Quoth the Raven ‘After FEC 3, then 3 more…’

Day 44

 

General status update 

Hair: Afflicted by usual pre-chemo paranoia – will this be the dose when the chemo finally hits the follicles? On plus side, Hair very much looking forward to its forthcoming snood mini-break. 

Nausea demon: back from Bilbao and boring for England re the genius of Frank Gehry. Have suggested he apply for Mastermind with this as his special subject. 

Chemo Muse: She can’t wait to gobble up the Dexamethasone – take those steroids, hear her ROAR! - and set me to work.

Chemo Brian: Depressed – Dexamethasone is to him as Kryptonite is to Superman. He likes drugs whose names begin with Benzo-  Told him they may well be on the agenda later in the week. .

Fatigue/weakness: anxiety trumps fatigue every time.

Sleep, lack of: That will start again tomorrow, after the steroids. 

Anxiety level (1-10): Breathing deeply, trying to stay calm, even though Stan did tell me right at the beginning that FEC 3 will be the worst one. And FEC 2 was Beyond Horrible. 

State of mind: Get thee behind me, Goa; the flights probably aren’t even running, what with all the snow. A trip to the chemo ward tomorrow, or a 24 hour wait in Heathrow airport? There are some things worse than chemo, and Heathrow when all the flights have been cancelled is one of them.

 

In Gurkha Towers, 2 days after the Eve of St Agnes, and on the Eve of FEC 3, the Anxiety Demon manifests itself to a troubled Fo, in the form of Edgar Allen Poe’s Raven…

 

 

 

Once upon a midnight dreary, while I pondered weak and weary,

Over many a quaint and curious volume of the cursed FEC chemo lore,

While I nodded, nearly napping, suddenly there came a tapping,

As of some one gently rapping, rapping at my chamber door.

`'Tis some visitor,' I muttered, `tapping at my chamber door -

Only this, and nothing more.'

Back into the chamber turning, all my soul within me burning,

Soon again I heard a tapping somewhat louder than before.

`Surely,' said I, `surely that is something at my window lattice;

Let me see then, what thereat is, and this mystery explore -

Let my heart be still a moment and this mystery explore; -

'Tis the wind and nothing more!'

Open here I flung the shutter, when, with many a flirt and flutter,

In there stepped a stately raven of the saintly days of yore.

Not the least obeisance made he; not a minute stopped or stayed he;

But, with mien of lord or lady, perched above my chamber door -

Perched upon a bust of Pallas just above my chamber door -

Perched, and sat, and nothing more.

Prophet!' said I, `thing of evil! - prophet still, if bird or devil! -

Whether tempter sent, or whether tempest tossed thee here ashore,

Desolate yet all undaunted, on this desert land enchanted -

On this home by horror haunted - tell me truly, I implore -

Is it- is FEC 3 the worst one? - tell me - tell me, I implore!'

Quoth the raven, `After FEC 3, then 3 more.'

Be that word our sign of parting, bird or fiend!' I shrieked upstarting -

`Get thee back into the tempest and the Night's Plutonian shore!

Leave no black plume as a token of that lie thy soul hath spoken!

Leave my loneliness unbroken! - quit the bust above my door!

Take thy beak from out my heart, and take thy form from off my door!'

Quoth the raven, ` After FEC 3, then 3 more.'

And the raven, never flitting, still is sitting, still is sitting

On the pallid bust of Pallas just above my chamber door;

And his eyes have all the seeming of a demon's that is dreaming,

And the lamp-light o'er him streaming throws his shadow on the floor;

And my soul from out that shadow that lies floating on the floor

Shall be lifted – ‘After FEC 3, then 3 more.'
 

There's a (happy) place in the sun....

Day 21 

General status update

Hair: The suspense is killing both me and Hair. Am tempted just to shave it all off, so I can stop waiting for it to start falling like autumn leaves. Hair, unsurprisingly, not overly impressed by this idea and determined to fend off the ravages of FEC 2 in the spirit of the Siege of Leningrad. Have nasty feeling that particular event ended up with everyone eating rats. And worse. Still, I could get Big Sis Fo to send some down from north Yorkshire, where there are plenty going spare.

Nausea demon: Pumped. There’s no other word for it. B*ST*RD.

Chemo Muse: Off out having her hair highlighted so she can look her best for Chemo Cycle 2. Of course her hair isn’t going to be falling out, is it? B*TCH.

