Week 2 & 3 (prologue)
Before I get into the actual treatment, let's talk about what happened the end of week 2.
Week 3 started off with an uncomfortable sensation of bone pain. What is bone pain? Well, imagine having shin splints but everywhere you have bones. It started with a shooting pain in my back, moving up to my shoulders and even behind my ear and into my skull. Go on, just imagine what shin splints all over your body would feel like. I'll wait....
It's worse than you think.
Nope, probably worse than that. It's sort of a stop you mid-sentence-and-take-your-breath-away-while-you-shudder kind of pain. I believe that's the medical term for it anyway. Now, I would not fault you for thinking, That sounds kind of serious. Did you go to the doctor? No, I did not. Because I am a man. Not much of one, but a MAN! Also, I was sort of getting curious about whether or not I would see any severe side effects and that answered the question.
It hit me on the Friday of week 2 and I sent a message to my Oncologist that night via the patient portal to document it. Doing a little bit of research on the interwebs for my symptoms, I found that it is a common side effect of the Neulasta white cell booster.
I had mine put on my stomach because I'm different.
Neulasta is a body injector that delivers a white cell booster over the weekend, 27 hours after chemotherapy for the week is complete. I got mine on the Friday of week 1, you can see what it looks like in the picture. Basically, at the end of treatment, the nurse injects that little beetle looking device with the drug and then adheres it to the patient. 3 minutes later, you feel a puncture (think a rubber band snapping your skin or a finger prick) to insert the catheter that will deliver treatment. 27 hours later, the device beeps and over the course of 45 minutes, it slowly gives you the Neulasta drug to boost your immune system.
Am I stupid?, you might start asking because you're lucky enough to not have Shinsplintitis [sic], Why would the white cell booster make your bones hurt?
Well, good news, you're not stupid. According to most of the resources I've found:
“The exact mechanism of this pain is not well understood.”
The nearest they can figure, bone pain is caused by some combination of histamine release causing bone marrow edema. (Editors note: This should not be confused with the metal band Adema though the effects on the human body are similar.) For the layman, which includes me if I'm being honest, edema is a fancy medical term for swelling. So basically, your body is mad you're asking it to produce more white cells, throws an allergic fit and the spongy stuff inside your bones swells. Being encased in bone, your marrow can do nothing but swell and scream at you, causing severe pain. Hence, shin splints. Everywhere. Did you think about it again yet?
Luckily, you can take an allergy/antihistamine drug (i.e. Benedryl) to block the histamines and and a simple tylenol to help with the pain. Although I did not know that until well after the pain started so it was a fun thing to deal with for about 48 hours at the end of week 2.
"Adema broke up? I thought they died from a freak hair gel arson. Also, who asked for this?" - Everyone
Speaking of week 2 (see how good I am at segueing between topics?), that one was a doozy...
Week 2 & 3 (Tuesdays, 1.5/2 hrs a day)
The once a week treatments aren't that bad, usually coming in around 1.5 to 2 hours on Tuesdays. The drug is Bleomycin, which is very caustic, in case you need a reminder. There is usually a good chance of a reaction in the patient so they administer an IV of Benedryl and give you Tylenol to mitigate this up front. They advise you to take another dose when you get home after treatment. Since I was exhausted when I got home, I decided to take a nap instead of taking additional pills. Do you think that was a mistake?
Alright, chills out.
I awoke after about 2 hours of sleep in a cold sweat with the chills. It felt about the same as having the flu, slight fever, cold sweat, chills and shaking, extra layers are too hot, regular is too cold.... This was the one time so far (I'm writing this at the end of my 2nd round) I lost my appetite. I couldn't eat, it was too uncomfortable. I couldn't bundle up to deal with the chills because I got too hot. I couldn't not bundle up because I was too cold. I finally took a Tylenol and Benadryl as I had been advised originally. By then, however, it was a little late. I just had to ride it out. It continued for about 48 hours after treatment.
That night was the oddest night's sleep I've ever had. I wasn't entirely asleep, nor entirely awake. I had some dreams I think, but they could have just been psychotic fever visions. I could never get very comfortable since the temperature was never right and every shift in position lead to a new round of chills as cool air hit the formerly warm side of my body. At one point, my brain tried to trick me with magical thinking such as burning the chills out of my body with a shot of Fireball Whiskey (Fireball may or may not contain antifreeze and is banned in several countries). Not only was that suggestion unhelpful and stupid but it would require me to get out of bed. There really were no good solutions besides taking the Tylenol and Benadryl like clockwork and riding it out.
Or you Macgyver your way through it like a Homeopathic couple abusing their children
This seems like a good time to note that there are two very distinct themes that have come out of my treatment course:
Tylenol and Benadryl are the answer for almost everything so buy bulk;
Tylenol and Benadryl only really work well if you take them prior to the onset of symptoms or side effects
After sweating through several rounds of clothing, my fever finally broke about 32 hours after onset and the chills began to go away. I was probably back to par around 48 hours after treatment. I made sure I took the Tylenol/Benadryl duet religiously after those two days. They were a nightmare.
So round 1 was officially over Sept 30th and round 2 began the following day with another Monday-Friday treatment. It really was very similar to Week 1 so I'll be covering something more interesting next time.
