Monday, February 25, 2008

Like Blood for Chemo

No counts, no glory (2/25/08)

Well, despite having a stellar week in terms of perceived energy, my counts were too low today to go in for chemo. Actually, my red blood cells were so low that I'm anemic and am sitting in the hospital right now getting a blood transfusion. It's not as bad as it sounds - I actually feel fine, despite multiple people having told me that I look pale today. Apparently your counts don't have much to do with how you feel when you're "young" like me.

They're going to give me three units total (I'll probably have to come back tomorrow to finish up) - one unit is about the amount you give when you donate blood. Incidentally, it's also the amount they needed to give me when I had my prostate surgery, though I think that was just the plasma/platelets. The blood they're giving me has been irradiated so that the white blood cells have been killed off. Apparently this is important in case I ever need a bone marrow transplant, as you don't want to have been exposed to anyone else's white blood cells. It's a pretty unlikely scenario, but it's good that they take the precaution.

So why the super low counts? Apparently another hidden symptom of radiation is that it blasts your bone marrow, and in adults the marrow in the pelvis and the sternum produce most of your red blood cells (RBCs). So when you blast the pelvis you really reduce the ability of that bone marrow to produce RBCs. The bone marrow in our adult limbs is all fatty and doesn't really produce RBCs anymore. Supposedly this is why kids are able to take on more radiation/chemotherapy than adults - the marrow in all their extremity bones is still active and working hard, while ours is old, fat, and lazy. Of course, I don't really feel like an adult, but apparently no one told my bone marrow that.

In any case, I'm told that I'll feel really good when I get through all this blood, so I guess that's a plus. It's always a bit of a mixed blessing to have to delay a week - you want to keep the treatment going but you also want to have some more time to feel good. This time around, another positive about delaying a week is that it'll give things a little more time to heal, which will allow us to actually go back to the other set of drugs for chemo. As my doctor puts it, normally this regimen alternates sets of drugs, so you get a "left punch, right punch, left punch..." but so far we've had to do left, left, right, right, because of the radiation therapy (can't give the left set during radiation). By giving things another week, we'll hopefully be able to alternate back to the other set this time instead of giving it a third right punch. Supposedly it doesn't make too much of a difference, but I guess you want to make sure the heavy left is getting its turn. (For those of you keeping track, the aforementioned right punch is Etoposide/Ifosfamide, and the left punch is Vincristine/Adriamycin/Cyclophosphamide. It's really the Adriamycin, also called Doxorubicin, that makes it a heavy left. It's so heavy in fact that it can cause "radiation recall", in which it actually brings back some of the skin symptoms from radiation. I'm not sure how it does that, but I'm hoping I won't have to find out. Stay tuned...)

Friday, February 22, 2008

Don't forget to look UP


Well I'm finally starting to feel a bit more normal these days. The itchy burns went through a period of gross oozing pus-iness, but now they seem to have dried out and are healing quite nicely. BMs are still a little painful, but I'm already doing everything the docs (and other folks) have recommended, so I think I'll just have to wait for things to heal up (it's getting better, anyhow). Round 5 is coming up next week...

Energy Levels

One of the things they tell you to expect is a lot of fatigue from the chemo. Lately I've been thinking that my energy with normal activities seems to be pretty good (walking around, driving, eating, doing stuff on the computer), but of course then I realized that most of those normal activities involve just sitting around. I guess maybe there's something to be said for achieving normality when sitting around itself is a bit of a feat because of bottom soreness. For most of last week I was trying to either sit on really cushy things (my mom bought me this Christmas tree pillow a while ago that I sometimes carry around with me) or lie down in a reclined position on my side. Luckily, that seems to be less and less of a problem every day. I can even sit on hard chairs now with no problem (wee! it's so exciting, I know).

In any case, beyond those normal activities, I've really noticed the limits of my energy when I try and exercise. I went "hiking" with my sister two weekends ago (right after my last round), and I started to get winded after a very short incline. We were walking on a trail that was mostly downhill, and then there was a little 2-minute stretch of uphill and all of a sudden my heart was pounding and I was breathing heavily like I had just sprinted 100 meters or something. I felt kind of lame, but once we got to the bottom I made Julia go back and get the car to pick me up.

Supposedly this is not abnormal, though. A couple months ago, I met a guy who had just finished the same chemo regimen as me, and he said he basically wasn't able to do any kind of cardio exercise like running or biking because his heart would start pounding like crazy.

I guess the nice thing about my normal hobby exercises is their scalability. Tai Chi is something you can do at varying levels, no matter what your energy happens to be. Climbing is a bit less scalable, but I've found i can do a little bit and just rest a lot in between climbs. It's kind of frustrating, though, since I want to be able to do a lot more but my body is not letting me. Even Tai Chi can be tiring. I'm hoping I can build back up some amount of strength and endurance. I went climbing yesterday and was able to do quite a bit more than last week. I guess it's a combined effect of all this crap (read: poisonous chemo drugs) taking its toll on me, as well as the simple fact that I haven't really been exercising for the past few months. The latter would probably knock anyone down a few notches in performance, eh?

Looking up

Well, so the other day in a stint of "I feel good"-ness, I decided to drive up to SF to see a friend who had the day off from residency. It of course turned out to be a rainy day after a stint of really nice days, but that didn't bother me too much. I picked her up and we decided to go to the MOMA to check out the latest exhibits. We were originally going to grab lunch, but it was a bit late by the time I got up there, so we decided to just go over to the MOMA and get something quick nearby.

