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