Cycle 4 in the age of Covid-45

     I'm starting this blog on day 1 of Cycle 4. It's been a hassle getting to this point. Mostly due to travel and other restrictions. My last post told of our travel to Annapolis. Here I'll tell you about our travels to Connecticut and what happens with our chemotherapy cycle, before, during and after.

     We called in to the doctor's office a week ahead of time and things started changing. They wanted us to be in the state two weeks, in quarantine, before they saw us. My doctor, knowing how we live, said we didn't need to do that. We have self-quarantined on the boat for a lot more than two weeks. They did change our initial appointment from Wednesday to Thursday, back to what I wanted originally. Carol had rented a car from Hertz in Annapolis at a place we used before. She got a Lyft to the place and found it was gone. Hertz is her company's preferred provider and Carol has a high status level with them. She also has an option to use competitors. She got a car from Enterprise which was across the street. She had to use real money however, not points. Boo. We also heard from the hotel we had booked. They said they were closing. At least they notified us almost a week in advance. We got a similar room at another Hilton corporate family hotel. Payment by frequent user points was messed up, of course. These hotels are having troubles due to fewer people travelling. They are reducing facilities like pools, gyms and food services. Understandable. They don't seem to be reducing their prices, however. Masked and gloved, I didn't go near the check in desk. Once in our room we went to work with our bleach wipes. Everything we could possibly touch got wiped down, by both of us. The drive to the Hartford area was uneventful, just long. Almost 6 hours. Traffic was pretty light and only up to moderate in the NYC area. One positive, at least, in this restricted era. At the hotel we found our 2nd favorite restaurant had closed even though it had a takeout business before the shut down of the state. We had to settle for 1000 Degree pizza even though we usually get Italian after day 1 of my cycles, not before. Oh the sacrifices we have to make because our orange 'leader' delayed any response to the virus for so long. At least we are still alive (so far), many have had it far worse.

     Our Day 1 of Cycle 4 started early and we had to eat the breakfast food we had brought ourselves. No food service at the hotel. They put out a couple of packaged muffins and some apples. First rate. Uh, no. Carol was not allowed to go into the Smilow Clinic with me. I was going to be all alone. No support. I would tough it out. As soon as you enter the building you have to get a temperature scan and answer 6 questions about travel and exposure to sick people. I answered these questions over the phone the day before and would answer them again several times during the admission process. At each level. It got to the point I would count out six no answers when they started the first question. 60+ years of being a smart ass doesn't just stop with a cancer diagnosis. They understood they were repeating the questions, I understood they had to ask them. I had my blood drawn before 0900 and then went to my chemo chair. Had the room to myself to start. They had converted the  eight chair room to a six chair room and then taped off two of the chairs to make the room four chairs only. You had an empty chair and curtains between you and the next person. There was someone opposite you in the room but it was about ten feet. Close enough to chat anyway. Apparently they also had a few private rooms and another small communal room. I was in the primary room. I had been here in December for an iron infusion. They started organizing for my treatment but I had to see my oncologist before I could start the treatments. He was late. Of course. We talked about my experiences with my Miami oncologist, my first three cycles and possible future treatments after these six cycles. Nothing definite, just possibilities and options and the chances of new treatments being developed before we get to future stages.

