I remember my first day of chemotherapy. WTF? Did I really just write that? Really? Seems like yesterday and so surreal. Two messages from friends kept going through my mind prior to my first chemo cocktail:
- You. Can. Do. This.
- All you have to do is B-R-E-A-T-H-E.
I remember being ready, cognitively, but was feeling a little nervous (scared is way too strong of a word). After you read about all of the side effects, you will understand why. As a caretaker for my mother who passed away from pancreatic cancer, I have seen all of these side effects first hand and let me tell you (when side effects are not properly managed): they ain’t pretty.
The good, no great, news was that I had an incredible team. I felt safe, secure and incredibly well cared for (Shining Moment). I knew that I would not have to manage all the side effects on my own (most of the time). However, since I didn’t have a significant other, I knew there would be a few nights where I would have to figure out how to manage the side effects. Boy, oh, boy! Talk about induced stressed, right?! While I knew I would be able to take an active part in the healing process, I learned that managing the side effects of chemotherapy takes a village. I felt so incredibly blessed and grateful to have my health care team. REALLY! It is truly a team. THIS is why I was not scared, but, dare I say, ready for the battle.
All that said, I welcomed Chemotherapy into my body to eradicate any and all cancer cells left (after the surgery). I was grateful for the opportunity to have a nuclear arsenal that worked magic.
One of my mantras prior to my first chemo was….Bring. It. On.
For those new to the world of cancer and its treatment, chemotherapy is a fluid that was administered intravenously (IV) through my veins.
The arsenal of medications that was administered to me every 3 weeks for 6 cycles consisted of:
- Docetaxel, which is commonly known as Taxotere®. Taxotere belongs to a class of chemotherapy drugs called plant alkaloids. Plant alkaloids are made from plants (DUH). The plant alkaloids are cell-cycle specific. This means they attack the cells during various phases of division. Taxotere inhibits the microtubule structures within the cell. Microtubules are part of the cell’s apparatus for dividing and replicating itself. Inhibition of these structures ultimately results in cancer cell death. In other words, Taxotere prevents cancer cells from dividing and therefore reproducing.
- Cyclophosphamide. Cytoxan works on cancer cells by damaging their RNA or DNA when they are in their resting phase (not dividing). Because Cytoxan causes breaks in the DNA of cancer cells, they can’t keep dividing, and they die.
Unfortunately, chemotherapy does not know the difference between the cancerous cells and the normal cells. Chemotherapy will kill all cells that are rapidly dividing. The “normal” cells will grow back and be healthy but in the meantime, gnarly side effects did occur during my treatment.
Please keep in mind each person’s reaction to chemotherapy is different. Some people have very few side effects, while others may experience more. Everyone’s body is different. When people asked me what I expected, I said that I didn’t really know and would have to wait to see how my body would respond. The unknown was the part that made me nervous. Good or not so good, I am and always will be a person who really likes to know what I’m dealing with. So, my first day of chemotherapy, knew I was entering the unknown (in terms of how my body would respond).
My philosophy that I always shared with my mother was: Hope for the Best, but Prepare for the Worst. I could not believe that I was telling myself the same thing decades later.
The general side effects that occurred with my drug combination included:
- Lowered resistance to infection. Chemo did reduce the production of my white blood cells by the bone marrow, making me more prone to infection. This effect began seven days after treatment was given, and resistance to infection usually reached its lowest point 10–14 days after each chemotherapy. The number of white blood cells (the cells of the immune system) slowly increased steadily, and usually returned to normal levels before the next cycle of chemotherapy was due. I always had a blood test before having more chemotherapy to make sure that my number of white blood cells had returned to normal. Occasionally, it was necessary to delay treatment when the number of blood cells were too low. It is because of this side effect that I had to be extremely careful about being around people who were ill. Additionally, I was washing my hands constantly.
- Tiredness and Fatigue (“Aesthenia”). Many people feel extremely fatigued during chemotherapy, particularly towards the end of treatment. Since I knew this was going to happen to me, I reserved my “Energy Bank.” I did my best to “store” energy for events like walks, visits with friends or going out. This however, meant that I had to pace myself, which was a little challenging for me.
- Bruising or bleeding. My chemo reduced the production of platelets (which help the blood to clot and stop bleeding). Signs and symptoms for me included: unexplained bruising or bleeding, such as nosebleeds, blood spots or rashes on my skin, and bleeding gums. I used an especially soft tooth brush during chemo.
- Anemia (low number of red blood cells). Anemia made me feel tired and breathless (more so than I usually am!). If ever there were a time to eat animal protein, this was it. Even though it completely grossed me out because I had a difficult time tolerating the texture and taste during chemo, I incorporated small amounts of meat into my diet during this period to avoid anemia.
