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Anyone on just Taxotere and Cytoxan?

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  • Tigwin
    Tigwin Member Posts: 115
    edited May 2008

    suzip..I have been scheduled for 6 treatments of TAC.  I had radiation 19 years ago for a different cancer so I will not have radiation this time. I will also have bilateral mastectomy and recon in the fall.  

    Okay.....need your help....I have been asked to be in a book of breast cancer survivors that will be published in September 08. The proceeds are going to two very worthy breast cancer charities.  I am very excited.  I can wear anything I want , wig, scarf, hat...bald  !!!!  It is suppose to be the positive side of being a breast cancer survivor...any tips of what looks good color wise to be photographed and or makeup...I am not the best in this arena.  What do you think is more positive...wig, scarf or bald for the world to see. I think I am the only one still in treatment ..You opinions matter, as I am representing my posse here.

  • artsee
    artsee Member Posts: 701
    edited May 2008

    Hi everyone, boy have I been out of it. Not posting awhile and I'm missing out on all the happenings.

    CHJ....Lucky you and congrats to you. I don't know what I'd do right now if I was going for 6 tx's. Just these 4 seem like am eternity.

    Otter... Thanks so much for concentrating on our group here. Don't know too many on the others. It's quite a chore keeping all of us straight. You may want to invest in some Nioxin shampoo, conditioner and the scalp treatment. These three come in a starter kit. It's got a minty smell and is made for thinning hair. The scalp treatment I put on my scalp morning and night and I have not had a bump on the scalp.In fact it will encourage the hair to grow. The $30.00 investment is well worth money.

    Please do post those pictures. I like putting a face to the posts.

    Suz...I always thought a bigger tumor went with the 6 Tx's. It sort of surprised me that they even started to do just 4. I always thought I was doing 4 because of Stage 1. Anyone have an explanation?

    Take care all, (two more days...Laughing)

    Artsee

    Tigwig...I received a book like that from a BC survivor and she was in the book. For me it was the most depressing book because 3/4 of the people in there got BC for the second and third times and with mets. I thought why would anyone want me to read this when I was just starting my journey. I do hope your is all positive experiences.

    Being a hair dresser I guess I'd do the wig or scarf. It's a personal thing. And I'd put on a bit of makeup so new lady's with BC can see how good we can look even though we have this bad disease. I want to hear survivor stories right now. The s/e's are depressing enough. Hope this helps.

  • chj127
    chj127 Member Posts: 146
    edited May 2008

    SuziP - I also got 6 treatments, and it was supposedly because this is my second time through, and they want to be more aggressive.  I'm IIb, tumor was just under 2cm.  What surprises me is that they told you 4 then suddenly upped it to 6.  That would feel like a kick in the stomach.  I went in with the expectation that I would get 6, so I was mentally ready for that.  I think you'll need to go with your gut on this one.  My onco said something to the effect that he couldn't guarantee that I would get more benefit from the extra 2 treatments, but that they wanted to be aggressive.  There is a tumor board where they all get together and discuss each case, and that's what they decided.  Also, I think that the preferred treatment would have been TAC, but I had Adriamycin during my first bout with BC in 1995, and they only give you "A" once in your life.  So I guess they compensated by giving me more "TC".

    Tig - I think I'd go with whatever you are the most comfortable in.  If you go bald, it really makes a statement, but if that makes you uneasy, go with what you've been wearing most of the time.  That is the look that you feel best in.

    Artsee, glad to see you back!  Good luck on Friday!

    My last tx was uneventful and went faster that previous ones.  I was in at 10:00 and out by 1:00!  RBC's were a bit low, so I got the Aranesp.  But right now I feel just fine.  We'll see how the weekend goes.  Undecided

    CHJ 

  • artsee
    artsee Member Posts: 701
    edited May 2008

    What is Aranesp? WhooHooo, I'm doing the happy dance for you CHJ!!!

    Would you guys please explain the different (stages of tumors) that are small, under 2cm. For some reason I thought under 2cm it was always Stage 1.Duh!!

    Thanks in advance. I swear this chemo brain is doing me in.

    Artsee Yell

  • lotodgs
    lotodgs Member Posts: 54
    edited May 2008

    CHJ, Horrah for you, we are over.!!!!!!!!!!!!!!!!!!!!!!!!!!!!!My baby Dollie Mae came home today, just picked her up from the vet, she is SO happy to be home, have her on a antibodic and easy on the food, little Tucker, her brother was happy to have her home.

