Results from the Phase 3 clinical trial called REFLECTIONS B3281006 were announced a few days ago. The trial compares Rituxan with a biosimilar called PF-05280586. The study found that the biosimilar had an Overall response rate that was the equivalent of Rituxan's.
Some reminders: A biosimilar is kind of like a generic version of a drug. However, a drug is created with a chemical formula. After a certain period of time, a drug loses the patent protections that are given to the company that developed it. Once those protections are gone, other companies can develop generic versions of the drug and sell them under a different name. It's relatively easy to do once they figure out the chemical formula.
A biosimilar works in the same general way. When the patent protection for Rituxan expired, other companies could come in and make their own version.
The difficulty is, Rituxan is not a drug. It's a biological treatment. That means the manufacturer can't just go to the chemical store and mix some up. Biological treatments are made from living things. And living things are complicated. So making copies of them are complicated, too.
It's certainly possible to make a biosimilar, but it takes some time, and you have to show that you did it right, and that patients taking it will get the same benefits, without harsher side effects, than those who take the original.
And that's what's happening in the REFLECTIONS B3281006 trial. There were 394 participants in the trial, all of whom had low tumor burden Follicular Lymphoma, and had not yet received any treatment. Half of the patients were given Rituxan, and half were given the biosimilar. The initial results show that the Over Response rate was the same for both.
So far, that's all the manufacturer of the biosimilar is saying. They plan to present more data at a future medical conference (maybe ASCO in June? That's just my guess -- the timing seems right). I assume they will use the results of this trial to seek FDA approval.
This would be the second Rituxan biosimilar to seek FDA approval, assuming they do seek it. The first was Rixathon. The application for Rixathon went to the FDA last September. Rixathon has already been approved by the European Commission.
So what does this mean for Follicular Lymphoma patients?
The biggest reason for a company to develop a biosimilar is that it will make them some money. Rituxan is one of the most popular blood cancer treatments in the world. It is on the World Health organizations list of Essential Medicines. It has made its manufacturer a lot of money.
Getting a piece of that with a biosimilar will make someone else a lot of money, too. And it will do it, of course, by charging less. Just like a generic version of a drug is cheaper, so will (it is assumed) a generic version of a biosimilar.
For patients, that could be very good news. Rituxan isn't cheap -- no cancer treatment is. Lower costs could help a lot of patients. Insurance companies must be less reluctant to add Rituxan to chemo, or to allow an extra round on its own. And lower costs all around show (it is assumed) reduce insurance costs for patients.
It will be interesting to see how biosimilars play out, once they are approved. Will insurance companies insist on them? Will doctors, if given a choice, stay with what they know (Rituxan) rather then the newer biosimilar? Will patients have an opinion? Will any switch to biosimilars happen right away, or will the people who choose them wait for more longer-term results of studies?
Time will tell. But my own personal opinion, as a patient, is that more options for us is usually a good thing.
Monday, January 29, 2018
Thursday, January 25, 2018
Immunotherapy
The journalist Jamie Reno just published "My Two-Decade Journey with Cancer Immunotherapy" on Healthline.
If you've never read his work before, you should be aware of it.
He writes on a lot of topics, but the one I like most is his work on cancer, especially lymphoma. He is, after all, a 21 year survivor of Follicular Lymphoma. (It's always great to read about the experiences of people who have survived so long.)
He talks about this in the Healthline article, especially his experience with Immunotherapy. In particular, he's had Bexxar, the RadioImmunoTherapy I wrote about in my last post. He had 12 years of Progression Free Survival with RIT.
The article talks about more than just his experience. It's a nice overview of Immunotherapy, especially for blood cancer. (He's as excited about CAR-T as the rest of us.) It's as clear an explanation of Immunotherapy, and why it will play such a big role in our futures, as you'll find online.
Reno is also the author of the book Hope Begins in the Dark, which tells the stories of 40 Lymphoma survivors. An excellent read if you're looking to see what some other Lymphoma journeys have looked like.
One more recent piece by Reno: on his blog, about a month ago, a discussion of some of the Lymphoma treatments recently approved by the FDA. (I've had this on my list of things to share with you since I saw it; this is a good excuse to get it to you).
In his usual clear prose, he discusses the treatments Aliqopa, a kinase inhibitor (I've written about this under its other name, Copanlisib); Gazyva, also known as Obinutuzumab, a monoclonal antibody like Rituxan; Yescarta, the CAR-T therapy; liso-cel, another CAR-T therapy; and some other trends in Lymphoma genetic-based treatments.
All good stuff. As I said, his writing on cancer is mu favorite, but if you like what you see, browse his blog (linked above) and see what else he has to say on a variety of topics.
Enjoy.
If you've never read his work before, you should be aware of it.
He writes on a lot of topics, but the one I like most is his work on cancer, especially lymphoma. He is, after all, a 21 year survivor of Follicular Lymphoma. (It's always great to read about the experiences of people who have survived so long.)
He talks about this in the Healthline article, especially his experience with Immunotherapy. In particular, he's had Bexxar, the RadioImmunoTherapy I wrote about in my last post. He had 12 years of Progression Free Survival with RIT.
The article talks about more than just his experience. It's a nice overview of Immunotherapy, especially for blood cancer. (He's as excited about CAR-T as the rest of us.) It's as clear an explanation of Immunotherapy, and why it will play such a big role in our futures, as you'll find online.
Reno is also the author of the book Hope Begins in the Dark, which tells the stories of 40 Lymphoma survivors. An excellent read if you're looking to see what some other Lymphoma journeys have looked like.
One more recent piece by Reno: on his blog, about a month ago, a discussion of some of the Lymphoma treatments recently approved by the FDA. (I've had this on my list of things to share with you since I saw it; this is a good excuse to get it to you).
In his usual clear prose, he discusses the treatments Aliqopa, a kinase inhibitor (I've written about this under its other name, Copanlisib); Gazyva, also known as Obinutuzumab, a monoclonal antibody like Rituxan; Yescarta, the CAR-T therapy; liso-cel, another CAR-T therapy; and some other trends in Lymphoma genetic-based treatments.
All good stuff. As I said, his writing on cancer is mu favorite, but if you like what you see, browse his blog (linked above) and see what else he has to say on a variety of topics.
Enjoy.
Monday, January 22, 2018
CHOP vs RIT: Long-Term Results for FL
Hot off the presses:
The Journal of Clinical Oncology just posted an abstract for "Continued Excellent Outcomes in Previously Untreated Patients With Follicular Lymphoma After Treatment With CHOP Plus Rituximab or CHOP Plus 131 I-Tositumomab: Long-Term Follow-Up of Phase III Randomized Study SWOG-S0016."
