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.
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.
