October 27, 2006

On my way to writing this evening I stopped by the counter for my blog and noticed that some people had already arrived this evening, perhaps in anticipation of a report from today’s treatment. How did I know it was this evening? By some odd fluke the counter is set for Greenwich Mean Time, which means it rolls over to the next day sometime around 7 and midnight. I have yet to put my finger on it because, quite frankly, I care too little about when people are reading this (if it all) to warrant a full-scale investigation. Still, I feel an apology is in order to those of you who are intently following my condition. Unless, that is, your interest is driven by some sort of bizarre odds-making on my health, in which case I demand a cut of the winner’s earnings. At any rate, I will attempt to avoid being too maudlin or despairing to cause regret on the part of the reader. Such is the nature of the beast I am recording, however. Before I begin, allow me to mention my good friends at the Shenandoah County Republican Committee, who this evening held a dutch treat dinner for Senator George Allen. I hope that the festivities found the Senator in high spirits and prepared the Committee to return the good Senator to Washington for six more years of forward thinking leadership rooted in time-tested Jeffersonian ideals. To my Democratic readers: Now that you may have a taste of the nausea I experience every two weeks, allow me to reassure you that this condition is temporary and most likely halted, in your case, through avoiding coverage of said event. I know I found myself teetering on the precipice of illness after reading a National Review article on the prospect of a Democratic congress.

But enough politics. Today was my second round of chemo. My mother came into town and again allowed me the pleasure of sleeping “as long as I could” (read: 11:00 A.M.) Unfortunately my slumber had already been interrupted once by my failure to reset my alarm clock from yesterday’s wake-up call, but a few more moments is always greatly appreciated, particularly in times such as these. Anyways, I got around and we managed to arrive on time at the Cancer Center. They got us back relatively quickly (as we were the only ones waiting), and I settled down for the magic of chemotherapy. My nurse, Susan, wrapped both of my arms in hot towels this time, aware of the struggle we had last time with finding a suitable vein. As I waited she got all of the details of last week’s experience, to see if any changes needed to be made (not that many could). Eventually it was time for the prick, which was again performed by “the master.” This time I was sure to note his name, Dennis. I suppose after hearing of last week’s battle my nurse was simply too squeamish to make an attempt, and I for one appreciate her honesty. Dennis was just about to try a vein in my left arm (where all the action was last time) when he realized my right arm was also available. He moved over and was quite pleased to discover a big blue track running down my arm: the perfect target. Surprisingly enough this involved little pain; with one swift maneuver and no squirming the needle was in and blood was drawn. Little did I know that the blood work would unveil a new twist in this tale.

After about twenty minutes Susan came back and informed us that my white blood cell count was low enough to cause concern amongst the staff and lead them to consult with the oncologist on duty. My doctor isn’t always present, but as a student myself I trust the training of the University enough to have no problem with using another doctor. The doctor approved the treatment, so Susan set me up with some steroids. She also brought some light reading regarding my new-found condition, neutropenia. This is simply a fancy word for “PLEASE DO NOT GET A VIRUS.” Essentially, my Neutrophil granulocytes (a specialized kind of white blood cell important to the immune system that apparently aren’t lymphocytes) have reached dangerous levels. In layman’s terms, an individual should have about 2000 of these little buggers in each 0.0002028841 of a teaspoon of blood. I, on the other hand, had 400. The threshold for my treatment is set at 500, but apparently it is not uncommon to proceed with treatment in spite of such levels. It does, however, raise new practical concerns. For starters, I can’t be in crowds, which means that the Virginia Cavaliers will have to struggle valiantly to eke out another win without me tomorrow. Also, I have to be careful about food preparation, lest I ingest some bacteria or get cut or burnt. This means there is absolutely no room for screw-ups such as last week, suggesting that the microwave find new use as a cooking implement in my home. Surprisingly enough, for a college student, I tend to eschew the microwave as a cooking method. Perhaps my mother spoiled me in regards to the beauty of well-cooked meal. But moving on, it also means that I have to avoid uncooked fruits and vegetables, which made me grimace at the thought of my newly acquired kiwis. However, perhaps the greatest disappointment is that I will be unable to play the guitar for a few days. You see, I recently started playing with great interest again after discovering a purchasing my dream instrument, a cherry red Epiphone SG, with a pick-guard and locking tuners. For those of you unfamiliar with the art of luthiere (the art of making stringed instruments), this is a good thing. This is the instrument of choice for such guitar luminaries as as Robby Kriger, Glenn Tipton, Mick Taylor…..not ringing a bell? Duane Allman? Carlos Santana? Pete Townshend? If none of those names ring a bell, I suggest at least 30 minutes a day with your favorite classic rock radio station. In the valley, I prefer 104.9. Trust me, you’ll thank me later. Anyways, this is all a problem due to the fact that when one plays the guitar too heavily there’s a tendency to develop blisters on the fretting fingers, such as I have. To avoid the possibility of having a blister pop and become infected, I won’t be able to play for a few days. I was quite aggrieved as music has helped me through some tough times (particularly of late). But no matter. I’m sure I’ll be able to return soon enough.

