R-CHOP Side Effects – Feeling The Downside Of Chemotherapy

R-CHOP side effects
The common R-CHOP side effects, that most patients experience with this type of chemotherapy, didn’t begin to hit me until after my third treatment. The effects began to take root slowly, and increased as time went on. In this post, I’ll talk about some of the different side effects I experienced during my R-CHOP treatment.

One of the first R-CHOP side effects to take place, was hair loss. I noticed some of my hair falling out when brushing it. It started slowly, so it wasn’t really noticeable until much later. Of all the side effects that people experience during chemo, this one was of the least concern to me.

Nausea is something that effects almost all chemotherapy patients, and is probably the most annoying of all the common R-CHOP side effects. Not being able to eat, without the urge to vomit, makes it difficult to keep up your strength. Nutrition is important during chemo, and not being able to eat without getting sick, makes it very difficult.
Loss of muscle mass and body fat also occurs with most patients. Out of all the R-CHOP side effects, this one has a major effect on a person’s ability to function normally, and also alters your appearance. I didn’t experience this in a serious manner, until my next oncologist switched my treatment (which is the subject of another post).
Loss of full immune system functionallity is the most concerning of all the side effects. Patients typically wear filter masks when going outside, and need to be careful of any germs. A simple cold virus could be fatal to someone experiencing this side effect, and is the one that doctors are most concerned with.
Those are just some of the side effects I experienced during my R-CHOP treatment. Doctors do whatever they can to alleviate some of the discomfort. However, they have yet to find a way to completely eliminate all “R-CHOP side effects”.

My Second Chemo Treatment – My Experience With Continued Chemotherapy

second chemo treatmentMy second chemo treatment came 21 days after my first treatment in the hospital. Once I saw the cancer nurse navigator at the oncology clinic, I was given a schedule of how the treatments would be given. According to standard R-CHOP chemotherapy, I would be receiving a total of 8 chemo treatments.
The first thing I did, when getting to the oncology clinic, was speak to the doctor. We talked about lab results and went over any concerns I may have. He again informed me of any side effects from the drugs, and also what the drugs actually do. Since at the time, I had no insurance, and no income, the drugs and money where actually donated.
However, because of having no income and no insurance, I would only be able to receive one more treatment at this clinic. The rest would be given at the Maricopa County Oncology Clinic, which will be the subject of a future post. For now, let me continue talking about my second chemo treatment.
After seeing the doctor, I talked with tne nurse navigator again. Then, it was time to begin treatment. I was taken to the treatment room, and assigned a nurse who would administer the chemo. I sat in one of the reclining chairs, and the first thing the nurse did, was check my vital signs (blood pressure, temperature, heart rate, etc). This is important, because the drugs could have very serious adverse affects on someone with a high temperature, or a blood pressure that is either too high or too low.
Once my vitals where checked, and looked good, it was time to access the Port a Cath. First, the nurse used a freezing agent on the surface of the skin. This numbs the area, so there is no pain when the access needle is inserted into the port. After the access needle and catheter unit are inserted, it’s time to start the second chemo treatment.
The order of the drugs was the same as my first treatment. First, some Benadryl to alleviate nausea. Then, each drug is given in it’s proper order, dosage and speed. This treatment lasted about 7 to 8 hours. Future treatments could be given faster, as my body became accustomed to the chemo drugs.
My mother sat with me during the treatment. We both brought lunches, and I slept for part of the time. The staff also came around offering juices, sandwiches and snacks. The reason they offer snacks, is to help curb any nausea that might occur from the chemo medicines. After the treatment was finished, my uncle came and gave us a ride home.
That was pretty much if for that treatment cycle. It went pretty easy, and I still didn’t feel any real nausea afterwards. Side effects would begin to occur later, as this was only my “second chemo treatment”.

