Dave’s Great Adventure
Chapter 5, Verse 5
December 18, 2002
Merry Christmas!!!
What a wonderful, wonderful Christmas present! I just got a phone call which had great news, news as good as anyone could hope for. My doc called and told me that my bone marrow biopsy was normal. They did a couple of tests on the marrow sample, and in neither could they find any leukemic cells! That’s really all the more amazing as just six months ago my marrow was comprised of 40% leukemic cells. Now there are none they can find. They also looked for telltale antigens on the cells and couldn’t find evidence of abnormal cells. That’s just excellent news!!
I couldn’t have asked for any more out of the therapy that we did on me over the past six months. I’m so grateful that the new medication (the Rituxan) was available and that my doc was willing to try the new combination therapy on me. Remember, I was the very first patient he tried it on. I also have to be grateful that my marrow responded so well, and so rapidly. At first I was disappointed when we had to stop the therapy after only four cycles (out of six planned) but four cycles were obviously all my marrow needed, at least for now.
So now we wait. I’m in a complete remission. Remember, however, remission doesn’t mean “cure,“ but rather means “no evidence of disease.“ I’ll be getting blood counts every month for at least the next six months to a year and will be seeing my doc about every three months for the next year. As long as my blood counts remain normal I’ll be in remission. How long will that last? Well, as my doc said last summer when we started the therapy, “We don’t know because we’re ‘writing the book’ right now.” In other words, there is no long term follow-up on this therapy to see how long the remissions last, or if, perhaps they are permanent. If they are permanent, that could be the “C” word (I hate to say “cure” because there really isn’t one yet, but this new stuff may be the answer...time will tell). I’m one of the pioneers, if you will, of this new therapy. And a very happy pioneer to be sure! There can’t be any better Christmas present than to be told that your cancer is gone!
Since I’m feeling better all the time, the only problems that remain are my suppressed immune system and my slowly improving memory problems. I’ll be on antibiotics for another nine months or so against certain bacteria (pneumocystis carinii, I believe they’re called) which can cause pneumonia in immunocompromised patients, I’ll also be at risk for viruses like the flu and colds, etc., for about that length of time. I’m going to continue to try to avoid anyone who is obviously sick and will continue to wash my hands compulsively throughout the day. I did get a flu immunization, but there is question about whether or not my immune system will be able to create antibodies (antikoerper) against the flu virus, as it has been so battered by the chemotherapy and will remain less than completely effective for many months.
I’ll be going back to work for a few days next month and then probably will be back full time in February. The nurses who put patients in the rooms for me will try to make sure that I am not going to see anyone who is obviously ill with a cough or cold since I will be at risk of infections for a long time.
One other step we’re still working on is to see if it would be reasonable to collect my stem cells at this time, for use later if/when I relapse. If we’re going to do it at all, this is an excellent time, as my marrow seems clean of malignant cells. As Brian said today when I talked with him, “It looks like we’ve got a pretty clean product now.“ Product? I guess that’s how oncologists talk about marrow. Anyway, Brian is in contact with the “transplanters” to get their opinions about an “autotransplant,” or a possible transplant using my own stem cells at some time in the future. It has been done many times in the past and the advantage is that there is no risk of the “graft versus host” reaction (in which the antibodies of the normal, immunocompetent transplanted cells attack the weakened, immunocompromised cells of the patient). This reaction is what causes much of the 25% death rate with marrow transplants. If we’re going to collect them, I’d like to get it scheduled before I start back to work. I really would like to collect the cells...it would be like having an insurance policy against a relapse. And it only costs about $200 a year to store them. Of course, the collection costs would be much greater.
So, what are we doing now, other than celebrating our good fortune? Our son Jonathan, who lives in El Paso, recently visited us with his girlfriend, Natalie, whom you heard about in our report from Las Vegas last August. She hadn’t been to Colorado before so we took her to the mountains to visit the snow and did a few other “Colorado“ things. Jon wanted to visit the new football stadium where the Broncos play so we also took a tour of the new “Invesco Field at Mile High,” a name only someone who works at Invesco (an investment firm) could like, as it’s named after a financial firm rather than any sports team or sports person!
And next week we’re going to have all our kids and grandkids here for Christmas! What a great way to celebrate this wonderful news! We really look forward to having all the family here.
And now for the bad news...remember when I first started my chemotherapy and the instructions I was given to get more calories, more fats in my diets, more gravies, more of every thing? Remember when I would go out for frozen custard every day? Well, now I have to go back on a diet and start watching my cholesterol again!! When I had active leukemia I really didn’t care about my cholesterol level, since it was so much less important than the leukemia. That’s no longer the case. You know, if it’s not one thing, it’s another. Of course, I’d much rather be watching my cholesterol than my leukemia!
December 19, 2002
We went out last night to have a celebratory dinner with our friends, Lou and Joan, to mark the occasion of getting evidence of my total remission. So, I didn’t get this letter out. But I’ll finish it up and get it on its way to you.
Last night Joan, who has faithfully been sending cards to me just about every day since I started the chemotherapy, said she guesses she’ll stop mailing the cards now. I guess that’s fair. What I’m going to do is start mailing cards to one of my colleagues. Those of you who have been getting my “journal” since the beginning may remember that I mentioned a colleague who was battling a recurrence of her breast cancer. She’s the one who warned me about the “fuzzies” I would get after each round, when I wouldn’t be able to think clearly. She also worked in my place in the clinic last August while I was out of the office. Well, she has gotten some more bad news. She has a large number of metastases of breast cancer in her liver. That is extremely bad news. She is considering going to M. D. Anderson Cancer Center in Houston for some radical therapy. I feel it’s my turn to be sending cards now, and I’ll be sending them to Laurel. If anyone that gets my letters would like to send her a “thinking of you” card also, her address is:
Dr. Laurel Harkness
9192 South Buffalo Drive
Littleton, Colorado 80127
Our friend Jane Forte, who winters in Florida and summers in Iowa, wrote to tell me she doesn’t think my memory problems and other lapses are necessarily the result of “chemo brain.” She says as one gets “older” (she didn’t say “old“) these things happen. Jane’s a bit older than me and says she knows from first hand experience that you don’t have to have chemotherapy to start forgetting things and saying things that you didn’t mean or expect to say. Yeah, Jane, but I’d rather blame it on the chemo than my age!
I’m trying to see if I can get my responsibilities at work changed to some extent, to eliminate some of the things I really don’t like doing. Though this remission is extremely encouraging, the average life expectancy for my disease is still only six years from diagnosis to death. And I’ve already used up one of those years! I’d like to plan a relatively relaxing time at work for the next few years and not have to do the things that cause me the greatest stress. For example, as I get older I enjoy surgery less and less. As you gain experience, you realize all the things that can go wrong in the operating room. I’d like not to do surgery and things like that for my last few years with the group. I’ve written a letter to the chief, to see if I could become primarily a clinic, daytime doc, but the initial response was to deny my request. So I’ve written another letter. We’ll see what happens, and what my options are.
I think that’s about enough for now. I’ll add a couple of post scripts from time to time, when there is any news to report, but otherwise this will just about wrap up Book One of the adventure. I hope that there isn’t the start of Book Two for many years. Thanks for all your comments, notes, prayers and interest in my progress. We’ll keep you up to date about any significant changes in what’s going on here.
Until later,
Dave
Thursday, December 19, 2002
Wednesday, December 11, 2002
The Bone Marrow Biopsy and "Chemobrain."
Dave’s Great Adventure
Dave's Great Adventure
Chapter 5, Verse 4
December 11, 2002
The Bone Marrow Biopsy
Well, yesterday I had my follow up bone marrow biopsy. It’s not what I would call a good time, but it’s probably not as bad as I thought it would be before I had my first one, or as bad as it sounds.
But first, an update on my last blood count which I had two days ago. Things are very slowly normalizing. My previous white count was low at 2,100 or so, and my neutrophils had dropped to sub-normal levels again after having gone up quite a bit with the Neupogen. Well, now things are approaching normal without extra medications. My white count is in the low but normal range at 3,300 (normal is about 3,000 to 12,000) and my neutrophils are also low-normal at about 1.7 (normal being 1.5 to 7.5). My red cell and platelet counts are still normal. The only thing that is still low is my lymphocyte count, which is still quite low at 0.6, but that’s okay for now...that’s what we want. My doc surprised me today when he told me they would likely be low for nine to twelve months. Also, since they will be low for so long, I’ll be susceptible to colds and the flu for at least that long.
So, I went in for the bone marrow biopsy today. The biopsy was taken from the same place as the first one, the back of the hip. They again gave me some intravenous drugs to sedate me a little, at my doc’s suggestion. I didn’t think they gave me enough...I was still talking and making sense as we started the procedure. Brian injected some local anesthetic and started the biopsy. I really felt it when he hit the periosteum, the tissue that covers the bone (bone itself really has no feeling; when you break a bone, it’s the periosteum that causes all the pain). I jumped a bit when I felt that, since it felt kinda like a nail going into my back, but then I settled down. It hurt again when Brian aspirated on the great big syringe he was using to suck out the marrow sample. Most people say that this it what they feel the most. I have to agree. But then, it was over. It took all of about five or six minutes and there was no pain afterwards. I stayed in the treatment room until the drugs wore off and then Kathy drove us home.
The results of the biopsy will be available in about a week. I think I mentioned a few letters ago that we are going to do flow cytometry on the sample, looking for residual leukemic cells, so the results will take longer than they did the first time. I think that the flow cytometry will give us about the same kind of information that the PCR (polymerase chain reaction) test I have also mentioned would give us. If there are no apparent leukemic cells remaining, that will be an excellent result indeed!
