Chemo #1: 1 down, 11 to go....

Hi everyone,

It's been about 24 hours since my first round of ABVD, and so far I'm feeling great (great, as in normal)! Part of this is likely due to all of the anti-nausea and steroids they pumped my body with, as well as the anti-nausea pills I've been preemptively taking. I'd like to think the other part is that my body handles ABVD really well, but that might be too soon to say. Some people feel the side effects -- which mainly include nausea and extreme fatigue -- right after the infusion, and others take up to 3-5 days to feel it. So, I'm not in the home stretch yet, but I'm holding out hope that I'll be one of the lucky ones with few to no side effects!

Without further adieu, here is a recap of my first chemo journey:

My mom, Becky, and my boyfriend, Scott, accompanied me as my cute little cheerleaders and were both awesome. We arrived at the U of M Masonic Clinic for my 12:30 pm appointment with my oncologist, Dr. Peterson. This was really just a chance for us to ask any other questions before chemo started. He also went over the results of all my blood work, which was pretty typical. The one interesting finding was that I did test positive for having the Epstein–Barr virus in my system (this is the virus that causes mono), though I never had any symptoms of having mono that I or my family can remember. Doctors and scientists think there is a correlation between that and Hodgkin's Lymphoma, though it is hard to say one way or another, as 90% of the human population is infected with the Epstein–Barr virus, and very few end up contracting Hodgkin's. Lucky me, I guess!

After my appointment with Dr. Peterson, I also got weighed and had to get a blood count. This will happen before each appointment. The amount of medicine you are given is directly related to your weight. Some of the medicines, such as Adriamycin, have lifetime maximum dosages you can have, so they want to make sure they don't overdue it, not even by a little. They also do a blood count before each treatment to make sure that you're healthy enough to go in for more chemo (aka poison). The main thing they look for is your white blood cell count (WBC). If it's too low, they may have to delay your chemotherapy treatment by a few days to give your bone marrow a chance to build up more white blood cells (the lower your count, the more susceptible you are to outside infections). However, ABVD is most effective when given on a very strict schedule, so any sort of delays are not a good thing.

After that, it was time to get poisoned. We went up a few floors to the outpatient infusion room, which was actually pretty nice (or as nice as that kind of room can be). There isn't much privacy -- each infusion room is separated by a curtain -- but luckily it was relatively quiet, so it didn't seem like we were right on top of each other. I also got a corner spot, so I had windows on both sides. In case you didn't know it already, I am huge sucker for natural light, so that lifted my spirits. After we were all settled, we met my chemo nurse, Ginger, who was great. I told her that I was keeping a blog and I wanted to take detailed notes, and she was a champ about that, even spelling all of the crazy medicines for me!

Now it was time to get to business. As I mentioned earlier, I opted against getting a port. The last few days leading up to my first chemo appointment I started to regret my decision, because it does seem that most people on the internet do end up getting them, and are grateful for them. While it requirers surgery to insert it, then stays in your chest for 6 months, and then requires another surgery to remove it, people like it because it speeds up the chemo process and you don't have to get your veins pricked every time. Also, the chemo drugs can also leak from veins into your tissues and cause complications, but this is rare. Lastly, they can make your veins permanently "hard". Moral of the story: gross.

Going into my initial meeting with my doctor on 8/22, I was feeling pretty 50/50 about the whole port situation. My doctor recommended against it, since I will only be having chemo twice a month, and he also mentioned that ports can become infected and can also increase your chances of blood clots. Though he did say that any time in the process I wanted to get one, he'd be more than happy to help.

Well, needless to say if all of my infusions go as smoothly as my first one, I'll be very happy I opted against getting a port. I believe I mentioned (or, rather, bragged) in an earlier post, medical practitioners are always drooling over my veins. Anytime I have to give blood or get shots, there is never a problem. Thankfully, this was also the case with chemo #1. I had read some horror stories of it taking multiple pricks -- and multiple nurses -- so I felt very thankful that the whole thing was done in seconds. However, after the fact, Ginger did confess that was a little nervous since apparently I already have kind of "hard" veins, which could have made the whole process more tricky. Hopefully those "hard" veins don't come back to bite me in the ass next time...

Sorry if you're squeamish, but this was the IV point in all its glory. Ginger was so great at inserting it, she didn't even leave a bruise!

Now, on to the juicy stuff: the drugs! It started with some saline (aka saltwater) to "prep" my veins for the medicine. This was also used throughout the treatment as a sort of "palette cleanser" in between drugs and also helps with keeping your body hydrated. The next medication was Aloxi, which is used to prevent chemotherapy-induced nausea and vomiting. This was given in my IV via the "push" method, where the nurse slowly pushes it in with a syringe. This lasted a total of 30 seconds. Then, there was some more saline and then another anti-nausea drug called Emend. This was given via the drip method and took about 20 minutes. Both of these drugs stay in your system for 2-3 days, which is likely why I'm still feeling pretty a-okay. Lastly, I was given Dexamethasone, which is a steroid that also helps with combatting nausea (but can also cause weight gain and insomnia -- goody!). This was given via the drip for 12 minutes.

