Tuesday, September 17, 2013

Chemo #3: Walkthrough of My Day

Chemo #3 is done!  75% of the way there - next (and last) chemo treatment is scheduled for Monday, September 30.  This time I wanted to walk you through my treatment day, hour by hour.  I also want to give some more information about the chemo regimen I've been receiving, called ABVD.

But before I do all that, here's an update on how the end of my week last week went:

I last left you with the exciting news that my white blood cells were back in the "normal" range (well, in the normal range for a chemo patient).  I was able to make the trip out to St. Louis on Wednesday for a work trip I was honored to be invited to.  Wednesday night I didn't feel great, but was able to eat a little bit at my BFF Heather's house - she lives in St. Louis, so I stopped in to visit when I got into town. Thursday was a pretty good day - felt good all day, the work meetings were great, and they treated us to a St. Louis Cardinals game that night.  Here's picture from my seat in the Champions Club Suite:

As a Pittsburgh Pirates fan, I was cheering against the Cardinals (who lost) :)
Unfortunately Friday wasn't as kind to me as Thursday was.  I woke up with nausea and terrible heartburn.  By the time our morning meetings were done, I was extremely fatigued and feeling like poo.  I spent the rest of the afternoon in bed in my hotel room while my coworkers went on the Anheuser Busch Brewery Tour and took a tour of the Arch.  By the time dinner rolled around I was feeling quite a bit better, other than a little bit of a headache.  Then at dinner I started to feel really sick and ended up throwing up in the bathroom :(  My coworkers all went out for after-dinner drinks, sadly I went to bed still feeling icky.  I felt better Saturday morning and headed home.  I ate a little breakfast and felt fine, but by that evening I was feeling nauseous again.  Sunday was about the same: nausea, no appetite, heartburn, and an all-around "blah" feeling.  I did feel ok enough to attend our weekly football get-together and the Nagel Bar & Grill (friends' basement)!

So that brings me to yesterday (Monday)!  Here's how the day went:

7:30 a.m.
Wake up feeling nauseous (more on that below), to the point where I stood in the bathroom for a few minutes convinced I was going to barf.  Put numbing cream over my port site.  Attempt a little breakfast  (thankfully the worst of the nausea passed and I was able to eat some toast and jelly).

8:00 a.m.
Head to the Cancer Center.  Although I know the chemo is working and is saving my life, I still wasn't looking forward to another round.  Here's how I felt in the car:

Actually, it was more like this:

Haha :)

8:30 a.m. 
Arrive to Cancer Center.  The sweet young gal who's the receptionist remembers my name now.  I wish her a chipper "Happy Monday!"  She snickers and checks me in.

8:45 a.m.
I'm called back by a nurse to check my vitals: weight, blood pressure, pulse ox, and temperature.  All are good :)  I've dropped a couple of pounds, but nothing drastic.

8:50 a.m.
Move to the next waiting room to be called back to see my oncologist.

9:10 a.m.
Meet with oncologist.  Unfortunately my white blood cells went back down again :(  They were up on on Tuesday last week (even though they were at the low end of the "acceptable range") but my blood work from Friday showed they have dropped again.  Thankfully they didn't drop too far, so I was still able to get chemo today as planned.

Doc wants to test my blood counts again (last test was done Friday) to determine if I'll need the Neupogen shots again or not.  I'm hoping not!  Read about my Neupogen shot experience here.

I told the doc about my severe nausea this morning.  She said it's actually very common for patients to experience this the night before and morning of chemo; it's called Anticipatory Nausea, which about 1/3 of chemo patients experience.  Basically my body knows what's coming and causes anxiety nausea (similar to a Pavlovian response).  She gave me some nausea medicine that has an anti-anxiety medicine in it for next time.

The doc is going to have a PET scan scheduled for October 21, which is three weeks after my last chemo treatment.  As long as the PET shows no signs of cancer, they'll have me meet with the Radiation Doctor (I seriously just typed "Radioactive Doctor" by mistake, hah) and potentially start radiation the week of October 28.  So that means I'd be done with EVERYTHING by Thanksgiving, which was my goal!!!!!!!!

