Chemotherapy -- Some Details

Several readers have asked for details of the two procedures that I'm currently undergoing -- that is, Chemotherapy and Radiotherapy. Given my recent "Blog ate my homework" experience, I thought I'd break the overall topic down into smaller parts.

(A number of you may well have a firmer grasp of this information than I do. Please feel free to correct, update or elaborate on what's written below!!)

First of all, you might want to know that there are dozens of different chemicals that could be used for chemotherapy -- either individually or in "cocktail" mixes. There are established protocols for different types of cancers, using different drugs in different combinations with different dosages and different schedules. I'm sure these, in turn are adjusted by the Medical Oncologist (a.k.a. the chemo doctor) based on the patient's condition, the extent of the cancer, and so forth.

This is one of those areas where faith comes in. You know you could never really understand all the in's and out's of your doc's decision to use a particular regimen for you, so you have to trust.

The facility where I'm being treated is located across the street from Chester County Hospital. Part of this office complex is lab set up to do blood testing (a critical, "need to know now" part of the overall treatment) and other testing as well (urine and what-not). There are also your classical examination rooms, where you sit one-on-one with a doctor and/or nurse.

But a large part of the complex is set up as a single room with maybe 15 or so reclining lounge chairs, set in informal-looking groups. When you walk in, there are usually several available, so if you want to watch the big-screen TV (whose volume is set quite low), there's probably a lounge to settle into. If you want to be in a small collection of lounges or a larger one, you typically have your choice. Beside each lounge there is a small table and a pole on wheels from which a drip bag of fluid can be mounted for intravenous injection. It's rather a nice place to be.

The room is run by a group of maybe 5 or 6 nurses, who come across as being wonderfully caring, competent, and efficient. They are almost always smiling and dispensing important information. The overall effect of their presence is wonderfully reassuring. No matter what problem you might develop while you're there, there will immediately be someone who's seen this issue before and dealt with it.

(I imagine that my treatment routine as outlined below is fairly typical, but imagine that there are many options as to how treatments are administered.)

The term that gets used around me for the actual chemical injected to kill the cancer cells is "toxic." The idea is that the chemical (in my case, something called "Cisplatin") attacks rapidly growing cells. This includes cancer cells, of course, but also includes normal blood cells and other types of cells that you'd really wish the Cisplatin wouldn't touch. But the science here is still developing...

The strategy is to get the Cisplatin flowing completely through my body (as its job is to track down and kill the microscopic particles of cancer that may have spread all over from the salivary gland where the primary tumor was located), then get the Cisplatin back out of my system as quickly as possible.

So we start the process by having one liter of saline solution injected intravenously -- to make sure that I am completely hydrated. This is followed by a bag of a diuretic. In other words, they want your body to be fully engaged in eliminating fluids even before the Cisplatin is injected. A third bag -- an antiemetic -- is also introduced to minimize the nausea and potential vomiting that occassionally show up as part of the process.

Then the Cisplatin, which turns out to be the smallest bag of the bunch is started. This drug bag seems to take practically no time to empty.

Finally, I'm given another one liter of saline solution to help clear the Cisplatin from my system. (Having the drug stay in the kidneys for any length of time can cause permanent damage to them.)

Did I mention that the drip bag poles were on wheels? Waltzing your drip bag to the bathroom is an oft-repeated event for the session.

Total time for a single session is running between 3 and 4 hours.

I'm told it takes 48 hours for the body to completely clear itself of the metabolized results of this procedure, and that it's vitally important to keep as hydrated as possible. At this point, our refrigerator is bulging with bottled water, Gatorade, diet/decaf soft drinks, Kefir (a wonderful beverage that tastes like a very nice strawberry yogurt), pink lemondade, various fruit juices, and so forth.

There is no pain whatsoever associated with the process, other than the needle stick. But the result of the treatment can leave you tired, nauseous, somewhat dizzy, and shaky for days afterwards. I'm sleeping a lot. And not blogging as much as I would like to...

I'm supposed to get 100 units of Cisplatin per treatment, but my doc has broken this into two back-to-back sessions of 50 units each. So I've just finished my first back-to-back treatment, then several weeks' rest (to allow my blood cells to resume a normal level), then a second back-to-back treatment, then several more weeks off, then a third and final session.

I believe that everything that can be done to make this experience as tolerable as possible is being done. I trust my medical team, and have become especially fond of the nursing staff, who seem to know everything I want to know, and are so pleased to be of help.

More on Radiotherapy later.