THE BLOG
08/16/2013 11:34 am ET | Updated Oct 16, 2013

Postcards From Lebanon: Part 4 in a Series of Cancer-Related Commentary

Head on down the highway...

The first day of chemo arrived, and I approached it with anxiety, which I suppressed through humor at every opportunity. We noticed a "Do Not Enter" traffic sign strategically placed in from the Cancer Center entrance at Dartmouth -- I told Ron they didn't want me today. Also, every time they asked me my name and birthday, I'd switched it around: A little spice makes for a better meal. And I wore the "party shirt" I bought for Ellie Gordon's 50th birthday party -- party on!

I had to decide whether or not to have a port surgically implanted for ease of infusions or to go the intravenous route: a prick each cycle, staying in place for the full three days. I was told I didn't need one by my dear friends Dorothy and Julian Josey (Julian is an oncologist). Of course, this doesn't mean that if my veins don't cooperating that I won't have a port. One word of advice: Do not view on YouTube how ports are implanted. I did and needed both my nausea and anxiety meds before I had even started chemo -- phew!

My appointment at Dartmouth was at 7:15 a.m. for blood work. During the Aug. 5 preparatory meeting, I was asked if I'd ever had hepatitis, so we included testing for hepatitis A, B & C, which showed positive for hepatitis A antibody (typically hepatitis A comes from traveling to exotic locations -- and we've been to a few). Rituxan can cause hepatitis to flare up -- something for which we'll watch. At 8:15 we met with Dr. Gautier to review labs, any health changes, and protocol, and I was okay for treatment.

The infusion room at Dartmouth has two nurses stations, three licensed nursing assistant stations, and roughly 31 infusion stations for patients. It was 9:50 a.m. when we entered. I was given a corner by the window after telling the licensed nursing assistant, Risa Mornis, that this was my first time -- I was a virgin. There is limited privacy provided by curtains as the nurses need to see their patients. Besides, chemo doesn't discriminate. Everyone in the infusion room is traveling the same road, hopefully heading in the same direction, remission, so it's nice to know you aren't alone. And I don't feel alone with all the friends who have sent notes or made offers of help. Fiona Morton has selflessly taken on multiple burdensome tasks, including arranging drivers for future cycles -- another reminder that I am not heading down this highway alone.

The witching hour finally arrived, and the IV went in smoothly, thanks to my wonderful nurse, Pamela Zahara, who made my first time comfortable (I will always hold a special place in my heart for Pam -- you don't forget your first time). The drugs and amounts I was given on Cycle 1/Day 1, as well as some of the potential side-effects, follow:

  • Dextrose 5 percent and sodium chloride 0.45 percent 1000mL -- for hydration
  • Tylenol (Acetaminophen 650mg) -- for flu-like symptoms
  • Decadron (dexamethasone 10mg) -- steroid for infection
  • Benadryl (diphenhydramine 50mg) -- for allergic reactions
  • Zofran (Ondansetron 16mg) -- for nausea
  • Ativan (Lorazepam 0.5mg) -- for anxiety
  • Rituxan (Rituximab 100mg) -- changes the way the immune system works; in addition to the Cytoxan and Fludara side effects listed below: non-responsive; chest pain; fast, irregular heartbeat; faint or lightheaded, falls; redness, blistering, peeling or loosening of the skin, including inside the mouth; stomach pain
  • Fludara (Fludarabine Phosphate 48mg) -- interferes with the growth of cancer cells; in addition to the Cytoxan side-effects: breathing problems; changes in hearing/vision; confusion; muscle weakness; tingling in hands or feet; swelling of hands, ankles, feet; trouble passing urine; yellowing of eyes or skin
  • Cytoxan (Cyclophosphamide 475mg) -- slows the growth of cancer cells; allergic reactions: rash, swelling; low blood counts leading to infection; fever, chills, cough, or sore throat; decreased platelets: bruising; black stool; decreased red blood cells: weakness; breathing problems; dark urine; mouth sores

And then there are the side-effects that don't require immediate medical attention: anxiety, headache, muscle aches, night sweats, constipation, diarrhea, hair loss, nausea, vomiting, loss of appetite, and trouble sleeping. Something else to watch out for while being treated is dental hygiene: Brushing, flossing or toothpicks may cause infections -- be careful and gentle with your mouth.

The hydration was set to go for the day, and then the Tylenol, Decadron and Benadryl were administered; the latter two drugs immediately left me dizzy, disoriented, with lose of short term memory. I requested the anxiety meds (Ativan) right away; the nausea drip (Zophran) was begun and administered over time.

Next up was my limited dose of Rituxan, monoclonal antibody, a smart bomb in that it is targeted therapy; I experienced a low grade fever 99 degrees and neck aches with a mild headache -- they gave me 650mg more Tylenol. Otherwise, my dizziness and disorientation had subsided but not gone away. Then the Fludara chemotherapy, a nuclear bomb that destroys both cancer and non-cancer cells; I experienced nothing during infusion, except the ongoing lessening of the earlier side-effects. Finally Cytoxan, another chemotherapy nuclear bomb, with no side-effects while being administered. Most side-effects show up over time. I will note that I had to pee a lot -- which meant I was definitely hydrated -- a very good thing as I need to flush out all the dead cells quickly so my kidneys don't get blocked.

