If you remember, a few months ago I confessed that I done got me a tumor on the base of my tongue and was just starting treatment. The first phase of that was eight weeks of what they call “induction” chemotherapy, which I’ve found out is nothing like a Hall of Fame induction. I tried donating my Leper House Hogballs basketball jersey, but they stuffed it in a biohazard bag, kicked me in the shin, and told me to keep that crap out of their hospital. But I digress. Induction chemotherapy is fairly new from what I understand. In fact, I don’t understand much, so let me offer up my disclaimer – everything in this post (and probably most posts) is just my interpretation and understanding of what the hell is going on. My studies in business have not helped much, nor did my failed attempt at an engineering degree. At times, my info is also based on websites maintained by slutty teenage girls and Romanian prostitutes. Other times, I ask Mrs. F’er, a first year med student, but I pretty much hear what I want to and often inaccurately translate into layman’s terms. So, induction chemo. I guess they can never really be sure that the cancer hasn’t spread elsewhere, and since it just takes a few cells to start up again, they pretty much carpet bomb your body with toxic chemicals to kill everything off. It’s meant to reduce the recurrence rate so you don’t try to come back and collect too many frequent chemo points and comps. This time alone I almost earned enough for a free sponge bath. With some luck, induction chemo should also shrink your primary tumor like a scrotum in an ice bath.
My doctors’ toxic chemicals of choice were:
Cetuximab aka Erbitux – This one is famous. It took Martha Stewart down. The maker, Imclone, had it's first application for this drug rejected, causing it's stock to plummet. Mrs. Stewart was buds with the CEO over at Imclone and coincidentally sold her shares immediately before the announcement. The FDA rejected it because they questioned some of the trial protocols, but a couple years later Imclone re-did their application in the proper color ink and the FDA agreed that Erbitux does what Imclone said it does. Erbitux blocks these things called growth receptors on cells. When those are blocked the cell never receives signals to split and the cell eventually gets bored and self-destructs. Kind of like marriage. I got this drug every week.
Taxol aka Paclitaxel – This one goes into the cells and finds a piece called the tubulin that they need to divide. Then it hooks up with the tubulin like a good wingman and keeps it busy so the cell can’t divide. So even if a cell gets the signal to split, it won't be able to accomplish that. It's like stealing a mechanic's socket set. I got this one for three weeks, with one week off so my liver didn’t explode. Then repeat for three weeks.
Carboplatin – This is the platinum based drug that I guess is pretty common in chemo. My understanding is that this one goes in and scrambles the DNA of the cells like McMurphy’s brain after a lobotomy. So even if it manages to split, it's all jacked up and your body signals it to commit cellular suicide. I guess this one is nasty, so I only got it once every four weeks.
The Process – Every Tuesday morning, I’d get up around 5 a.m. to trek down to the south side of Chicago, the baddest part of town, and if you go down there you better just beware of a man named Leroy Brown. Fortunately, Leroy isn’t up that early so my treks were uneventful. Once there, I’d check in and take my place with about 50 other people sitting there for all types of infusions. They draw some blood for labs and you sit and wait some more. Then eventually you gain admittance past the velvet ropes into the infusion room – about 30 recliners ringing a room. Not exactly Lazy Boy quality with drink holders, but just flesh colored vinyl. There are also some enclosed rooms with beds for the really sick or lazy and a couple nurse stations in the middle. After about an hour, I get a copy of my labs and have Mrs. F’er explain them. The explanation is usually over my head, but I nod knowingly and briefly feel good about getting my money’s worth on med school tuition. Once the labs prove I’m alive enough to get killed some more, they send the orders off to pharmacy and I wait about another hour. Then the pharmacist decides my labs aren’t good enough and “fails” me and throws out my order until my nurse calls and “unfails” me and tells them to quit being dicks about it. Where was she when I was in college?
Eventually the meds are ready and come in a nice biohazard bag, which makes the nurses look like they just got back from the Chernobyl Galleria. They unload the booty and after finding a juicy vein for the IV, start pumping the premeds into you. One to prevent nausea, another to prevent vomiting in case the first doesn’t work, some pepcid for your stomach and then my favorite – the benedryl. Week one they pumped it in but instead of the pleasant buzz they told me to expect, I got dizzy, started sweating profusely, turned green and my blood pressure dropped to 70/30. Just like my wedding day. It was quite the spectacle, but I eventually recovered and now they drip it in over ten minutes to avoid those good times. Everything else is half speed in week one, too, to make sure you don’t have any deadly reactions to the drugs that will kill you before the docs allow. I survived round one and would earn the privilege to repeat this process for eight weeks.
