Chemo Class

Yesterday we had an appointment back at the Lahey Clinic for what they call a "Chemo Teaching Session" where we would learn all about my upcoming treatment and have an opportunity to ask questions.  As usual, I brought my entourage: Tiffany, my parents, and my mother-in-law.  Now I have to admit that this is the part of the process that has me the most concerned so far, specifically how my body is going to react to the chemotherapy .  As soon as I found out the regimen that I would be taking, I started doing research on my own and seeking out others who had gone through it.  There is a lot of information out there on reputable websites (www.lls.org, www.cancer.org, www.livestrong.org. www.chemocare.com) as well as a lot of less than reputable sites.  I've also been fortunate enough to connect with a few lymphoma survivors who have shared their experiences with me and offered advice and encouragement.  Some who are friends of friends as well as through the Leukemia and Lymphoma Society's First Connection program.  My favorite, non-scary piece of advice so far came from a friend of my cousin's, Holly, who said she would imagine the long day of chemo as if it were a spa session.  I never would have thought of that, but hey, it's worth a try.

So back to the teaching session, we were led into a conference room and joined by Colleen, the nurse practitioner, and Katie, the nurse navigator.  Katie's role is basically to be a single point of contact for me and my family to answer questions as well as coordinate all aspects of my care.  We were all ready to take notes, however she had already put together a very comprehensive binder of information which she handed me as I sat down.  They first discussed the schedule; I would be coming in every three weeks beginning on April 1st for the chemo and then coming back the day after every time for a quick shot of Neulasta, which stimulates white blood cell production in the bone marrow.

The binder

Next we learned about what the treatment itself will look like.  Basically I will be a walking (hopefully) pharmacy.  I will start taking a drug called Allopurinol a couple days before the first treatment, which will essentially prevent the dead cancer cells from damaging my kidneys due to the size of my tumor.  On the day of treatment, I'll start with an anti-nausea /anti-anxiety drug before I leave.  Once I arrive, I'll be connected to an IV through the port in my chest and get 5 more drugs before the chemo even starts.  These consist of an antihistamine, a pain reliever, 2 more anti-nauseas (seeing a theme here), and a steroid.  After that, I'll begin the 6+ hour process of getting my chemo drugs, R-CHOP (Rituximab, Cyclophosphamide, Doxorubicin (apparently the brand name starts with an 'H'), Vincristine (Oncovin), and Prednisone (which I'll be taking by a pill for the first 5 days of every cycle.)  Once I'm all loaded up, I'll be able to go home although there's a slight chance the first cycle may be done inpatient.  I will also have 2 more prescriptions for more anti-nausea drugs to have on hand at home (definitely a theme.)  

We then learned about each chemo drug individually as far as their purpose as well as side effects.  I will be highly toxic for the first 48 hours so I'll have to be very careful during that time (they gave me a sign to hang in the bathroom that says "48 hours after chemo - FLUSH TWICE!!" with a picture of a toilet on it. Thanks.)  After that it varies by the person, but I could have to deal with fatigue, weakness, nausea (got pills for that though), mouth sores (I'll get to rinse my mouth with a delicious mix of baking soda, salt, and water three times a day to try to avoid these), constipation, and irritability, along with the expected hair loss (I'm in the market for some hats right now.)  Days 7-10 of each cycle will be what they call the nadir, or low point, of my blood counts and immune function, so I'll be at high risk for infection and will have to be extra careful during these days as well.  One thing that they kept reiterating was to call the office immediately if the side effects weren't manageable and that the goal was to make sure I made it through as comfortably as possible, which made us all feel good.

We had a chance to ask some questions and then the session was over.  Knowledge is power, and we all left with a greater understanding of what to expect as well as a better comfort level overall.  One week until cycle 1 starts and I am anxious to get it started (so it can be finished.)  Next on the schedule is the second opinion with Dr. Abramson at Mass General on Thursday and then Tiffany and I are taking a little weekend away before treatment starts while our parents watch the kids.


"In the middle of the storm, I am holding on to you..."