3 Jun 2011

Don't Be Afraid To Ask

Remember my blog on Chemo #1 (see Chemo Plus 7) saying that I spent the first five days afterwards in a green funk?  I ended up requiring home nursing to administer an anti-emetic (nausea drug) by I.V.   I also mentioned that this side-effect was a first for me.  A first in almost four years. 
At my checkup this Tuesday, before Chemo #2, my medical oncologist asked "What happened?".  He couldn't figure it out and nor could I.  We both attributed the nausea to the proximity of the chemo treatment to my recent surgery and a very slim chance that the usual ondansetron medication that I took could have been stale-dated.  We left it at that - but I wasn't finished puzzling.
The biggest Chemo #1 mystery to me remained the speedy delivery of the carboplatin infusion - normally taking between 6-7 hours and took a remarkable 3 1/2 hours.  At the time, I questioned and questioned when the nurse said I was finished as to where the second bag of carboplatin was as I'd never seen such a small one.  I also questioned why we had a second set of anti-reaction drugs left over that had always been used in the past.  The only comment she had to offer was the efficiency of her care - I'll give her that.  She never let the I.V. pump beep more than twice without being on top a things - a REAL first.
Yet I kept a "niggling feeling" about the whole thing...  Always questionDon't be afraid to ask.
Yesterday was day two of Chemo #2.  The same small bag of carboplatin was hung  and before the nurse had a chance to open it I questioned its size again.  She was extremely co-operative after I told her that I thought something was not correct; something had changed and that possibly "that something" could have been the reason for my five-day nausea marathon. 
She dug deeper into my file and noted that all previous chemos used a  500ml bag of this drug.  The bag she was about to hang was 250ml.  Somehow, somebody in pharmacy decided put the same amount of drug in a more concentrated solution without changing the timing on delivery.  Are you confused yet?  Well, I wasn't.  What it meant was that the drug was essentially delivered to me at twice the speed so the concentration and speed must have been responsible for the reaction that set in immediately afterwards.  Upon that deduction, I insisted that my medical oncologist be notified and consulted on the change.  He was.  And he re-iterated his standing order for the original concentration - in 500ml.
Unfortunately, the pharmacy suffered the financial loss of having to destroy the prepared 250ml infusion - but hopefully, as a result, I've  gained back those five days.
Last night, I ate a full dinner.  This morning, I woke up hungry, not nauseated and haven't even taken my ondansetron yet.
As I looked around the chemo suite yesterday, I noted that the average age of patients being treated was probably 70+.  I worry about who advocates for them.  I worry about them not having adequate chemo coaches and I worry whether or not they're keeping medical diaries - even to the extent of noting specific drugs and their volumes.  How many of us have the courage to challenge and re-challenge the system? 
Listen to your inner voice and don't be afraid to ask.

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