One More Baby Step

Had my appointment with Dr. Nakka my oncologist yesterday, so now I'm ready to start getting treated for MCC – What’s that?  -- I need another operation?  --  Woo hoo!  That’s great!  I may sleep through this thing yet! 

Dr. Nakka says it’s best if I get a “port” put in (installed?) to facilitate the chemo treatments.   I’m not wild about going through the whole surgery routine again but even though I’m blessed with good veins that are easy to stick (the phlebotomists rave about them!), a port has its advantages.  The chemicals used for chemotherapy are caustic and can damage blood vessels making the vein used during a chemo cycle a one-time use vein; sooner or later you’ll run out of veins.  If for some reason the vein blows up during infusion, those same caustic chemicals will leak into or “infiltrate” the surrounding tissue* which will destroy the tissue and cause complications and pain when you’ve already got enough to worry about.

So it’s off to the surgeon I go to get what amounts to a stoppered drinking straw implanted in my chest.  It’s an outpatient procedure and I don’t think I’ll be put all the way asleep.  They’ll probably just drug me happy unless I start making undue complaints during the procedure (which has happened before).

A port (also called “portacath”) is a device that is implanted under the skin, usually just below the clavicle.  It’s basically a catheter (the drinking straw) and a septum (the stopper) that allows blood to be drawn and medicine to be administered without having to hunt around for suitable veins.  When installed, the catheter is inserted into the surgeon’s major vein of choice and the septum is routed to a spot on the chest under the skin.  That means that once the incision heals, you’re water tight and there’s much less chance for infection, and, except for those who have access to your bare chest, it’s not noticeable to the outside world.  The septum is a bulb of special self-sealing silicon** that can withstand hundreds of punctures, allowing the medical staff access to a guaranteed viable site.

When it’s time for a blood draw, the site is treated just like any other needle stick site except that it’s flushed with saline or an anticoagulant afterward to prevent blood clots from forming in the catheter.  For injections or long term infusions, it’s just like any other intravenous access – stick the needle in and drip, drip, drip.  There’s still a needle going through your skin, but after that it’s just like any other intravenous procedure and probably more durable too.

Dr. Nakka also said that depending on how well I tolerate this round of chemo and radiation (six weeks of each, concurrently), she may follow up with three more chemo sessions (without radiation) three weeks apart.  The second round will consist of the same drug used during this round, carboplatin, along with another drug, Etoposide.  She said that it's part of a trial which made me feel good -- no matter what happens to me, at least someone will be able to learn something from my adventures.

As usual, Leslye and I will wait for the surgery center to call and tell us where and when to show up. 

*  For  bonus points, say “cause extravasation of the chemicals into the tissue. ”

** Wasn’t that sibilant?  Alliteration is fun!