Don’t think I’ve got much wit in me this post. Just going to run through my day of chemo cycle #3 today. Which was textbook. By the way, I use the word chemo to mean, more appropriately, infusion because I get both chemotherapy and immunotherapy infusions. Not all breast cancer (BC) patients get immunotherapy. And there many types of chemo drugs and immunotherapies depending on what type of BC and stage and receptors. My multi-drug regimen is abbreviated TCHP which is a common shorthand for the treatment regimen in literature and practice.

I’m resting, I feel very tired, I still have a headache (migraine), food continues to be frustrating, and I can’t sleep. But so far no mean side effects yet. 

My day started fairly early. I arrived at the hospital at 9 am to get my blood drawn. When they accessed my chest port for the draw today, I felt nothing! Imagine getting pricked by a needle and feeling nothing. In the past, I’d felt at least a pinprick, but today not even that! As I usually do, I applied lidocaine cream before I left my house and asked for ice to apply to it when I arrived at the sample draw room, so that of course helps. I am never getting rid of this chest port-a-cath, weird looking as it is poking out of my skin.

By the time I saw my medical oncologist, Dr. H, at 10 am, the blood and metabolic panel results were ready. Some numbers were, again, higher (liver function test), some, again, lower (red blood cell count). As well, my blood pressure is the highest it’s ever been measured (163/91). This could be partly attributed to my migraine, which I eventually medicated with 500mg of Naproxen to moderate success. But it can as well as to feeling anxious not just because I was unwell for many days last cycle but because I still harbored this thought that my numbers are something I could control and if I don’t do so I won’t get chemo that day. Dr H assured me that most numbers I cannot really control myself — not with diet, or some other thing I think I need to be doing. She also assured me that the numbers from this test alone will not be enough a determinant to interfere with my treatment. I’d have to be symptomatic and the change in the numbers have to be drastic. We’re both keenly aware why it’s important we stay the course with this treatment. This comforted me a bit. 

We discussed coming off one of my immunotherapies — the pertuzumab (Perjeta) and just staying on the trastuzumab (typically called by the brand name Herceptin even though what I’m actually getting is a biosimilar Kanjinti). One of the most common side effects has been hitting me very hard (diarrhea, very bad, ugh). But my response is that I’ll keep trying to manage the side effects unless it becomes serious, and we should continue to be as aggressive with the treatment. She said that the number of patients who, in studies, saw a benefit with pertuzumab is small for cases similar to mine (node negative), but we included it because my cancer is considered high risk being HER2+. I know it’s all probabilities, but I’m fully committing on the chance I’m in that benefitting minority at least through the end of my chemo this year. Since I’m meant to get immunotherapy infusions every 3 weeks for one year, I will, later, revisit the idea of discontinuing the Perjeta.

While the chemo side effects were rough and lasted longer, more importantly, the chemo effects are tremendous too: the tumor has continued to shrink! And it feels less dense since last cycle. This fortified me as I headed over to the infusion center next.

My actual treatment started at 11:30 and finished just before 3 pm. They are shorter now because of my tolerance of the fastest flow rate. Which incidentally may not be possible if my access is through a vein in my arm. Man, I love my chest port.

I have not had the same chemo nurse in my 3 cycles. I have had Erin, Gracie, and Bo Hee. Every single one has been stellar. They are caring and accommodating. They are upbeat and make you feel like you’re doing everything just right even as they give you advice on how to manage better. 

As per usual, we started with infusing my pre-meds: steroids (Dexamethasone to add to the dose I take orally in the morning and the night before) and anti-nausea meds (Aloxi and Cinvanti).

Followed by the immunotherapies: Trastuzumab 294 mL for 30 minutes then Pertuzumab 289 mL for 30 minutes. Then my chemotherapy drugs: Docetaxel (Taxotere) 276 mL for 1 hr then Carboplatin (Paraplatin) 332 mL for 30 minutes.

