Our family's efforts to raise the floodwaters...

Tuesday, April 8, 2014

Maintenance Chemo Round 5

We saw Dr. Danko on Tuesday, March 25th where we were able to report that the symptoms we thought might go away due to having no Rituximab in my system, in fact did not go away.  He indicated that I would go back on Rituximab for maintenance chemotherapy, and encouraged me to continue following up with the endocrinologist. He said he would consult with the endocrinologist also.  He scheduled the next maintenance chemotherapy treatment for April 4th.   

So, this past Friday the 4th we visited with him for a bit, then had the treatment.  Again, the treatment and after effects are not physically difficult.  The Benadryl makes me very sleepy, but otherwise there are virtually no physical effects.  The mental/psychological effects are significant for me, however.  Having not had a treatment for so long, it felt REALLY weird going back into the chemo suite and having more treatment.  I am struggling to get used to the healthy-and-fine, to hooked-up-and-getting-chemo transitions.  It contributed to a little depression Friday I think. 

My one-year PET scan is scheduled for May 28th.  Dr. Danko has said that with my type of cancer, if a recurrence is going to happen, it will most likely happen within the first year.  So, the results of this scan have us particularly interested.  Though a significant piece of what we have learned is that neither good things (clean scans) nor bad things (diagnosis, recurrence, etc.) cause us to feel too much hope or too much despair.  We have learned to simply move forward with faith, knowing without a doubt that Heavenly Father has a perfect understanding of what is best for our family...what will help us become who He would have us become if we allow it. 

I read this recently from a Book of Mormon student manual and thought it expressed some of my feelings very well.  I love the Book of Mormon:
"Nephi wrote of 'many afflictions' yet also acknowledged many blessings from the Lord. His record recounts numerous trials he and others of his family endured while staying faithful and grateful to the Lord. Nephi felt highly favored because he had come to a great knowledge of the goodness of God (see 1 Nephi 2:16), and relying on His strength became Nephi’s support (see 2 Nephi 4:19–26). The understanding of God’s plan gave context to the afflictions Nephi experienced."

Monday, February 17, 2014

Canceled Maintenance Chemo, and Questions

That brings us to today, February 17, 2014.  Had an appointment for a visit with Dr. Danko and my routine maintenance chemotherapy today.  It has been and felt like so long since I've been treated that when they called my name I forgot about the fact that I always do labs (blood draws) first, then I go sit back down in the waiting room, then they call me back for the visit with Dr. Danko's nurse, then Dr. Danko.  Weird that I forgot that...

Dr. Danko indicates that all labs appear normal.  I have no symptoms or complaints other than my continued hormonal issues.  To his knowledge/experience this issue has not been connected to a side effect from Rituximab (my maintenance chemo), but he is curious enough that he wants to try to find out.  

He indicated that Rituximab takes about 3 months to leave your system.  Rituximab was part of my major chemo treatment (R-CHOP), and it has been my maintenance drug.  So, the longest I have been without this drug in the past year+ is about 2 months.  Dr. Danko canceled today's treatment and wants to see if when Rituximab clears my system, my hormonal issues go away.  This brought us a bit of anxiety - forgoing treatment, but Dr. Danko explained current research, etc. that indicates there is nothing "magic" about the every other month treatment regimen I have been on.  He feels confident that this approach will not jeopardize my short or long-term health.

If these three months of not having Rituximab causes the hormonal issues to go away, Dr. Danko will consider pausing the maintenance chemo and having a PET/CT scan and bone marrow biopsy (re-staging) in April.  If the scan and biopsy are clean, Dr. Danko may consider discontinuing maintenance chemotherapy completely.  Dr. Danko also mentioned a one-time radioactive treatment for Follicular lymphoma maintenance.  We didn’t really discuss what would happen if this does not help with the hormonal issue, but we assume it means maintenance chemo will continue as originally planned…not sure.

As time has gone on, recently questions have formed in my head about my cancer.  I have listened to some webinars and gone on some online forums, etc.   It is interesting to both Mindy and I that I am just now having/forming these questions.  I think, for whatever reason, I must feel “ready” to wonder and ask these things at this time.

