Chemotherapy, Take 3

8:05 a.m.:  Back at Georgetown, in the Clinical Trials area on the Seventh floor of the Main building in Room 108 (this side of the building has the view of Georgetown I noticed in my very first GTown post), waiting to begin the first cycle of my third round of chemo.  I'm going to be building the blog in real time today, so feel free to check in periodically for updates.  The real fun should begin about 15 minutes after I get my first dose of intravenous Benedryl--hope I don't do the blogging equivalent of drunken texting.

Left the house at 5:20 this morning and got here at 7:25, which is not bad time for this run.  The Trials areas was already open and manned; Miss Marta got my vitals and sent me to my home for the day.

I was here last Wednesday for a trial dose of the trial drug, Ofatumamba.  Took for frickin' ever to get the 1000 ml (that's almost a liter) infused, but the good news is that other than causing a controllable rash (an ITCHY controllable rash) there were no adverse side effects.

Now I'm waiting for the pomp and circumstance to start.  The needling of the arm, the admis--BREAK BREAK:  we're about to insert the catheter (not there) in a vein in my forearm.  Weird, but even after the last two years of this stuff,  I still can't watch the needle go into my arm.  I've been swabbed up and...Jamela just nailed the vein with absolutely minimal discomfort, drew about eight vials of blood.  There's a lead attached to the catheter that ties into the IV line, and that will stay in place until tomorrow.  I'll break here and share this on Facebook.  Hope this is entertaining and informative today.
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8:55:  A big part of chemotherapy is waiting.  Now that they've taken blood, we have to wait for the labs to come back to say I can start infusion.  No big deal now, but later when my white blood counts may be suppressed, I can actually have counts too low to allow treatment.  Only when the labs come back OK will they order the drugs made up.  Unlike Tylenol or Theraflu, chemo drugs are not prepared in advance.  They are expensive and the pharmacy (located here on the seventh floor) will only start mixing when the patient is here and ready to start treatment.  This could easily translate into a couple of hours of sitting around.  Last Wednesday the labs were really slow, which led to my 8:15 p.m. exit.  (I've already appropriated an extra sandwich from the patients' fridge (no I didn't steal it--the hospital provides them) as an emergency back up dinner should I get delayed again.)

Back to the theme of "waiting", the real waiting today will start when they hang the big bag-o'-drugs up on the IV stand, tie it into my arm, then leave it there until it's all gone.  Effectively, I'm tethered to the IV stand from that point  forward.  It gets old, particularly trying to prevent the IV line from tangling if/when you move around.

Anyway, I've got connectivity through my work computer and my iPad.  I'm currently looking at workforce trends and listening to 14th century a cappela choral music courtesy of the iPad's Pandora application (well, somebody's got to listen to it).  It's very calming.
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9:50:  Still waiting.  As an aside, one advantage of getting here early?  You get to go around to all the other treatment rooms and steal the good magazines.
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9:55:  Mercedes just showed up and we're about to get the party started. Mercedes has promised smooth sailing today and forbidden me from getting a rash.  My blood counts came back and everything looks pretty good.  I'll be getting the Benedryl first, so this could be my last coherent posting for a while. 
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10:25:  Finally infusing, but only with the 'prep' drugs--no Bendaryl just yet, though.  I'm getting Zolfram to ward off nausea, then will get my Bendamustine afterward.  Apparently we wait an hour after the Benda before we can start the Ofatumumab.  I've already accidentally hooked the IV line around the arm of the chair, but you get really sensitive to the tug.  No hurt, no foul.
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11:10:  Lunch came early today.  Today we are having a brown bag lunch with a tuna salad sandwich, an apple, some Lorna Doone shortbread cookies, a 4 oz. container of cranberry juice cocktail, and a bag of Lays potato chips (yes, all that and a bag of chips).  Also got a spare banana for later and a USA Today.  Not a bad haul.
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11:35:  Done with the Bendamustine and starting on the next round of 'prep' drugs.  Still no Benadryl.  Just met Bethany, a nurse who took my vitals.  She normally works down on the 5th floor on the 'non-trials' floor, but is rotating up here every now and again.  Nice to see a new face.  Lunch is done, and if it is followed by the Benadryl, I see a nap in my very near future.
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11:53:  Fabulous.  Was just informed that I have to come back on Thursday for a growth factor shot (which will stimulate the production of white blood cells).  Good on some level, but I thought we were going to wait to see if it is necessary.  What this translates into is "Drive two hours, ride an elevator, get a shot, drive home two hours".  As I said, Fabulous.
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12:30:  Not sure if they gave me something, but staying awake does not seem to be an option just now.  I keep falling asleep and feel sightly drunk/drugged/sleepy.
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12:45:  Surprise!  I did get Benadryl infused earlier.  No wonder I got turned off like a light.  Mercedes just started the 1000 ml bag with the Ofatumumab in it.  God that's a big bag.  Now lets see if I get the rash again.
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3:05:  I've been drifting in and out of sleep for the last two hours as the Benadryl works its magic, but currently am fairly awake.  We are up to the maximum infusion rate (400 ml/hour)and I have about 750 ml left to infuse.  So I should be done by around 5:00 p.m., a much better time than I anticipated going into the day.  So far, no rash and no itching.  I'm still managing to get some work done, though I've been getting assists with logic from one of my staff.  We're working on a moderately tricky workforce policy and my mind isn't quite keeping up.  Thank heavens K4 is keeping me straight.
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4:45:  If my infusion bag was a peanut butter jar, it'd be about time to start scraping the sides and bottoms--almost done.  Looks like I have about ~50 ml left, or about 7 minutes worth to infuse.  Not a bad day so far.  I actually got a fair amount done.  As we speak the alarm on the pump is beeping, bringing in Mercedes to check on me.  She agrees with the 7 minute estimate.  We're going to leave the catheter in and use it tomorrow.  I used to do this routinely for two days, so one day is no big deal.
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4:55:  AND we're done.  At least for today.  Mercedes unhooked the IV then injected an anti-coagulent to keep it from blocking up.  We've wrapped the catheter in gauze.  Now all I have to do is clean up my scattered accoutrement and head for Jim and Elena's (though I may walk the campus a little first).

Hope you gained some insight into a fairly standard day of chemotherapy.  I'm lucky in that I have almost no bad side effects to deal with, but it's still a long day.  Tomorrow should be fairly short by comparison. 
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10:45: Postscript. In bed at the home of my friends Jim and Elena. Had a wonderful dinner, much beer and wine, and a great conversation with their daughter Tayrn. Greatly enjoying and appreciating their hospitality. Signing off for the day--thanks for coming along. (Now if I just had some intravenous Benadryl.)