Chemo Week #2 in Review: Chemo, Fevers and Snow

Hard to believe that I haven't blogged in a full week.  My apologies to all my die-hard fans out there.  But, it has been a bit of a crazy week.  Most importantly though, I am now 50% done with my chemo treatments.  Let's head to the "highlights" of the week:

> The chemo started kicking my ass much earlier than during week 1.  Whereas I previously didn't feel fatigued until Thursday evening, this time I started feeling fatigued on Monday evening.  Fortunately, I was just able to make it through a full work day every day, but once the evening rolled around, I was knocked out for a couple of hours, would "wake up" for dinner, then go back to bed for the night.  And when I say "wake up", I mean that Florence would stand over me and force me to get out of bed to eat dinner while I would beg for ten more minutes, knowing that I really had no intentions of getting out of bed on my own.

> The daycare called Florence on Monday afternoon to let her know that Sadie had a 102 fever, that she needed to be picked up and that she couldn't come back to daycare until she was fever-free for 24 hours (all standard protocols, so no issues there).  But, since this was a chemo week, life was already hectic enough in the Grossman household.  So, Florence took me to chemo on Tuesday while my mother took her first of three sick days (in that week alone) to take care of Sadie.  On Wednesday, Florence had to go into the office, so my mother took her second of three sick days to take care of Sadie while my dad took me to chemo.  Wednesday night, my mother went home but my father stayed over because of the pending snowstorm.  So, that night, my father shoveled my driveway while Florence took care of me and Sadie.  Thursday morning, my father did some more shoveling of my driveway and then drove me to chemo while Florence worked from home and took care of a still sick Sadie.  Thursday night, my father went back home to be replaced by Stephanie who was coming up from Delaware to take me to chemo on Friday and then help out around the house on Saturday.  But, Sadie was still sick with a fever so my mother then took her third and final sick day of the week to take care of Sadie because Florence had to be in the office for face-to-face meetings and because Stephanie had to be with me at chemo.

> Over the weekend, Stephanie helped around the house on Saturday while Florence's parents helped out with Sadie on Sunday.  You will note that I did no helping of any kind because the extent of my usefulness was moaning about my stomach pains, dealing with my nausea (no vomiting, but some good gagging) and laying in bed.

> Now, it's Monday morning and the first of two chemo-free weeks.  I get my Nulasta injection today, which will help my body to create white blood cells and fight off injection, hopefully avoiding another prolonged visit to the hospital.

> Chemo Week #2 was definitely tougher, all around, than Chemo Week #1.  The increased, and more pronounced, side effects were tough on me because I was able to contribute less to the household than I previous did.  With Sadie being sick, I felt ineffective as a father because I couldn't help take care of her without risking a serious infection.  Florence was literally taking care of two sick patients, and I know that I'm the more annoying patient.  And while it's very nice to have the revolving door of help from the family, it's personally frustrating when you are physically unable to care for your home and your family.

> Let's look on the bright side - 50% of the chemo treatments are now complete!  I have two weeks to recover and start feeling more "like myself".  Apparently, my birthday is in four weeks.  And, my baby girl turns 1 next month!!!  Thanks for coming to the blog.  I'll be back in a couple of days - I still have those rant topics that I never wrote about...

Hair Loss

So, today begins the second week of chemo treatments.  As of yesterday, I was feeling fantastic and going at full steam.  Over the weekend, I spent lots of time playing with Sadie, cooking in the kitchen, cleaning in the garage, feeding bottles to Sadie, helping with the laundry, running errands, going to synagogue, watching TV and swimming in the pool with Sadie.  If it wasn’t for the fact that I’ve started noticing some hair loss, I might not have even remembered that I have cancer…

Let’s talk about the hair loss.  In the comments section, please feel free to make the obligatory jokes like “How do you notice that you have LESS hair?” and “But you’re already bald!”  Anyway, it started on Thursday night.  When I took off my undershirt, the inside of the shirt looked like the outside of a gorilla.  And when I showered the next morning (because I like to shower in the morning, not at night), there was a nice smattering of hair on the floor.  Each night since then, I have continued to notice hair loss on the inside of my undershirts.  I can handle this, and I’m not really upset about it.  When I started to notice the hair falling off my head, however, that saddened me a bit.  I always knew my head hair was going to fall out, but it’s one thing to know it’s going to happen, and an entirely different thing to actually experience it happening.

