I was diagnosed with Stage II invasive ductal carcinoma of the left breast with 2/10 lymph nodes involvement. The pathology report stated that the tumor was estrogen (ER) and progesterone (PR) receptor positive. "Fortunately" it was c-erb or Her-2 negative, sparing me the agony of having to go through the Herceptin treatment! That was what my surgeon said! I was indeed the lucky one among the unfortunate!
So, the next step would be to undergo 6 cycles of chemotherapy plus 20 radiations, according to my oncologist. Something which I expected, thus, created no fuss. I went straight to "Ok, I understood what you have said, the bottom line is I want to go through these sessions as comfortable as possible, can you help me?". The good doctor appeared to be taken aback with my straightforwardness.
I asked him several questions on the side effects and the best way to minimize pain and discomfort. He was very accommodating and pleasant to speak with. I was certainly glad with my choice. I told him that I am terrified with nausea and vomiting but he quickly assured me that none of his patients suffer from N/V now. That was a great relief...
He also prescribed sodium bicarbonate 2% (v/v) mouth wash, oral gel and spray for mouth sores and ulcers, just in case, as per my request. He sort of reminded me that ulcers during chemotherapy are usually due to poor oral hygiene. I was surprised though. As far as what I have read, ulcers appeared to be pretty common among those undergoing chemotherapy. Anyway, I used the sodium bicarbonate mouth wash diligently three times a day after food, without fail.
I used to have gastritis and indigestion occasionally and having to go through FEC (5-Fluorouracil - Epirubin - Cyclophosphamide) for the first 3 cycles, I would need something to prevent any possible recurrences. He suggested IV cimetidine as part of the premedication regimen and a few days of domperidone after each cycle.
For pre-meds I was given palanosetron HCl (Aloxi) and dexamethasone IV injection plus aprepitant (Emend) oral capsule. To take home, I was prescribed ondansetron (Zofran) and dexamethasone for the next two days. Emend was to be taken as 3 doses over 3 days, starting on the day of chemotherapy, and for the following 2 days.
I was extremely lucky to have my sister around for the first few days after each cycle. She took care of my diet and kept me well hydrated with fluids and functional foods. I am forever grateful.
Here I noted down my experiences for the first 3 cycles:
Cycle 1 - 22nd July 2016
I had CT scan on the same day. Unfortunately it was a bad experience! The injection of contrast during the procedure injured my vein and thus, the nurse had to remove the catheter. That was stressful. The lesson learnt... definitely not a good idea to have both CT scan and chemotherapy on the same day!
My period started the same morning (lucky indeed!) and it lasted a few days longer than usual (up to Day 10). Initially I was worried but both the nurse and doctor assured me that it was perfectly fine to go on with chemotherapy.
The day ward located on the 4th floor was welcoming at first glance. Patients were asked to sit on the reclining chair during drug infusion. Most of them looked very normal, casual and I noticed some of them came alone. I saw a woman enjoying her curry puff during infusion! They certainly don't look sick or ill. The nurses were friendly. One of them came and assessed my BP before putting me on the normal saline followed by the premeds. I had my blood sample taken before I went for the CT scan the same morning. Unfortunately as the existing vein was already injured (by the high pressure contrast injection), Aloxi injection made it worse. I could see redness and the area was significantly swollen. The nurse stopped the injection immediately.
Luckily a very experienced chemo nurse secured a good vein and I had the premeds injected without fuss. After 1/2 hour, a scary looking bag filled with red solution (Epirubicin injection) was in first, followed by 5FU and cyclophosphamide. The whole session lasted for about 3 hours and it was uneventful. Although rashes appeared at the injection site during 5FU infusion, it was manageable with some cooling gel. I have no "wasabe" effects after cyclophosphamide infusion, a side effect cautioned by the nurse. There was some eye discomfort but a few drops of eye lubricant or artificial tears solved the problem.
And yes, throughout the infusion, I chewed on ice cubes. I am not sure if this is going to help me with the ulcers!
Not forgetting, after 1-2 hours injection with Epirubicin, you will notice your pee turned slightly red or orange in colour, definitely not a life-threatening side effect! The colour will go off even before you reach home, provided you continue taking fluids or sipping water during infusion.
After the session, I did feel a bit like motion sickness (especially in the moving car) but it was ok. My husband was with me all the time. I could walk and functioning properly. Once I reached home, I was given all the fluids and functional foods I mentioned in my last post.
As for the side effects, I had no nausea or vomiting, thus I have been eating normally from Day 1. There were no ulcers or sore throat. I may have problem with sleeping for the first 3 days but once the steroids were out from the system, I caught up with the comfortable sleep which I always had. Bowel movement returns to normal from Day 3 onward. A single Senokot tablet does the trick on Day 2. Overall, the energy level dropped from Day 2 until Day 5 and picked up after Day 7.