It was just before 3pm and we pulled up to some parking meters right across the street from the MOMA. The spaces were mostly empty but there was at least one other car there. The meters said they were active from 9am-3pm - "Ha! What luck! Free parking!" we said. Somewhere deep in the back of my mind, though, I knew it was too good to be true. We went to get some sandwiches, and when we came out, sure enough, there was my car disappearing around the corner on the back of a tow-truck. Urghh. So we rushed over to where we had parked, thinking, "Okay, what did we miss?". Looking up, we saw the signs that said in fact this was a tow-away zone AFTER 3pm. How nice of the parking meter to let us know. Apparently the readout on the meter does flash "see tow-away restrictions", but only after 3pm. Since we got there a little before 3pm, the meter just said, "expired". I could just hear the its haughty little voice going, "Well, technically there were no tow-away restrictions when you got here, ha ha ha..." I called the number on the sign and got a voice recording telling me where my car had been towed and how to get it back. Luckily, the tow yard was only a few blocks away, and so we trudged over there in the sprinkling rain.

It turns out they actually make it relatively quick and easy for you to get your car back. Make no mistake, that place is a money-making machine (there were probably a good 50-60 cars in the yard), but it's nice that they at least make it easy for you to get gouged. You basically walk into the place, take a number, and wait for them to call you up. There weren't too many people there when we got there (maybe 6-7), so we got called right away. The woman asked for my driver's license and $238.75 (Ack! And that's not including the $60 parking ticket), I gave her my credit card, and we were on our way. I took the receipt to the guy outside and they brought the car around within a few minutes. Then we drove off to Japantown, where the parking was a bit safer, and hung out there for a couple hours.

I guess it's hard to get upset about things like this in light of everything else going on. We didn't get to see the MOMA, but we had a nice walk in the city and eventually ended up in a cute tea shop in Japantown. It was a new experience anyway, albeit an expensive one. I suppose the moral of the story is, when parking in SF, and in life in general, don't forget to look UP...

Wednesday, February 13, 2008

Graduation from Radiation

(or "How I got sunburns on my butt") 2/13/08

Well, folks, 28 days came and went, much more quickly than I thought it would, thankfully. (Random aside: I wonder now where they came up with 28 days - I'm sure it's just a total calculated dose divided by the individual dose or something like that - but what about the obvious connection to the zombie movie 28 Days Later, its less-good successor, 28 Weeks Later, and the less well known and completely un-zombified Sandra Bullock movie, 28 Days? ... )

Anyhoo, I finished chemo cycle #4 last week and capped it off on Friday with my last radiation session (woohoo!!!). There wasn't too much ceremony surrounding the moment, but they did give me a spiffy certificate (as you can see in the picture). The rat is there to signify Chinese New Year (a gift from mom - can you tell which rat it is?) and how awesome this year will be compared to last :P. Apparently some people get dressed up in cap and gown on their last day, but I guess it didn't feel like that big a deal to me (plus I'd been in the hospital all week for cycle 4 of chemo anyhow - didn't have a whole lot of energy to put into it). It certainly feels like more of a big deal now that I don't have to go into the hospital every day and lie on a table for 15 minutes. Plus, I'm psyched to have these radiation burns on my bottom heal up (everyone get your inner chant on, "Heal! Heal! Heal!"), cuz they're painful and itchy and keep me up at night. I guess it's kinda like someone took a big magnifying glass while you were lying on your stomach at the nude beach and he/she aimed it in a nice concentrated 3x4 inch oval right on the midline. Then you get up two days later and it's all burned and raw and only in that spot and you say, "but I was only out there for 15 minutes!". And the evil maniacal laughter of the magnifying glass wielder echoes in the distance...

Actually, the magnifying glass looks a lot more like what's in the pictures below. About a week before I finished, I asked Lisa, one of the radiation techs whom I saw almost every day of those 28 days, to take a few pics for me:

Side view of me on the radiation table. As long as I wore loose-fitting pants with no metal, I didn't have to change into a gown every time, which was nice. The round thing above my pelvis is the gray cheese wheel I referred to in another post. The rectangular panel hovering below me is actually only there because they were taking some X-rays before starting the radiation. Usually that piece is retracted as the whole cheese wheel armature rotates around my body.

Onne, one of the other radiation techs, does something with fancy equipment. I never really saw this part, so I don't know what they would do out there. My impression is that everything is pretty automated, though.

They can monitor me from outside the room I'm in - gotta keep the radiation dose down for the techs!

A feet's eye view of me on the table - they have a mold to put the bottom parts of your legs into, so they can position you in the same spot every time. Also, there are lasers demarking a cross pattern onto the table, so they can use that, too. I also have little tattoos on my body for alignment...

I've been feeling pretty good after this last cycle, despite the burned bum and such - even managed to make it to campus twice this week and did a little bit of climbing yesterday. I've also been going to a "restorative yoga" class every once in a while (went on Monday). It's sponsored by the Stanford Cancer Center but is held at the Avalon Yoga Center in Palo Alto. It's more focused on relaxation and stretching, which is nice. Still having some painful BMs and other not-so-fun issues, but all and all, things are okay. It just gets a little boring on those days when I really don't feel so good and have to lie around the house all day.

K, til next post!