Taxol 4 of 9

Prior to my Taxol infusion yesterday I had bloodwork done, including ALT, a liver enzyme.  My results were 119 and the upper limit of the specification was 54.  Last time it was checked was on September 4th and it was 60.  I though 60 was a little high, but just barely and since chemo can do some weird things to your bloodwork I didn't think too much of it . . . ok, I worried a little but forgot to ask the doctor about it (I blame chemo-brain).  But now that my results were more than 2x the upper limit I wanted to know what the doctor said.  I sent her an email but did not get a response prior to chemo.  But the nurse was paging her and I specifically asked her to ask about that.  She said that it is high and the doctor will monitor it. Next week when I go in for my routine CBC bloodwork I will also be getting the liver panel.  I also have an appointment with my oncologist on Monday so I can get further clarification.  My google search tells me that they don't really worry about your ALT unless it is 5x the upper limit while on chemo but I will be asking more questions during my appointment.

The actual infusion was pretty uneventful except it lasted longer than normal.  I am not sure if this is because the nurse set it to go slower or if there was more volume.  My DH thought that the bag was bigger so I will also ask the doctor if she had them mix it more dilute or infuse over a longer time.

I had a nurse that I haven't had before and I think she is my new favorite.  Plus I also got a room with a window.  I say "room" but they are more like cubbyholes, but I was excited for the window even though the window was behind me and I couldn't look out (not much of a view anyway) but having natural light just seemed to make the place less industrial.  Here is a picture of my room with a view.

As far as side effects go, so far they are the same as previous ones, decadron steroid high and flushed face, muscle aches (like I just started exercising after a long break), fatigue, and my fingernails looking like they are about to fall off (I'm working on a separate blog post for this with pictures - if you are brave enough to look at them)

Good Cancer Quote

A friend shared this with me and I thought it was too good not to share.

Third Weekly Taxol

My third weekly taxol infusion was pretty uneventful.  I was hoping not to get my least favorite nurse and got lucky and got my favorite nurse.  But sadly, I still ended up with a bruise where the IV went in.  So now I am at a loss . . . maybe I am just destined to have a bruise after each infusion.  With six chemo's left I sure hope that is not the case.

My fingernails have taken a beating during chemo - on AC, my nails had lines on them, now the lines are fading and it looks like the nail is pulling away from the nail bed.  I have trimmed my nails so they are as short as possible and not using my nails for anything.  I also noticed that on my right hand where the nail is just growing looks whitish . . . I'll post some pictures later, but I am not liking the direction things are going.  Plus I have some neuropathy on my fingertips which means that they get numb and tingly and when I touch things it doesn't feel right, like how things feel when they are numb.  This feeling comes and goes and I have noticed that I am a lot more clumsy which I am sure is a side effect of the neuropathy.  I have taken some vitamin B6 and glutamine off and on to help with this.

And my hot flashes, although really mild, seem to be happening more frequently.  I also have more hot flashes on chemo days, which are now once a week.  It could also be that it is hot - I am ready for cooler fall weather.

I also still have muscle aches, primarily in my legs.  It makes climbing the 3 flights of stairs to my place difficult, but not impossible.  I feel sore, like I ran 5 miles yesterday.

I also had an appointment with the surgeon to discuss my lumpectomy.  It looks like that will be somewhere around Thanksgiving and will probably be the week after.  I have an appointment with the plastic surgeon too and will finalize the date after that.

Chemo Hair Loss Silver Lining - Top 10 Reasons to Like Being Bald

In my best David Letterman Impersonation

Drumroll Please . . .

Top 10 Good Things About Loosing Your Hair to Chemo


10.  Showers go much quicker since there is no hair to wash/condition/dry.

9.  Save the earth by not using a blowdryer.

8. Hair doesn't get caught in your necklace.

7. If you are cold, just put a hat or scarf on for instant warmth.  If you are warm, take off the scarf or wig for an instant cooldown.

