"I'm not gonna let them catch me, no..." -- The Allman Brothers
With September came, cycle two, which began with blood analysis reflecting that I was "good to go for chemo:" white blood cells and neutrophils in normal range with red blood cells, hemoglobins and platelets slightly low yet acceptable. It should be noted that the "dirty" lymphocytes were still in single digits at 2.6 (2,600) which is wonderful -- when I ruled the world.
During my meeting with the medical staff prior to infusion we discussed my "20 questions," including:
- Will I need to take Zofran (nausea med) and Ativan (anxiety med) during the cycle, or only after? I'll be given these meds during chemo so no need to take them. After chemo the Ativan may be used to supplement the Zofran for nausea in helping alleviate Zofran's side effects (constipation).
- What can I expect in terms of my blood counts after this round of chemo (and, if applicable, after future rounds)? For the white and red blood cells, they will drop some, but since we are starting higher they shouldn't drop as far as they did during cycle one, The neutrophils dropping to zero will be addressed by adding medicine on day four (see below for details). The hemoglobins and platelets will most likely respond as previously, but if there is any bleeding (nose, gums), bruises or pinpoint rash on the front of the legs or arms, let the hospital know.
- Will the side effects from the drugs become more prevalent with successive cycles? Generally what I have experienced will continue (except the neutropenic fever will be prevented), however, after the third or fourth cycle of chemotherapy I should start to become progressively more fatigued.
- Is there anything I can do to help with constipation? Yes, take an over-the-counter stool softener. Drinking Miralax powder helps and doesn't result in diarrhea.
- How long after chemo day three should I continue to take Zofran for nausea? Since I only took it proactively through Friday and didn't have any nausea after that time, it should be the same going forward. Also, Ativan can be substituted for Zofran at night.
- What can't I do? Unfortunately, the same things I've been told (see Part Four).
- What can I do? Use my judgement, based on how I feel over the course of the four weeks for each cycle.
- Are my past immunizations still effective? Yes, and they are only lost through a bone marrow transplant, but that is so far in the future -- I'm not gonna let it catch me, no...
We also discussed cycle three of chemotherapy scheduled to begin on October 7. My blood will be analyzed to again, ensure the counts are within acceptable levels to begin the third cycle. I also need to bear in mind that the remaining cycles may not happen as planned, as my various blood components will need to be in "safe ranges" (as described in Part Six) before each cycle can begin.
Once in the infusion room, my nurse for cycle two, day one, came over and asked if I was John Stark. After reading my name on the treatment protocol sheet she thought I was the namesake of the John Stark Highway in Newport, New Hampshire. Between figuring out who I was and after administering the pre-meds, karma intervened. I qualified for a faster infusion of the Rituxan. They gave me 900 mg (an increase of 200 mg over the total Rituxan received during cycle one) and decreased the infusion time from five to 1.5 hours so I could speed down the chemo super highway -- chrome wheeled, fuel injected! Of course, had I felt anything funky (rash, itching, fever or something out of the ordinary) I was to let them know so they could slow it down -- "slow down, man in the mirror slow down," (Chris Ledoux). But we kept the pedal to the medal and my day finished early.
When on cycle two, day two, I told my nurse she was joining my angels here on earth, she told me that one of her previous patients had claimed coming into the infusion room was like going to hell -- now I have a Hell's Angel by my side.
Cycle two, day three ran a little long since I arrived a tad late, but my nurse got things underway in reasonable time. The only out of the ordinary thing was a volunteer came and gave me Reiki -- which was calming. All in all, these three days involved my caretakers listening to my steroid-driven discussions or letting me sleep.
And then came cycle two, day four. I received a shot of Neulasta (Pegfilgrastim) to prevent my neutrophils from dropping to zero (see Part Six for why this is now part of my protocol). While it was a quickie, in and out, it landed me on my ass. By the evening I was feeling as if I was coming down with the flu, a typical side effect. I ran a low-grade fever, aches all over (predominately the lower back and legs), extreme exhaustion, nausea and headache. I didn't get out of bed until late Saturday night. While I was miserable, these side effects meant the Neulasta was doing its job -- "Working in a coal mine, going down, down, down... " (Allen Toussaint)
The dizziness I've been experiencing when I stand up continues and is most likely due to orthostatic hypotension which is when the blood in the body shifts upon sitting or standing. I have a mild case of this, and it could also be as a result of having low blood pressure from chemotherapy. And yes, my fingers and toes still tingle, but much less now. The fatigue, which will be with me for the duration, wasn't as evident until the fourth day when I began feeling this cycle's effects in force -- I'm in a chemo state of mind....
Timing: October 7 through October 10, cycle three of chemotherapy.
Oh, and Lynne Cannon, Karen Carmichael, Becky Greenan, Barry and Elyn and Macie Rosenthal, Renee Epler, JoAnn Onacki, Chris Perry, Judy Stutt and Sue Tomberg have been added to my list of angels here on earth. Who knew so many angels walked amongst us?
I'm not gonna let 'em catch me, no...