I have mixed feelings about getting the bone marrow test done. Ever since we started the chemotherapy I have had fantasies about really getting “cured” of this disease. I think there is a chance of this happening, but it’s probably not realistic to expect it. As long as my blood tests were looking as good as they have, however, I could continue to think I was getting cured, but when the bone marrow biopsy results come back I’m afraid of what they’ll show and I won’t have that fantasy to hang on to anymore. Of course, if they come back showing no residual disease, I can be ecstatic about that result! In any case, I’m in remission for now, and beginning to feel normal, for the most part.
One thing that is not completely normal yet is my thinking processes. Those of you who have been receiving my letters from the beginning remember me discussing the “fuzzies,” a feeling that I could not think well, concentrate on reading, etc. This was really bad after each cycle of the drugs, starting on about day four or so and then slowly getting better over about ten days. It has now been two whole months since my last round of drugs and though I’m mostly back to normal, I still do and say stupid things on an almost daily basis. I feel like an early Alzheimer’s patient sometimes. The other day I was talking to Kathy about putting plant food in the pot with one of our trees. I told her I was going to add some “WD-40” (ein Art Schmiermittel) to the tree‘s soil. I have no idea where THAT came from! Later, when Kathy asked me what kind of lights I was going to put on the Christmas tree I replied, “Flowers.” Those things are rather humorous, but more importantly, there have been a few times when Kathy has had to yell at me that there was a red light (Ampel) or a stop sign at an intersection I was about to drive through. Today I asked Brian about “chemo brain” which is an poorly defined entity associated with chemotherapy. He said it is hard to quantify and diagnose and can last up to a year or more. I will have to be very careful when I go back to work and am taking care of patients again. I don’t want to prescribe any WD-40 for their menstrual cramps. They probably wouldn’t understand.
So what’s next? If the bone marrow biopsy is completely normal we will do nothing except check blood counts about once a month for the next year or so. If the bone marrow biopsy is not completely normal, we’ll probably do the same thing. In other words, we’re finished with any sort of therapy for now. At some point, when/if my white count begins to rise again, indicating progression of the disease, then we’ll see about more therapy.
And what kind of therapy? Brian and I talked about a few options yesterday. One option is to go back to the combination chemotherapy we have just finished using, since it worked so well the first time. However, if the disease comes back after using it once, it’ll surely come back again after a second round of the same drugs. At least I would think it would.
I also inquired again, now that I’m in remission, about harvesting some of my stem cells for use in a possible future bone marrow transplant. Brian again said he’d ask the “transplanters” about that idea, and noted that it had been done before for some other folks. If nothing else works in getting rid of this disease, a bone marrow transplant might be a last ditch option. The advantage of using my own stem cells would that there would be no danger of my body rejecting the cells. The risk of using my own stem cells is that we may transplant malignant cells back into my marrow which were not entirely cleared out during the collection process.
Another very interesting possibility for treatment is coming up real soon. Do any of you out there remember way back to August 1st, when I was discussing some new possibilities for treatment? Remember I mentioned a drug called Genasense (or antisense)? I didn’t think so! Anyway, there is a new drug against CLL cells called Genasense which has recently been developed and is in clinical trials. We’ll be using it here at Kaiser (my health insurance plan, and my employer) within a few months so if/when I need treatment again, that should be available. That’s an exciting possibility. Genasense, by the way, doesn’t attack the leukemic cells and kill them, it just adjusts their internal genetic code so they die when they’re supposed to rather than living almost forever and crowding out all the normal cells, which is how they cause death.
I think I’ve used up enough of your time and paper (if you’re printing these out) so I’ll quit for now. I’ll be back with another update when I get the results of the bone marrow biopsy back. And that may well conclude Book One of my Adventure, as I don’t think much else will be happening for a while other than that I’ll be going back to work over the next couple of months as my white counts rise. But I’ll tell you about that later.
Bye for now,
Dave
Dave's Great Adventure
Chapter 5, Verse 4
December 11, 2002
The Bone Marrow Biopsy
Well, yesterday I had my follow up bone marrow biopsy. It’s not what I would call a good time, but it’s probably not as bad as I thought it would be before I had my first one, or as bad as it sounds.
But first, an update on my last blood count which I had two days ago. Things are very slowly normalizing. My previous white count was low at 2,100 or so, and my neutrophils had dropped to sub-normal levels again after having gone up quite a bit with the Neupogen. Well, now things are approaching normal without extra medications. My white count is in the low but normal range at 3,300 (normal is about 3,000 to 12,000) and my neutrophils are also low-normal at about 1.7 (normal being 1.5 to 7.5). My red cell and platelet counts are still normal. The only thing that is still low is my lymphocyte count, which is still quite low at 0.6, but that’s okay for now...that’s what we want. My doc surprised me today when he told me they would likely be low for nine to twelve months. Also, since they will be low for so long, I’ll be susceptible to colds and the flu for at least that long.
So, I went in for the bone marrow biopsy today. The biopsy was taken from the same place as the first one, the back of the hip. They again gave me some intravenous drugs to sedate me a little, at my doc’s suggestion. I didn’t think they gave me enough...I was still talking and making sense as we started the procedure. Brian injected some local anesthetic and started the biopsy. I really felt it when he hit the periosteum, the tissue that covers the bone (bone itself really has no feeling; when you break a bone, it’s the periosteum that causes all the pain). I jumped a bit when I felt that, since it felt kinda like a nail going into my back, but then I settled down. It hurt again when Brian aspirated on the great big syringe he was using to suck out the marrow sample. Most people say that this it what they feel the most. I have to agree. But then, it was over. It took all of about five or six minutes and there was no pain afterwards. I stayed in the treatment room until the drugs wore off and then Kathy drove us home.
The results of the biopsy will be available in about a week. I think I mentioned a few letters ago that we are going to do flow cytometry on the sample, looking for residual leukemic cells, so the results will take longer than they did the first time. I think that the flow cytometry will give us about the same kind of information that the PCR (polymerase chain reaction) test I have also mentioned would give us. If there are no apparent leukemic cells remaining, that will be an excellent result indeed!
I have mixed feelings about getting the bone marrow test done. Ever since we started the chemotherapy I have had fantasies about really getting “cured” of this disease. I think there is a chance of this happening, but it’s probably not realistic to expect it. As long as my blood tests were looking as good as they have, however, I could continue to think I was getting cured, but when the bone marrow biopsy results come back I’m afraid of what they’ll show and I won’t have that fantasy to hang on to anymore. Of course, if they come back showing no residual disease, I can be ecstatic about that result! In any case, I’m in remission for now, and beginning to feel normal, for the most part.
One thing that is not completely normal yet is my thinking processes. Those of you who have been receiving my letters from the beginning remember me discussing the “fuzzies,” a feeling that I could not think well, concentrate on reading, etc. This was really bad after each cycle of the drugs, starting on about day four or so and then slowly getting better over about ten days. It has now been two whole months since my last round of drugs and though I’m mostly back to normal, I still do and say stupid things on an almost daily basis. I feel like an early Alzheimer’s patient sometimes. The other day I was talking to Kathy about putting plant food in the pot with one of our trees. I told her I was going to add some “WD-40” (ein Art Schmiermittel) to the tree‘s soil. I have no idea where THAT came from! Later, when Kathy asked me what kind of lights I was going to put on the Christmas tree I replied, “Flowers.” Those things are rather humorous, but more importantly, there have been a few times when Kathy has had to yell at me that there was a red light (Ampel) or a stop sign at an intersection I was about to drive through. Today I asked Brian about “chemo brain” which is an poorly defined entity associated with chemotherapy. He said it is hard to quantify and diagnose and can last up to a year or more. I will have to be very careful when I go back to work and am taking care of patients again. I don’t want to prescribe any WD-40 for their menstrual cramps. They probably wouldn’t understand.
So what’s next? If the bone marrow biopsy is completely normal we will do nothing except check blood counts about once a month for the next year or so. If the bone marrow biopsy is not completely normal, we’ll probably do the same thing. In other words, we’re finished with any sort of therapy for now. At some point, when/if my white count begins to rise again, indicating progression of the disease, then we’ll see about more therapy.
And what kind of therapy? Brian and I talked about a few options yesterday. One option is to go back to the combination chemotherapy we have just finished using, since it worked so well the first time. However, if the disease comes back after using it once, it’ll surely come back again after a second round of the same drugs. At least I would think it would.
I also inquired again, now that I’m in remission, about harvesting some of my stem cells for use in a possible future bone marrow transplant. Brian again said he’d ask the “transplanters” about that idea, and noted that it had been done before for some other folks. If nothing else works in getting rid of this disease, a bone marrow transplant might be a last ditch option. The advantage of using my own stem cells would that there would be no danger of my body rejecting the cells. The risk of using my own stem cells is that we may transplant malignant cells back into my marrow which were not entirely cleared out during the collection process.
Another very interesting possibility for treatment is coming up real soon. Do any of you out there remember way back to August 1st, when I was discussing some new possibilities for treatment? Remember I mentioned a drug called Genasense (or antisense)? I didn’t think so! Anyway, there is a new drug against CLL cells called Genasense which has recently been developed and is in clinical trials. We’ll be using it here at Kaiser (my health insurance plan, and my employer) within a few months so if/when I need treatment again, that should be available. That’s an exciting possibility. Genasense, by the way, doesn’t attack the leukemic cells and kill them, it just adjusts their internal genetic code so they die when they’re supposed to rather than living almost forever and crowding out all the normal cells, which is how they cause death.
I think I’ve used up enough of your time and paper (if you’re printing these out) so I’ll quit for now. I’ll be back with another update when I get the results of the bone marrow biopsy back. And that may well conclude Book One of my Adventure, as I don’t think much else will be happening for a while other than that I’ll be going back to work over the next couple of months as my white counts rise. But I’ll tell you about that later.
