Bump, Set, Spike, Crash!

So much for my goal of fewer doctor’s appointments in 2015. This week alone, I had six appointments. Next week, I have four. The good news is, the nerve damage in my left arm is healing, and the pain in my knee appears to be subsiding, too. I spent the weekend celebrating my birthday to the extreme, culminating in a great feast and bowling with the family. I mostly watched the bowling, though, due to increasing pain in my right arm. Little did I know, that pain would throw my whole week off.

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The rest of the week, I felt like a volleyball, being bumped, passed and spiked from doctor to doctor, on an emotional rollercoaster. It all started on Tuesday. As I returned to work with my physical therapist, I had a new concern for her. I was having worsening pain in my right arm that felt like axillary web syndrome (cording). I struggled with major cording for the first 6 months after my mastectomy, but hadn’t had a recurrence in months. She took one look at my skin and noticed a hot, red area on my right breast and said it looked like cellulitis, a bacterial skin infection. She didn’t want to work on my cording until a nurse took a look at me, so she called down to my surgical oncologist’s office and accompanied me right then and there to see the nurse. The nurse started asking me if I’d been in a hospital setting or could have been exposed to MRSA. A strange question – as we sat / in / a hospital setting.

The nurse was quite concerned and prescribed a strong course of antibiotics to try and fight the infection. She wanted me to see my medical oncologist right away the next day. After that unexpected detour, I was bounced back up for physical therapy to try to relieve some of the pain I was experiencing. While there, I learned more about how quickly these infections can turn serious, often landing women in the hospital, resulting in emergency surgery to remove the infected implant. I was thankful, and feeling hopeful since we caught it early.

Wednesday, I was sent back to the Vince Lombardi Cancer Center to have blood work done and meet with my medical oncologist. At that visit, I learned that the study drug I was taking was continuing to make my blood cell counts drop, opening me up to infection. She told me to hold off on the drug for a few weeks, to let my counts come back up so my body could fight the infection. She then told me she wanted the plastic surgeon to look me over. So, I called to schedule that visit for the next day.

I always seem to end up in tears in the plastic surgeon’s office. Thursday would be no different. He explained that the dermal fibrosis (damage to my skin) was only going to get worse and would leave me open to infections, which can become serious very quickly. I asked him what we could do about it, and he said, “you’re not going to like my answer to that question”. So I told him not to tell me, but, of course, he did. He said I would need another surgery. He explained two options: Either remove the implant and use an external prosthesis, or undergo a much more involved surgery to take skin, muscle and tissue from my back or abdomen to replace the damaged skin on my chest, requiring two nights in the hospital and another long recovery.

Luckily, Andy was with me at this appointment to ask further questions, because my head was spinning. The LAST thing I wanted was another surgery. We came up with a third option which involves giving the antibiotic a chance to clear up the infection, and letting my blood cell counts improve so that my immunity would be less compromised. The doctor was okay with this option, as long as I really watched closely and got to the hospital at the first sign of infection. Andy, always helpful, volunteered to keep a watchful eye on me…

That was that. Watch and see. Walking to the car, my fear of another surgery hit me, and I collapsed into Andy’s arms. He’s always been there to hold me up when I’ve had weak moments. He hugged me tight, not letting go, and reassured me that we would make it through this, too. I let him drive me home.

It’s a good thing he was driving, because I was lost in thought and teary-eyed, looking down at my phone when Andy yelled, “Oh Sh*t” and hit the brakes. That jolted me out of my preoccupation and I glanced up to see two cars racing up the on-ramp, parallel with us. One of the cars lost control and went airborne. It appeared that he was flying through the air right into our path, but thankfully, the wall between the highway and the on-ramp halted his flight, as he crashed explosively into it right next to us. I am thankful that wall kept us out of the crash. The crash did, however, snap me out of worrying about my health, temporarily.

I had a long night second guessing everything. Did I choose the right reconstruction surgery for me? Should I have waited longer to heal from radiation? Did the study drug compromise my immunity so much that I would have to have another surgery? What can I do now to avoid surgery? Slowly, the answers to these question will work themselves out.

