Week 6 Complete... But the Battle Still Continues

It's taken me a few days to complete this post.  I wish I could blame it all on the fatigue and being too tired to get my thoughts together, but that's not the reason.  At the end of Week 6, while I was celebrating the "end-of-treatment" milestone in my journey, someone I love dearly was told that their battle is coming to an end.  While my mind has processed this news over the last few days, my feelings have been all over the place and I am struggling a bit to stay focused on the positive.

Ringing the bell!!

My last brachytherapy treatment on Friday went just as planned with no issues.  Afterwards, I headed home for some much needed rest.  My Radiation Oncologist explained that the side effects of radiation should improve over time but that it can be a slow process.  So I will most likely still be taking medications to manage the side effects for a while.

Nap time

I spent most of this weekend just resting.  My fatigue has continued to build with this last week of treatment and has had a significant impact on my daily life right now.  It just takes so much energy for me to do the things that used to be so simple.  However, I know I just need to be patient and give it time.  My body will heal and I will gain back my stamina and strength.

So what's next, you ask?  I am currently working with my Oncologist on a few things.  The first will be scheduling my "end of treatment" imaging.  These tests will be done several weeks from now to determine that the treatment was effective in eliminating the cancer.  In addition, I am hoping that I can participate in a study at the James that is looking at a vaccine that may decrease cervical cancer recurrence.  More to come on that!!

Last Day of Treatment!!

Insomnia Bloggin'

It is Tuesday morning and I am wide awake ʘ‿ʘ.  Initially I had difficulty getting to sleep this evening because of some pain (pretty sure it is the ovarian cyst that has become "angry" due to the radiation).  I took some pain meds and then some Ibuprofen a few hours later and the pain finally subsided around 1am.  However, then for some reason my brain wouldn't "shut off" (could be steroids or chemo - who knows).  So I did about an hour of work and then tried to get some rest but my brain just won't shut off!!  So I thought I would write a quick entry to update you all on today and to answer a question asked about my treatment plan this week.

THANK YOU ALL!!💗

I was shocked to find out that all my labs were good today and that I could get my 5th and final chemo infusion!  The PIV team had to come place a line and due to all the bruising on my arms they had to select a really weird spot.  The chemo infusion went smoothly and I was finishing up with my hydration when I got up to use the restroom and my PIV started to feel really painful.  The nurses stopped the infusion immediately and ultimately had to remove the line.  Since I only needed about 500mL more of hydration they said I just needed to drink more water at home.  My nurse said she had to go grab something for me and before I knew it she returned with a group of 5J infusion staff and members of my "5J phamily".  The presented me with my "Courage Award".  It is a certificate that staff award to patients after the completion of their last chemo infusion.  Although as a pharmacist, I am totally aware of this tradition at the James, I hadn't even thought about this as a James patient!  I was so touched and emotionally moved by this and words can never, ever, express how grateful I am for all of the care, support, and love that I have been blessed with!!

This week will hopefully be my last week of therapy with my brachytherapy treatment on Friday being the LAST treatment.  The optimal goal of the 6 weeks of treatment (5 chemo infusion, 25 external radiation treatments, and 4 brachytherapy treatments) is to eradicate the cancer totally.  There is no surgery required after treatment but I will have "end of treatment" imaging (dates TBD) to ensure that the cancer has been eradicated/killed/TKO'd!!  I am keeping with the positive thinking and am believing that my scans will be clean.  However, I know that if this is not the case, I will continue this Battle and will work with my Oncologists to do any necessary additional treatments to beat this!!

Just One More Week to Go....

My second brachytherapy on Friday went just as planned.  It really is amazing how far technology has come.  After I got a PIV placed, and had some Dilaudid on board, it was off to the treatment room where my Rad/Onc team placed the ring and tandem.  Next I was taken for a short CT scan and then back to a room to rest while the Rad/Onc team reviewed the treatment planning.  During this down time, I rested and was visited by the research nurse to have another session of reflexology.  Before I new it the nurse was ready to take me to the treatment room and I had the second session of brachytherapy.  Overall it was a shorter treatment day, about 5 hours, and by 1:30pm I was on my home to rest.