Bye for now,
Dave
Wednesday, December 4, 2002
Still Doin' Well, And Antarctica???
Dave’s Great Adventure
Chapter 5, Verse 3
December 4, 2002
Still Doin’ Okay
Well, this “adventure” has suddenly become quite boring, with not much going on, at least as far as the treatment and follow-up of my disease goes. But we’re still plodding along and using our time before I go back to work to see family and friends. But I did have another blood count last week that I’d like to update you on.
But first, in my last letter I reported that my white count was up to over 5,000 and was normal for the first time since we found out that I had leukemia. That prompted a good question from my family in Rock Hill, SC, who asked why my count, at 5,000, was normal, when my count at 5,000, last July after the very first round of chemotherapy, was not normal. The answer is that last July my total count went down from about 65,000 to about 5,000 after the drugs, but the percent of lymphocytes was still about 85%. Now, when my count went UP to 5,000 last week (after the Neupogen injections) the percent of lymphocytes was only about 8% or so. And since all the bad cells are lymphocytes, having a normal lymphocyte count and percentage put me into the definition of being in remission.
Now, a week ago last Monday I had blood drawn again. As expected, my white cell count went down again as the Neupogen effect wore off, this time to 2,100. That’s lower than I had expected, but I guess about what my doc had expected. Now what I don’t know is, that since my neutrophil count dropped so dramatically, but my lymphocyte count remained the same (at 500), the ratio of the lymphocytes to neutrophils and the other cells has now gone back up! Now my lymphocytes are about 23% of my white cells. That’s not normal. So am I in a complete remission now or not? I’ll have to ask my doc next week when I have my bone marrow biopsy.
Speaking of lymphocytes, with the four months of chemotherapy we killed off over 99% of them, dropping their numbers from about 56,000 or more, down to 500! I’m impressed that the chemotherapy could be so specific as to target the lymphocytes accurately enough to do that without also killing off 99% of my red cells, platelets and everything else. And that’s enough technical, medical talk for today!
Hey, I’ve gotten a lot of people asking me the same question: “What, Antarctica? Are you crazy?” Well, I’ve got this great brochure that describes some trips/cruises to Antarctica and I think they sound like a lot of fun. My wife, who doesn’t “do” cold weather very well, remains unconvinced, but I think she’ll go along. Cold is all in your mind. I’ve been reading Sir Ernest Shackleton’s book, “South,” based on his ill-fated voyage to Antarctica in 1914. At one point he notes, in his ship’s log, “Temperature 37 degrees Fahrenheit, pleasantly warm.” My wife does not think that 37 degrees is warm at all! The cruises go to visit penguin rookeries (I guess they’re places where they hatch their young), the old whaling stations in South Georgia, Shackleton’s grave, near the whaling stations, glaciers, ice cliffs and more. And we will get to land on and walk around on Antarctica! I think that sounds neat! How many of you have done that?
Over the last week Kathy and I were able to travel to Oklahoma and Texas, taking our first driving trip in quite a while. In Oklahoma we visited and had Thanksgiving dinner with Kathy’s folks and youngest sister. Then we headed south to visit our daughter Jen, her family and our younger son, Jeremy and his girlfriend. We were able to see my younger sister Deb and her family as well, as they were visiting in town from California just for Thanksgiving Day. They came for the Dallas football game, which Dallas actually won! After a couple of days in the Dallas area with the grandkids (have I ever told you that they are sooo cute!) we headed back north again to see Kathy’s folks again before returning home. While in Oklahoma we picked up a couple of things from her folks. They are moving to a retirement home soon and are downsizing all the things they have collected in their home over the last 35 years so we brought home a cedar chest Kathy’s granddad made in 1938. We also brought back a picture Kathy’s dad had gotten from a prisoner/artist who painted it while in the prison in Anthony, Texas, where Kathy’s dad worked for many years while with the Federal Bureau of Prisons.
This weekend we’ll have some houseguests. Our elder son is coming for a short visit and is bringing along his girlfriend. That’s going to be fun. Jon’s girlfriend, Natalie, has never been to Colorado so we’re going to try to give her a real Rocky Mountain experience. The mountains beckon....
I think that’s all that might be of some interest to you. I’ll be back with another update next week after the bone marrow biopsy and yet another blood count to let you know how I’m doing and what our short term plans are. Until then, this adventure just keeps plodding along.
Later,
Dave
Chapter 5, Verse 3
December 4, 2002
Still Doin’ Okay
Well, this “adventure” has suddenly become quite boring, with not much going on, at least as far as the treatment and follow-up of my disease goes. But we’re still plodding along and using our time before I go back to work to see family and friends. But I did have another blood count last week that I’d like to update you on.
But first, in my last letter I reported that my white count was up to over 5,000 and was normal for the first time since we found out that I had leukemia. That prompted a good question from my family in Rock Hill, SC, who asked why my count, at 5,000, was normal, when my count at 5,000, last July after the very first round of chemotherapy, was not normal. The answer is that last July my total count went down from about 65,000 to about 5,000 after the drugs, but the percent of lymphocytes was still about 85%. Now, when my count went UP to 5,000 last week (after the Neupogen injections) the percent of lymphocytes was only about 8% or so. And since all the bad cells are lymphocytes, having a normal lymphocyte count and percentage put me into the definition of being in remission.
Now, a week ago last Monday I had blood drawn again. As expected, my white cell count went down again as the Neupogen effect wore off, this time to 2,100. That’s lower than I had expected, but I guess about what my doc had expected. Now what I don’t know is, that since my neutrophil count dropped so dramatically, but my lymphocyte count remained the same (at 500), the ratio of the lymphocytes to neutrophils and the other cells has now gone back up! Now my lymphocytes are about 23% of my white cells. That’s not normal. So am I in a complete remission now or not? I’ll have to ask my doc next week when I have my bone marrow biopsy.
Speaking of lymphocytes, with the four months of chemotherapy we killed off over 99% of them, dropping their numbers from about 56,000 or more, down to 500! I’m impressed that the chemotherapy could be so specific as to target the lymphocytes accurately enough to do that without also killing off 99% of my red cells, platelets and everything else. And that’s enough technical, medical talk for today!
Hey, I’ve gotten a lot of people asking me the same question: “What, Antarctica? Are you crazy?” Well, I’ve got this great brochure that describes some trips/cruises to Antarctica and I think they sound like a lot of fun. My wife, who doesn’t “do” cold weather very well, remains unconvinced, but I think she’ll go along. Cold is all in your mind. I’ve been reading Sir Ernest Shackleton’s book, “South,” based on his ill-fated voyage to Antarctica in 1914. At one point he notes, in his ship’s log, “Temperature 37 degrees Fahrenheit, pleasantly warm.” My wife does not think that 37 degrees is warm at all! The cruises go to visit penguin rookeries (I guess they’re places where they hatch their young), the old whaling stations in South Georgia, Shackleton’s grave, near the whaling stations, glaciers, ice cliffs and more. And we will get to land on and walk around on Antarctica! I think that sounds neat! How many of you have done that?
Over the last week Kathy and I were able to travel to Oklahoma and Texas, taking our first driving trip in quite a while. In Oklahoma we visited and had Thanksgiving dinner with Kathy’s folks and youngest sister. Then we headed south to visit our daughter Jen, her family and our younger son, Jeremy and his girlfriend. We were able to see my younger sister Deb and her family as well, as they were visiting in town from California just for Thanksgiving Day. They came for the Dallas football game, which Dallas actually won! After a couple of days in the Dallas area with the grandkids (have I ever told you that they are sooo cute!) we headed back north again to see Kathy’s folks again before returning home. While in Oklahoma we picked up a couple of things from her folks. They are moving to a retirement home soon and are downsizing all the things they have collected in their home over the last 35 years so we brought home a cedar chest Kathy’s granddad made in 1938. We also brought back a picture Kathy’s dad had gotten from a prisoner/artist who painted it while in the prison in Anthony, Texas, where Kathy’s dad worked for many years while with the Federal Bureau of Prisons.
This weekend we’ll have some houseguests. Our elder son is coming for a short visit and is bringing along his girlfriend. That’s going to be fun. Jon’s girlfriend, Natalie, has never been to Colorado so we’re going to try to give her a real Rocky Mountain experience. The mountains beckon....
I think that’s all that might be of some interest to you. I’ll be back with another update next week after the bone marrow biopsy and yet another blood count to let you know how I’m doing and what our short term plans are. Until then, this adventure just keeps plodding along.
Later,
Dave
Wednesday, November 20, 2002
Remission?
Dave’s Great Adventure
Chapter 5, Verse 2
November 20, 2002
Remission?
Well, it’s been a week now since my doc told me that my bone marrow wouldn’t tolerate any more chemotherapy and left Kathy and me with nothing to do. We’d been planning our lives around these monthly infusions, so now, while we wait for my bone marrow to recover, we’re left with some open time. Like I reported last time, we’re going to get a couple of blood counts in the next few weeks, plus that ever-popular procedure, the bone marrow biopsy in about three weeks from now.
I need to update some information I sent out in my last letter. I said my white count had gone up to about 2,000. Well, since I have access to the computer with all the data, I looked up my last lab tests. Either Brian misread the numbers or Kathy and I misheard them, but my white count actually went up to over 5,000! Almost all of the increase was in neutrophils, most likely a result of the Neupogen I had been injecting. The net result is that my white count is normal...almost completely normal (except for very low lymphocyte counts), for the first time in many months. We need to see what it does over the next month or so, because as the Neupogen effect wears off, and my marrow recovers from the chemo, the numbers may change. But for now, the counts are normal, and my doc wrote in my chart that I was in “complete remission.”
