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If you can fill the unforgiving minute ... with sixty seconds’ worth of distance run ... Yours is the Earth and everything that’s in it.
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Monthly Archives: February 2008
One hundred signs that you may be a runner.
You start carrying your running shoes and clothes everywhere, you know, just in case.
When people ask what you do, you don’t mention your job or profession, you say “I run.”
You can eat at least pound of spaghetti at a sitting.
People don’t want to be around you if you’re injured because you’re not running and if you’re not running, you’re not pleasant to be around.
You know what GU is, you like to talk about your PRs, and your major goal in life is to BQ.
Even though you’re not a doctor, you can talk at length about VO2Max, oxygen transport, glycogen, and assorted other physiological terms.
You’ve considered taking a course in chemistry or biochemistry to learn more about how the body metabolizes things.
You know what a snot rocket is.
You’ve developed an excellent snot rocket technique.
You say fartlek — and don’t giggle.
All your shirts have a list of sponsors on the back.
Your idea of a good day is getting up before the rooster and running 10 miles.
You start to say things like “I’m ONLY running 8 miles today.”
People begin referring to you as the human garbage disposal.
Even your dog avoids you because even he doesn’t want to run that much.
You have a sports medicine doctor on speed dial.
People begin to tell you “I don’t even like to drive that far” when you tell them your weekly mileage.
You own so many race shirts, you can’t even close your dresser drawers.
You’ve had virtually every common running injury.
The trunk of your car is filled with running shoes and gear.
At least one of your toenails is black.
At least one of your toenails has fallen off.
Your podiatrist recoiled in horror at the sight of your feet.
You know what plantar fascitis is and you can pronounce it correctly.
You have to buy new shoes every month or two because you burn through them so fast.
You’ve worn out a treadmill motor (or two).
You’ve run so much on the gym’s treadmill, you are burning a hole in the belt.
You’ve run for two hours or more on a treadmill.
You wear your running watch, even with dress clothes.
You don’t think that a guy putting band aids on his nipples is strange in the least.
You watch how people walk and have to stifle the urge to tell them they are an overpronator and need stability shoes.
When you drive down a road you think this would be a great place to go for a run.
People assume your water bottle is an extension of your body because you have it everywhere, even when fine dining.
Although you can’t walk properly, you’re still going to “try” and run.
You’ve had to walk down steps backwards because you’re so sore.
You’ve done a double digit “recovery run.”
Even though you couldn’t do math well in school, you have an uncanny ability to calculate mile splits in your head.
You find yourself daydreaming about your run.
People don’t dare ask you about your running because they know you won’t shut up if they get you started.
When you go to a new city on a business trip, you find out where your hotel is beforehand and start planning out where you’re going to go for your run.
If a study came out tomorrow that said running is bad for your health, you’d be out running anyway.
You write stories about running.
You keep a running log.
You eat and drink double what everyone else does — and yet you are always the thinnest or fittest looking person in the group anyway.
You have every run you’ve ever done logged in detail since you began running.
When people don’t even bother to ask if you’re going to go running on major holidays — they know you are.
When you travel, you have to take an extra bag for your running gear.
Your MP3 player is filled with running music exclusively.
You’ve run around the block a few extra times, just to meet some arbitrary mileage goal.
You wear shorts even when it’s below freezing.
When you travel, you wear your running shoes, just to make sure they don’t get lost.
You avidly watch weather.com and the Weather Channel.
You’ve seen a major thunderstorm coming, and calculated precisely how many miles you can get in before it hits.
You’ve found yourself ten miles away from your car, in the woods, in the middle of nowhere and you were happy about it.
You have trouble remembering co-workers names, but you can recall precisely the time you ran five years ago in an unimportant race.
You can’t throw out old running shoes because there are “too many memories” attached to them.
You find the first and last things you think about is your run.
Although you know nothing about the metric system, you know exactly how far to the tenth of mile a 5K and 10K are.
Your resting heart rate is so low, nurses say regularly “Oh you must be a runner” without you even saying anything.
More than half your paycheck seems to be going towards running related expenses.
You flip through your medical chart, and find your doctor regularly comments on how much you run.
You’ve planned a vacation around a race.
You own trail shoes, road shoes, lightweight shoes for racing …
You buy Gatorade by the case.
You’ve run through a blizzard, because you didn’t want to miss a day.
You’ve run in a monsoon because you didn’t want to miss a day.
You’ve run when the heat index is over 110 because you didn’t want to miss a day.
Your neighbors all refer to you as “that crazy runner.”
You run five miles, as a “warm up.”
You see a runner while out driving on a cold and rainy night, and still say “damn, I wish that was me.”
You go to races for a chance to meet the opposite sex, since at least you’ll have running in common.
Finding someone of the opposite sex willing to talk to you at a race, you find yourself discussing snot rocket techniques.
You’ve said “I’m going out for an easy 10.”
You’ve said “20 miles” and “easy” in the same sentence.
You think golf courses are a great place — for running hills.
You spend a lot of hours on running message boards, just to be around other runners, since no one else “understands you.”
When you change your running route, the people who lived along your old route notice and miss you.
You try and convert everyone you know into a runner.
You’ve been told by a doctor that he isn’t going to bother telling you not to run, because he knows you’ll just do it anyway.
You have shelves full of “hardware” and medals.
You consider 6 AM to be “sleeping in.”