6. No hair to clean up on the bathroom floor or in the shower drain.

5. No hair in your face.

4.  No hair in your food.

3. End the curiosity of what your scalp looks like.

2. No hair "spiders" from the dryer - ladies know what I'm talking about, the clumps of hair that somehow find each other in the washer/dryer and look like spiders when they fall on the floor.

1.  Save money on shampoo and other hair products.


Just trying to put a little silver lining/ comic relief into a not so fun situation.  The way I see it is that you can either laugh or cry, and well I have done plenty of crying lately so it is time to try laughing.  I would looovveee to have my hair back, or to never have lost it in the first place.  BUT, it will grow back after treatment is done.  For most people the growth rate is about a half inch a month!  Yeah, it grows back but at a glacial pace.

Breast Cancer 101

Cancer is cancer, right?  The only difference is where it is found, right?  WRONG.  Each cancer is different, and each breast cancer is different.  Don't worry, I was clueless before I had to get educated ASAP.

Here are a few things I have learned about Breast Cancer, in laypersons terms.

Hormone Receptor Status - Hormone receptors are proteins on the breast/tumor that receive signals from the breast(or tumor) to grow.  The two hormones are Estrogen and Progesterone.  Commonly abbreviated as ER+ or ER- and PR+ or PR-.  The pathology report of the tumor, usually from a Biopsy or from surgery will indicate the hormone receptor status.  Basically it tells you if Estrogen or Progesterone "feeds" the cancer or not.

ER+ tumors - There are drugs, Tamoxifen or Aromatase Inhibitors that will block your natural estrogen production.  These are usually taken for 5 to 10 years (yeah, I said YEARS) after your treatment to prevent recurrence.  Tamoxifen has been around for years and was initially given for 10 years.  Further studies showed that 5 years was just as effective.  I believe there are current studies going on to see if 2 years are just as effective.  Aromatase Inhibitors are a similar type of drug as Tamoxifen but are given to postmenopausal women.  Tamoxifen is now just given to premenapausal women although prior to armotase inhibitors it was given to all women regardless of their menapausal state.

There are no known drugs to take to reduce the recurrence of ER- or PR+or- tumors.

The following is a breakdown of the frequency of the hormone receptor status of tumors, from breastcancer.org

• ER+: About 80% of breast cancers are estrogen-receptor positive.
• ER+/PR+: About 65% of estrogen-receptor-positive breast cancers are also progesterone-receptor-positive. This means that the cells have receptors for both hormones, which could be supporting the growth of the breast cancer.
• ER+/PR-: About 13% of breast cancers are estrogen-receptor-positive and progesterone-receptor-negative. This means that estrogen, but not progesterone, may be supporting the growth and spread of the cancer cells.
• ER-/PR+: About 2% of breast cancers are estrogen-receptor-negative and progesterone-receptor-positive. This means that the hormone progesterone is likely to support the growth of this cancer. Only a small number of breast cancers test negative for estrogen receptors but positive for progesterone receptors. More research is needed to better understand progesterone-receptor-positive breast cancers.
• ER-/PR-: If the breast cancer cells do not have receptors for either hormone, the cancer is considered estrogen-receptor-negative and progesterone-receptor-negative (or “hormone-receptor-negative”). About 25% of breast cancers fit into this category.

Human Epidermal growth factor Receptor 2 Status

This is a little more difficult to describe, but I will try anyway.  My understanding of HER2 is that it is a known "feeder" of breast cancer cells and that it tends to be more aggressive than HER2- breast cancer.  Prognosis used to be worse for the 25% of patients that had the HER 2 mutation.  Herceptin (Trastuzumab)
 a new drug that is helping save several lives.  It is referred to as a targeted therapy as it is a monoclonal antibody that is specifically targeted to the HER2 protein.

Here is an excerpt from breastcancer.org.  

The HER2 gene makes HER2 proteins. HER2 proteins are receptors on breast cells. Normally, HER2 receptors help control how a healthy breast cell grows, divides, and repairs itself. But in about 25% of breast cancers, the HER2 gene doesn't work correctly and makes too many copies of itself (known as HER2 gene amplification). All these extra HER2 genes tell breast cells to make too many HER2 receptors (HER2 protein overexpression). This makes breast cells grow and divide in an uncontrolled way.

