March 2008 Archives

Initially, I was told that I wasn't going to have treatment today.  Apparently, my white blood count was still lower than expected.  I do have a slight cold, so that may be affecting things.   The doctor didn't want to break the cycle just yet, so he decided to go with treatment.  Now, I have to be extra careful.  I may have pushed myself a little bit too much last week and exposed myself to something.  Luckily, most of my errands were done last week, so I should be ok to stick around at home.  I'll just have to take some walks to get out and get some exercise, but not go to stores or anything like that.

I'm at home now.  So far so good.  No feeling other than a metallic taste in my mouth.  It's a weird alkaline like taste.  But my appetite is there right now.  I want to eat a bit, but I have to make sure that it's light so I don't see it again when the nausea hits. 

So, today is the second of, at least, four chemo treatments.  I'm not really looking forward to this though.  The first time went pretty smooth, but it's cumulative.  I don't look forward to the blehs with chemo.  I shouldn't be so anxious since I know I'll do fine, but it's like having a hangover.  You know what it feels like and you don't want to feel like that.  And I don't know how cumulative it all is.

I'm here in the infusion room, just waiting for my blood count results.  I have to wait this time because it will affect the treatment.  It's a bit strange because I'm definitely the only person under 50 in this room.  It gets a bit depressing to have something and not seeing anyone your age with the same problems.  Of course, I'm only here on Mondays, so I don't know if/when other people come.

Oh well...just need to barrel through this one.  My parents are with me.  They got a laptop so they don't get too bored.

Yeah...more shocking news.  First, the cancer.  Now, my marriage.  What timing, eh?

So, Shruti and I will be splitting up.  Two days before my first chemo treatment, she told me that she wasn't happy and that she'd be moving out.  I was completely shocked by this.  It was only a week or two prior where she was not showing me any signs that she was miserable.  In fact, she had been there for me during all my surgeries and I thought I was seeing my wife's love during that time.  I know we've had our differences, but I always thought that we'd work them out.  I don't like to give up so easily.  In fact, I still wanted to reconcile and try to work things out.  But, she told me that she didn't.  It only takes one person to decide to split up. 

The strange thing is that a lot of the complaints were about how things don't change, yet going through this cancer is an life-altering event.  Things were going to change regardless.  I can think of so many things that were going to happen, once the treatments were over.  But I guess she couldn't wait.

I guess it would take a lot for me to get over the fact that she (and her family) abandoned me two days before my first chemo treatment.  If someone can't support me during the hardest time in my life, then should I even forgive that person?  The trust has been broken, and respect has been lost.  Without those things, it's hard to see where a relationship can continue.

My friends and family have been great.  My parents are in town this week to help with chemo and with this new development.  I've talked to my cousins, and I know that they are there for me.  My cousin put it best saying that she messed with the wrong family.  (Not in a violent way.)  We're pretty damn strong and proud, and we're always there for each other.  We won't let one person mess anyone up.

2008 hasn't been a kind to me so far, but I'll know it'll end much better.  Things are pretty early on, but I'll keep everyone up-to-date on any new developments. 

Today, I received a care package from my nephews, Akhil, Ashay, and Ajan.  In the package was some chocolates, some Crystal Light with extra vitamin C, some Hindi movies ("Jab We Met" and "Heyy Babyy"), a book ("21"), a card, a smile, and a CD.  The CD was named the "Anil Chacha Get Well Mix".  How cool is that?  Of course, I've been listening to the CD all day so far.  I'll be watching the movies and reading the book during my chemo. 

I can't wait to see them again so I can give them a big hug. 

Today, I went back to get some labs done.  It looks like the chemo is doing a number on the white blood cells as expected.  My counts were down today.  Luckily, not low enough to warrant some shots to help boost things.  All this means is that I need to be careful to not catch anything.  I was told that if I did catch anything, it would just take more time to fight it, but it shouldn't cause any danger. 

I have been feeling great the last few days. I'm finally able to concentrate on work and doing things around the house.  I have the energy to do a few errands with the folks.  My appetite has changed though.  I don't always seem to want to eat a big meal.  I don't really have nausea right now, but I still cravy the fatty foods, which have in the past been my way of settling down an upset stomach. 

I guess this week, I need to enjoy it while I can because it's not too much longer till I get the next round of chemo.

In my previous blog entry, I was talking about how much of a roller coaster this week has been. The whole time, my sister Renu was with me.  If you knew my sister and me, you'd know that we've had many differences.  We've fought many times.  We still bicker about tons of stuff. 

