Like cake

Serena cheering me through Cycle 15/17.

(11/17/08)

Numba 15 is done! It was like liquid cake, fed intravenously through my chest and bringing about a slight burning sensation in my nostrils. Okay, so the analogy doesn't work that well, but what I mean is, the day seemed to go by with few problems. I had to get poked three times in my double-lumen port, though - once in the morning to access one lumen for bloodwork, and then twice after my doctor's appointment before getting treatment, because the first needle was defective. No big deal, but we did determine that using the cold spray that they have does in fact help reduce the pain of inserting the needle (we did the first one without the spray and the second one with the spray. Normally I have to smear on this lidocaine cream half an hour beforehand to numb the area, but since I had done that before labs earlier in the day, it had worn off by the time I was getting treatment. Anywayz. . . ). I had a little bit of nausea after lunch, so I took an Ativan, and after claiming to my nurse Kyla that Ativan doesn't actually make me that sleepy, I promptly fell asleep for the rest of the afternoon until about 4pm. We got out of there pretty late, about 7:30pm, but I feel pretty good, relatively speaking. This was a Vincristine/Cyclophosphamide cycle, and it's been hit or miss since I dropped the Adriamycin. After the first one-day cycle I had, I went camping the next day and was relatively fine. I didn't feel perfect, but I was able to hike and wander around with no big problems. The second time I felt pretty crappy for a couple days after. We'll see what this one holds. Sometimes I think if I force myself to do something rather than lie around and feel crappy it might be better. Who knows.

In general, I'm still on track, thanks to the new timing schedule for my neupogen shots, and things are going pretty well. No lumps or bumps or humps or clumps anywhere. The latest scans show nothing in my pelvis, and the little lung nodules persist, indicating that they were probably not metastasis to begin with - a definite good sign. I've had some blood in my urine the past couple cycles, though, so the docs have upped my dose of Mesna, which Serena likes to say in the voice of Edna Mode from the Incredibles: "Mehhh-znah". Mesna acts as a bladder protectant, but apparently it's not been doing its job very well. Protect that bladder! Hopefully I won't have any significant toxicity issues, or I might not be able to finish off the last two cycles. I suppose it wouldn't be the worst thing - at this point in the protocol it's unclear as to whether these last two make a difference or not. Still, the big thing is. . . ONLY TWO MORE!!!

Psychologically, though, I'm cautiously optimistic. I've certainly had darker days (usually right before I begin a cycle I'm just in a bad mood - It's hard when you feel relatively normal and you know you have to go feel crappy for a couple days), but I think the worst of the uncertainty is yet to come. While you're getting treatment, you know that you're actively doing something. You have a plan, and a set of tasks that you need to accomplish. Once you're done treatment, you just have to wait and see. You go into surveillance mode and try and continue with your life, always wondering if the cancer will rear its ugly head again. I never thought I would be turning 30 with the prospect of this kind of uncertainty in my life. I'm sure it will hit me even harder when the treatment is done.

So, nice, vague question for the day: How do you deal with uncertainty in your life?

Here are some random pics to peruse while you're contemplating:

My cousin Monica had a baby girl in SF on Saturday. My mom and I went to visit on Sunday afternoon.

My mom holding her yet-to-be-named grand-niece.

The newly expanded family: Monica, Jimmy (her husband), baby, and Sophie (their two-year old).

Monica with baby, Mom with Sophie, and me with bald baby-like head.

Okay, now answer the question!!

Contemplating my prostate

(11/11/08)

A friend of mine was recently diagnosed with ovarian cancer and commented to me about how after the biopsy parts of her were now floating around the country for second opinions and what not. I guess I never thought about it, but it's true for me, too. There are chunks of my prostate in New York, Baltimore, San Francisco, and Stanford. Kind of a strange thought, eh?

In other news, the last cycle finished up without too much fanfare, except my last day was on Halloween, so there was a bit of excitement in the ITA with some of the nurses dressed up in costume. Also, my friend Blase showed up for a visit, as you can see in the pictures. He works over in the children's hospital next to Stanford and I'm sure had tons of fun with the kiddies (apparently they turn the hospital into a trick-or-treating extravaganza for a few hours during the day). The adult side was not quite as exciting, but there was a little bit more spirit than usual, so that was nice for the last day of my cycle. Only 3 more to go. . .

