A Busy Week

That might be a bit of an understatement.  This was one heck of a week.

Monday:  Fertility Fail

I guess not every appointment can be stellar, but this one was just particularly bad.  The first 30 minutes seemed fine - we went through all the normal intake measures, and then the nurse explained that with the treatment protocol we would be following, there would be a slightly increased risk of early menopause afterwards.  Since I am still very young, this isn't an issue we would have to be terribly concerned about right away, but she still walked us through the options for freezing eggs in case we were interested.  We were thinking that we probably wouldn't want to do anything since it was a low risk scenario and were feeling pretty good about this all until she said something about treating Hodgkin lymphoma.  Here's how the exchange went:
Me:  No, I have non-Hodgkin lymphoma.
Nurse:  *looks at me.  looks at computer.  looks back at me*  What?  My notes say Hodgkin lymphoma.
Me:  That's not right.
Nurse:  *looks at computer again*  What was your diagnosis?
Me:  Diffuse large b-cell lymphoma.  Non-Hodgkin.
Nurse:  *still looking at computer*  I need to go talk to the doctor.

So yeah.  Somehow, they had the completely wrong diagnosis and treatment plan in their notes.  After a hurried discussion with the doctor, the nurse comes back to tell us that there isn't enough data about the effects of the treatment protocol I am *actually* getting on fertility to really recommend anything one way or another (most people diagnosed with this are much older, so fertility isn't an issue for them).  Two of the drugs in my protocol are "more likely" to cause problems, and two are "less likely".  

We have decided that we are just going to see what happens.  We were leaning this way anyway, and there just isn't enough information to prompt us to act.  Plus, even if we were interested, we do not want to postpone treatment long enough to go through freezing eggs (the process takes an absolute minimum of 11 days, but when you factor in pre-approvals and scheduling, it's probably more realistically 3 weeks).  All we decided to do was gather some data:  they did some tests to measure my baseline fertility, and then we will recheck after treatment.  Even though it is a gamble, the one thing that we do know is that age is on our side.  As much as it sucks to be dealing with all of this so young, being young should help.  So right now, we are taking the "whatever will be, will be" approach.

And are not recommending this clinic.

Tuesday:  Port ... on the starboard side?!

For whatever reason, I was pretty sure that my doctor said the port would be put in on the left side of my chest.  I made a joke later about how that made sense, because if you put it on the right, you'd have to call it a starboard.  Turns out that it does go in on the right unless there's an issue with the vein on that side.  So ... everything went well with my starboard insertion ;)

The nurses loved me - apparently I had a little smile on my face for the whole procedure.  One of the nurses said that I should be the poster child for sedation.  Totally fine by me, since I'll take sedation over general anesthesia any day!

After having a harder recovery from the biopsy than advertised, I expected to have more pain from the port right away.  The next day was actually not bad at all!  The most uncomfortable part is where the catheter runs over my collar bone.  I am actually more sore today than I was on Wednesday, and I think that I have probably been over doing it.  Fortunately, it is finally the weekend and I will be able to rest up.

Wednesday:  #shorthairdontcare
Since I will be losing my hair, I wanted to cut it off before it started to fall out. 

I have never cut my hair this short before - the shortest I have ever gone is chin length.  Plus, I had most recently been growing it out, so this was a pretty drastic change.  I ended up with about 10" to donate to Pantene's Beautiful Lengths, the partner program with the American Cancer Society that provides wigs for women with cancer.  I am still getting used to the new style and the lack of hair.  In case anyone was curious, phantom ponytail syndrome is a real thing.  But I am actually loving the change!  I think it is cute and fun and I never would have tried it on my own (thanks for the moral support, e!).

Thursday AM:  We can be taught

I know I said it before, but I'm going to say it again:  I love my medical team!  We had our teach session with my nurse, and it was really good.  We covered the major side effects (nausea, constipation, aches, mouth sores, changes in tastes/appetite) and what we can do to combat them.  We talked about the things that I need to avoid (alcohol, getting pregnant), the things that I can still do (pretty much everything else, assuming I feel up to it), and the things we need to watch out for (fever, shortness of breath, signs of infection around the port).

She was appropriately appalled about how poorly the fertility visit went.  She was also pleased with our current habits of drinking tons of water and eating frequent snacks and meals, and I think she was somewhat impressed with the questions we had and how prepared we were.

We got lots of handouts, reference materials, and resources.  We also walked out with multiple different prescriptions to have on hand in case I need them.  I am now feeling fairly optimistic about how things will go.