I just felt tired and I spend time either sitting or lying down on the sofa, watching Korean dramas. After Day-7 once my energy returned, I went for evening walks. During weekends, I took longer walks at the Botanical Garden.
Life returned to normal after Day 7. I frequented restaurants and shopping centers as I normally would. I saw my students for their progress, worked on my pending manuscripts and read student's theses. Housekeeping, washing and cooking you name them. I met up with friends and relatives for lunch or dinner. Life and mood were as usual.
I had some minor backache and left lower rib pain from Day 14 onwards. No pain killers were needed though. It was tolerable.
Acne flared up for the first few days but easily managed with a few applications of Retin-A cream.
Hair started to fall on Day-15. My scalp was kind of sensitive and I could hardly put my head on the pillow. However, the discomfort went away after I got rid of the hair. I have to accustomed to wearing scarves and wig after that. I looked like a novice monk. I love the new me. No big deal with the hair. Totally no attachment!
Cycle 2 - 12th August 2016
Generally, the session was uneventful. However, I was slightly lightheaded and developed chills for the 1st few days. Low energy from Day 2 till Day 5 but recovered thereafter. Surprisingly I had a bit nausea and I supposed motilum (domperidone) helped to a certain extent. I ate normally despite the queasy feeling!
My father passed away on Day 6 and I have rushed back to my hometown in Melaka. It was a stressful week but I recovered well despite the travelling and emotional breakdown. I had a small ulcer under my tongue which quickly resolved within a few days.
To my surprise, I saw new hair growing on my scalp. I have to shave my legs and armpit as usual. Pubic hair remained! I still have tiny fine hairs on both of my hands! I was secretly hoping not having to shave ever again, but it was not happening.
No flaring of acne this time. I took 3 doses of bezoar powder on Day 1-3 and I am certainly not saying anything. I will review bezoar in my later posts.
I had occasional lower rib pain and backache but the pain was manageable. The soreness came and went.
Life was as usual from Day 7 onwards.
Cycle 3 - 2nd Sept 2016
Cycle 3 session was uneventful. Cimetidine and palanosetron HCl IV injection appeared to cause pain and stinging feeling at the injection site. The nurse had to slow down and stopped pushing the plunger a few times to aid the recovery.
The queasiness seemed to last longer this round but still manageable. The doctor prescribed additional anti-emetic, metoclopramide (Maxolon) until Day 5. Eating was still a bliss. Some weight gain there despite the queasiness and poorer appetite! Oh yes, I have to put up with flatulence aka chemofarting quite often!
No signs of hair loss, on the contrary I noticed the existing hair grew longer. Eye brow and lashes unharmed! Absolutely no signs of ulcer, sore throat or any infections. Bowel movement was good. No further breakouts.
Skin looked normal, no signs of dryness, perhaps a result of routine application of skin moisturiser after bath. Hand and toe nails looked normal throughout.
However, I did noticed some tenderness along my right hand and arm (injection site). Some discomfort when pressed or massaged on although my right hand was totally functional. I had occasional backache and pain at the neck area. Surprisingly no more rib pain this time.
Lower energy persisted until Day 7 this time. Life returned to normal after Day 9.
There was never a need for GCSF injection or immune cells booster throughout these 3 cycles. Blood profiles prior to each chemo were acceptable.
Side effects of FEC:
- Tiredness and low level energy were certainly there.
- Acne flaring up, insomnia and constipation were probably due to the steroids and/or chemo drugs - manageable.
- No signs of menstruation since the last period on Day 1 of 1st cycle - expected.
- Backache and bone pain -manageable without analgesics.
- Hair loss - no big deal.
- Chemofarting - pain in the ass
Some points:
- A good pre-medication regimen is crucial. Ask your doctor.
- Being well-hydrated during the course of treatment and a few days prior to each injection help minimize side effects.
- Regular exercises in the form of walking, stretching and yoga contribute to a positive mood and well-being.
- Perhaps ice-chewing during infusion, plus good oral hygiene, and using sodium bicarbonate mouth wash everyday help prevent mouth ulcers.
- Shaving the head completely bald helps reduce scalp pain and sensitivity.
- Avoiding spicy or sharp foods such as fish or prawn crackers help prevent sore throat and stomach discomfort.
- Perhaps the functional foods have also been contributing to my fast recovery and general well-being.
- Have someone to help around the house for the first few days.
- "Let your hair down", put on a bright red lipstick, get out from the house and do whatever you want.
- Keep away from sick people and yes, toxic friends or colleagues.
- Make love not war, use a condom for obvious reasons.
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