That term, “complete remission,” is a very nice term to hear, indeed. That means I’ve made the first two cuts in the treatment of this disease. Many of you haven’t been on the DGA mailing list since the beginning, but early on I explained what we were trying to do with my therapy. There is really no known cure for this disease (chronic lymphocytic leukemia). There are various treatments, and they may extend longevity, but there is no cure. However, a very recent study from M. D. Anderson in Houston reported the results of using some combination chemotherapy, the Fludara and Cytoxan, which have been around for years, with a new drug, the Rituxan, which has only recently been approved for use, but was developed for use in treating lymphomas. Lymphomas and leukemias are not the same disease, but they share some characteristics, one of which is that many of the abnormal cells share a common antigen (a particularly shaped portion of the cell wall). In this case, the antigen is called the CD-20 antigen.
Rituxan is actually a mouse antibody against the CD-20 antigen, and allows the body’s own immune system to destroy the abnormal cells. In combination with the standard chemotherapy, the Fludara and Cytoxan, the folks at M. D. Anderson found that there was a much higher response rate and remission rate than with standard therapy. Where a good response rate in the past, with most drugs was about 20%, they were getting up to 90+% response rates with the new combination. And up to a third or more of the folks that responded with a complete or partial remission were negative for disease with some sophisticated molecular testing, about 18 months after the treatment. So, that’s why we were using this very new, and really, almost experimental, protocol. Now, being negative for the disease with the molecular testing (called a PCR probe) is very encouraging. That is not necessarily a cure, but it’s the best anyone has gotten so far!
So, the first test I passed was that I responded to the drugs. Some folks don’t. In some cases, patients with this disease had their leukemias get worse despite the treatment. A few died of their disease, a few died of the treatment! Luckily, I did neither.
Next, at least in the very, very short term (pending my bone marrow biopsy), I seem to be in a complete remission. That was the second test. Some of the folks who responded to the drugs got only a partial response and therefore a partial remission. I seem to be in the fortunate portion of the folks with a complete remission (keep your fingers crossed for the bone marrow results!).
Now, of the folks who got into a complete remission, over half (56%) were negative for the disease with the PCR probe. We won’t be able to do that test (I believe it’s a research tool) but if my bone marrow is negative for apparent leukemic cells, and the flow cytometry fails to find evidence of disease, there’s a good chance that I’ll be in that fortunate group. At least the odds are better than flipping a coin! I’ll take those odds, in a disease that has had no known cure in the past. I’ll keep you updated as more data becomes available.
So, Kathy and I have been trying to find things to do that don’t involve getting into too many crowds of people. Though my white count, for now, is pretty normal, I’m going to be immunosuppressed and therefore be unable to effectively fight off some infections for the next six to nine months. That’s because the lymphocytes we’ve been killing off include mostly the B lymphocytes, which are involved in antibody production. Anyway, in an attempt to get back into a normal routine, we went to church last Sunday, but as I did at the medical meeting in Maui, we sat at the far edge of the congregation, away from the mass of people. Just as in Maui, there was a lot of coughing going on.
It’s really interesting how many people you hear coughing or sneezing when you really, really don’t want to be near anyone with a cold. Kathy and I automatically look at each other in alarm whenever we hear a cough anywhere near us; in church, a restaurant, or a store. And I’ve become very sensitive to touching things that might carry viruses, like door handles, money, people’s hands, etc. I wash my hands all the time and we carry (which is to say, Kathy carries in her purse) a small bottle of the new waterless hand cleaner that kills viruses (it’s mostly alcohol) and we both use the stuff all the time. And I keep my hands away from my face, I keep my fingers out of my mouth, and I don’t bite my fingernails. I really don’t want to catch a cold. My doc says I won’t easily be able to shake it off if I get one. And catching the flu would be a big problem as I wouldn’t be able to mount an immune response to the virus. I didn’t get the flu shot for the same reason; I wouldn’t be able to produce antibodies to it anyway.
So, we’ve been working around the house, doing a little shopping, and starting to get back into somewhat of a normal routine after all these months of living around my chemo cycles. I’ve been able to start working out a little for the first time in months. We have a Nordic Track Cross-Trainer that I was exercising on three times a week up until I got sick last February. I haven’t done anything in months, even when I felt well, because I knew I was going to do more chemo every four weeks and get back out of shape, so I just stopped exercising entirely. Now I have no excuses, so I’m slowly starting to get back in shape.
Kathy and I have had a number of things we were going to do “some day.” Going to Hawaii was one of them. Another was to go to Alaska. We’ve decided that since the future is uncertain, we’re going to start doing those things now. There is a self-guided tour to Alaska that we had been looking at for a number of months, and this week we signed up for it. Next June, presuming I’m still doing well, we’ll be flying to Juneau, Alaska for an eleven day trip. I think this should be a very interesting trip; it includes whale watching, a helicopter ride up to a glacier, a float plane ride out to an island with a large number of bears and bald eagles, a train ride for a day, a whitewater rafting trip, and “flightseeing” with a bush pilot who will take us around Mount McKinley. That should be enough to keep us busy for the eleven days. Next, we’re looking at a trip to Antarctica, maybe next year!!!
Did anyone else get up to look at the Leonids meteor shower last night? Kathy and I got up at 3:00 AM and spent an hour out on the deck in sub-freezing temperatures watching the meteors. It was a pretty good show, but we had partly cloudy skies that obscured some of the meteors, and the quantity of meteors wasn’t near what it was last year. I think I was spoiled by last year’s show, where there were probably a couple of meteors per second, a real meteor “storm.” By comparison, this year’s display was more a like a meteor “drizzle” as we saw perhaps two to four meteors a minute. Still, it was a pretty good show.
I think I’ve gone on long enough for this “verse.” We’re going to try to go to Dallas and Oklahoma to visit Kathy’s parents and our kids over Thanksgiving week. I’ll let you know how our trip goes, and how my next blood tests turn out, in the next exciting verse!
Until then,
Dave
Chapter 5, Verse 2
November 20, 2002
Remission?
Well, it’s been a week now since my doc told me that my bone marrow wouldn’t tolerate any more chemotherapy and left Kathy and me with nothing to do. We’d been planning our lives around these monthly infusions, so now, while we wait for my bone marrow to recover, we’re left with some open time. Like I reported last time, we’re going to get a couple of blood counts in the next few weeks, plus that ever-popular procedure, the bone marrow biopsy in about three weeks from now.
I need to update some information I sent out in my last letter. I said my white count had gone up to about 2,000. Well, since I have access to the computer with all the data, I looked up my last lab tests. Either Brian misread the numbers or Kathy and I misheard them, but my white count actually went up to over 5,000! Almost all of the increase was in neutrophils, most likely a result of the Neupogen I had been injecting. The net result is that my white count is normal...almost completely normal (except for very low lymphocyte counts), for the first time in many months. We need to see what it does over the next month or so, because as the Neupogen effect wears off, and my marrow recovers from the chemo, the numbers may change. But for now, the counts are normal, and my doc wrote in my chart that I was in “complete remission.”
That term, “complete remission,” is a very nice term to hear, indeed. That means I’ve made the first two cuts in the treatment of this disease. Many of you haven’t been on the DGA mailing list since the beginning, but early on I explained what we were trying to do with my therapy. There is really no known cure for this disease (chronic lymphocytic leukemia). There are various treatments, and they may extend longevity, but there is no cure. However, a very recent study from M. D. Anderson in Houston reported the results of using some combination chemotherapy, the Fludara and Cytoxan, which have been around for years, with a new drug, the Rituxan, which has only recently been approved for use, but was developed for use in treating lymphomas. Lymphomas and leukemias are not the same disease, but they share some characteristics, one of which is that many of the abnormal cells share a common antigen (a particularly shaped portion of the cell wall). In this case, the antigen is called the CD-20 antigen.
Rituxan is actually a mouse antibody against the CD-20 antigen, and allows the body’s own immune system to destroy the abnormal cells. In combination with the standard chemotherapy, the Fludara and Cytoxan, the folks at M. D. Anderson found that there was a much higher response rate and remission rate than with standard therapy. Where a good response rate in the past, with most drugs was about 20%, they were getting up to 90+% response rates with the new combination. And up to a third or more of the folks that responded with a complete or partial remission were negative for disease with some sophisticated molecular testing, about 18 months after the treatment. So, that’s why we were using this very new, and really, almost experimental, protocol. Now, being negative for the disease with the molecular testing (called a PCR probe) is very encouraging. That is not necessarily a cure, but it’s the best anyone has gotten so far!
So, the first test I passed was that I responded to the drugs. Some folks don’t. In some cases, patients with this disease had their leukemias get worse despite the treatment. A few died of their disease, a few died of the treatment! Luckily, I did neither.
Next, at least in the very, very short term (pending my bone marrow biopsy), I seem to be in a complete remission. That was the second test. Some of the folks who responded to the drugs got only a partial response and therefore a partial remission. I seem to be in the fortunate portion of the folks with a complete remission (keep your fingers crossed for the bone marrow results!).
Now, of the folks who got into a complete remission, over half (56%) were negative for the disease with the PCR probe. We won’t be able to do that test (I believe it’s a research tool) but if my bone marrow is negative for apparent leukemic cells, and the flow cytometry fails to find evidence of disease, there’s a good chance that I’ll be in that fortunate group. At least the odds are better than flipping a coin! I’ll take those odds, in a disease that has had no known cure in the past. I’ll keep you updated as more data becomes available.
So, Kathy and I have been trying to find things to do that don’t involve getting into too many crowds of people. Though my white count, for now, is pretty normal, I’m going to be immunosuppressed and therefore be unable to effectively fight off some infections for the next six to nine months. That’s because the lymphocytes we’ve been killing off include mostly the B lymphocytes, which are involved in antibody production. Anyway, in an attempt to get back into a normal routine, we went to church last Sunday, but as I did at the medical meeting in Maui, we sat at the far edge of the congregation, away from the mass of people. Just as in Maui, there was a lot of coughing going on.
