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BryanC (RIP)

Three Day Chemo Session: A Walk-Through

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Many of you are probably aware that I am presently (still) undergoing chemotherapy. I made a blog entry quite a while ago, detailing how the cancer was found (pure luck) and the following surgery. You can find it here: A Medical Message that may Save Your Life!
That was back in February 2012.

I also started an update thread back in June 2012 (here: Alligator Lines: Status Update (and for me as well) ) and updated it in December 2012, I have done nothing in the way of updates since then but it getting time for another.

In the mean time I thought some of you may be interested in a walk-through for a typical three day chemo session I undergo every 2 ½ weeks. Of course, there are many, many different chemo drugs and almost as many types of sessions! They can range from an hour or two at the clinic once a week through a variety of multiple formats. Think of a scenario and there is probably a session that comes very close! In my case, a session lasts for three days; a day at the clinic and two days of in-home infusion.

Please note, I receive my chemotherapy from the Cleveland Clinic (in Weston, Florida). I know nothing of the other establishments that provide similar services.

Before we start, it is probably a good idea to talk about the infusion port I use. If you are going to have any kind of infusion on a regular basis a port is the way to go! However, if your insurance will not cover one then you are stuck with the needle in the arm or back of the hand method and chemo drugs can be hard the veins.

A port is something that resembles a pipe in appearance (you remember, the kind people used to smoke). There is a bowl with a grid across it and a hollow stem. This contraption is placed under the skin and attached to a vein. In my case it is in my right shoulder area (just above the breast) with the “stem” attached to vein in my neck. It is put in place while under a local anesthetic (but a pretty strong one). I was awake but only barely! The actual port I have is an Xcela Power Injectable Port. Here is one link for a little further information http://info.navilystmedical.com/Blog...jectable-Ports but if you are really interested I suggest a Google (or Bing) search!

The doctor who inserted the port made it very clear that the biggest problem with ports was the possibility of infection. To keep this to a minimum, anyone accessing (more on this term in a minute) must use surgical gloves and a surgical mask. Additionally, the patient needs to turn their head away during this process. The person accessing the port needs to be trained in its use, be certified in its use (every six to eight weeks) and be an RN or above. Sorry, LPNs don’t cut it! Once installed, a port may remain in place for years.

I have a purple bracelet labeled “CT RATED INFUSION PORT” and a card I have to carry with me identifying the type of port, the date of installation and the doctor doing the deed! One of the best parts about the newer port models is that they are two way. They may be used for infusion or the withdrawal of blood. Very handy!

OK, on to the walk-through!

The day before the chemo appointment the “At Home Infusion” company drops off the necessary supplies for the in home portion.

On the day of there are actually three different appointments (for me, anyway). The first is with the lab for blood work, the second is with the doctor and third is for the actual chemo session.

Sherrie has been going with me recently and we arrive 15 minutes early at the Registration Desk. Here I am checked in (including a hospital bracelet – required for anyone having blood work). Once checked in we sit and wait for the lab tech to come and get us. Once called we go to the “blood work” room. We have had the same nurse doing this for quite a while so we are on first name terms with “hello” hugs!

The first order of business is to “access” the port. She first opens a sterile package for the surgical gloves and mask. I then open my shirt and she scrubs the area with an antiseptic (no alcohol) pad. Once that is done the needle is inserted into the port. The needle is about three quarters of an inch long and has a plastic “butterfly” to hold it in place with about three inches of plastic tubing (with a nozzle on the end). Once inserted the whole thing is held in place with a large, circular area of Band-Aid like material. If you have any hair in that area you are well advised to shave the area first!

The needle insertion feels like a needle prick, (of course, the skill of the nurse helps). Having my arm poked is much worse!

She then attaches a syringe (no needle) to the nozzle on the tube (this is a special design and only items that match the tube nozzle may be used) and flushes the port with a saline solution. Then the blood is extracted; once done the port is again flushed with saline and the tube is clipped close. We then return to the waiting area and wait for the doctor’s nurse to come for us.

It takes about half an hour to get the results of the blood work and the doctor’s appointment is usually half an hour after the blood work.

Michele comes to get us (with more hugs) usually, but not always, on time and guides us to the room we will be using. She takes my vitals and reviews the current medication list. We are then left to wait for the doctor.

He eventually comes in (usually late) and after greetings he discusses the blood work results. Following this we usually discuss the side effects of the last session. Depending on how they were he will make recommendations or prescribe any drugs he feels appropriate. Next, he formulates the cocktail I will be receiving that day and sends it down to the pharmacy. This formulation always happens (for everyone) and is based of height, weight, blood work and recent side effects! The visit ends with a quick physical exam and we are done.