The article reports on a 10 year follow up of a randomized trial. Half of the 531 patients were given R-CHOP, and half were given CHOP + RIT, or RadioImmunoTherapy, in this case 131I-Tositumomab, also known as Bexxar.
(If you need a reminder: RIT is kind of a super-charged Rituxan. Imagine a dose of Rituxan, which seeks out the CD20 protein on FL cells. But now add a drop of radiation to each bit of Rituxan, so those cells get the radiation delivered right to them.)
Over 10 years, the Progression-Free Survival was 49%, and the Overall Survival was 78%. The CHOP-RIT group had a better PFS than the R-CHOP group (56% vs 42%).
But there was no significant difference in Overall Survival between the two groups.
There was no difference in the incidence if secondary malignancies or myelodysplastic syndrome (sometimes called pre-leukemia) or acute myeloid leukemia (an aggressive type of leukemia). But there was a higher incidence of death from MDS and AML in the RIT group.
The researchers conclude that all of this points to Immunochemotherapy (R-CHOP in this case, but also R-Bendamustine and maybe CHOP or Benda + Obinutuzimab) remains the best choice for high-risk FL patients for a first treatment.
Two reasons for this:
First, there are the problems with RIT. Studies of RIT showed a great response -- about 70%. As this study shows, the response is not only broad, but durable -- patients can go a very long time without another treatment (the FL patient and advocate Betsy de Parry has gone over 15 years since her RIT treatment). But problems with payments and administration have made it underused (see the discussion of RIT at Lymphomation.org). It's so underused that Bexxar isn't even available anymore. It's a real shame.
And the other reason is the lack of difference in Overall Survival. If there is no difference in OS, there is no reason to go through the difficulties that come with administering RIT.
Two thoughts from me as I read this, for what they are worth:
1) It's pretty frustrating to read so many research reports that compare treatments, and have none of them show an Overall Survival benefit greater than the others. There has to be something out there that breaks through all of this. I don't know if it will be a single treatment or a combination, but I hope that something, at some point, breaks from the pack. Maybe it's already out there, in a clinical trial somewhere. It's a good reminder that we need to keep trials in mind when it comes to decisions about treatment -- there's no way to get new treatments without people to test them. (And since I have the Lymphomation.org page open, here's a link to their Clinical Trials page.)
2) It's also frustrating to see RIT be so successful, but see it so underused. I have a kind of emotional attachment to RIT. Another RIT, Zevalin, was approved a couple of years after I was diagnosed, and I remember being really excited about it. Over the next few years, I saw all the problems it was running into. Frustrating.
I talk a lot about "having more arrows in our quiver." That's the phrase that was used by the Lymphoma specialist that I saw a few days after I was diagnosed. He was talking about treatments available, and how each new treatment was another weapon available to us -- another arrow in the quiver. I've always thought that more arrows, more available treatments, was better for us. If the F;l comes back, there's something else to try.
I'm getting to the point where I don't want more -- I want better. I'd be pretty happy with fewer choices if those choices were personalized, and I knew they had a good shot at working for me, individually, based on the biomarkers that get found on my cells.
But that's a hope more than a reality, at least for now. I'll stay satisfied with my quiver full of arrows, trusting there's another one there when I need it.
In the meantime, I'll keep reading and reporting. And staying hopeful.
The Journal of Clinical Oncology just posted an abstract for "Continued Excellent Outcomes in Previously Untreated Patients With Follicular Lymphoma After Treatment With CHOP Plus Rituximab or CHOP Plus 131 I-Tositumomab: Long-Term Follow-Up of Phase III Randomized Study SWOG-S0016."
The article reports on a 10 year follow up of a randomized trial. Half of the 531 patients were given R-CHOP, and half were given CHOP + RIT, or RadioImmunoTherapy, in this case 131I-Tositumomab, also known as Bexxar.
(If you need a reminder: RIT is kind of a super-charged Rituxan. Imagine a dose of Rituxan, which seeks out the CD20 protein on FL cells. But now add a drop of radiation to each bit of Rituxan, so those cells get the radiation delivered right to them.)
Over 10 years, the Progression-Free Survival was 49%, and the Overall Survival was 78%. The CHOP-RIT group had a better PFS than the R-CHOP group (56% vs 42%).
But there was no significant difference in Overall Survival between the two groups.
There was no difference in the incidence if secondary malignancies or myelodysplastic syndrome (sometimes called pre-leukemia) or acute myeloid leukemia (an aggressive type of leukemia). But there was a higher incidence of death from MDS and AML in the RIT group.
The researchers conclude that all of this points to Immunochemotherapy (R-CHOP in this case, but also R-Bendamustine and maybe CHOP or Benda + Obinutuzimab) remains the best choice for high-risk FL patients for a first treatment.
Two reasons for this:
First, there are the problems with RIT. Studies of RIT showed a great response -- about 70%. As this study shows, the response is not only broad, but durable -- patients can go a very long time without another treatment (the FL patient and advocate Betsy de Parry has gone over 15 years since her RIT treatment). But problems with payments and administration have made it underused (see the discussion of RIT at Lymphomation.org). It's so underused that Bexxar isn't even available anymore. It's a real shame.
And the other reason is the lack of difference in Overall Survival. If there is no difference in OS, there is no reason to go through the difficulties that come with administering RIT.
Two thoughts from me as I read this, for what they are worth:
1) It's pretty frustrating to read so many research reports that compare treatments, and have none of them show an Overall Survival benefit greater than the others. There has to be something out there that breaks through all of this. I don't know if it will be a single treatment or a combination, but I hope that something, at some point, breaks from the pack. Maybe it's already out there, in a clinical trial somewhere. It's a good reminder that we need to keep trials in mind when it comes to decisions about treatment -- there's no way to get new treatments without people to test them. (And since I have the Lymphomation.org page open, here's a link to their Clinical Trials page.)
2) It's also frustrating to see RIT be so successful, but see it so underused. I have a kind of emotional attachment to RIT. Another RIT, Zevalin, was approved a couple of years after I was diagnosed, and I remember being really excited about it. Over the next few years, I saw all the problems it was running into. Frustrating.
I talk a lot about "having more arrows in our quiver." That's the phrase that was used by the Lymphoma specialist that I saw a few days after I was diagnosed. He was talking about treatments available, and how each new treatment was another weapon available to us -- another arrow in the quiver. I've always thought that more arrows, more available treatments, was better for us. If the F;l comes back, there's something else to try.
