Breast Cancer Fight: First Chemotherapy and Herceptin Jab Session

My first adjuvant chemotherapy and Herceptin jab cycle {Mon 5 Dec 2022} did not start off right. Le sigh.

Firstly, I had set my phone alarm to remind me to take my Dexamethasone pills in the morning of the day before my first session, but I still forgot and went out to exercise so took it later in the afternoon when I returned... and pushed back the second dose too.

Secondly, I accidentally took only ONE pill {4mg} for the first 3 doses and only realised I was supposed to take TWO pills {8mg} each time during my chemo session oops... it was because I was booked for 2 chemo sessions so when they gave me 12 pills, I thought I was supposed to take only ONE pill for each dose, since I had to take 6 doses per cycle. Quite silly but not an inconceivable mistake to make right??

Thirdly, and this is not my fault, the NCIS Pharmacy dispensed only 10 pills when I was supposed to receive 12 {3 days x 2 doses x 2 pills} for 1 cycle. I only realised this when I checked my pills at home while taking my first dose. This is the first time I was given the wrong amount of medicine so was quite surprised. Who is to know you are supposed to count your pills when you leave the pharmacy?? I didn't. Anyway, I told Dr Samuel and he said to just inform the pharmacy to give me the missing pills and luckily, they didn't make a big fuss and gave it to me with no trouble, just some time wasted.

Finally, and this got me a tad annoyed & sad, my cooling cap wasn't fitted properly. It was too small and precisely the way the manufacturer said patients should not wear it. I will explain more further down in my post.

But other than these little glitches, overall I reckon my first chemo session went pretty well. The nurses at the Chemo Bay were attentive, although quite busy since it was full-house, and the patient cubicles were spacious, clean and comfortable. Did not feel sick during the session or in the initial 2 days after.

There are I reckon 5-6 Chemo Bays at NUH Chemotherapy Centre.

Each Chemo Bay has 2-3 nurses stationed there and two toilets. There are 10 patient cubicles and each cubicle can house 1-2 patients who receive treatment on a recliner chair. When you have an appointment for your chemotherapy session, you are allocated a cubicle but actually once you reach the Chemo Bay for your appointment, you may choose whichever cubicle you like on a first-come-first-serve basis.

I was at Chemo Bay F15 for my first session.

Note: The green recliner chairs seem newer than the blue recliner chairs. They also have a longer leg rest. However, the blue recliner chairs come with their own side tables which will be useful during the session as you don't need to reach far to get your food/drinks.

Each cubicle also has a TV {think local channels only}, a table and computer for the nurses to use when they check and dispense the medicine, a noticeboard to note the patient's regime and data, an air purifier? and a seat for one visitor.

There are rolling side tables available for sharing, and the lights at each cubicle can be adjusted.

The chemo sessions for each patients last differently. I saw some that last for maybe two hours, while others like me may come for around 5-6 hours. I was basically there for half a day from 8am - 4pm, including all the wait time.

Once done, patients can leave and another will quickly take the cubicle space.

I'm not sure if the chairs are wiped after the patients left before the next patient use it {didn't notice that} but I'm sure the cubicles are cleaned somehow because NUH Cancer Centre {NCIS} is very particular and protective of their cancer patients.

Blankets are available but you are advised to dress warmly. I chose to wear my cotton Muji pjs, socks and slippers for comfort and used two blankets. Other patients wore normal outing clothes hehe.

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This is what my first chemotherapy session was like:

0815hrs Arrive at hospital

0820hrs Verify ID with counter {registered 1hr earlier on One NUHS app}

0830hrs Check vitals and the pharmacy will prep the medicine

0850hrs Go to Chemotherapy Bay

0900hrs Chemo Bay nurses start to come in

0915hrs Chemo Bay nurse checked verified my ID and stats

0930hrs Toilet break

0940hrs Start scalp cooling cap machine and pre-meds preparation

1000hrs Cannulate and run through with saline

1020hrs Try on cooling caps for correct size. Still got it wrong. Le sigh.

1030hrs Run pre-meds drip for anti-allergy and to protect stomach for 15mins

Start scalp cooling therapy

1050hrs Right arm started to feel weak and hurt a bit. Only a while.

