Understanding Chemotherapy

Please recognise this is done more for my clarification and understanding than for the future reader of this posting, but if you care to wade through the maze that follows, please read on.

In January of 2005 I had a bone marrow transplant. I was not expected to survive the procedure. I did. Morphine and food through a tube in my chest made the following few weeks a dream. Eighteen months later the cancer had returned. While I had enough T-cells for another transplant, the risk of  not surviving a second was deemed to be too high. Chemotherapy or bust? I chose chemo.

What is truly extraordinary is that most of the many drugs I take in this chemotherapy regimen are acting in a way for which they are not commonly prescribed.

Thalidomide was originally developed by a German chemist who worked for the SS in the field of chemical weapons research. After the war, it was determined the drug was an effective sedative/hypnotic, but due to an unforgivable oversight (it was never tested to see if it crossed the placental barrier), was further developed and marketed as a sleeping medication and a palliative for morning sickness during pregnancy. The rest is history. Since then, however, it has been found to be an effective treatment for certain cancers and HIV, among other things. While  the mechanisms are not well understood, it seems to mobilize the immune system to take advantage of what the other chemotherapy drugs are doing.

When Thalidomide is taken with Dexamethasone, there is an “improved response rate” of up to 70%. Against cancer this is very good. Dexamethasone is a synthetic cortisone and is generally used to treat inflammatory and allergic disorders and is an immunosuppressant. In cancer treatment it is part treatment and partly management of side effects – primarily nausea. It also reduces sensitivity to the side effects of other chemotherapy drugs.

When taken together these two drugs cause greatly increased rates of blood clots, so I take aspirin every day. No headaches anyway…..

Cyclophosphamide is an immunosuppressant and is generally used to treat Lupus (and therefore serious kidney disease – a negative side effect of amyloidosis) and other disorders such as rheumatoid arthritis. It works by interfering with DNA to keep cells from dividing – leading to cell death. This is very good when targeted against amyloidosis and multiple myeloma but hard on the blood. It means regular transfusions of packed red blood cells and immunoglobulins (basically white blood cells). So every couple of weeks I spend a quiet morning in the hospital reading and getting “topped up”.

Next on the list is Rabeprazole. It is generally prescribed to treat too much acid in the stomach but one of the nasty side effects is that it lowers blood pressure. But wait, transfusions increase blood pressure and amyloidosis adversely affects the kidneys (among other things) so decreased blood pressure actually helps the kidneys. Everything that helps is good. Another side effect is that it causes lung congestion so I take Pseudoephedrine.

Pseudoephedrine is the active ingredient in cold medications and works by narrowing blood vessels. I have never breathed so well and the scent of the forest out my back door has never been finer.

Codeine phosphate is ised to moderate pain and in concert with other drugs to reduce coughs. In this chemotherapy regimen it is primarily used to sedate my digestive tract as amyloidosis and the other chemo drugs have made it painful and overactive.

Next is Furosemide. This drug is a powerful diuretic and is used to treat fluid accumulation and swelling caused by, in this case, kidney damage from amyloidosis. Another effect is reduction of blood pressure, so this is good.

On to Clarithromycin which is generally used to treat bacterial infections. As amyloidosis and the chemo drugs which treat it cause suppressed immune function, fevers can be fatal and infections are common. Clarithromycin protects agianst those. It is very hard on digestion and makes one feel quite awful but that is somewhat resolved by some of the drugs already mentioned and by Ativan.

Ativan is usually prescribed as an anti-anxiety drug, but when used in concert with chemotherapy is an effective antinausea drug and reduces the impact of muscle spasms caused by the diuretic effect and electrolyte depletion of Furosemide. Makes me feel goood too.

Add Quinine sulphate, generally used to treat malaria (and paralyse peccaries at the tip of a blowgun dart) – but in my case to reduce muscle spasms. 

Take all these pills together and that is a BIG lunch. Add Folic Acid, vitamins and a couple of other antinausea drugs and there is desert.

Hydrogen peroxide and antibiotic creams keep my skin from falling off so I’m good.

See? It really does make sense. It works too. So I can’t walk very far or talk very well but I wake up every morning. I can hug my kids (and communicate my love to the one who lives far away) every day and I can hope that at some point in the future all these drugs will finally whip my illness into submission and I will get better, faster – than I do today.

What could there possibly be to complain about? Really!

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2 Responses to “Understanding Chemotherapy”

  1. museforrent Says:

    The marvels of modern medicine. After all those pills, you must be pretty much the healthiest guy around…!

  2. ceo Says:

    No comment.

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