I flunked chemo!

Well, I flunked chemo today, or more accurately, my blood test.  Both my platelet and hemoglobin counts were below the minimum level for receiving chemotherapy, so no treatment this week, except for Herceptin. Needless to say, I'm disappointed.  I was so hoping to finish this second leg of my tetrathalon today.  I am trying to focus on the fact that an extra week's wait isn't much in the larger scheme of things, but I haven't totally convinced myself of that yet.  I will!  In the meantime, keep your fingers crossed that my counts are above the threshold next Monday and I can receive my final round!

Preparing for the Final Round of Chemo

I sit here writing this through a veil of tears.  Not emotional tears -- just the overflow of tears from having clogged tear ducts.  I finally gave up the notion that this problem would resolve on its own, as it has after previous bouts. I guess my tear ducts are more clogged than before, perhaps from the cumulative effects of the chemo. So, on Friday I gave up and called my oncology nurse to see what she suggested. Apparently, this is a more common problem than the literature I’ve referred to suggests. The nurse told me that they can refer me to an ophthalmologist at the cancer center, who will do a procedure to open up the tear ducts. Although I don’t generally like any procedures having to do with eyes (mine or anyone else's), I am looking forward to this one, because this is one of the greatest nuisances I’ve endured since my cancer treatment began. 

In any event, tomorrow is my last round of chemo (fingers crossed it’s a go) and I look forward to having it behind me. Today, I am doing a few of the usual things to prepare. I’m working on a list of questions to discuss with the doctor about what to expect over the next few weeks.  I’m drinking a lot of water, have upped my fiber intake a bit – although I’ve found that this is a balancing act, so I’m not going overboard, and I have just cooked up a batch of Apple Mash as both a treat and a treatment should the often present side-effect of constipation become an issue. Even if it doesn’t, this is a great dessert, especially with a little vanilla ice cream served with it, and when the taste buds go south, as they always do after treatment, I add a good drizzle of maple syrup to enhance the flavor. (This could be why I've managed to put on weight, rather than lose it over the past 18 weeks -- or the weight gain could have something to do with the steroids I take for a week during and after chemo!)  Here’s the recipe in case you want to try it:

Apple Mash

2 lbs. apples, cut in large chunks (I like to use granny smiths)

½ cup apple cider

¼ cup raisins (I like golden)

¼ cup sugar (I tried dark brown this time – it’s a good addition)

¼ cup cinnamon (I use a little less)

Mix all in a 3-quart saucepan.  Heat to boiling over medium-high.  Reduce the heat to low.  Simmer 15 minutes or until very tender.  (I cook it at least 30 minutes – sometimes more) Mash coarsely with a potato masher.

Other than that, things are pretty much routine around here.  I will have labs at 11:00 tomorrow morning, meet with the doctor at 11:40, and, with any luck, will head into treatment at 12:30.  I should be done with my final chemo by 5:30 or 6:00, and then it’s home to relax and let this last round do its work, causing one last cycle of side effects before my body can start to regroup and gradually make its way back to normal!  

Side Effects: Can You Say Peripheral Neuropathy?

I have been relatively lucky when it comes to side effects from chemotherapy.  Although I’ve had the expected big ones – hair loss, low red and white blood cell and platelet counts, and some intestinal troubles, I have been fortunate to be treated in a time when there are very effective anti-nausea drugs.  These are delivered to me through an IV on the same day that I receive my chemo treatments. I consider myself doubly lucky because some patients still experience this most unpleasant side effect despite the use of these meds.  I have also been spared the intense fatigue I hear other people speak of. Some patients write that they can barely lift a finger without needing a rest and they spend much of their time sleeping. Yet I have had to take only a few naps along the way during the 16 weeks since I started this regimen. That is not to say that I haven’t had my share of side effects, but they have been manageable and relatively minor, and most have lasted for only a few days.  Below are a few of the more annoying or persistent ones.

