Chemo round three... It may be getting easier

Apologies to my dear avid readers for not posting a pre chemo brief. I had intended to, however for a couple of inadequate reasons it did not end up happening. Namely, I was acutely aware that I had already had one strop of a post earlier in the week, and did not wish to burden you with a second so soon after. Also there was a degree of laziness involved; a rather obtuse degree. 

My weekly bloods displayed a neutropenia warranting at least an eyebrow raise had I been validating the results at work. A level of 0.4 x 10^9/L of blood (a good scientist would have published this unit already), so we are getting clinically low now. I received my reliable Friday night phone call from the haem day unit, again mid-wine but fortunately pre-rugby, to inform me thusly and tell me my prize…. more GCSF injections! Three in fact, on concurrent days. The GCSF is kept in my fridge which creeps me out; my occupation conditioning requires strictly separate food and medical fridges. The only upside to my ever increasing appetite is that the subcutaneous injections are now much easier. It turns out weight loss may no longer be an issue.

I had been forewarned that GCSF makes some people feel a bit crappy, however, other than the previously mentioned sternum pain, I didn’t have too much strife the first time around. This time was not as successful. The promised ‘flu-like symptoms’; vomiting, aching, no sleep, more bone pain – both sternum and pelvic this time, were severely apparent. Mike would probably like me to also mention crankiness, but personally I think he is a little biased and this isn’t his blog anyway. There was a particularly low point Saturday afternoon, my head down the toilet heaving my guts up, tears streaming down my face, nose bleeding into the bowl, our toilet seat is broken so I am holding it up with one hand all whilst my body has decided to shiver uncontrollably. Potentially a Hunter S Thompson moment, although at least he got a buzz, all I got was a cytokine release. At the time of this despair it was difficult to ascertain whether it was due to the GCSF or, possibly, neutropenic sepsis. As you have probably noticed from previous posts, I have become rather neurotic since this pesky diagnosis. Fortunately, my temperature never breached the designated danger point of 38°C, and my previous CRP had been a staggering 1 mg/L, so the GCSF was attributed with the blame. 

Subsequent to my Sunday evening injection I was lucky enough to enjoy an all over body itch. Whilst silently thanking myself for having the forethought to trim my fingernails earlier in the day so I could go all out with the scratching, I was hit with a most unusual sensation. It was as though I had jumped into a pool of pop-rocks; an all over body tingling, which had the potential to been a kind of cool experience but instead it was entirely unnerving. Throw in some rigors for good measure (my body never fails to miss a good shiver if the opportunity arises) and I was totally freaking out. Scrutinising the drug information insert did nothing to relieve my concern, but did inform me that the vomiting could fairly and squarely be blamed on the GCSF. A quick google search gave me nothing but the certainty that I had febrile neutrophilic dermatosis (I didn’t) so I threw back an antihistamine and a not-so-magic pill and let the night put an end to my misery. 

I awoke alive, which is a plus in my books (as the great Tommy Ill would say) so it can’t have been too serious. Although it was Monday which, as the title of this post has promised but so far not delivered, was chemo day; a leisurely 2pm appointment. My attempt at losing a Civilization V scenario was interrupted by a call from the haem day unit around 10am politely inquiring where I was as they had expected me in at 9am. My timeslot had been changed; I hadn’t been notified. A power shower, a very well packed lunch from Mike and a taxi ride later I arrived flushed at the unit blubbering about a mix up in times. Who would have thought I’d have been so eager? Mike was tasked with collecting my parents at Gatwick after their thirty something hour flight from Auckland, so I was flying solo this time. Some may argue he had the harder task.

Once I had regained my composure (let us assume I had some to begin with), I noticed with unrelenting horror that I had lead you, my darling readers, astray! The previously mentioned oversized salmon chemotherapy chair is not even close to salmon in colour! More a dull hot pink, which I guess just makes it pink. I apologise profusely for leading you down this incorrect path of imagination. Although, I believe I did publish a photo last time, so most of you were probably aware of my inability to correctly describe colours before I was. Nevertheless, the apology still stands. 

