Chemotherapy 101

First, a confession -- I skipped my run today. I'm really in "maintenance mode," down around 30 - 35 miles per week, until training picks up for the Seattle Marathon in July/August. So, only running 3 or 4 time per week means missing a run can be significant -- but I had a good reason, I promise:

When people hear that I have cancer, one of the questions I get most frequently is "How do you run while on chemotherapy?" Well, the answer for today is, I didn't. I started chemotherapy round #5 on Sunday, so today is day five...and I've felt absolutely miserable. In honor of completing another round (I'll finish this round with my last dose tonight), I'll give you a (relatively) brief answer to another frequent question: "What is it like being on chemotherapy?"

Well, chemo sucks. And that's not an opinion -- I'm pretty sure it's an objectively verifiable fact. There are many different kinds of chemotherapy, but for me, a single regimen consists of twelve rounds -- one each month for twelve months -- a full YEAR of chemo. Each round lasts five days, with a significant dose of chemo each day. In short:

Sunday night, I start with Zofran (anti-emetic, keeps me from vomiting).

30 minutes later, I take 400mg (four pills) of Temozolomide (Temodar), the chemo. I'm usually nauseous instantly, so I have to take two pills at a time to break it up a bit.

As soon as the chemo is down, I head to bed. To goal here is to sleep through the worst of the nausea, but it doesn't always work that way (especially with a brand-new baby). So, I often wake in the middle of the night with horrible nausea. The challenge here is that I take the chemotherapy orally, so I must keep it down. If I get sick, then I have to go in and do the whole IV thing, which is terrible. So, most of the night is spent fighting the urge to get sick, which makes for a few long nights.

Starting the first day after chemo (usually Monday), the stomach troubles begin...pretty much running the gamut. The Zofran does a good job or preventing me from vomiting, but it also prevents me from doing...well...anything else. So, I also have to take Colase (a mild laxative) to help keep things moving (running helps too). To make matters worse, the toxicity of the drugs causes some acid reflux, so I also take Zantac to combat the heartburn. So, for at least the five days I'm on chemo (and usually one or two days after, as it gets out of my system), I'm a walking Pepto Bismol commercial -- nausea, heartburn, indigestion, upset stomach, diarrhea...I know you're singing the song in your head right now. It's okay, I do too -- I just add "constipation" to the list!

In 2005, I went through a complete regimen (12 rounds), and kept everything down 9 of the 12 times. Two times it was probably my fault -- once I ran a half-marathon on the fifth day of treatment -- and once I decided to fly while on chemo. I called the oncology nurse after the half-marathon to ask what to do and see if I needed to schedule an IV...when I asked what to do, she simply said "That was stupid. Don't do that again." Gotcha. Point taken. But we're runners, right? And runners run. I ran my first marathon two months later, in between my eighth and ninth rounds of chemo. My wife will be the first to tell you that I'm not very good at following the doctor's advice anyway...

See, the chemo treatments are cumulative -- toxicity builds up in your system. I usually feel okay on day one...a bit worse by day two...starting day three (Wednesday), I really start to feel miserable, and Thursday and Friday are usually spent curled up in a ball on the bed or in my chair, not wanting to eat, move, or -- like today -- run. I ran eight on Tuesday, but just couldn't get out there today. So, I'm blogging instead. Hope you'll forgive me.

Five down, seven to go!