Saturday, October 29, 2011

The Bell Rings and Round One Commences

The week has been filled with more doctor visits, procedures, and a whole lot of anticipation. Steve and I went to see Dr. Liao because he discovered two more masses on his body -- one lump was found on the top of his right foot and the other one in his groin. The one on the top of his foot was about the size of a marble. We had never seen it before, and when someone has lymphoma and a new lump appears, one immediately thinks the cancer has spread.

The pen is pointing to the new growth in his foot.

The growth in his groin was more like the size of a golf ball. This was was more suspicious, as it was in the area where cancer was found.

Dr. Liao examined Steve on Monday and said that he did not think the mass on his foot was cancerous. He thought it was more likely to be a bursa. He did admit that lymph nodes are found in the foot, but he said that it did not have the characteristics of lymphoma. He wasn't too worried about it. Steve and I couldn't help wonder though. This lump just came out of nowhere, similar to the ones he found in his groin.

Although, Dr. Liao was concerned about the one in his groin. That one was not there after surgery and had grown recently, just in a few days' time. He said he thought it was lymphoma and wanted to order another CT scan to get a new baseline. The cancer could have spread in the past three weeks since diagnosis. Another scan would tell us where it spread and how large any new tumors were.

The CT Scan was scheduled for Wednesday. Steve had to gag down another two bottles of that terrible berry flavored Barium solution. He hates that stuff! I guess there is no other way to do the CT scan. He just has to chug it down and deal with it!

Following the CT scan, we had the Thyroid biopsy scheduled for Thursday. He was quite nervous for this procedure, as his throat has always been a sensitive part of his body.

Here's Steve getting ready for the biopsy.

My mom had a thyroid biopsy a few years ago and assured Steve it would be fine. I think that Steve had a different outcome because of the location of the nodules discovered in Steve's thyroid. His two nodules were right smack dab in the center of his throat, directly in front of his voice box. If you tilt your head back and feel your throat, you will notice that there is not much in front of your throat -- just skin. Needles going into this part of the thyroid do not have much to sink into!

Here is Dr. Kimmel doing an ultrasound to find the nodules prior to the biopsy.
Dr. Kimmel tried to numb Steve's throat, but the needles would not penetrate the skin. I saw Steve wince, squirm a bit and clench his hands together, his knuckles white from the tension. This obviously was a painful procedure. I tried to hold his hand, but he just pushed me away, trying hard not to speak a word and deal with the pain of the procedure in his own way. After a second attempt, the doctor was able to get a bit of pain medication in his throat, but did say that it may not help too much simply because of the location of the nodules.

They allowed me to watch the entire procedure. Under the guidance of ultrasound, the doctor inserted about six different needles into Steve's throat, each time Steve responded in obvious pain. He was not enjoying this experience at all! The doctor would pull back on the syringe, extracting a few cells from his throat. The nurse then squirted the samples onto slides and fixed them with a spray mist, preparing them for pathology. Dr. Kimmel said that he thought he got some good samples, but wouldn't be surprised if they were not diagnostic in nature. This was a tough place to do a needle biopsy and he may have only been able to get thyroid tissue instead of tissue from the nodules. After placing a band aid over Steve's throat, we were sent on our way. The results should be ready in about a week.

Finally Friday arrived! The day we were eagerly awaiting; Steve would receive his first dose of Chemotherapy. After showing up in Dr. Liao's office with our laptops, lunch, books and magazines, and other items to amuse us, the receptionist led us back to an exam room where we met the doctor and Steve had his vitals taken. A medical assistant helped with this process and then told Steve she would need to take a blood sample from him. This would be customary practice with each Chemo cycle. She said she would just need to access his port to draw the blood.

Now that would be a simple statement from a nurse, but Steve objected immediately and said that his port was a virgin and had never been "deflowered." In a half joking manner, he told her to be "gentle."

She sprayed his skin with a freezing solution and told him to tell her when to stop. Steve let her spray a little too long and suffered a bit from burning, stinging skin. He would learn to stop her sooner next time! She instructed Steve to breathe in, which he did, and then breathe out. She inserted the needle into his port, but Steve had held his breath, not releasing it when he was supposed to. This did not help the process, as he did feel the stick of the needle more this way. Next time he would remember to breathe!

After drawing blood, Dr. Liao came in and told us the good news. The CT Scan results were back and the lump in Steve's groin did not appear to be his lymph nodes. It was probably a hematoma or another seroma. This meant that the cancer had not spread! What a relief! He is still in Stage 1. We asked if the 3rd pathology report was back from the National Institute of Health in Maryland and he said that it was not. It would take quite a while to get those results back as they analyze samples all over the whole world.

