Chemo #2, numbers, and radiation....

Last Tuesday's treatment was uneventful.  That is always a good thing.  Despite it being an "uneventful" infusion, it was still a long 5.5 hour process.

For those wondering, here's what a "typical" infusion day looks like:

-Arrive to hospital (via bike of course:)
-Shannon meets me there with car
-Secure bike on car

-IV placed, blood drawn

-Vitals taken by Medical Assistant

-Meet with Oncologist who does a physical exam and reviews lab work

-Get cleared for treatment

-Oncologist orders medications

-Wait for medications to be prepared

-Receive ~one hour of anti-nausea IV medications

-Chemo starts

-1.5 hours later go home

That's it.  Honestly, just typing it makes me a little sick to my stomach, but perhaps that is because I am still a little sick to my stomach!

Anyhow, as I've mentioned before, the first week after chemo is the hardest and this time was no exception.  It pretty much went exactly like last time.  However, I was prepared with toast, applesauce, NadaMoo dairy free ice cream, and pumpkin protein cookies.  The good news is that I seem to be rebounding from chemo #2 similarly to chemo #1.  Sometimes the effects can be cumulative, so I'll take the same!

Being a numbers person, I have been closely tracking my blood counts.  I even made a nifty chart with some of the more significant values.

Blood Counts	Target Ranges	Chemo#1	Chemo#2	Chemo#3	Chemo#4
WBC	4-8	4.18	3.43
Lymphocytes	>1 in treatment	2.5	1.6
Neutrophils	>1 in treatment	2.5	1.6
Monocytes	<.56	.3	.4
Eosinophils	<.24	0	0
RBC count	3.9-4.5	3.94	4.18
Mean Corpuscle Volume	<98 in treatment	94.6	92.2
Platelets	150-300	168	276
Protein Status
Hemoglobin	13-14	12.9	13.6
Albumin	4-5	4.0	4.3
Total Protein	>6.6 in treatment	6.6	7.1
Electrolyte Balance
Sodium	140-144	140	138
Potassium	4-4.5	3.5	3.4
Chloride	100-106	108	104
Kidney Health
BUN	13-18	15	9
Creatinine	.7-1.1	.63	.72
Calcium	9.2-10.1	8.8	9.1
Oxidation
RBC Distribution Width	<13	13	13.2

The "ranges" on my chart are the ideal ranges that my Nutritionist and I are targeting.  "Normal" ranges are a bit more lax.

Here's my interpretation:
-My white blood cells are a bit low, but still in the "normal" range.  This is despite not getting a Neulasta shot to help support immunity.
-Oddly, my red blood cell count, hematocrit, hemoglobin, and platelets all increased after my first treatment.  I am taking whey protein and chorella to help support my red blood cells, however I still find this odd.  Regardless, I'll take the little boost!
-The one value that I find a bit concerning is my BUN (blood urea nitrogen), which is an indicator of kidney health.  It is lower than what we are targeting, however it is still in the low "normal" range.  Other kidney health indicators look good, however from what I understand this value can also drop if your body is using more protein than it is getting.  I suspect this may be the case with me as chemo significantly increases your protein needs and I have been exercising routinely.  I will continue to focus on improving my protein intake.

In other news, I met with my radiation oncologist today.  I really like her.  If everything stays on track, I will meet with her again on October 1st where I will get measured and molded in preparation for radiation.  Even though I am going to get a crap load of radiation-boooo-they are extremely precise with their target areas.  My doctors typically have a hard time surprising me as I usually go into my appointments very well researched, however today I was surprised to learn that they will create a mold around my body that I will lay in for each radiation session so that I am in the exact same position.   Actual radiation will start the week of October 7th and will be daily for 5-6 weeks.  I was so psyched to "get out of" radiation back at my original diagnosis in 2011, however I know that it is 100% indicated this time around, so my plan is to move forward optimistically and see where the chips (i.e. how it affects my reconstruction) fall!

Photos from the week can be found here and weekly exercise here.

The power of visualization, a minor setback, and LOTS of happy moments!