Sleep, lack of: Pill last night, so no pill tonight. Oh Morpheus, gentle deity, please take me in your arms  tonight - PLEASE.

Anxiety level (1-10): The rapid, high-pitched whine of anxiety in my head has broken through the sound barrier, exited the Earth’s atmosphere, and is now heading towards Mars.

State of mind: No longer incubating escape plans, as I still was 3 weeks ago before FEC 1. Now resigned to being totally FECKED, in 6 instalments.

News from North Yorkshire: Hank keeps backing up into corners whenever the MC approaches. That is now one very nervous dog.

 

The second cycle of chemo - when the next dose of powerful toxins will be pumped into my bloodstream and, perhaps, bring about the rapid loss of my hair - will begin on Wednesday, and I seem to be becoming more than a little tense. Tomorrow morning I will be off to the hospital to see my oncologist again, to discuss how the first cycle went, decide whether the various meds to deal with the side effects need to be adjusted and, most importantly, go through the pre-chemo blood test, carried out to check that your now-compromised immune system has recovered sufficiently after the last dose of chemo for you to survive the next one.  

If the platelet count in your blood is too low, then they won’t let you have any more chemo until it has recovered sufficiently – otherwise the next dose might result in you becoming very seriously ill, or even dying. In order for the chemo drugs to be strong enough to kill off the reproducing cancer cells (chemo kills cells which are reproducing, mostly), they also have to be strong enough to kill the healthily reproducing blood cells which keep the immune system working. If too many are killed, the patient is at very high risk from any infection, however small, especially during days 7-10 of each chemo cycle, when the chemo has had time to do its work, and your immune system is at weakest, and has yet to start fighting back.  

A couple of my on-line friends have been re-hospitalised with infections already, and so I am being insanely vigilant about staying away from crowded places and public transport, washing my hands constantly, and insisting that anyone who enters the flat washes theirs before doing anything else - which can come across as quite rude, unfortunately. It’s hard to get across politely to a dear friend that you don’t want to hug them until they’ve washed their hands, but we live on the fourth floor, and visitors must touch the brass door handles to open and close the (old-fashioned, manual) lift doors, handles that are touched by hundreds of people each day; at the moment some of those hands may well be infected with the highly contagious Norovirus, currently laying waste to the London population, which can live for six months on hard surfaces… and the Norovirus would, at best , put me in an isolation ward for a couple of weeks. At best.  

I seem to have got through the first cycle of FEC relatively unscathed, apart from the constant nausea, sleeplessness and hyperactivity, the dry and sore skin and greatly magnified sense of smell; unlike some of my virtual chemo buddies, I have not yet  experienced any hair loss, mouth ulcers, thrush, cystitis, constipation, diarrhoea, indigestion, sore eyes, black nails, major fatigue or life-threatening infections.

It’s early days yet, of course, and not every patient gets ALL of these side effects. I know it will get worse, but it’s not clear yet if the side effects I already have will get worse, or if additional ones will start appearing – maybe it could be both. I’m most anxious about my hair – it’s been so good this cycle, after having the cold cap, just sitting there quietly on my head, and not falling out. Over the next few weeks, however, after FEC 2, it will almost certainly begin to fall out – if I’m lucky, and the cold cap continues to work, it will just start gradually becoming thinner; if I’m unlucky, the whole lot will go, quite fast.

Fingers crossed eh?

In the mean-time, am working on reducing the anxiety in 2 ways: first, obvs, through the use of weapons-grade pharmaceuticals and second, by doing a runner to my Happy Place in my head, even if I can’t do it in reality. I don’t know why I kept threatening to run away to Goa, in the early stages of denial, anger and rebellion after my diagnosis, because the Camel Barn and its environs, not Goa, is my Happy Place, and evoking and concentrating on images of Ayvalik can always calm me down and make me forget, at least for a little while, the many unpleasant things that are happening to me.

A couple of years ago I kept an on-line photographic diary for a while, on which I put  photos from my long walks in the hills around Ayvalik. I'm not much of a photographer, as will be evident, but I spent nearly 4 years pointing and clicking with my mobile phone at every beautiful view, and it is a place that abounds in beautiful views, both natural and architectural.

