Chemo Round 4/Insurance Update

How can I be cold when my face is so red ... welcome to chemo.

Two-Thirds Done
On Monday I had my fourth round of chemo. I had a feeling that this round would be a little tougher than the last one since I actually felt pretty good after round three. I was correct. This round I felt more nauseous than in the others. This is a thing that seems to be building with each round. I take the anti-nausea meds but I still feel pretty sick to my stomach. This finally seemed to start getting better on Saturday night. I guess if I had to describe how I am feeling, it would be tired, sore, nauseous and run down. It's like having a flu that you can't quite get over. I would usually be on the up-swing by now (one week after chemo) but I am not feeling the bounce back yet.

I have been having terrible hot flashes/night sweats since the last round. I wake up every hour or so feeling like I am on fire. And the sweat--it's everywhere. My knees even sweat. One night I sweated through my pillow. As you can see in the above photo, my face is bright red. My oncologist prescribed Effexor to help with the hot flashes. Aetna refused to cover it initially and my doctor had to file some additional appeal paperwork to get it to go through. So, I didn't get the Effexor until Thursday after it was prescribed on Monday. I started it on Friday. So far, I'm still having hot flashes and haven't noticed an improvement.

I have a confession to make. I am starting to gross myself out. After the chemo, I can smell the chemicals on me--in my sweat, my urine--just everywhere. I can't shower it away. I can't get the stench of chemo off me. Chemo makes you feel so disconnected from your physical body. You lose all of your hair and look like an alien. The chemo and assorted drugs mess with your head so you can't remember things or think like you used to. And then all of the side effects make you feel so sick and unlike your normal self. Right now, it feels like I am sort of floating through a life I used to have.

This is becoming a test of my mental strength. I cry when I think that I have to do this two more times. And then I start to think, what if the cancer comes back? What if I have to do chemo again? The only thing to do is focus on the next two weeks that I have before the next round. I just repeat over and over: I'll bounce back. I'll be ready again.

Obligatory swimsuit photo. This is after Round 4. My tummy hurts.

Insurance
In my last post, I mentioned that I was having a number of issues with my insurance coverage and with scheduling an MRI. The MRI is now scheduled for the Friday after I finish chemo. My surgeon's scheduler called and made the appointment and the MRI scheduler who I spoke with is allegedly being "spoken to" about scheduling appointments with chemo patients.

I emailed HR/Benefits at my company and they are looking into the issues that I had with Aetna last week. I think that they are concerned with the customer service aspect but they are also looking into the Hoag/in-network issues. I got an update on Friday (a week after I had my issues) and they said that they are still looking into it. I'm moving forward as if Hoag is in network. I have a consultation with my radiation oncologist tomorrow.

I ran the four plastic surgeons that are in-network in my area by my surgeon, Dr. Coleman. Dr. Coleman indicated that these surgeons were probably not up for a "high-risk" person such as me who needs to have breast reconstruction after radiation. As such, I decided to go with Dr. Zetrenne even though she is out-of-network. I am going to petition Aetna since they said that they may cover her if there were no in-network surgeons within a 30-mile radius who do this type of surgery. I'm sure this will be an exercise that drives me nuts but it is worth a shot. I like to believe that I am a persuasive person.

Surgery Game Plan
After having met with Dr. Coleman and Dr. Zetrenne, I have a game plan for my surgeries. Yes, surgeries. I have learned that I will likely have to have three. Unless the MRI reveals that the cancer has spread into my left breast (which I have no reason to believe that it has), I am going to have a single mastectomy. There is some risk that the cancer could come back in my left breast but at this point, I don't want to cut off that breast if I don't have to. Triple negative cancer is much more likely to come back in my bones, lungs or brain. Super, I know. Due to my extensive tumors, there is no way that they can save my right breast or nipple, even if the tumors shrink a lot (which they are doing). Thus, on March 22, I will have a mastectomy. At that time, I will have a tissue expander put it my breast. Dr. Zetrenne will slowly fill it with fluid so that there is skin available for reconstruction. Beginning in May, I will start radiation. Radiation is every week day for 4-6 weeks. When radiation is done, I have to let my skin heal for six months. So, reconstruction surgery is planned for December.  Dr. Zetrenne said that I do not have enough excess skin/fat on my stomach so she plans to use skin from my back to make a new breast. (Thank you CrossFit and IIFMM, I guess?!?) Once that is done, the third surgery would be to make my breasts symmetrical. I'm calling this my Perky Boobs 2018 plan.

Thank you
Once again, I want to say thank you to my amazing friends and family. I cannot express how much it means to me to receive all of your love, thoughts, texts, emails, gifts, cards, well wishes, etc.

