As you may recall in Hooter Hotlines #14 & #15, the day I learned I needed to have chemotherapy was not one of the highpoints of this adventure. I was having a lot of physical pain from fluid engorgement under the mastectomy incisions and I had to accept that I was not able to dodge the chemo bullet. The fast track to chemo was in high gear and it included a chemo class at 0900 the next morning. I took pain pills before I went to sleep that night. It had been such a draining and uncomfortable day that I fell into a deep and restful sleep. Rog was still taking John to school in the mornings, so I did not set my alarm. I heard the boys rustling around in the morning while I lay cozily in the place between REM and wakefulness, that peculiar state of consciousness where one can manipulate one’s dreams. The house became blissfully quiet when I heard the door close and the deadbolt turn. At that point, I chose REM over wakefulness and drifted back to sleep, completely amnesic of the fact that I had chemo class that morning. Perhaps I really did need the extra sleep or it was just a bit of narcotic hangover, but somebody was looking out for me at 0840 when I suddenly awoke for no apparent reason. Sometimes guardian angels can’t be subtle, especially when assigned to a DORK. I looked at the clock and my tardiness for class fully registered. I popped out of bed like a gymnast (not really), pulled on a pair of pants, a shirt (no bra, saved 60 seconds there), slip-on shoes and ran out the door. I didn’t brush my teeth or comb my hair. My braid was now two days and nights old and had a rather furry aura about it….kind of like a braid "Pigpen" from the Peanuts cartoon would have if he were a girl. I illegally called Rog on my cell phone while driving to let him know I was on my way, but would be late. I continued to break the law on my way to Tualatin. If 65 mph (which really translates to 70 mph) is okay after West Linn, it ought to be okay about 3 miles before West Linn, right? Fortunately, I did not receive a speeding ticket on my way there. Imagine handing Rog a $200.00 ticket to pay in addition to the daily bills for my three surgeries and numerous diagnostics. I don’t think my guardian angel supports unlawful activity, in fact, I’ll bet it’s in the G.A. contract, but on this day, the officers on duty urgently set down their radar guns to scratch a profound itch between their shoulder blades just as I sped by.
I arrived at chemo class and dropped into the chair next to Rog as if I had been swept in on a big gust of wind. I was welcomed and was relieved to see that I hadn't’ missed anything except introductions. I took in my surroundings. Three other couples were in class with us. We were the youngest couple by far in the small conference room. I was now fully awake and ready to learn. Rosemary, an oncology nurse with 30 years of experience was teaching the class. She had a wonderful way about her. She was relaxed, spoke knowledgeably and delivered the information in a way that was actually encouraging and had us chuckling off and on. Considering the subject matter, that is talent and skill mixed together into a tasty, nourishing casserole. I was grateful I would have access to her through this process and was especially delighted to be given yet another three-ring binder, this one dedicated to chemo information. It included Rosemary’s thorough PowerPoint presentation, wig/headwear resources, nutritional and fluid requirements, a guide for what to do the day before treatment, the day of treatment, 3 to 4 days after treatment, and most importantly, the "Cannon Ball Recipe" for chemo constipation. Anyone who really knows me, knows I can’t do any kind of project without creating a binder for it. I also have a weakness for plastic sheet protectors. Nothing irks me more than notebook dividers that are not wide enough to accommodate them. Yes, I have had counseling in the past, but thankfully, it never tampered with this sweet obsession. Yet another silver lining with cancer, three outstanding and organized binders are now in my possession. I am living proof that goose bumps of delight release endorphins. During the class, I took copious notes in my new binder (shiver) and absorbed everything I could. The gentlemen in the class all had different kinds of cancer. Our instructor spoke to each of us round the table about how our specific chemo concoctions would effect us. By the end of class, I was so armed with information, tips and strategies, that I actually felt empowered. This class gave me hope that I could minimize the "yuck factor" of chemo. There was stuff I could do. I was not going to be a complete victim in the hands of chemo. After our instruction, we visited the chemo room in the clinic. It was about the size of three large family rooms. Banks of windows allowed natural light to flood the area. The room was divided into several groupings of industrial recliner chairs (even uglier than my husbands blue velour LazyBoy). There was a relaxed atmosphere in the room. Some patients sat listening to music with earphones, others read and some just reclined, resting. One man let us take a close look at his port-a-cath access. Some had a companion sitting by them and others were alone. Several nurses cruised amongst the patients and a baseline of congenial conversation could be heard throughout the room. It didn’t look that bad. I thought to myself, "I can do this. I can do this well. Let’s get ‘er done."
The first step in starting chemo is getting an echocardiogram. This is essential for folks getting Adriamycin (the red chemo drug). It is toxic to heart muscle cells and one is limited to a specific quantity of the drug over a lifetime. The echo makes sure your heart function is adequate and able to tolerate the red devil. My first four treatments would by a combination of Adriamycin and Cytoxin. Word on the street is that this combo is rather unpleasant, but the last four treatments would be with a different drug, Taxol, usually less harsh and yet another silver lining. Adriamycin has an interesting history. It is an antitumor antibiotic made from Streptomyces peucetius, a species of soil fungus that produces a red pigment. In the 1950’s, an Italian research company isolated the bacterium in the soil surrounding a 13th century octagonal castle, Castel del Monte. French researchers made the same discovery at about the same time. In an absolutely generous (keeping an eye on "the big picture") and diplomatic (non-territorial) gesture, the two teams named the new compound together. I just love it. I would like to have been there to plant big wet kisses on all of them. They came up with "daunorubicin" which, when broken down, refers to a pre-Roman tribe, "Dauni," who occupied Italy in the area streptomyces was isolated and the French word for ruby, "Rubis," referring to its red color. By 1967, this compound was found to be fatally toxic to the heart and work began to create a new strain via mutating the original. Their success gave birth to Adriamycin. The new strain was named for the Adriatic Sea, which is near the castle (southeast coast of Italy above the "boot heel"). I love that they continued to incorporate historical relevance with the scientific name! If I ever get a chance to go to Italy, I’d like to visit the castle, drop down, roll around in the dirt and take a dust bath for good measure.