- Feeling sick (nausea) and being sick (vomiting). There were very effective anti-sickness (anti-emetic) drugs to prevent or reduce my nausea and vomiting (Shining Moment!). Barfing was one of the things that really sent me over the edge. When I took care of my mother and she barfed, I usually did as well, though right after I left her room. Barfing, for me, was and always will be brutal! Also, some anti-nausea drugs caused me to be constipated. Ohhhhhh nooooooo! With the help of my oncologist, we created the Senekot-Miralax-Colace cocktail with which was my “drink” of choice during my time in the “Pink Bubble!”
- Hair loss (“Alopecia”). Chemotherapy caused my hair to fall out. This started on day 16 after my first dose of chemotherapy. Thinning and loss of eyelashes, eyebrows and other body hair also occurred. My hair loss was temporary and my hair did start to grow again once treatment was finished. (Yay!!!)
- Sore mouth and ulcers. My mouth was sore and dry. I also noticed small ulcers during this treatment. Drinking plenty of fluids, and cleaning my teeth regularly and gently with a soft toothbrush, helped me to reduce the risk of this happening, daily. Additionally, gargling with salt and brushing with baking soda (yuck) helped alleviate my mouth sores. I did stock up on popsicles! My friends were very happy about this when they came for a visit! (Shining Moment)
- Taste changes. ALL food tasted different. My normal taste returned when my treatment ended.
- Bad taste in the mouth (“Dysgeuisa”). As if the appetite and taste issues were not challenging enough!
- Irritation of the bladder. Cyclophosphamide irritated my bladder. It was important to drink as much fluid as possible (up to 2 liters) on the days when cyclophosphamide was given, to help prevent irritation.
- Indigestion and heartburn. Pepcid was my friend.
- Changes to mental function (“Cognitive dysfunction”). I DEFINITELY already had this. Not sure how much more memory loss and lack of mental clarity I can actually take!
- Skin changes. Itchy rashes as well as severe skin dryness occurred. I felt like a scaly fish.
- Sensitivity to the sun. During treatment, and for several months afterwards, sun sensitivity was heightened. As a consequence, my skin burned more easily. I GOT TO stock up on sunscreen!
- Fluid retention. Weight and/or ankle and leg swelling were also side effects for me. FABULOUS. This decreased slowly once treatment had finished. To help reduce the chance of fluid retention, I was given steroid tablets (usually dexamethasone) to take for three days beginning the day before treatment. The dexamethasone helped to reduce the chance of an allergic reaction.
- Changes to nails. Chemo commonly produces redness, drying and cracking of the hands and feet, and often quite severe drying and cracking of the nails. I begged my oncologist to give me permission to have a manicure every once in a while.
- Cardiovascular. Cardiovascular side effects have included fluid retention, sodium retention, congestive heart failure, potassium loss, hypokalemic alkalosis (the most common metabolic abnormality resulting from vomiting and fluid loss). I suffered from potassium loss…A lot.
- Altered menstrual cycle and early menopause. Can I just say: UGH!
- Muscle pains. (“Myalgia”) Pain in joints or muscles, especially in my back and legs began 2 to 3 days after treatment. My pain lasted up to 5 days. It felt like “’flu” pain. After my third treatment, I felt like someone was taking a hammer and smashing my bones….just sayin’. I required strong pain killers. I would have rather had the flu.
- Loss of sensation. (“Sensory Neuropathy”) Docetaxel caused reversible damage to my sensory nerves. This lead to “pins and needles” in the fingers and toes, and sometimes tenderness or odd burning sensations in my palms and soles, but especially the feet. It was very weird. It came on after about two months of treatment, and took as long as nine months to resolve after the treatment finished. (Not everyone gets this problem and some women seem much more sensitive to it than others).
The drug-specific side effects are (www.livestrong.com):
- Taxotere Side Effects The most common side effects of this drug include: low white and red blood cell counts, which can lead to higher risk of infection and anemia; fluid retention; loss of hair; mouth sores; nausea and vomiting; peripheral neuropathy (nerve damage in fingers and toes resulting in numbness or “pins and needles”), and fatigue.
- Cyclophosphamide Side Effects Typical side effects include low red and white blood cell counts; hair loss; nausea and vomiting; loss of appetite; adverse effects on fertility; mouth sores; changes in the color of your skin or nails, and diarrhea. Because this drug may cause bladder irritation, it is important to stay fully hydrated while being treated with cyclophosphamide.
So, this is what I was up against. Vey is mere. To take it all in at one time was, well, overwhelming and made me wonder how on earth I was able to keep my head above water.
The fabulous SM here is that there is a wonderful array of medications and alternative treatments that did offset some of these side effects. As you know by now, at this point I was not exactly shy about asking for what I needed.
Since my diagnosis many “moons” ago, I take things one day at a time…and sometimes one hour at a time.
What I know for sure is that: I. Did. It. (and you can, too)!!
As always, wishing you SM’s throughout your day!