Archive for April, 2006

Radiation Oncologist

Friday, April 28th, 2006

Today was my first visit with the radiation oncologist. An initial visit to review my case so the doctor may later determine if I’m a good candidate for radiation therapy. After turning in whatever scans I had and filling out the usual paperwork, it was a short wait until we saw the doctor.

She briefly examined me and asked questions as she went along. She said my underarm and pelvic lymph nodes are okay. Everything that was abnormal, according to all my scans, is getting better. My rheumatoid arthritis may have increased the side effects of my treatment, but there are fewer in cases where the RA is under control.

She seemed to have a wait-and-see attitude, but also said the preliminary diagnosis is that I may not need any radiation treatment at all.

I need to go back at least two weeks after my scans for my next visit, at which time she’ll have a plan developed for my treatment. If I am to be treated, I’ll be fitted with a face mask since the radiation will be mostly to the neck area, where the large tumor was. I will also undergo tests at that time and be scheduled for my first treatment.

At this point she can’t say how many weeks of treatment I would need or how much radiation. Lymphoma requires less radiation than other types of cancer because it’s more sensitive to it. But the treatments would be daily (Mon-Fri) for 30 minute periods. I could schedule anytime between 7:30 to 4pm.

She sent me off with a cd video, vhs tape, and hardcopy info that describe radiation treatment and side effects and should answer any questions I might have.

Her prescription for me was to get out and walk as much as possible, and enjoy quiet hobbies. On the way out I made a follow-up appointment for May 23.

Feeling Better

Sunday, April 23rd, 2006

Although I’m still not sleeping much at night, this weekend I had a little bit of energy. It felt great to be able to get up and do things. I plan to enjoy it while it lasts – probably until the radiation starts.

Forgot to mention that on last Tuesday, the 18th, I saw the oncology P.A. at his request. The cat had bitten me three times last Friday
night/Saturday morning (14/15 April) and once again Saturday night/Sunday morning. She broke the skin so Sandi called the doctor (not to mention the veterinarian) who wanted to make sure there was no infection.

Fortunately there wasn’t; it was only only a scratch. Unfortunately, the reasons behind the cat’s aggression could fill a whole other blog. Let’s just say we’re working with the cat
on this one.

More good news was that my blood cell counts were okay. I had to get a new prescription for my headaches but as they’re fewer and further between I have a feeling this will be the last. Maybe this means that my energy and motivation levels will be gradually picking up soon.

Easter Sunday

Sunday, April 16th, 2006

Today is Easter and I’m starting to gradually get some energy back. Friday I was able to go out to run some errands, and today was the first day I haven’t spent in bed for a long time. I had a brief period of motivation and energy this afternoon; just enough to unpack and stack some boxes in the basement.

Sandi made my appointments for me, and was able to get them scheduled at the same facility on the same day. I’ll have the bone and PET/CT scans on 4 May. She’s really great at helping me out by making appointments and keeping track of them for me. She knows I sleep a lot during the day and sometimes don’t have the energy or motivation to even get up and talk to people on the phone. Of course, I’m always glad when I do get the chance to talk to someone.

Blood Test Visit

Wednesday, April 12th, 2006

I’ve spent the past week after chemo in bed, dozing on and off until late afternoon and unable to get back to sleep until 2 or 3 in the morning. Sunday night I felt well enough to go out for some ice cream after dinner, and actually drove for a change.

Today was a busy and tiring day with three doctor’s appointments.

I first met with my rheumatologist to discuss the resumption of my treatment now that I’ve finished chemo. I learned that Rituxan is being looked into for treating Rheumatoid Arthritis, and the doses I’ve received over the past four months may keep my RA in remission for up to six months. However, Rituxan would only be used in cases where patients haven’t responded to anything else.

Since I’ve responded well in the past to Methotrexate and Arava, we probably won’t have to go back to biological response modifiers/TNF blockers like Humira and Enbrel. Which is fine with me – I’ve had enough needles now to last me a lifetime.

