I'm all atingle...
Atingle. There's a word you probably don't hear very often. I hardly ever use it (and I use a lot of arcane and frankly pointless words), and even when I do it's always used sarcastically. Like: "Ooh! Another meeting? I'm all atingle."
Yeah... I'm kind of a dick sometimes. I was before I was diagnosed with cancer and spoiler alert: it doesn't look like the radiation got rid of that. But this time I'm not saying it to be a dick. This time I'm sincere.
I really am all atingle. But I'm going to keep you all atingle as to the reason while I give a little more background info. Don't skip to the end; trust me, my observations will be worth it.
So... yeah. The PICC was a no-brainer. I reported to the hospital I work at fifteen minutes before my appointment to have it inserted last Friday and sat in the waiting area, curious about which IV Therapy nurse would be inserting my PICC. I know all of them and any one of them would be great, but as is so often the case in healthcare each of them has their own unique characteristics. The nurse who called me did a double-take. "Is this why you haven't been working for so long?" she asked, her concern genuine but wrapped in good-natured ribbing.
"Yep. Just thought I'd see what healthcare was like from inside the cage," I teased back.
She was wonderful and the process of having almost a foot and a half of medical grade tubing stabbed into my upper arm and threaded into my chest was simpler than you might expect. I had to take off my shirt, but that was really just to put the special Y-shaped antenna on my chest that would help the nurse 'see' the catheter and make sure it wasn't going anywhere sneaky like up into my brain or down to my liver. She hooked up a few electrodes on my arm, chest, and left hip to pick up my heart rhythm as she advanced the catheter in my veins; the tip of the catheter is actually another electrode and all of these points of contact fed into an ECG that was also used to determine when the catheter was in the perfect location.
The nurse cleansed my entire right arm and part of my right chest and then draped me in a sterile surgical cloth that left only a portion of my upper arm exposed to her. She injected me with some local anesthetic and then slipped a fairly standard IV into a large vein - the Basilic vein - and then slid a catheter introducer - a sort of special funnel - over that and into the vein. She pulled out the original IV and then started to slide the long flexible tube into the introducer.
It felt strange at first. I mean, a fairly large tube was sliding inside my veins and making its way to my armpit. It wasn't painful and wasn't really uncomfortable, it just felt... different. Once it passed my armpit I couldn't feel anything though, although I did hear a couple of wet, squishy sort of clicks in my right ear at one point.
"Sorry. Having trouble getting past the jugular," she explained. "Tell me if you hear the ocean."
In the early days of inserting lines like this there were no antennas to guide the person putting in the catheter. A not uncommon issue was having the catheter go naturally from the basilic vein into the subclavian vein, then hang a sharp left and go UP the jugular vein into the neck. The blood flow from the patient's great big brain would have to get past the tube and would swirl, making a sound like waves on the shore in the ear on the side they were working on. I didn't hear the ocean - the nurse was more than capable of getting the catheter into the vena cava instead of the jugular - and a few minutes later they were pleased with its placement and cleaning me up. I was given care instructions, some emergency dressings, and a card with a product identification and serial number as well as the length of the catheter at the skin as well as external to it. If more or less of the catheter was exposed at any point of my care the PICC would need to be adjusted or removed.
I was now ready for my chemo.
The chemo room at the local cancer centre is as wonderfully and warmly decorated as the rest of the facility. It is a bit overtaxed though; originally designed for ten outpatients at a time, it now has eighteen chairs for peak treatment periods like this. It's a bit more cramped than the radiation rooms... okay, it's a LOT more cramped. Still, the nurses and volunteers are great and personable and the entire process of getting my chemo was explained to me in terms that were respectful of my level of knowledge yet still caringly phrased enough to not make me any more nervous than I already was.
Why would I be nervous? I know all about this stuff, right? Yeah... that's the problem. Knowing about the effects of the mid-level poisons that are being pumped into my heart may help my brain process the information easier, but it doesn't make my heart any more sure that everything's going to be okay. I know everything will be okay, but it's going to take a bit for my heart to catch up. I'm human, and I'm really starting to understand the whole ignorance is bliss thing in a much more appreciate light.
Two hour oxaliplatin and luecovorin infusion done including a PICC dressing change, 5FU bolus and 46(ish) hour 'baby bottle' infusion started, disconnection teaching and safe disposal supplies given, and a final double check that my infusion was hooked up correctly completed (all chemo drugs are independently checked by a second nurse to ensure that I am actually getting the chemo ordered for me), I was discharged home.
That little splash of cold water sensation I felt on my neck dashed across the backs of my hands as we walked out to the car. It was a mild day - about 17C - but with gusty winds. Each little gust of cool air that hit my bare skin felt like an ice cube. The sensation wasn't painful - just odd - and it went away as soon as we were in the car.
