Mon., March 30: first outpatient chemo

This is going to be a long day after all.

Even though the hospital gradually increased his drip (on Rituxan) to watch or side effects, the outpatient clinic will go through that slow process again -- luckily just this first time. Then about an hour on the other med (tomorrow is only the second med, hooray).

Rather boring.

Tues. March 24: Hair Irony

As I was going home from my hair appointment today, Mike called and exclaimed, "My hair is coming out in clumps! We have to cancel our friends visit tomorrow."

Honey, we knew the hair would go. And not that it matters, but the friends are coming the day after tomorrow. They don't care about your hair.

Mon. March 23: Mike is doing well

Bendamustine.  That is the chemo drug taking the place of the more toxic (and four days) combination. I will call it "Ben."  

Mike will have a half day of Rituxin next Monday. Then "Ben" will be about 90 minutes on Tuesday. Three weeks off, and do it again. 

Not to be misleading, however, because the effects can be as tough as any other chemo.  We still expect Mike to lose his hair over the next month. The treatment will tire him, and he can have a variety of gastric issues. And yes, it will kick this cancer's butt!

For nerds, why the change?  The first lab report said the stomach biopsy was type 3, large B-cell, aggressive; and the bone marrow sample type 1, small call, indolent or slow growing.  OHSU said type 2, intermediate, with type 1 in the marrow. Doc says, "We're going with intermediate. And the treatment has lower long term risks for him at his age.".   

Friday, March 20: yes, outpatient chemo

We will get more details from the doc Monday, but the medical assistant was able to tell us that Mike can have outpatient chemo instead of being in the hospital for a whole week every time. 

I'm a wee bit worried we could be traveling more.  Oh well, we will see.

Mike is doing very well.  He's had a little bit of mouth soreness, taken care of with some food changes and a baking soda + water swish.

March 16: First post-chemo appointments

Yes, today was hard on Mike, as he is in the "nadir," the low point of his blood counts (boo, expected).  But not so low he needs a blood transfusion again (hooray).

The doctor is still waiting for two reports. One is from OHSU (a chromosome report, I think).  I've forgotten the other.  Depending on the results, Mike might be able to do outpatient chemo instead of hospital inpatient!  R-CHOP instead of R-EPOK.  

Wednesday and Friday will also have quick blood draws and possible blood transfusions.  Otherwise, some good rest is on tap.

Today's gratitude: we have always been a good team.  We will continue to treat each other kindly. 

Thurs March 12: home

It feels so good to be back home, and the last eight days were -- were they real? We have three days to adjust, then a flurry of three appointments Monday.  Mike is likely to start feeling sapped of strength by then, unfortunately.  

I might not be posting for a bit, just because there won't be anything to report.

Today's gratitude: we really enjoyed today's great weather, with more on the way tomorrow.

Weds, March 11: home tomorrow

Two bags of red blood cells today.  When he discharges tomorrow, Mike will go to the oncology office for a shot to boost his white blood cells.  We were told it's cheaper that way than doing it in the hospital. 

By the end of the day, Mike was basically disconnected from stuff, except for the PICC which will stay in.

Mike did lots of walking today.  Visit from Brooke and Kylea.

Phone call from his cousin, whose answering machine contained Mike's message, "Well hi there.  Just wanted to let you know I have cancer.  Give me a call!"

Not much else to report.  We expect things to get uncomfortable within a week, and excuse me if I don't report the details.  What's that you say, thank you? Why, you're welcome.  

Yes, he will lose his hair.

Today's gratitude: blood donors.  I donated at the Salem Red Cross on Monday.  So if you are part of the 60% who can, please think about it.  

Finishing the last bag in the first round - Tues March 10

Mike just finished this round of chemo bags. Tomorrow he will receive some blood product to help boost his system before the drugs plunge all his numbers. Going home Thursday!

Next week he will need to check in at the doctor's office Monday, Wednesday, and Friday. About that time, his immune system will be at its lowest, so we have to be careful.  No trips to pre-schools!

The weirdest thing about this adventure is how much his kidney function has improved.  Yes, it will take a hit, but right now he is normal "Stage 1" instead of stage 3 (out of 6).

Gratitude of the day: family, friends, and neighbors.  Thank you all.

The treatment plan

First, updates. Bone marrow sample did NOT show his large cell cancer, aka, it has not matastized to the bone. And Mike has been walking during treatment, two walks daily, a big circle on "5 North."

The big picture on his treatment is five days (or so) inpatient chemo, three weeks off, five days in, three weeks out.  Expecting six cycles, but subject to change if tests show it should change, or he becomes intolerant of one of the drugs.

More specifically Mike gets R-EPOC:
One bag of Rituxan, dripping in over four hours
Four bags of Etoposide/Doxorubicin//Oncovin, each of which drip in over 24 hours (yup, almost 100 hours of drip-drip-drip)
One bag of Cytoxan -- we don't know yet how long it runs.

There are certain periods where Mike's blood counts will be low, when we will have to be extra careful to avoid possible exposure to germs. 

Mike's diagnosis

Never in my wildest dreams did I think my little blog would become a medical blog.  But here we go again.

Mike's medical history includes Parkinson's and congestive heart failure (CHF).  He occasionally has fluid build up around his lungs, making him take short breaths and feeling like he's not getting enough air (even though his oxygen level is not in danger).

The evening of January 23 he asked me to take him to the emergency room.  Tests showed he is suddenly very anemic. For example, one of the measures is hemoglobin, where the normal range is about 12 to 17.  He had been at 12 for a long time, including a blood test just three months prior.  Now he was 9. 

Jan 29: Follow up with our doctor, Mike referred to special testing (scopes, fun). 
Feb 10: specialist consultation.
Feb 20: colonoscopy, endoscopy (with biopsy of stomach)
Feb 24: biopsy result, lymphoma 
Feb 26: CT scan; and we got a report his hemoglobin is down to 8.
March 4: oncology doctor consult 

[A blip in this story: I had been summoned to report for federal jury duty March 2. Ask me some other time how it went.]

Mike's daughter Dianne joined us for the oncology consult. The doctor rattled off pretty much this statement, "So you are Michael Ramsby.  You have diffuse large B-cell gastric lymphoma.  The good thing about large B cells is that they respond very rapidly to treatment. I am going to admit you and start chemotherapy tomorrow.  We still need to does some diagnostics, including echocardiogram and bone marrow aspiration, but we are going to start hydrating you in preparation for treatment. I have a girl looking for a room right now.  Any questions?"

Mik asked, "So I will be admitted tomorrow?"

No, honey, now.

The doctor left the room, and we were very quiet.  I felt like a dump truck had just come in. Dianne said she felt like she had been in a drive-by shooting.