Tick, tock. The clock is ticking on post-chemo side effects.

Oh, wait. I just read that young people today don’t know how to read time on an analog clock. So no more tick, tock!

In any case, we’ve all heard chemo horror stories. So, for those interested, I decided to begin posting this record of side effects as I notice them. I’ll update it throughout the day over the next several days. It will also help me remember what to report to my oncologist at Queen’s. Side effects are personal and depend on the specific chemicals in the chemo cocktail, so your results may differ dramatically.

** Updates: Most recent at the top

Saturday, July 11, 6 p.m.

I have no new side effects to report.

The day started with the installation of grab bars in our two showers. After getting home from the hospital last Sunday, it suddenly seemed clear to me that this would be a most useful addition, a matter of personal safey. We were able to arrange their installation through a friend whose company provides “concierge services” to clients. The job took less than an hour, and cost us less than $300 including labor and the cost of the bars themselves.

When we rebuilt my parents’ old house 12 years ago prior to moving from Kaaawa, grab bars seemed like an unneeded amenity. No longer!

I can report also that we drove to our vet to pick up cat food this afternoon, the first time in two months that I’ve ventured out behind the wheel. Over the past week, I’ve gotten steadier on my feet, able to feel secure walking going out without relying on my cane, and generally feeling better. The drive out to Hawaii Kai, where our vet is located, is a straight shot, little cross traffic, and I felt it was a good test. All worked fine, I didn’t feel stressed, and so unless things change for the worse, I can start doing the short drive to Times Supermarket or Long’s Drugs (CVS for folks on the mainland).

Earlier in the afternoon, a friend drove me to the FedEx store in Kaimuki to send my iPad to Apple for a new battery. It goes overnight delivery to California, but won’t ship until tomorrow. I shouldn’t take for than a day or two to swap the battery out and get it back in the queue for overight delivery to Honolulu. So I expect it to appear at the door by Wednesday or so.

We’re having leftovers from last night’s dinner delivered from Thai Issan on the other end of Kaimuki. I’ve decided their green chicken curry is the BOMB! Flavors are just right, again from my point of view. So leftovers aren’t a let-down!

With any luck, tomorrow I’ll continue to keep those pesky side effects at bay for another day.

Saturday, July 11, noon

The morning was uneventful without the appearance of any new side effects.

I should note that for a while after taking my morning dose of pills, I felt–or imagined feeling–like I took a small hit, but that passed quickly.

And it turns out taking the somewhat larger antibiotic pills requires some extra effort. What I feared was a newly “discovered” allergy to cats seems, based on symptoms, much more likely to be Geriatric Rhinitis. Mucous in the throat and a constant need to clear the throat are symptoms of this affliction that hits many seniors. What it means for me is that I have to take extra effort to keep these pills from sticking in the mucous and starting to disintegrate in my throat. Yuck! Extra water, a few gulps while holding my head up and back to provide more room for the pills to get down. I can’t casually drop the pill in and toss down a sip or two of water, as I do with smaller pills.

For lunch I had a small bowl of good sour poi and a half-tin of smoked clams. The latter for their iron content, the former for its nutritive value and overall soothing effect on the gut.

And I was resting just before lunch and received a surprise visit from Ms. Bessie!!

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Prior entries in chronological order.

Friday, July 10, 2 p.m.

Round #2 of my chemotherapy started at 8:30 Friday morning at the Queen’s Cancer Clinic in the Kuakini Medical Plaza, and was done right on time at 1 p.m.
I was still a bit unsteady when Nurse Pattie cut me loose and a friend picked me up downstairs at the front entrance. During this stay, I tried some Crystal Light ice tea powder, peach/mango flavor. No added sugar, but over-sweetened with artificial sweetener. I cut it 1:1 with water and ice, and it was okay, covering up any weird taste bud activity. But next time I’ll try it 1:4, and perhaps use tea instead of water for the mix.

When I got home, Meda and I ate a light lunch. I had a bowl of corn chowder that our friend had picked up on his way to meet me. Then I took a short nap.

Friday, July 10, 5 p.m.

I awoke after about an hour nap without any new side effects to note. And as the afternoon wore on, I felt steadier on my feet as time passed.

I felt good enough to do a wee bit of entertaining. I had invited Linda Darling Lloyd, a close high-school friend of my late sister, Bonnie, to stop by for a short visit. She is here from her home in Arizona for the University High School Class of 1961 65th reunion held this week. My invite to her was, of course, conditional on whether I was up for a visit.

