Cycle #2

For cycle #2, I was an inpatient at Hopkins for six days starting on Wednesday, April 16. Unfortunately, the oncology center has been very full, so we were left waiting for much of Wednesday to see if I'd actually get a room. Gwyneth's chief resident arranged a happy hour at the Pickled Parrot for her pediatrics program. What better place to wait for chemotherapy? Amy's baby was kind enough to sport the same haircut as me (a much more charitable child than William).


Fortunately, we got a call around 6:30 and were admitted an hour later. My chemotherapy started at midnight. After my antinausea premedications, I received sequentially one hour infusions of etoposide and ifosfamide.

In aggregate, this was a more difficult cycle than my first for several reasons. First, the etoposide seems to be more emetogenic (i.e., makes me more nauseous) than my other agents. I was definitely queasy on two of my hospital days and took a few prn (i.e., as needed) antinausea medicines. I was always willing and able to eat and things never got messy, but it made my stay less pleasant. Second, the ifosfamide can be toxic to my bladder if it sits around for too long. So, along with my chemotherapy, I got lots of intravenous fluids. From midnight to 5:00 AM I received 2 liters of fluid, and then I got another 3 liters over the rest of the day. To simulate the problem, try chugging a 2-liter bottle of soda before you go to bed and see how much sleep you get. Then, repeat this for 5 days straight. No fun. Third, simply staying in the hospital for six days (even without the chemotherapy) is unpleasant. Understand that I have a wonderful hospital, a modern and immaculate inpatient unit, a private room and bathroom, and wonderful nurses and doctors. Nevertheless, after six days, I was very ready to leave.

My first two days home were notable for some residual nausea, achiness, and fatigue. I was able to work half days, but slept a lot more than usual. By Thursday, I was able to work all day and when I woke up Friday morning (day #11), I felt like a new man. The change was remarkable; I hope this keeps up on subsequent cycles!

Unfortunately, I had a minor complication that came to light on Thursday. Over the last few weeks, the veins in might right arm, chest, and neck have become a bit more prominent. Nothing dramatic or sudden, but by Thursday, it was definitely there (and I had some pain in my shoulder as well). Given where my Hickman catheter is, this raised concern for a possible venous blood flow obstruction. So, I had a CT-venogram (a CAT scan with intravenous contrast) which suggested that I may have some thrombus (i.e., small blood clots) that are building up around the catheter. Given my symptoms and the imaging findings, I was started on a blood thinner shot (Lovenox) which I take at home twice a day (similar to a flu shot injection). Hopefully, this will improve my symptoms. If it does, I'll transition to a blood thinner pill and keep my Hickman. If it doesn't, we may need to remove the line (and eventually put a new one in). Bottom line, while this is all a nuisance, it's unlikely to become a dangerous issue.

Each spring, we make a visit to Sherwood Gardens, a community garden in north Baltimore. They have beautiful tulip beds, but they don't last long, so you're timing has to be good. Fortunately, we made it up for a visit on Thursday and got the requisite baby photos for 2008 (see 2007 and 2006):