10 February 2010 – Chemotherapy for the First Time (Cancer and Me 10)
The weekend before chemo was lined up to start I was told that I could go home for the weekend. I wasn’t to go out anywhere, but I was essentially stable and nothing much was going to happen over the weekend (weekends are generally dead boring in hospital, as most functions are closed except for urgent inpatient care). I wasn’t discharged, so my room was thankfully kept aside for me.
I was over the moon. I hadn’t been home for ages.
It wasn’t all plain sailing, though. I was sick again on the Sunday. I couldn’t even keep soup and ice cream down now. We phoned the hospital and the nurses spoke about giving me an ‘NG tube’ (a nasogastric tube) when I returned the next day. I’d lost about 3.5 stone (22 kg) in two months – a heck of a crash diet! I was secretly pleased, because I was now an average weight. However, the hospital nutritionist was not so pleased, because he said if I lost any more weight then things could go downhill rapidly, and if I wasn’t getting nutrients through eating then they may get to the stage where they would have to consider giving me nutrients directly through a tube into my body (which sounded like it involved a major operation to insert the tube).
The NG tube was unpleasant, to say the least. An NG tube is a plastic tube that goes up through your nose and follows the passage up and over into your throat, through the oesophagus and down into your stomach. To get it in you have to somehow suppress your swallowing reflex to allow the tube to get into your stomach. In order to help with that you have to sip some water while the nurse pushes the tube up through your nose. The nurses warned me it wouldn’t be very nice. They weren’t wrong.
And then once the tube is in place they can get a big syringe and suck out the contents of your stomach. Then they can measure how many litres of stuff is stuck there. I hadn’t realized, but you don’t actually normally hold food and fluid in your stomach for very long, so most of the time your stomach should be empty. The first time they used the syringe a huge amount of green stuff came out. Gross! But quite a relief!
Then you have to keep the tube in place (taped to your face and pinned to your shirt), and most of the time a bag is attached to the end in case anything needs to come up. It relieves the pressure. So I had to walk around with a tube coming out of my nose, carrying a bag of horrid green fluid, sometimes also with my arm connected to a drip to stop me dehydrating.
I was allowed to keep eating the jelly, ice cream and soup, because the doctors were convinced that once I started the first lot of chemo the lymph nodes would start to reduce and the stomach would start to empty. In fact it turned into a bit of a benchmark of success, so that they knew I could go home once my stomach was able to empty naturally. And they would be able to tell that was the case if they could not get anything out of my stomach via the NG tube.
So on Wednesday 10th February 2010 I had my first lot of chemotherapy. I should say, incidentally, that chemotherapy is normally given in a number of doses several days or weeks apart. In the case of the R-CHOP treatment I had, it was 6 day-long sessions 3 weeks apart. (Obviously the first one I had as an inpatient, but for the remaining 5 cycles I came back in as a day patient.)
The first time you have Rituximab it can make you very sick, so they start it off very slowly through the drip. And then every half an hour they take your blood pressure and temperature and if you are coping they increase the flow rate. All in all, the first time takes about 6 hours just for the Rituximab. In my case I had about 90 minutes of feeling so sick that I couldn’t speak. Heidi was with me, and I couldn’t even open my mouth to say goodbye when she had to leave. At every subsequent time they were able to get the Rituximab through in 90 minutes or so, so clearly the body somehow gets used to having it.
The ‘P’ is Prednisalone, which is a steroid, which you take in tablet form. So that’s no hassle on the day. It has a few side effects – it makes you ravenously hungry and can make you restless and emotional – but on the day itself it’s just a few pills to swallow and then a few to take each day for the next 4 days.
The other drugs are given by infusion, i.e. through the intravenous drip. The specially trained nurse injects the drugs into the line while saline is flowing. That takes another hour or so.