Chemo - Cycle 4 - Day 1 - Juicing

He's doing good, so far!  Roberto didn't vomit the entire day!  That means we don't have to worry about him not having enough calories for the day and being dehydrated.  The oncologist moved one of the anti-nausea medications to the first day.  It might have made the difference.

We also got a mini-laugh today because Roberto's nurse's name could be interpreted as a stripper name.  hehehe  Any guesses?  No, it's not Krystal.  Try again.   Is it a fact that nurse's with stripper names help people heal faster???  Stripper nurses?  Wait, I'm taking this in a bad direction.

Anyway, Roberto finally understands the benefits of small portions and hydration despite his usual mode of inhaling all food products.  Yesterday, he went to the Latino grocery store in Woodland to get some special carbonated apple juice that is good for nausea (purportedly).  The icebox we use for infusion weeks is packed with the special apple juice, Powerade and plenty of fruits and yogurts.  Thank goodness for the super Safeway sale on Powerades!

This cycle already feels different from the others.  I feel the optimism returning!  I'm super happy that Roberto is starting the week off well.  I'll just have to ignore his twitchy leg that keeps hitting me. 

Only four more days to go!!! 

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I know that it's the end of the treatment, but I wrote this out a while back and decided that maybe it'll be good to just throw out there.  The stuff below is part of the "Hidden Side" stuff I was writing earlier.  We learned about all the drugs in one day for "Chemo Education."  

There are three main chemotherapy drugs that Roberto gets during his infusion week (the first week of each cycle):  Ifosfamide, Etoposide, and Cisplatin.

Roberto has seminoma with elements of teratoma cells.  Seminoma is a type of testicular cancer and it can occur outside of the testicles; this is what Roberto has.  The good thing about seminoma is that it responds well to chemotherapy drugs. 


Ifosfamide
Good:  Used to treat testicular cancer.
Bad:  Destroys the lining of the bladder

This is the drug that requires Roberto to carry around the fanny pack during the chemo week.  The fanny pack administers the drug Mesna to protect his bladder but it must be given continuously.  Usually Bleomycin is given but it causes lung toxicity.  Since Roberto practically had only one lung at the beginning of chemotherapy, the oncologist replaced the Bleomycin with Ifosfamide. 

Etoposide
Good:  Used to treat testicular cancer.
Bad:  Damages vein tissue.

This is where the advantage of the PICC line is apparent.  Since the PICC line goes almost all the way to the heart, it bypasses the smaller veins and the Etoposide doesn't have a chance to damage them.

Cisplatin
Good:  Used to treat testicular cancer.
Bad:  Damages vein tissue; causes kidney toxicity.

*This* is the drug that induces the most vomiting.  Apparently, most people do not handle Cisplatin well, and I guess Roberto is one of them.  Also, partially to combat kidney toxicity, Roberto gets some saline solution at the start and end of the infusion (so before and after all drugs are administered).  The IV fluid is also part of general hydration for Roberto to help him flush the chemicals out of his body. 

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Hidden Side of Cancer - Part 2

Cycle 3 - Day 11

Wednesdays are super busy for me and I didn't get a chance to write an update last night!  I'm glad to report that Roberto is doing much better now and is getting more and more energy each day.  He's still having trouble sleeping at night.  The oncologist did prescribe a new sleep aid for Roberto, but he's been a bit cautious with new medication after his reaction to Ambien. 

I might slow down on the posts since there won't be too much to report now.  Or I might just keep posting things about board games.  Who knows?

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The lack of exciting Roberto news does mean I get to do an educational post (blame the teacher in me).  I started the Hidden Side posts to share the things we learned about either in the *one day* of Chemo Education Roberto and I received or things we've picked up along the way.  We learned about most of the topics below during the Chemo Education day. 


