Saturday, February 14, 2004

Chemotherapy, Again.

Dave’s Great Adventure, Book 2
Chapter 2, Verse 1
February 14, 2004
Round Two

And so, last week, I went in to see Jeff, for my pre-procedure counseling, physical examination, and official signing of permits. I really like Jeff. He’s very informative, but he’s also humorous and personable, like I’d like to think I am. He went over what we were going to do and why we were going to do it, what the benefits were, and then, what the risks were. He started out with all the usual things I expected to hear: nausea, vomiting, diarrhea, hair loss, weakness (which the official permit described as “aesthenia“) and sterility (oh no!). But then he got down to the serious stuff. Possible loss of all marrow function, need for transfusions, irreversible damage to the heart, and a few other things before he got to the ever-popular “death.”

Now, I’ve had patients sign such forms for me for a couple of decades before I do their C-sections (Kaiserschnitt), hysterectomies, removal of an ovarian tumor or an ectopic pregnancy, or just about anything else. I have always known that the more serious complications are extremely rare, but I also know that they can happen. The patients have not, generally, been in a position to judge whether they are at significant risk for the more serious complications or not, however. They have trusted me and signed the permits, and thankfully, I have never killed anyone with a surgical mishap. Which is not to say that I haven’t had some surgical mishaps, just none that I couldn’t fix.

Likewise, I am not in a good position to have a feel for the likelihood of any of these complications either. It was, even for me as a doc, frightening to see all these things in black and white. But, I just trust that they really aren’t likely and that, ultimately, I have to do this stuff anyway. So, I signed the form.

Then, a couple of days ago, Kathy and I went in to the Rocky Mountain Cancer Center for the start of Round Two. We had to be there at about 8AM for the start of the first infusions. As previously mentioned, this was to be the first of four infusions of just Rituxan (rituximab), to try to “purge” my marrow and blood stream of leukemic cells. They had my dose precisely measured, based on my height and weight (which was documented by two nurses who had to be in agreement with the numbers, so critical can overdoses with chemotherapeutic drugs be) and had all the premedications ready.

I found it interesting how different they did things at this center as opposed to the way they had been done at my last set of infusions way back in ’02. For my Rituxan infusions back then, I was pre-medicated with acetaminophen and Benadryl (diphenhydramine) and nothing more. And I did fine. This time, I got both of those drugs plus everything I had gotten for the more toxic drugs, plus even more. I got steroids (decadron), Anzemet (dolasetron) for nausea, and then, as if the Benadryl wasn’t going to make me tired enough, they gave me a dose of Ativan (lorazepam). Ativan is a tranquilizing drug, but it is also used to quell nausea. I hadn’t expected nausea to be a problem after just the Rituxan, but I guess they didn’t want any puking docs in their clinic.

The Rocky Mountain Cancer center has an open bay area, with about a half dozen or so recliners for some of the chemotherapy patients. But they also have a series of small rooms, cubicles about ten feet square, or so, with a bed in them. I was put in one of the cubicles. It was a good thing, I guess. I had brought along a few things to read, plus the Discman. However, it didn’t take long after the drugs went in for me to realize that I wasn’t going to get any reading done, so drowsy was I. I put the magazines away, put on the Discman playing some peaceful music, and I went to sleep. I wasn’t much company for Kathy!

When I woke up three hours later, it was all over. No nausea, pain, diarrhea, no nothing. Just residual tiredness from all those drugs. Kathy drove us home.

But what do we do after a successful round of chemo? We go out to eat! Kathy drove us to a hole-in-the-wall barbeque place she had read about recently, right near the capitol building, and I had a rib dinner. Pretty good! Then we came home and we both napped.

And that’s been about all there has been. Friday I felt a little flushed and tired, like I was coming down with a cold, which can be side effects of the Rituxan. Of course, it could also have been the fact that I really was coming down with a cold, too. But that’s about all that has happened, I’m happy to say. And we do it again on Monday.

So, I guess I’ll close this short edition of the DGA report. I’ll get back again by about the middle of next week or so. That’s when things really start to get exciting. That’s when I get the line in my chest, and the nasty drug, the large dose of Cytoxin.

Before I close, I have a question. This week I received a package in the mail, with a very nice Irish cap in it. It was sent from a vendor in Ohio. A message enclosed said, “Keep your head warm” but there was no name. Does anyone out there know who my benefactor was?

And, we’ve been inundated with requests for pictures of us in Antarctica. Well, not exactly inundated... okay, we had one request. But for Kathy, out in Atlanta, and anyone else who is interested, I’m going to attach (if I don’t forget) a picture of Kathy and me on Coronation Island in the South Orkney Islands about two weeks ago. Those are seals and penguins on the beach in the background.

Enough for now,


“Health is merely the slowest possible rate at which one can die.”