Archive for December, 2005

Aftereffects

Friday, December 30th, 2005

My head is still buzzing from the medications, and I again feel out of it for a couple of days after treatment. My face isn’t beet red the way it was yesterday, though. At least my appetite is good. Nausea hasn’t been much of a problem.

Second chemo session

Wednesday, December 28th, 2005

Today’s treatment lasted about 5 hours, but I think that’s because they were so busy and there were fewer nurses working over the holidays. The benadryl knocked me out again but by the time I left I was ready for a milkshake at the mall.

The Week After

Thursday, December 22nd, 2005

Finally able to get out of bed after 3 days. I had a temperature that ranged from 97 to 101 degrees, and THE worst headache ever. I could just barely tolerate reading. Sandi made me call the doctor, who said it was probably caused by going from 100mg of prednisone for 5 days down to 5mg. He’s having me taper off with 50 for a couple of days, then 40, 30, 20, and 10. I feel much better.

Appointments

Sunday, December 18th, 2005

Had X-rays taken today of my shoulders, hips, and thighs. Among other doctor’s appointments, I spent most of the day in waiting rooms. Saw the oncologist in the afternoon. He didn’t see anything significant on the X-rays.

He also had the final results from the PET scan. It looks like I have activity in other lymph nodes, but it’s hard to tell in some areas. Inflammation from arthritis can also cause the films to light up in those areas. But since it’s in the chest and abdomen areas, it’s upgraded to a stage 3 or 4.

We’ll do another CAT scan after 3 cycles of chemo, and a final PET scan at the end.Had X-rays taken today of my shoulders, hips, and thighs. Among other doctor’s appointments, I spent most of the day in waiting rooms. Saw the oncologist in the afternoon. He didn’t see anything significant on the X-rays.

He also had the final results from the PET scan. It looks like I have activity in other lymph nodes, but it’s hard to tell in some areas. Inflammation from arthritis can also cause the films to light up in those areas. But since it’s in the chest and abdomen areas, it’s upgraded to a stage 3 or 4.

We’ll do another CAT scan after 3 cycles of chemo, and a final PET scan at the end.

Second Day After

Friday, December 16th, 2005

Appetite getting back to normal. Feels good to lie down and rest.


The lump on my neck is completely gone. It’s amazing.

The Day After

Thursday, December 15th, 2005

Only feeling a bit nauseous, but my head feels different and my heart is racing as if I’d had too much caffiene. That’s probably from the Cytoxin. Not to mention all the other stuff coursing through my body.

Chemotherapy

Wednesday, December 14th, 2005

The results of the PET scan showed some areas in the left shoulder and hips, as well as lymph nodes in the chest and below the diaphragm. That would make it a stage three or four, but we’ll wait and see what the final report says. I’ll need to get some x-rays.

The bone marrow test was negative – no lymphoma. That’s good news.

Had the first chemotherapy session today. I took a lot of notes. The medications used vary slightly from what I originally wrote down.


  • Benadryl – antihistamine
  • Dexamethazone 20 mg – Anti-inflammatory
  • Rituxan 791 mg – anti-cancer drug
  • Aloxi – long-acting anti-nausea
  • Doxorubicin – “the red devil” another anti-cancer drug
  • Neulasta (the only subcutaneous shot) – Reduces risk of infection
  • Vincristine – anti-cancer drug
  • Cytoxin – anti-cancer drug

For oral meds, I’m taking an Emend tablet once a day for three days starting today for anti-nausea, and 100mg of Prednisone a day for five days starting today.

The nurse explained each drug and its possible side effects. There are certain things I should watch out for and call them about.

Expected side effects are the change in or loss of taste, and my hair will start to fall out in about three weeks. I should still have hair for Christmas, though. A cumulative lack of energy is the most commonly reported side effect. Fevers can be expected about a week after therapy, for three or four days. It shouldn’t be a problem unless my temperature reaches 101.

The session started about 9:30am and was over with about 3:30. Once they see you’re not having an adverse reaction to the drugs, they can deliver it at an increased rate. Future sessions should take about three or four hours.

Bone Marrow Scan

Friday, December 9th, 2005

The Ativan helped relax me before the bone marrow test. That was an interesting experience. Five more needles, but who’s counting. It was very uncomfortable and I don’t know how these bone marrow donors do it. I guess you do what you have to do.

Sandi asked if I wanted to go home and lie down afterwards, but I was hungry so we went to the mall to grab a bite to eat and do a little Christmas shopping. Plenty of time for lying down later.