Watching Out for Germs

I've probably mentioned Roberto's increased risk for getting sick now that he's receiving chemotherapy.  The chemotherapy drugs themselves simply target rapidly growing cells which include cancer cells and blood cells.  As the chemotherapy treatment progresses, Roberto's blood cell counts (white and red) have slowly decreased.  One good thing is the Neulasta shot that Roberto receives at the end of each infusion week.  Neulasta promotes the growth of white blood cells by making the bone marrow do something crazy.

Still, Roberto's white blood cell count is low on certain days so it's important for him to not be in contact with sick people or germs.  It helps to keep him at home so that minimizes his contact with people.  Of all things, we had to prohibit contact with a baby because she recently had her immunization shots and was full of viruses! Dirty viruses!

We also have to be careful about the food we give Roberto.  While we want to give him fresh, healthy food, there is a limit.  For example, fruits that can be peeled, like bananas, are fine since they are protected with their peel.  On the other hand, berries are not because there's no way to fully clean the possible dirt and germs from them.  Vegetables are a little easier since we can cook the s**t out of them. 

Red Blood Cells

While Neulasta forces Roberto's body to make white blood cells, we recently learned that there's no wonder drug to promote the growth of red blood cells.  Moreover, Roberto's platelet count is nearing very low levels.  If his levels get too low, Roberto will require a blood transfusion before continuing with the chemotherapy.  Another good use of blood to make me feel guilty for not donating (Roberto donates all the time and hassles me about my dislike of needles).

Every Chemotherapy Plan is Different

Roberto has an infusion of chemotherapy drugs for six hours straight for five consecutive days.  Sitting at the Infusion Center for such a long time, we noticed that the other patients didn't stay as long as Roberto and didn't come in every day like him either.  For example, some patients would come for a couple of hours every few days.  Just to make sure our oncologist wasn't putting Roberto through some sort of torture, we asked the nurses about this difference.  The nurses told us that Roberto is on an intensive chemotherapy plan.  I guess this makes sense since Roberto tumor nearly (or did) double in size in one month.

You're Going To Lose Weight

During the first week of each cycle (infusion week), Roberto loses weight simply from lack of eating.  Unless you're on the Biggest Loser, it's not great to lose that many pounds in a week.  Fortunately, he gains some of the weight back during the two recovery weeks in the form of In and Out burgers.

The Hidden Side of Cancer

Yet another restless night, but I think we can blame last night on the terrible heat.  Roberto felt good enough today to clean up the backyard of his random crap!  His summer cleaning is just in time for his family to visit.  Now we can use the patio for barbequing.

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Since there's not much going on with Roberto, I decided to write up some of the little things we have to deal with since Roberto started chemotherapy.  The following are a few things we learned about before chemotherapy started when we had Chemo Education with the nurse.

PICC Line

The PICC line is the catheter in Roberto's arm through which he receives chemotherapy drugs.  We have to keep Roberto's PICC line dry which means showers are a big pain.  Before each shower, I wrap and tape up Roberto's arm in saran wrap.  Then Roberto has to awkwardly shower using only one hand.  All of this becomes slightly more complicated when he has the fanny pack during the chemo drug week because the fanny pack is attached to the PICC line.  Also, his PICC line has to be flushed with saline once a week to make sure the line is clear and the dressing is changed. 

Washing Sheets

I'm still not sure of the exact reasons for this, but we have to wash the sheets in hot water each week - twice!  At first, I thought maybe Roberto's body secreted the chemotherapy drugs out through sweat and that got into the sheets.  However, it's apparently okay for me to sleep next to him.  So, hopefully it's not that!  :-/  Perhaps it's to make sure the sheets are super clean and free of any little bugs.  

Fearing the Sun

Roberto has to make sure to not get any sunburns so he has to avoid the sun and wear sunscreen when he leaves the house.  One of our first purchases was a hat (unfortunately, not the fedora).  Wearing sunscreen is a new idea for Roberto since his dark skin rarely sunburns.  He needs to avoid sunburns because sunburns are breaks in skin which may become infected.  With his low blood count, infections are bad news. 


It hasn't been terrible dealing with those three things; just added nuisances. 

Cycle 2 - Day 10