IgM Antibody Negative

I saw today that Stanford redid my antibody test and corrected it to negative. I don't know what made them decide to redo the test. But I'm glad I don't have covid.

Covid and Antibodies Tests

On 12/21 I took a covid test as a requirement for my next chemo. The nurse inserted the swab way up my nose, swirled it around 10x, left the swab in my nostril for 10 seconds, then swirled it around some more before pulling it out. Yes, it was unpleasant as it sounds. That test came out negative.

On 12/28, the day of my second chemo, I was tested for covid antibodies. IgG antibodies develop 7-10 days after covid symptoms begin and remain in the blood after an infection has passed. I was negative for IgG.

IgM antibodies are produced as a body's first response to a new infection. It indicates you may have been recently infected. This afternoon I was told I was positive for IgM. I have no symptoms and hope it was just a false positive. 

But I had to take another covid test today. The nurse inserted the swab way up my nose, waited 10 seconds, then swirled it around 5x. While unpleasant, it wasn't as bad as the previous one. Unfortunately it will take 5-7 to get the test result. I really hope it comes out negative and that my friend who was helping me out doesn't get covid from me.

Dexamethasone

I'm supposed to take the steroid dexamethasone the day before, day of, and day after chemo. The dosage is two 4 mg tablets with breakfast and lunch. I realized today that I had been taking only one tablet at a time with the exception of the one given to me at the hospital. 😯

Dex is supposed to minimise delayed nausea and vomiting and help with other side effects. I haven't noticed any ill effects from my lower dose of dex. I've even reduced my Zofran from 3x a day to 2x a day. I wonder if my fasting helped. There was a trial where patients who fasted and didn't take dex compared favorably to patients who didn't fast but took dex.

Hair Loss

My hair started falling out on Dec. 17. I wasn't ready for a buzz cut. Hair kept falling out every day. Finally this morning I saw that I had hardly any hair left and decided to get my head shaved. It's not totally bald but is not a buzz cut either.

I thought I might cry when I got my head shaved, but I didn't!!! Now I'm cold.

It was my friend Sindhu who shaved my head. She also took me to Stanford yesterday and stayed with me last night and is staying again tonight. She also bought Thai food for lunch. Last night and tonight we played board games. I won only once. 😠

Chemo Cycle 2

I had my second chemo yesterday. Arrived at 11:30. Didn't leave till 18:15.

First appointment was for a blood draw. At my previous blood draw, I applied Emla cream on my port 1.5 hours before the blood draw and felt the needle deep inside. This time I applied Emla 2 hours ahead of time and didn't feel the needle at all. Yay! They must have taken at least 10 vials of blood. One of the tests was for covid antibodies, and I tested negative.

Second appointment was with my doctor. She said my tumor is getting smaller and also softer. I do feel a difference.

My WBC (white blood count) is higher than normal due to Neulasta. Technically I'm not immunocompromised at the moment. But I'm also slightly anemic, possibly due to chemo or meds I'm taking.

My doc recommended taking Zofran only once a day partly to ease constipation but also because she doesn't think Taxotere causes too much nausea. I'm afraid to cut it down from 3x a day to once a day but will compromise with twice a day. Constipation is already starting. I ate some prunes with dinner.

My infusion was at 1:30. Got saline for over an hour while waiting for my meds to be prepared. Perjeta took 30 minutes followed by 30 minutes of observation. Herceptin was also 30 minutes. Taxotere didn't start till 16:45 and took one hour. It did not give me diarrhea this time. But the heartburn is back.

Chemo Dosages

I ran across this article that talks about using lower dosages of chemo drugs. It mentions one of my drugs, trastuzumab (Herceptin). I'm supposed to be on it for a year. 

There was a large U.K. study that showed that six months on the drug was just as effective as 12 months. But there was also a French study that showed that six months was not as effective.

One serious side effect of Herceptin is heart problems such as reduced heart function and congestive heart failure. That's why I had to get an echocardiogram before starting chemo. I'll have to ask my oncologist for her opinion about the studies. It would be nice not to have to be on Herceptin and Perjeta for a year.

Tear Ducts

One side effect I was worried about was blocked tear ducts due to taxotere. My optometrist had told me before that my tear ducts were already blocked. But when I had a check-up last month, the other optometrist I saw did not mention the problem. 

So I visited an ophthalmologist today to see whether my tear ducts really are blocked. He did a test using a yellow dye and said my tear ducts are fine. What are blocked are the oil glands on my eyelids. I have to apply a warm compress to my eyes and also massage them twice a day. My eyes are also dry and was told to apply artificial tears 4x a day.

The doctor said what I need to watch out for is get excessive tearing. If it happens, that's when I need to return for a follow-up.

