Friday, December 1, 2006

Because of my large tumor burden, I'm at increased risk for tumor lysis syndrome, so I have to drive down to the hospital twice a week for blood testing. This stinks. It's devastating to my arm veins, it burns excessive fossil fuels, and it takes a three-hour chunk out of my days.

On the other hand, what the hell else would I be doing? I mean, other than sitting around the house watching House while knitting yet another colorful cozy for my refrigerator.

Besides, blood days at the hospital are pretty much the sum total of my pathetic social life these days. Since I go there so often, I've become extremely friendly with everybody who works up on the fifth floor. They all know me and stop to chat: the cleaning staff, the maintenance staff, the admissions staff, the orderlies, the phlebotomists, the other cancerites, and of course the chemo nurses. I'm so happy to see them all twice a week, I wave and shriek and carry on like a drunken debutante at a cotillion.

But today when I went in for my blood draw, I wasn't feeling so friendly. I couldn't figure out why. As soon as I walked into the hospital, I began to feel oddly woozy and queasy. At first I thought maybe it was because I'd been stuck in traffic behind a pickup with a bumper sticker that said, "I'd rather be hunting with Cheney than driving with Kennedy," enough to unsettle anybody's stomach. I scowled at the cleaning lady, grumbled at the receptionist, and refused to make eye contact with other patients. Not my usual chirpy supportive self.

Things perked up a bit when it was my turn to go into the tiny closet that serves as a blood drawing chamber. I like the phlebotomist a lot, mainly because she's so intrigued by my wig. She was tightening my tourniquet as we speculated over what kinds and amounts of product she would have to use to make her hair stick up in that wild and wacky way my wig does, when the door opened and one of the chemo nurses crowded in to use the fax machine. Because come on, where on earth would be the logical place to keep the fifth floor's fax machine if not in the teeny, tiny, blood-drawing closet?

This happened to be the same nurse who had administered my chemotherapy for the last two treatments. He's a really nice guy: friendly, smart, funny, experienced, and he has a great knack for being able to punch that big fat non-coring Huber needle straight into my port without any pain. Well, not much pain. I like him anyway.

The nurse recognized me and called out a cheerful hello. I recognized him and started to gag.

Ah hah. That explains so much. This phenomenon is called anticipatory nausea and vomiting, or ANV. It's a conditioned Pavlovian response that frequently occurs in patients after the first few courses of cancer treatment. Certain olfactory or visual cues associated with chemotherapy also become associated with the emetic (nausea-creating) effects of the drugs, so the next time they're encountered they trigger intense, debilitating waves of nausea and sometimes vomiting.

"Hi, Mike," I gulped. "I'm having that thing where I look at you and I get sick."

"Yeah, that's kind of been the story of my life with women," he sighed, politely pulling his sweatshirt up over his face so I couldn't see him.

The bad news is, ANV cannot be controlled by anti-emetic medication. The good news is, it has a very good chance of being alleviated by cannabinoids. The bad news -- yes, more bad news, always with the more bad news -- is that the fifth floor vending machines don't seem to carry brownies laced with THC.

Will my 12-year-old Iranian oncology resident write me a scrip? I'll be sure to ask him in clinic next week. Stay tuned.

Page 7: Updates from Cancerland: Alive for Christmas

To return to the beginning of Liz's blog, click here.

First published September 4, 2007
Copyright © 2007 Consumer Health Interactive

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