PET Scan

Wednesday, December 7th, 2005

Had the PET scan today – not a pleasant experience. That was the fourth needle in three days, but that wasn’t anything compared to my reaction. They inject you with a radioactive sugary solution and it let it take 45 minutes to get through your system before doing the scan. The solution is attracted to cancerous cells, so those areas are “lit up” on the films.

Of course I fell asleep in the recliner for about 20 minutes, and when I woke up I felt queasy and my heart was racing. I thought it was a normal reaction to having radioactive isotopes injected into me. I didn’t feel much different when they did the scan – fell asleep on the table too, with my arms over my head. (I think my primary care doctor is right about the narcolepsy, but I won’t find out until February.)

Felt pretty cruddy as I left but went home to lie down. Sandi called and was concerned about how I felt, so she called the PET scan center and they said I should go to the ER because there is no such thing as a reaction to the shot. I thought they were mistaken, but she came home to check on me anyway. When she saw I was okay, just waiting for the effects to wear off, she went back to work.

We should have preliminary results by Wednesday when I see Dr. K. for chemotherapy.

Prognosis

Tuesday, December 6th, 2005

Today marked the first visit with my oncologist, Dr. K. He gave us A LOT of information so this will be a long entry. We tried to take as many notes as possible, and he gave us a folder full of information. He also gave us a notebook to keep our notes in for the duration of my treatment.

While we were there he received the results of the biopsy from Boston. The official name is Diffuse Large B-Cell Non-Hodgkin’s Lymphoma and he would classify it as stage 2A, intermediate/aggressive. The growth rate is rapid and right now it’s confined to above the diaphragm. It only involves one lymph node that we know of, and I don’t have fever, night sweats, or weight loss.


He recommends six to eight chemotherapy treatments every other week followed by a dose of radiation. That would be 12 to 16 weeks, which would end sometime in April. I told him that since the cancer was aggressive, I’d like my treatment to be as aggressive as possible; whatever it takes.


He said I should notice a difference right away, shortly after the first treatment. The lump in my neck should reduce in size and the wicked headaches should go away. He’s treated many cases similar to mine with success.


We’ll probably be able to get rid of all the cancer and it will be considered in remission. With this type of lymphoma, there’s a 70% chance that it will be in remission permanently. Meaning I’ll never have it again. I like those odds.


He gave me a few prescriptions for oral medications to get filled prior to my first chemo treatment. They’re mostly to treat the side effects:


  • Gatifloxacin (Tequin) – antibiotic for fever control
  • Lorazepan (Ativan) – causes drowsiness
  • Prochlorperazine (Prochlorper) – to treat existing nausea
  • Aprepitant (Emend) – to prevent nausea (take 1 a day for 3 days starting on day of treatment)
  • Prednisone – a corticosteroid immunosuppressant (100mg/day for five days starting the day after treatment)


The chemotherapy will consist of a battery of medications given intravenously. As far as I could understand, they’ll consist of the following:

  • Cyclophosphamide (Cytoxan)
  • Rituximab (Rituxan)
  • 5-Fluorouracil (5-FU)
  • Doxorubicin (Adriamycin)

Apparently the Rituxan takes 6 hours to administer so it won’t be a shock to the system.

I need to schedule a 2D Echo test with a cardiologist to get a baseline reading. Apparently some of the medication can affect the heart or circulatory system.

I also scheduled a bone marrow biopsy on my way out. They need to make sure my marrow is healthy and there are no signs of the cancer in it.
I’m to take 2 Ativan tablets 45 minutes prior to the surgery to relax me. I could also take a tablet if I have trouble sleeping at night. Sandi will be driving me to the appointment so that will work out great.


He asked for the name of my primary care doctor, Dr. N., whom I’ll be seeing tomorrow for unrelated health issues. And he’ll also be in touch with my rheumatologist, Dr. Y., to see if I should stop taking Humira while undergoing chemotherapy treatment.
Humira (adalimumab) is another immunosuppressant, a biological response modifier in the DMARD (disease-modifying antirheumatic drug) class. It suppresses overactive immune systems and calms the arthritis. In my case, it’s kept it in complete control, similar to remission.

All of the chemotherapy drugs are also effective at treating rheumatoid arthritis (RA). So I’m to stop taking the methotrexate, celebrex, and 5mgs of prednisone daily (except when I’m not on the higher dosage).



Dr. K. stated that there is a high number of lymphoma patients who also have RA. Basically RA is when your immune system goes haywire and starts attacking healthy joints. And apparently whenever you have immune system problems, you’re of course susceptible to things you normally wouldn’t be. There is a possibility that the RA meds may also play a part, but there haven’t been enough studies yet.