Recovery Day 48-53

It’s been about 2 weeks now since my last round of treatment, apart from 2 days in hospital in the middle of my recovery period, this has been the longest stay at home since the end of November. It’s a strange feeling, and as the saying goes, the time has flown. I also realised that I haven’t driven once during that period, which for someone who used to clock quite a few miles is also a little strange, but I think I’ll pick it back up again!

Having mostly frittered the time on needless procrastinating, mindless TV (I even watched 2 whole episodes of Doctors!) and computer games, I feel I’ve wasted some of it. I’m sure most people (and definitely my consultant) would say that it’s important relaxation time, although it’s usually against my nature.

I was originally due to go back in to hospital on Sunday/Monday. In the seemingly haphazard, last minute approach that I probably wouldn’t accept from elsewhere, but have started to get used to; I had a call yesterday (Thursday) from the hospital saying that a bed had come available and they’d like to get cracking.

This terrible timing was a little frustrating for 3 reasons:

1: I intended to hand make Liz’s Valentines gift which I now had to rush in a day rather than span over a few days as originally planned.

2: I’d just received a second hand copy of Goldeneye for the wii in the post, and was looking forward to some nostalgic bond reenactment.

3: I was due several visits over the weekend from friends and family, which I now had either to cancel or relocate. (I did, however, cheekily combine my visit from Owen last night with a lift to the hospital for which I was grateful)

From the comments by the nurse, however, it sounds like my consultant had made a note on my file about the delays during my early phases of treatment and wanted me to keep on schedule. I am, on reflection, glad of this. A bit of frantic hassle now will lead to my treatment being completed quicker and more effectively meaning I can return back to a renewed sense of life.

So for now, I’m back in ward confinement on R-Codox-M starting with the R for Rituximab which has so far been running for about 2.5 hours with another half to go…

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Day 30 to 33 chemotherapy

Having completed round 1 the ‘R-CODOX-M’ part, I think I was lulled into a false sense of security thinking that the ‘R-IVAC’ cycle would comprise fewer chemicals. It seems that although infused over a shorter period of time, there is a greater volume of therapy.

Day 30 last day home

On Wednesday, I spent the day chilling out and sorting out my things ready to take to the hospital. In the usual convenient manner, having been told to call the ward at 14:00 to confirm arrival time on Thursday, they told me to get into Worcester by 16:00 which didn’t give me much time to arrange a lift and prepare myself for the journey.

on arrival, I went through the usual checking in procedure; general questions, next of kin, any power of attorney, weight, height, blood test, OBS, wrist band, MRSA swab, and logging of belongings. I was then allowed home for the evening although needed to be back in by 8.

Day 31 Chemotherapy

The journey in triggered my headache, so returning to my bed I spent the first part of the morning asleep or resting through the coughs beeps and whirrings of my new room mates.

The chemo started again at 12:00

Cytarabine 3900mg over 3 hours, followed by

Etoposide 120mg over 1 hour

ifosfamide (with Mesna) 2900 (+800)mg over 1 hour

mesna 2400mg over 12 hours

Cytarabine 3900mg over 3 hours

As you can see, this meant that my sleep was interrupted by fluid changes as well as (due to the volume of saline included with the above: 4500ml) regular toilet breaks. This meant that the following morning I was fairly tired.

Day 32 Chemotherapy

The onslaught continued and I spent most of my waking hours trying to sleep:

Cytarabine 3900mg over 6 hours

Etoposide 120mg over 1 hour

Rituximab 375mg over 3 hours

ifosfamide (with Mesna) 2900 (+800)mg over 1 hour

Mesna 2400mg over 12 hours

Cytarabine 3900mg over 3 hours

Day 33 Chemotherapy

I’ve had a few hours break this morning which was a quite a relief from being plugged into the pump.

The therapy is due to start after lunch as follows:

Etoposide 120mg over 1 hour

ifosfamide (with mesna) 2900 (+800)mg over 1 hour

Mesna 2400mg over 12 hours

How do I feel?

My main symptom is lethargy. This could be due to interrupted sleep although I expect some of the way I feel is due to the chemicals floating round my body. My headache has started to ease and although it still persists along with stiff neck and shoulders, it is much more manageable now.

