I stood before the cymbidiums at the market when a woman exclaimed, “You’ve got a PICC line.”
She was of medium stature, slender, mid-50s, long blonde hair. Her accent originated in a backwater part of South Africa. Maybe she was a Boer and her first language was Afrikaans. However hard she was to understand, she understood the plastic valve drooping on its line below my sleeve.
“How,” I asked, “do you know what a PICC is?”
She introduced herself as an RN, a visiting nurse who administers chemotherapy and the attendant meds to homebound people stricken with immune deficiencies. Then she offered to tuck the PICC’s valve into the mesh sleeve that had slumped down near my elbow, an act of tenderness on her part.
I accepted from yet another angel in six months of chemotherapy.
The 12 FOLFOX infusions—the kind of chemo for colorectal-cancer peeps—started Jan. 30; the last of the dozen was the other day. FOLFOX: FOlinic acid, Fluououracil, Oxaliplatin. The regimen entailed a major infusion every other Tuesday, followed by 48 hours of continuous nuisance via a pump and reservoir dragging along and wheezing in a fanny pack.
After each three-day treatment there followed an 11-day recovery period.
In my case, being hopeful, I call this whole business just-in-case chemo because, after surgery last October, the scans were negative. But one of 12 lymph nodes harvested in the O.R. was positive, so I might have adenocarcinoma floating around in my gizzard. If it gets to your gizzard, it’s all over, baby.
The pump connects to the PICC—peripherally inserted central catheter—where the valve extends from the upper arm. Like a narrow forest path leading to a spring, the catheter goes through the vein—I think the basilic vein—to a point near the heart.
Details of Treatment: For all I know, they gave me paint remover and swamp water, throwing in a few jiggers of ant-and-wasp repellent for good measure. But they called it those fancy stupefying names. Oxaliplatin, taking the lead in this onslaught, is platinum-based, so if that’s what I got, I feel good about the free upgrade. Leucovorin, the trick expensive name for folinic acid, goes in with the oxaliplatin and provides a kind of valet service in administering the drug.
After the drip infusion, requiring two and a half hours in-clinic, the fluorouracil streamed over the next 48 hours.
But that’s just the beginning of the story. Overall, during the six months, I received more than a dozen drugs and remedies. And there were three PICCs. As it turns out, a PICC does not come with total-satisfaction guarantees. If it worms out of the vein, too bad, sucker, you pay again. The first one, in the left arm, sneaked out like a puppy through an open door. With the second, also placed in the left arm, I developed blood clots from shoulder to elbow. The radiology team (a bunch of super nice people in their procedure room) pulled that line and bore the new one into the right arm. You needn’t ask, because of course this has reduced the velocity of my fastball.
Side effects became pronounced as the treatment went on. Neuropathy has resulted in two numb, spongy feet. I totter out of bed and wobble to the bathroom. Stepping into the shower is an iffy proposition. (Good thing I removed the sliding glass doors and made the shower much safer, although if I carom out, pulling down the shower rod and curtain and hitting my head on the toilet, you’ll know why.) My fingers tingle, too. The weirdest side effect, though, is the cold sensitivity. I suppose this is also neuropathy. To drink a cold beverage is to find the lips and tongue are made of bubbles. Inhaling through the open mouth on a cool morning–I remember them from February and March–is too much risk for all the disappointment. I once forgot entirely and bought an ice cream cone, a horrible experience. I’d shelled out $4, though, so I made sure to finish.
Last words about side effects: I was lucky to have avoided mouth sores and hair loss.
Good news is the cold sensitivity always wore off during recovery week. But the toll is cumulative: the farther into treatment, the greater and longer-lasting the impact.
Meanwhile, two new words entered my vocabulary: neutropenic and vesicant.
Neutropenic means your neutrophil count falls and the marrow makes too few white blood cells, leaving you susceptible to infection. One recommendation, in that case, is to avoid raw dark-green vegetables like kale, which I was happy to do. In February I had a neutropenic fever over 101 degrees and, according to guidelines, should have rushed to the emergency room. Instead I hit the hay and felt fine in the morning. I admit scoffing about immunity problems after that.
Having vesicant properties, Fluououracil can blister the skin. A few liters of this substance—ghastly stuff!—divided up among veins on both sides. For all I know, their inner walls will need to be sanded down and repainted.
Tomorrow look for details about the drugs and remedies as well as an accounting of real-life things I managed to do during treatment.