Monday, January 11, 2010

Rituxin, part 3

So here's what I can probably expect on Friday, from what I've read and been told:

Unlike chemotherapy, Rituxan doesn't seem to have too many harsh side effects, short- and long-term. Chemo works because it targets fast-growing cells; since cancer cells typically grow faster than regular cells, they tend to take up the chemo before most healthy cells do. But other normal fast-growing cells also get hit hard -- hair cells, for example, and the lining of the mouth.

Rituxan is not a chemo treatment, so those kind of typical side effects (like hair loss) aren't an issue. Most of Rituxan's side effects come from its partially-human (and partially mouse) nature.

Much like a food allergy (which we know something about around here), the body treats Rituxan as something thast doesn't belong, and behaves accordingly, releasing histamine or other mediators that allow the body to fight off what it perceives as an invader. (Histamine causes inflammation, for example, because it dialtes blood vessels to allow white blood cells to get to the invader that much quicker.) So many patients (really, most patients) who take Rituxan have an allergic reaction. Rituxin is an invader -- it doesn't belong there naturally. Typical side effects during the infusion are things like itching, nausea, hives, fever, and chills. And they usually stop once the infusion stops. (Longer-term side effects are much less common.)

The solution, as with any allergic reaction, is to give an antihistamine (like Benadryl) during the infusion. But this will slow down the whole process, especially for the first infusion.

I'll have my treatments right at the doctor's office, where they have a treatment room. I was told to plan for a full day on Friday. I'll get there by 9:30 and have some blood taken. Then I'll go to the treatment room, pick a nice chair (I was told to try to get one in front of a TV), and settle in. I'll probablly get some Tylenol, and maybe a steroid. The amount of Rituxan I'll receive depends on body weight; this means, unfortunately, that I'm going to get a whole lot of Rituxan, which is going to add to the time I'm sitting there.

Nurses will be watching me te whole time, looking for signs of a reaction, and listening for me to tell them that I'm feeling anything abnormal. If (when?) I do start to have a reaction, they will slow down or stop the Rituxan and speed up the Benedryl.

Other than those moments of excitement, I'll pretty much just sit there. They'll have reading material and DVDs to pick from, and coffee and tea and some juice. I'm supposed to bring anything else I might want to read, or watch, and maybe my iPod, my computer (though there's no wireless access), and some snacks. The whole "snack" thing is encourgaing -- they don't expect me to be nauseous, though it is one possible allergic reaction, which is nice. They tell me there's a good deli nearby if I want to send Isabel out for something for us to eat.

All of that Benedryl will likely make me tired, so Isabel will be us driving home. That tired feeling might last into the next day, too. I'm expecting that it will -- a mere teaspoon of Benadryl makes me feel all dried out and tired, even the next day (the dreaded Benadryl Hangover), so I'm guessing that getting a pint or two of it will be that much worse.

Of course, there are some people who have almost no reaction. And then there are some who can't tolerate Rituxan at all, and have to discontinue the treatment. But most have some kind of reaction that can be dealt with.

The other three infusions usually go faster and do not pressnt the same side effects.

So I'm not terribly worried about all of this. Seems like it's all tolerable....

5 comments:

Anonymous said...

Bob, we'll be thinking about you. Thanks for the very clear and informative Rituxin information. I have read about it before of course but like your brother I think I actually understand it better this time!

It seems to me that your choice of videos or reading material on Friday are pretty important. If you do experience uncomfortable side effects I would think that a video may be easier to handle than a book but I am probably just projecting. I'd recommend something that you don't have to follow too closely, or may be unpleasant in any way. Why not watch the Red Sox win the World Series or The Patriots win a Super Bowl again? It will entertain you and you won't have to worry about the outcome.

Better bring some Cheetos along too in case you get mice cravings.

TTFN,

Tom

Tom

Dave, Mandy and Marshall Hall said...

Bob,

I hadn't checked your blog since Christmas. I am sorry to hear treatment is being started, however, glad to hear you are going the Rituxan route. Don't know if you recall, but I did a clinical trial which was Epratuzimab and Rituxan. I have to say the Epratuzimab infusion caused no nausea and was actually not bad at all. My first Rituxan infusion, I did not have any reaction until I got home. Then it was fever and chills and well some vomiting.

Know that Mandy and I will be thinking of you on the 15th. We know what you are going through and will be crossing our fingers, toes and throwing up some prayers for a full remission.

Lymphomaniac said...

Tom,
Thanks for the excellent advice. I'm off to the bookstore this morning, and I'll think carefully about what to get. Maybe this isn't a good time for that FDR biography....And as for the Cheetos, the only problem there is: crunchy or puffy? Crunchy are seriously addictive for me. That could be a problem.

And Dave, thanks for checking in -- great to hear from you. I do remember you went through the clinical trial; I hope my reactions are manageable. (Though, speaking of reactions -- think you could just "send up" instead of "throwing up" those prayers? Either way, I appreciate them.)

Mike said...

Bob -

Karen mailed your Snuggie yesterday. You should have it for Friday. Of course we expect a picture of you wearing it.

Crunchy Cheetos apre the only way to go. Spicy if you can handle them.

Good Luck

Mike

Anonymous said...

When I was getting vertigo reading books and watching movies was hard to take but books on tape/CD was marvelous. I could close my eyes when I was feeling nauseous and have my mind concentrate on something other than how I was feeling.

I would suggest David Sadaris. He must have about 20+ hours worth of material on CD. And there is such charm in his voice that makes the stories that much funnier, but you already know this.

Love you all,
Mary