If I weren't holed up in the hospital, I would have been Avatar: The Last Airbender, but alas, the timing didn't quite work out. The alternative was to do as my friend PJ suggested and paint three holes on my head and be a bowling ball. In any case, I want more comments on the blog, so here's the question of the day: What were you for Halloween this year?

Look who dropped in!

Me and my puffy face

Phillies win!

(10/28/08)

Well, I guess in all honesty I'm a fair weather fan, but hey, I went to see one game when I was in Philadelphia, so that gives me some kind of street cred, right? I know who Mike Schmidt is - well, not what position he played, but . . . that's what Wikipedia's for, right? So anyhow, yay Phillies!! (Let's just ignore the fact that the Rays made huge mistakes in the 9th of game 3 and the first inning of game 6, which basically cost them the series).

Cycle 14

Okay, so down to the nitty gritty. Today was Day 2 of cycle 14 of 17. Nothing too new, although I had to make sure I got the correct premeds yesterday (they forgot to give me Aloxi, which is like Zofran but lasts over 3-5 days). Today I was just really tired and kind of napped on and off throughout the day. I did get a chance to catch up with a friend who I met when I first started this chemo last year. He has ewing's sarcoma and had just finished this chemo protocol when I started. Unfortunately he had a local recurrence recently, but he had surgery and will do a stem cell transplant after this new chemo cycle he's on. Hopefully that'll clear things up. Stay strong, Steve!

It's so difficult to have so much uncertainty about this whole ordeal. For me, there's no real data on this kind of cancer, especially not in someone my age, and it's similar for my friend. I guess it's good to know there's recourse after the first round, but of course you'd rather not have to go through it. For now, I guess it'll have to be good enough to get through this first (and hopefully last) bit. Only three more cycles to go!

Don't you know about the bird?

(10/11/08)

I watched the Family Guy episode, "I Dream of Jesus", last night and laughed my butt off. I thought the first half was awesome - second half wasn't that great, but for some reason I thought Peter's "Surfin' Bird" dance was hilarious. I could see some people thinking it's just annoying, but I would humbly disagree. You can see it on Hulu if you missed it. Actually, the spoof of Dane Cook is pretty good, too (anyone actually think that guy is funny? If so, can you explain why?). 

Anyhow, I finished number 13 on Monday (woohoo!). Just four more to go, but right now it's looking like I'll turn 30 before it's done. Not sure what's different, but this one seemed to really knock me down. Last time I had a one-day VC (Vincristine, Cyclophosphamide) cycle, I went off to King's Canyon that evening and did a 9-mile (though relatively flat) hike with everyone the next day. This time I was just really tired for the next few days, and even going out shopping for random things yesterday wore me out. I guess it could be psychological, or the cumulative effects of the chemo, or who knows? One definite difference is that this time we decided to delay the start of my 14 neupogen shots until today (usually I start them a day after treatment is done). That way, they'll finish closer to the time of my next treatment, which hopefully will keep me on track schedule-wise. Neupogen is supposed to boost my white cells mostly, which usually doesn't seem to correlate with my energy level, though, so I'm not sure why this round hit me so hard. I guess I could also be a little anemic (low red cells). That has definitely made me fatigued in the past. 

Sometimes the scientist in me wants to get blood tests every day so I can track this sort of thing and find out what affects me when and how, but I guess then I'd have to get blood tests every day, and that would be kind of a drag. I guess in lieu of that I'll have to keep to the Wheel of Speculation (that's the wheel in my head that's like the Wheel of Fortune wheel except the money values are replaced by reasons for my low energy - you get the idea). 

33 minutes

Day 4/4, Cycle 12/17
(9/19/08)

There's an episode of the new Battlestar Galactica show (I think it's the first one after the series intro) where the Cylons keep showing up to attack the human fleet every 33 minutes. As a result, everyone's all at their wits' ends with lack of sleep and exhaustion. I guess it's not quite the same, but with all the chemo and hydration they give me while I'm here, it feels like I'm up to the bathroom every 33 minutes, so even if I try to sleep through the whole day, it doesn't quite work out that way. I usually get some sleep in the morning, but then I'm mostly awake in the afternoon, which seems to drag on forever and ever. It's 3:55pm and I've got 3.5 more hours to go.

chugga chugga chugga chugga. . . . woo woo!