Now it is Friday, and I have come full circle, back to my physical therapist. She reassured me that my skin was actually in pretty good shape and the infection seemed to be under control. She thought that I would get past this bump in the road without requiring surgery. I hope she is right, because I have a lot of things I want to do this year, and none of them include room for more slow, painful recovery.

Comedy of Broken Pieces

Enough already! The past week has been one problem after another as my body breaks down from the strain of cancer treatment. It’s like the classic example of the driver, breathing a sigh of relief as they near home after a long drive, and then, minutes from home, they get into a car accident.

I was breathing that sigh of relief near the end of radiation, ready to be at home with a new chance at life. I am more than ready to done with doctors and hospitals and all things cancer. My body tells me otherwise. The effects of treatment keep popping up to remind me that I can’t move forward as if nothing happened. It is going to take more time and effort than that.

Monday I met with a specialist to try to find a solution for recurrent UTIs, which are exacerbated by chemotherapy-induced menopause. Tuesday was my final day of radiation, a milestone worth celebrating, to be sure. I brought a dozen donuts to St. Luke’s radiation oncology department. It was a lovely day, and I was thrilled to be done with the 7 weeks of daily trips to St. Luke’s. There were plenty of hugs and high fives. My skin seemed to be over the worst of the burns, and I was starting to heal, feeling like I was nearing the end of the long road.  I received a wonderful bottle of wine from a friend, so there was further celebration that evening.

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Wednesday I had a follow-up with the medical oncologist. Everything was looking good. Fatigue was my only complaint, yet initial blood work was showing improvements over the dropping numbers caused by chemotherapy. There were more congratulations and hugs. I donated my hats and scarves further symbolizing the end of that chapter. On my way out the door, beaming and ready to ride my motorcycle home on a beautiful fall day, the nurse stopped me and said she needed to talk to me…

Back into an exam room I went. The nurse came in to inform me that my blood work showed an elevated level of troponin, an enzyme that is released when there is damage to the heart. It is found in people who are having heart attacks. It also can occur if radiation stresses or damages the heart. So, having told me this and asking if I had any chest pain or shortness of breath, they sent me on my way with instructions to rush to the ER if I experienced any symptoms of a heart attack. NOT a reassuring thought as I strapped on my helmet and climbed onto my motorcycle for the ride home. I felt every beat of my heart on that trip.

As everything else on this road, the “not knowing” period is the worst part. Left without details, my imagination takes over and fills in the knowledge gap with worst case scenarios. In my mind, I beat cancer but surely would need a heart transplant or other extreme measure to survive the effects of the cancer treatment. The cardiologist called and I was scheduled for a heart echo-cardiogram on Friday. I do not like Friday tests. They usually mean I get stuck, waiting with my imagination, until Monday to hear the results. Thankfully, I got the call Friday afternoon assuring me that my heart was stable. Phew.
NOW, certainly I was done with hospitals and doctors for awhile. I looked forward to the upcoming weekend and a visit from a dear friend, Rania, and her boyfriend. I also was anticipating a possible road trip with my boyfriend with excitement. But (since it wouldn’t be November with orthopedic surgery) on Thursday, I had a recurrence of a sharp pain in my knee. I had already seen the surgeon for the knee pain earlier in the month and had x-rays and an exam. The next step was to have an MRI. I scheduled it and went on with RICE (Rest, Ice, Compression and Elevation), and went forward with fun plans for the weekend.

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I spent a wonderful weekend with friends, reminiscing, riding motorcycles, eating out and toasting the end of cancer treatment. Then Sunday night, the neuropathy that was finally almost gone from my left foot, came back with a vengeance. By Monday morning, my left foot was terribly swollen and painful, making it difficult to walk. I scrambled around to try to see the orthopedic surgeon asap and attempted to move the MRI date up. The surgeon didn’t want to see me until he had the MRI results in, but I did eventually get the MRI rescheduled and a new appointment to see the doctor.

