Mets Day 530: ddMVAC Chemo Day 1

The day started at 5:30 am, when I got up to take my son to his 6 am religion class – something that most Mormon high school kids choose to do each school day.  Jennifer and I take turns driving him to the church for his class.  Back when I was working, I’d frequently continue on into the office.  Today I came back home and crawled back into bed with my snoozing wife. 

We left for GW at 7:40, and I was reminded at how little I missed my morning commute.  Jennifer dropped me off at GW’s Cancer Clinic at 8:30 am, then went to run some errands and to attend a parent-teacher conference.  We knew this would be a long day, and I had urged her to not sit by my side and watch the IV drip for 8 or 9 hours. 

I met with Dr. Aragon-Ching first.  She was pleased that Monday’s CT scan was negative, and we could proceed with the chemo.  I asked her about why she had decided to do all the infusions in one day.  She said that she had been consulting with Dr. Apolo, who thought that I would be fine with receiving all four drugs in one day, especially since I had strong kidney functions.  After reviewing my lab reports and history, Dr. Aragon-Ching decided that the original plan – three bags of hydration and the Methotrexate today, and then come back for three more bags of fluid and the Velban, Adriamycin, and Cisplatin tomorrow – was more hassle than it was worth, and that I'd be fine with getting everything in a single day.  I'll get the Neulasta booster shot tomorrow.  I’ll  come back next week for a blood draw and to check my counts.  She also said that it was important that I continue to keep hydrated, even if I lost my appetite, because dehydration was the greatest risk of this chemo cycle.  We talked about the other likely side effects – nausea, constipation, peripheral neuropathy, hair loss, and how to deal with them.  She also noted that the doxorubicin (the generic name for the “A” drug, Adriamycin), would turn my urine red, as if it were bloody, and said that was normal while it passed through my system.  It might also might turn my fingernails darker, so it will be easier for me to go goth.  She said she’d give me lots of anti-emetics before I got the MVAC drugs, and also write scripts for them in pill form that I should take as needed.  She said that taking ginger probably wasn’t necessary with all the other anti-emetics I would have, but there wasn’t any harm in it. 

Onto the chemo infusion room, the same place that I had last year’s GemCis regimen.  The same staff was there, including Meg, a great nurse who remembered me from last year.  She accessed my port and started me on a bag of saline.  She said I’d probably get between 2.5 and 3 bags of fluid today.  My infusion rate is 500 ml per hour, so that means I’ll be connected to the IV for about 6 hours. 

Meg gave me printouts on all of the drugs that I’ll be getting, and the financial counselor gave me the cost sheet for everything.  Here’s what’s on the menu for today:

Three anti-emetics, to help control for nausea and keep my GI system going:  10 mg of dexamethasone ($1.10), 250 mcg of palonosetron ($207), and 150 mg of Emend (fosaprepitant) ($309).

The MVAC regimen: 100 mg of Methotrexate ($6.50), 6 mg of Velban (vinblastine sulfate) ($8.50), 60 mg of Adriamycin (doxorubicin) ($55.00), and 120 mg of Cisplatin ($112.00).

Each Neulasta growth hormone shot (6 mg of pegfilgrastim) costs $3083.83.  That’s not a typo.  After my infusion started, I spoke with OptumRx, the drug provider for my insurance, which confirmed that it could overnight the Neulasta drug to my home, where I could inject myself, or have Jennifer or Chelsea do it. I confirmed that Dr. Aragon-Ching was ok with my not coming in tomorrow and having the Neulasta shot at home, and confirmed the shipment with OptiumRx.  My copay was $60.   

According to the GW cost sheet, there are additional costs for the doctors, nurses, lab tests, the facility, etc., that runs around $850 per round.  Including the Neulasta, the total cost for each round of treatment is $4572.02, and the total cost for all six rounds is $27,432.12.  If I back out the Neulasta, the cost per each chemo round is $1488.18, and total cost for all six rounds is $8929.09.  My insurance covers 90% until I have paid $1500 in out-of pocket costs for the year, which I think I’ve already met, or am close to meeting.  Thereafter, it covers 100%. 

Unlike my first round of GemCis last year, there are no fire alarms, just the growling of the infusion pump and chatter of patients and nurses.  Two chairs away from my, another patient is loudly talking about the exploits of his father during World War II.  Fortunately for me, he’s facing the other way and directing his monologue to the poor guy his other side, who is tethered to an IV and can’t get away.  I studiously avoid eye contact with Mr. Family History, who occasionally glanced my way in hopeful search of a larger audience.  I put in my earbuds, closed my eyes, and cranked up Adele who could have been talking about my chemotherapy: There's a fire starting in my heart, reaching a fevered pitch and it's bringing me out the dark. 

By 3 pm, my butt was getting tired of sitting in one place for so long.  I switched over to Pink Floyd's Dark Side of the Moon, and Time started just as I am typing this:  Ticking away, the moments that make up a dull day . . . you're older, shorter of breath, and one day closer to death.  Not all prophets are religious. 

My friend Cynthia joined me at about 4 pm, and we sat together while the last drops of Cisplatin and saline entered my body.  By 5 pm I was done.  I'd had over three liters of fluid pushed through my port, and had drunk two more liters of PowerAide.  I made appointments for lab tests next Wednesday, and for my second round on October 9.  I picked up my new anti-emetics pills and headed home.  By the time I arrived, I was beginning to feel nauseated, so I began taking my pills and sitting very still.  It feels like I've got cellular seasickness:  every cell was slowly twisting and writhing.  I found that holding my granddaughter on my chest helped soothe the swaying feeling.