Thursday, March 31, 2011

Chemo #7 ....pictures ...

.... to come.  I have been struggling with my computer posting pics, but I am having it fixed today ... I hope.  I'll spare you more details.  If you're anything like me, dealing with computer issues is only slightly better than reading about someone else dealing with computer issues.

CHEMO DAY - Yesterday I walked briskly to the train stop about 10:30 am.  I was on my way to acupuncture prior to chemo.  The librarian sent me the Hodgkin files I requested one day early (late yesterday night); I had printed off one of the many files she sent and was reading and walking; luckily I didn't have any gum or I surely would have run into a poll.  When I reached the platform, my Aunt called me.  She wanted to tell me that she had read my previous post about the radiation or no radiation dilemma and that she was feeling for me, thinking about me, and sending love our way.

I was grateful to hear from my aunt.  First, her phone call took me out of mode.  Eric and I have been getting our arm-chair PhD in Hodgkin Lymphoma for a few months now, and a break from it is sometimes helpful.  Second, I think it was the first of several coincidences that occurred during my day; it reminded me of the powerful, and vast community network around me that I was unaware of prior to Hodgkin.  The community network helps me to do things that I wouldn't ordinarily do on my own. I'm basically a lazy, procrastinative, long winded, exaggerator, with dry skin, and funny toes; I definitely need all the help I can get.  Support (and not the type under wires generate) gives me confidence to find the right next step today and tomorrow.  Writing for example .... doesn't happen without y'all giving me some umphhhhh.  Anyway, let's move on.

While talking to my aunt, a man in the train car I was in was smoking ... not cool ... especially around someone like myself with potential lung toxicity from the bleomyacin (one of the chemo drugs I am taking).  I had to run away quickly to another car with a trail of other patrons on my heals.

Alright alright... let's make some progress with this day or I am going to blogging until the cows come home and there isn't a lot of room for them here in Chicago.  Acupuncture was relatively uneventful accept that my acupuncturist wanted to make a copy of the new article I was reading.  The article does a good job explaining the details of the radiation no radiation debate.  The fact that my acupuncturist was interested made me feel tingly inside.   Here's the link to the article in case you want to give me even more of these tingles/goose bumps ... no pressure ... unless you want pressure .. then lots of pressure.  Alright I get it... we don't have all day Kari.

http://asheducationbook.hematologylibrary.org/cgi/reprint/2010/1/108.pdf

Chemo #7 went as planned.  We talked to the nurse about my nausea the Sat/Sun following Chemo #6.  She said that the next step would be to add a drug called Emend to my regiment.  It is an anti-nausea that would be administered with the rest of my chemo drugs intravenously.  This isn't the first time I have heard of Emend.  It seems to be a "savior" drug in the cancer community.  However, I was reluctant because I'm doing pretty good overall with my treatment.  Isn't less ... more?  Eric and I decided that the upside was minimal, but the downside (having to "figure out" how another drug works and what side effects my body will create) was potentially more than minimal.  We decided to hold off for this chemo treatment.  If I'm really nauseous again, then we'll reconsider in two weeks.

Then, our Oncologist came for a visit.  I was loopy (feeling kind of drunk as I do every chemo treatment) from the Zofran that they administer prior to the chemo drugs.  Not many patients are affected by the Zofran, but even when given slower than normal, I still get a little loopy.  I believe that Eric and our Nurse truly enjoy my loopiness.  I'm a bit of a goofball during chemo.  For example, we talked about the possible places the chemo drugs could come from.  Shark Urine was my first guess.  Our nurse thought Turtle tears.  Eric thought Turtle sweat.  Somewhere (or so Eric says) there is a gym of turtles running back and forth.  They get sweatier with time considering they get skinnier and have to carry those super heavy shells.  Poor turtles.

In comes our fearless doctor (his title is medical oncologist by the way) ... and Eric and I had all of our ducks in a row.  Basically, it showed that we had graduated with arm-chair PhDs.  We even had the medical textbook sitting out on Eric's lap in case there was any doubt.  Our doc got the hint and pulled up a chair.  It was super good to talk to him, and super good to have Eric there because like I said, I'm a little drunk during treatment and nauseous ... saying the right thing to a very smart man becomes ridiculously difficult.  Eric did really well.  Our questions were not focused on clinical studies, though they certainly were periphery.  We needed the doctor to tell us how our case fit into the mix.  Our arm-chair PhDs taught us very little about reading PET scans, CT scans, and blood work.  To be honest, we never actually put the PET scan/CT scan DVDs into our computers.  We asked very specific questions about my 9cm conglomerate of lymph nodes and whether that's better than one big node, we asked where I fit on the international prognostic factors scale, we asked if my PET was controversial (as the new studies are finding that many PETs are read as negative, but that they could possibly be read differently - he said that we have one of the least controversial PETs ... great news), we asked about getting a CT scan which can also help determine if the cancer is gone (I'm getting one in a few weeks; the doctor was thinking the same thing we were thinking).  To sum it all up, we asked good questions.  As Eric put it, we came away from the conversation feeling like we had asked all of the right questions, AND we earned that feeling by doing our homework and knowing what to ask.

