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What is the procedure of chemotherapy?

It is very helpful to review information and know your resources before treatment starts. Materials to review may include: options for clinical trials, informed consents, drug information sheets, nutrition information and much more. While it is great to have so many resources available, we understand that it may seem overwhelming. Many people feel that choosing a caregiver who can partner with you as a support person and information gatherer is useful. It is also helpful to think about your questions and write them down before your visit with your oncology team.During your treatment when you visits hospital :In the infusion areas you will they have recliner chairs, beds and stretchers.The beds and stretchers are given based on the medical needs of thepatient or the type of treatment.You will need to wear a wristband during the time you’re in the infusion area. Patient identification is a top priority for safety. Throughout your visit, you will be asked to say your full name and birthdate many times. The infusion staff will compare this to your wristband, medical orders and medication(s).The method of administration of chemo treatments along with the dose is determined by rigorous testing called clinical trials, which are done prior to the specific chemo drug being available for commercial use with patients. During this testing process, scientists and doctors determine how specific chemo drugs are absorbed in the body and how they work. Sometimes stomach juices can destroy different chemicals, making some medications impossible to give as a pill. Other substances are found to have better anti-cancer action if given intravenously (needle in the vein). Some medications can be given as an injection into the muscle and still others are absorbed when given directly into the bladder or the abdominal cavity.Oral Chemotherapy Medications (Taken by Mouth)Oral chemotherapy medications - those that can be swallowed - come in a variety of oral forms (pills, tablets, capsules, liquid), all of which can be absorbed by the stomach or under the tongue.Oral chemo medications that are swallowed are encased in a protective coating that is broken down by the digestive juices in the stomach. The stomach acids dissolve the coating releasing the medication, which is then absorbed through the lining of the stomach.Some therapy medications can be encased in different protective coatings which are released at different times in the system allowing for a time delay, called an extended release. This method allows longer periods of time between doses.Sub-lingual chemo medications are adsorbed under the tongue are referred to as sub-lingual. These medications are placed under the tongue where they dissolve and quickly absorb into the circulation of the body. This is a rapid way to have medication introduced into the body. Anti-nausea medications are particularly effective when given in this manner, as they will not be lost if the patient vomits.Why can't all medications come in oral form? Some medications cannot be given orally because the stomach acids destroy them. Other medications cannot absorbed into the patient's body through the lining of the stomach or intestines. If the drug cannot be absorbed it is passed through the stool or urine and is ineffective. Other medications may be too harsh and could cause damage to the stomach lining.Some chemotherapy can be given by multiple methods such as oral or intravenous depending on the strength, convenience, and regimen that has been prescribed.Subcutaneous Injection of Chemotherapy TreatmentsSubcutaneous injections (sub-q) involve the use of a short needle such as those used by diabetics for the injection of insulin.With subcutaneous injection of chemo treatment, the needle goes into the space between the skin and muscle but does not enter as far the muscle layer.Subcutaneous chemo injections are commonly used for some types of biologic response modifiers and chemotherapy support drugs.If a patient's platelet count is low subcutaneous injections are less likely to cause bleeding than intra- muscular injections.Intra-Muscular Chemotherapy InjectionsIntra-muscular injections are given through the skin into the muscle layer. This involves the use of a larger needle with deeper penetration than the subcutaneous injection. The medication is deposited in the muscle tissue.Absorption of the medication is more rapid then the oral form but slower then sub lingual , subcutaneous injection and intravenous administration.Intra-muscular injection is a popular method for anti- nausea medications because it bypasses an already irritated stomach.Most chemotherapy cannot be given intra-muscularly because of the harshness of the chemical.Intra-muscular injection is avoided when possible in patients with low platelets, as bleeding within the muscle can be a complication.Intravenous Chemotherapy TreatmentsIntravenous administration of therapy medication allows for rapid entry into the body's circulation, where it is carried throughout the body in the blood stream. This is the most common method of chemotherapy administration, since most chemo drugs are easily absorbed through the blood stream. Intravenous administration offers the most rapid absorption time of all currently available methods and the most versatile. IV methods also enable more flexibility with drug dosing. Doses can be given as an IV bolus lasting from a few minutes to a few hours. Continuous infusions can be given over a few days or for weeks at a time. Portable pumps allow medication to be given at a slow continuous rate allowing for on going IV absorption of the medication. Intravenous medications are given directly into the blood stream