10/1/20: Port Removal

The port is out! 

It's covered with dressing that I can't take off for 2 days, and I'm told there are steri-strips under that, so it will be a while before I can tell what the scar will look like.

Ken drove me into the city for this appointment, and the first thing we noticed is that the mask compliance rate of people walking around in the city is WAY higher than in our suburban hometown.

Ken walked me into the hospital but then waited outside for the duration of my appointment.

The area I was brought to in the interventional radiology department was a big open space with a nurse's station in the middle and bays of hospital beds along the perimeter, separated by curtains. A nurse took me to a bed and had me change into a gown. She took my vitals and then gave me an IV. It took her two tries! The first time she stuck the needle in, poked it around, said it's not working, and then pulled it out. She then tried again in a different place, and it worked, though there was some bleeding. I've had several IVs by now, and that's never happened before, but I just shrugged it off.

A physician's assistant came to speak with me, and it was the same one I saw in January. He was easy-going and more of a jokester this time, which actually came across as less personable to me, like he was using the humor as a kind of shield. I told him about both of my concerns - the leftover non-dissolveable stitch and the messiness of the ugly scar. I felt like he was dismissive about both things. Of course he said, "If there's something in there we'll take it out," and, "We'll do our best to make it look nice," but they just felt like "the right thing to say," I didn't get a sense that he really cared.  

I was rolled into the operating room, where 4 nurses busied themselves getting me ready. They were all very nice. I was pleased that multiple people along the way took note of my chlorhexidine allergy, and one of the nurses said right away that they would use Betadine instead. 

The doctor came in after I was already prepped, and he didn't introduce himself to me at all. I was reminded that I actually liked the doctor who performed my port placement; he was friendly and he explained what he was doing while he was doing it. This doctor didn't say anything at all; I hope that means he was concentrating on the procedure.

I was given some kind of sedative for the procedure, so my mind was foggy, but I think I did try to mention the leftover stitch. I have a vague notion that I said something just as the doctor was getting started, so that I could be sure he was aware of the stitch, but I can't remember the details. I think I dozed off during the procedure. As he was finishing up, I asked him if he found anything, and he said no. Maybe it wasn't a stitch after all? Maybe it was, and it's still in me? It occurs to me that maybe he would say no even if he did find something, like maybe they shouldn't admit that they left a stitch in me for almost a year.  

The procedure went fine in that the port was removed and nothing went wrong, but I didn't leave feeling like my concerns were addressed. I think I would have gotten a more satisfying experience at my local satellite hospital, but I still think if I end up having any kind of healing problems later, if the port was removed by the same doctor as before, I'd blame him. So, I don't regret going to the main hospital for this procedure; this way, if I have problems later, I won't feel like it's anyone's fault, it's just what happened.

Anyway, I was given some ginger ale and graham crackers while waiting for some of the sedative to wear off. After maybe 15-20 minutes, they had me call Ken, and someone walked me to the main entrance to meet him. The whole visit was less than 3 hours.

Every person I encountered during my appointment, when they found out I was there to get my port removed, gave me a hearty, "Congratulations!" But somehow, instead of wanting to cheer, I felt like crying. I don't know if it's a sense of relief that a big part of my treatment is over, or what, but I do feel kind of discombobulated. In a weird way, I sort of feel the same as I did when I got the port placed. Like something has changed, and something else is about to start, and I don't know what it's going to be like. 

The area where my port was is sore and stings a little. Maybe I will take a Tylenol before bed tonight.

8/14/20: Maintenance Herceptin #12

Today when the medical assistant took my blood pressure, the diastolic number was a very high 106. She took it again, and it was down to a very normal 77. 

In recent visits this has been a relatively common occurrence: my first blood pressure measurement is high, so they take it again, and the second time it's normal. Not sure what that means. Do I come into appointments feeling anxious, and need to consciously calm down? I don't think I feel any more anxious about my appointments now than before. Anyway, my infusion nurse pointed out that my cardio-oncologist thought my blood pressure was fine, so I guess it's nothing to worry about.

She also mentioned that she'd ask my oncologist about scheduling me for port removal. After today, I have only 2 infusions left!! She said they might even schedule me in before my last treatment, which is fine because the Herceptin infusion can always be done via an IV in the arm. 

