Chemo #5

Chemo #5 was on Monday. My first appointment is always a blood draw. Two hours before the blood draw, I apply a thick layer of EMLA Cream (lidocaine 2.5% and prilocaine 2.5%) on my port and cover it up with plastic wrap and bandages. It numbs up the area so that I don't feel the Huber needle when it's inserted in my port. I learned in the past that applying the cream 1.5 hours before the blood draw didn't numb the area enough, so I always do it two hours early. The needle is left in my port after the blood draw so that it can be used for my chemo infusion.

About an hour later later, it's time for my infusion. A nursing assistant checks my height (it changes for some patients!) and weight (down to 98 lbs. 😮). Then they take me to an available infusion chair in an open area. The chairs are separated by curtains for privacy. But the Stanford infusion center has a certain number of private rooms available. I've been lucky so far in that I've always been able to get a private room. 

The nursing assistant checks my blood pressure, oxygen and temperature. At some point, an order is placed at the pharmacy for my chemo drug based on my latest height and weight. 

My nurse for the day then arrives and gives me premeds and starts a saline drip. The first two times I got Taxol, I was given three of the premeds intravenously (Pepcid, dexamethasone, Benadryl). Zofran was given to me in pill form. Starting with this third session of Taxol, only Pepcid was given thru the IV and the rest were in pill form. Dexamethasone should be taken with food, but I didn't want to break my fast. I took a chance that Pepcid will take care of any upset stomach, and it did.

The room usually feels cold, and I ask for two blankets. They're quite warm, as if they're fresh out of the dryer. Then I wait. The pharmacy must be very busy because it often takes two hours to get my chemo drugs ready. In the meantime the Benadryl makes me drowsy, and I manage a 20-minute nap.

A side effect of Taxol is peripheral neuropathy. To avoid that side effect, I apply cold packs to my feet and hands as soon as the Taxol infusion begins. You can see in the photo the blue cooler I brought with several cold packs. I also ask for a cup of ice that I chew on. It's supposed to help prevent mouth sores.

The Taxol infusion takes an hour. The Taxol and saline drip makes me pee several times. I have to drag the IV stand with me every time I go to the bathroom. 

When the Taxol is done, the nurse removes the Huber needle from my port and applies a bandage. My first appointment was at 10:20, and I didn't leave until 3:15. That's five hours for basically a one-hour infusion with a lot of waiting in between.

My cousin Nancy gave me a ride this time. I think I'll be okay driving myself for these infusions, but friends insist on giving me a ride, so thanks.

Chemo #4

My chemo yesterday was for Taxol only. Herceptin and Perjeta will continue every 3 weeks. 

My WBC last week was 9.7. Yesterday it was 6.3. I hope it doesn't go lower or I'd have to get a Neulasta shot again.

Because my chemo is now weekly, I fast for a shorter period. Instead of 4 days, I limit it to 2.5 days. On the day before chemo, I did consume something -- vegetable juice and some nuts. On chemo day, I did a water-only fast and continued for 24 hours after chemo infusion ended. Yesterday my infusion ended at 1pm, so I didn't eat anything till after 1pm today. I did get hungry yesterday but didn't eat. I didn't want to risk getting side effects by breaking my fast too early.

I do have a new side effect that started last week. My mouth is producing excessive saliva. It's not too bad but is an unusual side effect. I don't see it listed as a Taxol side effect at all. At least it's better than having a dry mouth.

Side Effects from Taxol

Because Taxol will be administered weekly, I'm getting a lower dose compared to Taxotere, and my doctor said I should experience milder side effects. I haven't had to take Zofran at home at all. No diarrhea. No fatigue. I felt a few tiny instances of nerve pain yesterday but didn't have to take gabapentin. While I haven't felt like I have heartburn, I'm avoiding foods that can trigger it.

That doesn't mean my other side effects have gone away. My skin is extremely dry. I keep seeing flakes of skin on my clothes. Food doesn't taste the same. It's not horrible but not great either. I've lost of a lot of muscle and am doing a poor job of eating more protein.

My next chemo is tomorrow. I started fasting again today.

Chemo #3

I had Chemo #3 today. I've switched from Taxotere to Taxol. One difference is that I don't have to take meds at home to prep for the chemo. But for Taxol, I was given premeds: 8 mg Zofran, 20 mg dexamethasone, Pepcid AC, and Benadryl. The Zofran was in pill form. The rest were IV and were given to prevent allergic reactions to Taxol. 

