...That Flesh Is Heir to

In Hamlet's "To be or not to be" soliloquoy, he talks about "The heart-ache and the thousand natural shocks that flesh is heir to." And he never went through chemo. :-)

What we all know (or think we know) about chemo is that it makes you nauseous and it makes your hair fall out, right? Well, not to be a downer, but there's a few other side effects that don't get as much press. They're not life-threatening, or debilitating, and also usually not apparent (like the hair loss), but they are a drag and when they're cumulative, they can be a real PITA.

Between mouth sores, a case of conjunctivitis I can't seem to shake, and some lower GI issues that have some other implications (I'm *trying* to be discreet), it's hard sometimes not to whine.

This reminds me a bit of when I was pregnant and I was left to discover some of the side effects of pregnancy and childbirth that aren't discussed in all those helpful books. While it's true that all my symptoms are listed on the literature for the meds I'm taking, I didn't really pay much heed. Because I almost never have the potential side effects they warn about when I am given new medication. But chemo is a whole new world, as I keep learning.

Meanwhile, my parents are visiting for the holidays and we're having a really nice visit. We've been playing card games and just hanging, for the most part. And Mom will go with me tomorrow to my first Taxol infusion.

Emily was home for the weekend and Frank was shocked to see that her head did not seem to have grown to accommodate her bigger brain. Our friend John says that doesn't happen until sophomore year, so we've relaxed a bit.

I Love My Oncologist

I had my check-up with Dr. Kuan on Monday, after a very rough weekend. My stomach still was causing me some distress on Monday and while I waited first for my blood to be drawn and then to see Dr. Kuan, I kept getting teary. I had to keep reminding myself to get a grip, that really I was doing fine, but I kept getting weepy.

So when she entered the examination room, and asked how I was, I just got weepy all over again. I apologized and explained that I am kind of spoiled by just how well my machine of a body typically works. And while there are lots of drugs for the nausea, the stomach cramps that I had been experiencing for three days were really just getting on my last nerve.

And what did my good doctor do? Well, she wrote me a prescription for something to reduce the acid in my stomach (still waiting for insurance to cover that, thank you). But first, she got up and gave me a hug. A really long one. Which made me cry again, of course, because I am nothing if not a one-woman answer to drought. Then she stepped back and said, "You need to do something for yourself this week. Pamper yourself. Get a massage."

Don't you love her? I'm getting a facial tomorrow (clean pores *and* a face, neck, and shoulder massage). Kisses to Dr. Kuan for the permission. If only insurance covered facials.....

Meanwhile, my numbers are still really good (like I said, I have a pretty good machine). So, on to the next and final AC infusion on Tuesday.

And Here We Are Again...

....on the other side. Mostly.

Day + 3 this time is much the way it was last time. My stomach is feeling a bit timid, but I'm drug-free and so feeling pretty good. I'm pounding the saltines and drinking the water, and even better--I'm not doped up on the sofa all day.

Tuesday evening, after the chemo, I was fatigued, but okay. Wednesday I was mostly okay, but fatigued. Thursday I slept and watched DVDs and ate some pretty bland food. Frank made pasta carbonara for dinner, which I enjoyed, but might have been a tad bit heavy for me. I didn't suffer too much, though, so, all in all, a good couple days.

We're lucky enough to be invited to several birthday parties this weekend, but I think we'll be seeing how I feel tomorrow before we make any social decisions for the weekend.

Meanwhile, my hair is mostly gone. I'd say I've lost a good 3/4 of it and it's so very sad looking. :-) I really wish it would just finish falling out so I could be done with it. I'm wearing lovely hats, including this very nice cap that Michael knitted for me (the pic is from before hair loss), and I'm sure the hats would be more comfortable without the pathetic itchy remnants of hair.

Lesson Learned

I'm guessing there's a reason that when the nutritionist was talking to me about diet, she did not include Mexican food from Juan's on the list of "rebuilding" foods.

I was in a truly cranky mood on Wednesday and so decided I needed Juan's for lunch to help comfort me. The words "big mistake" don't do the idea justice.

I have told my friends at work that if I even mention Juan's again in the next four months, they are not only to dissuade me from such madness--they are to slap me. Hard.

I had serious indigestion all night and most of the following day. It didn't really dissipate until last night. I don't think it was the spiciness of the food, per se, because it wasn't all that spicy. I think it was just the overall lack of any nutritional value in what I was eating. Loaded with fat and flavor, yes. But not much else, and my digestive system let me know how much it disapproved.

