Okay folks, let’s talk about Chemo Day. Whether you’re just curious what happens behind those photos of me on Instagram, smiling and holding up numbers proving I can count (I know, I’m really proud too), or if you are anxious about chemo – hopefully this post helps you.
I’m going to write a separate entry on chemo side effects but if you’re anxious about chemo, I will let you in on a little secret that I hope helps in some way. Chemo day itself,…..is actually really anti-climatic. Most of the anxiety and fear towards getting chemo will be alleviated after the first infusion. Before that, I thought that the minute the chemo flowed in, I would be immediately rendered useless, have all the side effects mentioned and have to be dragged home comatose (I wish I was kidding, I was that dramatic and fearful.) It’s not like that, at all. Thankfully.
A “typical” chemo day for me has been something like this. As a reminder, I am on the TCHP regimen, a year-long cancer treatment with 6 infusions of the chemo (TC) portion spaced out at 21 days apart. Full treatment plan here .
8:00 AM (1 hour before chemo) – Take steroid pill and put on my Lidocaine ointment to help minimize the pain of needle insertion. You have to put saran wrap so it doesn’t get everywhere. By the way, this does not help me minimize pain at all nor does putting ice on it but I still do it anyways,..because I’m a rule follower.
8:45 AM (15 minutes before chemo) – I check in with the nurse, she sticks a wristband on me, like the ones you get when going into a bar. This is used to not only identify you as a patient but each of those little scanners in the photo below are for the medicine to make sure no one messes up and that you have proper record. After being deemed worthy of entry into the infusion center, I wait for my name to be called and then am lead in to be weighed. They LOVE weighing you. All the time, every visit.
9:00 AM (Chemo time) – I’m now lead to my chemo room, I put down my things and get comfortable. I’m lucky because Johns Hopkins Sibley Memorial has private chemo rooms for patients and their guests. Sometimes the infusion center is shared. I’m sure it’s just as comfortable but I appreciate the privacy. I settle into the recliner and the nurse gives me freshly toasted (!) blankets. My oncologist has 3 nurses that support her so depending on the week and time, I rotate through them but you always have one of the same 3 nurses that is with you through the infusion.
9:10 AM – The nurse comes in and brings me my liquid lunch for the day and starts entering things into the computer. She/he scans my bracelet and confirms a few pieces of information with me and then gives me a mouth mask and then steps briefly away to “scrub up” for the port IV injection.
9:15 AM – The nurse comes back and cleans off the Lidocaine and the port area with antiseptics. He/she then asks me to count to 3, breathe in at 2 and injects the needle into the port. This can go a variety of ways. From just a strong prick to being really, really painful. This last round was super painful and I cried a little bit. This picture caught me trying really hard not to but a few tears slid out. It really hurt, or I’m just a big baby when it comes to needles, verdict’s still out. The nurse will then put on a plastic clear sticker and gauze the area so everything stays in place during the infusion.
Now I’m hooked up and ready for my liquids. They start you out with your baseline needs. My liquid Ativan (anti-anxiety) and two different types of anti-nausea liquids. This takes about 45 minutes total.
10:00 AM – Now it’s time for the hard stuff. The actual CHEMO drugs. The nurse will call in another medical aide into the room as a witness at this point. One will say my full name, my birth date and the treatment I will be given, the other confirms. They read everything out loud and scan each bag and my bracelet as it is given to me. First off is Taxotere, followed by Carboplatin.
11:30 AM – After the chemo drugs, now it’s time for the two targeted therapy drugs because I am Her2 Positive. Sidenote: Herceptin and Perjeta really changed the landscape of Her2 positive breast cancer patients in the last decade and I am truly thankful. What prior was basically a death sentence, these drugs have now made this type of cancer the “better one to have”. Or so they tell me.
Back to Chemo Day: You’re probably also wondering what I’m doing throughout. You can do pretty much whatever you’d like. There’s a TV in the room, really great Wifi (way better than mine at home that’s for sure), I bring books, or talk to whoever is with me. The Ativan makes me groggy too so half the time I’m in and out. Depending on how you react, sometimes you are given Benadryl which knocks you out cold (as Benadryl straight to the vein would). Some people will bring food but I find I’m never hungry during the infusions so I just try and stay hydrated. You can also walk around if you’d like but you have to drag the IV pole around, so I do not opt for that unless I have to use the ladies room.
1:00 PM – A loud beeeeeeeeeeep signifies the end of my infusion and I feel accomplished looking at the “infusion complete” display. I wait for my nurse to come back to me. The nurse then takes out the needle and prepares to flush out my port. This ensures (or tries to) that it doesn’t clog or get infected until the next chemo. Quick tip: bring sour candy to suck on because the flushing causes a weird taste that can make you gag. The sour negates it, I don’t know why but it works, so don’t ask questions.
1:15 PM – The last thing the nurse does to wrap up Chemo Day is to apply the Neulasta sticker. Within 3 minutes of applying the sticker, you will feel a needle prick and the light will go from orange to green. This signifies it’s on properly. 27 hours after chemo, this $6,000 (!) sticker will automatically inject a white count booster into your system for 45 minutes. I had a very bad reaction to it my first time around at the on-site but the following times while not great, have been manageable. The most common and annoying side effect is bone pain. Before this sticker, patients used to have to go back to the hospital the next day to get this shot, or in more recent times, give it to themselves. Both options are not something I would prefer over this. I like to joke Neulasta and I have a love and hate relationship but it’s a crucial part of making sure I am healthy enough for my next round of chemo so I am trying really, really hard to make it work. Relationship tips welcome.
A few other things to note, your first infusion will most likely be much longer as they have to give you the drugs much slower since they don’t know how you will react. If you are Her2 positive, your baseline for Herceptin and Perjeta will be twice your normal dosage, thus twice as long so keep that in mind. Most, if not all hospitals will have basics on hand like water, tea, coffee, juice and crackers. It’s helpful to bring snacks though so you don’t get hungry. I didn’t opt for the cold cap process (to try and preserve my hair during chemo) but if you do, that will add heavily to your infusion time (at least 3 hours) so keep that in mind. Otherwise, most of the unpleasantries associated with chemo start after chemo day, but more on that later. Until then, thank you for reading and as always, for the continued support.
(some stress balls the chemo cart fairy came by with at my last chemo. I kept the one at the very bottom with the buggy eyes.)