Chemo Orientation

Today I learned more about chemotherapy than I ever thought I’d need to know. My chemo buddies (two close friends came for support) and I arrived at the cancer clinic for our meeting with my oncologist at 9am. I thought this would be a routine session, like most medical appointments we’ve all had – at most 20 min with the doctor. We left three hours later. And that was only for a break for lunch. There was more in the afternoon. Jeez Louise getting set up for chemotherapy is a time-consuming process!

I had blood tests, an ECG and filled in YET MORE FORMS!!! Every form asked questions I’d answered countless times before. But there were a few new ones. I also signed on for a clinical research investigation – it’s important to me to further research whenever possible so that was a no-brainer.

In preparation for the oncologist meeting, I’d read through all the documentation about side effects and prepared a list of questions that filled about two pages. There is a real risk of infection after each chemo treatment because your immune system is so compromised. There is a drug they can give you to help boost your white blood cell count to help you fight infection – it’s not always prescribed and I wanted to know that they were doing this. (They are.)

I learned that the biggest risk of infection comes from your own body. When the system is in balance, all the good bacteria in your body fight off the bad bacteria that live along side them. When the good stuff is killed off with chemo, the bad stuff has a chance to grow unchecked. It takes your white blood cells about 10 days to grow back to a healthy level when left to their own devices. This drug boosts their reproduction time so that they grow back faster, leaving less time for the bad guys to, as my oncologist said, have a party while the parents are away.

The other thing I was nervous about (okay, totally and completely freaked out about) was the risk of damage to your veins where the chemo poison is injected. If that stuff leaks out, nasty things can happen. I wanted to know what was done to make sure there were no leaks. One option is a port – something they surgically insert into a chest wall that has a permanent catheter attached to make it easy for them to hook up the bag of stuff they infuse into you. It’s normally only done for people having  long chemotherapy treatments over many months because it’s a lot of work to put it in and 50% of the time they don’t work. I’m having four treatments – I would not normally qualify no matter how freaked out I am about my veins.

We compromised. I was promised that chemo nurses are the very best at inserting IVs into veins. (I’ve heard that before from others – chemo nurses are really really good at this because they have to be.) I will do my first session the normal way – with a regular IV. If there are any problems, or a hint of a problem, we will revisit the port thing.

She (my oncologist) also strongly suggested I take an Ativan 30 min before I start my first infusion. Both chemo buddies thought that was a great idea. I said no. I don’t do drugs. They said to get the prescription and they’d take it as sitting beside me would require some calming solution. The oncologist explained that a majority of nausea problems during chemo are self-induced through nerves. She prescribed the smallest possible dose – the pill is so tiny (0.5 mg) it looks like the head of a pin. I figured I’d take it just to be safe. Funny how facing someone pumping poison into your body makes you reconsider your objections.

Then I had to get blood tests for various baseline numbers for hemoglobin, electrolytes, white blood cells, liver function, kidney function and more. I also had to get an ECG. And I’m signed up for a bone scan and a CT neck-to-thighs scan so they can see what’s there now and make sure nothing shows up as they watch my future. They want to make sure there’s no sign of anything anywhere else.

The reason she’s being so thorough is that if breast cancer spreads outside the breast there’s no cure. If it takes hold in the liver or kidney or lung or brain, for example, there’s no chemo cocktail that can kill it. So, as she said, the focus shifts from cure to management/palliative. If I’d been waffling before about chemo, that sealed the deal for me.

She was very explicit that I no longer had breast cancer. It had been cut out of me and the chemo, radiation and endocrine treatments were all about making sure it didn’t come back.FullSizeRender

I start taking my first chemo side effect management drug tomorrow morning. I bought a chemotherapy barf bucket from a Halloween display – a witches cauldron. I figure they’re pumping a witches’ brew into me, what better receptacle for it on the way out than a cauldron.  (see note below about what comes out of you!)

Let’s do this thing.


Chemo Clean Up – they give you a sheet of instructions about cleaning up after the stuff that’s in you comes out. It’s toxic. You know it’s really bad when the instructions tell your family and friends who have to handle the stuff to wear gloves. If you miss the toilet, make sure it’s cleaned up right away, wearing gloves, and flush whatever it is down the toilet. Note to self, that ‘stuff’, even if I don’t miss, goes into our water systems. Yeuck.

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