Cancer Nurse Navigator – First Visit With The Cancer Nurse Navigator

[caption id="attachment_334" align="alignleft" width="350"]cancer nurse navigator cancer nurse navigator[/caption]

A cancer nurse navigator is a registered nurse, who guides cancer patients and their loved ones through the health care and cancer treatment process. Now that I had my first R-CHOP treatment in the hospital, it was time to get on a set regimen of treatment.
I was scheduled to visit the oncology clinic about a week after being released from the hospital. I saw the doctor, and we’ll talk about that more specifically in another post. When I saw the cancer nurse navigator, we discussed the entire treatment plan, and also addressed any concerns I might have.
The plan was to give me 8 cycles of the R-CHOP therapy. Each cycle would be given 21 days apart, as is common for this type of chemotherapy. I would be given my second treatment at the clinic, 21 days after my first treatment in the hospital. The nurse then gave me a tour of the chemo treatment area.
The room was filled with reclining chairs, where patients would sit back while receiving chemo. This is because, some chemo treatments can take 8 hours or even more, depending on the type of cancer and the patient involved. The cancer nurse navigator also introduced me to the rest of the oncology staff, and I even met some of the other patients.
After the tour, we went back to her office, and continued discussing treatment details. One thing the “cancer nurse navigator” mentioned, was the fact that, chemotherapy normally causes extreme nausea, hair loss, weight loss, and a whole bunch of other side effects. She also told me what the best foods to eat where, when experiencing nausea from chemotherapy. And, we talked about the importance of nutrition when going through cancer treatment.
All in all, the visit was very helpful. The nurse was extremely friendly and very knowledgeable on the treatment of cancer. And, she was very good at addressing my concerns and explaining everything so I could understand it. So, I would say that, my first visit with the cancer nurse navigator was very productive and enjoyable.

R-CHOP Chemo – My First R-CHOP Regimen

[caption id="attachment_318" align="aligncenter" width="400"]R-CHOP chemo R-CHOP chemo[/caption]

I began R-CHOP chemo the day after my first intrathecal chemotherapy procedure. In this post, I want to talk about my experience with my first treatment, what drugs are involved, and how I felt afterwards. I’m hoping this article is helpful to anyone who is about to start their first chemo treatment.

 
The procedure is very straight forward. Before beginning treatment, the area around the Port a Cath is numbed with either a mild freezing agent, or a shot of Lanacane. The port is then accessed with a special needle/catheter device, by piercing the the skin right above the access port. Since the port is so close to the skin, there is little to no pain.

 

After the port is accessed, it is flused with a Saline solution. This is to insure that there are no blood clots in the port. The nurse then tests the port, by drawing blood into the syringe, then injecting it back in. Once the functionallity of the Port a Cath is verified, they are ready to begin R-CHOP chemo.

 

The first step, is to administer Benadryl, which helps alleviate nausea. I was given a dose of Benadryl through an IV pump, connected to my port. Benadryl makes you very sleepy, yet is important to maintain the patient’s comfort.

 

The R-CHOP chemo regimen involves a series of drugs, which I will explain here in more detail. R-CHOP is actually an acronym, combining either the brand names of the drugs, or the chemical components within the drugs themselves.

 

The drugs included in the R-CHOP chemo procedure include:

R = Rituximab
C = Cyclophosphamide
H = Doxorubicin Hydrochloride (Hydroxydaunomycin)
O = Vincristine Sulfate (Oncovin)
P = Prednisone

 
If you’d like to learn more about each individual drug, just click on each name to be take to the National Cancer Institute’s website, for a description of each drug.

 
My first R-CHOP chemo lasted several hours. Three of the drugs are given via IV through the port, and the rate of injection varies with the patient. For a new patient, the IV pump is set to run slowly, so as not to overwhelm the body.

 

Doxorubicin can be given either via the IV, or through a handheld syringe into the Port a Cath. Finally, Prednisone is taken the 2 days following the treatment, in pill form. This has to be taken with food or milk, as it is extremely NASTY tasting, and can cause major nausea.

 

Chemotherapy does a great job of killing cancer cells. However, the drugs cannot differentiate between rapidly growning cancer cells, and other fast growing cells in the body (ie, red blood cells, white blood cells, and cells that are involved with hair, muscle, and skin development.)

 

To counteract this, I was given a shot of Neulasta the day after chemo. This drug stimulates activity in the bone marrow, to kickstart cell regeneration and production.

 

So, that was my first “R-CHOP chemo” treatment. I didn’t feel any nausea at all during this first regimen, which is common. Nausea usually doesn’t set in until future treatments. I’ll discuss future chemo sessions in my upcoming posts.  For now, I hope this article is helpful to anyone who is about to begin R-CHOP chemo.

