Hunger vs. Nausea

(12/5/07)
I woke up just now feeling pretty good, though a little hungry. Or was it nausea? It's strange how similar the two feelings seem after a while. At this point I should probably be okay without the anti-nausea meds, but I suppose it can't hurt to take them for a couple more days. It's been about 5 days after the last drop of my first chemo cycle, and usually the nausea side effects wear off after 4 days or so. Pretty soon my blood counts should start dropping, but I've been taking neupogen shots to try and keep those up (by the way, all you diabetics out there or other folks who have to give themselves shots regularly, I feel for ya).

You know, it's funny how medicine works these days. A lot of it is brute force or experimentally driven, and most of the time you have a couple of main meds you're administering, and everything else is to take care of side effects. Amazingly, though, they seem to have things down to some sort of pseudo-science at least.

(11/27/07-11/29/07)
So when I checked in for my first cycle, the attending doc and his entourage of residents and fellows came by in the morning to tell me, "Well, you're starting chemo today, and if all goes well, it'll be really really boring." I guess what he meant was, we've got so many drugs to take care of all of your side effects you'll mostly just want to get it done and over with. Ah, great.

They started pumping the drugs a little after 1pm. The first was Vincristine, a simple 3-5 minute push through the PICC line. Cyclophosphamide came in a drip IV bag that hangs for about an hour. Then came the doxorubicin. That's the one that can cause cardiotoxicity (basically heart failure after a large cumulative dose), so they diluted that one down and dripped it in 2 huge bags for 48 hours. So within an hour and a half or so the first two drugs were in my system, but then it would be two days later before I could leave, thanks to the doxorubicin.

So let's see, where did the side effect controllers come in? Every four hours or so I had to have drip bags of Mesna, which helps to protect the bladder from cyclophosphamide. For the doxorobucin, the nurse has to come in and check the line to make sure no meds are leaking out into the veins, since they can burn out your vessels if you're not careful (my nurse Linh is kindly doing that service in the picture). Eventually I'll need an echocardiogram to get a baseline reading of the ejection fraction of my heart, so that we can track if the doxorubicin is having toxic effects. As for other meds, there's a nice cocktail of anti-nausea drugs they can give: Zofran, Reglan, Compazine, Ativan - of course these are all household names. Well, at least at my house.

Oh, but Zofran can cause headaches, so you may need some oxycodone for that, and Reglan can cause diarrhea, but both Compazine and Ativan can cause constipation, so maybe they'll cancel out. If not, you should take some stool softener, just in case, and maybe some Senacot or Milk of Magnesia to help things along. Ah, and don't forget the fun injection of blood thinner that you need every day while you're getting the meds to make sure clots don't form. That one goes in through the belly, so yeah, it kinda stings.

Once the doxorubicin was done, though, I was allowed to leave the hospital and see how the fun would continue at home. It actually wasn't that bad. I couldn't eat too much the first few days and spent a lot of the time sleeping. Oxycodone was probably the best for just knocking me out and making my whole system feel calmed down and better. In general I was drinking tons of liquids and keep a rising temperature at bay. After a couple days though I was eating more and more, though certain food cooking smells tended to make me retreat upstairs to my room. Oh yeah, and at night I got to replace those blood thinner shots with nuepogen shots.

Ah yes, one thing I forgot to mention - since the chemo tends to attack your rapidly dividing cells, it wreaks havoc with things like your digestive system and even the cells in your mouth (incidentally, this is also why your hair starts falling out - mine hasn't, yet). So the past couple days I've had a nasty white blotchiness all over my tongue and on the inside of my mouth. Ick. At first it felt like I had cotton balls in my throat, but I've been using a special Stanford formulated mouthwash that has helped things feel less irritated. It still looks really gross, though. Serena says it'd take more than that to gross her out, but I'll refrain from posting a picture.

My temp seems to be pretty good today, so I might actually try some real exercise. Mostly I've been going out for short walks during the day and maybe doing some tai chi, but I think soon I'll start trying to work some more strengthening exercises back into the mix. My ultimate goal is to get back on the climbing wall soon (Gah - it's been months!). I've gotten the okay from Dr. J and a few different nurses, as long as I take it easy of course... We'll see.

I'm curious to see when my hair starts falling out. It's supposed to happen in the first 2-3 weeks. I imagine when I start to see clumps falling, I'll just have a haircutting party and shave it all off. Okey dokey, I guess that's it for now.