April 1, 2010

one little victory

After a very long day at MD Anderson, the first round of chemo is done and in the bag. All in all, it was a wonderfully uneventful experience. Basically, a lot of waiting, see the nurse practioner, doc, pharmacist, some more waiting. The chemo wasn't schedule until 6pm and the thing takes ~8 hours in all. Fortunately, they got him bumped up and we started about 3pm. The chemo is suprisingly dull. Basically, they pump him full of saline, antiemetics (blocks nausea), a bisphosphanate (helps with the bone mets), and a steroid for a couple of hours. The docetaxel took 1 hour and then the cisplatin took 2 hours. Then they run some more fluids through him. We watched movies, talked, and just kinda hung out. You hear all these horror stories about chemotherapy but that still may come over the next few days. We'll see how he handles it. He passed the first part with flying colors. A lot of thoughts are swirling around in my head about the experience, both from the patient's and doctor's perspective but two things stood out today. First, it's a big headache for my brother and his wife to pack up from Dallas to come down to MD Anderson. There was some confusion about their daughter getting picked up from an extracurricular activity and I'm watching my brother lying in a hospital bed calling friends to try to get someone to pick up his daughter. And I'm thinking to myself, is it worth it? I pushed the hardest for them to come down here. And I pushed hard. So I feel in part responsible for that choice. I'm beginning to see the responsibility doctors carry. Not only are you implicitly in charge but most people want to trust their doctor. In fact, I've seen people stick with bad doctors because of some strange loyalty that they wouldn't tolerate in other relationships. But I thought back to our visit with the doctor earlier. He mentioned that they could get this treatment up in Dallas, too. So I challenged him on the fact that the course of treatment recommended up there was slightly different - still a taxol and a platinum - but different nonetheless. After being diplomatic (what is it about doctors never speaking even a remotely critical word about another?), his reply was finally that his choice was more aggressive. And that's why we're down there. It ain't easy. It's a right pain in the ass. But as I told the NP, "we ain't here for the customer service, we're here for the brains." I don't think she knew whether to take it as a compliment or insult. So we tolerate the bs because we want the most aggressive therapy that he can tolerate. The second thing that struck me was just plain odd. Normally, when my brother sits in one position for longer than 5 minutes, he's got to shift around due to pain. He was laying there, not moving, looking perfectly relaxed. He looked like I feel after a few beers. So I asked him what his pain was (the ol' 1-10 scale for pain management). Usually, he's about a 4 on good days. Bad days can hit 6 to 8. It was a 1 right then. I had to do a double take. He hasn't been a 1 since this whole ordeal started. My mom was just lamenting to me how he had changed his walk due to the hip pain. The doc had bumped up the extended release morphine and he had taken that about 20-30 minutes earlier. He had gotten really well hydrated. He had received acupuncture the day before. And then there's the psyche of finally starting treatment. Extended release morphine isn't going to kick in that quick by just upping the dose a bit. Getting 500ml of fluid ain't going to do it. So that leaves either the psychosomatic or the acupuncture. To paraphrase Bull Durham, "never screw with a winning streak." If it was the acupuncture, then friggin' stay with the acupuncture. It could be pure placebo. I don't care. Anything that takes a pain from an average of 4 (and that's a 4 on ER morphine, hyrdocodone/acetaminophen, and celebrex) down to 1....well, I call that evidence based medicine even if it's voodoo. Whatever works. He walked out without much of a limp at all and that was a great sight to see. I hope he tries it some more and the pain relief lasts long enough for the chemo to begin to do its voodoo. We could use a winning streak right now. And today we got one little victory to build upon.

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