Chemo Cocktail: My 5 Month-Long Hangover

Sometimes, I’ll be going about my daily business and then all of a sudden it hits me: I was diagnosed with stage 4 breast cancer and survived 8 rounds of chemotherapy. From diagnosis to treatment, everything was such a whirlwind. When all the dust finally settled, I was left thinking… did all of that really just happen? How am I still here?

Chemo Crash Course: Chemo stops all quickly dividing cells in your body (because cancer cells divide quickly). Unfortunately your hair and nails are also quickly dividing cells (because they are constantly growing) which is why your hair falls out and your nails get real weird (more on that in a future post). But chemo doesn’t just destroy your vanity, it messes with your mind and body in all sorts of ways. This was my experience:

Chemo was my biggest fear. A lifetime of movies and TV shows had prepared me for the absolute worst. All I could envision was being bed-bound, throwing up, helpless, and bald. And yes, I did tick off those boxes on some days, but to be perfectly honest, most days I coped really well (all things considered). Don’t get me wrong, it was no walk in the park by any means, but it was significantly more manageable than I expected. I still lived a “normal” life. I went for daily walks, tried to keep up with my yoga practice, went grocery shopping, cooked, cleaned, etc.

It all started on August 17th, 2018: My first round of chemo. My port was freshly placed only 3 days prior and it was still swollen and bruised. My doctors told me the port would be ready to use as soon as it was placed, but what they didn’t tell me was how uncomfortable and stressful it would be to have a nurse poking and prodding at it when it’s still healing. It definitely made an already stressful situation a lot more stressful (and even made the nurse close the curtain so that other patients didn’t have to witness my mini meltdown). When it was all done, I felt surprisingly ok. We even went for tacos directly afterwards and then had a Sex and the City marathon (although I don’t know if you can call it a marathon if you fall asleep after two episodes). Is there anything Sex and the City can’t fix? The answer is no.

The first 4 rounds of chemo that I had (Adriamycin and Cyclophosphamide) is lovingly referred to as “The Red Devil” because it’s a red fluid that the nurse “pushes” into you from a large syringe. It also temporarily makes your pee red which is just one of many lovely side effects (including hair loss, low immune system, nausea, fatigue, diarrhea/constipation, and mouth sores). Luckily, I managed to not get bad nausea. My crowning achievement throughout chemo was only throwing up 2 times (once because of anxiety, and once because I had been exposed to too many fumes while staining some furniture… a casual activity for a cancer patient).

The cherry on top of all of this chemo business was the nightly injections I needed to get in my stomach to help boost my immune system. Carlos had to give me these injections because there was no way I would be able to give them to myself. These “Grastofil” injections make your bone marrow produce more white blood cells, which boosts your immune system. This is important because not only do they prevent you from getting sick easily, but they also ensure your immune system is well enough to withstand the next round of chemo. In total I needed (I believe) 42 Grastofil injections. Each injection caused my bones to ache, specifically my lower back and ribs (a slight preview of the real bone pain that would come with the last 4 rounds of chemo).

I also had to get monthly “Lupron” injections in my bum to keep my body in chemical menopause. Lupron puts your ovaries to sleep and therefore protects your eggs from the toxic effects of chemo. This helped preserve my fertility for the future (something I’ll also probably talk about in a future post). Even though I’m done chemo, I’m still receiving these injections to prevent estrogen from feeding any possible cancer cells. The side effects include hot flashes and a risk of osteoporosis. Ladies, I know periods suck… but let me tell you, menopause is worse.

me n’ my non-existent immune system

After chemo round 4, I needed a blood transfusion because my red blood cells were way too low and I was anemic. I never really realized that cancer patients were an entire group of people that sometimes need blood transfusions until I was a cancer patient that needed a blood transfusion. (Please donate blood if you can! It’s a small thing that can make a big difference). I was so nervous to get a transfusion, but afterwards I could literally see the colour return to my face and I suddenly had so much energy. It was like I literally had life injected back into my veins.

