Wednesday, April 08, 2009

First chemotherapy

Chemotherapy comes in all sorts of guises. The sort you get for abdominal cancer is very different from what you get for CLL.

The ‘chlorambucil’ of GI malignancies is 5-fluorouracil. How it works is this: DNA has four bases – adenine, cytosine, guanine and thymidine, RNA is very similar but instead of thymidine it has uracil. The body’s only source of thymidine in to make it from uracil. The idea is to feed the body modified uracil, with a fluorine atom stuck on so that when it is converted to thymidine, the stuck on fluorine prevents the DNA from replicating and therefore the cancer cell cannot divide.

The enzyme that does the conversion is called thymidine synthetase and the co-enzyme for the reaction is folinic acid. The idea is that giving excess folinic acid forces the reaction down this pathway and enhances the effect. Clinical trials have shown that this cheap vitamin greatly improves the performance of the drug.

The second drug is oxaliplatin which is one of a series of platinum compounds discovered when researchers tried passing an electric current through cancer cells in tissue culture. They found that the cancer cells died around the platinum electrodes. One of these drugs was developed by a boy in my class at school when he was doing his PhD. He is now a professor at Princeton. He was always cleverer than I.

This combination has some strange side effects. As well as marrow suppression, which is very common with all chemotherapy it can cause diarrhea and vomiting, but there are medicines to prevent these. The really strange thing is cold induced pins and needles. This means no cold drinks or going to the fridge. Even getting a clean shirt from the drawer can trigger it – put it in the airing cupboard first.

This in fact is the only side effect that I have had – it is disconcerting rather than unpleasant.

The other interesting thing is how the 5-fluorouracil is delivered. It is pumped in at a constant rate over 46 hours by a pump with no moving parts. The drug is contained in a thick walled balloon with a slow puncture, which deflates in exactly 46 hours. Very clever these Americans.

The pump is disconnected tomorrow and restarts in two weeks. The other noticeable change in me is the effect of one of the anti-sickness pills. Dexamethasone is a very strong steroid drug used for all sorts of anti-cancer effects, but also to prevent vomiting. It made me as high as a kite. I didn’t dare blog yesterday when under its full influence. Goodness knows what I said to my pastor when he came to visit, Garrulous isn’t in it.


John Wagner said...

Thank you for keeping us updated on the progress of your treatment. I always learn something from your posts and this time there was much to learn. One non-medical term I had to look up was "airing cupboard," to me an unfamiliar term. What I found was that it is primarily British and is a small closet that contains the heater or hot water heater and has shelves to store blankets, towels, and other items to keep warm. Is that correct?

I pray that you continue to tolerate your treatment well and even the annoying cold induced side-effect will go away. More importantly, I am praying your treatment is fully successful.

Terry Hamblin said...

Airing cupboard is right. We have a large walk-in one that allows the storage of shirts and underclothes as well. What would you call such a room in the US?

Bonnie said...

I don't know if we Americans have been clever enough to think of using the warmth of the hot water heater in that way, Dr. Hamblin. Our water heater is in the garage, possibly comforting our parked cars. ;)
My prayers are with you as are so many others.
Would it be agreeable to you to remove the visual verification feature from the blog? A purely selfish request, I know. I can only post replies if someone with vision is nearby. The audio feature has never worked for me. But I'll gladly wait for assistance if removal is undesirable.

John Wagner said...

We would call that a closet, some of which are walk-in also. Many are just long and narrow with sliding doors. However, they do not contain the water heater nor the home's heating system. Only a rack, or multiple racks to hang clothes, often with a shelf over the rack for other items. Some also have other shelves too. Most hot water heaters are either free standing in the garage, sometimes in the attic, or in a very tiny closet with no room for anything else. Same for the home heating unit.

Terry Hamblin said...

sorry about the visible verification feature, but without it I get spammed by robots advertising porn which I would rather avoid. If things are difficult you could e-mail your comments to me at asking me to put your comment on a particular article.

Anonymous said...

Pleased to hear you are tolerating your chemotherapy relatively well, Dr. Hamblin. I was amused to hear that even a great mind like that of Dr. Terry Hamblin is touched by high dose steroids -- I am always concerned about what I type while on IV steroids. I have had a couple of hysterical remarks on CLLCF while under the influence of steroids. Best to avoid the blog during those times!

Keep the faith, keep your humor, and keep fighting the good fight!
We continue to lift you up in prayer
- Stacie

PS - Did the steroids cause a desire to organize, list, plan, etc., as they do for me? They do make me very productive!

myrta said...

My husband(dx with SMZL and colon cancer) had the adjuvant chemo
with fluorouracil
and oxaliplatin. He had the
calcium-magnesium infusion before helped with
my best

Anonymous said...

I had a pretty wild experience with the steroids this last round of chemo.
Just a sample:
At 9 p.m. I said to my husband while chopping vegetables with a large sharp knife: "I've achieved one of my chemo goals! Mastering the pressure cooker!" NOT.
And then I was trying to work through my chemo. I stayed up late to write job interview questions. I thought I was BRILLIANT. Not so much the next day when I was conducting the interview and saw all the typos and the grammatically incorrect sentences.

I don't know if this will happen to you but I have gotten a few nasty "crashes" from the steroids too. Would happen to me a few days after and the world looked very, very bleak indeed. It helps if you know it happens. And, then it is sobering to realize that there are many people who live all the time feeling like that.

Bless you, Terry and thank you for sharing. Praying for you, too.

Liz W.
St. Paul, MN

Anonymous said...

I have had exactly this chemo, I can imagine what it feels like. The longing for a cold drink, the lack of taste, the minor side effects are what I remember most. I had one episode of spasm in the throat from lukewarm water, very frightening but over quickly. The neuropathy disappeared after treatment was over. You may - hopefully not - feel low for a couple of days about 4 -5 days after treatment. Thanks for your explanation of how Folfox works and I sincerely hope it is effective for you. My very best wishes.

Jan said...

Dearest Dr. Hamblin,

My husband, Kelly, and I think of you often and faithfully keep you in our prayers. You've been in our hearts for a very long time.

I'm loving the *airing cupboard* idea. How sensible it is. Our water heater is in our laundry room, cozying up to the washer and dryer. I doubt our appliances appreciate the warmth as much as we would.

*Warm* wishes and as gentle a road as ever there were,


Deb Light said...

Thanks for the update Dr. Terry.I hope you didn't tell your pastor any of your long lost secrets,Tehe!!I probably would have although not on purpose!
Praying you continue to tolerate your treatment well!

God Bless,
Thoughts & Prayers,
Deb Light

Terry Hamblin said...

The second day left me rather down, possibly because I was coming down from high dose steroids and possible because of a queasy tummy. Anyway I had a good night's sleep and am better today.

Anonymous said...

Hang in there T! Tom pulses Decadron throughout the month for controlling his rash from Revlimid. I now look forward to his "high" days as we go visit friends, clean the garage, etc. He makes a "to do list" that is by my estimate, about a mile long. Not very reality based to say the least.
Thinking of you every day,

Jenny Lou Park