Ken dropped me off at the Cancer Center at 12:30, went back to teach one class, then returned and joined me in my bay in the infusion room.
Port Access
When I get my port accessed, the port nurse starts by laying out all the necessary supplies. She usually sets out 3 packets of Betadine, the antiseptic she uses instead of the usual chlorhexidine, to which I seem to have an allergy. Chlorhexidine is now listed on my medical record, and I get a special orange band every time I check in to indicate that I have an allergy.
But today, as the port nurse was finishing up her preparations, I noticed she hadn't put out the Betadine. In previous appointments, she's told me very openly that I should feel free to remind her that I "need the brown stuff". At first I wondered if maybe she'd always remember, since she helped diagnose my allergy in the first place! But I know she sees scores of patients every week, so I don't hold it against her that she forgot, or didn't see the orange bracelet. (I was wearing a long sleeve sweater that may have hid the bracelet. I'll try to be more diligent about keeping my medical bracelets visible!) Anyway, I spoke up, and the port nurse thanked me for reminding her. Everything was fine, but it was a clear example of how I need to be fully engaged in my own medical care!
Medical Oncologist Appointment
After my port was accessed, a medical assistant took my vitals. My medical oncologist was running late by 20 minutes, but she was as warm and attentive as always when I saw her. I love that she's a hugger! Besides going over all the medical stuff, she gave me lots of encouragement and words of support.
One thing I mentioned is that when I was given a printed list of my medications to confirm, it listed docetaxel (Taxotere) instead of paclitaxel (Taxol). It looked like it was added by my OB/GYN. Somehow she entered the wrong drug, so my oncologist just deleted it. Said she doesn't like to list chemo drugs on prescription lists anyway. Again, another reminder for me to be vigilant in every part of my medical care!
The oncologist wanted to know all about my side effects. I reported that the continued sporadic, dry cough is not as bad as the first week, and I don't consider it bothersome. She was a bit concerned; I think she is on hyper alert for anything that might indicate a possible infection. She wants me to take loratadine (brand name Claritin) daily to see if that helps. Interestingly, even though it's an over-the-counter medication, she submitted a prescription to my pharmacy; she said if they can provide a generic pill, it might be cheaper than what is available on the shelves. I really appreciate how she took this step to try to address my out-of-pocket costs.
I also told her about not being able to focus my eyes on Monday. She said it does sound like a sensitivity to sunlight, which is expected on Taxol but not usually a big issue. Everybody is different, and this is just how my body is responding. In fact, now that I think about it, it's not that surprising because I do think I have sensitive eyes; I tend to squint a lot if I'm not wearing sunglasses, and my night vision is pretty poor. The oncologist said I should be careful even on cloudy days, because it's the UV light that's problematic. I should also wear long sleeves and pants when going outside; I know for sure I already have a sun sensitivity that appears as a rough, red, itchy rash on my forearms, and I'm not interested in finding out how it reacts to sunlight while on chemo!
Very interestingly, my oncologist pointed out that pretty much all the medical studies and clinical trials for chemotherapy drugs, including their dosing and side effects, have generally involved predominantly white women, and in her practice, she has noticed that her patients of Asian descent tend to respond differently than white patients! So that might be a factor in why I'm experiencing less common side effects. In fact, she said her Asian patients tend to have a harder time with chemo in general, so she was pleased that I'm doing relatively well so far.
She confirmed that she didn't want to give me the flu shot last week because of the cough, but since the cough seems mild, she would order a flu shot for today. With chemo compromising my immune system, I definitely don't want to get the flu!
Finally, she did a physical exam. She listened to my lungs and heart, and she looked at my port and surgery incisions to make sure they are healing well.
Social Worker Visit
I got to the infusion room late for my appointment, but they knew I was meeting with my medical oncologist. I got settled in my bay, and while waiting for my infusion nurse, my social worker came in for a visit.
