So this is what the 1st round of chemotherapy (Mon-Dec 28, 2009, Tues-Dec 29, 2009, Wed-Dec 30, 2009 and Thurs-Dec 31, 2009 and Fri-Jan 1, 2010), was like for Carl.
8:00 AM appointment, Carl shows up, Stacey the friendly receptionist asks him his room preference (Chair or bed). Carl selects bed. She assigns him a room and nurse, (special requests should be made now). Stacey informs the nurse that patient Carl is here. The Nurse preps the room for the patient, checks the patients orders, and sets up. After a time period the nurse comes to take patient (Carl and entourage-wife, kids, etc.) back. The nurse weighs patient, and escorts patient to the room.
An IV (Intraveneous) line needs to be set up to get the medicines into the blood. This can be done with a needle in a vein or in a port. Many chemo patients (and Carl) has an port implanted under the skin.
The nurse needs to access the port to set up the IV. The skin over the port site is cleaned and a 90 degree angle bent needle is poked into the port. Needle entry can be felt - Carl usually winces. Some patients ice the skin over the port in advance to numb it. Carl doesn't do that - yet.
A syringe of Heparon is pushed into the IV. Carl can instantly taste a bad taste in his tongue. This means the needle is in the port, and the flow from the port into the vein near the heart is flowing forward.
Then the nurse attempts to suction blood from the body back into the IV line. This doesn't always happen right away. Sometimes proteins can end up lining the tube from the port to the vein, and forward flow works, but backward flow is prevented. The nurse will work though this- more flushes, chemicals to de-block the line, etc. If all else fails, an arm vein could be accessed, but the point of the port is to NOT bruise up the arm with IV's.
Chemotherapy patient can wear street clothes and walk around while getting the chemotherapy, pulling along the IV machine and fluids on a pole. The IV machine displays the time remaining on the current "infusion".
Chemotherapy for Round 1:
- Over 2 hours of time
- Saline solution, 1400 mg.
- Over the next 15 minutes of time, Simultaneously:
- Ondansetron 16 mg - Anti Nausea medication
- Dexamethasone 20 mg - Anti Nausea medication
- After above, over 15 minutes of time
- Over the next 2 hours of time
- Mesna 700 mg - this protects the kidneys linings from bleeding, which is a side effect from taking Ifosfamide.
- Over the next 2 hours of time
- Ifosfamide, 3450 mg in 500 ml of saline solution.
- Over the next 2 hours of time
- Saline solution, 1400 mg.
- Break????
- 4 hours after the last of the ifsofamide
- Mesna 1400 mg - Mesna protects the kidneys linings from bleeding, which is a side effect from taking Ifosfamide.
Completing the use of the port for the day is a procedure as well, some patients choose to leave the needles in overnight. Carl elects not to.
The outpatient chemotherapy are has snacks like cereal, ensure milk shakes, fruit juices, and tins of Campbell soup. Carl is encouraged to drink lots of water. Each chemotherapy chair of bed is private via curtains or walls; and has a TV's able to watch DVD or Videos or multiple cable channels like Cartoon Network, National Geographic, etc.
The length of time a chemotherapy session is depends on the drugs and dosage being administered. Many chemotherapy sessions are just a couple of hours. Carl's first course had substantial doses of strong drugs, which meant that Carl had to be there from about 8:00 AM to 5:30 PM. We rarely left the hospital before 6:00 PM. Carl slept much of the time.
Carl prefers his milk shakes from McDonalds over the ensure shakes provided. Miranda and the other children are OK with both ensure and the McDonald's shakes. Carl also enjoys playing the Game of Life with Miranda.
Carl had his beautiful hair until Jan 16th, 2010.
We last left off December 22, 2009, the happy day where Carl got his port placed. Many of these fun new terms (ex. port) will be defined in later posts.
- 2009 Dec 23, Wednesday:
- We woke up calm and relaxed, a plan (and port) in place. We got the children off to school.
- Carl was showered and dressed, ready to go to work for a nearly full day.
- We get a phone call. Would we like to meet with the Radiologist? (by the way, TODAY?)
- 11:00 AM Meeting with the radiologist.
- The thing in your neck concerns us... (what thing?) Remember the PET scan on December 18? The first Scan including the head? Guess what...
- 1:00 PM Hi tech custom device to immobilize Carl's head and neck for radiation created (for photo see What Radiation looks like.)
- CT simulation of radiation to neck area done.
- I left Carl at Froedtert to collect the children from the last day of school for the year 2009.
