March 22, 2006 - Chemo 4, and Some Good News

This morning at 9:30 Claire and I drive over to Dr. Lerner's office for my fourth chemotherapy treatment. I go in by myself first, to step onto the scale and then have my porta-cath flushed in preparation for the chemo drugs. At my request, Raquel, the nurse, uses a larger needle to access my porta-cath – I had problems with the smaller needle reaching the deeply-implanted device on a previous visit – but now it appears that the prior problem was due to post-surgical swelling, which has now resolved itself. A regular-sized needle would have done fine. Raquel consults with a couple of the other nurses, and they decide to go ahead and leave the larger needle in (rather than removing it and sticking me a second time), even though there's a risk of it catching on something and being pulled out. They put a thick wad of gauze under its protruding end to support it, and cover the whole arrangement with a lot of adhesive tape. It seems pretty secure. Raquel then draws my weekly blood sample through the porta-cath. With a plastic cylinder that looks like the fluid-reservoir of a hypodermic needle taped to my shirt, I go down the hall into an examining room, where Claire joins me.

Dr. Lerner comes in, greets us, and opens my file – which, I can see, is growing. It's now a couple of inches thick. First, the news we've been waiting for – and it's good news. The CT scan reveals that the mass in my abdomen has shrunk to about half its original size: from 93 square centimeters to about 45. This, says the doctor, is good progress. Evidently, the radiologist who read the scan was able to make this judgment using the narrative report from my original CT scan – although it would have been better to do a side-by-side comparison of the actual films. Dr. Lerner suggests that, when I do receive the original films back from Sloan-Kettering, I take them over to Ocean Medical Center with a request that the radiologist do a supplemental report.

Dr. Lerner's plan is to continue with the same chemotherapy regimen I've been undergoing, because clearly it's working. At the end of the sixth treatment, I'll have another CT scan – although he warns me that, because I have a large tumor, it may show some residual tissue remaining. Generally, this is fibrous, scar-like tissue, and not a threat – although he says he'll probably want to order another PET scan, just to make sure no "hot spots" show up.

Dr. Lerner does give us a new piece of information. He says there's a possibility that, once the chemo sessions are ended, I may need to have radiation treatments. This is sometimes done with patients like me, who have larger tumors that can be clearly targeted. I ask him about the duration of these treatments, and he says they would probably last for three or four weeks – a series of very brief, daily visits. Another doctor, a radiation oncologist, would determine the schedule and oversee the treatments. When I ask him about the other tumors that showed up on my previous PET scan, he doesn't use the word "tumors" in his response, but rather refers to them as "hot spots." Clearly, his main focus is on the large abdominal tumor; he'll check on the other areas at the time of my post-chemo PET scan.

My blood tests continue to look pretty good. My white cell count is a little below normal, but only slightly – and the Neulasta injection I'll get tomorrow should resolve that.

Dr. Lerner asks about side effects, and I tell him I've been having some trouble with nausea for several days after each chemo treatment – even with the Aloxi they've been giving me intravenously on treatment days, and with the Compazine tablets I've been taking as needed. I remind him that, on my last blood-test visit, Raquel (after checking with him) gave me some samples of Kytril, another anti-nausea drug. I've been holding onto these pills at home, so as to start taking them following this week's treatment. Dr. Lerner says that, besides the Kytril and the Aloxi, he'll prescribe another anti-nausea drug, a new one called Emend. He first asks me if I have a prescription plan – evidently, this drug is expensive. Raquel had asked me the same thing, a couple weeks before, about the Kytril – the samples were of course free, but she was thinking about subsequent prescriptions. What price comfort?

After concluding our time with Dr. Lerner, I walk with Claire to the other end of the building, where I take my seat in the same corner treatment room. Janet, my nurse for the day, begins the Benadryl drip, then the Rituxan not long after that. The medicine makes me drowsy, as it's done before, and I doze through most of the morning. Claire returns around noon, bringing my new Emend anti-nausea prescription – the first pill of which I need to start taking about an hour before I start on the CHOP chemo drugs (these don't start until I've finished the four- or five-hour Rituxan drip, so there's still time). I don't know what the original cost of the Emend prescription is, but our share, after the prescription plan kicked in, is about $85. This is for three pills.

A couple of friends stop by this afternoon, for surprise – and very welcome – visits. Dottie, a retired minister from our presbytery who's receiving treatment for ovarian cancer, stops by to offer encouragement and a prayer. Then, a little while after she leaves, Don – the member of our church who also has NHL – looks in. Both have been in today to see doctors from the same medical group, and ran into Claire in passing, so they realized I must be back here and stopped by to say hello. Both are well-known to the chemo nurses and very familiar with the whole treatment routine.

After my visitors leave, I watch a video I've brought along with me. In this age of DVDs, the video selection in our local Blockbuster store is getting sparse, but last night I did find a videocassette version of the 1998 Robin Williams film, Patch Adams. It's about an iconoclastic young doctor's journey through a rather traditional medical school, and how he manages to chart his own course – despite opposition from some hidebound professors – in the direction of a more holistic, personal way of treating patients. I had heard that the film – while based on a real person – is highly fictionalized. That's obvious from the script, some of which is just too unbelievable – typical Hollywood! But Robin Williams makes it entertaining, with his special blend of humor and compassion. The movie raises some provocative questions for modern medicine, which all too often treats patients as cases rather than people. (Not that I have any complaints about Dr. Lerner or his staff in that regard – they're very caring.)

Claire returns about 5:00, and we leave about 5:30 – after stopping on the way out to schedule my next several weeks of blood tests, and my next chemo treatment for April 12th.