 

Below are three entries from that diary, about Ayvalik sunsets; the accompanying images are some of those I use to absent myself, temporarily, to my Happy Place in the sun when the unrelenting barrage of nastiness from this cancer and chemo business is just All Too F***ing Much…

 

  

Friday 23 April 2010: Another Ayvalik sunset...

 

 

'Coming back home again after 3 weeks travelling in south-eastern Turkey has made me look at both Ayvalik, and my house, with renewed appreciation. 

I took my dog up the hill early yesterday evening for his walk in the pine woods, and was welcomed back by a truly spectacular sunset over the Aegean. It reminded me how very lucky I am to have such extraordinary natural beauty there to enjoy freely every day, only a few minutes’ walk up the hill from my house in the town.'

 

Friday 30 April 2010: Why I can't leave Ayvalik...

 

The view, the light, the sense of calm that fills me every day when I walk up into the pine woods and look out over the Aegean. Even though I've photographed it a hundred times before, and posted it on here several times already, I can never get enough of this view.

 Wednesday 26 May 2010: Reaching new heights

 

‘Over the last few weeks I have been going on longer and longer walks every evening with my dog Freddie, gradually exploring and mentally mapping all the different tracks (they're fire roads, I think) that run through the pine woods on the hills behind & beyond Ayvalik. This is a labour of love: these woods, and these walks, are quite beautiful and I want to get to know them thoroughly both for my own benefit, & so I can show them to visitors. Very few people, other than beekeepers, ever go there - as a nation, Turks are not keen on recreational walking - so usually Freddie & I have miles of woods entirely to ourselves. 

Today was the longest and most beautiful walk yet. We were out for nearly 4 hours, and climbed to the highest point in the hills, from where there is a quite breath-taking view over the Ayvalik archipelago & across the Aegean to Lesbos. Freddie & I were very tired when we got to the top of the hill, so we sat in the grass to rest, & breathed in the scent of the pines & wild lavender as we watched the sun start to set over the Aegean..’

 

When times are bad, and I’m feeling sad, Ayvalik is my (happy) place in the sun.

Take it away, Stevie!

 

If you believed they put a man on the moon, man on the moon…

  

Day 9

General status update

Hair: no change

Nausea Demon: confined to his room, and sulking. Playing loud rap music to make his feelings clear

Sense of smell (NEW!): magnified by about 300x. I can smell cooking smells from 200 yards away, and they TURN MY STOMACH. I am turning into a dog. A dog with nausea.

Anxiety level (1-10): They’ve sedated me, dude. And I love them for that.

State of mind: None, currently

 

 

So I’m on the phone first thing Monday morning to Sister Chemo at the Chemo Day Unit (Monday-Friday, 9.00 am -5.00pm)  - the so-called Chemo 24/7 Emergency Help Line, as you will remember, having been mysteriously unavailable over the weekend  - 

requesting urgent assistance, given my continuing acute gastric distress, and the fact that my supply of anti-emetic drugs, which should have lasted for a couple of weeks, is about to run out.

Sister Chemo is very nice, but it is quite clear that she will not be providing any active assistance to alleviate my distress; this kind of thing, it seems, is Not Her Problem.

 ‘Oh, your GP will give you something for now,’ she says, ‘and then when you come for the oncology clinic appointment in 2 weeks’ time, before your next dose of chemo, you can talk to the consultant and get it sorted out, if it’s still a problem.’

She then adds, in a confidential tone: ‘I tell you what, though, you should ask your consultant for a drug called Fosapprepitant for your next chemo cycle – it’s MARVELLOUS.’

 

‘I’ve already had that’ I reply, perhaps a little sourly. 

‘Oh dear’ says Sister Chemo ‘OH DEAR’.

So I call my GP’s surgery, tell the receptionist I am a chemotherapy patient with severe nausea problems who cannot come into the surgery right now because of the infection risk, and request a telephone consultation with the doctor as soon as possible.

She sighs.

‘We’re very, very busy right now’, she says ‘So he can’t talk to you today, but I can fit you in for a telephone consultation between 5.30 and 6.30pm tomorrow evening’. So that would be another 36 hours of unrelenting nausea without any help. I had been told that I should DEMAND to speak to the doctor if necessary, and that they are obligated to let me, but I’m too weak and upset to argue at this point, and I don’t want to break down and start weeping uncontrollably on the phone. Or begging.

