Monday morning started off the way most Mondays do: getting the kids up earlier than they want us to, feeding them, packing them up for daycare/school, and heading out the door to deliver them. But instead of going to work, Adam and I got some breakfast with coffee and headed to the hospital for my first chemotherapy treatment.
While I’ve read plenty about chemotherapy and the drugs involved, and was sent this great post about what it’s really like to get chemotherapy, I had some vague trepidation about the process itself. Knowing on paper what’s to come and actually experiencing it are two different things. Having already gone through a false start to chemotherapy last week, I had already gone through a few nights of restless sleep and anxiety. Last night it took me a little longer than usual to fall asleep, but it wasn’t too bad, and once I get to sleep I was good for the night.
About an hour before chemo was due to start, I took the first of my arsenal of anti-nausea drugs – a fancy expensive drug called Emend.
At the hospital, I headed first to the lab to do some bloodwork. They need to check my blood counts before I go to the cancer centre for chemo: they check the red blood cells for signs of anemia (low iron), check the platelet count (platelets make my blood clot, which is handy), and white blood cells to make sure I’m not at a high risk of infection from low white blood cell count.
After that was done I walked over to the Cancer Centre, where I’m supposed to weigh myself and hand it in to the pharmacist. Having worked in a couple of food production factories, I already know how to tare (or zero) a scale, so it’s not really a tough job. The pharmacist makes sure my weight hasn’t changed and gets the drug dosages ready for my chemotherapy treatment.
Lily, a friendly chemo nurse, sat down and gave me a warmed flannel blanket so I could settle into my very comfy chair. She hands me four pills — two more of the anti-nausea drugs. Ondansetron (aka the electronic music robot reindeer that pulls Santa’s sleigh?) is a receptor antagonist that helps fights nausea by reducing the effects of seratonin, although I don’t entirely know how it does this. I’m sure it’s pretty badass about it though. The other is Dexamethasone — a steroid. I haven’t figured out how this one fights nausea, so maybe it’s for something else.
She then looked for a good vein to put in my IV, and was not impressed with her options. I’ve been through a lot of bloodwork, and I can attest to this: my veins aren’t so keen on complying. She put her IV into my left arm first, but the vein collapsed in on itself and said ‘NOPE’. Attempt No. 2 on the right wrist was more successful, but only slightly. So we discussed the idea of putting in a mediport (let’s just call it a port like everyone else does), which seems like a good idea to me.
I might be set up with a port in time for my next treatment, or I might not. Adam and I figure we can use it not just for chemo, but also for food, coffee drip, an audio input, and a direct fibre-optic connection to the internet. I’ll be going cyberpunk. What’s another teeny surgery on top of the rest, if it’s going to make life easier overall? Also, Cyberpunk!
ABVD: The Hodgkins Lymphoma treatment
I’m going to go over the chemo drugs I get, but please note: I am not a doctor, and this is not medical advice. This is my understanding (very simplified) of what these are and how they work. If you want to know real information, do some proper research and talk to a doctor.
A is for Adriamycin
With the IV in and the saline drip making my arm feel cold from the inside, nurse Lily brought over the first of my chemo drugs: Adriamycin.
Adriamycin is bright red, which has spawned the lovely nickname of the red devil. It’s given via a huge syringe over a span of a few minutes. The nurse plugged the syringe into my IV drip and sat there adding it, bit by bit, until the huge syringe was gone. Side effects of this one include pee turning neon pink, mouth sores, and hair loss. Oh, and nausea. And if you get it on your skin, it actively burns you. If it goes into your veins too quickly without diluting well enough, it burns your veins. Unpleasant stuff, the red devil.
The drug is also called Doxorubicin; Adriamycin is a brand name. It’s a drug that comes from bacteria found in dirt. They found some soil-based microbes in an area surrounding a 13th-century castle in Italy near the Adriatic Sea, studied it for years, and discovered that it was effective against tumours I honestly couldn’t make this up. Years of study and modification have made it less toxic (although still kind of toxic, especially to the heart). But don’t worry folks, it’s natural! Just don’t read the adverse effects on the wikipedia entry about it unless you feel like scaring yourself some.
I like to think of these drugs as itty bitty anti-cancer super-soldiers. In the arsenal, Adriamycin is a massive shirtless behemoth of a hairless monster-man hybrid with a glowing red sword. He looks scary, but he’s almost all talk — when he swings that sword and hollers at the cells, their DNA panics, gets distracted, and forgets how to divide and reproduce when it’s supposed to. Unfortunately, he’s kind of a douchebag and he scares a lot of other cells too. And everybody wishes he would put some clothes on over that loincloth he’s wearing…
B is for Bleomycin
The next drug Lily brought over to me was Bleomycin. This one is an antitumor antibiotic, and it’s made out of a naturally occurring soil fungus. I am not joking, it’s another natural drug. Who knew that dirt was so full of curative properties? No wonder I let my kids play in it!