My last question to our doc was twofold - what does he think my chances would be of a Hodgkin's cure if I had the radiation v. if I did not have the radiation.  He said without hesitation that he thinks my chances are 90% either way.

Eric and I left feeling good about the conversation.  I of course left feeling sick.  ughhh... well, we're more than half way done no matter how you look at it.  yeah!!!

As for today, I feel NAUSEOUS!  ugh.

Monday, March 28, 2011

Clean hair

It's been a fairly good week. The big radiation or no radiation question is still weighing on us. Eric and I have done a lot of research, and we have three appointments to get second opinions.
  • Radiation Oncologist at Northwestern - April 7th
  • Medical Oncologist at University of Chicago - April 7th
  • Radiation Oncologist at Stanford - April 12th
The doctor from University of Chicago studied in Belgium. I'm hoping he adds a European slant to the conversation; he's also an expert on stem cell transplant (the next step if this doesn't work). Most of the studies on Hodgkin Lymphoma are out of Europe because of their ability to fill the studies easier than we can here in North America. Perhaps he can explain the dichotomy between Europe and the US on the radiation topic from a different standpoint. Yeah yeah ... its a long shot, but we don't have anything to lose.

The Oncologist from Standford is Dr. Richard Hoppe. He wrote the medical textbook - Hodgkin Lymphoma - and he's our medical oncologist's friend. Our Oncologist thinks he may agree with no radiation even though he's a Radiation Oncologist. I'm hoping everyone is in agreement because it will make my decision easier. No radiation is generally for those patients with favorable Hodgkin's. I found out at my last appointment that I am officially considered unfavorable. To be unfavorable, you need to have at least one of the following (these qualifications vary quite a bit from program to program, but here's an example):

1. male (we always knew they were unfavorable)
2. Age greater than 45 (hmmm... my husband is but you don't get older from osmosis.)
3. Sed Rate without B symptoms OR >30 with B symptoms (I don't qualify, but I am just on the cusp of qualifying)
4. Greater than or equal to 4 lymph node sites (I have 4 sites and maybe even 5 sites)
5. 10 cm growth inside mediastinum (My largest growth inside the mediastinum is 6cm, but outside it's 9cm. Some programs say it can be inside OR outside the mediastinum which is the center of our chest. So again, I'm closer to qualifying than I want to be.)

As my doctor said, I am borderline. If I was favorable (and I'm not) and I did not have radiation, I would have an 87% chance of FFP (FFP basically means that I won't have a Hodgkin Lymphoma relapse). If I was favorable and I did have radiation, I would have a 94% chance of FFP. Having radiation comes with long term risks. Mainly, heart disease, lung cancer and breast cancer ... breast cancer especially may increase to as high as 50 times more likely than the average person 20 years post treatment.

Now Kari you ask.. what the heck does that mean. You just said you're not favorable ... what are the stats on not favorable. I don't have a good answer for you because many of the studies that have been done are stopped because too many people relapse without radiation (Sounds scary, but I guess a few percentage points is considered too many people... I'm not sure where the line is drawn. Also, many times these unfavorable studies include people who are stage III and IV so the data is skewed). The studies for unfavorable tend to concentrate on how much radiation and chemo to give not whether or not to give radiation.

Kari ... you're sounding like a lunatic ... why wouldn't you get radiation. ENTER ... the clean PET scan. In the last few years, doctors have started to use the early PET scan to help determine treatment. None of the favorable/unfavorable indicators can hold a candle to the early PET scan in determining whether or not a patient will or will not relapse. About 80% of patients have a clean early PET scan (actually it's 85% of favorable patients and 72% of unfavorable patients) and I am luckily one of the 72%. There are a whole bunch of studies that have just started or are ongoing regarding the early PET scan, but there aren't a lot of results yet ESPECIALLY for those considered unfavorable.

Now, you know .... you know all of it ... the dilemma ... the gamble. My doctor said that if I were his daughter, he would not do radiation. We'll see what the other three docs say. We have about 2 weeks to make the decision. We'll keep you posted.

