Cycle 5 Under Way: A Day in the Life

Posted 8 February 2016

Here’s what a chemo infusion day is like. I am writing this as a sit in the oncology office, waiting for the infusions for cycle 5 to begin.

I had a 3-week interval for the previous cycle, instead of 2 weeks, because I insisted on a week off after getting out of the hospital. I’m glad that I did.

9:15 – Waiting for the pre-chemo appointment with the nurse.

9:30 – Receptionist tells me that the nurse is out this week due to a personal emergency. Someone was supposed to call me on Friday but they didn’t. So I’ll start the infusion at 9:45 as planned, without a check-in. (The check-in is supposed to ensure I’m in good enough shape to get chemo, which they decided this time based on my blood work.)

9:45 – Sitting in the industrial-feeling recliner chair, waiting. Most of the chairs are out in the main area, which is noisy. I’m grateful to have the one private room.

11:00 – Still waiting for the infusions to start. Everyone was busy, and then my port wasn’t working right. So they injected it with Activase a drug that breaks down clots, let that sit for 20 minutes, and now the port is working.

I have learned to just let everything slide, assume I’ll be here as long as it takes, and relax.

11:20 – Now getting Emend, an anti-nauseau drug, which runs for 30 minutes.

12:15 – Oxyaliplatin, the first actual chemo drug, is now running. That bag in the photo costs about $10,000.

Starting to feel a bit queasy, gut clenched a bit. This runs for two hours. Feeling sleepy.

2:15 – Made it through the oxaliplatin. Feeling queasy, headachey, and tired. Atropine, a drug “used to treat certain types of nerve agent and pesticide poisonings”, running now, for 15 minutes. This is to fend off the severe diarrhea that can be associated with the Irinotecan, coming right up.

2:40 – Starting Irinotecan. This is a powerful drug that apparently I tolerate better than many people. Irinotecan has been nicknamed “I run to the can.” And that I did, three times in 90 minutes.

Just in case you were wondering, here is what Wikipedia has to say about its method of action: “Irinotecan is activated by hydrolysis to SN-38, an inhibitor of topoisomerase I. This is then inactivated by glucuronidation by uridine diphosphate glucoronosyltransferase 1A1 (UGT1A1). The inhibition of topoisomerase I by the active metabolite SN-38 eventually leads to inhibition of both DNA replication and transcription.”

Means nothing to me either, other than the final phrase.

More interesting is its origin: the drug was first extracted from the bark of a type of Yew tree found in South China and Tibet, known as the “Happy Tree” because it has long been used in Chinese medicine to treat a variety of ailments.

At the same time, I’m getting Leucovorin, which is a form of Vitamin B that is supposed to help the Irinotecan do its thing. At least one of these drugs is not a cytotoxin!

4:10 – I get a bolus of the final drug, Fluorouracil (also called 5-FU), injected into my port over the course of less than a minute. Then they hook my port up to a portable pump (see photo), which I wear home. It trickles the Fluorouracil into me for 46 more hours, and on Wednesday afternoon I’ll return to the office to have the pump removed.

The cautions on this drug are daunting: “5-FU injection and topical even in small doses cause both acute central nervous system (CNS) damage and progressively worsening delayed degeneration of the CNS in mice. This latter effect is caused by 5-FU-induced damage to the oligodendrocytes that produce the insulating myelin sheaths… acute cerebellar syndrome has been observed following injection of fluorouracil and may persist after cessation of treatment. Symptoms include Ataxia, nystagmus, and dysmetria” (all of which I would have to look up to even know what they are).

So it seems I’m on a palliative poisoning routine. It is hard to accept consciously doing all this damage to my body, but it is, I guess, better than the alternative.

5:00 – Home at last! A long day. I feel lousy, but not terrible. In fact, I felt well enough to take my daily walk with Irene to the duck pond down the street. It was lovely, connecting with Irene during a “normal” activity, both of us enjoying the unusually warm day.

Emotionally, and perhaps phyiscally, I’m in a better place than during the previous cycle.