A bloke in the corner called Kierkegaard, biting the heads off whippets...

Day 73  

General status update

Hair: bracing itself for FEC4, but looking forward to the snood

Nausea demon, Chemo Muse, Chemo Brian: back from their trip - to Whitstable, as it turns out - where the weather was lovely, they stayed in a designer B&B, and a wonderful time was had by all. Excellent. So happy they’re all BONDING.

Anxiety level (1-10): see dread

Dread: see below

State of mind: see dread

“Like one, that on a lonesome road Doth walk in fear and dread, And having once turned round walks on, And turns no more his head; Because he knows, a frightful fiend Doth close behind him tread”

Samuel Taylor Coleridge, The Rime of the Ancient Mariner, 

  

The 19^th Century Danish existential philosopher and theologian Søren Kierkegaard, or ‘the Danish Doctor of Dread’ as the New York Times recently described him, distinguishes between fear and dread: he argues that fear is the emotional response humans experience in response to some known potentially harmful or dangerous object or situation, as when facing a wild animal, or in a potentially embarrassing situation, such as public speaking.

Dread, on the other hand, he defines as unfocused fear, in relation to freedom, and the anxiety of choice: using the example of a man standing on the edge of a cliff, knowing that he could throw himself off it, and decide his own destiny. This realisation, that one has the possibility and freedom to do something, even the most terrifying of possibilities, is dread: the ‘dizziness of freedom’.

Kierkegaard so didn’t know what he was talking about.

Try a few cycles of chemo, Søren, and then you’ll be able to distinguish very clearly indeed between fear and dread. Fear can be of the known, but the greatest fear is of the unknown, because the very fact of something - say your first dose of chemo – being an unknown quantity means that your imagination runs wild. When what you fear is unknown, your fear knows no bounds, and the night before my first dose of chemo I was very scared indeed.

Tonight is the night before my fourth dose of chemo, and I’m no longer feeling fear, as I know now exactly what will happen to me, and just how bad it will make me feel, particularly between days 5 – 10 after I receive the chemotherapy. I don’t feel fear anymore – what I feel now is dread, and it’s getting to be much worse than the fear ever was. Every time I think about the chemo ward and what will happen to me there I shudder, and my stomach turns over, as well it might, since it is my stomach that bears the brunt of the side effects both of the chemo, and of the drugs they give to help with those side effects.

There’s another name for this: they call it ‘anticipatory nausea’:

“Many patients who experience nausea and vomiting as a result of chemotherapy

develop a preceding wave of symptoms, known as anticipatory nausea and

vomiting (ANV), before starting their subsequent cycle.

Nearly one in three patients experience anticipatory nausea, while anticipatory

vomiting occurs in about one in 10, according to the National Cancer Institute

(NCI). Unlike post-chemotherapy nausea and vomiting, however, which can begin

hours to days after treatment in reaction to drug effects on the gastrointestinal

tract, ANV shows up before treatment. Symptoms are generally experienced

among those whose nausea and vomiting were not controlled by medication or

other measures after prior chemotherapy sessions.

ANV is thought to be a result of classical psychological conditioning. The sights,

sounds and smells of the chemotherapy room, with oncology professionals

milling about, take on new significance once chemotherapy treatments begin.

These previously neutral stimuli then prompt a learned response from patients

once they begin to associate this setting with nausea and vomiting, and this

response becomes a pattern.”

http://curetoday.com/index.cfm/fuseaction/article.show/id/2/article_id/1985

I first realised I was suffering from this last week, when someone with the very best of intentions sent me a cheery video of a young woman with cancer dancing around and singing ‘What doesn’t kill you makes you stronger’ -  in a chemo ward. It was her way of putting two fingers up to chemo, and to cancer, and it was lovely, but I couldn’t watch it for more than a few seconds, because the images of the chemo ward, the machines, the plastic bags of chemo drugs on the drips, immediately made me feel ill: my stomach churned.

Even thinking about it now makes my stomach churn – and it reminds me of the film A Clockwork Orange, where the aversion therapy given to the brutal, vicious protagonist Alex - watching violent films after being injected with drugs which produce extreme nausea - not only makes Alex feel extremely ill when he thinks about violence, but also when he hears the music of Beethoven, which was played along with the films.

I have now become, like one of Pavlov’s dogs, or Alex, psychologically conditioned to respond to other cues besides the chemo drugs that actually induce nausea; just the sight of a chemo ward on that YouTube video evoked an instant, visceral response. This is a bit of a worry, as I don’t want to start vomiting tomorrow even before they start giving me the treatment. – or to be retching in anticipation all the way down the Fulham Palace Road.

According to the experts, because ANV is a learned response, behavioural interventions are especially useful in managing it, using techniques that focus on helping patients relax more before chemotherapy and enhance feelings of control. According to the US National Cancer Institute, what works best is ‘Progressive muscle relaxation with guided imagery, hypnosis and systematic Desensitization.’

Well, that would be nice, and they probably offer something like that at The Haven but as I’m having chemo tomorrow a quicker fix might be useful. Happily, it seems there is one available:

“While antiemetic drugs work well in controlling CINV, they’re not as effective

against ANV once it has developed. The anti-anxiety drug Lorazepam has shown

promise in preventing ANV, however, by stemming memories of vomiting

associated with chemotherapy. Studies show Lorazepam works best when given

the night before and the morning of chemotherapy.”

http://curetoday.com/index.cfm/fuseaction/article.show/id/2/article_id/1985

Right then – that’ll be one Lorazepam tonight, and another one in the morning.

I don’t think the Lorazepam will fix the dread though, because ‘anticipatory nausea’ is only a part of the dread, not the whole: when I think about having more chemo my whole being shudders, body and soul, not just my stomach. The dread consists in knowing what is going to happen to you, and just how horrible it will be, and it creeps up on you as the next dose of chemo approaches, getting bigger and bigger until it blots out the sun.

That’s what dread is, for me: and if Søren Kierkegaard had to undergo a course of chemotherapy, I’m sure he would agree.