HAIR WATCH (the crowd favorite) - I still have hair on my head. My eyebrows are intact and so are my eyelashes (though thinning). I don't have a lot of leg hair though. I have only been washing my hair twice a week. Someone told Eric the less you mess with it, the longer you'll have it and I took that to heart. I try not to touch it ... ever. Yes yes... I look like I should break out into song ..... grease lightning!

LIBRARIAN WATCH - So, there is a cancer library at Northwestern hospital. I called and spoke to the librarian. She is doing some research on radiation for me, and will be sending me lots of reading material tomorrow morning. She has access to a lot more material than I do. Yeah for librarians! They are similar to Fire Fighters .... everyone loves librarians!

Monday, March 21, 2011

Cancer-patient skinny

I am happy to report that I feel better ... pheww. Not great, but a whole lot better. I'll take it.

I also wanted to report that I have received several compliments on my trim figure. Basically, I'm cancer-patient skinny as I like to call it. I'm almost 15 lbs lighter than my typical weight (it fluctuates with the nausea). I eat peanut butter right before I go to bed to keep my weight up, and when it really drops as it did last chemo cycle, I grab pizza and alfredo sauce (there's only so much peanut butter you can eat before you become a nut) . Sooo, why the multiple compliments? Because skinny is hip. (I like being un-hip better.)

Saturday, March 19, 2011

Feeling .....

.... like crap. Eric, Bren and I made sure to get out in the sunshine today - played ball, shopped, ate dinner ... all necessary, minor distractions, but I still feel like .... crap. Mainly it's nausea ... eating is hard. I don't want to think about it too much ... don't want to vomit. I haven't felt sorry for myself all day. I was able to help a friend this morning. Helping someone else immediately turned off the mini violin that was drowning my sorrows.

I did receive "Hodgkin Lymphoma" by Richard Hoppe in the mail today. It's a medical textbook on Hodgkin's. Surprisingly, it isn't all that difficult to read, and I read a good chunk of it today. I also spoke to a friend of a friend who happens to be a radiation oncologist. He would do radiation in my case; it's the standard course of treatment. Still trying to decide whether to have radiation or not. Here's some other interesting facts:

1. Secondary cancers from radiation treatment are much more prevalent in a 22 year old than a 32 year old.
2. If the cancer recurs, it's usually found by the patient who complains of symptoms and not by a CT scan.
3. Lymphoma and Leukemia (Blood Cancer Awareness) day in Chicago is April 12th thanks to Mayor Daley.

With that, I'm signing off ... meditation time ... and then bed. Ugh.... if you feel healthy at the moment, be grateful.

Thursday, March 17, 2011

Coupon to help Lymphoma

http://gap.p.delivery.net/m/p/gap/giveandget/share.asp?id=13412053276&sms_ss=facebook&at_xt=4d7e0eeb93559cec%2C0

March 17-20
Enjoy 30% Off and The Leukemia & Lymphoma Society gets 5% of what you spend

It's Gap, Old Navy, and Banana Republic.

Monday, March 14, 2011

Is this a coincidence?

It's always good to get jolted back to who I am, or at least who I want to be. That's been this weekend. Catholics believe that lent is a time to get back to this place ... the place of who I really am ... who I was meant to be. (It's surprisingly similar to Ramadan which is a time Muslims try to purify themselves by practicing patience and kindness.) Lent happens to coincide with lymphoma which is a nice coincidence (I don't actually think such a thing exists, but that's what I'll call it for now). So where did this jolt I am referring to come from?

I think getting slapped upside the head with the illness creates a chain reaction. First, I went through survival mode. What do I have to do next? Go to surgery. Go to another surgery. Find a doctor, prepare for chemo. Eat the right food. Find the right medicine to combat side effects.

Then, I climbed up the mountain to take a look at the other side and ask -- What if? I know this will surprise most of you, but the answer I found was that life would move on without me. I know you were thinking that the world would evaporate without me, but alas, I'm not that important.

And now .... finally .... it's time to see life changes. How can I put every effort into the life I've been given? This is the fun part. What "coincidence" is going to happen next? Coincidences in my life usually highlight a growth opportunity. It was a coincidence for example that this time in my life coincided with lent. This coincidence emphasized that I am on the right road; if I allow it to, life is about to change. Yeah yeah ... I hear ya ... sounds like hogwash. You could be right, but my gut says otherwise ... and I may have a small gut (at the moment), but it's pretty smart.