I'm getting to the point where I don't want more -- I want better. I'd be pretty happy with fewer choices if those choices were personalized, and I knew they had a good shot at working for me, individually, based on the biomarkers that get found on my cells.
But that's a hope more than a reality, at least for now. I'll stay satisfied with my quiver full of arrows, trusting there's another one there when I need it.
In the meantime, I'll keep reading and reporting. And staying hopeful.
Thursday, January 18, 2018
Ibrutinib Trial Results
The latest issue of the journal Blood has the results of a phase 2 trial for Ibrutinib in Follicular Lymphoma patients with relapsed or refractory disease (that is, their FL has returned or had gotten worse). The results are kind of mixed, but with some interesting things worth thinking more about.
First, a reminder about what Ibrutinib is and does. It is classified as a Bruton Tyrinase Kinase inhibitor. BTK is an enzyme that is necessary for a bunch of processes in a cell to happen that let the cell grow and divide. When it gets out of control bad things happen (like cancer, since that growth and dividing doesn't stop when it should). By inibiting (or stopping) BTK, Ibrutinib shuts down that uncontrolled growth of the cancer cells.
The results are reported in the article called "Single-agent Ibrutinib in Relapsed or Refractory Follicular Lymphoma: A Phase 2 Consortium Trial." The phase 1 trial was successful enough to trigger the phase 2, which involves only FL patients -- 40 of them, in the United States, Canada, and Singapore. The results were not as good as those in the phase 1 trial, or as good as Ibrutinib in some other types of lymphoma: an Overall Response of 37.5%, with a Complete Response in 12.5%.
But the study went a little deeper than just looking at Response rates.
The researchers also paid attention to three other things: whether or not a PET scan predicted a response, whether any biomarkers could predict response, and whether or not patients with a Response were sensitive to Rituxan.
For the PET scans, 20 patients were given scans after 8 days of Ibrutinib. Researchers found that a particular SUV (Standardized Uptake Value -- a measurement of how active the cancer cells are) predicted whether patients would have a response. This is important -- because Ibrutinib is taken for a long period, it would be helpful to know in that shorter time whether it is likely to work.
The second thing they looked for involved genetic biomarkers. 31 patients were given a fine needle biopsy before they started the treatment. Patients with mutations of a gene called CARD11 did not respond to Ibrutinib. This, again, is important -- by identifying a biomarker like this before the treatment is given, it can eliminate certain patients from wasting the time and money trying something that won't work.
Finally, the researchers looked at whether or not patients were refractory to Rituxan -- that is, Rituxan had stopped working for them. Patients who were refractory to Rituxan had a much lower response rate to Ibrutinib than those who weren't: 16.7% to 52.6%. Again, this could be an important way to eliminate certain patients from trying Ibrutinib.
The journal also published a commentary on the study called "Choosing Ibrutinib Wisely." I found this to be particularly helpful in understanding the Ibrutinib study's significance. While the results were "modest" in terms of Response rates, and the study was pretty small, it still tells us a lot, and kinase inhibitor seem to have a place for FL patients, particularly those who are relapsed or refractory (rather than patients receiving their first treatment).
And while Ibrutinib had "modest" results on its own, there are still some trials that look at Ibrutinib in combination with Rituxan that have much higher Response rates (around 80%, give or take a few percentage points). And other kinase inhibitors are being studied that seem to improve upon earlier ones like Ibrutinib.
So while the numbers seem low at first glance, the study, in the end, seems very successful in what it has taught researchers. There seems to be a lot here that would be worth exploring further in a larger study.
Don't count Ibrutinib out yet.....
First, a reminder about what Ibrutinib is and does. It is classified as a Bruton Tyrinase Kinase inhibitor. BTK is an enzyme that is necessary for a bunch of processes in a cell to happen that let the cell grow and divide. When it gets out of control bad things happen (like cancer, since that growth and dividing doesn't stop when it should). By inibiting (or stopping) BTK, Ibrutinib shuts down that uncontrolled growth of the cancer cells.
The results are reported in the article called "Single-agent Ibrutinib in Relapsed or Refractory Follicular Lymphoma: A Phase 2 Consortium Trial." The phase 1 trial was successful enough to trigger the phase 2, which involves only FL patients -- 40 of them, in the United States, Canada, and Singapore. The results were not as good as those in the phase 1 trial, or as good as Ibrutinib in some other types of lymphoma: an Overall Response of 37.5%, with a Complete Response in 12.5%.
But the study went a little deeper than just looking at Response rates.
The researchers also paid attention to three other things: whether or not a PET scan predicted a response, whether any biomarkers could predict response, and whether or not patients with a Response were sensitive to Rituxan.
For the PET scans, 20 patients were given scans after 8 days of Ibrutinib. Researchers found that a particular SUV (Standardized Uptake Value -- a measurement of how active the cancer cells are) predicted whether patients would have a response. This is important -- because Ibrutinib is taken for a long period, it would be helpful to know in that shorter time whether it is likely to work.
The second thing they looked for involved genetic biomarkers. 31 patients were given a fine needle biopsy before they started the treatment. Patients with mutations of a gene called CARD11 did not respond to Ibrutinib. This, again, is important -- by identifying a biomarker like this before the treatment is given, it can eliminate certain patients from wasting the time and money trying something that won't work.
Finally, the researchers looked at whether or not patients were refractory to Rituxan -- that is, Rituxan had stopped working for them. Patients who were refractory to Rituxan had a much lower response rate to Ibrutinib than those who weren't: 16.7% to 52.6%. Again, this could be an important way to eliminate certain patients from trying Ibrutinib.
The journal also published a commentary on the study called "Choosing Ibrutinib Wisely." I found this to be particularly helpful in understanding the Ibrutinib study's significance. While the results were "modest" in terms of Response rates, and the study was pretty small, it still tells us a lot, and kinase inhibitor seem to have a place for FL patients, particularly those who are relapsed or refractory (rather than patients receiving their first treatment).
And while Ibrutinib had "modest" results on its own, there are still some trials that look at Ibrutinib in combination with Rituxan that have much higher Response rates (around 80%, give or take a few percentage points). And other kinase inhibitors are being studied that seem to improve upon earlier ones like Ibrutinib.
So while the numbers seem low at first glance, the study, in the end, seems very successful in what it has taught researchers. There seems to be a lot here that would be worth exploring further in a larger study.
Don't count Ibrutinib out yet.....
