Monday, June 22, 2015

And so the fight begins....

Finally - the day we have dreaded - yet looked forward to - was here!

It actually started Tuesday, June 16th when we had an appointment with Dr. Fenske to sign the protocol and go over treatment and answer questions.

The visit with Dr. Fenske included some measurements of his biggest tumors - you can visibly see them!

Mind you, Brett is super thin right now - so all the lumps you see are tumors (except for his Adam's Apple.. haha).  More lump pictures later:

 Then Brett had to go down to get labs done -- checking his numbers to make sure all was a "go" for the next morning.  My sister and I decided to take a selfie while we were waiting - and look who photo-bombed us! :)  I love this picture.  (My sister doesn't have a black eye - it's just the shadow from the window. haha)

While we were waiting... we see a lady pushing a harp... and she had a dog on a harness!  Right there at the lab elevator?!  If someone had told us... "Sit here - soon you will see a woman with a dog and a harp" - we would have thought they were mental!  I guess anything goes in the Cancer Center!  I take this as a good sign. haha

Wednesday - CHEMO DAY!
Brett was randomized (picked) for the standard care (normal regimen) in the study - which made me think... why did we wait? We could have started 2 weeks ago?!  I'm not sure, but I do know we prayed and knew it was the right thing.  On the other hand - it may be that the other part of the study isn't the best - so I have to believe we have the best option. Brett said, "It's the right thing."  so who can argue?!
We had to be at the Cancer Center by 7am.  We were on time (miracle)!  It was Brett, Aunt Carrie (my sister) and I.  We were led back to the room (which is like a room with 3 walls - and the outside wall open where a curtain can be drawn).  Brett got the comfy chair, of course.  Our main nurse was Mary, but there were usually 2-3 nurses attending to Brett at different times.  They explained what they would be doing (generally) and also what would happen throughout the process.  

Step 1:  Look at Brett's veins to decide which arm/vein to use. They inserted the catheter and had to be very very careful - it has to be absolutely in the vein.  These drugs cannot perforate through the vein or it causes some serious complications.  Inserted by one nurse - and double-checked by the other nurse.  Good to go!
Step 2: Administer the anti-nausea medicine.  This bag of medicine had 3 different medicines - including Dexamethasone and Ondansetron and one other, I can't remember (more minor drug).  The Dexamethasone is a corticosteroid that is a super-anti-inflammatory.  The Ondansetron is a anti-nausea.  All goes well!

Brett's chemo is referred to as ABVD - which stands for the 4 chemo drugs that are administered.  Chemo attacks fast-growing cells - such as the lining of the mouth, tastebuds, hair follicles (causing hair loss), toenails/fingernails, etc.

Step 3: A!  Adriamycin (or also called Doxorubicin).  It's a syringe that has RED in it.  It is a antitumor antibiotic and actually comes from a species of soil fungus!  Crazy,  However, it is VERY toxic.  If it comes into contact with the skin, or outside of the vein - it can cause severe tissue damage and blistering.  So they administer it very carefully - and check the vein throughout the process.  About halfway through - they had to switch to Brett's other arm.  

Popsicle!  So it was believed that eating ice chips (or a popsicle) will slow down the circulation in the mouth lining and lessen the damage of the chemo drug as it enters the system.  Some studies have suggested this isn't the case.  But why not give patients popsicles just in case!?  So Brett gets to enjoy a popsicle during chemo every time.  Not a bad thing.

Chemo Selfie!
Step 4: B! Bleomycin.  Another anti-tumor antibiotic -- again made from a soil fungus! This is administered by a bag/drip.  They start with a tiny bag to test for reactions first.  Then once that went well, they administer the rest of it,

Step 5: V! Vinblastine.  Made from the periwinkle plant - or a vinca plant alkaloid.  Wow!  Again given by a drip.  Each drug is double checked with his name and birthdate and by a 2nd nurse verifying everything.  They verify dosage, etc.  Veins are checked and checked again.  A test-dose is given before the regular dose.  All is going well.
The nurse brings Brett a turkey sandwich, soda, chips, etc.  He was so sweet and didn't want to bother her after she asked him.  She looked at him like he was crazy... and said, "No no.. let us do this for you! It's a long day and you need to eat!"  We brought snacks - but the sandwich looked way better than anything we had.

Step 6: D! Dacarbazine.  Given again by a syringe into the catheter.  This drug is an alkylating agent and adds alkyl (?) to the DNA of the cancer cells.  Medicine is amazing stuff.  

Step 7: Chemotherapy Education.  This is where they go through an entire booklet explaining each drug - all the side effects and when to call the doctor.  For each drug we get a list of possible side effects (normal) and those that are rare, as well as early side effects and late side effects, as well as how to take care of things that could happen.  A lot to learn!

All set!  We are good to go.  And now we watch and wait to see what happens....
Still keeping his humor... posing with one of the booklets!

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