Back to the chemo…  One full chemo cycle has been completed – a week of chemo plus two weeks of recovery.  I consider myself very fortunate because, all things considered, the three weeks went almost as well as could be expected.  Yes, I did have to endure 5 consecutive days of chemotherapy, but I only suffered from extreme fatigue and multiple IV puncture wounds, no nausea or vomiting.  Yes, I did have to spend 4 days in the hospital, but thankfully it was only a precautionary measure and it did end up being like a mini vacation, only if your idea of vacation is being cooped up in one room with limited TV channels and piss-poor food options.

Here’s to hoping that the second chemo cycle goes “as well” as the first!

I'm Home

Good News - I was discharged from the hospital this morning.  My white blood cell counts and my ANC are both back to normal.  Nice to finally be back home with Florence and Sadie!

Round 2 of chemo starts next Monday, but this week, the blog will be used as my personal pulpit to rant on topics that have been weighing on my mind...

Friday in the ER

If you haven’t read “Thursday in the ER”, please scroll down to that blog entry before reading this one…

Let’s pick up right where we left off.  It’s midnight, it’s now Friday, and we have just been put into an ER room…  Blood work, blood pressure, temperature, vitals, listening to my chest and lungs, checking for swelling of the ankles, hooking me up to an IV for saline and possible medications.  Doctor #1 walks into the room and begins his routine of asking basic questions, all of which I already answered for the triage nurse.  He leaves the room, we presume, to wait for the results of my blood work, but we will never see or hear from Doctor #1 again.  It’s now well past 1 AM, I am laying on a hospital bed with a saline drip in my IV, and Florence is sitting on the stiff chair in the corner of the room.  Doctor #2 comes in around 3:45 AM to discuss the results of the blood work and tell us what they think is going on.  Chemotherapy kills the things that need killing (like a small nodule on the lungs and microscopic entities in the blood), but it also kills the things that we like to keep around (like white blood cells that help your body fight off infection).

One main component of white blood cells are the neutrophils, which serve as the primary defense against infections by destroying bacteria in the blood.  When your white blood cell count is reduced, that also reduces your Absolute Neutrophil Count (ANC).  When your ANC is below normal, the condition is called neutropenia because the body is at a greatly increased risk of infection.  My ANC was extraordinarily low, so I needed to be placed in protective isolation.  The isolation is designed to protect me from everyone else, not to protect everyone else from me.  In the ER, this means that they keep the door closed, I have to wear one of those surgical masks, and anyone who enters the room has to wear a mask too.  It also means that they need to admit me into the hospital for observation, to give me antibiotics to kill off the infection, and to give my body time to grow its ANC back to normal levels.

Half an hour later, Doctor #3 comes in to confirm that they are admitting me and to let me know that they have begun the paperwork process to get me transferred to a room upstairs.

As dawn breaks and the East Coast is starting to wake up, Florence and I are still sitting in the ER, I have managed to sleep for an hour, and Florence may have dozed us for fifteen minutes.  We call my Mom who is at our house to ask her to take care of Sadie for the day.  We call my Dad who is at his house to let him know that we are still in the ER and he makes plans to join us there later in the morning.  After my Dad shows up, we meet Doctor #4, an incredibly helpful infectious diseases doctor who does a fantastic job of explaining what’s going on within my blood system and how they are going to attack the infection.  He’ll be watching me for the next couple of days as I recover from the infection and my ANC rises.  He tells us that we should plan to be in the hospital for 2-3 days, and that they are working to get me into a private room (because I need to limit my exposure to other germs and people).