    Now with the neutasla s/e, for us this week, hopefully they will be minimum. Thank you all for your concern about my DOllie Mae, I don't have any children, so these pups are my babes!!!!!!!!!!!!!!! 

  • Jisman
    Jisman Member Posts: 96
    edited May 2008

    Tigwin - very cool on being included in the book.  I say go with whatever you are most comfortable with (wig, scarf, bald) as you likely will be more comfortable for the picture.  As for make-up, any good make-up counters nearby???

    I actually waited until I was into chemo before picking up one of the survivor books.  It actually was done fairly well in terms of being positive and therefore helpful eventhough some did have recurrences and one or two had another primary cancer.

    Congrats to all finishing up their treatments this week.  Likely will see you over on the May rads thread soon.

  • chj127
    chj127 Member Posts: 146
    edited May 2008

    Artsee - Aranesp is to help with red blood counts if they get low.  I had it just once before, after my first tx.  I guess it's catching up with me.  My WBC's are fine, guess the Neulasta is doing it's job.  As far as staging goes, it's not just the size but the grade & other factors also.  When there are nodes involved (like me) you automatically get bumped to Stage II.  See here:  http://www.breastcancer.org/symptoms/diagnosis/staging.jsp

    lotodgs, hooray that Dollie Mae is home!!  We don't have human children either, so our cats are definitely our babies!!

    Still feeling OK so far; I still have 1 more day of steroids, started the Senokot, and started the Prilosec.  Jeez, I think I finally have the drill down pat, just in time for it to be over!  Guess I'll be heading into the fog before too long.

    Have I said lately how much I love all you girls on this thread???  (And Steve?  Where are you??)

    Have a good night, all!

    CHJ 

  • RJ62
    RJ62 Member Posts: 9
    edited May 2008

    Hi everybody. I thought I would join the TC group. I have finished my first round 2 weeks ago. I have 6 rounds all together 3 weeks apart. Sorry If I can't keep everybody straight as this is a very long thread and I haven't read the whole thing. This is my 2nd time going through these awful treatments (once in 2000). The 1st time I had AC/Taxol. I must say I was dreading this one something awful. This time though so far so good. Just a few bad days and thats it. Must of been the Adrimyacin last time that made me feel so awful. This time though just some bone pain....well a lot of bone pain, thrush and constipation. After about the 7th day I felt great and still do.

    I shaved my head last night and wouldn't you know its going down into the 50's during the day tomorrow. BRRR!!!.

    Well, just thought I'd introduce myself and give you some background. I hope everybody is well and congrats to those that have finished . Anybody here just starting their rounds?

  • debap
    debap Member Posts: 51
    edited May 2008

    Otter:  Have you tried hydrocortisone cream for your bumps?  I did, and the red,itchy bumps were gone in 2 days.  You are so good at keeping up with everybody!  This thread is really growing!

    chj127, swimmer60, jt1945:  I am so relieved to finish my last treatment today.  chj, I don't even want to think about doing this for 6 times, you rock!  I hope just knowing we are at the end makes the se's seem minimal.

    SharonS:  Your son is adorable!  You seem to have such a nice family.

    NurseLisa:  I start Tamoxifen next also, although, I have been considering having my ovaries removed.  My onco said that there are not many se's with Tamoxifen and that it is an excellent drug to prevent BC.  Does anyone else have info about Tamoxifen?  I did read that it can cause ovarian cysts but my onco said no.

    Tigwin:  I like to wear hats because it feels more natural to me, but it is like wearing a bc billboard.  That made me uncomfortable at first but I have received a lot of compliments and I'm getting used to it.  I guess you should go with what makes you feel the most comfortable.  Do you mind if I ask what type of cancer you had 19 years ago?

    Have a great night ladies!

    Debbie

  • ladybugcyndi
    ladybugcyndi Member Posts: 35
    edited May 2008

    Otter.. the "army of one" slogan is saying its an army of one, like a team... not just one person.  Its very confusing .. my son is in the army, will be 3 years this july.  He just spent his 21st b-day in iraq.  What a way to celebrate, huh?  And tomorrow is #3 for me, 1 more to go, 1 more to go... I have been stying hydrated, I think about right.  I have made a conserted (?sp) effort to drink enough w/o going overboard.  I will ask tomorrow about the headaches, nosebleeds, neulast shot (not sure if I want to do it "just because" its their standard protocol.)  I'm having this treatment here locally rather than going to DC.  Jeez, I am more nervous with this one than I was the first time. Just the change I guess? 