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Now it is Tuesday morning, the day of the MRI. I am able to put a little more weight on my foot, but I’m still limping quite a bit. I called around to make sure nothing implanted in my body contained metal (a no-no in MRI machines). The chemo port checked out MRI safe, the IUD also was okay. Then I spoke with the surgeon’s nurse about the tissue expanders (as I affectionately call them – boob placeholders). Tissue expanders have a metal port in them which the doctor uses a magnetic on to locate the port when injecting saline. NOT MRI safe…

The beautiful weather we had all weekend left with a drastic cold front yesterday, I struggle to walk without pain, I can’t have an MRI to determine the cause of my knee pain, I’m exhausted, disheartened, and my boyfriend is leaving tomorrow for a two week trip that I had hoped to accompany him on. I’ve had better days. I am ready to move forward, get my health back, get in shape, yet, here I sit, looking around at broken pieces.

Last Round. Done.

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Tuesday, July 1st was my last round of chemotherapy! A huge milestone, no doubt, and I am happy to be able to say that the experience of chemo is behind me. Never again (I pray) will I have to sit for hours with these chemicals coursing through my body. But, I’m not cracking the champagne yet. Realistically, it is merely the last hurdle in an event that is not yet finished, and there are additional events still looming on the horizon for me. As in track and field, the last hurdle needs to be taken cleanly and the runner still needs to land firmly on their feet and sprint across the finish line.

With the hurdles behind me, the final sprint is proving more difficult than I had imagined. I have cleared many hurdles and fought for my strength between them, seemingly just in time to clear the next hurdle. But the cumulative effect of the hurdles, chemo with its side effects, has left me weak. I was prepared, mentally, for the last round to end on July 1st, but that is just the first part of the last round – I still need to land and make it to the finish line. The drugs, along with their debilitating side effects will remain in my system for another four to six weeks, at least. I did not mentally prepare myself for that, and then, yesterday, that reality made me falter.

Going into the last round, I was already anemic, on the verge of needing a blood transfusion, and profoundly fatigued. I guess I had prepared myself to breathe a sigh of relief and move forward at this point, but the side effects hit me hard again this time, throwing me off balance.

Physically, I have never felt weaker. Small tasks sap any remaining energy I might have been able to summon. I have to stop to catch my breath halfway up a flight of stairs. The long list of things I want to do each day seems insurmountable.  Digestive problems have made it difficult to eat properly. Nothing tastes right, and my appetite is off. If I chose to eat the wrong thing, I become extremely ill. I also find it really difficult to keep hydrated, which further weakens me. Body aches and bone pain make getting around a struggle, too. Lately, I have been sleeping, hard, for fifteen or so hours a day, and it’s still not enough. Unfortunately, each round requires steroids to lessen the side effects, and with that, disruptions to the sleep I crave. Without sleep, and nourishment and water, I am finding it hard to rebuild the strength I need to cross the finish line.

Emotionally, it is taking a toll on me, too. I was not prepared for the physical effects of the final round, nor their effect on me emotionally. Chemo throws the body into sudden menopause, with its accompanying emotional moments. This week, the sleeplessness, chemo-pause, dehydration and negative external forces have been more than I was ready to handle. This weekend has been particularly hard for me and a low point on this journey.

It is the Fourth of July weekend. It is perfectly beautiful summer weather, yet I feel like I’m in someone else’s surreal life. It feels like a haze is over me. Surely, I did not just go through chemotherapy. This can’t be my body struggling to do simple things. None of it seems real. I am sad to be missing the usual celebrations that I have always shared with my kids on this holiday. There will always be an empty gap where there should have been more. Andy, who has been there for me when my own strength waivers, reminded me that missing this year’s memories to focus on getting healthy will ensure many more years of memories to come. I have to keep that thought clear in my mind when I’m feeling down. My priority right now has to be on my recovery and health, so that I will be here for all of the happy memories to come in my future.

I have a month to get back on track, rebuild and recover from the hurdles of chemotherapy before tackling my next event – radiation. I’m confident that I will be ready. Today is a new day, and I feel like I am back in my own life again and ready to reach the finish line.

