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Wednesday, November 2, 2011

The Night Before Chemo

It's the night before my first Chemo and my mum and Aunty come over to cook me and a few friends (Greg, Lyndal, Garry, Ethel!) a special meal of 'hoppers'. This is a Sri Lankan delicacy and quite difficult to make. There is a prawn curry and a selection of sambols finished with a Sri Lankan dessert, Vatalluppum. It makes it a special night because my Dad comes along too!

Here is a picture of my guests digging in!

As you would expect, my mum (and dad) have been very worried about me since my diagnosis. I have already had the little speech about how parents want their children to outlive them.

My mum, usually too busy with endless meetings and social engagements seems to have put some of her own life on hold. She's telephoned and visited with more regularity than I can remember in a long time.

It doesn't help that, at 73, Mum has the constitution of an ox and takes no potions or pills. (Her dad popped off at 92).

Today I had to have a blood test which is a prerequisite for each chemo session. It's just a bummer that I hate needles. Strangely, I am happy to watch a heart and lung cut out but I can't bear to see a needle inserted into skin - this despite my Dad being a career Type 1 diabetic.

It's a bit depressing that I will soon be on first-name terms with the lady at the pathology lab :(

A good thing though is that my aunty Marie called today from Melbourne for a chat. I like my aunty. She emanates a certain calm and patience. So of course, I find it hilarious when she tells me my Uncle will sometimes drive her to use the 'F' word in its adjectival form. Who knew?

Yesterday my cousin, Dilhara, rang from Sri Lanka. It was really nice to hear her voice and yet again I contemplate that strange thing about cancer: of bringing people to me - and not all wielding scalpels and injections!

In the lead up tomorrow, meanwhile, I've become an armchair expert in what I've learned is an age old treatment for cancer.

My passion for science means I am keen to learn as much as I can about the protocols I have to endure.

Besides, you're talking to a person who has, up until now, thought twice about pharmaceutical intervention, the antihistamines for my seasonal allergies notwithstanding.

It's basically hugely ironic that, right now, I'm depending on drugs - the big guns - and I can only be thankful to the generations of scientists who have given me access to the idea that breast cancer is not a death sentence, that there is a very high chance of cure.

It's just unfortunate that the cure will deliver the kind of side effects that will mean I'm less Miranda Kerr and more Mahatma Gandhi at the end of it :(

As I have already mentioned, I am to have the T.A.C treatment comprising the drugs docetaxyl, doxorubicin and cyclophosphamide, comprising six cycles at three week intervals.

This is just one regime of a multitude that is part of this fascinating area of medicine, involving many different drugs, 30% of which, I learn, are derived from 'natural sources'.

For example, Taxotere or Docetaxyl is derived from the bark of the Pacific Yew Tree.

Doxorubicin, an anthracycline antibiotic, was originally derived from a bacterium isolated from a soil sample collected from an area surrounding the 13th century Castle, the Castel del Monte (in Andria, Italy). Interestingly, the prototype resulted in some 2000 analogs - other antibiotics used across the spectrum of medicine! I find that amazing.

I have no bloody idea why the Castle figures in this history but I'm fascinated by the pathways of human inquiry. However, I still do not like the the fact that the nickname for Adramycine is "the Red Death" (I can expect red pee for a day or too. Jolly times.)

Cyclophosphamide meanwhile is described as 'the old war horse' of chemo, patented in 1952. It was accidentally discovered as a derivative of the nitrogen mustard gas stockpiled in WWII.

I could fool myself I suppose, that these drugs are made from natural sources.

In fact, did you know that medicines derived from terrestrial plants and microorganisms, marine organisms and terrestrial critters are used to treat 87% of all categorised human diseases?

Cone snails (their venom to be exact), sea hares, molluscs, the Carribean sponge, the dog shark, a plethora of bacteriums, fungi, trees and other biological sources area among the thousands of species of living matter that have contributed a part of their DNA to the modern pharmacy.

But despite their origins in nature, chemo drugs are cytotoxic and some, for example Docetaxyl (or Adriamycin), are in themselves carcinogens (that is, in some doses can lead to other cancers). Oh joy.