    Best wishes for a good tx tomorrow and friday for all having tx.  For those that have had it already this week.. sleep peacefully and no side effects.  For those finished this week,WTG!  Congratulations...

    SharonS... congrts on finishing last week and having  a better time with this one than previous.  I keep wondering what will #4 be like?  And, handsome son .. can't wait till he is out of afghan... I know you can't!

  • Tigwin
    Tigwin Member Posts: 115
    edited May 2008

    Ladies thanks for all thoughts on what to wear for the photo shoot. I have decided to go with the scarf. My wonderful niece took some time tonight to look at my options and thought I look like me in the scarf.  I have seen some of the photos the photographer has already taken and the book is to be 100% positive. That is what made me want to be in it. It does not state what type of breast cancer it just states how long you have been a survivor.  I am really excited I hope it turns out as good as I think it will be.

    Debap...you asked what type of cancer I had 19 years ago.  I had a cancer in my lymph nodes in my neck and chest yet not in my breast tissue.  I am very lucky as my odds were not stacked in my direction. They could not determine what the cancer was and so we just took a chance , went through chemo and rads and i have been well for 19 years.  Kind of a drag to now get bc...but I was not suppose to be here so I feel very lucky to have had such a well run in the last years and know my bc is just a fork in the road.

  • jt1945
    jt1945 Member Posts: 23
    edited May 2008

    Hi all,

    Well I'm done with chemo now.  Got my 4th and final tx today.  Yeah.  It was quite an interesting day.  First I had to go to my cardiologist's office to get a Holter monitor put on because of my rapid heartbeat reaction to the taxotere.  That went OK.   I get to the onc's office and they said I didn't have an appt today.   Not in the computer.   They pulled my file and fortunately the nurse had written in my appt for today and for tomorrow for the neulasta.  After the receptionist talked to the nurse they found out that the nurse had put the appts in the computer under a different last name.  Since they don't call with reminders none of us knew, including the women who didn't really have the appt's.  Then they had to check to be sure they had the 'cocktails' for my treatment.   They did.   It took 4 attempts to get a vein.  Good thing I'm done because I'm out of veins on that arm.  Within 5 minutes of very slow taxotere drips my heart raced right up to 133.  So we stopped for 1/2 an hour.  Started again very sloooow.  The heart rate stayed within reason so we started upping the drips until we were at 1/2 the usual drip rate.  Took 3 hrs, 55 minutes for the taxotere but I got every drop.  Heart rate at the end was in the 80's.  I guess my heart just objects and then gives in.  The cytoxan went in fine.  I was in the chair for 7 hours and have a bruised up left arm.  Then when I got home my cat scratched me on the back of the hand.  What a mess.  Anyway, it's over except for the s/e's.   Yeah.

    How did the rest of you Wednesday girls do?

    I asked my onc about a mammogram for my 'good' breast which hasn't been done since last April.  You'd think he would order the mammo, but he said to talk to my surgeon???? or my radiation oncologist.  I should have both breasts done be the radiation because the bad one will be too sore after.  What are your experiences with mammos during treatment?  

    Joyce

  • jt1945
    jt1945 Member Posts: 23
    edited May 2008

    Hi again,

    When of submitted my last post I got the page updated with all the posts of today.  So I see how it went for the rest of you.   Congratulations to us all.  I sorry I am not organized enough to give a personal message to everyone.  You all in my thoughts.

    I used cortisone cream on a few red bumps I had on my head and they went away.  I also use baby shampoo on my head.  There is a lot more grey stubble there now than I seem to remember when I had all my hair.  I think after the next fallout in 15 days I will buzz off everything and start with a clean slate so the hair maybe will grow in evenly and be the same length.  I will be interesting.

  • NurseLisa
    NurseLisa Member Posts: 15
    edited May 2008

    Congrats to jt and all you who have finished!!  Cool  Still going through the s/e after my tx Monday, but Ativan and Emend help a lot.  After my 4th and last tx on May 28th, am I automatically bumped to another site?  I guess then, I'll eventually get to see all of you again and pick up everyone's stories. 

