On Monday night, we stayed in Salt Lake because we weren't sure what the weather would do and because we had an early morning appointment at the HCI.
Ford was anxious to get started with treatment. It had been a little over 5 weeks since we first received the news that he had cancer. Now he was just hours away from beginning treatment and he was ready to get started. He ate a good breakfast, navigated us safely and efficiently through morning rush hour traffic (he is a GREAT navigator and co-"pilot") and we arrived on time for our appointment with the doctors.
Dr. Pollack gave us a run down on test results. As we pretty much knew, the cysoscopy and echocardiogram results were good. The PET scan showed areas of enlarged lymph nodes, but not "hot," which means those areas have Low Grade Lymphoma. The majority of cancer is in the stomach and is very "hot." The general concensus is that the Diffuse Large B Cell Lymphoma is largely what is in the stomach area.
Dr. Pollack explained that there is 70 to 80% chance of curing the lymphoma in the stomach with the R-CHOP chemo treatment. The 20% that isn't cured can be made into 10% (or increases to 90% cured) with other treatment.
If additional treatment is necessary, it would most likely be Prophylaxis treatment or Auto Transplant. The bone marrow would be cleaned and stem cells would be collected and frozen for later use.
If that didn't work, then the next step would be Allo Transplant (other cell treatment) from a donor. The best chance of a genetic match would be siblings. Offspring do not qualify because 50% of DNA is from the other parent.
Ford summarized it by saying that: "We play using our 80% free-throw shooter at the line. If he misses the shot, then the next best thing is for him to get his own rebound. If he misses the rebound, then another team member steps up and grabs it. There are options. The best option is to make the shot." Pretty succinct.
The enlarged lymph areas in the lungs are not as "hot" which the doctors believe indicates that it is the MALT Lymphoma (Low Grade) in the lungs.
If the MALT Lymphoma has affected Ford's eyes, the Prednisone (the "P" part of R-CHOP) should clear that up. (R-CHOP is an acronym for the drugs used in treatment.) Prednisone is a steroid that kills lymphocytes.
Lymphocites are small white blood cells that are a large part of the body's defense against disease. They are responsible for immune responses. One of the two main types of lymphocytes is B cells, which make antibodies that attack bacteria and toxins. To my understanding, it is one of the B cells that has gone beserk and is causing the cancer situation.
We then headed for the infusion room. This is a large open-air room with a central nurses' station in the middle, and several recliner-style chairs (probably 20 stations) lining the walls, set very close to each other with room for one visitor. The patient sits in a recliner and the bags of chemo meds are hanging from portable posts and run through electronic pumps. The IV insert was done and Ford did fantastic (no passing out--yea!). Then he was given a series of pre-chemo meds: Ativan (anti nausea), Benadryl (antihistamine or anti allergy), Tylenol (for redness & flushing), and Zantac (which helps with nausea).
Being Fat Tuesday, the nurses were wearing Mardi Gras beads and they offered us our choices. Ford declined and I chose 4 strands, one color representing each of our three daughters (purple, red, & green) and a small orange strand for the granddaughter (we think orange is her current favorite color. Go figure. <-: ).
Next, Ford was given the Prednisone (pill form, orally). The nurse went step-by-step explaining everything as she went through the procedures and also through the written material given to us in a large binder. This allowed time for the first series of meds to take affect.
The first drug in the next series is the R (Rituximab or Rituxan). This is a designer drug. It looks specifically for the marker on the cancerous cell and kills it. It is very powerful and we were told that within the first few minutes, it will kill millions of cancer cells. Because of the way it is made, it can cause severe reactions so during the very first treatment it has to be administered slowly and in increments by IV drip. If the patient reacts, the drip is shut off and saline is pumped in for 30 minutes. Then the Rituxan is restarted. When the total dose of Rituxan is through, then the Doxorubicin (which is the H of CHOP--a newer medicine that no one wanted to change the acronym for) and the Vincristine (or Oncovin--the O of CHOP) are both given by IV push. The last in the series is the Cytoxan.
Ford did well for the first hour and a half. Every half hour the dose is increased and vitals are checked. He made it up to the 200 level. Then the first reaction came. Ford became a little anxious, his throat began to tighten, and he started to get chilled. The nurse explained that when most people react to the Rituxan, it is usually right at this point, so not to worry. The drip was stopped and the saline began. They wrapped Ford in a lot of nicely warmed blankets and made a call to the doctor (protocol). This was at about 12:45 pm. In 30 minutes, the Rituxan was restarted at a lower dose (100). Again, every 30 minutes the dose is increased and vitals checked. Dr. Pollack stopped in to check on him at about 1:30 pm.
Ford made it back up to the 200 level and was just about to be increased to 250 (at 2:45 pm) when he started to itch. The drip was stopped for 15 minutes while the saline was given. It was restarted at the 200 level. This time Ford sailed right through and finished with the Rituxin at about 4:20 pm. The nurse switched the IV to a saline flush (the rinse cycle) and at 4:30 pm, she started the IV push of the next two drugs. This took about 20 minutes. At 4:50 pm, the last course of the "meal" was the Cytoxin. All was finished right at 6:00 pm. The nurse explained that normally there are no more reactions to the Rituxin in the other treatments. The other treatments should take about 5 hours instead of 8 hours.
Ford was superb through it all. He kept his sense of humor (relating his favorite joke to literally every member of the staff we encountered!) and was calm and cooperative. By the time we were finished, he was exhausted and a bit "loopy in the head."
We were told that Ford could eat during the treatment so we came well supplied with fruits, nuts, and other snacks, and a LOT of water. Ford read some, ate regularly, rested with his eyes closed, and did great at drinking most of the water. He was the ideal patient, in my opinion. He communicated what he needed to when he needed to do it. He cooperated and did what he had been instructed to do: eat, rest, & drink lots of water. I admire him. He never complained, just talked himself through the tough parts (smile).
We headed home, unloaded all our stuff from the car, and ate dinner. Then he spent the evening watching the BYU vs Aztecs in San Diego game.
He slept pretty well throughout the night until about 3:45 am. As predicted, he has a slight headache from some of the chemo meds and a bit of nausea. He has taken the prescribed meds for those.
This morning, he has had "his usual" for breakfast: Shredded Wheat, and is feeling okay. It is going to be a very casual day for him.
Ahead on the schedule: Blood work on Thursday, 2/26/09. Next chemo treatment on Tuesday, 3/17/09 (the day Ford refers to as National Persecution Day), St. Patrick's Day.