Chemotherapy begins.

Sep 11 2020

Mom had her first round of chemotherapy last Tuesday.  Early that morning I drove her to the Hillman Cancer Center at UPMC, got her checked in, and had to leave as they took her back because, due to the pandemic and generally immunosuppressed state of the other patients in the office I posed a contamination risk.  I spent most of the day puttering around the house, fixing stuff up, cleaning, and getting a bit of dayjob work done after dropping her off.  Mom spent most of the day hooked up to one IV line or another.  Unsurprisingly, it took some time to get the actual procedure started: Mediports can be used for drawing blood samples as well as administering medications.  However, while it was possible to flush her mediport with saline the doctors weren't able to draw any blood samples through it and they couldn't proceed until they were able to.  As I understand the situation, it required three heparin flushes to un-fuck the catheter, which took roughly 90 minutes.

Mom's oncologist says that each run of chemo has to be compounded specifically to the patient's current blood stats, height, and weight, which is why vitals and blood samples need to be taken every time.  Seems like it's pretty tricky stuff to get right and it gets mixed up immediately prior to administration.  Thing is, if the blood sample takes a while to get, the compounding process takes a while, and and and... this is why cancer patients normally bring lunch and things to occupy their time while they're in the office hooked up.  Once they got things going, though, they started the process off with a prophylactic IV antibiotic (probably to minimize the risk of something already in her system getting any ideas while her immune system is suppressed), IV benadryl (because hypersensitivity to chemotheraputic drugs is a known problem), and an IV dose of an anti-nausea drug before the actual chemo drugs went in.

Looking over mom's medical records and treatment plan (she'd asked me to translate them for her), she's on a cocktail of paclitaxel and carboplatin, which is a well understood treatment protocol for stage III ovarian cancer.  It's as well suited to its purpose as a shark and about as nasty.  Paclitaxel is a compound that, to simplify things because I'm not a medical doctor or chemist, interferes with cellular replication at several stages of the process.  In some respects, dividing cells get stuck somewhere in the process, and in other respects they get stuck and have to revert to an earlier stage in the replication process.  When you have a bunch of parts of a very complex system fall out of synch the whole thing collapses; in this context, the dividing cells self-destruct.  The other drug in the protocol she's under is caboplatin, a platinum salt, which seems to interfere with the replication of DNA as cancer cells divide and causes them to fail to complete replication and lyse.

While many of cancerous cells get caught up it's inevitable that other cells (like bone marrow and the lining of the small intestine) will also get caught in crossfire, which leads to some of the classic side effects of chemo, like nausea, vomiting, diarrhea, a suppressed immune system and anemia.  We have to be very careful about sanitation, hygine, and the like at home right now.  Also, and I didn't know this, we have to treat pretty much everything as a potential biohazard.  In the first 24 hours, 70% of the chemotheraputic compounds will be excreted, and we're talking some pretty cytotoxic stuff, so we have to handle everything with gloves, it has to be washed in hot water and detergent, things that can be disposed of have to be wrapped up and taped beforehand... you basically become a walking Superfund site.

The malaise set in on Wednesday.  By Thursday, mom was spending quite a bit of time napping and she started hitting the anti-nausea medication that night.  By Friday (when I started writing this post) mom spent a significant amount of the day sleeping and went to bed unusually early.  The doctors said that it would take 7-10 days before the side effects set in, but natural variation being what it is, sometimes things happen sooner, sometimes they happen later, and sometimes not at all.

In other news, the in-home nurse has been coming over every day or two and hooking mom up to a drainage rig to pump fluid out of her chest cavity.  Sometimes there isn't much, just a couple of CC's, sometimes there's a bit more, sometimes a bit more than that, but nowhere near as much as in previous weeks.  I'm inclined to think that the pleural effusion is pretty much managed at this point, though I do find myself worrying a bit about the edema returning in her lower legs.

Fun fact: The PleurX kits that the nurse uses to drain the fluid?  They cost about a grand each (thus sayeth the in-home nurse) which is why we have to treat them with kid gloves.  Researching the cost of them on the open market, however, they seem to average out to around $58.72us each... which makes me wonder just where in the process she's getting fucked and how many times.