Chemo - How it Worked for Me, Days 1 and 2

Okay, so this is what chemo was like for me the first time:

12pm: Arrive for appt at oncologist (Dr. Rinn) office, pick up paperwork for blood draw, and wait in a different lineup

12:15: called for blood draw - my first draw from the portacath. I had a nice nurse, who talked me through it, and it didn't feel too bad. They give me a tiny injection of lidocaine (sp?) into the cath so that I don't feel the bigger needle that is the IV, and that seems like a good system - pretty tolerable.

12:30: Wait again for Dr. Rinn. Get my blood pressure and other vital stats taken, answer questions about general health. Then Dr. Rinn came in, and I asked her my questions:
What was my FSH score? (Can't remember what the acronym FSH stands for, but it's a more accurate/more expensive her2/neu test.) My score was 9x the normal her2/neu gene....in other words, I am DEFINITELY her2/neu positive.

With Herceptin, is this a more treatable cancer than other types? Yes. Herceptin has changed the landscape, and is a miracle drug in many ways.

Will I get radiation? This is still undetermined. With zero positive nodes, the answer is no. With four positive nodes, the answer is yes. Since I have one positive node, it's on the fence. Later in the process, I will see a radiation oncologist to decide. Radiation would be given after the full course of chemo treatment, in any case.

What kind of hormone therapy will I get? At this point, we're looking at a drug called Femera (sp?) as more effective for me than Tamoxifen.

What can we do about nausea as a side effect? Lots of things! I got a high-density (lasts 5 days) Zofran IV before chemo, as well as a VERY strong drug called Emend that is taken orally for three days starting on chemo day, and four other prescriptions, two of which I take twice a day and two of which are on as "as needed" basis. One is also a steroid, which apprarently helps with joint pain, another possible side effect, as well.

What is my follow up for each chemo? The next day, in addition to keeping up with the many drugs I'm prescribed, I have to come back to the hospital to get a Neulasta (sp?) shot. The shot boosts white blood cell production, and enables me to do the dose dense chemo that I am taking. Dose dense without a white blood cell booster is almost impossible because the blood counts would get too low, but it's better to do dose dense (for me anyway) because it blasts the cancer before the cancer has had a chance to recover from the last chemo treatment, and studies have shown this to improve the odds. (Dose dense means having the same dose every two weeks instead of the standard every three weeks.)

Do I qualify for any clinical trials? At this time, no. There is a "dose denser" trial (chemo every week) but it doesn't allow for patients with Herceptin, and since Herceptin is such an important part of my treatment, there is no way to join that trial.

Should I have a hysterectomy or an oopharectomy? Unknown. It is important to remove the entire fallopian tubes, and sometimes that can't be done with an oopharectomy. I need to follow up with my OB/GYN (who will perform the surgery) and Dr. Rinn will ask her colleagues as well.

There were other questions as well, but these were the main ones. There was some debate about whether this was too soon to start chemo after my previous surgery/drain removal, but with Dr. Dawson's blessing and my somewhat miraculous healing rates we believe that the risk is small for starting "early" - what a relief for me.

Michele took notes through the meeting and asked the questions that I was somewhat too overwhelmed to remember, which was incredibly helpful. Thank you, Michele!

Then, we were transferred to another waiting room, on another floor, to wait a while for chemo. We were able to eat (I'd packed a lunch) which was good because it was 1:30 by this time and we were ravenous....but when we got in they offered us lunch! Guests and chemo patients have a whole smorgasboard of food to choose from (fruit, sandwiches, drinks, cookies, etc.). I had to take an Emend immediately because it has to be in the system for an hour before chemo begins, so we just sat and chatted and watched the clock, trying to ignore the soap operas on the TVs to either side of us (shielded partway by curtains). When the hour was up, Ryan called to say that he was on his way - hooray! - and he arrived before the actual chemo drugs were hooked up.

Then, I got saline drip and chemo. The Cytoxan is a small IV bag, but the Adriamycin is delivered through a syringe (two actually) into the port, by hand. Neither one hurt, and it was not unpleasant for the most part. The Cytoxan caused me some sinus pressure and pain (headache), and because of that they slowed my drip rate to take an hour instead of a half hour. It was noticeable, so I'm glad they did that.

When all of that was in me, they unhooked me, and sent me on my way! It was about a 3 hour process, I think, not including the doc appointment beforehand (and usually the doc appointment will be shorter, but I'll always have to do the blood draw to make sure my counts are up enough to have chemo - otherwise, I have to be hospitalized or delay chemo if my numbers are too far off).

I felt a bit woozy, but nothing I couldn't deal with, as I left the hospital. The "barf bucket" (a bucket WITH A LID, and a package of tissues....something I read about that sounded like a good idea because throwing up in a car on a freeway sounds pretty bad without a barf recepticle) sat patiently waiting for me, but was unused. I hope it remains unused!

My sense of smell is heightened - the lavendar out front smells divine - and I fight some minor nausea, but today I haven't had to take any "extra" pills. I'm fatigued, but not unbearably....I hope to go for a walk with Tessa again tonight.

The Neulasta shot was today, and sweet lovely Heather drove me and even bought me an iced Starbucks coffee. The shot had to be delivered subcutaneously (like a shot for diabetics) so the port was not help today, but though I was told it would sting, it didn't feel bad at all. I had them do it into my belly - which fortunately or not, depending on my perspective, is fatty and easy to inject, and I will repeat this next time because it felt okay. Plus, I had a nice nurse (with a three year old daughter, Mary Catherine) who massaged the site as the injection went in, and I think that helped.Its main side effect is joint pain, for which I am welcome to take Tylenol or Motrin or whatever. So far so good - and they say the first 48 hours are the worst.

I am scheduled every two weeks for this type of chemo (Adriamycin/Cytoxin) and then I will switch to Taxol and add in Herceptin as well. If this is as bad as it gets, I'm going to be just fine. Some people have nausea kick in on days 3-5, but I'm hoping that luck will be on my side.

And there's the long of it! I hope that answered a lot of questions - especially for people like Susan who have yet to begin chemo. My final analysis? It's not nearly as bad as I'd expected. And that, my friends, is delightful.

Love,
Kristina