As week 5 comes to an end, I am definitely feeling the many side effects of treatment.  The cystitis, caused by radiation, has gotten slightly worse but with the help of medications I am able to get through the day.  I've become pretty good at managing the GI side effects of radiation with diet and medication.  This week I have really struggled with food not tasting good (a side effect of chemo).  Food just doesn't taste right to me and many times there isn't any food that "sounds good to me".  I have to give Nathan a lot of credit for making sure that I eat and stay hydrated.  He always has lots of food and drink options to offer me and has been taking really good care of me!  But what has really caught up with me this week has been the fatigue.  Each week it just keeps becoming more and more difficult to do activities.  So this weekend I have spent a lot of time resting and trying to mentally prepare for this last week of treatment!

Week 6 Schedule:

• Monday:  external radiation and my last chemo infusion
• Tuesday:  external radiation
• Wednesday:  3rd brachytherapy treatment
• Thursday: last external radiation
• Friday: Last brachytherapy treatment

First Brachytherapy Treatment Done!

So I have decided to do a play-by play of Tuesday because although it was definitely a long day, I was really amazed by how the radiation technology works and how individualized the care is.

My day started in the pre-op area where they prepped me for the procedure.  A nurse got vitals, asked me a bunch of questions, and made sure that "Valarie" was working properly (flushed my PIV:).  Soon after I was visited by the Rad/Onc resident, then the anesthesiologist, next my Radiation Oncologist, and finally an anesthesiologist resident.  I was given Versed (a medication that allows you to still be "awake" but you don't remember what you say or do) to relax me a bit before the procedure.  Moments later it was time to go so Nathan and I said our "see you soon" and after a quick kiss I was wheeled away.  The Versed started working pretty quickly and all I remember is being asked to breath deep from a mask and the procedure started a little after 8am.  During the procedure the Smit sleeve (will permanently stay inserted) and the ring and tandem (will be inserted and removed for each treatment) were all placed.  As I was still sedated I underwent a CT to ensure proper placement.  

The next thing I remember is slowly waking up in recovery around 11am.  I was in some pretty significant pain so the nurse gave me some Dilaudid (a pain med I've never had before).  It worked pretty quickly but it also dropped my heart rate pretty low so the nurses had to monitor me closely.  After I was fully awake and more stable I was taken to have a short MRI.  This one was much more manageable (probably because it was shorter and I had some nice pain meds on board).

Next I was wheeled to a room where I was joined by Nathan.  The Rad/Onc nurse explained that for the next couple of hours my Rad/Onc team would be reviewing the imaging and completing the treatment planning.  She also explained that during this time I would need to remain laying flat to ensure that the proper placement of the devices stayed intact.  During this down time I was visited by a research nurse for the study that I am participating in.  With the lights dimmed and some nice soothing music playing, she provided a reflexology session of 15 minutes on each foot.  I did feel a decrease in my anxiety and pain and increased sense of calmness and relaxation. It was AWESOME and I look forward to this with every brachytherapy treatment.

Around 2pm the Rad/Onc nurse entered the room and said they were ready to start the treatment.  I was wheeled to a nearby treatment room and the Rad/Onc technician hooked up two tubes from the radiation machine to the two tandem tubes that were already placed.  My Radiation Oncologist double checked the set up and reviewed what the treatment involved.  Basically high dose radiation would travel through the tubes, would dwell in the cavity for a short time, and then the radiation would be returned to the machine.  The treatment session lasted less than 10 minutes and was not painful at all.  After the treatment, a Rad/Onc technician used a scanning device to ensure there was no radiation remaining in my body.  I was given some more Dilaudid and my Radiation Oncologist and the Rad/Onc resident removed the tandem and ring.  I was given some discharge instructions and wheeled back to the recovery floor.  

In recovery, the nurse checked my vitals, removed "Valarie", and told me that when I was ready I could change into my clothes.  By 3:30pm I was in a wheel chair and being taken down to the lobby where Nathan was waiting with the car to take me home.

Tuesday evening I rested and caught up on some work.  I had a little discomfort in my throat from the anesthesia and some minor cramping form the surgical procedure but it was manageable.