Monday, January 15, 2018
10 Years
Today is my 10 year diagnosiversary.
I was diagnosed with Follicular Lymphoma 10 years ago today.
This also means that it was 8 years ago today that I started treatment with Rituxan, and I haven't needed treatment since.
I consider myself very lucky to have reached this day.
******************
10 years is a big deal for me. Soon after I was diagnosed, the statistics I saw about Follicular Lymphoma said the median Overall Survival was 8 to 10 years. So back then, I wasn't sure I'd even be here today. In fact, back then, if I had to guess, I would have thought that I wouldn't be.
But here I am.
That statistic doesn't really mean as much to me anymore. I know a lot more about what Overall Survival means, and how little any statistic about FL actually means for my individual disease. And I also know that Overall Survival for FL has almost doubled since I was diagnosed -- we're somewhere in the 15-20 year range now, probably (it's kind of hard to measure).
While that statistic doesn't mean much, that number does.
I feel like I should tell you something really important and significant.
I wish I could tell you my Big Secret to Survival, but I'll be honest -- I don't have one. No magic foods, no special supplements, no life-giving exercise routines. I do try to eat well and exercise, but I do that for my overall health, not because I think it will cure my cancer. I don't do those things nearly consistently enough to think it has had any effect on my FL.
The best I can do is try to keep myself informed about what researchers and others are saying about my disease, and learn to separate what is true with what is wishful thinking. (I think I've done pretty well there.)
******************
If you've been reading the blog for even a little while, you know that one of my big beliefs about Follicular Lymphoma is that it is an emotional disease as much as a physical one. For a lot of us, when we are diagnosed, we don't even have symptoms. And some of us can go for years without needing treatment. And because FL is incurable, even if we are treated successfully, we know that chances are good that it will come back at some point. We need to find ways to live with the emotional side effects of the disease as much as the physical ones.
I've been thinking a lot about FL-related emotions lately, and how I have experienced them over the last 10 years.
There are 3 that keep coming up: Fear, Guilt, and (it's not all negative) Joy. I've been in conversations with hundreds of other FL patients over 10 years, in person and online. The first two are the emotions that we all seem to share. The third one is the one I hear less about, but that I wish the most for all of us.
******************
Fear.
The fear never goes away. If you're new to all of this, that's probably not what you want to hear. It definitely gets easier to deal with, but it never goes away entirely.
I came up with a rule for myself years ago -- if I have a new lump or bump or ache or pain that I can't explain, I give myself 3 days. If it isn't getting better, and I still can't explain it, then I can call the oncologist. But I can't panic right away.
About two months ago, I had a pain near my left hip bone -- the same spot where I had swollen nodes that required the Rituxan 8 years ago. I did what I always do, and gave myself 3 days. And it didn't go away. So I extended it a week. And it still wasn't getting better. I felt a pull every time I bent over to tie my shoe. I'd lie in bed at night and feel the the nodes in that area -- Maybe they're bigger. No, probably not. No, they are definitely bigger. Is the top of my leg starting to swell like it did 8 years ago? I convinced myself that it was time -- I would need treatment.
I started debating with myself for a couple of days about whether to push the oncologist for straight Rituxan again, or maybe go for Bendamustine instead. I looked up clinical trials at the research hospital nearby and picked out a couple that might be good that I could talk about with him. I didn't call the doctor right away -- I'd had an annual physical a few weeks before, and my blood work was fine then, and I wasn't getting any other symptoms that would make me think that I had transformed. I figured as long as the swelling held off, and I didn't have any other symptoms, then it wasn't too aggressive and I could probably wait until after the holidays and my anniversary trip with my wife before I called the doctor.
And then one day the pain went away. And those nodes maybe didn't seem so large after all. And, yeah, that "swelling" wasn't really swelling, but maybe too much pie at Thanksgiving. When I thought about it, I could explain the pain -- probably a muscle pull because I had to lug some big awkward things around my house, maybe about the time the pain showed up.
I'm fine.
That fear never goes away. It hides, but it's always there, looking for an excuse to jump out. Even after 10 years and 1200+ blog posts and who knows how many medical journal articles about Follicular Lymphoma that I have read, the fear is still there.
But over 10 years, I've learned not to let fear turn into panic. The fear doesn't stop me from looking back at what I've learned and thinking about what to do to deal with it.
****************************
Guilt.
I'm in a few online groups, some for Non Hodgkin's Lymphoma in general, and one for Follicular Lymphoma specifically. Last week, someone posted in one of the groups about losing a friendship. Her friend didn't believe that this FL patient was really sick. The friend's sister had cancer, and she saw what her sister had been through, and anyone who "supposedly" had cancer but didn't get treatment (the FL patient was watching and waiting) was obviously lying about serious it was. The FL patient felt awful about losing that friendship.
The weird thing is, I totally understand the friend's way of thinking.
I've seen many FL patients have a strange kind of survivor's guilt. We see other cancer patients going through horrible treatment, and here we are (some of us, anyway) with no symptoms, no major loss of Quality of Life, and (for me) a relatively "mild" treatment that left me tired and achy for a few days, but pretty much able to function normally.
It's enough to ask "Why me? What makes me deserve this luck?"
I remember, years ago, being part of an online group for Non-Hodgkin's Lymphoma patients. There were patients in the group with all types of NHL, not just FL (there are as many as 60 different kinds of NHL). For a couple of weeks, there was an ongoing argument about who had it better -- people with indolent lymphoma like FL, or people with aggressive lymphoma, like DLBCL.
If I could have chosen, I would have had FL like you -- no harsh chemo necessary. You get to just wait it out.
Oh yeah? Yours might be aggressive, but it's curable. I'm stuck with mine forever. And there is an emotional toll that comes with watching and waiting.
It was such a strange thing to discuss. People in a group that was meant for support, but they're fighting over whose cancer is worse. I still hear that whole "Well, at least you got the good kind of cancer" thing from time to time. But there's no "good" cancer. But even that comparison, especially from other cancer patients, can bring on some serious guilt.
And I have to say that I do feel guilty sometimes, even when I hear from some of you about the treatments you've gone through, that I haven't. Why me? What makes me deserving of this luck, when other people with FL have had it so much worse?
And if it isn't guilt about not having a "real" cancer, it's guilt about getting it in the first place. I've written before about why I don't want to know about what caused my cancer, and it's because it was most likely a random genetic mutation, and not something I did. And if it was something I did, there's nothing I can do to change that now. I have too many other things to worry about than to worry about something from the past that I can't change.
