Chemotherapy Rounds #5-8: September-December 2011

Chemotherapy Rounds #5-8
Round #5: Wednesday, 28th September 2011 - Tuesday, 25th October 2011
Round #6: Wednesday, 26th October 2011 - Tuesday, 15th November 2011
Round #7: Wednesday, 16th November 2011 - Tuesday, 8th December 2011
Round #8: Wednesday, 9th December 2011 - Tuesday, 28th December 2011

Chemotherapy becomes practically routine. That doesn't mean it sucked less, and each round would have it's own flavour - sometimes I would be expecting it to be really bad & I would feel better than expected, then I would go into the following round feeling more confident & it would wipe me out really bad again. There is also a cumulative fatigue that sets in... because you are allowed just barely enough time to recover from the last round before they hit you again, the fatigue gets slowly worse & worse. The positive news was that when I wasn't wiped out from treatment, I actually felt pretty normal - no more symptoms from the cancer itself, just from the treatment.

Round #5 was delayed a week due to my low neutrophil counts. Neutrophils are a type of white blood cell that fights infections. When you're on chemotherapy, there is a series of blood tests that are done the day before each round, to make sure your body has recovered sufficiently to handle the chemo. One of the tests done is counting your neutrophils. 1.5 and above are considered normal, 1 - 1.4 are considered mild neutropenia (you are mildly more vulnerable to infections), .5 - .9 is moderate, and below .5 & you are severely vulnerable to infections. My blood work on Wednesday, 28th September 2011 before my doctor's appointment was 1.4. The whole neutrophil thing over rounds #5 & #6 really showed how different doctors have different approaches. My pre-chemo doctor's appointment for round #5 was the first with a doctor other than Dr. Katakkar, because he was out of town. I saw the other full-time oncologist, Dr. Bishop, instead. His approach with the lowered neutrophils was to delay chemo until I was above 1.5. This was my first delay in treatment. The initial blood test was done on Wednesday, so Dr. Bishop scheduled me to come back the following Monday morning to be retested, and assuming my level was recovered to 1.5 or above, I would receive chemo right after. As it turned out, the blood test on Monday showed the level hadn't budged, so I was scheduled for the blood test again in 2 days, Wednesday. The third blood test on Wednesday, 5th October 2011, showed my neutrophils finally up to 2.0, so I had chemo #5 starting Thursday, 6th October, one week later than originally scheduled. I seemed to have a somewhat rougher time with chemo #5, I thought probably because the extra week off was an extra week to forget a little how crappy chemo makes me feel.

When I went in for the blood work for round #6 on Wednesday, 26th October, my neutrophil level was 1.3, but Dr. Katakkar was back, and I got to see a different approach. He decided to go ahead with chemo as scheduled, but also prescribed a week of Neupogea shots to boost my bone marrow's production of white blood cells. I had heard about these shots before, from nurses & other cancer patients. It's a very expensive drug ($1,318.38 for 7 little vials of the lowest dose). When we went in for chemo #6 on Thursday, 17th October, the nurse gave Sterling & I a little training session & all the paraphernalia we needed - syringes, disinfectant wipes, a sharps container, and a printout of detailed instructions. She recommended doing the shots right before bed, and taking a couple Tylenol a half-hour before doing the injection. The most common side effect is bone pain, which she described as being similar to growing pains in the bone when you're a teenager. Best to pop a couple Tylenol & then sleep through the worst of it. I was lucky in that I never really noticed any pain/side effects, other than dreading the shots themselves. Sterling gave them to me, starting the day after chemo (Friday) and the last one the following Thursday night. The shots need to go into fat, so we did them in my belly. Sterling was a little nervous, especially that first night, overcoming the natural instinct to not poke a sharp object into someone you love. But he did awesome, and I am so grateful because I don't know if I could have done it to myself. The only other thing of note for chemo #6 was that I got the baby bottle off on my 33rd birthday, 1st November. Happy Birthday to me! It's weird having your birthday after being diagnosed with cancer - you're just so grateful to still be alive, to have made it to see another birthday. And even though treatment has been going extremely well for me, I did think morbid thoughts, like will this be my last birthday? Since I was just finishing chemo on my birthday, I wasn't up for any celebrations on the actual day, but my work had a really nice birthday lunch for me on the following Friday. It was a sweet gesture.