    Tigwin--the choice to wear the scarf sounds like the perfect solution.

    RJ---welcome, but sorry to hear it's your 2nd time around.  Hopefully, this will be better.  Any tips to share??

    Well, these darn hot flashes are getting the better of me; I'm off to bed, pop an ativan and hopefully sleep.....

  • lotodgs
    lotodgs Member Posts: 54
    edited May 2008

    Tigwin, I know you will be beautiful with the scarf, if that is what you defintely decide to do. THat is a great honor to be in the book and will inspire others.

    about the red bumps, I used Cetaphil on my head and did help to keep my head mositured at all times. The Cepahil does not have a scent and is very good for dry skin,etc. Hope this will help.  

    I would like to second what CHJ,. said, about all the love on this tread from you girls, it is so hard for others to understand unless you are going thru this acutually yourself.Everyone hang in there today and hopefully limited s/e. 

  • chj127
    chj127 Member Posts: 146
    edited May 2008

    Good morning, everyone!

    So far, I'm feeling not-too-bad... Took the steroids, the Senokot, the Prilosec.  I think the Senokt is what's making my gut feel a little weird, but it is soooooo necessary!

    Welcome, RJ62!  There are a few of us who have been through this before.  I had 4 rounds of AC back in 1995, bc on the other side.  So I know just how you feel.  What, again???  Puh-lease!  But I just finished tx #6.  I got really discouraged a few times along the way because it felt like it would never end.  But somehow the time has passed, and except for the next few days, I'm finally through it.  You will get through it too!

    debap - you are right about being reieved that we are at the end.  And yes, we DESERVE fewer se's this time, I think.  It's only fair.

    jt1945, sorry your last tx was such a long one.  I'm sure you are glad it IS the last one.  BTW, my surgeon originally ordered my followup mammogram for  mid-July until I looked at the calendar and realized that would be right when I'm done with radiation, and while I did not have radiation before, I was pretty sure from what I had heard that I did not want to get my recently-radiated breast smashed in a mamm machine!!  So I had it rescheduled and I'll have it this coming Monday.  Not looking forward to that, but it is what it is.

    Hope you all have a good day!

    CHJ 

  • clcady
    clcady Member Posts: 8
    edited May 2008

    I will ask Monday. And I will let you know.

  • chj127
    chj127 Member Posts: 146
    edited May 2008

    NurseLisa, I forgot to respond to your question - upon completion of treatment, you don't get "bumped" - you can stay here as long as you like - but it seems like people often drift off to the next thing.  Many people will head to the rads board if they are doing radiation, since that's the information they will need for the next phase of treatment.  You can read and participate on any of the threads on this board. There are lots of interesting ones!

    CHJ 

  • goldilocks
    goldilocks Member Posts: 106
    edited May 2008

    Morning all.

    Welcome RJ52. I am also a 2 time BC survivor. My last time was just at 5 years ago. I did a similar "cocktail mix" as yours. Don't remember exactly what it was. I was not able to take the Tomaxifin. I have had serious allergic reactions to all the chemo drugs.  My body goes through several changes, and this time has been no exception to the rule.  I had my last tx #4 April 24. 

    Yesterday my legs, feet, ankles all swelled up like an elephant. The onc dr was not available. The onc nurse made me an appt. for this morning. They said that if I am not running a fever, to just keep my feet elevated and come in first thing. As you all know I have been fussing about the bone pain. Well, I guess the swelling may at least show, and therefore the dr may believe that I'm not making this up. Most of the people that go to my onc dr are seniors, so if I don't look pale, or lethargic I guess they think all is fine. YellThe nurse knows that I had swelling on round 3, but this time my ankles have disappeared. Wishing the se to be over. I know that I had my last chemo, but the lingering se are crazy. I also have completely lost my eyebrows. Tried to draw some on, but looked like a clown.  Need Artsee, to draw for me.Innocent

    Here's wishing everyone a comfortable day. Cool

    Stand strong!(former Army)

  • CarolC
    CarolC Member Posts: 5
    edited May 2008

    Nico,

    I've not been posting for awhile - not sure why but I think after my last chemo on Mar 19, I just needed to take a break from all things BC for awhile.