 

Intrathecal Chemotherapy Procedure – Hitting non-Hodgkin's Lymphoma Where It Hides

[caption id="attachment_300" align="alignleft" width="300"]intrathecal chemotherapy procedure Intrathecal Chemotherapy Procedure[/caption]

My first intrathecal chemotherapy procedure occured the same day as my Port a Cath placement procedure. In fact, I was taken down to have the procedure almost immediately, since I already had anesthetic drugs in me. This way, they wouldn’t have to wait and administer new numbing agents.
I was taken to a table, similar to the one used during the previous procedure. I had to lay on my side, so the doctor could perform the intrathecal chemotherapy procedure. The way it works is, chemotherapy drugs are injected into the spine. This is because non-Hodgkin’s Lymphoma likes to hide in the spinal and brain fluid. Standard chemotherapy only targets the blood, so this is used to insure that all cancer cells in the body are killed.
I will say that, it was a bit painful. I mean, having a needle injected into your spine, which is one of the central “hubs” of the nervous system, is not a pleasant feeling. I simply focused on the outcome, not the procedure. Once I did that, I didn’t notice the pain anymore.

 
Once the intrathecal chemotherapy procedure was complete, I was taken back up to my room. This time, they wheeled me back on a bed. This is because, once intrathecal chemo is given, they want you to rest flat on your back for about an hour or so. This is because, elevating your head could cause major headaches.

 

Once I got to my room, I was offered something to eat. So, I ate a sandwhich while laying flat in bed. Not an easy thing to do, especially when trying to drink some juice. This is where a straw came in quite handy.
That’s pretty much the procedure in a nut shell. A day or two after that, I would begin the standard RCHOP chemotherapy, common with most non-Hodgkin’s Lymphoma patients. Keep a look out for that post tomorrow. All in all, my first “intrathecal chemotherapy procedure” was a fairly easy process.

Port a Cath Placement Procedure – The Beginning of Chemotherapy

[caption id="attachment_273" align="alignleft" width="276"]Port a Cath placement procedure Port a Cath Placement Procedure[/caption]

Finally, it was time for my Port a Cath placement procedure. My oncologist needed to wait until they discovered what type of cancer I had. As soon as they gave me my non-Hodgkin’s Lymphoma diagnosis, they put together an action plan. You can read that post here.

The Port a Cath was placed the very same day that the pathology report came back. When it was time for the Port a Cath placement procedure, I was taken down to the O.R. level by wheelchair. From there, I was given an explanation on exactly what would happen, what the risks are, etc.

They explained that I would be given a local anesthetic, so I would be awake during the procedure. They also showed me a sample of what the Port a Cath looked like. It’s actually a very simple device. It’s basically a thin hose with an access port. The hose would be inserted into an vein in the chest, while the access port would sit just under the skin surface, just underneath the collarbone on the right side of my chest.
When it was time to begin the Port a Cath placement procedure, I was taken to an operating table, and given something to numb the area they’d be working on. I couldn’t see what was going on, because they draped a paper cloth over the area and in front of my face. I will say that, the needle felt like it was the size of a chopstick. And, they had to move it around to make sure the entire area was numb.

As the area became numb, I also began to feel kind of woozy. The anesthetic would allow me to remain awake, yet I would not really remember much. What I’m sharing here are just the bits and pieces of what I remember.

They tested the area, to make sure I didn’t feel anything. Then, the doctor made an incision just below the collarbone, and pulled back a few layers of skin. Then, he made an incision in the vein to insert the hose section. Once everything was in place, the skin was folded back in place, and the wound was sealed with disolvable stiches.

That’s pretty much how the procedure went. Again, I don’t remember all the details, since I was pretty doped up. When they where finished placing the Port a Cath, I was taken back to my room. The plan was to start chemotherapy once the wound had time to heal.

That same night, my oncologist put in orders to have me start intrathecal chemo, which goes into the spinal fluid. I’ll talk about that in my next post. It’s pretty interesting how that procedure is performed.

It’s kind of funny that, all my life, I never had any surgeries. And now, I had 2 within a few days of each other (the first being the left orchiectomy). I would soon be ready to start chemotherapy, now that the “Port a Cath placement procedure” was completed.

Non-Hodgkin’s Lymphoma Diagnosis – What Happens Next?

