Monday 19 November 2012

long and slow....but we got there in the end - chemo 3, day 1

Back in 2009 when Steve was having his first line chemo on the Velcade/cisplatin drug trial, his blood counts were so low before the start of chemo cycle 3 that treatment was postponed not one, but two weeks and the dosage subsequently reduced to help his body cope with the toxins.  

This time round, we were prepared for - even half expecting - the same thing to happen again.  It came as no surprise therefore when Steve phoned the hospital first thing to check whether he was clear to go, to be told that his blood counts from Friday were on the low side and would have to be tested again in the day centre before they would take the chemo off "hold".  

Alimta/pemetrexed is expensive stuff with a limited shelf life, so it's not made up until they are sure the patient is well enough to be given another dose.  Until then, it's ordered from the pharmacy but kept "on hold" until the green light is given for treatment.  

So rather than starting chemo at 10.00 am as planned, it was bloods first and the usual problem of getting a cannula in to vein, even after applying a heat pack to Steve's arm to warm it up.  

Part of the problem is that arthritis has fused Steve's wrists. Great for an extra bit of torque on a screwdriver, but not much help when asked to bend/flex the joint to get a straight line in!  

Ella the staff nurse managed to get a line in on the second attempt, bloods were taken followed by a saline flush, then we were told it would be about an hour and a half before the results were back.  Plenty of time for the pharmacist to give Steve his new set of anti-sickness meds, for the next set of tablets to be taken at lunchtime and for the staff to run through the checklist of side effects to see how he had been feeling on cycle 2.  

It was not until around 1.30 pm that chemo actually started, after a small problem when the pump didn't work properly. Alimta in first, followed by a saline flush, then (after an obligatory 30 minute wait) the carboplatin at 2.20 pm. That should have taken an hour or so, but the cannula was so precarious that Steve didn't have to move very much for the line to get "occluded" and the pump to stop.....which it did quite frequently, when he turned the page of a newspaper, drank a cup of tea, eat a biscuit and had a comfort break. When the pump stops, the bleeper sounds, and one of the nurses has to come and sort it out - assuming someone is available......  

At one point, at least three bleepers were going off in unison - quite tuneful as it happens.  I'm surprised Steve Reich hasn't composed a symphony for "Alaris" (although we were told by a fellow patient that someone had record the sound and used it as his alarm call - very effective!)

If you have never been in a hospital chemo lounge, you may be curious as to what it looks like. In Oxford, there are two HUGE rooms side by side, with nursing stations, offices and wcs in the middle.  The walls are lined with "easy chairs" for patients (which we discovered today had adjustable backs and leg rests) with small tables in between for drinks, magazines and cleansing gel.  

Each chair has its on pump on a wheeled stand which plugs into a socket behind the chairs, but can be unplugged and wheeled to the loo when necessary. There are also some bed bays. Oxygen is available to all, and I noticed two people using it today for the first time.  Patients are seated so that they face towards the nursing station, or their own visitors who sit on upright chairs opposite them. 

I didn't count them all, but there appear to be about eight bays around the outside of the chemo lounges, each with 6 or so chairs or beds, so anything up to 40-50 patients can be treated at anyone time. It's a bit of a production line in that respect - very different to the single room or bed in a four bay ward upstairs where Steve was treated when he was on the drug trail.

Back to today.....with all the interruptions, it was nearly 4 o'clock by the time the full dose of carboplatin had been pumped in, topped off by one last saline flush.  We were finally released into the wild at 4.10 pm, just in time to get caught up in Oxford's peak hour traffic.  Hey ho!  Still, after a long, slow and surprisingly tiring day just sitting around reading and dozing, the third dose of chemo is done and dusted and cycle three of six cycles has begun.  Getting on for half way there!  

Over the next week or so I imagine that life will be structure around anti-emetic pill popping times and afternoon naps, interspersed with manic steroid moments, lucid moments, longer periods of fuzzy-headedness which Steve hates, lots of eating little and often and I hope not too much nausea, if any.  All being well, life will be on a more even keel in week 2 of the cycle, but we will just have to wait and see.  

In the meantime, we are keeping our fingers crossed for Debbie who gets her scan results this week and others going through the same horrible waiting period; for Jan who is going through the same treatment as Steve and for everyone else on chemo for what ever reason, and those making the most of life between treatments.  Fight on warriors and stay positive :-)

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