This Is Your Brain On Chemo

This is your brain on chemo. Well, technically, my brain on chemo. Note the general air of seediness and disrepair about my person. Note the hairline, which is racing up and over the top of my head and heading for the back of my neck with great speed. Note the complete absence of large swollen tumors on the side of my neck which made me look a bit like someone with a bunch of tennis balls stuck in his throat. Note the dull look in my eye, which typically sets in about halfway through the Big Fun Bag of dacarbazine. Not so visible are the increasingly pronounced cheekbones and chin that serve to highlight the fact that I've lost roughly 50 pounds since this rodeo started back in December. Oh, and my moustache is falling out too, just not as quickly as my increasingly wispy and insubstantial hair. And here's a curio: I haven't shaved in a week, yet I show no particular sign of stubble. Chemo is wild stuff.

Chemo happens. But not without difficulty, some of it caused by the blood cell counting machine at the oncology clinic, and some of it caused by getting authorization from the new insurance company to proceed. Once you add white blood cell boosters to chemo, it gets pretty dang expensive, and insurance becomes not just a good idea but an actual necessity. For a time it looked like it chemo wasn't going to happen at all, but Jean and the insurance billing coordinator at the clinic managed to get through to the right people in India (the insurance provider apparently outsourced its call center to India) who then approved of everything.

I guess the short story is that thanks to Jean and the insurance coordinator, everything got worked out, and my oncologist figured it was safe to proceed without a CBC so long as they dosed me with Neulasta again. My bones hurt already, a dull and apparently meaningless ache that Tylenol never seems to touch. I'm tired, but the ache in my legs and pelvis make it difficult for me to sleep. A fresh refill of pain pills later this evening should bring blessed albeit somewhat sweaty relief. Anyone got any idea why Percocet makes me sweat?

Better?

I guess it's a sign that you're getting better when small annoyances start to become noticeable again. For a long time most things didn't bother me at all. I simply felt too bad for the ordinary run of minor irritations to even register on me. There were a couple of weeks when I probably could have lopped off a foot with a Sawzall and not even noticed.

But not any more - little things are starting to bug me. Like this morning, when I walked outside to go to work and went down to the barn area where my wife was. I was standing there, minding my own business, when my coffee cup emitted a sad little tink sound and fell off the handle. The handle stayed in my hand, and the cup fell and landed on my left foot.

That's a bummer. A waste of a coffee cup, but even worse, a waste of a perfectly good cup of coffee, now steaming on the ground like deep-seated regret.

I've thought about this, and not surprisingly I've come up with a theory. On the one hand, one has a cup of hot coffee. On the other hand, one has the handle of the cup exposed to reasonably cold air. There was ice on my car, so it was in the vicinity of freezing. I think these temperature extremes caused uneven patterns of expansion and contraction in the ceramic cup that eventually caused the handle to shear off.

Or maybe it was just a crappily-made cup with a built-in manufacturing defect; who knows? But it's a banner day when a broken coffee cup becomes the worst thing that happens to you in any given day!

These 32-Hour Weeks Are Killing Me!

Well, I've reached the end of my first week of work after chemo. It was pretty gruelling, I have to say, but it got a little better with each passing day. Monday was dreadful, Tuesday was kind of dreadful, Wednesday was merely difficult, and today was only interminable. Tomorrow is a normal day off where I work. I was thinking about working tomorrow just to accumulate some hours, but I think I've changed my mind. Though I'm stronger and fitter now than I was at the start of the week, I also think it's important to rest and not overdo things.

I'm continuing to improve. My leg is lots better than it was. It isn't quite back to normal, but it won't be long, and I find that I can do just about anything I need to without too much difficulty. If I have to get out of a chair many times in a row my leg starts to tire out, but things like driving, walking and getting dressed don't bother it any more. My oncologist is quite pleased with the swiftness of my body's response to chemotherapy, and believe me, it doesn't delight anyone more than me.

