22nd - John Larroquette...From a Distance

Thank you to the Kerrins' for bringing us an absolutely delicious pot roast over the weekend.  I will be enjoying the left-overs for days.  Thank you to Stuart's parents, Bill and Cathy, for coming down to keep us company and help out around the house.  Thank you to Shelley Typrin for the good-luck amber necklace.

Time has flown by over the last couple of weeks.  It is hard to believe that I am headed to see Dr. Frenette on Wednesday for my fourth treatment, which is the end of my second "cycle".  This one carries some additional significance, as it is protocol to follow the second cycle with a PET scan to check treatment progress.  The scan is not scheduled yet, but I suspect it will be next week at the hospital.  I am optimistic about it, but I would be lying if I did not admit to being nervous as hell.

As I mentioned in my last (very short) post, my third treatment went "fine".  I have come to expect a new experience (or more) each time I visit Dr. Frenette's office and this trip did not disappoint.  As I was sitting in the treatment chair waiting for my blood tests to come back, I found myself getting nauseous over just being there.  Apparently it is a pretty common phenomenon called "anticipatory nausea", which is when you get sick over the thought of something that has not even happened to you yet.  Next time, I will be taking the anti-nausea medication before I go into the office.  That said, the "hangover" from treatment was a little longer this time and I ranked the days following it as:

Friday: 5
Saturday: 3
Sunday: 4
Monday: 5
Tuesday: 6
Wednesday: 8 (fyi, I consider 8 "back to normal")

Since then, I have been feeling much better and my activity level has been pretty good.  I have done some work off and on from the house and have been walking regularly.  The walking is getting a little slower though, as I have developed tingling in both my feet.  Apparently, this "neuropathy" is a common side-effect of the Vinblastine (the "V", in ABVD), and there is not much you can do about it, other than stop that part of the treatment if it gets to be too much to handle.  I will certainly mention this to Dr. Frenette on Wednesday, but if history is any indication, he will not be impressed. 

During my last visit to Dr. Frenette, I complained of continuous pain in my groin, which I was afraid was lymph nodes acting up.  Rather than examining my groin, he carefully studied my neck...from his chair which was four feet away...and said I was fine.  Works for me.  Stuart has told me multiple times that Dr. Frenette reminds her of John Larroquette, of Night Court fame.  I can see it, from a distance, and his good sense of humor probably adds to the comparison.

Can you see the likeness?

Talk to you soon and Happy Thanksgiving!

11th - Good News At Last

I spent a couple hours this morning with Debbie, one of the nurses at Dr. Frenette's office.  The point of the meeting was to walk through the detail of the upcoming ABVD chemotherapy treatment.  It was called a "learn" session and was very similar to the one Stuart and I attended last week at Dr. Hellner's office.

Dr. Frenette sounds like he is a big believer in "throwing the kitchen sink" at the side-effects that may result from the treatment.  Debbie walked me through a very expansive regime of drugs to deal with nausea, fever, chills, allergies, constipation, diarrhea, indigestion, sleep problems, etc.  It seems there are many side effects to ABVD Chemotherapy that can be controlled through drugs up front.  Others, like blood count changes and sore throat are treated symptomatically.  Others still, like hair-loss, sadly, cannot be controlled.

Everything is now set for the port placement tomorrow morning and the start of treatment on Thursday.

Over lunch, we got wonderful news from Dr. Hellner's office.  The results of the bone marrow biopsy came back negative; everything is fine with my bone marrow!  This finalizes the diagnosis as Stage IIIa.  Stuart and I both cried, as this was the first piece of good news in a very long string of bad news.

7th - Learning About Chemo

With almost all of my test results back, with the exception of the bone marrow biopsy, it is time to start seriously planning for chemotherapy.  As I have mentioned previously, the standard of care in the US for Hodgkin's Lymphoma is ABVD chemotherapy.  For me, it will be a 6-8 month regime, with treatments given every two weeks.

In order to learn more about ABVD and the potential side effects, Stuart and I spent the better part of the morning with Lindsay D. Griffin, Oncology RN extraordinaire.  Lindsay was great and gave us a lot of detail, which I'll summarize for those of you who are interested.

ABVD is an acronym using the first letter of each of the four chemotherapy drugs used.

A = Adriamycin/Doxorubicin (a.k.a. "The Red Devil")

The red drug, Adriamycin, is usually given first.  It is administered via a slow IV push over 10 minutes or so.  Common side effects include:

• Reduced blood counts, possibly leading to fever, chills, etc.
• Hair loss
• Nausea and vomiting
• Discolored (red) urine - no shock here

I should have this drug in relatively low doses, although in higher doses it can cause heart problems.

B = Bleomycin/Blenoxane (a.k.a. Bleo)

Bleo is a clear fluid given via IV push, or mixed in 100ml normal saline solution and infused over 10 minutes or so.  Common side effects include:

• Fever and chills, which may occur after treatment
• Skin and nail changes, typically involving brown, yellow or pink discoloration and brittle texture.

More rarely, Bleo can case changes in your lung tissue, including shortness of breath.  It also contributes to hair loss.  In some cases there is an allergic reaction to Bleo, so prior to your first chemo treatment you will receive a "test dose".

V = Vinblastine/Velban/VLB

Vinblastine is another clear fluid given via IV injection/infusion.  Common side effects include:

• Nerve changes or muscle cramping, which may occur within two weeks of the first treatment or after several doses have been given.  Numbness, tingling or burning in the fingers and toes is common.
• Constipation

Less typically, reduced blood counts, hair loss and increased blood pressure may occur.

D = Dacarbazine/DTIC

Dacarbazine is a clear liquid or may have a faint yellow tint.  It is typically mixed in 250ml or more of D5W and infused over 30 minutes or longer (more of a drip).  Common side effects include:

• Flu-like syndrome
• Reduced blood counts
• Nausea and vomiting

Less commonly, it may promote hair loss.  Uh-oh!

That is ABVD...3-5 hours and you are done and on your way.