My Chemo Course

Welcome to Café Chimio, where we serve the finest chimiothérapie cuisine!

Today our special is the ABVD full course chimio delight, a classic choice for our Hodgkin Lymphoma patrons. Each entrée is served with complementary nausea, vomiting, hair loss, mouth sores, and a low blood count which leads to fatigue and an increased risk of infection.

Patrons may experience all, some, or few side effects to varying degrees of intensity. Sorry, no substitutions can be made.

When you arrive, our host will escort you to a private recliner. One of our expert servers will access your port-a-cath and flush it with prepackaged saline syringes in preparation for your chemo treatment. Patrons with a sensitivity to the prepackaged saline may request hand-prepared syringes.

Our servers are happy to accommodate your needs. Do not hesitate to ask for anything, whether it be a warm blanket, a pillow, a plastic puke bag, a light snack or drink, or extra antiemetics. We encourage feedback, so please also report any worrying side effects or discomfort.

While you wait between each course, we will serve you a constant vintage Saline Drip.

For an appetizer you will begin with Emend. This delightful refreshment will ensure you enjoy your full chemo course without side effects like nausea or vomiting. We want our guests to enjoy their treatment while they stay with us.

A second appetizer is a blend of Zofran and Decadron, more antiemetics to ward off nausea and vomiting.

As a palate cleanser, you will receive Tylenol to avoid potential headaches caused by Zofran and some of our main courses. You'll be glad you added it!

Let the main courses begin!

Your first entrée will be Adriamycin, also known as doxorubicin. Some of our patrons affectionately call it "The Red Devil." A server will sit by your side for ten minutes and carefully push small increments through a syringe into your IV. This decadent drug is lightly seasoned with possible heart damage. One course is enough to make your hair fall out! It may also cause savory mouth sores. You may notice a distinct chemical smell or aftertaste. When you sense this, you know Adriamycin is working its wonders! Another marvelous feature is that within a few hours, during your next trip or two to our toilet amenities you will excrete pink or orange urine.

Next, you will be served Vinblastine, also delicately hand-pushed through a syringe in small increments over the course of five or so minutes. This zingy medication is sautéed with peripheral neuropathy that will make your fingers and toes tingle. Painstakingly layered with nervous system changes including sensation changes, muscle weakness and pain, loss of coordination, and jaw pain. Other attributes include constipation and/or diarrhea. A pinch of headaches and a dash of depression perfect the Vinblastine side effect medley.

The third course, Bleomycin is served over thirty minutes as an IV drip. Garnished with possible lung damage, patrons may notice coughing and shortness of breath. Topped with possible chills, fever, and shaking, which subside after forty-eight hours. Many patrons report their skin darkening—who needs to visit a tanning salon? Additional side effects such as itching, shaking, and skin rashes are whipped together to perfection. Although this drug does not contain peanuts or shellfish, a few guests have reported allergic reactions. Our servers are well-prepared and will be on the lookout for any nasty reactions.


The final course, Dacarbazine is slowly served over sixty minutes, also as an IV drip. Like the previous courses, this lovely chemical also causes nausea, vomiting, and a low blood cell count. Headaches, body aches, weakness, and sinus congestion are simmered together for a twenty-four-hour flu-like experience. Sprinkled with just the right amount of metallic aftertaste.



When your infusion is complete, our experts will flush your port-a-cath to ensure you are ready for your next visit.

Before you leave, please stop by the Pharmacie. Your maître d' can recommend a number of take-home antiemetics (in pill form) to ward off nausea in the days to come and, if needed, can prescribe stronger pain relievers and medications to reduce symptoms as they arise.

For lesser aches and pains, many over-the-counter remedies can help, such as Tylenol for headaches and moderate pain (avoid NSAIDs). Laxatives such as Senna and Colace can overcome constipation.

During your many visits to Café Chimio, your maître d' will frequently check with you to guarantee your satisfaction and to monitor any pesky, severe, and/or long-lasting side effects. 

Be sure to immediately report any severe effects to your maître d', including but not limited to a fever over 100.5 °F, abnormal bleeding, and unrelieved pain.