It’s really interesting how many people you hear coughing or sneezing when you really, really don’t want to be near anyone with a cold. Kathy and I automatically look at each other in alarm whenever we hear a cough anywhere near us; in church, a restaurant, or a store. And I’ve become very sensitive to touching things that might carry viruses, like door handles, money, people’s hands, etc. I wash my hands all the time and we carry (which is to say, Kathy carries in her purse) a small bottle of the new waterless hand cleaner that kills viruses (it’s mostly alcohol) and we both use the stuff all the time. And I keep my hands away from my face, I keep my fingers out of my mouth, and I don’t bite my fingernails. I really don’t want to catch a cold. My doc says I won’t easily be able to shake it off if I get one. And catching the flu would be a big problem as I wouldn’t be able to mount an immune response to the virus. I didn’t get the flu shot for the same reason; I wouldn’t be able to produce antibodies to it anyway.
So, we’ve been working around the house, doing a little shopping, and starting to get back into somewhat of a normal routine after all these months of living around my chemo cycles. I’ve been able to start working out a little for the first time in months. We have a Nordic Track Cross-Trainer that I was exercising on three times a week up until I got sick last February. I haven’t done anything in months, even when I felt well, because I knew I was going to do more chemo every four weeks and get back out of shape, so I just stopped exercising entirely. Now I have no excuses, so I’m slowly starting to get back in shape.
Kathy and I have had a number of things we were going to do “some day.” Going to Hawaii was one of them. Another was to go to Alaska. We’ve decided that since the future is uncertain, we’re going to start doing those things now. There is a self-guided tour to Alaska that we had been looking at for a number of months, and this week we signed up for it. Next June, presuming I’m still doing well, we’ll be flying to Juneau, Alaska for an eleven day trip. I think this should be a very interesting trip; it includes whale watching, a helicopter ride up to a glacier, a float plane ride out to an island with a large number of bears and bald eagles, a train ride for a day, a whitewater rafting trip, and “flightseeing” with a bush pilot who will take us around Mount McKinley. That should be enough to keep us busy for the eleven days. Next, we’re looking at a trip to Antarctica, maybe next year!!!
Did anyone else get up to look at the Leonids meteor shower last night? Kathy and I got up at 3:00 AM and spent an hour out on the deck in sub-freezing temperatures watching the meteors. It was a pretty good show, but we had partly cloudy skies that obscured some of the meteors, and the quantity of meteors wasn’t near what it was last year. I think I was spoiled by last year’s show, where there were probably a couple of meteors per second, a real meteor “storm.” By comparison, this year’s display was more a like a meteor “drizzle” as we saw perhaps two to four meteors a minute. Still, it was a pretty good show.
I think I’ve gone on long enough for this “verse.” We’re going to try to go to Dallas and Oklahoma to visit Kathy’s parents and our kids over Thanksgiving week. I’ll let you know how our trip goes, and how my next blood tests turn out, in the next exciting verse!
Until then,
Dave
Wednesday, November 13, 2002
Chapter Five; Hawaii Was Great, But The Long Nadir....
Dave’s Great Adventure
Chapter 5, Verse 1
November 13, 2002
The Story...Continues??
Well, we’ve gotten back from our trip, and it’s time for another chapter to start, since I’ve been starting a new chapter with each round of chemotherapy. But, I really haven’t finished telling you about the events at the end of Chapter 4. We were getting ready to leave town, I was going to have to give myself those shots, and my white count was very, very low. Well, here’s what happened.
The night of the last “verse” I gave myself the first shot of Neupogen, as I had been taught to do. I didn’t do too badly, though docs are not taught how to give shots in medical school. It was kinda tough to actually stick the needle into my belly, but it didn’t hurt much and I got the job done. We got up at about 3:30 the next morning to catch a flight to LA that left at 6:55. Those of you who know Kathy well know that she always wants to get to the airport early so we won’t miss our flight. Well, we were sitting at the gate for our flight, all by ourselves, by about 5:30. We had plenty of time to eat a McDonald’s breakfast and read the paper! The plane left on time and we had a smooth flight to Los Angeles. I was paranoid about being around too many folks with my white blood cell count being so low, but on the flight to LA the plane was almost empty. We changed planes in LA and headed out to Maui, but this plane was full. Fortunately no one around us was coughing or sneezing too much.
We got to Maui on time and collected our luggage, finding that one of our suitcases had lost a wheel on the flight, so we couldn’t roll it along, but instead I had to carry the thing! But, we got our rental car and found our way to the hotel at which the conference was going to be held, the Maui Prince. It was interesting that, when I asked the clerk at the rental agency how far the hotel was, she gave us the answer, not in miles, but in minutes. That was to be a pattern. Rarely did people express distances in actual distance, but rather in the time it took to get somewhere. That turns out to be, I think, because traffic is very slow and the roads are very circuitous. Though actual straight line distances are not great (the whole island of Maui can’t be more than about twenty miles by thirty miles or so) it can take over an hour to travel twenty or thirty miles.
We checked into the hotel and found that it was very nice indeed. It was right on a soft beach with a gentle surf and lots of palm trees, flowers and birds. We also found out later that there were a lot of large sea turtles in the surf just off the beach. We were able to watch a large turtle one day, just about thirty feet off the beach, with a shell probably about 24 inches across and a head as large as my fist.
The hotel was a beautiful place, and is apparently a popular place for weddings. We must have seen at least five weddings of various sizes, during our stay. Kathy got her fill of checking out wedding dresses! I don’t know why women are so curious about what other women are wearing for their weddings. Anyway, we saw very large weddings with large receptions and music, and very small, private weddings with no one present except the bride and groom and the minister. At one wedding we witnessed, the bride and groom were standing alone on the beach with the minister saying their vows. There was no wedding party at all. The groom was quite a bit shorter than the bride, and so was standing on a small mound of sand to make him appear about the same height as his bride, at least for the photographer!
The meeting, which was the main reason we were in Maui, turned out to be an excellent educational meeting with excellent topics and experts on a wide variety of subjects. I was, again, a bit nervous about being in a large group of people, and the meeting was actually larger than I had thought it would be (about 200 people) so I tended to go in and get a seat all the way to one side of the room, rather than being surrounded by people. There was a fair amount of coughing going on, and I tried to stay away from anyone that appeared to be sick.
I was also restricted in my activities, because of my therapy and low counts. The chemotherapy made me photosensitive, so I couldn’t get much sun. And with my white counts being so low, I couldn’t eat fresh fruits and vegetables nor could I engage in, well, I’m not sure I can say it in a family publication, so I’ll just whisper it (we couldn’t have S-E-X). You know, because of germs and stuff.
Our son-in-law suggested that going to Hawaii with those restrictions was like taking a blind man to a strip show!
But we had a good time, nevertheless. The meeting was set up to run just in the morning and the daily sessions were generally over by about 1:00. That gave us the afternoons to do things. So we set about supporting the economy of Maui. The island is just beautiful, and we spent one afternoon just driving around seeing things and places that my excellent nurse, Debbie (who had lived on Maui) recommended. Then one morning, a day the meetings were held in the afternoon, we went on a helicopter ride around the island. We’d never done that before, and though I rode on lots of helicopters in Vietnam, I generally don’t like small aircraft. They tend to crash too frequently. Plus they tend to be way too expensive. But I have a new outlook on life now, and a different perspective on things. When you’re likely to have only five years left to live, and only that length of time to try to use your retirement money, things look different. If you crash, well, it was probably meant to be, and what is money for, if not to be enjoyed. I’ve been trying to save all my life; now it’s time to try to enjoy some of it while I can.
And one day we went out on a submarine ride. A group of about 20 folks signed up for the sub ride, and we were taken down to about 150 feet to a few coral reefs to see the fish swimming around. We were able to look out the portholes and see the underwater wildlife and take pictures. There was nothing too spectacular, but it was fascinating just to be there.
We went shopping, ate out too often and just had a good time being together. It was rather like a honeymoon, but in reverse, if you will. Generally a honeymoon is when you start your married life. We were there in what, unfortunately, may be the end stage of our married life, but it was beautiful, none the less. We spent a lot of time holding hands and just looking at each other and the soft green scenery. It was good for us.
Next I want to take Kathy to Alaska! Maybe this summer.
Kathy was watching out for me the whole time, guarding me from the dangers all around. She watched what I ate, kept me away from folks who were coughing and did most of the things that required interacting with groups of people. One day I joked that I was going to eat a big bowl of fresh fruit at the meeting, and she got teary-eyed! So I couldn’t eat the fruit! Because of the dietary limits, I ate mostly cheeseburgers and fish and chips, and occasionally other fish meals. And I gained a little weight.
I attended every meeting during our time in Maui. It was good to hear experts telling us that estrogen really doesn’t become a toxic substance to women just because they turn fifty, as many of the lay media would have us believe. And we were taught more about osteoporosis, breast cancer, abnormal pap smears and more. It was the best educational meeting I’ve been to in a long time. And when it was over, we headed home.
The ride home was tough, worse, I think, than the ride to Germany. The plane left Maui at 10:00 at night. Care to guess when we were at the airport? That’s right, we were there at 6:00! There was only one other couple at our gate, and they were coughing, so Kathy took me to the far end of the terminal where there were no other people and we spent time there, reading and talking. The plane left on time, and got to LA about four hours later, at 4:15 AM, where we had to change planes and had about a two hour layover. Then we boarded the plane to Denver, getting here at about 9:30 or so. The reason the plane ride was so tough is the layover in LA. On the flight to Germany, though it is longer, you can sleep. We had no real good length of time on this trip in which to sleep.
