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.

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.