Chemotherapy as a journey to survival

A body for assault

No two experiences of taking chemotherapy are the same, at least that is what I think from my own situation. As I took my delayed first session of Caelyx chemotherapy (liposomal doxorubicin) on the 5^th of October 2009.

It was scheduled for 9:30 AM but postponed for 3 hours. In that time, I received a brilliant bouquet of flowers from Stockholm which brightened my outlook quite a bit.

I had been informed that I was not going to lose my hair, not that I had any to lose, and my fertility will be affected, not that I was planning to procreate nor was I in the state to make a preservation order on that account.

Taking cancer head-on

When I was wheeled to the oncology theatre, I was canulated and this red liquid in large sachet covered in aluminium foil to shield it from light was passed into my veins for a period of 45 minutes to an hour.

It felt like a homeward straight in my therapy, the fungating tumours of Kapasi’s sarcoma were going to be snuffed out. The chemotherapy being cytostatic, meaning it kills cells and stops cells from growing also meant that I was a health hazard to others who had to be careful about having any contact with any of my bodily fluids including blood.

After the first session, my bed was cordoned off in isolation and that affected me more than the bloated feeling that was a side effect of drug. I was informed of everything I could expect apart from the isolation which was removed after 2 nights.

How it all transpired

I had 7 chemotherapy sessions every third Monday until the 8^th of February 2010. In terms of side effects, it was the loss of taste, the only things I could perceptively taste were yoghurts and cassis black currant drinks. I was literally knocked and without strength for the second and third day, then by the fifth session, I could not keep my food down that I had to be given medication to manage the emesis.

By December, the cancer lesions had disappeared, new pink skin was showing up from under the necrotised skin which needed to be cut away. It is not the best experience, but if it is the only viable course of treatment, you just have to hope you pull through it, for at the same time, a close friend on chemotherapy treated by the same oncologist did not survive his third session of chemotherapy.

Just striving to live

I guess what I learnt through the process was that you were given more of the chemotherapy if you tolerated it well. When I visited the hospital for my out-patient sessions, the ward was well-equipped, the couches were fully adjustable to recline into beds, if so desired. I took my thermos flask of tea, some biscuits, and some reading material.

Apart from the staff, we were a ward of people fighting to live, from the boy who came alone, hardly a teenager to the elderly people, just hoping that the medicine gave us a lot more time than when we first heard the word cancer spoken about our condition.

This blog of reflection is one that also recognises that people with my condition at diagnosis rarely lived for another 10 years. I have been fortunate, and I am grateful for the grace of God on my life, the amazing miracle of medical science, the support of extraordinary friends and now the wonderful love in my life, Brian. I am blessed.

Battling with my vulnerabilities to pain

The eye of pain

Quietly, I have been going about things as if it did not matter. I’ve been in pain for the past few hours, my right eyeball giving me such discomfort, and I am no wiser as to why.

I have placed a cold pad over it to ease the pain, and I would have taken painkillers if I was not already feeling so nauseous.

I cannot attribute anything to this uncomfortable feeling, though it does feel like I am coming down with something I do not want to yield to.

No glory in emesis

Thrice, I have been bent over the toilet bowl, ready for emesis, salivating a lot the first two times and then finally evacuating my guts the third time.

The horrid feeling is that if you are vomiting on an empty stomach, you convulse and retch, groan and contort without much to show for it. Nasty does not describe the feeling.

When the retching stopped, I poured a bowl of cold water over my head and appeared to calm down. The eyeball pain is still there, but I probably should just take a rest.

Have me in your thoughts. Good night!

Thought Picnic: Aborting peristalsis

A lunch-time malfunction

Suddenly caught within the travails of thought, taste, smell and food which was triggered at lunch this afternoon.

I had ordered beef stroganoff and rice, at the time of the service, it appeared the rice was hot, or maybe the plate was hot because I was getting uncomfortable as I stood at the till to pay as the till broke down.

I settled at the table and spooned the first and second mouthful at which point the mechanics of peristaltic movement seized to function, a massive paper-jam, in my throat.

Tearful choking

I took a few sips of my drink with the hope of eventually easing the blockage without much success; I could breathe but at the same time I was choking.

At which point, I had to run out unto the patio where all I could cough up was the drink, but the choke was still painfully there, I was already in great discomfort and in tears, my colleague that the table completely oblivious of what I had suffered.

Another drink of water did not help, as the time-out for regular peristalsis loomed, the process of ingestion could not be completed, I had to run out again and every that had gone in was seen again as the natural had been aborted for survival – Relief, but that was the end of lunch, I could not believe how much that experience had exhausted me, I was tempted to end the day at work.

Much, much later

Hungry as I was, the next intake I had was some tea about an hour after that, then two pygmy bananas before I returned to my hotel with the hope for supper.

The entrée of taramasalata and warm flat breads went down well but the main course after the second bite suddenly went off to my taste and with the collusion of my memory and my thinking exciting a feeling of nausea, I was in the gents the next minute and that was the end of dinner – I can only wonder what the whole problem was before I begin to worry.

Should I be bothered?

In the first instance, I could surmise that the rice was not really as hot as the plate felt and that could have the tendency of choking you but the event 8 hours after left me more concerned than it was comfortable to be.

