Tuesday, July 20, 2010

GND Chemo: Infusion One

And so it began again. The start of yet another chemo regimen. Another cocktail off the extensive chemo drink menu. Like the soda drink options at Sonic, the combinations are endless. We're hoping that it's this one that does the trick.

Last Thursday I was escorted to chemo by my childhood best friend, Kristen. My parents were on a much needed vacation and Craig was teaching at his summer job. I didn't want to go the first round alone not knowing how I would react to the drugs, nor trusting myself to be the only one to hear the ins and outs from the doctor of what the regimen will bring. Kristen and I have been close since I threw up all over her Cabbage Patch notebook in Miss Arel's first grade class. She's the kind of friend that'll be there for you in a heartbeat. So when I called and told her I needed a designated notetaker and chemo companion she took the day off and was on board.

She got to witness my chemo morning procrastination routine although I saved her the hissy fit my mom usually receives. I was still in the shower when she showed up and prolonged packing my snack bag until the last possible moment. It takes a lot of motivation to psych myself up to get to chemo after already going through so much. It is certainly no longer a novelty and I always go back to the metaphor of knowingly flattening your palm onto a hot burner ... but it's something that has to be done. At least I am able to receive this chemo locally in Hartford so as to not add the long travel time into the scenario. And even more placating, it does not require hospitalization.

To bring more anxiety to the scenario, Dr. Dailey was on vacation. I suppose this is allowed, but I don't like it. But being the caring oncologist that he is, he spent the morning on the phone with the doctor that I saw in his stead and filled him in on my biopsy results and the regimen that he wanted to begin.

We learned that the biopsy revealed – as expected – classic Hodgkin's disease, nodular sclerosis subtype. I was relieved that the cancer had not morphed into some incurable or unknown type. I'm familiar with this invader. With that said, we are going with a regimen called GND, which features the drugs Gemzar, Navelbine, and Doxil. Used in combination, these drugs have been proven in recent studies to be very effective salvage therapy for patients with Hodgkin Lymphoma who have failed chemotherapy or an autologous stem cell transplant. This is referred to as my "salvage" chemotherapy meaning that it is what we hope will immediately eradicate the disease and put me into a good enough remission to be able to head into the allogeneic transplant. They're standard line chemo drugs so not nearly as intensive as what I've been used to receiving. Always in the back of everyone's mind is to be delicate with me as my body is still reeling and recovering from the very recent bone marrow bashing that was my transplant.

We were told that my hair might not fall out from this regimen, which is fantastic as it's been growing at an amazing clip. I once again have a full set of eyebrows and my eyelashes are longer every day. My hair now looks like a very, very short buzz cut. One of the drugs, Doxil, can cause Hand-Foot Syndrome which results in redness, blisters, burning and flaking on the skin of the hands and feet. Other than that, the possible side effects of each of the drugs are pretty standard – they'll lower my white blood cell and platelet counts, fatigue, achyness, malaise, nausea, yada, yada, yada.

The regimen works in a 21 day cycle with chemo once a week for two weeks then two weeks off to complete one cycle. I will complete two cycles then we will check a PET Scan to see what the progress is and determine if another cycle is needed. This will happen in about five weeks or so.

In total, the whole process took about five hours, similar to the timeframe I used to spend at the cancer center during ABVD. The anti-nausea pre-meds take some time then two of the drugs drip over a half-hour while the third drips over an hour, then there is the fluid I need to flush through and the waiting between drug changeovers.

To prevent the possibility of contracting Hand-Foot Syndrome, the nurse had me rest my feet on ice packs and hold an ice pack between my hands during the hour that Doxil was flowing into my port. Quite contrary to the toxic substance that it is, hanging in the bag it looks like a refreshing bladder of pink lemonade Crystal Light. It's the most prettiest looking of drugs I've received to date.

Kristen and I were given a private room in Hartford with its walls covered with UConn and Yankees memorabilia and knick knacks galore – teddy bears, bird houses, plastic figurines, angels. There were pictures everywhere of someone's children and lots of motivational placards and posters. It felt a bit like getting chemo in a flea market. A handwritten note above the clock read in Sharpie: "The last time the Red Sox won the World Series" with an arrow pointing down. I didn't get it, but it was obvious that whomever decorated the space was on the pinstripes side of the rivalry. This is a stark contrast to the cool colors and meditative photographs that decorate the rooms in both the Avon Cancer Center and Smilow down at Yale. However, the double wide recliner was comfortable and my nurse was efficient, friendly and informative. A great combo.

We chatted the whole time catching up on funny middle and high school memories, bringing up random people that we haven't thought about in forever. We snacked on treats and rehashed the chemo plan until we both decided we had a fair understanding of it all. The time went by very quickly and though it's of course not the ideal situation, chemo is a fantastic way to catch up with old friends.

Fast forward to today and I have managed to avoid the rashy skin symptoms and really any other symptoms at all. Sure I get tired and have had some of the familiar feels like a flogging back pains reminiscent of ABVD treatment, but nothing has been even close to debilitating. The fact that the regimen orders a two-week rest period tells me that the drugs are pretty powerful, but I suppose it's all relative now. Having undergone chemotherapy that left me incapable of standing up or mustering the energy to eat at times leaves me with a pretty high tolerance. Even so, I'm impressed with how my body has handled this round after being so compromised just weeks ago. There was a high probability that this could have just flattened me right out.

But in fact, this week has been filled with lots of get togethers with friends who have stopped by, cookouts and fire pits, hikes and exploring. No matter how I feel, I've been walking every single day and am getting back into a yoga class routine. I drown myself in water to flush out the cancer cells that I visualize breaking apart within me as the chemo does its job. The healthy eating continues, our crop share at a local farm helping tremendously with that as we have access to so many fresh-from-the-ground veggies. I may even venture to say that I'm getting to be a decent cook ... and enjoying the cooking process.

Tomorrow I am back for more chemo already and can only hope that it goes as smoothly as it did the first time around.


  1. Hey Karin,

    If ya ever need company for a chemo trip or other test... I am willing and able. I can play a mean game of candy land, gossip with the best of them, nag like a typical mom, and embarrass the hell out of you!!! So if you really get desperate... give me a hollar.

    Love ya and always thinking of you,
    Mrs. Hogan

  2. So happy to be hearing from you, and that your body is handling this new chemo so well. Hope and pray it continues for you. Have been reading your last blog so many times. The poem was beautiful, and is so touching in so many ways. Keep up the good work, and know how much love is coming your way. Irene

  3. So happy that you are tolerating this well. You are so loved as I am witnessing daily by the profound growth of our facebook group page. You are educating so many people each day. We look forward to getting a phenomenal turnout on August 21st at the Karin Diamond Donor Drive. Everyone is sending their energy to you, use it any way you choose even to make a really powerful hissy fit:) sorry Laura

  4. Yeh---you go girl---you keep up the good work and we'll keep the donor drive going strong thanks to Ginny--glad to hear it didn't morph!!! Strong positive energy coming your way--xoxo Bev & Blake

  5. you're amazing, karin. such a fighter!

    i wear my cancer warrior shirt on the regular...i put it on, close my eyes, and send you good vibes from the ianuzzi house! we are all balls-out rooting for you.