Начало нового 2018 года было для меня началом нового этапа жизни, нового опыта — лечения онкологического заболевания.
3 января я поступил в отделение химиотерапии на свой первый курс. Вместе со мной с тот день в отделение поступило более 50 человек. Те, у кого был быстрый курс химии, лежали и в коридорах. В основном все пациенты — люди старше 50 лет. Видел только одну молодую девушку.
Заболевание в молодом возрасте все же скорее редкость. Часто сталкивался с тем, что врачи спрашивали меня кто пациент, считая, что я пришел на консультацию, как родственник.
Я, честно говоря, раньше плохо представлял, как проходит химиотерапия.
Химиотерапи́я — лечение какого-либо инфекционного, паразитарного заболевания либо злокачественной опухоли (рака) с помощью ядов или токсинов, губительно воздействующих на инфекционный агент — возбудитель заболевания, на паразитов или на клетки злокачественных опухолей при сравнительно меньшем отрицательном воздействии на организм больного. Яд или токсин при этом называется химиопрепаратом, или химиотерапевтическим агентом. (Википедия)
Химиопрепараты могут быть как в виде инъекций, так и в виде таблеток и капсул. У меня в первой линии были препараты, которые вводили внутривенно.
Химиопрепараты могут вызывать тошноту и рвоту, поэтому предварительно мне выдали противорвотное лекарство Эменд, а также с той же целью ставят капельницу Ондансетрона с Дексаметазоном.
После этого мне поставили Оксалиплатин. Затем Иринотекан. Перед ним профилактический укол Атропина для снижения рисков побочных эффектов. И вот на Иринотекане я начал замечать, что у меня начинает неметь язык. Я пытался поговорить с соседом по палате, но получалось не очень хорошо. Также начало першить в горле. Вызвал медсестру, она сказала, что это вероятно аллергия на Иринотекан и поставила антигистаминный препарат.
Уже после выяснилось, что это нейротоксическая побочка от Оксалиплатина, которую можно снизить более длительным введением препарата. Также горло будет меньше болеть, если пить теплое, так как особенность этого препарата — это реакция на холод. Гулять зимой после химиотерапии не очень приятно, так как при ветре особенно покалывает лицо, а если что-то начинает подмерзать, то тоже начинает покалывать и неметь.
В дальнейшем мне вводили препарата с инфузоматом, которые позволяет контролировать точное время введения препарата. Возможно реакция у меня появилась из-за более быстрой скорости введения Оксалиплатина.
Далее был Лейковорин (2 часа), препарат без побочек. Он усиливает противоопухолевое действие фторурацила. И после сам фторурацил, который вливают с помощью специальной помпы в течение 46 часов.
И вот помпа в первый мой курс меня подвела. Она капалась медленнее, чем необходимо. А я по неопытности этого еще не понимал. Я должен быть выписаться 5 января, но помпа все капала. В итоге вместо 46 она капалась 72 часа. Позже выяснилось, что это было не очень здорово. Вообще все препараты должны вводиться определенное количество времени для оптимального эффекта: не больше и не меньше.
Побочные эффекты разнятся от препарата к препарату. А при разных локализациях рака назначают разные лекарства. Но есть частые побочные эффекты, которые возникают:
Противоопухолевые препараты нарушают жизненный цикл всех быстро делящихся клеток. Страдают и клетки костного мозга. Этот орган вырабатывает эритроциты (отвечают за перенос кислорода), тромбоциты (отвечают за свёртываемость крови) и лейкоциты (отвечают за иммунитет).
Обычно рекомендуется регулярно сдавать кровь в перерывах между курсами химиотерапии (в идеале раз в неделю). Так мы видим, что происходит с кровью. Кстати, смысл того, что пациенты получают лечение не постоянно, а через определённые промежутки времени в том, чтобы к началу следующего курса костный мозг мог снова функционировать. Для этого подбирается правильная дозировка препарата.
Существуют специальные препараты, которые могут стимулировать восстановление популяции лейкоцитов. Зачастую иммунитет снижается, поэтому стоит избегать людных мест и контактов с инфекционными больными. Нужно полноценно питаться, особое внимание уделять пище с высоким содержанием белка.
По себе также заметил, что если первые дни после химии отлежаться, то побочка будет выражена меньше. А если сразу же после этого начать бегать по делам, то тут легко можно довести организм до того, что следующий курс будет отложен из-за плохих анализов. А это ставит под угрозу всю общую тактику лечения.
Препараты могут вызывать температуру.
Выпадение волос. Это не самое страшное, так как волосы потом обязательно отрастут снова. У меня было некоторое выпадение волос, но далеко не полностью. То есть это стереотип, что волосы обязательно у всех выпадают. Это далеко не так. Еще у меня перестала расти борода. Но это даже было плюсов, так как не надо было бриться)
К побочкам также относятся расстройства ЖКТ: диарея, запор. Нужно помнить: диарея опасна, так как вместе с жидкостью организм теряет и полезные микроэлементы. Их дисбаланс может приводить к серьёзным последствиям. Важно восполнять их потерю. А вообще самый основной рецепт против побочек — это пить воду. Именно чистую воду и желательно 2-2,5 литра (если у вас не проблем с почками).
Против рвоты и тошноты также помогает обильное питье и противорвотные лекарства в таблетках или свечах.
Еще один побочный эффект — стоматит. Я с ним не столкнулся, но очень активно профилактировал его в начале, так как читал, что есть такой риск: полоскал рот после еды специальными антисептиками.
Полинейропатия
Некоторые классы химиопрепаратов специфически повреждают нервные волокна. Это ведет в потере чувствительности кончиков пальцев рук и ног, становится трудно застёгивать пуговицы, меняется почерк.
У меня были такие симптомы. Здесь посоветовал бы держать руки и ноги в тепле. Проявление зависит от количества пройденных курсов. Обычно эти симптомы проходят, хотя и не сразу. Могут сохраняться год и более.
Советую перед прохождением химиотерапии узнать у лечащего онколога с каким побочными эффектами вы столкнетесь и попросите рекомендации по их устранению, минимизации риска их возникновения и воздействия.
Почитайте сами в инструкциях к препаратам (доступны в Интернете), виды и частоту побочек, чтобы быть готовым и профилактировать некоторые из них. Берегите себя после прохождения курса, не напрягайтесь. Это позволит вам во время восстановиться к следующему курсу.
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