Preparing for Surgery

I don't know how you are supposed to prepare to have your breast chopped off. I had done hours of research before getting my port put in and before my first chemo but for some reason I didn't feel the need to prepare as much before surgery. Maybe it's because I am getting tired...tired of thinking about cancer, talking about cancer and being a cancer patient. It has consumed me for 6 months now but it feels like so much longer.

Regardless, I did manage to do a few google searches the day before surgery and found some helpful tips for getting through a mastectomy: http://www.healthline.com/health/breast-cancer/tips-for-getting-through-mastectomy. The hospital gave me a list of items to pack but there are other things on this list that I hadn't thought about like downloading some of your favourite movies and songs. 

I also found it was helpful to increase my time in the gym leading up to surgery. Throughout chemo I was pretty good about getting out to the gym at least twice a week for an hour. I had read an article about Jennifer Griffin, the FOX news correspondent who was diagnosed with triple negative breast cancer in 2009. In the article she talked about how exercise and a strict diet became her tamoxifen. Unlike estrogen receptor positive breast cancer, when you are triple negative there are no drugs like Tamoxifen or Zoladex that can be taken after chemo and radiation are complete to prevent recurrence. For triple negative breast cancer, the main way to prevent recurrence is a healthy lifestyle so I figured that exercising regularly would not only help me keep off the extra pounds women commonly gain during chemo but also contribute to my recovery. After chemo ended and before surgery, I increased my exercise to 3-4 days a week.

The only other thing that was recommended is buying a mastectomy camisole or bra. I was once again reminded that breast cancer is usually something older women face upon walking into a local store where everything was obviously made for someone 50+. Thankfully, I managed to find a bra at a store near my hospital where everything on display wasn't something a grandma would wear. 

There Go My Eyelashes

Before starting chemo I spent hours scouring blogs trying to figure out when I would lose my eyelashes and eyebrows. For some reason, losing the hair on my head or the rest of my body didn't seem like a big deal because it can be covered up but I was terrified about losing the hair on my face.

If others are looking for the same answers, here is my experience:

After AC

• Lost 70% of the hair on my head after 18 days. The rest came out gradually after that but I wasn't really keeping track since I had shaved my hair short and didn't really notice. A lot of women rock the bald look which I commend them for but I personally am so glad I have a wig that I feel confident in. 
• Still had about 80% of my eyelashes and eyebrows, so it was not even really that noticeable.

After 1st round of Taxol

• Down to about 50% of my eyelashes and eyebrows

I lost the rest of my eyelashes gradually after the 2nd round of Taxol and by my last infusion, I only had a couple left. I tried not to touch them because the minute I rubbed my eye, they would fall out. 

Now I am 2 weeks post chemo. I still have maybe 20% of my eyebrows left, enough that I don't need to draw them on yet and all of my eyelashes are gone. I find that when I apply a black eyeliner on the top and bottom, it isn't really that obvious. I use a L'Oreal liquid liner on the top and an Annabelle pencil for the bottom.

A Cause for Celebration?

My 2nd, 3rd and 4th rounds of Taxol were as uneventful as the first one which I am grateful for. At my last infusion, the nurses in the chemo suite presented me with a certificate to congratulate me. I also received messages from family and friends all asking if I was excited that chemo is finally over. The problem is, I don't think of my last chemo as something to celebrate. I think of it as the last step in the first part of a very long journey. I still have surgery and radiation ahead of me, not to mention all of the question marks that come after that including returning to work, check ups, scans, hopefully having kids and doing everything I can to prevent this horrible disease from ever recurring. I don't mean to be negative, I would just call it being realistic. Some people may celebrate the end of chemo as a milestone in their cancer journey which is great, but it's not for me. I'm just glad they didn't make me ring the bell.*

*My cancer centre has a bell in the lobby that is used to mark a milestone in your journey. I think I will ring it in 2-3 years when I am still cancer free.

Taxol

Everyone says that Taxol is much easier than AC but because I didn't have many problems with AC, I was worried that I would be the opposite (that always seems to be the case with me). Luckily, I did not have a reaction my first infusion.

The pre-medications with Taxol are different as well, I took Dexamethasone 12 and 6 hours before chemo. My infusions were scheduled in the mornings so unfortunately this meant waking up at 3am to take my medications. One of the main side effects of Dexamethasone is insomnia so good luck getting back to sleep. Here is what I recommend:

• Take a sleeping pill with the Dextamethisone if you have to take it in the middle of the night. I took Zopiclone which helped me go back to sleep. 
• Eat something small with the Dexamethisone so your stomach doesn't get upset. 
• Bring something with you to your infusions as they are long. If my chemo was scheduled for 9am, I usually didn't leave the hospital until at least 2pm. I had magazines, an adult colouring book and of course, my family to keep me occupied. 

