FCR Chemotherapy: Round 1

I decided that perhaps, since I start my second round of chemo very soonly that it might be time to talk about round 1 and how it has gone so far.

Fair warning: picture heavy and some might be too graphic for the squeamish.

On April 2nd, I had my port placed in preparation for chemotherapy. It was my first procedure in over 4 years at a military hospital and to say I was apprehensive of that part was an understatement. My medical care is typically no longer on base for a reason. The actual pre-op/procedure went well. Very minimal pain and a courteous staff (minus one lady who woke up on the wrong side of the bed). I was in and out in less than 5 hours total. The incision sites are not healing as well as I’d like, but I don’t know if that is my body being stubborn or the procedure.

That very next week, it was time to dive in headfirst. I was scheduled for 3 days of chemo on April 9, 10 and 11. Then I would get a 3 week break. Rinse and repeat.

Round 1 :: Day 1 :: April 9

Today started off with my first port access and blood draw and then an appointment with my oncologist before heading over to the infusion room. This first time port access was a bit rough. Apparently, my port is wiggly and deep, then add in that I still had post-op swelling. Lots of pushing, lots of freezy spray and lots of being tough. Thankfully I have a pretty high pain tolerance, I really feel for people that don’t in this situation. Once that was done and I saw Dr. T, we went over my labs and rehashed my treatment plan. Everything was as it should be, so across the building we went.

Once we were in the infusion room, we had a few minutes to wait our turn. Mel was my nurse for all 3 infusion days and she was amazing. Calm, patient with my 50 million questions and personable.

Since I was still hooked up from the blood draw, Mel just had to flush my port and then get me all hooked up. Today’s plan was pre-meds (benadryl to help combat allergic reactions and aloxi to combat nausea) and FCR chemo (fludarabine, cyclophosphamide and rituximab also known as rituxan).

Premeds went well and then we started the rituxan. Slow, slow drip since allergic reactions are pretty common. Me, being the problem child, the medical mystery had a reaction at 25 ml/hr. Seriously?! At full “strength” they push at around 400 ml/hr. Sigh. It was really strange though, I was doing fine and then all of a sudden my hips started hurting. I thought it was just from sitting until it spread to every joint. Bryan got Mel and everyone moved into hyperspeed for me. They stopped the rituxan and pushed some more benadryl. Mel went to go talk to Dr. T and see how to proceed. We ended up totally stopping the rituxan for the moment and ran the fludarabine and cyclophosphamide next instead. Those bags both went off without a hitch.

After that, we started the rituxan back up super slow again. Only bumping up by 25 ml/hr every 30-45 minutes.

25 ml/hr….perfect.

50 ml/hr….fantastic.

75 ml/hr….and this…

I didn’t even realize anything was wrong until I got up to go to the bathroom and saw myself in the mirror washing my hands. Fun stuff. Since it was almost 5pm and I had been in the chair since about 9:30am, they opted to just stop the rituxan for the day, give me MORE benadryl and pick back up again the next day.

Round 1 :: Day 2 :: April 10

Day 2, back in the chair bright and early. While I was technically only supposed to have one long day (my FCR day) and two short days (my FC days), today was also going to be a long days since I didn’t finish my rituxan and we would have to move even slower today because of my reactions.

Premeds, fludarabine and cyclophosphamide went off again without a hitch. Then it was time for this evil drug.

We started at 25 ml/hr again and moved slower than a snail. But, look what happened next…

Yahoo! No reactions today and we finished the bag at 300 ml/hr. Thank you God! After sitting in the chair for 7-8 hours straight for the 2nd day in a row, I was DONE. While we will have to start lower than 300 again next round and move up, today was a huge, HUGE success!

Round 1 :: Day 3 :: April 11

Day 3, my last and final day for this round. Today was just a premeds, fludarabine and cyclophosphamide day. None of that yucky, necessary evil drug.

Today went off without a hitch, in and out in right at 3 hours. I even got my pretty blue box, really expensive shot. Neulasta basically stimulates new white blood cell growth. While it might sound strange for someone like me who had way too many WBC’s coming into this, chemo doesn’t know which ones are good or bad, it just targets them all and if my WBC count gets too low, it is a bad thing. The shot burns like heck and makes you achy the next few days but it is worth it for the benefits.

Labs & Follow Up :: April 23

Today I had my weekly labs, but in addition I get to see Dr. T. I just <3 her.

She walked in the room with a big smile on her face. Why, because of this…

For the first time in over 6 years, I have a WBC count in the normal range. 2 weeks after only 1 chemo round. AMAZING! She said she expected half, but not this.

To say we were thrilled would be the biggest understatement possible!

Round 2 was scheduled and I just needed to continue my weekly labs.

Round 1 :: Side Effects

After about the first week post-chemo, I thought that this chemo thing was just going to be a minor inconvenience. Right after chemo, I wasn’t miserable. Super tired and felt like I had a mild case of the flu. Bearable.

Then, 2 weeks in it hit.

This was my friend for 7 days. I experienced absolutely horrible lower digestive issues and some pretty bad nausea and a little vomiting. I dealt with the lower issues, taking Imodium and buying cushy, hiney wipes but when the nausea and vomiting hit, that was it. I don’t handle vomiting well at all. I would rather take a red hot poker to the eyeball.

2 days into the 7 days, we headed to the ER for an absolutely ridiculous, useless 7 hour stay. They offered no help other than some saline and zofran via IV, leaked contrast into my arm during the CT scan and took 5 hours to even call my oncologist on call, because the ER doc just thought he should let the diarrhea runs its course. Yes, in a chemo patient. 7 hours for me to have to hike to the bathroom 10 times, give blood, a urine sample, get 2 bags of fluid, 1 shot of Zofran, a CT scan and a RX from my oncologist on call. In addition to going in miserable, the whole experience was making it take everything I had left not to go ballistic on those people. That is the 3rd bad experience at the Centennial Hills ER and I will never go back unless I am literally dying and even then maybe not.

The next morning I talked to the nurse at my oncology clinic and they had me come in for more fluids and some more iv nausea meds. Sent me home with instructions to continue my oral nausea meds, Imodium AND the other Rx I got in the ER, Lomotil over the weekend and to call ASAP if anything got worse.

The nausea stayed under control all weekend but the other end did not, even with 2 meds. On Monday, I was back in the clinic getting more hydration and a new Rx that we could not find ANYWHERE in Vegas without a 2 days wait to order it.

Dr. T called in ANOTHER Rx but thankfully I didn’t end up needing it (orange flavored slurry anyone?).  After 7 days, my body finally kicked in and acted right. Just in time to start another round of chemo…tomorrow.

**As I am discovering, chemo brain is a very real thing. If this doesn’t make sense, just make it up in your head as you go along. :-)**