What is Taxol?

taxol

Taxol (Paclitaxel) is a taxane and it is one of three commonly used medicines in chemo treatments for breast cancer. Taxol actually comes from a tree, the Pacific Yew, which is very slow growing and quite uncommon. Taxol works within the cancer cells by “confusing” the process of cell division (scientific term- it is a mitotic inhibitor) thereby stopping the cancer from spreading.

Like other chemo drugs, it targets rapidly growing cells, which includes not just cancer cells, but also hair follicles, intestinal cells, bone marrow cells (where red and white blood cells are produced). It doesn’t just kill all of those types of cells- it actually kills any cells that are in the process of cell division. Not all cells in your body are dividing at any one time. But faster growing tissue have a greater proportion of their cells in the stage of cell division than slower growing tissue. So the chemo med comes in and kills off the ones that are trying to divide, both cancer cells and normal cells. Your body can easily replace the normal cells that died from the chemo, but the cancer cells cannot regrow.

The next dose of chemo then kills another bunch of dividing cells, and again the number of cancer cells in your body are reduced. Over time, the treatments kill off more and more cancer cells. Your normal body cells recover over time, but the cancer cells can’t. The goal of chemo, of course, is to kill all the cancer cells, but in my case, since I am having neo-adjuvent chemo (chemo prior to surgery), there will likely still be a lump left in my breast that they will then remove during surgery. The hope is that the chemo shrunk the cancer small enough that the surgeon can remove all of the remaining cancer with clean margins (i.e. they take just enough healthy tissue around the cancer to ensure they did get all of the cancer) and that the chemo killed any “floating” cells of cancer that may have broken loose from the lump and are floating around trying to start a new lump elsewhere.

Taxol side effects are pretty similar to other chemo meds- although the nausea is much less, there is still hair loss, GI issues, low immunity, fatigue and weakness.  Then there are added ones that the other meds don’t cause: nerve issues- like shooting spasms of joint pain, tingling and numbness (called peripheral neuropathy, which is sometimes permanent 😦 ). I had those things but luckily it went away after 5-6 days.  Some unlucky people (like the lady I sat next to- see People of Chemo – Part 2) have hypersensitivity to Taxol resulting in things like flushing, heart rate issues, increased blood pressure, etc. They give you a high dose of benadryl and steroids before giving you the Taxol to try to prevent these reactions.

I just had my 3rd Taxol treatment yesterday. Starting already to have a sluggish GI with a little queasiness. Today I had my neulasta shot (to boost blood cell growth) so I expect the flu-like pain to start this evening 😦 Tomorrow the joint pain will begin. I did learn after my last treatment that if I keep moving, pain or not, it seems to be more manageable. The hot tub is a good pain reliever as well. 🙂

The good news is that I have only one more chemo after this! I already have my post-chemo mammogram and my pre-surgery appointment with my surgeon scheduled. One more step forward 🙂

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The People of Chemo – Part 2

My treasured beads from Carmen The Bead Lady

My treasured beads from Carmen The Bead Lady

Yesterday there was a new puzzle. This one was a hard one, and I was only able to place a few pieces. While I worked on it, I thought about Carmen.

Carmen is the bead lady. She usually comes on Wednesday for chemo, so I’ve only seen her a couple times. Her son brings her, and he carries all her stuff, including a big bag with her beads.

She makes necklaces and bracelets out of these big bright colorful beads. When she comes into the Cancer Center she gives a new bracelet or necklace to each of her care providers and then sometimes hands them out to fellow patients as well. I was the happy recipient of a bracelet one day while I was getting my chemo.

After she left, I talked with one of the nurses. Carmen’s son had told her he goes to Michael’s Craft store and buys big bags of beads for her so she can make all of these strings of beads. She works on them all the time and gets great joy out of giving them as gifts. So, if she offers them to anyone, they know not to turn them down.

I think about that – how she is fighting cancer and uses her time to make something just to brighten another person’s day. I have all I can do to just make it through my own struggles. I don’t have a lot of extra to give to others, or to worry about much more than myself. Carmen must have a much bigger heart than I do.

During the 4th of July week, I had treatment on Wednesday instead of my usual Thursday because of the holiday week, and I expected to see Carmen. While I was there, one of the nurses got a call and she told me afterwards that Carmen wouldn’t be able to come to chemo that day because she had some sort of medical issue and had been taken to the hospital.

