Wednesday
[Journal not posted until Thursday at 8:30 AM. I posted a number of new messages last night, which delayed the writing of this journal entry.]
High-Level Journal Summary: Understanding the impact of adrenaline during the days of chemotherapy which are typically the worst in each cycle. A "fight or flight response" can kick in and give a dramatic burst of energy, even during chemotherapy. That is exactly what happened to me when I was at The Rose Bowl on Day 5 and Day 6 of this last chemo cycle.
However, there is a price to pay. The compensatory impact from this adrenaline surge is real, which then explains why I slept with head on shoulder with a complete stranger on the flight home from California to D.C. after the ecstatic events of the days before.
Countdowns:
1.) Day 17 of 28 in my 24th 5/23 Temodar chemotherapy cycle.
2.) Meet with Dr. Howard Fine on 8/24/07 at 9 AM to review my 8/20/07 Perfusion MRI.
2007 Seizure Activity:
1.) Last Simple Partial Seizure, or SPS, was today. I had two SPS's while walking this evening. One was at 7:15 PM, was medium in nature, was contained only in my head, and lasted for 1-2 seconds. The next one was at 7:45 PM, was a bit sharper (but still medium in strength), originated in my legs and rushed to the top of my scalp, lasting for 1 second. The odd thing about the second SPS is that it happened when I was walking DOWN a hill. I usually have SPS's when my heart is racing from being in physically stressful situations. As a result of these two SPS's, I ate a lot of chips tonight to get more sodium into my body. I have not been very good about doing this lately, so I suspect I was hyponatremic this evening. I also think I have been pushing myself too hard in a number of areas, which increases my stress level and also leads to SPS's. This is something also within my control.
2.) In 2007, I have had 37 SPS's in 234 days. This is an average of 1 SPS every 6.3 days.
Actual Journal: In my 8/11/07 online journal entry, I summarized the day as follows:
One of the strangest days -- if not THE strangest day -- I have had in all 24 chemo cycles. Instead of having a somewhat typical Day 5 of chemo, I had a day that was pumped with adrenaline.
Between the advanced preparation I had for today and the adrenaline from being with friends (all in the midst of high-powered music) I had tremendous energy levels that outright surprised me.
Being analytical about everything that happens to my body during chemo, I am left with a number of questions about how a day like today was possible. What allowed it? Was it a combination of things not normally present in my approach to a chemo cycle? Or, is this just an unusually good cycle of chemo?
While I have no complaints at all, there are a number of questions to figure out based upon what happened today. Almost a bizarre day that I did not expect at all.
The impact of adrenaline
Having gone through 24 chemo cycles, I know how my body responds to Temodar chemotherapy. So when the excitement of external events caused a day to be somewhat transformed, it made me more suspicious than anything else. I wanted some insight.
So it is that I brought up this subject with my local oncologist, Dr. Dipti Patel, when we met on 8/20/07. I asked if it was possible for adrenaline to kick in and cause such an effect. Was it really possible for the (typically) worst days of a chemo cycle to be transformed because of external events?
Without blinking, Dr. Patel told me that the answer is yes. She said that this is the same mechanism that has kept us alive for thousands of years. It is adrenaline that has kept us from being gobbled up by animals. In short, this is the "fight-or flight response" that was formally identified by American physiologist Walter B. Cannon back in 1927.
Fight-or-flight response
When researching this subject a little bit, I found the following information in Wikipedia. This information below currently has a few citations which have not been verified, but it certainly gives me a sense that the "fight-or-flight response" has been researched and is understood on biological, physiological, and psychological levels. The biology of this response is what interested me most, which is shared verbatim from the above link.
Biology of the stress response
Normally, when a person is in a serene, unstimulated state, the "firing" of neurons in the locus ceruleus is minimal. A novel stimulus (which could include a perception of danger or an environmental stresser signal such as elevated sound levels or over-illumination), once perceived, is relayed from the sensory cortex of the brain through the thalamus to the brain stem. That route of signaling increases the rate of noradrenergic activity in the locus ceruleus, and the person becomes alert and attentive to the environment. Similarly, an abundance of catecholamines at neuroreceptor sites facilitates reliance on spontaneous or intuitive behaviors often related to combat or escape.
If a stimulus is perceived as a threat, a more intense and prolonged discharge of the locus ceruleus activates the sympathetic division of the autonomic nervous system (Thase & Howland, 1995). This activation is associated with specific physiological actions in the system, both directly and indirectly through the release of epinephrine (adrenaline) and to a lesser extent norepinephrine from the medulla of the adrenal glands. The release is triggered by acetylcholine released from preganglionic sympathetic nerves. The other major player in the acute stress response is the hypothalamic-pituitary-adrenal axis.
Epinephrine, also known as adrenaline
"Elevated sound levels or over-illumination"
I think that drum & bugle corps in The Rose Bowl in front of 30,000 people qualifies for "elevated sound levels AND over-illumination," all at once. No wonder my adrenaline was kicking in as it was.
Compensatory impact
Dr. Patel was quick to point out that adrenaline is not this free supply of supplemental energy. There is a price to pay, if you will, for having adrenaline kick in like it did for me on Day 5 and Day 6 of chemotherapy. And, she is right. I already knew that part of the story.
I still felt the effects of chemotherapy before the drum & bugle corps events on Day 5 and Day 6. I slept for most of the afternoons, I had to regulate my foods, I ate to avoid constipation, I had to counter the metallic taste on my tongue from chemotherapy, etc.
And then, there was the day after. On Day 7 (Sunday), when I was flying home, I slept nearly the entire flight. I was in the middle seat (drat!), sitting next to this young woman who was doing work with the United Nations. She was working for the cause of human rights in Australia, helping Aboriginal Peoples of that land.
She was exhausted from 24+ hours of non-stop travel, and I was exhausted from going so hard while on chemo. We talked for a little bit, and then we both fidgeted around, trying to sleep for the entire trip from Los Angeles, California to the Washington, D.C. area. It was one of those trips where all of a sudden I found a perfect stranger's head on my shoulder, which gave me a perfect place to rest my head, as well.
That's how tired we both were, and I know exactly where mine came from. This was the "compensatory impact" later mentioned to me by Dr. Dipti Patel. Cute story, real payback.
