Friday, 3 January 2014

His first cycle chemotherapy...

Hello everyone..

Hope everybody had a blast holidays. Sorry for the long delay of this post. Today we are going to share our experience during hubby's first cycle of chemotherapy.

Chemo start date:
06th Feb 2013

Chemo completion date:
09th Feb 2013

Chemo drugs:
Day 1 > Epirubicin 1000ml + Ifosfamide 1000ml
Day 2 > Epirubicin 1000ml + Ifosfamide 1000ml
Day 3 > Ifosfamide 1000ml
Day 4 > Ifosfamide 1000ml

Additional medicine(s):
Maxolone (anti vomit #1) 
Emend-Aprepitant (anti vomit #2) 
Nexium (gastric)
Anti vomit #3 *cannot remember the name (via IV) 
Mesna (to avoid internal bleeding-via IV) 

Via IV

06th Feb 2013, Day 1:
We arrived at PPUKM around 8AM plus. Being first timers, we didn't know much about the procedures, the admission process, people and places.

We went straight to 1st floor Oncology Clinic, asked the staffs there where day care is. Confused between day care and in-patient oncology ward, we went to in-patient ward instead. We were then instructed to enter a door next to the ward.

Surprisingly the day care was full of people. We thought we were early; we were wrong! There were many other people came earlier than us.

I passed hubby's appointment book to the admin lady. We were new; she was aware of that.

After few minutes, hubby was called into treatment room. His weight was measured; 69kg. A nurse asked whether hubby has a chemo port. We said no, and she straight away setup an IV port* for him. Blood sample was taken and we were asked to wait at waiting area.

*Sorry if I got the term wrong.. :-)

There were many files on the counter. 2 MO were on duty. Me, being a newbie, failed to guess which file belongs to hubby :P. Well, I thought hubby's file was thick. Actually there were many more thicker files there!!!

After sometimes (couldn't remember how long we actually waited), hubby's name was called by one of the MO. Blood test was fine, so hubby could start with his first cycle chemo. The MO gave hubby free trial anti-vomit pills @ Emend to hubby; free for the first 2 cycles. We had to buy the pills for the remaining cycles. The admin lady issued an admission form and I did all the paperworks at the registration counter (located hospital's main lobby).

At the day care, hubby booked a bed. Since they hadn't started anything, we had lunch first. A nurse came and said, "Yes, better to eat first", leaving us with question marks. Cannot be the symptoms will start that very soon, huh?

It was around 1PM when the nurse came back and told hubby to take the first Emend. Anti-vomit jab was also given and hubby was put on drip for around 30 minutes. Emend had to be taken at least 30 minutes before chemo starts.

1.30PM nurse came and switched the drip to Epirubicin. It's a red color fluid. There was a machine; set as a timer to alert when chemo drug has finished.

Around 3 something PM, nurses at day care were already busy transferring patients to inpatient ward. It's sort of 'handover' process. Day care is open daily from 8PM to 4.30PM. Patients that are admitted in the morning or haven't completed their daily chemo; will be transferred to inpatient ward between 3.30PM to 4 something.

Hubby's first bed at Wad MAKNA HUKM was bed 25. Next to his bed was an uncle; who obviously was another cancer patient (Al Fatihah for this late uncle). I became quick buddy with his wife, Kak Maimun.

It didn't take long for the most common side effects to appear. Late afternoon, hubby started to get tired, sleepy @ drowsy, nausea and thus, losing his appetite. He didn't take much for dinner. And due to the color of the drug, his urine also turned into red color.

Around 5.30PM, nurse came to take off the empty bottle and changed it to normal drip. After half an hour, next drug chemotherapy started. First, nurse injected Mesna (purpose is to avoid internal organ bleeding - esp bladder irritation). Then Ifosfamide intake started; this one took 4 hours to be completed.

In between of the 4 hours, a doctor came and passed to me brochures on side effects of 'Epirubicin' and 'Ifosfamide'. Well, the OLD and IGNORANT me just went through the brochures and kept them in the drawer. The doctor also asked whether hubby is taking any supplement at that moment. To which, I nodded. At that time hubby just started taking 4Life Transfer Factor. Doctor told me to stop the supplement intake to avoid any interference with the chemotherapy. I didn't really plan to follow the instruction though.

Hubby didn't ate much for dinner. I prepared Milo for him and sort of forced him to take TF. However, the strong smell triggered his nausea. I tried to put 1-2 capsules; removed the capsules and just poured the powder into his mug without his knowledge. Hey!! His could even smell it!! I rest my case, had to stop TF so that he won't vomit.

Around 10PM, the Ifos finished and nurse gave him 2nd Mesna injection. The 3rd injection was given around 1AM.

Hubby on his 1st day chemotherapy
Date: 06th February 2013

07th Feb 2013, Day 2:

Same cycle was repeated; Epirubicin intake for 2 hours + Ifosfamide intake for another 4 hours. Hubby's nausea became worse. Yellow plastic was always on his side; in case he vomited. He didn't much and slept most of the time. New side effect, hiccup. It's not common for us to hear about this side effect, isn't it? But, it's true. Hiccup is one of chemotherapy side effects; I'm not sure which drug was causing the hiccup. Doctor said sometimes it can happen. It could be due to Epirubicin, Ifosfamide, Emend or maybe Nexium?

08th Feb 2013, Day 3:

On the 3rd day, only Ifosfamide was give to hubby. He slept most of the time due to side effect of the treatment, causing him feeling drowsy & sleepy, thus resulting in lesser food intake. But sleeping helps him a lot from feeling nausea. He had slight fever early on the day, which gratefully went down afterwards.

09th Feb 2013, Day 4:
Hubby's condition was better than the 3rd day. Lesser drowsiness, lesser nausea (except when he smells something too bad/too good!!), better appetite compared to the previous day.

The fatigue was still there. And he had slight temperature in the afternoon. The on-duty MO was reluctant to discharge him due to his fever. We put cool fever on his head and I wet his body to lower down his body temperature. We really wanted to go home after 4 days being away from the kids.


Here, I list down side effects for both Epirubicin and Ifosfamide:

  • Low white blood cells count
  • Anaemia
  • Bruising and bleeding 
  • Feeling sick or being sick
  • Sore mouth and throat
  • Loss appetite
  • Taste changes (suddenly chilli sauce taste TOO SPICY)
  • Hair loss
  • Skin changes
  • Discolored urine
  • Fatigueness
  • Diarrhea
  • Nail changes
  • Almost all from Epirubicin's side effects
  • Bladder irritation

I will continue with summary of each cycle (and post chemotherapy treatments) in next coming posts. After that I will share tips on how to boost up the patient's energy and immunization.

Intan & Naim
Shah Alam

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