The last 4 rounds of chemo that I had was called Paclitaxel, AKA Taxol (no “cute” name for this one). Along with Taxol, I also received my targeted therapy drugs (Herceptin and Perjeta) which I’m still receiving now every 3 weeks (thankfully, they have little to no side effects). Taxol, on the other hand, has all the same side effects as “The Red Devil” but with the addition of hard core bone pain and numbness in hands and feet. The bone pain felt like I was being stabbed in my knees, ankles, and hips. The first day that I experienced it was the worst. I could hardly walk without my knees feeling like they were about to buckle in. I still sometimes have “flare ups” of this bone pain even months after I’ve finished. Apparently this is normal and it will eventually fade away. Anytime I have a flare up I’m like, “Wow Really? Rude”. It’s like a little evil reminder of the pain I’ve already suffered. I also experienced the numbness in my hands and feet during chemo. It actually became too much and they had to reduce the strength of my last two rounds of chemo in order to protect my nerves. I still have slight numbness in my finger and toes, but apparently that’s normal and it takes a while for your body to recover (but it can be permanent for some people).

I also experienced “chemo brain”, which is a brain fog that affects your cognitive functioning (memory, attention, etc.). I’m currently trying to see how long I can keep blaming things on “chemo brain”, will report back.

Luckily I never had an allergic reaction to the chemo. To prepare for a possible allergic reaction they give you a benadryl drip before each infusion (which makes you super sleepy). They also have to give the chemo as slowly as possible when you’re first receiving it in case your body has a negative reaction. If you don’t have a bad reaction, they speed up the time it takes to give it to you so that it gets faster and faster every round. This makes for very long days in the chemo chair (7 hours or more).

I still can’t believe I survived all of this. But I think, like a lot of difficult things in life, you just get through it. One way or another. One day at a time. Then, when it’s all passed, you look back and you can’t believe the mountain you’ve climbed. Although I still have many more mountains to climb, this one has been by far the biggest and has left me feeling so much stronger than I ever thought possible.

xx

Sarah

The Diagnosis: Part 2

From the moment I heard the word “cancer”, everything happened so quickly. Like someone hit the fast forward button and couldn’t figure out how to turn it off.

Carlos and I had a flight booked to go to Hawaii for a week on August 2nd (for my 27th birthday) and I had no idea if I would be able to go. They rushed my first appointment with my oncologist for this reason. I met with her on July 31st and she told me the tentative plan for treatment:

  • 8 rounds (~4.5 months) of chemotherapy (expect hair loss, nausea, fatigue, and bone pain… yes BONE pain)
  • Nightly injections in my stomach to boost my immune system during chemo (expect more bone pain)
  • 1 year of targeted therapy (this is toxic to your heart so regular heart scans are needed)
  • Surgery (preferably lumpectomy with lymph node dissection)
  • 20-25 rounds of radiation (every Monday-Friday for 4-5 weeks)
  • Hormone therapy (oral pill and monthly injections) for possibly 5 years (this keeps your body in chemical menopause so that no estrogen can make the cancer grow, expect hot flashes and mood changes)

As someone who once fainted at the optometrist when I found out that I needed glasses, you can imagine how I handled this information.

When I asked about the trip to Hawaii, she explained that delaying treatment by a week wouldn’t make a difference and that I should go ahead and enjoy my vacation before I begin treatment.

So that’s what we did! It was a little taste of paradise to hold on to before I entered… well, not paradise.

The Road to Hana, Maui
RIP hair. It should be noted that I resisted EVERY temptation to not shave my head in Hawaii. Having to detangle it from salt water and wind every day was extra tedious knowing it would all be gone in a few short weeks.

I know it’s hard to believe, but I actually had an amazing trip. Sure, there were times when it all hit me at once, but changing my environment was the best possible thing I could have done for myself. On my birthday I rolled around in the sand, splashed around in the waves, went to a movie, and ate the most delicious fish tacos I’ve ever had in my life. It was perfect.

Having cancer sometimes makes being alive feel like you’re touching a live wire. It’s like all of a sudden, everything is amplified. The highs are so much higher, and the lows are so much lower. You start seeing beauty and joy in so many places you never saw before. This trip let me experience that and it kept pushing me to live in the present moment. When everything is new (new sights, sounds, smells, foods, activities, etc.) it invites you to fully absorb the present moment, which is exactly what I needed.