But, I really never appreciated her as much as I did this week.  She came to Denver this past Sunday, after Shruti decided to abandon me.  She was with me during the chemo treatment, she made me mac and cheese or mashed potatoes when I was hungry.  She even cleaned my kitchen.  She's just like her mom.  But, most of all, she was with me when I was feeling pretty down about myself. She got me off my butt to take a walk and talked to me about things.  And that's not easy since we're never the type to talk about things. 

Thank you, Renu, for being there this week for me.  I love you.

BTW, just be prepared to play some serious Guitar Hero when you return.

During the past week, I've been an emotional wreck.  I felt sorry for myself, looking for every excuse to have some sort of company.  I wasn't able to concentrate on work.  I've felt blah because of the chemo.  I felt stuck inside a house not able to do anything.  I felt like I was losing a little bit of control of my life. 

My sister gave me a good kick in the pants today and made me go for a really long walk today.  And something just snapped in me today.  I cannot give up anything just yet.  As someone who I really admire would probably say to me right now, "Sometimes life will throw you some lemons, so make some lemonade." 

With anything in life, challenges need to be met head on and fought through.  And you have to keep on fighting, no matter what.  It can be extremely hard and pretty painful to deal with.  Something really serious and extreme could happen to start making you feel like this is the end.  But, it's only the end if you just give up.  But that's not me.  No matter what, I will do whatever it takes to meet those challenges head on.

My uncle told me that lymphoma was just a detour in life.  But with any detour, you eventually get back on path.  Every other challenge is the same way.  It's just a detour.  You might do something stupid and walk the same path over and over again, but eventually, you'll find the right path.

I spent a little bit of time on the net looking at various articles and reading various websites.  I'm not alone.  With anything, there are tons of other people who have gone through the same things.  Some through a hell of a lot worse.  I've even known some of them.  But all of those people were fighters and have come back with amazing results.  So, I don't believe that anything I'm facing now can't be solved and fixed, no matter how much I think it hurts.

I came across this website from Jenny Goellnitz, which gave me even more inspiration.  It's strange that something like cancer is the thing that wants me to find my passion again.  Before I knew I had cancer, I was feeling content with the status quo, just sitting on my arse and not doing anything about it.

But not now.  I feel pretty damn inspired to go out there and show the world that I ain't just giving up yet. 

Well, it's been about two days since I got the first chemo treatment.  So, far, I'm quite surprised on how I've reacted so far.  I definitely don't feel 100%.  I feel a little sluggish, and my head's a little bit cloudy. 

Later in the day of chemo, there were a few times when I had a twinge of nausea.  When that happened, I immediately took the nausea meds that I was given.  That suppressed it immediately.  So, I never did throw-up or anything like that.  But it definitely made me sleepy.

The next day, I only took the nausea meds in the morning.  I did take a walk outside to get a little bit of exercise. 

Today, so far so good.  Again, I'm definitely not 100%.  But I'm able to work and hang out.  My sister and went to Whole Foods to get some lunch.  I'm still staying away from raw veggies.  We are also planning on going out to do some shopping.  I'll have my mask and my Purelle handy in case I need it.  But so far so good.

I'm recovering at home, now.

After the last chemo, Patti basically injected some saline to flush out the IV line and some stuff to prevent clotting.  I also got a pneumonia vaccine shot today afterwards.

Like I said, I'm at home now, lying down on the couch.  I feel slightly sluggish, but not out of it or anything.  I had the nausea medicine earlier so I don't feel nauseated right now.  I guess I'm a bit sleepy now, but not enough.

I guess I'm just going to lie here on the couch and hang out with Renu.  I got a bucket near-by, just in case, but I'm hoping not to use it.

Patti, my nurse, put the needle into my port to draw some blood.  I thought it would hurt because I wasn't sure about the EMLA cream, but it seemed to be fine.  I was cringing because I saw it and was anticipating it to hurt, but it didn't.  Since she didn't anticipate my blood count being low now, the treatments started immediately. 

The first treatment was the nausea medicine, which came through a drip.  That took about 1/2 hour.  Then they applied the bleo which Patti injected via a syringe.  The velban was next and that was done through a syringe. 

Next was the andryomycin, which also applied through the drip line.  It was a reddish-orange color.  That took about 1/2 hour.

Now, I'm waiting for the last of the treatments to finish.  It takes about 1 hour for this to finish.

So far, I've felt fine.  Not much is happening now.  Feels routine enough.  

Today is the first day of chemotherapy.  I have no idea what to expect.  Last night, I had a hard time sleeping because I was actually thinking about it and started getting a little nervous. 