Before we went home, I went by the clinic to get a blood count done because my doc needed to see what my blood counts were by the next day before deciding what we were going to do. Then we spent the rest of the day doing errands. And that’s the end of Chapter 4.
CHAPTER FIVE: Yesterday Kathy and I got ready for the next round of chemo. We packed up all the stuff we’ve found we need for those days. Since yesterday was to be a Rituxan day (a long day), Kathy had lunches made for us, I had my CD player and my reading material, and Kathy brought along the quilt we’re STILL working on for Brooke, our younger granddaughter. We got to my doc’s office on time and he got there just a bit late, after making his hospital rounds. Brian pulled up my blood count from the day before, which I hadn’t yet seen, and gave us the news. It was kinda like a good news/bad news, or maybe a good news/good news result. First, the Neupogen worked well. My neutrophils had gone up from close to zero (remember, they were at 200 with normal being 150 to 7500) to 3000; they were back in the normal range. However, my platelets had dropped to 110,000 from 200,000, and my total white count was still only 2,000. Other good news was that my lymphocytes (among which the leukemic cells hide out) had stayed down at 300. The bottom line was that after four weeks since my last infusions, I was still in a nadir! My stem cells, the cells in the bone marrow that create all the other cells, were pleading for mercy! They are pretty well depleted and not able to recover as they had during the first three cycles. As my doc said, “We’ve knocked off so many cells that now we’re just beating the crap out of the good cells!”
So, he is stopping the chemotherapy after just the four cycles I’ve had. I’m not sure what to think of this development. In theory, if we’ve gotten to the point that we’re killing off normal cells, then the leukemic cells, which should be more sensitive to the drugs, should be gone. In theory! On the other hand, if even two or three leukemic cells remain, they can come back. I’ve been happy that we’ve been on the offensive in the fight against this disease. Now we’re going to be passive again. If I can, I’m going to try to talk him into giving me a couple of more cycles later, but I guess we have to be careful...I do need to have some marrow cells left at the end of the treatment.
I asked what we’d do next. Well, we’re going to do another blood count in a couple of weeks, to see if my marrow is recovering, then one more two weeks later, with another bone marrow biopsy at that time. The bone marrow biopsy will tell us if we seem to have cleaned out the marrow. He’s going to have them run a flow cytometry (remember that test from the early DGA letters?) and see if they can detect any leukemic cells. And then? Brian said we’d watch and wait. In other words, we’ll just do blood counts and see what happens to my white cell counts. And if they go up, we’ll have to see what might be available because as of right now, there is no other real treatment.
And so, that’s the end of this verse. We’re going to follow my blood counts for a while and when they get back close to normal I can go back to work, probably some time in December or by early January, at the latest, though Brian said that this time of year is a bad time to go back, with all the coughs and colds and with the influenza season about to start. But, if we can screen out the sick patients, I should do pretty well.
That’s about all for now. I’ll be back if/when anything significant happens.
Later,
Dave
Chapter 5, Verse 1
November 13, 2002
The Story...Continues??
Well, we’ve gotten back from our trip, and it’s time for another chapter to start, since I’ve been starting a new chapter with each round of chemotherapy. But, I really haven’t finished telling you about the events at the end of Chapter 4. We were getting ready to leave town, I was going to have to give myself those shots, and my white count was very, very low. Well, here’s what happened.
The night of the last “verse” I gave myself the first shot of Neupogen, as I had been taught to do. I didn’t do too badly, though docs are not taught how to give shots in medical school. It was kinda tough to actually stick the needle into my belly, but it didn’t hurt much and I got the job done. We got up at about 3:30 the next morning to catch a flight to LA that left at 6:55. Those of you who know Kathy well know that she always wants to get to the airport early so we won’t miss our flight. Well, we were sitting at the gate for our flight, all by ourselves, by about 5:30. We had plenty of time to eat a McDonald’s breakfast and read the paper! The plane left on time and we had a smooth flight to Los Angeles. I was paranoid about being around too many folks with my white blood cell count being so low, but on the flight to LA the plane was almost empty. We changed planes in LA and headed out to Maui, but this plane was full. Fortunately no one around us was coughing or sneezing too much.
We got to Maui on time and collected our luggage, finding that one of our suitcases had lost a wheel on the flight, so we couldn’t roll it along, but instead I had to carry the thing! But, we got our rental car and found our way to the hotel at which the conference was going to be held, the Maui Prince. It was interesting that, when I asked the clerk at the rental agency how far the hotel was, she gave us the answer, not in miles, but in minutes. That was to be a pattern. Rarely did people express distances in actual distance, but rather in the time it took to get somewhere. That turns out to be, I think, because traffic is very slow and the roads are very circuitous. Though actual straight line distances are not great (the whole island of Maui can’t be more than about twenty miles by thirty miles or so) it can take over an hour to travel twenty or thirty miles.
We checked into the hotel and found that it was very nice indeed. It was right on a soft beach with a gentle surf and lots of palm trees, flowers and birds. We also found out later that there were a lot of large sea turtles in the surf just off the beach. We were able to watch a large turtle one day, just about thirty feet off the beach, with a shell probably about 24 inches across and a head as large as my fist.
The hotel was a beautiful place, and is apparently a popular place for weddings. We must have seen at least five weddings of various sizes, during our stay. Kathy got her fill of checking out wedding dresses! I don’t know why women are so curious about what other women are wearing for their weddings. Anyway, we saw very large weddings with large receptions and music, and very small, private weddings with no one present except the bride and groom and the minister. At one wedding we witnessed, the bride and groom were standing alone on the beach with the minister saying their vows. There was no wedding party at all. The groom was quite a bit shorter than the bride, and so was standing on a small mound of sand to make him appear about the same height as his bride, at least for the photographer!
The meeting, which was the main reason we were in Maui, turned out to be an excellent educational meeting with excellent topics and experts on a wide variety of subjects. I was, again, a bit nervous about being in a large group of people, and the meeting was actually larger than I had thought it would be (about 200 people) so I tended to go in and get a seat all the way to one side of the room, rather than being surrounded by people. There was a fair amount of coughing going on, and I tried to stay away from anyone that appeared to be sick.
I was also restricted in my activities, because of my therapy and low counts. The chemotherapy made me photosensitive, so I couldn’t get much sun. And with my white counts being so low, I couldn’t eat fresh fruits and vegetables nor could I engage in, well, I’m not sure I can say it in a family publication, so I’ll just whisper it (we couldn’t have S-E-X). You know, because of germs and stuff.
Our son-in-law suggested that going to Hawaii with those restrictions was like taking a blind man to a strip show!
But we had a good time, nevertheless. The meeting was set up to run just in the morning and the daily sessions were generally over by about 1:00. That gave us the afternoons to do things. So we set about supporting the economy of Maui. The island is just beautiful, and we spent one afternoon just driving around seeing things and places that my excellent nurse, Debbie (who had lived on Maui) recommended. Then one morning, a day the meetings were held in the afternoon, we went on a helicopter ride around the island. We’d never done that before, and though I rode on lots of helicopters in Vietnam, I generally don’t like small aircraft. They tend to crash too frequently. Plus they tend to be way too expensive. But I have a new outlook on life now, and a different perspective on things. When you’re likely to have only five years left to live, and only that length of time to try to use your retirement money, things look different. If you crash, well, it was probably meant to be, and what is money for, if not to be enjoyed. I’ve been trying to save all my life; now it’s time to try to enjoy some of it while I can.
And one day we went out on a submarine ride. A group of about 20 folks signed up for the sub ride, and we were taken down to about 150 feet to a few coral reefs to see the fish swimming around. We were able to look out the portholes and see the underwater wildlife and take pictures. There was nothing too spectacular, but it was fascinating just to be there.
We went shopping, ate out too often and just had a good time being together. It was rather like a honeymoon, but in reverse, if you will. Generally a honeymoon is when you start your married life. We were there in what, unfortunately, may be the end stage of our married life, but it was beautiful, none the less. We spent a lot of time holding hands and just looking at each other and the soft green scenery. It was good for us.
Next I want to take Kathy to Alaska! Maybe this summer.
Kathy was watching out for me the whole time, guarding me from the dangers all around. She watched what I ate, kept me away from folks who were coughing and did most of the things that required interacting with groups of people. One day I joked that I was going to eat a big bowl of fresh fruit at the meeting, and she got teary-eyed! So I couldn’t eat the fruit! Because of the dietary limits, I ate mostly cheeseburgers and fish and chips, and occasionally other fish meals. And I gained a little weight.
I attended every meeting during our time in Maui. It was good to hear experts telling us that estrogen really doesn’t become a toxic substance to women just because they turn fifty, as many of the lay media would have us believe. And we were taught more about osteoporosis, breast cancer, abnormal pap smears and more. It was the best educational meeting I’ve been to in a long time. And when it was over, we headed home.
The ride home was tough, worse, I think, than the ride to Germany. The plane left Maui at 10:00 at night. Care to guess when we were at the airport? That’s right, we were there at 6:00! There was only one other couple at our gate, and they were coughing, so Kathy took me to the far end of the terminal where there were no other people and we spent time there, reading and talking. The plane left on time, and got to LA about four hours later, at 4:15 AM, where we had to change planes and had about a two hour layover. Then we boarded the plane to Denver, getting here at about 9:30 or so. The reason the plane ride was so tough is the layover in LA. On the flight to Germany, though it is longer, you can sleep. We had no real good length of time on this trip in which to sleep.
Before we went home, I went by the clinic to get a blood count done because my doc needed to see what my blood counts were by the next day before deciding what we were going to do. Then we spent the rest of the day doing errands. And that’s the end of Chapter 4.