9:40 a.m.
To the infusion room, ready for chemo!  The doc drops off my chart and all my prescriptions (chemo, steroids, and IV nausea medicine) to be filled at the on-site pharmacy.  I find a comfy chair and wait some more.

9:55 a.m.
Steroids and nausea medicine are ready to go, so the nurse accesses my port (which means they stick a needle into it; needle has a tube attached to it where the drugs go in).  Of course there are more problems with my port.  It's nothing serious (quite common actually).  When they access the port, they first push in a syringe of saline, then pull back on the syringe to get a little bit of blood return in the tube.  If there is no blood return, there's a chance there is a problem with either the port tube or the needle entry, which could mean the chemo would enter into my chest cavity instead of the vein, which is very bad.  But more commonly, it's just because there's a small blood clot preventing the blood return.  I had no blood return at first, so after laying in different positions, lifting one arm, then the other and so on... they then shoot me up with heparin, which is an anticoagulant (fancy word meaning it keeps my blood from clotting at the port site).  They let the heparin sit for a few minutes and try again... no luck.  Then they try another drug that Josh calls The Clot Buster.  I don't know the real name, but it's a stronger anticoagulant that will break up any blood clots at the port site.  Finally after about 15 minutes, we get a blood return!

10:10 a.m.
Treatment starts!  My chemo buddy this week was my friend Nikki and we had a great time chatting and catching up!  My husband brought me to the appointment and waited with me until she got there (he had to work and couldn't stay the whole time).

The first drugs to go in are two types of nausea medicine and then steroids (to assist the nausea medicine and make me ineligible to fulfill my dream of playing for the Pittsburgh Pirates).  These drugs all "hanging" IVs, meaning they hang from a bag attached to an IV hanger, like this:

Before I start explaining about each individual type of chemo I receive, I want to explain a little bit about the ABVD chemo regimen.  ABVD is a combination of 4 types of chemotherapy drugs and is used as the first treatment option of Hodgkin's Lymphoma.  Each "cycle" of ABVD is given over a 4 week period and is split into two treatments given every other week.  In my case, I'll receive 2 cycles which equals 4 total treatments.  I'm including more info about each chemo drug below.

11:15 a.m.
Chemo Drug #1: Dacarbazine (i.e. DTIC)

Dacarbazine (DTIC) is another "hanging drug" and usually takes about 1.5 hours to go in.  They keep in on a slow drip since it can cause bad headaches if it goes in too quickly - and since I'm prone to headaches anyway, they go extra slow with me :)

Common Side Effects
Nausea - this is very common with DTIC

11:50 a.m.
Lunch time!  My chemo buddy Nikki ran over to Subway to get us lunch.  I'm usually ok to eat a full lunch on chemo days, this time was no exception!

12:45 p.m.
Chemo Drug #2: Adriamycin

Adriamycin is the deep red drug that causes my pee to be bright orange!  This drug is a "push" drug, meaning a nurse slowly pushes it in through a large syringe.  This is the drug that can cause mouth sores and mouth pain (which I experienced after my first treatment and was VERY severe).  To combat this, they had me eat a popsicle last time since the cold constricts the blood vessles and won't allow the chemo to be absorbed in the mouth.  I think this helped with the mouth pain as I didn't experience it too severely after my second treatment.  Unfortunately they were out of popsicles this time, but the awesome chemo nurses found me some yummy ice cream instead :)

Common Side Effects;
Nausea lasting 24-48 hours after treatment
Orange pee (sorry, still not going to post any pictures!)
Hair Loss - this is the one that causes the most severe hair loss; in my case, the dose is pretty low so although I've been losing a lot of hair, there's a chance I may not go completely bald.  This drug is used in a much larger dose for breast cancer patients, which is why they are usually bald within just a few weeks of their first treatment.
Mouth Sores
Long-Term Heart Damage (again, I'm taking a very low dose - and my heart function was above normal before treatment - so there's a very small chance of this happening to me)

12:50 p.m.
Chemo Drug #2: Bleomycin

Bleomycin is another push drug and as you can see is a fairly large dose.