I saw Dr. Feiner just earlier where he went over a few things like the results of all of the procedures that I've been having.  He's pretty positive about what's happening because he said that the lymph nodes have actually gone down in size.  Of course, that could be the result of taking one out during the lymph node biopsy.  He also set up my appointments with the radiation oncologist to go over the procedures, because I'll be doing radiation after the chemo is done.

Right now, I'm sitting in the infusion center, waiting for everything to start. I'm sitting next to the window where there happened to be more room.  Renu came with me today to give me some support.  It's snowing pretty good outside.  We're actually supposed to be in a winter storm watch today and could get 5-10 inches of snow.  Anyways, the room is not bad.  The chairs aren't super comfortable, but, at least, they recline.  There's WI-FI here so I can connect to the net, but I already downloaded some movies through iTunes so I'll be mostly watching movies today.

So, the first thing that they are going to do is to draw some blood from my port, so that they can do a blood count test.  Hopefully, I put the EMLA cream correctly to numb up the area.  We'll find out soon. 

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They put the needle into my port to draw some blood.  I thought it would hurt because I wasn't sure about the emla cream, but it seemed to be fine.  I was cringing because I saw it and was anticipating it to hurt, but it didn't.  Since they don't anticipate my blood count being low now, they plan on starting the treatments immediately.  The first treatment is going to be the nausea medicine.

I went to my ENT to get my suchers from my lymph node biopsy taken out.  Dr. Reichman told me that they were able to take out a small lymph node for analysis.  It appears that the results are that I have classical Hodgkin's lymphoma.  This is good because we aren't doing to deviate from the treatment plan.  At this point, things are looking much better.

The way that chemo works is that it attacks quickly dividing cells.  Unfortunately, this includes hair and sperm.  So, infertility is a risk.  According to my doc, it's about a 10% chance.  So, if I want to have kids after this is all over, then we need to make sure that we hedge our bets.  That requires a trip to the fertility clinic.

I went to the University of Colorado Hospital, Advanced Reproductive Medicine clinic in Aurora.  First, I had a consultation with a nurse to go over all of the forms I needed to sign.  Making a deposit apparently requires a lot of forms, because of the complicated nature of parental rights.  I can basically control who can have access, when they can have access, and what should happen if something were to happen to me. 

After my consultation, they took me to a room where I had to do my thing into a sterile cup.  After I finished that, I had to seal the sterile cup and place the specimen with another form in a small cabinet that was connected to the lab.  I then had to press a white button to make sure that the analysts could get started on analyzing the specimen.

So, they plan on doing a basic analysis to see how good my sperm is.  If everything is good, they will make some vials to be cryogenically frozen.  I have appointments on Wednesday and Friday so that we have as many samples as possible for the future.

BTW, this isn't a cheap process.  Most of this stuff isn't covered by insurance.  So, it costs several hundreds of dollars to do the freezing.  Most of the money will be made when there is a withdrawal.  In order to save some money, I took care of most of the bloodwork through my insurance.  That will save a couple of hundred dollars.

This is somewhat embarrassing to discuss, especially, since people, including my family, are reading this blog.  But, this is a necessary thing to do.  The worse thing we could do is take the risk and not be able to accomplish our future goals.

I recently got an email from a friend of a friend, who is a cancer survivor.  As I reread that email, and wrote D back, I kept thinking to myself, "Why am I so special to get this attention from people I barely even know?" 

I have had a difficult time being able to understand why I'm getting so much attention.  I'm not a cancer victim, only someone who has to deal with some nuisance called Hodgkin's lymphoma.  There are worse things in the world out there, so why would something that could be so simple to cure be something to even worry about?

It's this constant debate in my head.  Do I have cancer?  Do I have lymphoma?  Why don't I think about it as cancer?  Sure, my body has been sliced and poked, and it does get annoying after a while.  But, I've just been going through my tests and procedures like it's just a walk in the park, and it's just something that needs to be done.  But I've not been really associating those tests with the big C. 

I don't know if it means anything to be thinking about it this way.  Sometimes it's scary that I don't think about it in this way.  Part of me wonders how seriously I'll think about it in the future.  Will this motivate me to be more involved with cancer communities?  I don't know.  Maybe not.  Maybe I'll forget that I even had it.

I guess I just have to wait and see as I go through it. 

I'm now recovering from my lymph node biopsy.  Dr. Reichman performed the biopsy to remove a lymph node in my neck, or at least a portion of it.  I am not sure what he actually did because I didn't see him afterwards.  The idea was to get more tissue samples to see what kind of Hodgkin's lymphoma I have.  There are so many different subtypes that can change what kind of treatment I will actually get.