Eating was a little odd too. I can't eat or drink anything colder than room temperature for up to 5 days after the oxaliplatin I received yesterday. The funny thing about not being able to eat things like that is that that's precisely when you want them. I really wanted some Gatorade, but warm Gatorade is beyond unpalatable. I settled for room temperature apple juice, but room temperature was just a little colder than my throat could tolerate apparently. I felt like someone had slapped my left jaw or like I had just bitten a very sour candy on that side of my face. I even had tears form in my left eye, although not because of pain but rather just the overwhelmingly odd sensation. My son microwaved the apple juice (just think of it as hot apple cider at that point) and the sensation didn't recur when I drank my juice.
Lesson learned.
There were other tingling things too. Washing my hands after using the bathroom and not letting the water warm up first caused my fingers to curl up and be useless for about ten seconds, just like I was back on the prairies in January and had dropped my mitts. I dried them carefully and the sensation went away. I turned on the ball of my foot and it felt like the front half of that foot was twice the size it normally was, throbbing with sparks and tingles but never progressing to pain. A gust blew threw an open window and made its way straight to my scalp, causing what little hair I have to stand straight up in protest. I banged my finger slightly against a plate and couldn't move that hand for almost a minute. None of these things actually hurt, but they definitely were symptoms of mild peripheral neuropathy. I went to bed - a whole challenge with a baby bottle hanging from a tube sticking into my arm that I will go into in a separate post - wondering how long this would all last.
The answer? Not very long at all. I woke up around four AM, mildly nauseated and unable to sleep because of it and got up to to take some medication. I decided to try some tap water to wash the pills down - it would be below room temperature but not as cold as fridge water. I noticed a bit of that same sour tang I felt the night before with the much warmer apple juice but not nearly as bad. I took some jam out of the fridge - something I wouldn't have even attempted last night - and it was fine even though I felt a tingling anywhere my hands touched the jar. I will still be cautious, but at this rate I would be surprised if I noticed any more problems by tomorrow morning.
Which is good. As fun as it is to say, being atingle gets old real fast.
Yeah... I'm kind of a dick sometimes. I was before I was diagnosed with cancer and spoiler alert: it doesn't look like the radiation got rid of that. But this time I'm not saying it to be a dick. This time I'm sincere.
I really am all atingle. But I'm going to keep you all atingle as to the reason while I give a little more background info. Don't skip to the end; trust me, my observations will be worth it.
What's PICCing you?
Yeah... a stretch, I know. PICC stands for Peripherally Inserted Central Catheter. I only need to get eight courses of chemotherapy under my awkwardly-names GIRAJFFOX regimen and each course consists of a two-hour infusion of two drugs followed by a bolus (sometimes called a 'push' or rapid direct infusion) of a large dose of another drug and then a 46(ish) hour infusion of the same drug. The volumes of the drugs are pretty high and that's a lot of poking to start IVs - although fortunately it would only be needed every two weeks. But these drugs can be pretty hard on the veins so a PICC is generally recommended to allow them to be given straight into a "large vein in my chest" - otherwise known as the Vena Cava, directly where it dumps into my heart at its junction with the Right Atrium. It is the single largest vein in the body and it sees bloodflows in the litres per minute as opposed to a few tens of millilitres per minute in those super-squishy peripheral veins. So that's good. A PICC can also stay in place for months - very useful for cases like mine where I need to get IV drugs including an infusion at home for at least part of a four to five month period.So... yeah. The PICC was a no-brainer. I reported to the hospital I work at fifteen minutes before my appointment to have it inserted last Friday and sat in the waiting area, curious about which IV Therapy nurse would be inserting my PICC. I know all of them and any one of them would be great, but as is so often the case in healthcare each of them has their own unique characteristics. The nurse who called me did a double-take. "Is this why you haven't been working for so long?" she asked, her concern genuine but wrapped in good-natured ribbing.
"Yep. Just thought I'd see what healthcare was like from inside the cage," I teased back.
She was wonderful and the process of having almost a foot and a half of medical grade tubing stabbed into my upper arm and threaded into my chest was simpler than you might expect. I had to take off my shirt, but that was really just to put the special Y-shaped antenna on my chest that would help the nurse 'see' the catheter and make sure it wasn't going anywhere sneaky like up into my brain or down to my liver. She hooked up a few electrodes on my arm, chest, and left hip to pick up my heart rhythm as she advanced the catheter in my veins; the tip of the catheter is actually another electrode and all of these points of contact fed into an ECG that was also used to determine when the catheter was in the perfect location.
The nurse cleansed my entire right arm and part of my right chest and then draped me in a sterile surgical cloth that left only a portion of my upper arm exposed to her. She injected me with some local anesthetic and then slipped a fairly standard IV into a large vein - the Basilic vein - and then slid a catheter introducer - a sort of special funnel - over that and into the vein. She pulled out the original IV and then started to slide the long flexible tube into the introducer.
It felt strange at first. I mean, a fairly large tube was sliding inside my veins and making its way to my armpit. It wasn't painful and wasn't really uncomfortable, it just felt... different. Once it passed my armpit I couldn't feel anything though, although I did hear a couple of wet, squishy sort of clicks in my right ear at one point.
