" the quiet was so deep that their feet seemed to thump along while all the trees leaned over them and listened". from the hobbit, by j. r. r. tolkein

so, yesterday,  i went for my first check up with the oncologist after my first chemotherapy. i had had the usual side effects that i suppose everyone has to some degree- taste changes, sore mouth, a slight fever, some nausea. but i also had some very significant abdominal pain ( the taxotere) and the delights that come with that. just as bad or worse than that really, was extreme bone pain. that was from the neulasta shot that i was given the day after chemotherapy. the purpose of this is to stimulate your body to make white blood cells. it is a long acting drug- stays in your body for 2 weeks- and most people do pretty well with it. i have learned to expect the unexpected when it comes to me. every bone in my body hurt and i could hardly walk saturday night. when the nurse looked at my blood work, she said that my white blood cells were very high. who knew my body would try for the world record in white blood cell making? the nurse said that she had observed that the people who made the most white blood cells had the most pain. i could have told her that.

so, after a little discussion, i am not to be receiving the neulasta shots again. what the doctor will do is to monitor my blood work a little closer, and if my white blood cells do go down, they can give me an injection to stimulate production that is short acting, and hopefully less painful. the doctor is also going to reduce my taxotere dose a little bit so that perhaps the abdominal pain,etc. will not be as severe. i started out asking nicely about these changes, but was willing to beg or whatever if that was necessary! it was not. from this, i can conclude that it is necessary to have an oncologist who is willing to make adjustments, though not ones which would  jeopardize your health, when it comes to a chemotherapy regiment.  

so today has been my first good day after chemotherapy. i still have some of the above mentioned symptoms, but i do feel a little bit more like myself. when i had my first infusion, there was an almost unbearable quiet. there was plenty of noise going on around me - other infusion rooms, nurses station, people moving around, but when the nurse started my infusion, the world went totally quiet. jeff and i were holding hands and were  just waiting to see what would happen. hopefully, my second chemotherapy, which is scheduled for july 8th, will go well. at least now i know what to expect, somewhat. i think the world will still be a little quieter then as well, though.

" escaping goblins to be caught by wolves!" he said, and it became a proverb, though now we say, out of the frying pan, into the fire. in the same sort of uncomfortable situations." from the hobbit, by j. j. tolkein

one chemotherapy session down, three to go! what was supposed to take three hours, ended up lasting six. one reason was that the chemotherapy nurse took it easy on me, and reduced the rate times on all the drugs i received today. the other being, they were terribly busy. i even had to share, though i did not mind, my room with someone. she got off easier than i did. she was only there for about an hour.

i do not have a port or a pic line. the doctor said since i have only four chemotherapy treatments( his assessment, not mine), that we can just do them straight IV unless my one good vein runs away. after today, it might just do that! i started off with a little normal saline, to hydrate me. then, they added a pepcid drip. this is usually used for stomach trouble, but it is technically an antihistamine, and is also used for allergic reactions.( hint, hint, the taxotere). then, i got a small bag of the decadron, which is a steroid and is also used to help prevent allergic reactions. next, was the aloxi. now, i had never heard of this drug. it is used to help prevent nausea, but it really stings as it goes in. last, but not least, was an IV push of benadryl. this usually puts people in la-la land, but i fought to stay awake  and alert, well, as alert as you can be with all of these  medications on board.

just as the nurse was getting ready to hang the dreaded taxotere, i asked her if it was preservative free. she said no, and i explained my sulfite preservative anaphylaxis to her. while she was on the phone to the hospital( i had a great nurse), i got my smart phone out and looked it up myself. it does not have sulfite preservatives, score one for me! what it did have, however, was a " black box warning". now if you are a pharmacist and you are dispensing a medication to a patient that has a " black box warning" you worry, a lot, and you definitely counsel the patient. if however, you are a pharmacist and you are RECEIVING a drug that has a " black box warning", you nearly pass out! a very small number of patients have had anaphylatic shock and died during the first few minutes of a taxotere drip. my nurse came back in, with an epi pen, no less, and told me that we were going to take this very slowly since i had never had it before. i never knew that i could hold my breath for so long! since i am here, writing this blog, we can all assume that this had a happy ending.