She asked how each of us are doing - me, Ken, and the kids - and we talked about expectations regarding the level of support I might be receiving from friends and family. I told her how this is the first week I've had since surgery that I wasn't completely focused on recovery or overwhelmed with doctor appointments all week. It's like I am finally popping up for air, and now we can hopefully start to settle into a kind of routine, even if it does include Friday chemo appointments. I mentioned my blog and how it's kind of therapeutic for me; she was very supportive and encouraged me to keep it up.
She also told me about an amazing organization called the Ellie Fund, which provides support services for breast cancer patients in active treatment. Incidentally, a couple friends have told me about Cleaning for a Reason, an organization that provides free house-cleaning services to women undergoing treatment for any cancer. I appreciate these organizations so much! Right now I feel like we are in good shape, but it's great to know these options exist.
Chemotherapy + Targeted Therapy
Soon after the social worker arrived, my infusion nurse got me started on my pre-meds. This time, I had the same dose of Benadryl as last week, but I got it via a pill. The nurse said the side effects should be less pronounced when taking the medication orally rather than via the port. My Decadron dose was also the same as last time, and I again took it orally via 3 pills. Pepcid was the only pre-med that was administered via the port.
I started Herceptin at 2:30, and then started Taxol at 3:00.
Some time during the infusions, I noticed my arms started to feel kind of weak, like it was an effort to hold them up. This happened in previous visits, too, but what with feeling loopy from the Benadryl, I sort of wondered if maybe I was imagining it. Anyway, turns out, muscle weakness can be a side effect of both Benadryl and Decadron. The feeling was temporary, and my arms felt mostly fine by the time we left.
I also continued to experience a bit of loopiness and drowsiness, which I think is typical for Benadryl, so it's good Ken is still driving me for now. I'm still hopeful that maybe I'll get used to all the drugs so I can drive myself at some point; it would just be so much more convenient.
Physical Therapy Appointment #4
Soon after I started the Herceptin, the physical therapist came by. She closed the curtain for my bay and asked me how things were going.
I told her how pleased I've been with the improvement of my range of motion. She wasn't able to take any measurements with me in the infusion chair, but it's definitely something I can easily describe, even if we can't quantify it with numbers. She thinks maybe next week she'll give me new exercises since some of the current ones might be too easy now.
She spent most of the time working on the cording in my right underarm. I could definitely feel some discomfort as she massaged the areas, including the new length of cord in my upper arm. She said she will schedule herself to come during my infusions on Fridays to work on the cording. (I checked the online patient portal, and she already scheduled next week's session. Yay!)
Ken arrived during the physical therapy visit. He saw the curtain was closed, so he waited in a nearby waiting area. He met the physical therapist as she was leaving. I knew Ken was driving back and forth and teaching during his usual lunch period, so he was glad that I had ordered him a lunch! (The medical assistant who brought me to my bay asked if I was alone today, and when I told her Ken would be arriving late, she thoughtfully suggested I still order food for him!)
Flu Shot
At 4:00, the infusion nurse de-accessed my port.
I mentioned that I thought the medical oncologist had said I should get a flu shot today. The nurse checked the computer system. Turned out, we had to wait for the oncologist to put in the order, and also for the pharmacy to send up the shot. Once again, I had to take responsibility for my own health care!
I got the shot just before 4:30, and we headed home. All told, today's visit was 4 hours.
Blood Work
This week's blood work showed a decrease in my white blood cell count outside the normal range. Chemotherapy works by killing cells that divide quickly, which includes not only cancer cells, but also the fast-growing cells of hair (resulting in hair loss), the digestive track (resulting in nausea), and bone marrow, where blood cells are made. The white blood cell count is expected to decrease below the normal range, and then level off. My infusion nurse said they don't worry when the count simply dips below the range; instead, they look to see if the count levels off and then suddenly dips again, or if it continues to dip without leveling off.
Since my white blood cell count is lower than normal, even if it's not yet concerning, it does mean I have an increased risk for infection, so I need to be careful not to injure myself or get sick! In the TMI department, I'll mention that I'm not shaving during chemo because I don't want to risk nicking myself by accident with the razor.
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