I asked the following questions of Dr. Danko today:                
Q: My diagnosis is/was DLBCL and Follicular lymphoma.  Correct?
A: Correct.

Q: Which occurred first (DLBCL or Follicular), and which “transformed” into which? Is there ANY indication of why transformation happened, or what contributed to that happening?
A: Due to the positive reaction of my cancer to the treatment, Dr. Danko suggests that at this point they occurred at the same time (and didn’t transform as we were told on 1/25/13).  (Transformed Lymphoma is an aggressive and difficult to treat cancer…we suppose what he is thinking is that if I truly had transformed, I would not have responded this positively to treatment…)  

Q: My understanding is that DLBCL was aggressive and highly treatable.  My understanding is that I no longer have DLBCL.  Is that correct?  
A: Correct.  There is most often a likelihood that DLBCL recurs within one year….April/May will be one year for me.

Q: What is the likelihood of DLBCL returning?
A: Dr. Danko went over the Prognostic Index results again.  Based on that the likelihood is that I have an 80% chance of being clean of cancer 5 years from the ending of treatment (April/May 2013).

Q: My understanding is that my maintenance chemotherapy (Rituximab) is to treat my Follicular lymphoma (and that generally Follicular lymphoma responds well to treatment).  Correct?  
A: Yes.

Q: The implication of this is that I still have Follicular lymphoma.  Correct?  If this is true, how are my PET scans coming up as "clean as a whistle" (if I have cancer, how do I have clean scans?)?
A: Scans only show cancer the size of a pea or greater.  I could have cancer cells present that never show on a scan unless/until they begin to grow. 

I read a great article today from the American Cancer Society entitled, Living With Uncertainty: The Fear of Cancer Recurrence.  It states, “A recurrent cancer starts with cancer cells that the first treatment didn’t fully remove or destroy. This does not mean that you got the wrong treatment. It does not mean that you did anything wrong after treatment, either. It means that a small number of cancer cells survived the treatment you had. There were probably too few to be detected on tests or scans. But over time, these cells grew into tumors or the same type of cancer as the first one.”

Q: My understanding is that Follicular lymphoma is not curable.  The implication is that I will have cancer for the rest of my life.  Is that correct?  So, in 5 years I will not be considered, “cured” (I will never be considered, “cured”).  Correct? 
A: If the Follicular lymphoma is not doing anything (growing, causing symptoms, etc.), we don’t worry about it.  Dr. Danko said that “cured” is never a word he likes to use.  Even if I had just been diagnosed with DLBCL, he says he never gives a definite promise that the cancer will never come back, even if scans have been clean for five years.  This was interesting to me…I suppose I have been looking for a point at which I would be, “in the clear,” though I know there is always a chance of recurrence.  

Again, the ACS booklet helpfully indicates, "Most doctors avoid using the term 'cure' because it implies that the cancer is gone forever. As we have discussed, this is almost impossible to say in any case of cancer. The best a doctor can do is say that they can find no signs of cancer in your body at this time. This is most often stated as 'No
evidence of disease.'

(So, when I say that scans are clean, that only means that there is no evidence of any cancer....)

“Your doctor may continue to watch you closely for many years and do tests to watch for any signs of cancer recurrence. There’s no harm in assuring yourself that you are cancer-free if that’s what all the evidence shows. Enjoy the feeling that you do not have cancer. But it’s still possible for cancer to come back even after you have been cancer-free for 5 years or more."

Q: My goal is to stay in remission for the rest of my life.  Based on your experience in working with those with Follicular lymphoma, how likely is that to happen (stay in remission for the rest of my life). 
A: Dr. Danko does have 3 or 4 patients that have Follicular lymphoma and have been in remission for 6 to 7 years.

Despite all of these medical facts (whether they are interpreted positively or negatively), my faith is still in my Heavenly Father and His plan for me and for my family.  I continue to submit 100% to His will, with full confidence and assurance that He knows what kind of life is best for me and my family.  I have no doubt in that.  Do I want to feel better?  Yes.  Do I want to be fully “normal” again?  Yes.  But I have an understanding that come what may, I need to love life.  I have the faith to be healed, and I also have the faith to not be healed.

