(April was not) The Cruelest Month

OK, so I haven't blogged for quite a while, and I thought it was a time for a "Here's what's going on with Brendan"-type post. The (very) short version of the story is as follows: (a) I'm all done with chemo (woo-hoo!) but (b) I won't know if the chemo worked until May 25. I've been a little under the weather (even compared to what's been normal), but I'm looking forward to starting to feel better soon.

In any case, here's the story of cycle 2 (which covers basically the first two-thirds of April). I'll try to get the stuff on cycle 3 up in a few days.

Cycle 1: A Recap

I started my first cycle of chemotherapy on Monday, February 27th. My chemotherapy regimen consisted of bleomycin (B), etoposide (E), and cisplatin (P for "platinum") Each cycle was supposed to last 21 days—5 days on (BEP day 1, then EP days 1-4), 2 days off,1 day on (B only), 6 days off, 1 day on (B only), 6 days of—and then the next cycle was going to start on day 22. It didn’t quite work out the way, which I’ve written a bit about earlier. I made it through the first two weeks fine, but ended up having to wait ten days for the final dose of bleomycin, on account of my white cell counts being super low. In cycles two and three, I received the Neulasta (a longer lasting and much more expensive version of Neupogen, which is what I was given toward the end of cycle 1).

As far as setbacks go, a 10 day delay really wasn’t too bad, and it’s certainly was something I was willing to live with. If I could go back and do it over again, though, I’d be a bit more assertive with my physician (in asking for Neupogen, or in directing him to give my bleomycin even when my white counts were low). Live and learn, I guess. So far as I can tell, tinkering with the dosing regimens on BEP therapy has some effects on its effectiveness, but not overwhelmingly huge ones—for example, studies have found that doing things like deleting bleomycin or stopping after two cycles lowered cure rates by 5-10%. So, while I don’t think the ten day delay was optimal, I don’t think was a disaster, since I’m at least still receiving all the drugs. In any case, my HCG level dropped to 0 by the end of cycle 1, which means that there has been at least partial response to the chemotherapy.

When I started chemotherapy in February, I had two symptoms—sore nipples and a productive cough. The nipple soreness (which was due to elevated HCG levels) went away toward the end of cycle 1, while the coughing has stayed with me, though it has gotten quite a bit better (and for all I know, might be caused by something entirely different than my pre-chemotherapy coughing).  I’m still not quite sure what to think about the cough—it could be caused by active cancer cells, by dead cancer cells, by bleomycin-induced lung scarring, or by some infection (perhaps initially caused by the cancer) that my weakened immune system just  can’t get rid of. Whatever it is, I’ll have to wait for the CT scan to know for sure, and even then they’ll probably have to do a biopsy if they see anything in my lungs. CT scans, unfortunately, can’t tell the difference between dead tumors, live tumors, and certain types of pneumonia.

Cycle 2: Week One

 I start cycle 2 of chemotherapy on Friday, Mar 30th, and ended up going Fri-Tues (instead of Mon-Fri). This requires that I be admitted as an outpatient to the hospital oncology ward for Saturday and Sunday. The ward is small, windowless, and a bit gloomy looking. If you imagine a typical regional hospital ward built in the mid-60s, you’ve probably got the right idea. The nurse who administers chemo is very friendly and talkative, though, and she doesn't even mind when we filled up the ward to capacity with visitors (thanks to Anne S, Anne R, Kate, Graham, Liz, Rachel, and Steve!).

I don’t  accomplish much over the weekend, with the possible exception of watching a lot of college basketball. I’ve entered in two tournament pools and am poised to win money if either Ohio State ($150) or Kansas ($50) win the tournament. Obviously, things don't work out too well for me, and every team I root for loses: Louisville against Kentucky, Ohio State against Kansas, and Kansas against Kentucky. Oh well. Anne and I go to see The Hunger Games on Sunday, which I think was pretty good, though not outstanding. I imagine just about everyone on earth has seen this movie by now, so I’m not sure what else to say about the movie. I didn’t think books two and three quite lived up to the promise of book one, so I’ll be interested to see how those work as movies. Oh, and Jennifer Lawrence (the lead actress) is absolutely phenomenal in Winter’s Bone. So, you should all see that, if you haven’t already.

On Monday and Tuesday, I am back in the Cancer Center in the south clinic. My mom comes to visit for Monday and Tuesday, and we have a good time.  Chemotherapy (which runs Fri-Tues during the first week of each cycle) goes fairly well. On Wednesday, I get my first white-blood-cell-boosting Neulasta shot, which costs  $738 (well, it actually costs five times this much, but my insurance covers 80%). The shots end up doing their job, though, and I don't have to delay chemotherapy again.