Back to the treatment. After the steroids and my drug cocktail they started me off with Adriamycin again. At first I suspected I may have avoided a repeat of last week’s episode, but my highly trained nurse knew what to look for. Ok, she didn’t know exactly what to look for, but she did know that big red line across someone’s chest (I was wearing a polo shirt that has a tendency to pop open) and that falling backwards into the chair are not good things. She quickly summoned a cart to take my vitals, which came with a disproportionate level of staffers to tend (or at least stare) at me. I bounced back just as I did last time, but it was just as scary. The next two drugs went in without incident, although I did develop the aforementioned gassy sensation but that was to be expected. It was not until dicarabazine arrived on the scene that a new twist emerged. The nurse ambitiously set the machine for 400 m/l per hour, which given my dosage meant I would be out within thirty minutes. Since I didn’t have a problem last time, I figured this was a good thing. However, after about 10 minutes, I suddenly developed a sharp pain in my vein, along with with a red streak on my arm. Imagine someone literally pinching your vein; the sensation was localized entirely with my arm but unbearable nevertheless. The nurse could not get there soon enough. She flushed me with saline, turned the timer down, and went back to business. Unfortunately, this started a cycle. A little longer, and the pain would reeemerge. My mother had to get a nurse at least four times. Fortunately, 175 did the trick, and I was out by 5:30, just about the same length as last time. The symptoms are much the same: gas and nausea, plus a little fatugue. However, I’ve come to expect those, and though I suspect the symptoms may worsen, chemotherapy is not aware that I have over 16 years of experience in warding off nausea due to my chronic motion sickness and inner ear problems. I know I may have looked absolutely helpless on debate trips, with our station wagon pulled off the road and me steadying myself against the vehicle as I expunged the contents of my stomach. Little did my fellow students know that I had waited until we found ourselves on an open stretch of road where it was safe to pull off, which in Fairfax can take upwards of 40 minutes. This world has many unsung heroes.

But enough of my fantasies. It’s time for an observation. Over the past few days, I’ve found myself experiencing the sort of turmoil that college students often find themselves in: heartbreak. I’ll spare you the details to save everyone from some potential embarrassment and, more importantly, to avoid accusations of using this blog as a forum for my signature melodrama. But I’ve learned something from the combination of disappointment and my condition. You see, as many of you (especially my younger female readers can attest), I’ve spent a great deal of my time perusing romantic interests, particularly during my time here at college. Many times I’ve been castigated for pushing the issue, for being ahead of my time, for simply “wanting it too much.” And I suppose that at times I have been consumed by it, for the quest for affection (particularly of a physical nature), can be a powerful thing? And why not? It brings us joy, happiness, and all those things associated with a hug or a gentle stroke of the head. But it’s not the only kind of love. Over the past few weeks I’ve received an outpouring of compassion that I’ve never experienced before. Perhaps I’m overstating things; I may be mistaking the social nicety of cards for something else. But many of the notes, letters, and yes, even cookies have indicated something differently: that I’ve touched people sufficiently to warrant them to take time to let me know that they care about me, that they worry at the prospect of something happening to me. Perhaps this is a self-aggrandizing notion, but it is one that has opened me up to a new line of thought, that perhaps what I was seeking was not the most important kind of love, that mutual love between friends based not upon a deep physical and emotional attachment but rather a belief in the innate goodness of another individual is the sort of love that drives our society and has the power to make the world a better place.

At the same time, I’ve realized that love is only one of a whole range of emotions. There are good ones, such as joy and happiness. But there are ones that rip us apart, such as sadness and anger. At their greatest intensity such emotions have the potential to cause far more damage than the satisfaction of romantic love. This may seem a pessimistic notion, but it’s a fundamental truth. Shakespeare may enlighten individuals, but war, poverty, illness, and a myriad of other things can destroy society and create a general malaise. The experience of cancer has brought me to a new outlook: love may be a many splendored thing, but it’s not everything. Effort used pursing love could very well be used for other purposes. Love, if anything, is a pleasant accident, but not one that can be repeated at will. However, through perseverance and determination there are things that can be done to make this world a better place. So I have decided that it matters not if I never find myself in a romantic relationship again. It would certainly be a pleasant aside, and perhaps could strengthen my purpose of being, but I feel there’s enough out there that it’s not a necessity. If I die with the knowledge that a single act of mine somehow relieved some microscopic degree of human misery, I shall die a happy man. Will I refuse love henceforth? Hardly. But there’s no need in pursuing just one part of the rich tapestry of human existence.

