R-CHOP #6: All Done?

So I had the last of my six planned chemo sessions yesterday, and here I sit as usual before dawn, pumped on steroids and unable to sleep. A week of this, then the usual crash-and-burn when I go off the steroids, then everything should be uphill from there.

The plan now is to run follow-up, full-body CT and PET scans on October 14th, and then talk to my medical oncologist on the 19th to see what the scans show. If there’s anything left of the lymphoma that is very localized, they may decide on some radiation therapy. If there’s something left that is more diffuse, they may decide on another chemo session or two.

I mainly just want to get done with all necessary treatment so I can get over this chronic fatigue and get back to my normal life — but not before we’re as sure as humanly possible that all the lymphoma is gone.

Beef Stew à la Provençal

This is my take on the kind of beef stew they had in the south of France. It’s good all by itself, but you can also serve it over couscous or bulgur.

Use canned tomatoes if you can’t get decent fresh ones.

Ingredients

• 2 pounds stew beef, cubed
• 0.5 cup flour
• 1 tablespoon dry mustard
• 2 tablespoons extra virgin olive oil
• 2 cups sweet yellow onion, diced
• 6 cloves garlic, minced
• 4 tablespoons tomato paste
• 4 cups beef broth
• 1 large tomato, diced
• 2 tablespoons herbes de Provence
• 4 cups red potatoes, diced
• 2 cups frozen mixed vegetables
• salt & pepper

Directions

1. Heat oil in a large Dutch oven.
2. Combine flour and dry mustard in a large bowl; season with salt & pepper.
3. Add beef and stir to coat. Shake off excess flour mixture.
4. Brown beef, in batches if necessary, and remove.
5. Add onions and garlic and cook just until soft.
6. Stir in tomato paste and cook for 2 minutes.
7. Deglaze with part of the beef broth.
8. Return beef and add tomatoes, herbes de Provence and remaining broth; season with salt & pepper.
9. Simmer until beef is fork-tender, about 1 hour.
10. Add potatoes and mixed vegetables; season with salt & pepper.
11. Simmer until potatoes are tender, about 45 minutes.

Hungarian Goulash

This is a recipe for goulash, not for goulash soup (which is often served or sold as goulash in this country). It has been adjusted for a low-salt diet, so you may need to add salt for your own taste.

You can use hot or sweet paprika or a combination of both, depending on how much spicy heat you like. Substitute low-fat or fat-free sour cream if you’re counting lipids.

Ingredients

• 1.5 pounds lean stew beef, 1″ cube
• 1 large sweet onion, sliced thin (at least 4 cups)
• 2 cloves garlic, minced
• 2 tablespoons paprika
• 1 teaspoon dried marjoram
• 2 cups tomato puree
• 0.5 cup sour cream, room temperature
• salt & pepper to season
• canola oil

Directions

1. Heat oil in large covered skillet.
2. Season meat with salt & pepper.
3. Add onions to skillet. Cover. Cook 10 minutes.
4. Add garlic, paprika and marjoram. Cook 2 minutes, stirring constantly.
5. Remove onions and set aside.
6. Brown meat, adding more oil if necessary.
7. Return onions to skillet and add tomato puree. Cover.
8. Reduce heat and simmer 2.5 hours, stirring occasionally.
9. Remove from heat. Add sour cream and stir briskly to incorporate.

I like to serve this over wide egg noodles.

Cucumber Raita

Ingredients

• 1 large cucumber, finely diced
• 1.5 cups yogurt
• 0.25 teaspoon ground cumin
• salt
• ground white pepper

Directions

1. Combine all ingredients in a bowl and mix well.
2. Refrigerate at least 2 hours before serving.

Lamb Biryani

This recipe has been adjusted for a low-salt diet. You may need to add salt for your own taste.

You can use any kind of lamb for this — I’ve even done it with the breast. For maximum flavor, I like to roast bone-in pieces to be deboned and cut up after the fact, but you could do a stovetop braise on cubed boneless meat instead.

