CARLSBAD -- For cancer patients, chemotherapy can be nearly as frightening as the disease itself. Over decades, the image has become grimly familiar to anyone who knows a chemotherapy patient: emaciation from nausea and lack of appetite; a slow, halting walk; a wig or scarf to hide the hair loss, perhaps obtained from a store that caters to chemotherapy patients.

But the worst effect is often internal: a feeling of chronic exhaustion and helplessness. Chemotherapy drugs are poisons. While selected to be especially effective against cancer cells, they also affect normal cells. The result: a grim endurance contest between the patient and the cancer. The patient is an onlooker while the battle rages within.

It doesn't have to be this way.

While chemotherapy will never be pleasant, patients can shield themselves from its worst effects and tilt the odds in their favor. Harvey Rushfeldt discovered this while undergoing chemotherapy for non-Hodgkin's lymphoma last fall and this spring, The Carlsbad resident applied lessons learned from his own battle against alcoholism, along with help from the San Diego Cancer Center.

Tanned, smiling and fit, Rushfeldt today radiates healthiness. He finished his treatments in April, with no sign of the disease remaining. At 72, his plans revolve around travel, especially to Baja California, where he likes to go fishing.

A happy ending, to be sure. But for patients, the most important part of that story is in the middle. What was his secret?

A huge loose-leaf binder Rushfeldt compiled during treatment provides part of the secret: discipline and focus. The binder is full of charts, treatment records and other information related to his treatment. These include what drugs he was given and when, what classes he took in managing chemotherapy symptoms.

Instead of just going along for the ride of chemotherapy, Rushfeldt was determined to be in charge of his illness and treatment.

"It's said that chemotherapy is like skiing in front of an avalanche. You do one thing wrong, and the avalanche is going to get you," Rushfeldt said.

Attitude first

The most important thing in that binder may be a chart Rushfeldt made. It bears six large letters: ADELSS. Each letter refers to a component of his personal regimen.

First is A, for a positive Attitude. Rushfeldt said he would not have survived without it.

With the right attitude, Rushfeldt had the motivation not only to endure the treatment, but to do everything possible to keep his body strong. That meant, among other things, the proper Diet, Exercise, Liquid, Sleep and Support.

Rushfeldt had developed on his own some of the principles taught in the fatigue management classes at the San Diego Cancer Center, said Dr. Lynette Cederquist, his oncologist. Rushfeldt reinforced those lessons with classes he took in the winter of this year, shortly before the end of his chemotherapy, she said.

"The most effective means of managing the effects of chemo is an appropriate level of exercise, not overdoing it, and getting enough sleep," Cederquist said.

While exercise and sleep are good for everyone, healthy people have energy reserves that allow them to cut corners, Cederquist said. Patients undergoing chemo don't have those reserves.

"Patients have to take ownership of their health care during treatment," Cederquist said. "They have to learn a new lifestyle where they slow down and pace themselves."

However, Cederquist said some patients taking chemo don't fully understand what the fatigue will do to them, and don't think to report it.

How it began

A painless lump in the abdomen gave Rushfeldt his first clue that something might be wrong. Aside from having recently lost weight, Rushfeldt said he had no symptoms.

Rushfeldt went for an examination in late October. His doctor immediately ordered a battery of tests that diagnosed the cancer. The lump, which was 5 inches long, was an enlarged lymph node. The diagnosis forced Rushfeldt to cancel a planned fishing trip to Baja California that fall and this spring.

The treatment consisted of a well-known combination of chemotherapy drugs called CHOP along with a completely different treatment, Rituxan. A so-called "monoclonal antibody," Rituxan attacks certain white blood cells called B cells that become cancerous in non-Hodgkins lymphoma.

Rituxan was discovered by Idec Pharmaceuticals in San Diego, now part of Biogen Idec, based in Cambridge, Mass. It's sold by that company and Genentech, a biotechnology company based in South San Francisco.

Each person responds differently to chemotherapy. For Rushfeldt, one of the most alarming effects was a constriction in his chest.

"It was real tight. It was like I couldn't breathe," Rushfeldt said. "That went through the first three cycles (of treatment), then it just disappeared."

Lessons from alcoholism

Rushfeldt views his cancer and alcoholism as similar in that both are mortal threats.

"I am an alcoholic, and I stopped drinking July 7, 1979," Rushfeldt said, laughing slightly at the precision.

"It's as deadly a disease as cancer," he said. "It's going to get you if you keep drinking." Alcoholics Anonymous is very emphatic on that point.

"When you get on the pity pot, you're given tough love. If you feel sorry for yourself in AA, you're kicked out of a meeting. Go drink and when you're ready to come back, come back," he said.

So Rushfeldt said when he contemplated his cancer treatment, "my history with AA came back with full force."

"In AA, they say, if you're tired or alone, you're going to get into trouble. So this is the same thing: If you don't do this, you will suffer more. If you do these things, you will suffer less."

But at first, Rushfeldt didn't tap into the knowledge. Depression floored him.

"The first cycle, I just fell apart. I was on the pity pot big time. I didn't do anything right. When the chemo side effects started building up, I didn't drink liquids. I didn't exercise. I didn't sleep right. I didn't do anything right. I just felt sorry for myself until my temperature was up and I called the emergency room."

That was for about a week in November. After getting out of the emergency room, Rushfeldt shaped up. He got off the pity pot.

"I reached out for more personal support, and I had recognized what I had done to myself. I just changed that. It developed into this thing I made for myself," said Rushfeldt, thumping his loose-leaf binder.

That binder became Rushfeldt's treatment bible, organizing and documenting his treatment from November until this April. Part of it consisted of advice he'd received from doctors at the San Diego Cancer Center, part of it from his experience battling alcoholism, and part from information he'd gleaned from medical sites on the Internet.

Recovery

Rushfeldt soon became fascinated studying the course of his treatment and how his body responded. For example, he regularly weighed himself, and compared his weight over time with his chemotherapy regimen. A pattern emerged: Rushfeldt would lose weight, as much as 12 pounds in a day, after getting his cycle of drugs, then the weight would return.

"And I was rigid on my diet, exercise, liquid and everything else, but the chemicals have a strong effect. Certain things, no matter what you do, you're not going to overcome."

But even then, knowing what would happen helped Rushfeldt cope. After the first cycle of treatment, his hair began falling out. Rather than wait, Rushfeldt got a haircut.

"It was better to do than having it look scraggly," said Rushfeldt, who once again sports a full head of hair.

- Contact staff writer Bradley J. Fikes at bfikes@nctimes.com or (760) 739-6641.