Friday, June 21, 2013

Let's Get This Party Started!

Sorry for the quiet period. I'm not doing as poorly as you might assume from my lack of posts.

I kept trying to get a particular post written over the weekend but it requires a lot of research and still isn't done. And I was busy both days working in the yard and getting The Progeny outdoors to a couple of cool new places.

So I'll catch on up current events instead.

Monday I went to work and had a pretty productive day. I got my projects documented well enough that my peers know the status, next steps and who to talk to about each one to keep them moving forward. That felt good. Now I can relax and just monitor work, mostly from home. I'll go in when I feel good. Not sure how often that will be.

Tuesday was my first chemo infusion. Wonderful Wife and I spent all day at Dana Farber.

The day started with a visit to the lab to get an IV inserted. That went well. I don't have much a problem with needles. I'm a long time regular blood donor so I'm used to being stuck.

The we met with Dr. Chemo for an hour. She went over the treatment plan again and we discussed side effects and the strategies we'll use to deal with them. I got a better picture of how each of the three chemo cycles will go. I learned that in my particular treatment plan the cisplatin (the chemo drug) is serving as a booster for the radiation - it's the radiation that will do the real work. The cisplatin causes some DNA damage to rapidly dividing cells, then the radiation delivers even more DNA damage to the tumor and lymph nodes (I'm not sure whether the lymph nodes are referred to as tumors in this case - I think not). Cause enough DNA damage and the cells will kill themselves.

Cells have numerous and varied techniques for repairing DNA damage. Damage occurs all the time due to chemical entities like free radicals or external forces like environmental radiation (including things like cosmic rays). However, if the built-in DNA repair mechanisms can't make sufficient repairs, other entities in the cell recognize the accumulated damage and start a process of cell suicide, referred to as apoptosis.

I also learned that I am on a "high dose" cisplatin regimen. Big Sister tells me that has been one of the advances in cancer treatment: that in some cancers fewer cycles of higher dose chemotherapy are more effective than more, lower doses. "Shock and awe," she calls it. Weirdly, cisplatin dose is determined by estimated Body Surface Area computed from height and weight. My dose is 100mg/m2 and my BSA is 2, so my actual dose is 200mg per cycle.

Cisplatin can be very damaging to the kidneys. Thus, along with the infusion of cisplatin I get several liters of saline solution (water with electrolytes) to flush the kidneys. I also go back the next day after chemo for another infusion of fluids, then a week later and a week after that. There will be three cycles of chemo and fluids.

Pumping all that fluid in takes time: about 4 hours. I thought I would spend that time writing blog posts, but instead I napped and watched TV and ate and relaxed. I had a fair bit of anxiety about the first infusion so I was a little too distracted to write. I never even took my laptop out of my bag.

At one point a volunteer came around and asked if I would like a hand massage. "Yes!", I said. Wow was that nice. She had very warm hands and the first thing she did was encase my hand in hers. That warmth was very comforting. I dozed off for most of the massage. How pleasant. Thank you, volunteer.

Other volunteers come around with a food and drink cart. There are also free snack bars throughout Daba Farber patient areas with cookies, crackers and beverages.

Overall the first infusion was uneventful. Until the drive home, when we entered an unlucky confluence of events. A thunderstorm struck as I was finishing up. We were enjoying watching it out the window. But there was also an early game of a double-header at Fenway Park a few blocks away and the thunderstorm rained it out. So we left into that traffic. Which then turned into rush hour. It took a little more than two hours to get home - a drive that is about 22 minutes in no traffic.

Remember those multiple liters of fluids they had pumped into me? Let's just say I'm glad there was an empty drink bottle in the car. And a little bit of biohazard waste was improperly disposed of on the side of Boston roadways.

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