Chemotherapy is one of the main treatments used for Cancer and a scary word for many patients.
Actually, there are many types of chemo drugs used, several objectives (before surgery to reduce a tumor, post to reduce reoccurrence, palliative to soften the progression of Cancer), various protocols and different ways of administrating it. Medical oncologists generally follow international protocols depending on the exact diagnosis of each patient (area to treatment, cancer staging etc.).
What to expect? What about the side effects? Does it hurt?
Read MoreThese are some of the questions that people regularly ask and I felt sharing my experience could assist [To be specific my experience relates to a Breast Cancer on stage 2a, triple negative. Quite often, Breast Cancer doesn’t require Chemo and is treated with radiotherapy, surgery, hormonotherapy, or targeted therapy. On triple negatives, these last two are of no use so chemo had to be done.]
Verdict: surgery went well but…
The oncologist surgeon explained me what would be the protocol few days after my lumpectomy. Good news, tumor was gone but it was a triple negative and the protocol to avoid reoccurrence would then be 4 dose dense of AC chemo (Doxorubicin -also known as Adriamycin-and Cyclophosphamide) and 4 dose dense of Paclitaxel. I would need to have a Port-a-Cath inserted in few days and chemo sessions would start 3 weeks later, just ensuring I recover from the lumpectomy.
I must say, it came as a slap in the face as my doctor had so far suggested I would have radiation and hormotherapy. The news would have come few days earlier, I was ready for anything. Whatever to save my life. Anything to guarantee I will see my kids grow and become a grandma one day. I even had offered my breasts on a tray to the surgeon.
He explained the Port-a-Cath insertion, and with kindness but assertiveness ensure it would be fine. From a side effect point of view, he mentioned the hair fall and cooling caps.
It is shaken up that I left his office with few information booklet and loads of questions.
Preparing for chemo
The Port-a-Cath was inserted 7 days later on daycare full anesthesia surgery. I won’t detail it since I already wrote about it.
I tried to find info in Dr Google ensuring I would only look at official sites as I had promised myself on day one of the diagnosis. I wasn’t after medical effects that Doctors could help with the little tips and practical info which could help.
From my research, I concluded that I would go for the following feel & look good options:
- Cut my hair to get used to a new me
- Buy head scarves since I had decided fast that wigs won’t be for me
- Buy some protective mascara and eyebrow gels
- Buy protective silicium based nail polishes
There was no much else I could do. My mum would come back to help me with the kids, not knowing what to expect as side effects. I asked for chemos to be scheduled on Thursdays so I could rest over the weekend and only take one sick leave per cycle. At work, i didn’t take commit on anything on the Sundays and Mondays following these sessions and my boss offered me to work from home on these days.
Then, a lot is about your mindset, using brain vs. emotions and vice versa depending on what would help me to make it through.
I decided I wouldn’t allow the fear to take over me prior to the first session. I managed to convinced myself that it was a nonsense stressing out over something I didn’t know. Maybe it wouldn’t hit me too badly. After all, my oncologist had shared a list of potential side effects insisting that there were not applicable to all and intensity would vary.
I decided I wouldn’t count how many sessions, and handle one day at a time.
D Day
I came with my Mum to the hospital with my little bag (socks, phone charger, book) and after being admitted for the day and reaching my room the protocol started:
- Vitals
- Access and flush of the Port-a-cath
- Pre-medication administration to limit side effects: anti-histaminic, anti-nauseas, steroids, anti-acids
- After one hour, the chemo itself
So far so good. The anti-histaminic made me dizzy and the steroids woke me up. Nothing unbearable. Just a bit hyper resulting in lousy focus.
The chemo was administrated about one hour after with no pain and after I got saline and the port cleaned. I could go home. No drama. No pain. I was asked to come back for an injection boosting white cells after 24h and be careful as my immune system would weaken after 7 to 10 days.
Side effects of AC and Paclitaxel chemo drugs
All pre-medications allowed me to get through the first 24h without major issue. It hit me after as it would every second week as follows:
- D Day: not much, just lousy focus
- D +1: loss of appetite, a bit nauseous if I didn’t take the prescribed tabs of Zofran. Fatigue.
- D +2: that was my worse day. I would surrender to fatigue and only be awake for about 4 or 5 hours a day to eat a bit and see the kids.
