The Return to Chemotherapy (Post #5)

Hello and welcome back to my blog, I'm glad you're here!

So much has happened..

A review of what has happened so far: Two weeks after a surgery for a broken wrist in March 2024, I went to the Emergency Room with significant unrelenting pain in my right chest - especially when deep breathing. A CT found lung nodules, a PET scan later confirmed they were cancerous. (More info in the first blog post) A bronchoscopy at the end of April confirmed that the nodules were indeed a metastasis from my cervical cancer that was diagnosed, treated, and determined to have no further evidence of disease in 2020. I had a central line placed, called a port, and had my first chemotherapy appointment in late May 2024. A few days later I ended up in the ER with more pain and difficulty breathing - this time due to pleural effusions. Managing my pain was quite an issue over the few days, but after chest tubes drained the fluid I was released a few days later. More information on those events can be found in the second blog post. After that, my chemotherapy treatments were pretty uneventful, but the side effects took a toll on me physically and emotionally, which you can read more about in my third blog post. In my last blog post I talked about ending chemotherapy treatment, entering immunotherapy treatment, and returning to work, which brings us to the end of 2024.

What has happened since: Shortly after the turn of the new year, not long after making my last post, I attended one of my scheduled immunotherapy visits. My last PET scan results hadn't yet been posted, and my doctor decided that we would review them together in my appointment before my scheduled infusion. When we have reviewed scans in the office before, she would always show me side by side comparisons from at least one previous scan. As we reviewed the scans, two things became apparent. First, there were more nodules than there were on the previous scan, and one had more than doubled the size in the last few months. My current immunotherapy treatment was not effective, and I would have to reenter chemotherapy treatment. The second thing that we discovered was that there was a new finding of hydronephrosis and hydroureter on my left side, meaning there was a backup of fluid in my left ureter and kidney. I would have to urgently see a nephrologist before I could reenter treatment.

The first thing I said was, "I just returned to work." The second was, "I can't do this." I explained that I would of course go back into chemotherapy, but I was so emotionally drained from all of this. I mentally couldn't do this. I would, but this sucks and I hated it. I'm very thankful that my doctor is gracious and allows me to honestly have time to express my upset. I feel like, for a lot in my life, I've just had to act, without having the time to process what is actually happening, just have to move along and do the next thing. This has been especially true during this cancer treatment, where it feels there's always an upcoming test, scan, or appointment. So, there I was, having my moment of...annoyance at what this cancer journey has done to my life. Then, ever the pragmatist, knowing my emotions won't change the situation and there's limited time at these appointments, gathered myself together and asked, "What's next?" Just have to keep on keeping on, I suppose..

We discussed the options of chemotherapy. The first thing we discussed was removing the immunotherapy, Avastin and Keytruda, from the treatment plan, as they were obviously ineffective. Then there were three options (sort of). The first was to go back to carboplatin and paclitaxel, which I was just previously on. The second option was back to cisplatin, which I had during my first chemotherapy sessions in 2020, however cisplatin is nephrotoxic, and there's already an obvious issue with my kidneys. The third option was Tidvak, which she said she hadn't had a lot of people choose because of it's ocular toxicity. I opted to continue with the carboplatin and paclitaxel for now, which mean I would have longer appointment times again, and would have to return to putting my fingers and toes on ice to minimize any peripheral neuropathy that might be caused by treatment. I figure, if I want to change later I can make that decision but we do know these are effective. After three treatments three weeks apart I will have another PET scan to see if the treatment would be effective still.