Dr. Y. is very active in the international medical community and will probably present my case at various symposiums. Not much research is available on RA patients who have been given Rituxan, so I can expect to hear from him and may be asked to tell my story in person.

At any rate, if I am to receive radiation treatment, I’m to stop the Prednisone for the duration. I’m down to 10mg/day as a maintenance dose.

Next was my oncologist, for my between-treatment appointment to check my blood counts and see how I’m doing. My white blood cell count was low but apparently not low enough to require a shot. It should start picking up but the doctor still wants me to take a Tequin for the next five days to ward off infection and prevent fever.

He asked about symptoms and side effects, and I told him aside from the usual, my legs have been very sore during the past week. Not just the joints, but in the muscles, tendons, or ligaments. He told me that was common, and the medical term was arthralgia.

A fancy name for sore joints.

He wants to see me again in about five weeks, so I made an appointment for 16 May. Prior to that, around 8 May, he wants me to get a bone density test and a final PET/CT scan. The bone density test will show if my bones have been affected by the chemotherapy medications. They can sometimes cause a loss of bone density, which in turn can cause a lot of problems. I don’t know what the treatment for that would be, but I’m sure it’s correctible. The PET/CT scan will show if there is any cancer left in my body.

I asked about the radiation, and he wants me to make an appointment to be evaulated for radiation therapy as soon as possible. The radiation would be mainly to the neck area, where the tumor was. I made an appointment on the way out with the radiation oncology folks for 28 April, and I need to bring with me whatever films I have of any scans or X-rays, which is not many.

The third appointment was with a dermatologist for an unrelated issue. I’m sure that Andrew was glad when we were all finished, after dragging him around all day only to spend a great deal of time in waiting rooms. He was very patient and a good sport about it all.

Chemo Round Eight

Wednesday, April 5th, 2006

Today I saw the doctor’s assistant (P.A.) prior to my treatment. I told him how I have absolutely no energy or motivation and mostly sit in bed or the recliner, spending a lot of time reading and sleeping.

He said I’m experiencing the “chemo blues.” It usually affects patients around or after the sixth treatment. Today is my eighth and last treatment, and I’ve been this way for quite awhile now. The medical term for it is asthenia. A fancy name for having little or no energy or motivation.

I also asked about the radiation treatment Dr. K. had in mind, as I mentioned in my December 6th entry. He’d mentioned on two occasions that he wanted to follow up the chemotherapy with a dose of radiation. The P.A. said that radiation therapy would not be by injection, but by exposure/irradiation. It’s usually daily (Mon-Fri) for 3-6 weeks, taking about 30-45 minutes each session.

Facing the treatments doesn’t really bother me, but the thought of Sandi having to drive me there (at least 35 minutes each way) and then having to go to work (at least an hour each way) every weekday, concerns me a great deal. That’s a lot of stress for her. Maybe by then I’ll be able to stay awake at the wheel long enough to drive myself.

After speaking to the doctor I received my last chemo treatment. My white blood cell count is 7.6, up from .8 two weeks ago, so that’s good news. The nurse had to stop my IV drip for awhile when I started to feel my heartrate increasing and a kind of rushing feeling in my chest. Kind of how you feel before you get nauseous. After a while I felt okay. I was glad that Sandi was able to keep me company again. She was able to catch a few moments of sleep in an empty recliner, as I did after receiving the Benadryl.

It may take six weeks or more for this final dose of drugs to be completely purged from my system. The more time that passes, the more “back to normal” I should feel.

On my next visit with Dr. K. I’ll have to ask exactly what part of my body will be treated with radiation. The tumor was in my neck, but the cancer was in my lymph system both above and below the waist.

A Better Weekend

Monday, April 3rd, 2006

This past weekend I felt better than the last, but still didn’t have much energy to do anything. This is week three since my last chemo treatment, but I’m not feeling quite as energetic as I did during my last three-week hiatus. I’ve had achy joints almost every day, along with occasional bouts of drowsiness. But those could be unrelated to the chemotherapy – I’ll be sure to mention it on during my doctor visit this coming Wednesday.