Today is Day 4 of Chemo cycle 4, so I am now 2/3rds of the way done. Sort of… The world counts it that way – the moment that the drug drip stops, you are done the next cycle. But in real life, that’s just the beginning.
Each chemo cycle starts for me about 3 days before the actual day of drug administration. That’s when I head into the lab to get blood work done to determine my response to the previous cycle and whether I have recovered enough to have the next set of medications. Since all chemo is toxic and causes extensive damage in the body, the effects tend to be cumulative, with each cycle causing a bit more of a drop in bloodwork, a bit more damage to tissues such as nerves and gut linings, a bit more hair loss (mostly noticeable in brows and lashes at this point in the process).
So sometime on Monday of my chemo week, I get two vials of blood taken at our local lab, then wait anxiously for the results to be posted online so that I can check them. I read bloodwork results all the time as part of my work as a Registered Dietitian, so I can certainly interpret my own values. The blood values being checked are mostly to do with my bone marrow function, liver function, immune function and overall protein status. I obsessively reload the lab results page every 15 minutes or so on Monday evenings, even going so far as to take my phone to bed with me last week, so that I could check in the middle of the night to see if they had appeared yet.
On Tuesday of chemo week, I will have a phone call with my clinic nurse Tanya, who has reviewed the lab results and we discuss their impact on my chemo plans for the week. So far, even though I have had low lab results twice now, we have decided to have me come to London and re-do the labs on the morning of chemo, in the hopes that they have recovered enough to go ahead with treatment. So far, I’m 2 for 2 – both times I rebounded like a boss!
Tuesday evening is my last supper before going into the fasting phase of preparation. I make sure to have a flavourful and satisfying meal, because once it’s done, that’s it until Friday…
Wednesday, the day before chemo, is a full fasting day and I consume only black coffee, various teas, water and about 2 servings of bone broth. By mid to late afternoon, we are driving the 3 hours to London, to our hotel. I will watch my travel partners have supper (often delicious Schwarma if Mike is with me), but I have a bottle of water or take my tea thermos into the restaurant. It’s really not as hard as it sounds. Once at the hotel, I will warm up my second serving of bone broth and drink it down as my “supper”.
The pre-loading of medication starts the night before chemo with a high dose of Dexamethasome steroids at 9 pm, then again at 3 am. This totally buzzes me and makes it almost impossible to sleep. It also causes my blood sugar to spike, despite the fact that I’m deep into ketosis from the fasting at that point.
I watch Mike eat a full breakfast at the hotel, while sipping on my black coffee, then we check out and walk over to the cancer clinic across the street. During chemo day, I am poked for an IV site in my arm, poked again to access the chemo port site on my left rib, and given a bunch of oral and IV “pre-meds” to keep side-effects and reactions at bay. That’s the actual “Cycle 4” that people think of as “Chemo”. When a cancer clinic client is disconnected from their drugs on the last day of administration, they go out to the lobby, ring a bell that sits there just for this purpose, and the entire cancer centre erupts in applause. It’s supposed to be a significant event – the end of the ordeal!
Well, I can tell you that putting the drugs into my body is just the beginning. Chemo drugs are active in the body for up to two weeks, wreaking havoc on multiple systems as they rip through looking for cancer cells to annihilate.
In the first 24 hours or so after chemo, I have to sit in a car for the three-hour drive home, freshly loaded with 2 litres of fluid stuffed into the not-nearly-spacious-enough areas around my abdominal organs. If I can’t recline, or pull my legs up, I get pretty crampy. The first night at home is one that is still very impacted by the Dexamethasone, so I usually end up sitting up most of the night in my recliner, crampy, unable to sleep, but oh so tired. My energy level is low, so I get up, putz around my kitchen or go to the bathroom, but then return to my chair. This is the time that having a “nest” to retreat to, and a loving partner who is just kind of “there”, is so important. I’m still fasting at this point, so more coffee, teas, water and possibly one last serving of bone broth.
My fast-breaking meal happens at supper on Friday. I will again have something flavourful, but really easy, planned for that meal. I feel almost sorry to start eating again, as the feeling of fasting feels like it protects me from the effects of the chemo. Any mild nausea that I have had to endure has always happened once I started eating again, usually Day 3 or 4.
By Day 6-7, my energy level is returning to a more normal level, and I start looking around for productive things to be doing. I return to work on Day 7 or 8, usually with good energy to put in a full day’s work. Despite feeling so good (I’m sure as a result of the fasting and ketosis), the chemo drug is still present and in force, working under the surface of my awareness. I found this out the hard way by ignoring severe constipation that happened during week 2, and by being so surprised to find that my immune system labs were way low, despite how good I felt. I hadn’t been giving the chemo drugs enough respect – I’m smarter now…
So, by the end of week two, we’re within a few days of doing labs for the next cycle to start again. And that’s when each cycle actually ends for me. When the day comes that I ring the bell at the cancer centre, I will still be 2-3 weeks away from the “End”. Once that last few weeks are over and I don’t have to go back, THEN I will be done. THEN the hair growth will start up again. THEN I can start to think about exercising again. THEN I can start planning what next fall will look like, and our travel plans for 2020. THEN cancer treatment will be behind me…