A Spoonful of Atavan Helps the Medicine Go Down

Most of you know that I've completed two of eight rounds of Rituximab + Hyper CVAD. I haven't mentioned that the protocol consists of alternating courses of "A" and "B." For my friends who are addicted to "Discovery Health," ER and every medical show on TV (you know who you are), I'm going to do something uncharacteristic and list the drugs in each course. If this level of detail makes your eyes glaze over, simply skip this post.

Course A is as follows:

* Rituximab (aka Rituxan, a monoconal antibody) at 375 mg/m2 on day 1 of each cycle
* Cyclophosphamide at 300 mg/m2 IV over 3 hours every 12 hours for 6 doses on days 1, 2, and 3
* Methotrexate at 12 mg IT on day 2
* Doxorubicin at 40 mg/m2 IV on day 4
* Vincristine at 2 mg IV on days 4 and 11
* Dexamethasone (steroid) at 40 mg/d PO/IV on days 1-4 and 11-14
* Cytarabine at 70 mg IT on day 7

Course B is as follows:

* Rituximab at 375 mg/m2 on day 1 of each cycle
* Methotrexate at 1000 mg/m2 IV over 24 hours on day 1
* Leucovorin at 25 mg/m2 IV, 24 hours after the completion of the methotrexate infusion, every 6 hours for 6 doses
* Sodium bicarbonate at 600 mg PO (starting day before methotrexate) 3 times day for 4 days
* Cytarabine at 3 mg/m2 IV over 2 hours every 12 hours for 4 doses on days 2 and 4

This listing doesn't include the "pre-meds," such as Benadryl, which is administered as a drip prior to receiving Rituximab, or any of the anti-nausea medictions, such as Atavan. All of these, by the way, send me straight to slumber land.

Dr. Forman and I have both come to the same conclusion: Course "B" has been much tougher on my body than Course "A."

It's the 'roids, man!

Life on chemo has been described as a roller coaster at best. Between "main lining" highly toxic chemicals, coping with dangerously low white blood cell counts and feeling the artificial boost of steroids, I haven't been certain if my body's been up, down or round the bend over these last three weeks.

Since oral steroids were part of the protocol on days 11 through 14, I wasn't even aware that my white blood cell count had dipped to alarmingly low levels during that time frame. I was flying high on one hour of sleep in a 24-hour period.

Dr. Forman and I were relieved to learn yesterday that the inoculation I received on Monday boosted my white cell count to above normal levels. Ironically, just when my white count is soaring, I'm feeling the most tired. I'm maintaining a fairly active life (yesterday was Pilates, a bowling party for the children of Hillsides and a 3-hour appointment at CofH), but "I feel the need, the need for speed" has been replaced with "I feel the need, the need for zzzzz's."

When I asked Dr. Forman why I feel tired now and felt so good when my levels were low, he got a glint in his eye and said, "It's the 'roids."

These Are a Few of My Favorite Foods (Part 1)

A few years ago, when the great state of Texas published the "last meals" of its death-row inmates, I developed a morbid fascination with the final selections. And, being Texas, there were plenty of menus to peruse.

Alas, the site was discontinued, but my obsession with last meals continues. (The info. lives on at http://www.deadmaneating.com/dmearch.html)

In the last two weeks, I've consumed more than my share of "last meals" before my intense chemo protocol begins. My friend Melanie, a nurse in the hematology department at the City of Hope, warns that I may develop an aversion to eating. Food will no longer be a pursuit and a pleasure.

My last meals have included tender filet mignon and succulent lobster at JJ's Steak House in Pasadena. Pizza with crust as thin and crisp as a cracker at La Maschera. Oolong marinated see bass with ginger soy at PF Changs.

But my favorite foods remind me of why I love Los Angeles: It's teeming with inexpensive but extraordinary ethnic foods that just aren't available in Ravenswood, West Virginia. Last weekend, I had one of my all-time favorites, Vietnamese spring rolls at the Golden Deli Restaurant in San Gabriel.

Jonathan Gold, the food critic for the LA Weekly, first immortalized this popular treat more than a dozen years ago in his LA Times "Counter Intelligence" column. Since then, hardly a year goes by when he doesn't mention the spring rolls.

The New York Times even waxed euphoric about these crispy creations:
http://query.nytimes.com/gst/fullpage.html?res=9506E4DB1E3CF934A25757

For the uninitited, Vietnamese spring rolls come with a plate of crispy romaine lettuce, sliced cucumbers, fresh mint and bean sprouts. Wrap the roll in the lettuce, throw in the assorted veggies and dip in a fish sauce. The result is a heavenly blend of flavors and textures that's impossible to beat.

My Vietnamese manicurist believes that the Golden Deli is not the best and observes that "A lot of Caucasians eat there." But, truth be told, I can't imagine a better spring roll.

Cap it off with a cup of French-pressed coffee, and I could die a happy woman.

(If I have time, I'll share a few more of my favorite foods in pre-treatment blog posts. Please share yours with me too.)

Calendar Girl

I write prose, not poetry. But every million words or so, a phenomenon occurs, and I feel the need to express myself in verse. This poem can still use some polishing, but here it is in its mind-racing, can't-sleep, night-before-chemo state.

Calendar Girl

I’m a calendar girl –
The old fashioned kind.
My days are numbered
In neat little boxes
Parading across the page.

The boxes compete
For my attention.
Meetings, appointments,
Parties, dinner dates.
See how important I am?

The debris of my life
Spills into the boxes.
Double booking, triple booking,
Elbow to elbow
In crowded boxes.

When the doctor says
Let’s book you for chemo,
I answer, Let me check my calendar
For an empty box.
See how busy I am?

Chemo has five letters.
Strange. It won’t fit
Into any of my boxes.
I must erase
Meetings, appointments, dates.

One box every three weeks.
But I know the truth.
Chemo is a thief.
It will steal my energy
And encroach on all my boxes.

But without it
My days are numbered.
Now isn’t that ironic
For a calendar girl -
The old fashioned kind.

Chemo Klatch

My social life has really picked up since I got cancer.

Actually, it just seems that way because March is a month with a record number of weddings, birthdays, going-away get togethers (two different friends are moving to Arizona) and dinner parties, most of which were scheduled before I got the news about my mantle cell lymphoma.

There is one exception. Last night my friend Desiree hosted a happy hour that many of the guests referred to as a "chemo klatch" because it was a show of solidarity before I start chemo on Monday.

I got the following message from my friend Paula (yes, the funny one who was at The Ice House) about the eventing:

"You know, tonight made me feel like a member of a powerful female tribe. And when one of us is threatened, we join forces to vanquish the foe. "

I couldn't have said it better myself, Paula.

When I looked around at the group of women friends - every one of them smart, funny, accomplished, passionate and compassionate - I couldn't help getting all Sally Fieldsish and thinking, "They like me. They really like me."

The best part is that my "Chemo Klatch" extends far beyond the dozen women who were present last night because every single person reading this blog is a member. Now that's one powerful tribe!