Monday, November 16, 2015

The new normal

Tony is usually a man of few words. An old-school barber with an earthy beard and some weathered tatts on his neck, he is damn good at getting the job done with calm confidence and maximum discretion. So when I came in for my two-monthly cut on Tuesday and told him I wanted it off, all off, he was unfazed. “You see, um, it’s like this,” I half-spoke, half-whispered awkwardly. “I’ve been diagnosed with, um, cancer and the chemo means it’s all coming out. I figured I might as well get in early.”

Ever the cool professional, Tony sat me in the chair and draped me theatrically in a black smock. He reached for the clippers – this would be a number 1 cut – and got to work. Within minutes the salt-and-pepper (mostly pepper) locks from my head had gathered on my lap in the smock and my head’s full roundness was on display, with only a thin layer of hair remaining on top. When it came to shaving, I warned of the dangers of a blade given the blood-thinner I’d been taking, so instead Tony gave me a designer stubble look with an electric shaver. I told Tony it would probably be a while before I was back to visit. He said that when I was ready he had a shampoo I should try that was often used by cancer patients after chemo. Clearly I wasn’t the first.



I headed out the door and ran my hand over my shaven scalp. Bliss. Most people know the pleasure of running a hand over a freshly shaven head, but only those who have had the cut know the pleasure that comes to the head as well. Maybe this will be my permanent look, for summer at least, many years after the chemo has disappeared into the long-distant past of my personal history.

The decision to get my head shaved came the night before, when I was massaging some shampoo into my then-overgrown hair. After working the lather for a while I looked at my hands and saw some tufts had come out. I reached up again and tugged. The chemo drugs, nearly two weeks after I started treatment, were working their magic on my follicles. As I washed out the shampoo I wondered whether I wanted to let it fall out on its own time, but the hairs clogging the drain quickly illustrated the folly of that idea. Instead I would get ahead of the game and pay my man Tony a visit the next day.

As it happens the past week has played out rather well. As everyone from Bob Dylan to Paul Kelly has noted, they say the darkest hour is right before the dawn. So perhaps I shouldn’t be surprised that the medically complicated angst of a week earlier has been followed by a few cracks of sunlight.
There will, no doubt, still be dark periods ahead, but for now at least things are looking better.

The big development on the personal medical front was the installation of a new line to deliver the chemo treatment. To recap, a few weeks earlier I had a PICC line (peripherally inserted central catheter) installed in my left arm – basically it was a thin tube that exited the body at my inside elbow and then ran up a vein in my arm before turning a corner in the shoulder to end near the superior vena cava, a vein of the heart. While the chemo drugs the first round were successfully delivered via this line, it led to blood clots in the upper arm. As soon as the chemo drugs were in, the line was removed.

Debate raged among the cancer doctors and nurses I saw for the week that followed on just where would be the best place to install a new line. It turns out that specialists in this field have strong views on the merits of different locations, and different technologies. Some suggested we try again with a PICC line in the left arm, while others thought installing one in the right arm was a safer bet. Others thought I’d be better suited to a central catheter close to the heart with a tube that hangs down on the chest, and others again even suggested a Port-a-cath, which sits under the skin, sometimes for years at a stretch. (Chemocare offers a good overview of the options for intravenous treatment.)

But ultimately the doctors opted for a more unusual approach. Given my propensity for blood clots and the fact my tumour was in my mediastinum, limiting access to the superior vena cava, installing a line in the upper part of my body was just too risky. Instead, the line would be installed in the lower part of my body and deliver the chemo drugs to the SVC’s chip-on-its-shoulder counterpart, the inferior vena cava. This large vein carries de-oxygenated blood from the lower body to the heart, and extends all the way down to lumber vertebrae near the pelvis.

The technical name for what I was having installed was a tunnelled central venous catheter using the femoral line. In practice it means installing a tube that exits my body a bit below the belly button, then inside the body extends south to the groin before curving around to connect with the IVC. Under the skin, a couple of centimetres from the exit site, a cuff in the line has been created, around which scar tissue will grow to hold it more securely in place. Outside the body the tube extends for about 10 centimetres, part way along splitting into two parts (one to deliver chemo drugs, the other to take blood) and these are each capped with plastic devices that seal the ends. The procedure for getting this thing installed it not pleasant, but the local anaesthetic at the site and a mild sedative up top mean you hardly notice.

I later discovered that my procedure was one of the first to use a tunnelled catheter in the femoral line. Until recently, when patients were having a line installed in the lower half it would exit the body close to the site of the IVC, near the groin. This would mean the patient having, er, dangly bits near their dangly bits, creating a high risk of infection and making the delivery of the chemo drugs more challenging. Mine, however, was tunnelled, hence the much higher exit point, greatly reducing the risk of infection and making it far easy to administer the drugs. While a tunnelled device is pretty common for the top half, it’s a novelty for the bottom half. I do hope things go well for me and my
groin novelty.



So with my new line installed I am now ready for the next round of chemo starting on Wednesday. That’s when I’ll be hooked up to a portable CADD pump for five days as it slowly releases the drugs into the plastic cap, along the tube to the IVC, up to the heart and ultimately to my whole body.

The fatigue and other side effects will probably be more intense than they were the first time around, I’ve been warned. But at least I can run my hands along my shaved scalp as a distraction.

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