Category Archives: Health Barometer

“Not with a bang but a whimper” (health update)

❝ Hey you! I hadn’t seen a health update in a while, and I really wanted to know how you were doing. ❞

It’s been a while since I last posted an update about my health or my ongoing adventures with cancer, remission, and lymphedema.  Between our societal exhaustion of the pandemic and my own personal fatigue of dealing with the after-effects of cancer, chemo, lymphoma, and lymphedema, blogging about my health wasn’t as high a priority for me.

I was surprised and very thankful to hear from a beloved and old friend yesterday. It was really nice catching up with her, and she asked about my latest health.  She reminded me it’s been a while since my last update, so it prompted me to post this update.  Rather than retype much of what I told her, I thought I’d copy much of my summary here.

I really can’t understate how surprised and thankful I was to hear from her.  She’s someone whose opinions, observations, and life experiences I greatly respect and admire.  It’s fascinating how our lives have paralleled each other.

• • •

While being told “you have cancer, it’s Stage 4, we need you to go to the hospital for IV infusion” is pretty dramatic and a singular event, recovery isn’t so dramatic or so singular.

I’m on my third remission, it’s the longest so far, but the effects of 3 years of chemo and an imperfect bone marrow transplant continue to linger. The lymphedema of my left leg is such that at any given time, my left leg is 2-3x the size and weight of my right leg. It means I get cellulitis far more often (2-3x each year), and I get hospitalized each time for sepsis accompanying the cellulitis.

In these past few weeks as I try to walk more, hike more, and get out more, it means I walk funny as I try to put more weight, stress, and maneuverability on my right leg. It also means that twisted my leg and loosened my ligaments in my right knee. I had two x-rays of my knee, thankful it doesn’t need surgery, but means I need to wear a soft brace while I try to exercise more to strengthen the muscles in my legs.

I ought to write it all down and post it, but it’s tedious and ongoing (feels never-ending sometimes).

I wish I could have gone to Defcon 30. I had several friends who went, told me about the exciting time they had, and sent pictures. I still would like to go to Burning Man sometime. I figure I’ll have an easier time at Burning Man than at Defcon since it’s easier to maintain personal space and take various hygiene precautions/wear.

Still somewhat immunocompromised, so I work from home full-time, I try to limit my socialization, and it’s pretty funny (not really) how quickly sick I get from time spent around others who think they aren’t sick, or “it’s just the sniffles, nothing really, I’m not contagious” and then I end up in the hospital for a couple of days for IV antibiotics (which is a true story, exactly what happened after attending the wake and funeral of Vicky’s Dad)

Humor, sometimes dark humor, certainly helps with coping. Especially around others, who either have misconceptions about what cancer is, what cancer is like, or how they see it/handle it in others.

People don’t alarm me any more with their reactions. I don’t answer the trolls anymore, but will answer those genuinely curious or dealing with similar issues. My first few outings to the movies or to the restaurant were frustrating or exhausting.

And yeah… the pandemic has been something else, especially with how some people deal with it… or don’t. Since it’ll definitely knock me down, out, or kill me, I avoid others who I suspect have covid.

One Day at a Time (my current status as of Fri, 21-Feb-2020)

Another Day of IV Chemotherapy at Kaiser-Permanente

So my vaccination schedule and history have been restarted, starting with all the vaccinations from birth and childhood into adolescence and adulthood.  I had 3 intramuscular shots into my left arm and 5 intramuscular shots into my right arm (my dominant arm).  It was my left arm that was sore and causing me a stiff shoulder for a day or two.

Since my gastroenterologist determined it likely that I have radiation-induced proctitis and colitis, I began taking Carafate Enema once or twice each day to reduce the rectal bleeding and sloughing of the mucusal lining.  I still take two Lomotil and one Oxycodone (5mg) to reduce my diarrhea and abdominal cramps while the carafate addresses the bleeding.

