Chemotherapy 1st Cycle, Almost

This morning, I was the first patient this morning at the Santa Barbara Cancer Center. Bright and early.

I was nervous, really, really nervous.

At the reception desk, I was given a pink questionnaire (at least it’s my favorite color!) asking me about any symptoms I am currently experiencing. Apparently I will have to do this before every chemotherapy infusion.

Then I was escorted to the Treatment Room.  It is a beautiful, spacious and calm place (one of the reasons we chose the Santa Barbara Cancer Center). Sitting in a chemotherapy administration room means that I’m officially into the next phase next  of FBC.

Three nurses introduced themselves.  All were very welcoming and kind. I even had my pick of chairs.  Whoo-Hoo!

Though this isn't an image of my nurse (privacy issue, you know). I felt the warmth of their smiles...reflected in this photo.

The nurses already knew that I’m a nurse.  This type of knowledge goes a long way.  There is an inherent professional connection, communication and respect for one of your “own”, especially when illness and caring are involved.

We discussed accessing my port-a-cath.  Accessing a port-a-cath means putting a large needle into the port-a-cath.  Connected to the needle is an intravenous (IV) line through which chemotherapy  and other medications can be administered.

I told them that have an extremely LOW tolerance for pain, i.e., even the lightest touch hurts.  I requested both lidocaine and EMLA cream. EMLA Cream is the relieving pain of normal intact skin and numbing skin to pain from injections and other medical procedures. EMLA Cream is a local anesthetic. It works by blocking nerves from transmitting painful impulses to the brain.  They didn’t have any there.  To get EMLA cream, you need a doctor’s prescription and it takes and hour to work.  F-Bomb.

OK, well, how about a little injectionable lidocaine to numb the area.  Nope.  They didn’t have that either.  WTF?  I almost broke into tears, but instead, out came the F-bomb (outloud).  I reiterated exactly how low my tolerance for pain is and they promised to do it as fast as possible.  Really?  Really?

Let me explain briefly how a port-a-cath is accessed (www.childrens-mercy.org):

  • Accessing the port:
  • Supplies Needed: Appropriate sized Huber needle, Persist or Betadine swabs, 10cc syringe of Normal Saline, 5 cc syringe with 100 unit/ml Heparin, sterile gloves
  • Locate the port septum by palpation
  • Put on sterile gloves
  • Prime needle tubing with saline and leave syringe attached
  • Cleanse skin 5 inches out from center of the port  using the antimicrobial swabs. Use a circular motion and work outward

  • Placing the needle
  • Relocate the port septum (center) between two fingers, pulling the skin taut.
  • Firmly (as in STAB!) the needle at a 90 degree angle through the skin into the port septum until it hits the bottom of the port chamber.

  • Establish Patency
  • Establish that the needle is in the correct place by aspirating blood, then irrigate with 10 cc of normal saline (fluid).
  • Once blood is drawn and/or when medication s are complete, flus with 10 cc of normal saline and Heprain (blood thinner to keep the line open).
  • All I can say is that accessing my port-a-cath was a disaster and hurt like a F-Bomb.

    ALARM! ALARM! ALARM!  OWIE! OWIE! OWIE!

    Holy heavens.  Tears instantly poured down my cheeks.  I wanted to throw up.  It was AWFUL.  Not only that, but the nurse didn’t hit the bulls-eye and had to pull it out and do it AGAIN.

    The poor nurse was mortified and completely apologetic.  It was awful all the way around.

    She FINALLY hit the center of the port and was able to get fluids to go through.  Yeah!

    Before chemo can be administered, however, blood must be drawn back through a syringe connected to the intravenous (IV) line.  This ensures that the line is in the right place.

    If you look at the syringe in the image above, pulling back on the syringe should bring blood out of the vein. Well, that didn’t work initially either.  So, she gave me two small bags of normal saline (salt water) to see fluids running through the IV for a short period of time could get the holy grail of blood to pull back in the syringe.

    Well, FINALLY it worked.  Yipppeee!  Now we are ready to roll!

    In the meantime, she also gave me (per my request) intravenous Benadryl (to offset side effects, with the added bonus of making me sleepy) as well as Ativan (an anti-anxiety medication).

    After I was given these two drugs,  the steroid Dexamethasone was administered through my IV.  “Dex” as it’s commonly referred, helps prevent nausea and can increase appetite.  On the opposite end of the spectrum, it can produce sleepless nights and anger issues, commonly referred to as “‘Roid Rage.”  I’m not kidding. Let’s just say that the F-bomb has been dropped A LOT today!  …A LOT

    Then, my doctor came into the room to tell me that there has been a “snafu.”  WTF?  (‘Roid Rage was beginning to take effect).  Yesterday, in preparation for today’s chemotherapy, I was supposed to have taken Dexamethasone.  Really?  Really? Hmmm….why didn’t I, the patient, know this?