Even though I didn't feel the greatest, I got back to CrossFit on Saturday and on Sunday, I went on a four-mile hike. Nature and fresh air made a big difference ... not to mention the Green Bay Packers.

View from my hike.

Not a Warrior today ... but I will be tomorrow

This past week should have been cause for optimism and perhaps even happiness. I met with my surgeon, Dr. Coleman, to assess my progress and plan the next steps. But that meant that I had to think about the big picture. Not only did this force me to think about how far I have left to go, it meant that I had to deal with my health insurance company. Let's just say that Friday night ended with me eating a bag of potato chips and yelling at Seth.

[This is long but it felt good to write.]

But first, chemo and side effects update
This is my third week since my last chemo (which I had on December 19). So, in theory, this should be the week where I feel the best. But this round of chemo has been a little backward. I felt pretty good after chemo compared to the first two rounds. Less pain. Way less chemo brain and dizziness. I had a great Christmas. I felt a bit more winded than usual at CrossFit but I expected that to happen. But on the Friday, during week 2 after chemo (December 30), I experienced some intense chest pains. The day before, I hadn't eaten as healthy as I should have. I had an In n' Out burger for lunch and went out for dinner (salad and flat bread pizza). That night, I woke up in pain. I couldn't tell what it was--my chest, upper stomach, upper and lower back all hurt. I have also had hot flashes every night during this round so I kind of dozed in and out of the hot flashes and pain. I thought I had indigestion. I woke up in the morning and felt OK. I went to CrossFit and worked out with no problems.

Later that morning, I was sitting in the conference room for a work meeting. I had a portion in the beginning of the meeting where I was the main speaker. That went fine. About 20 minutes in, I started to get the most intense pain--chest, back, stomach, shoulder blades. I could hardly breathe it hurt so bad. I have no idea why, but I refused to excuse myself from the meeting. I guess it was because I didn't want my bosses to see me sick. I only wanted them to see me strong and kicking cancer's ass. So I sat there, sweating, turning white, gasping (although it must not have been audible). After 15 minutes, the pain started to come and go so I would have a few minutes with a dull ache before it became intense again.

The first meeting ended and every one agreed to a small break before we started the next. I went to the bathroom, locked myself in the handicap stall and laid on the floor. I was terrified. Was it just a side effect of chemo? Was I dying? Was something rupturing?

I went back to my office and then my boss's boss stopped by my office to let me know that the next meeting would just be three of us in his office. I got through the next 30 minutes and then called my oncologist. The office was closed.

So I did what any, 43-year-old would do. I called my Mom.

She has gone through chemo and said she did not have this happen to her but she also did not have Neulasta. She encouraged me to try to reach someone from my oncologist's office.

I called my oncologist's office and pushed the button for urgent matters. I got through to an answering service which, in turn, left a message for the on-call oncologist, who was not my oncologist. He called me back within 10 minutes. After we discussed my pain, he said that he thought I was reacting to the Neaulasta. He said that Neulasta causes bone pain and mine was now in the my sternum. During the second round, I had stopped Claritin after the first week with no issues. He told me to take it again and then to call him the next day with an update (even if I was feeling great). He said that lots of people end up in the ER because they think that they are having a heart attack but it's just Neulasta pain. Claritin is the non-medical, every-cancer-patient-knows way to counteract the bone pain caused by Neulasta.

I got home at 4:30 that day and took a Claritin. I had one more major attack about 4 hours later. This time I could lay on the lazy boy and moan. When the worst of it passed, I took a vicidon and went to bed. The next day, I just had a dull ache. I kept taking the Claritin. I had no more flare-ups. Hope that's all it is. Now, can these hot flashes stop!

My Meltdown
I saw my surgeon on Thursday (January 5). She did a manual breast exam and said that she could tell that the tumors were shrinking. She couldn't feel any lumps in my lymph nodes. She can still feel the lump that I found but said it was smaller. We still have some shrinking to do, tumors! She did say that  the difference between this exam and the one I had before chemo was "night and day." Super exciting, right?

She mapped out what would happen post-chemo: 1) Breast MRI to see how tumors look followed by an exam with her; 2) surgery; 3) radiation; 4) (3-6 months later) reconstruction. I told her that I was leaning toward just having a mastectomy on my right side if there was no cancer in the left side. Statistically, my kind of cancer is much more likely to come back in my bones, brain or lungs rather than the other breast and I'd rather spare myself the extra pain and recovery of removing a second breast. She supported this decision. I did not realize that I would have to wait so long for reconstruction, though. I guess they put something called an expander in after the mastectomy to prepare you for reconstruction. I have read that at best, it is uncomfortable, and at worst, painful. Three to six months with this sounds delightful.

I actually like to run but you get the picture. 

I started Friday with all this on my mind. I thought I would make a few quick calls to set up appointments and I would check with Aetna to see if the recommended doctors for radiation and surgery were in network. WRONG.