My only complaint (for today) is that I've developed a few sores in my mouth, which can happen. Compared to what I've been through in the last month or so they hardly qualify as uncomfortable, but they do make it difficult to eat tortilla chips, Cap'n Crunch cereal or certain species of hard candy (I really love those Valentine's Day hearts made by Necco, the ones with the little slogans like "Do me!" (not really) stamped on them, but they seem to drive my mouth sores nuts. They may be why I have mouth sores in the first place).

Today I feel almost normal, for the first time in months. My leg is almost normal. I have almost no chemo side-effects going on. My tumors are all shrunken to the point that they don't impact my daily activities. I feel... normal. And it's good.

So normal that I'm strongly inclined to work on a model. This isn't a particularly world-shaking announcement in the greater scheme of things, but it's a pretty powerful indicator of how good I feel, because I always seem to give up model-building the minute I start to feel bad. My main difficulty now is that I have about eleven different models in various stages of construction and I can't decide which one(s) I should make progress on. Should it be the S7-class torpedo boat? Or the Wells-Fargo stagecoach with four-horse team? Or the SA-2 antiaircraft missile?

It's good to finally have to confront a nice inconsequential problem like what model I want to work on. Personally, I'm sick of confronting much more serious problems, and I'm sure everyone else is too.

Back To Yon Grind

I went back to work today after a month off, half of which was an alleged "vacation" (try to convince yourself that it's a vacation when you've been diagnosed with Stage 4 lymphoma and you're waiting for chemo to start) and half of which was just me feeling too awful to work.

Work went okay, by and large. I started to get a little over-tired in the afternoon so I left early, fearing that if I stayed much longer I'd run the risk of falling asleep in the car on the way home. And by then my leg was heartily sick of standing up and sitting down. But it didn't go badly, all things considered. Other than being tired in general and my leg finally giving out, I didn't feel too bad, though I had to deal with a million and one interruptions from A) my adoring fans, and B) people who didn't even realize I had been out of work. Yes, both groups exist.

The fun part was sanitizing my cubicle and phone because of my low white blood cell count. How often do you get to play with Lysol disinfectant wipes at work? Not nearly enough, I aver.

Tomorrow's another day. Given a decent night's sleep tonight, I should be able to make the full nine and a half hours. I don't see why not. I just wish I could figure out why the Ambien the doctor gave me don't work worth beans. I swear they make me nervous instead of putting me to sleep, so maybe I'm better off with warm milk or a half a fifth of spiced rum...

Successful

I was successfully chemotherapied today. Is that a word? My blood counts were acceptable, though my white blood cell count was deteriorating and they saw fit to give me an injection of Neulasta to increase my body's production of... can I remember? Neutrophils? I think that's right. My legs seem to ache just a bit, something that I attribute to the Neulasta because I haven't had that particular sort of pain before. My red blood cell count is also slightly low, but it was slightly low before I even started chemotherapy - there is a family history of anemia in the men in my family, and apparently I did not escape that bequest of the past, though I'm sure my lack of appetite lately has something to do with the anemia as well.

But all in all, it was a pretty positive trip to the oncology clinic. The bone marrow biopsy suggests that I have no involvement in my bone marrow, though they can't be entirely definitive because they only got a partial sample when they did the original biopsy. They want two sorts of tissue to test. First, they suck (or "aspirate") a small volume of frothy red marrow out of the bone, and then they want a little core sample of bone material itself. In my case they got the aspirate with no problem, but my hip bone was so hard the core sample portion wouldn't come loose and stayed in the bone. So, technically, without both samples to test, they can't say my bone marrow is clear, but the aspirate tested negative, which is a jolly good sign anyway. It means I'll have to have another bone marrow biopsy in roughly five months, which is about as welcome a thought as digging up the septic tank, but it does tend to rule out the possibility that I'll ever have to have a bone marrow transplant.

