Wednesday, October 26, 2011

10 Things To Know About My Chemo

Since I haven't been able to keep up my posts in a timely manner, I thought that I would summarize everything that's been going, here are "10 Things To Know About My Chemo".

1.  My chemotherapy combination is referred to as "TAC".  TAC is Taxotere (docetaxel), Adriamycin (doxorubicin) and Cytoxan (cyclophosphamide).  Click on the name of the drug to read all of the scary, scary facts about each drug poison.

2.  My doctor has prescribed six chemotherapy treatments, which are administered every 21 days.  My first chemotherapy infusion was October 6.  The second one will be administered October 27, and the next one should then be November 18.  Day 1 of cycle 1 is known as day 1-1.  Day 18 of cycle 2 will be known as day 2-18, etc...Thursdays are also good, as I have to go back into the office the Friday after chemo is administered, for an additional injection.

3.  We chose Thursday for as my chemo / doctor appointment day.  By receiving my infusion on Thursday, that allows for me to have Friday and the weekend to deal with the lovely side effects of the poison cancer-killing agents.  I also have to come in weekly for blood count checks (days 8, 15), so in essence, that involves going into the doctor's office every Thursday.

4.  The power-port comes in handy, as all of my "sticks" happen with the port.  At each visit, the first thing they do is take my vitals, and then access my port.  I take a deep breath in, and then the nurse sticks a needle into my port.  Everything is sterile, and removed from a special kit...including the gloves that the nurses put on.  From there, they flush it with two syringes of saline, and then take several blood samples. Generally,  they take two vials.  After the blood draw, the port is flushed again, but some saline is left in the syringe for the next nurse to use.  The port remains accessed with the tubing hanging down.  Then, when it is time for chemo or an iron infusion, they once again flush and then connect the IV flavor of the day.  The weirdest thing is that I can actually taste and smell the saline when they flush it.  We know that the port is working well, as my "blood return" is good.  That means that they can get blood from it.  If the blood return wasn't adequate, then we would have an issue.  Thank God (and my wonderful surgeon) that it appears to be working well.  I have noticed that as the swelling around the port has gone down after insertion, it seems to be "sticking out" on my chest.  Some ports seem to be more superficial than others.  On the other hand, perhaps that is just one (maybe the only) place on my body where there's not a lot of "extra padding"!

5.  I take an oral steroid the day before treatment, day of treatment and day after treatment.  Added to my medicine regime are two pills (morning and night) the day before treatment, followed by two more pills the day of treatment and one pill the morning after treatment.  The steroid is Decadron (Dexamethasone).  Interestingly enough, I also receive Decadron intravenously during treatment.  The steroid is prescribed to limit the allergic reaction to the chemotherapy regime, reduce swelling (yet another side effect I'll get to later), and also helps with nausea.  This drug is also is an appetite stimulant (just what I need...can't a cancer patient with extra fluff loose a little weight?)

6.   It takes approximately 4-6 hours for my drug administration.  In addition to the three main drugs (TAC), I also receive additional drugs to avoid allergic reactions, steroid, and antiemetics (anti-nausea).  They begin with Benadryl, to lessen the effects.  Other drugs I receive during treatment are Aloxi, Decadron and Emend.  My Emend is given via IV, and not orally.  Tomorrow, they are combining my iron infusion with my chemo.  I wonder which one they will administer first???