I apologize for my jumping into matters of a more philosophical nature. Surely you did not expect it. But again, this is not just a means of communication, but an outlet to deal with the problems surrounding it’s reason for being as well. I thank you for respecting my thoughts, or at least sloughing through them on the way to this: Good night.

First Night

October 14, 2006

With cancer, many people are prone to believe that the cure may be worse than the disease. With Hodgkin’s, though, that’s hardly the case. Given that even the most advanced forms of the disease have a very high cure rate (my doctor told me that some patients take up to a year to be properly diagnosed), it seems like a rather agonizing and perhaps even awakward way to pass given the option of life-prolonging treatment. Still, the drugs needed to whip this thing entirely aren’t exactly a delightful cocktail, and the days of testing can make things all the more trying.

The day started off with a knock at my door at about 7:30. My parents told me they would call me at the top of Afton Mountain, but they decided to “let me sleep.” This was rather inconsequential, though, as I really didn’t sleep all that much. I’ve decided last night was my last go with the vicodin. One, I don’t really need it, and two, for some bizarre reason the stuff just kept me tweaked. I wasn’t able to sleep until 3 a.m. And you know what was distracting me? VH-1’s biopic of MC Hammer. That alone sounds like the perfect sedative, but no.

Anyways, I slowly got around and at about 8:30 we arrived at the hospital (again, I’m reveling in the fact that I live a mere six blocks from the hospital. If it weren’t for the treatment’s effects, I’d walk.) When I arrived all I knew was that I had a “heart scan” scheduled. In my conversation with the receptionist she told me I was to undergo a stress test (which despite the fact that this would require me jogging was still preferable to being scanned ad nauseum). However, when the tech took me back I was told that I’d get to revisit my old friends, the radioactive isotopes, for a photo shoot of my heart.

So far I haven’t had a very hard time getting over my aversion to needles. I simply came to accept it as a fact of how to get better. Today might have changed all that. First off, the tech had quite a time getting my IV in. He said the veins kept moving away in my hand. He then put an IV in my left elbow. This may seem rather innocuous, but it becomes a key part of the story later. Take notes; there might be a quiz.

Anyways, the heart scan went without incident. They did it in a rather dilapidated part of the hospital that is being transferred from radiology to another department. For some reason, though, there’s still a few cameras there. So after laying still for around twenty-eight minutes I got to see the results of my scans. I have absolutely no medical imaging training, and I even opted out of college biology. Still, it was pretty awesome seeing my heart beat, and, though perhaps overwhelmed by man’s medical progress over the last century, everything looked ok. You know, thump thump thump.

So after that we took a brief detour to the hospital cafeteria, where I had a bag of pretzels and a caffeine boost. We also discovered a fun fact; for a major hospital, the University of Virginia Medical Center has an alarming lack of bathrooms. Perhaps they abound on the upper floors, but in the lobby they are far and few between. In addition, the ones they do have are woefully small; we’re talking one toilet and one urinal. Certainly this is little more than an amusing side-note, but at the time it was an issue of major dispute.

At about 10:45 we headed to the Cancer Center for my appointment. When we arrived, however, we ran into an immediate backlog. I had been told that my bloodwork would start at 11; I didn’t get into the back until 11:45. And that was the beginning of the vein fiasco.

I was almost immediately informed that the IV that had been put in for the imaging was not going to work for my treatment. One of the drugs, adriamycin, is renowned for, amongst other side effects, causing great damage if it comes into contact with the muscles around the vein it is injected to. We’re talking the sort of damage requiring plastic surgery. This would explain why the techs all put on thick rubber gloves before getting anywhere near a used bag of the stuff.