The Benadryl made me somewhat drowsy for a couple of hours but not terribly no. Nothing like how I feel when I take the non-drowsy formula of Dramamine. It makes me very drowsy, and all I want to do is sleep.

My WBC has gone down from 32 to 10. I'm surprised it dropped so much in just four days.

Nausea from Taxol is supposed to be milder. I may not get nausea at all. My doctor and chemo nurse both suggested waiting till I feel sick before taking Zofran at home. But I don't know if I'm brave enough to wait. I don't want to experience any nausea at all, not even mild.

Instead of fasting for four days when I had chemo every three weeks, I've modified my fast to 2.5 days, including 24 hours after chemo infusion ends. My modified fasting diet yesterday was supposed to consist of butternut squash soup only. But I cheated and had a few nuts and seeds and olives to help me feel full from the fat content.

Today I'm doing a water-only fast, although I hadn't planned on doing so. I was hungry earlier this afternoon but not tonight. I'll see if I can continue till 3pm tomorrow drinking water only.

Chemo #3 Postponed

I went to Stanford today for my third chemo session. Blood test showed that my WBC (white blood cell) count was 32. Way too high. Normal range is 4-11. Taxotere lowers my WBC, and I get a Neulasta shot to raise it back up. Dr. Caswell thinks I'm a hyper-reactive to Neulasta and recommended switching from Taxotere to Taxol so that I can skip the Neulasta.

Dr. C has recommended Taxol in the past. I refused because Taxol is given weekly and I would have to fast every week. But I said yes this time. I will modify my fast to two days instead of four, but I will have to limit my fasting diet to simple vegetarian soups and broths, no nuts.

There are advantages and disadvantages to switching to Taxol. First the disadvantages:

• Weekly infusions instead of every three weeks. That means six more chemo sessions instead of two.
• I have to fast more often and with a limited choice of food but for a shorter period.
• I will be given Benadryl to prevent allergic reactions, and it will probably make me drowsy. I hate feeling so drowsy. And I won't be able to drive myself to the chemo sessions.
• Because my last chemo session will be on approx. Feb. 22 instead of Feb 4, surgery will be delayed by at least 2.5 weeks, most likely in April instead of March.

Advantages:

• Fewer medications to take. While I'll be given dexamethasone at the infusion, I won't have to take it for three days at home. I can limit Zofran to once a day, which should minimize the accompanying constipation. I can also skip Ativan, Neulasta and Claritin.
• Milder side effects. Or so I'm told. 
• I had read in the past that Taxotere works better than Taxol. But the recent DAPHNE trial showed 55% pCR (pathologic complete response) using Taxol. 
• Taxotere can permanently block tear ducts and cause permanent hair loss. Taxol doesn't have these side effects.

I'm still waiting for my insurance to approve the switch to Taxol, but my next chemo is tentatively scheduled for Tuesday, Jan. 19.

Improved Shoulder

I've had several physical therapy sessions, and my shoulder is much improved. I can raise my arm forward almost overhead. Sideways motion is not as good but is improving.

The therapist manipulates my shoulder at these sessions. Today there was a lot of cracking noises. She said that was good. I was afraid she was breaking something. 

At the last two sessions, she also did cupping. I don't know if it helps, but it doesn't hurt except that I'm left with weird round bruises on my back from the cups.

My next chemo is tomorrow. I don't want to go. But I started fasting again yesterday.

New Side Effects

Overall the side effects from the last chemo haven't been as bad as the previous one, but I do have a couple of new side effects:

1. Taste buds -- Food tastes a little off. Not metallic but maybe slightly bitter. Even water tastes funny.
2. Appetite -- I know I'm not eating enough, especially protein, but it could be related to the taste change. The lack of protein could be why I dreamed twice about eating meat (and it was so good!).
3. Irritated eyes -- All day yesterday I had intermittent irritated eyes. It might be due to the chemo drug Taxotere leaking into my eyeballs. My ophthalmologist warned me about this. If it continues, I will make an appointment to see him again.

The side effects that showed up after my first chemo are ongoing:

1. Dry skin -- Not just on my face but throughout my body.
2. Dry mouth -- I use Biotene.
3. Diarrhea -- Not as bad.
4. Constipation -- Not as bad because I didn't take as much Zofran.
5. Heartburn -- Unpleasant but it hasn't caused vomiting.
6. Nerve pain -- Not as bad but I'm also taking two gabapentin capsules instead of just one.
7. Raw nostrils -- It got better for a couple of weeks but is back again.
8. Hair loss -- I think my eyelashes are starting to go.
9. Runny nose -- I've used up a few boxes of tissues.