Exhaustion

Even if you or a close loved one have never been diagnosed with cancer, chances are we've all faced the strain of dealing with a serious illness in one form or another. Even just the fear of a potential serious health issue is enough to send anyone into a tailspin. As Christians, we know God is in control and trust that whatever comes, it is not only part of His plan, but He will carry us through it. Practically speaking, though, even the most faithful and optimistic of us still feels the strain of facing a battle with serious illness.

It's only been ten years, but I don't remember feeling quite this... tired the last time I was told I had cancer. Not really physically, but mentally and emotionally. Honestly, I'm struggling to not feel pointlessly guilty because Mark's going to have to go through this with me. If you read my thoughts during my breast cancer journey, I commented that I found it infinitely easier to be the patient than the caregiver. If you've never been either, let me assure you that being a caregiver for a cancer patient is exhausting in every conceivable way. It's a strain physically because you have to do twice as much as you're accustomed to doing. It's exhausting mentally and emotionally as well. 

Cancer is a a monster, but so is the treatment for it. Chemo comes is too many forms to list. Every kind of cancer has it's own stable of chemotherapy drugs to fight it. None of the ones I'll be taking this time around are ones I took for the breast cancer. They come with entirely different potential side effects. Except for the nausea. That seems to be almost ubiquitous. Still, last time around, I had virtually zero issues with nausea. Never vomited once. Last time I had to have a port implanted in my upper chest because one of the drugs (adriamycin) was so caustic that it literally could destroy any tissue it came in contact with outside the main vein it was injected into. This time around, assuming my veins hold up, I won't even need a port at all. 

The chemo protocol I'll be taking is called CAPOX. The CAP portion of the regimen is Capecitabine. It's given in pill form. Side effects include:

• stomach pain or upset stomach
• constipation
• loss of appetite
• change in ability to taste food
• increased thirst
• unusual tiredness or weakness
• dizziness
• headache
• hair loss
• skin rash
• back, join, or muscle pain
• red, swollen, itchy, or teary eyes
• trouble falling asleep or staying asleep

 The OX portion of the regimen is Oxaliplatin. It's an iv infusion. Here's the basic list of side effects:

• numbness, burning, or tingling in the fingers, toes, hands, feet, mouth, or throat
• pain in the hands or feet
• increased sensitivity, especially to cold
• decreased sense of touch
• nausea
• vomiting
• diarrhea
• constipation
• gas
• stomach pain
• heartburn
• sores in the mouth
• loss of appetite
• change in the ability to taste food
• weight gain or loss
• hiccups
• dry mouth
• muscle, back, or joint pain
• tiredness
• anxiety
• depression
• difficulty falling asleep or staying asleep
• hair loss
• dry skin
• redness or peeling of the skin on the hands and feet
• sweating
• flushing

My treatment will involve a two-hour infusion of the Oxaliplatin at the infusion center and two weeks of taking Capecitabine by mouth twice a day. Then I will have a week "off" before returning to the Cancer Center to repeat the regimen. I'll do this four times, for a total of three months, if I don't have any serious issues with the protocol. If I react badly to the oral chemo, I'll have to switch to the iv version of the protocol, called FOLFOX, which would take a total of six months to complete. 

The last time around, I prepared for all the worst case scenarios so that I wouldn't be caught off guard if they came to pass. I'll do the same this time while hoping and praying that things will not be as bad as the warnings say they can be. From discussions by countless other patients, I think it's a safe bet that the neuropathy (numbness, tingling, pain) in my hands and feet is pretty much a given. The severity is completely unpredictable, as it is different for everyone. The hand and foot syndrome (peeling of skin on hands and feet) is another issue that crops up. I've already started an intensive moisturizing campaign for both my hands and feet in the hopes of heading it off. Hair loss is actually fairly rare. Looks like I'll probably get to go through this without being bald, though that's honestly the one side effect I truly didn't care about. All things considered, being bald was the last thing on my mind. 

As before, I'm weirdly most worried about the nausea. I absolutely loathe feeling queasy. I mean, of all the issues chemo and the array of treatments meant to counteract the side effects it causes can trigger, nausea is the one that I simply cannot abide. Last time around I had no issues. I felt mildly nauseated one time after treatment, took one tablet to counter it, and never had to take anything else for the duration of my treatment. God willing, this time around will go the same. 

The Word No One Wants To Hear

Sigh.

I reached ten years since I was diagnosed with breast cancer last year. 2020 wasn't the sort of year to celebrate anything with any kind of fanfare. It was just a quiet, routine visit with my oncologist that involved her telling me that I didn't need to see her again, that my family doctor could monitor me from this point on. So I saw my family doctor for my routine annual wellness exam, which included routine blood work, and I got a call a couple of days later letting me know I was anemic. That required another relatively routine test as well as commencement of taking an iron supplement. I've done this test before. It's called a FIT Test and involves testing a stool sample for evidence of blood. Another couple of days and I got a second call telling me it was positive. 

