The 4th Treatment

I had my 4th treatment last Friday.

I was scheduled for bloodwork at 9:30, two doctor's appointments at 10:30 and 11:00 and then the infusion at 1:00.

My absolute neuts dropped again. Now I'm down to .32. The doctor said that it would be OK for me to proceed with my infusion. When I got to the infusion room, they said that the orders said that I was not to get the insusion unless the levels were above .50. Therefore, they refused to fill the order. It took an hour to straigten out the mess. In the meantime, I convinced them to get me started with an IV and fluids so we moved along once the orders were corrected.

Once we got going, the schedule was as follows:

Adriamycin - 3:10-3:15

Vinblastine - 3:16-3:20

Bleomycin - 3:20 - 3:30

Dacarbazine - 3:35-4:35

After the infusion, I felt great for the rest of the day and good the next day. As usual the next day I was tired and spent a lot of the day resting in bed. I've felt some aches and pains (especially in my arms) but nothing too bad. I've been trying to avoid crowds and sick people but everyone seems to be sick right now.

My mood is a 9 out of 10.

The Night before the 4th Treatment

Last weekend most of my side effects went away and I've felt great since then. I suspect tomorrow will be a long day since I have to wait 90 minutes between my doctor's appointment and my infusion. Oh well, it's best to expect it to be a long day and just relax through it.

I bought a book by Bernie Siegel called How to Live betwen Office Visits. He writes about cancer patients who give themselves permission to start living the life they want to live after they get diagnosed. As he asks, why do you have to get cancer to live the life you want to live?

By tomorrow night, I hope to be 1/3 of the way through my treatments. I know complications can interfere with the schedule and get treatments postponed but I would really like to be done by the middle of May. Of course this supposes a successful outcome to the treatments - and that's what I choose to do.

I'm going to rate my mood a 10 out of 10.

After the 3rd Treatment

I had my 3rd treatment on Friday. It turned out my concern about my FEV1 was unfounded. It turns out the DLCO [Hb] number is more important and it was fine. I guess this proves it doesn't make sense to worry about test results when you aren't qualified to evaluate them anyway.

I had an 8:00 appointment to get my blood drawn. I met with the doctor at 9:00 and then I was scheduled for my infusion at 10:00. Somehow things were slow to get started and I got my IV set up and fluids started near 11:00. Then the schedule went as follows:

Adriamycin - 11:05 - 11:15
Vinblastine - 11:15 - 11:20
Bleomycin - 11:20 - 11:25
Dacarbazine - 11:30 - ~12:40

I needed to slow down the Dacarbazine because I could feel it being pumped into me and it's not a comfortable feeling. A heat pack helped. I then got about an hour's worth of more fluids to reduce the chances of my getting constipated.

I got home by 3:00.

That night and the next day I felt great. I went to the gym for a 3 mile walk, I did some shopping and I went to a dinner party until almost midnight.

I went to bed at 2:00 AM on Sunday and slept until 9:00 Monday morning. Yes, you read that right. I slept 30 of 31 hours with only a 1 hour break to eat dinner on Sunday afternoon. At first, bed just seemed like a really comfortable place to be. Over time, I started feeling exhausted and couldn't get out of bed. This morning (Monday) I went to another doctor appointment, came home and, you guessed it, went to bed for another couple of hours until I had to go to yet another doctor appointment in the late afternoon. My doctors think I may have overdone it on Saturday and things caught up with me. My ENT said that I am showing signs of having a cold as well. The good news is that the remaining tissue in my adenoids continues to get smaller.





The last day kind of threw me for a loop. I think when things are going very well it's easy to get discouraged when you have a bad day. Some days will be good, some not so good. Even though I feel pretty good right now (just a little tired), I'm still going to rate my mood over the last 24 hours as a 6 out of 10.

The Night before the 3rd Treatment

For scheduling purposes, it was decided to move my appointments to Fridays instead of Thursdays. I'm fine with that because it will make it easier to work but I will miss the nurses I've been treated by so far.