So Many Side Effects

I did a version of the fasting-mimicking diet for 3 days before my first chemo, expecting that it would help minimize side effects. But I don't know if it helped at all. I experienced so many side effects. Here's a list.

• Constipation
• Diarrhea
• Stomach cramps
• Heartburn
• Nerve pain
• Dry skin
• Dry mouth
• Raw nostrils
• Hair loss

The skin on my face is peeling off. My nostrils feel so raw. I still have heartburn. The diarrhea comes and goes. And yes, I'm starting to lose my hair. I will have a get a buzz cut soon. At least the nerve pain is dwindling down.

CBD and THC

My friends George and Diane realized I was having a hard time and drove 3+ hours from Pismo Beach to help me out. Having them around helped ease my recovery from all the side effects I was having. 

Diane brought CBD gummies. I've been taking the Sparkling Pear gummy (2 mg THC, 6 mg CBD per gummy) during the day and the Midnight Blueberry (5 mg THC, 1 mg CBN per gummy) at night, mostly for pain but also for anxiety. I usually take 1/4 to 1/2 gummy per day. They don't make me high. In fact I don't notice any effect from them. They may or may not be helping. I don't know because my pain is dwindling down and I still take gabapentin at night.

We did a drug run while George & Diane were here. I ordered CBD tincture (20 mg CBD, 4 mg CBDA, 1 mg THC,  0.3 mg THCA). The dispensary was in San Jose. I was expecting a small storefront. Instead it was a huge warehouse where they grow their own weed. We did curbside pickup. 

I just placed an order for more of the gummies just now because they're on sale for 30% off. I'll do another drug run tomorrow. The taxes are expensive! 

Tramadol

I was afraid to try the Tramadol for my pain because of all the side effects. My pain had been subsiding but came back Tuesday, so I finally tried one Tramadol in the late afternoon. It made me drowsy but I couldn't sleep. I took another one at bedtime. It made me extremely drowsy, but I still couldn't sleep at all. I felt so horrible. It was an awful, awful feeling, even though technically it was just drowsiness. Not only that, but the Tramadol didn't entirely eliminate the pain. 

At 3am I called my cousin Joy in Florida in tears. Fortunately she was already up. Sitting up actually made me feel better, and I spent over an hour on the phone with Joy. I'm not sure I slept at all the rest of the morning, then I had to get up at 8am to let the plumbers in.

When I talked to my doctor later, she said I was too sensitive to the Tramadol. She also thinks that because my pain moves around, I might be having nerve pain from the chemo, not bone pain from the Neulasta. She prescribed gabapentin. I tried one pill last night along with some Advil and 1/4 of a CBD gummy. Together I was pain free and able to sleep till 3am. I had trouble going back to sleep though. Tonight I'll add melatonin.

Addendum: In addition to not eating much due to diarrhea, I was also suffering from heartburn due to chemo. After talking to Joy, I kept burping. I should have just stopped but was so uncomfortable. I ended up vomiting from all the burping. Fortunately I had a barf bag handy.

Rough Night

Last night I started getting bone pain from Neulasta. I took 400 mg Advil at 10:30 pm, Claritin at midnight, and 1000 mg Tylenol at 1:30 am. My doctor and nurse said Claritin and Tylenol would take care of the pain, but that wasn't the case. I kept waking up in pain over and over again. I'd rate it as moderate pain, not severe, but it was very uncomfortable. 

The pain wasn't in just one part of my body. One minute it would be in my left shoulder, the next in my right elbow, then in my thighs, then my lower chest, etc. Often it would be in multiple places at once.

Most of the pain eased up by morning. I called the chemo nurse and was given a prescription for Tromadol. I hope the pain doesn't come back because among Tromadol's side effects are nausea, vomiting and dizziness. Ugh. 

I spent most of the morning and early afternoon catching up on sleep. I still get occasional pain. Just now my elbow started hurting.

In the meantime, the nurse said to continue taking Claritin and Tylenol. I might take Claritin for 10 days. I'll ease off on the Tylenol once the pain stays away. Next time I'll start Claritin on chemo day instead of waiting till the next day like my instructions said.

Oh, I got a slight nosebleed this morning too. I turned on a vaporizer in my room to see if it helps.

Pill Organizer

You know you're taking too many drugs when you need a pill organizer. On a couple of occasions, I couldn't remember if I'd taken a pill less than a minute after taking it. Then I'd have to count the number of remaining pills in the bottle to confirm. So I thought I'd better do something about it.

I'll continue with Zofran for one more day. I'm taking Ativan tonight too because it also helps with nausea. I haven't felt nauseated but am not taking any chances. Dexamethasone I stopped yesterday.

