Good Numbers, Better Words!

Friday - December 7, 2012

Down a garden path?

And ... [drum roll please!] ... we now have a confirmed path to negotiate through the "watchful waiting" garden of the next six months!  So it was indeed a very good day at VCU --  I always enjoy a good plan.  Dr. Perkins had talked with Dr. Ambinder on the day of my visit to Hopkins 2 weeks ago.  Today, he and I reviewed and discussed the bottom line of this conversation:

• The Hyper CVAD and Rituxan protocol was an aggressive response to my aggressive stage 4 lymphoma.
• The reversal of Hyper CVAD cycles (starting with an even cycle) and two additional rounds of high-dose methotrexate targeted the lymphoma's presence in my central nervous system.
• I had responded quickly and completely to the chemotherapy.  In fact, my headaches had begun to dissipate while I was hospitalized during round #1 and I was in CR (Complete Response) by the end of my fourth round of treatment.
• Relapse is a 50% possibility.  However, the flip side of that coin is that there is a 50% chance that I could continue to be cancer-free --  that we "may have cured this."  (I do love his use of the word "cure" even if it is in a speculative sentence.)
• If I relapse, salvage therapy will probably be the RICE protocol followed by a mini-haplo BMT at Hopkins.
• Given my lymphoma's previous presence in my skeletal system, we will proceed with regular PET scans rather than Dr. Ambinder's suggested CT scans.  My next PET is scheduled for Tuesday and future MRIs and PETs will be synced up beginning in about March.
• I will continue with periodic Rituxan infusions as "insurance" against relapse and have my port flushed and my blood levels checked during these visits.
• Given my heightened liver enzymes (an indication of liver "inflammation") as well as blood counts that are viable but nonetheless indicate that my bone marrow is still straining to overcome the onslaught of six months of aggressive chemo, no more high-dose methotrexate is scheduled.  No more hospitalizations are on the horizon.
• Fevers and lumps need to be called in asap.  Common colds are probably in the future especially now that I'm back in classrooms.  Hot flashes are not unexpected for a 51 year old woman and actually should be increasing now that my body is recovering from chemo and its hormone-skewing effects; not to panic, not to panic....  Just hot flashes .... 
• I will stay off fluconozale for the foreseeable future.  My liver enzymes have now turned the corner and begun to decline.  They remain well above their already-elevated levels from Thanksgiving week but at least they are headed in the correct direction - DOWN!
• We did not discuss any timetable for removal of my port.

So, to summarize:  no more hospitalizations, specific monitoring scheduled, better liver numbers, and the use of the word "cure" by my naturally-cautious oncologist.  And THAT, ladies and gentlemen, is what defines a calming visit to Dalton  :)