I promise I'll be good from now on. Really.

Numbers Are Good

I had my bi-weekly checkup yesterday with Dr. Kuan. My white blood cell count and platelets are within normal range. My red blood cell count is a bit low, but still okay, she says. Given that yesterday was the 9th day, she said that if my white blood cell count was going to be low, that would have been the lowest day. Other than that, I'm healing just fine from the surgeries and, assuming my numbers are just as good next week (they test my blood before every chemo infusion), I'm good to go.

I told her that I'd heard that the side effects were "cumulative", inasmuch as your body grows weary of fighting this stuff and the side effects become worse with each infusion. She said that was definitely true of the "numbers" (white blood cell, etc.) but not necessarily true of the nausea. I'm wondering if she's just trying to help me maintain some cautious optimism, because then we started talking about the inherent suggestability of some words/sensations (like nausea).

I told her about the poor ill man at last week's chemo orientation, and she told me about a patient she had when she worked in Houston. He lived outside of Houston and so had to drive in for his treatments. It got to the point where all he had to do was see the sign for Houston as he entered town and he became nauseous. Another patient only had to hear her name and he became nauseous. So, there you go (and there you are). The wonderful world of chemo side effects. :-)

....And Back into the Light

Whew. That was certainly an interesting three or four days.

To recap: I had my first chemo treatment on Monday. All went well and I was fatigued Monday evening and experienced some insomnia that night.

Tuesday I felt okay. A little light-tummied and tired, but otherwise, okay.

Wednesday? Ick. Not so great. I was still using the Emend (the finest in anti-emetic medications) but the nausea would not be kept at bay. So, I supplemented with another medication that just wiped me out. So I felt nauseous and dopey. Perfect. By the end of Wednesday, I was starting to feel better and was actually able to eat some real food (as opposed to the saltines, almond butter toast, and yogurt I've been consuming since Monday afternoon).

Thursday morning I felt pretty much the same, but without meds, so I took that as a very good sign. I stayed on the saltine/toast/yogurt diet and got through the day just fine.

And today, Friday, I feel very hungry. Yay! Frank made me some very tasty bran muffins with flax seed for breakfast and I might get really crazy and have half a sandwich for lunch. No, don't try to stop me... :-)

In other news, Frank and I attended the Chemotheraphy Orientation at the ABCCC last night. It was interesting (intentionally and unintentionally). First the intentionally interesting part. Among other things, we learned that a) cancer cells rapidly divide, and b) the way chemo works is to attack rapidly dividing cells. Of course, your system has other cells that are rapidly dividing. These include cells in your GI track and your hair & nail follicles. Which explains many of the side effects of chemo. There was a lot of other information, too, and it was useful, overall.

The unintentionally interesting part was when the pharmacist kept talking about the N/V (nausea/vomiting) side effects of chemo. She was obviously knowledgeable and experienced and knew her field, but English was not her first language. And so everytime she said "nausea/vomiting", it sounded a bit harsh and abrupt. She described the various stages of "nauseavomiting" explaining that you could have Level 1 vomiting would would not be very much, or you could have Level 5, which would be pretty much all the time. The man sitting to my left had not, thus far, experienced any of these side effects, but confessed that with our friendly pharmacist constantly saying "nauseavomiting", he was beginning to experience some pschosomatic symptoms. This did not seem to impress the speaker as she continued to say over and over "nauseavomiting". Finally, the gentleman stood up and said he thought he needed some air. Before he could get to the door, he started to swoon, and luckily one of the nurses was there to catch him. The poor man was out like a light. When we went to bed last night, Frank and I kept cracking each other up, saying "nauseavomiting" repeatedly—remembering the absolute oblivion of the woman who tortured that poor man into fainting. (And have I made you a bit queasy with that charming story?)

Sleep patterns are weird, but that's a lot easier to handle than the ickiness of nausea. Typically, it's Frank who's up at 4 or 5 a.m. each day. Today, I was up, too. I was very hungry and so had a small bowl of cereal to tie me over until breakfast. But I got plenty of sleep, so I'm feeling fine.

So, while I wrote on Monday, "One Down....", today, I feel that a bit more sincerely. Here's to hoping the next infusion isn't any worse than this one was.

