Thursday, June 6, 2013

Chemo: Beware the Trojan Horse

Following is a day-by-day account of Marla Crider's post-chemo reactions and side effects.  The first treatment was May 28 and the days following were a true learning experience.

May 29I slept well after my first chemo treatment and had no nausea or vomiting.  I contributed that to taking the anti-nausea drugs as prescribed.  When I awakened at 5:30 a.m., my brother, Mike, and Don were up and anxious to see how I fared through the night..  We were all pleasantly surprised at my announcement of “fine.” I was more concerned that my 23 year-old feline companion, Fluffy Sue, was not on my bed as usual.  Instead, I found her sitting quietly on her favorite chair in the living room, where she had been most of the night. Still unstable after her near-death experience two days earlier, I offered her food that she would only eat from my hand.  She drank a little water then just kept staring at me.  She seemed to be searching my face for some sign that I was feeling okay.  I petted and reassured her then she returned to her chair in the living room.

marla crider,, breast cancer, patient stories, chemo
Beware the chemo induced insomnia and fatigue.
At 10 a.m., I reported to the UAMS infusion center for the Neulasta shot prescribed to stimulate the bone marrow and make additional white blood cells for fighting off potential infections.  When the nurse’s assistant called me back to the infusion room, I could only wonder which nurse would inject me – the lovely and sweet RN, who introduced me to the port numbing cream, or Mr. Nurse Ratched, my hair loss antagonist. It was the lovely RN, who greeted me at my assigned recliner.  She already had the needle and vial in hand and was ready to give me the injection – in the stomach.  Some might be frightened at this prospect; however, I give myself insulin shots in the belly each morning, so this was no big deal. She quickly gave me the injection and reminded me that I could experience pain in the leg bones, spine and pelvis area.  Okay, I thought to myself, I get the message; pain may pay me a visit.

Before leaving UAMS, I took the prescription that Dr. Makhoul had written for a “cranial prosthesis” and visited the wig shop, where I would receive one free wig.  Not about to give in to Mr. Nurse Ratched’s prediction that my hair would fall out on the 13th day after the first treatment, I still wanted to be prepared should it actually happen.  The volunteers in the shop were terrific.  They worked with me for nearly an hour.  We decided on a short-styled wig in a color similar to my dark brown and silver locks, but it would have to be ordered.  I was in a race for time with the wig manufacturer. 

Don and I returned home.  I decided not to report to work the first day after chemo just to make sure that I was in the comfort of my home, rather than the office, should side effects strike. As the day progressed, I continued to be elated that I had not experienced any signs of nausea or pain from the Neulasta injection.  So far, so good. 

I tried to rest during the day but wasn’t really tired or sleepy.  I was told to check my blood sugar often, since some of the anti-nausea medications were steroid-based and could have dire affects on an insulin dependent diabetic.  I was stunned my blood sugar levels were in the high 200s and that was after taking my usual units that morning along with the oral meds.  This wasn’t good.  I had three days of steroid meds to take and this was going to be an issue.  I contacted my primary care physician and he instructed me to increase the oral meds and leave the insulin units the same.  Okay, he’s the doctor.   

As I lounged on the couch like a slug, Fluffy jumped on me and curled up on my chest.  She was comforting me, which was so like her. She purred occasionally but there was no question that my girl was in distress.  Don could see my concern and, without me uttering a word, he said, “Renal failure doesn’t cause pain, just organ failure.”  There he goes again, telling me all the things I really didn’t want to hear but knew were necessary. 

Throughout the day, I continued to take the anti-nausea meds as prescribed and was still feeling fine.  I made plans to go to the office the next day.

May 30 – Another nausea-free night made me giddy and ready for a day at the office.  I checked my fasting blood sugar when I woke up and it was nearly 300 (normal is 80-120).  I had eaten very little the night before only because I wasn’t hungry.  This was extremely frustrating for someone who managed her diabetes very well in the past.  I consumed some scrambled eggs just to keep my strength up and prepared to increase my insulin units to counteract the impact of the steroids on my blood sugar.  My remedy, not my primary care physician. Don was concerned, as well, but reminded me that this was one of the side effects I was told to expect.  It seemed that my issues were going to be different than non-diabetic cancer patients in chemotherapy. Typical me… I always had to be different.

