In
order to make my decision, I asked myself many questions. To give you an idea
of what went through my head, here are a few of the things that I took into
consideration…Which doctor and nurses
made me feel the most comfortable and confident? Who was up on the latest
breast cancer research? Did I want to go with a “team-approach” and stick with
the same facility I was planning for my surgery, or did that not matter? What
type of environment did I want to be surrounded by during my chemo infusions?
How far was I willing to travel for appointments and infusions? How often would
the oncologist see me during treatment? The list of questions goes on and
on…
It
certainly didn’t help that my hormones were on overload from all the fertility
treatments – an emotional time was even more heightened. Making this decision
felt pretty daunting, I was worried that I was going to make a “bad” call. At
the end of the day, I had to remind myself that I couldn’t make a wrong
decision, I would get great care wherever I went, I just needed to reflect on
what was best for me. Naturally, I was also worried about hurting the feelings
of those I wouldn’t be moving forward with. However, I had to be selfish and
put my health and myself first, which isn’t an easy thing for me to do.
So,
how did I ultimately make my decision? After a lot of thought, family
discussions, appointments/visitations/tours, pro-con lists, prayers and
“signs,” I realized the answer was in my “gut” all along. I think I just needed
the time to logically “talk it out,” as I usually do. Once I made the decision,
a heavy weight was lifted from my shoulders. I immediately felt confident that
I had made the right choice for me; it was actually a rather empowering
feeling. I was making headway in this journey.
Another
big decision weighing on my mind was whether or not to get a port, which is a
medical appliance that is surgically installed beneath the skin, typically just
below the collar bone in the upper chest, but they can also be placed in the
arm. They are often used for oncology and hematology patients, so that drugs
can be injected and blood samples can be drawn. How does it work? Well, a catheter
connects the port to a vein (generally the jugular vein, subclavian vein or
superior vena cava) and the port has a silicone bubble for needle insertion (also
known as the septum), wherefrom the injections are given or blood is taken.
Patients that have to undergo frequent chemo treatment, are generally advised
to get a port, as chemotherapy is often toxic and can damage skin and muscle tissue
if administered elsewhere. The port has many advantages including easy access
to a vein (less needle pricks/discomfort) and a way to deliver chemo drugs
quickly/efficiently throughout the entire body. However, like anything else it
also has its risks including, infection, blood clots, mechanical
issues/failure, damage to the arteries, etc.
I
was told I would need a port – several times. When I learned what it was, I
physically got sick to my stomach. The idea of it caused a lot of anxiety for
me. For most people, it probably isn’t a big deal, but to me it was terrifying.
In my mind, it was a foreign object in and protruding from my body. Something
attached to a major vein. It was another procedure. Another scar – two in fact,
that wouldn’t easily be covered. It was another reminder of everything. I
wasn’t comfortable with the idea in the least bit. All my life I had been told
I had “good veins,” so I was adamant about having my veins evaluated to see if
there was any way around this. Granted they had recently been through the
“ringer” with all the blood work, contrast agents, etc., since my diagnosis.
When
various chemo nurses at many different facilities evaluated my veins, I was
highly suggested to proceed with the port. Many even mentioned that if I
didn’t, I might wind up with severe damage to my arms that would require
plastic surgery. Well shit, I didn’t want to have to deal with that on top of
all of this. So after a lot of sleepless nights, I begrudgingly set-up my
appointment to have the port placed the day before my first chemo infusion.
Remember that weight that I said was lifted off my shoulders when I made the
decision about my oncology team? Well, I wish that were the case with the port
decision. Rather, the weight came right back and felt so much heavier. I wasn’t
happy about this “port business” one bit.
As
I mentioned in a previous post, I was dealing with complications from my
fertility preservation right up to the day before my first scheduled chemo
infusion…and my chemo schedule could not be delayed any further. It was
beginning to feel a bit like I couldn’t catch a break but I knew that I had to
keep strong for everything that lied ahead. Since I was having complications
after the egg retrieval, I had to cancel my port placement. In my mind, it was
a blessing in disguise, even though the discomfort was out of this world. I
decided I was going to try to use my arms, at least for my first infusion. If
there was any trouble, I knew that I would have to move forward with a port for
the subsequent infusions. For the time being, my “port panic” (very
appropriately termed, I might add) subsided. Thank goodness.