7. I sit in a special recliner for chemo administration, that has reclining handles on both sides!  The chemo treatment room has approximately 30 treatment recliners, of various sizes.  The treatment room is a large, rectangular room, and the nurses' station is in the middle on one of the long sides.  There are always three or four chemo oncology nurses on duty.  After watching them for hours on end, I have a new appreciation for oncology nurses.  (They might even work harder than teachers.)  Just like educators, they rarely go to the restroom, or have time for lunch!)  Angie is my main chemo nurse.  Guess where she's from???  Jones County!  Bobby is another nurse that I've gotten to know some.  The treatment room is full at times, while half-full at others.  Sometimes, I've been there so long (like I will be tomorrow), there are very few other patients left in the room.  It's really something sitting in the treatment room, and wondering what everyone's story is.  Other than another gentleman that I know, and another lady I saw last week receiving chemo, we are by far the youngest patients that I've seen.  That's not to say that there aren't other younger, but I haven't seen them on Thursdays...and I've been there every Thursday, so far.  Some people sleep, while the majority watch television.  Due to FDA and EPA regulations, no family members or friends are allowed to sit with you during the length of time you are receiving chemo.  So far, one or both of my parents have been with me during chemo and iron treatments.  They patiently wait in the lobby (I haven't been able to convince them to leave and come back, yet...but still trying.).  They are able to step back to the chemo room, see how things are going, bring me drinks or snacks (even though I pack a lunch box), and then go back out to the lobby.  There have been a few times, especially if the treatment room is almost empty, that they are allowed to sit down and chat.  It's just another way to cut down on infection and exposure for the patients, but makes for a long day.  Look for another post in the future about how I spend my time in the chemo recliner!

8.  My treatments have caused me to experience many, many many that I now need a "pill container" to organize my medicine.  Throughout this three-week experience, I have had so many side-effects, it's almost comical at this point.  Nausea, vomiting, diarrhea, rash, constipation, changes in taste, tiredness, muscle pain, joint pain, fluid retention, low white blood count, hair loss (more on that one in #10), cough, mouth and throat sores and bladder problems are the majority of the symptoms I've experienced.  The nausea is fairly controlled with medication, though it seems to hit at odd times.  They give you many antiemetics in your IV, but the best advice I received was to take my nausea meds regularly for the first few days, even if I think I don't need them.  It's much easier to prevent vomiting, than play "catch-up" after it starts.  I have two different nausea meds, Compazine and ABH (a formulary created by the pharmacy at the Cancer Center).  The both seem to work, but I still wish I could have good old Phenergan, which is frowned upon in the Oncology world :(  The stomach issues and the mouth sores have by far been the worst side effects I've experienced.  Days 3 and 4 were very rough with a severe headache, body aches and nausea.  I broke out with thrush on Day 6, went back to the Doctor on Day 7 for Thrush (back on Day 8 for iron, too!), and ended up taking an anti-fungal (Diflucan) drug and anti-viral drug (Valtrex), in addition to prescription mouthwash (Caphosol).  During the first cycle, I was also put on a steroid to lessen the symptoms - past the initial three days.  For someone who only took daily allergy meds, I am presently taking Protonix (stomach medication) Claritin, Valtrex, Decadron, Caphosol, Alleve and Bactrim (for a UTI).  Tomorrow I will add in the two nausea meds as needed, and then Cipro comes in on Day 5.  This is one of the biggest shocks to me...I never thought about the oral meds that I might have to take between chemo sessions.  My family has to now remind me to take my medicine!!!

9. Part of my chemotherapy regime includes a colony stimulating injection called, Neulasta, 24-hours after I receive my chemo drugs.  One of the major side effects of my prescribed drugs is that it decreases neutrophils, a type of white blood cell necessary to fight infection.  Neulasta (Pegfilgrastim) is an injection (given in the tummy), that helps your body make additional white blood cells.  The injection is given on Friday after chemo, and the largest side effect are flu-like symptoms and body aches.  Research hasn't proven why, but for some reason, it has been found that taking Claritin daily helps with the body aches. Although white counts drop in the majority of patients, I went to the extreme and became "neutropenic".  My white blood count dropped to 1.4 (normal is 4.8 - 10.8) and my neutrophils level dropped to an alarming 0.3 (normal is 2.0 - 8.0).  Due to this low drop, I was placed on "house arrest" and told to limit contact with people.  I also could not eat raw fruits or vegetables, due to possible bacteria consumption.  If my white count is too low, it will delay my chemo schedule, but fortunately, I responded to the Neulasta, and by day 15 my counts were up to 4.9 (wbc) and 2.5 (neu).  Those put me back into the world, so I was able to return to work.  Apparently, this will occur each time, so I've been advised to quarantine myself on days 7-10 and follow the no raw fruits, veggies, rare meat, etc...  (Now, here's your shocking fact...on the day I had my Neulasta injection and some fluids for dehydration, insurance paid out over $6,000!)

