Surrounded by high-tech machines measuring, bleeping and pumping at chemo session No 3 yesterday, it was reassuring to see that in some instances the old ways are still the best. Need to dilate the veins in your arms so the needle goes in more easily? No problem, just stick your arm in a bucket of warm water for a few minutes!
I can’t exactly say I left home for the clinic with a spring in my step yesterday morning. However, knowing I wasn’t going to have to suffer scalp cooling meant I was definitely far less anxious than I was the last time.
The session still took a good while – more than three hours in all – although the last hour or so flew by as an old friend I hadn’t seen for ages came to chat and keep me company. With the cool cap out of the picture, I can allow myself to have what is known as “chemo company” (one of the many new terms I’ve learnt since becoming involved in the world of cancer). Thanks, S, I’ll enjoy the sweets and will look forward to the tennis match we arranged – our first ever after all these years!
This is what happens when you turn up for your 9.30am appointment:
- You check in with the nurses on the chemo unit and choose where to sit. I always pick a station with a good view of the unit so I can see what’s going on.
- Before you even sit down, you’re weighed by the chemo nurse assigned to you for the day. The dosage of the chemo drugs depends on your weight and height so you’re weighed before each session.
- You have your vital signs checked.
- You’re given the first of the many anti-nausea drugs you’ll be taking over the course of the day and the following three days. The first, Emend (aprepitant), is in tablet form, and has to be taken one hour before chemotherapy.
- They put in place the cannula, a small, flexible plastic tube that’s inserted through the skin via a needle into a vein to administer medication. They then connect a nifty little extension set with two connectors. One of the connectors is for the drugs that’ll be administered via a drip. The second connector is for the drugs that are given as injections.
- They inject a small amount of saline solution to check the cannula is in the right position.
- You’re given via injection through the cannula another anti-emetic, the steroid dexamethasone.
- The electric heat pad on which you rest or wrap your arm for the rest of the process (to keep the vein dilated) is plugged in.
- They start the saline drip – a litre of the stuff – which helps flush the chemo through the body and will later be used to dilute the doxorubicin as it’s being delivered.
- You’re given the third and last of your pre-chemo anti-emetics, Aloxi (palonosetron), again via injection.
- Only now do they start with the actual chemo. The doxorubicin comes first, and is injected by the nurse manually, slowly and carefully. It mixes with the saline solution that’s coming in from the drip so that it goes into the body diluted. That’s the doxorubicin in the syringe in the picture. More about “the red devil” – another one of those new terms – in a later blog.
- Once that’s done, you’re given the second chemo drug, cyclophosphamide, as a drip over the course of at least half an hour.
- Finally, they give you a final flush of saline to wash through the last of the chemo through the cannula.
In between all of that, you’re brought tea and croissants and, if you’re there long enough (as I have been every time), lunch. Also, the pharmacist appears at some point and asks you how you got on with your take-home meds the last time and then puts together and brings you your next lot.
Before you leave, you pick up from the nurses’ fridge the lipegfilgrastim injection that you’ve got to give yourself 24 hours later.
And that’s it, at just after 1pm, you’re gone.