Before starting Chemo, my biggest fear was the constant perforation of my veins, because I have always experienced much pain with needles, but also because I was shattered after having just finished my fertility treatment. The veins in my arms were so damaged after having had blood taken every two days for weeks, that I could almost not stand the idea of having more needles stuck to me for so many hours.
Doctors said that three days for recovery after my egg collection operation were enough (of course they would say that; it wasn´t their own body being put under such stress).
I didn´t even know where they would inject the drugs, and for how long. As I had watched in films, I was expecting a port in my chest that I would need to wear for months, until chemo had finished, and I also thought that the nurses would put me on a bed, and that they would be injecting the drugs for about 10 hours non-stop. Then I would need to leave in a wheelchair, as I´d be lacking energy, and I would need to take a taxi home; that is how bad I had imagined it.
But the day of the infusion is not as bad as you might think, although there are different types of chemotherapy, and the amount you receive (and for how long you will be there) will depend on the type of tumour you have, and also on your size (weight and height); not so much on the size of the tumour or the extent of the Cancer.
Cannula/Catheter/IV or Central Line/Port?
Cannulas or catheters are long plastic tubes used to put drugs into a vein. This is called intravenous or IV treatment, and the nurse will put the needle in your forearm or hand/wrist (wherever they can find a pretty vein).
If you need an IV weekly, or if you have difficult, small or even shy veins, then, you might need to get a port instead, which will be put in your chest/neck area. This one is a serious procedure, which they do under general anaesthetics (to place it, and also to remove it). The truth is that, if there is a minimal risk for the chemo to “fall” out of the vein during the infusion, they will place a port, instead of a simple cannula, as that can cause serious damage to your organs. The chemo needs to go through the vein, and the nurses will make sure that this happens.
I was lucky enough to just get an IV line instead of a port, although remember that there usually is a bright side to everything: if you get a port in your chest, once it is in place (and you will be asleep when they do this), you will not have to suffer the stress of nurses inserting a big needle in your arm, and removing it at the end of the day.
On my first day, an inexperienced nurse told me that, because I was stressed, my veins were hiding. I went mad, but tried to say in a calmish voice: “That is utter nonsense; my veins are hidden because it is extremely cold in here.” To be precise, about 15 degrees.
The Macmillan hospital in London has good heaters, but the chemotherapy floor is freezing. The chemo drugs are also really cold, because they keep them in fridges, so this doesn´t help the veins to pop out either.
After twenty minutes trying, that nurse had the common sense to call an experienced colleague, and this one immediately brought a bucket of hot water, so I could put my arm in it. Then, she found a good vein in seconds. My arm was really damaged by the inexpert nurse´s attempts, and, after my first chemo session, the wrist and arm were purple and brownish for about 10 days. On my second infusion, though, a wonderful nurse brought me the hot water straight away (as I quickly requested), and a male nurse found a great vein in my other arm; he put the huge needle on it while singing me a Christmas carol. No pain, no purple (well… there is always a bit of pain, of course, but it was much more bearable than the first time).
Piece of Advice! Never be afraid of opening your mouth and make simple demands; you know your body better than any other person. The process of chemo can always be slightly more pleasant.
If you are interested in knowing all about catheters and ports, please check the following link:
How Long does the Chemotherapy Infusion Last?
Before receiving any chemotherapy drugs, oncologists will always need to check that you are fit for it, so they will need to analyse your blood and the amount of cells you have.
Piece of Advice! To make your day shorter and nicer, do this always on the day before your chemo appointment, and in the opposite arm where you will receive the infusion.
If you have had an operation already to remove your tumour (i.e., you have had a mastectomy or lumpectomy), then, they will always give you the drugs in the other side of the operation, to avoid lymphedema (when excess fluid gets stuck in tissues, causing swelling). But, if you haven´t had any procedure done yet, you can then chose the arm they are going to use that day. In such case, you can alternate sides every time you receive the drugs.
Your chemotherapy could be just one drug, or, most commonly, it could be a group of two, three or even four drugs, as these work better in combination. You should be done within three to six hours approximately. However, some types of chemotherapy (especially when they are given to you for the first time) can take up to ten hours, as nurses will need to check if they cause an allergic reaction, for a whole hour after each one of those drugs is given.
