Today was my official teaching session.  We arrived at the office in Encinitas and pretty quickly were back in an exam room where we started out watching a movie that covered Chemotherapy in more general terms, then one of the nurse practioners came in to brief us on the specific drugs that would make up my particular cocktail.

Here is what I will start with.  In a few weeks I will pick up another drug that I will discuss at that time.

• Oxaliplatin – This drug works by damaging the RNA or DNA that tells a cell how to copy itself.  The intent is to prevent the cancer cells from successfully reproducing.  It has some possible side-effects, the main one being a sensitivity to cold, so it is good that I am doing this in San Diego.
• Flourouracil (aka 5-FU) – This drug works similar to the Oxaliplatin by targeting the RNA or DNA to prevent the cells from reproducing.  It has several possible side effects as well, with the main one being dry palms and feet and sensitivity to light.

The side effects of these are both related to how they will effect other fast reproducing cells.  Since it is not possible to just attack the cancer cells directly, the drugs will necessarily also attack other fast reproducing cells such as hair follicles, mucus membrane cells, and some skins of the dermis (skin).  Since the good cells in this category far out number the cancer cells, what will kill off the cancer cells will inconvenience the other system of cells which will be able to recover over time.

The war that we will be waging is like laying siege.  Once I have healed from the surgery, we will add another drug to the cocktail that will attack the ability of the cancer cells to receive oxygen and nutrients from the body.  The cancer cells exist because they possess the ability to fool the body into routing blood to them to feed their needs.  This last drug will restrict the bodies ability to create new routes for blood to flow which is why it needs to be delayed until my wounds are healed, but once engaged should start to starve out the cancer cells, which lacking the ability to reproduce will die without replicating resulting in the desired results.

There is a final drug in the cocktail that is not technically a chemotherapy drug, but acts to fortify those drugs.  In this case it is:

• Leucovorin (aka Folinic Acid) – This is a reduced Folic acid and is used in concert with the Flouroouracil to increase the ability of the cell to hold onto the 5-FU longer.  Normally the 5-FU would only stay in the cell for a short time, but this drug can enhance the binding of the 5-FU to an enzyme inside the cancer cells, increasing its effectiveness.

So that is my 411 on the chemotherapy cocktail.  The 5-FU will need to be delivered over a long time, so that will require me to wear a small delivery system for 2 days as it is slowly administered.  Unfortunately this precludes my original plan of getting the treatments on Friday since the delivery system will need to be removed on the second day, which would be a Sunday when the office is not open.  Tentatively my first treatment is now scheduled for next Wednesday (1/24) with the deliver system removal on Friday (1/26) and a follow-up (a one off due to this being the first treatment) on Tuesday (1/30).

Other than my teaching, I worked the rest of the day after that and the highlight of the day, Liz made a ground turkey Bolognese ( marinara sauce with ground turkey ) and whole wheat spaghetti for dinner.  It was a welcome change from the chicken or turkey sandwiches we had all been eating for the last week.  Due to the ileostomy I need to eat more nutritionally dense foods and since my weight loss has not yet been arrested, I am looking to add more calories as well.