Another One Down

Karen started chemotherapy December 31st, and the pump came off January 2nd. And we're ready to start again tomorrow. There's been no major problems or emergency visits to the hospital, but there only seems to be a couple of good days before starting chemo again. Each session seems to play out roughly the same.

When we go in for chemo there's a small wait, we usually see the physicians assistant first. She's very nice - we like her more than the doctor - and she asks Karen how's she's doing and makes suggestions to help her through the chemo. Last time, seeing that that extra hydration Karen received had helped, she signed her up for "home hydration." That's where we receive saline over IV at home. We were lined up with half a liter a day for 3 days. For comparison, when they give Karen hydration at the clinic, it's a full liter at a time.

We got a big package from Walgreen's, of all places, and a home health nurse came by to show me up how to hook everything up to Karen's port - which Arizona Oncology left accessed - and then came back 3 days later to de-access the port. This helped, and Karen felt better, but it wasn't enough and we ended up going back in on Wednesday (the 8th) for more fluids. So they told us they will set us up with 6 days worth of home hydration next time.

The chemo symptoms start with cold sensitivity; being the worst the first three days. I assume this is from the Oxaliplatin they give the first day. This lessens over time, but it no longer passes between treatments. They said symptoms will get worse over time, and this one certainly is. It's to the point where she constantly wears gloves and heavy socks, and wears a mask to cover her nose when she goes out. When it's at it's worst she can only drink warm fluids, and even at her best, metal silverware is too cold to hold even through gloves.

There are occasionally cramps in her hands these first several days. There's some foot cramping too, but it seems much less common. She says it's nothing unbearable. There's also the hiccups during this time but she can control them quite effectively through relaxation; this symptom might actually be lessening. By the second day she's feel pretty tired and starts sleeping a lot. This is also when her finger pains start. These are unrelated, but compounded by, her cold sensitivity. This is called neuropathy, and with the extreme cold sensitivity she gets, it's hard for her to tell one apart from the other. It may actually be reaching from one session to the next at this point.

On the third day of her treatment, when the pump comes off, she gets another dose of Aloxi, which makes a huge difference over what had previously been her two most nauseous days, bringing it completely under control now. Along with everything else they are doing, we only have to stay on top of the ondansetron (aka Zofran) to keep the nausea away. It's only the smell of certain foods that set it off, my beloved garlic being one of them. A lot of fried and grilled foods with strong smells do it as well, grilled peppers being another example.

In addition to the chemotherapy induced nausea, some of the nausea is also brought on by dehydration. As I mentioned earlier, they have been giving her a liter of hydration during each visit. The major cause of the dehydration is the diarrhea that starts on the third day as well. It slows down, but lasts for nearly a week. If she drinks too much fluid too quickly, even when she's not on chemo, everything comes flushing out. Coffee is particularly good at this, but anything can do it. So once the diarrhea starts, it's very hard to catch up.

To make staying hydrated even more difficult, anything she drinks has to be warm due to her cold sensitivity. And warm water by itself isn't pleasant. Lately we've been squeezing lemon into the water, which helps, and there are occasions where she'll feel like tea. But we have to be careful with sugar, as it makes the diarrhea worse. This is a constant battle, and why they've started hydration at home.

On her pump-off day, she receives an injection into her abdomen which stimulates white cell production. This causes bone pain, and weakness and fatigue similar to what you can get with a flu. Oh, and another side effect is diarrhea! They have her take naproxin before coming in so that it's already in effect when they give her the shot. Perhaps due to the careful management of the naproxin, she's never really noticed the bone pain. Or maybe she just doesn't notice it with all the other chemo side effects in the mix. She has mentioned feeling like she has the flu for several days after.

The weakness and fatigue are pretty much every day. While the injection to raise the white blood cell count has this effect, she had weakness and fatigue before they started it, just from the chemo drugs. The worst of it does seem to be for those first three days after the pump comes off, but her energy level is slow to recover.

All in all, she feels pretty bad for the first 8 or 9 days. There's 2 to 3 days where she can drink room temperature water and I start to see larger gains in her energy level, but in the end, that only leaves 2 or 3 truly "good" days before starting chemotherapy again.