Finding out about my neuropathy from the neurologist

Last week I posted about my visit with a neurologist about my memory issues. In that post, I focused purely upon the diagnostics and discussions revolving around my memory issues. For this post, I will blog about a few other topics I discussed with the neurologist. 

Neuropathy in my legs!

The biggest shock for me during the neurologist meeting was to discover I have peripheral neuropathy. After a series of questions, the neurologist took a small needle out of his jacket. He then proceeded to prick my skin by the ankle. I could not feel the needle at all. He continued to keep piercing my skin every couple inches, going towards my knee. When he reached just a few inches below my knee, I finally began to feel the needle sticking into my skin.

The fact I couldn’t feel those needle pricks came as somewhat of a surprise to me. I thought neuropathy meant I would feel lousy pain all the time. Apparently, there are different symptoms that people can have from peripheral neuropathy. Looking back, I do recall having a buzzing/tingly feeling in my feet and lower legs, but I never really thought much about it. Additionally, I do get what I assumed was charlie horse feelings in my feet, which I now wonder if it has been neuropathy.

After the needle, the doctor checked reflexes in my legs. I was surprised to find I had little or no reflexes in various parts of my lower leg. In particular, my ankle appears to have almost no reflexes. Again, looking back, I probably should have known something was wrong. I do seem to have problems standing still. Sometimes when standing, my ankles will almost seem to give out. Other times when taking stairs, my foot won’t always be in the position I would expect it to be. These odd symptoms appear to be part of the neuropathy.

The neurologist believes the neuropathy is a side-effect of the chemo regiment I went through. In particular, he thinks the neuropathy is a direct result of my infusions of Vincristine (Oncovin), the O part of the R-CHOP chemotherapy I was on. Right now, the doctor doesn’t want to do anything with the neuropathy. We will monitor and go from there if my neuropathy gets worse or doesn’t improve. 

Shaking hands

For as long as I can remember, my hands have shaken. It usually isn’t a large shake. It’s somewhat similar to the involuntary shiver someone gets when it is a little bit cold. While this has made doing things such as soldering and painting slightly tricky at times, it hasn’t impacted my life very much. Plus, it doesn’t seem to have gotten any worse or better over the years. My shaking hands seem to be a regular part of me.

My shaking hands is a part of the conversation with the neurologist I should have taken notes on. He gave me an excellent explanation as to why this happens. The neurologist also let me know there is no need to worry. Finally, he gave me a ten-dollar name for the condition. Since it was nothing to worry about, I didn’t pay enough attention to what he called it so I could remember it now. But it was good to know my shaking hands’ condition is not likely to be related to any deeper medical issues.

Bone abnormality in my head

Before seeing the neurologist, I had an MRI of my head performed. The MRI notes included mention of a small irregularity on a bone in my head. Since I was able to speak with a neurologist, I thought this was the perfect time to ask what this abnormality was. At this time, the doctor says this doesn’t appear to be anything to lose sleep over. The anomaly was present in a prior PET and CT scans. The neurologist noted this abnormality doesn’t seem to have changed between scans. My future remission scans will let us know if there are any changes in the state of that abnormality. But at this time, he does not believe it is something to cause concern.

Back to see the neurologist in four months

As I noted in my prior post, I will see the neurologist again in four months. Mostly he will be following up on my memory issues. But he also wants to ensure my neuropathy has not gotten worse. Additionally, by then, I will have had another CT scan. He wants to ensure the bone abnormality has not changed. I hope that this future appointment will be quick and boring.

PS. On a side note, I have the equipment I need for my upcoming podcast. I am very much looking forward to adding a podcast to this site!

Song of the day: Rockit

Today’s song of the day falls very much outside of my typical music. But this 80’s song from Herbie Hancock has some impressive animatronics that reminds me of my lower legs and ankles. With no feeling, it almost seems like my lower legs have become animatronics just like in this video.

Bonus song: Sirius – Eye In The Sky

Since I started with 80’s songs outside of my usual taste, I thought this classic track from Alan Parsons would be worth including. This song has nothing to do with today’s post, but I like this live version of the song and thought others might as well.

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.