Chemo II - second cycle - looking back from third cycle Wednesday 30 September 2020

 On the negative side, the aprepitant add-in didn't really help much with the nausea. It's a one-a-day thing and the first dose was at 3-ish before the chemo. Reasonable night with help of an early-morning rice cake then first  domperidone at 06:30 hours. However, took the first of the two home aprepitants at 3pm-ish on Day 2 then felt sick by 7pm and the same thing happened the next day. It's not doing the 24 hour shift, which is a shame as it seemed to the first time I went through this. 

Next two nights, woke up  earlier and earlier feeling sick. Night 4, 02:30 hours found me marching up and down the kitchen like a horse with colic, yawning paroxysmally and waiting for an early-morning ondansetron to kick in.  That was the lowest point and thereafter I got through with domperidone alone, gradually getting more sleep.

Day 7 was the first day with no anti-nausea meds and my chemo diary notes suggest it was OK - I made a cakey thing (Tarte Tintin) for elevenses as dear daughter was coming. There is also a  note that I took the dog for a walk but it made me grumpy. That's another excuse not to take the dog for a walk.

wrt aprepitant ...  a couple of days too late, I was looking up ginger tea on the interweb - can't remember the exact motivation now - perhaps to see how it might work physiologically, as it does seem to help in the moment. I found an article (Zick, Ruffin at all, Support Cancer Care May 2009 17(5) 563-72), about a trial done with encapsulated ginger/placebo - double blind and I think randomised - used in conjunction with people's  usual anti-nausea medication. Mostly found to be not much good, but interestingly, the authors separated out acute nausea and delayed nausea following chemo. So whatever they give me on chemo day seems to sort out acute nausea and it's delayed nausea that's the trouble. Also - drum roll - and statistically significantly, they found that people taking the encapsulated ginger who were also taking aprepitant suffered worse from delayed nausea than those taking aprepitant without ginger. Perhaps some sort of negative interaction. Having read it too late, I hadn't taken note of when I'd had ginger tea, but I definitely had, so may have jinxed the aprepitant. Anyway, I'm not going to chance it next time. Don't really want to be taking three anti-nausea meds unless absolutely necessary, so agreeed with Dr M that I'll try going with daytime domperidone plus bedtime ondansetron plus middle-of-night ondansetron if needed for  Cycle III. Fingers crossed again.

The pattern for the other side effects seems to be: fatigue (see below) for at least the first two weeks; sore mouth, gums, tongue and throat Week 2 onwards; watery eyes end Week 3 -4. 

On the positive side, still no muscle pains, and left wrist cannula resulted in no arm pain.
Also on the positive side, the filgrastim injections seem to have worked - neutrophil count from Monday blood test was 2.59 - not just over the threshold to have more chemo but within the normal normal range.

Lastly and very positively, Ca 125 is now down to 14 from 40 last time so it looks like the chemo is still working. I get another scan before the fourth cycle which will hopefully confirm that.

What else have I learnt, or relearnt this time? 

That Week 1 pretty much imposes 'pacing' - there are times/days when only the sofa or going back to bed will do, and there is no question of doing 30 minutes of pilates before breakfast, not even the one where you just lie on your back breathing. But in Week 2, I had a tantalising day where I thought I felt 'normal', only to crash completely the next - this time, I resolve to impose preventive pacing on myself.

To stock up with prune juice!

To prepare with Audible readings early, as may feel too miserable to do it once in the throes. I have The Cuckoo's Calling and Girl, Woman, Other downloaded  now. Am still in the middle of (very long) A S Byatt Frederica quartet which I dip into, often when gardening, but suspect it will see me out. Hard copy: thanks to daughter's friend for Nina Stibbe (😄), and am now in  middle of John Steinbeck's short stories The Long Valley, and must order Hamnet for book club reading.

That Day 10, second Saturday walks on the London Loop are A GOOD THING - an hour out and an hour back is the test, and passing it is good for  morale. This time we went to woods and gravels on Harrow Weald and liked it enough to do water and sunset from Enfield Lock to the edge of the Sewardstone hills for Day 17, third Saturday.