Hours go by, I am sitting on the hospital bed working on my laptop, Florence is sitting on her chair working on her laptop, my Dad is sitting on his chair reading the paper and getting us stuff to eat and drink.  Seriously, for hours, we treated the ER room like it was our personal cubicle.  And, the ER was getting crowded.  Apparently, the hospital is filled to capacity (which explains why I’m still not in a real hospital room), but the ER is also filled to capacity.  In fact, the ER halls are filled with other people laying in hospital beds.  Imagine back to the days of ER (Clooney, Wyle, etc.) whenever they did one of their “mass tragedy” episodes and they had so many people that the hospital was literally bursting with patients…

Late morning, we meet Doctor #5, who is a member of the oncology team at Sloan Kettering, so she is much more familiar with my records and has already spoken with my oncologist.  She too was helpful in giving us information, but unable to help us get a room.  Three hours later, Doctor #6 comes in and is completely useless.  In fact, she was more of a disruption than anything else because I had to put a work conference call on mute so that I could deal with her.

So, let’s recap where we are.  It’s now 2 PM, we have been sitting in this ER room for 14 hours, they’ve been trying to admit me into a real hospital room for the past 10 hours, the ER is literally overflowing with patients and I have seen SIX different doctors.  While some of the doctors did add value and provide new information or perspective, every single doctor went through the same routine of listening to my chest and lungs and then asking all the same questions about my cancer history, my latest chemo treatment and my symptoms.

Finally, after numerous false starts and countless statements of “you’re going to be in a room in five minutes”, I was moved up to an actual hospital room at 5:45 PM, a mere 21 hours after my arrival at Overlook Hospital for 21 hours!  And thus ended my Friday in the ER…

Thursday in the ER

On Thursday night, a crazy sequence of events unfolded that ultimately led to me being admitted to the hospital.  I am fine, but the doctors need to watch me for a couple of days to make sure I stay that way.  Let’s flashback to Wednesday afternoon…

I had developed a bit of an annoying hacking cough that was irritating my throat, giving me a raspy smoker’s voice and allowing me to hock up some thick mucus.  It was annoying, but everyone seems to be sick these days and a cold/cough usually isn’t much of a big deal.  On Thursday, the cough continued and I could feel my voice getting rougher as the day progressed.   Around 5 PM, I went upstairs to rest for a few minutes in preparation for Florence and Sadie returning home from work and daycare.  My hand grazed my forehead and I felt a little warm, so I decided to take my temperature – 100.8 degrees.  So, I had a slight fever, but I have been told countless times by my oncologist that you must call the doctor if you develop a fever of 100.4 or higher.  So, I call Memorial Sloan-Kettering at Basking Ridge to report my symptoms and the nurse calls back a few minutes later to let me know to take some Tylenol and that the doctor would like me to go to the hospital to get checked out, just to be overly cautious.  There is no rush to get to the ER, but I just need to make sure that I go tonight, so I tell the nurse that I’ll be there around 9 PM.

Now, it’s 6 PM, so I call Florence to give her the news.  Then, I call my parents who are driving home from work and ask if one of them can come by after they get home so that they can watch Sadie while Florence takes me to the hospital.  Let’s zip through the next sequence of events – Mom comes over, Florence finishes putting Sadie to bed, we pack overnight bags for the hospital (because you only stay overnight if you don’t prepare for it), we make tortellini for dinner to bring with us to the ER, and we ultimately arrive at the ER in Summit Overlook Hospital at 8:45 PM.  That arrival time is important to remember!

