Thursday, May 07, 2009

Report: first chemo session

Sherrie had her first chemotherapy session today. It's been about 90 minutes since the last drug finished dripping, and she's feeling no ill effects yet. The IV-administered anti-nausea drug is about to wear off, and she's taken her first anti-nausea pill, so we'll see how things go.

We first spoke with the doctor for a while. He reviewed the same information we received earlier about the treatment and the drugs. He re-emphasized the importance of treating a fever as a medical emergency. If she gets a fever, we are to go to the hospital right away and not wait around to see if it turns into anything nasty. He talked about the side effects of the chemo drugs. He then gave her a medical exam, reviewed the blood work results, and pronounced her ready to go.

We had quite a bit of excitement when we started to receive the IV. Another patient there, an older gentleman who is quite heavy, had a sudden urge to go to the bathroom. Evidently, he'd had a reaction to some drugs earlier, and was quite sleepy and drugged up due to the counter-reaction drugs they gave him. He had a lot of trouble getting to the bathroom and had fallen (without getting hurt) and was having trouble getting up. At one point, they had *five* people, including the oncologist, in the restroom trying to help him. In the end, it took 45 minutes to get him situated, so Sherrie's treatment was delayed that long. It wasn't a big deal to us; we each had something to read and we waited patiently.

The nurse talked to Sherrie for quite a while while she administered the drugs: about the treatment, what to expect in terms of side effects, how to manage side effects, etc. I had expected the drugs to be administered by IV drip, but two of the three drugs were "pushed" in the IV in a relatively short time (about five minutes). Evidently, the have done studies to determine how best to administer the chemo drugs. It depends on the drug and the type of cancer. For example, they pushed 5-Flourouracil in a quick burst, but other patients have to have the same drug pumped into them over a 48-hour period (with a take-home pump). So, for Sherrie, "5-FU" as it's called, and Epirubicin, are pushed in just a few minutes, but the last drug, Cyclophosphamide, was dripped over about 45 minutes or so.

Sherrie felt no real effects during the session, however, when the nurse started Cyclophosphamide, she said that a sinus headache is a common side effect, and a few minutes later Sherrie thought she felt a headache coming on. The nurse gave her some Tylenol and that seemed to help.

One thing we learned is that to prevent mouth sores common to Epirubicin, Sherrie should suck on ice while it's being administered. The drug affects the digestive track, starting in the mouth, and sucking on ice will reduce blood flow to the mouth and lessen the effects. Given that Sherrie has braces and has been prone to mouth sores since she got the braces, we thought it would be good to have a cupful of ice, so I ran to McDonald's before the treatment began. It turns out a large cup of ice is just the right amount to last through the treatment.

The nurse recommended taking the anti-nausea drug every six hours for three days, whether or not she's nauseous. Once the vomiting begins, it's tough to stop it because one can't keep anything (i.e., the pill) down. If the pill she's taking doesn't help, we're to call and get a prescription for a second pill to take in addition to the first. We should know more later tonight as the IV drug wears off.

We might expect Sherrie to feel worst after the first week of the cycle, not so bad the second week (when just 5FU is administered), and best the third week. Her white count will be lowest 7-10 days into treatment, so she'll have to be most careful then. We are all to wash our hands frequently, and Sherrie should avoid large crowds and anybody with an infection.

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