Round 7: Pushing for Poison

First, I’d like to thank my white blood cells for taking a vacation, allowing me an additional week in between chemo sessions. I thoroughly enjoyed food without it tasting like metal, and the extended leave from bizarre aches and pains was charming. While it was nice taking an extra week off from chemo, it messed up at least ten upcoming appointments there were already on the calendar. These appointments ranged from future infusions to scans, scopes, probes, and labs. After some much-needed help from savvy schedulers, they got me back on track. Now, it was time to get back in the business of kicking ass cancer.

The roster of my chemo crew shifted this round since my youngest sister rolled out to college. This time my rush-hour hardened Mom and soon-to-be-married sister joined me.

After my lab draw, we met with my oncologist’s physician assistant. We went over the results of the stress test in more depth, and everything looked just fine. We also discussed the nausea issues I had with the last round that lead to an ER visit. We agreed that the best course of action would be to add a few new medications to my list to keep nausea under control.  

The first medication added was an IV course of Emend 3-day. As the name suggests, this drug combats nausea for three days, unlike the old cocktail, which only lasted about eight hours. The second drug added was a four-day dose of Decadron, a corticosteroid that helps with nausea and serves as an all-around pick-me-up. The final drug added to the equation was Neulasta, designed to help stimulate the growth of white blood cells.  

There are two delivery methods for Neulasta, an injection you receive at a medical facility, and a “patch” that delivers a dose 27 hours after it is applied. Since I live a fair distance from the university medical center, and I have chemo disconnect on the weekend, I received the “patch” option (Neulasta Onpro). Neulasta Onpro is the Bugatti Chiron of the medical device world. A single dose “patch” runs anywhere from $6k all the way up to $12k depending on various factors. Thankfully, my insurance agreed to cover the cost of this medication.

After reviewing the new medications, I received a head-to-toe checkup, which bought enough time for the lab results to show up on the computer.  Insert dramatic music here. Lab results showed my white blood count was 1.0, which my PA informed me was too low to receive chemo. The acceptable white blood count level is 1.2. Given I was so close to the value, feeling well, and slated for Neulasta, my PA left to call my oncologist to see if we could make an exception. Never in my life, did I think I’d be disappointed about being told I couldn’t be poisoned, but I was.

I sat with my crew anxiously awaiting to hear my fate, would I be poisoned or would I be delay yet another week? After ten agonizing minutes, my PA came back and let us know the oncologist cleared me for chemo. Cue the ironic poisoning celebration.

We went back to the waiting room, expecting a two-hour wait since they had to finagle me into the schedule after the last delay. To our surprise, I was called me five minutes after we sat down. As a double bonus, I got assigned a “luxury” chemo suite with a TV and a private bathroom. Apparently I accrued enough frequent poisoning miles to get a complimentary upgrade.

Overall the infusion session went smoothly. Since the nurse was introducing Emend into the mix, the premedication phase took twenty minutes longer to ensure I didn’t have an adverse reaction. After carefully pondering every bodily twitch, tingle, and function for 20 minutes, I was convinced I wasn’t allergic. Bring on the poison.

Adding to the excitement of round 7, the university switched to a safer connection system for chemotherapy treatment. Pardon me as I geek out a bit… Instead of the old push-twist-and-lock IV connectors, the university switched to a much simpler and safer click and lock system. To add some color to the importance of this transition, during previous infusions, I saw a few drips escape the old connector system. Luckily, the pharmacy primed the lines with dextrose, so it did not contain any chemo. With the new system, chemo can’t leak onto the patient or nursing staff since it is a closed system. This is incredibly important since some of the chemo drugs can literally kill your flesh on contact. I’m confident it will be much safer for nurses who see dozens of patients each day. I was also happy to hear that in the coming months, chemo centers nationwide will all be making the switch. Ok, I’m done geeking out. 

One the fancy new connector was attached, and the poison started flowing things went surprisingly smoothly. Two and a half hours later, we were headed out the door, with my chemo grenade and fancy new connectors.