1105hrs Flush pre-meds with saline

1110hrs Pharmacist came to dispense home meds and Peglasta syringe {to boost

white blood cells to fight off infections - will be kept at the Chemo Bay

fridge and to collect before going home}

1120hrs Start Docetaxel drip for 1hr and jabbed Herceptin {thick liquid so 45s jab}

1125hrs Toilet break {unplugged to cooling cap machine but roll drip IV to toilet}

1245hrs Toilet break

1310hrs Start Cyclophosphamide drip for 30mins

1355hrs Continue with cooling cap therapy for extra 1.5hrs post-chemo

1540hrs End scalp cooling therapy and take out hand canula

1550hrs Collect meds and leave Chemo Bay

1600hrs Go home

I'll share more on scalp cooling in another post but you can read a brief introduction here.

Before the first scalp cooling session, a nurse will conduct a patient cap size selection to ensure the patients are wearing the correct sized cooling cap to help avoid any patchy areas of hair loss and bald spots following the scalp cooling treatment.

The nurse that did this with me was friendly and actually very patient. However, the size I ended up with was still the wrong fit, as shown in the cap fitting guidance from the manufactor's guide that came with the machines. If I did not read the guide, I would not have known I was wearing the wrong cap size too.

S is actually a typical Asian size {maybe because Asians have smaller heads??} but it was still too small for me perhaps due to my thicker hair, and I wore an M as recommended by the nurse.

After I read the manufacturer's guide nearing the end of the session, I realised that I should have worn a L instead though because my hairline was not fully covered, especially above the ears and behind. Looks exactly like the wrong way to wear it in the guide... right??!

I was quite understandably annoyed / upset when I found out since I wanted the best outcome for this therapy, and worried that if I wore the smaller cap, it did not fit properly and would not have a successful outcome (πーπ)

I mean, I expect hair loss and understand that even with scalp cooling the success rates in patients for reduced hair loss, not zero hair loss... are about 50 - 70%... but if it starts off badly then I'd have even less hair to "save" for future chemo sessions. Quite heart-pain especially with everything going on and knowing that this could have been easily prevented, you know?

Anyway the outer cap I wore this time was small and seemed ok. For the next session, I will try a L for the cooling cap but perhaps M will be ok as my hair is much, much thinner.

Other than the cap fitting hiccup, I did not have much problems with the scalp cooling therapy. Just some slight headache at the beginning, and it was kinda cold.. but not unbearably so.

Tips:

Wear warm and comfortable, especially if you have a long chemo session {ask your oncologist or the nurse navigator for the estimated duration}.
It really does get cold, so don't be afraid to ask for extra blankets if needed. I wore long pants and sleeves pjs, and long socks. Used two blankets but still felt cold, especially at my hands so for the next session I will also bring gloves. Sounds kiasu but I'd rather be comfortable..
Bring food and drinks, especially a big water bottle. Important to stay hydrated. I brought a box of snacks, fruits {cut persimmon} and lunch {tomato-based meat pasta} since I knew I was going to be there for a long time over lunch. However, I did not eat my lunch, just the fruits and protein bars since I didn't have much appetite.
There is no water cooler inside the Chemo Bay but the nurses will assist to refill your water.
The nurses can give you water, hot milo and crackers upon request too. However, they are really busy.
I do not think that you can ask them to help you buy food or order delivery food {unless absolutely necessary maybe..?}
I have a bad back and the recliner chair does not provide a good back support so for my next session I will bring a back support pillow too.
If you go alone for your session, you might want to use the blue recliner chairs instead of green as they have attached small side tables where you can put your food, drinks, books, mobile, iPad etc. The green chairs do not and the rolling side tables are on a share basis.
Bring enough books or devices to entertain you during the session.
Bring ear plugs and eye mask if you intend to nap during the session.
Do not bring unnecessary valuables and money.
One visitor is allowed at any time. No registration is required but they are not allowed to eat there.
The nurse will assist you to the toilets because of risk of falling. You have to tell them whenever you need to go.
Inform the nurse if you feel any discomfort or pain e.g. body pain, heart ache, fast palpitations, nausea, vomiting etc. during the session. For the first few chemo sessions you might want to sit closer to the nurse's station in the front so that they can monitor you more closely.
Bring a cooler bag with a small ice pack to bring your Peglasta syringe home. It needs to be kept chilled.