Posted Nov 1, 2008 5:10pm
The past two weeks have been almost surreal – my poor body, which hadn’t seen so much as an aspirin before all this started, is completely confused by this chemical bombardment.
So much for defending myself against chemo. A few hours after my previous chemo update, “Miffles” had dragged me to the couch and sat on me for the rest of the day. I was somewhat consoled with the thought that I wasn’t the only one laying around on a Sunday afternoon, watching TV and feeling flu-ish, but it was certainly out of character for me. I was back to a normal schedule on Monday, although my energy was up and down over the next few days. The worst of it was a mild nausea, not enough to feel like throwing up, but enough to make me feel miserable and not the least bit interested in eating. The medication alleviated the problem, but I found something even better. One of my patients told me her dad is going through chemo, and by using some pressure-point bracelets from Rite-Aid, he didn’t have any nausea. Sure enough, I tried the PsiBands, and I haven’t had to take the meds since. They have a button that presses on the anti-nausea pressure point on the insides of both wrists, and they really work!
On Wednesday I had the MUGA heart scan, and I’m delighted to report the injection was in the arm and not the heart (whew). My charming tech, Stefan, explained every step of the procedure which started with a blood draw. He then disappeared into a shielded room, where over the next 30 minutes, while I patiently re-read a 2004 Architectural Digest several times, he processed my blood to break down the outer cell walls, and replace it with a radioactive marker. He reemerged with my blood vial enclosed in a protective lead tube (that was reassuring) and injected it back into my arm.
We went next door to the imaging room, where he helped me get comfortably situated on a narrow padded table that would later slide into the scanning tube. I didn’t even have to change out of my regular clothes. He placed a pillow under my knees, had me slip my arms into a wide fabric tube so they wouldn’t dangle off the edges, and the table rolled into position. Unlike an MRI, this is an open tube, with film panels that rotated into different positions around my body. The film is sensitive to the radiation that was pumping through my bloodstream, and as they fill the heart chambers, the image produced by the gamma camera is essentially an outline of those chambers. With some fancy computer manipulation, the final product is a movie of the beating heart. About 20 minutes later, I was able to watch the final film of my “anatomically perfect heart.”
I didn't feel so hot on Thursday when I went for the don't-worry-there-are-no-side-effects herceptin infusion. No wonder – my blood draw showed that my white blood cell count (immunity) had dropped to 0.8 from 13.3 the past week. The normal range is 4.0 – 11.0, which means I started out with a stronger than average immune system, and the chemo knocked the living daylights out of me. They started me on injections right away to raise my white cells and told me to monitor my temperature. I snoozed through the 45 minute infusion, and hoped the nap would give me a little boost. By the time I returned to the office at 1:00, I felt pretty sick, had diarrhea and my temperature was over 102. I left the chemo nurses a message, cancelled all my appointments for the day and went home to go to bed. They called back late afternoon & told me to go check into the hospital. I decided that driving myself was probably not the best idea, so I called a girlfriend who lives nearby. God bless her, she interrupted her shopping spree to pick me up within 10 minutes - now THAT's a friend :>)
I called Dave before I left, pocketed my license, insurance card and keys, and off we went. I must have been delirious to not bring any personal items. Every trip to the hospital so far has involved only a few hours, so I wasn’t even thinking that I’d be there overnight. I checked into Sutter Roseville around 4:30, and when I first entered the lobby, I had to ask someone if I was actually in the hospital. It is a beautiful facility, with colorful landscaping and a rocky fountain in the lobby. The oncology ward is new, every room is private, and by my bed was an enormous window overlooking a wooded area. Dave was there within minutes of my getting settled, and luckily he had the foresight to suggest he run down to the gift shop to get me a toothbrush.
The staff was absolutely wonderful, although the first hookup to my port was… interesting. It gave me a profound appreciation for how adept my regular chemo nurses are at accessing it in an instant. You know how I dreaded the thought that the MUGA scan might be like the scene from Pulp Fiction? I may have been spared on that round, but we made up for it during the port episode. The nurse first lowered the bed to a fully reclined position, which was strange, since the port is always accessed with me sitting up.
I started to worry when after palpating around it curiously for a few moments, she muttered a “hmmmm….” I think a little bead of her forehead sweat hit my nose, but I was getting nervous and it could have been my imagination. At that point, someone opened the door to ask her a question, and through gritted teeth, she said, “NOT RIGHT NOW, I'M ACCESSING A PORT!” Oh boy. Please don’t piss her off. Just back out of the room slowly, and we’ll all be fine.
