24 October 2009

Chemical Warfare!

This last Monday I met with my medical oncologist, Dr. Singh. He had all the results of all the tests and scans that I had the week before. Thankfully, there were no surprises. The biopsy I had on Wednesday did show that the cancer had metastasized to the lymph nodes. That was expected, but now it was confirmed: Stage III Breast Cancer. The CT and bone scan showed no cancer anywhere else in my body. YEAH! But, I did learn that I have a small cyst on my ovary (unrelated) some gall stones, and arthritis in my lower back. I knew all too well about the arthritis.

My heart scan indicated a very healthy heart. You are given a percentage score as your result. Dr. Singh said that the heart of an athlete in training would be in the 70-75 percent range. Mine was 65. Not bad for a plus size 50 year old woman.

Now that all the tests were done, it was time to get down to the business of killing cancer cells. Because of the size and aggressiveness of my cancer, Dr. Singh was putting me on a "dose dense" chemotherapy regime of AC + T. This means that instead of the usual three week cycle of treatments (4 treatments evenly distributed over a 12 week period) I will have mine every other week (4 treatments over an 8 week period) Also, because I have "node positive" cancer, I will be given three different chemicals in my chemotherapy. The cycle of 8 weeks will be a chemo cocktail that consists of Adriamycin and Cytoxan. That will be followed by another 8 week cycle of four doses of Taxol or Taxotere (I don't know which yet).

For those who want to know the science behind the treatment, here's how the chemotherapy drugs work. Pretend you are in your 11th grade science class.

Adriamycin fights cancer by slowing or stopping the growth of cancer cells. This drug gets inside the DNA of cancer cells and prevents cell replication by inhibiting protein synthesis. It also forms oxygen free radicals which can result in heart and circulatory damage. (which is why I needed the heart scan)

Cytoxan works on cancer cells by damaging their RNA or DNA when they are in their resting phase (not dividing). Because Cytoxan causes breaks in the DNA of cancer cells, they can't keep dividing and they die. This drug will also affect normal cells, but will have less affect on those cells, since they divide more slowly and are better able to fix DNA breaks than cancer cells. Some of the normal cells that will be affected include: blood, mouth tissue, digestive tract and hair follicles.

After the AC combination, the Taxol will be administered.

Taxol is called a mitotic inhibitor. Cells grow by a process called mitosis (cell division). Taxol targets rapidly growing cancer cells, sticks to them while they are trying to divide, and prevents them from completing the division process. Since the cancer cells cannot divide into new cells, it can't grow and metastasize.

Taxol is included in my chemo regime because my cancer grew so incredibly fast, and because it has already metastasized to the lymph nodes and that needs to stop to prevent the cancer from spreading further. The hope is to shrink the cancer tumors before surgery, to make the surgery safer and insure that they can remove all the cancer.

Science Class is now over.

I had a surgical procedure on Monday. They put a Power Port in my upper arm. This is so that they do not have to tap into a new vein for every chemo treatment and blood draw that will be coming in the next months. The chemo drugs are very powerful and can damage the smaller veins. The port is surgically implanted under the skin and then a catheter is fed through a blood vessel.
This was called a simple surgical procedure. For me, this was not simple. I was quite nervous. They give me several shots of a local anesthetic, but I was quite awake for the whole procedure. I could feel a lot of what they were doing, and it was really uncomfortable...and often painful. Some of the sensations, were very unusual and I didn't like it at all. I really wished I had been sedated.

Michelle was my surgical nurse. I could not have made it through this without her. She was so understanding of my fears. I have never had a surgery before. Not one, ever. She held my hand the whole time and helped encourage me. She even wiped away my tears when I started to cry a little during the most difficult part. Michelle was my angel in the operating room.

My arm was in such pain and the bruising was so large, that they couldn't even use the port for my first chemo treatment, which was on Tuesday. Today is Saturday, and my arm still hurts where the port is and where the incision was made. I know it is for my good, but I didn't like this part at all.

On Tuesday, Doug went with me for my first treatment. It took about 3 hours, but should only take about 2 hours for subsequent treatments. Once the IV was in, they administered anti-nausea medicine with benadryl since there can be allergic reactions to the chemo drugs. They also gave me Ativan, an anti anxiety drug that also has anti-nausea benefits. After about 30 minutes, they started working and then they administered the two Chemo drugs over the two hours. I was really drowsy, but did not fall fast asleep. I was groggy the rest of the day.

On the day after each treatment, I go back to the cancer center for a shot of Neulasta. You may have seen this advertised on TV. This is a medication that is supposed to help rebuild the red and white blood cells that have been compromised due to the cell damaging properties of the chemotherapy. Neulasta comes with some side effects of its own.

On each morning this week, I have woken up with mild to moderate nausea and a terrible headache. I have also been so incredibly tired. This fatigue is worse than what I experienced in 2000, when my thyroid function dropped to nothing at all. Today, the nausea is less and the headache is not as bad, but I am still quite tired. I just have to get through today's wedding cake deliveries. That is all I have to do.

I am looking forward to next week, since I only have one appointment to attend. It is also the "off" week and each day I should start to feel better and better until Monday, November 2nd when I have my 2nd chemo treatment.

By all reports, my hair will have all fallen out by the end of next week. The nurse educator at the cancer center said that by day 7 the skin on my head will start to tingle and itch. During the few days after that, I will noticeably see hair coming out, while brushing or combing, or washing my hair, or just on my pillow case in the morning. By day 12 to 14, larger clumps of hair will come out and by day 15 it will be just a mess and so annoying, that you will just want to take a razor and finish the job.

