Chemo’s a lot easier to explain than radiation, because it’s simple from the user point-of view. Every week I plop my butt down in a recliner, get an IV, and then have drugs flow into my body over a series of hours. That’s really all there is to it, on a basic level, but there are still details that make it interesting.
I’m getting lower dose weekly chemo because clinical trials showed synergy between the chemo agent and radiation. The chemo agents seem to both shrink/stop the cancer AND sensitize it so the radiation is more effective. This combo also ratchets up the side effects though.
Many chemo patients have a port–a semi-permanent IV placement in their bodies, so all they have to do for chemo each session is “plug in.” They have to do some work keeping it sterile at home, of course, but it makes chemo much faster and easier for both the patient and the nurse.
I don’t have a port, although sometimes I wish I did! Every weekly chemo, they have to find a vein. It’s actually a bit worse than that because I get hydration (IV fluids) three days a week, so that means theoretically a nurse has to find a vein for an IV four times a week. At this point, my arms look like war zones and we’ve started trying to save IVs over multiple days. They have a device called a veinfinder that meets the “tech that seems like magic” criteria, at least for me.
Once they get an IV going, the first step is to take blood to check my CBC and WBC counts. One of the main side effects of my chemo cocktail (Carboplatin+Taxol) is the destruction of your immune system. I was, in fact, so low on white blood cells at chemo today that my final chemo was delayed until Monday, in the hope my system would bounce back. They can also give booster shots and even platelet transfusions to enable chemo in situations where your immune system is compromised.
You don’t get chemo at a chemo center–you get it at an Infusion Center. Infusion involves little pumps that accelerate the agents into your blood stream while strictly controlling the rate.
If they get the go-ahead from the doctor after the blood tests, they begin chemo. You usually get what I call the “toleration agents” first. These are the drugs that help prevent reaction to the chemo drugs during and for a couple days after the treatment. They include Benadryl, Ativan, Emend (yay! does miracles for nausea) and dexamethasone. Those are given in pairs or solo, and take a couple hours to administer.
After those infusions, the nurse puts on a pair of heavy gloves and a disposable gown for the active chemo agents. He or she brings a second nurse over to confirm the patient and dosage are correct, then he begins the first agent. These agents are infused carefully and slowly because if they burst out of a vein, they can cause serious damage. They also need to watch for adverse reactions. In my case, the Taxol comes first and takes an hour, then the Carboplatin takes a second hour, for a grand total of four hours in chemo.
As I mentioned, my last weekly chemo treatment was delayed until next week. Some time in January, I start the first of two consolidation chemo treatments: full dose treatments every three weeks. In these treatments, the larger dose of Taxol will take three hours, and I expect a higher dose of Carboplatin to take at least two, pushing the total chemo time up to seven hours.
One of the oddities of chemo is that it’s a day I feel best because the “toleration agents” they give you help counteract side effects not just from the drugs you’re about to get but from the side effects you’ve been having all week. That “I’m better!” feeling lasts about two days, and then you start back down into the trough. I don’t know what the pattern will be like for the larger dose chemo, but I guess I’ll find out when I get there!
So what do you do during chemo? A lot of patients have friends or family members there and they chat, but that seems like a really boring thing to ask of anyone. I brought my laptop and a lap desk in for the first couple, but as I grew more fatigued, that became too heavy. Many patients sleep through most of chemo, because the combo of Ativan and Benadryl is enough to put most folks out. I usually bring an iPad and my 3DS now, although I too have become so fatigued that I end up dozing through at least part of chemo.
Chemo is often the most dreaded part of treatments for patients but it’s surprisingly quiet and uneventful when you actually experience it. The most prominent aspect of it is the time you have: time to rest, think, chat, work, write… It’s ultimately like a really long commute on a train bound for Destination NED–“no evidence of disease.” Like most commuter trains, it can be dull and repetitive, and it can be draining to ride it for hours each week… but it’s about the destination, not the ride.
Sometimes I consider my pace
I’m reminded of a train gathering speed for the climb to the pass
In whose shadow it already lies
A small metal dragon approaching the ever present ascending rise
To the Seventh Mountain
Reeling and snaking, and leaping
It seems like it wants to come loose from its path cast in iron
But you can’t slow down now as the earth has presented a new crest to reach
Without barely a rest from the last one
And you wonder what lies just beyond
Though you’ve been there before and forget about the effort and the strain
Always ascending, each yard adds a mile
To the never ending pull of the steepening grade that’s before you
A valley, a forest, a desert, a stream with an over sized bridge
For the trickle there beneath
You remember the torrent it turned to last spring from the snow melting fast
And the river it became in the summer
Perhaps it is ruined from a fire that has scorched it
So badly that nothing will grow without rain
To wash away the blackened soil, now useless until called upon again
In a future as distant and far away as the next range of mountains
Then take it as far as you see and beyond
With eyes you don’t use enough to gather up strength
As Thoroughfare Gap, what awaits is whatever you see
When you get there
Or even before
It’s no matter.
It’s the ride.