I’ve been receiving IV immunotherapy and chemotherapy every Friday since we returned from the Seattle Cancer Care Alliance.  My platelets and neutrophils have been too low for me to resume my per-oral chemotherapy.  Ideally, I ought to be receiving R2 (Rituxan/Revlimid) to reduce or maintain my mantle cell lymphoma.

Kaiser-Permanente and Johns Hopkins would like to perform a full-body PET scan on Saturday, February 29th, 2020.  We’re hoping to determine the full extent of my cancer and its progression (if any).  From there, we’ll determine if I can remain on R2 (Rituxan/Revlimid), if I would need targeted radiation therapy to reduce specific tumors or clusters, or whether I would need to start another clinical trial either at Seattle Cancer Care Alliance (SCCA), the National Institutes of Health (NIH), or elsewhere.

Johns Hopkins would like to see me on Thursday, March 19th, for a follow-up appointment to my post-BMT (Bone Marrow Transplant).  This would have been my 6-month follow-up appointment, but we missed that appointment since we were already in Seattle beginning cancer care.  Dr. Bolanos-Meade will be reviewing my numbers, history, and looking for any symptoms of Graft vs Host Disease (GvHD).  In previous conversations with Dr. Meade at Johns Hopkins, it was disappointing to him and our medical team that my bone marrow transplant was unsuccessful.  I relapsed into aggressive mantle cell lymphoma less than three months after my transplant.  My bone marrow and blood product have performed poorly since, but it’s indeterminate whether it’s just young bone marrow that is taking time to mature, or whether there is a greater issue yet undiagnosed and unresolved causing my blood product to be consumed as quickly as my bone marrow can produce it.  Radiation-induced colitis or other unknown tumors are two possible causes for this latter idea.

And so it goes… I continue to take it day-by-day.  I am still on Long Term Disability and have not yet returned to work since I was hospitalized for a week in November 2019.  Once we know the results of the PET scan and meet with Johns Hopkins to discuss the results, prognosis, and treatment, we’ll know where we stand, what we’ll do next, and whether I can return to work part-time while continuing cancer treatment or if we need to begin yet another protocol or clinical trial.

My Current Status (Fri, 7-Feb-2020) and Long-Term Prognosis

Thankfully, I’m video-conferencing more from home to meet with my primary care physician (Dr. H.A. Nguyen) to discuss my current health, various issues (cold, congestion, nasal drip, sinus, diarrhea), and to avoid going into his office unnecessarily and being exposed to others during a very active cold & flu season.

Video Conferencing with Dr. H.A. Nguyen

Every Friday, I’m undergoing my traditional immunotherapy and chemotherapy protocols to keep my mantle cell lymphoma diminished while we monitor and research the next steps…

IV Chemotherapy every Friday

On Friday, February 7th, 2020, we met with Dr. Shalini Dogra, my oncologist for Kaiser-Permanente in Tysons Corner, VA.  Vicky and I were discussing my cancer and health issues over the past few months, our current issues, and asking where do we go from here?

CURRENT STATUS:

  • Diagnosed with Stage 4 Mantle Cell Lymphoma (Code C83.18  MANTLE CELL LYMPHOMA, MULTIPLE SITES LN).  Being treated using the R2 (Revlimid/Rituxan) protocol
  • Diagnosed with lymphedema (edema, swelling of the left leg) which will take time and exercise to recede to normal size.  May be treated using Lasik, but treatment would cause many other problems and side-effects given my history and current medications.
  • Diagnosed with radiation-induced proctitis (colitis) in the sigmoid loop of the lower colon.  Being treated using Carafate enemas to reduce bleeding, Lomotil to reduce diarrhea, Oxycodone to reduce severe abdominal cramps.
  • Diagnosed with viral cold or flu of the head and upper chest.  Being treated using an Advair Inhaler twice/day, Zyrtec in the morning, Benedryl at night.
  • Diagnosed with neutropenia and immunosuppression.  Continuing to monitor, receiving blood product transfusions when critically low, receiving Zarxio as needed to stimulate bone marrow production.