I'm looking forward to getting the port out. I'm so tired at looking at the ugly scar, I really hope they can clean it up when the port comes out... Given how the other procedures went, though, I guess I'll cross my fingers, but I won't hold my breath. The tiny non-dissolvable stitch is still there, too; it doesn't hurt or anything, but it just bothers me that it's there, and I'll be glad when it's out. 

7/24/20: Maintenance Herceptin #11 + Medical Oncology NP Appointment

After the port nurse accessed my port, and before I went upstairs for my infusion, I met with a medical oncology NP. My oncology appointments now alternate between the doctor and the NP, and this was my first time meeting the NP. She was great, like everyone else I've met at the Cancer Center.

We went through the whole history of the numbness and tingling in my hands. The symptoms have been at baseline since the beginning of June, and since they're not disrupting my daily activities anymore, there's no sense of urgency to get an MRI. The NP decided to wait, and to have me see the physical therapist in person first. If the physical therapist still thinks I need an MRI, maybe they'll order it then. I don't have a strong feeling one way or the other about it at this point. 

As instructed by my PCP, I asked if I should get a colonoscopy before age 50. The NP seemed surprised by the question, and said no, they do not usually recommend early colonoscopy for breast cancer patients. 

I also asked her opinion about getting my ovaries out. Based on the genetic counselor's advice, I should feel fine about not getting them out. I guess I'm just curious to know if anyone has any thoughts or information that I haven't considered. Anyway, she said she understands how complicated the question is, but she isn't very knowledgable about this particular issue, and would defer to the medical oncologist.

After the NP appointment, I went upstairs for my Herceptin treatment. When the infusion was finished, and the infusion nurse took off the dressing on the port to de-access it, I asked her to take a closer look at my port incision; lately I've noticed two little dots, and a tiny black shadow between them, on the incision scar. I think it's a tiny stitch! Not the dissolvable kind, either; it looks like the regular kind that was used for my re-stitch. The infusion nurse agreed, and said maybe it's working its way out. She put some antibiotic ointment on it, and a bandaid. I guess we'll see if it comes out. I figure, they can always take it out when I get my port out. I just don't want it to get infected or anything in the meantime.  

Today's appointment took about 3 hours total. Back at home, I checked my blood work online, and my vitamin D levels are back to normal! I'm taking a daily supplement of 2000 IU, and it's good to know for sure that it's working. 

1/17/20: (1 Month Post-Chemo, 5 Months Post-DMX) Side Effects and Symptoms

Both my cancers were hormone receptor-positive, which means estrogen and progesterone fueled their growth. Chemotherapy was supposed to kill any existing cancer cells that may have escaped from the tumors, but there's always a chance that whatever conditions in my body that produced the cancer cells in the first place still remain, and so could produce a new cancer. My hormone therapy is supposed to prevent recurrence; the goal is basically to eliminate the presence of estrogen, so there won't be any estrogen to fuel any new cancer growth.

My monthy injection of Lupron is for ovarian suppression; it stops my ovaries from making estrogen (and puts me into a chemically-induced menopause). However, other parts of the body also produce estrogen. So today my medical oncologist prescribed exemestane, a daily aromatase inhibitor pill that will stop any remaining production of estrogen.

I seem to have a compulsion for tracking my side effects and symptoms. So before I take my first exemestane pill tonight, I wanted to record my current baseline of how I'm doing.

It's been about a month since my last chemo infusion, and since then, I've been on just Herceptin and Lupron.

Interestingly, even after chemo ended, I continued to lose body hair, like on my legs and in my armpits. Like the hair on my head, though, it's not complete hair loss, so a few hairs remain.

Meanwhile, the hair on my head has started to grow back. I can see tiny new hairs interspersed with the slightly longer hairs that grew from shaved hair that never fell out.

I stopped noticing blood in my nose about 2 weeks after chemo ended. My sense of taste also seems to have fully recovered.

My eyesight still feels off. The blurriness isn't quite as bad as before, but it's still there.

The acne hasn't really gone away, either, but it's improving.

My belly still feels flabby. I remember being told that menopause makes losing weight more difficult. I haven't made a conscious effort to lose weight yet, though I am about 5 pounds heavier than I was before chemo.

I'm not as tired anymore, as evidenced by my ability to stay up past 9:00 pm on a regular basis. Also, during chemo, I almost always needed to lie down at some point in the late afternoon, but I haven't been doing that lately. (Perhaps relatedly, I've started to drink coffee again, and usually have a cup in the mid-afternoon.)

