Hello again,

Pat made it through her third week of radiation and had another round of Erbitux. Only 18 more Rad Tx's and three more rounds of Erbitux to go.

I know from reading numerous posts here at OCF as well as what the Drs and nurses have been telling us that there will be some period of time after treatment is over before we'll see any signs of improvement (i.e. pain, mucous, etc.) I imagine three to four weeks is an average to start seeing some improvement with gradual improvement thereafter over the course of several months. (Your thoughts/input here would be appreciated.)

This past week Pat really started to experience the side effects of mucous, phlegm, throat pain, etc. We added liquid Lortab to the arsenal this week as well. Also, this past week we were very focused on nausea and vomiting. I was initially thinking the culprit was the Fentanyl patch because shortly after taking it off we had a short reprieve from the nausea and vomiting, however, this respite was short lived. Soon enough these symptoms were back again full force. It was also at this same time that the phlegm and mucous became so pronounced, so after a process of elimination I've concluded that the root causes were a combination of pain, phlegm and mucous. I know from my own experience that pain came be very nauseating in and of itself. When combined with the gagging effects of phlegm and mucous it seems to make sense that they are the probable causes.

I spoke with Pat's med-onc today and he agreed. Therefore I applied another Fentanyl patch to Pat's arm tonight and I'll watch her carefully. She's done well with the liquid Lortab so far and it's given her some relief. So hopefully the patch will give her some ongoing relief and I can reserve the liquid Lortab for breakthrough pain. I'm now a firm believer that the skill set of a successful caregiving must include trying to be as knowledgeable as possible about current symptoms and symptom changes versus current meds versus recent changes in meds. The amalgamated effect of all three makes for a quite the mystery to solve - Not so elementary my dear Watson.

We've had good results with the Carnation VHC, but after some experimenting I've decided that it needs to be watered down in a ratio of at least one part Carnation VHC to one part water. Also, from experimenting I concluded that I get the best result when I mix the Benefiber with only water and give it to Pat separately in lieu of trying to add it to the VHC. I haven't had any real luck when mixing the two together as the combination goes in the Peg tube very slowly. Much better result separately.

Also, I've noticed that the liquid Lortab needs to be mixed with about three or four ounces of water and given separately. When combined with the VHC it's even more slow and very gummy in my opinion. I'm sure everyone's experience is different and I can only go with what works for us.

We had another change in our routine today when one of the onc nurses at the infusion center where we get the Erbitux suggested some additional fluids. We've been talking about this for a while now and felt that Pat could use some additional hydration especially in view of last week's numerous vomiting episodes. Pat reports that she feels much better this evening and we are scheduled to go back again tomorrow for some additional fluids before rad Tx. If this continues to be of benefit we may try this two or three times per week going forward. We'll play it by ear.

So, that's my latest report on how my sweetheart is doing and how this portion of our life's adventure together is progressing. We'll continue to trust the Lord no matter what.

Walt