Tag Archives: chemotherapy

Carrying on

This again

This again

I had my repeat mammogram yesterday. It was my right breast that was in question, and initially seven additional views were taken. Those of you who are of the female persuasion are only too familiar with this procedure, but for the rest of you, here is a precise description of a mammogram copied from womenshealth.gov (italics mine):

“You stand in front of a special x-ray machine. The person who takes the x-rays, called a radiologic technician, places your breasts, one at a time, between an x-ray plate and a plastic plate. These plates are attached to the x-ray machine and compress the breasts to flatten them. This spreads the breast tissue out to obtain a clearer picture. You will feel pressure on your breast for a few seconds. It may cause you some discomfort; you might feel squeezed or pinched. This feeling only lasts for a few seconds, and the flatter your breast, the better the picture.”

Ironically, after coaching you into an awkward position, and then squeezing your breast so hard you think it might just pop, the technician advises you to ‘try to relax’. Yup. Thats the same line repeated at our other annual exam, the pap smear. In both situations, relaxation is simply inconceivable.

After a sufficient amount of squashing I was ushered into a special waiting room while the radiologist reviewed the films. Morning television, a pile of tatty magazines, and, curiously, a large collection of Chicken Soup for the Soul’s. And a reassuring sign that read “We compress because we care.”

Soon I was joined by another woman; a real Chatty Cathy. The first thing out of her mouth was “Do you have breast cancer?” I was momentarily mystified, but then I realized that my lack of hair is a potent signifier. So I told her that no, I had lung cancer. Her next query: “Oh, and it spread to your breast?”. Oh my. After telling her that I hoped not, her final, and I suppose inevitable, question was, “Did you smoke?” I was relieved when my name was called and I was spared from further conversation.

It was but a brief respite, and I was returned to the waiting room after two further (and even flatter) compressions/impressions. Fortunately Chatty Cathy’s nose was buried in a magazine.

When I was fetched again I was led to a far room for ‘privacy’. There was no way this was going to be good news.

Sure enough, The findings were as follows: “Diagnostic views of the right breast including spot magnification views were performed demonstrating a cluster of suspicious looking amorphous calcifications in the right central medial breast. A second grouping of calcifications is noted within the right superior breast. These 2 groupings appear to contain morphologically similar calcifications. The breast tissue is heterogeneously dense, which may obscure detection of small masses. There are no dominant masses seen with the right breast.”

The radiologist explained further that these were ductal microcalcifications and that worst case scenario, she felt they might represent a ductal carcinoma in situ.

Tomorrow I will meet with Dr. Shaw for a scan review (I had a chest CT scan on Monday) and then my third round of chemotherapy. On Friday I will return to the Avon Breast Center at MGH to meet with a breast surgeon and to schedule a biopsy (80% of breast biopsies are not positive for cancer–I’m hoping mine will be one of those).

And just to make things more interesting, this is the regional forecast for Friday:

...A POTENTIAL HISTORIC WINTER STORM AND BLIZZARD IS EXPECTED TO
DROP 1 TO 2 FEET OF SNOW ACROSS MUCH OF THE REGION FRIDAY INTO
SATURDAY...
Never a dull moment…

Weathering

A gale has been battering me, from the inside out; there are moments when I have felt unmoored.

At the time of my last post, I was hopeful that the tide was turning. However, by the following morning, the nausea suddenly seemed inconsequential, as my peripheral neuropathy became more persuasive. Dr. Shaw checked in last night and I expressed my concern; her feeling was that by today (day four) it should begin to abate. When I awakened this morning, it was clear that my symptoms had intensified. My face had begun to lose sensation; by lunch time swallowing seemed to present a challenge.

Because of the steroids, I have been unable to really sleep. Two ambien buys me three hours on the top end, followed by another hour or two patched together. I am exhausted but wired and almost preternaturally aware. I cannot stop trembling. My vision has been effected as well, and I stumble when I walk. Warned that a crushing fatigue will likely follow withdrawal of the steroids, I almost welcome it. To sleep and not to think seems like the best way to weather this storm.

And then the weeks…

In addition to losing my hair, I had one other health ‘crisis’ following my first chemotherapy session.  I began to cough and to be quite short of breath again, and was cognizant of the same rattle in my lungs which had been a constant before my surgery.  After we called my oncologist, he asked that I come in. Following a physical exam I was given a CT scan of my chest, which showed nothing more than a small area of plural effusion around the lobectomy scar (to this day, I have lobular thickening in that area that is noted on each radiology report).   He then suggested that I try using a nebulizer at home.  This treatment prompted a lot of productive coughing and gradually resulted in an easing of the breathlessness.  I  followed up with a pulmonologist, who put me back on asthma medication again.  Perhaps three months ago, I finally weaned myself off of the inhaler (Advair), but as I also have allergies, I still take Singulair and Flonase.

And so it went;  all summer long.  Chemo would knock me on my butt, and then just as I would get back on my feet again, it would be time for another go. Psychologically, it was one of the most difficult challenges I have faced.  Cancer is tough that way.  While the purpose of the treatment is to make you better (whether curative or palliative), generally it makes you feel a hell of a lot worse, at least initially. However, the will to live is strong, and most of us will do whatever it takes to extend our lives.