 

So much for the urgent and immediate response to the needs of chemo patients – it hasn’t been a great start. By now I have tried all the prescribed official channels and got Absolutely Bloody Nowhere. So it’s time to try something else. I have one last telephone number I can try – at my last oncology appointment before chemo I had discussed with Stan the whole ‘How do I get help if things get bad between hospital appointments?’ issue, and he had given me the Chemo 24 hr. Emergency Helpline number, and reassured me that it was manned AT ALL TIMES, and that I would never be more than a quick phone call away from help.

 

 As an afterthought, however, he then gave me the number of the oncology consultants’ secretary ‘just in case’, saying that if all else failed I could give her a call, she would relay the message to him, and he would send a scrip down to the hospital pharmacy to issue me whatever meds I required. This would only work on a week day, obviously.

 

Calling this number is what I now think of as the Chemo Joker – it saved me.

 

I called the number, began talking, and then burst into tears. Through the sobs and the hiccups, while she made soothing noises and tried to calm me down, I explained to the oncology secretary - a truly wonderful woman called Dina whom I now love very much - the extent and duration of my nausea predicament, its on-going status, and the fact that not only did I need to add some new, different meds, but that the ones I already had were going to run out by the following morning.

‘I’m putting this into an email’ she said ‘and I’m sending it to Stan immediately. Give me the number he can call you back on. HE WILL CALL YOU, I promise.’

Stan called back within ten minutes.

Finally, the cavalry had arrived.

He quickly assessed the gravity of the situation, including my by this point very precarious mental state (the mantra ‘Goa, Goa, Goa, run away to Goa’ was now repeating itself in an endless loop in my brain), and said he would prescribe me more of the Domperidone and another anti-emetic drug, Cyclizine, which often proved helpful in particularly recalcitrant cases of severe and continuing nausea. He then suggested, gently, that an anti-anxiety drug might also be helpful at this point, which was music to my ears. Something along the lines of a horse tranquilliser might be good, I said, but he decided to give me Lorazepam. Stan promised that the drugs would be available for collection from the hospital pharmacy by mid-afternoon.

 

AND THEY WERE.

 

As I’ve said before, Stan’s the Man.

 

I should add that he apologised profusely for the problem with the Chemo 24 hr. Emergency Help Line, which was apparently unprecedented - the hospital has been having computer problems, and it was being fixed today. My GP, when I finally spoke to him, also apologised for his receptionist and assured me that I can ALWAYS speak to him or another doctor the same day if I have any further problems. And he has put ALL the anti-emetic drugs on to my repeat prescription list, so I can get them immediately when needed. This makes me feel much, much more secure, given that there are 5 cycles of chemo to go, and if there is one thing that is certain, in addition to death and taxes, it is that the side effects of the chemo will get worse as it continues.

The Cyclizine is helping enormously: the nausea hasn’t gone away, and I think it may well stay with me for the entire 100 Days of Chemo, but the new drug has somehow made it bearable, which before it wasn’t. It’s very hard to describe – the nausea is still sitting in my stomach, I can feel it, I’m still queasy ALL the time, but it’s not so sharp. I am going to be able to live with it, which is just as well, because I have no choice but so to do. 

In the evening, after R had brought me the drugs, and I had been very effectively sedated by the Lorazepam (which brings an entirely new meaning to the expression ‘Chemical Cosh’), I googled Cyclizine to see if there was anything I should know about this new drug. 

And Wikipedia told me that Cyclizine was the anti-emetic drug chosen by NASA as the space emetic for the astronauts who made the first landing on the moon. 

‘There you go, then’ said R, looking up from his Killer Sudoku, ‘If it’s good enough for Neil Armstrong, then it’s good enough for you’.

 

 

50 Shades of Pink..

Day Three: The Chemo Fairy arrives, bearing gifts

General status update:
Hair - still attached, gradually defrosting
Nausea - moderate, no actual vomiting
Hiccups - intermittent
Unexpectedness stonedness - lovely surprise! At no extra cost!
Anxiety level (0-10) - sorry, what?
State of mind: Totally chilled, man.
 

I’ve had the first dose of chemo, I’m still in one piece, and I didn’t make a break for the airport – possibly because I was escorted to the chemo ward, if not exactly under armed guard, but with my partner, R, on one side, and my little sister on the other, both staying very close indeed as they marched me briskly down the Fulham Palace Road towards Ward 6 East at Charing Cross Hospital yesterday morning. 

