Andre's update: 2 weeks off, MTX next

Dear friends,

after two weeks at home we are getting ready for the next round. The chest x-ray Radhika took in Oceanside today indicates that there is no fluid in her lungs, and so tomorrow evening we will drive back to LA and then on Wednesday Radhika will start her second round of Methotrexate at Cedars.

These two weeks have seen some ups and downs, but in sum total they were good. Radhika came home on a Wednesday feeling very weak and still nauseated from the IFEX, but the constipation and the pain (thanks to the Fentanyl patch and the chemo being effective) were pretty much gone. The most difficult part was that Radhika struggled with depression, and felt desperately hopeless for the first week. After that, with the help of Ruth and Ranjeeta, we came to the realization that only part of that was the magnitude of the situation, but that the chemo also can affect your brain chemistry. I am very grateful that Dr. Forscher and his nurse Susan were available for us on the phone even during these off weeks, and that Dr. Forscher consulted an expert at Cedars and they prescribed Lexapro for Radhika (coincidentally the same drug that our friend Suvrat recommended.) The difference that half a pill of that made in just one night was astounding: Radhika woke up with a real smile on Saturday for the first time in weeks. Marcia saw first hand how much Radhika turned around in such a short time.

The nausea is much better, as long as Radhika watches what she eats. Food that is too acidic doesn't agree with her: she threw up a batch of blueberries one evening, but otherwise she hasn't had any incidents. We also try to be careful with garlic for dinner, since that sometimes keeps her up at night. I think her stomach is pretty delicate right now, and part of the nausea during the first 2 rounds was from taking too many medicines orally, especially the bicarbonate during MTX round 1, and the cocktail of nausea/pain/constipation pills during IFEX round 1. Tomorrow she will get a 5 day nausea patch (Sancuso) that should help keep the nausea down during MTX round 2, and we know now that if she feels seasick again what to do. I hope that between the patches and the IV drugs there won't be as much need for pills.

As far as the pain goes we had a scare, when on the first weekend home her back and shoulders started hurting. We both thought that the cancer was back with a vengeance, but a call to the on-call nurse Ulysses at Cedars reassured me: after IFEX your white blood cell count drops, so just before you go home they give you a shot of Neulasta to stimulate the bone marrow (which is of course in the bones!) to make white blood cells. He suggested Advil, and it worked rapidly to reduce her pain, and her white blood cell count recovered very rapidly. The last 3 days Radhika's pain has slowly been coming back again, but it is still nowhere near where it was 3 weeks ago. It is time to go for the next round.

One thing that makes me very happy is that thanks to Leticia we now have an apartment in LA for 8 months that, thanks in large part to Vivienne, Leticia, Kent and Marie, is already fully furnished and equipped. We only saw the outside the day before we left from Cedars 2 weeks ago, but Leticia has described it so vividly to me that I am really looking forward to seeing it. I know they have put a lot of thought and effort into making it a home away from home for us, which will give us the chance to recuperate between treatments.

Another nice thing is that our friend Latha just arrived for a week (she will take care of Mira while we are at Cedars), and then Kali will come for a week, followed by Anurag, and finally Radhu (all of whom will stay for a week to get me to the end of the semester.) We don't exactly know yet what the treatment plan will be, but I think that if the MTX this week is successful, then next week there will be MTX as well, followed by IFEX (it would be a reduced dose, like what she was getting at the end last time) or ADR the week after that.

Tax day today has not been kind to us, but that was more than made up by the fact that Radhika has no water in her lungs. It isn't always easy right now but with friends like you we know we can make it!