"It's a Good Life"

Ever since I lost my hair, I feel like I'm living in a Twilight Zone episode.

Episode 73, season 3 to be exact.

When someone sees me for the first time, their first comment is invariably how good I look.

"You look good, Zach. Real good. It's good that you're bald. Honey, doesn't Zach look good?"

Relax, folks, I am not going to send you to the cornfield.

By the way, tomorrow is the first session of my final round of chemo.

Two Nurses, Four Pokes

The Neupogen worked like a champ, and my blood counts were back in the acceptable range. The first nurse poked and prodded in a couple of places and decided that someone with more experience could perhaps do a better job. She was right, sort of. The second nurse found a vein on the second try, and I was finished in an hour.

Just to keep things in the proper perspective, the guy in the chair next to me was diagnosed with pancreatic cancer, which has a one to two percent survival rate. I think of people like him when I feel like Joe Btfsplk. I don’t really have it so bad.

Only three sessions to go.

Keeping Score? Last Week 3, Zach 0

Last week’s blood count wasn’t entirely unexpected--my oncologist says few patients make it through chemo without a “time-out.” What was unexpected--to me--was the fatigue and nausea that followed me around like the black cloud above Joe Btfsplk.

The nausea (and granted, I wasn’t taking my anti-nausea pills because things were manageable up to that point) started at work. Within seconds of the first wave, I was on my hands and knees, vomiting into a trash can, and praying a client wouldn’t walk in the door. I left work and went to bed, where I stayed the rest of the day and most of the next.

The fatigue snuck up more subtly. I find myself going to bed earlier and earlier, sometimes by 6pm. I get up later and later. By the end of the day I’m practically worthless at work, and I take a nap as soon as I get home.

The co-pay for three Neupogen injections turned out to be $2040 for the week. If we didn’t have insurance, it would have been over $11,000.

Not a good week at all...

This week just kicked me all around the block.

My chemo session was canceled because my blood count had dropped below the minimum. I have to take a very expensive drug now to get the platelet count back up; how expensive you ask? Our co-pay is $2000 a week. I'm still reeling, and I have to take this drug for five weeks more!

I'll go into more details as soon as the holidays are over. We're going camping tomorrow. Screw cancer.

Session One--Round Two

Yesterday was a long session, 10am to 4:30pm.

But, unlike last cispatin-round, no nausea so far. And the nurse found a vein the first poke.

My blood count was a little iffy whether or not to go forward with the chemo that day, but the oncologist felt that staying on schedule was more important than the low numbers, especially since I felt pretty good.

One thought I had after completing the first round fairly unscathed is that some of the chemo patients I've met become so obsessively focused on analyzing their feelings and body-state in real time that they give undue weight to things they'd otherwise just shrug off. Woody Allen once said, "More than any other time in history, mankind faces a crossroads. One path leads to despair and utter hopelessness. The other to total extinction. Let us pray we have the wisdom to choose correctly." I see that a lot with some cancer patients.
There are many legitimate issues I've been going through--fatigue, diarrhea, constipation, some nausea--but when I don't focus on it, when I don't let it occupy more of my attention that it requires--it's easier to get through the unpleasant times.

Compared to what others are going through, dialysis patients for example (three times a week, three hours a session for the rest of their lives), I don't think I have it so bad. I can see the light at the end of the tunnel. Five more treatments and I'm through.

Besides, my wife thinks I look okay bald.

Final Hair Update

There's not a lot of updating to do about hair after you've shaved it all off.

I thought a buzz-cut might work, but instead of long hair falling out, all it accomplished was short hair falling out. Plus, I had a splotchy, uneven "chemo-head" that didn't look attractive or healthy. So my wife helped me shave it off.

In the space of less than a week, I went from a full head of hair to looking like I'm auditioning for the "King and I" at the Kettleman City "holiday spectacular" dinner-theater.

As they say, the show must go on!

Well, that was fast....

Despite what the oncologist told me, I lost my hair.
It fell out amazingly fast; start to finish was just a few days. A few very annoying days, since each morning I would wake up with a mouthful of hair.