Ingredients – Meat

• 1.5 pounds lamb
• 1 cup yogurt
• 2 teaspoons minced garlic
• 1 teaspoon ground cardamom
• 1 teaspoon turmeric
• 0.5 teaspoon ground ginger
• 0.5 teaspoon ground coriander
• 0.25 teaspoon ground cumin
• 0.25 teaspoon salt
• 0.25 teaspoon ground white pepper

Ingredients – Rice

• 3 cups basmatic rice
• 0.75 cups golden raisins
• 0.75 cups roasted cashews, washed
• 1 tablespoon minced ginger
• 6 cups water
• saffron threads (optional)

Directions

1. Combine yogurt and spices, mixing well.
2. Marinate lamb with yogurt mixture in a plastic bag overnight.
3. Roast lamb for 3 hours at 275 degrees or until bones fall out. Allow to rest for 10 minutes after removing from oven.
4. Combine all rice ingredients in medium pot, bring to a boil, reduce heat and simmer until liquid is all absorbed. Stir once and keep warm.
5. Debone lamb and cut into 0.75″ cubes.
6. Divide rice into thirds and meat into halves.
7. In a large oiled roasting pan, build five layers of rice and meat, starting with the rice.
8. Optionally, sprinkle with French-fried onions.
9. Bake for 20 minutes at 300 degrees.

Biryani is naturally a relatively dry dish, so serve it with raita (see my recipe for Cucumber Raita) and an assortment of chutneys.

R-CHOP #4: Talking To My Drugs

My fourth chemo session went down yesterday without a hitch. I’m rereading Bob Salvatore’s Dark Elf Trilogy (the core Drizzt novels).

As usual, I didn’t get a wink of sleep last night due to all the steroids, but I did get some rest for a couple of hours this morning.

One thing was different with yesterday’s session, though. The drug company (Merck) that makes Emend (a very expensive anti-nausea drug — just over $100 per capsule) came through with their replacement program, so I’m getting it for free. Yesterday was the first time I got to take it — one capsule before chemo, and one capsule this morning and tomorrow morning.

One thing was a bit weird when I took my Emend capsule this morning. My other morning pills were the Glucophage for diabetes and the five (count’em) five 20mg Prednisone (steroid) tablets. But I was already feeling some nausea coming on (yesterday’s Emend wearing off, I reckon), so I picked up the Emend capsule and — without thinking — held it in front of my face and told it, “You first!” and popped it down.

Suffice it to say that I’m not actually in the habit of initiating discourse with inanimate objects.

Let’s just say I’m a bit tired and leave it at that, shall we?

R-CHOP #3: Half-Way Point

So, it’s chemo week again, I’m pumped with steroids again, and I didn’t get a wink of sleep Monday night again.

At least I’ll be able to get some work done, as long as I can rest my eyes from time to time. My only real complaint during the last fortnight between chemo weeks has been severe fatigue — I had to spend a lot of time resting — so this is actually welcome relief, in a reverse-perverse sort of way.

Yesterday’s chemo session itself went without a hitch. I didn’t even fall asleep from the Benadryl this time, and I’m almost done with Nancy Kress’ Beggars trilogy. Next I’m going to be reading a book by Allerd Stikker called Teilhard, Taoism and Western Thought — I’ve owned a copy in German since like forever, but never got around to reading it front to back. I’ll have to see if I can snarf his later books on my Kindle. After I get a Kindle.

The only incident of any note from yesterday’s chemo was that I had to report some numbness/tingling in my fingertips that had started since my last office visit. This is a known side effect of one of the chemo drugs (Oncovin/Vincristine) which has a risk of becoming permanent, so my acting oncologist (regular doc is taking some well-deserved vacation) dropped the dose from 2.0mg to 1.5mg. I’m already noticing an improvement this morning, but it’s hard to say how much of that might be due to a reverse nocebo effect.

They’re planning a total of six R-CHOP treatments, so I’m now half-way done. I do have to go back in this afternoon for my Neulasta shot as usual — I’ll just ride in with my wife when she goes for her daily radiation therapy. (She’s not supposed to drive while on radiation because it messes with her reflexes, and I don’t drive, so we’re using one of the very few public transportation options this little town has to offer.)

So far, so good.

R-CHOP #2 – Slam Dunk

Here I am again at 4am, buzzed on steroids after managing to get about 5 hours of sleep (as much as I ever get, usually).

Yesterday (Monday) I had my second round of CHOP chemo followed by the Rituxan chaser, and the whole thing was completely uneventful. I go back tomorrow to get the Neulasta shot that will keep my immune system hopping.