By the way, my friend's team is one of the top 25 finalists in the American Express Members' project. If you've got an AMEX card, I urge you to vote (pref for their project, Embrace - $25 Infant Incubator, but if you find another cause more worthy feel free to vote for that). Here's the link and a video from Embrace:

Register to Vote!

(9/13/08)

Anyone else ready for this election to be over? Man, I can't even watch the news anymore. I guess the debates will be interesting. Anyway, if you're reading this and you're not registered to vote, go here now! Go ahead, I'll wait. . .

. . .
(doo doo dum dee dum)
. . .

Done? Cool. Well, I'm finished with my neupogen shots for the week (see previous post), and we'll see if I can go in for treatment after my appointment on Monday. I did wake up with some sores on my tongue today, but hopefully that doesn't mean anything other than my room is too dry. It's weird to be getting them now, though. Sometimes I think my body has some sort of weird Pavlovian response such that it starts to expect treatment before I'm even getting it. My energy level is better than it was earlier in the week, though, so that's a good sign, I think.

One other bump that we cleared this week. . . my bladder is A-OK. My doc said that a couple weeks ago when I had my cystoscopy, the urine sample they sent out looked "suspicious". The pathologists said I should be checked for signs of bladder cancer. The pathologists saw abnormal looking cells, but they also didn't know I had gotten radiation in that area and was undergoing chemo. My surgeon said the "suspicious" cells were likely due to radiation and chemo damage to my bladder and were nothing to worry about, but my oncologist wanted to do another sample just to check. So I did that on Monday and the results came back negative yesterday. They even went back and checked the old sample to make sure, and there was no sign of malignancy. I wasn't that worried about it, but my mom was, so anything that makes mom happy is definitely a good thing.

Some days I think back to when I had surgery, and though there are lingering long-term consequences, it's such a relief that I still have a fully functioning bladder and urinary tract. We have to hold on to things that we can be thankful for, and try to let go of pain and depressing thoughts as quickly as possible. But I guess both are easier said than done.

Tired tired tired

(9/9/08)

Huh, I guess a year from now this day will have some significance (9/9/09). Any cultures where 9 is a lucky number? Well, as the title says, I've been kind of tired the past few days, more so than usual, unfortunately. I'm not really sure why, since my red cells are fine, but I guess it's just part of the process. Maybe it's because I haven't really done any exercise in a week or so. I've been trying to sleep more, but that just makes me feel more tired. Ugh.

Anyhow, I've been delayed again. . . Last week I had a doctor's appointment on Wednesday and was supposed to get treated on Friday, but my neutrophils were just barely too low (1.4 instead of 1.5, which is the cutoff). I took a few days to rest, but yesterday they were even lower (.98). On the one hand it makes you question the accuracy of the tests - is 1.4 really that much different from 1.5? How much do your absolute neutrophils fluctuate in a day? On the other hand, I guess they have a cutoff for a reason. Normally when I have been delayed, my doctor has wanted to wait to have my counts come back up on their own. I guess she's seen so many people get delayed lately that she's now recommending I take some more neupogen to help boost my counts back up. So, five more days of injections this week, and hopefully I'll be able to go for treatment next week. She's also talked to the doctors doing the rhabdo clinical trial and has decided to reduce my dose a little more this round; I'm already reduced to 80% but she's going to bump it down to 75%. Apparently that's as low as the rhabdo docs want to go, but hopefully it'll help me bounce back a little more quickly. I have to keep reminding myself that the effects of chemo are cumulative, and my doc is always quick to tell me I'm not alone in these delays. Ugh, it's just the waiting that's so awful.

Well on a happier note, here are some pics from my trip to NYC:

A quiet moment in St. Patrick's Cathedral

Mom at the MOMA. Unfortunately it was free admission that day, so it was packed.

Gathering for Anthony's very low-key but very sweet wedding ceremony at Brooklyn Bridge Park.

Anthony and Nolwenn.

The high school gang at the after-party.

Me, Jeff, and Anthony (middle school buddies) at the climbing wall.

Holly, me, and Jess (freshman dorm friends) at the Shake Shack in Madison Square Park.

Me and Manasi in Midtown.