Today, as I sprinted my townie bike up the hill to Huntsman for my afternoon acupuncture appointment that I was running late for, I truly felt grateful.  Grateful for how well my body has tolerated this first round of treatment.  Grateful for my amazing husband who dedicates so much time to keeping me happy and healthy.  Grateful for my super fun friends who are great company whether we're doing epic mountain bike rides or rallying the skills park.  Grateful for the friends whose little gestures mean so much.  Grateful for the the team (both medical and complementary) that I have put together to support me through my treatment.  Grateful that I am able to maintain employment as I undergo treatment.  Grateful for my silly puppy, Dizzy, who is a great trail running and sleeping partner. But at that moment, I was soooo grateful that I could sprint that townie bike up that hill.  During that sprint, despite Huntsman being my destination, I didn't feel like a cancer patient.  I felt like myself: healthy, strong, fit, covered in sweat, and happy.  I have learned that when the going gets tough, and it does get tough, to visualize these happy moments.  It really is quite powerful.  

Anyhow, Week Three started with a little setback.  I developed a toothache and some mouth sores. Perhaps it was because I didn't follow my own recommendation and brush my teeth after all meals/snacks (in my defense this is difficult to do when you spend the day riding lifts and demo-ing enduro bikes:), perhaps it was something I ate, or perhaps it was unavoidable.  Regardless, it was bothersome enough to affect my sleep which makes me a wee bit cranky.  I finally resorted to getting a prescription for some magic mouthwash, but fortunately after a few days it resolved on its own.  

Despite this setback, my week was LOADED with happy moments.  

Tons of mountain bike rides with friends:

Trail running with Dizzy:

acupuncture, relaxation, a visit from Mom, baking:

(Gluten free, pumpkin, protein cookies)

and V02 max testing.  Yes, you read that correctly, V02 max testing.  I find that hilarious on so many levels.  First, I am undergoing chemo, am probably somewhat anemic, and definitely somewhat immunosupressed.  Not exactly the ideal time to measure my "true" V02 max.  Second, it was done (running) on a treadmill, and while I have been dabbling in trail running, I am NOT a runner!  However, Huntsman offers free fitness assessments, it will be interesting to track physiologic changes to my body as I undergo treatment, I am always game for some exercise induced suffering, and it is required in order to utilize Huntsman's really nice gym.  Since I seem to be at Huntsman all of the time and that is not going to change anytime soon, I really want to use their gym, especially when I am trying to kill time between appointments.  Anyhow, I don't have the results yet, but I do know that I was pretty efficient at threshold, my heartrate got up into the 180s (which is consistent with my typical max heartrate), and I didn't feel like I was going into cardiac arrest!  Plus, the fitness staff was a hoot and despite having to run as hard as I could up a ~20% grade, I had a really good time!  

In other news of the week, George Washington University's breast center featured me in their August newsletter.  I am flattered, honored and quite honestly speechless that they found my story worthy of their August inspiration.  The author of the story told me that I inspired her to train and compete in CrossFit regionals.  I love that through my blog I am able to inspire people with cancer to be healthy and exercise.  It is just as profound to me to inspire those who don't have cancer.  

Here is the story:

And, my weekly workout log:

Date:	Workout:	Total workout time:	Energy  (1-10):	Notes:
7/30	Easy road spin/leg/core workout	1.75	8	Rode up Emigration.  Mouth sores flare-up
7/31	Super fun MTB	2	8	Great ride with one of my favorite people!  Mouth sores flare-up
8/1	Townie ride for errands/V02 max testing at Huntsman	1	8	V02 max and fitness testing at Huntsman on treadmill!  Mouth sores improving
8/2	Skills ride at Trailside bike park	1.5	9	Fun ride with great company. Felt good.
8/3	Mountain Bike Ride	2.75	9	MTB in Park City.  Note: need to pack more food than normal for longer rides.  Rode w/ Shannon. Mouth good.
8/4	Mountain Bike Ride	2.25	9	MTB in Park City.  Another fun girl ride!
8/5	Trail run/Skills ride on dirt jumper	1.25	9	Felt good today.  Acupuncture in prep for treatment #2 tomorrow.
	Total hours:	12.5

Lesson of the week:  It appears as though my body requires more calories than normal when exercising, especially when exercising at moderate intensity.  Perhaps this is because my body is working extra hard with cellular regeneration after chemo???  Regardless, I got a little bonky on my AWESOME Saturday mountain bike ride and had to borrow some calories from Shannon.

Tomorrow is chemo #2.  When the going gets tough this week, and I know it will, I have lots of happy moments to visualize.  That and NadaMoo dairy free ice cream.  For this I am also grateful.

More photos of the week here.