Like fear, that guilt never really goes away completely.
*****************************
Joy.
Not all emotions are bad.
Now, there are cancer patients who say that getting cancer was the best thing that ever happened to them. After surviving the ordeal, they appreciate everything a little more now. The sun feels warmer, and strawberries taste better, and even getting stung by a bee is OK, because it reminds them that they are alive.
I'm not one of those patients. I could have done without all of this, thanks very much.
But that doesn't mean that I don't find joy every day. I feel joy -- I just don't get that joy from having (or surviving) cancer.
I'll tell you one of my great sources of joy over the last 10 years -- this blog. It started out as a way to keep family and friends updated on my diagnosis and possible treatment. And after a while, other FL patients found it. I can remember vivdly the first time I got a comment from someone I didn't know. That was pretty amazing. A joyful moment. And I remember the first time I got a comment from someone outside the United States (he was from Scotland, appropriately enough, given my family background). Another joyful moment. I remember when the blogging platform was bought out by Google, and Google added an analytics package, and I could finally see just how many people were actually reading the blog. Incredibly joyful. And you can't imagine how much joy I feel whenever I get a comment or an email or a Twitter message from someone saying that blog has helped them.
So it isn't cancer that gives me joy -- it's my reaction to it, and what follows from there.
************************
Maybe that the Big Lesson.
Not the Big Secret, because I hope most of you have figured it out already on your own.
We can't avoid the cancer. We can't avoid the emotions that come with it -- fear, guilt, sadness, worry, impatience, grief -- and all of the variations of those negative things.
But we can control how we react to it all.
And somewhere in that reaction, we need to figure out how to find Joy.
I'm so lucky to have been able to find a way to react to my diagnosis by writing, and being able to share what I have learned with others. It's been a gift. I can stay informed in a way that helps other patients and bring Joy to myself. How many people can say that?
But that doesn't mean everyone has to find Joy by thinking about cancer every day. If your way of finding Joy is to not think about it, go for it.
And if your way of finding Joy is to delight in getting stung by a bee while you're picking strawberries, then more power to you.
But whatever you do, find the Joy. Wherever. However.
That has to be the Big Lesson.
If I had spent 10 years focused on the negative stuff only, I don't think I'd have been able to get out of bed most days.
And of course there will be bad days. And it's OK to have them -- we've earned them.
But somewhere in there, we need to actively find Joy.
After 10 years, that's the best advice I can give you.
*****************************
There are a lot of people to thank after 10 years. My awesome wife, my rock. My great kids, who give me joy every day. My mom (who died almost 4 years ago) and my dad. My brother and his family. Lots of great in-laws, cousins, nieces and nephews. Many great friends. People who started out as strangers who have become friends. Support group members. Lots of doctors and nurses and other office support people. And all of you readers who have read, commented, emailed, and encouraged and supported me.
All have you have helped me fight the Fear and Guilt, and find the Joy.
In case you were wondering, I plan on being around for my 20th diagnosiversary, and for many more beyond that.
Thanks for reading.
I was diagnosed with Follicular Lymphoma 10 years ago today.
This also means that it was 8 years ago today that I started treatment with Rituxan, and I haven't needed treatment since.
I consider myself very lucky to have reached this day.
******************
10 years is a big deal for me. Soon after I was diagnosed, the statistics I saw about Follicular Lymphoma said the median Overall Survival was 8 to 10 years. So back then, I wasn't sure I'd even be here today. In fact, back then, if I had to guess, I would have thought that I wouldn't be.
But here I am.
That statistic doesn't really mean as much to me anymore. I know a lot more about what Overall Survival means, and how little any statistic about FL actually means for my individual disease. And I also know that Overall Survival for FL has almost doubled since I was diagnosed -- we're somewhere in the 15-20 year range now, probably (it's kind of hard to measure).
While that statistic doesn't mean much, that number does.
I feel like I should tell you something really important and significant.
I wish I could tell you my Big Secret to Survival, but I'll be honest -- I don't have one. No magic foods, no special supplements, no life-giving exercise routines. I do try to eat well and exercise, but I do that for my overall health, not because I think it will cure my cancer. I don't do those things nearly consistently enough to think it has had any effect on my FL.
The best I can do is try to keep myself informed about what researchers and others are saying about my disease, and learn to separate what is true with what is wishful thinking. (I think I've done pretty well there.)
******************
If you've been reading the blog for even a little while, you know that one of my big beliefs about Follicular Lymphoma is that it is an emotional disease as much as a physical one. For a lot of us, when we are diagnosed, we don't even have symptoms. And some of us can go for years without needing treatment. And because FL is incurable, even if we are treated successfully, we know that chances are good that it will come back at some point. We need to find ways to live with the emotional side effects of the disease as much as the physical ones.
I've been thinking a lot about FL-related emotions lately, and how I have experienced them over the last 10 years.
There are 3 that keep coming up: Fear, Guilt, and (it's not all negative) Joy. I've been in conversations with hundreds of other FL patients over 10 years, in person and online. The first two are the emotions that we all seem to share. The third one is the one I hear less about, but that I wish the most for all of us.
******************
Fear.
The fear never goes away. If you're new to all of this, that's probably not what you want to hear. It definitely gets easier to deal with, but it never goes away entirely.
I came up with a rule for myself years ago -- if I have a new lump or bump or ache or pain that I can't explain, I give myself 3 days. If it isn't getting better, and I still can't explain it, then I can call the oncologist. But I can't panic right away.
About two months ago, I had a pain near my left hip bone -- the same spot where I had swollen nodes that required the Rituxan 8 years ago. I did what I always do, and gave myself 3 days. And it didn't go away. So I extended it a week. And it still wasn't getting better. I felt a pull every time I bent over to tie my shoe. I'd lie in bed at night and feel the the nodes in that area -- Maybe they're bigger. No, probably not. No, they are definitely bigger. Is the top of my leg starting to swell like it did 8 years ago? I convinced myself that it was time -- I would need treatment.
I started debating with myself for a couple of days about whether to push the oncologist for straight Rituxan again, or maybe go for Bendamustine instead. I looked up clinical trials at the research hospital nearby and picked out a couple that might be good that I could talk about with him. I didn't call the doctor right away -- I'd had an annual physical a few weeks before, and my blood work was fine then, and I wasn't getting any other symptoms that would make me think that I had transformed. I figured as long as the swelling held off, and I didn't have any other symptoms, then it wasn't too aggressive and I could probably wait until after the holidays and my anniversary trip with my wife before I called the doctor.
