Chemo Round 3

I have a strong Christmas hat game.

I had my third round of chemo on Monday, December 19. I am now half way done with chemotherapy (unless something happens that requires us to change the game plan). Amazingly, I have experienced the fewest side effects with this round. I do not mean to give the impression that I feel great by any means, but I was a lot less dizzy on days 4 and 5 after chemo than I was during the first two rounds. Plus, I had much less bone pain on those days. My mouth got sore again on day seven (Christmas Day) but I was able to keep it from getting too bad by brushing my teeth (with Biotene toothpaste) after each meal/snack, using Biotene mouth wash and also the mouth wash prescribed by my dentist, which I use before bed each night. Biotene rocks.

The biggest negative change is that I am growing more tired and fatigued with each round of chemo. It makes me wonder how bad this will get by the end. In the immediate days after chemo, I am pretty bloated from the liquids given during chemo, plus the amount of water that I drink. (Every doctor, nurse, fellow chemo patient extols the virtues of drinking a lot of water to flush out the poison. I drink as much as I can given that water is starting to taste gross and ice cubes sometimes taste like garbage.) And, of course, when you drink a lot of water, you have to go to the bathroom a lot. Thus, I get up every two hours to go to the bathroom in the first few nights after chemo. Sometimes my pre-cancer insomnia comes back and I can’t get back to sleep after I go to the bathroom. By day 3 of this round, however, insomnia was no longer an issue. I’ve been going to bed at 8:30 (or earlier!) and sleeping until 5:20 am (if we do CrossFit) or as late at 7 or 8 if we do not. I sleep so long my back hurts from the inactivity. It could be that sleep has been helpful in alleviating some of the other side effects. Or, it could be that the chemo is starting to take its toll. Or it could be both.

Also, a troubling new side effect is that my fingers and toes are becoming sore and sensitive to touch. I’m hopeful that this is related to my fingernails and toenails becoming more brittle and is not the start of neuropathy in my hands, arms, feet and legs. Neuropathy is a common side effect of chemo. I had nerve pain in my right leg and foot due to my hip issues for many years prior to my surgery. I was on Gabapentin for at least five years. I just weaned myself off of it in January 2016. I’m hoping so hard to avoid neuropathy. Send me some positive vibes to avoid this. Dr. Coluzzi said that it will *usually* go away when chemo is done but sometimes it takes a few months.

I need to take a few minutes to discuss my hair. I shaved off the hair on my head several weeks ago. And I do have big bald spots on my head (including right above my forehead). But I also have areas where the hair on my head seems to be growing. In addition, I have one strip of leg hair that hasn’t fallen out, along with about half of the hair on my arms. I checked with my Mom and she said that all of her hair fell out during her chemo. Hmmm … I just found out that Taxotere, one of my chemo drugs, is the subject of a number of lawsuits for causing permanent hair loss. Oh good god. I hope that this is one of those baseless class action law suits. Now I have to worry about permanent hair loss. As if I wasn't worried enough about other stuff.

Overall, I’m doing pretty well at the halfway point. I’m back at work with my regular schedule. (I have taken three days off to get chemo and recover with each round.) I’m back at CrossFit. I’m losing a little strength and I become winded easier than before I found out I had cancer but I can still get through a workout. Miguel, one of my coaches, set me the goal of doing a handstand push-up before I finish chemo. I have two months. I am going to try like heck to do it. 

I have an upcoming appointment with my surgeon on January 5. She is going to check my progress. Hopefully she will agree that those tumors are shrinking!! Also, I am going to start to hear about my surgery options. She told me that a lumpectomy was out of the question. She said that she would not be able to save my nipple.  So I know that I am looking at a mastectomy of my right breast. But I do not know whether they will recommend a double mastectomy or whether they will recommend more extensive surgery. Ultimately, the decision will be mine. It’s a big decision. 

Pre-round three swim suit photo.

Genetic Testing

As part of my treatment game plan, my surgeon, Dr. Coleman, suggested that I be tested to see if I have any cancer gene mutations. This is important information for me to consider as I decide whether to have a double or single masectomy.

From the National Cancer Institute website: "BRCA1 and BRCA2 are human genes that produce tumor suppressor proteins. These proteins help repair damaged DNA and, therefore, play a role in ensuring the stability of the cell's genetic material. When either of these genes is mutated, or altered, such that its protein product either is not made or does not function correctly, DNA damage may not be repaired properly. As a result, cells are more likely to develop additional genetic alterations that can lead to cancer."

"A woman's lifetime risk of developing breast and/or ovarian cancer is greatly increased if she inherits a harmful mutation in BRCA1 or BRCA2."

