Chemo II: Return Of The Pump

5-FU is back and he's brought some friends!

I'm about to start the next set of chemo.  There are 12 treatments in all and each lasts three days.  This regimen differs from the previous in a couple of ways: I'll be on three drugs instead of one and the treatment will be for two days every two weeks instead of five days per week.  On day one, I'm hooked up to my old friend, the 5-FU continuous infusion pump.  I'll also get an leucovarin and oxaliplatin infused over three hours.  On day two, I'll continue to wear the pump and on day three it will be disconnected.  I should be finished in mid-July.  Here's more on the drugs:

• 5-FU (5-fluorouracil), which I was on last time, inhibits RNA and DNA synthesis.
• Leucovorin is a derivative of folic acid.  It enhances the effect of 5-FU and prevents neural tube defects in developing embryos (another way colon cancer is like pregnancy).
  
• Oxaliplatin also inhibits DNA synthesis, maybe by alkylating the DNA (the FDA approves drugs based on efficacy, often without knowing exactly how they work in vivo).
  

Oxaliplatin has some miserable side effects.  There's the run-of-the-mill stuff, nausea, diarrhea, reduced white blood cell counts.  Then there's the neuropathy. I'll have an extreme sensitivity to cold, such that I won't be able to take anything out of the refrigerator without wearing gloves.  I shouldn't take things out of the fridge anyway because if I ingest something cold I'll feel like I'm suffocating.  Then, as the weeks go on, I'll start losing the feeling in my fingertips and toes.  I'll have a hard time buttoning a shirt, tying my shoes, and doing other fine motor skill tasks that we take for granted.  Basically, I'll fail a field sobriety test without drinking.  Another side effect is hearing loss.  So, if I were to have a field sobriety test, I wouldn't even hear the policeman's instructions.

I've been a little disappointed in my therapy so far - not the efficacy, but its age.  5-FU, radiation, and surgery have been used against cancer since the 1950's. In practical terms, this is like driving a car with manual windows and door locks, no A/C, and an AM radio (in other words, Pasco, like your last rental car).  Sure, it will do the job, but it's boring and unsexy.  Other cancer patients are getting interferons, interleukins, and things that end in "mab" and "ux," while I was getting grampa's chemo.  Oxaliplatin, however, was approved in 2002.  So, finally I'm getting a 21st century drug.

Just Throwing This Out (Up?) There

I'll get back to the naming poll in a short while. In the meantime, week 4 is over. It went pretty well except for the radiation burns (dermatitis) that are really starting to chafe. The other side effects are increasing too. A pretty common one is dehydration - I wake up with cotton-mouth and my blood pressure has been low. The nurses asked if i want i.v. fluids to re-hydrate, but I've passed so far, opting to drink more, or "push the fluids." The problem with that is that the fluids push back.

Another side effect is nausea. I've been taking pre-emptive anti-emetics for this and so far, so good. They've prescribed three lines of anti-emetics.

"Take Kytril. If you still have nausea and vomiting, use Prochlorper. And if that doesn't work, use Lorazepam. If that doesn't work, we'll give you a new prescription.

The fourth line anti-emetic, Emend, is the one that actually works, but they don't prescribe that initially because it's too expensive (according to my infectious disease physician friend). Unfortunately, they don't prescribe Marinol. But that would be the best thing for cancer patients who are losing weight because one of the side effects is the munchies.

One of my friends, a mother of three, said about the side effects, "It sounds a lot like pregnancy." So, I have diarrhea, nausea, and exhaustion in common with pregnant women, and the radiation burns maybe feels like having an episiotomy. But the main difference is that I don't get a shower.

"I have a tumor."
"Oh wow. Where are you registered?"
"Tumors R Us, Bye Bye Cancer, and Target."