Hiccups, Bumps and Bruises

“We have some unexpected developments, huh? You doing okay?” he asked.

I instinctively smiled; it’s not hard to smile at my straight-shooting, young doctor with a sparkle of the boy still left in him. In any other career he probably would not have already lost so much of that fun-loving nature, but I am sure that being a cancer doctor takes a toll and matures a man beyond his years.

It was unusual for Dr. Pavelka, my remarkable gynecological oncologist, to be in the cancer treatment area Thursday, August 24. I don’t think he popped in on “our” side of things just to see me, but he did have reason to stop and reassure me. I greeted him, hoping to get some answers from him. Like most doctors who specialize in certain cancers, I imagine he has way more patients than he should or wants. That alone accounts for him having two wonderful nurse practioners who help handle his appointments. I don’t get to see him for all of my doctors’ appointments, which happen on the first of three cycles in each round of chemo. I see him about every third one of those. (That means six scheduled doctors’ appointments, but only two or three with him. They do work well as a team- the whole place does.)

“We have hiccups,” I replied, with a smile. 

His eyebrow danced up. “Hiccups, too?”

“No, silly. Not literally.” I nodded to my right leg which was propped up in the chemo treatment chair.

Dr. Pavelka chuckled and then turned serious. “Don’t worry about this. These things happen with chemo patients. We’ve got a plan and the nurse is talking with your insurance right now. It’s all just a bump in the road.”

The main wall of the vascular area of St. Elizabeth. Something to think about...

On that Monday I had noticed a tightness in my left leg that resembled the after effects of the charlie horses I used to get. I didn’t remember getting one, but I thought maybe a cramp just had to work itself out. On Thursday it was still around and I mentioned it to my chemotherapy nurse. She said she didn’t think it was a cramp, but that she would bring it to the attention of my doctor. She reported back that my doctor had ordered a sonogram of my leg to rule out a blood clot. A visit with one of the nurse practioners calmed my nerves and I was taken to the vascular area of the hospital. The sonographer explained things to me as she took sonograms of both of my legs from the ankle to groin. She wouldn’t tell me what she saw, but she did tell my nurse who wheeled me back to the cancer care center for my scheduled chemotherapy.

The word was that two blood clots had developed in my right leg, one in my calf (where had I felt the tightness) and behind my knee. Back at the cancer care center, my dear friend Amy was sitting in my chair visiting with my dad. She had come to experience my chemo treatment with me and support me. Her presence gave me more peace. After a hug, I took back my chair, and the nurses resumed my chemo routine. I was surprised by this, but glad we were going ahead with the long day. Visiting with Amy kept my mind off things and I'm glad we could bond over this. I had thought I would be leaving by 2pm and Amy would take me home, but all these developments meant it would be more like 4pm. Amy stayed as long as she could and Dad would see that I got home. I was assured that Dr. Pavelka had a plan to address the clots and the nurse was already coordinating with my pharmacy and insurance the best course of action. I took the fact they were going to proceed with my chemo treatment to mean that things were going to be okay. 

The support and love of friends like Amy mean so much!

That’s when Dr. Pavelka. came in. It turns out that it was more difficult to get my insurance to cover the life-saving treatment than to diagnosis and prescribe the treatment. Finally all parties agreed upon a blood thinning regime of subcutaneous injections twice daily for six months. Seems like a long time to me, but it’s what needs to be done. So for the next six months I am injecting a blood thinner in the fatty area of my stomach (that’s about anywhere on my stomach) twice a day. I get a reminder on my phone at 7:00 am and 7:00 pm to the tune of “Ode to Joy.” Good thing bikini season is over; I’m covered in tiny bruises in various states of healing and will be for awhile. 

Two weeks later Dr. Pavelka and I were discussing bumps in the road again during a scheduled visit with him before the start of my second last round of treatment. (I receive weekly treatment every Thursday. Six rounds with three treatments each. I am about to begin round five.) I had visited the cancer care center briefly the day before for my blood draw. Evidently two of my counts were low, my white cell count and hemoglobin. I had noticed that things were trending that way, so I wasn’t completely surprised by this news.

Dr. Pavelka wasn’t surprised either. He says that the effect of chemo is cumulative and that I should expect it to be harder now than in the beginning. I had noticed that I was getting more lethargic and my resting pulse was higher. He says that both are directly tied to these lower counts brought on by my chemo therapy. His treatment plan was to postpone the start of round five one week to give my bone morrow a chance to recover and to put me on an iron supplement.

Despite the blood clots and the lower counts I am doing well. I get very tired quickly, but I donn't experience the sickness we imagine with chemotherapy. I am taking anti-nausea medicines that really work. Still I don't like these hiccups and bumps. Dr. Pavelka admonished me, “You can’t expect everything to go smoothly all the time.” 

Yes, I can, and I do. But I am learning to nod my head and be flexible. I’m adjusting my brain around these developments. I’m disappointed that I’ll have to postpone some vacation plans Dan and I had discussed. I’m trying to be kind to myself, but not be lazy. I’m working part-time (24-30 hours a week), working on some creative projects when my brain is working, and trying to be more helpful around the house. I am still largely staying with Mom and Dad, for which I am greatly thankful. They are a great reason for my peace of mind, and the fact that I get fed and have clean clothes to wear.

“These are just bumps in the road. We are on the right course,” assures Dr. Pavelka.