2nd Chemo

At 7:10 am this morning it was already a familiar routine: 20 min drive, check in, IV, blood work, results and several hours in the infusion center. 

Today, to somewhat reduce George's anxiety, we decided that he would accompany me. This way George could see the process first hand, ask questions and hold my hand and feel useful. Gwen babysat Max and then went to work. 

For the 2nd chemo, my oncologist switched Benadryl to half the dose and in oral form instead of infusion, and lowered steroids a bit, though the rest of the premeds were kept intact. 

After all the premeds, I only had Taxol and Carboplatin for today's chemo, without the immunotherapy. Infusion wasn't as easy with pins and needles here and there, but absolutely manageable. Several hours later we were home around 2 pm. 

And, so far, no close acquaintance with the toilet, loss of appetite, or any other wonderful side effect, just fatigue (which is to be expected). 2 hour nap cured that!

As unique as I am, my side effects tend to show up four days later vs the next day. So we'll see what happens during New Year's celebration on Sunday.

Second chemo ✅

Lessons learned 1st chemo

DF explained all the drugs and side effects in great detail with chemo steps and schedule print-out: check-in, pre-chemo labs, conference with oncologist and chemo at the infusion

station. The rest of it was not that much -- just show up. The doctor made a few specific recommendations like get the ice mittens and booties from Amazon to ward off the numbing side effects and drink plenty of fluids, but that was about it.

Of course doctor Google was our next resort and today we came fully prepared:

• My daughter was my buddy to fawn over me and watch for unforeseen reactions to medications. (Fortunately I had none.)
• Turned out that we should have put the booties/mittens into the freezer the night before, so they were useless for today. Good thing, I didn't have those numbing sensations yet.
• Brought in my laptop to watch movies and downloaded tons of audiobooks (with the nurse running around and taking wasn't able to do much, but it will be useful next time).
• DF provides water and snacks, but we brought lemon/ginger water from home and nuts and pomegranate which was so much better than the sad looking mini egg salad in a plastic cup. I nibbled on a few nuts, but wasn't ravenous (often because the first infusion has a double dose of steroids, people are super hungry).
• We carried everything around in two backpacks -- the next time a small suitcase on wheels would be the right answer.
• My favorite red cashmere shawl made things not only warm and cozy, but also festive and matched some of the crazy xmas vests the nurses were wearing. :)

While I was in chemo, my friend Tamara dropped off bone soup -- returning home and crawling into bed -- it was a godsend! Sipping on this warm broth was so soothing and calming (no nausea yet). Having friends' support circle is INVALUABLE!

1st Chemo

Bright and early, after eating a few spoons of oatmeal and swallowing several steroid tablets, my daughter and I arrived at DF at 7:40 AM. After the mandatory Covid check-in on the 3rd floor, I headed straight to the labs to get the IV in and the basic pre-chemo blood draws.

The cubby-station felt like a luxury hotel -- light, aery, wall of windows. The lab technician wrapped a warm towel(!) over my hand, and then used some 007 spy looking stick to scan for veins, which glowed bright lime green. Surprisingly, the IV goes in the middle of the hand, and not in the regular vein.

After all the blood was sucked off, we met with my oncologist doctor and went over when/what/how. Long list of side effects and the schedule for the next several months.

We asked about medicinal weed candy to ease chemo aftereffects but were told to wait until a few days after chemo infusion...so no fun with weed for a while.

By 9:30 were already at the infusion center -- again, bright and cozy with a huge window; in the corner, a nice leather lazy-boy type chair that folds out as a bed with built-in heat, large TV screen and a first, lady with a snack cart stopped by, then acupuncturist.  

The nurse in a bright green garb was running around like a crazy chicken without a head because Dana Farber changed the infusion protocol and she had only seen how to do it via a printout. She was sweet and kind and talkative, and honestly, I got more tired from her talking, running around and asking different nurses how to do the infusion order, than the actual procedure. I guess this is a good thing :).

I got several pre-chemo infusions -- I remembered the one that stung for 15 minutes was Benadryl. Then the Taxol started... First chemo is usually done with lot of pre-drugs for allergies, nausea, etc. and at about two to three times the speed of infusion. 

Besides fatigue, I felt perfectly ok, so we didn't need to take breaks in between different drugs.