On the bright side, my beard growth has slowed to about half of what it was. So what we're paying for the chemo we'll probably save in razor blades. No more trips to Costco for those outrageously expensive five-blade Gillette Fusions.

See? There can be an upside to almost anything.

Hair today.....

The last couple of days my hair hasn't quite its regular self. Kind of dull and flat. I thought it might be the weather or the fact I've been going to bed earlier than usual, but when I tried to pull out a handful of hair yesterday, a lot more came out than I'd ever seen before. Even my wife commented that it looked noticeably thinner than usual. I'll definitely keep an eye on this.

In fact, yesterday was my worst day so far. I got tired very early, and went to bed at noon and stayed there on and off until this morning. The arm that received the gemzar is very sore from my elbow to my fingers, and is swollen and red. I'll keep an eye on this too.

Chemo is a bit like being on a teeter-totter. It's very easy to tip yourself one way or the other. On Thursday I had another guy in my room who was about to have his first session. As the nurse told him the side-effects, and what he could expect in the coming months--in much detail--he almost became ill before the IV was inserted.

This has not been a good weekend. But compared to what many others go though, I still consider myself pretty fortunate.

The Good, the Bad, and the Ugly

The Good
Yesterday (Gemzar only), was my last treatment in round one. Compared to cisplatin, gemzar is very tolerable--I haven't taken a single anti-nausea pill in a week.
Only two more rounds to go.

The Bad
My veins have grown increasingly shy, and need a lot of poking and prodding and pushing the IV needle around searching for a workable spot. Needless to say, this is painful and requires the ipod volume to be turned up another notch. And gemzar--unlike cisplatin--burns when it goes in. But, it's a short session, and I was in-and-out in an hour.
My platelet count, in one week, has dropped from 187,000 to 77,000. In a normal adult, the platelet count is about 150,000 to 450,000 platelets per microliter of blood. If platelet levels fall below 20,000 per microliter, spontaneous bleeding may occur and is considered a life-threatening risk. That's one of the effects of gemzar, but I was more than a little surprised at how dramatic the drop was. Next week is my week off before the second round, so the numbers should rebound somewhat.

The Ugly
I discovered today that one of the main ingredients in saline IV drips is dihydrogen oxide (also known as dihydrogen monoxide), which has been used for years as an industrial solvent and is a major component in acid rain.
Dihydrogen oxide is composed of hydrogen gas--very explosive--and oxygen--an ingredient in battery acid. It is colorless, odorless, and tasteless. It contributes to "greenhouse effect," is used in nuclear powerplants, as a fire retardant, and may cause severe burns.

After learning this, you can imagine how ill I felt. I went straight to bed and was far too sick for dinner.

Update:
Oops. My wife just informed me that dihydrogen oxide is another word for H20--ordinary water. Suddenly I feel much better.

Session Two--Round One

This morning was Gemzar only. Not much to report; the session lasted about 45 minutes, start to finish, about like a blood donation without the cookies and prying questions.

I have to say, chemo nurses really seem to be on a higher level than many of the nurses I've dealt with lately. Every one I've had contact with has been pleasant, competent, and empathetic.

Because I've felt pretty good, I've stopped taking compazine. I was warned to be on guard for any waves of nausea and to catch them early, since it's easier to keep nausea at bay rather than try to stop it once it grabs ahold of you. But all-in-all, today was just another day. And that's good.

The Price of Admission

I'm sure you remember the classic Pogo cartoon--"We have met the enemy, and he is us."

That's a bit like what going through chemotherapy is. We can be our own worst enemy. From my own experience, and that's all I have, my nausea -threshold is something that I can both raise and lower with certain thoughts. If I just imagine drinking another Readi-Cat 2 pina-colada, I can literally feel the waves of nausea beginning. If I concentrate on the beginning flicker of illness, I can feel it grow and crest. In fact, I can make this happen a dozen time before lunch.

And it's hard not to concentrate on how you're feeling. I find myself struggling to not put every sensation under my mental magnifying glass--but, I'm also finding that it's something I can control by not focusing on it.

