A Good Week! – June 19, 2015

With a week off from chemo, and just receiving Taxol and Herceptin last Thursday, this week I felt pretty good.  My BP hasn’t dipped low (I stopped taking my high blood pressure meds), and I’ve been making sure to drink plenty of fluids.  Basically I drink 30 oz first thing in the morning, which ensures that I get at least 1/3 of the 90 oz they want me to drink every day from the start of the day.

On Friday I had my appointment with Dermatology, to look at all of my nails.  I wouldn’t say that was the most productive appointment:  I received an antibiotic  ointment to use when my nails start falling off; the doc told me to keep my cuticles super moist (she suggested using Aquafor, which I’m discovering is the solution for everything) to try to keep the seal that cuticles create with the nails.  She did say that my skin looks terrific for undergoing chemo, so that was a plus.  I’d already lost one fingernail by last Friday, and today I lost another when I hit the gear shift in my car just right.  Both on my right hand, I’ve lost the nail on my forefinger and 4th finger.  I think I should have invested in Band-aids! Neither nails were the ones which were infected and caused the fever.  I guess it makes sense that I’d lose fingernails first because the hands get used for all sorts of things. The toenails were first to start separating from the nail beds, but for now they’re all still there.

I was able to go to work Monday-Wednesday this week.  Yesterday I had to take my car for servicing, so I worked from there and then home.  I got a blood draw first thing in the morning.  I’ve felt pretty good all week, and had very little diarrhea.  Once was when I forgot to have some yogurt while taking antibiotics and once when I couldn’t resist and ate a lot of cherries.  I love cherry season, but eating them in the quantities I can (and do) gives me diarrhea when I’m not undergoing chemo, never mind now!  Either way, I’ve learned to manage the diarrhea pretty well.

While I was at the car shop, Dr. Priya called to tell me that she was able to prevail and that the Perjeta was approved from this point forward.  PAMF will have to apply to have the May 15 treatment retroactively approved; on my insurance site that claim’s status has changed from “Denied” to “Pending” so I’m thinking that’s a good thing.

When I got home, I got a call from Velia, who informed me that while my counts looked good (mag was low at 1.2), my hemoglobin had fallen from 9.4 to 8.1 and that I would need a blood transfusion. At today’s infusion, they took blood to be typed and crossed, and I’ll have the transfusion after my breast MRI on Monday.  A transfusion takes 4-5 hours, and there is no time for a directed donation.  I need the transfusion on Monday, and for a directed donation, Stanford Blood Bank would need to do all sorts of tests – which would take a week.  Plus, insurance won’t pay for a directed donation transfusion (surprise, surprise).  So I have to trust that Stanford Blood Bank has done its job in screening and testing the blood I’m going to receive.  Because I’m getting chemo weekly, I’m figuring that my hemoglobin doesn’t have time to recover, which also explains the urgency in getting a transfusion on Monday.

The approval of Perjeta meant that today’s infusion was Taxol, Perjeta, Herceptin, and the ever present magnesium.  We had a little trouble drawing blood from my port, which is very unusual, but eventually we got what we needed.  After the pre-meds, the blood draw, and the chemo and mag, I finally left after 7 hours.  I woke up at 4 am this morning and couldn’t go back to sleep, so I’m super tired tonight.  I suppose I might have taken the Decadron a little late last night, which could be why I didn’t sleep well.  I don’t think that will be a problem tonight.

I’m off cycle a little:  I should have received Perjeta last week.  I don’t know what that means for how many more treatments I will get, and how many more treatments of Perjeta I’ll get.  I did get a phone call today while in the center from Jennifer the nurse educator, who said that it looks from my chart that Dr. Priya was planning on 8 treatments total, and that meant I should see Dr. Ching (breast surgeon) to start preparations for surgery.  I thought Dr. Priya wanted 10 treatments, so I’ll have to ask her when I see her next, but in the meantime I’ll be scheduling an appointment to see Dr. Ching soon.

Did you catch that I mentioned a breast MRI on Monday?  Yep.  I’m going to have another one to see if the chemo is doing its job and reducing the tumor.  Neither Dr. Priya nor I can feel it anymore, so the chemo has got to be reducing it, but we can see by how much.  Dr. Priya also wanted to make sure that the chemo WAS doing its job, because why put me through all this chemo if it wasn’t working.

I’m really happy that I had the forethought to go to Sephora before I started chemo to learn how to draw eyebrows.  It’s kind of shocking to see just how few eyebrow hairs I have!  and I have exactly 1 eyelash on my left lower lid.  I wonder how long that lone soldier will last.  The hair on my head is what I’d call just really, really thin – Ted hasn’t shaved my head for a couple of weeks, so I can see the hair growing.  It’s mostly white 😦 and just thin all over my head.   I may keep a shaved head even after I’m done with chemo. I like looking badass, and I’ll save a ton on hair product!

We have a relatively quiet weekend ahead of us, which is good.  I need to finish online traffic school, write performance evaluations, and work on my conference presentations. Aside from a late lunch tomorrow with our friends Jess and Matt, we’re homebodies.  And it’s a good thing – I have an incredibly busy week ahead.  I’ll tell you all about it next time!