At 5 months out from my DMX, my chest and right underarm still feel weird, but to an even greater extent than before. The areas are still numb, but also tingly, especially when touched, and my chest actually feels tighter. I think this is what others refer to as the "iron bra" feeling. My upper right arm, particularly around the underarm area, sometimes feels like pins and needles. I wonder if all the increased sensations means that some of the nerves are growing back. And/or maybe I need to do my stretches more frequently and/or consistently.

The cording persists. It comes and goes, but is overall worse than it was at first.

For the record, the stitch that poked out from one of my incisions is finally gone. It was significantly smaller and less noticeable about a month after I first discovered it, but it took over 2 months to fully go away. Now there is a tiny hole where the stitch used to be. I'm assuming it will close up in time.

Recently I've noticed a couple new side effects / symptoms, as I reported to my medical oncologist today. There's the leg stiffness that I first noticed a couple weeks ago, and also the numbness and tingling in my fingers and swelling of my arms (possibly fluid retention) that just started this week.

Geez. When I lay it all out like that, it's depressing. I can hardly recognize my own body. It's hard to believe that one year ago, I felt perfectly healthy. Now, is there even a single part of my body that's come through cancer treatment unscathed?

Honestly, when I think about it, I think my ears, and my sense of hearing, are literally the only things that have not been affected.

From another perspective, of course, I know I'm lucky. I'm still here, and my prognosis is good.

1/3/20: Interventional Radiology Appointment

At this appointment, there was a chance I might have the port incision line re-opened and re-sutured. Since technically that would be a surgery, I couldn't have anything to eat or drink for 8 hours before the appointment, and I wasn't supposed to drive myself, just in case. I was glad to have Ken do the driving, since this appointment was at the main hospital in the city.

Going into the appointment, the medical assistant tried to confirm that I was there for a port placement. I explained the situation as briefly as I could, and she said she'd have a nurse check in with me.

I was taken to a bay somewhere in the radiology department. I changed into a gown, and got settled into a hospital bed. Ken sat in a nearby chair, and we did a lot of waiting.

First, very quickly, a nurse did come by and confirmed that a doctor would look at my incision and decide next steps.

After a while, a physician's assistant (PA) came by. He asked for the full history of my port incision. I told him the whole story, and even pulled out my cell phone to show him some photos.

This is what it looks like now, pretty much the same as it looked before the re-stitch, only a little redder.

3.5 months after port placement.
Entire incision not closed.

The PA listened carefully, and was very friendly, but then said the doctor would be the one to decide what to do.

When the doctor came in, he was not the same person who performed the original port placement or re-stitch. He also asked to hear the history of the port incision, but he seemed not quite as interested as the PA was. I got the feeling the PA probably already told him the highlights.

The doctor weighed the benefits of re-opening and re-suturing the line against the possible risks. The fact is, the port works, and it's not infected. Those are the two most important things. If they open up the incision to re-suture it, the risk of infection goes up. And if it gets infected, there's a chance the port would have to be removed, which means I would have to finish my treatment by getting my infusions through a regular IV, which everyone says is hard on your veins and not ideal. As ugly as the scar is, there is no medical reason to re-open the wound, so the doctor advised against it. Re-suturing the scar would be entirely for cosmetic purposes, and I would have had to ask for it against the recommendation of the doctor.

I'm disappointed about having an ugly scar for 10 more months, but as risk averse as I am, I agree with the decision to not invite an increased risk for infection.

I asked whether or not the wound could be "cleaned up" when I get the port out at the end of my treatment. The PA talked about trying to excise some of the scar tissue and using non-absorbable sutures to try to get a clean closure, but the doctor was much more circumspect and basically took a "we can't guarantee anything but will do our best" kind of line.

It's worth noting that I didn't get to choose which interventional radiologist I saw. I asked when I made this appointment, and the scheduler said I would see whoever is working at the time of my appointment. It just seems so random.

12/16/19: Phone Calls

Last Friday, my infusion nurse said she'd send the photo of my open port incision to the doctor who performed the original port placement to ask what to do about it.

I got a call this morning about setting up an appointment with the interventional radiology department at the main hospital in the city. (Incidentally, not the same number or address as either of the last two calls. I guess it's a pretty big hospital network.)

