An Unexpected Complication on an Otherwise Restful Day

A Lousy Afternoon in the ER

I had anticipated not writing another of these for a few weeks–that’s when I start maintenance chemo.  But that plan was waylaid by a little drive down to the emergency room [ER] at Stone Oak Methodist Hospital this afternoon.  Susan came along to keep- me company.  Take my iPad away when medical personnel came into the room, return it when they were gone for a while.  Oh, I forgot to say why I went in in the first place.

Okay, yesterday was a long day.  Susan was busy in the kitchen much of the morning preparing a lovely and nicely barbaric, oven-roasted turkey to welcome our son the computer programmer/developer home for the day.  Everything went well.  Aside from a fine late afternoon dinner, the Cowboys beat the Dolphins and UT squeaked past the Aggies.  Both games went up to the last five or six seconds.  I did, perhaps, have a little too much chocolate and apple pie.

So, this morning I woke up and went quickly, more quickly than I had planned, to the bathroom.  I feel rather like a 3-4 year old with potty humor mouth, but what appeared in the bowl was (dear me!  Excuse me, please.) black and greenish.  Something for Halloween and not for Thanksgiving.

So, I called Doc Onc1 and did not take the Imodium I had reached for because its label cautioned against taking it when you have…ahem…”black stool.”  That’s a direct quotation and I apologize again for the language…if any of you are squeamish.  Doc Onc1’s on-call partner, Doc Onc3, called back and told me to hie myself to the ER for various tests normally conducted by my urologist.  What a pleasant way to spend 3 – 4 hours:  an IV, blood tests, digital test (‘nuff said), and an X-Ray of lungs, stomach and full disgustive (<-- pun intended) tract.

The results?  Nada.  I did not have blood in the place suspected of having blood <--circumspection.

So, Susan and I went home with orders to call Doc Onc1 first thing Monday morning.  Were you aware that more soldiers died of diarrhea in the Civil War than of enemy action?  I had found that interesting until today.

What Doc Onc3 had suspected was that I had, in all the time of chemo treatments, developed an ulcer that was bleeding a bit (not the case).  I had suspected that the Avastin™ (possibly the culprit) had caused some kind of bleeding (the reason it is no longer approved for breast cancer while remaining the most effective chemotherapy for that cancer).  Neither case was true.  Instead, I had an inexplicable anomaly, something vaguely related to an allegory, I think.

The X-RAY Tech did compliment me on my clear lungs.  I stopped myself before complimenting her on hers.

Again, my apologies for this crappy little report, but in the interest of full disclosure….

Last of the BIIIGGG Chemo Treatments

Bye, Bye Carboplatin!

[Carboplatin, or cis-Diammine(1,1-cyclobutanedicarboxylato)platinum(II) (trade names Paraplatin and Paraplatin-AQ) is a chemotherapy drug used against some forms of cancer (mainly ovarian carcinoma, lung, head and neck cancers).^[1] It was introduced in the late 1980s and has since gained popularity in clinical treatment due to its vastly reduced side-effects compared to its parent compound cisplatin. Cisplatin and carboplatin, as well as oxaliplatin, interact with DNA, akin to the mechanism of alkylating agents.--Wikipedia]

So, I delayed taking my sixth and final major chemo treatment until yesterday so I could be awake during my poetry reading at Gallery Nord in the affluent little suburb of Castle Hills—a suburb totally surrounded by San Antonio.  I had seen Doc Onc1 on Tuesday, my regularly scheduled meeting, once-a-month visit with my chief Onc Doc, and found out the things were still going well, cancer markers down below 25, and that my Thursday chemo treatment would be the last to use three different chemical brews.  After yesterday, I’ll be dropping the carboplatin and taking only the Alimpta and Avastin.  The after-effects should be much more easily handled.

It’s been a four-doctor kind of a week:  My primary care physician, a jewel among doctors, who is also working on my Type II diabetes and controlling it nicely; Doc Onc1; my ENT doctor who checks on my throat to help improve my voice; and my urologist who does unmentionable things.  Aside from that, two blood labs where the vampires dine heartily on my veins.

So, yesterday, feeling somewhat grumpy, I walked into the “treatment center”(read: chemo therapy drip room) with the dozen or so other cancer patients and got hooked up to an IV while three different chemo mixes and three flushes plus a B-12 shot found their way into my veins.  The whole chemo treatment takes a total of approximately four hours with nurses racing from patient to patient when their IV machines began beeping loudly.  I am usually the first patient in and the last patient out in the mornings.  each of us seems to be doing something different or suffering from something different:  testicular cancer, breast cancer, kidney cancer, brain cancer and so on.  I don’t think I could work in such a place and retain my sanity.  I have tremendous respect for those who can.

I finally cracked and asked the nurse who watches over my IV and sticks the needle in me each time (not having abused my veins in what I delicately call my wilder days, I do not need a mediport) what my real prognosis was.  She looked at my right foot and said, “Nope, no expiration date has been tattooed on.”  Meaning, she said, that as long as I did the maintenance and kept having regular check-ups with Doc Onc1, I should be okay.  That’s fine.  That’s something I can live with.  This morning, I went in for my Neulasta shot, an injection that restores some of the red blood cells killed by chemo.  I had blood labs done at Stone Oak Methodist Hospital.  I visited my PCP.  I saw my cardiologist.  I came to work.  

This little poem is for my cardiologist's EKG/Sonogram techie:

Dopplering the Heart

So, I’m almost watching this monitor, see—

no, its not an EKG—this nurse

with too long fingernails, some kind

of clear jewel in the middle of each—

well, she leans over and rubs cool gunky

stuff all over my chest and neck.  She had

soft hands, a delicate, well-trained touch,

but I hardly notice cause I’m looking

at her fingers and not feeling much

of anything until her blouse falls open

slightly and black lace starts showing,

my eyes shift a few degrees north

she jabs me with something, not a needle,

some hard device she rubs all over my chest

and neck and says look up at the screen

and I see my heart doesn’t look like much

it’s swelling, retracting, tiny little lines

open and close on the monitor but that

gets boring.  After a few minutes she shifts

slightly well, I’m tempted to look back

at the heart display just to see if anything

significant in that area had also sped up

but I’m kind of ticked about all these tests

anyway, missed teaching yet another class

and nothing’s shown up after these exams,

so I just enjoy the show—not the one

on the little  tv screen but the other display

 this tech puts on  intentionally I suspect

                         

she puts the stuff away, wipes my chest

and neck with coarse tissue “ just to get you

cleaned up,” she says and then she looks

down at me. “You have a good heart”

she says and I laugh.  She winks,

turns around,  looks back and waves.

She purses her lips, says "have a good day”

and  leaves the room.

Back to treatment:  the carboplatin, Nurse Maggie explained, was the chemical brew that caused most of the exhaustion for days, sometimes more than a week, after treatment.  It's better than cisplatin because it does not cause vomiting or nausea.  When I stop taking that, the Alimpta and Avastin will still cause some problems but not as many.  So, I'm facing a not great weekend, but a much better tomorrow.  As Scarlet O’Hara said, “Tomorrow is another day!”

I’ll go in once a month for a half year to have the other chemo brews dripped into my veins, will continue to get B-12 shots and Neulasta, but will not be as exhausted as I have been.  I get to keep my handicapped parking sticker.

More as more occurs.