The oncologist was also pleased with the speed with which my nodes were responding to treatment. I used to have a big icky thing under my chin, but it is now almost entirely gone. I can hardly tell it's there, and if you didn't know what you were feeling for, you'd probably miss it entirely. The nodes in my neck and behind my ear are definitely shrinking (some faster than others, notably the ones on my left side, which are at this point practically gone) and my left leg continues to improve as the deep nodes in my groin shrink. The sensation of strange surface numbness and hypersensitivity (what an odd contrast in symptoms) has largely vanished. I'm not ready to start full-scale rehab on my leg, which is weak as a collection of wet linguini at this point, but I can definitely walk, drive and work, and that's enough for now. A certain amount of rehab will happen by default as I walk and do things.

I myself am pleased that the chemo didn't really knock me on my keester today. I get four drugs: DTIC, bleomycin, vinblastine, and Adriamycin. The DTIC (also known as dacarbazine) comes in a fair-sized plastic bag that takes about an hour to empty into my port. Both times now, I've suddenly felt myself get old, tired and slow about three quarters of the way through the original blast of DTIC. It feels a great deal like suddenly realizing that you're coming down with a cold - you become aware that your limbs are suddenly heavy, you're suddenly very tired, and you really want nothing more than to lie back and sleep (to the detriment of those who sit through chemo with you, as it makes them think that they are uninteresting). But other than that one attack of the DTIC Malaise, I didn't feel too bad, and I only slept for an hour or two after I got home, after which I felt pretty good, all things considered.

So I feel pretty good tonight. No nausea, a sense that I'm making progress, a sense that my body and chemotherapy are going to win the war against cancer, and the realization that I'll be ready to go back to work on Monday - that's comforting, all of it.

CBCs

Today I go in for another dose of chemotherapy - if, that is, my blood cell counts are good enough to qualify me for the championship round. I didn't realize they could count blood cells that quickly; I only had it drawn yesterday and they'll know today if I'm robust enough for treatment. What I find amusing is the notion that it is somehow my fault that my white blood cell count is too low, as though I've been somehow slacking. Yeah, you got me, I was deliberately not making enough white blood cells...

I'm pleased to say, though, that most of my chemo symptoms are gone. The pain is all gone, or at least nothing that a few Tylenol can't deal with, so I've weaned myself off the Percocet entirely. This is good news. My leg continues to improve. The swollen thing under my chin continues to recede. So viewed from that perspective, my treatment has been a whopping great success thus far.

I just wish I wasn't STILL nauseated. It usually sets in around noon and it stays with me all day. It isn't always intense, though sometimes it can send me scuttling to the bathroom where I gag and retch uselessly for a few minutes. But it's always there, always, and it serves to depress my appetite, which I'm sure has something to do with potentially low blood cell counts.

My appetite is a funny thing. Certain foods appeal to me, like tomatoes, grapes, canned peaches, lean beef, soup, salad, cheese and, curiously enough, tacos. Other foods gag me with a spoon, like sausage, bacon, anything with gravy, fried chicken, anything with a cream sauce and pork. The idea of a full cup of coffee makes me retch; the idea of a half a cup of coffee appeals to me. A banana makes me uneasy; canned peaches sound infinitely comforting.

Well, we'll see what the blood cell count stakes have in store for me. I'd just as soon get the chemotherapy over and done with without any postponements or rain delays, but I'm not in charge, am I? Time to go drink apple juice and try not think about my stomach.

Chemo

It's been a while since my last post, mostly because I've felt like crap. Let me count the ways!

Nausea. Yes, there's been some nausea, but it hasn't been too bad. It started for real about two days after the chemo treatment, and lasted for maybe three or four days in declining potency. I only threw up a few times in total, but I spent a few days thinking I was going to throw up. Still, the yellow pills provided seemed to help, and I can't say that nausea was ever much of a problem.