I had a pulmonary function test on Wednesday. When compared to the test I had before starting chemotherapy, it showed a reduction in my FEV1 that put it out of the normal range. The FEV1 is the amount of air you can blow out of your lungs in 1 second. I hope it doesn't interfere with my treatment schedule.

I spoke to my dentist today although I know I can't have any dentistry done (including teeth cleaning) until I'm done being treated. He too is being treated for Hodgkin's. He was diagnosed with stage 3 Hodgkin's and now appears to be cancer free after 8 treatments. He has 4 more treatments to go to finish the regimen. His first treatment was difficult and he ended up in the hospital for a day and a half. He also needed to give himself injections because some of his blood counts were low. After the first treatment, things got better for him and now his experience sounds like it is similar to what I have experienced. It is very hopeful to hear that somebody who was diagnosed with stage 3 Hodgkin's is getting clean PET scans already.

I've started thinking more and more about my business. I would like to spend more time on sales but it is hard to focus while health issues have your attention.

I'm scheduled to have my blood drawn in 7 and a half hours so I should probably head to bed.

My mood is another 10 out of 10 tonight. Cross your fingeers that it stays that way after tomorrow!

My Second Treatment

The second of twelve chemotherapy sessions was scheduled for Thursday. Wedensday night I did a relaxation exercise at a friend's house. We also talked about identifying stressors in our lives and stopping to take a deep breath when we notice them. Then we went to a Qijong class. It was my first time and I found it interesting.

According to Wikipedia, Qigong or chi kung is an aspect of traditional Chinese medecine involving the coordination of different breathing patterns with various physical postures and motions of the body. Qigong is mostly taught for health maintenance purposes, but there are also some who teach it as a therapeutic intervention.

This morning, I had to get my blood drawn at 8:30. At 9:30 I met with my doctors and we discussed my blood counts. I then started my infusion at 11:00 and was out before 2:00.

My blood counts were down again for the second time in two weeks.

Here are the numbers.





The doctors pointed out that my Absolute Neutrophils were very low. They said that we could continue with treatment even if they were much lower but I had to be careful of infections. I was told to call the doctor immediately if I got a temperature over 100.5 degrees.

The infustion itself went well. I had a new nurse because my the nurse I had last week was taking care of one of her sick children. I know one of her little munchkins was sick when I got my first infusion. The nurse that took care of me today was very nice. I'm starting to wonder if Mass General has only great staff.

I started with some pills. They were Andonsetron and a steroid called Decadron for nauseu prevention. It took two trys to get a good vein but once we had one it was smooth sailing. I started with fluids for a short while and then I went on to the Adriamycin (Doxorubicin) I got 46 mg. from 12:19 to 12:33. Next was 18 units of Bleomycin from 12:34 to 12:39. Then we went on to 11 mg of Vinblastine from 12:40 to 12:45. Finally, I got 690 mg of Dacarbazine from 12:50 to 1:50. One of the drugs made my arm itch and feel cool to the touch. The nurse gave me a heat pack that took the chill out of my arm.

I went home and took a nap. Again I've felt no nausea ( as of 1:10 AM) and I ate normally and put up the Christmas tree with my Dad. I'm taking Senna to avoid constipation.

I have a pulmonary function test scheduled for just after New Years. They keep an eye on my lungs to make sure the chemotherapy is not causing any damage.

My mood is a 10 on a scale of 1 - 10.

Follow Up Appoinment One Week After 1st Infusion

My follow-up appoinment was scheduled for today. I had blood drawn and met with my doctors. As has become the custom, I got weighed and my temperature and blood pressure were taken. Then my doctors and I discussed my blood work and my experience with the first infusion. They were happy to hear that I experienced no nausea and said that my first experience was a good indicator of how future treatments would go. I was told that fatigue was the one symptom that might build up over the course of the treatments but even that was usually temporary.

I was told that my blood work was strong but I noticed drops in categories across the board.