Of course the time of the infusion will depend on your weight and height, and the kind of tumour you have. My first three sessions were quite short (lasting about four hours in total), but not the last four of them, which took much longer (seven to eight hours), because I received two different sets of chemotherapy drugs, being the second set of medicines more specific for my type of tumour.
Besides how long the infusion takes, you could also have to wait for an extra couple of hours on arrival, because, once you do the check in at reception, they will still have to prepare the drugs for you. Sometimes they will weight you (although the usual practice is to measure you the day before), and then they will take two or even three hours to prepare the magic potion, and thoroughly check the drugs that they are going to give you, as any error could be fatal. After that, they will put the IV line in a nice vein, as explained, and, if you are doing scalp cooling, then you should also allocate some time for this purpose before they give you the drugs, and after. I will soon write another post on scalp cooling.
If you are going to give scalp cooling a try, you will need to start 30 to 45 minutes before receiving the chemo drug that will make your hair fall out (i.e. Epirubicin/Doxorubicin, Docetaxel/Taxotere). The thicker your hair is, the more minutes you will need, and, then, you must wait for up to ninety minutes, after they have finished giving you the specific drug.
If you haven´t reached menopause yet, you will start receiving Zooladex, or a similar medication, to send your ovaries to sleep during your chemo tretment (once per month). If you start on the day of chemo, then the day will also be longer.
Piece of Advice! Ask your oncologist to request a Zooladex injection for you before your chemo appointment. It is painful, and you don´t want extra stress on the day of your infusion. It is a big and thick needle that goes under your belly button and it hurts, so ask them for a cream to numb the area (Emla or anything with Lidocaine/Prilocaine will work). It makes such a difference! Don´t be shy to ask for it; the less pain you encounter, the better.
The Worst Part of Receiving Chemotherapy
The worst part of receiving chemotherapy is, without a doubt, to have been negatively influenced by having read so many stories out there saying how bad chemo is for your body. It is indeed necessary to know how bad can be; anything that you put into your body, really. You also need to know how harmful is sugar for you. Chemotherapy drugs damage many of your good cells as well as the nasty ones, but, once you have made the decision to have chemotherapy, stop reading how detrimental it is, and think that those harsh liquids are not poisons, but The Elixir of Life.
I had been reading all kinds of websites and blogs that criticise chemotherapy and prefer to follow a natural and alternative way to deal with Cancer. They tell you what to eat, what not to, what to do or avoid, and they believe that chemotherapy can kill you faster than a tumour. Sometimes this could be the case, but it would be rare. The truth is that the right chemotherapy can work absolute wonders on you, and in a very little time; a much needed time for many Cancer patients. A true miracle of science!
So, once you decide to give chemotherapy a go, be happy with your decision.
The first time you receive your chemo you will be on a bed in case you have a bad reaction from it, but the usual practice is to receive it while you are sitting in an armchair. At the beginning I was horrified to think of being in one of those chairs, facing other people, but you get soon used to it, and I ended up finding it more comfy than lying on a bed. Besides that, it kind of made me feel as if I wasn´t sick, but just receiving some kind of vitamins. You can also choose more hidden areas; you don´t need to face other patients.
In my experience, during the actual infusion, I found quite relaxing to listen to “chemo meditations”, as they can help your body receive these powerful drugs in a peaceful way. On my first chemo I did listen to one of these audios from YouTube and I tried not to lose focus. It doesn´t mean that, by doing that, the drugs will work better on you, or that you will have less side effects, but anything that makes you calm on the day will always be somehow positive for you.
These drugs will hurt your fast dividing cells, so they will first affect your stomach; then, your gut; your skin, and, quite soon, your hair follicles as well (although not all chemo drugs will make your hair fall). But these clever drugs will also attack promptly those dreadful and fast dividing cells that have created a tumour in your body, and that probably are already travelling around. The aim is to shrink that lump(s) and target the bad cells, and these drugs can do it so much faster than garlic, lemons, turmeric, brussels sprouts and green tea. So, be friendly with chemotherapy, make peace with it, and this might be kind to you.
I Promise: You will get Used to!
After several chemotherapy sessions, though, you will become more familiar and relaxed with the whole process, and you will probably feel more in the mood of watching movies, reading or doing other things. You will have many moments when you won´t even realise that the drugs are already dripping into your veins. It all really depends on the specific drug you are receiving: some are really cold, and others will give you a metallic taste that you cannot ignore; but some of them actually feel like salty water. In any case, try to relax and do something nice with your time, that is able to distract you.