I was.

Her family lived for some time not far away, near the corner of Pueo and Farmers Road. They moved from Hawaii before her class graduated, but she and my sister had worked together decades later to establish a Daughters of Hawaii presence at the annual Arizona Aloha Festival, a two-day event featuring everything Hawaiian that draws as many as 100,000 people over two days. Apparently planty of Hawaiians and former Hawaii residents have relocated to sunny Arizona.

That’s Linda to the left in the photo, and Bonnie over on the right, in the Daughters of Hawaii booth. I don’t knon the year. Perhaps around 2010? Photo found among those I downloaded from Bonnie’s computer after her death in 2016.

After she left, I felt ready to eat. So we used DoorDash to have food delivered from Thai Issan, located next to Foodland in Market City. Chicken larb, green chicken curry, and white rice. I would normally order brownn rice, but they say white is easier for my system to digest. We ordered the larb medium hot, the curry mild. We discovered this combo on our last order and the tastes agreed with both of us.

I ate well, although I didn’t insist on eating until the food was gone, as I might have in the past.

When pau, I still felt good. Stayed up late, for me, and was in bed just before 10 pm.

Of course, I wondered what as-yet-hidden side efects might be coming at me just around the bend.

Saturday, July 11, 5:30 a.m.

I slept until 5:30 and found Kinikini curled up next to me. Opened my eyes slowly, trying to assess how I was feeling. During the night, I lay awake for a while feeling like I was buzzing. It passed, and I had fallen asleep again.

When I stood up, it took less time than it has to feel my brain catch up with my upright position. And, as I walked to the kitchen, I felt steadier than yesterday. I drank a glass of water, sat down at the table in front of my MacBook Air to check email and messages, then opened and worked my way through a commercial protein shake, part of case ordered from Costco a couple of weeks ago.

Meda got up an hour or so later. I made coffee (Peet’s decaf House Blend, dark roast) and sourdough toast, mine with a little honey. Then I got around to inally taking my pills (two antibiotics and one for an ulcer) at 8.

Still no new adverse side effects noted.

I wondered whether they are being masked by the residual effect of an anti-nausea drug aministered at the beginning of yesterday’s chemo session. So I looked up the medications in MyChart, which has become the standard data system available to patients.

“ondansetron 16 mg and dexamethasone 12 mg IVPB Stopped at 8:41 AM” So a combo, anti nausea with a steroid chaser to enhance its effects.

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Here’s what the Internet Web told me this morning about the residual effects of the drugs. The info was heavily footnoted, but I omitted the footnotes to make it easier to read.

When administered intravenously (IV) prior to chemotherapy, this single-dose combination is specifically designed to provide complete protection against acute side effects for the first 24 hours.
However, because chemotherapy-induced nausea and vomiting (CINV) occurs in distinct phases, the protection windows for each medication break down as follows:
1. The Acute Phase (First 24 Hours)

* Ondansetron (16 mg IV): This medication targets the acute phase of chemotherapy side effects. It works immediately upon injection and remains highly effective at blocking serotonin signals in the gut for 8 to 12 hours. Because 16 mg IV is the maximum safe single dose, its protective coverage naturally tapers off as you approach the 24-hour mark.
* Dexamethasone (12 mg IV): While given on Day 1 to immediately boost the power of the ondansetron, it also provides extended coverage. Its biological effects in the tissue will actively suppress inflammatory triggers and protect against acute nausea for the full first 24 hours.

2. The Delayed Phase (Days 2 to 5)

Chemotherapy side effects often experience a second wave—known as delayed CINV—which typically begins 24 hours after your treatment and peaks between 48 to 72 hours.

* The Coverage Gap: A single IV dose of ondansetron given on Day 1 will not protect against delayed nausea on Days 2 or 3.
* The Extended Role of Dexamethasone: The 12 mg IV dose of dexamethasone has a long biological duration (up to 72 hours) and will continue to provide a tapering baseline of anti-inflammatory protection into Days 2 and 3.

The first 24-hours after these drugs were administered will be at 9 a.m. After that, I guess, as usual, we’ll see.

And remember that I’ll be back to update this later in the day.

Photo taken earlier this morning as Kali and Kiko jockeyed for position.