- 4:00 PM Carl got Radiation #1 (of 10) and was driven home by friend. (see What Radiation looks like)
- The treat in treatments are starting, before Christmas even.
- 4:50 PM I got a call from an anguished Anthony. He was hurt at wrestling practice.
- 5:15 PM Carl home from Radiation #1.
- 5:40-7:45 PM Mom and Anthony at the urgent care facility, X-ray shows a totally broken collar bone with the two pieces of bone not even close to touching.
- 8:30 PM Pain medication prescription filled for Anthony and Carl.
- Lots of Christmas snow coming down.
- Children at home with Carl put up the Christmas ornaments on tree (front side only).
- 2009 Dec 24, Thursday:
- The children slept in at home - no school.
- 8:00 AM Carl got Radiation #2 (of 10) at Froedtert Hospital in Milwaukee, Wisconsin.
- Carl got a neck brace. (You have to be kidding, right?) After Carl indicated he was unlikely to wear the neck brace the nurse told him that one of his vertebrae had some bone that was partially missing... You don't want to be paralyzed, do you? (answer, nope, and Carl doesn't want a sarcoma either.)
- New song invented. "It's beginning to look a lot like cancer, Every-where they look..." [Sing to the familiar Christmas tune.]
- We went home and collected the children. They enjoyed the non-stop screen time while we were gone very much.
- Christmas Eve Party with family on my side of the family. Carl moved his head carefully and didn't wear the neck brace. He figured he would risk paralysis for one more day.
- I went home and Carl and I went to bed. Carl slept with the neck brace on. I sighed, then got up and wrapped the presents I had and put them under the tree.
- 2009 Dec 25, Friday:
- Santa left precisely 5 wrapped presents under our glowing (1200 lights!) tree. This does not compare favorably to the bounty from previous years. The children did NOT let us sleep in, and one present WAS open before all the family was assembled.
- The children still had a good Christmas anyway (It's not like we don't have any toys, after all), and a Shopping Spree Day for Saturday was discussed.
- Christmas Party with family on Carl's side of the family. Carl wore the neck brace. "Let the Freak show begin" Carl said as he walked in with his neck brace and cane. OK, this is not a great thing for Carl to say, and I probably should leave it out, but it's what he said, it's what he felt, and it's what I report here. Carl thinks he will blend more once his hair falls out.
- 2009 Dec 26, Saturday:
- Shopping Spree day with family and Uncle Paul. We got the children pretty much whatever they wanted [but alas, no XBOX 360, Anthony's dearest wish. Had the progress reports of multiple children shown more (some?) progress...]
- Lots of snow falling fast does not dissuade shoppers.
- Parking was atrocious at the stores and malls. Even handicapped parking was very full (Carl got a temporary disabled parking sticker with the cane). Carl thinks they must be giving temporary disabled parking stickers out to anyone who asks. (OK, lots of the humor going around is kind of dark at the moment...)
- 2009 Dec 27, Sunday:
- 11:00 AM Church service. (Carl, with neck brace and cane attracted some welcome attention - I love my church family! Thank you all!)
- 2009 Monday Dec 28, to Thursday Dec 31... :
- 7:30 Carl got Radiation
- 8:00 Carl got Chemotherapy
- Carl did other tests, labs, appointments...
Christmas and December 2009 will be remembered like no other... Each day of Dec 28, Dec 29, Dec 30, and Dec 31 were their own mini adventures... But I am now tired and will post this post, and I will have covered 2009. Sort of.
Happy New Year to all. (This I mean sincerely).
This is the first year in more then 15 years that I have not had my Christmas cards made and sent out before the New Year started. Something else to do in January 2010. I must make the cards, and I must get the photo, before Carl's hair falls out. After all, I scrapbook my Christmas cards into my Christmas Album. For that reason alone, if none other, I intend to create the Christmas cards, and send them out! [Note from May, 2010: I never sent out Christmas cards for 2009]
An IV (Intraveneous) line needs to be set up to get the medicines into the blood. This can be done with a needle in a vein or in a port. Many chemo patients (and Carl) has an port implanted under the skin. 
Chemotherapy patient can wear street clothes and walk around while getting the chemotherapy, pulling along the IV machine and fluids on a pole. The IV machine displays the time remaining on the current "infusion".
The outpatient chemotherapy are has snacks like cereal, ensure milk shakes, fruit juices, and tins of Campbell soup. Carl is encouraged to drink lots of water. Each chemotherapy chair of bed is private via curtains or walls; and has a TV's able to watch DVD or Videos or multiple cable channels like Cartoon Network, National Geographic, etc. 