You consider a bad run better than no run at all.
You like to eat salt.
You’ve run on every road within a twenty mile radius of your house.
You think meeting a living running legend like Bill Rodgers would be “way cooler” than meeting, oh say, the Queen of England or the President.
You know to the nearest second what your steady state, recovery, long, and tempo run paces should be.
When you get a new race time, you rush to enter it into a pace calculator to see what your new paces would be.
You know the location of all public restrooms and water fountains within a twenty mile radius of your house.
You’ve skipped work at least once to go for a run.
You’ve gone to court in running shoes because you forgot your dress shoes.
You double knot even your Oxford shoes.
You’ve run at 3:30 in the morning.
The salespeople are the local running store know you by name and know exactly what shoe you take.
You’ve tested the casual dress policy at work by wearing a running shirt.
You try and convince people to do a 5K, as it’s “only 3 miles.”
You think maybe Phidippides fate wasn’t such a bad way to go.
You don’t think -20 is too cold for running.
You don’t think 105 in the shade is too hot for running.
You take an especial pride in the fact that running is used as punishment in all other sports.
You laughed and related to most of the above comments.
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.
Dealing with Nausea - The Different Kinds of Anti-Emetic Drugs
Most people don't have a lot of nausea from ABVD, but some of us do. This section is for you. Anti-emetic drugs come in different classes based on how they work. If one drug doesn't work for you, don't give up, keep trying to find a drug that does work. These are the anti-nausea drugs specifically designed to treat nausea in chemotherapy:
Neurokin receptor antagonists are the newest class and they work by blocking the action of neurokinin, a natural substance in the brain that causes nausea and vomiting.
These include: Emend (aprepitant).
5-HT3 antagonists work by blocking serotonin, a natural substance in the body that causes nausea and vomiting. Their action is enhanced when taken in conjunction with a steroid.
These include: Kytril (Granisetron); Zofran (Ondansetron); Anzamet (Dolasetron); Aloxi (Palonosetron).
Cannabinoids work by affecting the area of the brain that controls nausea, vomiting, and appetite.. These include Marinol (Dronabinol).
Then there are other classes of drugs that were designed for other purposes, but are also useful for treating nausea.
Dopamine antagonists work by decreasing abnormal excitement in the brain, including in the vomiting center. These include Compazine (Prochlorperazine) and Reglan (Metoclopramide). Compazine tends to work better on chemo-induced nausea and vomiting because it suppresses activity in the brain, whereas Reglan works mostly on the GI tract as a pro-kinetic (speeds emptying of the stomach). For some people, this class of drugs can cause significant side effects.
Antihistamines (H1 histamine receptor antagonists) block allergy effects, are sedative, and help suppress the vomiting center of the brain. These include Phenergan (Promethazine). Phenergan is useful if you want to sleep. It is VERY sedating.
Benzodiazepines are anti-anxiety meds. These include Ativan (Lorazepam). They are weak anti-emetics, but their anti-anxiety effect is very useful for anticipatory nausea and vomiting. They have sedation as a side effect, though they aren't as strong as Phenergan.
Corticosteroids. These would include Decadron (Dexamethsone). They seem to work by 1) enhancing the effect of the 5-HT3 antagonists, 2) by reducing inflammation, and 3) helping increase appetite.
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.
Not all Hodgkin's patients lose their hair, but most do. My hair only thinned. Hair loss does not correlate with chemo effectiveness. If you lose your hair, it will most likely begin to fall out after the 2nd cycle or so. You may lose all of your hair from all over you body, or only some of your hair from some parts of your body. It really varies a lot from person to person.
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.
Drink plenty of water and other fluids. Try to stay well hydrated to flush out the chemo and toxins as much as possible.
Up your fiber intake. Vinblastine can cause severe constipation.
Be on the look out for shortness of breath. Bleomycin can cause lung problems. If you develop a dry cough or shortness of breath, make sure you let your oncologist know right away.
Be very careful of favorite foods. You can begin to associate foods, smells, even things like music with chemo. You do not need to stop eating your favorite things for 6 months, but be VERY careful of the things you eat at chemo or on chemo day. People don’t believe me when I tell them this and then they come back and say geez Jenny I wish I had listened to you. You WILL associate foods and drinks and tastes and smells with chemo. I can't even look at a can of ginger ale without feeling queasy and it's been four years.
Sweats are not uncommon during ABVD. Not really sure what causes them, but both men and women report them. They do not mean your disease is coming back, but I'd let your oncologist know. I got sweats from time to time during ABVD.
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 …
What should I bring to chemo?
Well, you should definitely bring yourself. Just kidding. Treatment rooms vary widely I imagine, but you could definitely bring an ipod, maybe your laptop (some places may have wireless), DVDs, etc. You probably will be in a fairly large room with other people, so of course you do want to be polite (i.e. bring your headphones if you want to listen to music). How about bringing someone with you to chemo? Up to you. I think it’s helpful to have someone at least come pick you up and drop you off since the drugs may hit you quickly or they may give you Ativan or something like that for anxiety, but other than that, it’s really up to you. If it makes you feel better, definitely bring a friend or family member. Just warn them that it will be a boring few hours.
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.
Understanding your counts.
Your doctor is checking the following counts:
- Your Reds (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 Whites (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. But it depends on your doc.
- 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.
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.
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 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.