Today’s infusion was pretty straightforward, no surprises. All the meds are going in at full speed by now, so this is as fast as it should get. We start at 8:30am to access the port and draw the labs. Dr. Cancer arrives a little after 9am, and I see her for ~15 minutes (Q&A, and then she listens to my heart) as soon as the labs are ready. Then it takes about another 20 or so minutes for her to put the orders in. They begin with pre-meds (Pepcid, Emend, and Aloxi – all to prevent indigestion and nausea/vomiting). Then they start the chemo drugs, one at a time: first Adriamycin, then Cytoxan, then Taxotere. I think there’s some IV saline thrown in here and there too. Finally, they attach the Neulasta adhesive device to my abdomen, and off I go. I was done a bit before 3pm today, which I can probably expect for the remaining cycles.
I also got a few questions answered. Sorry if this is boring, but it really helps me to write it all down. Here goes.
I asked last time if I should get a flu shot, and Dr. Cancer said yes; but today the nurse told me to be sure to get the shot and not the nasal spray, which contains live virus. That was not an option anyway, but good to know (a week too late).
My perpetually runny nose and drippy eyes are not due to a suppressed immune system as I’d speculated. Instead they are pretty sure it’s a reaction to the Taxotere. They have me on a steroid (Dexamethasone) that reduces reactions to this drug. I had been taking it the day before, day of, and day after my infusion. Going forward I’ll tack on one more day on either end. We’ll see if that helps.
I mentioned somewhat in passing that I have an eye doctor appointment to order new contact lenses. Dr. Cancer said to cancel that. Apparently there is a type of fluid retention common when chemo is administered called “third spacing.” This could effect my vision prescription, so going to the eye doctor right now is not a good idea. It takes a few weeks to abate. I’ll have to check to make sure I have enough contact lenses to get me through! This also explains why they keep asking me if I’ve had any swelling in my ankles; so far, I have not noticed any.
Oh, and this also explains my weight gain. I’ve been warned that people on this regimen often gain weight, which is partly due to the fact that they have the anti-nausea meds so well dialed in, and you get picky about what you eat (comfort foods!), so you gain weight. But I’ve actually managed to maintain a pretty good diet, so was assuming the 5 lbs I’ve gained recently had to do with all the salty food I’m eating (I have a post queued up about how all this is effecting my taste buds, stay tuned). That probably has not helped any, but the “third spacing” fluid retention is probably the main culprit. (And my blood pressure today was 103/65, so if you’re otherwise worried about my increased salt intake, don’t be!)
We talked about why round 2 was so much easier than round 1. Dr. Cancer agreed with my Google searches that it was unlikely to have been caused by the Neulasta shot that increased my white blood cell count. That was speculation on my part, but white blood cells really don’t effect energy levels, fatigue, and general feeling of wellness. So, the best explanation remains the fact that I was jet lagged during round 1. Sandy, my nurse, also speculated that I was dehydrated from the flight.
My dad asked about any long-term side effects of the chemo drugs I’m on. When he went through his cancer hell he was on a completely different regimen, so there is no comparison, and so he was curious. Turns out that this chemo regimen’s only significant long-term side effect is neuropathy. I have not had any symptoms of this yet, but they ask me about this frequently, and it’s something I need to remember to pay attention to.
I had some mouth sores this time around, later in the cycle. They did not hurt; they were waaay in the back of my mouth and I could just feel them with my tongue. I had speculated that it was probably due to me relaxing my mouth care regiment around then (I’d stopped the various peroxide and salt/baking soda mouthwashes I was using earlier in the cycle). They agreed that I should continue this and it may help. But in addition, I suck on ice chips during the Cytoxan infusion. Cooling the inside of my mouth reduces the drug’s effect on the fast-growing cells in your mouth (similar to the way cold caps work to prevent hair loss – which I am obviously not bothering with). The fact that I had the sores way in the back is probably an indication that I had not cooled that part of my mouth enough the last time. I tried to really get the ice all around in my mouth this time, so we’ll see.
All of this was a great lesson in “the only side effects we can’t help with are the ones you don’t tell us about,” because even the ones I’d mentioned in passing they had suggestions for, which was great.
I wrote most of this blog post while I was in the clinic. I’ve waited until the end of the day to publish it, and I can report that this feels more like cycle 1 at this point (unfortunate, but not unexpected). Foggy head, a bit tired, and a bit nauseous (responded well to a Compazine pill), and no appetite. Ah well, so it begins…