Questions

I've been asked several questions constantly, so I thought I'd deliever an update here:

How is she doing?

She's doing quite well, thank you. She has bad days, incredibly bad days, and pretty good days. This is a complicated question, of course. Emotionally, she has continued to be positive and driven about her prognosis. Physically, she is suffering a lot of side effects, ranging from deep bone pain from the GCSF, nausea and diarrhea from the chemotherapy, and fatigue from low blood counts. Internally, however, her spleen is shrinking and her lymph nodes are disappearing from sight on CT scans. It's a mixed package, as I discussed before, but it's paying off.

Is she working?

She was initially told that most people on chemotherapy are able to work on a limited basis, if not more. However, her program is extremely aggressive and rapid, also requiring inpatient stays of approximately one week every three weeks, so it's pretty ridiculous to expect her to work just knowing how fast-paced her therapy is. Additionally, she's quite in need of recovery the two weeks following inpatient therapy. During those two weeks, she also undergoes outpatient therapy, CTs, bloodwork, and other lab and diagnostic tests. So currently, she is not working and does not plan to return to her occupation until fall at the earliest. Following her transplant, there will be a long duration of recovery of at least a few months, and then after evaluating her energy levels and response to treatment, she may return part-time during the fall.

What are the blood counts like?

Her WBC (white blood cell) count is essentially at zero. This is a good thing because this means the cancer cell population, which are also from white blood cells, is decreasing. Of course, we still need to stimulate the immature blood stem cells for her apheresis. Currently, her platelet count is high (at ~50K), which we'd like to maintain. Previously, her platelet count had been crashing post-chemotherapy to 10K and lower, at which point, the protocol is to give platelet transfusions. Hopefully, she won't need a transfusion until after the next few drugs.

What drugs is she receiving?

Her core treatment consists of: rituximab, cyclophosphamide, vincristine, doxorubicin, and dexamethasone, followed by a round of cytarabine and methotrexate. She also has numerous drugs on the side such as mesna, acyclovir, ciprofloxacin, prednisone, and ativan, and hydrating infusions and blood product transfusions.

So what exactly is the program?

She is on her third cycle, ending week two this weekend. Next week she starts apheresis. The following Monday, 04/14, she will begin her last scheduled cycle of chemotherapy. Each cycle is 3 weeks long, beginning with approximately one week inpatient and the following two weeks at home.

What follows this last cycle?

More cat scans and pre-transplant workups and then radiolabeled immunoglobulin therapy, which will be inpatient at the university. She will be completely without an immune system at this point, and very vulnerable to microbes, so she will be kept in an isolation room during the therapy, perhaps even up to the date of transplantation and beyond.

Is the hospital food good?

Psh! Of course not! But we pretend it is. =O)