I met with a genetic counselor in November who spent about an hour going through my family history and explaining the process to me. She calculated my risk for a mutation at the time as only 2.7%. A number of studies have shown, however, that triple negative breast cancer tumors are associated with BRCA1 carriers. Plus, my family had a "mother-daughter pairing" of breast cancer which is also a possible indication of a mutation. I decided to go ahead with the testing and I opted to have them test for all mutations. At this time, they are not sure what all mutations mean so I was warned that I may test positive for mutations and not have any guidance for me on how to plan a treatment around those types of mutations.

On December 14, I returned to the genetic counselor for the results. The meeting took five minutes. I have no mutations or variants in the genes that they tested. Yes!

"... No mutations or variants of unknown significance were detected. Due to limitations of the current testing, negative test results in a woman diagnosed with breast cancer must be interpreted within the context of her personal and family history. Genetic testing was appropriate for Ms. Hable, given her diagnosis of early-onset triple negative breast cancer and a mother-daughter pair with breast cancer. There is no family history of ovarian cancer, male breast cancer or multiple HBOC-related cancers in one individual, however.

"Ms. Hable's cancer might be more appropriately classified as 'familial', i.e. due to multifactorial causes, the presence of low penetrate genes or a clustering of sporadic occurrences."

" Implications for Family Members: ... Women who had both a mother and sister with breast cancer were 3.6 times as likely to develop breast cancer as women with no affected first degree relatives."

The Indignities of Cancer

My wonderful hairdresser thought I might feel better about shaving my head

if she did up my make-up and gave me fake eye lashes.

One day, right after I found out I had cancer, I was doing the Workout of the Day ("WOD") at my gym. This is before I started chemo and I was feeling fine. It was a long workout that involved wall balls. Wall balls are my nemesis as I rarely breathe properly and end up panting and feeling like my arms might fall off. (For those who might not know, "wall balls" are squatting below parallel and then standing up as you throw a weighted ball at a 10-foot target. The prescribed weight of the wall ball for women is usually 14 pounds.) And I remember thinking, screw it, I have cancer, I can just stop now and no one will question it. I had my moment and then picked up the ball and started getting the wall balls done. And I just repeated over and over, no one is going to feel sorry for you.

Fast forward to this week. I'm a week out from chemo and I'm slowly crawling out of the hell hole of it and starting to feel better. But my mouth hurts and my tongue has white bumps on it, and my throat hurts. And I'm so effing tired but I am determined to work my regular hours at my job. Seth had a dentist appointment on Tuesday so I had him ask the dentist if he could recommend any mouthwash or toothpaste that might help. The dentist ended up writing a prescription for me for some mouthwash. Being the cautious person that I am, I emailed my oncologist on Wednesday morning to make sure that this was OK with him. He usually responds within the hour but I didn't get a response until 4:50 pm. My doctor was out of the office so his partner emailed me. He said that he thought I had thrush (very common for chemo patients) and he had called in a prescription for me for that. I Googled it because I wasn't exactly sure what thrush is. It's a yeast infection in your mouth. GROSS! So, I left work at 5 and traffic was bad. It took me 30 minutes to get home and I live 2.7 miles from the office. And somewhere in those 30 minutes I lost it and started feeling sorry for myself. First I lose all my hair and feel ugly and now I have a yeast infection in my mouth. I'm not even mentioning the constipation/diarrhea/hemorrhoid extravaganza. Could I be any more disgusting?

I got home and ate peanut butter cups and drank ginger beer (non-alcoholic) and cried. FWIW, ginger beer is one of the few things I can still taste and that tastes good to me so I drink it a lot. It's all carbs. I'm sure I don't need the sugar but it's worth it just to taste something. The other day I had a donut and it tasted like cardboard. I threw it away after eating half of it. What's the point if you can't taste it? A DONUT!!!

I felt sorry for myself for the rest of the week. I ate french fries (with an obscene amount of salt) and cried a lot. 

And then on Saturday morning, I came to the revelation that I was feeling sorry for myself and that was no way to act. This is not how I want to act. This is not the person I want to be.

I got dressed and went to the 8 am CrossFit X-Diesel workout. As I had each day that I worked out, I wore a head scarf to cover up my bald head. But half way through this workout, I ripped it off and worked out with my bald head showing. It was a long workout with a 35-minute time cap. I was the last one done but I finished it. It felt good. I know that CrossFit seems like a cult or crazy to some people but it is something that really keeps me going. I find myself in those workouts. I find the person that I want to be in those workouts. And that person is not someone who feels sorry for herself (for very long).

Chemo Day Round Two

I had my second round of chemo today, Monday, November 28. We had a little hiccup with getting a good vein. They are trying to save my "big veins" for later. These are the ones in your elbow creases. Last time, they found a good one in the middle of my left forearm. They tried to find its counterpart on the right side today but it wasn't producing enough blood so they went for the good vein. They check my blood before each chemo treatment to make sure I'm in good shape to handle the chemo. My white blood cell count was high because of the Neulasta and the steroids I take the day before, the day of, and the day after chemo. This is a good thing.