Overall the first treatment went well.  My next internal radiation treatment will be Friday but should be a shorter day since there will be no sedation and surgical procedures.

Platelets were all good today!!

Thanks for the cup Katie!

My platelets were 135 today (jumped up from 89 on Friday!!).  Was it the pickle juice?  Not 100% convinced but hey, I'll take it!!  On a not so great note, my ANC (a number that represents my white blood cells) has continued to drop and was 1.54 K/uL today.  The cut off for treatment is 1.5 K/uL.  So now I've turned my attention to willing and praying for my ANC to not drop - ahhhh if it's not one thing it's another.  I've also been dealing with a new side effect of radiation that developed on Friday - cystitis.  Pelvic radiation causes irritation to the bladder and basically makes you feel like you have a urinary tract infection (when you don't).  So my Rad/Onc team has added some Pyridium and it has helped with some of the symptoms.  For my non-Pharm family & friends this medication helps to relieve the pain, burning, urgency and frequency.  And it turns your pee ORANGE!!

Always Multi-tasking

Today's chemo visit did have a little excitement though!  For the previous 3 chemo infusions and the two lab draws last week we have used the trusted vein in my left arm that I recently named "Veronica" - named after that catchy (but somewhat depressing if you listen to the lyrics) Elvis Costello song.  Veronica is the vein that the Red Cross always chose when I donated blood.  But today Veronica was plain tuckered out.  My nurse was able to place a peripheral IV (PIV) in Veronica and draw labs but shortly after the PIV became painful and it had to get pulled.  But I still needed to get hydration and chemo so I needed a new PIV!  Nurses assessed my right arm and attempted a few times to get a vein but were unsuccessful.  An order was placed for the PIV team, a group of nurses that use ultrasound technology to place PIVs, so that they could come work their magic.  A member of the PIV team arrived and within a few minutes placed a PIV in a deep vein in my right arm.  I named her "Valerie" (after that super cool Steve Winwood song, but might be the lowest budget music video every made - please I beg you, just watch a few moments and you'll see:)  My chemo infusion after that went smooth and cool thing was - I was able to keep Valerie in place after my infusion so that she could be used for my MRI tonight and maybe for my procedures tomorrow (#nomorepokes).

My MRI tonight was the longest MRI I have ever had - around 45 minutes.  MRIs are probably my least favorite test that I have had.  They are just so noisy and then for the last 10 minutes the machine actually starts to move with you inside it! But it's done, checked off the list, and tomorrow's MRI should be shorter.

I am a little (well lets say a little more than little but not yet to the very level) nervous about tomorrow.  I just don't enjoy sedation and procedures.  I imagine that not many people do.  On a positive note though, I was asked to participate in a study that is looking at the effect of aromatherapy and foot reflexology on pain and anxiety during Brachytherapy.  I said yes, of course (duh - I'm a research pharmacist and if I'm gonna be "on the other side" I might as well get the experience of being a James research patient), and have been assigned to the group that will receive aromatherapy and foot reflexology.  So I am looking forward to that!

Chemo Deferred Again...

Unfortunately my platelet count on Friday was 89, still too low to receive chemo.  Good news is, I think they are on the way back up.  So the plan is to re-draw labs on Monday and hopefully get chemo then.  On Thursday, I spoke with my Radiation Oncologist and asked about the impact of not receiving chemo for a week.  She explained that these things happen and that 5 treatments is optimal but 4 is still okay.  I have had 3 chemo treatments so far so I am hoping that my counts are recovered on Monday and I can receive the 4th treatment (and a 5th the following week).  Friday's appointment was not a total loss though - I got to enjoy some tastiness from Amy's Donuts.  Thanks Sage!!

Word on the street (and by street I mean the 5James Pharmacy, the satellite pharmacy that makes my chemo and is where some AWESOME outpatient pharmacists work:) is that pickle juice is the solution to getting your platelets up!  Apparently, there was a patient that believed that drinking pickle juice was what kept her platelets up and she swore by it.  I know this sounds crazy but I've always liked pickles and pickle juice (reminds me of my time in Baltimore and those picklebacks at Pickles Pub:)  I think I might just drink a little pickle juice this weekend.  I mean, other than the high sodium content, what's the risk?  I did do a quick literature search to see if any foods can increase platelets but didn't find anything substantial.

