Dave got his mid-treatment PET scan almost two weeks ago. It showed that he’s had a partial response to treatment, which is evidently within the range of expected outcomes at this stage. There was no evidence of new disease or progress on existing disease, just regression, which is good, however, there was evidence of inflammation in the lungs. This could be due to sarcoidosis, which has been suggested as a possible comorbidity in Dave’s case. Alternately, sometimes Rituxan can cause lung inflammation. Either way, there are no symptoms of this inflammation, i.e. Dave doesn’t seem to be having any trouble breathing, so at this point, it’s just something to watch.
I want to review the molecular biopsy of the lymphoma so I can comment more on the level of treatment response to date. We’re working on getting me a copy of that. (NOTE: ask Dr. Patel for a copy of FISH assay results from colonoscopy polyps.)
When we went in for his chemotherapy appointment on March 31st, he admitted to Heidi that he had a slight cough, but he suspected it was reflux-related (i.e. not COVID-19). His main complaint was fatigue, which he says has affected the amount of exercise he’s been getting and had kept him mostly in bed for the three weeks prior. Nausea remains minimal, constipation is still present but manageable, and he isn’t experiencing any pain or numbness. His temperature was ever so slightly elevated at 99.1 F, which is common and not a concern. (It dropped later during the visit.) Heart rate was quite high at 104bpm, and oxygen saturation was 93. Heidi thought it might be related to some mild anemia (hemoglobin was at “10”), however a transfusion is not yet indicated. Also, adriamycin can cause heart damage, requiring the heart to work harder to do the same job. As an aside, my resting pulse went from 64 to 80 after chemo, and only now, 10 years later, is it starting to return to where it has been for most of my life. So if there is heart damage, the good news is that it can heal.
Dave’s blood pressure varied between 112/70 and 139/87 during the visit. Mandible palpation was normal, which from what I can tell is evidence against sarcoidosis.
Next chemo cycle is slated for 4/21. They’ll check his PSA that day. Last chemo will be 5/12. Lupron is also due that day. Six weeks after that, at the end of June, they’ll repeat the PET scan.
I just spoke with Dave on the phone. His least favorite side effect seems to be the mucositis. I can sympathize. When I went through this I easily had grade II mucositis for most of my treatment, which not only affects flavors, but can even become painful as ulcers form in the mouth. Fortunately, Dave is not experiencing pain, but the extreme effect on flavors is reducing his appetite and his willingness to venture out to buy more food. I offered to bring some over, but he said that was unnecessary. It’s more a motivation to eat thing than a fatigue thing. I recommended unsweetened cherry blossom tea. My experience was that the bitterness of it cut through the slime and gave some relief. He said that he’s been experimenting with lemonade since the tartness tends to help a little.
The journey has definitely gotten quite a bit more unpleasant for Dave this cycle.