Part 4 in a Series of Cancer-Related Commentary | James Stack

Part 4 in a Series of Cancer-Related CommentaryÂ |Â James
Stack
I did and needed both my nausea and anxiety meds before I had even started chemo -- phew!
My appointment at Dartmouth was at 7:15 a.m. Finally Cytoxan, another chemotherapy nuclear
bomb, with no side-effects while being administered. I had a ginger ale after my sleep. and Rituxan
at 1:00 p.m.
Dextrose 5 percent and sodium chloride 0.45 percent 1000mL -- for hydration
Tylenol (Acetaminophen 650mg) -- for flu like symptoms
Decadron (dexamethasone 10mg) -- steroid for infection
Benadryl (diphenhydramine 50mg) -- for allergic reactions
Zofran (Ondansetron 16mg) -- for nausea
Ativan (Lorazepam 0.5mg) -- for anxiety
Rituxan (Rituximab 600mg) -- monoclonal antibody
Fludara (Fludarabine Phosphate 48mg) -- chemo
Cytoxan (Cyclophosphamide 475mg) -- chemo
The pre-meds left me dizzy, disoriented, lethargic, dry-mouthed, short term memory losses, and
spastic muscles in my legs. One word of advice: Do not view on YouTube how ports are implanted. I
requested the anxiety meds (Ativan) right away; the nausea drip (Zophran) was begun and
administered over time.
Next up was my limited dose of Rituxan, monoclonal antibody, a smart bomb in that it is targeted
therapy; I experienced a low grade fever 99 degrees and neck aches with a mild headache -- they
gave me 650mg more Tylenol. When the Rituxan started it ran for four hours, during which I slept.
And I don't feel alone with all the friends who have sent notes or made offers of help. Otherwise, my
dizziness and disorientation had subsided but not gone away.
My nurse on the second day was Jillian Craig, and my licensed nursing assistant was Ernesto
Velazquez. 26 -- blood work check up to see how low on the Nadir my blood counts have fallen.
Oh, and Fiona Morton, Dorothy and Julian Josey, Pamela Zahara, Risa Mornis, Jillian Crain, Ernesto
Velazquez, Ann Gallagher and Phil Pomerville, Ellie Gordon, and Kathy Sullivan, and Donna Heath
have been added to my list of angels here on earth.
Head on down the highway...
Postcards From Lebanon: Part 1

. I was given a corner by the window after telling the licensed nursing assistant, Risa Mornis, that
this was my first time -- I was a virgin. The real side-effects will come over the next week or two. We
had franks and beans for dinner -- no, really.
We watched The Avengers, and from two days of steroids I found myself believing I could be a super
hero -- Colonel Chemo -- killing off foreign invading cancerous aliens. The nurses think we dance
around the IV poles we have to drag with us to the bathroom as if they are May poles since all our
tubes are a mess when we get back.
Head on down the highway...
The first day of chemo arrived, and I approached it with anxiety, which I suppressed through humor
at every opportunity. Fiona Morton has selflessly taken on multiple burdensome tasks, including
arranging drivers for future cycles -- another reminder that I am not heading down this highway
alone.
The witching hour finally arrived, and the IV went in smoothly, thanks to my wonderful nurse,
Pamela Zahara, who made my first time comfortable (I will always hold a special place in my heart
for Pam -- you don't forget your first time). Everyone in the infusion room is traveling the same road,
hopefully heading in the same direction, remission, so it's nice to know you aren't alone. Most side-
effects show up over time. Gautier to review labs, any health changes, and protocol, and I was okay
for treatment.
The infusion room at Dartmouth has two nurses stations, three licensed nursing assistant stations,
and roughly 31 infusion stations for patients. and had lunch (Thai beef and noodles) in the cafeteria
and then we got to go home. I was wide awake thanks to the steroids and up for day two, which