the last IV bag that i got was the cytoxan. here is where the " escaping goblins to be caught by wolves" part comes in. i had not worried one bit about this medication.i have dispensed the tablet form of this on many occasions, and it has been around for years.  they administered it slowly, which i was thankful for, but this drug causes( short term) extreme pressure in the sinuses, eyes, forehead,etc. think of the worst sinus headache that you have ever  had- bingo! long term, it can cause urinary tract infections from, well, you know where. i was drinking water like crazy because you have to flush it out of your system. it has a rather short half life, so it is very important to get on with the water before, during, and after chemotherapy- especially with this drug. the terrible " sinus infection" went away about 30 minutes after the treatment ended , thank goodness.

so i survived my first chemotherapy infusion. jeff was loyally by my side, and was very supportive. the nurse told me that the nausea, vomiting,etc, from the taxotere would happen on day 3 through day 7. i have zofran, which is a drug for nausea/vomiting, that i plan on taking every eight hours around the clock starting about thursday  night. tomorrow, i go back to get a neulasta injection. it stimulates the production of new white blood cells. this reduces the risk of serious infections. of course, this drug has side effects,too. i always tell my pharmacy patients  that they need to weigh the side effects of any drug against the health benefits. in the case of neulasta, it can cause extreme bone pain in some patients. my nurse told me that  taking aleve and zyrtec could possibly prevent or lessen these side effects. i understand how the aleve would help with bone pain, but i am not sure how or why an antihistamine( zyrtec) would help. i already take zyrtec for my allergies, so this is a moot point, i guess.


i like to have information about my health care. i feel more secure when i have knowledge about medications and their possible side effects. i would still get the treatments, of course, but knowing makes me less scared. and even if i escaped ( i may have to wait until friday to say that conclusively) a goblin only to be caught by a wolf, i feel that things went about as well as they could today.

thank you to all of my family and friends  who said prayers for me  and sent good wishes my way. i really appreciate each and every one. i hope that the information that i have provided may help someone else who is dealing with this health issue. and i sincerely hope that goblins and wolves can be avoided.

" never laugh at live dragons, bilbo you fool! gandalf said it to himself, and it became a favorite saying of his later, and passed into a proverb. you aren't nearly through this adventure yet, he added. and that was pretty true as well. " from the hobbit, by j. r. r. tolkein

today i went to the oncologist's office for chemo 101. or to put it more correctly, for orientation. my husband and i met the head chemotherapy nurse, and she went over the medications that i would be receiving, as well as possible side effects. the process takes about 2 and one-half hours, she said, if everything goes well. first, i get the medications that will hopefully help with the nausea. there are three scheduled, and a fourth one, if i need it. then, i get an IV dose of dexamethasone- which is a steroid and is used to prevent ( hopefully) my body having a reaction to the chemotherapy. these infusions take about an hour.

next comes the big bad drug, or dragon if you will. this dragon goes by the name of taxotere. it takes an hour to infuse this one. since this is my first chemotherapy session, they will be watching me carefully for immediate problems. anaphylaxis, i assume. the somewhat milder drug comes after this one, and is called cytoxan. it takes about 30 minutes to infuse the cytoxan. my husband will be with me for support, and to drive home afterwards. it takes an hour to get home from the oncology center to my house. i am not sure how the ride home will be. i think that the fear of not knowing is the worse part for me. hopefully, after the first chemotherapy treatment, i will know what to expect and it will not be so terrifying.