After this is where the real fun began. ABVD time, baby! ABVD is a cocktail of drugs which all work together to fight The Hodge. Before each drug, Nurse Ginger called over one of her colleagues and read the medicine amount and my patient information just to double check I was getting the correct dosage. As I mentioned above, you are given a specific amount directly correlating to your weight, so precision is key. Here is the order I was drugged up on:

1. Adriamycin: This was given via push and took about 10 minutes to go in. Oh, and it was also BRIGHT red -- we're talking Hawaiian Punch style red. Kind of eerie. This is one of the drugs they have to be particularly careful they give you the exact amount on, since there is a lifetime amount that you can get and it can also cause heart damage, even with safe doses. This is why I had to get the cardiac echogram last week to make sure my heart could handle it.
2. I know what you're thinking, following the acronym, it should be the B drug, right (which, by the way, is called Bleomycin)? Wrong! The next one I was given is called Vinblastine. This was also given via a push. This was just a few minutes or so -- nothing significant to report back on that one.
3. Now, it was time for Bleomycin. This particular drug is the most likely one to cause an allergic reaction (though still, this is rare). So, I was given an itsy-bitsy dose via the drip IV, and then had some steroids and Benadryl on hand in case there was any funny business. Usually this so-called funny business, in the form of an allergic reaction, happens in the first few minutes, but they want to make sure they're extra careful, so we waited a full HOUR to make sure there was no reaction. I'm happy to report that my body was totally fine with the Bleomycin. One hour later, I was given the rest of the Bleomycin via the drip, which took another half hour or so.
4. Last, but not least, it was Dacarbazine time! This was given as a drip for one hour. With ports, this only takes a half hour, but it can make your veins sting badly if it's given too quickly, so they slow it down for those of us without ports. I was also given a heated blanket for extra comfort. I felt zero discomfort, and I was totally okay with putting in the extra half hour to make it pain-free.

After the infusions, the pharmacist came by with some more oral medications to help with the nausea, etc. Here's what he gave me (FYI the first 2 are mandatory; the second 2 can be taken as needed):

1. Allopurinol: This is a medication that I will take once per day for 10 days, likely only for this cycle. This prevents a buildup of uric acid, which can cause gout or kidney stones. This is given because dying cancer cells give off a lot of uric acid, so combatting this is very important.
2. My good friend, Dexamethasone, the steroid I was given via IV, but this time in pill form! Again, this is used for anti-nausea purposes, but unfortunately has the side effect of weight gain and insomnia. I slept fine last night, but that was likely due to another one of the "goodies" I was given (more on that later). I will take this on Day 2 (day after chemo), Day 3, and Day 4.
3. Next is the Compazine, which is another anti-nausea medication. Interestingly, this was on the market for about 40 years as an anti-psychotic drug, but they realized it did more to treat nausea than anything. Good to know if I'm feeling any psychosis coming on I have this bad boy to also turn to!
4. Lastly, I was given Avitan. This is another anti-nausea drug which has the extra bonus of making you sleepy! The pharmacist advised that this might be good to take to counter-balance the steroid Dexamethasone, which can cause alertness and insomnia. I took one pill last night around 9 pm, and was out at 9:30. Then I woke up wide awake at 4 am, popped another (you can take them every four hours), and then slept soundly until 8 am. How glorious...until I did more research and found these are highly addictive. So, until severe nausea starts up, I might stick to good ole fashioned Benadryl as my sleep aid while I have steroids in my system.

All in all, it took about 4 hours total for the first infusion. Moving forward, it be closer to 3 hours, since we won't have to do the allergy test for the Bleomycin. And while 4 hours seems like a long time to have drugs being pumped into your arm, the time went by surprisingly quickly -- a big part, I'm sure, due to my dazzling company. My mom and I watched a few Gilmore Girls episodes, while Scott solved "puzzles" on his gameboy and intermittently piped up something snarky about the episode (why he does not like a show that's all about coffee, witty banter, and pop culture references -- not to mention a ton of Twin Peaks guest stars -- is beyond me). The icing on the cake was some delicious homemade chicken parmesan courtesy of Jenny Meslow! I really couldn't have asked for the day to go any smoother.

Thank you again for all your kind thoughts and positive vibes. I'm not out of the clear yet as far as the nausea is concerned, but I'm still feeling good and am hoping this lasts as long as it can!