Bummer

My third round of R-CHOP was scheduled for this past Wednesday at Georgetown.  Andrea and I drove back to DC from RI on Tuesday (horrible traffic again - I despise driving through NY/NJ) to make sure we were back on time for the treatments.  Woke up bright and early on Wednesday morning eager to get started with Round 3. I showed up around 7:30 and was shortly informed by Linda, one of the infusion nurses, that my some of my blood counts (from a sample taken the previous day) were pretty low and that she wasn't sure I'd be able to get treated. 

According to Linda, my neutrophil count (neutrophils are white blood cells that carry oxygen and help fight infection) was less than 700 cells per microliter.  The minimum required count for chemo is 1,500; counts for a normal healthy person fall anywhere between 1,500 and 7,800. Any additional chemo could have wiped out even more of my cells, forcing me down below 500 and into a condition called neutropenia and much more susceptible to infection.  So, after chasing down the oncology doc covering for Dr. Cheson (almost all of the Lombardi docs are on vacation this week, so it took a while to get a final answer), they decided to skip the chemo and give me a Neulasta shot instead.  Neulasta is a white blood cell booster that helps the body increase production of cells and fight infection. 

It seems a little weird to say, but I actually look forward to getting these infusions now and this news was definitely a disappointment to me, especially since I've been feeling pretty normal the past couple weeks.  Since Dr. Cheson won't be back until next week, there's still some uncertainty about my treatment schedule going forward.  Not sure if we'll skip this treatment all together or if it'll get pushed back to next week.  And what will happen to the following three treatments?  Typically the docs prefer to stay on strict treatment regimen, with infusions exactly 3 weeks apart.  Lots of questions I can't answer, so I guess I'll just have to wait until next week to hear from the doc.  To be safe, Andrea and I went ahead and booked additional appointments just to be safe; I'm hoping that they tell me to come in next week for Round 3. 

Andrea and I are headed to West Virgina today to spend a few days honing our (lack of) snowboarding skills.  Everybody was kind of scattered in their New Year's plans this year, so we decided it would be fun to get out of town for a few days and hit the slopes (not to mention I bought a new snowboard this past spring and I've been dying to test it out for the first time). 

I want to thank everyone again for the amazing support you've provided over the last few months.  And thank you so much for all of the awesome donations to Team in Training and the Leukemia and Lymphoma Society.  As of this morning, you've donated over $3,500!  Thank you again and Happy New Year!  I look forward to seeing all of you in 2010!

Round 2 Update

OK it's been a while since I posted anything and I keep telling myself that I should be good about posting stuff, so I'm going to try to make more regular updates. Since I have such a horrible memory, this could serve as a handy tool down road for remembering how I was feeling at points along the way.

Also, thanks to all of you for your support in my Team in Training fundraising efforts.  To date, I've raised more than $2,000 for the Leukemia and Lymphoma Foundation to help fight blood cancers!

So it's been a little more than a week since round 2 of my chemo. I went in to see Dr. Cheson the day before, just to touch base (as I'll do before each treatment). My appointment was for 11:30 but, as expected, didn't end up seeing him or his resident until about 1. Over the past couple months, I've experienced first-hand the numerous inefficiencies in the medical system and while annoying, I'm just glad I have good insurance and am able to get the treatments I need when I need them. I can usually count on my appointments with Dr. Cheson actually finally getting underway at least an hour after the scheduled time; however, I know that he's late because he is taking his time making sure each patient gets the time they deserve - therefore I have no problems waiting. Dr. Cheson reminds me of a eccentric professor or mad scientist - crazy hair, funny mannerisms - but I'm lucky to have him as my oncologist. This guy's one of the leading experts on lymphoma - has 30+ years of experience and has published hundreds of articles on the subject and heads the scientific board of the Lymphoma Research Foundation. His team of residents and nurses is equally capable and helpful; I can always count on Maura, his clinical nurse coordinator, to get me the answers/documents I need quickly.