CHAPTER FIVE: Yesterday Kathy and I got ready for the next round of chemo. We packed up all the stuff we’ve found we need for those days. Since yesterday was to be a Rituxan day (a long day), Kathy had lunches made for us, I had my CD player and my reading material, and Kathy brought along the quilt we’re STILL working on for Brooke, our younger granddaughter. We got to my doc’s office on time and he got there just a bit late, after making his hospital rounds. Brian pulled up my blood count from the day before, which I hadn’t yet seen, and gave us the news. It was kinda like a good news/bad news, or maybe a good news/good news result. First, the Neupogen worked well. My neutrophils had gone up from close to zero (remember, they were at 200 with normal being 150 to 7500) to 3000; they were back in the normal range. However, my platelets had dropped to 110,000 from 200,000, and my total white count was still only 2,000. Other good news was that my lymphocytes (among which the leukemic cells hide out) had stayed down at 300. The bottom line was that after four weeks since my last infusions, I was still in a nadir! My stem cells, the cells in the bone marrow that create all the other cells, were pleading for mercy! They are pretty well depleted and not able to recover as they had during the first three cycles. As my doc said, “We’ve knocked off so many cells that now we’re just beating the crap out of the good cells!”
So, he is stopping the chemotherapy after just the four cycles I’ve had. I’m not sure what to think of this development. In theory, if we’ve gotten to the point that we’re killing off normal cells, then the leukemic cells, which should be more sensitive to the drugs, should be gone. In theory! On the other hand, if even two or three leukemic cells remain, they can come back. I’ve been happy that we’ve been on the offensive in the fight against this disease. Now we’re going to be passive again. If I can, I’m going to try to talk him into giving me a couple of more cycles later, but I guess we have to be careful...I do need to have some marrow cells left at the end of the treatment.
I asked what we’d do next. Well, we’re going to do another blood count in a couple of weeks, to see if my marrow is recovering, then one more two weeks later, with another bone marrow biopsy at that time. The bone marrow biopsy will tell us if we seem to have cleaned out the marrow. He’s going to have them run a flow cytometry (remember that test from the early DGA letters?) and see if they can detect any leukemic cells. And then? Brian said we’d watch and wait. In other words, we’ll just do blood counts and see what happens to my white cell counts. And if they go up, we’ll have to see what might be available because as of right now, there is no other real treatment.
And so, that’s the end of this verse. We’re going to follow my blood counts for a while and when they get back close to normal I can go back to work, probably some time in December or by early January, at the latest, though Brian said that this time of year is a bad time to go back, with all the coughs and colds and with the influenza season about to start. But, if we can screen out the sick patients, I should do pretty well.
That’s about all for now. I’ll be back if/when anything significant happens.
Later,
Dave
Monday, November 4, 2002
A Low White Count Supplement
Dave’s Great Adventure
Chapter 4, Verse 4
November 4, 2002
A Supplement
I thought I’d send out just a short update to let you kind readers know what happened to my white count and what we’re doing about it. I believe at the end of my last “episode” I said we’d be getting another white count on Friday (November 3) and see if I needed any treatment.
I had the blood drawn Friday morning, but the lab was having some trouble with their auto analyzers so we didn’t get the results until late Friday evening, just at quitting time. My doc had left work by then, but the counts were roughly the same, but just up slightly. My white count had gone up to 1,500 from 1,100, and my neutrophils, more critical at this time, had edged up just slightly, to 200, still critically low. I was feeling well, and so I waited until Monday to see what we needed to do. Meanwhile we had Kathy’s sisters and their spouses visiting at the house for the weekend. One of the sisters had a little cold, with a scratchy throat and a little cough, so we tried to avoid getting too close to each other during the weekend, and we spent our time sucking zinc lozenges and taking echinacea tablets (do they REALLY do anything?). So far I seem to have avoided any signs of having contacted her virus.
Today I got a call from my doc. He’s concerned that my white count didn’t recover any better than it did, so he wants me to take the Neupogen, the medicine I mentioned to you in the last letter. Neupogen is a growth factor that promotes the growth of neutrophils. It also has to be given by injection, so I had to go to the clinic today to learn how to give myself injections of the stuff for the next five days. It shouldn’t be too awfully difficult for me to do. They fixed me up with all the syringes and needles I’ll need for the five day course of the medicine.
Did I mention that five days of the stuff cost almost $1000! One vial a day, at almost $200 each. Of course, it’s important stuff, since I really need those neutrophils.
Brian said we can still go to Hawaii. There is a Kaiser (the company I work for) clinic not too far from the hotel where we’ll be staying, so I will know where to go for help if I start feeling sick. However, you may remember some of the dietary restrictions I have during my nadir times, right? No fresh fruits and vegetables?? Well, that will apply to me throughout our time in Hawaii since my white counts are so low. So, I’ll be in a tropical paradise, surrounded by fresh fruits and juices, and won’t be able to eat any of them! I guess I’ll just have to have bacon, eggs and potatoes for breakfast everyday.
When I get back I’ll have another blood count done to see if my marrow has recovered enough to get the next round of chemo. There is a good chance that I’ll have to wait an extra week or more before I can have the next round, since my stem cells in my marrow seem to be so depleted right now. I hope we don’t have to wait, but I guess I don’t really want to wipe out my marrow either!
Anyway, tonight I give myself my first shot of the Neupogen at bedtime and then we get up about 3:00 AM tomorrow to catch a 6:55 AM flight to Los Angeles. Then we catch another flight from there to Maui, which will arrive about noon, local time. We’ll be plenty tired by tomorrow afternoon. Temperatures in Hawaii lately have been about 85 (29 C) degrees during the day and about 78 (25 C) at night. Eat your heart out, you folks in Iowa, Colorado and Illinois! We’ll get another letter out when we get back, or within a day or two, and let you know how we did and what we’re going to do about the next round of chemo.
Later,
Dave
Chapter 4, Verse 4
November 4, 2002
A Supplement
I thought I’d send out just a short update to let you kind readers know what happened to my white count and what we’re doing about it. I believe at the end of my last “episode” I said we’d be getting another white count on Friday (November 3) and see if I needed any treatment.
I had the blood drawn Friday morning, but the lab was having some trouble with their auto analyzers so we didn’t get the results until late Friday evening, just at quitting time. My doc had left work by then, but the counts were roughly the same, but just up slightly. My white count had gone up to 1,500 from 1,100, and my neutrophils, more critical at this time, had edged up just slightly, to 200, still critically low. I was feeling well, and so I waited until Monday to see what we needed to do. Meanwhile we had Kathy’s sisters and their spouses visiting at the house for the weekend. One of the sisters had a little cold, with a scratchy throat and a little cough, so we tried to avoid getting too close to each other during the weekend, and we spent our time sucking zinc lozenges and taking echinacea tablets (do they REALLY do anything?). So far I seem to have avoided any signs of having contacted her virus.
Today I got a call from my doc. He’s concerned that my white count didn’t recover any better than it did, so he wants me to take the Neupogen, the medicine I mentioned to you in the last letter. Neupogen is a growth factor that promotes the growth of neutrophils. It also has to be given by injection, so I had to go to the clinic today to learn how to give myself injections of the stuff for the next five days. It shouldn’t be too awfully difficult for me to do. They fixed me up with all the syringes and needles I’ll need for the five day course of the medicine.
Did I mention that five days of the stuff cost almost $1000! One vial a day, at almost $200 each. Of course, it’s important stuff, since I really need those neutrophils.
Brian said we can still go to Hawaii. There is a Kaiser (the company I work for) clinic not too far from the hotel where we’ll be staying, so I will know where to go for help if I start feeling sick. However, you may remember some of the dietary restrictions I have during my nadir times, right? No fresh fruits and vegetables?? Well, that will apply to me throughout our time in Hawaii since my white counts are so low. So, I’ll be in a tropical paradise, surrounded by fresh fruits and juices, and won’t be able to eat any of them! I guess I’ll just have to have bacon, eggs and potatoes for breakfast everyday.
When I get back I’ll have another blood count done to see if my marrow has recovered enough to get the next round of chemo. There is a good chance that I’ll have to wait an extra week or more before I can have the next round, since my stem cells in my marrow seem to be so depleted right now. I hope we don’t have to wait, but I guess I don’t really want to wipe out my marrow either!
Anyway, tonight I give myself my first shot of the Neupogen at bedtime and then we get up about 3:00 AM tomorrow to catch a 6:55 AM flight to Los Angeles. Then we catch another flight from there to Maui, which will arrive about noon, local time. We’ll be plenty tired by tomorrow afternoon. Temperatures in Hawaii lately have been about 85 (29 C) degrees during the day and about 78 (25 C) at night. Eat your heart out, you folks in Iowa, Colorado and Illinois! We’ll get another letter out when we get back, or within a day or two, and let you know how we did and what we’re going to do about the next round of chemo.
Later,
Dave
Thursday, October 31, 2002
Low White Cell Counts, and Hat Tricks
Dave’s Great Adventure
Chapter 4, Verse 3
October 31, 2002
It’s limbo time....
My apologies to anyone younger than 30 or older than 60 who has no idea what the limbo is. It was (is?) a “dance” that was popular in the 60s (coming over from the Caribbean islands) during which people tried to get under a stick that was progressively lowered after each try. The DJ at the dance would say, over and over, “How low can you go?”
That’s the question we’re asking right now. I had a blood count done at my nadir, last Friday (five days ago, now), and got the results back Tuesday. My counts, which had been doing okay, have sort of fallen off the edge of a cliff. Actually, my red cell count is still very normal, but my platelets are down to 126,000. That’s sub-normal, but not dangerous. However, my white cell count is concerning now. It has been in the 2,500-3,000 range, low but adequate. Suddenly, it’s only 1,100. And my neutrophils, the “good guys,” have dropped to 100! That’s damned near zero, the way I see it. It looks like my marrow, where the cells are made, is surrendering to the chemotherapy, having been blasted so many times in the last four months! So, because my white counts are so very, very low, Kathy has me quarantined in the house to keep me away from crowds. I’m very susceptible to just about any kind of bacteria or viruses at this point. I also cancelled just about all the work I had been able to arrange in the clinic for the next couple of months. You know, sick people tend to congregate there! I probably shouldn’t spend much time there if I can avoid it.