By
the time I was discharged after my second vaginal aspiration, I had less than
15 hours to recover before chemo was to begin. Fortunately, I was feeling so much
better after my procedure. A good thing because I knew I was going to need my
strength. When we got home that evening, my mom started preparing all my “chemo
stuff,” so that we would be ready to go bright and early the next morning. Boy,
did she hook me up with everything and anything you could have needed! She had
all my favorite snacks, hard candies/mints, a cozy blanket, a travel neck
pillow, magazines, iPod/headphones, a cooler full of popsicles (I’ll explain
later) and so much more. I’d like to add that it was all amazingly organized
and well packed, but that was of no surprise to me! By the looks of all the
bags, you would have thought I was moving into the place. She thought of it
all, just as she always does.
The
morning of Tuesday, September 18th 2012, came sooner than I would have liked
but that’s often the case, especially because I am not a “morning girl.” My
original idea was that I was going to “fashionably” see my way through each of
my chemo infusions. I figured since I wouldn’t be feeling well, I might as well
try to look fashionable and cute. Ha, what a joke that was. When I got dressed,
I said screw that idea, sweatpants it is! I did at least put make-up on, so I wouldn’t
scare anyone away on my first day. My mom made me a nice breakfast that
morning, saying it was important to get something in my stomach, especially
before receiving treatment. She’s always looking out for everyone else and
making sure they are okay. Before I left the house, I had to give myself a
blood thinner injection in my stomach. This was a post-op instruction as a
result of the fertility complications, to prevent developing blood clots. I was
told I would have to continue these shots daily until I got my menstrual cycle.
Where
I decided to have treatment is a bit of a trek. We had to allow for at least an
hour and a half to get there. Of course, the weather was yucky which made the
already bad traffic worse. The car ride was pretty quiet; for the most part I
just tried to escape into whatever was on the radio. At one point, we were
worried we wouldn’t make it on time. Fortunately, my mom, the always-calm driver,
made it there right on schedule. She dropped me off at the infusion center with
all the bags, so that I could register while she parked the car. Typically,
before every infusion I would have blood work and meet with my oncologist and
oncology nurse; however, for the first infusion I could skip these steps, since
I had done all of that the week prior.
After
checking in, I proceeded to the waiting area, where I was surrounded by individuals
double and triple my age (and some even beyond that). Quickly, I realized I
would most likely be the “baby” there. I wasn’t young enough for the pediatric
unit (under 18) but I didn’t quite fit in with this crowd either. I joked that
I was between “pediatrics” and “geriatrics.” I was surprisingly rather calm, as
I waited to be called back. I’m not sure if I was just zoning out, still in a
fog from the previous day’s anesthesia, or just at ease. Whatever it was, in hindsight,
I am thankful for it.
When
my name was called, I was taken back to be weighed – ugh. I don’t know anyone
who likes to step on a scale! This is especially important on infusion days
because your weight factors into your chemo dosage. After that, my mom and I
were seated in one of the curtained off sections, similar to what you would see
in an ER, except instead of a hospital bed there was a reclining chair, two
visitor seats and a TV. My vitals were checked and as per usual my pulse was ridiculously
high. Next the chemo nurse that was assigned to me that day, went through my
“chemo orientation,” including, treatment schedule, specific drugs and their
administration, side effects, etc.
Before
I get into the “nitty-gritty” of my specific chemotherapy treatment, let me
stop and do a very general “chemo orientation.”
What is chemotherapy?
Also
called, “chemo,” it is a type of cancer treatment that uses drugs to destroy
cancer cells. It is considered a “systemic” therapy, meaning it travels
throughout the body, unlike surgery or radiation, which are called “local” therapies.
There are many different chemotherapy drugs, what each patient receives
is based on many factors specific to their individual case.
How does chemotherapy work?
