Two Weeks of Chemo: Day 10

This is part of an ongoing two-week series. For more info, see this introductory post.

One amusing thing about the days I have my chemo treatments is seeing what new way we will manage to delay our departure. Don't get me wrong; I love the chemo nurses and we generally have a very favorable experience at the chemo suite, but I would be very happy never going back there again. So it's frustrating that about half of the time we go, we are stuck there for longer than is scheduled.

First of all, IV Pump #2 and I do not get along. IV pumps are designed to administer fluid at a constant rate and to detect if there is an unexpected rise in pressure during infusion which would indicate a kink or other blockage. The problem is that whenever my Adriamycin and vinblastine (the "A" and "V" in the ABVD chemo regimen) are infused, they must be administered manually from slow pushes by the nurse. Each push causes a wave of pressure that can trigger an error in the IV pump. Each time this happens, the nurse must reset the pump before continuing. A half-hour of pump error beeps will drive anyone crazy.

A second problem I have encountered is that my body seals off my port. Immune cells rightly detect the tip of the port's catheter as a foreign object and try to seal it off from the body. They do this by building up a layer of fibrous scar tissue on the surface of the catheter, the open tip of which becomes blocked. The nurse can usually push fluids in because the tissue forms a sort of flap that is flipped open as fluids rush out. But as the nurse attempts to pull blood back out, the flap swings shut and holds strong against the suction.

The nurse needs to have good blood return before we can proceed with the chemo as it indicates that the medication is making it to the blood stream, rather then getting trapped in the nearby tissue. In order to fix this the nurse 1) pulls really hard whilst I jump and move about, 2) injects an anti-clotting agent that is left to sit in the catheter for 30 minutes, and 3) pulls really really hard while swearing. If none of the above works, they would have to send me to get an x-ray to see what is causing the blockage. Thankfully it has always resolved before that.

One week, our delay came in the form of a lesson in pharmacology. We helped teach the nursing staff that dacarbazine (the "D" of ABVD) is a photosensitive drug. It was a beautiful sunny day outside, so we had the blinds up and one of the nurses used the large window sill as a counter for holding my basket of IV bags. When we arrived at the last drug in my treatment for the day, dacarbazine, we noticed that the IV fluid had turned pink from its usual colorlessness. The nurse returned it to the pharmacy and we had to wait for another bag to be mixed.

Apparently the same thing happened to another patient on the following Monday and now every bag of dacarbazine has to be placed inside a brown plastic sheath to prevent the light induced degradation of the drug. I am amazed that in the history of the administration of this very common drug at this office, this effect had never been seen before my treatment that day. As my nurse pointed out, at least the degradation likely wasn't harmful. If you break down a poison, it generally becomes less dangerous, not more so. If this had been happening before, it likely only led to a slightly less potent drug. In light of this, I am kinda glad that I inadvertently helped point out this danger, so that from now on more people will get more of the drug they need.

Well, here's hoping that this Friday goes smoothly (but I'm not holding my breath)!

Back to Day 9.
Ahead to Day 11.