Since we moved to Denver, I‘ve had 31 infusions of pemetrexed
spread over four cycles since December 2011.
The cycles lasted from about four to eight months each and were
separated by four chemo breaks lasting from four to ten months. I get my infusions on Wednesdays, and in most
cycles I would feel unwell and suffer from fatigue starting Friday evening. I would begin feeling better late on Sunday
afternoon and get pretty well back to normal by Wednesday. I get pemetrexed every three weeks, so I’d
feel good about two of every three weeks of a chemo cycle.
Near the end of the last extended chemo cycle (from
March-September 2014), I became fatigued during the second and third weeks
also, so much so that I qualified for supplemental oxygen. I felt so bad that I terminated that chemo
cycle earlier than I might have otherwise.
As I noted in an October Cancer Couple post, I attributed my increased
fatigue to changes in my red blood cell count, and I was taking a chemo break
to let my body readjust. I began chemo
again at the end of December and completed the third round of my new schedule
at the end of February.
In addition to the increased fatigue and shortness of
breath, I had become increasingly bothered by premature ventricular
contractions or PVCs. A PVC occurs when
the heart ventricles, the chambers of the heart that pump blood out to the
lungs and the body, contract before they have had time to refill following the previous
contraction. When I saw my primary care
physician in January I told her about my PVCs and she ordered a Holter monitor
test. A Holter monitor is a sort of
portable electrocardiogram that you wear for 48 hours. The test was done in February and showed a
large number of PVCs. I finally saw a
cardiologist a couple of weeks ago, and she ordered a stress echocardiogram for
last Friday. The test showed a possible
weakness in the contraction of my ventricles.
The thinking was that a blockage of a coronary artery reduced the blood
flow to the ventricle wall resulting in a weak contraction. Consequently, an angiogram was scheduled for
yesterday. The angiogram would produce a
movie of the movement of blood through my coronary arteries after the injection
of a dye which would reveal any blockages.
If any blockages were treatable, a stint would be placed to open up the
artery and ultimately restore full blood flow.
If the blockage could not be repaired, it would be necessary to undergo
a coronary bypass operation.
All of a sudden my view of my fatigue and shortness of
breath was radically altered. I had been
attributing my symptoms to some kind of cumulative impact of chemo. Now it was possible that my problem was plain
old coronary heart disease. No one wants
to have coronary heart disease, but the silver lining would be that it could be
treated, and my symptoms would be alleviated.
I had the procedure yesterday. So, what were the results? I had no blockages. My pipes are clean which is good news, but
there no easy route to symptomatic relief.
My symptoms appears to be the result of my mesothelioma, chemo, and/or a
general lack of physical fitness. I am
taking a beta blocker now that helps a lot with the PVCs, and I will adopt a
fitness program to try to counter my fatigue and shortness of breath. I start chemo again on May 6, and it will be
interesting to see how I do this cycle.
David
PS I write this blog
to record our experiences with cancer for several reasons, one of which is the
desire to record early 21st century medical practice for our
grandchildren and great-grandchildren so they can marvel (I hope) at the crude
nature of medicine in our time. What
follows is a description of the patient’s experience of getting an
angiogram. I doubt that it will be of
interest to current readers.
An angiogram is a procedure for recording moving and still
images of the heart using x-rays. I
expect there are multiple uses of angiograms, but in my case the purpose was to
see if any coronary arteries were blocked.
The coronary arteries supply oxygenated blood to the heart. If they become partially blocked, the heart
is weakened. Complete blockage deprives
heart tissue of oxygen and results in cell death.
Here’s what happened in my angiogram. The procedure took place in the Cath Lab, a
large room with a high, narrow bed in the center. I climbed up on the bed and centered myself
left to right. On each side was a sort of
shelf for the arms. The procedure
required one or more thin tubes known as catheters to be inserted into an
artery and threaded up to the aorta and then to the coronary arteries of the heart. The arteries lie on the outside of the heart
and therefore are easy to see with x-rays.
The catheters can enter the femoral artery at the groin or at the radial
artery at the wrist. The wrist artery is
smaller than the groin artery but easier to access. To get me ready, the nurses attached electrocardiogram
leads to my side and shoulder, attached a blood oxygen sensor to my right
thumb, and cleaned the possible insertion areas with alcohol. Then they, covered me with sterile drapes and
with a large overall drape that ran from my neck to the end of the bed and all
the way down to the floor. Then all of the
equipment in the room was covered with clear plastic elastic covers. Running parallel to the bed on my left side
was a very large computer screen (perhaps four by eight feet in size) which
displayed my vital signs and the electrocardiogram results with about ¼ of the
screen reserved to display the angiogram pictures.
When I had been prepped, three doctors came in to join the
nurses, and there was at least one person in an adjoining room electronically monitoring
(and recording?) the procedure. I had an
intravenous line attached to my port, and a nurse began giving me medication
through the IV. I got a drug for pain,
and one for anxiety. I was quite relaxed
but awake. The one doctor inserted a
catheter into the radial artery of my right wrist about 1.5 inches below the
bottom of my hand. She then began
threading the catheter up through the artery to the aorta and into the coronary
arteries.
I really wanted to watch this on the screen, but the x-ray
head blocked my view. Another doctor
controlled the position of the x-ray head with his legs (I think) while the
young cardiology fellow moved it into position.
When the catheter was in place, she injected a contrast agent or dye into
the artery. Had the artery been blocked
the dye would not have moved quickly throughout the artery. In my case there were no blockages, so the
dye flowed quickly onward. I believed
that they imaged the left coronary artery first. The third doctor in the room, who was not
fully gowned, came over and told me that the artery was clear, and the echocardiogram
had been a false positive. Then they
moved to the right artery. Apparently
the fellow was having some difficulty getting the catheter in the right place,
so the second doctor took over guiding the catheter for a little bit. Then the third doctor was fully gowned and he
came over and got it in place. It was
interesting to note the differences in the work of the three doctors. The first two had pressed more firmly on my
wrist while working, but the third doctor pressed more gently and seemed to
transmit a sense of relaxation and confidence in his actions. Was it my imagination or did his touch
reflect his experience.
When they had pictures of both arteries, I got to view them
on the screen. Then the catheter was
quickly extracted, my wrist was bandaged with an inflatable bandage that
pressed down on the insertion point, the nurses unhooked me, and my procedure
was over. One nurse wheeled me back to
an examination room with a reclining chair.
The nurse there check me out, called Jana so she could come back, and
got me something to eat. I had not been
able to eat since 3 am that morning or to drink anything after 7 am. It was about 2:10 pm, so I was ready for some
lunch. Jana and I sat there reading our
books until about 4:30 pm when the nurse began letting air out of the wrist
bandage. When it appeared that the wound
was not going to start spurting blood across the room, she put on a bandage,
and we went home. All in all, it was an
interesting experience.
