ABVD Chemotherapy Part 1 March to April 2014

Chemotherapy ABVD Commenced 13^th March 2014 Ended 14^th August 2014

P.E.T. Scan March 2014 (P.E.T. Number 1)

A Positron Emission Tomography scan is a type of imaging test. It uses a radioactive substance called a tracer to look for disease in the body. A positron emission tomography (PET) scan shows how organs and tissues are working. This is different than MRI and CT scans. These tests show the structure of, and blood flow to and from organs. Prior to the scan they do a blood sugar test mine was 6.2 a little high but okay.

How the Test is Performed

A PET scan uses a small amount of radioactive tracer. The tracer is given through a vein (IV). The needle is most often inserted on the inside of your elbow. The tracer travels through your blood and collects in organs and tissues. This helps the radiologist see certain areas more clearly. The main substance is basically Glucose – cancer cells love sugar so glucose is like a magnet to cancer cells. The cancer cells are tagged by imaging process and rated. This mixture of Radiation and Glucose is called a tracer (In basic terms the radioactive particles race the glucose around the body dumping glucose into cancer sites). The PET detects signals from the tracer. A computer changes the signals into 3D pictures. The images are displayed on a monitor for the Radiologist. The test takes about 2 hours pending on “how deep” the scan is. Basically you are given the tracer and left alone for 1 hour so it can circle your body. The basic initial scan would be classed as normal, this takes about 30 minutes but if the Oncologist wants greater detail the he will tell the Radiologist to go deep.

Cancer areas basically light up, mine looked like a Christmas tree

Formal Diagnoses

Based on all findings including Biopsies and P.E.T scan the Oncologist diagnosed me with Hodgkin’s Lymphoma Stage 4 – the cancer cells had commenced to mutate into my Liver and right lung. On the 6^th March 2014 he decided to go with a first line chemotherapy regime called ABVD with an urgent commencement date 13^th March 2014. I was warned well in advance that this particular type of Chemo was aggressive and could produce a large number of side effects.

ABVD Chemotherapy

A – Doxorubicin (Adriamycin ®)

B – Bleomycin

V – Vinblastine (Velbe ®)

D – Dacarbazine (DTIC).

The drugs are administered generally as a day patient and are based in Cycles. 1 Cycle will equal two treatments over a 28 day period. Therefore each Cycle of ABVD takes 28 days (four weeks)

I was given doxorubicin, bleomycin, vinblastine and dacarbazine on day one and day 15 of each cycle. At the end of the 28 days, would be the start of the second cycle of ABVD. This is exactly the same as the first cycle. So I will have 6 cycles of treatment over 6 months. So in total 6 cycles consisting of 12 Chemo sessions

I wanted to take time to consider my approach to this keeping in mind that I wish to share as much as possible without causing undue concern for victims reading this blog.  So the current date is November 2017 (yes its taken a long time to get this covered but my 2017 blogs were very important), no mystery ending to this sections or yes I made it through ABVD.

March 2014

So 13th March 2017 I was at a business meeting in Cork when I got a call from the oncology unit asking where I was, my answer was that I was due in the next day (Friday) to commence. But the nurse said “no its today” I told her I would be there in about an hour. So I headed home to change out of my business suit and into more comfortable clothing what I later called my Chemo Gear. These consisted of baggy trousers (combats) and a baggy rugby shirt. You see we had no idea what to expect. Everything pointed towards weight loss, vomiting, fatigue and 100 other side effects. We prepared for the worst.  Maybe it was the sudden call to Anita saying it starts today or just the plain “bring it on” approach that helped me evade most of the side effects. Anita and myself agreed that I would face the chemo ward alone (more what I wanted to be honest) I didn’t want or need any distractions and I basically did not want Anita to see me getting sick, which as you will see never happened during the entire 6 months of Chemo. I arrived into the ward at 11:30am, my blood test was the previous day so they could commence straight away.

Each session was quiet simular so I will explain the basics now and get that part finished. The nurse commenced with giving me anti nausea medication which was followed by a small IV drip of steroids (steroids are used to build up the veins and speed up your system to take the chemo drugs, they are also a great form of anti nausea medication). My veins were strong enough to take a cannula (my understanding is that this has since been replaced with a PICC line)

A – Doxorubicin (Adriamycin ®) this is given through an injection, the liquid is red in colour and it is the official welcome to Chemo drug. Different hospitals have slightly different approaches. Following the Adriamycin I was given a second IV of steroids followed by the

B – Bleomycin which was given by a drip over about 30 minutes followed immediately by

V – Vinblastine (Velbe ®) again over 30 minutes. Once completed you are then given the

D – Dacarbazine (DTIC) which is via an IV for about 1 hour. All going right you then see the doctor who prescribes various steroids, anti nausea, sleeping tablets etc and off home.

Sounds easy? Well no its not, you need to fight nausea, you need to be aware that your taking chemotherapy drugs you need to fight for your life. The moment the cannula is placed in your arm you become aware of how deadly serious this is. But as you will read it is so something you can achieve and conjure.

