Cleared for Takeoff

It's a Monday, so here I am, back at the hospital. My platelets rebounded from last week's low and are well over 100,000, well over the threshold for chemo, so I have been cleared for takeoff!

The routine this morning was just that -- very routine. Lab work at 9:30, doctor at 10:20 and treatment center at 11:30. The doctor, as always, was delightful and willing to answer my every question. She did point out that my hemoglobin is quite low and I'm likely to need a blood transfusion next week. In the meantime lots of red meat and spinach for me, and perhaps some chicken liver too. She also called me a model patient because I'm coping so well with the chemo! I have always aimed to please!

I'm hooked up and underway. I'm getting a benadryl drip as I type this, so I expect to fade off shortly. More later, perhaps!

3:15 p.m.

Awake again, albeit a bit groggy, after the Benadryl/Lorazepam induced sleep.  Each nurse does things a little differently and I received my Bendaryl first, to be followed by two bags of anti-nausea meds.  They weren't going to give me the Lorazepam until after that, but my legs were already bouncing around in reaction to the Benadryl, making sleep impossible, so I asked them to give me the lorazepam next.  My legs quickly settled and I fell into a much more peaceful sleep for an hour or hour and half.  During that time, I apparently went through all my pre-medications and was put on the first of the chemo drugs.  Now I'm partway through my second drug, Taxotere, and will end with a chase of Herceptin. 

The taxotere is what causes me some side effects I'd rather do without: very teary eyes, especially for the first couple of hours in the morning; skin rashes, leading to toughening skin and eventual peeling, particularly on my hands, constipation and then, possibly diarrhea.  My tongue loses its coating and then foods taste really blah for a week or so, and the newest one is muscle aches, particularly in the thighs.  Fortunately, the taste buds have come back each time, so by the 3rd week, I have gone back to enjoying food.

Ah, the home stretch.  We finished drug #2 and are on the final one of the day, Herceptin.  Herceptin takes a half hour or so to be infused, so I may actually be gone by close to 4:00.  With enough Benadryl/Lorazepam in my system, I anticipate a nice stretch out on the couch once I get there and perhaps another short snooze.  It sounds like heaven to me!

Halfway Home – Round 3

I awoke at 6:20 Monday morning and lay in bed for just a few minutes listening to NPR’s Morning Edition. I was pleased to hear Linda Wertheimer’s voice and realized that she was playing host. Hooray, she’s back, at least temporarily. (No disrespect to Renee Montagne who is very good, but I am a huge fan of the trio of great women reporters from the early days of NPR:  Linda Wertheimer, Cokie Roberts and Susan Stamberg. It’s sort of like going home again!)  After indulging in that pleasure for a few minutes and catching the morning news at 6:30, I got out of bed to appease the intently staring Sam (he is part border collie, after all). I put on my slippers and let him out into the near darkness, on one of the shortest days of the year.  I prepared both Henry’s (the whining cat’s) breakfast and Sam’s and then let him Sam back in to wolf it down in 15 seconds flat.  That can’t be very satisfying and could explain why he has become such a beggar of late.

Then back to my room to find something to wear that would be comfortable for the relatively long day at the Cancer Center.  Some stretchy black pants that are frayed around the edges, but are too warm and comfy to even consider pitching; a fleece top with buttons down to the middle of the chest, making access to the port easy for the nurses; another layer of fleece, because it is sometimes cool in the treatment pods; and, of course, a hat or head scarf.  After trying on several, I opted for the oatmeal crocheted cloche, which was apparently a good choice, because several people in the treatment pod asked me about it.  At least, I assumed, perhaps incorrectly, that by asking they were signaling their approval!

Then I moved into the bathroom where I applied some makeup to liven my face up a bit.  I had a quick bite and then Lydia, my chauffeur and chemo buddy, and I left here around 7:30.  Despite it being a busy time of day for commuters, we were at the hospital in 15 minutes and I signed in for lab work right away.  When I was paged I went in and met up with one of the nurses, who deftly accessed my port (read: stuck me with a needle with lots of clear tubing attached), took several vials of my blood and then taped the needle and line so it was ready for use during chemotherapy. 

From there it was off to see the doctor for an 8:40 appointment, during which we chatted about my side effects and the results of my blood work.  As expected some of my counts are low, but not nearly low enough to be of concern.  She did suggest I might want to eat some red meat to boost my hemoglobin a bit.  Although we don’t eat a lot of red meat, quite by chance we had already planned to have hamburgers for dinner that night.  Now I can say that the doctor prescribed it.  I like my doctor a lot.  She is extremely competent as well as very patient and pleasant and she giggles at my jokes and comments.  I hope that is a good thing!

