Good News on the Blood Sugar front

This afternoon was the follow up trip to see the nephrologist because of the spiking glucose on his previous blood test. She had the results of the blood test he had last week and his glucose is normal which is lower than it has been since the doc has been with the Palo Alto Medical Clinic. Before the spike his blood sugar had been flat but a bit above normal. So no diabetes.

The bad news was that he lost another 2 pounds. So the doc said to add another Glucerna and nuts to his diet (to try to gain back some of the weight he has lost). An extra Glucerna (Ensure for diabetics - only 6 grams of sugar vs 23 grams of sugar) will add 250 calories a day and nuts should add a few more calories.

Also, he seems to be getting soome of his energy back. We took a walk yesterday morning before it got too warm.

The Latest Checkup

Rader Bob visited Dr. Cho Monday and the reports are all good. He is very happy with Bob's hand and the fact that he won't need to do surgery on it.

He used the liquid nitrogen on a number of places on Bob's arms, head and face. This is to freeze any pre-cancerous keratoses before they go bad. Magie has had a bunch of these done over the last several decades. It's no big deal. It makes a little blister that is really, really annoying for about a week.

He has sent a prescription to Medco for a cream for Bob to put on his face for the Rosacea (non-specific, rosy-red rash) plus some stuff to use to wash his face. After a couple of months (according to the brochure we picked up) the redness should be receding from Bob's face. He does not think Bob will get any reactions from these new items like he did from the other stuff.

More Info/Clarifications

Sort of in response to Magie's post of yesterday(?), I thought I'd clear up a couple of things.

INR = International Normalized Ratio

This is a calculated number based on a test for the time it takes your blood to clot. For normal, everyday, walking-around-healthy humans, this number should be around 1.0, but could be in the range of 0.8 to 1.2. The lower the number, the faster the blood will clot. This number will vary in that range on a day-to-day basis for everyone depending on their diet, liquid intake, and a number of other factors.  If a normal, everyday, walking-around-healthy person had an INR of over 1.5 (or under 0.8), their doc would definitely start paying attention.

For people with "clotting issues," this number needs to be driven higher with medications. Examples:

• As folks get older (and more sedentary and less cardiovascular and have more clogging in their arteries), they are more likely to develop blood clots. These could be in the form of Deep Vein Thrombosis (DVT) from sitting on that long drive or long flight to visit their grandkids or just sitting in their recliner feeling generally crappy for a few hours. This is why most docs have their elder patients start taking "baby aspirin" (81 mg) daily, because aspirin has an anticoagulant effect for protection from clots. The smallest of clots that get to the heart will cause a heart attack or, if they get to the brain, will cause a stroke.
• Folks with specific medical conditions such as Atrial Fibrillation (AF, like Rader Bob has experienced a few times) will be prescribed a stronger anticoagulant like Coumadin (aka Warfarin or "Rat Poison") to get their INR up into the 2.0 to 3.0 range. (AF tends to cause clots to form in the atrium because the blood is not being actively moved through the system.)
• Folks who have had heart attacks or bypass surgery will also be prescribed with anticoagulants to keep their INR up around 2.5 to 3.5.
• People with mechanical hearts will be given strong anticoagulants to keep their INR up around 4.0. (The mechanical heart is more likely to damage blood cells and induce clotting.)

So, with Rader Bob's history of AF and his INR down at 1.1, his doc has asked him to increase his dosage of Rat Poison and to get his INR checked again in two weeks.

Hope that helps!

s

30 Packets Have Been Used

Last night we applied the 30th packet of Aldara to Bob's left hand, left temple area, and head. The part applied to the hand was mixed with some Tazorac. As you can see from the photos, the pharmaceuticals have been doing a real number on the areas where they have been applied. As you could guess, the areas are quite tender and Bob is very happy to not have any more applications.

