Saturday, September 24, 2011

So What's Chemo Like, Anyway?

As preparation for chemotherapy, a medi-port was placed 10 days ago during conscious sedation about three inches below my right collar bone. (The nurse said that during the entire procedure my mouth was slightly open and I was smiling.) It is akin to the placement of a pacemaker only my device is shaped like a heart (awww) and is the size of my thumbprint. It has a tough plastic center into which a needle can be inserted. From there blood can be withdrawn for my weekly lab tests. 

As importantly, all chemo liquids infuse through the needle into a catheter attached to the device which courses under my skin into my descending jugular vein in the side of my neck. The catheter continues into the descending vena cava, that part of the huge vein which receives all the blood returning to the heart from the upper parts of the body. The catheter continues downward into the opening of the right atrium of my heart. Thus, all IV fluid that flows in from the port pours into a gulf rather than the creek of a regular vein, saving injury to the lining of my veins from the caustic chemo drugs.

My first three treatments on Wednesday, Thursday and Friday were fine. The infusion room is on an upper floor of a medical center. The room is large and shaped like an “M.” The nurses’ station is in the middle of the room and along the outer walls are six areas each containing six easy chairs so that at any one time 36 people could be receiving chemo. I have never seen more than 10. There are strategically placed artificial but attractive greenery to provide additional privacy between the six areas.  But it is a solemn and serious place. The nurses don’t interact much with us. Few people smile or even return smiles. On the other hand, maybe I am one of the blessed few who has such a strongly positive prognosis.  

I choose a chair in the farthest area along the last side of the “M” facing northeasterly.  Through the large and plentiful windows I can see the lake, the basilica, the largest four-sided clock in the world (take that, Dubai), the downtown buildings which form our skyline and the top of the courthouse, plus hundreds of treetops. Not many people sit this far back so it is quite private. Being steps away from the restroom doesn’t offer me any benefit because I can’t ever get there in time.
I take along a rosary we got last year in Rome that looks quite similar to one of the rosaries my mother had while she was alive. I keep it in my pocket which is in the vicinity of my second chakra (within which the bladder is physically located) and imagine it as an antenna to receive the blessings I know she is giving me from across the veil with her rosary.

I sit in my eggplant-colored chair and an RN comes to get me started.  My regimen (everyone’s is different):

°      1 hour to infuse1 liter of normal saline (NS).  (NS has the same concentration of saline as in the blood, 0.9%).  My liter of NS is fortified with potassium and magnesium because these tend to be washed out by the chemo agents.

°       After half of this bag has infused, 60 seconds to push into my IV line 20 mg. of Lasix, a diuretic. This is to make sure the fluids are perfusing all of my body and being washed out through the kidneys, so that there is confidence that the chemo drugs also will perfuse my entire body but will then be washed out through the kidneys before they do damage to other organs. Calling all Depends!

°       ½ - ¾ hour to infuse Aloxi in 150-250 ml. of NS followed by Emend in 150-250 ml. of NS. These are anti-emetics that last for three to five days (yippee!). One of my chemo drugs has a reputation for being very emetigenic. (Isn’t that a great multi-syllabic word?)

°       ½ - ¾ hour to infuse in 250-500 ml. of NS which has a very strong steroid (10-20 times more powerful than prednisone) in it called Decadron. Its purpose is to lessen my body’s reaction, including nausea, to the chemo drugs.

°       Ah, finally the chemo drugs: one hour to infuse cisplatin in 500 ml. of NS followed by one hour to infuse etoposide in 500 ml. of NS.

°      Ten minutes to rinse the line with NS.

Then I am disconnected, my port is bandaged and I am done.

Since the two IV anti-emetics each last at least three days, I only get them on Wednesday and therefore that day is a five-hour affair, Thursday and Friday a little less long.

The anti-emetics are good. The steroid is fierce! It makes me crazy by Friday: emotionally overwrought, manic, irritable, grumpy, crying for cigarettes. This wacko feeling goes on for a couple of days. Plus I am all swollen up and feel quite pathetic overall. By far the worst experience of the cycle.

Then I feel a low-level nausea for a several days: 1 on a scale of 1-10.  As has been the story of my life, this does not prevent me from eating. Nor does the episodic heartburn. Nor the odd taste in my mouth.

I was able to go back to work a week later for three days. That was really good for me, feeling part of the stream of humanity again.

To go back to work and feel this good after only one week is wonderful. I wasn’t supposed to feel good until later next week. It bodes well for the next three rounds, although I know it will become progressively more challenging. 

© Jean DiMotto, 2011    Website: 

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