I went with Dave to chemo treatment #5 on April 29th, meeting primarily with Heather. While there, Dave admitted he was still short of breath and that he was still coughing up clear-to-white mucous, however he said his appetite had returned, albeit with some slight nausea (hiccoughs), and he was without fevers, bumps, rashes, bruises, or pain, only suffering with some (manageable) constipation. He said he was starting to get pins and needles in his left toes, which is an expected, reversible side effect of the Vincristine.
Vitals were weight 179.3, blood pressure 118/84, oxygen saturation 95, temperature 98.2 F, resting pulse 83 bpm.
Dave said that he continues to need Claritin for five to six days after each RCHOP treatment for tooth pain.
Regarding labs, it was gratifying to note that LDH had dropped. This number, which had been steadily increasing, had entered a zone that might have indicated that the lymphoma was growing more active. Seeing it drop out of the zone of concern is promising, and of course, as mentioned before, LDH has many confounding factors, unrelated to cancer, that can affect it.
Additionally, Dave’s white blood cell count was elevated at 14.7, however that’s a typical side effect of prednisone, and unlikely to indicate anything untoward in this case (like an infection). Hemoglobin also remains low at 11.7, typical of myeloablative (i.e. bone marrow destroying) therapies like RCHOP, and well above the danger zone. Finally, creatinine was elevated, indicating that his kidneys are working pretty hard. Dave confirmed that his urine has been darker than usual. His potassium remains low so Heather gave him a potassium pill and told him to eat some potatoes.
Dave remains on supplemental prednisone, not just because it’s the “P” in RCHOP, but also because they’re using it to treat the pulmonitis he developed as part of his allergic reaction to Rituxan last cycle. While there has been some talk of tapering him down over time after chemotherapy is completed, it has been my personal experience that prolonged corticosteroid use at these doses portends protracted adrenal suppression, which is very unpleasant. I’ll be keeping an eye on Dave after they wean him off to make sure anything like that gets treated immediately.
As stated previously, Dave’s infusion on 4/29 was without Rituxan (so just “CHOP”.)
Dave’s final CHOP session is scheduled for next Wednesday, 5/20. Barring complications, he should then be free to recover at home until his PET scan on 6/22, where we can determine next steps. Unfortunately, he’ll probably have to get another PET after that to assess his prostate cancer. Evidently, the scan protocols are different enough that you can’t consolidate them into one.
Wouldn’t it be a wonderful outcome if Dave’s lymphoma were to remit completely, and his prostate cancer were to regress to such an extent that Dr. Lily looks at it and says, “let’s wait and see”?