Oncologist Appointment on Monday June 20th

I was pretty wiped out when I got home from my appointment on Monday, so that’s why I am just now updating you. Each appointment is usually about 2 hours long, from checking in to leaving, and depending on how I am feeling on that particular day, it can take a lot out of me. Below is an explanation of what happened during those two hours. 

When I check in, I fill out a short form with my name, arrival time, if I have been recently hospitalized and if I have changed my insurance. I give the staff my name, birth date, and the short form. The staff person goes into a drawer and pulls a file with two more forms for me to fill out, hands me a clipboard, and they put a hospital bracelet on me. I sit in the waiting room, which is almost always pretty full, so about 16 to 18 people, both patients, and caregivers. The first form is a general form asking about any recent side effects, hospital stays, surgeries, medications, allergies, and what questions I have for my doctor. The second form is a suicide form with a few questions about self-harm and caregiver abuse. It is sad that such a form exists, but it is a reality for cancer patients, especially older patients. I fill out both forms, keep the forms with me and return the clipboard to the check-in area. This process is done every time I have an appointment.

Next, I am called back to the lab area, where I hand the tech my completed and signed forms. They weigh me, take my temperature, blood pressure, and oxygen. The tech then asks me about my pain level and if I am constipated, both common issues while undergoing cancer treatment. Last, the tech draws two vials of blood, puts them in the machine for processing, and walks me to the exam room. To give you an idea of how big this office is, there are eight doctors and twelve exam rooms.

Everything is very efficient, so I rarely have to wait longer than five minutes before my Oncologist’s PA comes in and hands me the results of my blood panels. I see his PA almost every time I have an appointment, and every other time I am there, I see both my Oncologist and his PA. On Monday, the PA said that everything looks good considering the treatment plan I am on. My white and red blood cell counts are a little low, but nothing to be overly concerned about. My ANC is low again but not too low, so hopefully, it will stabilize as I continue my treatment.

The last part of my appointment is when I go back to the chemo treatment room to get my injections. This is generally the longest part of my appointment because the medicine for my injections isn’t ordered from the pharmacy (which is in-house) until my Oncologist or PA has seen me and approved for me to get my injections, which is determined by my blood panel results. Once my nurse gets the injections from the pharmacy, she warms them because the medication is so thick, so this adds on extra time for me to wait, but it is an important step. Once the injections are sufficiently warmed, I am taken into “The Shot Room,” and I am given my injections which take several minutes due to the amount of medication. I mentioned on Monday that I have a lot less pain and discomfort after my injections if they massage the area after taking the needle out. By massaging the site of the injection, they help the medication disperse quicker. My nurse thanked me for letting her know that info and said she would pass the word on to the other nurses. Patients are often scared to speak up about even a minor issue, and it doesn’t need to be that way. I have learned to be very open no matter how embarrassed I might be because I know that after coming to see my oncologist and his staff for over three years, they want me to be open, honest, and, most importantly, not to suffer in silence if something is causing me issues. So please remember, you are your best advocate when it comes to our healthcare system!

So what is next? I started back on iBrance on Monday after having a much easier time on the lower dose. On July 11th, I will have my PET scan to check the size of my tumors. Hopefully, they will be smaller, which means that the medications are working. On July 18th, I will go back to my oncologist’s office for my monthly appointment and get the results of my PET scan. My husband will go with me on the 18th but not on the 11th. Unfortunately, I am used to PET scans now, so he does not need to go with me.

Take care, everyone!

Oncologist Appointment & Third Round of Faslodex Injections

I had an appointment with my oncologist on Monday to run my blood panels, talk about my side effects and get my third round of Faslodex injections. I spoke with the PA first about the medications I had picked up at the pharmacy over the last week for nausea and heartburn. I assured her that both were working great, so I was finally getting some relief.

My oncologist came into the exam room and handed me my blood panel results, and it was not what I expected. I knew that certain levels would be off but for them to be where they are after only three weeks on iBrance was a shock. My white and red blood cell counts are low, not dangerously low, but lower than we would like, and my ANC is low. ANC, Absolute Neutrophil Count, is the “infection-fighting” count. My count is .8, and the low end of normal is 1.25, so I am at high risk for infection. I need to stay away from crowds, busy restaurants, and people who have a cold or the flu because I could end up in the hospital with an infection and become severely ill.

After taking in the initial shock of this news, my doctor said he was very concerned, so he told me to stop taking iBrance for the next month. The break in taking the medication should give my system a chance to get back to normal levels. I had already received this next round of drugs from Pfizer because I was scheduled to start back on it after a week off a few days ago on Monday. We did discuss dropping my dose from 125mg to 100mg, but we will only do that if my bloodwork doesn’t improve. So, for now, he told me to hold on to the meds, so I will have them to take again starting on May 23rd.

Once I was done discussing everything with my doctor, I went back to the infusion room to get my Faslodex injections. Have I said how much I hate injections? I absolutely hate injections, but that is the only way this particular drug is administered, so I don’t have a choice. It seems that each time I have the injections, I have different side effects from them. Generally, I deal with headaches, bone pain in my hips, and, as with this last time, pain from the medicine itself. I have a small area on the left side near the injection site that is causing me some pain, but it has improved each day. Some good news is that I am done with the initial three doses, so now I will have the injections monthly instead of every two weeks.