Common Side Effects
Nausea and/or vomiting
Fever and/or chills
Hair loss (although less common)
Darkening of skin
Pulmonary toxicity, which is a fancy way of saying lung damage; my lung function was above normal (measured at 107% before treatment) and I've never been a smoker, so the chances of any long-term damage are very small for me.  Short-term however can show some minor problems that can last 6 months or so after treatment ends.  The chemo nurse warned me that if I get a cold I may carry a cough longer than normal and if it lasts more than a few weeks to see my doctor and let her know I've had Bleomycin.

1:00 p.m. 
Chemo Drug #4: Velban

Velban (or Vinblastine) is the last chemo drug and is also pushed in by the chemo nurse.

Common Side Effects
Mild nausea and/or vomiting
Pain at injection site (I've never experienced this)
Pain at tumor site up to 3 hours after injection (I've never experienced this)
Hair loss
Bone Marrow depression (drop in white blood cells, red blood cells, and/or platelets)
Constipation (boo)
Mild numbness or tingling of fingers and toes (I've never experienced this)

1:10 p.m.
Chemo is done!  The nurses flush out my port with more saline and heparin (which tastes terrible!).  I stopped by to visit with my new friend Sandy on my way out.  If you remember, I met Sandy at my first chemo treatment - she also has Hodgkin's Lymphoma.  She's stage IV and will have a total of 6 cycles (12 treatments) of ABVD.  She was so sweet and helpful the first time we met, so I stopped to chat with her on my way out after this treatment.  She's just finished treatment #8 and is doing very well!  She told me she had severe mouth pain after her first treatment like I did, but she said hers was never as bad after the first one (similar to me).  So there's still hope for a pain-free mouth! :)

1:30 p.m.
Stopped by the blood lab for my blood draw.  They're testing my blood cell counts to see if I'll need to come back for Neupogen shots again.

2:15 p.m.
Back at home!  I was feeling pretty good, so I was able to work for a couple of hours.  Only side effect at this point was itchiness from the steroids.  Took some Benadryl, which helped.

4:30 p.m.
Ran out of steam.  Tried to start this blog post, but literally couldn't keep my eyes open.  Nap time!

7:00 p.m. 
Woke up to this:

Apparently somebody had to go potty.  Considered ignoring her because I was so darn tired.  Realized the consequences of ignoring her and got my butt out of bed to let her out.

7:30 p.m.
Josh gets home from work and forces me to eat dinner and drink lots of water.  I was hungry but had no appetite, if that makes sense.  I have an herbal medication to help with nausea and loss of appetite, so I took that and was able to eat (had some yummy soup that was homemade and delivered by my awesome friend, Carmen).

8:30 p.m.
Back to bed :)

I woke up around 4:30 this morning, which is about normal for the morning after chemo.  I napped yesterday and went to bed early, plus the steroids they give me make me antsy - so I'm normally awake really early that morning after.

I worked a little bit at 4:30 a.m. - mostly catching up on emails since I was traveling most of the week.  I took a break but then worked the rest of the day.  I'm feeling pretty good today, so I figured I'd squeeze as much work in as possible in case I don't feel well later in the week.

Unfortunately my blood test didn't come back today - they said they should have it first thing tomorrow morning.  So I should know early tomorrow whether or not I'll have to do the Neupogen shots again.

Like I said, I'm actually feeling pretty good today.  Not much of an appetite and I'm pretty tired, but otherwise good!  I have a weird craving for tachos - which are like nachos but made with tater tots.  We have someone bringing us dinner tonight, so I'm hoping I'll continue to feel good enough to eat it!

Thanks to everyone who's sent prayers and well-wishes these last few days!


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