First Step to Getting Better

Tuesday was the day of my first chemotherapy session. Didn't sleep well and felt sick on the way over to the hospital, nerves I guess. Arrived at the hospital in good time, the receptionist showed us around the ward, there are 3 rooms and 4 bay areas, it is nice because it is so small and not overwhelming. I was lucky enough to be in one of the rooms, with its own plasma TV!

Had a consultation with my Dr going through my lymphoma, chemotherapy and its side effects. I was diagnosed with aggressive Hodgkin's lymphoma IVB - IV meaning the lymphoma has spread through the lymphatic system and is now present in organs and / or bone marrow outside of the lymphatic system and B meaning I am experiencing additional symptoms to a swollen lymph node, such as weight loss, fever or night sweats. Mine is 'quirky' in that it has manifested itself in the abdomen and liver, but the DNA is most definitely that of Hodgkin's. The plan of action is for me to receive 2 cycles of ABVD which is actually 4 treatments (because for some reason, 1 cycle of ABVD = 2 treatments of chemotherapy) and then have a PET scan to see how my lymphoma is responding. If it is responding well I will continue with ABVD if not he has the option to chance my chemotherapy to a German regime called BEACOPP which is more aggressive and the chances of infertility are greater.

My consultant also went through the side effects of ABVD -

1. Lowered resistance to infection - ABVD can reduce the production of white blood cells by the bone marrow, making you more prone to infection. This effect can begin seven days after treatment has been given, with your resistance to infection usually reaching its lowest point 10–14 days after chemotherapy. Which is why in this period I have to be careful to avoid people with colds and crowed places with recycled air, like the cinema.
2. Bruising or bleeding - ABVD can reduce the production of platelets (which help the blood to clot).
3. Anaemia (low number of red blood cells).
4. Feeling sick (nausea) and being sick (vomiting) - anti sickness tablets can reduce this.
5. Tiredness - many people feel extremely tired (fatigued) during chemotherapy, particularly towards the end of treatment. This is a very common side effect and it's important to try to get as much rest as you need.
6. Hair loss - this usually starts 3–4 weeks after the first cycle of treatment. Hair is usually lost completely.
7. Sore mouth and ulcers - your mouth may become sore or dry, or you may notice small ulcers during treatment. Drinking plenty of fluids and cleaning your teeth regularly and gently with a soft toothbrush can help to reduce the risk of this happening.
8. Taste changes - you may notice that your food tastes different.
9. Numbness or tingling in hands or feet - this is due to the effect of vinblastine on nerves and is known as peripheral neuropathy.
10. Pain at the injection site or along the vein - this can happen while dacarbazine is being given.
11. Allergic reaction - some people can have an allergic reaction to dacarbazine or bleomycin.
12. Fevers and chills - this may happen several hours after bleomycin is given, but does not usually last long.
13. Skin changes - rarely, your skin may darken. If it does, it usually goes back to normal a few months after treatment has finished. Bleomycin can cause a rash that may be itchy and your doctor can prescribe medicine to help with this.
14. During treatment, and for several months afterwards, you will be more sensitive to the sun and your skin may burn more easily.
15. Changes in nails - your nails may become darker and white lines may appear on them. These changes usually grow out over a few months once the treatment has finished.
16. Changes in the way your heart works - this is very rare with usual doses of doxorubicin, but may occasionally happen when high doses are used.
17. Changes to the lungs Bleomycin can cause serious lung problems. This can happen during treatment or after it has finished. This is more likely to happen if you smoke.

Once we had gone through that little lot the Dr explained that he wanted to do a bone marrow biopsy - at the mention of that Dad made a swift exit. Oh no I thought, this was the one procedure I thought I had avoided as last time my consultant had said he didn't want to do one and now he wanted to do one there and then!!! To be fair it wasn't as bad as I had imagined as he completely numbed the area and the discomfort didn't last more than 5 seconds, I know because he made me count!

Will that out the way I was given my pre-chemotherapy drugs, steroids and anti sickness tablets and left to eat my lunch. After lunch chemotherapy started. There are 4 drugs in ABVD (doxorubicin originally adriamycin, bleomycin, vinblastine and dacarbazine ). First the nurse put in a cannula and to that attached a saline drip. Then into the same cannula she injected 2 of the drugs via slow injection, which all in all took about 45 minutes, completely painless and she sat and chatted while she administered it. She was a lovely lady and made me feel as at ease as possible. The last 2 drugs were given in a drip form, one over 15 minutes and the last over 2 hours. The last drug was a little uncomfortable going through my veins, this was eased with a heat pack over my arm.

Towards the end of the 2 hours I started to get the shakes and feel cold. The nurses thought it was a reaction to bleomycin, my temperature was also up, so I was prescribed more steroids which she said would have me climbing the walls later!

After the chemo had finished I was attached back up to a saline drip, which I was to be on all night. They call the first treatment the hit hard treatment, where they hope that the tumours start to break down and therefore toxins are removed, because of my enlarged liver they weren’t sure how my liver was going to react so they wanted to keep me in overnight to flush my system through with fluid and check the function of my liver and kidneys.

At around 5pm I was taken down to the ward in a wheelchair, I have to say I didn’t protest. I was taken down to my room. It was all very nice to be in my own room but it was in the old part of the hospital and it throw me a bit, that I would be staying here on my own tonight, you felt a bit alone, not like on the ward where stuff is constantly going on and the nurses can see you all the time, I felt a bit vulnerable.

No sooner had I settled in I was given yet more drugs and then dinner arrived. I don’t know whether it was the stress of the day or the steroids but I had a good go at all 3 courses! Didn't get much sleep partly because of the steroids and partly because of the machine the drip was in, making noises and I was up and down to the toilet because I was having so much fluid, bearing in mind it is no easy task when attached to a drip and you have to wheel your machine in with you! Was discharged the next morning.

ABVD Cycle 1, Day 1 - DONE!