Today was my first chemotherapy treatment. I'm wasn't sure what the best way to approach this was, but my thought was to go into it slightly tired. (And I did). So, I stayed up until about 11:30 last night. The thought was that I'd be more likely to sleep or be mellow, and less likely to notice side effects. I'm not sure if this was wise or foolish. Probably the latter. As it turned out, around 1am, I was up with the shaking chills that have characterized my illness for months. So, I got very little sleep.
**BTW, if you're uninterested in reading about the nitty gritty of side effects, skip to the very end, or even wait until tomorrow or Wednesday**
Breakfast was some instant oatmeal. I was told to eat something substantial, but not "heavy" nor "greasy." In addition to the chills, I had some GI issues this morning, so I was already feeling fairly badly going into treatment. We went to the clinic and got there around 9:00 am for the "Chemo Class." The class had 7 people, of which 4 were patients. The class itself was alright, it was very generic overview of some precautions and some strategies for side effects. Basically, I'll need to do special mouth rinses, and I'm not supposed to eat sushi now for a while. I also shouldn't have soda around treatment time, unless "de-fizzed" ginger ale or 7-up, and I need to postpone my upcoming dental appointment. I also need to start thinkng about shaving my head, probably in about 2 weeks. After the class, which was taught by a nurse, we saw a video which was basically a repeat of all the same info.
I then had 30 minutes, and I was hungry again, so I had some cracker sandwiches, some gatorade, and a few mini-chocolate donuts. I took some time out for "GI fun." Then we went up for chemo.
I was still alternating between the hot and cold thing since I skipped ibuprofen not knowing if I should be taking it or not. (As of now, I'm supposed to really minimize it due to the problems it can cause to the GI tract, which all chemo assaults pretty heavily, and due to its affect on bleeding, which chemo also affects). My nurse was absolutely great. She was extremely knowledgeable and very kind, and spent a lot of time in explanation of everything. Although the process is supposed to be about a "half day," in theory it could be less. It wasn't today, though. The IV line she placed was actually a very small IV which was placed on my top of my hand.
They start IV fluid, and then I got some anti-emetics. Sarah wrote the doses, but it was IV Zofran, IV Decadron, and oral Emend. The Emend is sort of interesting, I'd been wondering about this drug since summer - long before any sort of diagnosis. I had to study for a pharmacy exam, and this drug was in the study materials. I'd actually never heard of it to that point, and so I was a little surprised something so big escaped me (not like we deal with tons of nausea in infectious diseases, though).
After that, the chemo starts. As I've noted before, my regimen is ABVD, and that is the order they give it in. Adriamycin (or doxorubicin) is an IV push from two syringes, for as much as I needed. It is sort of neat watching it being slowly pushed, the color is something like Hawaiian Punch in the syringe, but it flows in with the saline drip at just the right rate to dilute it into orange colored "streams." It was almost hypnotic, truthfully. This one should turn the urine red, but I haven't seen that yet. Bleomycin is next, and this is one I've been worried about with my lungs. The side effects for this to note are dry cough, shortness or breath, etc. Unfortunately, the symptoms of my disease thus far are the same..... Vinblastine was a little bag which went quite quickly, and then the dacarbazine (or DTIC) was last.
All of these drugs are considered desiccants, which in the world of chemo is not entirely the same as in the chemistry lab. In either case, the goal is to be sure extravasation does not occur. Dacarbazine was a drug that an oncology pharmacist friend in Texas had warned me about, suggesting that if it was painful at all, tell the nurse immediately. The first 3 drugs went in without any sensation, except perhaps being slighly cool. I was worried I wouldn't know if I had an issue, but the nurse assured me it would be quite obvious if there was a problem. This one did hurt some going in. Even though they place a warm and dry compress on the arm to keep the vein as wide open as possible, I did have some weird sensations. The nurse checked it several times, and it was OK, but eventually slowed the rate of the infusion and increased the saline drip that was going with it. This may have helped marginally, but it was nice to know it was simply pain versus a real extravasation. In the world of pain, I would have rated it no more than a "3" as a minor annoyance, I just kept worrying about something going wrong.
What else can I describe? All the fluids and the chills made me have to urinate about once per hour while there, which required me to do a funky dance taking the IV pole into the bathroom. However, once done, I felt pretty good. I was a little tired. Because they slowed the rate of the DTIC from ~ 1 hour to ~2 hours, Sarah and I watched part of Bull Durham on the DVD player she had purchased for my hospital trip last month. I was fighting to stay awake towards the end of the infusion when we wrapped up. I'm not sure if that was due to lack of sleep last night or fatigue from the meds. Or both.
On the way home, we stopped to pick up some bagels as a "bland" food I could put peanut butter on for protein. I still felt pretty good and was sure I would be at work tomorrow with no problems. However, when I got home, I took a quick hour nap. Now my GI tract sort of hurt (more pain than nausea, but not cramping), as I woke up, and then had myself a decent diarrhea session. Midway though that, I was starting to get worried about vomiting. All the autonomics and auras were kicking in. So, this really was just like the wee hours of the occasional college bender -triple threat!- without the fun beforehand. (or rather, a different kind of "fun" beforehand.)
**IF you did not want to read the sick stuff and skipped - you may resume here**
I took some nausea meds (compazine and ativan) and things are better now, although I'm definitely slowed way down. I'm definitely kind of foggy in thinking too. I'll probably have a smoothy very soon, or maybe a shake. Watching TV with a show that was spinning (Simpsons) didn't help, so I turned it off and attempted to fix / reset our cable modem and Apple Airport, which was a lovely task for today. (Obviously, Sarah and I got it working, though).
I thought for sure I'd be working tomorrow, now I'd say I'll need a huge night of napping and no nausea. I do have more Emend to take first thing in the morning, along with compazine, and probably more tylenol for the fevers / chills. We'll see.
Last curious thought: My impression from pharmacy school (keeping in mind I have ZERO background in oncology) was that regimens become harder and harder to take over time. This was the opposite told to me by our oncology pharmacist and my nurse, who suggested the first regimen was the worse, and after that the body starts to tolerate it better. I hope so. This is a large reason I'm hoping not to vomit just yet - I'm not sure if that will or will not be a harbinger of more trouble in rounds 2 through 12. I really hope this is truly the worst I'll see. If so, I don't mind being a little knocked out for a day or two, knowing that may not happen on future rounds. Time will tell.
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