Chemo Treatment #1

[TMI Warning!]

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There is info below that may be considered “too much information” for some. I include it because it’s been helpful to me to know the range of ABVD effects/side effects even though not all (hopefully) will impact me.

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Jen, David and Alison accompanied me to the appointment; they wanted to see for themselves what my days are going to be like every two weeks. We were on time and checked in with Lauren Wirth. She is Dr. Seifter’s Patient Service Coordinator, and the first person I really spoke to when I was getting down to the business of getting well. She could have easily said, "he’s not taking new patients", or no you don’t have a referral, or some other polite brush-off that I have heard before. But she took my call, listened to my plea (short story), and had Dr. Seifter call me back. And I’m grateful for her decision because here we are about 6 weeks later and doing well.

We met Dr. Seifter promptly at 9:30 for a quick checkout. My temperature was below 97° and my blood pressure was 120/80 – I’d like to think this means I was cool and calm heading into my first treatment.  I’ve been taking my temperature for a few weeks now, first thing in the morning, and it averages 97.6°. At the time of starting this blog entry I am up to 98.5° but it’s back to normal now. No worries.

Here’s Dr. Seifter (nice tie!) and me...the time stamp is off by an hour (now fixed):

Dr. Seifter and me

Even though I make him look average in height (like I do most people), he is larger than life for me! We had a chance to ask some additional questions in Dr. Seifter’s office and here are the answers:

1. Anti nausea meds will be given intravenously and will last up to 3 days.
2. I need to continue with allopurinol (keep Uric acid from building up) until 18-Oct.
3. Dosing is based on Body Surface Area, a known calculation. MY BSA IS 2.62 m². Here’s an example of how to calculate this based on one model/equation (DuBois): 

Body Surface Area Calculator

And voila, here is my record-setting dose (that is based on a relatively small population of 80+ patients):

Adriamycin “A”: 65mg 

Bleomycin “B”: 26mg  

Vinblastine “V”: 16mg 

Dacarbazine “D”: 980mg

We then walked down to the chemotherapy room and met Anna Ricchio and Dawn Guttman, the oncology/chemo nursing staff, or “angels” as Dr. Seifter calls them. And they truly are. Each are as accommodating and loving as anyone you will meet. They take time to explain everything and make great conversation as well. They have further extended the group excellent professionals who have guided me quickly and smartly in my search for knowledge about my enlarged lymph node and subsequent diagnosis. And as I now know, this chemo room (5 chairs, 4 rotating staff) is for Dr. Seifter’s patients. I settled into my recliner chair joined a couple others who were already into their respective treatments. One humorous note...the lab that makes the chemo prescription called Anna and Dawn to verify that the doses they ordered were correct. My height and weight were reiterated, and after some quick calculations, the doses were confirmed.

Angels

We got started at 9:55. The vein of choice is on the topside of my left wrist, just above the hand and ulna “knot”. First is a liter bag (I’ll go through two total today) of standard saline solution - sodium chloride (NaCl). Then the anti-nausea medications drips were started. First was Emend and then Aloxi. Each were hung as small IV bags, and only after the previous bag was drained. Next was Decadron, a steroid (glucocorticosteroid) was started. It assist with the possible affects of the chemo. This may make for a sleepless night tonight. Here’s some good info on Decadron:

Decadron Info

 After an hour, it was time for the chemo. In a slight change from a prior discussion we are going to start with the three that are “pushed” into the IV.  Here’s the brief timeline.

11am: Start with A. It’s a red liquid, looks like commercial hummingbird food, was pushed into the IV via a medium syringe. From the dose levels above, it’s the largest dose of the three being pushed. Dawn sat next to me and gently squeezed the syringe for about 10 minutes until that dose was complete. I ate ice chips, which seem to help reduce mouth sores from A by reducing blood flow in the mouth while it’s being administered.

11:10: B is next and is a clear liquid. Dawn pushed it in via syringe just as she did A.

11:20: V is the last to be pushed. I felt a slight but noticeable tingling as it was pushed in.

11:30: Time to start the IV drip for D. It’s a much larger dose and is metered in through an IV pump. There was a little burn on this one as it started. And the burn went in waves. I told Anna and Dawn and it was easily remedied by slowing the drip rate on the pump to closer to 90 minutes. It was much less and I got used to it and there was no real discomfort. Midway through I had to use the bathroom. Fortunately it’s a 10’ walk since the restroom is in the chemo room. And it’s the first time I’ve ever seen pinkish or copper colored urine. Thankfully the bathroom is part Proximity to restrooms will be important since I’ll take in two liters of IV fluid and all the drugs. I’ll am going often today - up to 6 times so far.

12:45: The IV is extracted and we’re done. As a final order of business we review a long list of effects, side effects and warning signs watch for:

Chemo Effects Cheat Sheet    

With hugs from Anna and Dawn for all of us, we're off to lunch. On the way out of the office, Lauren was able to move up my last two appointments in 2012. They are now on 12/7/12 and 12/21/12, both at 9am.

As the day progresses my stomach is grumbling occasionally. I’m not sure if I’m hungry or not wanting to eat - so I eat. I’m sure it doesn’t help that the Orioles just lost to the Yankees. 8 hours after the chemo IV was extracted, I’m feeling fine. I’m a little stuffy and have some slight stomach acid brewing. A 12 hour Sudafed and a couple Tums seem to do the trick.

It was good for Jen, David and Alison to see the process and take the mystery out of where I’ll be going for the next 6 months. Thank you to all who emailed, texted or called today. I was on my iPad or phone throughout the chemo session today enjoying the good wishes, prayers and banter.

Love to you all