I have had short hair for about 15 years so on approaching the first chemo I had it cut a little tighter, so really no visible changes

In 2014 I was self employed running a small transport company called Speed Express. I had reduced the turnover prior to commencing Chemo as we had no idea how I would react to the drugs. But I had the okay from the medical team to take calls even during Chemo. On the 13^th I went straight from the ward home. I was still expecting side effects. But there were none. I got up early on the 14^th and heading into my office. I felt okay and the steroids were bumping me up. The office staffs were very much on a stand off attitude, something all cancer victims will experience. The only thing that felt unusual was my temperament. Normally I am very cool mannered and never loose my temper but I felt twinges of temper flares that I haven’t felt in close to thirty years. I kinda passed it off as having a bad day, added to the fact that a substantial contract that I had been after for years and was close to agreeing terms had found out that I was ill, the call between their managing director and myself did not go well but it appeared that we could close the following week. This particular weekend was a bank holiday as the Monday was St Patrick’s day, so I had a long weekend to recover. The weekend went okay as we travelled to Dublin that weekend and came back down on the Monday. So all weekend there were no real side effects showing apart from the slight flare ups in temper which were simply out of character for me.

Things changed on Tuesday. I was in my office following up on paperwork when one of my office staff came in, she said that one of our photocopiers was stuck, this copier was a backup desktop type copier & on occasion’s paper would stick in the centre drum, difficult to explain but I knew how to get the jam out. I went up to the copier and as I went to undo the lid my mobile went. The contract that I had been after meant that we would need substantially more warehouse space which I had agreed in principle for, the new landlord was the person that called me to tell me that he had let the warehouse to someone else. I lost my temper. The result was that the mobile in my fist went through the side of the photocopier, I literally pulled the drum out of the photocopier and flung it to the ground. I then walked back into my office and closed the door. My first thoughts were “Oh Fuck”.

We were never told that temper would be an issue so I never spotted that one coming. Once I was aware that it was now a borderline issue I could handle it to some degree.

Two weeks later I was back in for the second part of the first cycle 27^th of March. Prior to each chemo secession you are asked a number of questions by the doctor, really getting to see how you got on since the previous one. Most of the answers were “No I was fine” then I said except for my temper. The doctor got really interested and asked me how I felt and I explained that I just felt like killing everyone. So he wrote a “Do not kill people” prescription for me, a type of valium, with instructions to take them once I felt the urge to kill coming on.

It is vital that you explain in details to the doctors if there is anything unusual between therapy so they can address the issues and help resolve them. Communication is a must, don’t be shy or reserved about it there is no pint making things worse or allowing issues to go unattended, the longer you are having the issues the longer it will take to resolve them.

So end of cycle 1 (1.1 and 1.2),the only problem was temperament. Just to add the loss of the new warehouse that caused the demolition of the photocopier worked to my advantage as the new contract fell apart the same day.

Another item to note was a massive increase in my sense of smell. I first noticed this within the first week of chemo. I could smell the drugs coming through my skin, Anita thought it was my imagination until a few months later, my watch has a leather strap, I took it off one day a could smell the chemo drugs off the strap so AIB handed it to Anita and she was nearly sick from the stench off it – point made and she didn’t doubt me after that

April 2014

Commenced cycle 2.1 10^th of April was uneventful followed by 2.2 on the 24^th. On the 20^th I notice gaps appearing in my hair so I took matters into my own hands and shave my head. I started waring baseball caps from then on. On the 24^th my Oncoligist decided to call a PET scan in as he felt I was doing exceptional well. And this led to the first serious issue from the Chemotherapy  

1st May 2014

P.E.T. Scan organised for 10am – I had a restless night the night before & drank a lot of water, but for some reason I felt like eating chocolate. But I was fasting so couldn’t eat anything.

I felt drained when I arrived at the PET unit. Prior to any scan they do a blood sugar test, in my first scan in March my blood sugar was at 6.2 considered to be slightly high, the normal should be between 4.5 & 5.5. So the nurse takes a blood sample and says “the machine must be broken as the reading is ridiculous” the machine is about the size of a small mobile. She goes out of the room and re enters with a new one. Takes another sample and says “Oh my God” & calls for a doctor. The reading was at 33.2 five times the threshold. Hence the reason why I was craving for chocolate. In comes the doctor who takes the test again and confirms 33.2, he told me that if they attempted to inject the tracer into my system I would be in a coma before the scan. The PET scan unit is in a different hospital than the hospital doing the Chemo so they sent me home, yes home. So when I get to the house I google “blood sugar levels” and yea I’m in trouble but the craving for chocolate escalates. At about 5pm the hospital doing the Chemo phone & the nurse explains that the PET scan unit must of made a mistake but that I was to be admitted the next day for some test.

The 2nd of May I drop into my office to sign off a few items before arriving at the hospital at hospital at 10am, first thing they do is a blood sugar test and the read is 34.5. I’m then asked about a million questions about my history of blood sugar. I explained that my average was 5.5 but the last PET showed 6.2 so off they go to check their records, about 20 minutes later I get an insulin injection followed by a blood sugar test followed by another insulin injection. By that evening I was down to 10.5 and another self insulin injection. I never injected myself before so they had a soft duck to practice on. By Sat the 3rd of May I was able to do it easy. But I was now classed as Type 1 Insulin dependant diabetic. This was further classed as chemotherapy steroid induced diabetes……….before I left the hospital that day I was told I would be on insulin injections for the rest of my life. As you will see that changed within a year.