Chemo #12: The light at the end of the tunnel

After 6 cycles (aka 12 actual infusions), I can finally say I'm done -- forever -- with ABVD!

This doesn't mean I'm officially in the clear with beating Hodgkin's -- I still have to wait for my scan on March 18, which will show if I'm officially in remission. If, on the off chance, it still shows some metabolic activity -- which my doctor thinks is highly unlikely, given my clean interim scan after 2 cycles of ABVD -- I would have a whole new, likely more intense, treatment regimen. BUT this would not be ABVD. So, even though I don't know if I'm officially done with Hodgkin's, it's good to know that I can speak with absolute certainty -- which is something you can rarely do in Cancer World -- that I'm done with ABVD for good, and that alone is enough to celebrate.

#BritBrit4lyfe

Now, on to the nitty gritty. My last infusion went pretty smoothly. We stayed away from my right arm, following the weird rash/irritation that happened after chemo #10. My left arm, though, wasn't perfect, and the first vein we tried on the top of my forearm didn't work, so we had to move to my hand (you might remember my weird, semi-irrational fear of the hand vein). Not the most pleasant IV experience, but not too bad either.

The occasional vein dramz aside, I can say with 100% confidence that I'm glad I didn't get a port. It seems like ports are more common than not, so for anyone who is recently diagnosed and happens to read this, do not feel like a port is necessary to complete ABVD. If you are extremely squeamish with needles, it's probably a smart thing to do, but if you can handle a few pokes here and there I think it's best to keep things as simple as possible and just go the IV route. In the grand scheme of things, you only have to do it 12 times. Each time (for me, at least) took no more than a minute of maneuvering to get the right spot. So really we're talking about 12 minutes of discomfort -- which is shorter than a surgery to get a port installed. Obviously this is a personal decision, but I feel it's important to add my two cents, since it seems like ports are almost a unanimous consensus among Hodgkin's patients.

The rest of chemo went by pretty smoothly, and we finished in about two and half hours -- around noon. The usual suspects, Scott and my mom, accompanied me, along with Adriana (aka Mote -- long story where that nickname came from), who I've known since we were in second grade. Jenny and Cathy also stopped by for a bit, which definitely helped pass the time!

After chemo, I normally go home, eat lunch, and veg out, but we had to stick around a little longer because I scheduled a last minute appointment with Dr. Peterson at 2:30 pm to talk radiation. To kill some time, we went out for lunch, where I got some delicious Pho (which is actually pronounced 'Fuh'. Go figure!). At the end of the meal, I got a pretty relevant fortune cookie:

Today is a lucky day for those who remain cheerful and optimistic. 

While I'm definitely pretty neurotic about my health, deep down I do feel optimistic that I'm done with this whole saga. Sure, a positive attitude won't help me get a clean scan, but it won't hurt, either. This next month of limbo will definitely be challenging for someone who wants to know everything, right away, right now. But I'm trying to look at it with a glass half full attitude. Given 85% of people diagnosed with Hodgkin's are cured with the first line therapy AND I had a clean scan AND my fortune cookie basically told me things will be fine, I have more reasons than not to believe things will work out.

So, as you can see I walked into my appointment with Dr. Peterson feeling pretty good, and I left feeling even better. He explained more about radiation, and which cases benefit from it and it which don't. It sounds pretty counter-intuitive, but radiation is only an option for Hodgkin's patients who are stage 1 or stage 2. More advanced disease (stage 3 or 4) is strictly given chemotherapy. Now, it's sort of a toss up which patients at stage 1 or 2 get radiation. It is more common for those who have "bulky" tumors (those over 10 cm in size), but many patients without bulky tumors also get radiation. This is where there are a few trains of thought. The two most common treatment options for patients at stage 2, without bulky tumors, are as follows:

1. 4 cycles of AVBD + radiation
2. 6 cycles of ABVD and no radiation

Unfortunately, as I mentioned in my recent post on radiation, there isn't really a consensus among oncologists which is the better option. Dr. Peterson is very much on board with option 2 -- mainly because an additional 2 cycles of chemotherapy are much less toxic in the long run than radiation. Since I had a clean interim PET scan, which meant I was very responsive to chemotherapy, radiation would be sort of an overkill, needlessly exposing me to more risks. It's clear that Dr. Peterson is more of a marathon runner than a sprinter, repeatedly talking about his goal to make sure that his patients long term quality of life is preserved. 

What really made me feel more comfortable, though, was his explanation that I was being treated the same way as someone with stage 3 or 4 Hodgkins, where the standard treatment is 6 cycles of ABVD (some with advanced stages are given an alternative chemotherapy regimen of BEACOPP, but that is a whole other can of worms that I'm too lazy to elaborate on -- lucky you!). Basically, I was given a little bit more chemo than I probably needed to ensure that all the little hodgers were obliterated, in place of radiation, which is more harmful in the long run. If 6 cycles of ABVD, on its own, is enough to get patients at stage 3 or 4 in remission, it seems like it's more than enough to get me, at stage 2, there.

I mentioned earlier that, in addition to talking to Dr. Peterson, I also wanted to get a second opinion, just to be sure. At this point, I feel very confident in Dr. Peterson's explanation of things and no longer think a second opinion will be necessary. While it's good to have all options on the table, my case seems pretty black and white as far as radiation goes, and I feel very confident in my treatment plan (which says a lot, since I am normally full of doubt or uncertainty when it comes to medical issues).

So, I walked out of the Masonic Cancer Center feeling pretty good about a lot of things: that I was done with ABVD, that radiation would not be necessary in my case, and that I would probably have a good scan in the next month. 

The last development that really got me on the Happy Train was learning that yesterday, February 4, was World Cancer Day, which, according to their website, exists to "take a positive and proactive approach to the fight against cancer, highlighting that solutions do exist across the continuum of cancer, and that they are within our reach." Cancer is no longer the death sentence it once was, and I truly believe that in a few decades (or less!), we will have come even further with identifying more of the causes of cancer, which will help in prevention efforts, and, more importantly, new, less toxic, and more effective cures.

I'm still in the process of debriefing myself on this whole crazy experience, and will likely have more thoughts to share in the coming weeks. But for now, I want to say a HUGE thank you to each and every one of you for all your support and encouragement. It means so much to me, and I am so incredibly touched. Namaste. :)