It wasn't clear to me what would happen at this appointment. I was told that a doctor would look at my incision (not sure if it'll be the same one who did my port placement and re-stitch), and just in case I need to undergo some kind of procedure, I should not eat or drink for 8 hours beforehand, and I should have a ride home.

Later in the afternoon, I got a call from my port nurse. I appreciate her so much!! She was basically acting like my point person, and wanted to make sure I knew what was going on. She saw that the internal email thread about setting up my appointment did not include my medical oncologist, and since I'm an active chemo patient, she thought it was important for my oncologist to sign off on any procedures I might get done. She said it sounded like they might want to re-open the line and re-suture the whole thing. (The re-stitch was an attempt to bring together the skin layer, but left the deeper layers alone.)

My interventional radiology appointment is next Monday, which apparently works out well because I have an appointment with my medical oncologist this Friday. She can look at my blood work, and the port incision, and help me figure out what to do.

12/12/19: Cycle 10 Side Effects

Same old side effects, plus the new rash on my hand:

• Dry, red, bumpy, itchy rash on the back of my hands
• Continued hair loss (I find tiny little stubble hairs on the bathroom counter.)
• Blurry vision
• Mild headache
• Blood in stuffy/runny nose
• Acne (face, back, and scalp)
• Dry mouth (on day 1 of cycle)
• Insomnia / Trouble sleeping
• Occasional mild neuropathy (occurred more frequently this week than previously)
• Tiredness / Fatigue (on days 3 through 6 of cycle)
• Changes in sense of taste (e.g., no sense of taste at all, or something tastes metallic; has not persisted beyond 1 meal at a time)

This week I was mostly pre-occupied by my port incision. It bums me out. It's completely open again. I don't know if the stitches came out too early, or if it was too late to re-stitch in the first place, or what. It's not quite as wide as it was before, and it does look like it's going through some stages of healing, so maybe the stitches did something. I just need to accept that it's going to be an ugly scar, and hope that there will be a way to ensure a better outcome when I get my port out.

It does occur to me that of all things to go wrong, having the port incision not heal is probably the least problematic of things that could have gone wrong. Thankfully, my DMX incisions are healing well, and chemo has been going fine, too. (Knock on wood.) It's probably a bit much to expect everything to go as planned, so if something has to go wrong, it might as well be a poorly healing port incision. 

12/6/19: Chemo Cycle #10 of 12 + (3.5 Months Post-DMX) Physical Therapy Appointment #9 + Nurse Removed Port Incision Stitches

Warning: This post contains photos of my unhealed port incision.

Today I drove myself to chemo. I think it went fine! I'll plan to drive myself for the last two treatments.

I had a 10:45 appointment to get my port accessed, but the port nurse was running about 30 minutes behind schedule. The Cancer Center was super busy today, even the parking area was full. The port nurse said it's because the flu is going around early this year; patients are supposed to call their oncologist if they get a fever during chemo.

After getting my port acccessed, I was 30 minutes late for my physical therapy appointment. Luckily my physical therapist didn't have another appointment immediately after my original time, so she could still see me without much disruption to her schedule. She purposely scheduled this appointment before my infusion appointment so that we could meet in her exam room, making it easier to take measurements of my range of motion. It was very satisfying to see objective evidence of improvement!

Meeting in her exam room also gave us more privacy for her to look at my DMX incisions. She massaged them to help break down the scar tissue. The area is still numb, and tingly when touched, so it felt weird, but not in a ticklish way. She said I've healed really well; my incisions are nice and smooth, no bumpiness or puckering, which can sometimes happen. (There's a bit of extra skin at the outer end of each incision... They bother me, but I'm working on accepting them.)

I told her I was still feeling a kind of tightness in my right arm. She took a look and said it's cording again. She massaged the area, and it did feel a lot better afterward. She said she'd schedule me for another physical therapy visit next Friday, while I'm in the infusion room, to work on the cording some more.

I got to the infusion room around 12:00. My usual nurse had told me she'd be out, and I had the same substitute nurse I had once before.

I started my pre-meds around 12:15. Started Herceptin just after 12:45, and then Taxol at 1:30.