Breast cancers with HER2 gene amplification or HER2 protein overexpression are called HER2-positive in the pathology report. HER2-positive breast cancers tend to grow faster and are more likely to spread and come back compared to HER2-negative breast cancers. But there are medicines specifically for HER2-positive breast cancers.

Summary
There are 3 main ways to classify a breast cancer tumor, ER status, PR Status and HER2 Status.  HER2 positive is generally aggressive, as are tumors that are negative for all, called triple negative.

Treatment is based on the ER, PR and HER2 status of your tumor.  ER+ can be given an estrogen blocking drug such as Tamoxifen or an Aromatase Inhibitor.  HER2+ can be given Herceptin, a recent targeted therapy.

Disclaimer - I am not a doctor so please consult your doctor.  I am just trying to explain my understanding of things in a clear and concise manner.

Taxol Infusion Number 2

I was worried about infusion number two of Taxol because it was my second infusion of Taxotere where I had the bad allergic reaction.  But I tried not to think about it cause worrying does no good.

I got called in to the infusion center and found out I again had my least favorite nurse.  Why is she my least favorite you ask?  Because the IV always hurts more when she does it than when any of the other nurses have done it.  Plus she was my nurse when I had the pain in the infusion site after only getting saline and I ended up crying during the adriamycin push.  She is very nice and I don't think she is doing anything to purposefully hurt me, but she does.  I think it has to be a slight difference in her technique.

She was eyeing my forearm vein again but I asked her to go for the hand.  She did go for the hand, but said that "the vein was not happy to see me" and that she couldn't get it (later I saw she tried in almost the exact same spot as last week - um, couldn't you have went a few millimeters away?)  Well, she went for the forearm vein that she was initially looking at.  It hurt, but not as much as my hand was now hurting.  She was nice and went slow on the infusion to help me with my allergic reaction fears, which was nice.  The infusion went without incident.  It was quite boring in fact.  I was so bored that I took a picture from my chair.

I told you it was boring. 

When I got home and took the bandage off my arm I noticed I again had a bruise,sigh.  Now I have 2 bruises, one on my hand where she couldn't get the IV and one on my forearm.

See the bruise below my index finger.  The scars on my wrist are from  prior infusions - the left one was from adriamycin and the right one from taxotere.  I'm not sure about the reddish/brown discoloration on the upper arm (farthest down in this picture).  It doesnt hurt and seems like it is slowly going away - it showed up about the same time as the shingles so who knows.

I hope that next week I get another nurse, but if I get her again I will definitely say something.  I think my bruises will still be there and I will use that to start the conversation.  And if it turns out that I am assigned to her for the duration of my treatment (when I got AC it seemed like I was randomly assigned a nurse but so far 2 weeks in a row I have had my least favorite nurse so it seems like it is not a coincidence) I will call and ask for my favorite nurse, or at least another nurse that I don't end up with bruises - my left arm is beat up enough, I don't need to suffer any more than I have to.

So far the side effects have been mild, although I am now having some nasal congestion.  I am taking zyrtec and it seems to help a little.

Taxotere to Weekly Taxol - Change of Plans in my Chemo Treatment

Two weeks ago I had an allergic reaction to Taxotere.  My bloodwork prior to the treatment showed that I had high eosinophils.  According to the doctor eosinophils are high due to an allergic reaction.  I had noticed that my eyes were puffy, and I was cleaning out some stuff and exposed to a lot of dust (and stress, but that is another story).  Well, last week I had blood drawn in preparation for my chemo on wednesday and I also had high eosinophils . . . even higher than last week!!!  WTHeck is going on??  My oncologist called me on Tuesday to tell me my results.  She also thought that since Taxotere has been really harsh on me that I should be switched to weekly Taxol.  I was relieved as I was really fearing going back in and having a repeat reaction to taxotere.  And by really fearing it, I mean I was dreading it with all I have left right now.  I even sent her an email asking her for specifics on how/what will be done to ensure I dont have the same reaction again.