From there it was back to the treatment center.  I signed in at the desk, remembered to get my free parking garage pass, and took my pager and waited.  My appointment was scheduled for 9:30 and I was called in at about 9:40.  We were escorted back to pod 3, where the medical assistant took all the standard readings, and then offered me that most wonderful treat of all – a warmed blanket.  She also brought a pillow and a can of cranberry juice, and I didn’t have to pay extra for any of it.  It’s not like flying these days. 

The nurse of the day came by and checked on me, after which the next wait began.  I have learned that despite the attentiveness of the pod staff, the backlog at the pharmacy is what holds things up.  There are too many cancer patients on any given day for them to process all the medications at once.  Fortunately, my pod mates were a friendly group and for the first time I really interacted with the other patients and their companions.  We got involved in helping the man across the way with his crossword puzzle, providing words like pap, and milksop, latkes and halvah.  With my handy iPod Touch and the hospital’s guest WiFi service, I was able to look up and share the definitions of some words with which he was unfamiliar.  He was in his mid-50s and was there with his elderly father as his companion, which I found so very touching.  There was a husband and wife, and a daughter with her elderly mother.  We talked at length about my hat and others they had made or seen.  Then a man came in and took a chair next to me.  Once he was settled in he turned on a little TV that is available on a swivel arm each lounge chair.  He did hot have headphones and, apparently, not such great hearing, because he turned up the volume quite a bit.  That and the fact that the medicines were ready seemed to put an end to the friendly chatter.  By 10:30 we were underway.  There were a few adjustments to my infusion, some of which were made by the doctor that morning and some that were expected changes in protocol.  Most everything goes in one at a time, so the lineup was:

1.    Saline

2.    Dexamethasone – a steroid to help control some reactions to the chemo.

3.    Pepcid – a surprise, but I have apparently been getting that each time and just didn’t know it.  It has certain antihistamine properties.

4.    Benadryl – again to fight off any allergic reactions to the chemo drugs.  During round 2 it gave me a major case of restless leg syndrome, so the doctor decided to cut that in half this time.

5.    Lorazepam – to relax my muscles and thereby reduce the risk of restless leg syndrome.

At that point, 4 and 5 combined to knock me out for 2 whole hours, so I am guessing from past experience on the rest of the lineup:

6.    Emend – an anti-nausea drug I previously had to buy at the pharmacy in pill form for about $370 and take by mouth on days 1, 2 and 3.  My cancer center has now switched its protocol so that it is administered in IV form, and that releases me from having to purchase pills to take at home.  Yay!!!

7.    Some other anti-nausea drugs, which I can’t name at this point.  Maybe I’ll stay awake long enough next time to ask.

The actual chemotherapy drugs:

8.    Taxotere for 1 hour.

9.    Carboplatin for ½ hour.

Last up for the final infusion of the day was the monoclonal antibody for my HER2+ status that I have to have for a full year.  It prevents the HER2 receptors in cell membranes from causing any cancer cells that might crop up from reproducing willy-nilly.

10.    Herceptin for ½ hour.

Then when the infusion is done, and most of the lines are disconnected, just before the needle is removed from the port I was given the usual nightcap:

11.    A final syringe of saline to clear the port

12.    A syringe of Heparin to prevent clots from occurring in the port.

In the midst of all this, I awoke at 1:30 to find that two people had left the pod while I was out, and three new ones had moved in for the second shift.  Lydia was there and kindly fished out a turkey sandwich from her loaded backpack for me to eat.  She is such a good chemo companion, filling her pack with things I might need or want as she sits for seven or eight hours each time, without the benefit of a Benadryl induced sleep! 

We were done at 3:00 and home by 3:30.  Still a bit groggy from the Benadryl/Lorazepam combination, I took another nap, but not before a couple of hugs and the acknowledgement that I am halfway done with this part of my treatment.  3 down, and 3 to go!