And then one day the pain went away. And those nodes maybe didn't seem so large after all. And, yeah, that "swelling" wasn't really swelling, but maybe too much pie at Thanksgiving. When I thought about it, I could explain the pain -- probably a muscle pull because I had to lug some big awkward things around my house, maybe about the time the pain showed up.
I'm fine.
That fear never goes away. It hides, but it's always there, looking for an excuse to jump out. Even after 10 years and 1200+ blog posts and who knows how many medical journal articles about Follicular Lymphoma that I have read, the fear is still there.
But over 10 years, I've learned not to let fear turn into panic. The fear doesn't stop me from looking back at what I've learned and thinking about what to do to deal with it.
****************************
Guilt.
I'm in a few online groups, some for Non Hodgkin's Lymphoma in general, and one for Follicular Lymphoma specifically. Last week, someone posted in one of the groups about losing a friendship. Her friend didn't believe that this FL patient was really sick. The friend's sister had cancer, and she saw what her sister had been through, and anyone who "supposedly" had cancer but didn't get treatment (the FL patient was watching and waiting) was obviously lying about serious it was. The FL patient felt awful about losing that friendship.
The weird thing is, I totally understand the friend's way of thinking.
I've seen many FL patients have a strange kind of survivor's guilt. We see other cancer patients going through horrible treatment, and here we are (some of us, anyway) with no symptoms, no major loss of Quality of Life, and (for me) a relatively "mild" treatment that left me tired and achy for a few days, but pretty much able to function normally.
It's enough to ask "Why me? What makes me deserve this luck?"
I remember, years ago, being part of an online group for Non-Hodgkin's Lymphoma patients. There were patients in the group with all types of NHL, not just FL (there are as many as 60 different kinds of NHL). For a couple of weeks, there was an ongoing argument about who had it better -- people with indolent lymphoma like FL, or people with aggressive lymphoma, like DLBCL.
If I could have chosen, I would have had FL like you -- no harsh chemo necessary. You get to just wait it out.
Oh yeah? Yours might be aggressive, but it's curable. I'm stuck with mine forever. And there is an emotional toll that comes with watching and waiting.
It was such a strange thing to discuss. People in a group that was meant for support, but they're fighting over whose cancer is worse. I still hear that whole "Well, at least you got the good kind of cancer" thing from time to time. But there's no "good" cancer. But even that comparison, especially from other cancer patients, can bring on some serious guilt.
And I have to say that I do feel guilty sometimes, even when I hear from some of you about the treatments you've gone through, that I haven't. Why me? What makes me deserving of this luck, when other people with FL have had it so much worse?
And if it isn't guilt about not having a "real" cancer, it's guilt about getting it in the first place. I've written before about why I don't want to know about what caused my cancer, and it's because it was most likely a random genetic mutation, and not something I did. And if it was something I did, there's nothing I can do to change that now. I have too many other things to worry about than to worry about something from the past that I can't change.
Like fear, that guilt never really goes away completely.
*****************************
Joy.
Not all emotions are bad.
Now, there are cancer patients who say that getting cancer was the best thing that ever happened to them. After surviving the ordeal, they appreciate everything a little more now. The sun feels warmer, and strawberries taste better, and even getting stung by a bee is OK, because it reminds them that they are alive.
I'm not one of those patients. I could have done without all of this, thanks very much.
But that doesn't mean that I don't find joy every day. I feel joy -- I just don't get that joy from having (or surviving) cancer.
I'll tell you one of my great sources of joy over the last 10 years -- this blog. It started out as a way to keep family and friends updated on my diagnosis and possible treatment. And after a while, other FL patients found it. I can remember vivdly the first time I got a comment from someone I didn't know. That was pretty amazing. A joyful moment. And I remember the first time I got a comment from someone outside the United States (he was from Scotland, appropriately enough, given my family background). Another joyful moment. I remember when the blogging platform was bought out by Google, and Google added an analytics package, and I could finally see just how many people were actually reading the blog. Incredibly joyful. And you can't imagine how much joy I feel whenever I get a comment or an email or a Twitter message from someone saying that blog has helped them.
So it isn't cancer that gives me joy -- it's my reaction to it, and what follows from there.
************************
Maybe that the Big Lesson.
Not the Big Secret, because I hope most of you have figured it out already on your own.
We can't avoid the cancer. We can't avoid the emotions that come with it -- fear, guilt, sadness, worry, impatience, grief -- and all of the variations of those negative things.
But we can control how we react to it all.
And somewhere in that reaction, we need to figure out how to find Joy.
I'm so lucky to have been able to find a way to react to my diagnosis by writing, and being able to share what I have learned with others. It's been a gift. I can stay informed in a way that helps other patients and bring Joy to myself. How many people can say that?
But that doesn't mean everyone has to find Joy by thinking about cancer every day. If your way of finding Joy is to not think about it, go for it.
And if your way of finding Joy is to delight in getting stung by a bee while you're picking strawberries, then more power to you.
But whatever you do, find the Joy. Wherever. However.
That has to be the Big Lesson.
If I had spent 10 years focused on the negative stuff only, I don't think I'd have been able to get out of bed most days.
And of course there will be bad days. And it's OK to have them -- we've earned them.
But somewhere in there, we need to actively find Joy.
After 10 years, that's the best advice I can give you.
*****************************
There are a lot of people to thank after 10 years. My awesome wife, my rock. My great kids, who give me joy every day. My mom (who died almost 4 years ago) and my dad. My brother and his family. Lots of great in-laws, cousins, nieces and nephews. Many great friends. People who started out as strangers who have become friends. Support group members. Lots of doctors and nurses and other office support people. And all of you readers who have read, commented, emailed, and encouraged and supported me.
All have you have helped me fight the Fear and Guilt, and find the Joy.
In case you were wondering, I plan on being around for my 20th diagnosiversary, and for many more beyond that.
Thanks for reading.
Thursday, January 11, 2018
Refining Therapeutic Strategies for FL
OncLive has another Peer Exchange video series on Follicular Lymphoma. The Peer Exchange series is always excellent -- it brings together experts in an area to discuss up-to-the-minute research.
This series is called "Refining Therapeutic Strategies for Follicular Lymphoma," and it features Dr. Ian Flinn, Dr. Sarah Cannon, Dr. Peter Martin, Dr. Loretta J. Nastoupil, Dr. Grzegorz Nowakowski, and Dr. Anas Younes. It highlights recent research in FL, especially research from last month's ASH conference.