One needs to see what tomorrow brings before panic sets in, puréed food or a liquid diet – let’s not go there yet.

Boldly tell your doctor everything

I tell it all now

There probably is a drug for every type of condition if you can articulate to your doctor exactly how you feel and your doctor is aware of that condition, to offer the best advice or medication to help with that situation.

During the time of my illness and the process of recuperation, I have learnt to be more open about the things I observe about my body, my feelings, my reactions and my comfort to my doctors; there is no time to be embarrassed about having to drop your pants and show them things.

With this kind of information, my doctors have sympathetically heard me and sometimes adapted or modified my medicine to help me get better and feel better about the medication I use.

Healing the pain

The two areas where I have benefited most from the management of my medication in relation to how I feel have been in pain relief and sickness manifested as vomiting.

I think by now we have gotten the reduction of pain down to just using an epidermal patch, which I place on the skin of my belly that releases 25 micrograms per hour of Fentanyl [1] into my body fat over 72 hours.

This required a little adaptation; the patch itself can easily come off, so my neighbourhood nurse gave me sheets of transparent plasters I could place over the patch to keep it fully adhered to my body – that advice came because I freely offered that information of discomfort, not knowing there was an easy remedy to the situation.

Stopping the throw-ups

As for vomiting, that has been brought on by all sorts of things, it was first with the morphine in the hospital, I was taken off that and given pills to handle the pain instead. A change in my medication brought on more vomiting, so I had to take suppositories to reduce the nauseating effects. In fact, the suppositories are still part of my daily medication as an antiemetic.

After my first chemotherapy, I had read up on the side effects and asked if I would have the antiemetic pills for that particular chemotherapy. I was given something similar, but by my fifth chemotherapy, it was not as efficacious as before. I was so horribly sick for days, unable to keep food down or take my medication.

So, at my last meeting with the oncologist, I mentioned this. It was important because it was based on my saying I was tolerating the chemotherapy well, that my dosage was increased from the initial 6 to 8 sessions, and no,w after my fifth, it looked like I was not managing it that well.

What the doctor ordered

The oncologist prescribed Emend aprepiant [2], which, with the other anti-emetic medication I already use, helps prevent chemotherapy-induced nausea and vomiting (CINV). It consists of three pills, the first large dose to be taken an hour before chemotherapy and for the two days afterwards.

Apparently, it blocks the vomiting signals from the brain rather than from the stomach, and I could almost say I feel the battle between my brain and stomach, where I know I would not vomit even though there seems to be every inclination to want to vomit – the wonderful power of chemicals in the body.

Looking through the side effects of using Emend is interesting because it literally has all the ones we know that chemotherapy sometimes causes, like hair loss, loss of appetite, itching and so on, but I must say, stopping the vomiting is probably the better trade-off in the circumstances.

As for drowsiness, well, I have been doing a good deal of sleeping all day, a good few of the pills do cause drowsiness in any case, but Emend is just what the doctor ordered – don’t be afraid to tell your doctor all the truth, it always helps.

Sources

[1] Fentanyl - From Wikipedia, the free encyclopedia

[2] Emend aprepiant

No Gloria in Emesis

Warning: To be read only by those with a strong disposition, it is full of talk of emesis, sickliness, vomit and puking.

Tired out completely

It was a hard slug getting home on Monday evening; I think I had tired myself out after chemotherapy, the long walks and the visit to the library.

A few chills had set in as I trundled to the tram stop just in time to catch the tram going home. I was homing for bed and not long after a snack, I was under the duvet and ready for sleep.

I was out for just over 2 hours and got up for my elevenses, well, I take my pills twice a day, though only one set has to be taken every 12 hours, there are 5 sets of pills, the other 4 are taken daily and I have split them into the morning set and the night set.

This regime is easier than when I first left hospital with pills to take 6 times, 4, times, 3 times, 2 times and once a day – it called on all your powers of organisation to sort out.

Then there is the emetic suppository to be taken as needed, an anti-constipation powder to be mixed in water and taken for the Fentanyl pain patch that gets changed every 72 hours.

Puking all the time

This was the first time that my chemotherapy session and pain patch change coincided and this probably lead to the sickly feeling I had throughout Tuesday.

Just before my first elevenses, I was feeling quite nauseous so I went over the toilet bowl and threw up violently but nothing of substance came through, the feeling continued all day, I could hardly eat and really could ingest no medicines in that condition – I took the anti-emetic suppository hoping it would alleviate the situation but it seemed like a long shot, I was on the verge of calling the hospital.

During one of the 5 times that I was sick, I was in the middle of a telephone conversation literally answering back between each puking session, it was an absolutely rotten feeling.

Neighbours bring strength

I settled back in bed and more or less spent the day lain down and hoping for some improvement – afterwards, I found that my neighbours had returned from holiday, we had a chat and as usual they were there to help and the first thing I could keep down was some bouillon they made for me.

I gained a little strength to do some shopping, had some fruit and when it came to my nightly elevenses, I took the anti-emetic medication which also comes in tablet form along with my main medicine and the suppository.

What a day, glad it is over, thanking God for His mercies and looking forward to another day – it is white outside – it has been snowing again after the complete clear-up on Monday.