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Reflections on Chemotherapy

When I began chemo five years ago, my oncologist told me that her goal was that I would get through treatment and say, "That wasn't as bad as I expected it to be."

Chemotherapy is a systemic treatment meant to kill cancer cells, but it does not discriminate between cancer cells and other fast-growing cells, which is why it changes blood counts, disrupts hair and nail growth, and causes mouth sores. 

My chemo regimen began with four rounds of dose-dense Adriamycin (also known as the “red devil” because of its coloring) and Cytoxan, administered at two week intervals. The Cytoxan was infused by IV, but the vial of Adriamycin was shot directly into a vein. Each infusion lasted about two hours.

Adriamycin causes hair loss within two or three weeks of the first dose. My oncologist cautioned that hair loss was imminent, and like clockwork, the first tufts came out in my hand the day before my second dose. It was the strangest thing—one day my hair felt like hair, the next, it was brittle and dead.

I lost the rest of my hair over the course of treatment—eyebrows, lashes, body hair—all but a few stray strands that managed to stay attached to my scalp. I discovered that I had a tanned triangle of freckled skin in the area where I used to part my hair.

My scalp itched and burned like it was ablaze. Dandruff shampoo and self-massage with jojoba oil soothed it some. It also had a surprising number of sweat glands in it, a fact that I quickly realized when, unfettered by the working hair follicles that had always mopped up, I found streams of saltwater running down my face and neck in the summer heat.

Adriamycin is known for its nausea-provoking effects. My premeds (infused just prior to the chemotherapy) included a potent anti-nausea drug, Emend, which was also taken by mouth for the first two days after chemo. I also had Compazine pills to take as needed to manage nausea, but I’m happy to report that I only needed to use them twice. The rest of the time I was able to control my stomach upset with home remedies like seasickness bands and crystallized ginger.

I gained a minimum of four to six pounds immediately after treatment, likely from the steroids that were part of my premeds, and the puffiness didn’t dissipate until the following week. It was annoying but livable, as was the chronic fatigue that made naps a part of my daily routine.

Another major side effect, this one caused by Cytoxan, was a perpetual metallic taste in my mouth. All sugary treats tasted sickly-sweet and were enough to induce nausea. The lining of my mouth was easily irritated, so I had to avoid even mildly spicy foods. I also had to change mouthwashes. I found that Therabreath, an alcohol-free rinse made with straight peppermint oil, was the only one that didn’t make me gag.

By my fourth dose of the Adriamycin/Cytoxan cocktail, the mere thought of the infusion was enough to make me retch. I was more than ready to be done with it. I’d entered menopause, suffered a cold sore that took three weeks and an anti-viral medicine to heal it, developed heartburn so severe that it required a prescription-level antacid, and started regular use of an inhaler to manage shortness of breath.

I switched to another drug—Taxol—for my remaining four treatments. Also infused at two week intervals, Taxol had the potential to cause an allergic reaction, so every infusion was preceded by a shot of Benadryl in the IV. The Benadryl left me loopy, which was fine because the IV had to drip very slowly to minimize allergic potential. Each Taxol infusion took three to four hours, which gave me time to sleep off the Benadryl.

The beauty of Taxol was that it didn’t turn my stomach, so I no longer needed the anti-nausea meds. The trade-off for this reprieve was that I now had to contend with neuropathy, numbness and tingling in my hands and feet. It wasn’t too bad after the first infusion, but grew increasingly worse over the course of treatment.

I also experienced one of Taxol’s less common side effects—intense bone and joint pain. It began on the day after treatment and lasted for a full week. The pain began at an excruciating, screaming level and gradually wore down to a dull ache as the week went on. Pain meds barely made a dent. The treatments I found most effective in providing relief were gentle forms of exercise like walking and swimming, and good long soaks in a hot tub.

Most of the side effects are now a distant memory. My hair came back brown and shiny in shade that suits me. I have a handful of grays, but honestly, they don’t bother me in the least. Texture-wise, it’s still thick and fine, and it frizzes in humidity just the way my previous hair did. It did come back curly, but adding some length to it straightened out the kinks.

I have full sets of brows and lashes again, though the lashes are sparser than I remember. The dark chemo rings in my nails gradually grew out in the year after treatment. It took a bit longer for my mouth to return to normal, and I still have to avoid mouthwash with alcohol and overly spicy foods to minimize sensitivity.

I have lingering neuropathy in my fingers and toes. It comes and goes, but makes running and walking trickier because I don’t always feel where my feet are and have a tendency to trip on uneven pavement.

I’m also troubled by a touch of chemo-brain, which mostly affects my language skills (I lose nouns with frequency and my train of thought goes off the rails with regularity) and my short-term memory (multi-tasking is a thing of the past and I now have to write everything down).

But, as I approach the five year anniversary of my final infusion, I can't complain. Though chemo definitely posed its share of physical and mental challenges, it was--overall--endurable.


And you know what? My oncologist was right. It wasn't as bad as I expected it to be.   

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