My first chemotherapy is today and I’m nervous. I am more nervous than I was for my hysterectomy surgery! I wasn’t sure if I should eat or not prior to arriving at the infusion center but I decided to go for it and have something for breakfast. If I get hungry later, no issue since I have snacks in my chemo bag, right? It was the right decision.
Meeting the Nurse Navigator
The day started off slowly enough even though it was quite early. It was very foggy out there but traffic moved smoothly. When we got to the cancer center, I was told to go to the registration area and wait for the nurse navigator to help show me the ropes. I met with her and she took me to register, showing me how I needed to be sure to get the sheet of paper they print out which includes my wrist band.
From registration it was up to the second floor and the lab area. There were two different piles of numbers there, one pile for people with ports and the other for those without ports. Only nurses are allowed to access a port.
First Stop the Lab
This stop is where the nurses take blood samples from me. They run a Complete Blood Count (CBC) and a metabolic panel. In addition, they test magnesium levels and a CA-125, a test measuring a cancer antigen somewhat related to endometrium cancer. Evidently it is far better at predicting ovarian cancer and not real reliable for endometrial cancer. From what I’ve seen, it may be better at indicating when there is metastasis.
The CBC and metabolic panels are run to determine if blood levels are high enough to administer chemo. If not, chemo may be put off a week and if that isn’t enough there are drugs that can be considered. I prefer not to have to use more drugs.
Prior to commencing the infusion, I had to wait for the blood work results to show up and then the gynecologist/oncologist has to give the order to proceed. Got the all clear after waiting what felt like more than an hour.
The Infusion Center
Finally I am brought back to the actual infusion area. It is vastly different from what I expected. Along the outer wall there are 12 infusion chairs, all facing inward. Each chair is separated from the others, something I found disappointing since I had the idea I’d get to meet and talk to some of the other patients. There were three different nurses’ stations with each nurse being responsible for four patients. In each little area was also a chair for one’s chemo buddy. I’m told by my chemo buddy that the chairs aren’t exactly comfortable, at least not for an extended period.
I am on chair 10 which means I’m away from all the action of the central area. Facing me, directly in front of me, is the bathroom. I wait until the infusion begins.
The wait wasn’t all that long and suddenly we are about to begin. I allowed myself to get swept up in the moment so as not to perpetuate any residual nervousness. Since it was my first time around, the nurse was quite good at explaining each step.
The Pre-Meds
First, the pre-meds were administered. Famotidine and Ondansetron are prescribed to help prevent nausea and vomiting. Diphenhydramine, better known as Benadryl, is given to prevent allergic reactions. All three of these are injected into the IV line as an IV push. The last pre-med – Dexamethasone – is a steroid, used to keep the chemo from causing any major reactions in the body. This one is hung in a bag and infused over a little bit of time. Maybe 30 minutes? I don’t remember for sure.
The nurse told me I’m likely to have a strong desire to sleep as a result of the Benadryl. She was not lying! It was extremely difficult to stay awake but I managed. I really want to know what’s going on!
Carbo and Taxol Are Next
And now the fun begins! The chemo comes up from the pharmacy. Only the nurses can go to pharmacy to get it and bring it back. The chemo IV bags are within these ominous looking bags. It’s pretty clear these are dangerous substances. The nurse then gowns up to prevent any of the chemo drug from accidentally touching her or her clothing. I’ve yet to understand how such a dangerous drug cannot touch the nurse but is okay to put directly into my body. Scary.
As the nurse begins to prep the first infusion which is Paclitaxel (Taxol), I quickly fumble around looking to get my ice mittens and booties on. The cold is supposed to prevent or lessen chances for neuropathy. No neuropathy for me! At least not if I can help it! The Taxol begins to drip into the pump, through the tubing and into my veins. I feel nothing different and am surprised by that. I suppose I expected some kind of drama or something but, nope, just quiet. This is not a bad thing!
Titrating the Taxol
Since Taxol can cause some fairly strong reactions in some, it is titrated in three different speeds, from slower to faster. Or should I say from slower to less slow? If it is tolerated on one level, they proceed to the next, faster level. I was told this was only done once, on the first chemo, to make sure there were no issues. After this time, it would only take an hour for the Taxol to be administered. Keep in mind that my Taxol dosing is administered in thirds (metronomic dosing), spread out over three different infusions/weeks which is why it is only one hour. For regular dosing it would be three hours.
Freezing Hands and Feet!
I can tell you that those ice things I put on my appendages are darned cold! Freezing actually! At first I didn’t really feel much but somewhere just before the five minute mark my hands and feet started to feel really cold. Then came the pain. I was afraid I might end up with frostbite! Wiggling my hands and toes seemed to help, probably because it increased the blood circulation. Interestingly, I thought I’d freeze while I was icing but, instead, I actually found my body feeling warmer! I assume that’s from the increased circulation.
Around the half hour mark the pain started to ease. Either the ice was beginning to get significantly warmer or my toes and fingers got so cold they could no longer feel anything! Maybe a bit of both. I was grateful.
Time for the Carbo
The Taxol ended and now it is time to start the Carboplatin. Carbo is supposed to be the easier of the two on the body and icing was not necessary. I heard this from several nurses but I don’t know if that is true for me. It is the Carbo that seems to do more neuropathy stuff to me. Next time I will wear my icy things during both treatments. While my Taxol treatment will normally be an hour, Carbo can be infused more quickly over only 30 minutes.
My First Chemo is DONE!
Finally, after all the drugs have been administered, the port gets flushed with normal saline from the IV bag. After that, as the port is deaccessed, a shot of heparin is given to prevent blood clotting around the port.
As for the icing, I cannot tell you that it worked or didn’t at this point. I probably won’t know that until well after chemo is finished and that’s a while away from now. What I can say is how there are lots of prickly pins and needles along my legs and arms. I’m told that is not neuropathy since that won’t show up until day 3 or so after chemo. Whatever it is, it is uncomfortable.
Walking out of the infusion center was a little weird since my feet were still not back to normal given the cold. I found myself walking on feet that don’t feel like they were there! Kinda strange.
I was surprised at just how well the whole thing went. I feel tired but that is from the Benadryl I’m assume. It took around four hours all together but I’m it will be faster next time, mostly since the taxol won’t have to be titrated.
The first infusion is over. I am grateful! One down, 17 to go!