Saturday and Sunday, I noticed remarkable improvements in my appetite thanks to the Emend and Decadron. I was thrilled that I had absolutely no nausea all weekend. Unfortunately, the Emend caused some pretty awful acid reflux inducing hiccups every once in a while, but it was still better than nausea. Then there is the Decadron, it certainly improved my nausea, but it added +20 to the “oooh shiny” ADD factor. There’s something special about feeling like a cracked out squirrel!

Sunday afternoon, it was time to be disconnected from chemo, but the home healthcare nurse didn’t show up at the scheduled time. It turns out after the delay in my last round of chemo, some wires got crossed, and home healthcare was never notified of my disconnect. Fortunately, I am married to a beautiful social worker who has to deal with this stuff every day at work. Needless to say, a few hours later, a nurse arrived to disconnect me from my pump. After everything was unhooked and I was receiving fluids, it was time to be hooked up to my Bugatti Chiron Neulasta Onpro.  

Neulasta Onpro is quite the device. After you unpack it, you need to use the included syringe to fill the pump with the medication. The kicker is, once you fill with the drug, the device begins blinking orange and, you have three minutes to get it stuck in place. The device must be connected to either your abdomen or the back of an arm. I chose to placed it on my stomach since I sleep on my side and flop all over the place at night. After the device was in place, a few minutes pass, and it began beeping to taunt me.  

I knew what was coming next; it was going to stab a needle into me and place a catheter. BEEP, BEEP, BEEP… yeah, yeah, yeah, get it over with already. My kids were looking on in anticipation, ready to see their dad get stabbed. After what seemed like an eternity, the device began to make a clicking noise and then stopped, refusing to stick me. Finally, after I was convinced it was broken, the damn thing jabbed me. Startling me, I jumped about two inches off my chair before saying, “it got me.” My jumping must have been quite the sight since my kids, nurse, and wife all started laughing. It didn’t really hurt at all, it felt more like being snapped with a rubber band more than anything, but it was startling nonetheless.

On Monday, I could tell the three-day anti-nausea medication was wearing off, but I didn’t feel the need to take additional meds. I spend most of the day laying low since I was feeling a bit worn out. That evening, twenty-seven hours after the Neulasta Onpro “patch” was applied it began beeping to let me know it was about to start administering the medication. I couldn’t feel anything when it started pumping, but I could hear it clicking as it pumped away. About 45 minutes later, it was done and could be removed. Removal was straight forward, all my wife had to do was peel away the adhesive and lift it away from my skin. Once it was off, we could see the little purple catheter sticking out of the device. And just like that my Bugatti Chironeque patch made its way to the sharps container for disposal.

On a side note, I began taking Claritin the day Neulasta Onpro was attached. The PA said it could help prevent bone pain associated with the drug. I believe it helped since I didn’t start feeling any pain until days 4-5 after having the Neulasta. Bone pains is an unusual sensation, its like a dull ache that penetrates your soul. Unlike muscle aches and pains, it doesn’t get any better or worse with movement, it just lingers. Fortunately, Tylenol took enough of the edge off for me to continue with my daily routine. I’d like to think that Claritin helped alleviate most of the pain, so I’ll be sure to take it next time as well.  

I started feeling more like myself about 9 days after the infusion, although I find myself getting tired very quickly. Then again, I’m a dude that has gone through seven rounds of chemo, so I give myself some slack. I’ve also slowly grown accustomed to not trying to do everything around the house that I used to. With that acceptance, the feelings of guilt and worthlessness have also slowed down a bit. I’ve finally realized that I need to focus on healing so I can start tackling the “new normal” once I kick this cancer’s ass.

Finally, as I spend more and more time in the cancer center, I see many people who are going through this journey by themselves. I can’t even imagine having to endure this crap alone. I’m so grateful to have such a fantastic support system! Thanks to everyone who has supported me along the way, it really means a lot. Only one more round of chemo to go and then we are on to the next leg of the journey.