Round six of chemo done, yes I’m still blogging

Last round of R-CHOP chemo done!

It has been a few weeks since I have been able to blog. As I mentioned in my last blog each round of chemo has hit me harder. Round six was no exception to this trend. But I do have good news, I am now done with my R-CHOP chemo! And now that I am past the hump created by my sixth round of chemo I can get back to regular blogging again!

Last week I had my sixth and final round of R-CHOP chemo. The oncologist met with me prior to my round six chemo injection. She had determined based upon the PET scan I had done after round three and other factors that going past six rounds of chemo would not be necessary. I was so happy to hear this news. The fifth round of chemo had really beat me down and the thought of having three more rounds seemed impossible. She did mention however that I would have another PET scan and have to get a bone-marrow biopsy done to ensure the cancer is gone from my bones. If there is still active cancer in my bones she will come up with a plan of action based upon the PET scan and biopsy results. I am more than happy to move on from R-CHOP chemo and possibly on to other treatment options. Although honestly I just hope the R-CHOP kicked the cancer out of my bones and I can just start my two years of maintenance injections.

After the oncologist gave me the good news I had my sixth and final round of R-CHOP chemo. As with the other times receiving chemo I don’t remember much; the Benadryl really did a number on me. Recovery from this round of chemo has been particularly hard on me. For the last week and a half I feel like every part of me has been on the losing side of a boxing match. My energy levels were also at all-time lows. The few times I had to go out and see anyone in public I would use an energy drink and put every bit of energy into seeming normal. Such outings would leave me completely without energy for a day or so. During that time my wonderful boys really stepped up and helped me any way they could. I could not be more proud of them!

Yesterday I finally felt half-way normal. To celebrate I spent the afternoon ice fishing. Again the boys really helped me by getting my stuff out to the ice and helped me bring it back to the house afterwards. I didn’t catch any fish worth keeping, just a dozen or so perch that really weren’t big enough for anything. The lack of catching bigger fish really didn’t bother me though. I was just happy to get out of the house.

Today I feel even better. For the first time in a few weeks I actually feel good enough blog again. I plan to take a trip up north to help move my oldest son. Even though I won’t be much help in actually moving his stuff, I can still drive my pickup to help him out. Hopefully this upward trend can continue! And hopefully I don’t overdo anything; as I really do get tired and wore-out very quickly.

I’ll end this post here. This post was really about getting an update out there about my status. Also I wanted to ensure everyone knew I was still blogging. Actually I have the topics for dozens of blogs ready to go for this year. I just needed to energy to start blogging again. I appreciate the many messages I received during the past few weeks asking if I was OK. It never occurred to me that a lack of blogging by me would even be noticed. Again, thank-you to everyone out there for the support.

Bonus song!

Now that I’m feeling better I can’t get this classic from Robert Earl Keen out of my head.

R-CHOP, the chemo regiment I’m on

21746916A follower of this blog noticed I’ve mentioned R-CHOP often as being the chemotherapy regiment I’m on. She asked if I could briefly explain what this means as she is about to start R-CHOP chemo herself. The doctor did give her information about R-CHOP, but it was basically just a sheet explaining the many side-effects which are possible. In this post I will try to briefly explain what R-CHOP is.

What is R-CHOP

R-CHOP is a chemotherapy used specifically to treat non-Hodgkin lymphoma. R-CHOP actually is actually an acronym for the five drugs that are used together to best battle the lymphoma. Combinations of drugs are often used in chemo. The five drugs which make up R-CHOP are as follows:

  • Rituximab
  • Cyclophosphamide
  • Doxorubicin (Hydroxydaunomycin)
  • Vincristine (Oncovin)
  • Prednisone

Explanation of each drug in R-CHOP

Only three of these drugs are actually chemo therapies. One is a targeted therapy drug and another is a steroid. Here is a further breakdown of these five drugs.