through a variety of methods.An angiocatheter may be placed in a vein in the arm or hand and then removed after the chemo medication is given. This is a temporary venous-access device inserted by a nurse prior to treatment then removed after treatment has been completed. The in-use time of angiocatheters generally ranges from a few minutes to a few days.PICC line. Although still considered temporary, a PICC line can be inserted and used for six weeks to a few months before it is discontinued. PICC line insertion involves the placement of a long plastic catheter into one of the larger veins of the arm. This procedure is a non-surgical outpatient procedure. A special x-ray, called fluoroscopy will confirm that the PICC line catheter is in the right place. This option is ideal for multiple short infusions or continuous infusions given in a hospital or at home with a portable pump.Non-tunneled catheters. Non-tunneled catheters are inserted directly through the skin into the jugular or subclavian vein and travel through the vessel to the superior vena cava vessel at entrance of the right atrium of the heart. These can be inserted at the bedside, in a non-surgical setting. A special x-ray, called fluoroscopy, must be done to be sure the catheter is in the right place. These are used most commonly short term or in emergency situations since long-term use is associated with the potential for infection along the catheter. Most refer to these catheters as "jugular" or "subclavian" for the vein in which it is inserted. These catheters require dressing changes and careful maintenance.Tunneled Catheters. Tunneled catheters are placed through the skin in the middle of the chest. They are tunneled through the subcutaneous tissue (the layer of tissue between the skin and muscle) and inserted into the superior vena cava vessel at entrance of the right atrium of the heart. There is a dacron cuff about two inches from the part of the catheter that exits the skin in the chest. Scar tissue forms around the cuff to hold the catheter in place. These catheters are inserted in an outpatient surgical procedure and a special x-ray, called fluoroscopy, must be done to be sure the catheter is in the right place. These catheters can be left in place for months or years with low incidence of infection. Dressing changes and maintenance is required. These catheters can have multiple lumens (entrances) for medications to be infused or for blood to be drawn. A single lumen has one entrance for medications, a double lumen has two entrances and a triple lumen (the most available) has three entrances. These catheters are most often used for extensive chemotherapy regimens such as bone marrow transplant procedures. Tunneled catheters are usually called by their brand names: Broviac, Groshong, and Hickman. The Hickman catheter, like the Broviac cathether, has an open-ended line inside the vein. In contrast, the Groshong catheter has small, valve-like openings in the line's tip.Port-a-cath. A more permanent option involves the placement of a port-a-cath. The port-a-cath is placed under the skin on the chest. The catheter is then inserted into the superior vena cava vessel at entrance of the right atrium of the heart. This catheter can be placed in radiology by an interventional radiologist or by a surgeon in the operating room. It is approximately a one-hour procedure. The useful lifetime of a port-a-cath can be as long as three to five years. The port-a-cath can be felt under the skin and the nurse can find the entrance by locating the edges of the port-a-cath and inserting (cannulating) a special needle (called a Huber needle) into the soft middle section. Medications can be given through the port-a-cath and blood can be drawn from it eliminating the need for a blood draw from the arm. The use of a portable pump and port-a-cath allows the medication to be given over several days in the home setting rather then as a patient in the hospital. There are no dressing changes required but there is someWhat Should one Expect?You will be able to go home once your infusion is done.When you first discuss your treatment plan, youroncology team will review what is normal to experienceafter treatment. The Chemotherapy and You booklet isa great resource during and after chemotherapy.It is normal to be worried about the possible side effectsfrom your treatment. It is important to discuss yourconcerns with your oncology team. Remember, not allpatients get side effects. The severity and type of sideeffects that may happen will depend on the treatmentyou are getting.Even though certain treatments have expected side effects, please call youroncology team and let them know what side effects you’re experiencing. Youroncology team will review side effects linked to your treatment plan. They willalso give you suggested ways to manage them.The Side Effects and Ways to Manage Them section of Chemotherapy andYou gives more information about side effects, how to prevent them and waysto manage them. Your oncology team will continue to give information to youas you progress through your treatments. Remember, each chemotherapytreatment is different, and every patient experience is unique.When should I call my healthcare team? Any symptom that concerns you. A fever of 100.5° Fahrenheit, or greater. Bleeding or unusual bruising. Burning and/or pain when urinating. Constipation (no bowel movement in 2-3 days). Diarrhea (loose, watery stools) four or more watery stools in 24 hours. Nausea, vomiting or if you cannot keep down any liquids. Pain not controlled by your current medications. Redness, pain, sores or a white coating in your mouth. Shaking and chills. Unusual cough, sore throat, lung congestion or shortness of breath.References:How Is Chemotherapy Given?