I arrived at the Rose Surgical Center, which happens to be in the same Founders building as the Rocky Mountain Cancer Center.  I was starving because my surgery was at 2pm and I wasn't allowed to eat or drink (even water) since 12am the night before.  The night before, a bunch of us met at BW3's and scarfed down a bunch of wings.  But that didn't stop me from being hungry this morning. 

After waiting for about twenty minutes, I was led to the pre-op area where they got my vitals.  I put on my beautiful surgical gown and laid down on my gurney.  My nurse tried to put in my IV.  First try was on my left wrist.  That didn't work.  Second try was on my left hand.  And that didn't work.  At this point, she gave up and asked another nurse to do it.  They finally got the IV line in on the bottom of my forearm.  I am pretty much sick of being poked with needles.  I feel like a pin cushion.  Thank god that this was the last time I have to deal with it for a long while. 

I met with the anesthesiologist Dr. Louis and with Dr. Reichman to go over the procedure and to sign some paperwork. 

They wheeled me into the surgical room where, after I switched from the gurney to the operating table, Dr. Louis started the anesthesia.  I felt sleepy at first and then I was out like a light.

I woke up about an hour and half later.  After a few minutes, I was about 3/4's awake.  A little groggy, but good enough to ask for some apple juice.  I guess my color was good enough because the nurse allowed me to have something.  After about twenty more minutes, I was awake enough to leave.

Now, I'm still a bit sore in the neck and still require some pain pills to make it more comfortable.  That makes me more groggy and makes it hard to write this blog.  I'm just sitting in front of the TV relaxing, so hopefully tomorrow, I'll be better.

I went to the Rocky Mountain Cancer Center (RMCC) to meet with Patti, one of the oncology nurses.  Her goal was to give me as much information about what we need to know about the how/what/where of chemotherapy.

So, Patti gave me a tour of the chemo room.  It is basically a big room with a lot of somewhat comfy chairs.  There are some TVs to watch.  There is also Wi-Fi so I can connect to the outside world during treatment.  Snacks and some non-smelly foods are available.  We are allowed to bring outside food, as long as it doesn't smell, because that could cause even more problems with the nausea.  This particular morning, it was not crowded with people, but apparently it could be.  In those cases, anyone with me may be asked to leave to the waiting room.  Let's hope that Monday mornings are quiet.

I then went to a conference room to go over some information.   Alot of the information, I had already heard.  For the sake of those reading this blog, I'll just reiterate what I was told.

Treatments last from 3 to 4 hours.  First part of the treatment will be to extract some blood to get the current blood count.  This is done through the port.  In order to make sure that the needles don't bother the skin above the port, I'm supposed to use the EMLA cream an hour before I go to the chemo center.  This EMLA cream basically numbs the area.  After getting the results of the blood count, they will add nausea medication to the IV line, which is connected to the vein via the port.  Then one by one, the drugs are given.  There are four main drugs of the ABVD treatment:

1. Adriamycin (Doxorubicin)
• Looks like a red fluid.
• Injected via an IV bag through the port.  Takes about a half hour
  
• Common side effects:
• Nausea and vomiting may occur 1 to 3 hours after the drug is given and may last up to 24 hours.
• Complete hair loss generally occurs 2 or more weeks after treatment begins and is not permanent.
• Discolored urine may occur up to 48 hours after the drug is given
• Reduced blood counts occur 1 to 2 weeks after treatment
• Less common side effects:
• Heart muscle damage may occurs. 
  
• Fatigue, weakness
• Mouth sores
• Tissue irritation.  Important to note any burning, pain, stinging while the drug is injected.
2. Benoxane (Bleomycin)
• Looks like a clear fluid
• Injected into the vein via the IV line
• Common side effects:
• Fevers and chills may occur 2 to 10 hours after drug is given
• Mouth sores
• Dark rings in nail beds
• Darkening, peeling, or rash on skin
• Less common side effects:
• Nausea and vomiting
• Tiredness or weakness
• Hair loss
• Headache
• Pain and swelling of joints
• Scarring of lungs
3. Velban (Vinblastine)
• Looks like a clear fluid
• Injected via IV line
• Common side effects:
• Reduced blood counts occur 1 to 2 weeks after treatment
• Less common side effects:
• Constipation
• Nausea and vomiting
• Headache
• Tingling, numbness in hands or fingers.  Need to keep track of this
• Depression
• Loss of appetite
• Fatigue
• Tissue irritation.  Need to keep an eye on this if there are any burning or stinging when the drug is injected
4. DTIC (Dacarbazine)
• Looks like a clear fluid
• Injected via the IV line
• Common side effects:
• Nausea and vomiting
• Flu-like symptoms (fevers, aches, or tiredness)
• Discomfort along vein
• Reduced blood counts occur 2 to 4 weeks after treatment
• Less common side effects:
• Metal taste in mouth
• Eye and skin more sensitive to sun

After the treatment is done, I may stick around for a while until I'm ready to go home.

