The Proof is in the Pudding

Well Friends, I'm not really sure where that saying came from or really what it means, but this week I am thrilled to report that I have some delicious pudding for you--pick your favorite: chocolate, tapioca, rice, butterscotch, or all of the above... this is it!  I finally have confirmation of fantastic news; what we have been hoping for, praying for, anticipating and suspecting all along.  The MRI results are in, and the impression from my radiology report reads, "Persistent bilateral enhancing orbital masses right larger than left showing overall significant partial regression compared with the prior study."  The plain ol' English translation of all that medical mumbo jumbo is this:  The Rituxan is working, and the tumors are
SHRINKING!!!!!!!!!!!

Now brace yourself for another cliché: A picture is worth a thousand words (sorry).  A few weeks ago I showed you photos of what the Rituxan has done for my outward appearance, but now I'd like to share with you some pretty incredible images of the inside of my head.  Yesterday (Thursday) I went to see Dr. Suddesh, my ophthalmologist, and on his computer, he pulled up my MRI from August as well as my MRI from Monday so we could compare them side by side.  I took pictures of his computer screen so I could document these amazing before and after images and share them with you.

This first shot is a cross section--imagine my head is sliced vertically, like a loaf of bread--and this slice is about in the middle of my head, right behind my eyeballs.  In these images, you are looking at my face straight on, so my right eye is on the left side of the pictures (by the "R").  The left image is from my MRI in August, and the one on the right is from this past Monday, just three months later.  Here you can see that all of the white areas around my eyes are the tumors.  You can see how much more white there is in the left image than the one on the right; the grey and black areas around my eyes are what normal tissue should look like.  In the image on the right you can see the greyish circles in the center of my eyeballs are my optic nerves.  They had been completely enveloped by the tumors.

MRI images: Before (from August, on left) and After (from Monday, on right)
The white areas around my eyes are the tumors.

This next picture is another cross section--now imagine my head is sliced horizontally--and this slice is through the center of my eyeballs.  This view of my head is looking from the bottom up, so imagine I'm lying on my back and you are looking up toward my head from my feet, and again, my right eye is actually on the left side of the images.  These images are particularly striking to me, as this clearly demonstrates just how much my eyes were protruding and bulging out of my head before, especially my right eye.  Look how far forward that right eyeball is--it sticks out past my nose!  Notice the grey streaks from my eyeballs back toward my brain.  Those are my optic nerves.  Notice in the image on the left how the tumor is pushing my optic nerve and bending it toward my nose, and in the image on the right it is now straight and normal looking.  In addition you can see how much more white (tumor) there is in the left image.

Another before and after, here, a horizontal cross-section.  Notice the
dramatic protrusion of my right eyeball in the "before" image,
and how much it has regressed in the "after" image.

So clearly you can see that in three months time, I have made great progress!!  Though I will admit that I was a tiny bit disappointed to learn that the tumors still exist, I am very satisfied to know that they are significantly reduced, and the outward appearance of my eyes is pretty much normal.  Dr. Suddesh took measurements again this week, measuring the distance from the bone at the outer corner of my eye, to the tangent of the front of my eyeball.  In August, that distance was 27mm, in my right eye, and 25mm in my left.  Last month it decreased to 24mm in my right and 22mm in my left.  Yesterday, the distance measured was just 20mm in both eyes!  All of my friends and family members who see me all the time can't believe how different I look.

Today I met with Dr. Vempaty, my oncologist, who was extremely pleased with my response to the Rituxan, and said that my progress was better than expected.  She told me that the Rituxan will continue to work in my system for the next several months, and that I can expect that the tumors should continue to regress.  She said it is possible that they will be eradicated completely, but they may remain, or even grow back.  We must monitor them now, watching and waiting to see what to do next.  I will go back for another MRI in three months, at the end of February.  If the tumors haven't changed or are smaller, then I will not need to do additional treatment, and I will go back in another three or six months for another MRI.  If we continue to see changes for the better, and the tumors continue to shrink or go into complete remission, then we can go longer between check ups.  At any point if the tumors start to grow back or if the lymphoma spreads to another part of my body, then we will have to take action with more treatment.  