Source: UC Davis Comprehensive Cancer Center Chemo Class slide show

Bon appétit!

❧   ❧   ❧   ❧   ❧   ❧   ❧

Sources

• Notes my oncologist provided me during my first consultation
• Individual handouts about Adriamycin, Bleomycin, Vinblastine, and Dacarbazine provided by the UC Davis Comprehensive Cancer Center

Further Reading

LymphomaIngo.net: ABVD
RxList: Adriamycin
RxList: Bleomycin
RxList: Vinblastine
RxList: Dacarbazine

Disclaimer

Every person is different and their experiences will differ from mine. Always discuss your particular symptoms and concerns with your doctor.

I did not mention every side effect listed on the handouts and websites I consulted. Nor did I personally experience every side effect stated on this page. For example, I never developed mouth sores or a skin rash. I definitely experienced infection, fatigue, muscle aches, nausea. The peeing orange/pink thing is totally real with Adriamycin (makes one's urine smell extra bad, too. Blech). Some side effects I experienced weren't listed anywhere, such as the horrific mouth burning and overactive menstrual cycle. As for heart and lung damage, the odds are in my favor against those and so far so good. My oncologist will continue to monitor me in the years to come. 

You can read more about my personal side effect experiences through My Side Effects series. 

You can read about other ABVD side effects by clicking on the links above.

My Twelfth Chemo Costume: Katniss Everdeen

Twelfth and final chemo infusion. Yay!

Super strange. And SUPER EXCITING!!!

Also, not very eventful. No anticipatory nausea or vomiting, thank my Lucky Charms. Ditching prepackaged saline in favor of hand-prepped saline proved the biggest help. I still had a few minor bouts of nausea, took a decent nap during infusion time, slept most of the day when I got home, and my appetite is currently nil.

BUT I'M DONE!

Aaalmost, still have a couple weeks of side effects and fatigue to battle through. No biggie. Been there, done that.

Next week I'll have a PET scan to make sure the all nasty cancer cells are defeated, and hopefully soon thereafter I can officially announce that I am a survivor!

Much like the inspiration for my twelfth costume: 

Katniss Everdeen

Oops. Katniss is a better archer than I am.

That's okay. I've got my costumes.

My incredible infusion nurses: Cheri, Mary, Jayne, and Terri.

For Funzies:

BAMF Girls Club

(Other favorites include: episode 6, episode 8, episode 11, and episode 13)

A Bad Lip Reading of The Hunger Games

My First Chemo Costume: Time Warped

In keeping up with my out-of-order crazy tire swinging, here are some pictures and reflections from my first chemo treatment on May 8th. 

Wow, has the time swung by!

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10:00 AM: Arrive at outpatient infusion center.

Only two days before my first infusion, I had my port placement surgery. Obviously my chest still felt incredibly bruised and sore from having been cut open and a small foreign object crammed inside it. 

I had not yet been able to get my prescription for lidocaine cream, which numbs the skin before a nurse jabs through it and the "soft top" (high grade medical plastic) septum with a needle to access the port. 

Source

Source

Add to my predicament a sharp fear of needles, and you've got a recipe for a hurricane of tears, which I did my best to hold back.

My nurse for the day, Cheri was amazing. She listened to my concerns and talked me through the procedure, per my request. As I braced myself for super intense pain— squeezing Mom's hand, closing eyes, tissue ready, big deep breaths, big deep breaths—Cheri accessed the port faster than a dart hitting a bullseye. 

Whoa. No tears at all. In fact, I distinctly remember thinking, "That was easier than getting a navel piercing." 

(Note: I have to give praise to all of the nurses at the infusion center. Cheri, Terri, Mary, and Jayne are exceptionally skilled at accessing those ports with precision and speed, which leads to minimal discomfort even when I haven't used the lidocaine cream.)

With the drama of needles and port access out of the way, my first infusion continued.

