This week I worked a fairly regular schedule and tried to see all of my clients before taking more time off for chemo. I also had several doctor appointments so here's the quick rundown on that:
Eye Doctor 8/20/14
Went for an annual exam (love waiting until I'm on my last pair of contacts!). I went to a new doctor this time because I wasn't crazy about the place I'd been going for the past several years. My vision hadn't changed and I talked briefly with the optometrist about my diagnosis. She mentioned that because breast cancer can sometimes spread to the brain, it is good to monitor for any changes in vision that could be a symptom of brain metastasis.
Maternal Fetal Specialist 8/21/14
Jeremy left work a few hours early so he could come along for another ultrasound to get some pre-chemo measurements of the baby. As of today, I'm 22 weeks, 5 days pregnant. Baby is measuring perfectly and weighs about 1lb. 3oz., right on par! His heart and all of his organs are up and running normally. We saw him stretching and moving around, though he was too stubborn to pose for any pictures. We joked that he officially met his first bully: the ultrasound tech who pushed him around trying to get him in a different position to no avail. I wonder where he gets his stubbornness from?!
We'll be visiting Dr. R. every 3 weeks, so she can check on Sweet Potato just prior to each chemo treatment. She'll mainly be monitoring his growth, to see if it stalls or becomes restricted in any way.
Oncologist 8/22/14
My mom came along to my oncology appointment today. I'm glad she's been able to meet some of the doctors on my team, not to mention she's really good at taking notes so that I'm free to just listen to the doctor and not have to commit everything to memory.
I was the first appointment of the day and lucky me, I got to have labs taken by my favorite gruff nurse! She took one look at my arm, which has a huge bruise from where I had a blood draw last week and said "Oh boy, I hope they left some juicy blood for me!" Gee, I hope so too, lady. My right arm can no longer be used for bloodwork, IV's, or even blood pressure cuffs, due to my surgery and the lymph nodes that were removed on that side. So, my left arm gets all the action. I was told this will be the case for the next 5-10 years and possibly forever? I wonder what people do who've had a double mastectomy and can't use either arm? Oh well....gruff nurse did a great job on the blood draw so that's all I cared about at the moment.
Dr. M. came in to review each chemo medication, along with all of the pre-meds I'll be getting (such as fluids, anti-nausea, and steroids). He then looked up each medication on the computer to show us risk factors, side effects, etc. as well as their history of use during pregnancy. He even looked up a variety of OTC meds that I might need, to combat various side effects in the days to come. Most of my meds are Category A or B (safe to take during pregnancy), but some are Category C (not as safe for pregnancy). However, in some cases the potential benefits outweigh the risk and so we just have to cross fingers that the meds will do their job and not harm the baby.
Not all chemo drugs are created equal. For example, they don't all cause hair loss. In my case, hair loss will be a definite. It should start to happen within a few weeks after my first treatment. I'll cross that bridge when I come to it, because I know it's going to be weird. If you look at me right now, there's no way to tell that there's anything "wrong". But once the hair is gone (not to mention the presence of a pregnant belly), I know it's going to draw a lot of attention my way, and I'm not looking forward to this! If I were to donate to Locks of Love, would they let me take my hair back so I could just glue it back in place? Hmmm...
For my first four treatments, here are the specifics on the two chemo drugs I'll be receiving:
Doxorubicin (Adriamycin): This med is lovingly nicknamed "the red devil." Common side effects include nausea/vomiting, hair loss, fatigue, mouth sores, red urine, loss of appetite (due to food tasting different), nail weakness, increased risk of infection due to low WBC, and heart problems. There's a lifetime cap for anyone taking this med, due to it's potential to cause heart failure. My doctor assured me that my doses are well below maximum levels, but I'll still be monitored carefully.
Cyclophosphamide (Cytoxan): low WBC count, hair loss, nausea/vomiting, loss of appetite, mouth sores, stomach issues. This med can also affect kidneys, so drinking a lot of water is super important.
Each treatment should take about 5-6 hours and I'll be going to an ambulatory care unit at the hospital. Dr. M. explained that I'll probably feel my worst during the 3-10 days after treatment. This is also when my immune system is weaker and I'll be more susceptible to infection. So, he recommended that I stay home for 10 days after each treatment. This caught me off guard a bit, since I expected I'd feel sick for a couple days afterward, and then be good to go for the next two weeks. He also explained that the effects of chemo are cumulative, meaning that the side effects typically worsen as you progress through each treatment. Being pregnant complicates things further, since pregnancy alone causes a weaker immune system. But I'm learning to keep myself and my baby's health the top priority right now, so I'll do whatever it takes, even if it means some very sad looking paychecks. I'm just lucky to have a pretty flexible job that allows me to work when I'm able, and allows for time off when needed.
When I had my mastectomy, Dr. A. also inserted a port, which is a small device implanted directly under the skin in which you can receive IV medication and also have blood drawn. It's located on my left side, kind of halfway between my collarbone and armpit and feels about the size of a quarter. It's internally connected via a small catheter to a vein (maybe the jugular? Honestly, the idea kind of freaks me out so I don't ask a lot of questions about this). In any case, a port makes the process of frequent IV/bloodwork a lot easier because they don't have to mess with your arm. They just do a quick stick into the port and then all of the various drugs are administered directly through tubes without having to touch you. I was a little nervous about the "sticking" part of the process, and asked the doctor about some topical cream (called EMLA cream) I'd read about that can numb the area. He said I could try it but that most people don't feel the need for it. I decided to tough it out and see how the first treatment goes before deciding if it's necessary.
Dr. M. is also going to send me in for IV fluids on the 3rd day following each chemo. This is another precaution to make sure I don't get dehydrated. It should take about 2 hours.
So, overall, this was a good appointment, and I left feeling prepared rather than defeated. My mom got a good vibe from the doctor, and appreciated his thoroughness and ability to answer our questions with confidence.
The countdown is on, and I'm ready to hop on the chemo train and get things rolling! Next on my agenda is a busy weekend, which I'll write about next so stay tuned :)
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