After the Taxol finished around 2:30, the nurse took out the port incision stitches. It took a while because the nurse said the stitches were really tight, she had a hard time cutting them. I figured that was a good sign that the stitches were done well, but when I finally had a chance to look at the incision at home (no mirror in the infusion bay), I was disappointed. The bottom half, maybe 2/3, looks closed. But a portion at the top is still open.

At this point, maybe a series of photos would be helpful. Here's what the incision looked like over time:

6 weeks after port placement.
Not healing, 2 spots not closed.
Started using antibiotic ointment.

8 weeks after port placement.
Entire incision not closed.
Stopped using antibiotic ointment.

9 weeks after port placement.
Incision closed tightly with stitches.

10 weeks after port placement.
Stitches removed after 9 days.
Inside circle, not closed.
Left of circle, a scab spans opening.
Left of scab, skin is closed.

I guess when I compare the little opening after stitches to the big opening before stitches, it's definitely an improvement. It's just kind of ironic how the two giant DMX incisions healed so smoothly, and this 1-inch incision is having so much trouble.

I wonder if the stitches were taken out too soon. From what I can gather, stitches on the chest area are generally removed in 7-14 days; mine were removed in 9 days, clearly within the range, but on the early side. I did some Googling, and I guess wounds opening up after stitches are removed is not uncommon. It sounds like, if "too much time" has passed, the opening won't be re-stitched, and the person just has to wait patiently for the wound to heal across the gap, which takes a long time (could be months) and results in a more prominent scar. In my case, these stitches are already the re-stitch, so a re-re-stitch seems unlikely. The re-stitch was a solid 2 months after the original surgery, too, so maybe it was already "too late", but they tried.

I was lamenting the potential scar, and my son said, "No, it's good to have battle scars! They prove that you've gone through hardships. You're badass!" (Reminds me of the meme I posted about my DMX incisions.)

I assume I will get another incision in essentially the same spot when my port comes out in about a year. However it heals now, it is what it is. The port removal procedure will leave me with the final scar, and there's still a chance to get a better result then. It's just unfortunate, and annoying, that it's not healing smoothly.

Anyway, circling back, I left around 3:00, so my visit today was over 4 hours, one of the longest. Thankfully, lunch was included.

Oh, there was something new on my blood test results. I had a value very slightly out of range on the high side for Phos (phosphate). As far as I can tell, phosphate is one measure related to kidney function. I guess it's weird that I want to look at my numbers when I don't understand them. But I like to check just in case some numbers go way out of whack. It's reassuring when they are mostly within or very near normal ranges.

12/7/19 Update: Spoke too soon. Woke up this morning to find the bottom part of the incision has opened up. Not as much as the top part, but it's definitely not closed, there's a gap. OH, WELL. 

11/29/19: Chemo Cycle #9 of 12 + Lupron

My sister is in town for Thanksgiving, so she came with me to today's appointment. It was a smooth and uneventful visit!

I took off the dressing for the port incision at home because I needed to put the numbing cream on the port itself. The incision is covered with Steri-Strips, so I still can't see what the stitches look like.

I got my port accessed at 9:45, headed up to the infusion room, got my vitals checked, and was settled into a bay by 10:15. The infusion nurse gave me my pre-meds, and we waited for my blood work to finish and for the hospital pharmacy to prepare the drugs. (I think the Taxol and Herceptin aren't prepared until the blood work confirms I will get treatment that day; the drugs expire within 24 hours, and it sounds like the nurses don't request them until they know they will definitely be used.)

I started the Herceptin just before 11:00, then started Taxol at 11:30.

After the Taxol finished at 12:30, the nurse de-accessed my port and looked at the port incision. She said to leave the Steri-Strips on until they fall off by themselves, and next Friday she'll remove the stitches. (Actually, she said she wouldn't be in next week, but she'll leave instructions.) She also confirmed I can go ahead and cancel the other appointment that the other nurse made for me in the city.

I got my Lupron shot, and my blood work report. I had two values out of range, the same two as last week. The Im Gran (Immature Granulyte) value crept up a tiny bit higher, and the AbsLymp (Absolute Lymphocyte) dropped a teeny bit lower.

We left around 12:45. Today's visit was about 3 hours total, probably the shortest visit I've had!

It was nice to have the one-on-one time with my sister. For the first time, though, I did not get offered a lunch! I'm guessing it was an oversight, maybe because the medical assistant who checked me into the infusion room wasn't the one who is usually there. It was fine, though. With yesterday being Thanksgiving, we knew we'd have plenty of food waiting for us back at our parents' house.