tomorrow, i go back to the plastic surgeon . he is going to remove more stitches, and possibly add some more saline in my implants. no, i am not going for the " dolly parton" look. i just want to look a little less like a young boy. and, also i would like  to have my clothes fit a little bit better. the reconstruction process has been more difficult than i had expected. the doctor is expanding my chest wall out- so it hurts and i feel a lot of pressure in my chest. i am also  having " phantom" pain, which is very strange. i thought i was losing my mind until i read in a breast cancer book that it is fairly common. the article that i read said that it takes a while for the brain to know that a part of the body is missing. wow, i thought that my brain was smarter than that. i hope that my brain gets up to speed soon.

i have a basket in the kitchen that i call my " sunshine basket". it is filled with get well cards from my family and friends. probably the best thing is the cards that my grandson's daycare have made for me. they could not possibly imagine how much their colorful drawings mean to me. i look at the cards a lot, and it is very comforting. i am fortunate, as i have said before and will probably say again, to have such a great support system. i honestly do not know how people go through something like this on their own. my faith has also deepened- and has been a great source of comfort to me.

i am not laughing at the live dragons. i think that i have done pretty well so far, but as gandalf said, " you aren't nearly through this adventure yet.". nothing could be any truer.

"a sudden understanding, a pity mixed with horror welled up in bilbo's heart. a glimpse of endless unmarked days without light or hope of betterment, hard stone, cold fish, sneaking and whispering. all these thoughts passed in a flash of a second. he trembled. and then quite suddenly in another flash, as if lifted by a new strength and resolve, he leaped. " from the hobbit, by j. r. r. tolkein

i thought that i had prepared myself pretty well for this news. i have researched breast cancer treatments, and i was fairly certain there was a good chance that i would need to have some chemotherapy. my general surgeon hinted at it at my visit last week. he told me, " well, you know, your lymph nodes are clear, which is great, but the kind of cancer that you have, and the fact that you have three lesions- two of which are fairly big, the oncologist just might advise that you have chemotherapy." he went on to say that he really was not sure what the oncologist might say for sure. my surgeon told me that if i had had  only had two lesions, or if it had not been the " invasive lobular" kind that he was pretty sure that i would not need chemotherapy.

invasive lobular is the maverick of breast cancer types , evidently. i have heard this from several doctors. they have used the words " unpredictable" and even  " sneaky". the oncologist told me today that it sort of spreads out, like fingers , and tries to invade other organs in your body. he told me that he recently had a patient return after 9 years in remission, to have this cancer appear in several other organs in her body. that sort of sealed the deal for me. i would rather suffer though a round of chemotherapy than to gamble that this cancer might return in a few years.

so, my " introduction to having chemotherapy, 101" so to speak, is next wednesday. a chemotherapy nurse will go over what will happen, side effects, medications used,etc, and i will ask questions. then, the actual chemotherapy is the wednesday after that. the oncologist told me that i would get four treatments- each three weeks apart. it is a combo therapy of two drugs, one which has fairly severe side effects. yes, i will lose my hair. but the scariest one is the fact that i could develop leukemia from the treatment. they will boost my white blood cell count with an injection that i will receive on the thursday after my first chemotherapy treatment. i will see the oncologist the week after- to tell him how badly i feel, i imagine, then just every three weeks when i get another chemotherapy treatment.

my husband and i listened to what the oncologist had to say and tried to process everything. i will say that the words "horror" and " pity", as noted in the hobbit quote above , did cross my mind. medically, logically, this makes sense. but when it comes to the reality of the situation, and the fact that this is something that is going to be happening to YOU - well, it scares me and my husband to pieces. i am certainly not the first or last woman to have to have chemotherapy. i am sure that it is much improved from just a few years ago. i appreciate all of the research that has gone on, and the fact that early detection was available to me.

so, after a time of fear and apprehension, which i am sure will come and go over the course of the next week, i am planning to gather my strength and faith, and leap into the only course of action that i can. i have to go forward, and i have to try everything that i can to be here for my wonderful and supportive family and friends. to use one of my favorite quotes from the hobbit, and one that i have used before, " so comes snow after fire. and even dragons have their endings".