Chemo #2 – February 19, 2015

Today was Round #2 of chemo treatment.  It was only 4.5 hours long (as compared to over 8 hours last time); in addition to not receiving Perjeta today, the Herceptin was dialed back, from 90 minutes to 30 minutes.  Taxotere and Carboplatin were given at the same amounts.  I had mild neuropathy in my left hand while receiving Taxotere, but I had flushed less.  The neuropathy is gone, as are the flushed cheeks.

I had a blood draw at the end of my infusions to check on my potassium levels, and they’re already back to normal.  Dr. K reduced my dose from 40 mg to 20 mg, but wants me to take it for a week.  At least I have pills now, but I’ll finish the terrible liquid form first.

I’m feeling very good, normal even.  I haven’t had diarrhea since 1 pm yesterday, and while I haven’t had a BM either, at least I feel more like myself.  Things could change, obviously, but I’m confident that I’ll sail through this treatment.  I’m taking a vacation day tomorrow (assuming I feel okay) to go with my friend Nancy to Stitches West, the knitting convention. Then my sister Chris has a birthday dinner.  My weekend is packed full, so I have to believe that all will be well.  I’m meeting my friend Chris for breakfast on Saturday (he’s in from Seattle); we have a Stanford Men’s Basketball game at 3:30 and then the Sharks vs. Kings Stadium Series game at Levi’s Stadium at  7 pm.  On Sunday, we have a Stanford Women’s Basketball game at 1 pm, then I head off to work to meet the BlackBaud consultants at 3 pm, followed by a dinner.  Next week we have a intensive user acceptance testing for our new database, so we’ll be busy.  Hopefully all will be well!

January 29, 2015

First Chemo Treatment!

It was a long day, a lot longer than I thought.  We got there on time for an 8:45 appointment.  Things got going with the puncture of the port – which is through the skin, obviously.  Some infusion centers spray a little novocaine or lidocaine to numb the port area, but not at PAMF.  The puncture was actually pretty bad, and while I adjusted to it, I was surprised at how much it hurt.  I’m no wimp, and I’ve been poked and punctured a lot – donating blood, blood tests, IVs for 5 major surgeries and sedation procedures – but this hurt.  I’ve now got a numbing cream, EMLA, ($45 later) to put on about 30 minutes before my next port puncture.

The first thing to go in was saline to flush the port.  That was for about 10 minutes, and then the pre-meds – no, not undergraduate students, but Decadron (steroid) and Zofran (anti-nausea) which took about 20 minutes.  So my first drug, Perjeta, didn’t get started until about 9:45.  That infusion took 60 minutes, which went just fine.  There was a 30 minute break, and then the second drug Herceptin, got started.  This first time, Herceptin was a 90 minute infusion.  The next chemo treatment the Herceptin will be 60 minutes, and then 30 minutes after that each time – which is good because that’s the targeted chemo drug that I will need to have for 52 weeks.

Each infusion is given mixed with a saline solution; that with all the liquid I’m supposed to drink meant that I went to bathroom a lot!  and I really should have taken a potty break between the Herceptin and the Taxotere!  Taxotere is the drug that the nurses watch very carefully while it’s being administered.  It was started right away, first with a saline flush, then a slow drip of 50 mls over 30 minutes, then increased to 100 mls for 30 minutes, then the last 220 mls or so over 45 minutes.  I was told to hold a cup of ice for possible neuropathy and asked if I wanted to put my feet in a cold bath to help with possible neuropathy, and then asked to eat ice chips.  The nurses asked if I was getting itchy or a rash, and whether I had any back pain repeatedly.  I had none of those symptoms, but by the end my face was flushed, as if I’d had a drink.  So they took my vitals, and decided to give me a saline flush for 30 minutes, then retake my vitals.  My vitals after the flush were more back to what they’d been all day (although the vitals right after the Taxotere weren’t terrible).  So it was decided that my face was flushed more likely from the steroid than the Taxotere.

After a quick break, the final drug of the day was given, Carboplatin.  Only a 30 minute infusion, it seemed to finish in no time flat.  Then it was about 30 mls of saline flush for the port, then Heparin in the port to prevent clotting, the needle removed, and I was pretty much good to go – at 4:45!  8 hours in the infusion center.  Wow.

Well, I was sort of good to go. I had to make an appointment to get a Neulasta shot for tomorrow. Neulasta stimulates the bone marrow, and can cause extreme bone pain. Fortunately, my friend Lori pointed me to recent research about taking Claritin with Neulasta, so I’m going to be proactive and take Claritin.  I’d rather avoid bone pain, thank you very much.