"Castel del Monte or Castle of the Mount is a medieval castle located on a small hill near Bari in the Apulia region of southeast Italy. The castle was built by the Holy Roman Emperor Frederic II between 1240 and 1250 and was used as a hunting lodge. Later the castle was turned into a prison and served also as a refuge during a plague." Source: Castlexplorer.org
Being discovered next to a medieval castle is awfully cool all by itself, but knowing how Adriamycin works is equally exciting. The ruby juice binds to DNA of rapidly multiplying cells by squeezing between base pairs (intercalation) of the DNA strand. Once in place, it inhibits an important enzyme needed for transcription of DNA. Imagine you are sitting on park bench just inches away from someone you have a crush on. Out of the blue, a gorgeous model walks over to the bench and squishes herself between the two of you. Yep, it's all over now. Adriamycin is the gorgeous model. The result is an unwinding of the DNA with the result being an inability to replicate. Wow! When I’m not feeling so hot on chemo, it will be nice to know what’s going on inside and cheer on the process.
My treatment plan combines Adriamycin with Cytoxin for the first four sessions. Cytoxin also effects cell DNA, but has a different approach. The liver breaks Cytoxin down into two chemicals, which slow the growth of cancer cells by interfering with DNA actions. The combo is sort of a "one-two punch" to the bad guys. As the referee in this match, I’ll catch a few punches in the process (hair loss and immune system suppression), but that’s only temporary. The worthless, unraveled DNA of the cancer cells takes a permanent hit. Buuuuuuubye!
And now, a couple words need to be said about the closing act: Taxol, the drug of choice for the last four chemo sessions. It has an intriguing history too. In 1958, the National Cancer Institute commissioned the US Department of Agriculture to collect samples of more than 30,000 plants in order to test for anticancer properties. Arthur Barclay collected 15 lbs. of twigs, needles and bark from Pacific Yew tress near Mt. St. Helens. The good news was that the bark turned out to contain antitumor properties. The bad new was that the bark of a 40-ft., 200-year-old Yew tree only contained a half-gram of Taxol. Environmentalists weren’t happy. Fortunately, another researcher, Robert A. Holton, developed a process to convert a related compound in Yew needles into Taxol. Thank goodness! Taxol attacks the cytoskeleton of rapidly dividing cells. It’s the "Terminator" because it prevents restructuring of the cytoskeleton, which is necessary for rapid cell growth. Preventing restructuring induces programmed cell death…cell suicide. I like the sound of that! Good cells are also subject to its effects, but rapidly dividing cancer cells are much more susceptible to its wrath. I can live with that. (Source: medic8.com)
The last step in preparing for chemo is having a port implanted into a large vein in my chest. The catheter is tunneled under the skin to prevent the tip from shifting out the vein. The purple port at the end of the catheter is placed just beneath the skin a few inches south of my right collarbone. For sterility sake and pain control, it is inserted under sedation in the operating room. Great, my fourth trip to Good Sam’s Short Stay Unit. Another day of lost work. Another day I have to ask Rog to drop me off, take John to school and pick me up later. "Stop whining and make the best of it," I nag myself.
"Power Port"
I know the drill by now. Arrive two hours before the scheduled procedure. Bring only your driver’s license, insurance card and knitting. Bring your patience and a sense of humor for all the waiting around. Strip down, all the way down, put on the gown, but don’t tie it in back. I even hook up my own compression leggings. Go through all the same questions about allergies, removable body parts and spiritual preferences. Sign the permit, get the IV started and go potty. The autograph of the surgeon on your insertion site and the appearance of the OR nurse mark progress towards the goal. Make small talk with the housekeeper and tell her how she is outworking all the staff. Bide your time, knit, observe, wait. Then the anesthesiologist, Dr. R. Ford comes round your curtain. And just like shaking hot sauce on your eggs, he immediately spices things up. We hit it off instantly and begin yucking it up and trading one-liners. This is great! Suddenly I don’t feel like I’m here for mundane port placement. This is as fun as going out to happy hour with good friends! It sure felt good to laugh. And to top it all off, I knew this guy was going to give me the best nap of my life and I was right. So, it was a really great day and experience after all. It was a far cry from my pre-op experience with the mastectomies. I’ll cover that another time.
Getting chemo every other Friday means that if uninterrupted, my last treatment will be the first Friday in June. By mid-June, my hair can start growing again. Toxins will be gone from my weary body and there will be cause for celebrating the termination of my 120-day (minimum) chemo odyssey. Odysseus met many obstacles, sabotage and heartache in Homer’s epic Greek poem. He had to contend with bickering gods, a Cyclopes, a medusa and sly sirens to name a few of his woes and foes. My adversaries and side trips may look a bit different than his, but I will move forward with confidence in my caregivers, my support system and my loving God to help me do my part in making all of these efforts successful.
"…let us throw off everything that hinders and the sin that so easily entangles, and let us run with perseverance the race marked out for us." Hebrews 12:1 (NIV)