Shingles, Maintenance Chemo Round 3, 5K, LIVESTRONG Graduation, PET Scan and Results, Maintenance Chemo Round 4, Depression

PET Scan Results, Maintenance Chemo Round 2 on 8/13/13 was the last medical update.  Here is what has happened (generally) since then:

-9/10/13 Diagnosed with Shingles (on my chest).  Antibiotics prescribed.  This went away after a few days, thankfully.
-9/24/13 Saw endocrinologist about hormonal issue (we think it is chemo-related, but we're not sure).
-10/14/13 Received maintenance chemotherapy.
-10/26/13 Ran a 5K with my family.  Grateful I set the goal, and was a wonderful experience!
-10/28/13 One-year anniversary of this whole deal. I also “graduated” from my LIVESTRONG at the YMCA program this day.  This day is also Mindy’s birthday! :)  Tried to focus on enjoying the day with Mindy, and tried to minimize the emotional effects of recognizing the anniversary.
-11/5/13 Saw endocrinologist – hormonal issue seemed to have gone away.
-11/12/13 PET/CT Scan.
-11/15/13 Scan continues to be clean.
-12/12/13 Spoke with endocrinologist about the return of the hormonal issue.
-12/16/13 Visit with Dr. Danko and received maintenance chemotherapy.
-1/5/14 Experienced some depression around this day – it has happened a handful of times throughout this process.  I’ve never experienced this before.  Difficult, but gained some insight into what some of those that I work with every day go through. My experience with depression is a very physical experience - there are no identifiable cognitive or environmental causes...

Tuesday, November 12, 2013

"Maybe, or maybe not."

I've been listening to an audiobook and came across this.  Very valuable and inspirational to me.

------------------------

“He asked, ‘Are you familiar with the concept of equanimity?…Equanimity is the idea that when things are going well, we are at peace. And when things are not going well, we are at peace.  The ideal in a spiritual life is to be at peace with what is, and always react steadily.’ We must have looked dumbfounded. ‘Have you heard the story, ‘Maybe, Maybe not?’ Again, we answered no, so he told it to us. 

“There was a farmer who used a great horse to help him on his farm. One day his horse ran away. His neighbors said to him, ‘Farmer, that is awful!  You lost your horse!’  He replied, ‘Maybe, maybe not.’  Within a few days the farmer was surprised to find that the horse had returned, with three additional wild horses.  The new horses could be quite useful on his farm.  His neighbors marveled at his good fortune, ‘Farmer, you are so lucky! You now own several horses!  You will work so much faster in your fields.’  The farmer replied, ‘Maybe, maybe not.’ The next day the farmer’s son tried to ride one of the wild horses but was bucked, resulting in a broken leg.  The neighbors came to visit the farmer and said, ‘Farmer, this is tragic! Your son cannot walk!’ The farmer replied, ‘Maybe, maybe not.’ Soon an army troop stormed the town, kidnapping all of the town’s young men to press into service in their war. The troop was attacked and all of the town’s young men perished. The neighbors came to the farmer and said, ‘Farmer, you are so lucky!  All of our sons have died, yet you still have yours because he was too injured to go with the soldiers.’  The farmer replied, ‘Maybe, maybe not.’” 

Inconceivable: AMedical Mistake, the Baby We Couldn't Keep, and Our Choice to Deliver theUltimate Gift, by Carolyn Savage

Tuesday, August 13, 2013

PET Scan Results, Maintenance Chemo Round 2

Just met with Dr. Danko, and am getting my one chemo drug today. I had a PET scan last week and Dr. Danko let us know that it was, "clean as a whistle" (insert Irish Spring sound clip here). We are very grateful for this as we always are. I'm dealing with some other minor chemo-related issues, but overall, all is well physically.

I was telling Mindy as we parked today that coming back here to CCNW for chemo treatment every two months is bizarre for me. I know how to "be sick," and I know how to "be well," but this in-between place is difficult on my brain and emotions. I have enjoyed getting back to work, but there are times when I'm going about my daily tasks and responsibilities at work, and where I have been and what I have been through the last few months settles on me. It is sometimes really weird to be "back to normal." (And then here I am getting chemotherapy again.) My work/job is a great blessing in my life.

