My Frenemy, Dexamethasone

When initially discussing chemotherapy treatments, most people begin with the thought that it is the chemo drugs themselves, those infamously toxic concoctions, that the patient would complain about most, or fear, or suffer from. And chemo does suck, what with the potential for nausea and fatigue and that notorious chemo brain. But do you know what really sucks, dear Reader? Steroids.

I recognize the importance of the Dexamethasone pills I take for three days at the start of each infusion cycle. And I appreciate that I am not taking Prednisone, which some of my friends have been saddled with for lengthy periods of time and which I had seen turn my father’s final years into a much less pleasant time than they should have been. I owe a debt to Prednisone, without which I would not have gotten ill enough to eventually lead to my cancer diagnosis, but I will never take it again. Dexamethasone, on the other hand, I can deal with. I don’t like it, but I understand the need to make my peace with the sleepless nights and mild dizzy spells and increased irritability, the hoarseness and seemingly endless peeing.

During my last cycle, we had cut my dose in half.

Dexamethasone Tablets
Who would have thought that one of these little guys could turn out to be such a pill.

The idea was that, since I had been responding well to my Alimta (technically, I’m taking Eli Lilly and Company’s Pemetrexed, of which Alimta is a brand name), I did not exhibit any likely signs of allergic reaction and was not having trouble with keeping food down, that we could give it a go and adjust as necessary if things got ugly. They didn’t. There was a day or so when I thought, maybe, just maybe I would get a little sick after eating, but I made it through just fine. And I slept a lot better. And I didn’t really lose my patience or snap at anyone for the last few weeks. I really like the half dose.

And after last night, after having started the next round with a lovely night of nearly 3 hours of sleep to lead into my infusion, I was feeling ready to get on with the chemo. But even at the half dose, and being super tired, I knew I still had to pay attention to my behavior. The infusion of my chemotherapy drugs went well. My nurse in the infusion center found a suitable vein and, with a little jockeying around of the tube was able to get it into a proper position that kept the flow moving. I was in and out on schedule, able to rush down to the restroom and get the saline drip right out of my system (the morning’s coffee was dispensed with upon arrival at the center). Did I mention that the steroids affect my frequency of urination? I pee a lot.

For the next couple of hours, I was pretty mellow. Tired, mostly, because the previous night was progressively catching up with me. But also mellow. I appreciated that the steroids had kept any potential inflammation at bay, and that I was able to come home and make myself a gratuitous burrito with probably too much beans, rice and cheese and just enough freshly browned pork belly, consumed without the slightest hint of nausea. But midway through that monster on my plate, I did begin hiccupping in the special way that Dexamethasone springs upon me. It’s not as bad as it had been, but the sudden seizing up and catching air in my esophagus isn’t a fun mealtime experience.

Everything is a trade-off.

And that’s the way it is with treatment. All the way through, understanding the trade-offs is important. Chemotherapy in general is more easily tolerated. Improvements in the science make it better, both in effectiveness and in how the patient feels, though it the latter may only be slightly more incremental. And it is a grand sign that the steroids are my main point of complaint, I suppose. Which is one reason I am glad to be taking them. Not only are they doing their job (though I look forward to reducing them further), but the mere fact that I complain more about the Dexamethasone than I do about the Alimta tells me things are a lot better than they could have been. And they are a darn sight better than what everyone outside of my medical team was expecting when this whole process began.

Cancer might be bad, even very bad, but when treated properly with the best science out there and a caring team to support the patient, it’s totally doable. I’m not recommending that everyone go out of their way to get it. But for those of us living with cancer, the living part is a lot better than it used to be and it keeps improving.

Now, as Breast Cancer Awareness Month draws slowly to a close, I’d like to point out that Lung Cancer Awareness Month is coming right up. November is the month when a small media blitz will try to remind everyone that lung cancer is far more prevalent and less funded than the other well-known cancers. It has been held back by habitual victim-blaming, even though an ever-larger percentage of patients are young, non-smokers. Expect to hear more from me about this…

In the meantime, I’m going to try really hard not to be irritable with my daughter over the next few days. (I failed miserably for about five minutes just before dinner, but I think we both saw eye to eye about it before we sat down to eat — half dose might still make it too easy to get riled up, but it also makes it a lot easier to recover quickly.) And I’m hoping that I can succumb to the fatigue on schedule this evening, defeating the steroids and their insomnia-inducing ways. Then I’ll pop another in the morning, ready to enjoy another day of eating whatever I want and knowing that the effects will probably wear off by the weekend.

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