I did suggest that I could make a quick detour to Pret to get some provisions for later, and meet them at the hospital, but this met with a very dusty answer – R went for the sandwiches, while my sister continued marching me down the road, thus eliminating any possibility of me doing a runner. Still, it was worth a try. 

The chemo ward was a nice surprise – comfort, calm, delightful nursing staff AND free bananas, always a plus. I was hoping to avoid the whole Pink Thing throughout this process - it just doesn't do it for me, and it's not compulsory, after all.  

Yeah, right.

 

 

Not only is the cold cap - with which you try to prevent, or at least delay for a while, your hair falling out - a particularly acid shade of Day Glo Pink, but the Chemo Chair, in which you recline in some comfort as the toxins are pumped into your veins, is also pink. Mine was, anyway:

The bright pink machine to the left of the chair is where the cold cap - or Ice Cap, as my friend Amanda has rather more appropriately dubbed it - is plugged in, and freezes your head down to about -7 deg C.

THERE IS NO ESCAPING THE PINK.

The first few minutes were spent playing with the remote control for the chair, obviously: it arranges itself into a number of different positions, and is very comfortable indeed. I'd quite like one at home, although I wouldn't want to upset the Ektorp, which has very adequately fulfilled, for several years now, my overwhelming need to be horizontal whenever possible. 

My chemo nurse, the lovely and impressively efficient Sister Elena, gave us an impromptu, and fascinating, lecture on how Romania had suffered under the yoke of various pesky imperial powers over the last two millennia. She does not have a good word to say about the Ottomans and really, who can blame her? I would very much have liked her to continue, and indeed encouraged her vociferously, but Elena saw right through this stratagem and moved swiftly on to the arcana of chemo and the dreaded Ice Cap, which makes grown men cry.

The protocol was very strict, and timed down to the last minute, viz: 

1)    A 30 minute infusion, by my special request, of the strongest intravenous anti-emetic drug known to man, Fosapprepitant - they even named it after me, apparently. This is very expensive, and usually not administered unless you have proved you really, really need it by vomiting continuously for 24 hours or so after your first dose of chemo. 

This seemed to me an inherently unsatisfactory arrangement for those of us particularly prone to nausea, so last week I put it to Stan, my oncologist, that I had already put in the requisite vomiting hours during the extended, highly unpleasant allergic reactions I suffered after the administration of radioactive dyes for various scans. Happily Stan accepted this argument, and agreed to give me the good drugs up front.  

A fine man, Stan. 

2)    Application of the Ice Cap, and initial, preparatory freezing of the head, to stop the chemo going into the hair follicles and making all your hair fall out. I was warned this would be very painful for the first 15 minutes, but that if you can keep going, your head will eventually go numb, and the pain recede. Some women rip the cap off, screaming, after 5 minutes. Stan told me that most men don’t even get to the 5 minute mark, which made me laugh immoderately.  

3)    Half an hour later, after repeated checks that the correct drugs are being administered, the sequential infusion of the 3 chemo drugs that constitute the FEC chemo regimen: Fluorouracil, Epirubicin and Cyclophosphamide.

      -  Between them they provide a dizzying (literally) array of possible side effects: moderate-to-extreme nausea, hair loss, severe fatigue, anaemia, mouth infections, including both ulcers and thrush, stomach pains, heartburn and indigestion, both constipation AND diarrhoea (covering all bases), bladder infections, conjunctivitis, skin rashes and extreme sun sensitivity, taste changes (all food tastes the same, of cardboard), your nails going black, thrombosis, changes in heart and liver function (not entirely surprising, that one). Oh, and loss of fertility.

     But don't worry, most of those are only short term - except the possible death from any random infection you may acquire while your immune system is down. Longer term effects include increased risk of heart disease and, as a particularly ironic twist just for me, of developing Acute Myeloid Leukaemia. My original fear of chemo was acquired after my former husband died of its sister disease, Chronic Myeloid Leukaemia -

     I have a PICC (Peripherally Inserted Central Catheter) line already installed in my upper arm, there to remain for the next 5 months. It has a narrow tube inside, leading up through a vein to the top of my arm and thence to a rather bigger vein near my heart, where there is a much greater volume of blood into which to dilute the poison (chemo drugs are so toxic that if you insert them into the smaller veins in your arm they may fry them, not to put too fine a point on it).