I also had to make appointments for my next chemo treatment, which isn’t as easy as you might think.  I have to have a blood draw at least 2 hours before a doctor’s appointment, because I’m choosing to have the blood draw through my port (although if EMLA doesn’t work, I may choose to having a regular blood draw) and generally the doctor’s appointment is the day before chemo.  And because it was suggested that Neulasta be given by the injection specialist in the infusion center, I’m going to have chemo on Thursdays, rather than Fridays, if I can.  Otherwise I have to receive the Neulasta shot at Urgent Care, and most likely not by an injection expert.  Neulasta is pretty thick and is best given in a really fleshy part of the body (my arms are way fleshy, so I think I’ll spare my butt).  So I’ll have doctor’s appointment on Wednesdays, chemo infusion on Thursday, and work from home on Friday with time for a Neulasta shot.  I was able to do some work today, and some knitting, but my sister and I talked a bunch, which was great.  Thank you notes and other work will have to wait until tomorrow.

The only thing that was disappointing today was I learned that Dr. Priya is on medical leave from February 9 until April 13, which means I won’t see her until right before my 5th treatment!  I’m so sad.  I just hope Dr. Kushlan is just as good.

I finally wrote out all the drugs and supplements I need to take from Day 0 through Day 7, because they all have times to be taken and different dosages.  I could probably keep it all straight in my mind, but it helped to write it all out.

I have so much support from all over, but I have to give kudos to my sisters for today. Lucy picked me up this morning and Chris met us at Oncology.  Lucy stayed for about an hour and then had to go, but Chris stayed until about 3:15.  Lucy came back around 3:30 until the end, and then took me to run errands and home.  It was great to have my sisters there for this first session.  I would have been fine, but it was awesome to have them there.  And of course, Ted was home with dinner and just made me cherry-mango popsicles, so the awesomeness continues.

Pretty long day, and I feel as if I should head to bed, but right now I’ve got Loa purring on my lap and the Sharks are beating the crap out of the Ducks, so life is good!

January 12, 2015

My world got rocked today.

My medical oncologist asked for an appointment, which was today.  I thought it was to discuss my HER2+ status more in depth, and I thought it was just to confirm that I’d need to have Herceptin for a year.  Well, the appointment was to discuss my HER2+ status more in depth, that’s for sure!

Dr. Priya would like to start with neoadjuvant therapy, aka start with chemo first. Surgery would then be after chemo, followed by radiation.  In a previous post I’d mentioned that I wanted to know if I was a candidate for Perjeta (pertuzumab)…well apparently I am.  Studies have shown that Perjeta before surgery is highly effective in treating 2 types of HER2+ cancers, and Perjeta has been approved for treatment before surgery. It has not yet been approved for therapy after surgery; while there’s nothing to say it’s not effective post surgery, because it hasn’t yet been approved for this, insurance won’t pay for it.  At $8000 per treatment, it’s not something I can afford out of pocket, so pre-surgery it is!

Having chemo before surgery will reduce the size of the tumor, which, if logic follows, means that during surgery less tissue will have to be removed.  Further logic follows that perhaps I won’t go from a C cup to a B cup, but maybe a C- or B+ instead!  🙂

What I did not realize is that because I’m HER2+, my chemo regimen is not 12 weeks, but 18 weeks.   Now I know some of you will think this crazy, but this change in my treatment plan actually is better for me at work.  We are in the middle of a huge database conversion and we go live on July 15; with this new plan, I will likely be done in June, and have some time to recover while we go live.  Because the tumor will be reduced, there’s not a huge urgency to have surgery, so I can honor my commitment to chair a conference in early August, then have surgery.  If I proceed with surgery on January 28, have a 6 week recovery, then 18 weeks of chemo, I’d not only miss critical times during conversion but perhaps would have to miss the August conference.

The chemo treatment plan is Perjeta plus TCH (as opposed to THC  🙂  ).  Taxotere (docetaxel), Carboplatin (paraplatin) and Herceptin (trastuzumab).  I had also misunderstood the Herceptin regimen:  while the treatment lasts 52 weeks, the infusions are every 3 weeks.  So I start the Herceptin along with the other chemo drugs, and I continue it while I recover from the other chemo, through surgery, through radiation.

There was discussion about whether there should be biopsy of the sentinel lymph node before I start chemo.  Dr. Priya says that current thinking, at least among medical oncologists, is that it’s not necessary; the chemo will reduce anything in the lymph node as well, and the lymph node will be removed during surgery anyway.  In my case, the MRI showed nothing in the lymph node, which Dr. Ching did not mention (or I forgot), so it’s especially true that I won’t need surgery to remove the lymph node before chemo.  I’m pleased to know that nothing showed up in my lymph nodes on the MRI; chances are that my cancer is Stage 1 with this news.  Pure speculation on my part, but considering the factors which decide stage, that’s what I’m going believe.

It’s all good, right?  I mean, no matter what I need 18 weeks of chemo, so I might as well have it first.  So why was my world rocked?  The way I’m able to deal with this whole cancer thing is to break it down into goals or milestones.  I was completely focused on getting through the surgery first, then I’d move onto chemo, and then onto radiation. I’m goal-oriented, and it helped me to think of my treatment plan this way.  Flipping chemo and surgery was just something to which I needed to adjust.  Now that I have, I’m good!