Eventually both the nurses and I get tired of starting an IV every week, so a few weeks into it they installed something called a port-o-cath into my chest. This is about the size of a contact lens case with a couple rubber pads in which they can stick the IV needles without having to find a vein every week. A line runs from the “port” to the jugular vein, and my arms no longer look like those of a heroin junkie. But I now have a contact lens case implanted in my chest just below my collarbone. If I were still in school, the teacher could literally pin notes to my chest. On my off weeks I use it to display my 3-year-old niece’s art projects.
When you start the process, they give you an exhaustive list of every possible side effect so if you start to bitch they can just say “we told you so” and get back to poisoning you. After my first round I felt fine. Even went to work on Wednesday. And then around noon I passed out on the conference room table and didn’t wake up until Friday when the cleaning lady poked me with a feather duster to see if I was alive. I quickly learned that after my Tuesday feedings I had about a 24-hour grace period before a nasty hangover took over for about 4 days. Like a bottle of Murphy’s Whisky hangover. I never laid in bed so long in my life. Except for that time in the handcuffs. Lost keys, my ass. But I digress. I didn’t want to move, speak, or eat. So I didn’t. Sometime Saturday I’d come out of hibernation, and I’d actually feel like Irish river dancing on Sunday and Monday before starting the whole process over again on Tuesday. I scoured the countryside on horseback looking for Irish rivers in the tri-state area to no avail. So I’d usually just opt for a pot pie and watch some football.
They said my hair would fall out, but I doubted the drugs would be able to pierce my lush mane. Then in week two I discovered I could pull out my hair as easily as the pink flamingos in my front lawn. I made pre-emptive strike to avoid shedding like some breed of dog that sheds a lot, and I grabbed the clippers, set them on 1, and trimmed my locks like a sheep during a yarn shortage. My George Clooney good looks transformed into some Matthew Fox good looks, which seemed more relevant and made me pretty happy. However, a couple days later I was washing my hair and my hands were covered with my newly shorn fuzz to the point that I looked like Chewbacca. At this point in the shower I was simply wiping my remaining hair from my scalp, and then finished off the remaining stragglers with my clippers. My Matthew Fox good looks had quickly transformed into some Howie Mandel good looks. I searched the house for hot models with silver briefcases to no avail, and then sadly retreated to my bedroom. Not sure where to turn for consolation, I went to my idol Britney Spears’ website and was inspired by her undying fortitude in handling a divorce at such a young age and preparing for a custody battle all under the unforgiving and relentless media. I wrote her a fan letter telling her how she had inspired me, and how now I no longer feared my hair loss, but instead embraced it as a symbol of my struggle. I joked that she should do the same and even put one of those ;) emoticons on my note. I threw out my Jan Brady wig after that and proudly wore my shiny scalp proudly.
However, at about the same time I was warned that the Erbitux would give me a delightful rash on my face, chest and back. It did. And it wasn’t a problem until late in week two when the rash on my face erupted into a gaggle of pustules. The area around my forehead, nose and cheekbones soon resembled and felt like a meltdown in a nuclear reactor. Cold compresses were the only relief and that only lasted a few seconds, kind of like sex. I walked outside hoping to get hit in the face with a soothing snowball from some mischievous kids, but found no one but some lonely senior citizens hoping for the same attention. It sucked like that for two weeks. They gave me some antibiotics, but it mostly gets better on its own. After the pustules went away, it just looked like a bad case of acne. I survived that in 9th grade, so I think I could handle that now.
The only other side effects of consequence during this were some minor mouth sores. The type you might get by accidentally biting the side of your mouth or burning your tongue on a blowtorch. When these occurred, it was resolved by using one of my mouth rinses containing lidocaine, which would numb the mouth until I could finish eating or drinking.
And so it went for eight weeks. I met some good nurses. I gained even more respect for family members that would accompany me and sit there for 6-8 hours while the bags dripped into me - even when I didn’t feel like talking and wasn’t very good company. I slept more than I had in the previous year to date. And I learned that this was going to kick my ass no matter how healthy I thought I was going into it.
Now that the induction chemo part was over, I would start the chemo-radiotherapy. Continued chemotherapy to support the radiation treatments I would receive over the next ten weeks to finish off the primary tumor. More on that to follow.