Today it feels as if I am coming up for air after what has undoubtedly been the hardest, darkest week of my treatment so far.
The physical and mental impact of round three of chemotherapy has been significantly worse than the first two, and has left me feeling sideswiped and exhausted.
My oncologist recently described the impact of chemotherapy.
"Imagine you start your chemotherapy at the top of a flight of stairs, feeling strong and fit. With round one, we knock you down three stairs. In the following weeks, as your body reacts and then starts to recover, you try to climb back up the stairs.
"But you likely will not get back up to the top stair before we hit you with round two. In round two we again knock you back down another three or four steps. Again, your body will react and then begin to recover, but remember, you started this round from a lower stair. Although now a little weaker, you may manage to climb back up a step or even two, but you will not get back to where you started before we hit you with the next round....and so on in a descending cycle through (for me) the six rounds"
This is why most people find that the impact of chemo is cumulative, and they often find it harder and harder to cope with as they progress.
When I started this treatment, I automatically assumed that everyone who started a programme of chemotherapy got the end. I was very wrong. For any number of reasons, many people do not make it through their whole programme as planned. Sometimes the impact of the drugs on the body can simply be too much, and may require a reduction of dosage or even the total stoppage of treatment. As my oncologist explained, her job is one of delicately balancing risk - trying to find the treatment sweet spot between maximising the chance of destroying errant cancer cells and not stressing the body so much as to land the patient in intensive care, unable to continue treatment.
Chemotherapy is intended to knock out cancer cells. But it is a blunt instrument. Its inability to distinguish good cells from bad means that other areas where our cells reproduce rapidly are also hit hard. Hello hair loss, mouth sores, bleeding nose, GI tract inflammation, nausea and digestive issues, sore and shredded skin, chemo acne and brain fog. Hello too a seriously compromised immune system, leaving the body struggling to defend itself from even simple everyday bacterial loads and the resulting and very real risk of chemo related sepsis. And hello bone aching fatigue and an overarching feeling of having been poisoned.
Quite frankly, I have been mindful (and grateful) that until this latest round I have got off rather lightly. My mastectomy, although surgically challenging, went well. My recovery from surgery was relatively straightforward. The first two rounds of chemo were (albeit far from pleasant), very manageable and my side effects limited. Lulled into a false sense of security, I secretly thought I might just breeze through this.
But this round has felt different. It has taken me to a far darker place and I am beginning to realise that this is not going to be a walk in the park. Not only has the down time been significantly harder and longer this time (there is a repetitive pattern to each 3-week treatment phase - treatment day, steroid induced high, steroid come down and side effect crash, recovery, treatment day...and repeat), but recovery has been slower and the 'up' times have been less 'up', marking my descent on the chemo staircase.
With the potential for accelerating side effects, the treatment stakes now feel high. The challenge for me is to do everything I can to try to optimise my chances of being able to complete the next three rounds, even while I am dreading them. While mentally confronting, given how unpleasant this last round has been, I am also acutely aware that chemotherapy may literally save my life and so the thought of having to cut it short is more scary than the thought of the treatment itself.
An extended crash period now leaves me with less time to recover before my next round. It means too that I risk going into round four already wrung out, starting from a more vulnerable base. Last cycle, my treatment was almost postponed because my immune system was borderline too low to tolerate it. Although not uncommon, that felt deeply uncomfortable. And so my job for the next week is clear...rest, restoratively gentle exercise, healing food and most importantly, yet more rest to prepare my body as well as I am able for the next onslaught.
On the plus though, I now feel able to rightfully own that I am halfway through my chemotherapy treatment. Although only one of four post surgical treatment regimes for me over the coming year, it is undoubtedly the hardest. While I know I still have to face the harder half, for the next week at least I will be celebrating having come this far. It is no small achievement.
