Nearing the End

Today Rebecca and I met with my oncologist. First we addressed my increased neuropathy. He decided to completely omit Vinblastine from my chemotherapy this week. Next week I am scheduled to get Vincristine which also causes neuropathy, and we may or may not omit that as well. Vinblastine is the larger culprit of the two, so hopefully we will just omit that. Obviously if we omit the drug, I am not able to get the benefits associated with it. But my neuropathy has gotten pretty bad, and it is painful to walk toward the end of the day. My doctor does not want it to get any worse, especially since it may last for a year. On rare occasions, it is permanent. I hope omitting the Vinblastine today will reduce the neuropathy, because I am really dreading having this sensation in my feet for up to a year.

We also discussed my voice. Again there is no definitive explanation, but the worst possibilities have been eliminated. There is no indication of lung damage which is a possible side effect of Bleomycin. Thrush is another possibility but there is no indication of that either. It could still be allergies, acid reflux, a bacteria infection, or a viral infection. Either way, I am likely to be stuck with a hoarse voice for the remainder of my chemo regimen plus however long it takes to recover.

We also discussed radiation. An absolute definitive answer was not made, but my oncologist specifically stated that if it were he or a family member he would opt to not radiate. The expanse of my cancerous lymph nodes was such that they would need to radiate a large area. This would greatly increase my risk of secondary cancers later in life. At this point, although not absolutely certain, I would be shocked if I end up getting radiation therapy.

We also discussed removing my port. I can get it removed whenever I wish. Typically, it is not left in long term (anticipating the possibility of a relapse) because there is a risk of developing a blood clot, and a small chance of infection. I will likely get the port removed two weeks after my final chemo treatment (week of Dec 17th). That week I will get another CBC to see if I need another transfusion. If I need one, I would get it that week, and then get the port removed. After the transfusion there would be no need for the port unless I have a relapse.

Finally, we discussed my post PET scan. The date of the scan is not yet set, but it will likely be in January. If the scan is negative, which is expected because my last scan was negative, I would get scans every six months to check for a relapse. If the scan is positive, my doctor said it would likely be a false positive and a biopsy would follow. Only a positive biopsy would prove that cancer still exists. Again, this is not likely.

Today was obviously a big day, and I am down to eight days until my final chemo treatment.

Tryptophan and Chemo, a Tiring Combination!

This weekend I was able to get a lot of rest, which was greatly appreciated. Nausea was not a problem, and I was able to eat way too much at Thanksgiving dinner. The tiredness you feel with the combination of tryptophan and chemo is a unique experience! My chemo treatment on Wednesday went smoothly without any major side effects. My only concern is that my neuropathy has progressed, and the numbness in my feet has gotten worse. My voice has also become more and more hoarse each day. In the past, my voice would recover over night and in the morning it would sound normal. This morning, the first words that I spoke were hoarse and weak. By the end of the day, it is difficult to understand what I say.

This week my oncologist will likely reduce my dosage of Vincristine and Vinblastine for the last two chemo treatments. These are the drugs that cause neuropathy. Almost all patients on these drugs experience neuropathy, and most have their dosages reduced during chemotherapy. The dosage reduction will not be significant enough to threaten the cancer killing effectiveness, especially after 10 weeks at full dosage.

My voice, on the other hand, will likely remain hoarse until after my body is no longer being poisoned. My oncologist could not definitively determine what is the cause, but he ran some tests to rule out any possibilities that would be detrimental. The worst-case scenario, which has been ruled out, was that the Bleomycin was damaging my lungs. The likely cause is a viral or bacterial infection causing a nasal drip, which has affected my vocal chords. Another possibility is acid reflux that is common for chemo patients. To combat these possibilities, I am taking a daily antibacterial and a daily antiviral prescription. I also take Prilosec OTC for acid reflux. All of these are just not enough to cure the problem because of my weakened immune system. Oh, well, it is a small price to pay to kill the cancer.

No more Mustard Gas

My last dosage of mustard gas (Nitrogen Mustard) was given on Thursday. This chemo drug has thus far been the worst for inducing nausea. So far I have made it through the weekend without needing any anti-nausea medication. Hopefully this will be the last exposure to mustard gas of my lifetime!