It
works by stopping or slowing the growth of cancer cells, which grow and divide
quickly. However, since chemo does not know the difference between the
cancerous and normal cells, it can also harm healthy cells that divide quickly,
including those that line our mouth and intestines or cause our hair to grow. Unfortunately,
damage to these healthy cells may cause side effects. Generally speaking, the
side effects get better or even go away after treatment is over, since normal
cells will grow back and be healthy.
Sometimes it is used as the only cancer treatment, however, more often than not it will be used along with other treatments including: surgery, radiation therapy, or biological therapy. Terms are given to describe when chemo is given in the sequence of treatments:
- Adjuvant therapy: given after surgery or radiation to reduce the likelihood of the cancer returning and to destroy any cancer cells that may remain after the treatment
- Neo-adjuvant therapy: given before surgery or radiation to shrink the tumor; potentially allowing the surgery to be more successful
- Concurrent therapy: when 2 or more therapies are given together (i.e. chemo and radiation)
Where do people go for chemotherapy treatment?
It
varies, depending on the patient and the drugs received. It can be received in
the hospital, at home, a doctor’s office, clinic, or outpatient unit in a
hospital.
How often do people receive
chemotherapy?
Treatment
schedules vary widely. How often and how long treatment is given is based on:
type of cancer and how advanced it is, the goals of the treatment, the type of
chemo and how one’s body reacts. Some patients receive chemo in cycles. A cycle
is considered a period of chemo treatment followed by a period of rest. For
example, if a patient receives 1 week of chemo, followed by 2 weeks of rest.
These 3 weeks make up one cycle. The rest period gives the body a chance to
build new healthy cells.
How is chemotherapy given?
It
can be given in many ways. How it is administered is based on the specific
chemotherapy drug given. Examples include: Intravenous, Oral, Injection,
Intraventricular/Intrathecal, Intra-arterial, Intraperitoneal, Intravesicular,
Intrapleural and Topical.
How does chemotherapy make
people feel?
Chemo
affects people in different ways. No one can know for certain how a patient
will feel during chemo or what side effects they may have. A lot depends on how
healthy the patient is before treatment, the type of cancer, how advanced the
cancer is, the kind of chemo drugs given and the dose. There are a variety of
side effects that one may experience but the most common is fatigue.
This
is by no means a complete overview of chemotherapy; rather it’s a “quick
snapshot.” For more information, I recommend checking out the sources I’ve
referenced including: Chemocare and National Cancer Institute. The important
thing to realize is everyone’s cancer journey is different and treatment
plans/side effects vary from person to person. Also, not everyone with cancer
requires chemotherapy.
Now,
going back to my specific chemotherapy treatment plan: dose-dense, neo-adjuvant
therapy, given every two weeks for 8 total infusions (two parts) intravenously
– which equates to four and a half months of chemotherapy. Wait, what does
“dose-dense” and “neo-adjuvant” mean? Dose-dense chemotherapy is when drugs are
given with less time between treatments than in standard chemo treatment plans.
Neo-adjuvant chemotherapy means I was having chemo before surgery or radiation,
to try to shrink the tumor, and specifically in my case, pull it away from my chest
wall. “Part 1” of my chemotherapy treatment would include 4 infusions of Adriamycin
and Cytoxan, while “Part 2” would include 4 infusions of Taxol. While my chemo
nurse covered my entire treatment plan and all the drugs, she covered “Part 1”
in the most detail, since those would be the drugs I would receive first.
Want
to know how my first chemo infusion and the rest of “Part 1” went? Keep an eye
out for another blog post soon! Nothing like a chemo cliffhanger, huh?
“I’m choosing happiness over
suffering, I know I am. I’m making space for the unknown future to fill up my
life with yet-to-come surprises.” -- Elizabeth Gilbert; Eat, Pray, Love
Kelly
P.S.
My very first freeboobin’
blog post was on September 18th 2012, the same day as my first chemo
infusion (partially a result of many steroids from the day’s treatment, ha ha).
Here’s a throwback picture (age 3) of my early “blogging” days.
P.P.S. I find it very symbolic that I just watched my college quarterback win the Super Bowl. I'll take that as a sign that one hell of a fight leads to a great big win. 2013 is going to be a SUPER year. Congrats to Joe Flacco and the Ravens!