One symptom I have experienced is constipation. When you're used to having no problem in this department it's a real drag when you can't go. I'm now taking Senna and Colace and it's starting to get better. I'm definitely going to try to keep on top of this. I'd recommend asking about medication and taking it at the first sign of trouble.

I'd rate my mood as an 8 out of 10.

My First Treatment

I had my first chemotherapy treatment yesterday. It went better than I expected it would and I'm glad I didn't worry too much. The first infusion takes much longer than future infusions. They need to perform a test to make sure you are not allergic to one of the drugs and to teach you what to expect and review information for after you go home. Total time for the first appointment: 7.5 hours. Future appointments should take about 4.5 hours.

Here's how the day went:

I arrived at the hospital at 10:00 AM. My blood was drawn by 10:10.

I met with my oncologist at 11:00. We discussed the fact that my blood counts were good and that I could attend the first treatment. Before every infusion, I'll have to have my blood drawn to determine if I can get the infusion scheduled for that day. The doctor answered all of my questions and we reviewed possible side effects and ways of dealing with them. I was given a consent form to sign.

I read the following about blood counts and chemotherapy on the web:

Low red blood count = fatigue, low energy
Low platelets = bruising and bleeding
Low white blood count = susceptibility to infection

My numbers along with the normal ranges were as follows:
WBC - 7.6 (4.5 - 11.0)
HCT - 41.7 (41.0 - 53.0)
RBC - 4.86 (4.50 - 5.90)
PLT - 278 (10 - 350)
Poly - 56 (40 - 70)

My appointment was over by 11:30 and the infusion was not scheduled until 1:00. I had coffee with my dad and toured a new hotel near the hospital.

At 1:00 my weight, height, temperature, blood pressure were measured. Height and weight are used to calculate the dose of medecine you receive.

By 1:20, I had met my nurse, Pam. She was absolutely wonderful. I feel very comfortable with her and fortunate to have her on my team. She seems very personable and professional at the same time.

Pam inserted the IV into a vein and started administering fluids by 1:40.

From 2:15 until 2:30 I received a test dose of 1 unit of Bleomycin. It is important to determine if the patient is allergic to Bleomycin. I suspect people who are allergic can go into shock. I was told that I shouldn't feel anything when the drug was given to me and that I should say if I felt anything immediately. If so, the nurse would ring a bell and a group of people would come running to help me. After receiving the drug I had to wait an additional 30 minutes to see if I had any reaction.

I was then given two anti-nausea drugs in pill form at 3:05, a steroid called Decadron (Dexamethasone) and Zofran (Ondansetron).

The next set of drugs were given via a push method in which the drugs are injected by the nurse into the IV.

I received 46 mg of Adriamycin from 3:35 - 3:45.

I received 10.9 mg of Vinblastine from 3:46 - 3:53.

I received 683 mg of Dacarbazine from 3:55 - 4:02.

The last one was then given via a drip method.

I received 17 more units of Bleomycin for a total of 18 units from 4:03 - 5:03.

Finally, I got a flu shot in the arm. We discussed what I might expect after going home and when I should call the doctor's office or the hospital if I noticed certain symptoms.

I was given a schedule to use to take the prescription anti-nausea pills I picked up the day before the appointment. The drugs are Zofran, Compazine and Adavan. I was told to take Zofran every eight hours for the first three days. This was non-negotiable. I had to take them even if I felt no nausea. The other drugs could be taken if I needed them in addition to the Zofran.

I booked my appointment for the next session and was done by 5:15 PM.

I felt no side effects at all the first night or the day after. I went to the gym for a three mile walk and ate usually. I was told it was very important to drink lots of fluids. I know that there is the possibility of side effects popping up over the next week or so but I feel great right now and I feel relieved that the process of getting the infusion is not painful or scary. The first time is a little tense because you don't know what to expect but I'm not concerned about going back in two weeks at all.

On a scale of 1 - 10 I would rate my mood at 10.