How I Feel

I’m back from Day 1 chemo. I asked for and got my preferred nurse, Marissa, and she is getting ever more efficient, cutting another 20 minutes from my time. Yay!

Since I never seem to have the energy to write on Days 2-4, here’s a description of how I am likely to feel over the weekend. (In fact, once I got to writing I decided to just give you an overview of a whole cycle.)

Right now, I mostly feel the physical effects of having 2.5 liters of fluid in my belly. It’s a little like having eaten too much at Thanksgiving, except of course it’s spread out all over the abdomen and not just in the stomach. Uncomfortable would be a good descriptor, with a little back pain thrown in for good measure. I probably won’t feel like eating too much dinner, just because of the pressure. I feel very thirsty in the aftermath of Day -- which is odd, because I’m pumped so full of fluid -- and David set me up with an Edy’s fruit bar and a glass of lemon water. And, later, a dish of the bread-and-butter pickles we just made. Very yum, but won’t help the thirst.

The chemical effects won’t set in in earnest until tomorrow morning sometime. Once they do, it will feel a bit as though I’m recovering from a bad stomach bug. I’ll sleep a lot, drifting in and out. When I’m awake, I won’t be able to concentrate much, so reading is pretty much out. I will eagerly read emails, but most likely will put off responding. I’ll listen to music or watch TV/movies/cartoons. I will feel generally unwell. The meds will prevent nausea, but I won’t have much, if any, appetite. I will try to drink a lot of fluids, because it helps the kidneys flush out the chemo drugs, but I will struggle to get anywhere close to the recommended two quarts. David will keep me supplied with diluted Gatorade, lemon-flavored water, ginger ale, limonata, aranciata, and Dang! brand butterscotch root beer. If I eat, I will probably have relatively small quantities of soft/smooth things that can be sipped. Last cycle, peach-almond smoothies were a favorite. I’ll probably drink at least one bottle of Ensure, a meal-replacement drink, because it’s an easy and tasty way to get nutrients and calories packed into a small volume. So are banana/chocolate/peanut butter milkshakes. I probably won’t really enjoy any of this food, in the conventional sense, but I know that eating will help me regain my strength sooner. I will have diarrhea – at least until I take Immodium, which I am instructed to do so as not to lose too much magnesium and potassium.

By Monday, I will probably feel somewhat better, and will continue to feel better each succeeding day. Not well, but better. I’ll start eating real food – oatmeal, scrambled eggs, well-soaked cereal, soup, mashed potatoes – in small quantities at first, then larger ones, and starting with just one item and progressing to composed meals. I’ll be able to sustain more focus, and will read again – first short stories and magazines, and of course all the Sarah Palin news (big week coming up – will she? won’t she?), and then books. By Monday or Tuesday, I will try to go out for a walk, but it will be slow and close to the house so I can bail if need be. Most of the time, sitting up will feel like too much effort, and I’ll want to recline. Luckily, David gave me a new outdoor recliner for our anniversary, so I’ll spend lots of time in it soaking up the shade on the back deck. Throughout the week I will feel varying degrees of weak and shaky, but always getting stronger. Fatigue will set in each afternoon, at the latest, and I’ll probably nap at least once each day. I won’t schedule workouts for this week, or much of anything else, but I’ll take advantage of (relative) energy spurts to walk or do some chores.

With luck, by Friday I’ll have regained enough strength to face the Day 8 chemo. Of course, I have to face it whatever my condition; it’s just easier the better I’m feeling. At first I was puzzled about why my Day 8 experience feels so much harder than Day 1. After all, it’s way shorter (four hours vs. eight) and I get just one drug and lots less fluid. Nevertheless, typically I just close my eyes and wrap up in a blanket and listen to music, and, I guess, try to avoid the whole thing. On Day 1, I’m usually pretty alert, and I chat with Marissa and generally participate more. The difference is that on Day 8 I’m depleted, even if I think I’m feeling relatively well; on Day 1, I really am rested and strong.

The Day 8 side effects are both quicker to resolve and milder. Not much nausea or appetite loss, but I feel fatigued and have the same desire to recline. By the following Wednesday, I can expect to feel pretty decent and it’s all uphill from there. I still get plenty fatigued, and need a rest if not a nap. Evenings are pretty much a lost cause. But days get better and better, and before you know it, I’m shooting layups in the gym and doing heavy yard work! The caution here is that I don’t yet have much experience with the additive effects of each cycle. I’m told that diminishing blood cell counts will eventually cause fatigue to increase and become more pervasive. On the other hand, my body is doing so much that is unexpected and doesn’t fit the usual mold that all I can think is, we shall see.

Speaking of which: my latest INR (blood clotting time measure) is still 1.3. Still hasn’t budged, despite four weeks of titrating ever-higher doses of Coumadin. My team consulted the anti-coagulation specialist, whose opinion is that probably I’m just young and active and basically healthy – you know, except for the cancer thing – and need a high dose. She suggested 10 mg daily. She didn’t see any need yet to test for weird medical conditions that promote clotting. And for those of you with more advanced knowledge of these things, no: I do not consume large quantities of kale, spinach, chard, broccoli, beef or pork liver, or any other sources of concentrated Vitamin K, as far as I know. Anyway, you all know what this means: continued Lovenox injections. In fact, the specialist said I really need to have two consecutive INRs of 2 or greater to discontinue the Lovenox. Luckily, these do not have to be a week apart. Once I hit the magic number, I can go back two or three days later and see if it persists.