Round 2 – The Lay of the Land

The seventh floor of the Center for Advanced Medicine features a large open area in the center of building, ringed by the offices of the medical oncologists on one side and the cancer treatment center, lab and pharmacy on the other.  There is a large sitting area, comfortably arranged, and often very crowded, especially later in the morning.  Although it was fairly quiet Monday morning at 8:00, it can often be like Grand Central Station at rush hour.  There are generally pairs of people, one of whom is there for treatment and a spouse, significant other, child or friend there for support. It is often hard to tell one from the other, but in some cases it is clearer: the woman wearing a head covering – hat, scarf or turban, or the man in the wheelchair or walker or carrying a tank of oxygen, or occasionally someone who is obviously not well. 

The unusually uncrowded waiting area

The cancer center has made an effort to make this space friendly.  There are several tables along the edges set up with partly done jigsaw puzzles or chess sets.  There are library carts with books to borrow and magazines of all kinds are placed throughout the area.  They also provide free coffee and hot chocolate from machines that are impressively fancy. 

When you enter the area you sign in at one of two reception desks and receive an electronic pager, such as you might get at a restaurant while waiting for a table. Then most people, myself included, just sit and wait their turns, conversing quietly with a companion, reading, or just watching the world go by.  While most of the group appears to have mastered the etiquette of communication in public spaces, others seem to be completely oblivious.   Occasionally there is a thoughtless person among the crowd who talks too loudly on a cell phone or entertains his or her companions with loud tales of little interest to the rest of us.  Fortunately, these people seem to be in the minority.

On Monday I went to labs first, where I had blood drawn through my port – this funny Frankenstein bump protruding from under my skin, just below my left collarbone.  From there it was across the way to see my doctor for a check and a chat about how things were going, side effects I had experienced and whether there needed to be any adjustments in treatment or follow-up to deal with some of the range of rolling side effects I’ve had.  Fortunately, none of my side effects were unbearable, though she made some minor tweaks in my post-treatment plan.  She was pleased with my status and most surprised to see me sporting my own hair, which had thinned but not enough to call it quits yet.  She said I had “strong” hair!

I was cleared for take-off, so back across I went to the treatment side of things where I signed in once again and got another pager, and waited my turn to be called in for chemotherapy.  I was scheduled for 9:30, and it wasn’t long after that before I was buzzed and then escorted to my “pod” where I had a choice of a bed or a reclining chair.  During my weekly “30 minute” infusion the week before, I had discovered that, although all the recliners are comfortable, there is one deluxe model scattered throughout the pods.  It was vacant on Monday morning, so I grabbed it and settled in.

The pod

Two nurses and an assistant are assigned to each pod with room for six patients.  The assistant does the initial check-in, taking blood pressure, oxygen levels and temperature – again.  It’s interesting to see how one’s BP can vary from hour to hour, as all of these readings were taken an hour before on the doctor’s side.  The change wasn’t dramatic from a medical standpoint, but both numbers were up just a touch.  Anxiety, perhaps?  Fortunately, I am blessed with healthy, low blood pressure, despite my love of salt!  After taking your numbers, the kind assistant provides little luxuries, such as warmed blankets (a favorite of mine), pillows, juices, sodas and snacks for the asking to both the patient and her companion. 

After a bit of settling in, an RN comes in and again checks to see how you’re feeling, whether you’re having any side effects, answering questions and providing tips and advice.  Although I had discussed these with the doctor, not everyone sees the doctor every week, and the RNs have an incredible wealth of knowledge and techniques to share.  They are on the chemotherapy front lines and have seen and heard it all.


Then the next wait begins.  There is a pharmacy based in the treatment center so they can dispense the drugs right there.  They don’t prepare your drugs until you are there, seated in your chair and have been checked and cleared.  The center is a very busy place, treating 160 patients on an average day and 200 on a busy one, so it takes some time for the medicines to be prepared, delivered to the pod, checked and rechecked before they start to administer the IV drips. We started at about 10:30. First in: some IV steroids and anti-nausea drugs to help with side effects, and IV Benadryl to battle any possible allergic reactions.  The Benadryl knocks me out for a bit, which is a lovely way to pass some of the time.  Then a one-hour drip of Taxotere, followed by thirty minutes of Carboplatin and finished off with a chaser of the weekly thirty minute dose of Herceptin.  

Hooked up and ready to go

At least that’s my mix – it varies from cancer to cancer and patient to patient.  When we’re all done they flush the port with saline and then inject some Heparin to keep blood from coagulating and clogging the port.  It is therefore primed and ready for its next use.  At 2:00 p.m. we were ready to head home, where still a bit dopey from the Benadryl, I promptly sank into my bed and took another nap!