ABVD for Newbies – What happens on chemo day

ABVD is almost always given as an out-patient regimen.  (Speaking from experience, it could also be done in a hospital if your oncologist is worried about your basketball sized spleen breaking up too quickly and overwhelming your kidneys, though … We’ll just assume you’re not nearly as bad off as I was at diagnosis!)  So you probably will be treated at an out patient cancer center.  If you can go check out the treatment room ahead of time, go for it.  My cancer center’s treatment room had chairs with TVs attached.  You can also bring your ipod, laptop, whatever entertains you.  You probably will be in a room with other people, so of course you do want to be polite (i.e. bring headphones if you want to listen to music).

Should you bring someone with you?  Up to you.  I think it’s helpful to have someone pick you up and drop you off since the drugs may hit you quickly, but other than that, it’s up to you.  If it makes you feel better, bring a friend or family member.

So what happens on chemo day?  In a nutshell this was a typical “chemo day” for me.

Go see my oncologist.

I didn’t always see him before treatment for an office visit, but every other treatment or so I had a short office visit with my doc.  Usually this was a feel-the-nodes session and a chance to whine incessantly about the side effect of the week to the architect of my misery.   If I recall, this was also my chance to beg the boss for no more Dacarbazine.  If your oncologist is anything like mine, good luck with that last one, by the way.  =)

Time for some blood.  Accessing the port or starting an IV.

Throughly disappointed that I would indeed be getting Dacarbazine, again, I would then go get my port accessed and hooked up.  Access is a nice word for “stab” — if you want to know more about ports check out my port post over in the side bar.    If you decided to go without a port, they will start a peripheral line in your arm, hand, wherever they can located a good vein. They will also draw some blood (through the IV or port) and check your counts. This is the threshold that determines whether you can get chemo; too low of counts, and they can’t treat you.  Low counts aren’t real likely during your very first chemo, but they could be later on.  They will look at:

• Your RBCs, to check for anemia, including your hemoglobin. If you are low, your doctor MAY withhold treatment, mine never did and I was extremely anemic in the beginning.
• Your platelets.  These make your blood clot. I had some trouble with low platelets from time to time if I recall, but my oncologist always went forward with treatment anyway.
• Your WBCs. They will especially focus most not on the total but on something called your ANC. What is an ANC?  You don’t really need to know, but if you’re curious ANC refers to the percentage of neutrophils (white blood cells that fight infection) and cells that will become neutrophils multiplied by the white blood count (WBC). It breaks down as follows:
  • ANC below 2000 is considered to be neutropenia
  • ANC between 1000-1500 fairly low risk of infection. Chemotherapy will usually be given in this range, but not below it.
  • ANC between 500-1000 – moderate risk of infection
  • ANC below 500 – severe neutropenia – high risk of infection
• They will also do a basic check of your electrolytes and kidney and liver functions before they decide to go forward with treatment.  You know, just to make sure there’s nothing wrong.

Getting your counts depends on the speed of the lab; in general, I would have mine in fifteen or twenty minutes.

(If your counts are too low, you’ll likely just go home and your oncologist will either wait for your counts to come up or he/she will start treating you with WBC boosters such as Neulasta. I never had a chemo delayed.  My oncologist gave Neulasta whether I needed it or not because he wanted to stay on the plan.)

They get your weight, bp, etc. and the oncologist writes the order, and the pharmacy makes it up.

They will do a basic vital check — blood pressure, pulse, and weight. There is a formula based on weight and height used to calculate your chemo dosage exactly — my oncologist weighed me each time and calculated the dose from there. The pharmacy then custom mixes your chemotherapy drugs. It used to take about 30 to 45 minutes to fill the order.

The Pre-Meds and Fluids.

Once your “premeds” are ready, you can go get hooked up to an IV pole.  IV poles exist to annoy you.  I know; I dragged one around for three days for my first ABVD session because I was treated in the hospital and my oncologist was worried about tumor lysis so I had to get round the clock fluids.  Luckily you’ll only be hooked up for about three hours.

Because ABVD commonly causes nausea and vomiting, most doctors will pretreat you for nausea and vomiting.  I got Zofran, Aloxi, and Decadron as my pre-chemo anti-nausea drugs.  Other drugs can include Antzamet, Kytril, and Emend.  I used to take Emend (a pill), then get IV Zofran and Aloxi, then start taking Ativan, Compazine, Kytril …. I had a huge arsenal of literally thousands of dollars worth of anti-nausea drugs at my disposal.