The Peer Exchanges usually involve a series of videos, with a new one published every few days. In this series, the first video is called "Follicular Lymphoma: Outcomes After Immunochemotherapy," and it was posted last Friday. Dr. Nowakowski makes an interesting and hopeful point: As we know, about 20% of FL patients who have had immunochemotherapy (like R-CHOP or R-Bendamustine) will relapse within two years, and these patients have a less favorable outcome, statistically, than the rest. However (this is the hopeful part), for the other 80%, Nowakowski says, "if you do not relapse within the first 2 years after chemoimmunotherapy in follicular lymphoma, your life expectancy is just like anybody else in that population." That's nice to hear.
(Again, this is based on statistics, and describes the whole group of us. Each of us will respond differently, whether we're in the 20% or the 80%, good or bad. He also points out how very heterogeneous the disease is -- we all have FL, but there are lots of different things happening in our bodies as a result.)
Dr. Nowakowski also had hopeful things to say about transformation (something we all fear). He says patients who have an anthracycline-containing treatment (such a CHOP) after transformation often "do quite well." (I like this doctor. He gives me lots of good news, but he seems realistic, too.)
Dr. Martin discusses the use of prognostic tools like the different FLIPI scores. They were not meant to be predictors of patient outcomes, and they don't always match up with how a patient's disease carries on. That's a good reminder for us all -- statistics don't say anything about us as individual patients.
The second video in the series is called "Upfront Therapy Strategies in Follicular Lymphoma." Dr. Nastoupil discusses some of the factors that go into deciding which treatment to use at first, and when to treat. Again, the message is that we're all different, and there's no single right answer. She tries to consider many factors in making those decisions (and she believes other oncologists do the same thing), including how well a patient will be able to tolerate the side effects of particular treatments. Knowing the patient seems like a very important part of making the decision. (She is also sure to discuss clinical trials as options, something we should all think about.) Dr. Younes agrees with the idea that we have a number of options, and the needs of the individual patient need to be considered.
The third video in the series (published today) continues the conversation, and is called "Challenging the Role of Maintenance Therapy in FL." Maintenance therapy is still a controversial topic among FL experts, with lots of discussion on whether it is necessary, and for how long, and which treatment should be involved. A recent presentation at ASH, says Dr. Martin, confirms that maintenance (Rituxan for two years after immunochemotherapy) improves Progression Free Survival (the time until patients' disease gets worse), but not Overall Survival (it doesn't help patients live longer). The panelists discuss the results of several long-term studies of maintenance, and don't find any easy answers about who should have it and when. Dr. Younes points out, again, that it is an individual patient's choice.
And that seems to be the theme here. Follicular Lymphoma is, unfortunately, the "No Easy Answer Cancer." We have lots of research that tells us important stuff, and lots that seems to tell us the opposite.
But I think that's OK. In the end, we have a lot of choices, and most of them are good choices. the important thing is, as patients, we need to stay informed about those choices, and continue to communicate with our doctors about what is important to us. Does PFS matter -- do we want to go as long as possible between treatments? Does Quality of Life matter -- do we want the fewest and least harsh side effects so we can live relatively normal lives? Does being aggressive matter -- do we want to feel like we are doing everything we can to attack the cancer?
Those questions matter, and a good oncologist will want to hear the answers, and help guide us to treatment decisions that make the most sense for what we need.
This Peer Exchange series will probably continue for at least a week. If you want to hear more from the panel, click one of the links every few days and see which videos they have added.
Lots of good stuff here that should bring us lots of hope.
This series is called "Refining Therapeutic Strategies for Follicular Lymphoma," and it features Dr. Ian Flinn, Dr. Sarah Cannon, Dr. Peter Martin, Dr. Loretta J. Nastoupil, Dr. Grzegorz Nowakowski, and Dr. Anas Younes. It highlights recent research in FL, especially research from last month's ASH conference.
The Peer Exchanges usually involve a series of videos, with a new one published every few days. In this series, the first video is called "Follicular Lymphoma: Outcomes After Immunochemotherapy," and it was posted last Friday. Dr. Nowakowski makes an interesting and hopeful point: As we know, about 20% of FL patients who have had immunochemotherapy (like R-CHOP or R-Bendamustine) will relapse within two years, and these patients have a less favorable outcome, statistically, than the rest. However (this is the hopeful part), for the other 80%, Nowakowski says, "if you do not relapse within the first 2 years after chemoimmunotherapy in follicular lymphoma, your life expectancy is just like anybody else in that population." That's nice to hear.
(Again, this is based on statistics, and describes the whole group of us. Each of us will respond differently, whether we're in the 20% or the 80%, good or bad. He also points out how very heterogeneous the disease is -- we all have FL, but there are lots of different things happening in our bodies as a result.)
Dr. Nowakowski also had hopeful things to say about transformation (something we all fear). He says patients who have an anthracycline-containing treatment (such a CHOP) after transformation often "do quite well." (I like this doctor. He gives me lots of good news, but he seems realistic, too.)
Dr. Martin discusses the use of prognostic tools like the different FLIPI scores. They were not meant to be predictors of patient outcomes, and they don't always match up with how a patient's disease carries on. That's a good reminder for us all -- statistics don't say anything about us as individual patients.
The second video in the series is called "Upfront Therapy Strategies in Follicular Lymphoma." Dr. Nastoupil discusses some of the factors that go into deciding which treatment to use at first, and when to treat. Again, the message is that we're all different, and there's no single right answer. She tries to consider many factors in making those decisions (and she believes other oncologists do the same thing), including how well a patient will be able to tolerate the side effects of particular treatments. Knowing the patient seems like a very important part of making the decision. (She is also sure to discuss clinical trials as options, something we should all think about.) Dr. Younes agrees with the idea that we have a number of options, and the needs of the individual patient need to be considered.
The third video in the series (published today) continues the conversation, and is called "Challenging the Role of Maintenance Therapy in FL." Maintenance therapy is still a controversial topic among FL experts, with lots of discussion on whether it is necessary, and for how long, and which treatment should be involved. A recent presentation at ASH, says Dr. Martin, confirms that maintenance (Rituxan for two years after immunochemotherapy) improves Progression Free Survival (the time until patients' disease gets worse), but not Overall Survival (it doesn't help patients live longer). The panelists discuss the results of several long-term studies of maintenance, and don't find any easy answers about who should have it and when. Dr. Younes points out, again, that it is an individual patient's choice.
