Melinda's Chemo Graduation!

Chemo cycle 6 is in the books!  Initially, way back in August, the oncologist had said 4 or 6 cycles, and she eventually settled on 6 cycles.  Each cycle consists of 3 consecutive days of chemo, with 18 days off, so a 3 week cycle.  Day one was always the hardest, as it included lab work, consultation with the oncologist, then an infusion of both Cisplatin and Etoposide.  We've had some day ones where we were in at 8:30am and didn't get out till after 6pm - a long day at the Cancer Center!  On days 2 and 3 Melinda only got the Etoposide, no docs or labs, so were usually in and out in 2 or 3 hours...  Anyway, today was the 3rd day of cycle 6, so Melinda has officially graduated!  We've never covered the details though, so yesterday brought the camera along to document the process, if not just for us, perhaps for someone else going through treatments for small-cell lung cancer.  At left we were waiting for Melinda to get called into the infusion center.  In the waiting area they have a big-screen TV showing a loop tape or CD of scenes of Hawaii - nice, relaxing calming video to ease the nerves...

Inexplicably, they either seemed to be packed to the gills with patients, sometimes we were the only ones waiting - we never figured it out the difference...  Yesterday we waited all of 5 minutes or so before getting called in.  Check-in consisted of vitals - weight, blood pressure, temperature...  Here nurse Kathy charts info while Melinda checks Facebook correspondence before getting started.  Nearly all the rooms have windows facing either mountains in the distance, or trees out in the atrium.  It is nice to have views of outside and natural light.  Most of the rooms have chairs for 4 patients and escorts.  There are also a few private rooms with beds for those with medical complications.

Melinda had a port installed after cycle1.  It makes the chemo infusion a lot easier for both the nurses and patients after all the vein pokes as an inpatient at UMC.  It is just under the skin under her right clavicle, so easy to access.  Melinda starts the morning of a chemo with a numbing cream applied a half hour or so before her appointment.  The Tegaderm covering that protects the area after application is shown at left.  After peeling it off, the nurse scrubs the area with a little scrubbing sponge and antiseptic to sterilize the area where the port is located...   As shown at right, I got put to work just after this picture was taken to pull her necklace aside to clear the area...

After the area dried, it was time for the poke!  A port is accessed by a Huber needle, something just under an inch long.  The patient is usually instructed to look the other way, and while the nurse feels for the boundaries of the port, the patient inhales and holds for a moment while the needle is pushed in (shown at left).  Thanks to the numbing cream, it is usually painless, or at least, it certainly helps!  As soon as the port is accessed, saline is injected to make sure there is a good connection and there is a good blood return from the port line.  The needle and line are taped down with gauze over it for the infusion in case it is accidentally pulled during the process.  After the chemo, the needle and line can be left in for an infusion the next day - they can put tape over it to keep the area clean.  However, you are not supposed to shower with the needle/line installed.  Melinda did both - sometimes kept it in overnight to save a poke the next day, and also had it removed daily so she could shower before the next infusion.

After all that, the rest is easy - relax for as long as the infusion goes on.  First came a small bag of Zofran and Dexamethasone to help with nausea, followed by a 30 minute wait.  The Cisplatin on day one was a 2-hour infusion, and the Etoposide  on days 1, 2 and 3 were for an hour.  With a 4 hour or more infusion, Melinda would sometimes sleep - a reaction from the oral drugs Atavan, another anti-nausea and anti-anxiety, and Emend, again for nausea.  We would usually do the NYT crossword puzzle.  Some days I'd go out and fetch lunch, some days go downstairs to the little café where they had reasonable cheeseburgers for $2.50!  Most days you would see Joe or another volunteer come by with the snack cart (at right).  If nothing else, they want their patients to be happy and snacking and drinking, with either goodies off the cart, or a variety of juices or cookies out of the cantina.  As shown at left, the patients are also spoiled by bundling up with warmed blankets too.  It isn't that the rooms were so cold, but the chemo fluids weren't warmed certainly, so most took advantage of the offer!

Today was day 3 of Cycle 6, so Graduation Day!  For the occasion we had a nice view of the Catalina Mountains, and one of our favorite nurses Molly.  We didn't know they made a big deal of finishing chemo - figuring we'd have a private party, but were surprised when a half dozen nurses gathered round, clapping and showering Melinda with bubbles!  She was more than a little overwhelmed, as shown at left...  They also presented her with a graduation certificate and a little ceramic heart - it was almost sad walking out of the place today, knowing we'd not be going back to the second floor, hopefully for a long time, other to take them up on stopping by to say hello!

So no more chemo in the foreseen future!  After the New Year, she'll get another PET scan, and a brain MRI, then get a referral to a radiation oncologist, likely to follow up with some radiation treatments.  In the reading she has done, evidently follow-up with radiation has an improved outcome, so her attitude continues to be "whatever it takes!"  So the end isn't in sight yet, but the final steps are becoming clearer...  We'll post more then and let you know what is decided then.  In the meantime, at left is a "Selfie" that Melinda took today on her chemo graduation.  Congratulations!