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."

And the Envelope, Please

The Oscar-nominated stars have nothing on me. Stars endure weeks of anticipation from nomination until announcement of winners. I've hung in for weeks between initial diagnosis (mantle cell lymphoma), test results and treatment recommendation. I wish that I could say that it's an honor just to be nominated for this disease. I am, however, in very good company of other stellar human beings who've received a point from the fickle finger of fate.

I went yesterday for the dreaded bone marrow biopsy, which will determine if the lymphoma has spread to the bone marrow. On Thursday, I go in for the final test, the spinal tap, which will show if the lymphoma has entered the central nervous system.

I start chemotherapy on Monday, March 12. (The doctors wanted me to start on March 5, but I didn't want to miss Paula's debut at The Ice House.) The regimen is called R-CHOP, a combination that's proven very successful in treatment of both mantle cell and follicular lymphoma. The C, H and O stand for various cancer-fighting chemicals, the P is for a steroid that's taken post infusion. The R stands for Rituximab, one of the latest new cancer fighting drugs. I like to call it a smart drug because unlike chemo drugs, which attack, the good and the bad cells, Rituximab zeroes in on the proteins of the bad cells.

And, to return to the Oscar analogy, I wish that there was just one "envelope" announcing the results and the treatment, but my life will temporarily be a series of mysterious envelopes.