Tuesday, May 28, 2013

In the chair

This is that day.

Normally treatment is on Monday, every other week.  Due to yesterday's holiday, the schedule is pushed back a day.  I get the chemo cocktail for four and a half hours and have the pump added today, then I return Thursday to have the pump removed and get a shot of something called Neulasta to try and keep my white blood cell count up.

The picture above is actually from two weeks ago, but the visuals are pretty similar each week.  I arrive at Thomas Johns Cancer Center at Johnston-Willis Hospital near Midlothian, about a ten-minute drive from where we live.  First stop is the lab to have blood taken for testing.  In all honesty, that's my least favorite part of the day, particularly when it involves having my finger pricked.  I don't like any sharp object poking holes in my body, but in my finger...ouch, ouch, ouchouchouch.  Having it taken from my arm is no picnic, but these days I'll prefer it to the finger-prick.  Ouchouchouch.

After a few more minutes wait it's time to enter the transfusion room.  Most weeks I'm the youngest patient room and it isn't close, and today doesn't seem to be an exception so far.  It's typically about noon when one of the oncology techs starts to hook me up.

Back on March 1 I had surgery to have a transfusion port installed in my upper chest, on the right side.  In the picture above the port area is somewhat concealed by my shirt.  During the week when I'm not hooked up to the port, it's a little odd to feel this lump in my chest and know that it's (hopefully) part of the solution, not the problem.  It doesn't hurt, but I can't really say that I don't know it's there.  It's enough of a lump that it's impossible not to notice.

For today, that port is the means by which the day's cocktail of drugs passes into my body.  The tech is generally kind enough to numb the spot thoroughly before inserting the connection into the port, so I can't really say I feel what's going on (believe me, I look away).  Once that is done and the tech can see that the connection is secure (unfortunately, this involves seeing "blood return" issuing from the port into the injection tube.  Now you know why I look away), the initial preparatory drugs can be hooked to the tube and the day's fun can begin.

In the mix of drugs that get pumped into me in a given session, almost as many of the infusion liquids are devoted to preventative measures as to the chemo itself.  At least two of the first to be injected are primarily for the prevention of nausea.  It should be noted that these apparently work, as I have not really had a major problem with nausea, aside from one day several weeks back (and that was as likely a consequence of a poor meal choice as anything).  Eventually a saline solution is hooked up to keep a regular flow going and to act as a little bit of a buffer against the chemo drugs proper doing too much damage.

Another of the preventative drugs administered is a kind of steroid, which means that I'm suspended from Major League Baseball (the NFL would obviously have no problem keeping me on if I were in it) and that I will have a pretty ravenous appetite tonight.  That effect passes after a day or so, otherwise I would end up even more unsightly than I already am.

I know when the serious drugs are being administered, not because I can recognize anything by name (please, prescription and drug names might as well be in Sanskrit -- thanks to biblical study I'm more comfortable with Greek* than with these drug names, and therefore the old "it's Greek to me" line doesn't apply), but because of the protocols that kick into place.  I get not one oncology nurse, but two; I have to repeat my name and date of birth, and the second nurse is double-checking and observing closely as the IV bag is hooked into the system; and the nurse is wearing an extra protective gown.  No fooling around here.  One of those drugs can feel a little cold as it enters my body; otherwise I can't say I notice much when the transfusion is happening.

*I didn't say I was comfortable with Greek.

If you've spent time in a hospital, you probably remember that a typical IV drip doesn't go quickly.  By the time the various preventatives and chemo drugs are swapped in and out, I spend about four and a half hours in the chemo chair.  The IV bags and monitor are on a rolling stand, so I can make the trip to the bathroom when necessary.  My arms and hands are not particularly encumbered, so I can do serious things like complete classroom assignments such as papers or take-home tests, read articles, etc.; or, I can do silly things like live-blog my chemo, as I'm apparently doing now.  Back at the beginning of April I tried to catch some major-league baseball on Opening Day, but the poor quality of the wifi connection and the lack of any sports channels on the room's TV system doomed that for the most part. Conversations are sometimes possible, but frequently other patients are either asleep (particularly the older ones) or accompanied by friends or drivers and are therefore primarily in conversation with them.