I know this isn't easy, and is perhaps even counter-intuitive. For many months I didn't pay attention to what my body was telling me, and my cancer may have spread because of it. But we can choose what we think about, and to the best of my ability I'm choosing to not magnify and exaggerate every new or different sensation--even those that aren't pleasant--into something that can make me sick.

I'm not naive enough to believe that I can control all this, or that I won't get legitimately ill, but all I have to do is get through the next three months.
I can do this standing on my head.

And this is your price of admission. Along with what's really going on with my chemo, you have to read what I think is going on. I hope it helps.

Session One--Round One

We arrived at the clinic yesterday at 8am, and I was welcomed with another of Edna Wilholtz's Readi-Cat 2 pina-coladas, which as I grow more accustomed to them taste a bit like a pina-colada mixed with Elmer's Glue.

The CT scans were clear, so that was a relief.

The actual chemo session lasted about four-and-a-half hours, since Cispaltin needs a lot of saline solution to dilute the evilness. They begin with some anti-nausea drugs before the Cisplatin and Gemzar, and quite honestly, except for the sheer boredom of sitting there, it was no worse than a morning spent with English-as-a-second-language DMV workers.Perhaps even better, since chemo nurses are very nice.

Only one part of the treatment was a bit unpleasant. Towards the end of the IV drip, they infused the solution with something called Lasix, which is a powerful diuretic. I was warned that I would probably have to urinate about every ten minutes. Well, since people who have had a radical Cystectomy do not necessarily feel the same urgency that we did before, this can be a problem, especially if there is only one bathroom for the whole chemo section. Plus, the nurse wasn't exaggerating--I've never had to pee so much in my life. She finally brought me a portable urinal, which not only worked fine, but had measurement printed right on it, so I didn't have to use one of my wife's cooking measuring cups to satisfy my curiosity about my flow and volume. The first wave was twelve ounces in a very very short time--not bad.

I was sent home with two prescriptions, compazine for anti-nausea and ativan (which helps with sleep).

The entire day wasn't bad at all. Much better than what I expected. I had some pizza and went to bed.

In the interest of honestly, however, this morning was less than perfect. I had one wave of nausea and threw up a couple of times, but it passed in about ten minutes. After than I felt a bit tired, but fine. I worked all day without any incidents.

I'm certainly not predicting that this is as bad as it's going to get, but for me, right now, 2:45pm, Friday, Pacific Standard Time 2006, this certainly seem doable.

My next session is October 19, and is Gemzar only--which goes very quickly; about half an hour.

The Night Before

I told my wife I could do this standing on my head. Now we'll see.

A little background. I turned 50 in September, and was diagnosed with T3a N+M0 bladder cancer in May, 2006. Because my cancer was both invasive and aggressive, my urologist recommended that I have surgery at USC Norris Cancer Center. My surgeon was Dr. John Stein. In that regard, I couldn't be more fortunate. Dr. Stein is one of the leading BC surgeons in the world, and my surgery (on June 23, 2006) went very well.

In fact, three months after the surgery, I feel terrific. Looking at me, you'd never know anything was wrong, and indeed, most of the time I almost forget I had surgery at all--my bladder, prostate, two feet of intestine, and 85 lymph nodes would probably be disappointed that they aren't missed too badly, but it was either them or me. They lost. My pathology report, however, indicated that the cancer had spread to one of my lymph nodes, so three rounds of chemo were indicated. Both Dr. Stein and my local oncologist agreed on gemcitabine (Gemzar) and cisplatin.

I was pretty apprehensive about the chemo before meeting with my oncologist, but really, it doesn't sound as awful as I'd dreaded. I'm generally an optimistic person, and perhaps I'm being a bit naive, but I'm not as fearful about this as I was just last week. I'm going to bring my ipod, turn it on, let the nurse find a vein, and listen to music for four hours. I can do this standing on my head.

That's the plan.

Tomorrow is the day. I'm keeping my fingers crossed.

Update: Since I'm having CT scans and x-rays right before the chemo begins, I just drank a bottle of something called Readi-Cat 2, no, not a new kitty litter, but a barium solution that tastes a bit like a virgin pina-colada served by Edna Wilholtz at the Boise Rotary Club's annual Luau night. A bit of rum would make it more palatable.