| BACK |
| HOME |
|
| NEXT |
|
|
|
|
|
|
| 25 years ago, at about this time of year, while anxious over finishing my Ph.D, I found out that I had cancer, and I made an appointment to see the cancer specialists at Dana Farber Cancer Institute. My cancer was staged, the treatment protocol was decided, and it was time for the first treatment. |
| After the staging of my cancer, It was decided that I would get the standard treatment for my form of lymphoma called CHOP for six cycles of three weeks each. Each letter stands for one of the drugs in the protocol. These drugs and their mechanism of action are listed next. (See my October 18th entry for a details of how the drugs work) |
|
C = Cyclophosphamide, an alkylating agent which attacks DNA chemically and causes damage and links strands of DNA together. H = Hydroxydaunorubicin (also called doxorubicin or Adriamycin), is an intercalating agent that inserts into DNA between the base pairs. and unwinds the DNA. O = Oncovin (vincristine), is a plant alkaloid that binds to tubulin which arrests spindle formation and thus prevents mitosis and cell division. P = Prednisone or prednisolone is a hormone of the class corticosteroids. It interferes with some biological processes that take place in cancer cells. |
| The administration of several drugs instead of just one is called combination chemotherapy. The different mechanisms of actions of the drugs and the attack during different stages of the cell cycle by each drug decreases the likelihood of drug resistance. If one drug is not effective at killing certain cancer cells, perhaps these cells will be sensitive to one of the other drugs. |
| Before the first treatment, a Portacath (a combination of of "portal" and "catheter) was implanted in my chest just below my collarbone and between the muscle and the skin. The device is a little larger than a cap of a two liter soda bottle. The top is a silicone membrane that can be easily punctured with a needle through the layer of skin covering the device. Chemotherapy drugs are administered into the portacath through a needle and enter a small reservoir connected to a catheter that joins a vein running along the collarbone that empties into the main vein that enters the heart (superior vena cava). One advantages of the portacath that it is inside the body and requires no maintenance like an external catheter. Another plus is there less chance of damage through repeated insertion of needles in a given vein. Probably most important, it allows drugs to enter the heart quickly where the drugs are diluted by mixing well with the blood and rapidly delivered to the rest of the body. It is important to have rapid dissemination of the chemotherapy drugs because of the toxicity of the drugs, and the potential damage that a high local concentration would do to tissues. |
| After my chest healed from the insertion of the portacath, I was ready for my first treatment. The first round is administered with more care than usually because it is not known how the patient will respond to the treatment. The drugs were administered in a private room in which I was monitored carefully. |
| The first three drugs (C, H, and O) are delivered sequentially in threee separate IVs through the portacath. A Prednisone pill is taken on each 5 days foloowing these three drugs. Drug dosage is calculated from a patient's height and weight. It is designed to be proportional to body surface area. One can imagine the capillaries covering the surface of the body distributing the drugs. Each drug has milligramg/meter^2 dosage depending on its balance of toxicity and efficiency determined through clinical trials. Two drugs form colorless solutions, but Hydroxydaunorubicin in the IV is the same color as cherry Kool-Aid, evil cherry Kool-Aid, some call it the red devil. It colors the urine the color of rose wine for a few hours after dosing. |
| After the drugs were administered I had to hang around for about two hours while my vitals were monitored. I was given a meal of a tuna fish sandwich and potato chips. (More on this later). During this time I showed no adverse effects, and I felt relatively well. After the nurse was satisfied I was OK, I was given a cab ride home |
| I went home and ate a small meal and went to bed. At about 9 PM, my dinosaur brain sensed that something was amiss. The body doesn't know about IVs so the assumption is that these poisons that are circulating through my system were part of something that I ate. To minimize the effects of these toxins, the bodies response is nausea and vomiting. For about six hours, once an hour, I emptied the contents of my stomach violently for two or three minutes. A headache and feeling of illness accompanied this period. I tried to drink a little water, but it was difficult to keep down. By the end of the six hours it was just dry heaves. As the concentration of drugs in my system decreased, the nausea subsided and I learned to tell when the last round of vomiting would occur, and I could fall into a deep sleep. This sounds very unpleasant, and there areanti-emetics that can reduce the nausea. I tried one, but it made me feel like a zombie, so did not used it again. Once you know what to expect and understand the vomiting will be ove, it is manageable. As you know, marijuana is said to alleviate these effects. I am a child of the 70s, but I have no first hand experience with this. The controversy of medical marijuana is often in the news |
| The next morning was the beginning of what is somewhat innocuously called a a general sense of malaise. Mailaise is such a nice sounding word, but it is a rotten way to feel. Chemotherapy beats one up, not like a fight where one receives localized damage at the site of attack. Chemotheraphy is systemic which is another nice sounding word that means it is distributed through out the body. Nearly every cell in the body in pummeled, and the tiredness radiates from the inside out. It was to me, the worst part of the treatment: being tired all the time. |
| I took my Prednisone in the morning, and in the afternoon I went to school. One of the side effects of Prednisone that I found curious was described as "a false sense of well being". T As I got to the chemistry laboratories, I saw the stairs to the third floor lab. I was feeling excited, and I started to bound up the stairs in defiance of the damage that my "medicines" had done to me. After the first flight, my legs suddenly lost their spring, and I felt weak. Oh, that is what a "false sense of well being" means. I looked up the stairs and began the first few steps of my long climb. |
| I want to end this segment with a two anecdotes about the mind and body connection. One of my friends in college was a psychology major who did a research project on food choices for chemo patients. Giving people bland foods as an alternative to their favorite foods when they are undergoing treatment prevents the mind from associating their normally enjoyed meals with the unpleasant effects of treatment. I was aware of this research. For a year after my treatment was over, the sight of a tuna fish sandwich or potato chips made me violently ill. I knew it was all in my head, and I tried to ignore the feelings and eat this sandwich and those snacks, but my dinosaur brain used his veto power. My chemotherapy nurse also told me a story that happened to a colleague of hers. Her coworker ran into a patients in a fancy Boston department store. The patient's conscious mind was happy to approach and greet her caring nurse, but her subconscious mind recognized the person who periodically gave her poisons. The patient threw up in at the nurses feet. |
| Next up a description of side effects that occur between treatments. |
| Stay tuned for more of the story. |
| (Cancer Chronicles is a series of status updates that account the events of 25 years ago when I went through a bout with cancer. Its purposes are multi-fold: catharsis, education, information, celebration, etc. ) |
| This originally was posted to facebook October 8, 2012. |
|
|
|
|
|