I started my LIVESTRONG at the YMCA program for cancer survivors a week ago yesterday. I am very grateful to have this program...I have a strong belief that it will help me significantly with my overall recovery, health, and wellness.

Tuesday, June 18, 2013

Appt with Dr. Danko, Maintenance Chemo Round 1

I contacted Dr. Danko and he got back to me on June 4th.  He reiterated that there was nothing abnormal on the scan, and indicated that he was awaiting a couple of tests from the blood they took on May 31st.  He said to call him on Friday the 7th.  Around that time the clinic called indicating that my appointment was moved up from June 14th to June 11th, so I just waited to talk with him about things on June 11th. 

We met with him the morning of June 11th.  He recommended I start taking Prilosec a couple times a day for a bit to see if that helped the abdominal pain/discomfort before ordering GI testing.  

After visiting with him I received the one chemotherapy drug I’ve mentioned (Rituximab).  It took a few hours and there were no complications.  Whenever getting chemotherapy (R-CHOP, as well as just this maintenance chemo) they give me some “pre” medications and one of those is Benadryl.  There have been times I have stayed awake but this time it made me very tired and I slept for quite a while.  And again, there are no side effects associated with Rituximab. 

From June 11th to today, the pain/discomfort has decreased…whether it is the Prilosec or not I have no idea.  I have been working in out in the yard, and have been working in the office full time with very few problems.  Things are going very well. 

Mindy and I have discussed it, and we’re not sure how much more we will use this site for updates.  In the event that something of significance occurs, we will certainly let you know.  We love and are so grateful for our family and friends.  Your support, thoughts, and prayers through all of this have made all the difference for me, and for our family.  We will forever be grateful to you.

Friday, May 31, 2013

Pain/Discomfort, Clean CT Scan

On Fri, May 31, 2013 at 10:26 AM, Brad Reimer <mindnbrad@gmail.com> wrote:

Hey All,

Missy texted to see how things were going, so I thought I would just email you all.  About 2 weeks ago I started having this pain that would come and go in my upper/middle abdomen, below my sternum.  It was only about once a day, and lasted for 5 minutes or so.  We figured it was something connected to digestion.  But the last couple of days it has turned from pain to discomfort, and it is pretty much constant now.  It is not disabling pain, but constant discomfort, and certainly not normal.  

So I called Dr. Danko's office yesterday.  The nurse I spoke with talked with him, and he ordered a CAT scan, which I will be getting in about 30 minutes.  We don't really know what to think at this point, but will certainly keep you all updated.  

Our faith in Heavenly Father and His plan for me and for us is unshakeable.

Brad (and Mindy)

-------------------------------------------------

On Fri, May 31, 2013 at 4:36 PM, Brad Reimer <mindnbrad@gmail.com> wrote:

What an interesting day we've had.  Ultimately, we have no real news, which is good....for now...I think. 

We got to the hospital this morning and waited a while before getting into the CT room.  They did the CT scan, and the tech guy said that since there was a "STAT" order on this scan, I needed to wait for a few minutes before they would let me go.  We assumed that meant that they would read or do a preliminary reading of the scan, and communicate with Dr. Danko.  As we sat in the waiting room we could hear the administrative assistant talking to Cancer Care Northwest.  She then came out and told us that CCNW wanted us to go directly over there.  We assumed that this was not good news....why would CCNW have us come over there to tell us the scan was clean?? 

We went over to CCNW and after a while they took my blood to do labs.  We then waited for a LONG time.  As you can imagine we thought a lot about what we might hear, and what that might mean.  We talked a lot about recurrence (to some degree we have expected tihs...but not this quickly...)  After the long wait, one of the nurses called my name, took us into the hallway, and indicated that nothing was found on the scan, and that Dr. Danko wanted me to stay on a clear liquid diet for 24 hours (to "give my gut a rest") and then call him. 

We're not sure what to think.  We're of course glad that nothing was found on the CT scan.  We obviously want to figure out what the pain/discomfort is all about.  And we were very confused by how this all happened today. 

We love each of you, and so appreciate your love, prayers, and concern for us. 

Brad (and Mindy)