So needless to say I was very relieved to be told I would get weekly Taxol.  Until the fear of having a reaction to Taxol (which is like a cousin to Taxotere, both are in the taxane family of chemotherapy drugs and are derived from the same Pacific Yew Tree, Taxus brevifolia ) set in.  I told the nurse that I had a reaction to taxotere and that this was my first time with Taxol so please go slow.  She obliged, although she is not my favorite chemo nurse.  Remember a few weeks ago when I had my last AC infusion and my vein leaked and I ended up crying during the whole infusion?  Same nurse.  I was less than thrilled.  She looked for the same arm vein and I told her that I had it leak and to please use my hand.  She used my hand but it hurt!  She was kinda snippy and said that is why I dont like using the hand cause it hurts.  But none of my other ones hurt - to be honest it only hurts when she does it.  She is really nice and actually shows me the drugs before she hooks them up (after another nurse verifies she has the right chemo for me), but so far she is 0 for 2.  At least I didnt have an allergic reaction this time.

I did get IV premeds - decadron, benadryl and pepcid.  The benadryl hurt going in and gave me restless legs, so I ran a "mini-marathon" in place in my recliner.  My legs had so much pent up energy I wanted to run, and my nurse said some people walk around, I didnt really want to drag my IV setup with me.  I'll do it to go to the restroom, but I didnt really want to tote it around just to walk.  But my marathon in place worked until I started to get drowsy.  At least she told me if I take Zyrtec an hour before my next infusion I dont need the benadryl IV.  Yippe, one less painful drug and less time in "the chair".

Aside from a hurting hand where the IV was placed I was fine during the infusion.  I went home and was ok. On Friday I started to feel kindof out of it and without motivation to do anything (lazy).  Saturday and Sunday my legs felt like I had run a real marathon.  I didnt take anything but did spend a lot of time on the couch which may have hurt the situation as I always felt more stiff after I had been sitting for awhile.  But it was manageable - I know people who have way worse bone pain than I do, so I'm not complaining  And of course I had my usual sensitivity to acidic foods and heartburn, but aside from that I am doing OK.

Now I'm worried about my eosinophils and what is causing them.  The doc seems to think it is allergies as I did have a sinus headache that seemed to get better when I took Zyrtec, but only my next bloodwork will tell the true story.  Oh and I am also worried about having a reaction to my second Taxol because it was my second Taxotere that had a reaction.  My oncologist acted like I was crazy when I told her my worries.  She has me convinced that more people have a reaction with Taxotere and it is really really REALLY uncommon to have a reaction to Taxol.

Never fear growing old, there are many who never had the privilege.

Happy Birthday to Me!  

Never fear growing old, there are many who never had the privilege.  That is my new mantra.  Prior to BC I was dreading my birthdays as I turned 39 today which means that next year I will be the dreaded 4-0.  But now that things have changed and I have a new perspective I appreciate each birthday more.  And I hope to have at least 39 more birthdays!

Feeling Better, Finally

I realize that most of my posts have been negative and that is in part because when I do start to feel good I am too busy catching up on all the things I put off when I wasnt feeling good.  Even making dinner and cleaning up are suddenly more enjoyable.

Anyway, I wanted to post saying that I feel somewhat normal again.  I am still nowhere near a pre-chemo normal feeling, but when you have hit rock bottom even feeling halfway decent feels sooo good.  I was able to go for a 20 minute walk today[this was supposed to be posted on Saturday when I wrote it], sit on the couch and browse through pinterest my new favorite passtime, as well as make some dinner.  And DH cleaned the house - that alone is enough to make a girl feel better :-).

I still have to talk with my oncologist to discuss how a reaction will be avoided next time.  And I have to find the courage to go back and subject myself to the torture that is chemo, but I know the "torture" is for the best but it is a little scarier after my reaction.