 

[caption id="attachment_265" align="aligncenter" width="450"]non-Hodgkin's Lymphoma diagnosis Non-Hodgkin’s Lymphoma Diagnosis[/caption]

After the results came back from the lab, I was given a non-Hodgkin’s Lymphoma diagnosis by my oncologist (Stage 3 E to be more specific).  If you want to read the last post, where I talk about my left orchiectomy  surgery, click here.  Now that I was given a diagnosis, my oncologist was ready to put together a plan of action for treatment.

He assured me that, a non-Hodgkin’s Lymphoma diagnosis was much better than an Hodgkin’s Lymphoma (also known as Hodgkin’s disease) diagnosis.  With his experience, he’s seen a 50% remission rate in patients with NHL.  Compare this to testicular cancer, which was one possibility, where his experience was a lower rate of remission.

We discussed what the treatment would be.  First, they would install a port-a-cathe in my chest, to administer chemotherapy.  The reason they use a port-a-cath when treating someone with a non-Hodgkin’s Lymphoma diagnosis (and many other cancers) is because the chemo drugs could actually eat away at the skin.  The port-a-cath allows the drugs to go directly into the blood stream, so they can go to work, killing the cancer cells.

He prescribed the RCHOP therapy, which Is the standard chemo treatment for someone with  a “non-Hodgkin’s Lymphoma diagnosis”.  I would also be receiving what is called intrathecal chemotherapy, which is injected into the spinal fluid.  I’ll talk about the details of the RCHOP therapy and intrathecal chemo in future posts.

So, now that I was given a non-Hodgkin’s lymphoma diagnosis, they were ready to install the port-a-cathe.  That will be the subject of my next blog post, where I’ll talk about the procedure and what was involved.  This was the beginning of a long and rough road to recovery.  I’ve been fortunate enough to work with, in my opinion, the best doctors, nurses and medical staff during my non-Hodgkin’s Lymphoma diagnosis.

 

Left Orchiectomy – My Left Orchiectomy Surgery Experience

left orchiectomy

In early 2012, my urologist performed a left orchiectomy, to remove a tumor.  Now, in my last post, I talked about the initial lab test ordered by my urologist, and my experience with that.   You can read all about my experience getting lab work blood tests done here.  Today, I want to talk about what the surgery entailed, and my experience.

 

An orchiectomy is the removal of one or both of the testicles.  Since my left testicle had developed a tumour, that testicle had to be removed.  The right one was left alone, as there was no indication of the tumour spreading.  Surgery was performed the same night that I arrived at John C. Lincoln Hospital.

 

My mother had gone with me to the hospital, and sat with me in surgery prep while the doctors and nurses got everything ready.  This was the first time I had ever had surgery.  My urologist and the anesthesiologist both saw me before the surgery, explaining everything that would be happening.

 

The anesthesiologist explained how the anesthesia worked, and what he would be doing, to make sure everything went well.  He also told me of any possible risks.  My urologist explained how the left orchiectomy surgery would be performed, and also informed me of any risks involved.  He said that, this type of procedure used to be done by cutting into the scrotum sack, and removing the testicle that way.  He doesn’t like doing that, as it leaves a very large and noticeable scar on the scrotum.

 

Instead, he prefers to make an incision just below the lower abdominal area.  From there, he’s able to pull the testicle upwards, and remove it that way.  He says it “just hangs there like a Christmas ornament” and is easy to remove that way, with minimal scarring.

 

The surgical nurse told me and my mother, that the surgery would be about an hour and half.  My urologist said he could do it in about 20 minutes.  He’s done enough of these surgeries in his career, that he’s become proficient at doing them well and in less time than many other surgeons.

 

After the left orchiectomy, I woke up in the recovery room.  For those who have never had surgery, they want to make sure you are awake so you can start drinking, and flush out the anesthesia drugs, as they can be harmful if they remain in the body.

 

That same night, after being put back in my room, my urologist came up to see how I was doing, and I also met my first oncologist, who was also present during the surgery.  My oncologist joked and said “it feels good getting that rock out of there, doesn’t it?”, referring to the tumour engrossed left testicle.  I agreed that it did feel much better.  And, it didn’t really feel much different having just one testicle.

 

They wanted to see how I was doing, and told me what would happen next.  They would send the testicle to their pathology lab for testing.  They would determine whether it was testicular cancer or lymphoma.  My oncologist did assure me that, if it was lymphoma, his experience with patients has been a 50% remission rate.

