The highs and lows of chemo
Hyper-CVAD. Its the name of the chemotherapy regimen that can be used to treat some types of Leukemia and Lymphomas. The “hyper” portion refers to how it is broken up into numerous small doses given over a period of time. “CVAD” refers to primary drugs that make up the regimen (Cyclophsphamide, Vincristine, Adriamycin, Dexamethasone, Cytaribine). By breaking up the administration of chemotherapy over multiple days into small doses, the intended effect is to minimize the side effects. This regimen is considered one of the toughest chemotherapy regimens to undergo, and is usually reserved for patients who are in pretty good health already. Though with the advent of very strong antiemitics it is being used in less-abled patients as well.
Course A
* Cyclophosphamide (Cytoxan)
* Vincristine (Oncovin)
* Doxorubicin (Adriamycin or Rubex) – Kool-Aid Chemo, has the same color as cherry kool-aid
* Dexamethasone
* Cytarabine or Ara-C (Cytosar)
* Mesna (Uromitexan)
* MethotrexateCourse B
* Methotrexate
* Leucovorin – Leucovorin is used as a ‘rescue’ agent to prevent excessive cellular damage by methotrexate.
* Sodium bicarbonate – Sodium bicarbonate is used to produce a mild metabolic alkalosis, desirable when administering large quantities of methotrexate.
* Cytarabine
My original intention with this post was to detail how I felt undergoing each of the drugs and the effects they had on me. Though as I sit here, I am finding it hard to recollect the exact details of each drug and the days they were administered. I guess that speaks more to the effects than a segmented description of each drug could. I am midway through my third round of chemo. I have went through Course A twice, and Course B once.
Overall I would say that anyone who is facing the prospect of undergoing this treatment that it is very doable. Many days you will be tired and sleep the whole day through. There will be periods of time when nothing will sound appetizing, and you may subsist on Ensure or other meal replacements. You will probably find Zofran or some other antiemitic to be your new-found best friend. Moreover, while you are being administered the chemo, you will likely not have 100% of your mental acuity. I liken this to the feeling you have 5-10 minutes after you wake-up before you shake the sleep out of your head.
The good news. It will pass. In Course A, I found that about 3 days after the final administration of Doxorubicin (Kool-Aid Chemo) that I really started to get my appetite and mental faculties back. This usually coincides with day 7 or so of the chemo regimen. After that you have a small break in the administration of chemo during which time, your blood counts will usually begin to fall, about day 10ish. You may need a few transfusions of blood and platelets, but in my experience, the worst of the round is over.
Course B feels very front loaded in its administration of chemo. I slept for the most part the first 5 days of this regimen, after that, if I did not have the spinal headaches associated with the lumbar puncture, I likely would have felt that the worst was behind me. Again, you will likely have to endure transfusions and the waiting game for your blood counts to rise long after the chemo has stopped.
I won’t kid you. Each round is getting a little bit harder. I feel a bit more tired, a bit more nausea, a bit more out of it. Then the chemo stops, the fog lifts, and I realize that I made it through the worst part of another round. Some mornings you will wake up and feel so exhausted that rolling over feels like a herculean effort. Some mornings I question whether I woke up at all. Maybe its a byproduct of being in the same room for so long, but the days and dreams begin to blend together after a while.
In truth, the hardest part is the day before a round begins. When I am out of the hospital, I feel normal. I take on a lot of my old routines and its easy to forget that I am afflicted with cancer. Then the party comes crashing down with the realization that I am indeed still sick, and about to leave my home for weeks. You will need to find your gravitational center. Something that you can cling to that gives you hope on the dark days. For me, my wife, daughter and friends are the sunshine that poke through the clouds. Whatever it is for you, hold on to it. Tightly.
