R-CHOP Round 2

Dave’s 2nd cycle of chemo went much better than the first. I put lidocaine over his port before we left the house and he only felt a small pinch when it was accessed.  Chemo ports are accessed with a special non-coring needle called a Huber needle to minimize damage to the silicone port placed beneath the skin. The needle has IV tubing attached which connects to the infusion pump to deliver the medication at the prescribed rate.  Here is Dave modeling the set up….

Before Dave receives the first medication in the series, Rituxan, the RN “pre-medicates” him with several meds to minimize side effects of the subsequent chemo infusion.  For the 1st cycle, all of these meds were given in pill form without any adverse reactions. The route of administration (oral, IV, rectally, topically, etc) affects how the med is metabolized in the body.  I don’t want to turn this into a dry pharmacokinetics lesson, so I’ll tell you a fun ER story instead.  I once cared for a patient who took a high dose of oral Dilaudid, a powerful narcotic, on a daily basis.  This stuff is so potent we call it “Da la la” in the hospital because patients quickly enter la la land.  I gave her half the usual dose into her IV and 10 mins later found myself assisting in my first ever “rapid intubation sequence”.  When a patient cannot breathe on their own, they’re placed in a medically-induced coma, a tube is placed in their airway, and a ventilator assists or breathes for them.  In short, swallowing a med is not the same as receiving it directly into the vein.

For this cycle, Dave received Benadryl (diphenhydramine) IV instead of the pill form. Yup, the same stuff you take for allergies.  While he was being pre-medicated, I left to speak with his case manager about his upcoming appointments.  When I returned, Dave looked as though he was withdrawing from meth.  He was restless in the chair, tapping his feet, rocking back and forth, and looked miserable.  We now know Dave cannot tolerate IV Benadryl and we’ll have to ensure he only receives it orally in the future.  Dave tends to have a paradoxical reaction to medications.  The pain meds he takes put most people to sleep, but Dave is able to go about his day like normal.  Ativan usually relaxes anxious people, but not Dave.  It was supposed to relieve the restlessness from the Benadryl, but it instead turned into a child on a sugar high.  He pulled his knees into his chest and was rocking back and forth giggling with a grin on his face.  He was still restless, but seemed VERY happy about it, so we left him alone. About an hour later he was back to his usual self.

The chemotherapy was given without any problems.  The infusion rate is increased in increments provided there’s no adverse reactions.  The Rituxan that had caused a reaction the 1st cycle, didn’t really phase him and the infusion was completed much faster.  We arrived at 9am and left around 4pm.  Dave was sleepy, but without complaint the rest of the night.  Aloxi, a long-lasting anti-nausea med, was added this cycle to prevent the awful nausea Dave experienced immediately following his first infusion.  As you can see there’s a lot of trial and error that goes into perfecting a chemo regimen.  What works for one person may not work for another.  I think we finally have all his meds dialed in and Cycle 3 should be even better. Our RN was kind enough to photocopy his treatment plan for those curious about all the meds administered on chemo day.

The following afternoon Dave felt well enough to join me and the dogs on a long walk to the harbor.  Not that the dogs gave him much of a choice – this is their usual “Dad wake up and pay attention to me” routine…

Kona (the small furry one) got a bit too hot on our harbor jaunt.  He couldn’t keep up with our leisurely pace so I had to carry him for the last stretch and as a result, we received some strange looks and unwanted comments/advice.  “That dog looks hot”, “it’s too warm out for that coat” – it was 74 today people.  Walking our dogs to a beautiful grassy park along the harbor on a nice day hardly constitutes animal abuse.  I’m not sure who felt more ridiculous – me as the human carrying a 20lb dog or the dog who needed to be carried by a human.