Treatment Update

I'm about half way through my second chemo regime and wait for it...TWO WEEKS FROM FINISHING CHEMO ALTOGETHER!! 

So I thought I would do a post on how I am getting on with this round of chemo.

This chemo regime is known as AC and consists of Adriamycin and Cytoxan. This regime has been different in that I am only receiving 4 infusions every 2 weeks. I have currently received 2 out of the 4 infusions and will be having my 3rd on Monday. Adriamycin is an anthracycline drug which works by stopping or slowing the growth of cancerous cells. Cytoxan also works by stopping or slowing the growth of cancer cells and is also an immunosuppressant.

Adriamycin is a red coloured drug which is referred to by some people as the Red Devil. It's a very strong cytotoxic drug and it has the potential to cause heart damage although this is a very rare side effect. I was extremely anxious about starting AC. I felt that because my tumour seemed to completely disappear on TC that I was putting my body under unneccessary strain and potential harm. I mentioned this to my oncologist and she immediately shut me down and said that his part of the treatment regime was definitely neccessary unless I could give her a very good reason. Obviously I couldn't give her a good reason other than fear! So I went ahead. I had an Echocardiogram done before starting treatment which showed my heart to be in good condition so I was deemed fit to start AC!

Infusion Procedure

Pre-meds before AC are a bit different from TC and only consist of  two IV infusions of an anti-nausea drug and a steroid. I was also started on another anti-nausea tablet called Emend. This tablet should be taken 1 hour before chemotherapy and then again for the following two days. Unfortunately on my first infusion the Emend was not given to me until after the Adriamycin had already been infused and I knew all about it later that day! Once I'd had the pre-meds, it was time for the Adriamycin. When they came towards me with this bag of bright red coloured liquid, it did not calm my nerves at all!

Adriamycin is a vesicant, which means that it is extremely damaging if it comes into contact with the skin and can cause very severe burns. This was another worry for me as I do not have a port or a Picc-line. During my first infusion I just sat there staring at the IV line terrified the crazy-looking red liquid was going to leak out and burn a hole in my arm, all while causing damage to my heart! The Adriamycin takes about 30 minutes to infuse and then they started me on the Cytoxan, which also took about 30 minutes. The time spent in hospital for this regime is only about 2 hours, which is about half the time in comparison to TC!

Side Effects

Nausea; The evening after my first infusion of AC, I was very unwell. I was vomitting and wasn't able to eat anything. For the following few days I took anti-nausea tablets regularly and although I felt somewhat nauseous, it wasn't too bad and I was able to manage bland food. This was not the case after my 2nd infusion and I think it was because my Emend tablet was given to me an hour before chemotherapy began, so I suffered much less with nausea.

Brain Fog; The worst side effect I have experienced so far happened after my 1st AC infusion. I was on steroids for 3 days after receiving chemo and then I stopped taking them, as instructed. Once I stopped taking them I had the most horrible foggy head for about 3-4 days. I felt like I was dreaming and I felt very disconnected from what was happening around me. Even simple tasks like just making lunch seemed more difficult than normal and I was extremely emotional and anxious. I spoke to my oncologist about this when I was in the hospital for my second infusion and she changed my post chemo steroids to a tapering off plan which completely eliminated this side effect, thank god!

Muscle/Bone Pain; When on AC, you have a high likelihood of becoming Neutropenic. This means one kind of White Blood Cell - Neutrophils, become very low, which opens you up to infection in a serious way. Due to this, when on AC, you are given an injection within 24-48 hours of Chemo which stimulates production of blood cells. This injection is called Neulasta. Due to the fact blood cells are produced in the Bone Marrow, this injection can cause alot of Bone Pain. I had read some serious horror stories online about Neulasta and the Bone Pain associated with it. I also had read that taking Claritin while on Neulasta reduced bone pain for some reason, so I decided to give it a try. I have been extremely lucky and have had very minimal pain after Neulasta! I don't know if this is due to taking Claritin but I am beyond happy that I haven't had to deal with that horrible side effect!

Fatigue; The fatigue I feel with AC has definitely been worse than TC but then again I expected this. I actually expected it to be worse than it has been. I have been able to do so much more than I thought I would!