 

So, that was my first surgical experience, and the first of many treatments and procedures in my battle with cancer.  In my next post, I’ll talk about what the pathology lab discovered and my experience with my first chemotherapy treatment, and how everything fell into place after my “left orchiectomy”.

 

 

Lab Work Blood Tests – The Next Phase In Diagnosis

lab work blood tests

After seeing my Urologist, he wanted me to get lab work blood tests done.  This was to determine what the exact health issue was.  To read the post about my first Urologist appointment, click here.  I was sent to Sonora Labs, which is one of the nation’s most reputable laboratory testing facilities, with labs all around the United States.

 

When I got to the lab, there was not much waiting.  Only a few other people were actually in the lobby waiting area.  When it was my turn to get my lab work blood tests done, the lab technician took a few vials of blood from my arm, and that was it.  Being without insurance and money at the time, my brother paid for my lab tests.

 

The test results came back within a few days, and based on the results, my urologist wanted me to get some followup tests.  What usually happens is, they’ll do the most common tests and then narrow it down to detect more specific illnesses and diseases.  So, I was told to go back to Sonora Labs to get more lab work blood tests done.

 

Knowing at the time, that I couldn’t afford the other tests, which were going to cost around $600, my urologist came up with an idea.  He said to go to the ER at the hospital (where I went before) and hopefully, since I was feeling very ill, they would admit me.  Then, all lab work would be done in the hospital, and I would not have to pay out of pocket.

 

Well, I went back to the same hospital, which was Paradise Valley Hospital in Phoenix, and went to the ER.  The same doctor examined me, and then came up with the (not so) “brilliant” conclusion that I had Bronchitis.  He sent me home with a prescription for antibioitics and prescription cough medicine.

 

When my urologist heard of this happening, he couldn’t believe it.  They should have admitted me, yet they didn’t.  Now, this is not a PV Hospital bashing session, however, many people I know have had similar experiences with that hospital.  They seem to not want to deal with anybody that has no insurance.

 

So, the next day, my urologist’s medical assistant called me and said to go to the ER at John C. Lincoln Hospital, and that he would contact the doctors there to have me admitted.  I will say that, overall, the people at John C. Lincoln where fantastic.  I was eventually admitted,  and had some more “lab work blood tests” done by their lab techs.

 

My urologist met me there, and I was also assigned an oncologist.  They both talk to me about what was going to be done.  The first step, was to have surgery to remove my left testicle.  Then, the pathology lab would test it, to determine what the issue was.  It was either testicular cancer that spread to the armpit, or, lymphoma that had spread to the testicle.

 

I would be having surgery done that same night, which I will talk about in my next post.  If you are experiencing any of the symptoms I had, make sure you see your doctor right away.  Their first action will most likely be to order some lab work blood tests.

 

My First Urologist Appointment – First Step Towards Diagnosis

réflexion

After being examined at the hospital emergency room, I was scheduled my first urologist appointment.  You can read that post, about the lump in my armpit here.  It was a few days after the ER exam, that I went in to have an examination on my testicle.  In my last post, I mentioned that I discovered a lump in my left armpit, and that my left testicle had become enlarged.

 

The urologist’s office was in the same complex as the hospital, which was convenient, as I didn’t have to travel far, or search for it.  This first urologist appointment was fairly short, yet very helpful.  The doctor examined me, then we discussed some of the possibilities of why my left testicle had become enlarged.

 

There were two possible scenarios as to why this had occurred.  One possibility was that I had developed testicular cancer, which spread to the armpit, and thus, caused that lump. Or, I had developed lymphoma, which spread (or metastasized), to the testicle.  In order to learn more, he put orders in for me to get some blood tests done at the lab near his office.  The tests would be done in a few days.

 

He was clear about letting me know, that I would possibly lose my left testicle.   He also assured me that, it would not affect my quality of life in the least bit.  He mentioned people like Lance Armstrong, who developed testicular cancer, and continued to thrive after surgery.  After this first urologist appointment, I went home, awaiting my appointment with the lab.

 

So, that was my initial experience with my urologist.  He was able to explain to me what the possible outcomes where, and also assured me that my quality of life would not be affected.  Be sure to watch for my next post, where I talk about my experience with the lab and getting my blood work done.   From my experience, my “first urologist appointment” was very helpful.