11/27/19: My Port Incision was Re-Stitched

Yesterday, a nurse in the radiology department called. She said she saw the photo of my port incision (presumably the one my infusion nurse took), and it needs to be re-stitched!! She got me in today to see the same doctor who performed my original port placement surgery.

As an aside, I'll mention that later in the day yesterday, I actually got a second call from a different nurse, this one from the interventional radiology department in the main hospital in the city. She had the exact same message for me, only she scheduled me to see a doctor next week in the city. I told her about the other nurse, and the other appointment at my local satellite location. She said to keep the local appointment, and then apologized for the confusion. I said it's okay, it's nice to know that all the right people are looking at my case and trying to help!

Anyway, so today's appointment was quick, only like half an hour.

I put on a gown, walked into the operating room, and laid down on the table. The doctor said the incision looked good in that it's not infected, and it looks like it's healing fine under the skin. He said it looked worse in the photo.

He started to clean the area around the port. As he was applying the antiseptic, I thought to ask, "Is that chlorhexidine?" It took me a moment to speak up as I realized what he was doing, and I wondered if he had seen my chlorhexidine allergy in my medical file. But I guess I can't assume people will see it! I told him about the rash I got after the port placement; it's not like a serious reaction, but probably worth avoiding if possible. Without missing a beat, he reached for a towel and very calmly said, "Okay, we'll just wipe this off." It was kind of funny. So then he asked the nurse for some Betadine, but they didn't have any in the operating room. The nurse left to get some, but I guess the doctor got tired of waiting, because he decided to clean the area with alcohol.

I got 2 injections of local anesthesia. The pinch and burn hurt a lot! But then I didn't feel a thing as the doctor stitched up the incision with regular sutures. He asked me casual questions about Thanksgiving while he worked.

I have no idea what the stitches look like, they're covered with gauze and Tegaderm. The doctor said my nurses can remove the dressing on Friday when I go in for chemo, and he'll tell them they can remove the stitches next Friday.

Now that the local anesthesia is wearing off, the area kind of stings. I just hope the incision heals properly now, so it can be one less thing to worry about!

11/25/19: (3 Months Post-DMX) The Last Bit of Surgical Glue Came Off

For the record, it took about 3 months for every last bit of the surgical glue to come off my incisions.

The stitch that poked out is still there, only now it's really tiny, and only noticeable when I go looking for it.

The areas around the incisions still feel weird. Same tightness and tingling, and numbness in my right underarm.

I need to stay on myself to keep doing my physical therapy exercises. My range of motion is good enough to not limit my daily activities, so the exercises don't feel as pressing anymore. But I can definitely feel the setback if I skip a couple days.

11/8/19: Chemo Cycle #6 of 12 + Medical Oncologist Appointment + (11 Weeks Post-DMX) Physical Therapy Appointment #7

With today's treatment, I'm halfway finished with chemo!

My 8:15 appointment was the earliest it's ever been. Accounting for traffic, we left the house at 7:15, before the kids usually wake up for school. But today we made sure they were up before we left the house, and a friend in town drove them to school. Ken took the day off and drove today.

I got my port accessed (I could feel a small pinch, so I guess I didn't use enough numbing cream today), had some blood drawn, had my vitals taken, then went in for an appointment with my medical oncologist.

I mentioned that I've noticed my blood pressure has gone up. My pre-chemo blood pressure was always something in the 110s over something in the 60s. Now it ranges anywhere from the 110s-130s over 60s-80s. I guess it's still in the normal range, so not considered concerning, but it's still relatively high for me. My oncologist said the steroid can cause high blood pressure, and also just the stress of having cancer and being in active treatment can be a factor. Apparently both Taxol and Herceptin can cause high blood pressure, too.

I asked her for her thoughts on whether or not I can drive myself to future appointments, and she said it's really up to me, if I feel up to it. She did confirm that my chemo regimen is not expected to change.

The most important part of these appointments, I think, is for me to report my side effects, so she can make sure I am tolerating the treatment. If any side effects are too severe, she could adjust my medication doses, or prescribe additional medications to manage side effects. Anyway, all my side effects are so relatively mild that it sort of felt like I was looking for things to report! I guess I'd call that a good thing. My oncologist was pleased with how well things have been going.

