We got to the chemo place shortly thereafter, and when I went in to have my blood drawn, they asked me which arm to use (because, like all women who've had a mastectomy, I can't have blood drawn on that side). I was surprised because I thought they would draw blood from the port. Although no one at Dr. Krekow's actually ever told me this, I'd read that several times on the Internet. The phlebotomist said she'd get the nurse, so shortly thereafter, Sue showed up and explained that they don't like to use the port to draw blood for a couple of reasons: first, the port is more likely to wear out with weekly blood draws over 6+ months, and second, the port works better for putting stuff in than taking stuff out. So I said that was fine; I just wanted to understand what was going on, and the tech drew the blood from my arm.
We then went to the chemo room. It's a long room with a bunch of recliners in it; the chairs are pretty comfortable, but they don't have much in the way of accommodations for caregivers (in my case, Kyle), just a straight-backed, lightly padded chair that I could see my butt going to sleep in after about 20 minutes. So I asked one of the nurses if it would be OK for Kyle to lie down in a recliner if they weren't too busy, and she said it was. Thirty minutes later, he was snoring -- softly, thank goodness.
The nurse who was taking care of me was very nice; her name is Sheela, and she appears to be Indian or Pakistani. She asked me how I was doing, and I said "scared" (I started crying a bit shortly after I sat down, mainly because I so didn't want to be there and because I was so scared). She said she would explain everything, and she did. She first got the line going in my port and started some saline. I couldn't even feel the needle going in because I had put some numbing cream on my skin over the port about an hour earlier. We then had to wait for my lab results, which didn't take long (about 15 minutes for them to get a CBC; I don't know whether it will take longer next time because maybe they will look at more stuff?). She then gave me the three pre-meds: the very strong and long-acting antinausea med plus the steroid that makes it work better through one bag, and a shot of Ativan into my line. The Ativan made me feel fairly loopy pretty quickly. They offered me something to drink; they have lots of juices and sodas available, so I chose a Diet Coke, and the guy who was serving me (he seems to have sort of a room-manager-type of position there) told me that I could have one, but that it was dehydrating and I really need to drink non-caffeinated beverages when I get home. Sheela told me that once the pre-meds were in, they would give me the chemo drugs, but we may have to wait a few minutes for them to finish mixing them, which we did.
So my chemo is administered in two ways. The Epirubicin and 5-FU are "pushed" (injected slowly into my line); the Cytoxan is a drip. The Epirubicin is red, and it makes my urine reddish. We had to wait about two hours for the Cytoxan to finish, then we got some last-minute instructions from Sue along with an appointment card covering the next month, and headed out around 2:30 or 3. So all in all, it didn't take as long as I thought it would. The only thing that was really disappointing was finding out that they do not have Wi-Fi.
One thing we had talked to Sue about was the Zofran prescription; for some reason, the insurance company was requiring an extra authorization from the doctor's office. She said she would take care of it. I also gave her the huge stack of photocopies from my mom's medical history; she said, "Wow" at first, then said she'd take a look at it and make copies of stuff that might be relevant to me. I'll get that back from them next time I'm in.
When we got home, I had a late lunch of some leftover pasta with chicken and a light cream sauce plus an apple with peanut butter. I felt OK, mostly just a bit sleepy and headachy. I definitely was starting to experience things tasting strange and smelling bad (or at least different). I had a light dinner of some macaroni with a bit of leftover marinara sauce; I took the Zofran and Ativan before I ate dinner. And yes, the pharmacist was a huge pain in the ass; I called to be sure the prescription was ready around 4:30, and he was still saying it was denied; I called Sue, waited another half hour or so, and called the pharmacist again. He was all tetchy and like, "I told you your insurance isn't paying for this without extra authorization." I told him that my doctor's office said it was taken care of, he checked again and said, "Oh yes, it's been cleared but not for the 30 they prescribed. I can give you 10." I asked him to check and see if my insurance would let me get 20, and he didn't want to do that but finally did and said yes. Now I realize that pharmacists are busy people, but good lord, was this guy rude.
I was, at this point (7:30ish), feeling a bit queasy. We got on the game for a little while then watched an episode of Buffy. So around 9:30, I'm feeling very queasy and I end up losing all my dinner. Kyle put me to bed after that, and I tried to get to sleep but really didn't until around 2:00, I think. My alarm went off at 3:00 so that I could take more meds, and I decided to take a Phenergan this time in the hopes that it would help me sleep better. Around 4:00, I realized it wasn't helping. Around 4:30, I had to vomit again. I think I finally fell asleep after that and slept until around 10. I got up, took a Zofran, had a cup of tea and again lost my tea about an hour later. I looked at my instruction sheet, and it said to call if the meds weren't helping with nausea and vomiting, so I put in a call to the on-call doc. She returned my call promptly and I told her what meds I've been on. She said she wasn't sure what to do because I was already taking the strongest stuff they can prescribe. I told her that my anti-emesis instruction sheet said that a suppository of Haldol/Ativan/Benedryl could be prescribed; she was unfamiliar with this protocol, but said she would call it in. After checking on the Internet, I did find a couple of journal articles supporting this treatment for CINV -- a new term for me: chemotherapy-induced nausea and vomiting. (I was a bit freaked out after seeing that Haldol is an antipsychotic drug; I know what the other two are.) So, anyway, I am now waiting to call the pharmacy in another hour or so to see if it's ready. And feeling nauseated again. Peace, Jody.
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