first infusion week

And we're off. On Friday (7/7), Rick and I checked in at 9am, met with my Oncologist, and then got a seat in the infusion center at 9:30am.

The Short Version

First infusion went like this: 

1. Subcutaneous injection in the leg
• 30 min wait
2. Pre-chemo meds to mediate reactions/symptoms
• 30 min wait
3. Chemo #1: into the port
• Slight reaction (coughing, throat swelling) = immediate stop and 30 min delay/wait
• Restart and complete chemo #1 infusion 
• 30 min wait
4. Chemo #2:  into the port
• 30 min wait

Checked out at 3:45pm. Long day, not unexpected. 

The Longer (Technical) Version

1. Subcutaneous injection (into leg): Phesgo (brand) - Pertuzumab, trastuzumab, and hyalurondase. This is a HER2 targeted antineoplastic agent and anti-HER2 monoclonal antibody. Treatment is every 3 weeks for 12 months. 8 minute injection plus 30 min wait. (1/17)

2. Pre-chemo meds: two different steroids to treat immediate reactions and delay the effects for a couple of days and Dexamethasone, an anti-inflammatory to balance the steroids and reduce fluid retention. 60 mins(?) plus delay. Tx every 3 weeks for 6 total. 30 mins plus 30 min wait. (1/6)

3. Infusion Chemo #1 (into port): Taxotere (brand) - doxetaxel. Anti-cancer antineoplastic cytotoxic. Slight reaction (cough, throat congestion) to the start of this infusion delayed it for 30 minutes while nurses assessed me for allergies and to let the steroids take hold. No reaction when they resumed the infusion. 40 mins plus 30 min delay plus 30 min wait. Tx every 3 weeks for 6 total infusions. (1/6)

4. Infusion Chemo #2 (into port): Paraplatin (brand) - carboplatin anticancer antineoplastic cytotoxic. No negative reaction. 30 mins plus 30 min wait. Tx every 3 weeks for 6 total infusions. (1/6)

The Days After 

Days 1-3: The steroids were still in full force during this time, which alleviated any of the expected side-effects (nausea, diarrhea, mouth sores). I woke up each day with a headache mild chest constriction, both attributed to the steroids. On the 3rd day, I woke up with my face flushed bright pink, but it was gone by the end of the day. The dexamethasone dose continued to reduce inflammation and fluid retention. 

Days 3-8: Granix (tbo-filgramsim) was ordered to stimulate white blood cell regrowth, since those guys are getting killed by the chemo drugs. My insurance denied the claim for the time release version, so it requires a shot in the infusion center every day for five days. So there's that. The shot is a subcutaneous injection in my arm. The anticipated side-effect is bone pain that is alleviated by an H1-antihistamine, like Zyrtec, which I already take every day (because I'm allergic to air, apparently) so I did not feel any side-effects. 

Days 4-7: Expected side-effects kicked in really on Day 4. I already deal with IBS (Irritable Bowel Syndrome), and it definitely crashed my gut, cycling between both extremes of cramping constipation and diarrhea. I also began to experience some heart palpitations in the evenings that didn't last, but gave us a red flag. By middle of Day 5, I was taking regular anti-nausea and anti-diarrhea meds, and the help nurse triaged me for dehydration. On Day 6, when I went in for my Granix shot, the infusion center re-triaged me and my BP was super low, so they went ahead and gave me IV fluids as well as the shot. It definitely made me feel better. 

I think the biggest thing we learned through this was how quickly the dehydration happened, and our takeaway was to be more aggressive proactively with the anti-meds. We also doubled my fluid intake and added a second round of electrolytes. 

Day 8: (today) I feel so much better, even though I am not 100%. My gut has (mostly) resolved, the nausea is less, and even the mouth sores seem to be healing. Although I also got a crazy prescription today for "magic mouthwash" that totally makes my mouth numb, like completely. Did it help? I can't tell yet.... still drooling. 

Final Thoughts

What a weird and crazy experience. My port is bruised black that freaks out the nurses. I've been wrung and wracked up-ways and back. My hair hasn't fallen out (although it is thinning). What seemed like a hardship with the Granix shots being required at the hospital turned out to be helpful since I was assessed every day as the worst of the side-effects kicked in, which resulted in the quick treatment with IV fluids on Wednesday. Successful? So far so good. 

Only five more infusions to go. I feel like poetry will help me through. 

Sherri

 

People Walking in Fog

by (the beloved) Marvin Bell 

 

They try to watch themselves, drifting in a white sigh, 

the boats and trees, and themselves, too,

when they think of it, spun from sheets of gauzy droplets

with which to tar the morning white and walk upon it.

The horizon yawns. The earth is liquid. They can feel

it, and not just it but the blanket meaning of it. 

Here, bravado is the pretense of the immortal

before the infinite. There being no other side, 

they must surrender to this, seeing they cannot

see far, find a door, hack a hole, or mark a spot.

Goats love fog. Parked lovers and beachcombers

love fog, and those who fear the authorities,

and the camera-shy love it, and they adore it

who wish to be wrapped in beauty so delicate

one must step outside it to be able to see it.