Tuesday, August 27, 2013

Rhode Island Escape and CEP Start

No energy to write a long blog, though I’ve got many story nuggets collected. Consider this an executive summary of what’s been going on with me.

We spent two weeks in Narragansett, Rhode Island. It is beautiful, especially the beaches. We rented a cottage the first week with Craig’s brother and his wife and our niece and nephew; the second week with my parents and sister. We had visitors on top of that and it was relaxed and easy – for the most part.

-Getting to play with our niece and nephew in the sand and water and be with them for their morning and evening routines. They are adorable.
-Spending time together with our brother and sister-in-law who we rarely get to see.
-The sun and ocean and sand: warm, sparkling and soft.
-Bringing our beach chairs right down into the water and reading a book while the waves rode over our feet.
-Being with my parents and sister on the beach all day bringing back so many childhood memories.
-Lobster rolls.
-Del’s frozen lemonade.
-Sunset cruise in Newport Harbor.
-Staying for a night at a special friend’s fabulous Newport ocean-side beach house – even though Craig lost the key and the debacle that followed.
-Escaping for a favorite couple’s wedding and reconnecting with many college friends from UConn.
-Watching Jaws on the beach with thousands of others on beach chairs under blankets with the ocean and a full moon behind us.
-Visits from friends and their kids and even an overnight with my parents’ longtime best friends and their son.
-Fantastic outdoor showers.
-A visit from my brother and his wife on the last night.

-Adjusting to the side effects of the difficult CEP oral chemotherapy I am currently on – incredible fatigue, lightheadedness, thrush and mouth coating, no appetite. I started it on vacation so every day brought a little surprise. 
-Difficult mornings/early energy then big crash that didn’t jive well with other’s schedules.
-Major frustration surrounding how weak I am and not being to help out much with the kids or beach packing or anything, having to be so focused on not throwing up, and on garnering the strength to get my bum from the house to the beach.
-Breakdown moments missing my old days of swimming and boogie boarding and biking and paddle boarding – all of which I couldn’t do. Tried to push resentment away but it was difficult.
-Breakdown moments surrounding people having to help me and again, not having the energy I wanted. I had to keep shifting expectations and knowing that everyone else was there for a slow, relaxing time too and all did their own thing in our own time. It was very hard to let go.
-After one week on the CEP, I had to get my blood counts checked at the local hospital. Got a call that night from Dr. O that it was unsafe for me to go through the night without a transfusion. My platelets dropped to 6,000 and my hematocrit was under 23%. I spent the night in the ER/hospital with Craig receiving both blood and platelets. My port leaked and I woke up covered in a bloody mess. Otherwise, the nurses were very kind and the facility beautiful.

Because my counts dropped too low, I have been pulled off the CEP regimen until they rise. This was not unexpected as we knew it’ll be a fluid process as we watch how my body reacts to it; that’s the only reason I signed onto the idea knowing that there were no hard and fast rules but that we would listen to my body. I have not been on treatment for about 9 days now, only remaining on the Prednisone which is the “P”. I’ve been on Prednisone for almost two years now regardless, but it still makes me crazy. I’m very emotional and still dealing with breakthrough pain, pain management and functioning on narcotics trying to find some kind of balance.

I was in the hospital again for the day yesterday needing more blood. It is obvious that we will need to reduce the dose of this regimen or move on from it. I’m worried about playing catch-up again. The longer I am off of treatment because of low counts, the more chance there is of the cancer growing. Again, seeking that magic drug that won’t knock me down and will just keep things at bay.

We’re now talking about adding in Rituxan, which has just started being used off-label for CD-20 positive Hodgkin Lymphoma. It is a targeted antibody that has proven effective in NHL and CLL. Supposedly no side effects since it is even more targeted than SGN-35, however, big risk of scary infusion reactions.  I think that it is worth a shot though.

I took a complete break from all correspondence, social media, writing, blogging, etc. so it’s been a bit of a crash landing getting back into reality. Having everything scattered and unopened does not help my anxiety level. I can’t run and hide from reality forever. I just want to be comfortable physically and emotionally again and am working day by day to get there: some days are easier than others. Ones spent on the beach with the people I love were certainly the easier ones. Now it’s back to being alone every day and trying to figure all this shit out. What do I do with this time? How do I make these decisions? What if I’m just plain tired and don’t want to deal with any of it? Why can't I just keep burying my head in the Rhode Island sand?

Wild child, Anna. 

