Chapter 5 - PICC line

After the first round of chemotherapy ended, the doctor advised us to get  a PICC line, it will be good for papa. I wondered how? Anways we had to get it done. But what was supposed to do good to papa, brought so many problems. Anyways, when the doctor said abut picc line, I wanted to know more about it. Since it was anew domain, i decided to do a research.

What is PICC line?

If i were to put it into  simple words - PICC (or peripherally inserted central catheter ) line is basically a very sleek tube made of biocompatible (silicon) material, is inserted in to the vein and is advanced till it reaches the chest. This helps the doctors in avoiding daily pricking and finding the vein(s) for tests, infusing chemotherapy medicines. And I was told it will help papa.

Hep Lock

A part of the tube is left outside. This opening on the outside is closed with a lid (or cover).  It is through this opening that the blood is taken for test(s) or chemotherapy medicines are induced. But in CANCER nothing comes without side effects. So did the picc line insertion. The whole process turned out to be very difficult and painful. Both before and after the chemotherapy session,  HEP lock ( flushing medicine) was used to flush (clean out) the intravenous (IV) catheter, in order to prevent any kind of blockage ( blood clots)  in the tube after the IV infusion(s). While  FLUSH (ing), it is important to care that no air bubble(s) is present in the vaccine (which may  further complicate the matters). 

Side effects

After every 7 days, it was mandatory to do the picc line "dressing" ( cleaning, flushing, and finally bandaging) in order to prevent any type of infection(s). Precautions were needed to be  taken so that no water enters in the picc line “area”.  As a result papa couldn’t  move his hand freely, wear his favorite full sleeved shirts or sweaters, or bath as frequently as he wanted.

Opening of the picc line tube

Since the “picc” line was inserted in papa’s right hand, which made things more difficult for him. The pain actually never subsided. But under the influence of some drugs, he would sleep for few hours, picc line only made it worse. He had to be alert  even while in his sleep- the picc line doesn’t get pulled out or pressed. He never slept literally. Usually the picc line is inserted in the left arm, heart being on the left side . That ways the tube inserted in smaller in length, therefore less chances of breaking. And since left hand is not used much so it becomes easier( unless you are a lefty).

Insertion of the tube

PICC line in india is usually inserted by a trained staff ( in papa's case-  by a  junior doctor). Although,  the picc line can be removed by anyone ( even by a family member) as long as the necessary precautions are taken care off. For papa, it was removed by the palliative staff who would visit papa at home after he became bedridden.

The picc line can stay upto 1 year with proper care before it is discarded . In papa’s case it was for 7 months. I got it removed only after the doctor’s declared “ nothing can be done”. After the picc line was removed, i noticed a black circular ring around the hole created by the insertion of the picc line. I told the doctors, they prescribed an ointment. The ointment did lessen the itching and but pain remained as it is.

By Side effects

Other side effects of picc line papa suffered were rashes, itching and swelling (in the throat), dizziness, and difficulty in breathing.

Having lived cancer (with papa), now for almost 2 years, i can say that cancer is not just one disease but a combination of many disease(s). And this is what killed papa. Though papa’s ordeal ended but mine’s is still continuing. I cannot forget the moments when papa would endure all the pain without a single complaint just to be with us.

Love you papa!

Chapter 5 - Acid in my veins

While in my earlier posts, i have talked about chemotherapy being a painful process. My experiences with chemotherapy were horrific especially because papa received  it through veins (Intravenous). He

was confined to bed, starting from 10hrs to as long as 56hrs. The only time the he was allowed to move was when using the wash room. The process was repeated every 8th day. Apart from the known side effects of chemotherapy. There were some by-side effects also such as:-

• The veins were always swollen
• At places blood clot appeared
• The area around the prick darkened as compared to the natural  color of the skin.
• There was itching and since, the healing mechanism was already very slow, so the prick actually never healed.

My knowledge about chemotherapy was very limited then. All i knew was, what i could see. Papa was already in pain due to spreading cancer and chemotherapy only added to the woes. I am not not suggesting not to get chemotherapy. In 97 % of  the cases it doesn’t work.  May be you are one of the fortunate 3% who beats cancer and survives (Pls see the video )

To understand pain, you don’t  really need to know about chemotherapy. But to understand the treatment your loved is undergoing, it is important that you know all about chemotherapy

Chemotherapy, is a treatment usually given to patients suffering from cancer. More then 100 drugs are available and to treat cancer they are combined in different proportions depending upon the type and stage( spread or size of tumour) of cancer and the patient's age, overall health  and the ability to deal with the certain side effects.

Depending upon the prescribed treatment, your oncologist will be able to tell you about the schedule that you need to follow in the months to come. Papa, in all received 2 cycles of chemotherapy  orally. Each cycle comprised of 3 months. In the these 3 months the treatment was received in 2 phase(s). These  cycles comprised of  giving medicine and drugs orally and through veins. After the first phase a picc line ( will explain in my next post)  was inserted in papa's right arm.

In the first phase, he had to spend 3-4 days in the hospital. After that a gap of 7 days was given in order to heal ( known as the recovery period). In the second phase .i.e on the 8th day the chemotherapy session lasted for about 6- 10hrs, so papa was allowed to go home the very same day. And again on the 8th day, he was admitted to the hospital for 3(or 4) days. This continued till the end .After 3 months,  a review was done to check the response of cancer to  chemotherapy (medicines). 

Chemotherapy - ways to receive

Through Veins (Intravenously) :The medicines are injected  directly into the veins. This is the most effective method and most of the  traditional chemotherapy drugs are given by this method. A single dose of IV chemotherapy can last from a few minutes to a few hours. However, there are certain drugs which have best effect  when given at a slow continuous rate for a few days to fews weeks at a time.

Via Injection:  The medicine is given injected  as a shot to a muscle or to the fatty part of the arm abdomen or leg.

Oral : Pills, capsule, or liquid(s). Popular traditional treatment method. But of late is becoming a much more common method of administration, especially with newer targeted therapies.

Intra-arterially (IA):  The medicine  is sent directly into the artery that supplies blood to the part of the body affected with cancer.

Intraperitoneally : The medicine is sent directly into the abdomen or peritoneal cavity ( part of the body that contains the intestines, liver, stomach). In case of women, the medicine is sent to ovaries.

Topically. Ointments and creams. The medicine is applied on the surface and then  rubbed into the skin.

In 2012, when papa was detected with cancer, my knowledge about cancer-the disease was very limited. To be honest, I just knew the term “CANCER, that too heard mostly in hindi movies. But when papa was diagnosed and  treated for cancer, everyday was a new challenge. The journey was painful. It was an emotional roller coaster for me and papa.  Ultimately papa lost his life and it gave my life a new direction.  I decided to write about CANCER. My father's last wish was that i write ( how unfortunate that i am writing when he is not here to see ) I learnt things mostly during the course of treatment or after papa left.  Now , I try to read about cancer as much as i can. So that i can pour my research into words to the benefit of someone who wants to know. There is so much, I have learn't , there is still so much to learn. But i will never stop. This  is my way of keeping close to papa and may be..... he is reading!

Love you papa!