Is there a way you can make a very sick person go to the doctor?

To be blunt NO.For the best part of 2009 I asked, begged and pleaded with my dad to make a doctors appointment as he had been vomiting every time he tried to eat something and with that obviously losing weight.This continued for months, what could I do ? How could I get my dad to a doctor ? By now its October and I am at my wits end. I drive to my dads and tell him he has to get in the car so I can take him to A&E to see a doctor. Again he declines but asks that I take his 2 dogs for a couple of days so he can get some rest. Reluctantly I agree and get the dogs in the car and before I leave I give him the number for NHS24 and beg him to call them.The next day I get a phone call from a nurse at the local hospital to tell me that my dad had walked into A&E dropped to the floor and begged for help. He gets admitted shortly after and put up in a ward soon after that where he would receive a blood transfusion as he was very anaemic and in need of good pain relief, an endoscopy and MRI is ordered for the following day (dad is convinced he has a hairball or something like that) and knowing he is much more comfortable and being well cared for I leave for the night.Next day after he’s had endoscopy and MRI doctor comes to discuss the results. There is no hairball. There is cancer. Primarily stomach cancer but it has also spread to lungs and liver. In the blur that follows, surgeons and oncologists come to talk things over and shatter our worlds as they tell us there is nothing that they can do, no operation and no amount of chemotherapy or radiotherapy will cure it. Palliative care is the only option to try and buy some time, on October 30th he is discharged from hospital and comes home with me and my family and await 6 rounds of chemotherapy to begin.After his first chemo session he was looking great, good colour about himself and good positive attitude, so home we go to continue oral chemo via 7 Tablets a day until the following week when he would be due another overnight stay for IV chemo.2nd round isn’t as positive as 1st, things steadily decline and when he goes for further doses of IV chemo his blood is never at a good enough level for him to receive it. We try our best to continue at home but he’s writhing in pain and the tramadol makes him really sick we try so hard to help him and make him comfortable but by December 30th he can’t cope anymore and we go by ambulance to hospital. Dad has now developed neutropenic sepsis which was apparently due to the chemo.Over the next few days he looks brighter and much more comfortable. 6pm visit on January 2nd 2010 I walk into his room and he’s on oxygen and has a catheter in monitoring his urine output which was new. I speak to a nurse who tells me that he thinks my dad has reached his terminal point his kidneys have started to fail and he may not be able to return home with me but be admitted to a hospice instead, as my dad has noted me as is next of kin I am asked to consent to signing do not resuscitate forms in the event of anything happening. Heart breaking as it is I sign the forms along with my dads agreement as in my heart I know I couldn’t bear to watch him suffer any more than he already had.Around 9pm dad asks me to go and ask the nurse if he could get some more morphine for the pain and I do as he asks. The nurse asks that I leave the room while she administered the morphine and minutes later I returned to my dad and sat by his side again. Shortly after he turned to me and said he was going to take a “wee nap” and grabbed my hand. As I sat there holding my dads hand,as I had so often done as a child, the strongest man in the world and my super hero, my precious beloved dad Took his last breath and I swear my heart actually broke.10 weeks was all my dad had from diagnosis until he died and it haunts me that if maybe Just maybe he had went to the doctors when I first asked him to at the beginning of the year he might’ve had a much better chance at survival.

What are the best non-fiction books you read, but are not popular?

I prefer non fiction over fiction..and if you prefer a wide range..I can vouch for these books..1.”One River”-Wade Divas. Yeep, that river is Amazon.2. Voices from Chernobyl: The Oral History of the Nuclear Disaster by Svetlana Alexievich. She is a nobel laureate and her writing and story would stay with you.3.”The death of cancer” by Vincent T Devitta. He is the one of the main pillars of Chemotherapy,a giant in the field and who has a different approach on treating cancer and how bureaucracy and policies are hampering progress.4.”Manufacturing Consent” by Noam Chomsky and Chomsky need no mention.5. “The Holocaust” by Martin Gilbert and “if this is a man” by Primo Levi.Part of Holocaust cannon and must read for people remotely interested in that period.6. “The looming tower:Al-Qaeda and road to 9/11″ -A definitive read of that period.7.”The discovery of the tomb of Tutankhamen”-By the people who discovered it..and the whole process of unraveling one of our most important connection with history.Happy reading!!!

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