Dr. Coluzzi did a breast exam today. Getting your bra and shirt somewhat off while having a major IV in your right arm is no small task. Thank you, Perla, for helping me or I'd still be trying to get my left arm out of my sleeve. Dr. Coluzzi was very pleased with what he felt and saw. He said that he could see that the tumors were smaller than when he had last examined me and that the lymph node area felt great. He was pleased and believes that we have the right chemo combo. This is good news. Chemo is the only option for people like me with triple negative breast cancer (TNBC). Based on what I've read, chemo-resistant tumors for TNBC patients are a very bad thing. They can try to cut the cancer out in surgery and do radiation but the recurrence rate is much higher in that case. So the fact that Dr. Coluzzi believes it is working is a huge relief.

The nurses at UCLA Health who administer the chemo are true angels. I was loopy from the pre-chemo drugs and, as a result, a bit clumsy and I managed to knock over my water bottle. They cleaned it up with a smile.

Round 2 swimsuit pic from Saturday, November 26. It is very common to gain weight during chemo, per my on-line support groups. (Another thing that is different than in the Julia Roberts movie.) I don't really care if I gain or lose weight during chemo as long as I can remain as healthy as possible. That is the goal. I'm trying to get in my usual 165 grams of protein in each day. Ideally, I eat 165 grams of protein, 185 of carbs and 40 of fat. I've been a little off my game since the cancer diagnosis. Also the first week of chemo is tough and sometimes all I can eat is saltines and pita chips. Chemo affects your taste buds to the point where you either can't taste at all or foods taste differently than they did before chemo. I crave chips and salsa and drink a ton of non-alcoholic ginger beer. You do what you have to do to get through. The most important thing is getting rid of all the cancer cells in my body and doing whatever it takes so that they don't come back. Hopefully many more cancer cells were killed today!

The First Three Weeks

As I mentioned in my previous posts, I have my chemo treatments three weeks apart. Going into my first chemo treatment, I had no idea what to expect. One of the first things that went through my mind when I found out I had to do chemo was that Julie Roberts movie where she takes care of a good-looking guy with cancer. (I looked it up. It is called Dying Young and it came out in 1991, the year I graduated from high school.) I recall there being a lot of vomiting.

Dr. Coluzzi, my oncologist, told me that chemo treatment has come a long way since then and that they can give you a lot of different drugs to prevent many of the nasty side effects. He said I probably wouldn't puke. And if I do have any side effects, he wants to know about them because they can probably give me something to help with that.

Nonetheless, if you read stories from people on-line (and as Dr. Coluzzi and all the nurses say) everyone reacts differently. Here is what it was like for me.

I received my first round of treatment on Monday, November 7. In addition to the two chemo drugs (TC), I was given intravenous Benadryl and anti-nausea medicine. It made me a little loopy and made me fall asleep, which is a good way to pass the time. It takes nearly five hours for chemo.

Right after getting chemo, I was fine except for feeling a little loopy. (I actually went and got my nails done right after chemo. This sounds crazy but I just hadn't had time before and there is a salon across the street from our apartment. I had them take my existing polish off, cut my nails short, and then had them buffed. No new polish or cuticle cutting. You aren't supposed to get mani/pedi during chemo but I thought that this would be OK. And I really needed it. I didn't have anything bad happen so it seemed like a solid decision.) Day 2, Tuesday, I was fine. Just tired and a little nauseous. Day 3, Wednesday, I felt fine in the morning but by the afternoon, I started to feel awful. As I mentioned before, I'm not sure if it was the chemo or Neulasta shot that was causing the deep bone pain and the achiness. Most of that pain was gone by Saturday but it was replaced with fatigue like I've never felt before. There is no pushing through this fatigue. I've seen it referred to as crippling fatigue, which is pretty accurate.

On Monday (one week after chemo), I started to feel sick again, with an incredibly sore throat. That can be a side effect of chemo so I thought that was what I was dealing with but then I realized that I had a cold. And, what a cold it was. It started in my head and then worked its way into my chest. It gave me vertigo. Dr. Coluzzi and I corresponded and, because I did not have a fever, he thought that it was just bad timing. (I had traveled to Minnesota right before chemo and had been at a conference with hundreds of strangers. All those public places made it easy to pick up a virus. I did get a flu shot right before I found out I had cancer.) The reason for the concern with the fever is that chemo destroys white blood cells and a fever can mean that you have an infection and is definitely no bueno. I have to monitor my temperature pretty closely for this reason. Had it not been for the cold, I think I would have bounced back in about a week.