Sugar Feeds Cancer

When I first started chemo, it didn't occur to me that what I ate would potentially impact the effectiveness of my treatment. Dieticians are available to patients through the cancer centre so I asked to meet with one in hopes of getting some guidance on what I should be eating, what foods to avoid and healthy recipes. I even signed up for a nutrition course which unfortunately turned out to be an overview of Canada's Food Guide.

Since I was not having much luck through the hospital, I decided to do some of my own research and found several articles regarding the link between sugar and cancer. This seems to be a widely debated subject with some sources saying that sugar feeds cancer cells. Although I'm not the extremist type that is going to cut all sugar out of my diet, I really wish someone would have told me this information! One of the arguments behind this claim is that cancer cells uptake sugar at 10-12 times the rate of healthy cells.  In fact, that is the basis of PET (positive emission tomography) scans — one of the most accurate tools for detecting cancer growth. You can read more about it here: http://beatcancer.org/2014/03/5-reasons-cancer-and-sugar-are-best-friends/

Of course, there are also many articles stating that the relationship between sugar and cancer is a myth and as long as you consume sugar in moderation and maintain a healthy weight, there are no risks. I found that this was an interesting article: https://www.oncologynutrition.org/erfc/healthy-nutrition-now/sugar-and-cancer/

Regardless, I have decided to limit the amount of sugar that I eat during treatment and going forward. All of the sugary brownies and cookies that people were nice enough to make when they found out about my diagnosis have now been replaced by natural sugars found in fruits. If there is even a possibility that limiting sugar could help in my recovery, I'm willing to try it.

AC Chemo Done!

I think I was pretty lucky in terms of side effects because I didn't have many with this portion of the chemo. It's gross and not many people want to talk about it but the main issue was with constipation. If you are pro-active and start taking Colaise and Senekot as directed 1-2 days before each treatment, it should prevent any issues. Obviously the nurses keep telling me to eat lots of fibre and fruit but that doesn't always work!

Like many others doing dose dense AC which is every 2 weeks instead of every 3, I had a Neulasta shot 24 hours after chemo to boost my white blood cells. I was told that this shot is $3,000 so many people take the alternative which is Neupogen. The main difference is cost and that Neupogen is given daily as opposed to one shot. I was glad that my employer covered 60% and the remainder was paid by the Victory Program. If you are in Canada, the Victory Program may be worth looking into. The nurse that administered the shot said most people take it in their arm but I found my stomach was much less painful. Another tip to reduce the stinging of the medicine going in is to take the Neulasta out of the fridge at least one hour before the injection. I got some pain in my shoulders and neck for about 1-2 days following the shot but other than that, the side effects were minimal. Many people experience much worse than this so again, being younger probably worked in my favour.

All through AC, my white blood cell count remained pretty low so I can only imagine what it would have been without the Neulasta. Even though your count might be below the "normal" range, they can usually still go ahead with chemo unless it is really low. I ask for all of my blood test results and put them into a spreadsheet so I can track them. I have found that this can be helpful and may spark some questions when meeting with your Oncologist depending on how things are tracking. 

Now, on to Taxol...

The Red Devil

Of course when I started chemo, the doctors and nurses told me all about the side effects of adriamycin and cytoxan (a.k.a the red devil). Some of these include:

• Nausea and vomiting
• Appetite changes
• Painful mouth sores
• Hair loss
• Constipation

There is a lot of talk about how horrible these drugs make you feel but through this post, I want to tell you that not everyone is bedridden for days or not able to eat because of a metallic taste in your mouth or sores. I did have mouth sores but found that gargling with salt water helped them go away before they got so bad that they could prevent me from eating. I love food so I think that side effect more than anything would have been devastating. In fact, whoever accompanied me to my chemo sessions always brought food and I ate while the drugs were being pumped into me. I actually think that helped limit the side effects that I experienced as I was never nauseous. I'm sure my age also had something to do with it...I guess that is one good thing about having to go through this when you are only 30 years old. 

In case anyone is interested, I used the mouth wash after every meal and also sometimes in between. It consisted of:

1 cup of water

1/2 teaspoon of salt

Put the mixture beside your sink in a glass bottle so you remember to use it often. If I did see a mouth sore, I soaked a Q-Tip in the mouthwash and applied it to the area. After doing this for 1-2 days, it went away. There is also the "magic mouthwash" that can be prescribed but I never needed it.