When I land back in Vancouver, it’s go time. Here’s a brief timeline of what happened:

August 14th: I have a port surgically put under my skin on my chest so that I could get treatment and blood work more easily (you can read about that here)

August 16th: I have a PET scan in order to find out exactly what stage I am.

August 17th: I start chemo (ew).

August 18th: Me and my amazing friend Charli get pixie cuts together to prepare me for hair loss.

August 21st: I go with Carlos and my sister Lucy to meet my oncologist for my first follow up appointment after chemo. My oncologist also has the results of my PET scan (warning, this is where shit gets real). Her voice gets a bit somber. She says “The good news is that it’s not in your heart, your liver, your brain, or your lungs, but… we did find two small spots on your sternum, I’m so sorry Sarah”.

My mind went completely blank. I instantly crawled up into a ball and just kept turning towards Carlos and looking at him with a complete look of panic. I couldn’t even cry. I was completely shell shocked. I couldn’t look at Lucy. I could see her in the corner of my eye with her head between her knees and her hands on her head. My oncologist continued, “So unfortunately this does make you stage 4 and you will be considered a cancer patient for the rest of your life“. I basically combusted into a ball of anxiety and panic. I didn’t have anxiety, I transcended and BECAME anxiety personified. Even though she followed this up with “but I don’t view you as a stage 4 patient because you have such a minimal amount of disease in your body”. And “There is a very good chance you will make it through this”.

So let me just clarify, no I’m not dying. The cancer did metastasize to my sternum in a small area (which technically makes me stage 4), but I’m not considered terminal by any means. My oncologist explained that I am what is considered “oligometastatic” (a new term, and very rare). Oligometastatic means the cancer has spread to a different part of the body, but it has only spread to one area and in a very small amount. What does this mean? It means I have a shot at a “cure”, meaning I could live a long life without this ever coming back. The other good news is that my mets (metastases) are in the bone, and women with bone mets have better chances of long-term survival. Bone mets also respond really well to radiation.

Let’s fast forward to present day for a second: The GOOD news is that I responded insanely well to chemo. After my lumpectomy, they analyzed the breast tissue and 7 lymph nodes they removed and found ZERO cancer cells. In the cancer biz, this is called a complete pathological response and it’s the best case scenario. Although I haven’t had a follow up PET scan yet to confirm all the cancer is gone, my doctors tell me it is HIGHLY likely that the mets on my sternum are also gone.

So am I cancer free?
The answer: we think so, but it’s not yet confirmed. But trust me, when I know for sure I will scream it from the rooftops!

I expected my treatment plan to completely change with this new stage 4 label stamped across my forehead, but it didn’t. What did change is that my oncologist added an extra drug into my targeted therapy regime. Instead of just receiving the drug Herceptin for 1 year, I was now going to receive Herceptin and it’s sister drug Perjeta to better attack the cancer cells. She also explained that instead of just doing targeted therapy for 1 year, I should now do it for 5 years. However, since I had a complete pathological response, she thinks that maybe it won’t be necessary (it’s something we’re going to discuss in the future).

In case you don’t already know, the survival rate for metastatic breast cancer is extremely discouraging. But, I am not going to let it bring me down. I’ve responded incredibly well and I’m going to keep fighting every day to live a happy and healthy life for as long as possible. I never understood the concept of “fighting” cancer until I had to fight it myself. It’s more than a physical battle, the real fight is choosing to take back your life every day and live it to the fullest, despite your circumstances. So that’s what I’m going to keep doing. It’s hard as hell and I didn’t expect to ever have to do this, let alone do it in my 20s, but it’s really the only choice I have.

I don’t know why I suddenly feel like writing a thank you speech, but I honestly cannot put into words how much I love and appreciate all the people in my life who have been there for me or supported me in one way or another. I have the best partner, family, friends, and coworkers anyone could ever ask for. My heart feels so full and I’m so excited to beat this with all of you amazing people by my side.

xx

Sarah