On Friday, January 31st, my eggs were retrieved, fertilized, and started their journey to become blastocytes. Here are the final numbers: 20 eggs were retrieved. 19 eggs were mature and fertilized. On day 3, 18 “cleavage stage” embryos existed (the cells in the embryo are cleaving (aka dividing), but not growing in size), and 16 were grade 1 and 2 were grade 2. UNC Fertility grades their embryos 1-5, with 1 as the highest/best grade, which means all cells are the same size and have no fragmentation and that they have the best chance of becoming blastocytes. From day 3, our clinic generally sees about a 50% survival rate. On Thursday (day six), we found out that 8 embryos were frozen on day five and 4 embryos were frozen on day six. Embryos frozen on day five generally have a higher implantation rate and will be eventually used first when we are ready to transfer. If you remember, Dr. Fritz told us he would be happy if we ended up with 6-10 frozen embryos, and we have 12!!! Needless to say, I’m over the moon!
My first infusion day was last Tuesday, February 2nd, which was also Groundhog’s Day, and Punxatawney Phil saw his shadow and predicted six more weeks of winter, and that felt fitting given I was standing at the starting line of treatment. Over the weekend and into Monday, I had frequently strung together multiple curse words expressing my dismay, frustration, and anxiety. Jason and I had taken Monday off from work initially thinking we would have to be at the Cancer Hospital finishing up requirements for the clinical trial, but due to Elizabeth’s diligence and efficiency, we were able to take the day to relax. We had a nice afternoon walk through Chapel Hill followed by a late lunch and wine. Last Monday night, we went to the UNC vs. UVA basketball game with Jen who was down from D.C., and is always one of the most delightful, enjoyable, and genuine people. Throughout the afternoon, I relaxed and embraced the moment and company, and then enjoyed a great game, cheering for UVA. Once Jason and I got back to the hotel, I was able to settle in and fall asleep watching House Hunters International shortly before midnight, but unfortunately that only lasted until about 2:30am when I woke up and never really fully fell back to sleep. My alarm finally sounded at 7:00am. I showered quickly, so I could ensure I had the full hour to let the lidocaine cream set and full numb the skin around my port, because I did not want to feel a damn thing when the nurse would soon access it for blood work then to administer the chemotherapy drugs. I put a quarter sized blob of the cream on top of my port, covered it with Seran wrap, and taped it in place.
By the time we stopped for a chicken biscuit from Sunrise Biscuit Kitchen (featured on the Travel Channel) and arrived at the Cancer Hospital, the skin around my port was sufficiently numb. As I waited to be taken back for labs, I overheard the nurses trying to figure out why I had an appointment, but no order for blood work. I shook my head and rolled my eyes, but sat back and let them work this out, since my experience on the previous Friday with the orders for the CT scan had worked out well. Once it was corrected, Mary took me back to access my port and draw blood. She, like many other nurses I have encountered thus far at UNC, had a very soothing personality ensuring me I wouldn’t feel any pain and that I would be great, which I found to be kind of a funny thought: “great at port accessing and chemo, huh? Who is great at chemo?”, but I rolled with it as she cleaned and prepped my skin. She flushed my port and described that she was first using sodium chloride and then another agent that prevents fibers from building up between the catheter and port. She warned that I may taste the sodium chloride, but I didn’t feel or taste it. The only thing I really felt through the port accessing process was when she cleaned my skin, which was cold, and then the pressure when she put the needle in and locked it in place, but it was simply pressure and not near as painful as the pinching and stinging that I have felt when having regular IVs put in my arms and hands all too frequently recently.
From there, we were off to wait to meet with Dr. Park. We spoke with him and Dr. Beckman, and there was not very much to discuss outside of addressing my low vitamin D and protein levels and whether or not I could use Rogaine throughout my treatment to facilitate quicker hair regrowth (Jason and I had read that there had been some patients had used Rogaine during chemotherapy and their hair grew a bit faster, but not conclusive); however, Dr. Park ruled that out very quickly as being too risky to add more drugs/chemicals to my body. Dr. Park instructed me to increase my dose of vitamin D3 to 2,000IUs/day and eat a protein rich diet, because both help the body respond to chemotherapy better and restore quicker. Finally, he reviewed our treatment plan and reiterated that he thinks I am going to do very well and is still optimistic that the PET scan after three rounds will be clear. From there, it was time to bite the bullet and finally face the fact that I was really starting chemotherapy.
We were greeted by the nurses on the third floor, who remembered me from the previous Friday when Elizabeth had given us the tour of the infusion area. We were taken back to my chair relatively quickly. The infusion area is divided into four pods (approximately 8′ x 12′ each) that have the reclining chairs for patients and a guest chair with curtain dividers between each patient’s area. The area is spacious enough that I was able to have Jason and Daniel sit beside me in their own chairs throughout the day, without us sitting on top of each other. After Jason and I unpacked our bags for the day and met my nurse Victoria, Daniel arrived from the airport around 11:30am. Victoria started a sodium chloride drip for the first half hour, gave me Tylenol and Benadryl, and ordered the first of my chemo drugs, Rituxan. Finally at 12:00, the Rituxan started. It is known for causing pretty severe allergic reactions in patients, so it is administered at a very slow rate for the first infusion, and mine was started at a rate of 50mL/hour. At each half hour, Victoria checked my vitals and constantly watched me for signs of allergic reaction. I made it through the Rituxan, increasing to a rate of 400mL/hour by the end, and it took until about 3:30pm to receive all of the Rituxan, but I never had any of the chills, fever, rashes, or other adverse reactions to it. Throughout the first several hours, I chatted with Daniel, Jason, and Victoria, ate lunch, did some work, responded to emails/texts, and read magazines and books. Before starting the Vincristine (the O in R-CHOP), Victoria did another flush with sodium chloride and gave me more Tylenol and my first dose of Prednisone (100mg). She cheered and hugged me and told me we were on to the easy part with only three more drugs that should take less time together than the Rituxan took alone. I got through the Vincristine in less than an hour, and then had to be moved to another pod area prior to starting the last two drugs, due to the nurses’ shift change. In the same lovely affection Victoria had continually shown me throughout the day, she hugged me and told me how well I had done all day and that she was looking forward to seeing me a gain in a few weeks.
