I found out that I had the types of drugs being administered for chemo incorrect. Since this is an even round, I'll actually be getting cytarabin (ara-c) instead of vincristine. Cytarabin is the drug that struck me blind last time around. I have steroid drops that should help prevent this. I just have to remember to put them in four times a day at certain intervals.
Some of the IV drugs require IV pre-meds. One of the chemo drugs, methotrexate, requires a pre-dose of dexamethasone which is a steroid. The idea is to protect my heart from the damage that could occur as a result of the mexthotrexate being pumped directly into my heart.
The thing about the dexamethasone is that it made me throw up the last time I received it. I' had it many times before and it's never bothered me. Last night, I was having dinner while getting infused. Minutes after the bag finished I was violently ill. It seemed like every single thing that I'd eaten for the day was staring back at me from the bottom of a pink bucket. Then my back started to feel like a million vicious mosquitoes were taking little chunks out of me. I couldn't stop scratching. The night nurse checked me over and I didn't have any outward signs of a rash. Rash or no, the itching was hellacious.
Chris's theory is that the first time I went through Hyper C-VAD I was working with my original immune system. Aside from not being able to fight off cancer, it was pretty good to me the first 32 years. My new immune system is fairly untested and we aren't sure of what it's capable of. Now we know it doesn't like methotrexate. My nurse gave me so IV phenegren while we waited for an order of IV zofran to come up from the pharmacy. I instantly felt sleepy when the phenegren finished. It wasn't the kind that I could fight and so I passed out like a darted bear as Chris has said.
Let me back up a bit and explain a second set back that I was responsible for. In order for the methotrexate to be administered, the pH of my urine must be 7. This means that I have to leave samples in the bathroom. I know this has to be done, but I feel really silly using the intercom system to let every one know that I've left a large container full of urine in the bathroom. I was the reason for the delay, yet again. My initial sample was an acidic 5.2pH. I was asked to start drinking a lot of water and a pill was ordered that would help. I dutifully started drinking. An hour later my sample was 5.8pH. At this rate, the bag would never be hung and did I mention I was sleeping in between making samples.
Chris was given the unenviable task of having to wake me up every hour to make a sample. If you've been following this blog, you know that I am the worst kind of monster when someone wakes me up from a deep sleep. Poor guy told me that I was absolutely vicious when he woke me for my 1:10 AM sample. I had absolutely no recollection of this. I also have no recollection of any of the nurses hanging any of my chemo drugs. They're required to have you confirm your identity and medical record number verbally. I also had absolutely no recollection of doing this. I can only hope that I was civil. I pray that I was civil. I know how childishly cranky I can be when wakened from a deep sleep.
I eventually passed the pH test, just barely. A two hour drip of methotrexate was hung, followed by a twenty-two hour bag of the same stuff. It should finish sometime tonight.
I had a lumbar puncture today and it went off without a hitch. The APN was going to do it without ativan and I think that was also my fault. When she came in to introduce herself, she asked me if I needed anything for the puncture and since I thought the ativan was automatically administered, I told her that I was fine. When she came in later to let me know that we'd be starting soon, I asked her when the ativan would be hung. I had to apologize for misunderstanding, since I knew that waiting on the pharmacy would throw her schedule off. She put the order in and I got it thirty minutes later. She did a great job and it was over before I knew it. The samples were absolutely clear which is a good sign.
I was told to lay perfectly flat for an hour to avoid the nasty headaches that can develop because of the procedure. Chris was kind enough to hold a soda at mouth level while I harvested the caffeine to ward off the same headache. The last thing I remembered was watching tv. Apparently, I fell asleep again, a la darted bear, and woke up two hours later.
I've been told that I'll be in here until Monday. Dr. Kebriaei is supposed to be popping in for a consult. We should know more about the transplant then. So, I'm looking forward to a quiet week of getting vital signs taken and taking tons of meds. Sporonox has made it back into the equation. Bleck!