I was glad when the bloodwork for chemo #7 came back & my neutrophils were much higher (2.1) thanks to the shots the previous round, so the shots weren't needed for this round. I had heard from other patients that once they started needing the shots they needed them every round, and I like to avoid as many pokes as possible! Round #7 wiped me out entirely, it was when I really felt the cumulative fatigue catch up with me. The day I got the bottle off (Tuesday, 22nd November) I got winded sitting at the table eating a bowl of soup! It was awful, literally just sitting up lifting a spoon to my mouth repeatedly almost took more than I had. I hadn't been too exhausted to eat since round #2, which was my eating-is-really-hard-no-appetite round. The fatigue did get better, of course, but I was just dreading more chemo. During most rounds, in the worst of it, there would be moments, hours, days when I would think, I can't go through this again. But that feeling was really strong in round #7. I was worried about the upcoming CT scans, that they would say I needed another 3 rounds.

I was scheduled for two CT scans, on Thursday, 1st December & Friday, 2nd December. This was what we had been waiting for since the last scans after round #4. Dr. Katakkar had pretty much refused to talk about a long-term treatment plan until after these scans. The first one was a bit of a gong show. It was the same scan I'd had twice before, of my abdomen. It involved drinking Telabrix contrast on a schedule over the two hours preceding the scan. Then they inject an IV contrast as well. Last time I'd had my port & gotten them to use that instead of putting an IV in my arm. They'd had to get a nurse to come in special to do that, as the CT technicians aren't allowed to use the port, but other than a bit of a wait for the nurse, it went off without a hitch. This time though, something went wrong. The nurse put the needle in my port, everything seemed fine, they got me in the machine & went to inject the contrast - and triggered a high-pressure alarm, shutting my port down. They got me out of the machine, the nurse fiddled, took the needle out, and put in a second one, but no luck. I was a little worried they'd broken my port, to be honest. Finally, they sent me down to the chemotherapy ward to let the more "expert" nurses there have a try. They were extremely busy in chemo that day, but one of the nurses took the time to stick me a third time & managed to get the thing working. We never did figure out what exactly went wrong. Anyways, needle inserted in my chest, we went back to CT to finally get the scan. Friday's scan (which was of my chest, just to be absolutely certain it was clear of cancer) went much smoother - no contrast, either to drink or to inject. Just show up & take another ride through the giant doughnut.

A week later, on Wednesday, 7th December, we had our bloodwork & doctor's appointment for round #8. The nurse had booked it, assuming at the very least whatever the results of the CT scans, I would be kept on Herceptin. It turned out my doctor's appointment was with one of the GPs who also work a few shifts in the Cancer Centre, rather than with Dr. Katakkar. I found out later this was because he was extremely busy with an epidemic of new patients, but at the time it hurt a bit, feeling like I'd been sluffed off. The doctor was very nice, she explained that the CT scans showed stable disease from 3 months ago, and so they were going to try me on just Herceptin (one of the 3 drugs I'd been receiving each round - the one that's targeted to the mutant gene my cancer has). This was very positive news in a lot of ways, but I cried & felt quite conflicted. It's the whole difference between trying for a cure, even if it's enough of a long shot to be considered a miracle, and accepting that I'm going to have live with cancer until treatment stops working & I die. Honestly, the Herceptin treatment was what I'd been expecting, but I just couldn't help hoping for the miracle. I had round #7 of Herceptin on Thursday, 10th December & it was SO much easier than full chemo. In, get one little bag of chemicals dripped into my port over the course of about an hour, leave. Pretty much no side effects, and no dreaded baby bottle. I was able to curl the next night!

For now, life is good. The Herceptin-only treatment is totally manageable to fit into a normal life - a couple hours at the hospital every 3 weeks, no sweat. I'm planning on going back to work in January, when the office reopens after the holiday break. Try to rebuild a life that's been on pause for six months. I'm having a hard time coping mentally with the fact that it's only been my life on pause, and that all around me, life has gone on without me. And with the idea of living with incurable cancer. I try to stay focused on how well everything has gone to this point, but it's hard not to worry about if/when the treatment stops working, the cancer becoming resistant & progresses. The whole "I'm-going-to-kick-cancer's-ass!" attitude that I had at the beginning has been whittled away by the realities of life with cancer. Sterling's approach to this (and life in general) has always been, hope for the best, prepare for the worst. That's what I'm trying to do these days.