 

     Oh, and you’re still wearing the Ice Cap while this is going on; it takes about an hour, and for in-flight entertainment they give you a short and terrifying DVD to watch about the dangers of Neutropenic Sepsis in days 7-10 of each chemo cycle: during this time you effectively have no immune system, because the chemo kills all the good blood cells as well as the bad ones. Should you acquire any kind of infection

     

     - going out during this period is really not recommended, and best practice would seem to be compulsory fumigation for your loved ones immediately after they walk in the door -

 

     and your temperature rise to 38 deg or above, you must leg it to the A&E with your 'I am a cancer patient' document and demand to be admitted for tests and in-patient treatment. If you don't do that, death may follow quite rapidly.

 

     I've bought a really, really good digital thermometer.  
 

4)    After the chemo has finished, you have to keep the Ice Cap on for another hour to continue protecting the hair follicles from the various poisons that are by now coursing happily around your bloodstream, looking for stray cancer cells – ‘circulating tumor cells’ – to destroy. Many cancer patients have some of those left, apparently, even after surgery – they will have split off from the primary tumour site at an early stage in the proceedings and, if you’re unlucky, they find another organ to colonise. I read somewhere recently that you should think of the cancer cells as terrorists, and the chemo drugs as the crack SAS sharpshooters sent in to hunt them down and kill them. 

Yes, that works for me.  

I often find it hard to remember that the real enemy is the cancer, not the chemo, something obviously evident to my oncologist. A couple of weeks ago, after what must for him have a been a rather trying meeting, during which I inflicted on poor Stan a spirited and extended interrogation on the effectiveness or otherwise of chemo, exact long-term survival rates and the risks of iatrogenic illness, he said rather sadly to me as I walked to the door “Please remember that we are trying to help you get better, Caroline”

5)    Then they let you go home.

 

It’s quite a long day, but it doesn’t hurt – apart from the cold cap, and I didn’t really mind that all. After 5 minutes of fairly severe pain, my head was frozen, and for the remaining two and a half hours it just felt not unpleasantly cool and tingly.

This is not a competition, but I must admit to feeling slightly smug that I tolerated the cold cap so well, and even quite enjoyed it; it certainly distracted me from the chemo. Anyway, I think that makes me officially the 27th hardest woman on the Charing Cross Hospital Chemo Ward, currently. Those who can tolerate the nausea without the Weapons Grade anti-emetic drugs constitute the elite top echelon, obvs.

And just to prove I am not exaggerating about the ice, look:

 

 

That was the inside of the Ice Cap, after the chemo, and below we see the outside of my very frozen head. Not a good look, but needs must..

 

 

 

The only occurrence of note during the infusion of the chemo was that as the final drug, Fluorouracil, was going in I suddenly started to feel very, very Spaced. Out. There was something in the pre-chemo info mentioning 'possible feelings of light-headedness', but they were being too modest: for me, it was definitely at the 'off your face' end of the 'feeling woozy' spectrum.

 

Hey, no one told me that chemo makes you STONED…

 

I giggled all the way home in the taxi, saying to my sister ‘Wow, I can’t believe I’ve actually had CHEMO’,

and she replied ‘Yeah, and I can’t believe you’ve had chemo and been so CHEERFUL about it’.

Unspoken between us lay the memory of how I had been bouncing off the walls during the previous few days, and the 2 previous months of blank refusal to participate, fervent protests, and intermittent threats to catch the next plane to Goa and cure my cancer by sitting under a palm tree, consuming health-giving vegetable curry. And mangoes. 

And so to bed, for a blessedly vomiting-free night. 

Thanks for the good drugs, Stan. I owe you one.


Addendum, 23/12/12: I've just re-read this for the first time since I published it, and feel I should make clear that the cold cap is NOT compulsory - in fact most people don't do it. At Charing Cross they have had good results with the cold cap for people on the FEC chemo regimen (although it doesn't work for everyone), my oncologist encouraged me to give it a go, and my chemo nurse seemed more than happy to administer it; I'm told, however, by my online chemo 'buddies', that at some hospitals the chemo nurses tend to discourage people from trying the cold cap, telling them it's a waste of time, because it means additional work for them - a patient who uses the cold cap is there for a couple of hours longer than one who doesn't, and there's a lot of faffing about fitting the cap, and operating the machine. For anyone reading this who is about to start chemo, and whose hospital in theory offers the cold cap, then don't let them put you off if you want to give it a go - it is your right to do so.