THP

That stands for Taxol, Herceptin, Perjeta, although I actually receive them in the reverse order.

Week 1 of chemo is an experiment for everyone. It’s my first time receiving these drugs, so no one really knows how I’ll respond. It’s the first time Husband and I have been in the infusion center at DF, so we are meeting all the nurses for the first time. This is the most obvious statement of all time, but I’ll go ahead and say it: that first chemo treatment is horrifying.

That said, I was pretty amazed by all they do to make patients comfortable.

The visit starts with a measurement of my

This was actually a thing.

weight and height. It’s critical to have up-to-date measures each week, since the medicinal dosage is based on body surface area. One of the side effects of my rapidly dividing liver tumors was a significant loss of appetite, which means that I’ve been steadily losing weight. NOTE: I do not recommend this weight-loss plan. It’s stupider than the Cigarette Diet.

A few minutes later, Husband and I were ushered into the infusion center, which consists of 4 or 5 large rooms, each separated into small individual units by large hospital curtains. I was directed to a big chair outfitted with massage and heating functions. Husband’s chair was not so great, but he endured. (My word, not his!) Perhaps because it was our first time, or maybe just because we got lucky, our Week 1 position happened to be along the outside wall, giving us a fabulous view of the Boston skyline through the large plate glass windows.

Then began the parade of visitors/caregivers. First my chemotherapy nurse, M, who is absolutely wonderful. I was raised by an RN and spent a good deal of time surrounded by nurses as a kid. I have immense respect for this profession, and I know that a good nurse can make a great difference in a person’s medical outcomes. M is one of those special nurses who immediately put me at ease with his competence, curiosity, and compassion.

 

 

He explained that things would unfold slowly over the day, according to this plan:

• pharmacy prepares my THP infusions based on the weight/height data
• M delivers the pre-meds (anti-nausea, steroids, etc.)
• Perjeta infusion followed by observation period
• additional pre-meds as needed
• Herceptin infusion followed by observation period
• additional pre-meds as needed, including Benadryl
• Taxol infusion

I would only get this “long treatment” every 3 weeks, with Taxol-only infusions every week. All told, we could expect the long THP day to take a good 4-5 hours, in addition to the 4 hours or so of driving we had to get to and from Boston. Alrighty, then!

While we waited for the pharmacy, a volunteer came by to offer me a hand massage! I happily accepted. She has been volunteering there for six years, and gave us the low-down on the many services volunteers provide. They come by with snacks (yogurt, goldfish crackers, etc.), lunch (itsy bitsy little sandwiches suitable for chemo-sized appetites, etc.), and books and magazines.

M periodically came over to check on us and see if we needed anything, until finally the show got started. The Perjeta infusion went beautifully! Nary a problem and I felt just fine. I was feeling very confident at this point.

Then Herceptin. Oh boy. Almost immediately after the infusion started I felt a warm flush in my throat and into my stomach, much like the feeling I get from a contrast injection during a CT scan. I was quietly observing these sensations, trying to determine whether they were real or imagined, and whether they were a problem. M told me before each infusion what I might expect in terms of sensations, and he didn’t mention this flush. I then noticed a mild feeling of nausea and a growing pain in my back, so I hit the call button to alert M.

Ok, he said. Let me know if it becomes more intense.

Within another 5-10 minutes, it had. Before we knew it, a full-on exorcism started. Over the course of about 60-90 minutes, during which time they stopped and started the Herceptin infusion multiple times, I vomited, got intense chills that caused me to shake violently for 15+ minutes, and spiked a 103 degree fever. During all of this, there were at least 5 nurses who came by to assist in various ways and they threw a bunch of meds at me to slow or stop the various reactions.

They called down Dr. M at some point in the madness and he said something like, “this could be happening because the meds are already killing cancer cells.”

In my drugged-up, demon-ridden stupor, it seemed that the nurses looked at him a little dubiously, but they didn’t argue. I recalled Dr. M’s early statement that fast-growing tumors tend to respond very quickly, but this was ridiculous. Could it possibly start to happen this fast?

Once we finally got through the Herceptin infusion and observation period, we started the Taxol, which went well. They gave me a massive Benadryl dose at the start that knocked me out for the duration, and for the rest of the night.

So that was it. Week 1 down, 11 to 17 more to go.

Some good news here is that they give the largest dose of Perjeta and Herceptin in Week 1. Hopefully this means my response won’t be quite so crazy in weeks 4, 7, 10, etc.

The best news of all is that I started to feel better as of the very next day. I’m still amazed by this. The liver and back pain receded for the first time in months and weeks, respectively. I was tired, but had far more energy than I had in ages. Nurse M gave me a call to see how I was doing, and was actually surprised to hear that I felt so great, given my bad response to the Herceptin. I became a little more tired over the next few days, but still felt much better than I’d expected.

This past week , week 2, was a very busy one, starting with outpatient surgery to place a Power Port in my chest on Tuesday.

Image: http://www.bardaccess.com/assets/literature/0723905_PowerPort_Patient_Guide_web.pdf

The port is a way to avoid having IVs placed in my arms or hands each week. My once great veins have already become pathetic from past cancer treatment, and chemo is sure to make this worse. The Power Port is like an artificial vein. It’s a small plastic triangle placed under the skin, which connects to a catheter directed into a large vein near the heart. They can use the port to take blood samples as well as deliver meds. It’s far less painful than getting poked for a regular IV (IMHO), but they even make a special numbing cream for use over the port if needed.

The next day was Taxol day, which went very well. They halved the Benadryl dosage, which left me sleepy, but not zombified like last week.

The best news of the week is that my appetite started to return as of Wednesday night. I’m still nowhere close to my normal level of hunger, but this is the first time I’ve wanted to eat anything more than a small cup of soup in quite a while. Also, the expected side effects have not yet begun to affect me. I think I’m in a Goldilocks zone right now where the cancer is responding to treatment (as Dr. M suspected), immediately lessening the effects of all those liver tumors. I know that things will get more difficult as treatment wears on, of course, but I’m thrilled to be in this moment.

Finally, I had a visit with a social worker yesterday and those two MRIs (thoracic spine and brain) that had been scheduled a while ago. A friend and I were just joking about the fact that the MRI techs ask if you want to listen to music while you’re in the machine. I said yes, please. Classical. Of course, this had the ultimate effect of sounding like someone was using a jackhammer next to my head for an hour while the polite sounds of a piano plinked in the background. Not super relaxing, but you take what you can get when you’re wrapped up like a burrito in a hot, shaking, jackhammering coffin.

We’re anxiously awaiting the results of these new scans, of course. I will let you know, but I’m trying to stay positive. I figure we’re due for some good fortune at this point.

Husband and I went to visit a local azalea garden yesterday. They have countless varieties of both azaleas and rhododendrons there, with an array of colors that is both gaudy and perfect. Along the way Husband spotted this tulip tree. Clearly the gardeners had tried to stunt this tree’s growth, but it would not be stopped. That’s me, folks. I will not be stopped.

-xo