My initial dose was over 2000 mg, but as mentioned in the last post, we had to reduce it in week 2 due to how low my counts went. We stayed on the 1580 dose through cycle 2, but due to my low counts, we reduced it on cycle 3 to 1350 mg. While we expected my counts to get better with the lowered dose last cycle, they actually went even lower than before. So, my oncologist is doing another reduction to 1060 ml to hopefully help with the counts. We of course need my treatment to be livable, but it does make me a little nervous that we have basically cut the dose in half. So, really hoping that it will still work for me at this amount. Balancing life and treatment is always a bit of a tricky thing.
This chemo affects many counts but white blood cells, red blood cells, hemoglobin, platelets, and neutrophils have been the major ones that have tanked for me. This causes me to be anemic and experience more fatigue than I've had in the past. I'm still able to work without a problem, but I am having to make some changes and adjust extra activities to ensure that I have the energy to do what I need to do. While I have some stomach issues, generally, it is pretty well controlled; so, the fatigue is the worst physical side effect that I deal with.
I can't really tell physically when the platelets, white blood cells &/or neutrophils (or ANC, it is how much your body is able to fight off infection) are lowered, but they are the ones that I have to be most careful about. Gemzar is apparently a platelet killer, and it has definitely been that for me. The lowered platelets create a bleeding risk, and then I have to be super careful to avoid cuts, avoid meds like NSAIDS, etc. The ANC has been going into mild & moderate neutropenia each cycle. Since your body can't fight infections when neutropenic you have to be really careful to avoid germs and getting sick. This makes me have to wear a mask, be careful of being in large crowds and even quarantine myself. The 2nd weekend tends to be the worst, & I've had to basically quarantine myself to avoid coming in contact with any germs during that part of each cycle. Because I don't feel bad during those times, it makes it harder to stick to being stuck in my house, but I know that the risk is too great to play around with it. My oncologist actually just walked by and said that at this new dose there is a chance that we can avoid going neutropenic. (Which of course I heard in the "so, you're telling me there's a chance" voice) I really hope that will be the case. I feel super self-conscious when having to wear a mask, but my students have been really good with rolling with it. I've even got a box of masks in the classroom I use most often, and they have been helpful by putting a mask on if they are feeling a little under the weather, etc. Wearing a mask and the dose reductions that have been done have helped me to be able to teach all of my classes and not have the chemo interrupt my work which I am so thankful for.
I will be having a PETscan on Friday 12/6, but won't get the results until a couple of weeks later. Its a longer than normal wait, but I am getting to take the trip to Israel with my parents that we had planned before I started this treatment. I'll have my week 3 off week for this cycle, and we will take a 1 week break and then restart treatment once I return. I am so thankful that my oncologist believes in her patients being able to truly LIVE their lives and make the most out of all of their time. This will be the first scan since the August radiation as well; so, we will be seeing how all of this has worked.
Please send prayers and/or good thoughts that this chemo & the previous radiation are working to keep things stable; a reduction would be even better, but in stage IV world stable is still a really good thing. If you could add in that the counts will keep me out of the most dangerous zones & avoid being neutropenic, I would greatly appreciate that as well. I'm so thankful to have a team that works with me and helps me have the best quality of life possible while dealing with the treatments.