Other; I have been having a bit of pain in my chest, a mild dull achey pain. I was told to come into the hospital to have some tests done yesterday to just make sure it wasn't heart related. I have also noticed that my resting pulse is higher than normal at about 90-100bpm. I also suffer from Hashimoto's Thyroiditis and am on medication for this. I had general, heart and some thyroid bloods done yesterday aswell as an ECG which all came back fine. They have put the chest pain down to a muscular issue and they are unsure of why my pulse is higher than normal and have said it could be due to steroids. I think the medication I am on for my thyroid problem is probably too high and has put my body into overdrive, I'm going to reduce down that medication and see how that goes!

In Other News...I got some great news since the last time I posted! I got my genetic results back finally! I was tested for 3 genes - BRCA1, BRCA2 and P53 and all three of these genes came back negative! I was actually in the supermarket when I got the call to say I had tested negative and I burst out crying! I'm sure other customers were highly amused at me. Getting this news really helped to give me some positive feeling towards my future. Not having these genes reduces my risk of recurrence hugely and also means that if I have children I wont be passing on this gene to them. I am also very aware of the fact that just because these 3 genes are negative, it does not mean that I don't have a genetic mutation that is unknown or hasn't been discovered yet but it definitely helps to know that these three known genes are negative! This news also gives me more information that I need to make a decision towards the type of surgery I'll be having. I will be meeting with my surgeon soon to make this decision, I currently don't have a clue what type of surgery I need.

On Monday, I go in for my second last Chemo. I am also having an MRI, Ultrasound and Mammogram done too in preparation for surgery. At the moment, it looks like the tumour has either completely disappeared or is very tiny. The scans will clarify this so fingers crossed its completely gone! I'm getting very excited to be coming towards the end of chemo. I know I still have quite a while to go until I finish treatment but the longest part of treatment is nearly over!

Loss of Identity and Mental Health

I wanted to do a post today to acknowledge the fact it is World Cancer Day! This post is going to be a little bit different as it is not really about my treatment. Every post I have done so far has been more about diagnosis and the physical treatment of my Breast Cancer. This post is going to focus more on the psychological impact that a cancer diagnosis has had on me and how I have managed that.

So before I get into how cancer has effected my mental health I will write a bit about how my mental health was pre-cancer.

Before Cancer

From a fairly young age I have been a person who has suffered on and off with my mental health. At a young age my main issue was that I suffered somewhat from Depression and I was excruciatingly shy and therefore found it very hard to interact with people which led to a bit of Social Phobia. As I got older I suffered less with Depression and more with Anxiety. I am a perfectionist big time and expect perfection in the things I try to do in my life. I can and have put myself under enormous amounts of pressure in the past to achieve things and find it hard to cope with any kind of failure or criticism.

From September 2014 to May 2017 I started to undertake a college course which consisted of attending college for one full day a week. I then worked 39 hours over the other 4 weekdays. In 2015, I was made Supervisor within my job which came with a lot of extra responsibilities! I also started going out with my current boyfriend who lived in Kilkenny at the time. So I was extremely busy with college, work and travelling to and from Kilkenny at weekends. I also had periods of serious stress during those three years where I wondered what the hell I was trying to do!

Diagnosis and Treatment

Obviously, diagnosis was a huge shock for me. I spent that day in a bit of a day dream and when I went to sleep that night I hoped I would wake up and it would all be a dream. Clearly that didn't happen and so I spent a lot of time trying to inform myself on what exactly I was dealing with. Initially I was smart in where I looked for information, I read a lot of Irish Cancer Society booklets, I bought a book about Triple Negative Breast Cancer and I stayed off the more casual unreliable websites for fear of what I might find.

For about the first two weeks after diagnosis I was very emotional and my mood was all over the place but once I accepted my diagnosis I became very positive about what I was about to go through. I have to say generally throughout TC treatment I remained very positive and I didn't feel overly anxious about having cancer. I started to see a Psycho-Oncologist and decided I would continue to see them throughout treatment because I had a feeling that the positivity I was feeling would not last forever!