While dressing for work, I checked on Fluffy in her favorite chair.  She blankly stared at me.  My heart was in my throat as I called Dr. Marvin and told him I was going to bring my girl in later that afternoon and put her down.  I haven’t cried that hard in a long, long time. 

The only unusual feeling I had while at work was several hot flashes.  Even though I immediately stopped taking the hormone replacement pills three weeks earlier when I was told I might have cancer, I had been spared the much maligned hot flashes experienced by my gal pals.  These hot flashes seemed to be different and I could only assume they were related to the chemotherapy. 

I left the office that afternoon about 3:30 and drove slowly to my condo, dreading what I was about to do. When I arrived and pulled the cat carrier from the closet, Fluffy didn’t run from me as usual, she just stayed in her favorite chair.  I picked her up, placed her in the carrier without a fight and drove the one mile to Dr. Marvin’s office.  The staff was quiet when I walked in with Fluffy and told me a room was ready for us. I took Fluffy from the carrier and placed her on the exam table, where a soft towel had been placed for her comfort.  Dr. Marvin walked in and reassured me that I was doing the right thing for Fluffy.  (But what about me?   Now, more than ever I needed Fluffy’s comforting nuzzles and therapeutic purring next to me.  What about me?)  He told me to take as long I needed to say good-bye and let him know when it was time.  I stroked Fluffy as I explained to her that I could no longer keep her with me just because of my selfishness. I needed to release her from her age-induced, physical burdens.  I tapped on the door and Dr. Marvin came in with a vet tech.  I continued to stroke Fluffy as the tech stretched her out on her side. Dr. Marvin found a vein on her left back leg and injected her.  I would rather have taken a bullet to the heart.  It only took a few seconds for Dr. Marvin to pronounce her “gone.” Again, he left me alone with my girl, my companion, my best friend for nearly two decades.  He returned a few minutes later, wrapped Fluffy in the towel and said her ashes would be returned to me in about a week.  I thanked Dr. Marvin for his compassion, gathered up the cat carrier and got the hell out of there.

When I turned into my condo complex, I stopped and tossed the cat carrier in the dumpster and made another trip with Fluffy’s litter box and all other reminders of her.

I found it difficult to sleep that night.  While I thought the insomnia was due to not having Fluffy nearby, it was evident that the harsh night sweats were a contributing factor.  Besides the elevated blood sugar, my post-treatment side effects were insomnia and night sweats.  How lovely.  I mean we’re not talking about a little perspiration; I was sweating like a sow. The sheets were drenched and no matter how much air was blowing on me, I couldn't get comfortable and fall asleep. It was a long night for several reasons.

May 31 – How strange.  It was 5:00 a.m. and there was no furry feline demanding to be fed.  I got up and checked my blood sugar – 159.  Much better.  I dressed for work and made sure my attire included a light sweater that could be tossed aside when the hot flashes hit – and they did, at least a dozen times during the day.

That night, insomnia was back on the menu, along with the night sweats.  Two nights and no sleep.  How long would I be able to endure these sleepless nights, I wondered?  I compared this part of the cancer treatment to that of the mythology about the Greeks and the Trojan horse.  The chemo played the role of the Greeks, running through my veins declaring war on the cancer.  Thinking I was home free after three days of no nausea or vomiting, I accepted the chemo as my friend and cancer-killing colleague.  Just as I let my guard down, the chemo (Greeks) outsmarted me and unleashed havoc on my ability to sleep and my sweat glands.  Perhaps this analogy was created purely from sleep deprivation, but it sure made sense at the time.

June 1-2 (weekend) – More sleepless nights and drenched bed sheets.  I ran a few errands, composed my blog, listened to music, and did online research about chemo side effects.  What I was experiencing wasn't unusual, just very frustrating.  In communicating with friends who recently completed chemotherapy, they confirmed that fatigue from not being able to sleep and night sweats were pretty typical.  Okay then,  I can do this.   I did manage a short nap on Sunday afternoon, which temporarily eliminated the extreme fatigue.  Now, I was just ordinarily fatigued.