    A long story short, they were NOT able to give chemotherapy today (because I had not had a dose of Dex the day before chemotherapy).  I’m not kidding.

    This is a classic example of a patient falling through the cracks.  Patient = me.

    So, tomorrow morning at 8:30, I will go back to the Cancer Center to try it again.  Get back on the horse, as they say (but this time I’ll have EMLA and anti-emetics in my saddle)!

    Well, I had to look LONG AND HARD for a SL’s (silver linings) today (especially consider the ever mounting ‘Roid Rage), but was able to find several:

    1. I was able to get out all of the initial worries and anxiety about going to a cancer center to receive chemotherapy.
    2. For the first time in my professional career, an Oncologist apologized (and truthfully, it wasn’t his fault, however, as “the decider” he took responsibility).  This gave me even more respect for him.
    3. I now have EMLA cream to place on my port-a-cath before tomorrow’s stick.
    4. I took a long nap to offset the effects of the Benadryl and the Ativan.

    Now, I’m just holding the highest hope that the ‘Roid Rage stays at bay.  The last thing that I want to add to this situation is being grumpy.  That is so not how I roll!

    Wishing you all a day filled with SL’s!

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    Comments

    1. Lisa says

      Hi Hollye,
      I had the port a cath from h**l or PFH! The nurses at the Cancer Center of SB were fantastic. They could infuse it but it never got a blood return. So, I had to do a dye study to find out that it was a thumb nail too short. The Cytoxan and Adria (don't drink the Kool-Aid) were awful. With the Taxol I joked that, "this isn't your mother's chemo anymore" because I tolerated it really well. With the PFH I had to take two Tylenol and put on lidocaine cream two hours before, then add more one hour before, then add a last dose right before. I would put on my headphones and try to zone out as they accessed the PFH. After about 30 seconds of breathing and trying to come back from orbit(from the pain) they would continue with the poisons.
      I call my silver linings "Hallelujah moments." I remind everyone to find these moments of grace in each day. I suggest that people ask if they can hug a person, when that person tells them about a big c diagnosis. That was something I most needed after my diagnosis. It seemed like everyone was afraid to even touch me, initially. Fortunately, the hugs flow freely now.
      My mastectomy was November 8, 2011 and reconstructive surgery (diep) will be December 2012.

    2. Nan and Hilary Jacob says

      You are an amazing inspiration to all of us and thank you for taking us along on your journey. Thinking of you every step of the way, as you bravely do what you have to do..and do it one day at a time. By the way..looking beautiful and so chic…love the orange bag!

    3. MaryAnne says

      Now that you've got the Murphy's Law of chemo out of the way, here's hoping it goes smoother. You are that strong tea bag Eleanor Roosevelt spoke about with all the hot water you keep dipping into…xoxo lots of love.

    4. Rob Jacobs says

      Thinking of you this morning Hollye and hoping all goes much better than yesterday….also thinking of the famous quote from Teddy Roosevelt:

      "Do what you can, with what you have, where you are"

    5. Fran Sachs says

      Your information is amazing. I went for chemo, went to lunch (even after 16 years, I won't eat barley soup anymore) and came home and sucked on frozen hershey kisses to combat nausea. Really helps. Because of the redish chemo drug, I couldn't look at ketchup bottles on tables. That went away. And the worst day was putting on a wig for the first time…But the best was taking it off 6 months later and dying the grey hair that grew in. Its all a bitch, but you WILL do it – and be a stronger woman for it…love and good thoughts

    6. Cameron says

      Well you found a SL during your chemo dress rehearsal! Good luck tomororw…was thinking of you today and will again tomorrow . I know you will do great and at least the procedure will be more familiar after today's experience. Sweet Dreams xx

    7. Diana Brill says

      My mother and grandmother both had FBC and I never knew about so many of the things you are writing about. Thank you, for giving me a new accurate perspective. YOU are a SL.

      Oh By The Way . . . my mother is 86 this year :-) almost 30 year survivor!

      You will be in my thoughts and prayers tomorrow !

    8. Merryl says

      Well, that was a huge "SA" moment, but you handled it with your trademark style and grace, sister!!! You are the best and you are loved so dearly by us all.

    9. Carol Sacks says

      Thinking of you, your amazing resilience and grace. Here's hoping tomorrow's session goes better and that recovery over the next three weeks happens without complication. Take care and keep breathing!

      carol