    But I will tell you that in my case, my first onco did recommend A but I had researched it and refused to take it because of the cardiotoxicitity. I have a family history of heart disease. I then went to UNMC for a 2nd opinion where CT was suggested - partially because of my concerns about tolerability and also the fact that I was triple negative, if I'm remembering correctly.

  • kathys_hubby
    kathys_hubby Member Posts: 22
    edited May 2008

    Hi Ladies, I'm back! As the primary caregiver, this family has me running around in circles, I don't know how single parents do it! Add all of the family business (four kids) to trying to maintain a full time job, and I'm toast! I was in NYC all day Monday for meetings, then with Kathy for the tx on Tuesday. Just geting back to my desk today and wanted to check in, hope everyone is doing well. Congrats to all who finished this week.

    Otter, fyi Kathy's tx#3 was Tuesday 5/6, please add her to your calendar. We are now officially halfway done!

    SuziP - Our onc also recommended six treatments of the TC because Kathy had lymph node involvement (4/20). He said he was very comfortable with using TC instead of ACT, but that he could not recommend it for the usual four tx's because of her staging. He convinced us that the combination of two extra treatments and the lesser side effects compared to the ACT was the right plan for us. What is your diagnosis/staging? As everyone here says, every decision here is particular to the individual, but we trust that this is working and have faith that we'll get through it.

    Our doc said an interesting thing that I want to remember. As he was discussing our case during Kathy's check up, he told us to remember that we are working on prevention now, the goal is to stop a recurrence. The cancer was gone with the surgery, what we are doing now is killing any microscopic cell leftovers that might be lurking around. Sometimes it's important for Kathy to take a step back and remember that the surgery was reactive, the chemo and radiation are proactive.

    Have a great day!

    Steve

  • texrn
    texrn Member Posts: 6
    edited May 2008

    Hi everyone - I don't post on this thread often, but I enjoy reading

    everyone's posts.

    Goldilocks - I, too, had a lot of swelling in my legs, feet, hands, eyelids, & a poofy abdomen - which all showed up all of a sudden about a 3-4 weeks out from my last chemo tx ( TC x 4 completed 2/29/08 ). From what my onc told me & from what I've researched - it can last up to 4-5months - luckily for me it only lasted 2-3weeks.

    I kept hydrated during that time, & continued to exercise everyday, & put my feet up at the end of the day - but I tell you, my feet haven't been that swollen since my last pregnancy (w/ twins ). My feet looked like a pair of hotdog buns! My onc found that more amusing than I did.

    The hair on my head is growing pretty good - I am keeping it trimmed down, weekly, to a military style until it all fills in, then I plan on letting it grow. Since it looks pretty even, I feel very comfortable going out in public 'topless'. About 75% of my eyelashes & eyebrows came out about 6-8 weeks after chemo finished. I have stubble in those places now. So far so good on the nails.

    The muscle & joint pain completely subsided about 5-6 weeks out from my last tx. 

    Had my exchange surgery this last Tues. , so I'm a little sore from that, but overall I'm feeling pretty good.

    Just wanted to let all of you who are still in the middle of TC chemo, & all who have just finished, that it is possible to bounce back sooner than some onc's might say. My onc told me that I would be feeling 100% by summer - well this is one area where I am glad I have proven him wrong.

    Therese 

  • goldilocks
    goldilocks Member Posts: 106
    edited May 2008

    TXRN: Thank you for sharing.  I really needed to hear that. It seems like this last treatment S-L-AM-M-E-D me.  Just want to be done.  I'm trying to be patient.

    Also good to hear that you are getting better every day.

    So, the onc dr. prescribed lasix for the swelling. They want me to return tomorrow so as to check my "swelling" and see if this helps. So, came to work and am having to run up and down the hall since these are water reduction pills.  If it goes crazier, I may need to get home.  The bathroom there is much closer.  We'll see.

    Cynthia

  • kathys_hubby
    kathys_hubby Member Posts: 22
    edited May 2008

    Therese - you mention your exchange surgery - did you have to go through radiation? Kathy is halfway through her treatments (TC x 6) and we'll be talking to the radiologist soon. We're not sure if having the expander in will effect the radiation at all. The expander is finally comfortable and fully inflated, so I'm sure she would like to leave it in for rads and have the exchange done at the end when she feels 100%. Any helpful hints?

