oncology appointments

art journal page with red triangles

The way my cancer clinic works, you meet with your oncologist the day before your chemotherapy treatment, so they can check your white and red blood cell levels and make sure the levels are high enough for you to have the chemo. If not, your chemo is postponed until the levels are okay.

The routine is, you check into the clinic early on the day you’re meeting with the oncologist, and get some blood drawn for testing. The last time I had chemo, right after Christmas, all my appointments (including the chemo) were on one day, and I had blood for the blood tests drawn from a vein in my inner left elbow, the way I always do.

(I had some lymph nodes removed from my right side when I had my double mastectomy, so I always had blood drawn and blood pressure taken – and chemo given – from my left arm, because of the risk of lymphedema in my right arm.)

I didn’t know it, but apparently having the blood drawn from my elbow on the day of chemo was a mistake. It meant that they couldn’t put the chemo line in the same place (the same vein in the inner elbow), out of risk that the puncture wound from the blood test would leak the chemo drugs into the surrounding tissue, which can be very toxic for the tissue.

(The chemo drugs need to stay in the blood vessels so that the drug can be spread throughout the body, and even then, chemo drugs are very hard on the blood vessels where they’re injected. They’re poisonous and irritating.)

The chemo nurse told me to always have my blood taken from a vein in my hand before my chemo treatments, so that the possibility of an unhealed puncture wound was “upstream” from the chemo injection, and therefore the risk of a leak was much lower.

[Update: after going in for my blood tests for my fourth chemo, the technicians told me that I only needed to get blood taken from a vein in my hand if I was having chemo that day. Otherwise they can use a vein in the lower arm or inner elbow.]

Luckily the oncologist had just given me permission to have my chemo injections in my right arm, because they deemed my risk of lymphedema (where poor fluid circulation in the arm causes swelling) was low.

So the routine is, have your blood tests, then wait up to an hour for them to process the blood test results, then meet with your oncologist.

There’s a lot of waiting at the cancer clinic.

There’s also a self-assessment you can do at a computer kiosk while you wait. It helps them monitor your symptoms (like pain and fatigue) from visit to visit. I do the assessments, but the nurse in the examining room always asks me the same questions all over again, so sometimes I wonder what the point is.

When they have your blood tests back, they call you into an examining room (they weigh you on the way in), and you talk to the nurse about any current symptoms. And then you wait some more. Oh, and I’m always asked to take off my clothing above the waist, and put on a hospital gown, in case the oncologist wants to examine my chest area, which he didn’t even do last time.

Waiting in the cancer clinic – at least in the public areas – is very depressing for me. It’s crowded, and they’re processing people all day long, so there’s a constant flow of traffic through the waiting area, but it feels like you’re waiting forever.

(You’re waiting about an hour, remember.)

You know that all the cancer people are sick, and some of them look very sick. The first few times, I had a lot of trouble concentrating on the books I was trying to read on my Kindle, and so I just people-watched and chatted with Mom, and was bored out of my mind.

Once the oncologist comes into the examining room, they ask you how things are going, check to see if you’re on any new medications that might interfere with your chemo, and talk about any chemo symptoms that are bothering you. In the past they’ve adjusted my nausea meds for me.

This time, I want to talk about my migraines, my periods (I’ve had periods twice when I’ve received chemo, and it’s been a horrorshow) and constipation.

When you’re done with the oncologist, you can go to the clinic pharmacy to pick up any of the drugs that you need before your chemotherapy appointment the next day (some nausea meds are taken the day before, or earlier in the day before you’re scheduled for the chemo), and you’re free to leave. You have chemo the next day, if everything has gone okay.

Photo: Try Angles art journal page, wax crayon and pencil on paper, October 2006