Another Good Treatment Day

Had my 3rd Rituxan infusion today. Like the last one, it went well. No allergic reactions, and it was over in less than three hours.

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Dr. R's office was a bit on edge today. The receptionist seemed frazzled. No witty banter with the nice woman who took my blood, who wasn't even playing the classic R & B radio station she usually has on. And then the nurse who took my vitals saw Dr. R stroll past the exam room, and whispered to me, "I'd like to strangle him!" while mimicking the activity with her stethoscope. I was a little taken aback, because Dr. R is such a sweetheart. She told me, "He was in early today, and she's just been sitting around, so when he sees one of his patients, he rushes us to get finished." Then she rushed through taking my blood pressure, pulse, blood oxygen, and temperature, and thanked me for listening as she hustled me to another exam room.

We had the potential for a difficult day....

But when I saw Dr. R a minute later, he was in a happy mood. Just anxious to see me, I guess, even though no one else was in quite as enthusiastic a mood. (Strange how a doctor's office can be so different at a different day and time. I almost always have appointments with him on Tuesdays at 1:30 in the afternoon; this Friday morning stuff is a whole different world.)

Dr. R said my blood work was "solid," which is a good thing, of course. Had my blood counts changed for the worse, it would be a sign that the Rituxan isn't working. But they're still within the normal range that they have always been.

He asked me if I'd been feeling any different. I told him that I though the Rituxan was working, and mentioned a couple of physical signs, apart from the size of the nodes, that I'd been noticing that seemed to indicate that things were working. He said that was a good, but that he was going to wait until next week to do a full physical examination of my lower abdomen. Basically, the Rituxan is about a week behind schedule, so this, my third week, would just begin to show signs of my second infusion. He says it's still early to look and decide if it's working after just two weeks. I'm OK with that -- I don't want to look at it and say "Nothing seems to be happening," and get discouraged, and neither does he. Waiting until next week will give us a more accurate assessment.

There's a whole lot of waiting involved with this lymphoma, isn't there? I've been waiting for two years. Seven more days won't be that tough.

I asked about extending the treatment to 6 or 8 rounds, as he suggested might be a possibility. He said we'd evaluate that next week, too. If it seems to be working, we'll extend to 6, and possibly 8. If it's not working, we'll stop at 4. It's rare to go beyond 8, since Rituxan's only real long-term (but reversible) side effect is a slightly lower immunity, because it targets normal B-cell lymphocytes as well as cancerous ones. Stopping gives the immune system a chance to recover.

I asked about Rituxan maintenance as well. R-maintenance involves extending the Rituxan treatment if it has been successful: in six months, I'd have 4 more rounds, and then repeat that again two more times in six-month intervals. As he said (and which I knew), there is some evidence that Rituxan maintenance is effective if the initial treatment has been successful. We have some time to decide that, obviously, but I wanted to get a sense of what he felt about the idea.

After an abbreviated exam, I was off to the treatment room.

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It's probably in poor taste to say a treatment room is "dead," but I was the only patient in there until about noon.

For the third straight week, I wore my lucky Jon Lester Red Sox shirt, but today I had my BU hockey jersey over it. One of the nurses saw it and signaled to me from inside the nurses station and said "BU!" and gave a cheer. I figured she wasn't a grad, since they closed their nursing school a while ago. Turns out her sister and brother-in-law went to BU, where he was equipment manager for the hockey team. She told me he taught his five-year-old son to say "BC sucks The Big One!" I told her I was kicked out a BU/BC hockey game for saying something similar about BC players, which is true. But that's another story for another blog.

The infusion itself went fine. Tylenol and Benedryl beforehand. The nurse said that next week, they may give me Benedryl pills, rather than the drip, which will make me "a little less loopy." I slept for an hour or so after I got the Benedryl, but that was all. When I got home, I slept for another hour, and I'm still a little groggy, but otherwise OK.

So next Friday, I hope to have more to report, on how the Rituxan has been working, and where we'll be going from here. But it at least seems to be going well.