While on TC I read a lot about AC. I knew that the A in AC was Adriamycin and I knew that drug was strong and that it could cause damage to the heart and sterility. I joined support groups on Face book and read lots of peoples experiences of AC. I read to the point I scared the crap out of myself. As TC was coming to an end and I knew I would be starting AC soon, I started to get very nervous. I had my first infusion of AC on the 22nd January and driving in to the hospital that day I was scared of what this drug was going to do to me. I have only had one infusion so far and it was definitely harder than TC. I was a lot more nauseous, tired, weak and I had a few days where I felt like I was in a daydream and found it hard to concentrate or even be around people. This brain fog type feeling lasted about three days and those three days I was extremely anxious. I spent those three days thinking and over thinking about my future, possibility of recurrences and possibility of infertility. I have to say I would take nausea, tiredness or any other side effect over feeling that way again. I have a feeling that this was caused by the fact I was taking steroids for 4 days and then I stopped taking them and I must have crashed in some way which caused the brain fog and anxiety. I have my second infusion tomorrow and I will be talking to my Oncologist about this so hopefully it wont happen again.

What I also noticed about this cycle of treatment is that because it is a stronger regime there is more downtime between treatments. Because of this there was more time where I wasn't up to leaving the house and I wasn't up to doing much inside the house either. Therefore, there is a lot more time to think and feel sorry for yourself and obviously this is going to have a negative effect on your mood!

I had an appointment with my Psycho-Oncologist on Friday and within a few minutes of meeting her she was able to tell from my body language and the way I was speaking that I was anxious. I didn't necessarily feel anxious but when she got me to stop talking and spend some time focusing on areas of my body I realised that I was tensing certain areas to the point they were painful due to the fact I was anxious. She stopped me a number of times throughout our session and again got me to locate the area of tension and helped me to relax. I had had a number of sessions with this psychologist in the past but this was the first one where my anxiety was obvious to her. I don't know exactly why this is but I had a feeling all along that it would eventually rear its head.

So, what do I do to help with anxiety?

I find that the best thing I can do to prevent myself over thinking and becoming anxious generally is to distract myself by doing something I enjoy;

• Getting out; doesn't matter what to do but feeling like I've achieved at least one thing everyday makes me feel somewhat productive.
• Going for a walk; I try to go for a walk as often as I can. Sometimes I find the most basic walk tiring but getting out in the fresh air helps crazy amounts!
• Knitting; knitting has become my obsession. I always enjoyed it but since I have been off work I have discovered I have an insane passion for it. I find it distracts me and calms my mind and I love creating things and gifting them to the people in my life.
• Spending time with friends and family; I have an amazing support system of people around me. If it wasn't for them I think I would have gone crazy from boredom by now but they keep me occupied and I probably don't thank them enough for that - Thanks guys!
• Having Baths; baths are incredible for helping you to relax. I fill it right up to the top and add in Epsom salts and bubble bath. I pick an album and just relax and listen to the music.
• Mindful Breathing; I try my best to incorporate this into everyday. It helps me to relax and focus on the present moment, even if its just for a few minutes.

Loss of Identity

I don't know if every cancer patient goes through moments where they feel like they've lost their identity but I definitely have had those moments. When a person goes from such a busy lifestyle to being unwell and having a huge amount of time on their hands they don't only lose a part of their identity but also a piece of their self worth. I complained so much about college, work and everyday things before being diagnosed. I would give anything now to be in the situation I spent so much time complaining about! I think perspective is everything though and I know that when I do get back to my normal everyday life it will never be the same again, I will be a much calmer person with a whole new perspective on life and I really look forward to that!

The other side of feeling like you've lost your identity is your self image. My self image has changed so much since I was diagnosed on the 15th of September. I had just lost almost 4 stone so I was the slimmest I had been in years. I have gained back some of this weight, which is to be expected and I try not to dwell on this too much. Being bald doesn't bother me hugely either anymore. There are times when I catch a glimpse of myself in the mirror and feel very unhappy about what I see looking back at me but I know all of this is temporary and I remind myself that this too shall pass.

In about two months time I will be having surgery, I don't know what type yet and how invasive it will be. At the moment I don't feel too concerned about it but I'm sure when all is said and done there will be an adaption period for me to learn to accept the change there will be to my body.

I plan on getting a tattoo when I finish up treatment. I haven't decided where or what of yet but I want to do it to remind myself of this time in my life where I was stronger than I ever thought I could be. Being faced with something as scary as cancer makes you reach inside yourself and find coping mechanisms that you didn't know you had, well at least for me it has. This whole experience has given me a new appreciation for life and I find myself crying over beauty as well as pain now which I never did before!