Thursday, July 11, 2013

In the Chemo Zone

I had my second of three chemo infusions on Tuesday. The infusion day is long but uneventful.

It starts at the lab for IV placement. I was nervous because of my one previous bad experience when I was dehydrated, but this IV placement went fine.

Then we meet with the Medical Oncologist, Doctor Chemo; NP Kate and Nurse Holly. They check in on what's happening for me and help us figure out how to meet various challenges. And Doctor Chemo also sets expectations for the next period.

The chemo depresses activity in the bone marrow, which leads to slowed production of white blood cells, which leads to an inability to deal with infection. We have to keep an eye on my temperature - any fever at all during this period means an immediate call to the doctor.

My white blood cells (neutrophils in particular) were barely above the threshold below which they would delay chemo. But the entire treatment regimen is timed to take advantage of the cell cycle and deliver damage at the optimum time and you don't really want to disrupt the schedule. Since I was above the threshold she/we decided to proceed.

I have access to all of my blood work, which gets taken at least weekly and sometimes twice a week. I'll try to get that organized and add a plot of my blood changes.

The infusion itself is easy. They put in a liter of saline, then a half liter of Emend solution and a shot of Aloxi, both anti-emetics that prevent both acute and delayed nausea and vomiting.

Then the nurse suits up in gown, gloves and mask to obtain the chemo from the pharmacy and hang it on my IV stand. She verifies that it is the right dose and person. Then she gets another nurse to come and verify all of the same information.

One of the most dangerous aspects of chemotherapy is accidentally delivering the wrong dose or wrong drug. There have been cases of patients severely injured or killed by, for example, getting their intended five daily doses all as one dose. So they try to be very careful.

After the chemo it's at least one more liter of saline. Then the next day I go back for two more liters of saline. They need to dilute the cisplatin because it is very kidney toxic.

I felt decent when I got home. I even fixed the screen door from which the closing mechanism had come loose. But I started feeling a little funky as the evening wore on.

Time to go to bed but I'll write more about the chemo aftermath tomorrow.

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