She said to continue with the loratadine, since does seem to help with the cough.

She did a physical exam, and looked at my surgery incisions. She said what's left of the tiny stitch didn't look infected, so instead of triple antibiotic ointment, I could use Aquafor. But I shouldn't use a bandaid to cover it up, because she could see my skin was getting irritated. (Later at home, I discovered that a small piece of Glad Press 'n Seal works as a great bandaid alternative for just keeping the ointment in place and off my clothes.)

I mentioned that the area around the port was achy today, and I suspect I didn't put enough numbing cream on it. She said to just go ahead and be generous with how much cream to use, and instead turned her focus to the port incision. She said it doesn't seem to be healing well. I was glad she noticed, actually, because I've been disappointed in the way it looks; I'm anxious for it to heal, but it's not a smooth scar. There are still a couple small places where a scab hasn't fully formed, so it can't fall off. I'm not sure what's going on there. She said it doesn't look infected, so really there's not much to do but wait and see. Ken says they will cut me open in the same place anyway when my port gets removed, so I can just hope that the surgeon who does the removal does a better job with closing the incision! I mean, I guess that's true, but I'll still have my port for almost a year, so it doesn't make me feel much better about right now.

Finally, I'll mention that she looked at my nails, and reminded me to keep them cut short. I don't remember being told to do this before, so I looked it up when I got home. I found a helpful page from Memorial Sloan Kettering Cancer Center about how Taxol might affect nails, and what I can do to try to prevent nail changes.

I got settled in my infusion bay around 9:45, and started my pre-meds at 10:00.

My regular infusion nurse was back, and she gave me some of her thoughts on hair thinning. She said I definitely shouldn't shave it all off, because she still thinks I won't lose it all. She said she thinks my hair still looks good, that the thinning really isn't noticeable to other people. She said I could cut my hair shorter if I want it to look fuller, but I should only do it if I want to. I really appreciate how she and last week's nurse presented some options, but then reminded me that it's always up to me, that I should do what feels best for me.

When I asked my infusion nurse about whether or not I can drive myself in the future, she was quick to say that she definitely thinks I can. The concern is mostly about the Benadryl pre-med making me drowsy, but by the time I leave, I should have a good feel for whether or not I'm alert enough to drive. She suggested I do a trial run and drive home on a day when Ken is with me, so he can both observe me and be a back-up if I don't think I can do it.

My physical therapist came in around 10:30, and I started the Herceptin soon after.

The physical therapist worked on my cording for just a little while. She said it's so small now, maybe it'll be gone by next week. I told her about the muscle soreness I was feeling along my ribs, but around back. She was able to identify the muscle, and she gave me a new stretch to help that particular area. She also gave me a recommendation to follow a physical therapist on Instagram who is certified for oncology and lymphedema. She posts a lot of suggestions for stretches, including helpful videos.

I started Taxol around 11:15.

An hour later, a different nurse de-accessed my port, then looked curiously at my port incision, saying it looked red. She had my assigned infusion nurse look at it. My infusion nurse said it didn't look infected, said it's clearly still healing, and maybe there was a stitch or two not dissolving. She suggested I use some triple antibiotic ointment on it, and see if it helps. Ken mentioned that I had said I accidentally got some of the numbing cream into the incision today. She said it's okay, I should try to avoid doing that, but a bit of accidental exposure shouldn't be problematic.

My infusion nurse also brought me my blood work. 3 numbers were just slightly out of range: Baso (Basophil) was a little high, Im Gran (Immature Granulyte) was a little high, and AbsLymp (Absolute lymphocyte) was very slightly low. They're all related to white blood cell count, so they have to do with possible infection, or maybe even allergies. My medical oncologist had particularly asked me if I might have any kind of infection (I don't), and I wonder if these numbers helped prompt that question. Still, she said my overall numbers were good, so mostly I'll take these counts as a reminder to keep up with my handwashing and water drinking and other preventative measures.

We left just after 12:30, which means total visit time was about 4 1/2 hours. Incidentally, we did not get a free lunch today! Guess we finally stumbled on a time frame that didn't warrant it. Haha. Ken and I had a nice lunch out, and then we went to a nearby Costco. Surprisingly, we ran into a friend from town, spent some time catching up with her, and she said she wouldn't have known I had lost a lot of hair if I didn't tell her. That was nice to hear. She's a pretty straight shooter, so I think she meant it.

