire to complete the items on your agenda or is it a fear and dread regarding the consequences if you don't?

I watched an interview this week with Donald Trump and his five children.  I found it interesting what his children said about him.  They talked about his drive and his single mindedness in living his passion.  They said that he is uncompromising but that he is also known for being kind to the those he encounters and to those who work for him.  I don't know if that is really true but I cannot think of any better compliment.  I felt inspired.

I have taken the time to reflect on my life professionally and personally.  I have been asked to write my eulogy a few times.  I wrote my second one in my graduate program and I wrote one in a life management seminar I attended.  I know what is said about me in my professional life.  I know that what I am known for and celebrated there is not the same things that my family would say about me.  I am not sure what makes these two facets of my life different.  I suspect that at the heart of the matter lies passion and inspiration.

I do not think that I live my personal life as inspired and filled with passion as my professional life.  This presents a problem for me as I feel the need to suck every drop out of every day.  I am making progress.  I am aware of this internal conflict and I am taking measured steps to correct what I foresee to be an issue.  I have introduced different forms of each into my personal life.  I think it is a matter of focus and intention.

In the professional parts of my life I was fortunate  to discover a path that was inspired and in which I have great talent.  It became easy after that.  I struggled for a time finding balance.  At times I over worked and over did it. For awhile, I was in the right job but the wrong location.  With each self correct I was closer and closer until I reached my destination. I was always inspired and always filled with passion.

I am now attempting to do the same on a personal level.  I am working to create a home for my family that is beautiful and functional.  I am inspired to create a life filled with love for my son and for my husband and for myself.  I am passionate about my son feeling safe yet having the freedom to explore and learn.  I have a renewed desire to participate as a member of my extended family.  I yearn to connect with friends and form lasting and meaningful relationships outside my family.

There are a number of dreams that I still have in the works.  I would like an opportunity to pull everything together into a life that is balanced, beautiful and consistent.  I would like to be known, really known, by those who are close and I would like them to experience a consistent Susan.  I would like to be known as someone who found meaning in her life and then crafted that life to perfection.  I want to wear my passion on my sleeve fully recognized by those around me.  I am not done yet.  There are so many miles left to go.

I cannot yet say that I am filled with gratitude for this cancer experience but I am getting there quickly.  I am motivated to life my best life in a way that I have never experienced.  Every moment with my family is a blessing.  My hands are filled with inspiration and dripping with passion.  I just need to figure out how to stretch it and grow it in order to allow it to encompass more and more of my daily living.

Sunday, February 6, 2011

A good laugh feels good

Yesterday, we drove to my in-laws home in Thornton, Colorado to celebrate Chinese New Year which is apparently big even among Vietnamese families.  We were a little concerned about making the trip as the weather called for snow but it had been awhile since we had been there as a family.  We made a decision to turn back or leave early at the first sign of snow and made the trip.

If you have never had fresh roll your own spring rolls in a Vietnamese restaurant you should plan a trip at your earliest convenience as they are delicious.  We grilled up shrimp, fish and thinly sliced beef at the table on a griddle and wrapped them in rice paper wrappers with rice noodles, romaine lettuce, cilantro, pineapple, cucumber and pickled jicama and carrots.  I ate mine with fish sauce but my family members ate theirs with shrimp sauce.  My son Tan just gobbled up the rice noodles and helped himself to the sesame candy tray.

We had only begun to enjoy ourselves when it began snowing heavily.  We made a quick exit but the ride home was slow going.  I noticed on this trip that heavy interstate traffic was quite nearly unbearable for me.  I have never suffered from anxiety previously but this time I was very uncomfortable.  On the way home, I sat with the baby so that he could watch a video on my lap top and have an easier time as he grows restless.  He had napped on the way to Thornton so I knew that we wouldn't have as much luck the return trip.  After my lap top batteries gave way we snacked on apples and sang songs.

Though the traffic was bad we had a fairly enjoyable ride home.  At one point, the baby broke out into hysterical giggles which soon broke into full blown laughter.  I have no idea what he was laughing about but I began to laugh also.  When I stopped laughing I would look over at my son and he would get started again.  This brought us some quizzical looks from Huy in the rear view mirror but I was unable to explain what we were laughing about.  I still do not know but I can tell you it felt good.  It helped break the tension for me during the uncomfortable drive and we shared a nice family moment.