I don’t really know if I should travel. I’ve called my doc’s personal message number a little while ago and asked about that but haven’t gotten an answer yet. Since I’m still in even more of a nadir, or low point, than usual, I still can’t eat fresh vegetables, fruits, etc. The nurse I talked to at the Oncology clinic also said I need to practice good hand washing, take my temperature if I think I have any signs of a fever, and avoid sex! Well, that wasn’t much of an issue anyway. I guess she’s telling me that sex really is “dirty!”
Hey, I found out where the term “hat trick” came from. None of the sports savvy members of my family came up with any information, but Kathy’s sister Sharon in Bozeman, Montana and her uncle Jim Griffith in Arizona both sent me the derivation of the term. We all knew that is was some sort of ice hockey term for getting three goals in one game. Well, it turns out that before it was an ice hockey term, it was a cricket term in England. It dates from about 1877 and was used to describe taking three wickets off with three successive bowls (whatever that means). This entitled the bowler to receive a hat from his cricket club to commemorate the achievement. By 1909 it was being used in other sports as well to describe getting three of anything in one game. So, there you have it!
So where were you in 1988? Back when my pills were new. Natalie Campos, our son Jon’s girlfriend, wrote in to say that in 1988, when our eldest was starting college, she was starting middle school! I guess the age difference would have made quite a difference then, but means nothing now. By the way, Natalie, my neutrophils are still waiting for those jokes! They didn’t get here in time. (I’m making reference to a line from several DGAs ago in which Natalie had written that she’d tell jokes to my neutrophils since they were “depressed.”)
Our son-in-law Dan wrote to me to suggest that if I in fact elected to die in our home that Kathy could tell prospective buyers that there was a friendly Gyne (Frauenarzt) ghost in the house who would do pap smears for the new inhabitants! Hmmm, I wonder if that would make them feel better or worse!
Our friend Claudia Koetzle in Germany, who lives in the little town of Dettenheim, not too far from Karlsruhe, wrote another nice letter after she and her SF 49ers-loving husband Mike got back from a vacation in southern France. She had written in several months ago after I trashed (schmaehen) Las Vegas to add her comments. She and Mike have been to America several times to visit our wonderful national parks. They’ve probably seen more of them that we have. Anyway, they visited Las Vegas a few years ago and she had to admit that they had walked around taking pictures of the outrageous hotels. The way she so accurately put it, it was amazing to see what could be done in the absence of any common sense and against all obstacles! As an example, all the fountains in the middle of the desert!
I just got a call back from my doc. He’s not too worried about my low counts. He says I can still travel, and that I should get another blood count tomorrow. If it’s still very low, we can try some stuff called Neupogen, a medicine that boosts the production of neutrophils, before I travel.
Well, today is Halloween. There is snow on the ground here as there seems to be just about every Halloween since we moved here. All the little kids who come around for candy are always so cold that most of the Trick-or-Treat-ing is over by about 7 PM or so. Speaking of Halloween, Claudia notes that it’s getting to be a big thing in Germany too, in recent years. Halloween is an American tradition that adults are adopting, as all American are aware. Well, the Americans in Germany brought the tradition to Germany and we often had German kids coming to our door looking for candy on Halloween. In fact, the Americans had a great big Halloween party at the Frankenstein castle in Darmstadt (south of Frankfurt) for many years until it became too, too popular and unmanageable. Well, now Claudia says it’s being promoted by the folks who manufacture costumes and decorations and folks get together in their Halloween garb, drink too much and do stupid things. Sounds like an American tradition, all right!
Kathy just yelled for me to look out the back window. There was a big, beautiful coyote (Steppenwolf) in our back yard. It looked like it was trying to find some rabbits or birds for lunch. In the absence of wild fare, they also start looking for dogs and cats left outside. We lose a lot of small animals in the neighborhood to the coyotes, especially to people new to the neighborhood who don’t realize the dangers of leaving their pets outside.
I guess that is all for now. We will be having company in the house for the next three days and then we’ll hopefully be going to Hawaii, so I probably won’t get another update out until after about November 11th or so.
Bye for now....
Dave
Chapter 4, Verse 3
October 31, 2002
It’s limbo time....
My apologies to anyone younger than 30 or older than 60 who has no idea what the limbo is. It was (is?) a “dance” that was popular in the 60s (coming over from the Caribbean islands) during which people tried to get under a stick that was progressively lowered after each try. The DJ at the dance would say, over and over, “How low can you go?”
That’s the question we’re asking right now. I had a blood count done at my nadir, last Friday (five days ago, now), and got the results back Tuesday. My counts, which had been doing okay, have sort of fallen off the edge of a cliff. Actually, my red cell count is still very normal, but my platelets are down to 126,000. That’s sub-normal, but not dangerous. However, my white cell count is concerning now. It has been in the 2,500-3,000 range, low but adequate. Suddenly, it’s only 1,100. And my neutrophils, the “good guys,” have dropped to 100! That’s damned near zero, the way I see it. It looks like my marrow, where the cells are made, is surrendering to the chemotherapy, having been blasted so many times in the last four months! So, because my white counts are so very, very low, Kathy has me quarantined in the house to keep me away from crowds. I’m very susceptible to just about any kind of bacteria or viruses at this point. I also cancelled just about all the work I had been able to arrange in the clinic for the next couple of months. You know, sick people tend to congregate there! I probably shouldn’t spend much time there if I can avoid it.
I don’t really know if I should travel. I’ve called my doc’s personal message number a little while ago and asked about that but haven’t gotten an answer yet. Since I’m still in even more of a nadir, or low point, than usual, I still can’t eat fresh vegetables, fruits, etc. The nurse I talked to at the Oncology clinic also said I need to practice good hand washing, take my temperature if I think I have any signs of a fever, and avoid sex! Well, that wasn’t much of an issue anyway. I guess she’s telling me that sex really is “dirty!”
Hey, I found out where the term “hat trick” came from. None of the sports savvy members of my family came up with any information, but Kathy’s sister Sharon in Bozeman, Montana and her uncle Jim Griffith in Arizona both sent me the derivation of the term. We all knew that is was some sort of ice hockey term for getting three goals in one game. Well, it turns out that before it was an ice hockey term, it was a cricket term in England. It dates from about 1877 and was used to describe taking three wickets off with three successive bowls (whatever that means). This entitled the bowler to receive a hat from his cricket club to commemorate the achievement. By 1909 it was being used in other sports as well to describe getting three of anything in one game. So, there you have it!
So where were you in 1988? Back when my pills were new. Natalie Campos, our son Jon’s girlfriend, wrote in to say that in 1988, when our eldest was starting college, she was starting middle school! I guess the age difference would have made quite a difference then, but means nothing now. By the way, Natalie, my neutrophils are still waiting for those jokes! They didn’t get here in time. (I’m making reference to a line from several DGAs ago in which Natalie had written that she’d tell jokes to my neutrophils since they were “depressed.”)
Our son-in-law Dan wrote to me to suggest that if I in fact elected to die in our home that Kathy could tell prospective buyers that there was a friendly Gyne (Frauenarzt) ghost in the house who would do pap smears for the new inhabitants! Hmmm, I wonder if that would make them feel better or worse!
Our friend Claudia Koetzle in Germany, who lives in the little town of Dettenheim, not too far from Karlsruhe, wrote another nice letter after she and her SF 49ers-loving husband Mike got back from a vacation in southern France. She had written in several months ago after I trashed (schmaehen) Las Vegas to add her comments. She and Mike have been to America several times to visit our wonderful national parks. They’ve probably seen more of them that we have. Anyway, they visited Las Vegas a few years ago and she had to admit that they had walked around taking pictures of the outrageous hotels. The way she so accurately put it, it was amazing to see what could be done in the absence of any common sense and against all obstacles! As an example, all the fountains in the middle of the desert!
I just got a call back from my doc. He’s not too worried about my low counts. He says I can still travel, and that I should get another blood count tomorrow. If it’s still very low, we can try some stuff called Neupogen, a medicine that boosts the production of neutrophils, before I travel.
Well, today is Halloween. There is snow on the ground here as there seems to be just about every Halloween since we moved here. All the little kids who come around for candy are always so cold that most of the Trick-or-Treat-ing is over by about 7 PM or so. Speaking of Halloween, Claudia notes that it’s getting to be a big thing in Germany too, in recent years. Halloween is an American tradition that adults are adopting, as all American are aware. Well, the Americans in Germany brought the tradition to Germany and we often had German kids coming to our door looking for candy on Halloween. In fact, the Americans had a great big Halloween party at the Frankenstein castle in Darmstadt (south of Frankfurt) for many years until it became too, too popular and unmanageable. Well, now Claudia says it’s being promoted by the folks who manufacture costumes and decorations and folks get together in their Halloween garb, drink too much and do stupid things. Sounds like an American tradition, all right!
Kathy just yelled for me to look out the back window. There was a big, beautiful coyote (Steppenwolf) in our back yard. It looked like it was trying to find some rabbits or birds for lunch. In the absence of wild fare, they also start looking for dogs and cats left outside. We lose a lot of small animals in the neighborhood to the coyotes, especially to people new to the neighborhood who don’t realize the dangers of leaving their pets outside.
I guess that is all for now. We will be having company in the house for the next three days and then we’ll hopefully be going to Hawaii, so I probably won’t get another update out until after about November 11th or so.
Bye for now....
Dave
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