Another coincidence was that right before I was diagnosed, I forged new friendships with a group of woman in my neighborhood. Lymphoma has actually strengthened these friendships. The verdict is still out, but I think I'm learning - how to gossip less and help more? It's not brain surgery, but it takes just the right situation to move a speeding train. So ..... when you stop reading that you're pregnant with twin aliens in the tabloids, you'll know, I'm a changed woman.

I'd tell you more about the coincidences in my life, but I'm already feeling like I'm metaphorically in my skivvies so that's all you get today ... (did you know skivvies was spelled with two v's?)

Sunday, March 13, 2011

I feel good. No really ... I feel gooood. Apparently when I feel bad for a few days, the good days that immediately follow are really good. No ... I mean really good. It's like the moment you realize that you feel like yourself again after a bad illness ... only I get to have these moments every two weeks. Do I dare say it. No... I can't say it. Well alright, but I'm going to whisper it -- It's kind of fun. Now ask me if I still feel this way on Wednesday, and I may vomit on you.... graphic, but true.

The radiation or no radiation question is weighing on Eric and me. I added links to some websites below if you're intersted. The impossible balance -- do radiation and have a higher chance of getting rid of lymphoma the first time around, or don't do radiation and have a higher chance of being disease-free (breast cancer, heart disease, leukemia) 20, 30, 4o, 50 years from now. We're still trying to figure this one out.

http://www.medscape.com/viewarticle/737540?src=smo_nur
http://forums.lymphoma.com/showthread.php?t=42163&highlight=radiation
http://jco.ascopubs.org/content/28/7/1232.full

Tuesday, March 8, 2011

A cold

So, I caught a cold. I don't feel bad, but I have a very minor stuffy nose and a wimpy cough. When I told the nurse, she said "to avoid hospitalization and missing future chemo treatments, we want you to take a strong antibiotic." To that I had nothing to say except - where do I pick up the prescription? In the past I used to baulk at antibiotics, but I am clearly a changed woman. Bring it on. Brennan had a fever of 102.5 all day last Wed (poor little guy! He's doing just fine now.) To say I'm thankful to only have the common cold is an understatement. My white blood count is very low, so my ability to fight off infection is also very low. Sometimes patients with low white blood count have elevated monocytes (immature white blood cells) which can also fight off infection, but alas, my monocytes are normal (most of the time, normal is exactly where I want to be, but not in the world of monocytes - who knew).

I also have odd dots on my finger tips which I'm going to have looked at tomorrow by a dermatologist that specializes in chemo side effects. I'll keep you posted. Then on Thursday I'm going to the OBGYN for a 3 month Lupron shot. I actually received a one-month Lupron shot in February. Lupron is an odd drug - basically it fakes my body out into thinking it's in menopause. This may or may not help with fertility after treatment is over. We'll see; the studies that have been done are all inconclusive. It does give me hot flashes which are annoying, but not a big deal so far.

Otherwise, we are 9 days away from being half way through chemo! Whoooo Hooooo!

Saturday, March 5, 2011

post PET scan

Thank you so much everyone for your support and for doing the clean PET dance with us. I'm imagining the dance looking similar to the potty dance on the diapers commercials; it involves lots of jumping and wiggling!

A clean PET is a step in the right direction. It also gives Eric and I enough information to think about a second opinion. We are going to arrange a meeting with our doctor to discuss the matter. Hodgkin's treatments are fairly straightforward (aka - ABVD is the chemo regimen of choice among doctors in the US) except when it comes to whether or not to do radiation. In fact there's a 1200 person study of active stage I and II Hodgkin's patients that started in July of 2010; this study is (among many other things) attempting to shed light on this very question. It's a fairly decent sized study considering that there are only 150,000 people with Hodgkin's (remission or active, all stages) in the world. As Eric pointed out, if they're doing a huge study, it probably means they don't have the answers yet! Brilliant! So, to radiate or not to radiate .... that is the question. Luckily, with the clean PET, I've got good odds either way. I do however want to be active and deliberate when making such a decision, and having a wonderful doctor who doesn't seem to mind intelligent questions makes this process much easier.

Other exciting things happening right now:
- I just took a bath.
- I still have my hair
- Eric and I stayed out until 12:30 last night .... dancing. Perhaps we even did the PET scan potty dance -- though I'll never tell.

Tuesday, March 1, 2011

PET scan after 2 cycles is negative

I just got a call from the Nurse Practitioner. The PET scan was negative meaning that there was no detectable cancer. It means that the chemo is working. The nurse believes that the doctor will want to continue doing the 6 months of chemo, but will not advise doing radiation. This way if there is a recurrence, they can use radiation instead of going right to the stem cell transplant. This is great news!!! yeah. More soon...