Yesterday was day 1 of treatment. … and
it was a long day.
Bruce works around the corner from
both of the hospitals where I had appointments today so we walked together. It
was going to be a lot of waiting around so I encouraged Bruce to go to work and
meet me at the end of the day to take me home. We hugged and kissed goodbye on
the street corner and we went our separate ways, looking over our shoulders as
we parted, nervously smiling and waving encouragingly. Both of us trying to be
strong. It was a tender loving moment between us and I held back a tear or two.
A resident assisted by a
technician did the insertion. Although the resident knew the procedure I don’t
think the he was very experienced. The technician provided a lot of guidance.
After land marking the vein with
ultrasound they punched a hole on the
inside of my upper arm and fed a thin tube through the opening, along the vein,
up the arm, over the shoulder and into a larger vein stopping short of the
heart. During all this time they followed the catheter on an x-ray, negotiating
the catheter along the vein.
I was conscious through the whole
procedure. I don’t profess to understand their conversation but I couldn’t help
but try to interpret what they were discussing. Apparently, my commitment to
exercise has resulted in muscular arms, which resulted in some issue with my
veins so they had to pause the procedure momentarily to dilate the vein so the
catheter could pass through. They also ran into a couple of situations where
the catheter would bend or fold back on itself so they had to insert a wire to
make the catheter stronger so they could straighten out the catheter and push
it a little bit further.
An hour later my 42.5 cm PICC line
was complete.
I had a couple of hours to kill
before my chemo appointment so I decided to do a little shopping and take
myself out for lunch. I needed to get some sweat pants and casual shirts to
make my treatments a little easier. I went to Winners a few blocks from the hospital.
It was the first day of winter in
Toronto. We had our first temperatures below 0C, a wind chill effect and a
little bit of snow, so I had bundled up that morning for my walk with Bruce. I
had worn a hoodie under my winter bomber jacket.
After carrying around my courier
bag, hangers of clothes and dressing and undressing in the store’s change room
I noticed blood running down my arm. It was more than a little bit but it
didn’t seem like a lot but It was more than I was comfortable with … and it had
soaked the inside arm of my hoodie. I was alarmed but I remained calm.
I skipped lunch and headed to the
chemo department at Princess Margaret Cancer Care Centre an hour early hoping
that they would be able to see me ahead of my scheduled appointment.
The reception staff triaged my
visit and a nurse cleaned me up while other staff walked by oohing and awing
and commenting on how much blood there was. They weren’t very reassuring but at
the same time I was relieved that it wasn’t serious.
Just before 2:00 my chemo nurse
started an IV with saline solution in preparation for the purple-coloured mitomyicin.
Mitomycin, a chemotherapy medicine, is a
vesicant and can cause extensive tissue damage and blistering if it escapes
from the vein.
The nurse or doctor who
gives this drug must be carefully trained. The mitomycin is manually and slowly
injected into the IV line. I will receive the mitomycin as a single dose on the
first day of each chemotherapy cycle.
Once the mitomycin was done it was
time to set up the
Fluorouracil(5-fu) pump. This was not what I was expecting.
The 5-fu comes in a 500 ml IV bag a
tube passes through a battery-operated pump, which delivers a dose along an IV
tube to the PICC line. Every 30 seconds the pump makes a little whirring sound
and delivers 0.01 mL of 5-fu into my vein.
There are some potential problems
that are signalled with a loud alarm. The most common problem is a kink or
twist in the IV line preventing the flow of the 5-fu or the batteries could die
or I could be late for an appointment and the 5-fu runs out. All easily
remedied.
I am attached to the IV bag, pump
and tube 24 hours a day for five days and I visit the hospital every 24 hours
to have the IV bag changed. The kit and I are never more than two-and-a-half
feet apart.
The nurse gave me an oversized reusable shopping bag to carry my pump and IV bag of 5-fu. The bag isn’t very efficient.
When I got home I found a man purse that everything fit into and I
can easily wear it over my shoulder.
I am learning how to dress,
undress, go to the bathroom and sleep and not kink the line or leave the kit
behind. It’s awkward but I am figuring it out.
References
Chemocare