Peripheral Neuropathy:  Until this last round, I’ve only had brief encounters with numbness and tingling in my fingers and toes, or peripheral neuropathy. In rare cases, once you get it, it never goes away, but my experience with it has been fleeting, until now. Round 5 brought on a longer lasting and more significant case of numbness.  I was not able to feel my big toes for a few days, and haven’t been able to feel any sensation in my left thumb for quite a bit longer!  It is truly an odd sensation to touch or poke your thumb and not feel a thing!  I’m confident this will pass.  In the meantime, caution is required when using knives or dealing with hot items because the nerve endings can’t sense and communicate to our brains that we should let go of a hot skillet, or whatever may cause a burn.

Taste:  My sense of taste has come and gone. After each round of chemo I go through a period of 4-5 days when things are tasteless or downright yucky, and I resort to a very bland diet.  During these periods, chocolate doesn’t taste like chocolate at all and is totally wasted on me.  This was the first time in my life that I tasted one M&M and I didn’t even want another – a clear indication that all was not well with my taste buds.  The only foods that are palatable during these taste bud blahs are those with that special quality the Japanese call “umami” or a savory taste.  Umami is now considered by many to be the fifth basic taste, along with sweet, sour, bitter and salty.  Somehow it can break through the blandness and provide some satisfaction.  So when the taste buds go south, I switch from turkey sandwiches to roast beef. We also make a wonderful slow cooker stew with oven-roasted beef, barley and roasted root vegetables. This experience makes me think of my poor mother, who, in her later years lost her sense of smell, and therefore her sense of taste. She found it really hard to bring herself to eat much and she became a little slip of a thing. Food, often the centerpiece of family events, gave her no pleasure.

Tears:  I have cried only a couple of times since learning that I have cancer, and I’m not even sure those tears were related to my own situation.  However, I now shed tears like nobody’s business, especially for the first few hours of the day. The doctor feels that one of the two chemo drugs I receive is the culprit, causing clogged tear ducts. The odd thing with this side effect is that it, like my neuropathy, is a very one-sided problem. My tearing is pretty much restricted to the right eye, and causes some significant vision problems. It is perhaps the most annoying of my side effects. The past couple of days it has been an all day, all night event and I get tired of dabbing at my eye and face as the water overflows onto and down my cheek. After awhile it almost makes me want to cry for real!

Skin: Winter is never a friend to my skin, and despite my best efforts to keep the house humidified, and to lather myself with the dermatologist recommended skin cream, Cetaphil, it is still an uphill battle. Add to that the fact that chemotherapy causes some strange changes to the skin on my fingers and I have a bigger problem than usual. The skin at the tips of my fingers splits and I have had as many as four bandaged digits at time. Talk about a decline in my typing accuracy!  It’s a real challenge to hit the right keys with bulky fingertip bandages on. This nuisance, and sometimes-painful side effect starts with a hypersensitivity to heat. Washing my hands in hot water burns for a couple of days before that sensitivity abates. Then the skin on the affected digits hardens, reminding me of elephant skin. No amount of moisturizing softens it up, and ultimately it starts to split and peel, like an insect shedding it exoskeleton. My thumb looks like a patchwork of layers at the moment.

So, although I consider myself quite fortunate, I will be most grateful when these all passes. It will be good to cry only when I’m experiencing emotions that warrant it!

Jennifer, Hats, Scarves, and Jane Austen

One of several close friends named Jennifer (I once worked in an office full of Jennifers – six in all) was in town late last week and over the weekend. She was kind enough to come over and hang out with me for part of her time here.  Not the most thrilling of endeavors for a visitor, particularly during the first week after a “big” chemo, when I am likely to be even less active and engaged than usual.  She was a good companion and seemed content with the slow pace of things, my occasional lost thoughts, and unfinished sentences – the joys of chemo brain.  We caught up on news, though honestly there was very little news that I could offer, watched Pride and Prejudice (the Knightley version) for the umpteenth time, and she helped the household along on its quest to complete some leftover Sunday crossword puzzles. 