10.  Just like the doctor said, my hair did not make it to Day 21!  I am on some very strong chemo drugs, especially Adriamycin, aka "The Red Devil".  On Days 14-15, my head started hurting, or more accurately, my hair started hurting.  Certain drugs cause the hair follicles to actually release the hairs, and as they happens, discomfort occurs.  Heading to the doctor last week for an iron treatment, I was styling my hair, and used some hair product.  As I brought my hands out of my hair, they were covered with hair.  Lots of hair!!!  I asked the Nurse Practioner, Jeff, what could be done to help with the tingly, achy scalp, and his suggestion was just to "go on and shave it".  I went to see my favorite stylist, Shana, and she shaved it for me.  (Future post, complete with pictures).  As soon as the hair was gone, my scalp felt so much better.  I now have little black whiskers on my head, which are rapidly falling out, exposing bald spots.  While leaning over the bathroom sink, after I rub my head, it looks as if my Jeff has just shaved.  On a plus side, no hair greatly adds to the time I get to sleep in the morning, and I get to brush my hair with a lint brush!

Treatment #2 is tomorrow.  We are hopeful that the addition of a stomach and anti-viral medications will help to lessen the side-effects.  Only time will tell.  As a rule, your symptoms and side-effects seem to be predictable with each round, with certain symptoms occurring on the same days.  I will just have to wait and see.  Thank you for your continued prayers and support as I continue on my journey.


Monday, October 24, 2011

My First Day of Poisoning

Throughout my life, many people have stressed the importance of not having contact with poison:  parents, grandparents, teachers, store clerks,  policemen, etc.  Caution is to always be used with household cleaning supplies, pesticides, and herbicides.  I remember even being told not to polish my nails with white-out, for fear of how the chemicals might sink into my bloodstream.  Have you ever heard these precautions before?  The big  skull and cross bone appears...Do Not play with poison.  Last week, I willingly took save my life.

Utilizing my Power Port for treatment
Thursday, October 6 was Treatment 1 in my new regime to battle this breast cancer demon.  As I reflect back on my first chemo treatment,  I have experienced some of the hardest days in my life, with the ones that followed.  Throughout it all, I know that I have had the prayers of many surrounding me with peace and comfort, but it is still something that is indescribable.  There are days that I remember with clarity, and days that are fuzzy, but I'll try to share my experiences in "keeping it real".

Day 1 - I arrived at the cancer center at 10:30 a.m. on Friday morning.  I utilized my numbing cream, so it was a breeze when my port was accessed.  The easiest way I could describe my port access is that it was a sterile "plug in".  All of the sterilized equipment, gloves, masks and needles were there, and then she just plugged the needle in to my power port.  Testing was done for blood return, blood collected for testing and flushed with saline...and then it was good to go.  Next step: poison time!

The chemotherapy recliner that was mine for six hours!
I met with Dr. Jones, and we went over my final chemotherapy regime, and answered any other questions I had.  She detailed that my HER2 status was negative, or not-amplified, so Herceptin will not be added to my chemotherapy treatment.  My actual drug combination is TAC.  This involves Taotere, Adriamycin and Cytoxan.  My regime will also include a Neulasta injection the day following chemotherapy.  Early clinical trials of my chemo combination showed that there were fatalities during the first five days of treatment, due to infection, so I will be prescribed an antibiotic to take each cycle for days 5-11.   (Isn't that what you always want to hear your doctor saying?)  It was rather traumatic hearing my oncologist state that fact, but it is what it is...and I will gladly take the antibiotic!  (Can I tell you how much I hate medicine, though!)