I went in for my second round of chemo on Thurs, Dec 10. I've had morning appointments for both rounds so far, which is fine by me since I have a good choice of chairs at that point in the day. Once I get in, a nurse will measure my weight, height and vitals and then send the order down to the pharmacy for the drugs. This time around was supposed to be faster than the first time, but it ended up still taking about 6 hours in total; apparently my neutrophil count was pretty low at that point and an authorization was needed from Dr. Cheson before proceeding. No biggie though, doc gave the go ahead and I ready for the hookup. Beth has been my infusion nurse for both rounds so far and I'm really glad I got placed with her. She definitely knows her stuff and always keeps me in the know on the important elements of my treatment. She puts in my IV and gives me my pre-meds (saline, tylenol, sudafed). It takes a good hour for the hard stuff to arrive from the pharmacy, and Beth wastes no time in getting me started.

The treatment regimen I'm on is called R-CHOP, which is basically an acronym for all the drugs I'm being treated with:

• Rituxan - I get this one through IV and it takes the longest (3 hours the first time around and 1.5 going forward).  This is a monoclonal antibody and is a targeted cancer drug that attaches to the target CD20 antigens on the B-cells in my body.  My immune system is then called in to destroy the marked B-cells.  Kind of like those laser-targeting systems the military uses to blow up enemy strongholds.  Rituxan is made using rat proteins...nice.
  
• Cytoxan - Also given by IV.  Aids in the destruction of cancer cells by halting cell division by damaging the DNA that tells the cell how to copy itself.  Unfortunately, chemo does not know the difference between good cells and bad cells, hence the side effects.  Cytoxan is actually a derivative of mustard gas, believe it or not.  
• Hydroxydaunorubicin (Adriamycin) - Given by IV.  Also aids in the halting og cell division.  Classified an an antitumor antibiotic and made from the natural products produced by species of the soil fungus Streptomyces.   
• Oncovin (vincristine) - Also through IV.  This one's also tasked with disrupting the division of bad (and unfortunately good) cells in my body.  It's classified as a vinca plant alkaloid is made from the periwinkle plant.  
• Prednisone - the only drug I take in pill form; taken day of treatment and fours days following.  A type of steroid hormone that doubles as an effective antitumor therapy when coupled with the other bad boys above.  

All in all, I'm still feeling pretty good after round 2 of treatments.  Some noticeable, if minor, side effects up to this point include: pressure in my abdomen (hopefully related to the death of cancerous cells), minor headache, fatigue and a very unpleasant canker sore (which I'm happy to report has finally departed).  I've probably lost about 10 pounds since this whole mess started, and most of that's probably due to stress and muscle atrophy from not exercising for so long following my surgery.  I've also noticed that my head and facial hair has become thinner and started to change texture; it has become noticeably softer.  While not the most ideal situation, it has made shaving a bit more manageable (the hair above my lip stopped growing all together!); if there's one good thing that comes out of this whole ordeal, it might be less ingrown hairs and less excrutiating shaving.  Last week I finally noticed that my hair was slowly starting to come out, especially in the shower.  Bought an electric buzzer and Andrea went to town on my head...see her handiwork below.  Wanted to stick with the mohawk, but didn't think it would be work appropriate.

Team In Training 2010

I Owe You One Swine Flu

A timeline of the events leading up to and following Diagnosis Day ("D-Day"):

• D-Day -5: I had a cough that had been nagging me for a week or so, but nothing out of the ordinary. Peak of the swine flu hysteria: lots of Purells being distributed around the office and increased communications encouraging employees to stay home if exhibiting any flu symptoms
• D-Day -1: Annoying cough still around but no flu-like symptoms so figure I'm fine. Return home from work to hear that one of the roommates may have the swine flu
  
• D-Day, Oct 13. 2009: Decided to make an appointment with Dr. Huang, my primary care doc, just to be sure I didn't have the flu; was able to book a same-day appointment as soon as I mentioned the dreaded swine flu. During my appointment, doc concluded that none of my symptoms indicated swine flu, but decided to perform some other routine checks since it had been a while...eyes, ears, heart, stomach. While performing the standard stomach palpitations, he noticed something that did not feel quite right. I couldn't see anything different while I was laying there on the table, but I could definitely feel it. A bit firmer on the right side. Doc used his fingers to tap around my stomach - the sound from his taps on the right side were noticeably different. He recommended I get an ultrasound as soon as possible.
• D-Day +1: Ultrasound at Fairfax Radiology confirms that there is indeed an abnormal mass of approx. 7 cm in my lower abdomen. Doc recommends CT scan for further analysis.
  
  
• D-Day +2: After drinking two horrendous barium "berry" smoothies, my CT scan also confirms the preliminary findings - large mass in the lower abdomen suggestive of lymphoma. The picture above was from my CT scan - that round shape in the bottom half of my stomach is my unwanted visitor.
  