Jennifer also very gamely watched YouTube videos with me of women demonstrating different ways to tie headscarves.  I can manage to tie a decent square scarf, but had not ventured into the realm of oblong scarves.  Jennifer, a very creative and crafty person, in the best sense of the word, adeptly wrapped me in some of the styles we saw, and gave me confidence to give it a go myself.  I even wore one to the local repertory theater on Sunday night where I saw the ever-cheery MacBeth.  It was fun, like playing dress up when I was little.  She even brought me a fabulous fleece hat she had made herself – soft, warm and comfy.  I would post its picture here now, but it went back to Minnesota with her for some slight adjustments  -- my head is apparently quite small, so she will adjust the size a bit. 

It was lovely to have a fresh face on the scene and to have someone here who was comfortable and easy with the snail’s pace of activity at my place.  If one is looking for excitement, this is not the place to be, at least at the moment! (If ever!)  Thanks for spending time your time with me, Jennifer.  It was great to see you!

Blue Skies

“Blue skies, smiling at me, nothing but blue skies, do I see.”

“Blue days, all of them gone, nothing but blue skies, from now on.”   

~ Irving Berlin

After a gray and gloomy winter, with over 80 days of snow on the ground – a record for St. Louis - and record cold temperatures, this is our second of two stellar clear blue-skied days.  What a difference the bright blue color of the sky makes!  Added to that, and although it is still only 23° F at 9:30 this morning, we are actually due to rise above freezing today, and the rest of the ten-day forecast looks even better, with highs in the 40’s and 50’s.  Goodbye snow!  (I won’t give too much thought to “hello, muddy paws” at the moment!)

As we ease toward spring here in the northern hemisphere, the increasing day length also adds to the cheery mood.  It’s so nice to leave work at 5:00 and come home with enough daylight to get the dog out for a romp, fill the bird feeders before dark, and have a good look around the yard.  Despite the very cold temperatures, in the past week or two the birds have started to warm up their voices.  I hear a cardinal calling as I write, and have heard sweet tunes from the song sparrow and the Carolina wren.  Our resident red-shouldered hawk has also become more vocal, as have the area barred owls. 

Although my spirits haven’t been particularly low, I have been plodding along through these 14+ weeks of treatment with my routine of visits to the hospital every Monday, getting into work when I can, coming straight home, and marking time from one week to the next.  I have felt somewhat isolated – definitely self-imposed – as I’ve chosen not to be out and about too much, trying to avoid catching any bugs that flit about more easily in the dry winter air.  My sense of being housebound has not benefitted from the many gray days we experienced in December and January.  It is amazing how uplifting these sudden changes to sunlight and blue sky are, as are the accompanying signs of movement toward the spring.  I can’t wait to sit on the patio, and soak up a little of the sunlight (being very careful to protect my exposed scalp from the rays of the sun) and soak in the progression of the changing seasons. 

We Have Lift Off!

I went to the hospital this morning, fully expecting to be sent home without having chemotherapy, because of low blood counts.  Much to my amazement, the pattern of having my lowest platelet counts on chemo day was broken, and my platelets actually went up!  Yahoo!  Chemo Round 5 was ready for take off, which it did at about noon today.  Five rounds down and one more to go!

Blood Counts!

As I watch the rise and fall of various factors in my weekly CBC (Complete Blood Count) certain trends have emerged. My hemoglobin levels were within normal range when I started this journey. However they have never fully rebounded since that first chemo back in November. They have been below normal range every week since then. They were sufficiently low last Monday that I needed a blood transfusion. I’ll be curious to see tomorrow’s CBC and find out how the transfusion of someone else’s blood impacted my hemoglobin levels. I don’t feel any different, but then I wasn’t overly out of breath or more fatigued than usual before the transfusion, which are symptoms many people have when they have low hemoglobin levels.

However, my bigger concern this week is where my platelet levels are. The last time I was scheduled for chemotherapy we had to postpone it a week, because my platelet levels had dropped below 75 (75,000 per micro liter of blood). Last Monday, they had dropped to 81. I can usually count on them to drop even further by the time I’m scheduled for my next chemo session. If they have fallen further, I’m likely to face another delay in receiving chemo, something I would really rather not have happen. I want to keep moving forward and any delay at this point is a bit hard to swallow. So, I’m keeping my fingers crossed that my platelets will somehow be at least a 76!  Is that too much to ask? Tune in tomorrow!