If it has been awhile since you have had a good laugh then my question to you is..what are you waiting for?  It might be a good idea to look up the post I wrote on Being Silly (9-10) and re-read it. In it I include a video of the baby laughing with me which might help you get started.  I hope you laugh til your sides hurt.  It is a good stress reliever.


Thursday, February 3, 2011

Attitude is Everything

Nothing can stop the man with the right mental attitude from achieving his goal; nothing on earth can help the man with the wrong mental attitude.
Thomas Jefferson

Most of the shadows of this life are caused by our standing in our own sunshine.
Ralph Waldo Emerson

by: Charles SwindollThe longer I live, the more I realize the impact of attitude on life.
Attitude, to me, is more important than facts. It is more important than the past, than education, than money, than circumstances, than failures, than successes, than what other people think or say or do. It is more important than appearance, giftedness or skill. It will make or break a company... a church... a home.

The remarkable thing is we have a choice every day regarding the attitude we will embrace for that day. We cannot change our past... we cannot change the fact that people will act in a certain way. We cannot change the inevitable. The only thing we can do is play on the one string we have, and that is our attitude... I am convinced that life is 10% what happens to me and 90% how I react to it.

And so it is with you... we are in charge of our attitudes.

Wednesday, February 2, 2011

Neutropenic Fever

When I finished this latest round of chemotherapy I was really hopeful that I would be able to avoid a hospital visit.  I was hospitalized once during the last round for Neutropenic Fever and actually was unable to have the last treatment of chemotherapy.  I had been on a cycle of one treatment a week for three weeks and then one week off the first time around which ended in April 2010.  This time it was four treatments of Adriamycin and Cytoxan given once a month and ending January 2011.

On Monday I began having diarrhea and cold chills.  As instructed, I checked my temperature and initially it was only 99.1 degrees Fahrenheit.  I got into bed with the heating pad around 2 pm praying fervently that a little rest would take care of things.  I reached into my purse and pulled out my medication information which lists symptoms and suggestions on what to do if you show any.  It very clearly states that a fever of 100.5 and chills are a sign of possible infection and that I should call my doctor immediately day or night if I show signs of these symptoms (additionally blistering at the IV site and Shortness of breath or swelling of throat or facial features).  I have gotten in some hot water on past occasions for not calling as this is a sign of a serious problem.

It is also very vital to pay attention to these symptoms at the nadir (low point) of the blood counts occurring between 7-14 days after treatment.  January 31, 2011 was exactly 7 days following my last treatment so it wasn't something that I could just ignore. By 4 pm my temperature was up to 100 degrees Fahrenheit and I called my friend who is an oncology nurse and consulted with her.  Upon seeing there was no way to avoid a phone call to Dr. Matei I then placed a call to her.  Dr. Matei was unhappy that I had waited until around 4:30 pm to call and wished I had called sooner.  She instructed me to go to the Emergency Room.  I asked her for a direct admit and she told me that it was too late in the afternoon.  I then received a quick call back from her and was instructed to go to Penrose Main and go directly to the 11th floor.

I was admitted and placed on IV antibiotics for Neutropenic Fever.  If you look this up on the Internet you will find that this is a common result of being on chemotherapy.  I was released the following day when the temperatures were at record lows in Colorado and the rest of the country. I consider myself very lucky to have been released so soon as I did a five day stretch last time.

Fever, Neutropenic Fever, and their Relationship to Chemotherapy

What is fever and can it be caused by chemotherapy or other cancer treatments? 
Fever is an abnormally high body temperature.  Usually defined by 3 oral temperatures greater than 38ºC or 100.4ºF in a 24-hour period, or one temperature greater than 38.5ºC or 101.3ºF.  Fever is the body's response to infection.  However, only in about half of all patients with cancer, who develop a fever, can a definite source of the infection be found.

Fever is particularly concerning if it occurs at a time when the white blood count level is known or expected to be low (at the nadir).  During this time the body's normal defenses against infections are down, and fever needs to be further evaluated immediately.