And, well...there's not a lot else to describe.  The transfusion room has been, at least the six days counting today I've been here, a drama-free zone.  The techs and nurses are generally friendly and highly capable, and the patients are frequently asleep or otherwise involved.  Generally, not much happens aside from the individual treatments going on at any given time.

I would not have you think my regime is typical.  Some patients actually receive their treatment not through a port, but through a typical IV hookup in the arm or hand.  I have to admit I'm happy to have the port in that regard, as strange as it feels sometimes.  Most patients don't stay as long as I do, but then they're often coming every week or even more often, whereas I do get two weeks between Monday treatments.  That fact has probably been why I've been able to keep up with classes and otherwise function like a normal human being.

If this week is typical, I'll be famished tonight; my fingers will tingle when I try to handle anything cold, possibly the rest of the week; and I'll be fairly fatigued for three or four days -- not debilitatingly so, but noticeably.  I'm rather happy that this week is an "off week" for me; I really don't have anywhere to go before Friday of this week, which means I'll be free of the pump before then.

The pump is the last part of the chemo treatment, and probably the most obnoxious because of the inconvenience it causes for parts of three days.  It gets linked into the tubing hooked to the port at the end of today's treatment, and has to remain attached for forty-six hours (yes, forty-six and not forty-eight).  Typically the pump is kept in what is often called a fanny pack, with the tube snaking around from it to the pump.  This tends to require a buttoned shirt if I'm going out, so that the tubing can be slipped in between buttons and kept from getting caught on other odd stuff like doorknobs.  Around the house it's less of an issue, but in any case it gets pretty darn tedious, and makes a lot of ordinary activities a bit more laborious.  Since I tend to keep the fanny pack positioned on my right hip, it means I can't sleep on my right side -- usually not a problem, but a little inconvenient some nights.

On Wednesday afternoon (Thursday this week), forty-six hours later, the pump (which looks a bit like a water balloon encased in a plastic jar) is removed and a last flush is pumped through to clear the port, which then is bandaged for a few hours (with an ordinary band aid, mind you); the last injection goes into the fleshy part of my left arm, and I'm done.  Free at last, free at last...

Once Thursday is done this week, I'll have two more treatment cycles to go, which means chemo is done on June 26.  I'll see the oncologist mid-July, at which time a determination will be made about when to do another endoscopic ultrasound or other scoping procedure to see what's left of the cancer, if anything.  Obviously what happens next depends on what that procedure shows.  I'm studiously avoiding expectations of any kind at this point.

I can already feel the fatigue starting to settle in just a little bit today.  Having this kind of stuff pumped through you is going to be a wearying experience, with some lingering effects.  Yard work is beyond me right now; between the labor and the sun exposure I can't cut it ("it" being the lawn at this point).  Sleep, though it certainly comes and sometimes when I least expect it, is a little bit more fitful.  The cold sensitivity is rather inconvenient; I can cook dinner, but my wife has to handle the cold stuff.

Still, considering that others can and do have a much tougher time with chemotherapy treatment, I can't really complain.  Despite my general bulginess and non-athleticism, I was apparently a reasonably healthy person (aside from the cancer), in that I've come through radiation, surgery, and now most of chemo without many of the usual side effects and not a lot of degradation to my body.  I'm losing hair, but not at any faster rate than I was before starting cancer treatment (I do wonder if my beard is turning white faster, however).  The presence of the port limits what I can do in terms of upper-body exercise, but the legs are continuing to be in fairly good shape.  My brains haven't totally deserted me, as I apparently managed to get through classes in better shape this spring than back in the fall.

There will also be long-term ramifications, of course.  I'll always have to be on guard for cancer.  The financial ramifications will be devastating (not going to get into that here).  Insurance may be tricky, particularly between graduation from UPSem and finding a call (thank God pre-existing conditions won't be allowed to deny me coverage...).

At this point, though, all I can really do is get through each treatment, while working on my internship this summer and getting ready for ordination exams in August.  I don't see a point in whining too much as long as I'm being spared the worst effects of the chemo that so many people have experienced in the past (and still do in some cases today).  If the chemo is judged not to have worked, mind you, I'll be whining pretty fiercely, but that's still a couple of months away at the least.

So, that's about what it is these days.  Nothing terribly interesting, but it is a fairly large chunk of my life right now.

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