During the first hour while anti-nausea meds dripped into me, Cheri gave me and my mom a quick tutorial on each of the four chemo drugs I would receive (Adriamycin, Bleomycin  Vinblastine, and Dacarbazine) and their side effects. (Click here to read more about my chemo course.) 

Then, chemo-ification time came! Usually I receive the drugs out of ABVD order. It's more like AVDB or AVBD. The order doesn't matter, as long as it's the correct drug and the correct dosage.

Adriamycin and Vinblastine come in syringes and the nurses "push" each drug in small amounts into my IV. Bleomycin and Dacarbazine hang from the IV pole and are pumped through automatically.

Total chemo time:

Adriamycin: 10 minutes

Vinblastine: 5 minutes

Bleomycin: 30 minutes

Dacarbazine: 60 minutes

Nurse Cheri and the four chemicals she's about to infuse me with.

You will note a lack of costume. The advice I received was to "dress comfortably," and dress comfortably I did. The idea to dress in costume originated sometime near the end of my first treatment.

Almost done for the day! (Oh my goodness! I still had hair back then!)

2:00 PM: First infusion DONE!

I was surprised I felt as good as I did when I walked out of the infusion center. Mom and I went grocery shopping to pick up some grub for the weekend.

Afterwards, I celebrated my first successful chemo infusion by dressing up and nibbling on a piece of pie. Because everything is better with pie. And steampunk gear.

My Facebook friends might be familiar with this lovely photograph:

It's all smiles and silliness for a little while...

By 4:00 PM the chemo caught up with me and my body felt as if it had gone through a blender.

Yuck.

Just…yuck.

Yet I still tried to attend a small family gathering to celebrate my brother-in-law's birthday. This was the result:

I've used this pic before, but it captures the distress of chemo day.

My mom and I left the party early, and I sat in my shower for a solid thirty minutes letting warm water soothe me. I had an evening snack of fruits and veggies, and my body felt better. Lots of rest over the weekend also helped.

–   –   –   –   –   –   –   –   –   –

So, that was my first chemo experience. Of course, over the next two weeks there were a lot of side effects and gross days and ickiness that I'm glad are in the past.

I've adjusted over time and basically become a pro at it now.

Most chemo days have followed a similar pattern: wake up, apply lidocaine cream, rest/nap while getting infused, endure nausea, return home, sleep off the side effects the rest of the day and most of the weekend. Take pain relievers and warm showers as needed.

Also über important: Take anti-nausea meds on time.

It's weird to think I'm almost done, and also super relieving. The first treatment is rough because neither you nor your body knows what to expect, and it's only the beginning. Looking back is kind of empowering because Hell yeah, I did it!

Well, I've almost done it.

Only one more to go!

My Eleventh Chemo Costume: Kermit the Frog Princess

My penultimate chemo treatment! Only one more to go!

I love shopping at thrift stores for costume pieces.

A few months ago I happened to find this gorgeous evening gown for $10 and it happened to be a perfect fit. When I told the sales clerk I planned to use it as one of my chemo costumes, she gave me a 50% discount. Yup, that's a $5 gown right there!

As pretty as the dress is itself, I couldn't help adding a little twist.

So, without further ado, I present Kermit the Frog Princess!

This princess has only one wish: for a banjo ukulele.

Frog princesses don't wave. They flail enthusiastically!

As for updates, everything is going smoothly. Side effects have been less severe than they were in the beginning and middle of my journey. I think my body is adjusting. Nausea is still annoying, but at least this time my breakfast stayed down! YaaAaAAaay!

Mahna Mahna, my friends!

Just for kicks and giggles, leaps and ribbits, here is one of my favorite Muppet songs:

My Dark Moments

Tire swinging would not be complete without its dark moments. Except the monkey isn't swinging because she's fallen off and landed in a pit.

I once cried so hard that I made myself nauseous and almost didn't make it to the bathroom to throw up. I've also huddled up in a fetal position next to my coffee table because I had no energy to pull myself up to the sofa. I've cried in my kitchen, in my bedroom corner, in my sister and mother's arms.