I take Wednesday and Thursday off from work, and spend most of my time watching Ken Burn’s Civil War, which I really like. I sometimes find Shelby Foote (a nonacademic historian who features prominently in the series) a bit annoying, though. For example, he likes to say things like “Abraham Lincoln and Nathan Bedford Forrest were the two great geniuses of the Civil War.” Really? I guess Forrest was good at strategy, but so were lots of other people—Grant, Sherman, Lee, and Stonewall Jackson, just to name a few. And Forrest was an absolutely terrible human being, even when judged against his contemporaries—he had a policy of executing black soldiers after they surrendered and helped found the Ku Klux Klan, among other things. I know they still think he’s a hero in Tennessee, but he seems to me like he’s a whole lot closer to Joseph Goebells  than to Erwin Rommel. The postwar U.S. government would have been perfectly justified in having him tried and executed as a war criminal, had they decided to do so. And Shelby Foote doesn’t help things by comparing him to Lincoln. Just sayin.

Cycle 2: Week 2

On Friday, I go in for my bleomycin dose, which is fairly uneventful (basically, I just sit around and then go to sleep--see the next section for more details). I find out that the Neulasta is doing its job, and that I have approximately 10 times as many neutrophils as an ordinary person has (and, therefore, around 500 times as many as I'd had toward the middle of cycle 1, when my white cell counts were in the toilet.)

The rest of the week is really a high point, at least in terms of how I feel. Greg and Laura are in town with their baby boy, Nathan, for the weekend, and we get together with them both Saturday and Sunday. On Saturday, we have lunch at the Esquire; on Sunday, we have Easter lunch with a group of friends at Adriana and Eduardo's house (being the weirdo that I am, I bring Boca spicy chicken patties, and focus my energy on eating the vegan-friendly side dishes, which are all wonderful.)

I go back to work from Mon-Thurs, and think that I am fairly productive, all things considered. Anne and I have a pretty fun week, too. We watch Your Highness with Kramer (which is absolutely terrible), go to eat with Kate and Graham at Dublin O'Neil's with Kate and Graham (which has the best "English-style" fish and chips in town, even if it can't compete with the Seaboat) and go shopping and out to Fazoli's on Wednesday.

The discouraging aspect of this week is that it marks the beginning of an absolutely terrible 2012 baseball season. The Twins lose 4 of their first 6, which turns out to be a pretty accurate prediction for how the succeeding weeks will go (they are currently 8-22, and behind by 5 runs to Toronto at home). The Brewers win 4 of their first 6, but 3 of these wins are against the Cubs, so it's tough to know what to think (they are current 13-18). At this point, I'm still holding out hope. (By the time of this writing, I'm mentally preparing myself for another postseason of rooting for the Cardinals, if for no other reason than that it annoys the Cub fans to no end.)

Cycle 2: Week 3

Just like week 2, week 3 starts on a bleomycin day, which means that it basically consists of the following routine: 

• Check in at 7:00. Sit around for a half hour. 
• Blood test from 7:30-7:35. They leave an IV line dangling from the port in my chest. (On occasion, I've forgotten it was there and have gotten some strange looks in coffee shops...)
• Waste time from 7:35-9:00. I always spend this time having a "second breakfast" in the hospital cafeteria, which is actually pretty good.
• Meet with my oncologist from 9:00-9:15. In these sorts of meetings, we basically just look at my blood counts, which I've learned to interpret fairly well. On this particular day, my white blood cell counts sort of sucks, and we decide I should get a Neulasta shot in the hospital on Saturday.
• Sit around in the chemo area from 9:15-9:45.
• Get hooked up to "pre-meds" at around 9:45. For bleo days, this includes saline, a steroid, Benadryl, and Tylenol.
• The Benadryl always puts me immediately to sleep, and I usually am not fully awake until six hours later.At around 10:30, a nurse pushes bleomycin through a syringe into my IV. This takes around 10 minutes. 
• Go home at 11:00 and sleep until 4:00.

When I get up at 4:00, I help Anne clean the house in preparation for her parents' arrival. (Actually, I might be making up the part about me helping with the cleaning. I mostly remember that cleaning was being done, and that I was awake...)  They arrive around 6:00, and brought us all sorts of goodies from Trader Joe's. We decide to have Seaboat for dinner, which (as I've noted in a previous post) is pretty awesome.

On Saturday, Anne and I get up and go for a run in the rain, and then meet up with her parents. The four of us go to the hospital to get my Neulasta shot administered. Due to a whacky provision in my health insurance (which won't cover the use of the exact same shot when it is provided by the hospital pharmacy), we have to stop at Walgreens along the way to purchase the shot. Everything goes fine, though, and we're in and out in less than 30 minutes.  We have a good time hanging out for the rest of the day, and went downtown to celebrate Anne's birthday. I'm feeling a little queasy in the evening, though, so I have to duck out on Anne's birthday meal at Boltini.

The rest of the week is pretty quiet, at least as far as cancer related-stuff is concerned. While I don't feel absolutely terrible (which I will by next week), I also don't feel nearly as well as I did during week 2. I'm at work Mon-Thurs, though I usually only make it through about half the day before going home. On Wednesday, Anne, Rachel, Kramer, and I go out for Anne's birthday dinner at Red Lobster (courtesy of Grandma Feck); on Thursday (Anne's actual birthday), I stay home while the girls go out dancing until late.
On Friday morning, cycle 3 starts.