Chemo: Round 2

I had my second dose of chemotherapy on Friday, October 23. Before I actually got the chemo, I met with Dr. Krekow's physician's assistant (PA), Lisa. (This is the same person who did the genetic counseling with me before they did the genetic testing.) She spent some time asking me about all the problems I had had with the first dose, and I went over them in detail with her. The one thing I forgot to tell her about was the emotional low that I hit at the end of week 2. I will ask Dr. Krekow about that next time if it happens again (Lisa and Dr. Krekow alternate seeing patients on chemo days). Lisa told me that we were going to stick with our plan of taking the Emend, and she asked me if I wanted the HAB topical cream as well, and I said yes, since I was skeptical that the Emend would actually work. She also told me that because my WBC got so low last round and the mucositis was so bad, they are going to give me an injection of Neulasta, a medication that stimulates the bone marrow to produce white blood cells at that critical point when counts start getting very low. Neulasta's website is crap -- they don't explain how the drug actually works. Here is a better explanation I found:

Chemotherapy often decreases the bone marrow's ability to produce neutrophils, a certain type of white blood cell (WBC). Neutrophils help protect the body from infection, and having a low neutrophil count (known medically as neutropenia) increases the risk of infection. Neulasta belongs to a group of medications called granulocyte colony-stimulating factors. Colony-stimulating factors bind to stem cells in the bone marrow, stimulating the production of blood cells. Granulocyte colony-stimulating factor (G-CSF) is a naturally occurring chemical in the body that stimulates the production of neutrophils. Neulasta is a synthetic version of G-CSF attached to another molecule designed to make it stay in the body longer. This means that it needs to be injected only once per chemotherapy cycle. Neulasta binds to stem cells and stimulates the production of neutrophils, helping to decrease the risk of infection. (from here)

So I will get this injection tomorrow, and hopefully it will prevent the neutropenia (low neutrophil count) that I had last time, which caused the mucositis.

Here are my counts from Friday:

WBC: 5.2

RBC: 4.32

HGB: 14.0

The report they gave me was different from earlier ones and did not have the neutrophil count; it does have something called "Seg %" that's listed as being 40, and I think the nurse who was administering my chemo said that was the most important number, and it was good. My RBC is still a bit low, but everything else looked fine.

So I went to the pharmacy that they have on site to pick up the Emend. It came in a bubble pack with three pills, and the cost was $385, but for some reason I had $0 copay. Perhaps it's considered part of my chemo regimen and thus no copay? I don't know, but I was happy not to have to pay anything for it. I took my first pill after sitting down to wait for the chemo, which was somewhat delayed because the lab was backed up and my bloodwork results were not ready. Kyle went to get the HAB topical cream prescription filled; he also had some lunch.

I ate lunch when we got home and then took a nap for a couple of hours. I was still feeling queasy, very much so, in fact, but did not actually get sick. I asked Kyle to get out our juice extractor that we had never unpacked and make me some carrot/apple juice. I drank that for dinner and we watched several Buffy episodes.

Yesterday, I slept late and still felt queasy when I woke up. I took my second Emend pill, and felt better after a bit. I asked Kyle to make some scrambled eggs and toast for me. I had that with a yogurt and again, was NOT SICK! At this point, I was beginning to believe that the Emend was going to work. The true test came last night. We had pork chops, mashed potatoes, and broccoli for dinner. I got pretty queasy with the cooking smells and was afraid I wouldn't be able to eat, but once I had the plate in front of me, I started eating and it tasted pretty good, so I was able to finish all of it. Yay! We watched more Buffy and I went to bed about midnight and slept until 11:00 this morning. I took my third Emend and made myself some scrambled eggs and toast and am feeling pretty good now.

Let's see, what else has happened since I last posted? Oh, the mucositis did start to improve by Monday. The sores were still there, but not as severe, and by Friday, I was able to eat a pizza and salad. Woot! On Thursday afternoon, I saw Dr. Heistein, who took a look at my tissue expander, comparing it to my natural breast, and said that I would need at least one more fill. I talked with him about what I wanted for an eventual outcome and said offhandedly that we had lots of time to figure all this out. And he said, "Well, we have to be done before you start radiation. You can't have any more fills after that. AND radiation will affect your tissue expander in that it will cause it to shrink somewhat, how much we don't know." I didn't know any of this. I probably was told before and had forgotten, but Kyle said he didn't remember hearing this before now either. So I got another 60 cc's that day. Boy, was that a mistake. Dr. Heistein asked whether I wanted 60 or 30, and I opted for 60 with the hope that I could reduce the number of times I have to drive over to Fort Worth again. BIG mistake. I was in so much goddamned pain that night. I took three muscle relaxers, and they barely touched it. I was in more pain than the day after my surgery. I'd put it at an 8/10 on the pain scale. I barely slept that night and so was very tired when we went in for chemo the next day. I was having an extremely hard time moving because it was very unpredictable which movements would cause a spasm in my extremely overstretched chest wall muscles. I am still very, VERY sore, but doing better. Dr. Heistein wants to see me again in two weeks; he's thinking another 30 cc's will be enough, but I'm not sure. I'm thinking I'd like to get an implant on the right side, just to lift that breast a bit so that they won't be so lopsided (the reconstructed breast will sit much higher than my natural breast). Dr. Heistein says that the minimum size implant I can get is 100 cc's, so the tissue expander must be 100 cc's larger than my natural breast is now, and I don't think we are at that point yet. Anyway, all this must be done and settled by the time I start radiation, so we do still have about 9 weeks yet. What is most definitely decided in my mind is that I WILL NOT BE GETTING ANY MORE 60-cc FILLS! At most, 30 cc's from now on.

That's about it for this week. So, as usual . . . . Peace, Jody.