My sister had given me a tremendously tough personal best target of five hours, but I was up for the challenge. The Friday neutropenia resulted in further blood tests, and therefore another pre-chemo wait, however the cannula went in without a hitch, so I was feeling confident I could achieve her ridiculous goal. Unfortunately my faithful laboratory friends had other plans. At least a 2.5 hour wait for the neutrophil count, a count around the 27 x10^9/L, so rather elevated. I like to think that a rip-roaring blast flag, some poor clinical details and a panicked urgent blood film requiring a manual differential was the cause of the delay. As I have alluded to in the past, I do enjoy a bit of drama. Whatever the cause, pharmacy had definitely brought their A-game that day, I think I had the drugs within the hour, but even with this promptness my five hour objective was already looking shaky. 

My chemo has arrived, the old lady opposite is giving me a scowl. She has been waiting for as long as I, in fact her transport has already arrived to take her home, but there is no sign of her therapy happening anytime soon. I have a brief discussion with the nurse about my previous darcabazine reaction, but couldn’t convince her to give me an antihistamine to cover me. This should be fun. The A, B and V infusions go well, even my previously documented agitation as a result of the vinblastine was absent. I was pretty chuffed, I am knocking on the door of five hours biatches! But no. Darcabazine time. The prescribed infusion rate means it should all be over in thirty minutes, but the nurses inform me that no one has ever managed that. This may sound like a challenge, but I can assure you it is not one I will ever be attempting. They set me up with a ninety minute infusion, and not even five minutes in I am thrashing in agony. Honestly, how cytotoxic is this drug? Is actually stripping the endothelium from the inner my vein, whilst bursting every valve it is passes through? Because that is what it feels like. A viscous blob slowly destroying my insides. No wonder my spleen is causing me so much pain. In what I wish had been a much calmer voice, I plead for the nurses to decrease the rate again. I can imagine my sister, had she been there, feeling a perfect revenge opportunity had arisen; revenge for all the ultra-marathons where I have denied her a rest in order for her to achieve her target. Thankfully, she wasn’t there to utilise such an occasion. 

The pain is still epically present, but it seems to reduce somewhat if I drape my arm over the side of the chair and hold it perpendicular to the floor. Unfortunately this draws attention from the nurse, and she turns the infusion rate down yet again. Is that a wry smile from the old lady opposite? I think it is. I expect you all to be judging her accordingly right now. Despicable behaviour, having therapy races. Given her age, she was probably a pro. I am still a rookie. Tut tut. Despite the further reduction in infusion rate, now in excess of two hours, my arm still needs to be held at a right angle in order for the pain to be remotely bearable. I find a more subtle way to achieve this, the old ‘I am actually holding my book comfortably whilst resting my elbow on the arm of chair’ routine. You should try it sometime.

Furthering my torture, the ‘ever eager to beep’ mechanism the infusion runs through has an unavoidable ‘time remaining’ countdown on it, persistently informing me of my imminent failure. I am pissed off, Mike has already completed his mission and wishes to come and join me since I am having oh so much fun. Is he rubbing his success in? Has this become some sort of Amazing Race episode - chemo vs husband vs old lady? He is getting one word responses. When he does arrive I am relieved he can read through my tough texting exterior, because although, to be quite honest, this was easily my best chemo experience thus far, I was still very close to tears. And crying would have given that old lady far too much pleasure. Two hours later we were on a bus, total time of six and a half hours, still a personal best, but only narrowly.

Now, Tuesday morning, I am not feeling too bad. Certainly the best I have felt the day following chemo. I am pale, with dark grey bags, but am comforted by the current Topman model; apparently the cancer patient look is in this season. I was just now thinking that the colour of my nose would put Rudolf to shame, then it started oozing blood. Obviously my nose does not take kindly to such compliments. I have bruises down my left arm, not only down the entry vein, but bluish purple tracks running entirely down my forearm as well. At least I have something to point to and cry “I am not exaggerating, the pain was shocking!” A poorly scheduled fasting ultrasound appointment means I am trying to quell my insatiable appetite with the horrid mouthwash and copious amounts of water, resulting in frequent trips to the ladies, where I am rewarded by catching a glimpse of my Knight of the Woeful Figure reflection. On the positive side, I still have both my ears.               

I would like to take this chance to thank everyone back home for all their kind words, cards and gifts that my parents brought forth from Aotearoa, they were very gratefully received, and, in most cases, heartily devoured. Thank you!