NEAR-TERM TREATMENT:

  • My entire immune system has been reset and needs to undergo a complete vaccination history from birth to adulthood.  Influenza vaccine was received in October 2019.  Childhood (6mo age) vaccinations now required once my neutrophil count (immune system) supports introduction of dead or live viruses.  Will need to monitor neutrophils weekly and receive vaccinations as necessary for next 16 months.
  • Johns Hopkins and Kaiser-Permanente would like to perform a full-body PET scan (identify existing cancers, tumors, any new ones) and a bone biopsy.  Johns Hopkins would like to perform DNA and Blood Chimerism analysis to see how much of my immune system is original and how much is from my donor.  The last chimerism analysis (3mo post-BMT) was 100% Donor.
  • Seattle Cancer Care Alliance (SCCA) recommended and Kaiser-Permanente agreed that my mantle cell lymphoma is responsive to targeted radiation therapy and R2 (Revlimid/Rituxan) chemotherapy.  I am to undergo both until the cancer is eliminated, maintained, or progresses (and requires further intervention by NIH and Seattle Cancer Care).

LONG-TERM TREATMENT:

  • My prognosis for the success of CAR-T therapy was 10-15% given its history with mantle cell lymphoma patients.  Kaiser is impressed that it was unnecessary and that lymphoma reduced due to targeted radiation therapy and Revlimid/Rituxan chemotherapy.
  • I am to undergo R2 (Revlimid/Rituxan) as weekly IV and daily oral for the foreseeable future.  Until the cancer is in remission or progresses, this is how I am to be maintained.
  • Targeted radiation therapy has been proven highly-effective given large inguinal clusters in October-November 2019.  I will undergo further radiation to target aggressive clusters if necessary.
  • My lymphedema may take many more months or year(s) to resolve.  Elevate left leg and exercise as much as possible.
  • My proctitis/colitis is being treated via Carafate enemas for bleeding, Lomotil for diarrhea, Oxycodone for pain, but 30% likelihood it may become chronic.
  • Kaiser-Permanente recommends no changes to treatment, medication, long-term disability, or status until March 31st, 2020.  Kaiser-Permanente would like to base all further recommendations and prognosis pending near-term PET scan, bone biopsies, and responsiveness to Revlimid/Rituxan.

 

Introducing a more-frequent “Health Barometer” for my cancer updates 🤒🤕🤮🤧🥺

Walkies Together as Family

My heartfelt thanks to Linda DeYoung for her wonderful suggestion and advice this morning:

Linda DeYoung
Maybe some days you’re feeling rather ill from all the RX or effects of it, and you might not have the strength to relive it in writing, and need a break? Don’t you worry about posting then, give your mind something else to ‘eat’ — Relax and think about raindrops on roses, whiskers on kittens, give your mind a treat. That’s OK, don’t you worry, you write when you wish, at your pace. I’m glad you two get out for your healthy air times with the darling dogs.

Linda DeYoung
Maybe on your journal page, when you aren’t posting details, make up an ‘instant post’ — you can make something like a “Ken Report” for days you are too busy to write: kind of like a weather barometer … you can have a grading of 1 to 10, or just a two word ‘feely’ post from the gradation: i.e., “feeling stronger” “feeling rested” “feeling depleted,” … etc.

Ken Foreman
Linda: OH THAT IS A GREAT IDEA!

For people who want to check if I’m still here, if everything’s OK, if I’m at home rather than the hospital, or my general health, having a simple “instant post / health barometer” is a really GREAT idea.

It’ll help me feel less guilty for the days (or stretches of days) where I’m not feeling well enough to be too talkative, but to let family, friends, and neighbors know that things are OK.

Thank you for that great idea!! 💕👍🤗