Today Bob had his INR checked at Dr. Galli's office and the reading was 1.1 where they want it to be between 2 and 3. (Dr. Galli may change his coumadin dosage but he was not in when the test was done.) That is probably why the displacement of a scab on his arm yesterday (when we went to the audiologist) caused blood to run down his arm onto his watch band. We were waiting for the audiologist to get back from lunch when I noticed the blood. Fortunately we were able to take care of things with a tissue and it has not bled any more.

Bob after 3 weeks of Aldera creme

On Monday, 29 June, Bob had an appointment with the dermatologist, Dr. Cho. By June 26 Bob was complaining mightily about the tenderness his right temple. He was occasionally having blood run down his face from the irritated area. At night he was getting blood on the pillow case. We finally switched to having a dark towel over the pillow case so minimize Magie's chore of washing the pillow case and zip pillow covers every day.

Dr. Cho loved the damage to the right temple of Bob's face (as in - hooray the creme is doing its job). So we can stop putting Aldera on that part and start putting it on the left temple area instead. He also gave us some samples of a gel called Tazorac to add to the Aldera being put on the hand since the hand is not reacting enough to the Aldera alone. Any Aldera left over in the little packet is to go on the left temple area and on the top of his head. We are to continue for 3 weeks (Monday through Friday) with the Aldera and Tazorac and return in 8 weeks. By that time Dr. Cho expects Bob's skin to have recovered from all these treatments. We are to call if there are any problems or questions in the meantime.

Bob's right temple was very tender so he is most happy to not have any more Aldera applied there.

Cancer Treatment = Wrinkle Cream?

I was reading the online news this morning and came across an interesting article that seem to indicate that the topical chemotherapy Bob was using also holds promise as a wrinkle cream! 

Treatment with fluorouracil cream did cause the hideous "road rash" as expected, but after the treatment was stopped and the rash healed, actinic keratoses (pre-cancerous rough patches of skin) were greatly reduced and other types of skin damage were greatly improved. This includes wrinkles and dark spots (what some of us call "liver spots"). Another article about the same study also suggests that general skin color also improved from being sallow (yellowish) to a healthier pink. Still other articles say that the recovered skin is also much softer. 

An LA Times blog makes sure to note that the 2-week treatment is "no day at the spa," but goes into more detail about the effects of the treatment as well as the underlying causes of improvement.

So, as Magie indicated in an earlier post, there's a good reason that Bob's head looks better than it has in many months!

The cancer on Bob's head is gone.

Dr. Cho is pleased with Bob's head. He removed the excess dry skin on the hand and prescribed a new cream. He sent the prescription directly to Foothill Pharmacy (FP). When FP checked to see if it was covered, they got a message "prescription limit exceeded". I thought maybe it was because this cream would cost over $2700.00 and Bob has had some other very expensive prescriptions this year. FP gave me a copy of the computer screen with the message and a copy of the prescription. When we got home I called the insurance handler (CBCA) and told the lady my sad story. She was able to transfer me directly to Medco where I told another lady my sad story. She checked and found that the prescription should be covered and the copay would only be $20. She gave me the number of the help desk so that FP can call and talk to them about it. I called FP and gave the number to them and told them what Medco had told me. So someone will call the 800 number to hopefully get things squared away. If I don't hear back from Foothill by mid afternoon I will call them to see what's the scoop.

The new cream is to be put on the hand AND the head although the head appears to be fine. This cream is not a chemo cream but it could make his head and hand look nasty by the end of 6 weeks of application. Bob goes in after 3 weeks for an inspection. The cream is supposed to boost the immune system such that the immune system kills off any abnormal cells. I am also to put the cream on an area of Bob's face that Cho is not happy with. Whichever way the cream goes, Bob will not need to have surgery on his head. Since the cream comes in packets and you use one packet a day, the cream not used on the hand will be applied to the spot on his face and then whatever is left over in the packet will go on the head for any keritoses that might be lurking there.

One day short of 6 weeks since last chemo cream application

To recap: Bob started on the chemo cream on 4 April. Since he did not seem to be making progress the doc had the cream stopped on 20 April. Since the next appointment is 3 June this might be a good time to give an update on how things are going.