With all of the side effects and everything else, depression happens. And life keeps going on. And that gets depressing because what the hell do you do when your finances spiral down the toilet, but you're too exhausted to work, and as grateful you are that your family is helping, you also mourn the lost aspects of your autonomy, and some days no matter how much you wish everything would just go away and life would be a bucket of rainbows you know that's just not possible. At least not right now. Not for a while.

When I was in the ER back in May, my nurse shared her mom's philosophy with me (her mom was a cancer survivor): 

It's okay to cry. You have to cry. Having a pity party once in a while does not mean you are weak. It means you are recharging. It means release. Getting stuck in pity mode for too long is not good; the party has to end sometime. However, neither is it good to pretend to be happy 100% of the time.

The darkness is temporary. It always passes.

Treasure the good days. Because they happen, too.

So climb back on that tire, little monkey, and keep swinging!

My Tiny Tumor Adventure Part 3: Port Placement and Other Procedures

The final installment in My Tiny Tumor Adventure and all the tests, procedures, and whatnot leading up to and following my first chemo treatment. Basically the chapter between the beginning of my adventure and my brief hospital visit.

Short version at end of post.

Click here to read My Tiny Tumor Adventure Part 1: A Diagnosis Story.

Click here to read My Tiny Tumor Adventure Part 2: A Cancer Staging Story.

Quick Recap

April 30: Diagnosed with Hodgkin Lymphoma.

May 1: Met with my amazing oncologist.

May 2: Diagnostic tests confirm my cancer is Stage IIA.

Monday, May 5

A much needed night of normalcy. My sister, Michelle and I attended an awesome Ingrid Michaelson concert in Oakland.

Tuesday, May 6

10 am: Port placement surgery at the Interventional Radiology department.

A port is basically a little device surgically implanted under one's skin. A connecting catheter is also tunneled under the skin, over the clavicle bone, and guided close to the heart through a vein. This allows chemo to be administered safely (direct exposure to chemo can cause tissue damage if, for example, the chemicals contacted the skin) and more efficiently (the heart pumps the chemo throughout the body, and the blood in the heart dilutes the chemicals). There are, of course, other options for administering chemo. The port seemed the best for me.

Source

Source

This procedure was done under conscious sedation. Normally this means a "twilight sleep" which means the surgical team can communicate with the patient during the procedure, yet supposedly when the patient wakes s/he forgets everything. 

Well, since I'm slightly crazy/curious, I asked if I could be more conscious than sedated because I wanted to remember the procedure. The nurse grated my request. 

The memories are hazy since I was still sedated via IV. Mostly, I rested and occasionally opened my eyes. When I saw all the blue drapery around me I mentioned the fort a friend and I made last Christmas (I think my speech was too slurred to make any sense). The surgical team probably thought I was nuts. They've probably had sillier patients. As for the gorier details, there isn't much to tell. They used a local anesthetic, which stung each time they injected it (five or six times), but I was so loopy the pain was diminished. I also remember a lot of pressure on the right side of my chest as they tucked the port under my skin. Once the procedure was complete, I glimpsed an x-ray projection of my torso with the port implanted. I also mentioned pirates (the surgical hairnet/cap was covering my eye—like an eyepatch—and I asked if someone could fix it for me because my wrists were secured because they don't want patients Kermit flailing during the procedure, as if I would do ever such a thing). The whole experience was kind of cool. Glad I asked!

Afternoon: Infusion Center called to schedule my first chemo. I really wanted to postpone this until after my sister, Christine's 21^st birthday because months before I had promised we would get cocktails together. I did not want that moment taken from me. Unfortunately, there were scheduling conflicts, yet I stubbornly insisted on keeping my moment.

Five minutes later: Oncologist called to convince me to start chemo ASAP. Despite some tears, I listened to her advice and scheduled my first treatment for May 8th.

Wednesday, May 7

9 am: MORE BLOODWORK! Because my blood counts need to be checked at least 1-2 days before chemo. Sheesh. Just take it all.

Aaaaand because I’m crazy, afterwards I play at the park with my sisters and nephew.

Queen of the playground!