Its side-effects include some scary things like pulmonary fibrosis and impaired lung functions (it is suggested that I no longer go Scuba diving or climb mount Everest), fever, hair loss and mouth sores again, and poor appetite and weight loss.
Similarly to Adriamycin, this drug works by making the cells forget how to divide and copy themselves. In the super-soldier army, Bleomycin likes to hang out with his good buddy Adriamycin. I imagine him to be a little like Chester to Adriamycin’s Spike, although that doesn’t mean they actually work together or anything.
Chester isn’t as big and scary as Spike, but he’s kind of distracting and annoying, so once again the cells forget what they’re doing and don’t multiply. Bleomycin irritates the cells so much that they give up and perform seppuku.
V is for Vinblastine
This is the first of my anti-cancer drugs that does not come from dirt. Instead, Vinblastine is classified as a plant alkaloid, which means it’s made from plants. It’s made from four separate plants: the periwinkle plant, bark of the Pacific Yew tree, the May Apple plant, and the Asian “Happy Tree”.
It was administered by hooking up a bagful of it to my IV line and letting it slowly drip into me.
I imagine Vinblastine as Audrey II from Little Shop of Horrors. FEED ME SEYMOUR! I envision many tiny Audreys running through my veins, screaming at my cancer cells and eating them up. Not because it’s accurate, but because it’s fun. Vinblastine inhibits the microtubule structures within the cells, which prevents them from dividing and replicating themselves, which ultimately kills them.
D is for Dacarbazine
Dacarbazine seems to be a strictly chemical drug — there are no castles, dirt, or plants involved, as far as I’ve read. There was research done in Alabama, and that research produced Dacarbazine. It also works differently from the other three drugs, by destroying cancer cells during their resting phase rather than during the dividing phases. It’s known as an alkylating agent.
Lily attached the bag of Dacarbazine to my IV and set it to drip into me for about 45 minutes or so. When I commented that my arm was aching a bit from it, she added more saline to dilute it as it went in, and extended the amount of time it was going to take. This is another drug that burns your skin and veins if it’s not well diluted. As of today, I have no pain from the injection site or up my arm, so I think it was diluted enough, thankfully.
Side-effects again include hair loss and nausea, as well as low blood counts (anemia) poor appetite, and elevation of blood liver enzymes. It can also sometimes cause flu-like symptoms and numbness or tingling in the hands or feet, although this is less often.
Dacarbazine is the ninja in my mighty army. While the other guys are attacking my cells head-on when they’re awake and trying hard to multiply, Dacarbazine is sneaking in under the cover of darkness, taking them out silently as they try to sleep. You never see Dacarbazine coming; silent but deadly. Unfortunately it also attacks all your fast-growing cells indiscriminately, so it has very poor eyesight. A blind ninja. But still deadly!
Talking with the dietician
During the chemo treatment, a dietician came by to go over my weight loss last year (making sure, once more, that it was good, healthy weight loss) and to discuss my diet. I need to increase my protein intake while I’m on chemotherapy — it helps fight off infections and the like. I should be able to handle that. She recommended lots of goat cheese. I can definitely handle that. And I have to eat lots of fibre, because some of the drugs can stop you up right good. Duly noted; I’d like to avoid that.
What’s next for me?
I came home from chemo yesterday and had lunch at the local vegan restaurant of tasty goodness, Chomp. Food will start tasting weird and flavourless soon, so I want to enjoy what I can now until this experience is done.
I spent the rest of yesterday relaxing. I had some mild nausea in the evening, so I took one of my additional anti-nausea drugs to help control it. This one is an anti-psychotic called Prochlorperazine, generally used to treat anxiety, tension, and delusion, which also happens to control nausea. It was helpful, but I only need to take that one on an as-required basis, so I’m not going to rely on it too heavily if I don’t feel bad.
By the time we were putting the girls to bed I was already quite tired. Once the girls were both down I started writing about the day. By the time I was half-way through my writing, I realized my brain was getting muddier and fuzzier, and I couldn’t focus. I was also having some trouble typing accurately, which made me crazy, so I decided to quit for the night and continue in the morning. I was in bed early and fell asleep pretty quickly.
Today I’m taking it easy at home, gauging how I feel and how controlled the drugs are keeping my nausea. It’s been good. I’m a little brain-fuzzed, but functional, and the nausea is under control. I just feel a bit off and muddled, otherwise.
I’m going to go out to run a couple of easy errands with Adam and see how that goes; if it’s all right, I may go in to the office tomorrow for part of the day at least — I don’t want to get stir-crazy at home if I can help it.
My hair won’t fall out for another week or two, so this weekend I’m going to have a head-shaving party. Come on out for the fun! Head-shaving is optional — I’m going to do my head, but you don’t have to.
The next chemotherapy session is in two weeks. But this time I’ll know what to expect, and it will be easier on my system, I’m told.
And life goes on.