In between treatments, I would nestle in the hammock until I was strong enough to move about.  Occasionally, bundled up to shield my skin from the sun, David took Peter and I out in our skiff.  We lived in a coastal community bordered by salt marsh, and David would guide the little boat inland amid the tall grasses.  I took a lot of photos of the marsh that summer, some of which I am using now as reference for paintings.

As predicted, each chemo treatment was harder than the previous one.  By my fourth and final infusion, I vomited what looked like coffee grounds; it was actually blood.  But I had made it through to the other side.  Bald, skinny, and for a time diminished in both a physical and mental sense, I was happy to turn my back on this particular summer.  At the beginning of September I would have another scan, and I was oh so hopeful that the report would be  a good one.

The day(s) after chemo

Within 24 hours after a chemotherapy session, we would travel back to the hospital, where I would receive an injection of Neulasta. Neulasta prompts the body to boost production of white blood cells, as low white cell count (neutropenia) can result in secondary infections.  In addition to feeling wiped out, I now began to experience intense bone pain that would last for several days. This is a common side effect of Neulasta, and my oncologist had preemptively written a prescription for Percocet.

I was also experiencing the most intense heartburn of my life, ringing in my ears, and a bowel that would lurch between diarrhea and severe constipation. Exhausted, I spent lots of time sleeping in my ‘lazy girl’ recliner, but my sense of smell became disoriented (along with taste) and I couldn’t bear the smell of our newish oriental carpet.  David ended up having to haul it outside where he gave it an intense shampooing.  Luckily, it being June, I had the option of hanging out in the hammock on our screened-in porch, and it soon became my second home.

I was not without an attendant angel.  Our friend Miranda organized a schedule of prepared and delivered meals during the many weeks of chemotherapy.  She enlisted neighbors, friends and acquaintances, and an amazing bounty of food would arrive each evening.  Certain dishes I would have to avoid, both due to my repressed immune system and my skewed palate, but it was a huge burden off of David’s shoulders and great fun for my kids as well.

By the end of the second week, my hair began to come out.  I was taking a shower, and as I shampooed my head, my hands filled with clumps of hair.  I hadn’t been very concerned about hair loss, but when it happened, I became rather emotional. After I toweled off, I asked David to shave my head.  Soon the stubble would fall out as well, as well as any remaining hair on my body.  There was now no doubt that I was a cancer patient.

Picking up that old thread: chemical warfare

I have been putting off writing about chemotherapy. The truth is, there is a lot from that period of time that I don’t remember, and most of what I do recall is far from pleasant.  Although perhaps not quite as terrible as I had imagined, it was still a miserable experience.

The lobectomy had actually been a more physically demanding procedure, but there was a significant difference between the two treatments.  Once surgery had reached its conclusion, healing began, and the process was linear.  As chemotherapy is administered in cycles, just as you’ve begun to recover from one infusion, it is time to begin another.  And the side effects typically worsen with each consecutive cycle.  You are knocked down, you stand up, and then are knocked down even harder.

My chemotherapy consisted of a cocktail of two different agents:  Taxotere and Cisplatin (a platinum drug).   I received four cycles of each, at three week intervals.  The day before a cycle, I would take two Decadron, to combat nausea as well as inflammation;  it is also an appetite stimulant.  The morning of chemo, I would take two more Decadron and then an hour before, one dose of Emend, another anti-nausea drug.

The wing at the hospital where chemotherapy is administered is referred to as infusion.  The room itself is large and sunny and lined on both sides with recliners.  I would sit in one of these recliners as first taxotere and then cisplatin were dripped (via the port) into my veins. This would take several hours.  During the taxotere phase, my nurse Lisa would immerse my hands in a bowl of ice.  One of the possible side-effects of taxotere is peripheral neuropathy, and she believed that by chilling my fingers and thereby limiting blood flow, we could limit the degree to which that might happen.  I did develop noticeable neuropathy (numbness) in my feet, but very little in my hands, so perhaps it was effective.

One of the potential side effects I had been most anxious about, nausea, was actually fairly well managed by the plethora of anti-nausea drugs: in addition to the decadron and the emend, I was prescribed ativan, compazine, and zofran to take as needed.

Chemotherapy can also take a real toll on your blood cell counts, which is referred to as bone marrow suppression.  On the day of infusion I was given a shot of Procrit, to combat red blood cell depletion.  Procrit is a man-made form of the protein human erythropoietin, and is no longer used prophylactically to ameliorate anemia, as subsequent studies have revealed a host of dangerous side-effects.  It now carries a boxed warning, which states that “increased mortality, serious cardiovascular events, thromboembolic events, stroke, and increased risk of tumor progression or recurrence” can all occur.  Of course I don’t like the fact that I took Procrit, but at that time (June of 2005) these studies had not yet come to light.

Kidney damage is a possible side effect of Cisplatin, and prior to the second phase of infusion, I was given a large amount of fluid intravenously.  I was also encouraged to drink two to three quarts of water daily, particularly the first couple of days after therapy.

During infusion, the strongest sensation was a flushing of my skin, as well as a metallic taste, and as the day wore on, a feeling of being very out of it.  By the time David helped me to our car for the drive home, I would feel as if I’d come partially undone; my ability to think, unravelled.