During my next appointment on May 23rd, I will see my oncologist, have my blood panels run, and get my Faslodex injections. This will be my regular schedule moving forward every month for an indefinite period of time.

**WARNING** Graphic details about side effects: Days Thirteen thru Twenty-one on iBrance and Starting My Week Off

A quick disclaimer, please remember that the subject matter in this blog post is specific to my experience while taking iBrance for Stage 4 Metastatic Breast Cancer. If you are about to start or take the same medication, your experience may differ from mine, so please keep that in mind.

On days thirteen thru eighteen, I continued to have issues with nausea; it was not as severe or as frequent but still annoying. I called the nurse’s line at my oncologist’s office, and my doctor prescribed an anti-nausea medicine for me since the one I have is three years old and has expired. It is comforting to know that I have a current drug that I can take should I need it.

On days nineteen through twenty-one, the nausea, for the most part, had stopped, but my heartburn was getting worse. Every night after dinner, I would get heartburn from mild to severe, and it didn’t seem to matter what I ate. I had the same scenario as I did with the medicine for nausea; my heartburn medicine was expired. I rarely ever have heartburn, so I know that just like the nausea, it is a side effect of the iBrance.

Today is day three of my seven days off of iBrance, and I feel much better. I still have slight nausea, but it has stopped for the most part. My heartburn continued, so I called the nurse’s line yesterday, and my doctor prescribed a new med that I will be taking every day. I took it last night before dinner, and I was very pleased to finally not have that dreaded pain in my chest after eating.

On Monday next week, I am starting back on iBrance, and I have an appointment to see my oncologist, have my bloodwork done, and get my Faslodex injections. I am curious to see where my white blood cell count is now that I have completed my first twenty-one days on iBrance. I know it could be potentially low, but I hope it won’t be too low because it puts me at risk of having issues with a weakened immune system.

I will update again after my appointment next week. Thank you for being here! 🙂

**WARNING** Graphic details about side effects: My First Twelve Days on iBrance

A quick disclaimer, please remember that the subject matter in this blog post is specific to my experience while taking iBrance for Stage 4 Metastatic Breast Cancer. If you are about to start or take the same medication, your experience may differ from mine, so please keep that in mind.

Information about possible side effects: Nauseavomiting, loss of appetite, diarrhea, tiredness, weaknesshair lossmouth sores, or numbness/tingling of arms/legs may occur. If any of these effects persist or worsen, tell your doctor or pharmacist promptly.

People using this medication may have serious side effects. However, you have been prescribed this drug because your doctor has judged that the benefit to you is greater than the risk of side effects. Careful monitoring by your doctor may decrease your risk.

Tell your doctor right away if you have any serious side effects, including: signs of anemia (such as unusual tiredness, pale skin, fast heartbeat), easy bruising/bleeding (such as nosebleed), signs of lung problems (such as chest pain, shortness of breath).

This medication may lower your ability to fight infections. This may make you more likely to get a serious infection or make any infection you have worse. Tell your doctor right away if you have any signs of infection (such as fever, chills, persistent sore throatcough).

A very serious allergic reaction to this drug is rare. However, get medical help right away if you notice any symptoms of a serious allergic reaction, including: rashitching/swelling (especially of the face/tongue/throat), severe dizzinesstrouble breathing. This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.

My first seven days, March 28th – April 3rd, on iBrance were fine; no significant changes in how I felt. Unfortunately, I am not a stranger to chemo treatments, so I knew that it was a matter of time before I began to deal with possible side effects as the medication builds up in my body.

On day 8, I started having waves of nausea all day with diarrhea after every meal, and that evening, I started having abdominal pain and cold sweats while in the bathroom. I made sure to keep my water intake up as suggested by my pharmacist, which is 2 to 3 quarts a day, but it didn’t help much.

Day 9 was about the same but with less abdominal pain. I began to get scared to eat because I would feel better initially, only to feel worse about 20 minutes after eating.  I started to have other side effects combined with those I already had, like tingling in my hand and losing my appetite.

On day 10, I woke up with diarrhea, but it only happened once, and then I had the opposite problem the rest of the day, constipation. I am still nauseous on and off all day, and my appetite is non-existent, but I hope that I will improve in the coming days as my system continues to adjust to the medication. I am eating, but sometimes I need to force myself because I know I need to eat to stay healthy. I am losing weight but not so much that I am concerned since I am still about 20 lbs overweight.

On days 11 and 12, I have felt much better. The tingling in my hand has stopped, but I am still dealing with nausea on and off; it is nowhere near as severe as the past three days, so that is an improvement. My appetite is slightly better, so eating hasn’t been as much of a struggle. Hopefully, I am turning a corner, and next week, my third week on the drug will be much easier. I am worried about having a week off, starting on the 18th and then starting back up again, but I am trying to remain optimistic that it will be OK.

My upcoming appointment at my oncologist’s office is Monday, when I go in for round two of my Faslodex injections. I am not scheduled to see him so I will discuss the side effects with my nurse, and if she feels it’s necessary, I can ask to talk to my oncologist. Overall, I am doing OK, considering that I am dealing with more side effects with this medication than I ever did while going through infusion chemotherapy.

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