So at this point my right arm was wrapped with a warm towel. This apparently helps the veins contract. Every tech has something different. Some simply ask for a fist, others use a squeeze ball. This technique, however, was a welcome diversion. However, it didn’t seem to help very much. My tech got “really close” on his first go around (I’m reminded of the old adage that close only counts in horseshoes and hand-grenades), but he then informed us of his “one poke” policy. This means he only tries once; if he fails, he calls in “the master.” I’ll admit, the master knows his stuff and was relatively gentle, but it still took him two swings. The port (which would be a line inserted into my chest) is looking better all the time. Anyways, after all this I finally had a line in and we were getting close to starting treatment at about 1:30. It was about time; had he not made it the second time, I probably would’ve left that chair. I’m not sure where I would’ve gone, but some place other than that room. The tension was too much. So I was quite glad to finally be on the cusp of getting what I was there for and perhaps settling in for a nap. However, this was complicated by the fact that, since my elbow line was still viable, they would leave that in in case they needed to pump me full of Demerol if there was a reaction. Oh well. I had a sandwich (which although I really wasn’t all that hungry I couldn’t really resist, given the persistence of the volunteers) and settled down after a nice mix of Tylenol, benadryl, and zofran (an anti-nausea drug that is supposedly one of the best there is). They put me on the premeds (steroids to help with the other drugs), and I tried to take a nap while my parents left to get a bite. All the while I thought we were getting somewhere.

By the time my parents got back it was time to start the actual chemo drugs. The first one was a test dose of bleomycin; they start with this one because it has the greatest chance of a reaction (in the form of chills and shakes) but the reaction comes on comparatively slowly. After that they moved on to Adriamycin, which I mentioned before. This little wonder is affectionately known as “the red devil.” For a drug, it really has quite a range of side-effects. Just take a look!

-hair loss (not just on top, either. We’re talking about all of it)
-the strongest chance of nausea
-the greatest infection risk
-and just for kicks, red urine!

For some darned reason (perhaps psychosomatic), this one hit me hard. It’s a simple injection rather than a drip, but for some reason as soon as the first drop hit my veins I went FLUSH, like every muscle in my body simultaneously released. My tech was busy and only my dad saw the look, but apparently it was close enough to the look of nausea to warrant the introduction of a pan. I wouldn’t know what that was for. They also tried a wash cloth on my head, but I quickly vetoed that. It was a little much, as I bounced back rather quickly.

Relatively speaking, I felt nothing from the other drugs, which took about another hour and a half. Finally, with no major side-effects appearing, it was time for the bleomycin. The “pitch” for this drug was enough to warrant my mom spending the night with me. However, this all went without incident, and by 5:40 I was safely at home. I was tired but not particularly weak. I did feel nauseated, but I felt an odd gastric sensation. Not quite gas, but just a “full” feeling without being full. If that makes any sense.

Some friends visited, and I was find, though I refused to yield my perch on the futon except to open the door. By this time the fatigue really kicked in. I just didn’t want to move. I was, however, able to manage a bowl of soup and two slices of pizza. Quite impressive given the fact that I didn’t really feel all that hungry.

Anyways, that brings me to now. Still tired, but now a little queasy. I don’t feel the urge, but it’s unsettling. I can take my nausea drugs again, though.

So what did I learn today?
-Ports can be a good option for all sorts of patients, even when the doctor is convinced you have good veins
-Bring something to do; it’s rather tedious just sitting there, and you run out of casual conversation after about 20 minutes with the tech. If you have parents, though, they’ll be fine. Talking to the tech and other patients , that is.
-Expect the unexpected. Those side-effects are really a bag of tricks.

One last take away, and one that may be painfully obvious. Still, I found it intriguing. Cancer is truly an equal opportunity disease. With that brings people of all races, creeds, genders, and classes together in one place. Chemo truly is the great equalizer. Although everyone takes it a little differently, rarely is there a person that gets off the hook. But truly interesting is how many different mindsets there are. For some, this is a big deal that needs to be attacked with positive imagery. Apparently, these are the same sort of people that are into evolutionary science and time travel. But I digress. For some older people, it’s just another thing. Same goes for people who are on there second or third go-around, or trying a different hospital. There almost seems an air of resignation. Then there are those people that are calmly serene, despite what complications they have. They take advantage of the relative peace of the clinic, and even though their life may be threatened they are keenly aware it isn’t over. These are probably the people who will be found, no matter the eventual cause of their demise, with a pencil and pad in hand or with a book dropped by the bedside.

Anyways, I’m getting a little tired and now’s a good time to cash in on my drug timing. I probably won’t have a big update tomororw, given my relatively lengthy narrative of the day’s events, but I’ll try to check back in with some report.

Until then, best wishes.

OH! The quiz!

1) Which chemotherapy drug is affectionately known as “the red devil”?
2) How many times was I stuck today (not including in traffic or the waiting room)?
3) Which drug turned out to be the underachiever of my cocktail?

You have ten minutes. Black or blue ink only. Good luck.