chemo day 1

First day of chemo.  My husband asked me last night if I was ready, and I told him I wasn't sure if I'd truly feel ready.  I mean, my chemo bag was packed, I read through all the literature on my meds, picked out my outfit, checked off my lists.  So I was prepared, yes.  But feeling ready?  I just really wished I didn't have to be ready for something like this.

Soph had a bit of a meltdown at bedtime since we know she could feel the stress we've been managing.  She understands that I'm sick and that I'll be given medicine.  In her world, that's kind of like having a cold or the ever-present daycare cough, maybe a visit to the doctor for medicine, and gradually getting over it.  It's hard explaining 16 rounds of chemo to a 4-year-old for her to comprehend... so I use terms she understands and then put on my brave face to try to keep our home life as unaffected and routine as possible.

This morning we were up a bit earlier so my MIL could bring Soph to school and we could be on our way to the hospital by 7:30.  The scheduler had told me the infusion center had allotted 7 hours so I was prepared for a long day.  My nurse was ready for me and talked me through every step, which helped to ease my anxiety.

My weight/height and vitals were taken and recorded.  Next came the cold cap/scalp cooling prep.  Even though I watched the educational videos on how to prep and fit, it was more of a two-person job to make sure the cap was as snug as it could be to my head.  Once it was plugged in, then my port was accessed and pre-meds were started.

First one, 15 more to go!

The nurses were amazing.  They hooked me up with my favorite treat. And the cup that Anthony got me for Christmas was perfect for treatment.

Time to get comfy!

And then it was time to start A/C therapy.  I was most nervous about Adriamycin (I mean, look at the color of it!) and the fact that the nurses suit up to administer it, but besides the metallic taste in my mouth, I seemed to tolerate it fine.  The infused Cytoxan hit my sinuses though, enough for me to say something.  A bit of ice on my nose and it relieved the pressure.

The "A" part of chemotherapy.

Effect of "C" on me.

Then it was time to wait.  Time seemed to pass fairly quickly... IR visited to check on my port, and the dietitian I had requested for a nutrition counseling went over how I could feed my body to help manage potential symptoms.  After treatment, I had to sit with the cold cap for 90 minutes.  After the first 10 minutes or so getting used to the cold, it wasn't so bad.  The nurses couldn't believe I wasn't even using a blanket, but I think that's partly because I run hot naturally and even hotter with pregnancy.  So in a weird way, that may have kind of worked in my favor?  As the countdown was nearing an end though, I definitely was eager to have it thaw and off my head.  Vitals were checked again, and soon after, we packed up and headed out.  One down!  And onward...

Post-chemo meal.  So glad I could eat.

P.S. The fatigue hit me later... and I've been pushing through like my nurse had recommended at my chemo teaching.  It came on like she had described it would, like that feeling you get when your body is readying itself to fight off an illness -- a bit flushed, working on overdrive.  The way I see it, I've been growing a little human inside me for 7 months now with an active preschooler at home, so I kind of understand managing fatigue and moving forward.  And that's all I can really do for now.

a welcome surprise

My teams surprised me with a cake today and it was such a wonderful treat to celebrate baby mango.  Less than 2 weeks ago, I found out that I need chemo after all, and am already scheduled for my first infusion this Friday.  Needless to say, there’s been a lot on my mind... and it often can overshadow the joy of carrying the life inside me.  So thank you to my awesome coworkers for reminding me to pause and simply be grateful.

insurance policy

Here I am on my husband's birthday, sitting in the lab for 3+ hours for my dreaded 3-hour GTT (which luckily for me I've done numerous times due to PCOS and insulin resistance).  At the same time, I was scheduled for a full CBC panel so thought, why not?  Five vials of blood so far, 1.5 hours down, baby is kicking like crazy, and I could really go for a hamburger.

We met with hematology/oncology on Thursday afternoon, and so much has changed in a matter of days.  My Oncotype DX (https://www.oncotypeiq.com/en-US) recurrence score came back on my tumor, and to my surprise and dismay, it indicated a high risk of recurrence.  While my surgeon and I both thought and hoped I could be spared chemotherapy and move straight to radiation after delivery, that is no longer the case.  With the new information, the statistics show that with both a combination of chemo and endocrine therapy, the risk of recurrence in my individual case will decrease by half.  In my oncologist's words, he said I would benefit from chemotherapy and the treatment would be like "an insurance policy."

Even though I don't always feel it, I know I'm young to be diagnosed with breast cancer.  At my age, I wouldn't have been scheduled for my first mammogram for a couple years yet and my oncologist said it was good that I had found the lump on my own.  It's because of my age that I understand the recommendation for chemotherapy, as difficult as it was to hear and process.  My logical mind could understand those facts, but the mother in me immediately thought of the child I'm carrying and what it would mean for the both of us moving forward.

We discussed timing.  I had a few options.  The standard is to treat pregnant patients like non-pregnant ones.  A few adjustments would be made, yes, but overall chemotherapy is "safe" when it is administered in the second and third trimesters since all the baby's organs are fully formed.  Does that just blow your mind or what?  I had been told this by my nurse navigator the same day I was diagnosed, but hadn't been ready to process it then since I was hoping for a miracle.  So option #1 is to start treatments right away.  I would go through 2 phases, the first being 4 cycles of Adriamycin/Cyclophosphamide every 3 weeks since I wouldn't get the booster shot being pregnant and it would take that long for my blood counts to recover.  The second phase would be Taxol every week for 12 weeks, which means when all is said and done, that is roughly 6 months of chemo.  So timing is crucial.  My oncologist felt I shouldn't delay, otherwise I would not see the benefit in the long run.  We talked at length about chemo during pregnancy.  Since I'm currently 28 weeks, he recommended that I start as soon as possible so that we could undergo 2 cycles prior to stopping at 35 weeks, before resuming treatment a week after delivery.  Since my pregnancy is being followed by MFM, we agreed consultation was necessary with all providers involved to give their blessing.

I had an appointment with my OB that same evening where we discussed the risks and benefits, and she promised to reach out to MFM before my appointment the next morning.  MFM consulted with my husband and me on Friday morning, covering the research on chemotherapy drugs during pregnancy and any reported incidents of issues affecting babies.  We talked about coordinating therapy with a delivery date, as inducted at 35 weeks was no longer necessary but at 36-37 weeks a distinct possibility.  We agreed to a referral to the NICU to prepare for a pre-term baby and what to expect.  Meanwhile, baby, at 28w2d is measuring at 30 weeks, already 3 lbs 3 oz, and as my OB says, happy and snug and pretty much oblivious to everything going on outside of the womb.

By Friday afternoon, I was already scheduled for my bloodwork, 2D echo, nurse education, port placement, first 2 cycles of chemo, and follow-up nadir visits.  My first chemo will be in less than 2 weeks.

Besides our families and a few select friends, we haven't updated anyone else on this new development.  My initial feeling?  A bit of fear.  Baby and I have made it this far, through surgery and recovery, and I'm scared of going through anything else that could put him at risk.  It's a bit hard to align my head with my heart, so I've been relying on my logic to move forward.  My parents are currently overseas and can sense them freaking out a bit.  Obviously, this wouldn't have been my choice.  Who wants to go through chemotherapy?  Especially while pregnant?  But my oncologist assured me he's seen it done with successful outcomes and I think my MFM provider said it best when he said I need to get healthy to be around for my kids' weddings.  So here I go... investing in our future.