At 2:20 we were already in the parking lot, and home at 3 pm

First chemo ✅

Chemo calendar

As of right now, if there are no interruptions due to health and everything goes according to plan  --- this is the approximate schedule for the next year: 

December 22nd  ---  March 9th weekly TCK cycle  ----  12 times

March 16th        ---   April 27th biweekly AC cycle  ----  4 times

Total of 16 infusions (not counting the Ketruda immunotherapy in between)

May 12th surgery

Four weeks of recovery with physical therapy (unable to lift anything for weeks, I am told)

Than several weeks of radiation and 

One year of Ketruda infusions every 6 weeks

I bet most of you don't have such well-defined, concrete plans for the year! :)

Treatment regiment

Dana Farber recommends doing TCK chemotherapy EVERY week for 12 cycles, then AC chemotherapy every two weeks for 3 cycles, then 3-6 weeks break to recover before surgery. Then 3-4 weeks after surgery another 4-6 weeks of radiation and immunotherapy IV every 6 weeks for a year.

In one sentence, the fun would last for a while, with the surgery sometimes in May/June 2023.

TCK: Taxol, Carboplatin, and Keytruda (Pembrolizumab)

AC:  Adriamycin (Doxorbicin) and Cytoxan (Cyclophosphamide) and Keytruda (Pembrolizumab)

Interesting, that Lahey has the same drug cocktail, as least for the first 8 cycles (didn't get much details beyond that), but every 3 weeks with much larger dosage, and worse side effects up front.

Dana Farber Cancer, second opinion 12/19

A week after my appointment at Lahey regarding our options and treatment roadmap, George and I were sitting in a brightly lit waiting area of Dana Farber Cancer Center meeting with another team for a second opinion appointment.

And within the first 20 minutes, it became apparent why Dana Farber is the leading cancer center.  The doctor was able to explain the entire course of treatment in great detail, with printouts and explanations, rather than the Lahey approach of giving general descriptions of chemo and promises of details later. Lahey didn't even mention radiation as a required step in the treatment

We walked out of the meeting and decided that we are switching to Dana Farber (especially as they were working on squeezing in my first chemotherapy before the holiday bonanza during this week,  this coming Thursday, 12/22).   

Haircut

It looks like chemotherapy is the first order of business for the next few months and it is coming up fast, next Friday 12/23. 

I was told that the hair is the first to go, so decided to chop off most of mine in the beginning, so that the loss would be more gradual (who know, maybe I will be lucky and most of the mane will stay?)

I wanted it to be even shorter, but the hairdresser kept it more "feminine" as she put it :)

Chemotherapy 101

What have been told so far from Lahey-- the three main chemicals in chemotherapy are:

1. Taxol, 1 hour, weekly
2. Carboplatin, 1 hour, every 3 weeks
3. Keytruda or Pembrolizumab, immune system booster, every 3 weeks, 40 minute

Plus another drug cocktail the night before with some steroids, Benadryl, nausea medication. Still trying to get the full list of pre/during/post medications.

I wonder if this is standard protocol across all hospitals or will this differ when we hear our second opinion in a week?

Treatment 11/12

Today was the day of reckoning -- at least half the tests came back. We had an appointment first with surgical oncologist, followed up with medical oncologist to discuss treatment options. George filled out half the notebook with notes...

"The cancer is a 4 cm invasive ductal carcinoma. Ductal means it started in the lymph glands, invasive means it spread to the breast. The tumor in the lymph isn’t strictly measured, it’s 2mm in the biopsy, but that’s just the part that was in the biopsy. The cancer is triple negative, which means it doesn’t respond to 3 hormones, estrogen, progesterone and human epidermal growth factor (HER2). It should however respond to chemotherapy."

Surgery on the breast will probably be a lumpectomy, just the cancerous part of the breast, rather than mastectomy, complete removal, unless genetic testing reveals a hereditary tendency towards cancer. (still waiting on results) Lumpectomy would be about 2 weeks recovery, mastectomy would be 2-3 months recovery."

Well, there are three options:

One: 6 months of chemotherapy, every three weeks for 4 hours each and every week an additional hour of immune treatment. After half a year of chemotherapy, the surgery of hopefully reduced tumors and limited lymph nodes and another year of milder oral chemotherapy (depending on the overall outcome)

Two: much more extensive surgery now, with removal of several lymph nodes (up to 24) which might result in lymphoma, followed by chemotherapy for 1 year

Three: with no treatment projected death within six month to a year

It looks like we picked door number one for now.