Chemotherapy and fever are sometimes related because fever can also be present in patients who are receiving chemo treatments and biologic therapy as part of the "flu-like syndrome (FLS)."  The fevers associated with FLS usually peak at 40ºC or 104ºF and often spike after a severe chill.  This can mimic the clinical picture of sepsis (an infection in the blood), so it is important that patients who are receiving biologic therapy to be aware of the usual course of fever after treatment. 
How is fever evaluated?
Physical exam and history of symptoms:
  • Questions as to whether there are any other signs of infection, redness, swelling, pain, pus, productive cough, color of phlegm, breaks in the skin, presence of an IV line, mouth sores. 
  • Questions as to when last chemotherapy was given and what type of chemotherapy was given.  This gives the health care professional an idea whether the patient is likely to be neutropenic.
Characteristics and symptoms of neutropenic fever:
  • When a person is neutropenic (has low white blood cells or neutrophils) the usual signs of infection (redness, swelling and pus formation) are absent. Pain and tenderness may be the only other indicators of infection.
  • If a patient is taking biologic therapy where fever is a likely side effect of the treatment knowing the timing of the fever and it's association with the treatment will help to evaluate if infection may also be present.
Lab tests:
  • Complete blood count (CBC) may be checked to see if a patient is neutropenic (low white blood cell count) and at higher risk of infection.
    • If a patient has a fever and low neutrophil count (less than 500/mm3) (febrile neutropenia) they are at risk for infection they may be hospitalized, monitored and receive antibiotics.  The concern is that an infection can develop in the blood and lead to a life-threatening condition - sepsis.  So the patient is admitted to receive antibiotics until the fever resolves, and neutrophils increase to safe levels - if no source of infection is found.
  • Cultures to try to determine the source of infection from:
    • Blood
    • Urine
    • Throat
    • Drainage from catheter or draining wound. 
    • If diarrhea is present in a neutropenic patient a sample may be checked.
Chest X-ray (CXR):
  • This is a quick and painless procedure where a picture, or an x-ray, will be taken to look at the internal structures of your chest. The chest x-ray will look specifically at your lungs, heart, and ribs. 
  • When infection is suspected CXR are often repeated to compare one to another.  Sometimes this is more helpful to detect subtle changes especially in patients with prolonged neutropenia (low neutrophil counts).
Things you can do to minimize the effects of fever:
Fever related to febrile neutropenia/infection:
  • Notify your health care professional immediately if you have a fever greater than 38.5ºC or 100.5ºF.
  • Know what chemotherapy drugs you are receiving (write them down) and if they are likely to cause low white blood cell counts.  This will help if you develop a fever on an evening or weekend and need to talk to a health professional who is not familiar with your case.
  • If you are receiving chemotherapy that is likely to decrease your white blood cell count, check your temperature twice a day if you feel warm.

Tuesday, February 1, 2011

How do you know when you know?

Every day I make decisions.  Nearly every day I sit with people who are wrestling with decisions they are trying to make.  When I reflect on my life and some of my decisions I honestly wonder how I was so fortunate to make the right ones.  The ones that were not right still sting a little but I can say I learned a lot from them.

I wish that I had a formula for decision making that was a little more solid than first impulse or going with my gut.  How do you know when you know?  Do you?  Maybe you don't.  Perhaps that is what is meant by hindsight being 20/20.

I have sat with someone convinced, absolutely rock solid, that she needed to get divorced and was firm in this conviction for about eight months straight.  Then we had a great joint session with her husband and three months later she was glad that she didn't because it would not have been the right decision.  I have accepted a job and then offered another one a week later that I thought was better so I took it.  It wasn't.  The thing is that our minds can be so convincing.

A  premise of my job as a counselor is to counsel people in the midst of a decision.  I listen to them and ask question based on my knowledge of them as a person.  Having a sounding board can be a huge help but you must be careful.  When you put your life up to committee make sure that the committee members are educated, somewhat neutral and have experience in the arena in which you want their assistance.  If you want business advice consult business men and women who are achieving a level of success.  This is a helpful process as long as you are careful not to be steered in a direction or substitute another person's ideas for your own feelings.

This is sort of what I have figured out so far.  I welcome your thoughts and anecdotes.  Do you have a method that is tried and true?  Please share it.