In any case, I am NOT going to worry about that last scenario for the time being, but I am going to continue to focus on the positive, as I have done all along throughout this journey.  I can't help but marvel at the appropriateness of the timing of this news, in that it is received so near to the most wonderful holiday where we express our deepest gratitude for our multitude of blessings.  I tell you, there is nothing like a cancer diagnosis to get one thinking about life's priorities, and to focus on appreciating all the gifts we receive, both tangible and intangible, on a daily basis.  Next week I, for one, plan to raise a glass with my closest loved ones, and celebrate the myriad of reasons why I am thankful.  But trust me, the celebration of my appreciation will NOT be limited to next Thursday, November 25.  

MRI Today

Hi Friends!  Really not much to report, but I thought I'd post a quick update because my parents have been getting phone calls asking about my news, which means that people are wondering.  I've thankfully recovered from my cold and I'm feeling much better.  I still feel tired though, and have been taking naps pretty much everyday.  Sometimes I really do forget that I am battling cancer, because I just feel so "normal."

Today I went in for my MRI.  I thought I'd post a pic for those of you who have never seen one.  This was the third MRI I've had since August.  Luckily I'm not claustrophobic, as many people get very freaked out at the prospect of being confined in such a tight space for an extended period of time.  It doesn't bother me in the least.  I pictured a Maui sunset, and went to my Zen place, trying to ignore the raucous cacophony of what sounded like really LOUD, bad techno music, muffled through my ear plugs, all the while not being able to move.  Forty minutes later, I was done.

Unfortunately, I won't have any results to report until Thursday or Friday this week.  I meet with my ophthalmologist (did you try and spell it right? :-D) on Thursday, and my oncologist on Friday.  I will certainly let you know what they have to say about the status of my tumors, and what lies ahead in terms of future treatment, because I am obviously anxious to find out!  In the meantime, I am keeping myself as busy as possible to keep my mind off of it.  Based on my own observations, as well as family and friends who have commented about the dramatic difference in my appearance, I am very hopeful that I will have some good news to report later this week.

Last Treatment Completed!

After a very long week of feeling extremely crappy, I am delighted to report that as of today, I have completed my cancer treatment!!  That felt so good I think I need to say it again, louder.  I HAVE COMPLETED MY CANCER TREATMENT!!!!!

My EMPTY bag of Miracle Juice!

Why feeling crappy, you ask?  Nothing to worry about, really.  It's just that my immune system was too busy fighting cancer to be bothered with something as mundane as attacking a bug bringing a low-grade fever and common cold.  I pretty much spent the week reading, watching TV and napping, as I had absolutely no energy to do anything else.  Luckily by Saturday my fever was gone and I was just feeling the annoying cold-like symptoms of congestion and a dry cough.  I had been on the phone with the advice nurses and emailing Dr. V during the week, but there was nothing they could do for me other than telling me to rest and drink lots of water, which I was doing anyway.  Dr. V did ask me to go in to get blood drawn on Sunday.  We were both a little worried that I would have to postpone my last treatment.  But my bloodwork checked out -- just a little high white blood cell count, probably due to having this stupid cold.  Dr. V checked in with me before I went in this morning and gave me the go-ahead, as long as I was feeling good.

It was Gavin's turn once again to be my care-taker today.  I was pleasantly surprised to be led to the Royal Rituxan Suite, the same room where I had been for my first treatment with the flatscreen TV, DVD player and private bathroom.  I had called last week to request it, but they told me that Monday was crazy-busy, and there was no way.  Not sure what caused the change, but I wasn't about to complain!  I had yet another different nurse, Lisa, who was fairly warm and friendly.  I climbed into the super-comfy-deluxe hospital bed and we got started right away with the same drill. Luckily, I had no reactions to the Rituxan this time, but the Benedryl hit me hard, and I pretty much slept on and off for the first few hours.  My nurse ramped my Rituxan slowly, since I had reacted in the past, but we didn't have to stop it at any point which avoided delays, so we finished earlier this time.  We were there for about 5.5 hours from start to finish.

At home, right after finishing my treatment:  I give you, the smile of a cancer SURVIVOR.

