Scared, but ready!

Tomorrow is my first round of chemotherapy.  If I said I wasn't anxious, or nervous, or scared, I would be lying.  I am all of those.  I'm even a little teary just thinking about it. 

We met with Jennifer,  who is Dr Sheehan's NP on Tuesday, and got all educated on my chemo.
My first round will consist of two drugs, Adriamycin and Cytoxan, or A/C.  I will get this combination four times, once every other week.  Each infsuion will take 2-3 hours.  I then get a break for 3-4 weeks, then get my last drug-Taxol four times, once every other week also.  The Taxol will take more like 4-6 hours each time.  I will then take an oral chemo drug-Tamoxifen for 5 years upon completion of these three drugs.

This is a pretty common combination of drugs for breast cancer patients with similar pathology as mine. 
Now for the high points of this course:
Adriamycin-otherwise known as "The Red Devil", as this drug is kind of a kool-aid red color and has probably the most severe side effects of all three.
This drug is the reason I had to have an echo of my heart prior to starting, and will have one at the end of treatment, and possibly one during.  This drug is cardiotoxic, and can affect the left ventricle-or squeezing action of the heart.  My heart is awesome-ejection fraction is 60%, well within the optimal range of 50-70%.
*In a chemo regimen the day of treatment is Day 1, then count up to Day 14 and start all over!
So I will start with what should happen from Day 1-14 in order.

Day 1:
Lab draw, infusion of chemo, go home feeling fabulous

Day 2-4:
Nausea and vomitting.  Woo-hoo, my favorite.  I hate to throw up, and I hate throw up.  Brian is the vomit parent in our house.  I do poo and boogers.  He does vomit.  They loaded me up on 4 different drugs to help counteract this, and if I follow this I am told I may not ever vomit, just have some waves of nausea.  There is a great pill on the market made specifically for chemo nausea-it's called Emend, and I'm thrilled we have insurance, because the cash pay price is $247.99 for two pills.  Yep-2. dos.
I will take these pills on day 2 and 3.  Fortunately with our insurance these two pills were only $50. The other nausea standards I got were Zofran and Compazine.  They also gave me Ativan for anxiety.
Another trick for counteracting this-drink lots of water.  And when I feel like I'm floating. Drink more.

Also on Days 2-4:
Bladder irritation.  Seriously.  Bladder irritation.  This is where the Cytoxan comes in.  It is toxic to the bladder and I will need to empty my bladder every 2-3 hours to keep this drug from sitting in my bladder causing toxic irritation.  Whippee.  I work in health care.  I sometimes forget to pee for hours.
I may need to set an alarm to help me.  But I'm sure if I have pain or bleeding with urination I'll remember real quick.  Again-to help with this-drink even more water.
Days 5-7:
Mouth Ulcers.  No toothpicks. No mouthwash with alcohol.  No dental floss. No spicy, acidic food. No alcohol.  Darn.  I was kinda hoping to just be drunk through this whole process in the hopes it would make the time fly.  No such luck now.  Oh, and for the mouth ulcers likely to show up-I get to rinse and gargle with baking soda and salt. Yum. And watch for bleeding gums.  Fabulous. Good thing I got my teeth cleaned in February. 

Days 7-10:
Neutropenia.  Blood counts will bottom out-namely my white blood cells or the infection fighters. 
Good hand washing. Bathe daily-duh. No picking or cutting cuticles.  Avoid places with lots of people.  Damn no more wandering around Walmart and Target.  Avoid sick people-this is the one that makes me angry-cause it means no work.  Avoid people recently vaccinated.  Avoid shaving with a real razor-electric only.  Not that it matters much-read on down to Days 14-15.  Oh, and my favorite-if I have a temp of 100.5 or greater I am to call the office right then.  If it happens at 3am-do not wait til office opens, do not wait til 5am.  RIGHT THEN.  This temp indicates an infection and means a probable trip to the hospital for high dose antibiotics and admission.  This one will be hard for me.  I'm used to not calling until at least 104.  My husband has asked that anyone who comes to visit-feel free to shove the thermometer in my mouth and check my temp randomly because he knows I won't.  Also-this is the time that I will need my family and friends to understand that if you are sick, feverish, feeling crummy, if your kids are sick, or even if you think 'it's just allergies', stay away.  My goal is NO HOSPITAL ADMISSIONS and a sick person around me will put me there faster than anything.  So be warned, there is hand sanitizer just inside the front door of my house-lather up if you come in, every time, and if I do get sick and suspect it was from you, be prepared to receive a bill for my co-pay.  Just kidding.  No, not really.