In addition to the standard side effects which seem to coincide with all of the chemotherapy drugs (bruising/bleeding, anemia, sickness, diarrhoea, sore mouth, hair loss) the current round of treatment has  the additional symptoms of eye problems, skin changes, numb hands and feet.

To minimise risk of eye problems, I’m taking medicated eye drops which are applied every 3 hours.

the fact sheet for Mesna under ‘why is Mesna given’ states the following: “if you are given ifosfamide or cyclophosphamide chemotherapy, you may get bleeding in your urine. Both drugs can cause irritation of the bladder lining. Mesna helps prevent this by protecting the lining.” Thankfully, the Mesna seems to have done its job!

my skin has become very dry especially on my hands and face.

I’m also experiencing numb hands and feet, but otherwise, my symptoms are so far mild.

With regard to hair loss, this has slowed down somewhat but I have noticed that my beard hair has been coming out in the shower. In fact I  think I prefer wiping my beard off to shaving so I think I’ll not bother shaving for now!

Days 11-15 Chemotherapy

It’s worth noting that the frequency of my writing will be subject to how I feel and, for the last few days, I’ve felt pretty rubbish which means this post is a little delayed. I’m lying here today with the remnants of probably the worst headache I’ve had in my life (which being prone to migraines is not a small matter). So I think for a bit of a change, I’ll start with a run down of the symptoms over the last few days followed by the treatments.

How do I feel?

To explain the headache in more detail, it is one of those pounding aches which seems to run across the temples. It is at its worst when I’m sat upright or standing. The doctor said that it could be related to the intrathecal injection or possibly a virus. My neutrophil levels have been low also – in fact I’m currently neutropenic; meaning that my body has less than half the safe levels of white blood cells so it has to work extra hard to fight infection. When I woke up on Friday morning and went for my shower, my headache was so intense that I was sick for the first time since treatment started. I went straight back to bed and apart from toilet and shower breaks and a couple of treatments, I have done nothing other than lying down or sleeping every day since.

In addition to the headaches, I’ve noticed that my finger tips have become sore as if I’d been playing a string instrument too hard, but this is otherwise a minor ailment.

The other key symptom which is related to the course of Methotrexate which started on Saturday morning, is sore mouth and throat. I’ve had mouth ulcers in the past, but this is quite extreme, it hurts to brush my teeth, and the bristles make my gums bleed. I have 3 types of mouthwash which are to be taken 4 times a day. Currently I have sores under my tongue, inside my cheeks and under my lips, my throat feels dry and scratchy and my bowels are in discomfort as the drug can affect the whole system. The mouthwashes do seem to ease the pain a little but even opening my mouth and eating are currently uncomfortable activities.

The treatment.

So as mentioned before, on Friday, I had a Hickman line inserted (see separate post), this is to replace the PICC line. It has 2 lines rather than 1 so the nurses can apply treatment and take blood samples at the same time. I needed this line to be inserted before I could start the methotrexate.

After returning from the procedure, they sent me for an X-Ray to check that the line was located correctly. 30 mins later, the doctor had confirmed ok, and it was ready to be used, they applied flushes as normal then started me on a course of Rituximab. Being the second round, they were able to start the dose a little more quickly but monitored me every 30minutes as before. The course lasted about 4 hours. Due to my headache, I spent most of the time resting and didn’t feel any other effects.

Saturday morning, although I didn’t feel it, I was ready to start my dose of Methotrexate they started by applying saline solution for hydration, along with a series of blood and urine checks. The body finds it difficult to break down this chemical so the hydration helps to give my bladder the best chance. The PH levels of my urine are measured every 2 hours until traces of the chemical are down to an acceptable level at which point the hydration will stop (I’m still on hydration as I write, but expect it to finish today) the chemical was applied in 2 bags which were yellow in colour, the first containing 750mg and lasting an hour, and the second having 5350mg and lasting 23 hours. The hydration course has lasted about 4 days, and I’m looking forward to a night of sleep without interruption every 2 hours!

