March 19, 2014

Back in the Chemo Chair Again

Yesterday I had one of my periodic CT scans and got the results from my oncologist today. It's been almost 11 months since my last chemotherapy in April, 2013. Before going to see doctor, I reviewed my old CT or CT/PET reports and found that pemetrexed had generally decreased tumor size slowly while I was receiving it, which led me to think it was time to begin again. The latest report showed continued, slow increase in size, and there was an indication that the cancer in the area of the diaphragm has been pushing down on my liver which is not good. \

I have also been concerned about the mutations that are occurring in the tumors. My understanding is that when cells turn cancerous, the proofreading of the DNA when cells divide is damaged so that copying errors, a kind of mutation, become more frequent. I suppose many of these errors may kill the cells before they can grow, but as in evolution, some persist and reproduce. Some of these mutations give the cells the ability to grow and develop into well functioning tumors by acquiring the capacity to develop needed blood vessels to provide food to the cells and the ability to avoid detection by the immune system, for example. If pemetrexed takes out some or most of the cells that are undergoing cell division, then it may be removing some of the cells that are of benefit to the cancerous tissue and harmful to me. Ultimately the cells may acquire the ability to neutralize pemetrexed, but until that time, the drug can help keep the tumor-positive mutations from taking hold.  

Taken all together, my oncologist wanted me to go back on chemo, and I agreed. They arranged for me to get back into a chemo chair in the infusion center today, and I received my first new round of pemetrexed. I'll be getting chemo every three weeks now and will continue until it stops working, or until there are better options available (for example, a drug that unmasks cancer cells so the immune system can find and kill them). 

Luckily, the side effects of pemetrexed are not horrible, mostly a few days of fatigue, but it is something of an inconvenience and limits our flexibility.


What It's Like in the Chemo Chair

I'm not sure I've ever written about the process of getting pemetrexed, so I thought I'd write a description today in case anyone would find it interesting.

After checking in at the desk, I go to the waiting area while I wait my turn. They have a good selection of donated magazine there, and look for something interesting to read. Then an assistant comes in and takes me back to my chair. The chairs are like large recliners, and are in cubicles separated by walls or curtains and face a wall of windows that look out on the hospital and the mountains beyond. The cubicle has chairs for visitors, a table, a TV, and more magazines.

Then the nurse comes in and we begin. She (always been a woman) verifies my identity and ask questions about my current health that she enters into a computer on a rolling stand. They have to calculate how much pemetrexed I need based on my weight and height, and today I had to have my height measured for this year, and it has to be witnessed by two people.

She then accesses the port in my chest and attaches it to a bag of saline, and she also attaches a bag of Kytril, an anti-nausea drug, that infuses for ten minutes.  In the meantime, the oncology pharmacy is preparing my pemetrexed infusion based on my weight and height. When it is ready, she returns with the drug which is shrouded in a brown plastic bag, and with another nurse they verify who I am, what my patient number is, and what medicine I'm getting. Then the infusion begins and lasts for 10 minutes. She deactivates my port, and I am ready to go.

Most of the time is taken up sitting in the waiting room and waiting for my pemetrexed to formulated. I sit back in the recliner, and I always find something to read. Today I found a copy of Science magazine in the room and had the pleasant surprise of reading an article about the domestication of the dog that quoted Greger Larson, the son of our friends Roger and Jane Larson.

I don't typically like to drive after chemo (even though it does not seem to have any affect on me), so Jana goes shopping while I'm in the chair. Today we went to Schlotzky's for one of their good sandwiches on the way home.

No comments:

Post a Comment