One drug is actually manually pushed in for safety!
My first chemotherapy administration began at approximately 11:30 a.m.  Via my power port, I received the following drugs:  Aloxi, Cytonxin, Decadron, Doxiruben (Adriamycin), Emend and Taxotere, in addition to regular fluids, Tylenol, and Benadryl. I can't even tell you how surreal it was to sit there in the chemotherapy recliner, and know that I willingly agreed to have poison injected into my body.  How did I get so far...worried about polishing my nails with white-out and the poison factor, to actually having it injected into my veins to save my life?

As I sat in the chemotherapy room until almost 5:00 p.m., I saw people come and go.  My family members could come in and check on me, bring me a drink, etc... but they are forbidden by FDA and EPA regulations to remain in the chemotherapy room.  The room itself actually has over thirty treatment chairs in it, and some of the hardest working nurses I have ever met in my life.  The first few moments of administering any drug were closely monitored, in case I had a reaction.  My nurse's name was Angie, and as long as she was on duty, I was her responsibility.  (I'll have to write another post just about the chemo room in the future.)

I returned home with several new prescriptions, including one antiemetic.  An antiemetic is a drug that controls or may even prevent nausea.  I began taking them immediately upon returning home, but about 6 p.m. the nausea hit, and there wasn't any point of return, or so it seemed.  Finally, about 10 p.m. we called the on-call physician at the cancer center.  Jeff ( my mid-level practioner) immediately called me back.  I was instructed to come back into the office for additional fluids the next day, and was allowed to take a Phenergan tablet to see if it would assist with the nausea.  My whole life, phenergan has been our "vomiting go-to drug", but apparently it is very disliked in the oncology world!  The Phenergan helped, and I was finally able to rest after midnight.

This is just a summary of Day only took me over two weeks to finally finish writing it!  I apologize for lapsing with my blog for a few weeks.  As you can imagine, so much has gone on since my first chemo fact, it will take me several blog posts to catch you up on it.  Maybe I'll catch up just in time to have my chemotherapy number 2 session, which is scheduled for this Thursday!


Wednesday, October 5, 2011

"Catch Up" Before Chemo

Two-inch incision

Before I begin chemotherapy treatment tomorrow, I find myself playing "catch up" much to do and so little time!  I guess I'll be like The Sound of Music, and start at the very beginning...

Monday morning, I reported to Coliseum's Day Hospital for my insertion of my "Power Port".  Our time to report was at 5:45 a.m., but I don't think my surgery actually began until after 8 a.m. New and old Jones County friends helped to make my experience as comfortable as possible during outpatient surgery.  I say it was an answer to prayers.  After a while, it was quite humorous about all of the Jones County folks that were taking care of me in the hospital.  I saw it as just blessings from God. 

A new tag for my key ring
 A smiling friend greeted me as I checked into the Day Hospital, and was allowed to be my discharge nurse.  How nice it was to talk with her while I waited!  My anesthesiologist is a parent of a Clifton Ridge Middle student, so we chatted about a major project that his son had been working on.  The Nurse-Anesthetist is a JC resident, and even the next-door neighbor of my principal.  The sister-in-law of one of my dear co-workers was one of my recovery nurses.  Don't forget that my surgeon is a Jones County native!  It really helped me to be surrounded by such kind and caring people during this anxious time.

The actual surgery wasn't too bad.  I have an incision on my left chest area, approximately two inches wide.  The Power Port is placed under the skin, and then connected to a main vein.  There is still some swelling, but all in all, just a bit discomfort.  The incision is closed with surgical glue.  I now have a medical card to show security personnel if I beep, in addition to a key tag (guess I'll put that right between the Ingles and Kroger tags!).  There's also a rubber bracelet that I can wear, to let everyone know that I have a Power Port installed.  One of my co-workers has suggested that we "bling it up"!  (I'll let her keep working on how to do that!)

I found out Tuesday that after three tests, my HER2 test results are not-amplified.  Praise God!  That means my chemotherapy treatment will be over in 5-6 months, as opposed to 12 months of treatment.  You can only imagine how excited I am to know that chemo will be over in January.  God is good!

