Getting ABVD is pretty simple -- really, a non-event for many people.  But I know you’re wondering … how do you feel after ABVD?

Keep in mind is that EVERYONE reacts a little bit differently to even the exact same chemo. So my experience is not going to be your experience. It’s very difficult to describe exactly how you feel on chemo.  I’m a lawyer, so I write descriptions and explanations of things for a living, and even I have trouble articulating what chemo was like.  It was sort of like a cross between having a stomach flu and just being completely out of it.  Like you're alive, but you don't care at the moment about anything. You just feel ... BLEH.

My experience was this:  I was treated on a Friday morning.  I would start feeling uneasy Thursday night.  (I started to dread chemo more and more by the end.) Friday morning I would start feeling sick AT the treatment center before anything even happened.  That's anticipatory nausea. I would get treated and feel almost immediately terrible -- nausea and a headache mainly.  Really, all I wanted to do was lay down.  It made no sense to sit up and try and distract myself.  I found the absolute best thing to do was go straight to bed and lay there and try to sleep.  I usually wasn’t nauseated as long as I was laying down. I never actually threw up, but I often felt nauseated for a few days, and I didn’t want to eat.  I would eat nothing at all on Fridays, then pick at my dinner Saturday and Sunday. By Monday, I would feel well enough to eat a normal amount and maybe go for a run.  By Wednesday I would be at 95% and would be pretty normal … until the cycle would begin again.

Most of the time during ABVD, I felt pretty good.  Really, I had about ten good days, one so-so day, and three really bad days every two weeks.  It seems from talking to other Hodge patients that most people don’t feel immediately sick like I did, but rather the side effects hit later, usually a day or two later. 

My first treatment basically established the pattern, and the rest were very similar in terms of side effects and when they occurred.  I didn’t find I felt “worse” as treatment went on, but I think that may be because I was sick to begin with. Some people do report fatigue increases as treatment goes on, which makes sense.

Anyway, I hope that gives you an overview of what to expect from ABVD and hopefully allays some of your fears.

If you ever have any questions, feel free to email me. Best of luck and hopefully someday YOU will be the one giving back by helping someone else. :)

13 miles today. And, my gosh ... 41 mile per hour gusts, sustained at 31 mph ... 17 degrees, felt like -4 ... half an inch of slippery snow ... I'm tired of building character! Gimme 50 degrees, no wind, some sunshine, and some nicely blooming wildflowers!

ABVD is almost always given as an out-patient regimen -- which means you don't need to be in the hospital. 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 …

All right ... So chemo day. What to expect. From start to finish, I would usually get there at about 8 to 8:30, and I would be back home by 11 to noon.

Meet with the boss.

I didn’t always see him before treatment for an office visit, but every other treatment or so, I would have a short office visit with my doc before going to chemo. This is your chance to talk to your oncologist about your side effects, for him to make any dose adjustments (hopefully not necessary), and for him just to check up on how your doing.

Getting hooked up.

The next step was to have my port accessed and hooked up.  Access, by the way, is just a nice word for “stab.”    If you decided to go without a port, they will start a peripheral IV line in your arm, hand, etc. -- wherever they can locate a good vein. They will draw some blood (through the IV or port) and check your blood 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 likely to effect your very first chemo session, but they could be an issue later on. 

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

Here's an insider's tip. If you are taking Emend as one of your anti-nausea drugs, wait to take the Emend pill until your counts come back from the lab and you know for sure that treatment is good to go for the day. Because Emend is so freaking expensive, you don't want to "waste" the pill if you don't end up getting treatment for whatever reason that day.

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 exact 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 get hooked up to an IV pole.  IV poles exist solely 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 doctor wanted me to have hydration the whole time. I tripped over said pole several times, I accidentally kicked it, by the end of the weekend I thoroughly hated it. I gave it a name even -- Ivan.  Luckily you’ll probably be treated as an out patient and you will only be hooked up to YOUR Ivan for about three hours.

OK ... back on topic. Premeds are basically your anti-emetics which is medical speak for your anti-nausea meds. I got Zofran, Aloxi, and Decadron (a steroid) 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 …. whatever I needed ... I had a huge arsenal of literally thousands of dollars worth of anti-nausea drugs at my disposal. I will talk a little more about anti-emetics in the next section, but for now, know your oncologist is very likely to give you anti-emetic drugs before you get chemo to hopefully prevent nausea.

It would usually take about thirty minutes to get these pre-meds.  They should not make you feel sick or anything. None of mine had a taste.

Bring Out the Cancer Killers!

Once you have gotten your pre-meds, the nurses can start the actual chemo that hopefully will annihilate each and every last Hodgkin's cell from your body. 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.

Adriamycin

The red drug, Adriamycin, is usually given first. It comes out in a large syringe (I used to call it a turkey baster). Adriamycin is also known as Doxorubicin. It is considered an "anthracycline antibiotic."

The nurse will “push” Adriamycin — that means slowly inject it into your IV line over a period of a few minutes. You probably will not feel anything, but you may taste the Adriamycin.

Adriamycin can cause mouth sores. To prevent mouth sores, you can suck on ice or Popsicles while getting Adriamycin. Your nurses may suggest this, or you can ask for ice before they give it. Adriamycin can also cause nausea and vomiting -- but your pre-meds should take care of it. Finally, Adriamycin also tends to cause hair loss. If you lose your hair, blame the Adriamycin.

You should be warned that Adriamycin is REALLY RED and it will usually turn your urine RED too, so don’t freak out when / if that happens. (The first time it happened I was like hmm, um, uh oh I sure hope I am not bleeding to death.)

Of the drugs, Adriamycin is the one supposedly hits the Hodge the hardest. A lot of cancers get treated with Adriamycin, and it’s frequently referred to as “The Red Devil.” 

Bleomycin — which I always would just shorten to “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 infamous for causing lung problems — again not immediately (as in two seconds after they inject it), but down the line a ways.  There really isn’t anything worth noting about Bleo, other than the first time you get chemo, they will usually 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 definitely wouldn’t freak out about the possibility. 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 if it's ok with your doctor.  I didn’t have that problem.  Bleo just messed up my lungs … but that’s another story for another day. You should be aware of Bleo's lung effects and report ANY shortness of breath or cough to your oncologist as soon as possible. If you do develop Bleo problems, they are usually treated with corticosteroids and discontinuation of the Bleo. Don't worry; studies have shown that they can safely discontinue Bleo after a couple cycles if necessary.

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 they gave it rapidly through the IV. It didn’t seem to matter either way.

Vinblastine doesn’t have any taste.  Vinblastine’s main side effect is nerve damage and constipation. On the latter point, I highly recommend eating a lot of fiber. I ate a lot of frosted mini wheats and that seemed to help. Many of the anti-emetic drugs, including Zofran, also tend to cause constipation as a side effect, so it's something you want to try and stay on top of.

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 comes out in a bag and is given as 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 longer time to get). The Dastardly D drug would come out in a brown bag to protect it from sunlight. Dacarbazine causes nausea and vomiting in about 90%+ of people treated with it who don’t receive 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. I hated Dacarbazine and have trouble thinking about it even now ...

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.

Conclusion:  What to Expect After Chemo.