Well, sounds like the next 2 months are planned out at this point. First went to see the foot surgeon on Wednesday. He looked at the new x-rays and looked at my foot and decided that surgery would NOT be needed!!! He wants me to stay non-weight bearing for the next month, until June 1 and then come in again for an x-ray and hopefully will be able to start some walking on the boot.
These last few days my foot gets so sweaty in the boot…at night I hate having David taking the boot off because I know the sweat has done its work. So when the surgeon’s nurse went to take my boot off I told her sorry if my foot is stinky. She said to me “we knew that would happen when we decided to work this speciality!!” I guess if my foot was stinky it was not her first! :-). So at this point I know no walking on that foot, using the heel only for pivoting and just taking everything slowly.
That night about 8 pm Dr. Chen called me. She said your ears must have been burning because I have been talking to a lot of people. First she talked again to the surgeon and pathologist that did the pelvic biopsy. They both agreed that they did not get a significant sample and could only say what they did get was benign, but could not say a sample right next to it might not be malignant. Certainly removing the whole lymph node would be a good next step but with all the surgery already done on my left leg with the sarcoma removal the risk of lymphodoma in that left leg. And once you get lymphodoma you most likely would not get rid of it so that leg would always be larger than the other one. Chen even called the surgical team at Mayo and they confirmed that they felt that was too big of a risk to take to go back in and try to remove that full lymph node.
So Dr. Chen talked to the rest of her team at Park Nicollet and they all agreed with her 2 options that she outlined to us. First option would be to take a wait and see approach meaning taking PET scans every 3-4 months to check on the neck lymph node area and the pelvic lymph node area. We would never know when or if the activity would increase, but would most likely not go away on its own. Option 2 would be to start a Rituxan routine.
Rituxan is considered an antibody therapy. It can be used on its own or in conjunction with chemo. The plan is to start using it alone, and do scans to make sure it is doing what is expected. Rituxan targets and attaches to the CD20 protein found on the surface of blood cells with cancer and some healthy blood cells. Once attached to the CD protein it is believed that in works in different ways including: helping your own immune system destroy the cancer cells and destroying the cancer cells on its own. (Source: Rituxan.com). Dr. Chen said that the regime would be once a week for 4 weeks. The first session is usually 6-8 hours because they want to assure that I have no adverse effects. There can be side effects like chills, etc. but it would be if there are more adverse ones that they would start to slow down the process. It is very closely monitored with that first IV. The other 3 applications are usually down be a below the surface injection and not by IV, unless the insurance company does not approve the injection option. Although less time consuming for the patient, the injection is more expensive which is why the insurance company may decline.
David and I both decided that we would prefer to take the proactive approach and start the Rituxan regime. Waiting and wondering if the lymphoma has spread or gotten worse in the locations we are already aware of is just not what we would prefer to do. Dr. Chen said knowing me she assumed that I would prefer to take the proactive approach.
I did remind her that I have the broken bones in my foot and although no surgery is needed, I would prefer to wait to start until I may be able to do a little walking on the bad foot. Even if I could just move up to using the walker it would be better than now where I have to use a wheel chair. So the plan is to have the check up with the foot surgeon early the first week of June and then hopefully later that week start the first infusion.
I have done a good amount of reading on Rituxan and the side effects seem pretty minimal compared to chemo so hopefully it will do exactly what they hope. Seems like a good plan.
Yesterday I went back to PT and am really sore today. He definitely is pushing me but hopefully not too hard. I do want to get the strength back to where I was before breaking the bones!!
Raining again today…so look for some sunshine in your life!
Dandy Ventures 