So, right now, as it stands...my first chemo treatment will be on March 17th, St. Patrick's Day (I asked if they could put green food coloring in the chemo bags)  and every other Monday after that.  I'm hoping that this could be done in two months.  We haven't determined the schedule for radiation yet.

I was supposed to meet with the financial counselor to go over the financial aspects of treatment. Unfortunately, this did not happen because of some conflicts.

Today, I'm recovering from the port insertion.  I had it done in the radiology department at the Rose Medical Center main hospital. 

We got there early this morning for the procedure.  We were walked to the care unit of the department to get prepared.  I got changed into the surgical gown.  They put an IV line into my left arm.  But no blood was drawn this time.  Thank god...since I'm a bit tired of getting poked with needles. 

I met with the radiologist to answer any questions we had.  He gave me an overview of the port devices that I could use...one for the arm or one for the chest.  Both are basically the same.  The port is a bottle cap looking device with a silicon bulb in the middle and attached to a catheder line.  The chest port is placed under the clavicle bone under the skin.  The line is then brought up to the neck and then put inside the jugular vein in which is just hangs down.  The arm port is put in the bicep and the line is brought up the arm and put into the vein. In either case, the silicon bulb can be felt under the skin.  According to the radiologists, there are more risks with the arm port because it's smaller, so it was an easy choice picking the chest port. 

After talking with the doc, they wheeled me into into a room where they were going to do the procedure.  Above the table was a big x-ray machine to give a visual to where the line will be going.  This is the reason why radiologists do this procedure vs someone else.  Apparently, the first round of sedation didn't really kick in, because I was still talking coherently when the doc was asking me questions.  So, they had to add more...which knocked me out.  Next thing I knew, I woke up in the post-care unit. 

Luckily, I ordered food ahead of time so I had something to eat right away.  Because of the surgery, I couldn't eat after midnight the night before, so I was pretty hungry.  I know the secret now.

It's been a pretty hard day.  I've been pretty tired for most of the day, dazing in and out, while watching TV.  I can see the port underneath the skin, and I can definitely feel it.  My neck hurts like crazy because they had to move the muscle in order to put the line in the right place.  So, that's been a bit tough, because it's hard to swallow. 

Today, I'm recovering from my bone marrow biopsy. 

So, for those who don't know what this entails, it is simple...sort of.  This procedure is meant to take the bone marrow out to see if the lymphoma has spread to those areas.  They take the bone marrow out of the lower back/hip area because that's where a lot of bone marrow is created.  They numb the area with some local anesthesia and cut to get to the bone.  Then they take what's basically a corer to break open the bone.  Then a needle, the size of a knitting needle, is inserted to extract the bone marrow.

This was done on both sides of the body.

I had the procedure done in the Post-Anesthesia Care Unit at the Rose Medical Hospital.  I got there around 9:45 and immediately, I was put into a surgical gown.  Blood drawn, IV line put in.  We met with the anesthesiologist who basically told us I'd be asleep during the procedure.  That put my mind at easy, because I was freaking out about the potential pain.  So, after I met with the anesthesiologist, we met with Dr. Feiner who basically gave us the results of our PET/CT scan and just told us how easy this procedure will be.  Then they wheeled me into the room where they did the the procedure.  I turned over to lay on my stomach and the anesthesiologist gave me something to put me to sleep.  I went out like a light, because the next thing I saw was the nurse standing over me, waking me up.  After about a half hour more, I was able to get up and leave. 

Right now, I'm a bit sore in lower back.  So, it's a bit hard to get up, so I've planted myself in front of the TV.  I've been told I'll be sore for a while.  But I should be able to do things as normal soon.

Before my biopsy today, Dr. Feiner gave us the results of my PET/CT scan.  Everything looks good and so far, things are pointing towards being in stage I.  This would mean that the lymphoma has not spread too much and may be localized to the right side of my neck. 

Of course, still have a few more tests to go through to figure out how much treatment I will need.  But this is looking very positive.