Plot Twist: Chemo Cycle 4 (of 6)

There is a routine to these cycles and cycle 4 had very little deviation from previous cycles. Monday I went in, had lab work done, saw my doctor, got the Rituxan injection, and then got admitted to the hospital where they got the chemo started. The biggest change in the routine was the printer outage on Friday which meant they couldn’t print my discharge paperwork. The staff was as frustrated as the patients. They came up with a work around and I got leave – just a little later than planned.

Then it is the daily routine in the hospital. I worked a lot during this round including conducting multiple interviews, attending meetings, working on documentations, and more. It was a busy week for work. The nurses and doctors are amazed that I do so much work while getting chemo. The truth is that while I am getting chemo I feel ok so work is a distraction from what would otherwise be mind numbing boredom.

I met one of the other patients and his wife on one of my walks. He is getting the same treatment I am but is one cycle ahead of me. We walked our circles together and chatted about our cancer, our treatment and how we are tolerating it, and life outside the hospital. It is interesting to talk to others going through the same experience and the different ways we have of managing it.

I learned a little more about my treatment. I am receiving EPOCH-R-DA. The EPOCH are the chemo drugs, the R is the Rituxan, and the DA is dose adjusted. My doctor told me they were going to increase my dosage again so that I would be at level 4. I asked – What do these levels mean? What is the highest level? I got a kind of vague and unsatisfying answer so I whipped out my google foo and researched it.

First, EPOCH-R-DA is the standard treatment for my type of lymphoma and 2 others and it has a very, very high success rate. This is why the doctors all say that I should expect to be cured.

Second, DA – dose adjusted means that each subsequent cycle has an increased dose 20% higher that the last cycle for 3 of the 5 chemo drugs. So, cycle 2 was a 20% higher dose than cycle 1, cycle 3 was 20% higher than cycle 2, and cycle 4 was 20% higher than cycle 3. All these dosage increases are dependent on my white cell (and more specifically my neutrophil) counts staying above a certain level. And the Neulasta shot I get the Monday following chemo helps make sure those levels are within the range they are looking for.

My doctor stated I might start having more side effects for cycles 4, 5, and 6. And indeed, I am having a few more side effects. I have what I describe as a tender tummy – basically some foods just strike me as unappetizing. This was especially true for hospital food. The bitter taste in my mouth is stronger and I suspect that is contributing to the tender tummy. I am also anemic as my hemoglobin levels are pretty low. Anemia makes me tired (no energy), weak (my muscles just don’t have what it takes), and cold (chills for no good reason). This should get better on its own as I recover from the chemo. It means I need to make sure I am getting adequate iron, folic acid, b vitamins, and vitamin c. If it doesn’t get better on its own then they will treat this by giving me a blood transfusion.

I am still managing fairly well in spite of these new side effects. I am not sure, however, I want them to increase the dosage for cycle 5, but if they do I will manage the best I can.

And, Cycle 4 of 6 means I am 2/3 of the way done. I have 2 more cycles after this! I can see the end!