Despite having a cold, I tried to make weeks two and three after chemo as normal as possible. I worked a full week in week two and three days in week three (since it was the Thanksgiving holiday.) I was tired often and I did leave early a few days to take a nap. I also returned to the gym. My co-worker, Justin E., mentioned that studies have shown exercise increases the success of chemo. I looked it up, it is true. So, I am committed to continuing to workout as much as I can for as long as I can. One day, I just went to CrossFit and did the warm-up stretching and then I walked laps around the block while everyone else did the WOD (Workout of the Day). Once I felt a bit better, I started doing the regular WODs with everyone else. Sometimes I do lighter weights than I normally would use but I try to make it a good workout without making myself so fatigued that I can't function. I'm learning a lot about my body and I will keep trying to find the right balance. I overdid it once but otherwise I think I am making wise choices. Plus, the support from everyone at the gym has been amazing. They make me feel like a rock star for just showing up.

Dr. Coluzzi says that chemo is cumulative and that with each treatment, I'll probably feel a little more tired and have a few more side effects. He said my hair would start falling out on Day 18. Accurate. I have some left but it is thinning quickly. Next I can expect to be more fatigued and my finger and toe nails will start to become discolored and weak.

As I mentioned, I wasn't sure what to expect from chemo. I wasn't sure how much time to take off from work or whether I would be able to work out. Three days, and yes.

Above is right after our Thanksgiving workout at Orange Coast CrossFit. Seth and I did 104 sit-ups with a 14 lb wall ball that we tossed back and forth. Then we did Cindy. 24 minute AMRAP (as many reps as possible) of 5 pull-ups, 10 push-ups, 15 air squats. I did modified pull-ups and push-ups from my knees but I got through 14 rounds plus 5 (modified) pull-ups.

A Pull-Up!

Seth thought it was important that I get this on video. It makes me happy to watch it. I worked really hard for this. The funny thing is I probably would have never even known that I could do one if not for my CrossFit Coach, Miguel. He kept insisting that I should try and I kept insisting that the only way I would be able to do a pull-up was with a forklift. But I tried. And I did it. (The video is the fourth one I've done.) The first one was about a week after I found out I had cancer. This one was yesterday, almost three weeks after my first round of chemo. I'm not sure what role cancer played in my pull-ups but I do feel like going for it a little more than I used to.

Happy Thanksgiving .... My life is pretty darned good

As I walked home from Target this morning, tears and snot (of course!) were streaming down my face. I didn't even realize it at first.

As you might imagine, when you are waiting for test results to find out if you have cancer and then when you are diagnosed with cancer, you have a lot of thoughts about living and dying. My coworker, Justin S., asked me if there were things I wanted to do with my life that I hadn't done yet. He told me he thought I was funny and that maybe I should try stand-up comedy. You should just go for it, he said. I told him, actually my life is pretty good. And stand-up comedy is way harder than it looks! I've done a ton of things that I have always wanted to do. Sure, there are so many things that I still want to do but think about this. I got to tell Ryan Braun that I loved him while he had his arm around me while standing on the field at Dodger Stadium this year. 

And, anyway, I don't plan on dying any time soon.

Why was I crying today? Because I live across the street from Target and this morning I got a cup of coffee and slowly wondered around the store. I bought myself a new shirt and some cleaning supplies. And then I walked home in the sunshine and 70 degree weather. And I cried because the sunshine felt good and I like my new shirt. And because I can't wait to scrub toilets with my new toilet wand. OK, maybe not that.

And because .... on Thanksgiving, my co-worker Justin E. and his wife, Laura, had us over for Thanksgiving dinner just because they knew Seth and I have no family in the area. Laura was diagnosed with breast cancer last year right before they got married. And just because she knows what it's like and because my hair is falling out, Laura has insisted on ordering me some hats. We had to measure my head.

And because ... my freshman (high school) comp teacher and his wife sent me a card the other day. I probably never said this but I would not be the writer I am today without Mr. Holle. I use those writing fundamentals almost every day.

And because ... my Ladies of Cobra Kai teammates (my softball team back in MN) sent me a care package.

And because .... my friends at Timberwolf CrossFit sent coffee and cards and so many well wishes.

And because .... my new friends at Orange Coast CrossFit hug me when they see me and make me feel happy every time I show up. Also, I did a pull-up. (I found a post-it in my desk the other day with 2016 CrossFit goals that I wrote in January. Pull-ups and toes-to-bar were on the list and I can do both now. I did three toes-to-bar in a row the other day.)

And because ... I have so many friends that just text and call to check up on me. Just to see how I'm feeling. And the cards, the awesome, funny cards keep rolling in. And all the Facebook messages are so wonderful and awesome. And the Rhude family from my high school basketball days!

And because ... my family checks up on me and I always feel the strength behind their messages. Keep sending me those cute pics of your kids. No, I am not sick of them.

And because ... Seth continues to make fun of me everyday and is an absolute rock. There is no one I would rather have by my side.

Much love to you all. Thank you for supporting me through this. I hope you had a wonderful Thanksgiving.