24 May 2023
The chemotherapy consultation was interesting in a few ways. The RN pretty much read me the information sheets. I could tell she was exhausted and several times she lost her train of through even though the printed information was in front of her.
The long and short of the consultation is the chemotherapy consent form has two outcomes: “Become free of my cancer with the hope that it will not return.” and “Slow the progression of my cancer, relieve my symptoms and help prevent future problems.” Fortunately for me, the first one was prechecked.
As I mentioned in a previous blog, I’ll be infused with four drugs, called the TCHP cocktail: Taxotere, Carboplatin, Transtuzunab (trade name Herceptin – that’s from where the “H”comes, and Perjeta.
The first two, Taxotere and Carboplatin are the heavy hitters and will have a great physical effect on me. Also, Transtuzunab does have a history of causing heart problems, including heart failure, hence the echocardiogram today.
After the first six sessions with the four drugs, I’ll do eight more with only Trastuzunab and Perjeta, both of which are monoclonal antibodies. The idea is monoclonal antibodies are produced in a lab from a specific type of white blood cell and are used to interact with surface antigens of other cells, viruses, etc. In essence, you make a factory out of white blood cell to manufacture monoclonals. I used to deal with them when in graduate school at the University of Mississippi Medical Center when I would attach fluorescein dye to the surface of catfish white blood cells.
More often than not, the four drugs cause similar side effects from fluid retention with weight gain, swelling of the ankles or abdominal areas, peripheral neuropathy, nausea, diarrhea, mouth sores, hair loss, fatigue and weakness, infection, muscle aches, vomiting, anemia and changes in nails and many others. The lists simply go on and on about the side effects.
All four cause diarrhea but in one case, a side effect on one of the drugs is also constipation. What the left hand gives away, the right hand takes.
Side effects are reported in terms of (1) common in 30% or more of the population and (2) common in less that 30% of the population. Additionally, the side effects are broken down into categories of (1) you should expect these side effects (2) you should notify your doctor when you have time with these side effects and (3) you should go immediately to the emergency room if you experience this.
Taxotere, in particular, has greater than 30% lowering of white blood cells (increases my risk of infection) and low red blood cells (anemia). According to the info sheet, I should have this effect 5-9 days after infusion and should recover in 21 days (just in time for another infusion).
Several of the drugs can cause allergic reactions and all allergenic reactions should send me to the emergency room.
The “falls into to notify your doctor” category for Taxotere is fever of 100.4°F or higher and/or chills, vomiting more than 4-5 times in a 24 hour period, or diarrhea of 4-6 episodes in a 24 hour period. There are a lot more but you get the gist. Oh yeah, I should definitely not try to get pregnant but that’s not gonna happen because I’ll be impotent during treatments.
Several of these drugs affect the liver and kidneys and they will do a blood test before each infusion to see if I’m OK to do the infusion. They’ll also monitor my blood for levels of K+and Mg++.
For absolutely anything that goes wrong: mouth sores, diarrhea, infections, etc., they have a pill for it. Before each infusion they will give me anti-nausea medications and then after the infusion I’m to take the two prescribed anti-nausea medications every four hours on a rotating basis.
After the consultation I was waiting around for my 1:45 pm appointment for the echocardiogram. I kept getting phone calls during the consultation (I had my phone on vibrate) and when I checked who called, it was Holy Cross. The echocardiogram specialist had a cancellation and wanted to know if I was nearby. Yes, I was sitting outside the main entrance of the hospital. I was called in a little after 1 pm and was finished by my appointment time of 1:45. She kept asking me if I had an echocardiogram before and I kept saying no but when she started the procedure I realized I did have one in 1985.
While teaching at Itawamba Junior College (now Itawamba Community College), I was diagnosed with a prolapsing mitral valve. The main consequence was I had to take penicillin when I had my teeth cleaned. The reason was any bacteria in the mouth could invade the gums when the gums. bled during cleaning.
When I moved to Florida in 1985, I told my physician the diagnosis and he said the only way to confirm a prolapsing mitral valve was to do an echocardiogram. They did and I didn’t – have a prolapsing mitral valve. It was when she started the procedure that I remembered. I guess two echocardiograms in 38 years is not too bad. She mentioned that back in the 80’s that was over-diagnosed (she had been at Holy Cross since the 80’s).
Tomorrow, I go in for the insertion of the port. I asked the Breast Health Navigator if they would put me under with a general anesthetic and she said no, it would be a local. It should take, at most, an hour.
Stay tuned!