So now what are the next steps?  Well, my MRI is scheduled next week on Monday 11/15.  I am very anxious to find out these results, as you can imagine.  I have an appointment next Thursday with Dr. Suddesh, the ophthalmologist (by the way--interesting aside-- I am very proud to report that, as a result of my cancer journey, I can now actually spell "ophthalmologist" correctly without looking it up.  Can you?  Try it without looking first.  Consider it your challenge for the day!)  This is a follow up to take more measurements and look at my MRI so he can hopefully tell me, "Julie, your tumors are GONE.  KA-BLAM!!"  I have another appointment the next day, Friday 11/19, with Dr. Vempaty to discuss the MRI and the next steps.

Now, it is possible that I still will need to do further "maintenance" treatments in the future, but it should only be one treatment at a time, perhaps every three to six months.  She did tell me that it is not guaranteed that the Rituxan will completely eradicate my tumors.  My type of lymphoma is supposedly "treatable, not curable," and is considered to be treated more like a chronic disease such as diabetes.  Still there is a chance that the Rituxan WILL completely dissolve them and send them packing, never to return.  That is what I am praying for, my friends, and what I humbly ask you to continue to pray for.  Based on the dramatic progress I have seen in my eyes so far, I truly, truly believe that this has been the work of God, and our powerful answer to prayers.  I hope to have some wonderful news to report to you next week, just in time for Thanksgiving.

Three Down, One To Go

Be afraid, cancer... be VERY afraid!

Today I went in for my third of four Rituxan infusion treatments.  I'm beginning to feel like an old pro at this, as I'm a quick learner.  This time, I decided to pick up some bagels for the nurses to grease the skids.  Thankfully,  I had a delightfully warm and friendly nurse today who expressed great appreciation for the thoughtful gesture, and took good care of me throughout the day.

Once again I was in a recliner, but it was a much nicer, more private station, bright and sunny, right by the window.  Today I had the pleasure of my dad's company, who over the course of the day proved to be a worthy opponent in a heated match of "Words With Friends" (Scrabble for the iPhone).  Much to his chagrin, I beat him, fair and square... he is far too principled to take pity on the cancer patient.

Dad and me at my sunny recliner station... notice the pleasant window seat!

We began the day with the same drill of premeds: Tylenol (given orally), then steroids, and Benedryl, administered through the IV, again inserted in the top of my left hand.  This took the better part of an hour, then it was time to start the miracle juice.  Unfortunately this time I reacted immediately to the drug sensing a fuzzy, itchy feeling in the back of my throat and along the sides of my tongue.  My nurse stopped the drip right away, consulted Dr. Vempaty who recommended we take a 20 minute break or so, followed by an additional steroid drug.  This seemed to do the trick, but set us back some time.  This, in combination with having to ramp up taking slooooow baby steps once we started up with the Rituxan drip again, made for a very long day.  The rest of the day went smoothly, but it was just long--almost seven hours from start to finish.

Still, I am feeling great overall, and still pleased with the progress we have seen in the last two weeks.  The only real side effect I've been continuing to feel is some grogginess and soreness around my eyeballs, but Dr. Vempaty agrees that this is a positive sign, that something is really happening back there!  I am excited that I am almost done with treatment!  I just have one more infusion next Monday, and then we will do another MRI the following week to get an accurate measure of what this drug is truly doing for me.  I'll have a couple of more follow up appointments, and then hopefully be done with this for good--or at least a long time!

I still have my surgery to remove my ovarian cysts (most likely unrelated to cancer, but we're taking them out, just to be sure) looming, once I am through this, and scheduled for January 7.  I've decided it would be far to stressful and disruptive (for me as well as for my students and colleagues) to go back to work for just three weeks before my school's winter break, especially during one of the most stressful times of the year, and then be out again.  I think it just makes the most sense to continue my leave of absence until after I am completely healed from surgery and 100% healthy again.

In the meantime, I am getting plenty of restful time at home, and enjoying the beginning of the holiday season, spending time with family and friends, getting into the spirit.  We had a fun Halloween weekend, especially now that Ewan really understands what it is, and is having so much fun with dressing up and trick-or-treating.  Here's a pic of our adorable little pirate.

Ahoy, mateys! It's Nobeard, the pirate!