Barfing in a Bucket

Good morning from Cathy Brown. Health care workers often resort to gallows humor - it is one coping mechanism that lets us continue to function when faced with so much pain and suffering on a daily basis. It is what I have to resort to right now, because if I can't laugh about some of this I will be in a puddle of tears.

When I told a co-worker Cathy and I were going to Chemotherapy school she asked if they were going to teach us how to 'barf in a wastebasket'. Even though I have been a nurse for a measly eighteen years compared to Cathy's 35, I readily admit I don't know anything about chemo. Like most of the population all I 'know' is that you vomit a lot and you'll lose your hair. Guess what? These aren't always true.

So here's a crash course on Chemo 101, the blogger's version.

Chemo affects rapidly growing cells in the body, so besides the cancer it also affects bone marrow, the lining of the mouth and digestive system, hair, skin and the reproductive organs.

From the top then:
There are three types of cells made by the bone marrow affected by chemo:

White Blood cells (WBCs)
- these cells fight infections in the body
- they will be at their lowest levels (and least effective) from day 7 to day 14 after the chemo treatment
- Cathy has to be vigilant checking her temperature and watching for signs of infection. An out of control infection can kill her
- For the rest of us this means we have to be very careful when we visit. Frequent, thorough hand washing is the most important thing we can do to keep her safe. We have to monitor our own health and postpone our visits if we are sick. We especially have to be vigilant during the seven to fourteen day period after a treatment

Red Blood Cells (RBCs)
- these cells carry oxygen
- since the chemo will destroy some of these cells, Cathy will have less oxygen circulating in her blood and she may be short of breath and tired.
- some people have well defined, short periods of fatigue, while others suffer from it for the entire cycle
- there is no way to predict how it will affect Cathy

Platelets
- these cells are responsible for blood clotting
- low platelet levels mean Cathy might bruise easily
- she might bleed a lot, even from a minor cut
- nose bleeds can be very serious

Lining of the mouth and digestive system

Nausea and Vomitting (N&V)
While my stereotypical picture of barfing in the bucket won't necessarily come true, it still might happen to Cathy as the drugs she will be on do tend to cause N&V
- N&V can be immediate or delayed
- the doctor will give her a prescription for drugs to control this
- she will need to take these medications regularly for the first three days and then as needed after that

Mouth Problems
- many people on chemo get sores in their mouth and throat as well as bleeding gums
- the Cross (Cancer Institute - where Cathy will get her chemo) recommends rinsing with baking soda in water or club soda. Cathy might need to do this after eating and every two to four hours
- many people on chemo find their sense of taste is affected, so besides their mouth hurting when they eat, stuff may taste funny (only if this happens to Cathy will I send some of my cooking over!)

Constipation or Diarrhea
- constipation is more common with the drugs Cathy will be on, but diarrhea is still possible

Hair Loss
- not everyone loses their hair, some have no change, some thin a little, and some lose everything
- If it is going to happen, the most common time is about 15 days after the first treatment
- hair often grows back and may be a different colour or texture
- the doctor told Cathy she will probably lose her hair
- I'm hoping Cathy becomes a curly headed blonde when her hair grows back

Skin
- may be sensitive to the sun for one year after chemo
- this means Cathy will need to be vigilant about covering up and wearing sunscreen next summer

Reproductive organs
- not really an issue for Cathy

Others
- muscle weakness, numbness in the toes and finers and ringing in the ears are all possibilities
- Cathy has already been trying this one out at work - whenever our boss starts talking Cathy tries the "I can't hear you - my ears are ringing" thing

Here's a quick recap of all the above:
Cathy may or may not be tired, barfing, bald, sore mouthed with sun burned bruises, unable to hear while she flips up her middle finger to 'get rid of the numbness'. Irritability isn't on the list - I can't imagine why not.

I hope my primer has given you a bit of information on chemo. If any of my attempts at humor have offended you, please forgive me. As most of us are finding, I struggle daily just to understand how all this could be happening to Cathy. Some days I am grown up and functioning and other days I am crying like a little child who doesn't understand what is going on and just wishes someone could promise me everything will be all right.