• D-Day +3: Appointment to discuss test results with Dr. Huang. Today I learned that I almost definitely have some form of lymphoma. Doc lets me know that this is about as much as he can help me and recommends seeing a hematologist/oncologist ASAP.
  
• D-Day +6: Appointment with Dr. Spira at Fairfax Oncology. He agrees with the preliminary assessment on lymphoma and recommends a CT-guided biopsy, a procedure in which an interventional radiologist uses long needle to collect a specimen from the mass. Also in my last weeks of tapering for the Marine Corps Marathon on 10/25...Dr. Spira assures me that there should be no problems in running - good news, although not the advice Mom wanted to hear
  
• D-Day +8: Appointment with the interventional radiologist at Georgetown to discuss the CT-guided biopsy procedure. At this point, I start to hear concerns from others regarding the effectiveness of the CT-guided procedure. There is the chance that this procedure will not be successful in obtaining a large enough sample for pathology to interpret. Start looking at a laparscopic biopsy as the better procedure to obtain a sample...
  
  
• D-Day +13 (Marathon Day): Nerves are high for my second marathon and I hoping for significant improvements over my first time last year. Weather ends up perfect for a long run and the spectators are out in full force. Andrea and me both end up running well and beating our PRs, despite bronchitis beating her down and my little friend hangin out underneath my abs. My final 2009 Marine Corps time: 3:55:32, almost 15 minutes faster than my 2008 time!
  

• D-Day +16: Thanks to Andrea's connections at Georgetown, get squeezed in for an appointment with Dr. Cheson at the Lombardi Cancer Center to discuss a plan going forward and Dr. Bhanot to discuss laparoscopic biopsy procedure. Dr. Bhanot's one of the country's top-rated surgeons and treated us very well, so I was confident that I was in good hands. Surgery scheduled for Friday morning with full anesthesia (was a little nervous about this since I'd never been under before).
  
  
• D-Day + 18: Into pre-Op at 7am sharp. Lots of paperwork and repetitive questions to answer for the surgery team. Head into the OR at approximately 9:30, where Dr. Bhanot makes three small incisions (for camera and tools) to remove a small sample of the mass. All finished and sent to the recovery area within an hour. They send me home with Percocet for the pain (actually didn't experience too much discomfort overall) and tell me no strenuous activity for the next 4 weeks (don't want the sutures blowing out).
  
  
• D-Day +25: Still waiting on results from pathology. Go into Lombardi to get a bone marrow biopsy (allows the docs to see whether disease has spread to the marrow). Fairly quick procedure but certainly not the most pleasant. I heard the needle was sizeable but luckily I didn't see it before it went in. Don't even know how to describe the feeling of needle penetrating your bone...not enjoyable. Also learn during the biopsy that there is some uncertaintly surrounding the exact pathology of my biopsy sample taken last week...they've sent the samples to Dr. Jaffe at NIH, a world-reknowned pathologist specializing in cancer.
  

Surprise!

My name is Trevor. I'm 27 years old. I have a good job. I exercise frequently. I don't eat McDonalds or Taco Bell. I just ran my second marathon a few weeks ago and improved my personal time by almost 15 minutes. Oh and one more thing: I was just diagnosed with cancer - lymphoma to be more precise. I wasn't expecting to hear that I had a big old tumor in my stomach when I went to see my doctor for a routine checkup in mid-October, but that's the news I received. The past few weeks have consisted of a whole lot of scrambling to make appointments, hours upon hours in waiting rooms and on doctors' tables, countless scans and biopsies and a whole lot of anxiety and uncertainty about what the heck this thing growing in my stomach actually is.

Fortunately, I now know that I do not have a little baby growing in my lower abdomen; rather, a nasty "gray zone" lymphoma has decided to set up shop in my body. I have now joined the ranks of the millions of others across the US who are also undergoing their own personal battles with cancer. While my battle will not be easy, I am now ready to focus all of my energy on kicking my unwanted visitor to the curb for good. I never thought I'd be blogging about anything, but I figure it'll provide a convenient space for documenting my experiences and sharing with others. Hopefully in 4-5 months there won't be a need for any more posts. First chemo treatment scheduled for this Thursday, so here we go. Fighters ready...