Parrish is back in his new home away from home, also known as the 9th floor at UAB. He will begin his chemotherapy regimen tonight. The regimen is referred to as "ICE" chemotherapy. This stands for the three chemotherapy drugs used: ifosfamide, carboplatin, and etoposide. He will receive these as a continuous infusion during the next three to four days in the hospital. (By continuous infusion, I mean that he will have at least one of the drugs going into the mediport in his chest at all times.) He will return here once a month for the next 4 to 6 months to receive the ICE infusions.
Before he was admitted, Parrish saw his hematologist/oncologist in clinic to go over the tests from last week. Parrish's creatinine and urine output were both better, which is one of the main reasons he could start chemo tonight. The results of the PET scan and CAT scan also came back this afternoon. The PET scan allows the doctors to see exactly where the cancer is by causing the cancerous tumors or cancer-filled lymph nodes to glow. This is different from a CAT scan which just shows where growths are but cannot differentiate between a growth that does or does not have cancer. The PET scan showed that, as we knew, the large mass on the right side of Parrish's chest is cancerous. In addition, it showed lymph nodes under the clavicle that are cancerous, as well as lymph nodes on the left side of the chest that have cancer. These other areas do not have large tumors but rather are inflamed lymph nodes (think a swollen gland). The good news is that the PET scan showed that the spleen does not have cancer cells. There is a small growth or tumor there, but it does not contain active cancer cells.
This means that because all of the cancer cells are found above the diaphragm, we are dealing with Stage 2B, rather than Stage 3B. It is technically "Recurrent Stage 2B Bulky Hodgkin's Lymphoma." The "Bulky" is added because the mass in Parrish's chest is so large. And, the "Recurrent" is because of the fact that the cancer has returned. It's a mouthful to say, that's for sure. But it is very good to be dealing with a less-advanced stage of cancer. The fact that it is less progressed doesn't change the treatment plan (the chemotherapy regimen followed by a bone marrow transplant), but it just means that we caught it earlier than we at first thought.
As of now, Parrish is hooked up to fluids to help keep him hydrated. Hydration is crucial because as the chemotherapy kills the large tumor, the dead tumor cells will be washed out of his body through the kidneys. They don't want the tumor waste to build up in the kidneys causing what is called "tumor lysis syndrome." This is one of the complications with this size tumor. Large amounts of IV fluids and a medicine that Parrish just took will help prevent this. Parrish's on-going lemonade addiction will also aid in his hydration management!
Parrish should get discharged on Thursday evening or Friday morning of this week. During the three off weeks, he will go to weekly clinic appointments for blood work. One of the biggest concerns of any chemotherapy is the effect on a patient's blood counts. They will closely monitor Parrish's cell counts, and help manage his risk of infection with these weekly check ups. As a side note, low blood counts tend to peak 10 to 15 days after a treatment. There are other more short term side effects of the chemotherapy, including nausea, vomiting, and hair loss. Of course, Parrish has already taken care of the hair loss...he got his head shaved on Friday (pictures to come, I promise!).
Whew...lots of information to digest and probably more questions raised from this new information. I am going to do a "frequently asked questions" post soon...
I will keep everyone posted on how the next few days go. Please pray for strength for Parrish, wisdom for the nurses and doctors and patience for all of us as we wait for these drugs to work their magic.
Much love,
Molly
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