no more bleo

There was a lot of information to take in today, so I hope I can recall everything here. Let's start off by stating that I'm now taking the following medications:

• Neupogen, the injections I've been giving myself for seven days after each treatment, ever since the second session, to keep my white blood cell counts up
  
• Prednisone, for lung inflammation, which I'll be weaning off slowly over the next three weeks since I've been taking it more than seven days
  
• Bactrim, in case I had a bacterial infection last week, to keep it away; taken three times a week, Mon/Wed/Fri
  
• Acyclovir, to prevent shingles; taken twice daily

Essentially, the last two medications' purpose is to protect against infection, since the Prednisone reduces the immune system's response. I'll only be on them as long as I'm weaning off the Prednisone.

But the major report is that all the tests and cultures taken last week came back negative. No penumonia, atypical or otherwise. Obviously there was some sort of inflammation, what with the thing making me cough/gag when I took a deep breath (which has been gone since Sunday). The Prednisone is probably what made that obstruction go away, and probably also the reason I've had a bit more energy over the last week. I started taking Prednisone the same morning I had the antibiotics, and before we had the results of the bronchoscopy and all that, we were thanking the antibiotics for reducing my fever, but generally it wouldn't work that fast, so it was most likely the Prednisone doing the work.

So what about the bleomycin toxicity? From WebMD: "Rarely, this drug can also cause swelling/inflammation of the lungs (pneumonitis), which could lead to permanent lung damage (pulmonary fibrosis)." But that usually occurs after the chemo is done, sometimes even as much as five years later. In even rarer occasions, signs of toxicity will show up during treatment, such as shortness of breath (however, my only "shortness of breath" was the obstruction when I took a deep breath). It is possible that I am in the latter group.

The two options are pretty obvious: continue receiving the bleo and hope that it's not actually bleo toxicity and just some other sort of inflammation... or stop getting the bleo. The lung injury the bleo can cause is pretty scary, and as a 24-year-old going on 25, it's not exactly something one would want to live with for the rest of one's life (especially considering the high cure rate of Hodgkin's).

Of the four drugs I get for chemo (ABVD), bleomycin is probably the least important. But because toxicity is so rare -- and toxicity during treatment even rarer -- there aren't good statistics on how effective ABVD is without the B. However, we're over halfway done with my treatments, and the X-rays and CAT Scan show that the mass in my chest is shrinking (it was originally 9x9 cm, it's now 4x2 cm), so we've made it this far. Taking out the bleo at this point may not make much of a difference. Also don't forget that after the chemo is done, I'll be getting three weeks of radiation therapy right on the spot itself, which will have even more of an effect.

And even if my cancer does return at some point (whether as a result of eliminating bleo, or simply because it's possible regardless), there are further options for treatment, namely a peripheral stem cell transplantation: "A method of replacing blood-forming cells destroyed by cancer treatment. Immature blood cells (stem cells) in the circulating blood that are similar to those in the bone marrow are given to the person after treatment to help the bone marrow recover and continue producing healthy blood cells. Transplantation may be autologous (the person's blood cells saved earlier), allogeneic (blood cells donated by someone else), or syngeneic (blood cells donated by an identical twin)." Stem cell transplants, according to various WebMD articles, seem to be more effective than bone marrow transplants, though that claim is not entirely conclusive.

In other words, the good news is that the treatment I've received so far is obviously working, and even if eliminating the bleo reduces the effectiveness of my treatment, we still have further options for treating Hodgkin's. So today's chemo was business as usual, except I didn't receive bleomycin.

My oncologist, the first time we met, said "apparently your Hodgkin's has been reading the textbook, because it's been doing everything we'd expect Hodgkin's to do, so it will probably continue reading the textbook." Today we mentioned that my Hodgkin's is attempting to edit the textbook. Quoth Dr. Pohlman, "OK, but you're only allowed one complication per disease." :)

I think that's everything. Like I said, it was a lot to take in, so I hope I've accurately represented everything here (I type out these long posts not just for friends' and family's benefit, but also to help me remember what's going on, as I occasionally read back through the archive). I feel fine right now, but should be getting to bed. I'm hoping that the Prednisone will help me be less lethargic and less indecisive about eating tomorrow... we'll see.