I saw the oncologist before starting treatment, and he continues to be very pleased with everything. My blood work is all good, the side effects are within reason, and of course the gross manifestations of the lymphoma are as good as gone.

They made pretty good time with the infusions. They had me on the drip by 9:30am and we were out of there by 3:15pm, and that includes a 30-minute wait on saline while the pharmacist was getting caught up with my Adriamycin.

I was able to confirm that the only so-called “pre-meds” they’re giving me before the actual chemo are Aloxi (a nausea medicine) and Decadron (another steroid to go with the 100mg Prednisone I take orally every morning during chemo week) at the very beginning by IV, and then one Benadryl and two Tylenol orally about an hour before they start the Rituxan.

Basically I just sat and read the whole time (I’m rereading Nancy Kress’s Beggars trilogy, for a good reason that I can’t quite put my finger on). Just for the last half hour or so, I dozed off from the Benadryl until the nurse came around to unhook me.

Leane was there the whole time, like a champ. The nurses did a great job of keeping her comfortable, even though she was technically just a visitor that day. They let her use a recliner next to me that was free, brought her a blanket and a pillow, and even brought her a Benadryl when the allergies caught up with her.

Our roles are reversed tomorrow when we go back for Leane’s chemo.

Never a dull moment.

Saving on Shampoo

So, my hair and beard started falling out on Tuesday, exactly 15 days after the start of chemo. According to the nurse practitioner, that was the longest I could expect to go without my hair falling out — and she was right.

I got my wife to shave my beard down to a heavy stubble. It’ll fall out just the same, but this way I won’t see the whiskers in my soup if I don’t have my glasses on.

When the hair started pulling out by the handful (a moderately disconcerting experience), I took a long shower and removed what I could. I’ve always had a ton of hair, so that made me look like a normal 53-year-old male. Later in the week, hair was coming out by the handful again, so we cropped it down to a standard Napoleonic style. I expect that when I shower tomorrow morning, the rest will come out and I’ll be left with a standard cueball style.

No matter. It doesn’t hurt, I’ll save on shampoo, and it’ll grow back anyway after the treatment is over. In fact, my sister suggested that hair often comes back after chemo differently than before, and that I shouldn’t be surprised if it comes back red (I have touches of red from my mom). Oh, the suspense.

Fortunately, the severe abdominal, chest and neck pain that sent me running for CT and ultrasound scans on Monday has all but disappeared. I’m now down to 1/2 a Lortab twice a day to control the residual twinges. Easy come, easy go, I guess.

In related news, my wife and I have both been fighting severe fatigue, recurring nausea and sinus allergies yesterday and today — good for nothing but taking lots of naps and watching reruns on the Food Network.

I never knew I’d been making jambalaya the wrong way all these years.

It Only Hurts When I Breathe

I woke up yesterday morning with pretty bad pain from the top of my neck on the left all the way down the shoulder to the upper arm and shoulder blade. It was like the usual orthopedic twinges I get from time to time, except that my neck hurt like hell whenever I swallowed.

Then yesterday evening, I was getting some serious pain in my lower left abdomen, right chest and front chest whenever I inhaled. So today when we were at the hospital for my wife’s weekly blood work, we popped into the cancer clinic to report these new pain symptoms, as I’d been instructed to do.

The nurse thought it was serious enough to get the oncologist to take a look. After his impromptu examination, he became concerned that the neck and shoulder pain (and some puffy cervical swelling he noticed) might be due to a blood clot in my left arm. So he ordered an ultrasound scan of the arm and shoulder and, to try to get a bead on the other pain syndrome, a CT scan of the chest and abdomen.

Fortunately, there were no blood clots. What I do have is a slightly enlarged spleen (no surprise, as it’s part of the lymphatic system), and that would account for the abdominal pain.  There were no further findings of note from either scan, so they didn’t really have an explanation for any of the rest of the pain. So it’s presumably some combination of plain, old orthopedic pain, the beginnings of psoriatic arthritis and possibly other side effects from the cancer treatment.

Hydrocodone is pretty much taking care of the neck and shoulder pain. After a couple of regular doses, it’s also reducing the chest and abdominal pain a bit. When I can borrow the heating pad from Emily (our tortoise shell cat), that tends to help with the abdominal pain as well as anything.

The bills for the extra scans will be barely noticeable at the top of the stack.