Claritin I'll take for about 10 days. The nurse I spoke to today said it's fine to continue taking it. He said if I don't take it and bone pain starts, Claritin won't work. I think it's Claritin that's making me drowsy today even though the packaging says it's non-drowsy.

I'm taking meds for high blood pressure. My oncologist recommended Vitamin D, so I got some gummies. I'm also taking L-Lysine capsules to see if they prevent mouth sores. The pills are so big. I hate swallowing them.

Neulasta and Bone Pain

I mentioned Neulasta before. Because chemo can reduce your white blood cells, increasing your risk of infections, Neulasta is given to help the body make white blood cells. For my first chemo session, a self-injecting patch called Neulasta Onpro was applied to my belly. A few minutes after application, it automatically stung me with a small needle. The needle then withdrew and left a thin catheter in my belly. 

Twenty-seven hours later, it beeped and started delivering Neulasta over a 45-minute period. It didn't hurt. I just felt a little warmth in the area. When it was done, it beeped again. There was as indicator to show that the patch was now empty. I pulled off the patch from the narrow end and could see the catheter. A tiny spot of blood appeared on my belly, and I cleaned off the area with soap and water.

Front of the cartridge showing it's empty.

Back of the cartridge showing catheter on top.

Neulasta affects histamine, inducing inflammation and swelling in the bone marrow and resulting in bone pain. The antihistamine Claritin decreases inflammation and swelling in the bone marrow and therefore reduces the pain. My chemo instructions said to start Claritin tomorrow, but I started it this morning and will continue for at least 5 days.

When Ma got Neulasta, she was in severe pain and needed Vicodin. My oncologist said she had never heard of pain that bad from Neulasta. But there are many reports from women who experience unbearable bone pain even when they take Claritin. Now I'm worried. Maybe I should have started Claritin yesterday and continue for at least 10 days. I can also take Tylenol. There's a study showing that Claritin and Pepcid AC may work together.

First Chemo Session

Short Version

I was at Stanford from 8:40 am to 5:00 pm for a blood test, visit with oncologist, and chemo. The drugs were given in this order -- Perjeta, Herceptin and Taxotere. I got slight diarrhea and cramping as soon as the Taxotere infusion ended. The only pre-med given to me was 8 mg Zofran in pill form. As soon as I got home, I took another Zofran and two Imodium.

Very Long Version

First thing in the morning, I applied EMLA cream on my port area around 7 am to numb it up. My appointment for the blood test was at 8:40. I still felt the needle when it was inserted, but it wasn't too bad.

My visit with the oncologist was at 9:30. My weight is down to 103. It had been 114 in early October when I first found my tumor. The weight loss is due mostly to anxiety, but I've also been fasting for my chemo.

My blood glucose was 170 mg/dL due to dexamethasone. That's very high. It's supposed to drop after I stop taking dexamethasone. I have one more day to take it.

Chemo was late getting started. Appointment was at 10:30, didn't get called til 11:00, then had to wait for doctor's orders, then wait for the pharmacy to fulfill the order. Also Mondays and Fridays are busy days at the infusion center.

The nurse gave me an overview of the drugs and side effects. Eventually she asked me if I worked in the medical field because I either asked good questions or already knew the answers. Several doctors and nurses have asked me the same question. I always confess I just google a lot.

I have to get a covid test before every chemo. They forgot to order one for my first chemo.

I wore a big shirt for port access. It worked out fine. I was thinking of making my own chemo shirt by modifying a t-shirt with a velcro opening on the right side for the port, but there's no need.

I was given only one pre-med -- 8 mg Zofran for nausea. I'm surprised they gave me a pill, not an IV.

Meds didn't start till 12:09. I thought I would receive the meds in this order: Taxotere, Herceptin, Perjeta. Instead it's the reverse order. Perjeta first for 60 minutes followed by 30 minutes of observation for reactions, then 90 minutes of Herceptin, then 60 minutes of Taxotere.

The needle in my port gave me intermittent mild pain. Sometimes shifting my position made the pain go away. Receiving the IV drugs did not hurt.

When I got the Taxotere, I put ice packs on my hands and feet to prevent neuropathy. I put an ice pack on my head to minimize hair loss. I chewed on ice chips to prevent mouth sores. Don't know if any of them will work.

As soon as the Taxotere infusion ended, I got stomach cramps and slight diarrhea. The cramps got so bad I thought I would throw up, and that was while I was still at the hospital. I took 2 Imodium when I got home.

Last step at the hospital was a Neulasta patch called Onpro. Chemo lowers your white blood cells, making you susceptible to infections. Neulasta raises your white blood cells. Then Onpro Patch automatically injects you with Neulasta 27 hours after it's applied. It feels weird applied on my belly.

Removing the needle from my port stung a bit. I didn't expect that. There was some slight intermittent pain for a few hours.