"Sorry. Having trouble getting past the jugular," she explained. "Tell me if you hear the ocean."
In the early days of inserting lines like this there were no antennas to guide the person putting in the catheter. A not uncommon issue was having the catheter go naturally from the basilic vein into the subclavian vein, then hang a sharp left and go UP the jugular vein into the neck. The blood flow from the patient's great big brain would have to get past the tube and would swirl, making a sound like waves on the shore in the ear on the side they were working on. I didn't hear the ocean - the nurse was more than capable of getting the catheter into the vena cava instead of the jugular - and a few minutes later they were pleased with its placement and cleaning me up. I was given care instructions, some emergency dressings, and a card with a product identification and serial number as well as the length of the catheter at the skin as well as external to it. If more or less of the catheter was exposed at any point of my care the PICC would need to be adjusted or removed.
I was now ready for my chemo.
So... atingle?
Yes. Atingle. You see, I started my first course of chemotherapy yesterday and one of the drugs - Oxaliplatin - causes temporary, reversible peripheral neuropathy. Like, pretty much as soon as it was being infused in my PICC. I had a warm blanket draped over my legs and was wearing the wonderful scarf my daughter embroidered for me to keep drafts from the air conditioning off my neck. But I missed a spot and there was a sharp, sudden sensation of cold on my neck, almost as if ice water had been splashed on my throat. I wrapped my scarf tighter and settled in for my three hour tour (hoping that it turned out better for those folks on that boat on TV).The chemo room at the local cancer centre is as wonderfully and warmly decorated as the rest of the facility. It is a bit overtaxed though; originally designed for ten outpatients at a time, it now has eighteen chairs for peak treatment periods like this. It's a bit more cramped than the radiation rooms... okay, it's a LOT more cramped. Still, the nurses and volunteers are great and personable and the entire process of getting my chemo was explained to me in terms that were respectful of my level of knowledge yet still caringly phrased enough to not make me any more nervous than I already was.
Why would I be nervous? I know all about this stuff, right? Yeah... that's the problem. Knowing about the effects of the mid-level poisons that are being pumped into my heart may help my brain process the information easier, but it doesn't make my heart any more sure that everything's going to be okay. I know everything will be okay, but it's going to take a bit for my heart to catch up. I'm human, and I'm really starting to understand the whole ignorance is bliss thing in a much more appreciate light.
Two hour oxaliplatin and luecovorin infusion done including a PICC dressing change, 5FU bolus and 46(ish) hour 'baby bottle' infusion started, disconnection teaching and safe disposal supplies given, and a final double check that my infusion was hooked up correctly completed (all chemo drugs are independently checked by a second nurse to ensure that I am actually getting the chemo ordered for me), I was discharged home.
That little splash of cold water sensation I felt on my neck dashed across the backs of my hands as we walked out to the car. It was a mild day - about 17C - but with gusty winds. Each little gust of cool air that hit my bare skin felt like an ice cube. The sensation wasn't painful - just odd - and it went away as soon as we were in the car.
Eating was a little odd too. I can't eat or drink anything colder than room temperature for up to 5 days after the oxaliplatin I received yesterday. The funny thing about not being able to eat things like that is that that's precisely when you want them. I really wanted some Gatorade, but warm Gatorade is beyond unpalatable. I settled for room temperature apple juice, but room temperature was just a little colder than my throat could tolerate apparently. I felt like someone had slapped my left jaw or like I had just bitten a very sour candy on that side of my face. I even had tears form in my left eye, although not because of pain but rather just the overwhelmingly odd sensation. My son microwaved the apple juice (just think of it as hot apple cider at that point) and the sensation didn't recur when I drank my juice.
Lesson learned.
There were other tingling things too. Washing my hands after using the bathroom and not letting the water warm up first caused my fingers to curl up and be useless for about ten seconds, just like I was back on the prairies in January and had dropped my mitts. I dried them carefully and the sensation went away. I turned on the ball of my foot and it felt like the front half of that foot was twice the size it normally was, throbbing with sparks and tingles but never progressing to pain. A gust blew threw an open window and made its way straight to my scalp, causing what little hair I have to stand straight up in protest. I banged my finger slightly against a plate and couldn't move that hand for almost a minute. None of these things actually hurt, but they definitely were symptoms of mild peripheral neuropathy. I went to bed - a whole challenge with a baby bottle hanging from a tube sticking into my arm that I will go into in a separate post - wondering how long this would all last.
The answer? Not very long at all. I woke up around four AM, mildly nauseated and unable to sleep because of it and got up to to take some medication. I decided to try some tap water to wash the pills down - it would be below room temperature but not as cold as fridge water. I noticed a bit of that same sour tang I felt the night before with the much warmer apple juice but not nearly as bad. I took some jam out of the fridge - something I wouldn't have even attempted last night - and it was fine even though I felt a tingling anywhere my hands touched the jar. I will still be cautious, but at this rate I would be surprised if I noticed any more problems by tomorrow morning.
Which is good. As fun as it is to say, being atingle gets old real fast.
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