Once the specific gravity of Des' urine got to where it needed to be, it was about 5:30 pm. The nurses said we were ready for chemo...so they'd get it made. That was a surprise to us - you have to make chemo every time? In retrospect it makes sense - if a patient isn't going to be able to use the very expensive drugs at the time you are expecting them to, due to illness/side effect/low fluid levels, you probably don't want that stuff just sitting around. But at the time, it was another delay we weren't expecting.
By the time his chemo was made in the pharmacy and sent up to our floor, and then checked, checked, and rechecked by the nurses, it was about 8:00. The nurses started off by giving Des a dose of Zofran, a strong anti-nausea medication. All of the medications were given by IV drip, so nobody had to touch Des except to take his vitals, they could just give him his medicine on the IV pole. Next they game him something called mesna, a drug to protect his kidneys from the strong side effects of the cancer drugs. Finally he was given his chemo cocktail, which we call VAC for short. He was given three drugs in a row: vincristine (V), dactinomycin (A), and cyclophosphamide (C). You can read more about VAC here: http://www.cancerresearchuk.org/cancer-help/about-cancer/treatment/cancer-drugs/vac. It only took between 1 and 30 minutes for each of the drugs to be given via the IV, and we were done with the drug administering around 10 pm.
At this time it was still "The Desmond Hour" at the hospital. He got quite a reputation for being charming and funny while we were there, and the nurses seemed to enjoy coming into the room to interact with him. He still felt well, so he could put on a good show, cracking jokes and rolling his eyes and telling people to "Walk the plank!" When I left to go home for the night shortly after 10, he was tucked into bed and I was hopeful that the Zofran would do its job.
Jeremy stayed the night at the hospital and told me later that Des did get an upset stomach after I left, and was up feeling ill until about 5:30 am, when the nurses gave him a dose of a different nausea medication, Ativan (aka Lorazepam), and he was able to sleep. I came back around 9 am and he definitely didn't feel well, but he wasn't throwing up. However, he wasn't eating or drinking much, either. We meet with Dr. Meeker who told us that he'd wait until later in the day to advise whether we should go home that night as we had planned. I think Des had another dose of Ativan around noon, but in the early afternoon while Papa Jeff was visiting he started throwing up bright yellowish orange vomit, and while it wasn't a lot, it was unpleasant. Nobody likes to be sick and throwing up, but we were so appreciative that Jeff was there and able to help him while we had to meet with our MSTI nurse Arika for what I call "Captive Audience Cancer 101" - how to take care of your cancer patient at home.
The nurses, Jeremy, and I all agreed that we should try something different for the nausea, and so they gave him a common combination of Phenergren (which I took when I was pregnant with Regan, to help with the morning sickness) and Benadryl around 3:00. That was a bad idea. He had a bad reaction to that - it was scary to watch. He was thrashing around on the bed, slurring his words and scratching at his skin. He'd reach his arm out like he was reaching for something and then he'd just hold it straight up in the air, like he just fell asleep. He was also moaning and crying and screaming. The nurses were unable to take his vitals because he wouldn't hold still for them, and sometimes he'd stop what he was doing for just a few seconds (again, like he was asleep) and then he'd start thrashing around again. He also kept calling for Regan. Dr. Meeker came in to check on him and said, very calmly, after a few minutes of observation, "Well, we can scratch that combination off the list." It apparently is a rare reaction, but an unpleasant one! And there was nothing we could do to make it pass through his system any more quickly, we just had to wait it out. Finally I was able to maneuver Des and myself to the bed and I was able to kind of hold onto him and he was able to sleep.
Jeremy and I decided we would like to keep Des in the hospital for another night, simply because a) the doctor was okay with it and b) Des hadn't had any fluids or food that day, and we wanted him to be well hydrated to flush those chemo drugs out of his system. I picked Regan up from daycare and got Des some more pjs, and we had dinner with Jeremy, my mom, and Melisa in the hospital that night. It was good for Regan to see Desmond, she spent Monday day and evening with my mom and she had an uncharacteristically emotional day at school on Tuesday, suddenly crying out for all of us for no reason. Obviously she has a reason - she missed seeing us and her normal routine, but it's not typical for her to start crying for us in the middle of her day. She loves her daycare, and she loves her teachers, and I am thankful we can at least keep that part of her routine going.
Jeremy again stayed with Des on Tuesday night and on Wednesday I got Regan dropped off and went to work until I heard from the boys. Jeremy reported that by Wednesday morning Desmond had already eaten and drank more than he did all day Tuesday, and they were discharged from the hospital around noon. Des took a few more naps than normal the rest of last week, and complained about feeling crummy several times, but there was no more vomiting or other obvious side effects.
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