For further proof of the incredible toxity of these drugs, I consult the 'Patient Diary' I've been given that provides specific instructions for dealing with the by-products of chemo - those secretions that are inevitable from one's nether orifices at some stage.

(I'm sorry I have to mention them but I'm hoping charming modern movies such as "Austin Powers", "The Hangover" and "Bridesmaids" has primed all of you for the concept of spew, wee and poo. This is a blog about illness, after all and sadly, tea and tulips do not figure in this narrative.)

These are, apparently, particularly toxic and must not come into contact with human skin for the first 7 days after each treatment: toilets must be fully flushed lid down; the area must be cleaned with household detergents and disposable sponges; disposable gloves are to be worn when handling bed pans and urinals (yuk!); gloves, wipes or anything else that comes into contact with the various excretions must be sealed inside two plastic bags and immediately placed in the wheelie bin; any bedding that is soiled must be washed separately from other linen in the washing machine in hot water for one full cycle.

So you see, I'm going to be positively radioactive!

Another important thing about chemotherapy is understanding its three-stages: Onset (7 days); Nadir (10-14 days) and Recovery (21-28 days). I especially like the word "Nadir". It sounds like an exotic location don't you think. "I'm sorry. Bronwyn is uncontactable right now - she is in Nadir."

What this means is that basically in every 28 days, I'll have 7 days of feeling crap, a period when my immunity will be at such a low point that even my dog will have to be sent away; and then recovery when hopefully, I'll be able to kick up my heels and whistle dixie.

That's the theory anyway.

Meanwhile, my friend Tim asks a good question: why, if I am node negative and the cancer has been cut from my breast do I need all of this, chemo, maybe radiation, ongoing drug therapy?

I find an article a 2001 Journal article that explains: "Despite apparent curative surgery in the treatment of breast cancer, 21% of node negative patients still develop lump node and distant metatastatic disease at 18 years. It is likely that this group has occult micrometastatic disease at the time of initial surgery and that they are unidentified. Recent studies have established that current routine histological assessment of regional lymph nodes underestimates breast cancer metastasis."

I guess what this really means is that cancer progresses at a microscopic level, through lymph nodes and tiny blood vessels. Locating it is as difficult as finding, say, a single quotable quote in any season of 'The Kardashians.'

I supposed that chemo is the only way to ensure these rogue little bastards can be destroyed.

So now, after my feast of hoppers, as I prepare for bed tonight and hope for a good sleep, I have to admit that, dire as the side effects are, I NEED chemo and I hope like hell it all goes well tomorrow.

For now, what can I do other than be impressed and amazed at the scientists who worked out that toxin can be therapy, that poison can be cure?

There's a certain genius behind it all.

I'm relying on that.


  1. Thinking of you and praying for you for tomorrow Bron =)

  2. Bron
    Your comments have brought back many more memories again. I recall when I was going through the same treatment that my kids (aged 1 and 2.5 at the time) always seemed to become a little off colour in the week after my chemo sessions. I actually asked my oncologist if I could be making them sick by being around them and he said it was quite a possibility!
    Keep your loo and bathroom to yourself (Al can share with the boys) for the next 5 months just to be on the safe side (that's where all your 'waste' will be expelled - from every orifice too!!). Keep lots of fresh air circulating in your room as well.
    Thought about you constantly today and was sending you lots and lots of beautiful thoughts.
    C xoxox

  3. Don't think of yourself as radioactive Bron. Think of yourself as 'glowing' (in the dark occasionally).

    You'll always be radiant to me. Tom. xxx

  4. How are you doing? Wishing you all the best. I stumple on your site while look up on Pacific Wee Tree. Hope you are doing well! Just wonder if Pacific Wee Tree also can help with people with colon cancer...Mydieu, Tallahassee

  5. Mydieu, ah, the Pacific Yew Tree is what you are researching. The bark of this is used to make the Taxotyl line of drugs. Yes, Taxol is used to treat colon cancer. I hope things are good in Tallahassee :))