Cycle 2, Day 1 (Chemo – Gem/Tax)

Yesterday, Teresa started her second chemo cycle and received her third dose of gemzar (gemcitabine).

It was Halloween, so we dressed up. T wore her Top Gun jacket and kept her sunglasses (aviator style) on. I wore my Gryffindor robe (which kept me almost warm enough this time!). You can see us in a photo at the end of this post. You should be able to click on it to make it larger.

T’s doctor dressed up as Dolly Parton, but by the time we had our office visit, she’d gotten too hot and changed, so we only got to see a photo of her. Most of the staff were wearing something – either a fun hat or a full costume. A drug rep came by in full costume. It was a jovial atmosphere!

Usually all the premedications are in the drip bags, but yesterday, each one had to be slowly fed via syringe. The bags they use come from Puerto Rico, which currently cannot produce them, much less ship, so they’re under a shortage. Only her gemzar was in a bag.

She did not develop a rash from the gemzar in Cycle 1, Day 8, but it could have been all the dexamethasone she took for the taxotere. If it’s coming back, we’ll probably know by this Sunday evening.  One of the nurses told us though that it could just be an initial reaction to the toxicity of the chemo, and that it won’t repeat. She told us that this happens to a lot of people. No more rash would be great!

She is still not having any nausea. And, in fact, wasn’t even sure she’d know what nausea felt like, so one of the nurses described variations of nausea. Nope, not having that!

Hair Loss

Either shortly before or shortly after the gemzar infusion began, I noticed that Teresa was shedding more than normal. And a lot.

She was given an estimate of 2 weeks from Cycle 1, Day 8, for hair loss to begin. Yesterday was 2 weeks.

It is not coming out in clumps or anything, but you can see many loose strands; can even see them slip out at times. She is having some itchiness of her scalp, but it’s not severe. A gentle shampoo is recommended (although it’s also recommended you don’t wash your hair too often once it starts coming out, so that you don’t lose it faster than necessary), so I picked her up some Johnson & Johnson Baby Magic shampoo today.

Today we visited a nice wig store in Roanoke, VA. The owner fitted her for a wig Teresa really likes. She was also going to call Blue Cross Blue Shield to find out what they will specifically need to cover either most or all the wig cost ($425). She will call us tomorrow to let us know, and then we can call the Cancer Center to get a prescription faxed in for the wig. Although shorter, it looks a lot like her regular hair style and color. This first wig comes with a set style, which seems like a good starting point for getting used to having a wig. If she gets a second one, we’ll probably consider the synthetic ones which are heat-safe and can be styled. That way, Teresa could get one that really matches her current hair!

Iron Deficiency:

At Teresa’s last chemo session, she had blood drawn for several iron panels. The only one they didn’t do, which I’d specifically asked about was B12, so we’ll have that done next week.

Teresa has iron deficiency anemia, and has started taking ferrous sulfate once a day. The dietician also gave us a list of iron-rich foods. Several we were already familiar with, but there were some new ones too. They will check her again next week. If her hemoglobin is still going down (it’s down to 9.2), she will get IV iron.

Her platelets are still within normal range.

White Blood Cell count:

Teresa’s WBC is currently at 20.2. This is normal after Neulasta treatment, and is what we should expect with that medicine. The standard range is 3.5 – 11.0 K/uL.  The upshot in layman’s terms is that if you’re wanting to visit Teresa, this is a good time to do it.

Metabolic Panel:

Except for her bilirubin, everything in this category is in range. Also, her bilirubin has been steadily coming down over the last month, and is now only .2 above the highest end of the normal range.  

Vaccines and Other:

She is having occasional dry eye; I got her some Refresh Tears today.

A few weeks ago, she started experiencing the side effects of surgically-induced menopause.

As some people have said online about their own experience there, she won the menopause lottery: hot flashes and night sweats. ☹  Not the lottery you want to win!

My sister-in-law, Donna, recommended the book The Wisdom of Menopause (Revised Edition): Creating Physical and Emotional Health During the Change. She also gave me some good tips to pass along to Teresa, such as paying attention and seeing if what she eats coincides with the hot flashes/night sweats, and then eliminate trigger foods.

Both symptoms have eased off some, but there’s no way to know if they’ll come back around again or not.

If anyone has any other suggestions, for these symptoms, or others which may come later, we’re open to hearing them.

Dr. Musgrave said that if anyone has a live vaccine, there needs to be a minimum of a week in between the vaccine and visiting with Teresa. We’d be okay with more in case you develop a reaction to it (ex: blisters often happen with chicken pox and shingles vaccinations).

I asked if it was safe for me to get the DTaP vaccine booster, which is a good one to have if you’re going to be around people who either can’t be vaccinated or have a compromised immune system. She said it is (safe).

She has her next treatment (Cycle 2, Day 8) on November 7. We have to be there at 7:45am. ☹

Amanda (Gryffindor Robe) & Teresa (Top Gun jacket and sunglasses) on Halloween at the Cancer Center.

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