The desk nurse checks me in, after I just stood there for 10 minutes waiting for her to show up.  Where was she?  No idea, but clearly not at the location that her job title would suggest.  Then, we wait and eat our dinner.  One hour later, at 9:45 PM, the triage nurse calls me in, taking my vitals and asking me a bunch of questions about my medical history and symptoms.  Then, we wait.  One hour later, at 10:45 PM, the registration desk calls my name to register me.  Then, we wait.  Another hour later, at 11:45 PM (three hours after I first arrived), they finally take me to an actual room in the ER to examine me.  Since this blog is titled “Thursday in the ER” and it’s now approaching midnight in the story’s timeline, let’s stop here.  Join us in the next blog entry (to be posted immediately after this post) titled “Friday in the ER”.

What's in your Bathroom?

So, one of our favorite topics here on the blog is the bathroom, especially since I seem to spend so much time there.  On my mind today is what you do to pass the time while you’re in the bathroom.  Some people claim to just sit there and stare off absentmindedly into space while they go about their business.  However, I will never claim that.  My bathroom time is quality thinking time and must be treated as such.  Whence I sit upon my throne, my finest pondering I shall do!  To that end, I have an assortment of logic puzzle books located throughout all the bathrooms of the house so that I have something to do no matter where I am.

It started with Sudoku puzzles.  That’s the 9x9 grid where each row, column and 3x3 mini square needs to contain all the digits 1-9.  The complexity of the puzzles depends upon how many filled-in numbers the puzzle gives you as a starting point, but I admit to having gotten bored of Sudoku puzzles when I wrote a Visual Basic program in Excel that could solve Sudoku puzzles for me.

Then, I moved onto Kakuro puzzles, which are single-digit math crosswords.  You will be given the “total” number and a set of blank spaces, and the digits can not repeat within any given sum.  So, if you have the number “16” with two blank spaces, the digits have to be 7 & 9 (ordering to be determined by the intersection of other sums) because the only other combination would be 8 & 8 which isn’t valid.

My current puzzle of choice is Ken Ken, which you have probably seen in the pages of USA Today or AM New York.  It’s a twisted combination of Sudoku and Kakuro, but it uses all four math operators instead of just addition.

Not everyone will find math as a “fun” way to pass the time, but if you like math or if you’re a geek at heart, don’t judge me until you’ve sat on the toilet and at least attempted one of these puzzles to pass the time.  Feel free to do a puzzle when you visit our facilities…

So, how do you pass the time when you sit on the throne?

Fatigue

Like a bag of bricks…  Seriously, there is no other way to describe the onslaught of fatigue I started experiencing on Thursday afternoon.  After Thursday’s chemo, I took a two hour nap in the evening.  After Friday’s chemo, I took a four hour nap in the afternoon/evening.  On Saturday, I was asleep for more hours than I was awake, by a substantial margin.  After waking up at 6:30 AM to make Sadie’s bottle, I was awake for 3 hours, slept for 2 hours, woke up for 2 hours, slept for 6 hours, woke up for 2 hours, then slept through the rest of the night.  Sunday was slightly similar to Saturday.  Was awake for a few hours in the morning, took a 2 hour nap, ate breakfast, somehow managed to be awake (not intentionally) for 5 hours, and then my body made up for it by sleeping 5 hours before waking up for dinner and then going back to sleep.

Yes, fatigue sucks and it’s draining, but it was totally expected.  Instead, I’d like to focus on the positives of the past couple of days:

1)  I’m eating – while there may have been times that I was tired and didn’t want to get out of bed to eat, I always did eat.  And, when it was time for my body to dispose of the food after it was done processing it, that disposal always happened consistent with the expectations of my bodily functions.

2)  Poop – yes, I’m talking about poop again.  It doesn’t matter how old we get, the topic of poop will always be a fascinating one.  Constipation was not a problem this weekend.  Instead of the once daily marathon sessions that I am “famously” known for, I am evolving into a sprint runner – greater frequency, shorter durations, same distance traveled.  I do miss Taco Tuesdays…

3)  Coherence – While I may have been severely exhausted, whenever I was awake, I was able to maintain “coherent” conversations and be my typically charming self.

4)  25% Done – I have already completed a complete week of chemotherapy treatments, and now I have two full weeks to recover and prepare for the next one!