Thursday PM:  Nerd Alert
The last thing on tap for the week was the muga scan to look at my heart.  As much as I dislike having to have all these tests done, I also find them very fascinating.  This test looks at how well your heart is pumping by measuring your ejection fraction (how much blood is pumped out).  Being the nerd that I am, I had to ask the nurse how it works.  For all you other nerds out there, first they give you an injection of sodium pyrophosphate, which binds to your red blood cells.  About 30 minutes later, you get an injection of a radioactive tracer (this time, it's technetium!), which binds to the pyrophosphate.  They can then image the blood moving in and out of your heart.  So if you've been keeping score at home, I've now had radioactive iodine, glucose, and technetium.  No results from this test yet - we should get those at our appointment on Tuesday.


Friday-Monday:  Rest
Four days in a row without an appointment?  No pokes, prods, or tests until Tuesday?  What is this?!

Much needed, that's what it is.

Just The Facts, Please

Disclaimer:  everything in this post is accurate to the best of my understanding.  We've gotten a lot of information thrown at us in the last week, and I am not an expert in this field.  I may not have all the details quite right at this point, but hopefully close enough.  I am also writing under the assumption that will I tolerate the medications well and that the treatment will be effective.  So here we go!


I have Diffuse Large B-Cell Lymphoma (DLBCL), which is the most common type of non-Hodgkin lymphoma.  Although it typically presents in much older people, there is a sub-type that presents in young women in their chest.  It is very treatable, but it is also aggressive.

When my tumor was first measured, it was 8.5 x 9.5 x 7 cm - for all you sports fans out there, that is bigger than a baseball.  It is large enough that it is causing me pain, but vicoprofen is helping with that.

The best news that we've received so far is that my PET scan was clear (except for the mass in my chest, obviously).  We are waiting on the results of a bone marrow biopsy just to make certain, but that is expected to come back clean as well.

We had all of my scans and reports sent out for a second opinion, although we don't expect anything to change.  Apparently, I am pretty much a textbook case, but it never hurts to have someone else look.

I am scheduled to start chemotherapy on March 31st following the R-CHOP protocol (rituxan, cytoxan, adriamycin, vincristine, prednisone).  We are looking at 6 cycles of 1 dose every 3 weeks, so 18 weeks total.  After each treatment, I will need to get a Neulasta shot to keep my white blood cell counts up and lower my risk of infection.  If my red blood cell counts drop too low, I may have to get a transfusion.  I will lose my hair, and there are lots of possible side effects, but they should only be short term issues.  My oncologist doesn't think that radiation will be necessary, so we will be done mid-July.

Things that have to happen before then:
- Port insertion:  I will need frequent blood draws and IVs over the next few months, and all that wear is hard on the veins.  More importantly, some of these drugs can cause serious tissue damage if it is not injected into the vein properly.  A port addresses both of those issues, so I'm getting one put in next week.
- Muga scan: adriamycin can be hard on the heart.  They need to check my heart function before hand to make sure there isn't anything extra they need to monitor.
- Fertility counseling:  in general, there is a risk of loss of fertility with chemo.  My oncologist does not think we will have an issue, but we are meeting with a fertility specialist to discuss our options.
- Teach with my nurse:  we have an appointment to go over all of this information again and more with my nurse.  We'll get more information about things to watch for and things to avoid, and get another chance to ask any questions we've come up with by then.

One more thing that we discussed, which doesn't need to happen before starting chemo, is that we should see a genetic counselor.  When you combine the fact that I am 28 and have already had two malignancies with the cancer history in my family, you have a very strong case for seeing a genetic counselor and doing some further investigation.  My oncologist recommended it, though if he hadn't, I would have brought it up.  We still have to get this scheduled.



If that wasn't enough information for you, there is a good lymphoma resource available from the American Cancer Society (http://www.cancer.org/cancer/non-hodgkinlymphoma/).   And for anyone who wants to read more about the drugs in my treatment plan, you can look them up at  http://chemocare.com/chemotherapy/drug-info.

Far Too Soon

When I wrote my farewell post just a few months ago, I knew that there would likely be a day when I would need to dust off the blog and write again.  I just never expected that day would come so soon.

A little over three weeks ago, I went to the doctor's office about a lingering cold that felt like it was moving into my chest.  Expecting to be in and out quickly, it was a complete shock when a chest x-ray revealed a mass on my lung.  After a CT scan, an appointment with a cardiothoracic surgeon, a biopsy, and several emotional ups and downs, we know what we are dealing with.


I have lymphoma.


So unfortunately, the blog is back in business.

I've got a lot of information to process and share, and will hopefully get a couple posts up in the next few days.  This treatment will be completely different than what we experienced with my thyroid, and there's a lot that has to be done to prepare.

But I am ready.

And I will beat this.


Stay tuned.