Nurse Angie in the same cheery nature as Victoria helped me grab my bag and rolling IV rack of chemo-drugs and walked me over to the “wild side” as she called my new pod where I would finish out my first day of infusion. After I got settled in, I received the doxorubicin hydrochloride (called the “red devil”, because of its bright red color and side effects). It was pushed into my line from a very large syringe by one of my nurses over the course of about 10-15 minutes. Again, I had no side effects, so we started the Cyclophosphamide, which was administered over the course of 30 minutes, and was expected to cause me to at least have a runny nose and itching, burning, and watery eyes. Again, I defied the odds and made it through my last drug without any allergic reactions. Elizabeth stopped by to check on me and see how I had handled my first day of chemotherapy, and also expressed her surprise that I had made it through all four drugs without incidence. She also said that she thought that was a good predictor of how she thought I would handle the side effects between cycles. I was diligent throughout the day on ensuring I drank over 3 liters of water and tea to really flush my system, stay hydrated, and lessen the side effects.
After one more sodium chloride flush, we packed up and headed out to dinner. I left the hospital relieved that I had not had any major reactions and that I finished the entire infusion in under six hours, instead of the expected eight. While we were having a great dinner at Lantern (where I sadly started the habit of avoiding wine, sushi, meats cooked less than well done, and the numerous other things I like to eat and drink that present too much of a risk of infection/illness for my newly depleted system), I had a sudden hot flash and remedied it by standing outside without a coat for a few minutes between courses. Although I was ready to remove every article of clothing to cool down, I found this one minor effect amusing rather than worrisome. We finished dinner, stopped by the pharmacy, and then settled in for the night.
I went to work on Wednesday and felt great outside of a little nausea around 4:00pm, but I took one of the anti-nausea pills Dr. Park gave me and felt fine by the time I left work, and went to the gym. Daniel and I cooked dinner together, and I snuggled up with Annabelle in one of the living room chairs and fell asleep by about 9:30. I woke up Thursday morning and headed into work. When I got into the office, I felt a bit tired. I thought I would perk up after eating my yogurt and having a Diet Coke. I continued to drag throughout the day, which I found quite frustrating, because I realized it was the fatigue Dr. Park predicted I would start to feel. I thought I could overcome the fatigue with will and mind power, and I quickly found out that was not possible. Determined to not fall victim to the side effects of chemotherapy, I continued to work until we had to take Annabelle for a check up with the therapist, which went very well. She is expected to make almost a full recovery with some therapy and stretching at home over the next month.
I continued to push through the rest of the day, striving to make it as routine as possible with a 45 minute cardio session, but I left the gym without the extra pep in my step that I normally have after a couple of mile run and light weight lifting. I had enough energy left to go eat pizza with Dan and Jason, and then resumed my position from the night before, curled up in a chair sleeping with Annabelle. I slept for over eight and a half hours Thursday night, and woke up Friday morning still feeling quite tired. I went through the same thought process of the morning before expecting to perk up after yogurt and Diet Coke, but instead found myself struggling to hold my head up as I sat at my desk. I had to leave work around 12:30, because I could not push through the wall I had hit. After having lunch, I snuggled up on the couch with the girls and woke up a couple of hours later to Dan unloading groceries. I slightly revitalized and spent the rest of the night cooking an butternut squash and chickpea curry with Dan, then eating with him and Jason and watching basketball before falling asleep pretty early again. I had much more energy Saturday and was in for a full fun day. Jason and I had one last meal with Dan at Dos Perros (which was the perfect blend of my love of Mexican food, puppies, and a puppy themed restaurant, like my favorite Fred‘s from home) prior to dropping him off at the airport.
The rest of Saturday continued on the happy trend. Kat was in town, and we walked over to UNCG in the awesome upper 50 degree sunny weather to go to the Ebix Charity Challenge, which was hosted by John Isner and benefits the UNC Lineberger Comprehensive Cancer Center. After a fun afternoon watching Isner, Blake, and the Bryan brothers play raising money for Lineberger (where I’m being treated), we walked back downtown for some tacos and spent the rest of the evening enjoying each other. The weather on Sunday was incredible: upper 60s and sunny in February! It seemed to be reflective of how I felt, and was a perfect day for getting up early to have breakfast with Kat before she had to leave and then getting some work done around the house, so we could spend the afternoon playing an hour and a half of tennis, reveling in the sunshine and how great I felt. I hoped that I would continue to keep my normal energy levels as I started the week today, but found myself dragging slightly today at work. I continued in the mindset I’ve been taking of not letting the side effects become my focus, and using every bit of strength I can find to push through and maintain normalcy, so I went to a HIIT class after work. I feel pretty lucky in the scheme of side effects in my first seven days of treatment since I’ve only mainly had a bit of fatigue and the slightest nausea. Otherwise, the only other effects I’ve experienced thus far is a constant headache, and on Saturday, I started to notice a bit more hair in the drain than normal and a bit of sensitivity in my mouth, which were anticipated. Based on norms and what I’ve been told, all of these effects will likely worsen as I get deeper into treatment, but I am focusing on the short term nature of all of these and my ability to handle and control them and my reactions to them.