However, none of these things could happen until I saw a nephrologist. My doctor told me she would make the referral, and that after they booked an appointment for treatment of the hydronephrosis and hydroureter, we would book chemotherapy for after. I wouldn't be receiving immunotherapy that day, and after they deaccessed my port I started to head home. I remember driving in silence for the longest time. I wanted to talk to someone, but there's a certain feeling that you're letting people down by telling them that you have to go back into cancer treatment. It's not rational, but that doesn't mean it is preventable. I also had no idea what I was going to do, how quickly this was going to happen. I remember glancing at the clock repeatedly, counting down the minutes on my ETA to home. I thought, the longer I can wait to tell people, the more time they'll have before I ruin their day. I'll give them more time of happiness. About half way home I got a call from a nurse that works with my oncologist - they had been able to get me an appointment for the next day with a nephrologist right around the corner from them. I turned around and headed back, pausing briefly at a rest stop to call my mom. After telling her the news, I secured an early check in at a hotel, headed straight there, and took a long nap.

The next morning I saw the nephrologist, and he suggested we do a cystoscopy and ureteroscopy with biopsies. He wanted to do it all under general anesthesia in case a stent placement was going to be required. A few days later they called and scheduled the procedure for the following week. After confirming the appointment, I called my oncologist and they scheduled my next chemotherapy for the day after my surgery.

An absolutely amazing meal before going back into chemoterhapy.

The surgery went well - the biopsies were sent off, but the doctor didn't believe they were cancerous. He believed that my radiation treatment had over time, caused a shrinkage in my ureter, a result that he had seen many times before. He did place a urethral stent, which went internally up to inside my ureter, through my bladder, down my urethra and had strings exiting my body and taped in my pelvic area. It would be my job to pull this stent out in four days time. Yes, you read that right, I would be pulling it out. The stent was about as comfortable as you think it might be, and I was constantly worried about accidentally tugging the wires. That night I went out with my mom to Longhorn Steakhouse and had a nice steak dinner with a big glass margarita. My mom wasn't sure I'd want to go out the night of my surgery, but I was whole heartedly determined to go. It was absolutely worth it. I knew at some point I wouldn't be able to eat whatever I wanted, and I wanted to make the most of what I could while I could still eat freely. A funny thing happened later that night, when I attempted to eat the strawberry shortcake dessert in bed at the hotel. I flipped the top over, not realizing there was a perforation in the lid until minutes later, when part of the strawberry sauce had already leaked onto the sheet. I went out to the front desk and explained the situation, and they kindly offered me a new sheet in exchange for the current one, so they could throw it in the wash quickly I presume. I went back, about a quarter to midnight and changed out the sheet - all while my mom slept peacefully in the next bed! It was quite a funny story to tell her about all the action she missed!

Getting all settled in for my Taxol treatment!

The next morning, everything at my infusion ran smoothly. I did have to put my fingers and toes on ice again for hours, but I feel like I'm pretty much an expert in this by now, and with my Taylor Swift blanket, and very soft oversized sweater I had gotten as a gift recently, I was very comfortable. I even brought out my laptop and watched a few episodes of Man on the Inside with my mom. I had her take a picture that would sort of show the little bench your visitor gets to sit in, it's very teeny! I'm so appreciative to anyone who is willing to sit for an entire day in that tiny space!

As it had been a while since I had chemotherapy drugs, this first time back did not cause terrible side effects. As each day passed I was thankful - surprised, sure - but thankful that I was given a reprieve from the expected side effects. The stent, however, was a little less forgiving. It was uncomfortable, but occasionally when I was lying flat I could almost forget it was there. An expected side effect, increased urgency, was incredibly heightened. I was having trouble making it to the bathroom on time and thus I brought out my bedside commode from its temporary retirement. Thankfully Monday rolled around quick enough and it was finally time to remove the stent. Although I had extreme anxiety about pulling the stent out myself, it wasn't as bad as I imagined it would be. It wasn't painful and instead was a quick, smooth process. It's not that I'm recommending for everyone to go out and get one today, but hopefully this can ease the fears of someone who might be in the same position now or in the future.

This brings us to late Jan 2025, and there's still so much that has happened, I'm following up this post with another that will be out shortly! Thank you for reading to the end of this post and I'll see you soon!