If the chemo room is ready for me, we go straight there (down the hall, at the end); if not, we get a beeper and they buzz us when they are ready.

The chemo room is a large rectangular room and we enter in the middle of one end. On the immediate right is a washroom and a kitchen area with coffee, tea and water available, as well as a variety of snacks. From there, there is a long desk with seven work stations in total. It wraps around at the end where the last two (of the seven) are situated. Six of the stations are for the six Registered Nurses who look after the chemo patients. The seventh station is for an admin personwho makes appointments for your next session plus any other stuff that may become necessary.

On the left are nine chemo “stations” with three more across the far end. (Two patients per nurse). Each station comprises a comfortable recliner, a small book case with magazines and a TV, and a chair for any visitor. They only encourage a single visitor but will accommodate more if necessary. Finally each station has curtains which may be drawn around the station for privacy if needed. Of course, there is also the pole for hanging the drugs on. These poles can handle two drugs at a time and have electronic monitors to monitor the flow and the time remaining.

If they are not busy you can choose where you want to sit; if they are busy you are told where to sit! I always try to get the earliest appointment available so they are usually not too busy when I arrive. Once I claim my station I visit the washroom and pick up a snack of two.

The first drugs to be infused are the “pre-meds” which takes about 45 minutes. These include a variety of drugs all designed to make the actual chemo infusion go smoother. Included are Benadryl (which puts a lot of people to sleep but has no effect on me) and an anti-nausea drug.

The actual chemo drugs usually arrive (via a dumb waiter) during the pre-meds infusion. In my case the chemo infusion takes about four and half to five hours. I always call my “at home” nurse when the chemo infusion starts so she will have an idea of when I will be through.

Each of the drugs is fully labeled with my name, birth date and other information. The nurse always reviews this information with me prior to using it.

During the several hours of infusion I usually spend the time reading stuff on my tablet (no, it is not an iPad – I don’t do Apple). Cleveland Clinic maintains a free, public Wi-Fi network so that is very useful. Sherrie is also reading magazines or sometimes she will go off and run an errand or two!

Finally the infusion is over and we can leave, but not before the port is flushed with some saline! (The needle in the port remains in place for the “at home” part!) I will call my “at home” nurse as we are leaving.

She usually arrives at the house between one and two hours after we get home. She will hook up the pump and the reservoir (containing more of one of the drugs I received at the clinic) and place them in a small carrying case that may be worn as a fanny pack (or over the shoulder). Another flush of saline and she connects the tubing from the reservoir to my port and turns it on. And that’s it for 46 hours!

The fanny pack is nice because it doesn’t hinder me. I can walk around or even drive (if I feel up to it). I’ve been to the store more than once while wearing it!

46 hours later and she is back to disconnect everything. The pump is turned off and the tubing from the reservoir is disconnected. The port gets a shot of saline and this time it also gets a shot of heparin (to help prevent the blood from clotting in the port). The needle from the port is removed and I am “de-accessed”!

That is pretty much it for another 2 ½ weeks!

Please share your chemo experiences; that is, if you are unlucky enough to have had any! If you have never had to endure these sessions, count yourself as very lucky and look after yourself. This includes eating and drinking healthily!
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Comments

  1. Albey25's Avatar
    Is there an end in sight? All the cancer survivors that I know have eventually been able to stop their chemo. I seems like you have been enduring this for at least several months now. Best wishes to you and while it seems horrible to have to do this every couple of months, at least you are alive to do it! I am never less than amazed when I read about the advances in treatment of this dread disease. The complicated ritual you go through was arrived at by smart, dedicated people, working independently all over the world who have come up with this as a means to cure you. Think twice everyone, when someone from the American Cancer Society comes around soliciting a donation. It is the ONLY way this thing will get beat!
  2. zosimas's Avatar
    Quote Originally Posted by Albey25
    Is there an end in sight? All the cancer survivors that I know have eventually been able to stop their chemo. I seems like you have been enduring this for at least several months now. Best wishes to you and while it seems horrible to have to do this every couple of months, at least you are alive to do it! I am never less than amazed when I read about the advances in treatment of this dread disease. The complicated ritual you go through was arrived at by smart, dedicated people, working independently all over the world who have come up with this as a means to cure you. Think twice everyone, when someone from the American Cancer Society comes around soliciting a donation. It is the ONLY way this thing will get beat!
    well said, i was lucky and didn't need such treatments.