I go up to the 4th floor and into a room full of lazy-boys on wheels. There are windows on 3 sides and it is well lit and not too crowded. I take my seat. A nurse comes over to put in an IV, fortunately it goes in on the first try. The first 1L bag of fluid to be administered is connected to the pump. It is just saline, intended to hydrate me to avoid hazardous side effects from the first chemotherapy drug, cisplatin. It will be pumped into me over 1 hour. There are 3 chemotherapy drugs today. How long will I be here?
Cisplatin is in a 750mL bag administered over 1hr. Etoposide is in a 750mL bag administered over 1hr. Finally Bleomycin is in a small bag that is administered over 15 minutes. Bleomycin is described as being toxic to the lungs. Lance Armstrong opted for alternative treatments to limit the effect on his career as a professional cyclist. Before starting treatment, I have done a lung function test to define my baseline numbers if anything were to happen.
Chemotherapy drugs kill cancer by limiting cell division in the body. This prevents cancer cells from dividing rapidly, but there is collateral damage inside the body. Division of white and red blood cells and skin cells in the body is also affected by chemotherapy drugs. This is the reason for side effects such as fatigue (from lack of red blood cells to transfer oxygen through the body), being immunocompromised (from lack of white blood cells) susceptible to infections (like COVID), and cuts that heal slowly outside and inside of the body.
4 hours later, I get back to my bike to ride home. My body feels swollen from having taken on 3L of fluid, so much that my knees hurt when I crouch down to unlock my bike. The first day, I go for a fatbike ride in the evening on the flatter Oleskiw trails. Mostly I feel bloated from the fluids. So far, side effects are excessive hiccups that keep me up at night (fortunately I can watch the Olympics on TV), the odd headache and that the couch starts to feel like it has a gravitational pull.
The first weekend, my taste buds are shot. A carrot becomes inedible. After that, just try to eat pizza and pasta, foods I enjoy. I eat waffles every morning as they are softer on the gums. I call it "living my best life" so that I don't lose weight because of a poor appetite. Fortunately, my taste comes back after a day.
One cycle for me was 3 days in a row of cisplatin and etoposide with bleomycin on the first day of those 3. Then bleomycin on 1 day of each of the next two weeks. Some blood tests to make sure that the kidneys are still functioning and blood cells are at reasonable levels then the next cycle begins. I did 3 cycles total over 9 weeks.
In each cycle, the 3 days in a row hit hardest, but the effect is delayed until the weekend and early the next week. For instance, the Tuesday following always brought a headache and nausea, relegating me to the couch for the day. In the following weeks with just the bleomycin infusions, I start to feel better, but then the next cycle begins.
The message throughout the treatments is to try to continue my normal levels of activity. Well, I know better than that and definitely dial it back, limiting things to 1.5 hours if I am having a particularly good day. The weekend before the beginning of the 2nd cycle, I do a 3 day stage race on Zwift. I am curious how much fitness I have lost. The first day, I start at about 95% of my pre-chemotherapy numbers, but blow up and finish at an average of about 85%. It doesn't seem like much, but it is striking how much just 1 cycle has taken out of me. The next day, I smarten up and try to pace at 85%. I'm at the back of the pack, and I see someone using the sticky-watts (exploiting the game by surging for 2-5 seconds, then easing off) cheat pass me. How pathetic. I finish the 3 days, but decide that it's not worth pushing myself for such meagre numbers.
I start to lose my hair just before the start of the 2nd cycle. The hair on the side of my head is starting to fall out, there is hair all over my pillow and my toques, so I shave the rest of my hair off. Other parts of my body and my finger nails are becoming extra sensitive.
I arrive the morning of the next cycle and there has been a bit of a mix up. After my initial weigh in, someone along the way interpreted my weight as being 90-something kg instead of 70-something kg. That means that during the first cycle I was given a much higher dosage of chemotherapy than proposed. There is a bit of a delay as they have to mix new bags at the lower dosage but I am glad that error has been caught!
After the first treatments of the 2nd cycle, I discover that the gravitational pull of the couch isn't because it has suddenly gained a large amount of mass. It is the nausea. It's not like the nausea you get when you've had a few too many beers. It feels different, but it has the same effect: it makes you want to lie down. I have been provided with prescription anti-nausea medications, but they only work so well.
I start to notice the effects of having less red blood cells. I get head rushes if I get up too quickly. My heart rate races even if I go up a flight of stairs. The stairs on my bike ride to the CCI is starting to require more from me. One day it snowed and it was a really difficult ride to get to the CCI. On the way back, the final hill out of McKinnon ravine up to 142 street always required some strategy to be able to make it up: resting on the flat section.
I didn't mind sitting on my indoor bike and grinding it out at 35-45%. Besides the Tour of Watopia group rides were going on. But I found that if I exerted myself too hard or for too long, I would get a bit of a sore throat. Nothing that couldn't be soothed with some tea, but I was always worried that that would be the precursor to something more serious.
In February and March 2022, we are still in the midst of a pandemic. Being immunocompromised from the chemotherapy makes me exceptionally vulnerable to Covid. So I've had my partner do all of the grocery shopping and I didn't go to any indoor public spaces aside from the CCI, where I've been wearing an N95 mask.
Think about the political background at the time. February was marked by anti-mask and anti-vax, and anti-whatever (progress) occupation of Ottawa and blockades of border crossings. Basically selfish people who were fed up with having to do the bare minimum required to participate in a civilized society. I felt like I didn't have a choice about whether to put toxic chemicals inside my body and get several needles a week and these people were scared of a little vaccine. The government caved and mask mandates lifted. There goes another level of protection.
Near the end of the 3rd cycle, with one last treatment to go, I didn't have to leave the house all weekend. My parents dropped off some food, I was happy to spin for 1.5hours at a time on Zwift. My partner had gone away for the weekend to go skiing, only stopping for gas and a short grocery shop. The Tuesday after she got back, I woke up with a bit of a sore throat...and a fever.