October 2011 - My Brain Cancer Diary

Nausea. It feels like someone reached down my throat, grabbed my stomach and pulled it out through my mouth.

The Temodar is getting to me, finally. The first three of five straight days of 340 mg are fine, then the nausea hits on the fourth and lingers for a few extra days. Food seems absolutely repulsive. Any strong smell is like a poison gas.

Over the summer I took lower doses of Temodar without the nausea reliever Zofran. When the dose was upped to 250 mg, I learned (the hard way) to take a Zofran ahead of time. I’m taking it around the clock now, but still in the grip of this dreary, ill feeling.

Enter Marinol. My oncologist prescribed it for me last week to back up the Zofran. One of his assistants, in preparing the prescription, counseled me earnestly not to expect a “high”. Like marijuana, Marinol’s active ingredient is THC. ([10. http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0000403/

This article explains the medicinal use of dronabinol (brand name: Marinol). Some enlightening excerpts:

Possible side effects include: “feeling like you are outside of your body, ‘high’ or elevated mood, hallucinations (seeing things or hearing voices that do not exist), sleepiness, strange or unusual thoughts”.

Symptoms of overdose may include: “inappropriate happiness, sharper senses than usual, changed awareness of time, red eyes”.

Would someone please let me know when it’s appropriate to be happy?]) Rather than risk my health inhaling some pungent plant smoke under cover of darkness, I would ingest a medically necessary, socially acceptable and completely legal pink pill. ([20. http://www.justice.gov/dea/ongoing/marinol.html

This is a (rather snarky) illumination of the differences between Marinol and all other (illegal) THC vectors. It opens with this choice retort: “Medical marijuana already exists. It’s called Marinol.”

I appreciate Marinol’s convenience and precise dosing. The cost, however, is ridiculous. On Oct. 20, 2011, Drugstore.com listed the price of 60 capsules of 2.5mg Marinol as $441.97. The illegal “bud” form of the drug is a fraction of that cost. (I would guess 5 to 10 percent for a similar dose).])

It arrived at my local pharmacy Monday and my wife picked it up. That was day four of the Temodar. I felt unsettled and my appetite was nil, so I went to the fridge and took one. And guess what? After a few hours, I was high.

It’d been years since I had that kind of experience. My mind was swept up in a garish parade of thoughts and meta-thoughts, a peculiar but recognizable sensation. I felt compelled to write, and laughed at myself, suspecting my revelations were the same worn offerings I’d ignored when sober.

All in all, I prefer my normal frame of mind, though in contrast it seems inert and bundled. Fortunately, my appetite came back.

Tuesday morning I was not queasy, but had a headache. I rallied for an outing on the sailboard, took a Zofran while sitting on the board out in Casco Bay, then swallowed the last of the Temodar when I got back to the landing. The nasty feeling crept up again in the evening, though I was able to eat and avoided Marinol. I woke up twice during the night and beat back the nausea with will power.

But this morning was just wrong. I pushed myself through each tiny step of a mundane morning ritual and got my son to school. Later I napped and was able to stomach a pear.

At this point, I’m not sure which I prefer: sober nausea or stoned hunger.

NOTES:

I killed my cat yesterday. Euthanized, whatever. He was sick.

Requiescat in pace, Lulu. 1999-2011.

He lost a lot of weight. My wife noted this with concern, but I was not impressed, for he retained his monotonous, demanding yowl. Who’s to be alarmed by a lazy old cat?

He left squirts of diarrhea in my shoes. That got my attention. I was angry at first, then surprised and frightened by his weakness. I asked my sister to bring us to the vet.

After a few moments of examination, the vet declared Lulu’s kidneys irretrievably failed. Without treatment he would slowly wither. With twice-daily hydration drips he would “go on for a while”. Or we could end it now.

Lulu groaned and wriggled meekly, a shadow of the hissing, bucking tomcat of previous visits.

I wanted time for us to say goodbye. I wanted my seven-year-old son to understand Lulu’s illness and death. Before it’s my turn to die. And I wanted to give Lulu a few days of treatment to help him feel better. Before we killed him.

So we brought him home with a liter bag of fluids, drip line and ten needles. I treated him morning and night, piercing the skin between his shoulders and draining 100 ml per treatment of “lactated ringers” from the elevated bag. He walked away bowlegged, with the fluid pooling in his legs and belly.

His condition improved and we savored the time. We stroked his fur, tolerated his uremic odor and forgave his now regular incontinence. For five days. Then the vet (this time, a lady who makes house calls) came to put him down. We would not continue the hydration treatments indefinitely.

He sat in my lap as she injected the anesthesia. He seemed woozy and turned his head as if surprised, then slumped. Time was expiring. In seconds it would be too late to stop, too late to grant my ward the care I expected for myself. And then it was. She injected a medicine to stop his heart and then checked for a heartbeat. There was none. He was dead. Days (or was it years?) of anguish yielded to the irreversible truth, and I sobbed.

Back in ’99, before we were married, my wife and I answered an ad in Uncle Henry’s for free kittens. They were giving away the females and we took two: a black-and-white tuxedo we named Otis (after their place of birth, Otisfield), and Lulu, a sleek silver-hair. We took them back to my father’s house in New Gloucester, where we were visiting, then back home to Lawrence, Mass. and then, a few days later, to the vet, who gently disabused us of our sisterhood with the revelation of Lulu’s distinctly male genitalia. Otis had a boy’s name by design, Lulu a girl’s by accident.

They were joined a year later by an orphaned, flea-bitten mackerel tabby kitten we named Henry. For eleven years the threesome prowled, seeking plunder in youth and then, with age, just dinner and a warm lap. Otis grew fat, Henry selfish, and Lulu paced a middle ground, apparently the only cat who could get along with the other two. He often groomed them (especially Henry) and was fond of licking us as well.

We often thought of Lulu as “not the sharpest knife in the drawer”, given his tendency to get stuck in closets or on roofs or anywhere the route of escape was not readily visible. His breath was terrible, his claws indiscriminate, and his potty training incomplete. He regularly vomited on the furniture. He was also affectionate, and delightfully strange. When he trotted, his loose belly fur would wag comically.

After the vet left, and my wife and I stopped crying, I wrapped Lulu’s body in a shroud of old tee shirts tied up with old socks. His eyes were rolled back. His head swung. I held him in my arms as my wife drove us back to my father’s house in New Gloucester, almost to the very beginning of our journey together, now with our son along. We buried Lulu next to Mittens and Cosmo (my father’s cats) in the tall grass down by Woodman Road, and marked his grave with a plain stone which is less than he deserves. We spoke a few awkward words, sang Michael Row Your Boat Ashore (terribly) and swatted mosquitos.

I don’t find myself regretting our shortage of poignance. Why pretend that any volume of stirring words can meet his peculiar bearing, his flat whining, his maddening habits, or the pleasures and pains of the time we might have had?