Dr. Coleman had said that she wasn't sure that the plastic surgeon she wanted me to see would be in network. But she wanted me to have a consult before we scheduled surgery. I checked, she wasn't. But when I first tried to find one that was, I couldn't get any options on the "Find a Doctor'"  benefits website. Then I got a list of about 100 names. So I called Aetna member services. I asked if there was a way to narrow the list to those who specialize in breast reconstruction after mastectomy. I was told I had to call every doctor on the list. After fighting with the rep for a while, she brought a nurse in who super condescendingly said "if it were me, I would want to call and make sure I had an expert and the right person doing my surgery." No shit, if I had 5 people to call. But 100? She told me that I could appeal and try to get the recommended doctor to be covered. So I asked what the criteria to overturn was and she said if there's someone else in your network that can do this surgery within 30 miles, you will be denied. But you can appeal that, too, she said. And what would overturn this decision? If there wasn't a doctor within 30 miles.

And then the rep said that she would stay on the line with me and we could call a few. I declined and hung up. Sigh.

I then checked the recommended radiation oncologist. I couldn't even find this person on our website in or out of network. So I called Dr. Coleman's office. Waited on hold. Ended up leaving a message. The nurse who called back said that the radiation oncologist was in network and that they only refer to this facility. So I called the radiation oncologist's office and they said that they would call and talk to Aetna. Aetna told them that they were now out of network. Ocologist's office gave me their tax ID number and told me that I should call and ask again.

So, I called Aetna again. I asked about the oncologist and the facility that they bill out of and provided the tax ID number.  Out of network. In fact, the rep told me that my employer had selected a crappier insurance for us that greatly narrowed our network in 2017 and now all of the Hoag system is out of network. Hoag is one of the largest hospital networks here. I had my mammogram, biopsy, MRI, pet scan, genetic testing done there. Oh, and my surgeon is part of Hoag. I freaked out. I asked if I was grandfathered in because I started treatment last year. Nope. I started sobbing. Like really sobbing into the phone at this point. The rep then put me on hold so she could double check. 15 minutes later she came back and said she confirmed it's all out of network.

I checked the website and said that that didn't make any sense since my surgeon is still showing as being in network and Hoag Hospital is showing as in network. She put me back on hold for 30 minutes. She returned and said that she and her supervisor both submitted mock claims for me and that Hoag is in network and that I can see the recommended radiation oncologist. She said it was a glitch in their system. She said that she was documenting everything in case they claim that these are out of network later. Super comforting.

She, unlike the first rep, however, was able to give me a list of FOUR in-network breast reconstruction plastic surgeons from the larger list. She was appalled that the first rep told me to call everyone on the first list.

I had one more call to make. All I had to do was schedule a breast MRI for one of the four days that my surgeon said I needed to have it on. OH BOY ...

Scheduler: what was the date of your last period?
Me: Um, a few months ago but I'm going through chemo so it's stopped.
Scheduler: Ok, call me back when you get your period. The MRI has to be 5-12 days after the start of your period.
Me: But it's not going to come back until after I need the MRI.
Scheduler: It HAS to be in the 5-12 day range.
Me: But I saw my surgeon yesterday and she wants me to do it during this particular week.
Scheduler: You need to call her and REMIND her that it needs to be 5-12 days after.
Me: But I'm not getting a period right now.
Scheduler: Well then have her write that on your order.
Me: But I'm telling you ...
Scheduler: Sometimes they forget about the 5-12 days.
Me: I can't deal with this today. I'll call next week.
Scheduler: Sorry but you really need to call when you get your period.

I can only assume that if you schedule breast MRIs for breast cancer patients for a living, you would be aware that chemo causes menopause and lots of patients never get another period.

After this, Seth texted and asked if I could please stop at the gas station on the way home and get him Diet Coke. I stopped and the line was at least 10-deep to check out. So I bought a bag of chips since I was standing next to them for quite a while and screamed at Seth for not getting his own effing Diet Coke since we live across the street from Target. I instantly regretted it. And then I just started sobbing that it was too much. WHY DO I HAVE CANCER? WHY? WHY IS AENTA SO DUMB? WHY IS THE SCHEDULER SO DUMB? And getting through this is not even going to be the worst part. The worst part is going to be knowing that this fucking cancer might come back. In my bones, my lungs or my brain.

So, no, I do not feel like a warrior today.

But I will find warrior me again. I will get up on Monday morning and go to CrossFit and then I will let them put an IV in my arm and slowly drip poison into my body in my strong belief that this is killing my cancer for good. This fight is on.

Warrior prep: Here I am after my Monday CrossFit workout. Twinning (hair) with my coach, Miguel. 

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.