It's D-Day for Cycle 4 of Chemo

June 14 (Day 1 of Cycle 4 of Chemotherapy)

It's starting again, the fresh after chemo side-effects of nausea, fatigue and loss of appetite. So this account will be sketchy at best but hopefully will include all the pertinent details of the day.

8.30: Took a cab with Vic carrying my overnighter and laptop (just in case) to reach the medical center before 9.

9.00:Did my pre-chemo FBC. Had to wait 45 mins for results. Read papers.

10.00: Pre-chemo review with Onco. The blood test results were out and I could proceed with chemo. And surprise and SyukurAlhamdullillah, the wbc was excellent, the best so far, in fact it exceeded what it used to read before chemo. It was 8.7, a high jump from 1.8 before Neupogen. The diet of daily beef stock and red meat and kacang botol, midin must have helped. I was grinning despite my sore bottom.

My Onco was told the gory details of my bouts with constipation, and resulting sore bottom. He prescribed 7 days of Ducolac this time. He recommended increasing my Epirubicin dosage (the red drug) by 10-15% to 125mg, he says to increase its efficiency to bump off any mutant cells and also to try push me to my limit so that my wbc reads 1.0 on day 9 (one day earlier than usual interim blood tests). Wot??? I asked him on the rationale of hammering my wbc, and he told me not to worry as it will recover with the Neupogen to be given, maybe more shots if really required. The idea is to be more aggressive with Epirubicin.


On the surface of it all, I appeared concerned why it is necessary. But secretly I am quite supportive as my sometimes sore and bleeding bum is causing me concern. Especially since Breast Cancer and Colorectal Cancers are sometimes partners in crime. This I gathered reading some reports either in the internet or even some of the newspaper reports that are displayed in Oncologist's waiting rooms in most of the medical centers I had visited. My take is that if the constipation is unattended, leading to eventual hard poo, it may strain that last bit of the digestive canal. I felt really uncomfortable discussing this with my Onco other than mention it in passing and therefore forgot to ask for a prescription for a balm that might heal any cut tissues. Hardly a subject to discuss with a straight face. I will call him tomorrow and seek his tele-opinion.

We discussed my collapsed vein and I told him, Dr A his standing-in MO prescribed some steroid cream for the thrombophlebitis. He corrected me saying that Dr A is a specialist, one of his best post-grad doctors! Anyway, I told him that after a few days of steroid, there wasn't any improvement in the pain and tightness and I had resorted to massage gently with minyak panas (nutmeg and gamat oil) which helped relieve the pain but the venins are still lumpy and hard. For the chemo, he will prescribe a dose of cimefidine (or something that sounds like it as a I couldn't identify the item fin the billing)which will help to dilate the collapsed veins. They need to re-use the first chemo vein as no other veins look good enough. I asked him where will the clots go (to my head/lung/heart?) and he reassured me there wasn't any clots, only inflammation which felt like lumps under the skin.

10.30: Off to Chemo Daycare and was given Day 1 (of 3) oral prescription of Emend. Must wait for an hour before chemo can start. The Onco nurse started to fix the gadget on my vein (sakit this time) and started a drip of saline.

11.00: Shot of Kytril given, and more waiting. I think the shot of Dexa was also given, this time I got the prickly sensation even under the skin of my tummy, not just at my bottom extremities.

11.30:Start of chemo. First shot was the Cimefidine to dilate the veins. Boy, was that painful as I could feel the frug coursing through my vein and the inflammation in the veins must have caused some sensitivity. I was ouching and aahing throughout. The Epiribucin was next, the increased dosage means 2 fat syringes and a little one. I reminded my nurse to go slow and steady. ANd for the first time since Cycle 1, I actually felt pain when the drugs are being shot (bolus method , she said). Sakit, real sakit. Reminded me of the comments on people who refused chemo because chemo is painful. All along from Cycle 1-3, the chemo injections were never painful except for the initial needle prick to install the gadget, but for cycle 4 it was painful due to the dilation of once collapsed veins. During the procedre I was supposed to suck a cup of ice, but one look and my stomach lurched, and after 1 cube, I was ready to throw up but managed to control. Very nice of the nurses to get me a lime flavoured ice-lolly to suck in lieu of ice to help with damage control in my mouth as the lining is so thin and the drugs can cause havoc with taste buds ( which are already extinct by now in my mouth. I taste food but a different taste from what others do).

11.30-2 pm: Continuation of drug injection, a painful process throughout. The cytoxan was administered via drip, and it was painful too.

2.00-3pm: An hour of saline infusion to flush the veins after chemo, and after that I was free to go rest in the ward.

3.00-3.30: Late lunch at cafe before resting as I had missed the lunch rounds in the ward. Vik ate heartily, she must be bored and hungry sitting there waiting, and waiting. I couldn't cope with much, just some items of yong tau foo and I realised that my taste buds have gone crazier. Everything tasted bitter and awful, except for food with a tang (masam-masam) but I need to watch that to avoid recurrence of gastritis and acid reflux in the stomach.

3.30-9 pm: Rested in medical center. The nurse checked my vitals and said I could discharge as I agreed with my Onco that I can go home once I feel stable. All vitals ok except she was puzzled why my bp was low at 88/55. I decided to
move out of the ward about 8.30 as a new patient was admitted in my room with a chronic cough that sound so frightening, hawking and she had to pit phlegm into a bag. I felt so sorry for her and yet at the same time realised that I cannot and should not be in the same room with her as her coughs and sputums would release millions of virus and bacteria that will not be good for my condition. I asked her about her ailment, she said she is 30 yrs old and have been suffering of a chronic cough for years and now felt weakened by it and the doctors needed to examine and investigate her lungs. I explained to her I was supposed to be out by 7.30 and they must have thought the room is vacant, that is why she was admitted there. Personally I felt that she would be better off in a single room. I wished her all the best and hope it is nothing serious like TB or lung cancer and explained to her I have to go and wait for my friend in the lobby.

9.30: My friend picked us up and gave Vik and I a ride home. Very nice for someone to swing by all the way from B.Utama to do that.

10.00pm: Unwind at home with a glass of warm horlicks and oats before retiring for the night. Mentally I am determined not to vegetate during the first 5 days,if only to feel a sense of personal triumph. Already planning to surprise my Dad with a visit on Father's Day if someone can drive me there, I will not be able to drive long distance during the first 5 days. My friend SNA had indicated she will consider it and we could go to that nice Ikan Bakar place for lunch!