Is It Normal To Feel Normal?

It has been four days since my first chemo treatment, and so far I feel... fine.  Really normal, actually.  I got up and went to work the next day, just like any other day.  I have not felt tired or sick to my stomach or anything out of the ordinary really.

It's funny, because I keep expecting to not feel okay, and so I've been a little paranoid about every little thing.  That first night after chemo, as I was reflecting on how normal I felt as I was trying to sleep, I suddenly became aware that I was really warm.  At first I didn't think anything of it, but then my mind started churning, and I remembered that the nurse told me to call if I developed a fever of 100.5 or higher (because it could be a sign of infection) and then I thought - oh no! do I have a fever?  So I got up and took my temperature.  98.3.  I think the problem was too much flannel.  

I had a similar experience when I first found out I had cancer, but hadn't yet had my first official doctor's appointment with the breast surgeon or oncolologist.  That first weekend, I started noticing that my right arm was sore, and I suddenly became convinced that the cancer was spreading down my arm and I would soon be an amputee (yes, I know how ridiculous that sounds).  But then my friend - who is a physical therapist - suggested that maybe I was subconsiously tensing my arm to protect the affected side, and that was why it was sore.  Turns out she was right because once I made a point to relax it, it was no longer sore.

Before I had my first appointment with Dr. Sara where I learned what chemo was all about, I had some pretty antiquated ideas in my head.  I kept thinking of that old Julia Roberts movie from the early 90s where she plays a caretaker for a cancer patient who is violently sick for much of the movie.  But that was 20 years ago, and luckily, it's not like that anymore.  There have been many developments in anti-nausea drugs to prevent this, and one of these was part of my "pre-meds" on chemo day (in addition to a prescription they gave me to take for two days following).

Of course, there are many different variations of chemo which produce varying side effects.  Dr. Sara said that on a scale of 0 to 10 as far as how bad chemo side effects can be, with 0 being no side effects and 10 being absolute hell (because I guess there are some that are still hellish), my experience should be about a 4.  I can handle a 4.

It's important to mention here that the intensity of chemo side effects has absolutely no correlation with how the chemo is working.  A person can have no side effects while the chemo is effectively doing its job in killing the cancer cells, and the reverse can also be true.  I learned this in the "Chemotherapy and You" book they gave me on Wednesday, which, despite its cheesy title, is actually quite helpful.

So what can I expect?  Well, I will lose all of my hair.  I have heard that this doesn't always happen to everyone (and I do tend to have a lot of hair), but Dr. Sara seemed pretty certain that this will happen to me.  He said that when it starts to happen (usually after the second treatment), it will be shocking and traumatic no matter how prepared I think I am.  I will probably cry.  I will wake up in the morning and there will be clumps on my pillow.  Or I'll take a shower and it will look like a small animal is scurrying around in the water at my feet.  Once it starts falling out, most people take matters into their own hands and shave their heads.  Dr. Sara said this is good thing to do because it makes you feel empowered - that you are taking control of the situation.  You shaved your head; it didn't fall out.

To prepare for this, many people choose to cut their hair short before starting chemo.  There are a couple reasons for this.  One, quite practically, it's easier to try on wigs when you have less hair (and I've been advised to get a wig BEFORE my hair starts falling out).  Second, it makes it at least a little less traumatic (and easier to clean I would imagine) when it does start falling out, if there is not as much to lose.

I took this advice and got my hair cut about two weeks ago.  Here is me before:

And here is me now:

(Special thanks to my stylist Rita for giving me my new 'do!)

The hair loss does not only apply to my head, but all over.  This will actually be quite convenient I think - no shaving my legs for several months!  I will probably also lose my eyelashes and eyebrows, though they tend to take longer to fall out.  My hair should start growing back about one month after chemo ends.

Besides losing my hair, I will probably start feeling some fatigue as the treatments go on.  This effect tends to be cumulative, so I will probably start feeling this more and more as I have more treatments.

I may also start noticing that my nails and toenails start to get brittle, and some people even start losing nails.  It sounds like this might hurt, but I'm told it doesn't, it just feels weird.  Also, just like the hair, if I do lose any nails, they will grow back after chemo.

Another side effect of chemo - a big one - is that it might leave me sterile.  I did inquire about any preventative measures that could be taken in advance to give me options in the future, such as freezing my eggs, but unfortunately this is not an option for me.  For one, in order to do this I would need to take certain hormones, and since my cancer is hormone-receptive, these added hormones could actually help the cancer grow.  Secondly, it would delay treatment.  And finally, even after all of this, these methods have not be proven to be super-effective, so the risks just aren't worth it.

If I do end up sterile, this is something that will probably upset me in the future, but right now I can't afford to think about it.  I need to keep my eye on the bigger prize - getting cancer-free - and worry about the possibility of having kids later.  After all, there are so many other options for becoming a parent these days that don't require viable eggs, including adoption.  And, there is no guarantee that I will become sterile as Dr. Sara said that he's had many patients have kids after chemo, so it is possible.

All in all, Dr. Sara said that I should be able to live a pretty normal life through chemo.  I should be able to continue working.  I can pretty much eat whatever I want - I just need to avoid uncooked foods like sushi and steak tartare because my immune system will start to weaken, making me more susceptible to food-borne illnesses I would normally be able to fight off.  But I'm a vegetarian so I don't eat that stuff anyway.  I can still drink alcohol (much to the delight of my friends), just not on the day of or the day after chemo, while the drugs are still in my system.  I can even continue to exercise, though I might find as time goes on that my stamina is not what it normally is (as my Dad says, this means I should be pleased with what I would now consider a "sissy run").

From the time I was diagnosed, I have said that I'd like to maintain as much normalcy in my life as possible throughout this process.  According to Dr. Sara, this is an entirely attainable goal.  He said it's very important that I stay "Emily" and that I don't become "Emily The Cancer Patient".  So, while there will certainly be many changes in my life over the coming months, as much as I can stay "normal" - going to concerts, talking about the usual stuff with friends, even traveling from time to time - the better this experience will be.  I think this is something I can accomplish!