TCH #5 of 6: The Home Stretch!

Infusion #5 in— which means I am getting very close to the end! At this point, I have figured out ways to keep most of my chemo-related symptoms in check and I am obsessively rubbing my head to monitor for new hair growth (it is there!). I am also still going to the gym 3-4 times per week, including one strength-training workout with my trainer per week (I wear an arm sleeve during the exercise, but am not sure this is actually necessary).

At this point, the allergists have worked out a regimen that works well, including a slow infusion and pre-treatment with singulair and the tried-and-true aspirin. I have not had any problems since, but do get quite bored with the 10-hours of infusion time.

Side effects of TCH & Management

In general, the steroids part of the regimen remains the worst part for me (and my husband) because they make me batty. However, this only lasts for three days, and, because of the desensitization unit, I am no longer getting high-dose IV steroids, which helps a lot.

Other than the steroids, the other nagging symptom is the metallic taste on my tongue—it is fairly predictable, and very difficult to manage. The two strategies I have come up with are masking the taste (mint gum works well) and acupuncture. Acupuncture does not cure the symptom entirely, but I think it helps and is better than doing nothing.

Here are the rest of the symptoms I have experienced, and what has helped:

Bone pain (from neulasta): The major intervention that has helped with the bone pain is going to the gym. I do not do a hard work out, just relatively light and short cardio, but this keeps my joints from getting stiff and significantly reduces the bone pain. Plus, it was recently shown that regular exercise during chemotherapy and radiation is beneficial to cancer patients-- even during therapy. So there are many reasons to do it! Although in the past, the medical establishment has been reluctant to recommend exercise during acute illness, in nearly every setting in which it has been studied (post-MI, intensive care patients, others), exercise improves outcomes.

In addition to going to the gym, I have maintained pre-treatment with Claritin and naproxen, then Claritin x 4 days after injection and naproxen twice day for four days after injection.  I am not sure that all of this is actually necessary, but now that I have a system that works, I am reluctant to change it.

Dry eyes: Use of preservative-free eye drops on rare occasion, and acupuncture, which was recently written up in a major ophthalmology journal as one of the optimal treatments for this condition. Acupuncture has been demonstrated in many clinical trials to be a very useful adjunct treatment in chemotherapy symptom control; click on the links for a list of WHO-recommended uses and clinical trial summaries.

Peripheral Neuropathy: I definitely experienced some peripheral neuropathy in my infusion arm after the first infusion. This has been very well controlled (I have almost none at this point) with both B-complex vitamins and acupuncture.

Nausea: Overall, I have had very little nausea, but I am given aloxi prior to every infusion. What little nausea I do get is very well controlled by acupuncture.

Reflux: Pepcid once per day on the day of chemotherapy, and once per day for four days following each infusion.

Infusion #4: Past the Halfway Point!

Infusion #4 going in as I type.

This is very exciting, as our goal all along was to get in 4-6 cycles of traditional chemo. The major clinical trial was conducted with TCH x 6, followed by Herceptin for a year, however, more recently presented data suggests that 4 cycles is non-inferior to 6 cycles, and so, in my mind, I consider 4 a must and 6 ideal. But the great news is that I reached the minimum goal!

Back on the allergy unit again, which, while painfully slow, is honestly not that bad. For the second time in a row, I was able to avoid the high-dose steroids that are the worst part of the regimen for me. I would say the second worst part is the neulasta, followed by poor wound healing and a funny taste. The other symptoms are manageable. At this point, I have most of them under control with over-the-counter and complimentary- and-alternative medicine strategies.

As for how things have gone, each infusion has gotten easier. The first was definitely the hardest, mostly due to dread (as my very wise Godmother reminded me, the dread of something is often worse than the reality! And this has definitely been the case for chemo and me).  It was also hard because I did not know how to manage the symptoms that come with chemotherapy, and so my pre-and post-infusion protocol has gotten better with each round. Second was better than first, third better than second, and I am hoping fourth better than third.

And the really exciting thing?....

My hair is growing back!!

(And, in one of the greatest comebacks in sports, the Americans won 8 in a row to keep the cup home!)