Saturday, April 30, 2016

Last A-C Chemo!

My last A-C chemo was yesterday, and I'm quite excited to be done with it. Mostly, I'm excited that around 3:30 this afternoon I will take my last shot of Neulasta (God willing and the creek don't rise, my last ever ever ever).
Kevin's mother came with me again, despite still feeling worn out from a bug earlier in the week. I am so grateful to her and constantly count my blessings for the amazing family I married into.
I saw the oncologist before my infusion, and because of the way the scheduling worked out, it was the first time I'd seen him since I started chemo. I've talked to him a couple of times, but it was my first actual appointment with him. I had my list of questions ready, and we got through them pretty quickly. The longest discussion was about poop. Now, if you know me very well at all, you know I kinda sorta like to talk about poop. And if you read a certain recent post, you probably wish you'd fortified your TMI shield before doing so. Here's your new warning: TMI ahead. Feel free to skip the next paragraph.

Anyway, in our discussion about side effects, obviously this came up, and both Dr. D and the new nurse practitioner (I'm pretty sure that's what he said, but she may be a PA) gave several suggestions for dealing with the constipation that gets so much worse after infusions. They suggested Senokot-S rather than Colace, which is probably the most gentle and not going to do much for me at this point. Senokot-S has Colace in it, but the Seno is a natural laxative that tends to work really well for folks. I do need to clear it with my OB first, and in the meantime, they said to try Dulcolax. If I can't go for a couple of days, then I should use an enema. They both chuckled at my expression when the suggestion was made, but then explained how helpful it can be, so I guess I'll just cross my fingers it doesn't become necessary. So far, I've been able to poop twice, and though they weren't comfortable, it wasn't the agony I experienced after my last infusion.

OK, you can come back now. Poop talk is over. I asked my most pressing questions: when would I stop the Taxol before the baby, when would I restart it, and is breastfeeding still going to be an option?

Barring any complications, I'll be on the Taxol starting May 13 (yes it's a Friday, but Friday the 13th tends to be a good day for me. I met Kevin on a Friday the 13th, after all) and get in six infusions, taking me up to June 17 (the last day of school for the year). I'm scheduled to be induced one week later, on June 24. I'll get that day off, but I'll restart on July 1 (my original due date). He said that even if I end up needing a c-section, if there are no complications with it, I can still restart on the 1st. I was kind of hoping for a little more time off, but I also want to be done with everything as soon as possible, so I'll take it.

As for breastfeeding, he said he wants to do more research before giving me an answer. There isn't a lot of information available about Taxol in pregnancy, since ethical guidelines typically prohibit studies on pregnant women and babies. However, he said that Taxol can only be given via IV since the stomach/intestines would break it down and render it useless if given orally, so even if it were to pass into breast milk, he isn't sure that it would be a problem. I told him about the incredibly generous offer from my sister's husband's cousin, and explained that even if I could just have that one week, I'd be thrilled. Even still, I asked him for the safe answer and not the one I wanted to hear. They'll get back to me with whatever they decide (and probably with two or three articles to support it, if previous discussions are any indication).

He gave me the full packet on genetics testing and said to give them a call to get scheduled. The test itself takes a few weeks, but I'll also meet with a genetics counselor to talk about what it all means (I'm surprised every time I hear that people often want to skip this step--why wouldn't you want someone who understands it all to help explain it?!). The test can be done via blood sample or even a cheek swab; they just need some DNA and as much family history as I can provide (that helps them figure out which panels to run to give me the most relevant information).

Dr. D also did a physical exam, and he couldn't even feel the lump at first. As he was checking, he said, "I like what I can't feel!" Me too, Dr. D., me too. I cannot express how exciting it is to actually watch the chemo at work to shrink this tumor to where we can hardly feel it--and this was after only three out of sixteen total infusions, with surgery and radiation still to come. This stupid Titmonster has no hope.

Appointment over, it was time for my infusion. I forgot completely about the Emla cream, which I'm supposed to put over the port before leaving for infusions to numb the area. I knew already many people don't bother with it, and some people aren't even given the prescription unless they know to ask for it, so I wasn't too worried. I could feel the stick as she accessed the port, and there was a little stinging for about 15 minutes, which the nurse said was likely just the antiseptic they use over the area. It wasn't bothersome, so I doubt I'll worry about the cream in the future. One less chemical to subject my body to, right? (I mean, that cream is probably the least toxic of anything I put in my body yesterday, peach slush included, but still).

Right after I got hooked up and started my pre-meds, the social worker came by to check how I was doing and let me know they'd gotten our financial aid application and would have a decision for us in a few weeks. She also wanted to introduce me to a volunteer from the Ulman Cancer Fund for Young Adults. The volunteer was diagnosed with breast cancer when her youngest daughter was six months old, so I was able to ask her about some of my concerns, particularly around what I'd be up for and able to do at various points in treatment, especially after surgery. She told me about the events they have regularly and what other help they can provide, and she promised to send me more information. I'm interested in it; I've found I appreciate even online support groups more than I would have predicted, so an in-person one might be really nice. She said they even offer free family retreats for families dealing with cancer. I might could use a beach vacation sometime in the future, and I've always loved retreats.

A cancer center volunteer came by with his tray of sandwiches, so I got to have a yummy chicken salad sandwich instead of the PBJ I'd asked Kevin to make for me while running around before his mom came to pick me up. That man cracks me up. He's been there every time I have, and he is as nice as can be, and he'll talk to you forever if you want. He was delighted last time to have an egg salad sandwich for me last time when I told him I'd forgotten my lunch bag on the counter.
The navigator came by right after him to see how I was doing and have me fill out the stress and nutrition surveys, but she didn't stay long since I'd just seen the social worker a few minutes before. I love how they wrap patients in care at GBMC. I don't know if it's as thorough or convenient at other places, but I sure appreciate it here.

Visits complete, I did a few overdue progress notes for work. It was difficult to concentrate, particularly knowing the deck of Phase 10 cards was in my bag right next to me, so after I got a few done, I put away my computer and started shuffling just as the last bag of pre-meds finished and the nurse came back to start my Cytoxan. She offered me lemon drops to help with the sinus burning I always experience, and they did help. They also last a lot longer than the Life Savers I've used the last three times, so that's nice. It still burned quite a bit more than before, so I asked if the drip could be slowed down any to see if it'd make a difference, and it did.

She also sat down with me to talk about Taxol, since I'm to start that next time. She said the pharmacist had balked a little at it, since it's listed as a category D during pregnancy, meaning there has been documented harm to a fetus, though potential benefits may still outweigh risks. She said they wanted to do some more research into it and would talk with Dr. D about it as well. I trust Dr. D's judgement, and I know how thorough he is in making decisions, so I am not too concerned. Actually, the pharmacist's reaction only increases my confidence, since I know everyone involved in my care is so thorough.

The second and last med for the day was the Adriamycin; I have had it first during my other infusions, but because of the timing with my nurse's other patients, it made more sense to have it last this time. I kept my mouth as cold as I could, and so far I haven't had any issues with mouth sores (yay!). She flushed my line and port, took everything out, and set me free.

When I got home, I took a little nap, then Kevin and I went to dinner at The Barn with friends Mike and Kimmy. It was, as always, nice to see them, and that restaurant makes a mean french dip.

Today's plans include a trip to IKEA to get the baby's crib! Kevin has a baseball game tonight, so I think I'll try to force myself to finish those progress notes and maybe start on thank you notes from last weekend's shower. And I'll probably take a nap, because it's an overcast Saturday, and why not?

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