Up Next:  Week 5 and it's gonna be a busy one!!

• Monday will be external radiation, chemo (come on platelets!!) , and an MRI that evening that will be used for brachytherapy planning.
• Tuesday will be my first brachytherapy treatment.  It will be long one (about 8 hours) that starts in pre-op so that I can be sedated.  Then I will undergo the Smit sleeve placement procedure (a device that is surgically placed and used for all brachytherapy treatments) and a CT to confirm placement.  Then I will have another shorter MRI.  Next I will have some down time while my team reads the MRI and does some treatment planning.  After that I will have my 1st brachytherapy treatment (only lasts 10-15 minutes) and then it's back to the post-op area to officially be discharged once I meet the criteria.
• Wednesday and Thursday are just external radiation.
• Friday is my 2nd brachytherapy treatment (shorter time frame of 5 hours since no sedation or sleeve placement is needed).

Thank you everyone for all the prayer, positive vibes, and support!!  I could not do this without you all!!!!

Not Enough Platelets Came to the Labor Day Party.....

Turnout for the "Platelet Party" over the 3-day weekend was not enough.  On Tuesday my platelets were 90 (need to be 100 to receive chemo) so my Oncologist/Nurse Practitioner team decided to delay chemo this week.  My labs will be re-checked on Friday and if my platelets are at least 100 I will get chemo then.

As a pharmacist, when I would see patient's have their treatment delayed I never really thought about how the patient felt.  I simply thought "one less chemotherapy order we need to verify and make".  But being the patient on the other side, there are so many emotions.  I feel frustration because I know that chemo makes the radiation work better and worry that by delaying chemo - the tumor isn't getting attacked as efficiently as possible.  I feel impatient and helpless as I wait for my body to get my platelet count back up (platelet transfusion is the only quick fix and not medically necessary at this point).  But to be completely honest, I also feel a little bit of relief in getting a few more days before I receive chemo and steroids again because that means I get a few more days without the side effects that come along with them (⌣́_⌣̀).  And I feel a little guilty for feeling that relief - ahhhh to be human!!  Ultimately though, I know the importance of treatment parameters and I understand that my medical team has my safety in mind.

So Week 4 will be filled with radiation appointments each morning and hopefully chemo on Friday.

So Thankful for Labor Day.....

Labor Day Plans = rest, rest and more rest.  I've always really enjoyed the 3-day holiday weekends (well, the one's that I haven't had to work:).  But this Labor Day I am thankful to have one more day to rest before I begin Week 4 of treatment.  The fatigue from radiation has been accumulating and I have just been so tired this week.  Being asleep by 8pm is the new norm for me and taking a 2-3 hour Saturday or Sunday afternoon nap has become a necessity.  I think back to my fast paced life just  a few months ago and can't believe how different my days and weekends are.  My life used to include social events after work, dinner out with Nathan, festivals and sporting events on Saturdays, and "brunching" on Sundays.  Now, everything takes more effort and resting and relaxing is the priority.  As my treatment continues I know that I will become even more fatigued and my life may change even more, but ultimately I am determined to get to the other side and get my life back!!

Shout out this week to Abby (my super talented Stylist) who gave me this awesome cut/color for fall and to Juli (my super talented Massage Therapist) who gave me such a relaxing hour long massage.  I really needed some extra pampering this week!!

On Thursday my Radiation Oncologist and I finalized the plan for my internal radiation treatment, aka brachytherapy.  She has decided to overlap my brachytherapy with the last two weeks of my external radiation/chemo.  I am scheduled to receive 4 total brachytherapy treatments (2 per week) with the first being on Tuesday September 12th.  If all goes well, my last day of treatment should be a brachytherapy session on Friday September 22nd.

Up next:  Week 4 - with external radiation and chemo on Tuesday and external radiation on Wednesday, Thursday, and Friday.