He did tell us some other news that we had not heard before. After the Chemotherapy Steve would have to come back to receive I.V. fluids to fight against dehydration. He would also have to get injections to help raise his white blood cell count. These injections would be given subcutaneously in his stomach or back. If you have not figured this out already, Steve hates needles and shots. This news was not received too well, as Steve cringes with the thought of more pokes and medications. He would now have to go in and receive these injections every 2-3 days.

After our debrief with Dr. Liao, Steve was brought back to the Chemo room where he selected a corner leather recliner and set up "shop." He set up his laptop and day timer, made himself comfortable and waited for Shara, our nurse, to administer the pre-meds.

Steve, determined to get some work done, set up "shop" for the day.
The first bag of meds would include Benedryl, to block the histamines; Lorazapam, an anti-anxiety medication; and Zopran, an anti-nausea medication. After those meds were administered, she hooked him up to his first bag of chemo in the R-CHOP cocktail called "Rituxan." Rituxan is different from regular Chemotherapy because it is considered "targeted therapy." It specifically targets and goes after the lymphoma cells; it is an important one in our Chemo regime.

Drugs used in Steve's R-CHOP cocktail:
R - Rituximab - (Steve got brand name Rituxan)
C - Cyclophosphamide (Steve got brand name Cytoxan)
H - Doxorubicin Hydrochloride -- (Steve got brand name Adriamycin)
O - Vincristine Sulfate (Oncovin) - (Steve got brand name Vincasar)
P - = Prednisone (Steve takes this in pill form - 100 mg once a day)

Steve did fine at first and Shara increased the titration rate. It wasn't too long after that when I noticed that Steve's nose was as red as Rudolph's. His ears were also red and looking through his thinning hair, I could see his scalp was red too. When I mentioned this to Steve, he looked on the tops of his thighs and noticed that he was developing hives. He was having an allergic reaction to the Rituxan. Shara shut off the Rituxan, started him on another histamine blocker, and continued to give him Adriamycin, another one of the Chemo drugs.

Steve had no trouble with the Adriamycin, so Shara started him back on the Rituxan. Steve was able to finish the whole bag with no further reactions. With two drugs down, he only had two more to go. When I asked him how it felt, having these toxic drugs go into his body, he said that he could feel it circulate and his port would burn intermittently. He was not enjoying the procedure, but it was tolerable.

Steve: "This is all a bunch of B.S.!"
Michelle: "This B.S. just happens to be saving your life honey,
so stop complaining and take your medicine like a champ!"

Dr.Kim came over from his clinic across the hall to recheck Steve's drain. (How is that for 'house calls?") I brought in the most recent collection of lymph fluid to show him. Three days ago Steve collected 45 milliliters in one day, the next day it was down to 20 milliliters, and that day it was down to under 10 milliliters -- this is the amount we were hoping for! The lymph was finding another path in his body and the drain was working to close up the pocket that had formed from the seroma. Dr. Kim said his drain looked good and that if the amount of lymph fluid remained under 10 milliliters/day, he would take out the drain on Tuesday! He was satisfied with the way Steve was healing and glad to see that Steve was not developing Lymphema! We were too! We know that this is a testimony of God's healing and the fact that we have hundreds, if not thousands, of people praying on Steve's behalf specifically for this! Praise the Lord: the lymph has found a new path!

Here is a more recent picture of Steve's leg with the drain. As you can see, all of the swelling is gone. The lymph is that yellowish fluid in the bulb on the lower left of the picture.

The last two bags of chemo went in without a hitch. It wasn't too long before we were getting our meds from the convenient pharmacy in Dr. Liao's office and were being sent home just shortly after 4 pm. Steve went home with two different anti-nausea medications and his Prednisone.

Feeling generally well but with a bit of melancholy fogginess lingering in his brain, Steve requested that we go to the mall and try to "walk off the chemo drugs." He heard from another cancer survivor that walking helps to get the Chemo in and out of the system faster, so he took the advice and we walked the mall since it was raining outside.

I gave Steve his Prednisone at about 7 pm, not realizing that it is best taken once a day in the morning. He did have some trouble sleeping, but we moved his does to the morning so that it would have a chance to wear off some during the day and he may sleep better tonight. Dr. Liao called in some sleeping medication, so if he does have trouble sleeping from the Prednisone, the pills should help with that.

The treatment we are receiving from Dr. Liao's office is absolutely phenomenal. We feel we are in expert hands receiving the best possible, personalized care. God has been so good to care for us and has led us every step of this journey. We rejoice in His care and His goodness as he carries us through this difficult time. We trust Him completely to protect Steve and heal him from this terrible disease.

Steve was declared the winner in this first round of Chemo! So far he is strong, full of energy and ready for the next round. So one down, five to go! The next round will be in about three more weeks.

Thank you all for your prayers! They have been effective -- God is listening and answering each one! We rejoice that Steve's cancer has not spread, that the lymph has found a new path in his body, and that he is being healed completely of his cancer! God is good and his grace is sufficient for us each day!

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