11/15/19: Chemo Cycle #7 of 12 + Social Worker Visit + (12 Weeks Post-DMX) Physical Therapy Appointment #8

Ken dropped me off today so he could teach a double lab in the middle of the day.

I had a 9:45 appointment to get my port accessed and blood drawn. The port nurse noticed that my skin was irritated again, and I told her I've been alternating between bandaids and gauze with medical tape to cover the incision with antibiotic ointment. She agreed that the incision looks better. She said she sees every port that goes through the Cancer Center, and she's noticed an increase in the number of incisions that don't heal well. She's been keeping track of all new ports starting from a couple months ago, and I'm one of her data points! A whopping 55% of new ports have had issues. She thinks it may be related to stitches poking through and not dissolving properly. Anyway, she's reporting her data to the appropriate people at the hospital, and she says they are looking into it. It feels pretty great to know there are nurses like her who are actively trying to improve patient care!

We chatted a bit about my hair loss, too. She said that years ago, the Cancer Center used to provide their patients with cold caps, to help prevent hair loss. But they stopped at some point because of a concern that the cold that prevents hair loss also prevents the chemotherapy drug from circulating in the scalp, which may actually increase the likelihood of stray cancer cells surviving in the scalp. So one perspective is to look at hair loss as evidence that at least the chemotherapy is doing it's job; if it's killing fast-growing hair follicles, hopefully it's also killing cancer cells lurking in the scalp.

With my port accessed, I went upstairs to the infusion room, and the medical assistant took my vitals. She showed me to my bay around 10:15, and she set me up with a pillow and a warmed blanket, as usual. I ordered my lunch, plus one for Ken since he'd be joining me later.

My infusion nurse came in to ask about my weekly side effects, and suddenly the tears just started falling. She sat down and was very comforting. She reassured me that losing my hair is a kind of loss, and so there is a grieving process. I heard the same advice about losing my breasts when I had my surgery. It's just a lot to deal with, especially at the same time.

She asked if I had considered a wig, and I said I'm not really up for that option. She suggested again that I could cut my hair shorter, it might make the thinning less visible. I don't know, I'm just not feeling a hair cut, either. Basically, if I want to do something about the hair thinning, the options come down to getting a short hair cut, wearing a wig, or wearing a headcover like a scarf or hat; just none of them feel like "me". So the "best" option feels more like the least uncomfortable, least drastic option. My nurse encouraged me to get some hats, like a bunch of beanie-style hats in all different colors, and just wear them all the time so I get used to wearing them myself. Without my even mentioning it, she touched upon my hesitation to wear a hat to dinner last night (I didn't), and also suggested getting a more formed hat for when a winter beanie or baseball cap wouldn't feel appropriate, like when going out to a nice restaurant.

Anyway. I took my pre-meds around 10:30. My nurse said we would have to wait for my doctor to put in new orders, and then wait for the pharmacy to prepare the drugs. In the meantime, she got my IV set up, and took a look at the port incision through the clear dressing. She said it does look better, and to keep using the antibiotic ointment, since it still looks like it has some more healing to do.

Around 11:00 the social worker stopped by for a brief but helpful visit. (She just happened to see me while passing through the infusion room, but had another appointment coming up.) She sat down and asked me how my week went, and again the tears just came. She gave me some much needed comfort, saying that even though side effects can be predicted, that doesn't make them any easier when they happen. She also pointed out that hair loss in particular is so visible and drastic that it makes the whole idea of being in cancer treatment feel more real. I think that's especially true for me, because with other side effects being "mild" and not visible, and not experiencing any nausea at all (knock on wood), I kept thinking I was getting off easy, which makes this dramatic manifestation of cancer treatment feel all that more distressing.

My physical therapist came in at 11:15. She worked on my cording, and then declared it resolved! She said she couldn't feel it anymore. She also took measurements of my range of motion, so now I have objective data that my range has improved to be within the low end of being fully functional. Yay!

She took a peek at my incision scars, and said they are healing really well. I've been massaging them as instructed sort of intermittently; it just feels weird when I touch them. I'm supposed to keep up with the massaging as much as I feel comfortable, and also continue to stretch, since I still feel a lot of tightness, a little soreness, and my range of motion has room for improvement. We decided to set up a follow-up appointment in December to see how things are going, and we'll have that appointment in her regular exam room so there is more privacy for her to work on my scars.

I started the Herceptin around 11:30, during the physical therapy visit, and then started Taxol around 12:00.

Once finished, the nurse gave me my blood work report. My Im Gran (Immature Granulyte) is still a little high, a bit higher than last time. For the first time, my Monos (Monocyte) number is out of range on the low side. I kind of wonder if the healing action going on in my port incision is affecting these numbers. Also for the first time, one of my liver numbers, TotProt (Total Protein count of albumin and globulin, which are both within range), is very slightly out of range on the low side. I guess all this is normal during chemotherapy, so I'm not worried about anything, just find it an interesting exercise to track my blood work.

My nurse also gave me a note with instructions to call the cardiology department for an echocardiogram appointment. I need an echocardiogram every 3 months, I think because Herceptin can weaken the heart. (I called and they said they need to get insurance pre-authorization first, so they will call me back once they have it.)

Ken hadn't returned yet, so at 1:15, with his lunch in hand, I went downstairs to wait in the larger waiting area downstairs. Not counting the time I had to wait for Ken, this appointment was about 3 1/2 hours.