Today marks the beginning of ‘Chemo Four’, my fourth cycle of chemotherapy. After this afternoon, there are only two more.
Sure, there’s still a fair distance to go. But at least it’s shorter than we’ve come so far.
Here’s how it breaks down.
Chemotherapy for my particular type of tumour features a cocktail of drugs called PCV. The regime actually began yesterday: in the morning I went to my local doctor’s surgery to get a blood test. Then yesterday afternoon, I called the Cancer Centre in Belfast to ask if I should come in for treatment today.
In my case, the question is whether my white blood cells have recovered from my last treatment. If my blood test shows they’re too low, I can’t have treatment and have to postpone for another week.
(You may remember that I ended up waiting nine weeks between ‘Chemo One’ and ‘Chemo Two’ for this reason.)
This week, my bloods are up to scratch so I write now from the waiting room at the Cancer Centre.
When I arrive, I am given a pager and asked to take a seat. Usually I pull out my laptop and deal with some admin or emails to pass the time. The Friends of the Cancer Centre do a good line in celebrity gossip mags, Country File and People’s Friend magazine, none of which quite float my boat.
After about ten minutes I’m called in by a nurse to take my weight, before sending me back to the waiting room. There’s free instant tea and coffee on offer, but I’m a snob so I head to the coffee shop downstairs for a full-on large Americano.
Back to the waiting room and pretty soon, I’m called in to see my oncologist. We chat about how I’ve been feeling, any side effects I’ve experienced, and she answers any questions I have.
She knows I keep myself very up-to-date with research on my kind of brain tumours, which means we can often have quite detailed conversations about what is and isn’t, should and shouldn’t be, happening inside my head.
Today it’s a short meeting, as there’s nothing new to report. After Chemo Two she had told me my MRI scan following my radiation had shown nothing new to worry about.
Mostly we just talk about my cycling and the fact that, despite the cold, I’m still wearing shorts.
She sends me back to the waiting room to wait for the pharmacists to prepare my chemotherapy drugs, and for a spare slot for me to be treated.
This is the longest wait. There are lots of patients here to receive treatment, and lots of drugs cocktails to make up and deliver. It’s good blog writing time.
The chemotherapy delivery comes towards the end of the day. I sit in a room, with three to five other patients all receiving their own concoctions.
I have my own dedicated oncology nurse who stays with me from beginning to end. This ensures there’s no possibility I get the wrong drug, or dose, or something vital is missed out. Also, any problems or emergencies can be acted on within seconds.
Before we get started, the nurse checks my address and date of birth with me, and then double checks the doses she’s about to deliver with a colleague.
The nurse puts a cannula into my arm. A needle is injected into my forearm, through which a thin tube is delivered into a vein. With the needle removed, she sets up the tubes that will first deliver saline solution, then chemotherapy into my body.
The drug delivered intravenously is vincristine. It comes in a plastic bag that is hung above my head so gravity can carry it into my arm. The bag comes with an opaque cover, because it reacts to light. A machine delivers measured amounts of the vincristine into my blood stream. It feels cold going in but I quickly forget I’m hooked up.
My nurse then gives me the other two drugs that make up the PCV regimen. Lomustine is four shiny blue capsules which I down right away, along with four dextramethazone steroid tablets and an anti-nausea pill called ondansetron.
The third drug, procarbazine, is given to me to take around 6pm this evening.
The intravenous drug takes five minutes to deliver, after which arguably the worst part of chemo day one takes place: the removal of the cannula. It’s not the withdrawal of the tiny tube that’s so objectionable. Rather, the fierce ripping off of the industrially sticky plaster that’s been keeping it in and firmly attached to the skin and hairs on my arm.
We’ve tried it slow, we’ve tried it fast. It’s equally painful either way, and every time I swear I’ll remember to shave my arm before I come. Today, I’ve forgotten again.
The hospital visit usually takes around three or four hours, and I’m home just in time to take the third of my chemo drugs. For the next week I tend to drink a sachet of ‘orange flavoured’ laxative two or three times a day, perhaps the most disgusting substance known to humanity. Without the laxido the anti-nausea tablets will cause constipation that is far worse.
The next nine days feature a complex drugs intake. In the morning I take two different anti-seizure medications, and the steroids.
Mid-morning it’s the laxatives, along with anti-sickness tablets. At lunch I take steroids.
In the evening, it’s more seizure medication and my dose of procarbazine, the third chemotherapy drug. A little later I take some more anti-sickness. At bed time, I take two more types of anti-seizure medication.
Then it’s the same the next day.
After two days, I drop the steroids. A few days after that – if things are running smoothly – I’ll drop the anti-nausea pills and the laxatives too. But I keep taking the third chemotherapy drug for a total of 10 days, and the seizure medication is permanent.
I’d like to say that’s the end of my chemo cycle for this round, but really its only the beginning.
The first ten days are just those when I’m taking the medication (and the drugs to offset their main side-effects). Following that are the weeks where the chemo does its work: attacking my body, particularly my rapidly reproducing cells.
Hopefully that means my brain tumour cells. But it also means blood cells (red and white), cells in the mouth and stomach (resulting in ulcers), sperm (not too bothered about that, to be honest), and pretty much everything in between.
In short, it’s no surprise I feel pretty wrecked and a bit sorry for myself for a week or so even after I’ve stopped taking the drugs.
Slowly, though, I get better. I start to feel fitter and, if previous cycles are anything to go by, I feel tired but not nauseous or ill. By week six I tend to feel so much better that I’ve forgotten what the previous five have been like.
And then – if my bloods are OK – we start it all over again.
Throughout treatment, longer bike rides and heavy exercise have eluded me, either through lack of energy or from poor motivation. There’s no doubt about it. Chemo is hard. It’s harder than I kidded myself it would be: not necessarily on my body, but on my motivation and mental well being.
But I’ve come to terms with that now, and know there’s nothing worse for my sanity than expecting more of myself than I’m able.