Just as an aside, I want to point out that because I suffer from GERD (acid reflux) that I had a lot more nausea than most people.  Chances are you will do way better than me as far as nausea goes.

It usually takes about thirty minutes to get these pre-meds.  They shouldn’t make you feel anything.  Mine never had any taste or anything.

Time for the actual chemo.  Leading off the Red Devil – Adriamycin

As I mentioned before, ABVD stands for the name of four drugs — Adriamycin, Bleomycin, Vinblastine, and Dacarbazine.  They are almost always given in that order.

The red drug, Adriamycin, is usually given first. It comes out in a large syringe (I used to call it a turkey baster). To prevent mouth sores, you can suck on ice or Popsicles while getting Adriamycin, or at least you could at my chemo center. The nurse will “push” Adriamycin — that means slowly inject it into your IV line. Warning that it is REALLY RED and it will usually turn your urine RED too, so don’t freak out when / if it happens.

Of the drugs, this one supposedly hits the Hodge the hardest. A lot of cancers get treated with Adriamycin, and it’s sometimes called “The Red Devil.”  Since so many cancers used Adriamycin, a lot is known about it.  Adriamycin will probably cause your hair loss and may affect your heart muscle, so your doc will monitor for those things.  These aren’t immediate effects, though.

Adriamycin has a taste, and if you happen to be one of the people who can taste it, you’ll quickly note that it’s a bad taste, so you may want to suck on hard candy in addition to the popsicle.  I used to gag over Adriamycin; I found sour flavored candies were the most helpful.  Of course, now I also hate sour-flavored candies because I associate them with chemo.  Oh well.

That’s another good point I want to bring up — do NOT eat your favorite foods on or around chemo day because you can start associating them with chemo.  Stick to bland stuff or stuff you won’t care if you never eat again.

Next up … Bleomycin

Bleomycin — which I always shorten to just “Bleo” — also comes out in a turkey baster (or syringe if you prefer to call it that), but the baster is much smaller than the Adriamycin. Bleo is pushed in slowly the same way as the Adriamycin.

Bleo is a clear, utterly harmless looking drug that’s known for causing pulmonary effects — again not immediately but down the line.  There really isn’t anything worth noting about it, other than the first time you get chemo, they will give you a test dose and wait to see if you have an allergic reaction.  I didn’t have any reaction.  In fact, reactions are EXTREMELY rare, so this is a better safe than sorry safeguard.  I wouldn’t freak out about it. That test dose does add some time to your first chemo that you won’t have at the later sessions, however.

Some people get fevers from Bleo; if this is you, you can try tylenol.  I didn’t have that problem.  Bleo just messed up my lungs … but that’s another story for another day.

Vinblastine

Vinblastine is basically identical in appearance and in method of administration to Bleo, except they don’t do a test dose and I think I recall the syringe was a touch smaller for the Vinblastine dose. Sometimes my chemo nurses did not push Vinblastine slowly, but instead gave it rapidly through the IV. It didn’t seem to matter either way.

Vinblastine doesn’t appear to have any taste and is clear.  Vinblastine’s main side effect is nerve damage.  This would show up somewhere down the line and wouldn’t be immediately apparent.

The Dastardly Dacarbazine

I absolutely hated Dacarbazine.  I decided it was the drug that made me the most miserable.  This is the last drug of the four and it’s given differently than the others.  The first three are “pushes” — Dacarbazine is a drip.

Dacarbazine is given at a specific rate of speed, over approximately an hour or so (assuming you have a port; if you don’t Dacarbazine may take a long time to get). The Dastardly D drug comes out in a brown bag usually to protect it from sunlight. This is the one that apparently is most likely to make you sick to your stomach.  Dacarbazine causes nausea and vomiting in about 90%+ of people treated with it who don’t recieve anti-emetics.  The use of anti-emetic drugs like I listed above makes Dacarbazine very tolerable and many Hodge patients don’t have ANY problems with nausea and vomiting.  Me, not so much.

That’s it.  You’re done!

Once you’ve gotten all your drugs, they will flush your port (if you have one), unhook you, and you’re usually good to go.

And that is pretty much all there is to it to ABVD chemo. It takes about 3 hours from start to finish.

Now let’s look at how you might feel after chemo.

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