In Between Days

I was discharged from the BCCA on Sunday, and Meg and I have been settling in back at the apartment. My brother Mike returned to Africa on Monday, and for the first time, we're on our own, but only for a couple of days. Meg's parents arrive on Thursday, and it will be nice to reconnect with them over the next week and a half or so. Several friends are also passing through Vancouver over the next little while. Below I've outlined my chemo as it took place this round. It's a highly medical process, and I thought it might be interesting for those who (thankfully) have no experience with it. On the whole, I think my protocol is relatively easy on me. There were many more difficult stories surrounding us at the BCCA, and again, we have to consider ourselves lucky in many many ways. This is what round one of chemo looked like:

Tuesday.
8:30 - Arrive at BC Cancer Agency to check in. Opthamological exam at vision centre down the road. Six vials of blood taken from my right arm on 3rd floor. Circumferential jaw X-Ray and Chest X-Ray in imaging. Meds as since surgery. Appointment with dental hygienist on 2nd floor to clean teeth - precautionary measure to prevent mouth sores common with this treatment. Prescribed Bicarbonate and Chlorhexidine mouth rinses for use after each meal.

Wednesday
7:30 - A lab technician wakes me up and takes three vials of blood from my right arm.
8:00 - Continue regime of 2 mg of Dexamethasone Corticosteroids to reduce swelling in my brain and 150 mg of Ranitidine to calm my stomach from the Dexamethasone.
9:00 - Spinal Tap in my room on 5th floor by two resident oncologists.Uncomfortable, but not terrible. Atavan to calm my nerves.
9:30 - 4 hours of Sodium Bicarbonate IV to increase the alkalinity of my body in preparation for High-Dosage Methotrexate Chemotherapy. Following this, six 50 mg "Bicarb" pills (literally baking soda tablets) every four hours to maintain body alkalinity. Urinate in a bottle, record volume, and test pH for nurses each time.
13:30 - 8 mg of Ondansetron (an anti-nauseant) and 4 hours of Methotrexate via IV - a chemical that can penetrate the "blood-brain barrier" and target cancer cells. Continue montioring urination and taking Bicarb pills. Need to take them with milk each time to get them down.
17:30 - Back on Sodium Bicarbonate IV to maintain hydration, good kidney function, and alkalinity. 10 mg of Prochlorperazine (more anti-nauseants). I pass over 5 litres of urine in the night and measure pH each time, waking up every 90 minutes or so.

Thursday
7:30 - a lab technician wakes me up and takes three vials of blood from my right arm.
8:00 - Breakfast: hot cereal, cold coffee, two steaming pieces of toast, and a boiled egg. More if I want it. Also, meds: Deximethasone, Ranitidine, and 200 mg of Carbamazepine as an anti-seizure precautionary. 25 mg of Leucovorin in 5 tablets to "rescue" the Methotrexate Chemotherapy from my healthy cells. 14 tablets in total.
9:00 - Bone Marrow Biopsy taken from my left hip. More Atavan. Hurts like hell for a half second.
Saline hydration IV for most of day, and continue with Leucovorin rescue and Bicarb tablets.
Nurse wakes me at 12:00, 2:00am, and 4:00am for meds. Up in between to urinate.

Friday
7:30 - a lab technician wakes me up and takes three vials of blood from my right arm.
9:30 - 4 hours on Rituximab IV - antibodies made of a chimeric combination of human and mouse DNA that costs $2000/500ml in the private system - not particularly good at penetrating the blood-brain barrier, but definitively effective against large B-Cell type lymphoma. Take 2 Benadryl and 2 Tylenol before the IV pump is switched on because of potential in all patients for allergic reaction. Nurse begins with slow administration of drug, and watches me for the first half hour before leaving, returning half an hour later, turning up the dosage, and repeating this sequence three times. The Benadryl makes me feel awful. Continue with 6 Bicarb pills, 5 Leucovorin tablets, Deximethasone, Ranitidine, Carbamazepine, mouth rinses, and monitoring urine. Nurse wakes me at 12:00, 2:00, and 4:00 for meds. Up in between to urinate.

Saturday
7:30 - a lab technician wakes me up and takes three vials of blood from my right arm. Continue with 6 Bicarb pills, 5 Leucovorin tablets, Deximethasone, Ranitidine, Carbamazepine, mouth rinses, and monitoring urine.
12:00 - Resident oncologist informs me that the Methotrexate levels in my blood are still too high to send me home.
22:00 - Watch movie.

Sunday
7:30 - a lab technician wakes me up and takes three vials of blood from my right arm. Continue with 6 Bicarb pills, 5 Leucovorin tablets, Deximethasone, Ranitidine, Carbamazepine, mouth rinses, and monitoring urine.
10:30 - nurse informs me that my Methotrexate levels are at .04 - safe enough to send me home as long as I continue the Leucovorin rescue for three more doses. Will continue Dexamethasone, Ranitidine, mouth rinses, and Carbamazepine in between treatments. I check in again next Tuesday. . .