I took 8mg Zofran for nausea when I got home and at midnight. This was not in the list of instructions given to me. I had to ask the nurse. My instructions said to take Zofran every 8 hours starting tomorrow. I'm not waiting till tomorrow. I'm also not going to wait till I feel sick because Zofran takes 2 hours to take effect.

I've been trying my own version of the fasting-mimicking diet to help minimize side effects and was disappointed it didn't prevent diarrhea. I also didn't expect the side effect to start so soon. I thought it would happen a day or two later. I suppose it would have been worse if my stomach was not empty.

Lymph Node Biopsy Result and Gene Test Result

My lymph node is positive for cancer. That makes me Stage IIB instead of IIA. My chemo treatment does not change.

I also got the BRCA gene testing done because Ma was triple negative. My test shows I'm negative for the gene.

Plumbing Emergency

I was in the kitchen when I heard what sounded like splashes of water. Found two puddles of water in the entry hall and the hall leading to the kitchen. Then I saw that the coat closet wall was wet and had peeling paint. Same with the opposite wall for the utility closet. The floors inside both closets were also wet.

I called the HOA, and they sent a plumber right away. Half an hour later, two more plumbers showed up from another company. The HOA manager forgot to cancel the first plumber. But the first plumber was able to find the leak before leaving. The other two plumbers finished the job. Before any of the plumbers even arrived, one of the board members stopped by to check out the leak. 

My friend Sindhu will take me to chemo in the morning, then she'll come back to my place to let the plumbers in. They need to cut out the wet sheetrock and let the interior dry out.

I expect that the HOA will pay for the pipe repair, but I'm responsible for the sheetrock repair. I've opened a claim with State Farm, but my deductible is $1000. I don't know if the sheetrock repair will cost that much.

The plumber said he will recommend that the HOA replace my pipes with copper. The old galvanized steel pipes are pretty corroded. Ten years ago I had a similar leak in the same area. One good thing about this fix is that I now have hot water in the faucet in my master bathroom. For a long time I was getting only a trickle, possibly due to a blockage somewhere along the pipes.

I'm very happy with the service I got from the HOA, the board and the plumbers. I did mention that I start chemo tomorrow. I don't know if that made a difference in the speed of the service. But I got prayers and good wishes, and one of the plumbers said he's a cancer survivor himself.

Breast Cancer Support Group

I finally got around to joining a local support group online. It's not just for newly-diagnosed patients but also those already undergoing treatment. It was supposed to be only for an hour but lasted two hours. 

There were 10 of us, including the moderator, in various stages of treatment. One had just been diagnosed, some are already undergoing chemo, several already had surgery, one had surgery and doesn't need chemo, a couple are undergoing radiation, etc. 

A few people have tried fasting with mixed results. A useful tip was to try acupuncture if I get neuropathy. The group meets every Saturday afternoon. I'll try to join them every week. I'm sure I'll have questions for them as I undergo treatment.

Biopsy of Left Axilla

Today Stanford was able to squeeze me in for a biopsy of the suspicious lymph node in my left underarm. I had to hold my left arm, the one with a frozen shoulder, in an uncomfortable position for a while. I told the radiologist that my last biopsy was extremely painful. She gave me extra lidocaine. It took a while to receive the painkillers. The medical assistant and ultrasound tech distracted me by rubbing my legs and arm while I received the shots. It helped. But I probably shouldn't have watched the ultrasound screen showing the needle going into my underarm.

The procedure was a core needle biopsy. The radiologist took four samples. I was pretty numb, so it wasn't painful, but it was not a quick procedure. There was a clicking sound every time she took a sample. I probably shouldn't have watched the needle on the ultrasound screen.

The last step was to insert a nickel marker and tattoo dye in the lymph node. I felt the needle for the tattoo going in, but it wasn't too painful. I probably shouldn't have watched it on the screen.

After that they took a mammogram of the underarm area showing the marker. It wasn't too bad. The mammo tech got a good pic on the second try.

I was given a compression wrap to wear over my chest. I'll wear it overnight. It also helps keep the ice pack in place. My after-care instructions says to ice the area for 10-15 minutes several times for 24 hours. The painkiller was just starting to wear off, so I took some Tylenol. Overall this experience was so much better than my previous biopsy. 

My friends Ratu & Clint gave me a ride. I'm glad they insisted on helping. I could have driven myself but found the procedure stressful. Ratu also brought me a big box of groceries with apples, potatoes, carrots, celery, peanut butter, pasta and lots of canned goods with fruits and vegetables. I don't have to go shopping for a while. Thanks again, Ratu and Clint!

My chemo is scheduled for Monday, Dec. 7. I think it's finally going to happen this time.