And that seems to be the theme here. Follicular Lymphoma is, unfortunately, the "No Easy Answer Cancer." We have lots of research that tells us important stuff, and lots that seems to tell us the opposite.
But I think that's OK. In the end, we have a lot of choices, and most of them are good choices. the important thing is, as patients, we need to stay informed about those choices, and continue to communicate with our doctors about what is important to us. Does PFS matter -- do we want to go as long as possible between treatments? Does Quality of Life matter -- do we want the fewest and least harsh side effects so we can live relatively normal lives? Does being aggressive matter -- do we want to feel like we are doing everything we can to attack the cancer?
Those questions matter, and a good oncologist will want to hear the answers, and help guide us to treatment decisions that make the most sense for what we need.
This Peer Exchange series will probably continue for at least a week. If you want to hear more from the panel, click one of the links every few days and see which videos they have added.
Lots of good stuff here that should bring us lots of hope.
Monday, January 8, 2018
I'm Back!
I told you I'd be back, and here I am.
I also told you I was going someplace warm, and I did.
My wife and I celebrated our 25th anniversary last week with a cruise. We stopped at Nassau, Bahamas for a day, and at Havana, Cuba for a day. We enjoyed both stops very much. We also enjoyed knowing that it didn't get above 15 degrees at home (-9C), and that our kids had to shovel a foot of snow without us.
It was the first time either of us had been on a cruise. We'd heard a lot about the cruising life from some family and friends who have done it, so had some idea of what to expect. We decided not to pay $20 per day for internet access, so we were able to unplug and just relax and enjoy ourselves. A few days in, I told my wife that I had realized this was the longest I had ever gone without checking the blog. A strange feeling.
But worth it. Mostly because it was nice to spend a few days not thinking about cancer. Even if it isn't worrying me, I check my blog at least once a day, and check into a couple of online support groups, and my Twitter is pretty much devoted to cancer advocacy. So it's really not possible for me to not think about cancer in some way everyday. It doesn't mean I worry about it. Just that I think about it.
But not for those few days. Instead, I spent my time hanging out with my wife of 25 years, eating good food and listening to great music, and meeting really nice people from all over the world -- passengers and crew members. That was the part my wife and I liked best. I always enjoy hearing what life is like for people whose lives are different from my own.
And that's what made going to Cuba so great. That was the real highlight of our trip. As you may know, the U.S. had travel restrictions for Cuba since the early 1960s. They were relaxed a few years ago, but then tightened up again within the last year. So I wanted to go to Cuba, mostly because I don't like being told what I can't do. (You might have guessed that if you've been reading for a while -- I think it's a good attitude for a cancer patient to have.)
The people in Cuba were very friendly, and we learned a lot about their lives. We also met some very nice people from around the world -- New Zealand, Canada, the Philippines, Indonesia, Russia, and of course, from all around the U.S. As one of the Cuban folks we met said, "People are people. We're really all the same, deep down." Very true.
So it's time to get back to work. I have a very long list of Lymphoma-related things I hope to accomplish in the next few months. I hope you'll keep coming back to hear all about them.
Thanks, as always, for reading. I hope this new year brings you all peace, happiness, and good health.
I also told you I was going someplace warm, and I did.
My wife and I celebrated our 25th anniversary last week with a cruise. We stopped at Nassau, Bahamas for a day, and at Havana, Cuba for a day. We enjoyed both stops very much. We also enjoyed knowing that it didn't get above 15 degrees at home (-9C), and that our kids had to shovel a foot of snow without us.
It was the first time either of us had been on a cruise. We'd heard a lot about the cruising life from some family and friends who have done it, so had some idea of what to expect. We decided not to pay $20 per day for internet access, so we were able to unplug and just relax and enjoy ourselves. A few days in, I told my wife that I had realized this was the longest I had ever gone without checking the blog. A strange feeling.
But worth it. Mostly because it was nice to spend a few days not thinking about cancer. Even if it isn't worrying me, I check my blog at least once a day, and check into a couple of online support groups, and my Twitter is pretty much devoted to cancer advocacy. So it's really not possible for me to not think about cancer in some way everyday. It doesn't mean I worry about it. Just that I think about it.
But not for those few days. Instead, I spent my time hanging out with my wife of 25 years, eating good food and listening to great music, and meeting really nice people from all over the world -- passengers and crew members. That was the part my wife and I liked best. I always enjoy hearing what life is like for people whose lives are different from my own.
And that's what made going to Cuba so great. That was the real highlight of our trip. As you may know, the U.S. had travel restrictions for Cuba since the early 1960s. They were relaxed a few years ago, but then tightened up again within the last year. So I wanted to go to Cuba, mostly because I don't like being told what I can't do. (You might have guessed that if you've been reading for a while -- I think it's a good attitude for a cancer patient to have.)
The people in Cuba were very friendly, and we learned a lot about their lives. We also met some very nice people from around the world -- New Zealand, Canada, the Philippines, Indonesia, Russia, and of course, from all around the U.S. As one of the Cuban folks we met said, "People are people. We're really all the same, deep down." Very true.
So it's time to get back to work. I have a very long list of Lymphoma-related things I hope to accomplish in the next few months. I hope you'll keep coming back to hear all about them.
Thanks, as always, for reading. I hope this new year brings you all peace, happiness, and good health.
Monday, January 1, 2018
Happy New Year
Wishing you all a Happy New Year.
Remember what I said a week ago -- it's time for new beginnings. Do something, be someone that you haven't had the courage to do or be. If it doesn't work out, forgive yourself and try again.
*****************
I'll be taking about a week off, starting today. No new posts. I might even get away with not thinking about cancer for all of that time.
And I'm going someplace warm with no internet access. In the Northeastern United States where I live, it's about 6 degrees F right now (that's about -14C). I need some sunshine and the Vitamin D that goes along with it.
I'll tell you all about it when I get back. There may be new beginnings for some things, but the Lympho Bob blog isn't going anywhere.
See you in a week.
Remember what I said a week ago -- it's time for new beginnings. Do something, be someone that you haven't had the courage to do or be. If it doesn't work out, forgive yourself and try again.
*****************
I'll be taking about a week off, starting today. No new posts. I might even get away with not thinking about cancer for all of that time.
And I'm going someplace warm with no internet access. In the Northeastern United States where I live, it's about 6 degrees F right now (that's about -14C). I need some sunshine and the Vitamin D that goes along with it.
I'll tell you all about it when I get back. There may be new beginnings for some things, but the Lympho Bob blog isn't going anywhere.
See you in a week.
Subscribe to:
Posts (Atom)