Bob's head is looking much better than it has in many months but his hand has minimal improvement.



At the appointment on June 3 the doc, as we understand it, will give Bob a prescription for a different chemo cream to apply to the squamous cell carcinoma locations. This cream will also have about a 70 to 75% chance of killing the cancerous cells. Bob wants to try the 2nd cream with the hope that it will take care of the problem so that he does not have to have surgery (and skin grafts).

After the trip to the hospital on the hill in St. Helena, Bob saw his cardiologist on May 21. The doc said that he thought the passing out was caused by his not taking the proper dose of Lotensin - he was taking twice what he was supposed to be taking. So now he is taking the proper dosage, so things should be better.

In addition to that, the thallium stress test that he had on May 27 showed that his heart is stable.

After 9 days of chemo cream application

The pictures were taken yesterday and the chemo cream will be applied for another week. So the head and hand will probably be more red by then. The spots where the liquid nitrogen was applied to his face are red and angry looking. The spots on my face did not look like that, but I am not taking a blood thinner. He says that the spots on his head and hand that are more red are getting quite tender to the touch.

Day 17 of Chemo Cream

The trip to the dermatologist today was not very encouraging. The doc had expected Bob's head to be looking pretty messed up and it is not as red/irritated/whatever as it would be if the chemo cream was doing a good job of eliminating cancer cells. So the new instructions are to apply the cream for 2 more weeks, then let the areas heal until he goes back to see the doc in early June.

Apparently there is another chemo cream that could be applied after the areas heal from having been annoyed by the current cream. There is a possibility that the other cream also won't do the job of destroying all the cancer cells. At that point surgery is the only option left for getting rid of the cancer.

Bob could opt for the surgery without trying the 2nd chemo cream. Surgery might also involve skin grafting because there isn't any loose skin on the scalp that can be pulled over the area from which the cancer would be excised.

Edit - I forgot to mention that the doc froze some precancerous spots on Bob's face with liquid nitrogen (like he did to me last week) so Bob has red spots on his face that should be scabbing over within the next week.

Day 9

We are continuing the cream applications and the spot on his hand is getting red and angry looking. As it turns out, the cream was supposed to be applied to the entire back of his hand, not just the one spot. (I asked the doc this morning for clarification.) So, starting today, Monday, we are applying the cream to the whole back of his hand. Although the cream has been applied to the entire top of his head for the same length of time as the spot on his hand, his head is only getting red in some areas. Go figure.

His hand is starting to be sensitive to muscle movement, so he will be inclined to move his hand less as it gets more tender.

First blog entry by raderbob

Stephanie is teaching me the in's and out's of dealing with blogs so bear with me as I struggle with the problem of doing the correct procedure.

Fluorouracil cream (abbreviated 5-FU, really) is still being applied twice a day. No "road rash" yet.

Cream Chemo Started This Morning

Now that we have recuperated from the flight home from Honolulu, it was time to start applying the chemotherapy cream to Bob's head and hand. The formal name of the cream is "Fluorouracil 5% Topical Cream." I was instructed to apply it twice a day starting today. This will continue for 6 weeks. We actually filled the prescription on the second of March but Dr. Cho did not want him to be using it while he might be out in the sun in Hawaii. The cream will cause the top of his head and his left hand to look like he has road rash (according to my cousin Marilyn who observed her father, my cousin George, use the cream). Dr. Cho also said that Bob's head would look like one big sore after a while.

There is a 70 to 75% chance that the cream will kill all of the cancerous and precancerous cells on his head and hand - so he may still need to have some surgery on the currently large spot on his head and on his hand but the surgery would be less invasive than if he had gone straight to surgery for the squamous cell cancers on his head and hand.I am supposed to wash the cream off my finger immediately after applying the cream to his head and hand.

On Monday, April 20, Bob will go visit Dr. Cho so that the doc can see how things are progressing. It will be about 12 weeks or so before his head and hand are healed - 6 weeks of cream then 6 weeks of healing according to the doc.