I was able to eat my lunch (broccoli, rice and meat cooked and packed by my niece) around 1 pm.  Actually, I pretty much snacked continuously during my infusion because I know by the next day my appetite will be unpredictable. We packed a bunch of snacks: popcorn, banana, hard boiled egg, dried mango, and I ate nonstop. This has the added benefit of having something else to taste because some of my infusions give an odd taste in the mouth during. 

The infusions proceeded with no problems. I had to empty my bladder every hour — it’s a lot of liquids being pumped into me (there’s also saline pumped in there). I roll my IV stand down the hallways to the bathroom while it makes like a directionless but eager dance partner. 

My infusions are “easy” — I’m in a comfy lounge chair with my own cozy blanket, I have my kindle and I occasionally am on my phone, but I don’t make phone calls out of respect for the other patients. The infusion center is quite busy and the patients are seated in a fairly small space in close proximity with each other that each of us can pretty much hear everything spoken in a normal voice. We sometimes chat with each other but it’s not a gab fest.

Because the day is typically fairly smooth and I think I’m amped up because of the steroid infusion I had it in my head that I’ll feel well enough to go to a show the same evening as my current favorite performer is in town at the Paramount in Oakland. But that’s me being delusional that I wont be tired and dizzy post-infusion, and as if I’m not supposed to still be staying away from crowds as much as possible. Oh well there will be plenty of time for concerts yet in my future.

Let’s hope the side effects are a bit better this cycle. 

But if they are rough, I have support this week not just from my niece but also from friends who signed up via my LotsaHelpingHands Community (December). This has been helpful when I can’t keep up with texts or messages that, while wonderful, say “call me if you need help”, “or let me know how I can help.” There was indeed one instance when I did text a few local friends when I needed emergency ride for a procedure I may need to be put under twilight sleep. Most, for absolutely valid reasons, couldn’t. My beautiful friend  was able to move her schedule juggling her small children and their own packed schedule and volunteered. I didn’t end up getting the procedure but I was so grateful at her generosity. The site is my way of letting friends know what I need. Hopefully it helps my them too because they only ever need to say yes when they can (by volunteering for a task) instead of no. Hopefully it doesn’t seem too project manager-y although maybe it ain’t so bad that it is. 

Last cycle by the 2nd week I was feeling fairly normal. The harder to manage and more health threatening side effects (nausea, diarrhea and constipation, dizziness and headache, body pain, fatigue and weakness) have dissipated, and I “only” had the more “benign” side effects to work through…or not work through because sometimes there’s nothing to be done but live through them: food tasting bitter? (I just douse everything in vinegar — even spaghetti); some hyperpigmentation; tingling and numbness of fingers (peripheral neuropathy); hair loss (not just scalp care for my nearly bald scalp, but have you given much thought to what happens when you start losing your nose hair?); mouth/throat sores; dry… everything: skin, mouth, nostrils…; daytime drowsiness; and most frustrating of all, cognitive impairment more commonly called chemo brain. Most of these are quite manageable. Many, I just live through knowing they’re temporary. Some, do affect my morale a bit. When I’m not actively nursing my debilitating side effects, my battle is a fight for normalcy.

Last Friday afternoon, I went out in public for the first time wearing a wig, or a cap with hair attached and went for a walk. I had been tired a lot and winded after climbing the stairs of our 3rd floor walk-up. I attended a restorative yoga class last week. It was supposed to be relaxing and I still felt nauseous. But finally after 2.5 weeks I was feeling strong enough for a walk. So that I did at the Ferry Building Marketplace; I bought empanadas, sweet potato fries, a cat toy. I stared at the boats moored by the waterfront. I conjured up backstories for passengers streaming out an SF Bay ferry. It felt…normal. I was at times self-conscious about the wig, but realistically, I don’t think anyone noticed. We don’t really scrutinize the hair of the people we come across in public unless maybe if it’s wildly out of the norm, do we? Perhaps, I even encountered a few folks wearing wigs as well and I’m none the wiser.

But more importantly, I felt normal because I wasn’t thinking I wasn’t. I sometimes forget that to the outside world, my cancer battle is invisible…until maybe when I start losing my eyebrows and eyelashes…or perhaps not even then.