     By the time I got back to my chair other people had come into the other chairs in the room. There was some turnover as some had quick treatments or, in one case, the gentleman was tossed out because he was too healthy. Good news. Didn't need his infusion just continual monitoring. We had to wait for my doctor's new orders to filter into the system. An injection of retuxin was planned but we (me actually) were concerned about a possible reaction which could happen a few days into the future given my adverse reaction during my cycle 2. We could be on the boat 350 miles away and/or out of immediate range of urgent treatment. We stuck with what we knew was a good method and flow rate for me. They changed the order of my drugs while I waited for the retuxin. Bendomustine went first. This is not an issue. The other change was some prep drugs being pills not IV meds. Takes longer for effects but not a problem otherwise. Snuck a nap in. Talked with lady across from me after her nap. She was getting blood due to aplastic anemia and perked up after half had gone in. During our conversation she broke off to speak to her nurse and referred to me as a young man she was talking to. That hasn't happened in quite some time. She was 9 years older that me. How to I know? We have to give our names and DOB several times to different people as they do multiple confirmations of the right drug to right person at the right time. I also ask to see my name on the IV bag and ask what other meds I'm getting and what they are for. In Miami we caught an error that way, well before the possibility of a serious problem. I was called to a wrong room at the wrong time instead of the person on the list above my name. Carol caught that but here I was solo. There actually was a minor mistake anyway. We had decided on a max flow rate of 150ml/hr but a nurse assumed I was due for an increase to 200. By the time we caught the error I felt I was doing okay at that rate and we would continue it. I noticed the difference but it was minor. When I saw the number on the machine I checked in with all my systems and decided I would be alright. Some minor pressure changes felt in my head but nothing important. Brain issue? No problem. Breathing or heart issues would have got my attention. My primary nurse had to have a chat with nurse that had made an assumption. Those can be bad. Not this time.

     We headed home about 1630 and went to a takeout Thai restaurant as the Vietnamese Pho place we liked was closed. The Thai was quite good but it was slightly spicier than I requested. Normally that is how I like it but my treatment has me take the heat down one notch. It's interesting how chemo makes you more in touch with your body. You are more aware of how the poisons affect you in the short run and through the 28 day cycle. One more interesting thing from the morning as I was checking in. They always check your weight but they also wanted my height this time. I am 6' 1", I have been for a long time. I wondered if I might have shrunk with age. No, I was an inch taller. Had I grown? No, I don't think so. Operator error. The only other issue on day one was lack of sleep overnight. This had happened before. It's the steroids. When I slept it was fine, it just wasn't long.

     Day 2 of Cycle 4 started early again but not quite as early. 15 minutes later. Today my weight showed a 10 pound gain. Overnight? No, I don't think so. These electronic weigh machines are always erratic. I have had these impossible 10 pound variations before. We got my pill form drugs, waited for 30 minutes for them to kick in and then started the bendo again. About 15 minutes later I was done and ready to get on the road back to Annapolis. I got my next month's schedule including a C-T scan to check on my progress. The most important event was stopping at Neil's Donuts in Wallyworld on the back to the boat. 7th best donut shop in the U.S. Traffic again was good and we made good time. Colder in Annapolis than when we left two days ago. And much windier. Over 20kts with higher gusts.

     As I finish up this blog entry it is the end of day 3, Saturday. I usually wait until after day 4 to post in case there are any adverse reactions. I don't anticipate any. I am taking two different anti-nausea medications today and Sunday as a preventative, before I feel sick, just in case. I feel fine, luckily. We are going to stay in the Annapolis area a while longer and then cruise slowly up the Bay. It is too early to head home. And too cold. Now we're just hoping our precautions in Hartford were good enough to avoid catching the Covid virus. Back to nearly complete isolation.

     The biggest takeaway from this cycle was the infusion room I was in this time. The four chairs in the room made the experience more communal. I mentioned this after my December infusion of iron in the same room. This time I was getting chemo with people getting chemo or blood or some other infusion. This was unlike in Miami where I was in a private room with Carol. There still was a sense we were all in this together or at least we knew what the others were experiencing. We may have had different blood cancers and getting different treatments but we were sharing a similar, bonding experience. No one talked much about what we were going through in our conversations but I felt a connection and I think they did too. There is something to be said about the private rooms we had in the past but the community experience was good for me, too. I'm glad I had both experiences. Well, maybe I'd prefer not to be going through this at all but I know in spite of the disease, I have been pretty lucky with the type and severity of my situation. Chronic, not acute. Long term treatment but not necessarily life shortening. We hope.

     Before I start Cycle 5 I will have to have another scan to see what is happening inside. Bloodwork has continued to improve and we will still  check that monthly.

     Until next time...