10/25/19: Chemo Cycle #4 of 12 + (9 Weeks Post-DMX) Physical Therapy Appointment #5 + A Stitch is Poking Out

Last night I discovered a little pokey thing sticking out of one of my incisions! It's tiny, I can't actually see it, but it feels like a tiny fishing wire. Thanks to some helpful posts I saw in Facebook support groups, I suspected it was a stitch sticking out, but wasn't sure what to do about it. I called the Breast Center this morning, but no one answered. I left a message, and told them I'd be in the Cancer Center later today.

Today was the first time a friend drove me to chemo instead of Ken. Ken is able to take off as much time as he needs, but practically speaking, it's difficult to juggle his lesson planning if he misses too many classes. I'm still hopeful that I may be able to drive myself eventually, but in the meantime, it's super helpful to have friends who have offered to drive.

I am pretty bad at asking for help. I just don't like inconveniencing other people. And this is a big inconvenience, potentially taking several hours. But as my infusion nurse pointed out today, if it's something I would do for someone else, then it's okay to let someone else do the same for me.

The friend who drove me today is one of my dearest friends. It was actually really fun spending the day with her. I mean, I would call it a pleasant way to pass the time, if only I wasn't getting cancer treatment at the same time. Hahahaha.

Ideally, my appointment in the infusion room would be 15 minutes after my port access appointment, so I can go directly from one appointment to the other without delay. That has pretty much been the case up until today. Today my 1:00 PM infusion appointment was 45 minutes after my 12:15 PM port access appointment, and all 10 infusion bays were occupied when we arrived. There's a small waiting area, and we had plenty of time to chat! We were given menus to order our lunches while we waited.

Also, my infusion nurse used this time to ask me about my side effects, so we could jump right to the meds when I got to my bay. I said I seem to always feel fine on Saturdays (day 2), and she said that's because of the Decadron steroid; it takes a few days to wear off.

I told her about the blood in my stuffy/runny nose, and she said that was not surprising if my platelet count goes low. (My platelet count has been on the low side, but still in the normal range.) If my nose feels irritated or dry, she said it might help to put a humidifer in my bedroom.

I also told her about the tiny pokey thing. She said it's probably a stitch, and she would consult with another nurse who previously worked in the Breast Center.

Once I got assigned to a bay, I started the pre-meds around 1:30. The regimen was the same as last time.

I got Herceptin starting at 1:45, then Taxol starting at 2:15.

During the Taxol, my physical therapist came in, and my friend stepped out and went back to the waiting area. The physical therapist worked on my cording while talking to me about ways to manage my tiredness. She referred to cancer-related fatigue and emphasized the importance of getting my heart rate up. Like if I take a nap during the day, I should get my heart rate up for a few minutes afterwards; I could go up and down the stairs a few times, or even just swing my arms around for a while. She reminded me that my walking should be "moderate" exercise, a brisk pace while still being able to carry on a conversation; it's all about the heart rate.

She also said I can start massaging my incisions to help break up the scar tissue, which can help make scars less noticeable. At this point, most (but not all) of the surgical glue and scabbing have come off, exposing the pink scars underneath. She showed me how to very gently massage my scars, basically the "vertical" and "circle" methods described in this "Managing Your Scar" document from the Moffitt Cancer Center that I found online. But my physical therapist said not to use lotion while massaging for now because it's important to maintain the friction between my fingers and the scar. I didn't think to ask if I should use any lotions otherwise.

Finally, I asked the physical therapist about the pokey thing in my incision. She didn't look at it, but she said it sounded just like a stitch. She said she's seen it a few times, and the first time she encountered it, she was advised by a nurse to recommend applying triple antibiotic ointment (besides preventing infection, it helps to soften the stitch), and covering it with a band-aid to keep the ointment in place.

I finished the Taxol at 3:15. The infusion nurse gave me my blood work report (nothing remarkable this time), and also took a look at my pokey thing. She confirmed it's a dissolveable stitch, and the other nurse who had worked in the Breast Center had advised her to snip it as close to the skin as possible! It was really tiny. She did the best she could, and now I can only feel the stitch if I run my finger over it in one particular direction. She said to use the triple antibiotic ointment and band-aid at night when sleeping.

We left around 3:30, so today's appointments were about 3 1/2 hours total, not including driving time.