Lunch the first day was a tuna sandwich on whole wheat, a fruit cup, chicken and rice soup with a diet soda -- and vanilla ice cream with Fig Newtons for desert, with honey graham crackers as a snack. Dinner was -- yes, I wanted Mexican -- a vegetarian burrito, chips and salsa, water, and Gatorade.

We spent the night at the Courtyard Marriott, which offers a special rate to Dartmouth-Hitchcock Medical Center patients -- be sure and ask for it, but be aware that New Hampshire does charge a "state occupancy tax, and I'd thought NH was tax free. I didn't have any problems getting to sleep, but by 3:30 a.m. I was wide awake thanks to the steroids and up for day two, which began at 7:00 a.m.

My nurse on the second day was Jillian Craig, and my licensed nursing assistant was Ernesto Velazquez. The drugs and amounts I was given on Cycle 1/Day 2 follow:

  • Dextrose 5 percent and sodium chloride 0.45 percent 1000mL -- for hydration
  • Decadron (dexamethasone 10mg) -- steroid for infection
  • Zofran (Ondansetron 16mg) -- for nausea
  • Ativan (Lorazepam 0.5mg) -- for anxiety
  • Fludara (Fludarabine Phosphate 48mg) -- chemo
  • Cytoxan (Cyclophosphamide 475mg) -- chemo

The hydration drip was started at 8:15 a.m. followed by pre-meds of Decadron and Ativan; I relaxed immediately. The Fludara was followed by the Cytoxan; thanks to the pre-meds I haven't experienced any side-effects other than chemo brain, yet I am able to maintain my sense of humor. The nurses think we dance around the IV poles we have to drag with us to the bathroom as if they are May poles since all our tubes are a mess when we get back. I'm blaming it on the Ativan and chemo brain -- a condition where you are sluggish, disoriented and slight confusion that is nearly a permanent state for those of us undergoing chemo. It's also a great excuse for everything if you aren't blond.

I was released at 12:20 p.m. and had lunch (Thai beef and noodles) in the cafeteria and then we got to go home. We had franks and beans for dinner -- no, really.

We watched The Avengers, and from two days of steroids I found myself believing I could be a super hero -- Colonel Chemo -- killing off foreign invading cancerous aliens. POW! ZAP!

Cycle 1/Day 3: Here comes the Rituxan! My nurse today is Ann Gallaher (covered in freckles -- my mother told me my freckles were fairy kisses -- Ann wasn't buying it) and the licensing nursing assistant is Phil Pomerville. Pre-meds started at 11:30 a.m. and Rituxan at 1:00 p.m.

  • Dextrose 5 percent and sodium chloride 0.45 percent 1000mL -- for hydration
  • Tylenol (Acetaminophen 650mg) -- for flu like symptoms
  • Decadron (dexamethasone 10mg) -- steroid for infection
  • Benadryl (diphenhydramine 50mg) -- for allergic reactions
  • Zofran (Ondansetron 16mg) -- for nausea
  • Ativan (Lorazepam 0.5mg) -- for anxiety
  • Rituxan (Rituximab 600mg) -- monoclonal antibody
  • Fludara (Fludarabine Phosphate 48mg) -- chemo
  • Cytoxan (Cyclophosphamide 475mg) -- chemo

The pre-meds left me dizzy, disoriented, lethargic, dry-mouthed, short term memory losses, and spastic muscles in my legs. When the Rituxan started it ran for four hours, during which I slept. They had Demerol, more Tylenol and Ativan at the ready should I have begun shaking or gotten a fever or headache, but not this time. I rocked and kicked Rituxan's butt from the third day of steroids -- BANG! Then the Fludara and Cytoxan were administered. Nurse Donna Heath ended the day with me and successfully removed the IV -- bless her!

Of course I was disoriented and confused, with no short-term-memory; but at least no flu-like symptoms. The real side-effects will come over the next week or two. It will be up to me to self-medicate in preparation or to lessen their effects. I will continue taking Allopurinol 300mg through the rest of the week to help my kidneys. Already my hands and face have started to dry out (I'll start to apply moisturizer). My fingers are still tingling from the vincristine, and they are getting worse, which I was told they might. I'll let you know what happens over the next couple of weeks.

Lunch on the third day was chicken salad on whole wheat, chicken with rice soup, fruit cup, and apple juice. I had a ginger ale after my sleep. For dinner I had cereal.

I found out from my dear friend Kathy Sullivan, an attorney in New Hampshire, that the state will take about 18 months to write and adopt the regulations for dispensing medical marijuana: [expletive deleted].

Timing: Aug. 26 -- blood work check up to see how low on the Nadir my blood counts have fallen.

Oh, and Fiona Morton, Dorothy and Julian Josey, Pamela Zahara, Risa Mornis, Jillian Crain, Ernesto Velazquez, Ann Gallagher and Phil Pomerville, Ellie Gordon, and Kathy Sullivan, and Donna Heath have been added to my list of angels here on earth.

Head on down the highway...

Postcards From Lebanon: Part 1
Postcards From Lebanon: Part 2
Postcards From Lebanon: Part 3