I have not yet heard how it turned out, although yesterday I was told she wouldn’t be back for a while. They can’t, of course, tell me anymore than that. I said a prayer for her and her son and I thought of the beautiful string of beads at home.

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Yesterday, a lady sat next to me in the treatment room. We barely talked but exchanged a few things, like – “geez I hate to be a kleenex hog but I really need this box next to me”. (There are a ton of things that chemo does to your body and your life that you wouldn’t know about unless you’ve gone through it. 😦 )

A few minutes into her chemo treatment, she suddenly exclaimed to the lady who had come with her that she was feeling very flushed. Her companion called out to the nurse who came right over. She was having a reaction to the Taxol (so Taxol is actually a tree product. See: Taxol). She had pins and needles throughout her body, and the nurses stopped her I.V. immediately while someone ran for the doctor. The doctor and residents came rushing in and I asked if I should move, so one of the nurses helped me relocate across the room  to give the medical personnel  more room.

They checked her blood pressure and gave her some medicine (not sure what) and watched over her. I could hear her gasping and then vomiting 😦

I felt so bad for her and her companion and wanted somehow to comfort her, but of course, it would require me to drag my I.V. trailer across the room and I would be in the way of the doctors, residents, and nurses that were coming and going as they tried to help her. Then Jane (a staff member) came in and patted and rubbed the companion’s back and asked if she was okay. The nurses and staff here are so incredibly caring. As a cancer patient- you really really need that.

After a bit things calmed down and she seemed to be resting. But, damn! This was supposed to be her second treatment of Taxol (usually you are given 4 of them total for breast cancer). It may be she has to discontinue the Taxol. Not good. I said a prayer for her and hope for the best. Seems I am praying a lot lately.

The puzzles

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In the waiting room there are some small tables and they leave puzzles out on one or two of them. I always sit at one of those tables and work on a puzzle while I’m waiting to be called in. Some people come in to one of the regular chairs and just sit there, some sit pointing towards the t.v. where a news program is always on. I always sit at a puzzle.

I wonder about why they leave them. To keep people busy, maybe keeping their mind off of the reason they are there? Why do some patients not take advantage of the distraction? When I sit there, do people wonder if I am looking to be distracted?

My Grandma Green used to bring puzzles to our house when I was a girl, and we would lay them out on our dining room table (which we only ever used when we had a holiday get together, or for puzzles). They were always these very small pieced, hard to do puzzles and we would spend weeks, a little bit at a time, working on it until it was completed. Then we would start another. There are two things I know for certain that I got from my Grandma – my love of puzzles and my love of books and reading.

I think there is more to the puzzles in the waiting room than keeping people busy. It’s the circle of life. At a puzzle table is where I met Mary (People of Chemo) and where we discussed life, choices, and death.

When I sit down to work on one of the puzzles, the first thing I do is see what has already been done. Are the edges all put together, nice and organized and ready to be filled in? Did someone undo the pile from where the box had been dumped and turn them all over yet? Has anyone separated the pieces out by color and by texture? Sky blues and  tree branches at the top, grassy greens, flowers or ocean blue waves at the bottom?

While I sit there and start my contribution to the rebuilding of the scene that the puzzle depicts, I think about all the others who have worked on it before me. Are you an organizer? Did you sit here and enjoy putting all the similar colors in a group and not put any pieces together? You made it easier for others to start piecing things. Did you succumb to the draw of the easy to find edge pieces and get satisfaction of piecing the boundary that all others who come after you will have to fit their pieces into? Or like me, do you waver back and forth between finding a small pile of like pieces and then working your way through them to see if any of them fit together? Small contributions at a time that may not be as easily noticeable by the next person, but important progress nonetheless.

When you sat working on the puzzle before me, did you think about your cancer? Did you think about your kids? How are your treatments going? You’re gonna make it through, I want to tell them all. You can do this. We  are sisters and brothers in this fight, even if the only thing we ever know of each other is what we contributed to this puzzle, and the reasons why we are each here.

Today while I sat there, I thought of Mary. Is she the one who separated out the green grass pile on this puzzle?  What did she think about while she did it? Has she heard the words yet? You need to do chemo again to fight off your cancer again. Has she told the doctor ‘no’ yet? Has she told her family of her decision? Are they anxious, worried, sad – wishing selfishly that she would continue her fight? Do they understand why she said no?

See? It’s the circle of life.

I’d rather have the pain than the nausea

I know that I said this. I really did. But wow! Ouch, ouch, ouch!

