Cycle 3

My third cycle of chemo began yesterday. The drill has been the same as the previous two. I get three drugs, given over the first two days, with another day and a half for intravenous hydration. They all carry side effects, some quite harmful. I'm being given protective medicine for this too, but it does not take care of everything.

All of the medicines have two particular effects that even with compensantory treatment can cause problems. One is nausea. Though you get a lot of anti-nausea medicines to help you with this in the hospital, in me, still it kicked in by dinnertime during my first day of treatment. Still, take these medicines, religiously. If they can help you eat, it's huge given your need for calories. When the nausea fully kicked in, food then lost a lot of its appeal, though not entirely. A more accurate description would be that my appetite shifted. Instead of wanting my classic 3 big meals a day, I now wanted many smaller meals, as I would get hungry several times per day. However, each time, the hunger was shallow. I desperately needed nourishment each time, but too much and I would be unable to keep it down. I also needed something that would truly fill me up (which many "munch" size foods do not do) to satisfy each craving. This was toughest during the first cycle, when all I knew how to do was drink water to give stomach something that I knew it would keep down, but I gradually would expand my horizons. I was told by my doctors that I would need to focus on calorie-dense foods, as during chemo I'd be losing weight and want to keep from doing that as much as possible. Yes, you heard that right, the heart-healthy diet goes out the window! Lack of energy is another related problem -- the past two cycles, I was dead tired the weekend after I'd received chemo, beginning my return to life after the weekend was over.

The first thing I tried to satisfy my small meal cravings were Ensure shakes, recommended by a dietitian. These provided many more nutrients, plus a nice chocolate flavor, but they did not go down in a way that satisfied me. Through more trial and error, though, I was able to find some staple foods and drinks, many of the modifications to past foods and drinks I'd enjoyed. Oatmeal was one thing I'd always loved for breakfast -- instead of having it with water, though, having it with hot whole milk gave it a needed calorie boost and left me satisfied until almost lunchtime. Hot whole milk also played a big role in tea, where I got the soothing effect of tea combined with the calories and filing effect of the whole milk. Yes, we're seeing a theme here -- liquid-based foods are much easlier than my system than pure solids -- so time for some calorie packed soups. Next on the line have been thick soups, cream soups, and chilis, and all have so far been well received. Now, if only the available foods at the pediatric day hospital at Sloan-Kettering would include these... Nope, it's instead a largely unpalatable though appropriately targeted selection of kids-themed foods (the selection of foods at the main hospital, which I got to partake on after my surgery, was light years better). Thankfully, the cold cut sandwiches aren't too bad. We'll see how things turn out this cycle, but if the past two are any indiciation, I'll start regaining my original appetite midway through the second week.

The other big side effect is reduced blood counts, most specifically white blood cell counts. This is the biggest hazard during the second week of a cycle. If these fall too low, any illness requires immediate hospitalization. This has not happened to me yet, but I did have a close call when I caught a cold at the end of the second week of my second cycle. Thankfully, by then my white blood cell counts had already rebounded, due in large part to a shot they give you during chemo administration to enable to counts to rebound more quickly. Another cell type that undergoes a drop is the platlet. Platlets are key to enabling your blood to clot, and if the count falls too low, a transfusion is required (this why by the way you are told not to have any NSAIDs  -- popular medicines like aspirin, ibuprofen, and naproxen -- during chemo as these impact platelet function). So far, I haven't needed any transfusions yet. Hopefully, this continues to be the case.

Before I get to more specifics, I would be remiss to mention another general-purpose side effect that is unavoidable even with compensatory medicine. As chemotherapy drugs target fast-dividing cells, this means that they kill a number of fast-dividing cells that are completely non-cancerous. The most classic example is the hair. The cancer patient is seen as someone who is completely bald, and while degree of hair loss varies from patient to patient, it's a fact of life for almost everyone. I haven't lost too much hair from my body, yet, but the majority of the hair on my face and on my scalp is now gone.

To get to more specific medicines now: one medicine, doxorubucin, is bright red and given quickly through IV.  It's big side effect is that it can damage your heart. This is counteracted with another medicine given by IV before every doxorubicin infusion. However, to be sure no damage has happened, I'm getting an echocardiogram as part of my post-cycle 3 battery of scans. Another one, vincristine, is given as a injection push into my IV. It is known to cause constipation, for which I am taking stool softeners, and nerve damage. The latter is something to watch for; the telltale sign is unexplained tingling sensations. I'm getting such sensations, but in my amputated limb as the nerves are having to readjust, with no out of control escalation, so everything is ok on that front.

The medicine that's required the most compensatory measures has been cyclophosphamide. Each day I'm supposed to get it, I get it over 6 hours through IV. The effects don't show up right away, besides the nausea, but they do kick in. By the second week, my mouth feels agitated because a lot of its mucus lining has been destroyed. My throat will get sore. Mouth sores can develop. And these are just the simple side effects. The others are hit hard with compensatory medicine to avoid them. Cyclophosphamide can damage the bladder, so it is given in addition with a drug called mesna that protects it, along with copious amounts of intravenous fluids to constantly flush my bladder. Just one day of fluids was enough to cause my residual left leg to swell to the point of being unable to wear its prosthesis, so now I'll have to wait until the week is done before I can do that again :( As if the daytime fluid influx is not enough, I have to take a back pack of fluids and mesna (except for the very last night) with me every night when I come home from the hospital, connected to my IV port, and have them running until I'm back at the hospital to resume treatment. The last two and a half days I spend there are for hydration only, without any additional chemotherapy administered. I guess by now I shouldn't have been surprised when I looked up that cyclophosphamide has roots in the WWI chemical weapon mustard gas. Well, if it's going to wipe out my cancer, that's what it's going to take... To lighten the mood some, I'll now mention my last side effect from cyclophosphamide: hiccups!

After this cycle, I will get scans to see how my cancer is progressing, along with an echocardiogram to check on my heart. Assuming no changes to the treatment plan, my next two cycles will involve a pair of drugs with a different profile as far as side effects and how often I have to take them. I will be discussing those as my next cycle approaches. For now, so long, and I'll have more updates here as they come in.