Big boy, Jake. 

Our Bonnet Shores rental - perfect.
The ladies in the back of the Jeep. 

Fellow sailors.

Newport sunset cruise. 

Beautiful Buddha in the sand. 

Flowers bigger than my face at the Umbrella Factory - and I have a big Prednisone-swollen face. 

Perfect set-up. 

The whole gang on the last night. 

Friday, August 9, 2013

Shift in Plan

I am here and okay. There have been some changes but I feel strongly that they are the right ones. I am no longer pursuing inpatient IVAC. It did not hold the disease for more than a couple of weeks and for the massive side effects it caused and all the required transfusions and hospital time it required, it seemed against all logic to keep going with more cycles. I’m having unmistakable lymphoma pain.

We’ve regrouped – long conversations with Dr. D, Dr. O, my therapist, family, special friends and most importantly, myself, over the past couple of weeks. I have decided not to pursue a third transplant at this point. I am trusting my gut and my instinct on this one, which are speaking to me very strongly. I am not on board mentally, physically or emotionally and I’m most concerned about quality of life right now. I would need to be in close-to-perfect remission

With that said, tomorrow we head for a beach vacation in Rhode Island where we’ll spend time with my brother- and sister-in-law and niece and nephew and then my parents, sister and maybe brother and wife with friends dropping in and out as well. Sam Dog is coming, too. I know that the sea and the sand will do wonders. We secured the house rental months back, and I'm so excited that the timing actually worked out for us to make it. 

I’m starting up an oral low-dose chemotherapy regimen today, which I’ll be able to bring with me. I’m getting hooked up with at-home Neupogen shots in case I need them. I’m able to get bloodwork checked at a lab down there. I’m in the hospital right now getting two units of red blood cells to boost my energy as my counts were very low and I’ve been very symptomatic (hematocrit of 7.4). Dr. O and his team are doing everything to accommodate this vacation realizing, as always, the importance of being able to manage this disease while still living my life.

I hope to have some quality writing time with my laptop over these two weeks away as well. I’ll write in more detail about what this all means but that’s the gist. I’m looking forward to sunsets over the ocean, lobster rolls, outdoor showers, and plopping my toes in the water, ass in the sand.

Thursday, August 1, 2013

IVAC At-Home Recovery

Welcome, August. I’m proud to say I made it through July – barely, but I made it.

I’ve been home since last Thursday when I was deemed ready to leave my hospital bubble. This past week has been one of recovery and discovery of my limits and my capabilities.

There has been a whole lot of sleeping happening and resting in general, but also some actual summer fun mixed in. I refuse to be robbed of the entire experience of summer 2013, so I’ve done what I can with the incredible help of Craig and my mom and sister who have been here to nurse me back to health and keep me entertained so I don’t totally lose my shit focusing on what I’m facing at the moment.

I can’t say enough about how kind my husband is. Since the very beginning he has ensured that I keep normalcy in my life and knows what makes me happy and wants to make sure I do it. Even if I complain at the onset and say that I can’t, he pushes me just enough so that I don’t fall down the rabbit hole and disappear.

Incredible ladies
It’s very easy to push people away when I’m not feeling well, but he knows I always feel better when surrounded by the very, very special friends I have in my life (in balance with my much-needed alone time). With that in mind, this week we went to an outdoor Rolling Stones tribute concert with friends, had a few friends here in the evenings just to hang, had a date night of a delicious dinner in one of our favorite parks, and I had a girls night at my home where six of my closest friends since high school (or earlier) brought over tons of food and albums of old photos and we spent the night laughing and talking out on the porch under the summer stars until the mosquitos sent us indoors to continue there. It’s been a lovely and wonderful week.

I feel so very loved and so much more comfortable in allowing myself to talk more openly and honestly and to allow others to help me – whether by talking with me, bringing us food, sending adorable gifts and treats that brighten our days. I am much more accepting of those who want to spend time with me and help out because I realize that it’s not a burden to them  - they truly want to – and I truly appreciate them being in my life. I’ve also accepted those who are not there and realize that this is difficult for others to handle, too. Yes, it’s taken me being fantastically weak to get to this point socially, but I’ve been testing the boundaries and have been so pleased with how receptive and loving everyone has been – not that I ever doubted it, just that I was always scared and guarded. Right now I don’t really have a choice but to let it all hang out.

wooded beach
I’ve also been spending many days with my mom and my sister (who is home from out west to spend time with family for a while). My mom is beyond incredible and has always been. She swoops in and cleans my house, changes my sheets, helps me with paperwork, rubs my feet and calves with lotion, waits outside the bathroom door to make sure I don’t fall in the shower, escorts me to appointment after appointment, cooks for me, tucks me in, all while able to laugh and bitch right along with me about this crazy conundrum we find ourselves in.