Blood transfusion
Blood transfusion

On Sunday my neutrophil levels dropped quite low so they performed a blood transfusion. Although there is a risk of allergic reaction, it is rare and otherwise the only sensation is renewed energy. My complexion up until this point had started to yellow a little and although this did perk me up a little, the headache was pretty much all I could feel. The course was 2 bags of A-rh positive blood, each lasting 2 hours. It seemed a little strange to think of someone else’s blood mixing with my own and I wondered whether having 3 sets of DNA within my body may affect me, but apparently not!

Monday and Tuesday, I spent mostly sleeping, I was moved to a side room as it came available and having an increased temperature, they felt my headache could have been due to an infection, although I’m still waiting for blood results to confirm. I’ve also been having an injection of folic acid at regular intervals to aid with the recovery process along with the usual array of tablets. I’m due a couple more intrathecal injections, but these have been postponed until I’m well again. The doctor confirmed this morning that once this round of treatment is complete, and I’ve had a few days to recover, round 2 starts which is a little quicker but more intense, and the whole course is repeated once more (4 rounds or cycles in total).

Day 2&3 Chemotherapy

So Merry Christmas! I’m feeling in as much the spirit as is reasonably possible. I’m wearing teal striped PJ’s which my mum said looked a bit like the ones the boy in ‘The Snowman’ was wearing, and my socks have baubles on!

Xmas PJ's
Xmas PJ’s

Yesterday was pretty tough going but not anywhere near as difficult as I thought; I was due to have an intrathecal injection (through the spinal column) but that has been delayed due to shortage of staff.

Here’s the low down of my chemotherapy treatment over the last 48 hours:

The chemicals day 2 (Christmas Eve):

Each morning at about 6:30 the nurse wakes me up to take blood samples before breakfast, they also check my blood pressure, temperature and heart rate to make sure I’ve had no effects during the night (these “obs'” are performed regularly throughout the day. I went through the usual round of intravenous flushes and bladder protecting compounds (along with anti sickness tablets and others that I’m losing track of)

Rituximab

This chemical is from a group of chemicals called ‘monoclonal antibodies’ which can accurately pinpoint specific cells via proteins. In this case, as my cancer is related to ‘B-lymphocytes’ which have a protein spot called CD20, the manufactured antibodies attach to this compound so that my body can break down and destroy these cells. The downside, is that at the same time, they attack good cells (which my body will eventually replenish) this can lead to certain side effects.

Although this is a very effective treatment, it can lead to allergic reactions such as itchy rash and sickness. I was also given an antihistamine to reduce this risk. During infusion, the nurses start the drip very slowly and take observations at 30 minute intervals to check how I’m coping. If all is well, they notch up to the next flow rate and so on. To start with I felt fine, but after about the 3rd hour, I started getting short breath, light headedness and my blood pressure had dropped slightly so they continued at this rate for a while. I also experienced some severe stomach cramps which I’m told could be due to the growth receding and my bowels moving around.

The drip lasted for about 7 hours, and by the end all I was feeling was a little light headed and lethargic.

Cyclophosphamide

Finally I was given a bag of cyclophosphamide, this is one of the main chemicals used in my treatment and most of the days of my schedule I will be having this.

This drip lasted for an hour and at the end I was starting to feel quite tired. I watched Skyfall on ITV and then was given a sleeping tablet to help me drop off!

Day 3 – Christmas Day

Today the schedule is thankfully a little more relaxed, I’ve had the usual pre-meds and tests, and I am due to have another round of cyclophosphamide in a moment. This should last for about an hour.

I’m still a little tired this morning and felt a little dizzy coming out of the shower but I feel much less pressure around my abdomen. I opened my bowels this morning too which as ridiculous and disgusting as it may sound, was probably the most comfortable passing I’ve had for weeks. I will regard this as the first Christmas present of the day!

I was left with a stocking of gifts by my mum and have just received a present from the nurses on the ward which is gratefully appreciated. I am also looking forward to seeing my family this afternoon to exchange gifts (I had a bit of a logistical nightmare getting people to buy, collect and wrap presents for each other on my behalf, but I think I managed to pull it off!)

anyway, that’s me for today- wishing everyone a merry Christmas.