Interestingly, the medical powers that be have altered the recommended beginning age for routine colon screening from 50 to 45, so my family doctor had already set up an appointment with a gastroenterologist for me. I saw her nurse practitioner, who told me that even though it is now recommended that we all get screened at 45, insurance companies have not adjusted to the new recommendations and would not pay for a screening colonoscopy. That positive fecal occult (hidden/not visible) blood test meant I was getting one anyway, though. So, I had that done on Monday, January 25. The doctor told me then that she'd found multiple polyps in my colon and removed several and a few pieces of one that was too big for her to take out that she believed would be cancerous. A few days later, the call confirming her suspicions came.

Cancer.

Again.

The first step regardless of biopsy results or anything else was to have the section of my colon with the malignant polyp removed, so I met with the surgeon, who scheduled a CT Scan to get a look at my chest and abdomen to confirm there were no distant metastases of the cancer. That came back clear, and last week I went into the hospital to have part of my sigmoid colon removed. He removed just over 5 inches of my colon along with several lymph nodes to have them biopsied for evidence of metastasis.

I spent Wednesday, February 24, and Thursday in the hospital, then got to come home on Friday, the 26th. I'm recovering more rapidly than I expected to. My abdomen is still tender, especially when I try to bend over, but generally speaking, I'm getting around very well and having no real issues at all getting back to a "normal" diet, though I'm still avoiding anything tough to digest like raw vegetables and nuts and spicy foods, which sucks because I love me some spiciness. 

So, yesterday, Tuesday, March 2, I learned that one of the thirteen lymph nodes biopsied came back positive. Just one out of thirteen, but that one makes all the difference in the world. Because of that one positive lymph node, my cancer staging leaps from 2 to 3. Because of that positive lymph node, I go from probably not needing any further treatment to facing 3-6 months of chemo. 

I have stage IIIa colon cancer. 

I'm limited in how much research I can do until I see the oncologist because there are multiple options for chemo protocols. Most likely is FOLFOX or CapeOx. These two protocols have one drug in common called Oxaliplatin. It's a nasty little chemical. I don't mind admitting that I am not looking forward to having to deal with it. It comes with a few side effects, primarily neuropathy, meaning pain, tingling, and numbness in the hands and feet that can last up to a couple of years after completing the chemo. If it gets really bad, the damage can be permanent. There are other side effects, of course, ranging from unpleasant to horrifying. I can only pray that I handle this encounter with chemo as well as the last one. 

I have my post op follow-up appointment with my surgeon next week. I should get the results of additional testing that is being done on the tumor then. Suffice it to say that if it comes back with unfavorable results, it will open an entirely new can of worms, so we're praying that what we already know will be the worst of it. I will need chemo, but rads are unlikely since we have no target for them. The point of the chemo is to kill off any stray cancer cells that may have moved beyond that one positive lymph node. I'll be seeing at least one oncologist sometime soon, though no appointments are made, yet.

 

As always, I am constantly aware that it could be much, much worse. It's cancer. It's chemo. It's a new journey into the unknown where we begin with a long list of potential side effects, many of them horrifying and nightmare-inducing, but all of them only possibilities. As before, I'll prepare for the worst and pray for the best. It's really all I can do.

Please pray for me, of course, as well as the doctors and nurses who'll be part of this journey. But make special mention in your prayers for Mark, please. As I've said before, it's infinitely easier to be the patient than to be the caregiver. 

Also, though the COVID-19 pandemic is generally considered to be plateauing if not on the way to it's conclusion, it's still not over. I will be starting chemo well before everyone gets a vaccination. I don't know if they'll give me a vaccination and have me wait a few weeks to start the chemo or if that's even an option. I know I will absolutely not be able to risk exposure once the chemo begins. Mark has a co-worker who was forced to take time off while his wife went through chemo because he could not risk being exposed at work and bringing it home to her. There are vaccines available now, though, so maybe we'll both be able to get one of them and then not have to worry about it. I just don't know, beyond the fact that COVID makes an already complicated process even more difficult to navigate. 

March is Colorectal Cancer Awareness Month, so it's only fitting that I end with a note about colorectal cancer screening. No one wants to talk about having a colonoscopy. I'm still a couple of months away from my 50th birthday, which is apparently when at least most insurance companies will pay to have screening done. By next year, I assume insurance companies will have caught up to the new guidelines about screening at 45. Either way, I advise everyone to talk with you doctor about getting the screening as soon as you're eligible. It's nothing to be embarrassed about and honestly, it's no big deal. The worst issue I had, by far, was the liquid prep solution. I'm hyper sensitive to flavors, especially the artificial sweeteners that are used in almost everything these days. The prep would have been fine if they hadn't tried to "flavor" it. I almost didn't  get it down. For my surgery I got to use a pill and Miralax prep that was infinitely easier. I'll need colonoscopies far more frequently from now on, possibly every year, but I'll never do the liquid prep again. 

Other than having to choke down several ounces of an overly artificially flavored and sweetened drink, though, the colonoscopy was a breeze. I just wish it had come with a better result. So, get screened. Tell your spouse to get screened. Make sure your parents get screened. If they find nothing, you don't have to repeat it for ten years! Trust me when I say it's worth having a simple test you may find embarrassing to avoid the process I'm now going through.