began at 7:00 a.m. The drugs and amounts I was given on Cycle 1/Day 2 follow:
Fludara (Fludarabine Phosphate 48mg) -- chemo
Cytoxan (Cyclophosphamide 475mg) -- chemo
The hydration drip was started at 8:15 a.m. They had Demerol, more Tylenol and Ativan at the ready
should I have begun shaking or gotten a fever or headache, but not this time. Besides, chemo doesn't
discriminate. POW! ZAP!
Cycle 1/Day 3: Here comes the Rituxan! My nurse today is Ann Gallaher (covered in freckles -- my
mother told me my freckles were fairy kisses -- Ann wasn't buying it) and the licensing nursing
assistant is Phil Pomerville. It was 9:50 a.m. There is limited privacy provided by curtains as the
nurses need to see their patients. My fingers are still tingling from the vincristine, and they are
getting worse, which I was told they might. when we entered. 5 preparatory meeting, I was asked if
I'd ever had hepatitis, so we included testing for hepatitis A, B C, which showed positive for hepatitis
A antibody (typically hepatitis A comes from traveling to exotic locations -- and we've been to a few).
Of course, this doesn't mean that if my veins don't cooperating that I won't have a port. Something
else to watch out for while being treated is dental hygiene: Brushing, flossing or toothpicks may
cause infections -- be careful and gentle with your mouth.
The hydration was set to go for the day, and then the Tylenol, Decadron and Benadryl were
administered; the latter two drugs immediately left me dizzy, disoriented, with lose of short term
memory. It will be up to me to self-medicate in preparation or to lessen their effects. Nurse Donna
Heath ended the day with me and successfully removed the IV -- bless her!
Of course I was disoriented and confused, with no short-term-memory; but at least no flu-like
symptoms. followed by pre-meds of Decadron and Ativan; I relaxed immediately. Then the Fludara
chemotherapy, a nuclear bomb that destroys both cancer and non-cancer cells; I experienced
nothing during infusion, except the ongoing lessening of the earlier side-effects. I'm blaming it on
the Ativan and chemo brain -- a condition where you are sluggish, disoriented and slight confusion
that is nearly a permanent state for those of us undergoing chemo. At 8:15 we met with Dr. It's also
a great excuse for everything if you aren't blond.
I was released at 12:20 p.m. I'll let you know what happens over the next couple of weeks.
Lunch on the third day was chicken salad on whole wheat, chicken with rice soup, fruit cup, and
apple juice. I didn't have any problems getting to sleep, but by 3:30 a.m. Already my hands and face
have started to dry out (I'll start to apply moisturizer). Pre-meds started at 11:30 a.m. The drugs and
amounts I was given on Cycle 1/Day 1, as well as some of the potential side-effects, follow:

Tylenol (Acetaminophen 650mg) -- for flu-like symptoms
Benadryl (diphenhydramine 50mg) -- for allergic reactions
Rituxan (Rituximab 100mg) -- changes the way the immune system works; in addition to the Cytoxan
and Fludara side effects listed below: non-responsive; chest pain; fast, irregular heartbeat; faint or
lightheaded, falls; redness, blistering, peeling or loosening of the skin, including inside the mouth;
stomach pain
Fludara (Fludarabine Phosphate 48mg) -- interferes with the growth of cancer cells; in addition to
the Cytoxan side-effects: breathing problems; changes in hearing/vision; confusion; muscle
weakness; tingling in hands or feet; swelling of hands, ankles, feet; trouble passing urine; yellowing
of eyes or skin
Cytoxan (Cyclophosphamide 475mg) -- slows the growth of cancer cells; allergic reactions: rash,
swelling; low blood counts leading to infection; fever, chills, cough, or sore throat; decreased
platelets: bruising; black stool; decreased red blood cells: weakness; breathing problems; dark urine;
mouth sores
And then there are the side-effects that don't require immediate medical attention: anxiety,
headache, muscle aches, night sweats, constipation, diarrhea, hair loss, nausea, vomiting, loss of
appetite, and trouble sleeping. Also, every time they asked me my name and birthday, I'd switched it
around: A little spice makes for a better meal. The Fludara was followed by the Cytoxan; thanks to
the pre-meds I haven't experienced any side-effects other than chemo brain, yet I am able to
maintain my sense of humor. During the Aug. Dinner was -- yes, I wanted Mexican -- a vegetarian
burrito, chips and salsa, water, and Gatorade.
We spent the night zofran lawsuit arizona at the Courtyard Marriott, which offers a special rate to
Dartmouth-Hitchcock Medical Center patients -- be sure and ask for it, but be aware that New
Hampshire does charge a "state occupancy tax, and I'd thought NH was tax free. I will continue
taking Allopurinol 300mg through the rest of the week to help my kidneys. For dinner I had cereal.
I found out from my dear friend Kathy Sullivan, an attorney in New Hampshire, that
https://www.gsksource.com/pharma/content/dam/GlaxoSmithKline/US/en/Prescribing_Information/Z
ofran_Oral/pdf/ZOFRAN-ORAL.PDF the state will take about 18 months to write and adopt the
regulations for dispensing medical marijuana: [expletive deleted].
Timing: Aug. I will note that I had to pee a lot -- which meant I was definitely hydrated -- a very good
thing as I need to flush out all the dead cells quickly so my kidneys don't get blocked.
Lunch the first day was a tuna sandwich on whole wheat, a fruit cup, chicken and rice soup with a
diet soda -- and vanilla ice cream with Fig Newtons for desert, with honey graham crackers as a
snack. I rocked and kicked Rituxan's butt from the third day of steroids -- BANG! Then the Fludara
and Cytoxan were administered. I was told I didn't need one by my dear friends Dorothy and Julian
Josey (Julian is an oncologist). And I wore the "party shirt" I bought for Ellie Gordon's 50th birthday

party -- party on!
I had to decide whether or not to have a port surgically implanted for ease of infusions or to go the
intravenous route: a prick each cycle, staying in place for the full three days. for blood work. Rituxan
can cause hepatitis to flare up -- something for which we'll watch. We noticed a "Do Not Enter"
traffic sign strategically placed in from the Cancer Center entrance at Dartmouth -- I told Ron they
didn't want me today

Part 4 in a Series of Cancer-Related Commentary | James Stack

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Part 4 in a Series of Cancer-Related Commentary | James Stack