    Steve

  • texrn
    texrn Member Posts: 6
    edited May 2008

    Kathy's hubby -

    I did not have to go through radiation therapy, as I had bilateral mastectomies & no node involvement. I understood from my ps that

    the expanders are  strong enough to withstand radiation ( the implants are not ), & once radiation was completed I would have had to wait up to 6 months for the breast tissue to heal before having the exchange surgery.

    Hope this info helps...

    Therese

  • Skarem
    Skarem Member Posts: 4
    edited May 2008

    Dear Clcady. Hi, I'm Sarah, 42, Stage I. I just finished round one. I am getting four rounds, every three weeks. No one week break though. I hear what you are saying about everything moving fast, but I am with you on the I just want to get this over with. I did about 30 minutes of reading on this web site chat room about Taxotere and Citoxin before my first round and decided that was all I needed to hear and that my side effects were going to be mine and no one elses. So far I have had some very different side effects in addition to some of the mentioned ones. But overall, other than about three days of icky, I am doing better. I have found that the more I exercise the better I feel so my husband sends me on long walks in the evenings before we put our 5 year old to bed. That helps everything. If you want to know more of my side effects I will let you know, but yours will be yours and you will have to deal with them the way you deal with them. It is scarey at first....but I made it through round one, even with an allergic reaction. The biggest advice I can give is make sure the poop is running smoothly before bec I did get stopped up for four days. I would advise a stool softener for about two days before and just stay on it for about a week after until the drugs have started to work their way out of your system. Blessings on the journey dear. Because He Lives, Sarah. Phil. 4:11-13

  • robink
    robink Member Posts: 60
    edited May 2008

    A question for anyone...

    when you go in for your follow up lab work, does the office staff use your port or draw from a viable vein?

    Today I went to my oncs office (a 45 minute drive) and had my blood drawn from my right arm (I have a port).  It was not a good stick, she poked around and finally backed into the vein then eventually got enough blood to fill the purple tube.  3 hours after the draw (we had just arrived back home) I got the call that the blood was clotted and I needed to go back for a repeat draw.  So now I'll drive back into town and hope for success this time.  I'm tired and will do this tomorrow.

    I am p.o'd. and frustrated.  Should I request the port be used for labs or is it strickly for chemo infusion?  What has anyone's experience been?

    Robin

  • kathys_hubby
    kathys_hubby Member Posts: 22
    edited May 2008

    Therese - Kathy's ps said that the radiation man might not like the expander because there's a little metal in it that might deflect the radiation around. Our oncologist said that he didn't believe it would be a problem, so we're hopeful. We also want to avoid the possibility that there might be some tissue shrinkage and/or scar tissue around the "permanent" implant, so if she can go through the radiation with the expander still in that works best for us.

    Any other ladies here looking into this issue?

    Kathy also asked the onc yesterday about ovary removal. He said it was totally voluntary, not necessarily anything she needed because with no family history she is relatively low risk. BUT if she was done with children it was probably a good idea. She told him we are definitely done with kids (tubes tied after number 4!) and she would probably think about doing it. He said she should absolutely wait until the chemo and radiation are well over, when she's feeling back to normal, then think about it. 

    Anyone else thinking about this?

    Steve

  • chj127
    chj127 Member Posts: 146
    edited May 2008

    robin - I get my followup blood draws at the onco's office and they always use my port.  The onco nurses do it, not the other nurses.  If you get your blood drawn somewhere else, they might not be trained to access the port.  Not every nurse can do that.  I would pursue it, though.  You don't need that kind of stuff going on!!!

    CHj 

  • revkat
    revkat Member Posts: 122
    edited May 2008

    Hey all, congrats to all those who are finishing up! I am going for number 3 (of 4) next Tuesday.

    The thing that is driving me nuts this time around is the twitchy eyes. That along with the watery/goopy stuff makes me feel like my vision is going out of focus all the time. Sort of a pain since so much of what I do involves print -- on paper or computer.

    I had a check in with the onco this morning and everything I mentioned is "due to the chemo". Which I kind of knew, from reading about everyone's experience here. My rbc is low, but not so low that she wants to do anything about it yet (around 11.5 for those who know about such things), but I'm wondering if that is why this round I have not bounced back the way I did after the first one. I just feel heavier, more achy, and more tired.