My red blood cell count is much improved after the transfusion, although I am still below normal. Instead of a hematocrit level of 22.4% of total red blood cells, I was up to 33.0. Normal is between 35 and 60. My overall red blood cell count was lower than normal, but again an improvement. I still don’t feel any substantial improvement in energy, but I know I am better off after the transfusion.

This week I get chemo one day early, to avoid the Thanksgiving Holiday. I am taking Wednesday, Thursday, and Friday off of work. A nice long weekend will be greatly appreciated. My body needs the extra rest.

Disappointment, Hoarseness, and Numbness

I received an infusion of two units of red blood cells on Friday morning. The process took over 4 hours and afterward I decided to take the rest of the day off of work. I had high hopes that the infusion would give me some of the strength that I have been lacking the last few weeks. So far, I have only felt a slight improvement. It has been over 4 days now, so I expect if I were going to notice a large improvement, I would have by now. I probably was a little over optimistic expecting a large improvement.

On Thursday I start the last third of chemotherapy. I also have another appointment with my oncologist that morning. I will try to get an answer regarding the cause of my hoarse voice. I do not have a soar throat, and it does not hurt to talk, but it is frustrating because it is difficult to communicate. It is possible that the hoarseness is no major concern and may just be something that I will have to get used to. Another symptom that I have had to adjust to is neuropathy. Neuropathy is nerve damage, which commonly results in numbness. My neuropathy is slight in my fingers and is only in my fingertips but is a little more extensive in my feet. The numbness makes walking interesting. It is difficult to explain, but it is not painful, just a unique feeling that is similar to when your feet get really cold. Typing and handwriting also feels very different with very little feeling in the tips of my fingers. If the numbness spreads or gets worse, my oncologist may reduce the amount of Vincristine and Vinblastine that I receive each week. Usually neuropathy is temporary and the feeling returns after chemotherapy, but occasionally it is permanent.

Transfusion time

Today’s treatment was the last of the second third of my chemo regimen. After today I only have four more treatments left. Yeah!!! Before my treatment, as always, the nurses collected blood for a CBC. My white blood cell count was high, due to my Neulasta shot last Friday. My red blood cell count was again the lowest is has ever been. Normally, the red blood cell count should be between 4.00 and 6.00 million cells per cubic millimeter. My count was at 2.50. Red blood cells are divided into two categories: hemoglobin and hematocrit. A normal hemoglobin count is between 11.0 and 18.0 grams per deciliter. My count was at 8.0. A normal hematocrit count is between 35.0 and 60.0 percent of the total red blood cells. My hematocrit level was at 22.4%. What does all of this mean? I am getting a transfusion…tomorrow. My doctor is not a procrastinator; that is for sure! I am actually looking forward to the transfusion because my energy level has been decreasing steadily for the last few weeks and it has been harder and harder to do anything. I am looking forward to the extra energy that the donated blood cells should provide.

PET Scan Images

These images are a little fuzzy, but you should be able to figure them out. Both scans are 3D frontal views from my head to my knees.

The first image is the PET scan from Sept 19th. The bright white areas are cancerous. As you can see, there are quite a lot of bright spots along my spine, with some larger areas near my heart. This image is a little misleading because it appears that I have some quite large masses, but in actuality, since this is a 3D image, some lymph nodes are stacked on top of one another making them look like one large clump. In the individual slices of the PET scan my doctor was able to measure the sizes of the lymph nodes and the largest clump was a little more than 5 centimeters.

The second image is the PET scan from Oct 29th. As you can see, almost all of the bright spots are gone along my spine. You should also notice that my skeleton is much brighter in this image. This is due to the production of blood cells, which attracts the radioactive isotope that in injected for the PET scan, and causes the brightness in the image. My bones have been in high blood cell production since starting chemo. I am not sure what is the cause of the bright spots that are almost symmetrical about my spine in this image. They don’t appear in the first image, so I don’t think it is cancer, but I don’t know what it is. I will have to ask my doctor.

This is a great visual that shows how effective my chemo has been.