Friday night I was getting a little stiff-necked as usual.  That usually is bad on Saturday, and eases upon Sunday, gone by Monday. I woke Saturday thinking maybe I’d slept through the worst of it. I spent a little time sitting at the counter at my computer and suddenly realized that my elbow was raw. From barely leaning on it at the counter for a little while. Ugh! It peeled a dime-sized piece of skin off like a blister.

As the day progressed I got more and more sore. This time, not just muscles in my neck, jaw, and back, but deep shocking spasms of pain in my joints and bones. Mostly my hips, knees, and ankles. I have been hobbling around for the last two days, barely able to walk. I can’t sit, stand, or lay in any position for more than a minute or two without being rocked by sharp pains that jerk from my joints into my leg bones. I only slept last night for an hour or so before waking in such pain, without any position to turn to that didn’t hurt. 😦  I ended up coming upstairs to get the heating pad and tried sleeping on the couch with it. I tried the old ‘pillow between the knees’ pregnancy trick. I tried ibuprofen and tylenol. I switched sides, I switched pillows, I switched couches. I tried lying flat on my back, then all scrunched up, and in between. I even tried sleeping sitting up. I am not ashamed to say I lay there sobbing the rest of the night. 😦

Today was no better. I had hoped it would ease up some, but no luck. Before Tim and the kids left for church, he took the cover off the hot tub so I could soak in it while they were gone. I sat on the deck for a while first, hanging out with Zeus (the dog). I thought it would be a nice pleasant time for him and for me to enjoy the morning… I was thinking to myself- gosh I am so tired I could fall asleep if I just didn’t hurt so bad. I thought if I went into the hot tub and fell asleep, maybe I’d end up drowning accidentally. I had leaned back in the chair for a moment and closed my eyes. Then I heard a splash. Yes, Zeus had fallen into the pool. In the deep end. Where I couldn’t reach him. He was panicked, and so was I. The solar cover was stlll on, so there was no room for him to swim and he had simply hooked both front feet up over the edge of the pool and hung there.

I ran to the upper deck to try to grab his collar and pull him forward enough that he could get his feet up onto the deck, but he’d fallen far enough over that I couldn’t reach him very well. I then ran over to get off the deck and around the pool to reach him from the outside. But of course, I’m too short to get a good grip on him, and had no strength due to the chemo to reach up and over the edge of the pool to get to his back feet. So I pushed him over as far as I could towards the edge of the deck (his front paws clinging tightly to the metal edge of the pool as tightly as he could), then ran back onto the deck to try to pull him up. He’d slipped back down into the pool a little, but I was finally able to pull him up onto the deck. We both lay on the deck, soaking wet, and panted for a few minutes to recover. 😦

There were a few moments when I was trying to get him out where I honestly did not think I had the strength to continue. I was certain he would drown. That’s not to say that I wouldn’t have jumped into the pool, clothes and all, to try to get him to let go of the wall so I could pull him into the shallow end where the ladder is. But I am not certain how well I would have fared if he’d fought me from fear.  I am so weak that it’s pitiful. When I finally recovered from the shock and could breathe again, I looked into the pool and realized he’d gouged two holes in the pool liner where he’d been digging wiith his back legs to try to get out. I cried. And cried. And cried.

Then, once I’d rested a bit, the adrenaline faded and the pain in my hips and legs came back into sharp focus. I decided I would soak in the hot tub for the heat and the weightlessness to try to relieve some of the pain. It had really helped for a while yesterday. When I put my foot in, I realized that it was extremely hot. Somehow the temperature knob had gotten turned as far as it could go to ‘Hot’. It was over 112 degrees. I put my feet in but it was so hot, I couldn’t soak in it to relieve my pain. I cried some more.

I had tried to call my doctor to see if they could prescribe pain meds, but no luck. They said they couldn’t do anything for me until the clinic opened tomorrow. The on-call doc said to use ibuprofen and tylenol, which I’d obviously already tried without relief, and if it got too bad to go to the ER, where they could prescribe something. 😦 So, here I am at bedtime with the same miserable pain tonight.:( Andy and Chris rubbed my back for a few minutes before bedtime. Reagan rubbed my legs, just like she did last night. They offered all on their own 🙂

Tim was able to patch the holes in the pool liner fairly easily. My babies are trying to take care of me. And I don’t have any nausea. 🙂  Life is still good, right?