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 19th 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.