During this time I could also become anemic-low red blood cells and/or thrombocytopenic-low platelets or blood clotting cells. So I will be a tired, but clean, bruised germaphobe. 

Basically I'm gonna feel like I just got ran over by a truck on days 7-10.  A big truck.

Day14-15: (after this first dose only)
Alopecia.  Hair loss.  Yep, that's why no worry about the shaving bit on days 7-10 cause once I hit day 14 of the first round, I will be hairless within days-and this will last until I am done with all my chemo.  In preparation, I cut bangs in my hair last night.  Yep, I'm a closet hairdresser and I know all my real hairdresser family and friends reading this are cringing right now, but I did a pretty damn good job if I do say so myself.  It will all be gone soon enough, so I may just start chopping every couple days or so. 

So, I will feel great, then nauseated, then tired, then just when I start to feel better again, we start all over.

To help counteract the low white blood cells, I will receive a shot of Neulasta on Day 2 each time.  This won't increase my counts, it just helps them from being at their lowest for longer than 1-2 days.  This is another fabulous drug, and side effects include severe bone pain-starting in the lower back, then the femurs-or thigh bones, and can even be in my sternum-or breastbone.  The sternal pain can sometimes be severe enough to mimic chest pain and has sent folks to the ER thinking they are having a heart attack.  To help with these symptoms, I will take 3 days of Claritin and 3 days of Aleve. Odd, I know-but if they say it works, I'll try it!

Oh, and did I mention all of this will put me in 'chemo-pause'. Yep, add hot flashing, emotional dishrag, psychotic crazy woman to the tired, clean bruised germaphobe.  Who wouldn't want to be around me???

I'm not even going to start on all the fabulousness of the Taxol, we'll just wait for that goodness til close to time to start it!  As far as any restrictions,  there are actually no restrictions while on chemo except no sushi-OMG I almost cried when she told me that! And no salad bars or raw salad or veggies that I don't prepare myself at home. So if bringing salad to us-it needs to be in a bag so we can re-wash it.  And I have to be careful with honey if my counts are low.  Oh, and no plants or flowers please. 

I'm feeling good though, getting enough rest, and felt the best I have since surgery on Wednesday and today.  I went to dinner with my bestie Andrea and her friend who is a survivor.  Sherri answered a lot of my odd questions only a survivor could, and it's kind of funny how much our courses are the same.  We were both even diagnosed on the same day. 

Oh, and we heard back from Ethan's Make-a-Wish wishgranter, and the days are set!  We are going to Disney May 6th-12th!  It will be the first week of my 3-4 week break and I was cleared to go from the doctor!  We are all excited beyond belief, and I ought to get by with just one bag since I won't need one whole suitcase for my hair products!  My prep time will be super fast, and I won't have to worry about the icky Florida humidity.  I just have to remember to use sunscreen.  Me and the bald kid with our SPF 7000.  I can't wait to get on the plane with a face mask on and see how many people freak out.  I'll just announce "It's ok, it's not the bird flu or SARS, just breast cancer"  think people will believe me?  Oh, yeah, I'll be bald, they sure will.  Or if anyone asks, I'll just put on a red bandana, eye patch and big hoop earring and tell them I'm a pirate.  What the hell do you think anyone would say back to me then?   

Enough for now, need to go to bed so I can be nice and rested for my treatment tomorrow!

I may need to start on my Ativan now.