Thursday is the big day...the day I begin my next battle phase.  My oncologist has prescribed the chemotherapy combination of TAC, which is a combination of the drugs Taxotere, Adriamycin and Cytoxan.  The treatments will be administered every 21 days, for a total of six treatments.  24 hours after chemotherapy, I will be administered a Neulasta injection.  Neulasta is a white blood cell booster that will help reduce the risk of infection during treatment.  I began taking a required oral steroid today, that also doubles as nausea medication.  Two doses today, two doses tomorrow and one dose on Friday morning.  Lots of additional pre-treatment medications will be administered tomorrow, but I am not exactly sure what.  Extra fluids, anti-nausea meds, benadryl and more are given prior to the administration of medications.  Sometimes, up to two hours is allocated just for pre-meds.

My appointment at the Cancer Center is for lab work at 10:40...this is the first time that my port will be accessed.  I have numbing cream to place on the port prior to the visit.  The cream should be applied 30 minutes prior to the visit, and I cover it with plastic wrap after administering the medication.  (Think that might be a picture worth sharing!)

I will meet with a nurse practitioner after labs, and then will begin infusions.  The treatment should take approximately four hours for actual drips, but there will be additional time required for monitoring after treatment is administered.  I'm hoping that we will make it home by 6:30 p.m. tomorrow night.

The side effects for my chemo combination are quite frightening, but I'm trying hard not to read / research too much.  My provider has assured me that they will do everything possible to keep me comfortable, and manage my side effects, but it is imperative that I share them with the doctor.

Just like Scarlett O'Hara says...."Tomorrow is another day".  In my world, tomorrow is the beginning of another phase in my battle with breast cancer.  All of my life, I've been told not to play with poisons, but yet tomorrow, I will be willingly hooked up to poison...the things we do to save our lives!

The Jones County School system begins Fall Break tomorrow.  My children and co-workers won't report to work.  At my house, I'm jokingly referring to it as my "Chemo Break".    My Nook and laptop are charging.  Headphones are packed.  Silly romantic comedies have been rented from Redbox.  Snacks are packed, and my journal is ready.  At this point, only God knows how the day will unfold, but one this is for certain...I am a survivor!


Sunday, October 2, 2011

Woman With a Power Port Coming Through

Monday morning, at 5:45 a.m., I report to the hospital for outpatient surgery.  Dr. Martin will be inserting my "Power Port", which is an implantable device that will make life easier...or so I've been told. 

One of the side-effects of chemotherapy is that your veins are often damaged during the process.  This especially happens when drugs are administered intravenously.   My oncologist wants me to have an implanted catheter inserted to assist with chemotherapy, as well as with blood draws and injections.

The surgery takes approximately thirty minutes, and is performed as an out-patient procedure.  While under general anesthesia, a small port will be inserted into my chest.  An incision will be made on my left side, and the port inserted.  Looking at the picture, you can see how the port inserts directly into a vein.  Think of it like a permanent IV for a while.  The port will be one of my lifelines.  Chemotherapy treatments and any "sticks" will use the port after it is inserted.

It is a triangular shaped object, and has three raised "bumps".  Providers and nurses can feel the bumps under the skin, and then know where the "hole" is.  One of the best things is that I have been prescribed numbing cream when the port will be inserted.  The cream is applied approximately thirty minutes prior to my appointment, and will numb the skin over the port.  After the cream is applied, I have been instructed to place a piece of plastic wrap over the site.  There will now be a roll of plastic wrap in my first aid supplies!

Monday afternoon, I have another appointment with Dr. Jones, my oncologist for final instructions before chemotherapy.  My first chemotherapy treatment will be Thursday, October 6. 

After Monday's surgery, I may have the power to set off security alarms, due to the small amount of metal in the port. Security systems may or may not pick up the metal, but I will have the medical information card to show authorities.  It's not a weapon setting of the security system, just another one of the perks I'm getting during this cancer diagnosis!