Chemo Pain. Yes, there was a lot of that. The chemotherapy stopped my digestive tract dead in its tracts. I don't want to dwell on this in any detail, for the details are horrid, but suffice it to say that about a week after my chemo treatment I developed a most painful sort of intestinal impaction. Heavy use of laxatives finally brought relief to this problem, but only after a few days of significant pain.

Cancer Pain. Once the chemo pain let up, it was time for the cancer pain to start up again, that horrid pain in my side, lower back, hip and leg that I had just before my first chemo treatment. The treatment for this pain is more chemo, which happens on Wednesday, but for now I can do nothing about this pain save take lots of pills and scowl a lot.

Right now I don't feel too bad, but that's mostly because I've beaten the pain back with four Tylenol and the trailing edge of a Percocet. I decided to post a brief update while I felt halfway decent, because halfway-decent states don't last long.

So, what have we learned? Mainly, that one neglects the digestive tract at one's own peril. And that lymphoma sucks. But Wednesday I'll get a fresh dose, and I fully expect for things to get better. We now know what to expect and how to treat the digestive issues, and I think the chemo will help with the cancer pain. So my main strategy at this point is to stick it out till Wednesday.

Mix Muddle

I got up this morning and found myself once again blessedly without a pain. Well, that's not quite right. I had a mild headache, which demonstrates that my pain receptors and processors are working, but that there is simply no real pain input from my body. It's still too soon to celebrate, but can I be permitted a moment of hopefulness that the chemotherapy has done something good for me?

So I thought this being New Year's Day and all, I'd listen to "New Year's Day" from U2. Normally I'm not a huge fan of U2, though in the sense of "I don't listen to much of their stuff" rather than "I can't stand the poser bastards." Once you become roaming ambassadors to the United Nations and are presumably powerful enough you've gained the Sinatra-like power to have anyone silenced with a mere telephone call, you are sufficiently elevated above the hoi polloi that their cries of "Poser knuckleheads!" or "fruity artistic blowhards!" are meaningless.

But I do like "New Year's Day", a song I've never evaluated in terms of lyrics, but I do like the way it sounds. Or sounded. Because in the world of iTunes, odd things have happened to this song. There are about ten different mixes, and none of them sound like the one I'm used to. They bear relatively unhelpful labels like "War remix" and "Kevorkian Remix", neither of which sound aupicious to me, and when sampled, none of them sound right. All of them seem to have screwed with Edge's guitar work on the side. They all have the evocative piano doodle and the bass track, but why must they always step on Edge and squash his guitar like a stinkbug? In some, it's gone entirely; on others its been made mushy and indistinct. And unless I'm greatly mistaken, none of them are an improvement.

Maybe that's the curse of being successful. You find yourself having to remix your existing music to suit a variety of powerful but niche audiences, and you find yourself with enough money and spare time that all that remixing becomes fiscally rewarding, or at least painless. This leaves your casual fans scratching their heads and saying "How come I can't find the radio version of New Year's Day on iTunes?" But since I'm not liable to sink more than 99 cents into U2 over my lifetime anyway, maybe I'm a market segment that can be safety ignored.

But it does make you (me, anyway) wonder if one of the reasons death and black metal tends not to be remixed is because black and death metal bands never have enough time and money to screw with the existing oeurve. One imagines the conversation taking place in the Bunker-like confines of the basement beneath the Norwegian Mother Record Store:

"Dude, we should remix the song Funeral Fog."
"What?"
"We should remix Funeral Fog. Pop it up a little, maybe get some play on AOR stations."
"We're going to have to pawn your boots for food money as it is; how do you propose we buy the studio time to remix anything?"
"I could sell a kidney..."

So what I'm saying is that I've bought two various mixes of "New Year's Day" and neither of them is the version I'm used to, so I'm calling this U2 expedition off before it turns crazy.

But, for whatever it's worth coming from my U2-impaired world, Happy New Year!