My sister has been here to relax with me, watch over me, cook me food and just hang like sisters do. We don’t have to impress each other and it’s so nice to have her around. I can talk or not talk, fall asleep or be demanding and she's cool with it. As going to an actual ocean/beach would take way too much out of me, we spent one day together set up on a blanket, me under an umbrella, at a little pond beach in my town. It was so nice to be out enjoying some sun and summer breeze amid the pine trees. We made our own “beach” experience. She’s been so helpful and thoughtful in so many ways.

I just started driving again – short distances – for the first time in weeks and that feels good. Every day I am getting a little more strength. But it’s taken a while to get here and I’m still far from perfect. Tuesday marked three weeks since the start of IVAC. It is as brutal as they promised. Even since being home I have been so weak. I could barely walk up the stairs for the first few days and taking a shower and getting dressed was a big accomplishment for the day. I would need to go to bed afterward. The nausea has lingered and the fatigue is phenomenal. I really have to pace myself.

I barely have an appetite, but I do have overall body aches and some pain. Yes, in my damn hips. It’s nearly impossible to know if it’s pain from cell death, pain from the Hodgkin’s flaring despite the harsh treatment, pain from my bone marrow working hard after the Neupogen shots. I try so hard to stay in tune, but things are all over the place right now. But what I do know is that it is nowhere near the pain I was in pre-treatment and I’ve also still been remiss of high fevers, so this must mean something!

Same goes for the palpable lymph nodes in my neck, which I touch no less than 129 times a day. Some days I feel that they’re growing, others that they’re shrinking and even others that new ones are popping out. It’s certainly difficult not to let paranoia take over.

We’ve been watching my blood counts closely. My white cells are great – high in fact. My reds are low, but no more than usual. It’s my platelets that are lagging. At most recent check, they are 59,000. It is unsafe to do a second round of IVAC until I am closer to 100,000, especially knowing how low my platelet level dropped and how minimally effective transfusions were after the first round. If I don’t have enough reserve there could be life-threatening bleeding complications. Dr. Dailey and I also agreed that I should get my body stronger before more treatment. I’ll get my counts checked again tomorrow and we’re tentatively aiming at starting up Monday.

However, if I am having Hodgkin’s symptoms, then we need to strongly consider not doing another round of this. It would not be worth putting my body through that extreme toxicity again. It is very dangerous. We’re going to see how I feel.

In the meantime, we’ve been back and forth with the haplo-transplant team at Fred Hutchinson in Seattle. My parents, brother and I are all getting our HLA typing redone and having to get special bloodwork done to be sent back to them so that they can determine who of the three of them would be my strongest match. The doctors there are in touch with Dr. O and everyone is working so that if I do hit a remission and I do decide that I want to do a third transplant that all is ready to go as quickly as possible.

I haven’t gotten any closer to making that decision. I don’t think I’ll be able to until I see the results of my PET Scan post cycle 2. That’s going to reveal a whole lot. And, whatever way it goes, each scenario carries a whole lot of baggage. No evidence of disease? Great, but that leaves me with a huge decision to make. Do I go for transplant, which could potentially cure me despite the very real risks, or does it mean that I opt for much less toxic, novel therapies in clinical trial that will give me quality of life but we have no idea how much life if the remission starts to slip away. The chemo didn’t work? Does this mean it’s over? I was told if IVAC doesn’t work, nothing will work. Do I continue to pursue more trials if and when something opens that I haven’t tried already, or do I just focus on comfort and quality of life, spending time enjoying it instead of in and out of the hospital all the time? I’m predicting a pretty hellish time leading up to that scan and have no idea how I’ll stay sane. One test has the potential to seal my fate.

But before I deal with all of that, I first have to somehow gear up to knock myself down to zero again just when I’m getting a little glimpse of feeling better. It’s that old scenario of knowingly placing my palm on a hot burner. It will hurt. Isn’t this the definition of insanity? Banging your head on the wall continuously and expecting a different outcome? Well, this is one final bang, one big hopeful push that for once I will have a different outcome: instead of growth, retreat.