First Nadir

8/01/07

I wake to sleep, and take my waking slow.
I feel my fate in what I cannot fear.
I learn by going where I have to go.

-- Theodore Roethke, The Waking

I’m 10 days out. My intention in describing the particulars of that first treatment (see 7/25/07) was to provide my fellow sufferers with a detailed account of that day. In that same spirit, allow me to attempt a description of what I’ve experienced to date. No matter how the layman’s literature tries to sugar coat it, a look at the possible side effects is scary: fatigue; loss of appetite; nausea and vomiting; pain; hair loss; anemia; infection; blood clotting problems; mouth, gum, and throat problems; diarrhea; constipation; nerve and muscle effects; effects on skin and nails; kidney and bladder effects; flu-like symptoms; fluid retention; and effects on sexual organs. One thing to keep in mind is the human impulse/compulsion to confuse cause and effect. The non-specific aches and pains we dismiss under healthy/normal circumstance are now interpreted as the consequences of chemo; the roughness produced by hot pizza on the roof of the mouth becomes a symptom of the treatment; those weird tastes and smells that everyone gets become dangerous signals of insidious chemical processes. But sometimes the cause of sensations we experience have no explanation, they are non-specific and beyond the ken of science. A second thing to consider, and it pains me to say it, is that the treatments are cumulative. In the course of a 6-8 treatment cycle, number 4 would surely be more debilitating than 1. But I’m getting ahead of myself. Let’s review where I am and what I’ve felt so far. Days 7 through 10 are when most anticancer drugs affect the bone marrow, making it harder to make white blood cells. One would think this condition of having a weakened immune system would be preceded by the side effects listed above.

This hasn’t been the case. Since I feel fine, so far, I have to assume my body is dealing with outside air and water borne disease agents in spite of my white blood cell count. Admitting that I was resigned to the worst from the outset, let me address the side effects listed above in terms of my case. One last caveat: consider the precautions listed on even the most benign over the counter medications. The list of possible contraindications and side effects is typically so long and daunting I doubt any of us would take anything if we thought we would really experience these consequences. My point is that the list of possible side effects in no way means one is going to experience each and every one, in fact it is possible, or so they say, to avoid many if not all of these unpleasant effects.

Okay, so what have I experienced? Here’s what I’ve felt:
-- Fatigue – minimal. I’ve swam a quarter to a half mile in Lake Superior every day and taken occasional (not daily) naps;
-- Loss of appetite – zilch. I’ve been eating tremendous quantities of food and enjoying every mouthful;
-- Nausea. They gave me some powerful anti-nausea drugs (Kytril and Compazine) which I haven’t taken;
-- Pain -- none;
-- Hair loss -- none;
-- Anemia. As I said, I’m not tired;
-- Infection -- unknown;
-- Blood clotting -- normal;
-- Mouth, gum, and throat -- Had a scratchy throat and high voice a couple of times but it passed. Mouth and gums seem normal;
-- Diarrhea -- normal bowel movements;
-- Constipation -- none;
-- Nerve and muscle effects -- none;
-- Skin and nails -- fine;
-- Kidney and bladder -- normal;
-- Flu-like symptoms -- none;
-- Fluid retention -- none; and
-- Effects on sexual organs -- minimal.

As I’ve said before, I hope none of this seems too boring.

Being a child of the sixties, I would be remiss not to talk about those medications ancillary/peripheral to the actual pathology of the disease. I am of course talking about painkillers (Oxycodone) and sedatives (Ambien). There’s a certain irony in the fact that we dissolute flower punks with a history of dabbling in opiates, hallucinogens, and other recreational drugs have entered a period of life where such medications serve a practical purpose. Having cancer allows me to get anything I want, which has put my hippy friends and acquaintances, all of whom I love dearly, in the delicate position of looking for a buzz while reassuring themselves they’re not denying me future relief. Of course, I always reassure them that my good health never stopped me from badgering cancer- ridden friends in the past. Truth be told, rather than copping a nod to a Coltrane CD, we, the afflicted hip, must ultimately resign ourselves to the idea that keeping our wits about us is advantageous to our progress. What I’m finding is this, since my energy seems to flag later in the day, a minimal dose (10-15 mg.) of oxycodone seems to give me (and I only speak for myself) a burst of energy that takes me up to bedtime. I anticipate that balancing the scale between comfort and dependence, while at the same time maintaining a fulcrum of energy and focus, will be an ongoing battle as my strength dissipates, as it inevitably will/must. I’ll be saying more about this along the way.

Many of you, I’m sure, are curious about my take on alcohol, caffeine and marijuana. Given that the anecdotal evidence on the medical benefits of medical marijuana is overwhelming, I’ll refrain from taking up this issue. As for alcohol and caffeine, I can think of no sound reason why we who enjoy beer and coffee should deny ourselves in a time of crisis and uncertainty. Given the vast pharmacopoeia of drugs and chemicals that constitute the various chemotherapy regimens, a cap and a brew seem fairly innocuous in the larger scheme of things. In terms of overdoing it, it seems logical that the combination of disease and treatment should induce a kind of moderating effect that requires no self-regulation.