Fortunately, I will be down in Beaufort for Halloween and to celebrate my grand-daughter Charlotte's first birthday. Catherine will be there too, and so I will have my daughters to help me through this event, and try to make it more fun. We'll go to a salon and have a hair shaving party (they both tell me they will shave their heads too, but I told them it wasn't necessary) get some cute hats and scarves and go out for dinner.

I've been thinking about this. The losing of my hair is a sign and symbol that I have started on the path of healing. It is something to celebrate. My hair will be gone because I have started the treatments that will kill this cancer and put me closer to being cancer free. It really is a small price to pay. And so is nausea, headaches and fatigue. If this were a few decades ago, the outcome would not be as optimistic.

Elizabeth drove up from Beaufort on Monday with my little grand-girls. It has been wonderful to have her here with Amelia and Charlotte. Catherine has also spent a lot of time here with me this week. I love my daughters. I love to see how much they love each other.

Elizabeth and Catherine have both helped me this week on my quest to find a lovely wig to wear. We went to several places and I was getting more and more depressed because nothing looked right. I just didn't look like ME. I don't have much hair to begin with, and everything was so thick and pouf-y. Then the nurse educator at the cancer center told us about Angel Hair.

We went yesterday afternoon. I have about 2 hours of energy in the afternoon between 2 and 4 p.m. Elizabeth drove me to North Raleigh, and Catherine met us there. Krista was my angel at this wig gallery. She was so knowledgeable, and kind and helpful. The choices there were outstanding. The quality was incredible. I can't believe the difference between the other places and here. In the end I found something that I really liked and that looked like how I might actually wear my hair. I was so relieved. And, to make things even better, just the day before they began a "Buy One - Get One" special and so I was able to pick two looks.

The first is the look the girls loved, something fresh and classic. It's a little shorter than I am used to now, but I like it a lot. The second is the most like how I wear my hair now.

"Regan" front
"Regan" side view

"Claire" side view
"Claire" front view
it just looks like "ME"

I just cannot begin to express my gratitude to those who generously contributed to make this possible. Every day my life is blessed in some new way by my family and friends and others who I don't even know that well. I am so thankful for all the delicious meals and for the cards that come in the mail each day.

I cannot find enough words to thank Kim Bloomfield, who worked so hard this week on completing the three wedding cakes for this weekend. I baked some cake early Tuesday morning, and had a few hours that I could help on Thursday afternoon, but the side effects of my treatment left me pretty incapacitated to be much help otherwise. I pray that the Lord blesses her with all the desires of her heart.

For my birthday, many years ago, Patti gave me this little porcelain egg that says:

"True friends are God's angels here on earth".

I used to think that a true friend had to be someone that you had known for years and years. But now I know that isn't necessarily true. Many of you I don't know that well, and some of you, who have blessed my life, I do not know at all. But make no mistake, you are all true friends and my angels.


jbpennock said...

Hi Sally-
I finally found my way to your blog!! You have been in my mind and prayers every day that you go through this odyssey. When I went to the Seattle Temple last week I put your name on the prayer roll and will keep it there so there a bunch of people out here in the Northwest praying for you, too. I think "Claire" looks darling on you--it truly doesn't even look like a wig--and the style is really cute and "you." Unhealthy breasts/Super-Healthy Heart--what a trade-off!
Jo Ann

Tracy Whitt said...

You are amazing! I love your daughter and how blessed you are to have such great support with your family. P.S. I like the "Claire" wig. You are in my thoughts and prayers.

Leann said...

Sally, cute wigs, and "Claire" really is so "you". I love reading your blog - it so very upbeat and inspiring. Thanks for allowing me to be a small part of your journey. What a blessing you have been in my life and that of my family. We are here for you, and you are in our prayers every day!
Love you,

Sally said...

Thank you all for your loving support and your sweet comments. It is like opening a present everyday to read the things you have written. I never feel alone because I know that you are there following this journey with me. You are all a great blessing in my life and I will never forget your kindnesses.

Amy said...

I have been waiting and waiting for your post, and it was worth waiting for. You are an excellent writer, and I am touched every time I read your blog. Thanks for keeping us informed.--Amy

carykate said...

You are such a great writer, Sally. Each entry is witty, touching and entertaining. I truly admire how you see the very best in each person and experience you've come across. And I love the wigs. I'm glad you'll have the fun to switch them around at your whimsy.

Catherine said...

Another job well done, Mom. I, too, have been waiting for your posts. I know there are a lot of people praying and rooting for you who love the updates! You are a trooper and I am proud of the strides you made last week. We'll keep fighting this! I love you so much. And I am so grateful for Kim too. This would not be possible without her. I only hope I can think up something that will be enough to say thank you to her. You both are my heros!

LoveYaMissYa said...

My sister shaved her head once and she said it was so fun for her to try out all those hairstyles she's always wanted to try but didn't want to cut it so short... something to think about!

I love both looks. Absolutely adorable. Our prayers and thought are with you!

Brenda said...

You are such a beautiful person. Inside and out. Love you!

Heather said...

Wow, I learned so much reading your blog and we are praying for you too Sally! You do look exactly like yourself in the Claire wig. Beautiful. Thank you for your post, you are amazing.

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