- D +3: I would start getting better but extremely slow. Bad heartburn and acidity. Working from bed, I would need to nap at my lunch break and as of 5 or 6 pm to be able to join the family dinner.
- D +4: same but getting better from a fatigue point of view.
- D +5 and 6: getting better everyday
- D +7: back to normal but taking care of my immunity, avoiding public spaces and crowds such as malls, supermarkets, taxis etc.
If I summarize the AC cycles, my immune system and the acidity were the worse. I shaved my hair few days after the second cycle.
After 4 cycles every second week, the protocol changed as planned to Paclitaxel.
Side effects were different.
- D Day: not much, just lousy focus
- D +1: loss of appetite, a bit nauseous if I didn’t take the prescribed tabs of Zofran. Fatigue.
- D +2: that was my worse day. Fatigue though less than with AC but joints pain (hips, legs, hands). I would need Brufen tabs for 48h and pad myself to sleep, sit.
- D +3: I would start getting better but be slow.
- D +4: same but getting better from a fatigue point of view. Almost no pain.
My issue here was the pain and after the first cycle I started having the hand and feet syndrome and peripheral neuropathy. Later, it would force my doctor to push a session for a week and reduce its dosage. The doctor explained me that chemo side effects are monitored based on Toxicity levels (1 and 2 are treated and treatment continues, 3 and 4 serious and require adjustments or interruption of treatment). This is the reason why it is crucial to monitor and report side effects to your oncologist.
Strange enough, in between I had good normal days when I would forget about all the bad days and simply enjoy my energy.
Keeping up
Overall, my body reacted very strongly to chemo. I am one of a kind!
In fact, I ticked the boxes of 90% of the side effects. My body fought like hell.
It might sound scary but even if it was tough, I won’t lie, I could have taken more. Determined to heal, I really was hesitant to accept to push a session and offered the doctor to do few more to ensure I would be fine in the same mindset I had offered to do a double mastectomy. Actually, it is not an “A la carte” menu and treatments are seriously defined by protocols and discussed in medical boards.
How I kept up? Again, I decided few things.
- As mentioned earlier, I decided not counting sessions, days and avoiding any countdown has been a blessing. Chemo is really heavy and people with kind intentions telling you things like “only 2 left” or “so next week you will be tired”, or “but that’s 4 days after your session” have absolutely no idea. Can’t blame them, they try to be nice but really one day at a time is the rule. No long term planning.
- I decided I would not fight the chemo side effects on my body. Surrender, accept to heal faster. I don’t mean staying in bed and giving up. I mean accept that I was being poisoned and it was killing cells in me – bad and good ones as collateral damage). Yes, it meant sliding in limbos for few days but that was part of a controlled and monitored process I should trust and not be scared of.
- That being said, of course I decided forced myself to eat a minimum. It would mean selecting food that wouldn’t smell, taste too strong and bring me the minimum nutrients and focus on finishing my portion. It would require a real effort and focus, but I knew I needed it so I did gathering all granular bits and pieces of strengths.
- I also decided forced myself to walk 20-30 minutes a day (except on D +2 days when I simply couldn’t do anything) even if it meant a 2h nap afterward to recover the effort.
- I decided though to work in order to ease the Chemo brain effect. No matter in which blurry world my thoughts would get lost, I would exercise it by working, tidying up my things, doing lists, etc. Chemo brain is actually very strange and I would say somehow a “funny” one: for months, you live in a foggy galaxy and feel like Dory the Nemo friend.
- I decided that even the bad days I would shower, dress up, and live. Have a chat with the kids, family and friends.
Chemo a necessary evil
Even my closest friends didn’t really witness side effects. In fact, many saw me on the chemo day but that’s the piece of cake part. Probably only my husband, parents who came home to help really saw me in bad days.
I tried hard not to show the kids but let’s face it, they probably saw more than I hoped to but I kept smiling. Genuinely. I was blessed and alive, doing all this so Cancer wouldn’t come back. I would have done and will do anything with a smile to be given the chance to be a grandma one day – that thought kept me going.
During these days, all what I learnt in my yoga practice in terms of living the present made full sense. What a blessing. Unfortunately, I couldn’t practice yoga and chemo brain refrained me from meditate but I fully lived the present as a gift.
Today, it is hopefully behind me and it feels like long ago though I completed chemo treatment only 4 months back. Amazing how body and mind are so resilient.