 

 

 

Immunosuppression’s a Frustrating Mess

With a nod to Jimi Hendrix and Shel Silverstein. Really.

Every round of chemo has given me different side effects, including some odd symptoms that I have never experienced before. It brings to mind a Shel Silverstein poem from my childhood entitled “Sick”. My list of ailments over the past few months is almost as preposterous as Peggy Ann’s. Chemotherapy attacks all fast growing cells, including beneficial cells found in the digestive tract, mouth, hair and nails, so it throws everything out of whack. About a week post-chemo, I find myself with neutropenia, an abnormally low count of neutrophils, a type of white blood cell that helps fight off infections. This has left me susceptible to all kinds of sickness. Here are of some of the things I’ve faced:

Side Effects
Chemo has been quite a ride.
I’ve fought back with strength and pride.
Neuropathy gives my toe tingles.
I came down with a case of shingles.
Boils, pains, insomnia, and rash.
Nasty gastrointestinal distress.
Exhaustion and anemia.
Bronchitis, cold sores, and alopecia.
Flu-like symptoms, extreme fatigue,
All these things I just don’t need.
Low white blood cells cause infection,
Low red blood cells cause exhaustion.
Dehydration.
Taste sensations.
Hot Flashes! Chemopause
is their cause.
One eye twitches, one knee aches.
Now and then my fever bakes.
My lymph nodes swell where cysts dwell.
I am not well!
But all this amends
when chemo ends.

On Tuesday, I went in for my weekly labs, and we discovered that my slowly dropping red blood cell count had dropped to a level at which the doctor recommended a blood transfusion. Short on time, because I had to pick my kids up, I asked if we could postpone. I also wanted to learn more before I underwent a blood transfusion. I scheduled it for Friday and went home to ask questions. I learned that the chemo has been attacking my blood cells (as it does all rapidly growing cells). A low red blood cell count causes weakness, shortness of breath and extreme fatigue. I knew chemo was causing me fatigue, which has crept up on me cumulatively over the course of my treatment, but it has become extreme lately. I live on the second floor. I can only make it up half way before I start huffing and puffing and slowing down. I wake up after 10-12 hours of sleep needing a 3-4 hour nap. I think I could sleep all day, in fact.

I went back to the Vince Lombardi Cancer Clinic on Friday, fully prepared to spend five or so hours receiving a blood transfusion, but my labs came back showing a slight rise in my red blood cell count, taking me out of the critical zone. The doctor advised waiting on the transfusion since my body is trying to recover on its own and I only face one more round of chemo. So, armed with the information that my body is fighting back, I went home and took a three hour nap. Guess I’m just going to have to deal with extreme fatigue a while longer. Excuse me, while I take a nap.

And now, a real poem…

Sick
Shel Silverstein

“I cannot go to school today,”
Said little Peggy Ann McKay.
“I have the measles and the mumps,
A gash, a rash and purple bumps.
My mouth is wet, my throat is dry,
I’m going blind in my right eye.
My tonsils are as big as rocks,
I’ve counted sixteen chicken pox
And there’s one more–that’s seventeen,
And don’t you think my face looks green?
My leg is cut–my eyes are blue–
It might be instamatic flu.
I cough and sneeze and gasp and choke,
I’m sure that my left leg is broke–
My hip hurts when I move my chin,
My belly button’s caving in,
My back is wrenched, my ankle’s sprained,
My ‘pendix pains each time it rains.
My nose is cold, my toes are numb.
I have a sliver in my thumb.
My neck is stiff, my voice is weak,
I hardly whisper when I speak.
My tongue is filling up my mouth,
I think my hair is falling out.
My elbow’s bent, my spine ain’t straight,
My temperature is one-o-eight.
My brain is shrunk, I cannot hear,
There is a hole inside my ear.
I have a hangnail, and my heart is–what?
What’s that? What’s that you say?
You say today is. . .Saturday?
G’bye, I’m going out to play!”