Symptoms Update

Monday (infusion day) was pretty much fine. I had a low-grade headache for most of the day and that evening. I had some insomnia between 1:40 and 4 a.m., but otherwise, things were okay.

Tuesday I was a little light-tummied and my cheeks were flushed (I wasn't feverish, but I looked like I was). But I was able to go for a nice walk and I was mostly okay.

Yesterday? Ugh. On the one hand, I am happy to report that the anti-nausea drugs appear to be working. While I am occassionally feeing nauseous, I'm not getting sick. On the other hand, they kind of knock you out. I felt tired and or dopey most of Wednesday and that is just a drag.

I know, I know. I really should quit my whining. Imagine going through this without all the many anti-emetics available to me.... <sigh>.

Anyhoo. I slept well last night and have my fingers crossed for today.

One Down—Nine to Go

Frank and I checked in at the Alta Bates Comprehensive Cancer Center (ABCCC hereafter) around 8:30 this morning. Around 9, they took me to the VAD Draw room where I was swabbed and then they put the totally cool little hooked needle/catheter into the port. They drew blood for testing and then sent me back out to the lobby. I took the first of the Emend 3-day anti-nausea treatment pills and prepared to wait.

Typically, we're told, it takes them about 20 minutes to do the blood testing and then they start to gather your chemo meds, but they had some issues this morning and I didn't go back to the treatment room until about 10. No biggie, really. As Frank reminded me, this is the beginning of a marathon--there's no need for sprinting right now (i.e., chill).

I neglected to take my camera with me this morning (maybe next time?) so I shall endeavour to describe the treatment room. Imagine a large room, maybe half the size of a basketball court. In the middle of the room is a nurse station/counter. Lots of carts, and monitoring equipment, etc. scattered about. (Probably not "scattered". Probably placed. But to my untrained eye--scattered. I don't judge. I merely observe and report.)

Around the perimeter of the large room is a succession of glass door cubicles. There must be 20 or so of these little cubicles. In each cubicle are two easy chairs, a TV, a visitor chair, a bathroom, and cabinetry with supplies, etc. Also, primarily, of course, the automated IV machines that let them administer multiple fluids simultaneously.

I was seated and they took my vitals (again. Three times today I had my vitals checked. They are nothing if not thorough.) Jessica, the nurse, explained that first, they'd give me some anti-nausea meds with the saline IV. When that was done, she had to "push" the nasty Adriamycin (also known as Doxorubicin) through a syringe into the IV. It was the color of Kool-Aid or Hawaiian punch and it triggered my asthma. Just a bit of a drag, and Frank retrieved my albuterol inhaler from the car, just in case, but my body sort of picked up the slack and the asthma started to dissipate on its own, so I was fine.

It took about 20 minutes to finish up the two fat syringes (looked like about 25 cc's each) into the IV, and then Jessica put the bag of Cytoxan on the IV rack.

While we were patiently waiting (me with my fabulous elasto-gel therapeutic cold gloves, to try to minimize the effect of chemo on my hands and fingernails), the pharmacist dropped in to see if I had any questions about the meds they'd prescribed for me (three anti-nausea meds, in addition to the Emend I take the first three days of the infusion, and an antibiotic for if/when I spike a fever) and to make a list of everything I'm taking (including my asthma control meds).

He was pretty young and cute and very earnest and he typed up the list and printed a copy for me, so when I see a different physician for any reason, I can just whip out my list of meds for them. Most excellent.

When he was done, the nutritionist stopped in to talk about my chemo diet. First week is to "dextox" and to make sure I'm not taxing my system but ensuring I get what I need. Second week is the building week--lots of legumes and other non-heavy proteins (sardines, wild salmon, cottage cheese, eggs). She also recommended Glutamine powder the first week (yum!) and ground flaxseed. Oh! and the good/interesting news: she'd prefer I drink green tea, but that it not be decaffeinated. She doesn't like to have the tea any more processed than it need be. So, there you go. I *can* have a cup of tea in the morning.

When the Cytoxan was done, about an hour after it started, the nurse "flushed" the catheter with saline and then shot me up with Heperin (anti-coagulant, to prevent clots). She removed the needle and catheter and Frank and I were on our way home by about 12:15. One treatment done. Yay!

With all the anti-nausea meds, I'm being cautiously optimistic, and thinking I'll be fine tomorrow. But, we've been told that, if it's coming, tomorrow is when the nausea will hit. So, keep your fingers crossed.