Rituximab

Rituximab is not actually considered a chemo drug. Instead it is a type of targeted therapy drug known as a monoclonal antibody. Here is what cancer research UK has to say about this drug:

Monoclonal antibodies target proteins on the surface of cells. Rituximab targets a protein known as CD20. CD20 is found on white blood cells called B cells. It is the B cells that are cancerous in the most common type of non-Hodgkin lymphoma.

Rituximab attaches itself to the B cells and marks them. The cells of the immune system recognize the marked cells and kill them.

It is a pretty cool idea to use the body’s own immune system to fight cancer. Rituximab is given via IV just like the chemo drugs. It is also the drug that makes the first round of chemo last seemingly forever. This drug has a lot of potentially nasty side-effects and the first IV has to be done very slowly to determine if the drug can be safely used for a patient.

Cyclophosphamide

Cyclophosphamide is one of the three chemo drugs. It is classified as a “cytotoxic agent” due to it being toxic to both bad and good cells. This drug is given through the IV.

Doxorubicin (Hydroxydaunomycin)

Doxorubicin is also a chemo drug. This may be prescribed as Adriamycin. It is given through an IV. Cancer patents often know this drug as the “red devil”. I have to agree with this name. The drug is deep red. It looks like a poison to me, but I’ve heard other say it looks very cool. It is also very dangerous if it leaks on the skin or out of a vein. But it is also a very effective chemo drug, so I find the risk worth it.

Vincristine (Oncovin)

Vincristine is the third and final chemo drug in the R-CHOP regiment. It is also given through an IV.

Prednisone

This is actually a steroid, and not a chemo drug at all. Some patients have Prednisolone instead of Prednisone during their R-CHOP treatment. This is taken as a pill instead of through the IV. In fact I take this the day of chemo, and the four days following. While prednisone has anti-inflammatory properties, it is used in this chemo regiment because it can “stimulate programmed cell deaths“.

How often is R-CHOP given

R-CHOP is typically given every three weeks. Each three-week period is called a cycle. I’ve read about two-week cycles, but honestly I can’t imagine being so aggressive with R-CHOP unless it was absolutely necessary. R-CHOP can last up to 8 cycles. In my case I was told I would likely be on R-CHOP for 6 to 8 cycles. As I write this post I am actually preparing for my fourth cycle. Today I should either be half way done or two-thirds of the way done with my chemo treatment. The results of my PET scan will help determine that.

Other thoughts on R-CHOP

I’ve heard of R-CHOP being referred to as a “shotgun approach” due to the mixture of drugs. I don’t think this is an unfair assessment of R-CHOP as a treatment. One of the problems with certain blood cancers, such as some types of non-Hodgkin lymphoma (NHL), is that they are not curable and can only be pushed into remission. NHL patients often have to wait for their symptoms to be bad enough for treatment. When they finally get that treatment they want it to be as potent as possible to help prevent the need for further treatments any time soon. Personally I am thankful R-CHOP treatment exists. At the same time though I hope new treatment options are created in the future which aren’t so hard on the body. And yes, R-CHOP is very hard on the body.

Low blood pressure during chemo

22376520Today I had my third round of chemo. By this point I don’t even fret about chemo days anymore. One of the first drugs they shoot me up with is Benadryl, which knocks me out for the next few hours. The only chemo day side-effect which is somewhat troubling is my blood pressure getting low.

My blood pressure was 130/68 at the begging of this mornings appointment. As each IV bag was given to me the blood pressure would be checked. After taking the first IV R CHOP drug (I believe it was the rituximab) my blood pressure dropped. It dropped even further after the other three chemo drugs. At the end  of chemo my blood pressure was 99/52. My bottom number technically fell into low blood range since it is under 60. The nurse was concerned about this. But my blood pressure did this the last two rounds of chemo as well. I’ll just take it easy for the next couple of days for my body to recover from the chemo drugs.

In researching R CHOP blood pressure problems I’ve noticed this is a somewhat common side-effect. My advice to others on chemo is to not be overly worried about blood pressure drops as long as the nurse is continuing to monitor the decline. But just like anything if the low blood pressure continues after going home I would definitely call the doctor! The low blood pressure may not be an immediate concern, but it could turn into a very bad situation if allowed to get out of control.