Catching up on chemo #6, the second of the Taxol regimen, found me a bit apprehensive and nervous as the day approached. After the acute leg pains in the first cycle of Taxol, I made sure to let my oncologist know what had happened. Not wanting to take narcotics to ward off the pain should it recur or even get worse on the second cycle (a likely possibility given the cumulative nature of this treatment), the other option would be to split the final two cycles into 6 weekly cycles of a lesser dose thereby reducing the side effects. That seemed less than desirable to me in terms of time and visits, but ultimately would put me at the same finish line which would be OK in the long run. More good news: maybe it was being more aware of what the beginning of the leg pain would feel like that allowed me to get ahead of it this time, but it was much more manageable (I slept through the nights), it never felt as intense, and even though it still lasted just over 3 days (and I was on the road, of course, for most of it in CA on a recruiting trip), I am now not worried about cycles 3 and 4. I do not envision the split treatment to be necessary over a final 6 weeks, yay! Another huge plus - no neuropathy. My fingers and toes did not suffer any numbness or tingling during or after this cycle either. Good news abounds!
With the Taxol, the biggest side effect for me has been fatigue. While I don't feel like I have the flu, not that totally run down kind of feeling, I am definitely lower on the energy spectrum. If I run up a flight of stairs, I am breathing hard. Don't even ask me what my splits are on the water where I am just ahppy to be able to be on the water rowing! Anything at steady state (running or rowing moderately) is fine. Anything intense really takes it out of me really quickly. Mostly, though, it feels like I haven't had enough sleep. While I don't feel the lack of concentration associated with sleep deprivation, I'm experiencing just plain tiredness, most days the last three weeks, I have been taking a nap which is one more thing "I don't have time for." I'm not normally a nap person. On the rare occasion when I have taken a nap in the past, it is usually because I have been sleep deprived for more than a few days and a 30' session of shut eye will take care of it, making me feel much better and more alert. These days, I can easily take a 60-80' nap every day. Making time for that takes a different effort, one in managing everything else that is going on in my life which is not always easy. Even if it is something I enjoy doing, I have to take the energy budget into account. For example, I opted out of working our rowing camps this summer. The days dedicated to camp would have used up energy I would prefer to spend on me and the things I want or need to get done (exercise, nap, walking Max, coaching a fast rower or two). Sure, I miss the paycheck, but know it would have cost me much more in nap time and the ability to have time for me more than the cash could have made up for.
One other incidental (and unintended) cost is being public. One friend recently acknowledged that "there's a lot of pressure to stay positive and you probably don't feel cheerful all the time." She's right, this is true. Most days, most hours, I do feel good. I'm generally an upbeat and optimistic person, truly, even though I know some of you are laughing. When I am out and about, it is because I enjoy spending time with people and I am feeling up to it. Being active and actively engaged in life is one of the best ways to not have to think about what I am going through. Being able to say I feel just OK or that I am a little tired is helpful, even if it isn't what someone wants to hear. (I know, people ask how I am because they care, and that means a lot to me!) Leaving early from somewhere because I am tired doesn't feel like I am playing the C-card, it's just part of the energy balance that's going on. It's not like I suddenly have all this free time. I still have everything else in my life to take into account - family and work being the most dominant two. It, cancer, is a lot to take in all at once, and I can appreciate that someone who is finding out about my cancer for the first time can be overwhelmed (I know I was). What has helped me is finding perspective. I've tried to break it up into manageable chunks, the big three of which are 2000m of chemo (finally, I am through that third 500 and into the last 500), the surgery, and the radiation. I've also tried to focus on how lucky I am - good prognosis, otherwise good health, and many loving friends and family.
More good news! On Friday, June 20, I met with my surgeon after a follow up mammogram and ultrasound earlier that day. The appointment was to discuss surgical options and basically review where things stand. Typically, surgery is scheduled 3-4 weeks following the final (July 7 for me) chemo. Waiting any longer than 6 weeks following that would allow for the possibility of the tumor starting to grow again, not good. Results from the imaging backed up completely what my oncologist has been feeling (literally) since the start of the second cycle of chemo back in mid-April that the tumor has been shrinking. While the largest dimension I was given was about 3cm, that included a bit of a finger-like growth off of the bulk of the tumor. Right now, it is hard to tell whether that exists now or not. Either way, looking at what the bulk of the tumor was initially (just over 2cm), it is now a mass of about 1cm. This makes it difficult to feel (as evidenced by the NP's experience on May 27. In order to find the tumor accurately since going by feel won't be good enough (this is where the clip inserted during the biopsy helps as well), a wire guide will be inserted during ultrasound in the morning before my surgery. The wire is about the thickness of a few human hairs, and a hook on the end will lodge it in the tumor. This allows the surgeon to know where to make the incision to go after the tumor. Although we looked at surgery two weeks post-chemo, I am scheduled for surgery on July 30. I was glad to be able to work around my personal calendar given the possibility that I will be out of the country in late July, and that this fits with my surgeon's operating calendar as well.
Tomorrow begins the last 500 in my chemo rowing metaphor, #7 of 8. In a race, this is where I (used to) try to sit up a little taller and be ready to go (empty the tank), and pretty much every muscle hurt. If I experience leg pain or fatigue in this last 500, I know that means the treatment working. Bring it on!