Friday, March 11, 2016, North York General Hospital.

Today, I started chemo treatment for Breast Cancer.  And while I’ve had chemo twice in the past four years for Non-Hodgkin Lymphoma and Multiple Myeloma, this feels like a familiar but different experience.  It’s like taking the same journey, but to a different location.

North York General Hospital does a fantastic job of preparing patients for chemotherapy.  I went to a chemo class a few weeks ago where patients, regardless of type of cancer, are invited to participate if their treatment requires chemo.  At this class, held every Friday, we heard from a pharmacist who talked about the different types of chemo (neo-adjuvant, adjuvant and palliative), how it works to kill both good and bad cells (so it’s effective but not targeted), and who pays for most of the chemo (Government of Ontario, Cancer Care Ontario).

I loved the calendar she shared with us on what to expect for a 3 week chemo cycle:

– Fatigue for the entire 3 weeks
– Nausea for the first 5 days of chemo
– Mouth Sores around Day 10
– Expected Hair Loss between Days 15 and 25

It seems like the toughest point is 7 – 10 days after chemo; that’s when your immunity is at its lowest.  And, although each individual will react differently to chemo, this calendar helps to give the patient some semblance of control over what to expect.

I also found it so helpful to have a pharmacist sit with me on Day 1 of chemo to give me specific personalized information about my cancer, to ensure that any current medication I am taking will not interfere with the chemo regimen, and to discuss how best to manage the side-effects.  I told her about the multi-vitamins and other supplements I’ve been taking. Then, I mentioned that my cousin in Mombasa had sent some herbal medicine but she probably didn’t need to worry about it.  She was way too smart for me – she did some research and came back with detailed instructions on when I can eat Moringa (not during the chemo, but ok for the anti-body treatment after), and how long I’m allowed to eat Terminalia Arjuna (maximum three months).

At the training class, we  met a dietician who talked generally about the do’s and don’ts of food to take while undergoing chemo.  This was followed by a Social Worker who talked about the kind of support she could provide (counselling for self and family, financial assistance, transportation, etc).  We also met with an advocate of Wellsprings, a place that offers support and programs for patients and their caregivers.  The session concluded with instructions from a nurse on the blood work regimen, the length of the chemo treatment (generally 4 – 8 hours) and a tour of the Chemo Clinic.  I was beyond impressed with the quality of the session — it was just the right content, delivered by the right people, to get me comfortable with what I can expect over the next few months.

What I am learning from my experience with cancer is that, while the cost of the in-hospital drugs are covered, drugs required out-of-hospital are not covered at all.  You have to rely on your group insurance plan (if you have one) and that, too, has annual maximums, which you will likely blow through very quickly.  For instance, I need to be injected with a drug called Neulasta after each chemo treatment, to increase the white cells in my body.  Neulasta costs approximately $3,000 per needle and I need 6 of these injections for the 6 cycles of chemo, totalling $18,000, well above the maximum annual limit of our group insurance plan.  So part of the process is to work with our insurance company, the Victory Program (funded by the drug companies) as well as the Government of Ontario’s Trillium Drug Plan (which is income-tested) to figure out how best to get the drugs I need without being too much out of pocket.  And while this is a time-consuming process that requires several phone calls with all the stakeholders and completion of forms requiring extensive details, I am thankful we live in Canada where these medication and resources are available.

Chemo Day 1

My first day of Chemo was quite memorable.  I ended up with an allergic reaction to one of the chemo drugs – Taxotere (aka Docetaxel)- that caused me to have sudden severe back spasms, neck pain and difficulty in breathing.  All the nurses in the Chemo Centre calmly gathered around me, and immediately stopped the chemo treatment.  Then they proceeded to give me an antidote that controlled the side effects.  Once everything was under control, with Dr. Robson’s approval, they administered Taxotere again, slowly. It was a bit scary in the moment but it all worked out in the end.

One of the funniest things was, I was in Chemo Chair #2 and behind me was some soothing artwork.  When I needed oxygen after the bad reaction, the head nurse slid the picture frame off the wall, to reveal emergency equipment hidden behind the picture.

Another funny thing was that, while I was getting one of my chemo drugs, I had to keep my fingernails cold so that they would not be affected by the harsh drugs.  Here’s a picture of me with my hands in bags of ice:

I am counting my blessings yet again today.  In spite of what I am going through, I am just so grateful for the support, prayers and encouragement I have received so wholeheartedly from so many people.  It bolsters my spirits and gives me the strength to keep fighting.

I take my hats off to the caregivers who are the true heroes in this journey.  Nagib and Sabrina sat with me the whole time in the hospital completely focused on making things better for me (we managed to get through a lot of wedding planning stuff in the process!).

The caregivers at the hospital do such a fine job to ensure patient comfort, education and safety.  There is really no price you can put on love, friendship and community.  It is what the world needs more of to be kinder and happier place.

In the meantime, I’m on Dexamethasone and I can’t stop running around and driving everyone crazy!  See my previous experience with Dexa here:  The Dark Side of Chemotherapy

-Munira