After a few uncomfortable and unsuccessful attempts, I suggested that maybe it’s just my type of port; we never have a problem if I’m sitting up – would she like to give that a try? (Please???) She gave a surprised “Hmph…,” and said they had been trained to have the patient prone for the process. I convinced her it might be fun and easy, and she agreed to sit me up. Fortunately it worked, although for the first hour or so I still worried if she may have missed entirely and the fluids were just splooshing uncontrollably into my chest. When all was said and done, I was again very grateful for the port. For the next 4 days I was on IV antibiotics and fluids, and frequent blood draws; I can’t imagine what a nuisance it would have been if I were trying to function with a needle in my arm.
Thursday had been one of those days I didn’t really need to wash my hair, and it looked perfectly fine up in a clip. Which means by Friday I knew it would be plastered to my head and I’d feel like I’d slept under a bridge. Once I realized I would probably be there at least until Friday night, I sent Dave home with a list of a few basic toiletries to retrieve for me when he came back after dinner. Very basic – he is just too sweet a man to be subjected to digging through drawers of potions. I didn’t even care about cosmetics; I just wanted to get clean. But I should have thought of a hair drier, since it was a little chilly trying to dry my hair with just towels. Oh well, hopefully I won’t have to do this again, but if so, I know how to prepare,
My mind felt so dull that I didn’t even feel like reading, and although daytime TV should be enough to bore anyone into a trance, it is very difficult to sleep in a hospital. By Friday night, my blood pressure had dropped to 77/44 (from my usual 125/70). Since that can be a sign of sepsis (systemic blood infection), they were considering calling in the Rapid Response Team to determine I should be in ICU. Fortunately, I wasn't having any signs of low BP - dizziness, slurred speech, etc. - so they checked it every 1/2 hour all night and it slowly started going up. Whether it went up because I was recovering or because I was getting agitated from being awoken so often, at least it was increasing.
Although it was the only time it happened, they were not able to draw blood from the port that night, so the nurse said she would send in a phlebotomist later. In the middle of the night, just as I was starting to rest, there was a knock on my door. It slowly squeaked open, and a short, bald, wiry guy with glasses poked his head in the door. “Miss Andreoni? They sent me here to see you…” Good God, now what? As he pushed the door open with his back, and dragged in his cart of tubes & vials and needles, I swore he was one of those sinister “doctors” that would have the means to make me talk… I’ve been watching too many Netflix episodes of Alias. I’d been pumped up with so many fluids that he had no problem painlessly accessing a vein in my hand, and actually told me I had the kind of veins that phlebotomists dream of. How sweet.
A neutropenic diet was my introduction to the dark side of oncology nutrition. If the cancer doesn't kill you, the hospital food and/or lack of sleep from being prodded every 1/2 hour will for sure. I was so excited when I saw a "Tossed salad" on the menu - ah, leafy greens at last! Imagine my dismay to learn that in hospital language, this means 1/2 cup of the whitest part of iceberg lettuce, a 3 inch shred of red cabbage and a cherry tomato. Most vegetables are canned (unless you choose the baked potato chips), and I never realized there was a way to cook brown rice to bring out the ultimate bitterness of the grain.
I had requested grapes for dessert, but since they can’t be peeled, they substituted a tiny sealed 2 ounce container of “strawberry” ice cream. It was the color of Pepto Bismol, and glowed threateningly in the dim light of the room. On Saturday I had Dave smuggle in some real food, although my choices were still limited because of my susceptibility to infection. No fresh fruit, except bananas, which could be easily peeled after a thorough washing. Everything else had to be factory sealed. So I settled for some Odwalla shakes, carrot juice and organic yogurts. YUM!!! Really, I felt so nourished!!!!
The upside of all this is that the staff was wonderful, and the room was as comfortable as a hospital can be. If I hadn't had to drag an IV contraption with me every time I went to the very nicely tiled huge bathroom where I had to pee in a measuring "hat," I may have felt like I was in a hotel.
Apparently the reason they could not give me the meds prophylactically to prevent the drop in my white count is because the shot is $3800 a pop, and until I show a need, the insurance company won't approve it. I'm going to guess a couple of shots of this stuff would probably have been less expensive than 4 days in a private room in the oncology ward, but what do I know about cost containment... :>) In all fairness, Laura (my oncology nurse) said most folks don’t react this strongly to the first treatment. The good news is that the chemo is working. The other news is that I am extremely sensitive to it. If I have a similar reaction on the second treatment next week, they will lower my doses for the next two treatments. I thought I was just supposed to grin and bear it. But the objective is to wipe out the cancer without my feeling so miserable in the process. They kept me on shots to raise the white blood cells, IV antibiotics and fluids, and the worst food on the planet until Sunday, when everything normalized.
Dave's mom had us over for a wonderful dinner on Sunday night, so I didn't have to cook. Even though I don't have my normal appetite, it was such a delight to eat real food!! You would think 4 days of starvation would be a great kick-off for diet, but with all the fluids, I actually gained five pounds. I was back at work full time & feeling my old normal self on Monday, and the extra weight dropped of over the week. But wait, the fun didn’t end there! To be continued…