At the end of the day, you will be quite dizzy, if you have used the scalp cooling system; but if you haven´t, you should feel generally OK, although some chemo drugs are stronger than others, of course. In any case, you are expected to walk on your own without any help, and sometimes you might even feel well enough to take the public transport home. However, try to be with someone, and if you can return home by car/taxi, then do so, as if there are many people using the bus/train/tube, it can be a bit overwhelming.
What to Bring to your Chemo Infusion:
It is possible to attend a chemo session on your own, and some people will actually prefer this, especially after having experienced a few infusions and having seen that is by all means manageable. At the end of the day, if you are not a talkative person and you can take a taxi home, why bother going with someone? Some people find it exhausting to have to be talking in such an uncomfortable time, and, as the day can be very long, they might feel stressed about friends or relatives spending their time in there. If you decide to go on your onw, the nurses will be extra kind to you; that for sure.
On the other hand, to have someone to chat with can be consoling, and, in my experience, holding hands with your loved ones can actually help you more than meditation, at least during the first infusion.
But the decision is really up to you.
Wear something comfortable like wide trousers, t-shirts and jumpers. Make sure you can put your sleeves up easily, as nurses will be accessing your arms, checking blood pressure, etc. Wear several layers, as it can get very cold, but you could also be having hot flushes from some medication (especially the one that induces you to enter into premature menopause – i.e. Zooladex). Wear also thick shocks and very comfortable shoes.
-A large bottle of water.
You want to pee those drugs as soon as you can, and it is better to do it with mineral water rather than with the tap or filtered water that they will provide for you at the hospital. In the UK they give you the antinausea medication in the form of pills before chemo starts, but funnily enough, I was never offered water.
-Your amusement pack (phone/tablet/MusicDevice/Book)
Even if you have company, you want to give your company a bit of time off as well, as you will spend there several hours. After the first chemo you will know if you are more the book, phone, tablet or the ipod/mp3 type. You will soon learn if you prefer to read, to listen to some music, to watch a movie or TV series, or to use your phone to communicate with people, for example. I never used the tablet much, as I found myself not in the mood for a movie or book while on chemo, but, as I said, I did listen to a few meditations that I found in YouTube. I didn´t want to isolate myself listening to music either, so, as I became very talkative on chemo days, I would send lots of voice messages to friends and relatives in Whatsapp. I found monologues to be very relaxing.
Note: If you are doing scalp cooling, you won´t be able to fit in headphones (or very badly, depending on the brand of the cold cup).
-Chewing gum/frozen fruits
Many patients report a metallic taste while receiving the infusion. It only happened to me once with Epirubicin, but I would still bring chewing gum just in case. Frozen fruits, ice-creams and ice cubes can help a lot, as they can dissimulate this unpleasant taste, and might also avoid the chemo going into the cells of the mouth, provoking less mucositis side effects (the very common and painful inflammation and ulceration of the mucous membranes).
I never brought any of this to my appointments, as I didn´t want to pack a luggage. Besides, the hospital will provide you with a pillow and a blanket. If that isn´t enough, you can ask for more. I always wanted to bring an electric blanket; that´s how cold I always was, but I didn´t want to dirty my gorgeous one (hospitals are full of bacteria and viruses, no matter how much bleach they put), plus there aren´t always sockets around.
-Your own food
They will always offer you tea/coffee/biscuits, and a meal (lunch or dinner), so you don´t really need food, but many people decide to bring their own snacks, as we all know how bad hospital´s food can be.
I was very surprised to see many patients eating crisps, sandwiches and even McDonalds on the day. Even the food at the hospital will be something like ham and cheese sandwiches or omelettes filled with cheese, frozen chips and beans.
My recommendation is try to eat as little or as lighter as you can, as the first place the chemo goes is the stomach and, then, the gut, so you don´t want to have a full stomach when that happens. I am writing another post on the benefits of intermittent fasting during chemo.
-No need for Nappies!
Ok, this one is actually a bit weird, but it is something that crossed my mind before starting chemo. As I was determined to use the scalp cooling system, I thought I wouldn´t be able to go to the toilet, as I would be stuck to that frozen cup trying to save my hair. Anyway, for me, peeing in a nappy was a very small price to pay to save my hair. But no need! You will be happy to know that the Paxman scalp cooling system detaches from the machine, so you can freely go to the toilet and pee in there and not on yourself.
Have a lovely chemo day!