Over the weekend, my blood sugar returned to normal, at least for the time being. I continued to eat light meals comprised of protein, fresh fruits and vegetables, which seemed to help stabilize my system.

June 3 - I reported to the office and managed to accomplish a great deal on pure adrenalin.  My body was exhausted  from lack of quality sleep and my sweat glands were still working overtime. Linda, one of my “go to” office cohorts, borrowed a spare fan from one of the girls in the office, who was dealing with menopausal symptoms of her own and hooked it up, which helped me tolerate the chemo-induced hot flashes that were coming even more frequently.  Work and my office friends were keeping me focused on things other than my sweaty body and zombie-like mannerisms.

That night was no different than the previous five – insomnia, night sweats, and mindless television options. I could hardly wait for the sun to rise.

June 4 – I awoke and checked my blood sugar and was stunned that it was in the upper 200s again.  Crap!  I hadn’t done anything any differently. These yo-yo blood sugar readings were something I was going to have to contend with for the duration of my chemo treatments, so I might as well get used to it.

Don arrived for date night that  afternoon instead of our usual Wednesday outing because I was scheduled for a brain scan the following morning (June 5).  A brain scan: we were lucky to find a heart when the MUGA scan was conducted. Now, the poor radiology techs were going to have to find a brain, as well.  I wondered if the test would indicate that the patient had experienced six sleepless nights and was recreating Greek mythology stories in her head?

After dinner, Don and I returned home, where I proceeded to immediately plop on the sofa.  The fatigue was beyond anything I had experienced to date. I told Don if I was lucky enough to doze off, just to leave me, which is exactly what happened.  I actually slept for about four hours, even though the night sweats were still prevalent. It was about dang time that slumber made a return visit.

June 5 (brain scan day) – Instead of feeling refreshed when I awoke at 5:00 a.m. I felt more like I had the flu.  There was no nausea, but I felt achy and the fatigue was worse than ever.  I managed to shower and dress for the trip to UAMS and the brain scan. Don and I arrived at 8 a.m. and made our way to the MRI section of the WRP Cancer Institute. My size 8 rear-end was dragging and all I wanted to do was get through the brain scan and return home to my bed.

The radiology tech called my name and escorted me to the area where he would search for a vein to inject the contrast dye. He decided on a vein in my left hand, where he inserted the port.  From there, we went to the MRI room.  I laid down on the gurney, where the techs placed a cushion under my knees and a cage around my head.  I was given ear plugs just before the gurney moved slowly into the narrow tube.  In seconds, the noise began and I dozed off – a true sign that I wasn’t feeling well.  About 20 minutes later, the noise stopped and the gurney moved out from under the tunnel, where the tech was waiting with the contrast dye that would be injected into the hand port.  Back into the tunnel I went; this time for a mere 10 minutes. At the conclusion of the brain scan, the tech returned to remove the port, then I was outta there. 

During the ride home, I had a sudden sharp pain in my lower back that took my breath, followed by another.  What on earth, now? I felt like crap and, now, severe back pain.  Really?   Being a retired orthopedic surgeon, Don recognized that the pain was probably from the Neulasta injection I received exactly one week before.  Talk about delayed reaction!  Then, I recalled the warnings from both Dr. Makhoul and the lovely RN who injected me with the culprit.  That’s exactly what I was experiencing – pain associated with my bone marrow being in overdrive, making an abundance of white blood cells…just in case.

I retreated to the sofa after taking one of the pain pills prescribed a week earlier should the Neulasta kick-in and, boy, did it.  I slept for about two hours and as long as I was horizontal, the pain was manageable. Hopefully, this will be a fleeting side effect and I can return to work on Thursday. In the meantime, I now understand why my cancer team has been so generous with the prescriptions.  A martyr, I’m not.  Give me the drugs.


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