All right, I’m not that crazy. I spent most of the time sitting at a park table. And I didn’t play so much as saunter around and take silly photos.

Cuts and boo-boos.
Long cut on neck = lymph node biopsy
Small cut on neck = catheter placement
Medium cut on chest = port placement

Thursday, May 8

10 am: First chemo treatment. Mom goes with me.

After thinking about it, I want to give my first chemo treatment its own post, so I'll be brief.

The infusion went extremely well, much better than I expected. That is until later that evening when my body felt as if it had gone through a blender. 

Mom spent night with me.

Friday, May 9

Felt surprisingly well. No nausea thanks to anti-nausea meds. However, also minuscule appetite. Juice was my friend. My amazing mom cared for me all day. 

Afternoon: Attended a "Chemo Class” with my mom and two youngest sisters, Julie and Christine. Learned about all the fun side effects I could look forward to. $#^†. Gonna take it easy, one day at a time.

Source: UC Davis Comprehensive Cancer Center Chemo Class slide show

Sunday, May 11

Celebrated Mother's Day with family.

Mouth burning begins. OMG!!! Like thousands of bees stinging the inside of my mouth!

Monday, May 12

Celebrated Christine's b-day despite feeling ill and lingering mouth burning because nothing was gonna stop me!!!

Tuesday, May 13

10 am: Echocardiogram. As I mentioned in Part 2, this test was required to establish a baseline for my heart's health because one of the chemo drugs I receive, Adriamycin can cause heart damage.

Mom accompanied me. One hour of ultrasound imaging and measurements of my heart. I was so exhausted, I was beyond caring that the male sonographer could see my very exposed chest. Wearing an open-front paper shirt/cover thingy proved pointless. Whatever. I closed my eyes and pleasantly recalled the time I visited Baden-Baden's Friedrichsbad (a nudist spa). 
(P.S. Don't worry. That link goes to the spa's totes appropriate (PG-ish) homepage. If you ever visit Baden-Baden, I highly recommend Friedrichsbad and the Caracalla Spa, which is more family-friendly (swimsuits required)).

2 pm: Biopsy post-op with ENT. Tiny’s scar was healing nicely. I thanked my ENT for his help during the diagnosis process.

Thursday, May 15

Follow up visit with oncologist to make sure things are going well. They are! (Relatively, speaking.)

Friday, May 16

8 am: Pulmonary function test. Also mentioned in Part 2, this test was required to establish a baseline for my lungs' health because the chemo drug, Bleomycin can cause lung damage.

Christine accompanied me. One hour of various exercises breathing into a tube, having measurements recorded by a computer, and feeling like an idiot the entire time. (At least I could wear my normal clothes.) I was terrible at following the instructions the technologist gave me. Inhale quickly, exhale slowly, vice versa, use your diaphragm, pretend you're blowing out a thousand candles, breathe in in in in in yourlungshavemorecapacitythanyouthinktheydoooooo, breathe out out out out out almost theeeeeeeeeere *gasp!* Great. Now let's do that five more times. 

The tech was a nice guy though. Fun to talk with. 

Weirdest aspect of the test: sitting inside a large, clear plastic box (to measure volume and lung capacity). The box was closed for only one exercise, but I had to stay inside it throughout the full hour of testing.

Source

Saturday, May 17

Intense back pain.

Sunday, May 18

Belly button feels a bit sore...

And that brings us up to speed on the first month* of my odd little adventure with lymphoma. Phew! It was quite the whirlwind of appointments, a medley of miracles, and a whole lot of emotional tire swinging. 

Super grateful to all of my doctors for their prompt care, as well as all the other health professionals for helping me arrange appointments and complete needed tests. 

*Seriously. Only three and a half weeks transpired from my first visit with my primary care physician ("Hey doc, what's this lump in my neck?") to my first chemo treatment ("So long, cancer!")

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THE SHORT VERSION

May 6: Port-a-cath implanted to make chemotherapy easier and safer to administer
May 8: Had first chemo treatment
May 13: Echocardiogram
May 16: Pulmonary function test