Thursday, March 26, 2009

Day +57 - PUVA, UTI going away, cold symptoms

Johanna and I celebrate a long week with a banana split hot fudge sundae!

Well, the steroids must be kicking in because it's 2 in the morning and I've got a bunch of newfound energy. I just finished folding the laundry, emptying the trash, downloading 3 new CDs from, and cleaning the house. I'm on a chronic GVHD taper schedule at the moment, which means that I alternate between 15mg and 60mg of Prednisone each day and the steve-totally-wired effect seems to be delayed by about a day. Yesterday was the 15mg dose, and today I was worthless all morning and afternoon. I started by taking Johanna to work, dropping by the SCCA clinic for my regular dose of tanning bed treatment to help with the GVHD, then I headed back home, watched a movie, and fell asleep on the couch for a couple of hours. After I woke up, I thought I should probably get more sleep to help fight off this newfound cold I caught, and went upstairs for another few hours of sleep. By then it was around 4pm, so I dropped in to watch my dad put in sheetrock at my sister and brother-in-law's basement, then I headed back home where I lounged around again, totally unmotivated to do anything until Johanna came home. It wasn't until after dinner that the 60mg dose of steroids from this morning finally kicked in, and here I am, totally wired and ready to re-organize the garage, the house, you name it. Tomorrow I expect it to taper off again, and by the next day I'll probably be totally worthless again. It's a weird life I lead.

These last 2 weeks have been the roughest so far. My uncle commented the other day, "suck it up!", and that made me laugh out loud. I remember thinking back to when I read Into Thin Air, the book about the climbing disaster on Mount Everest. The thing I thought was most interesting was that most of the folks that tackle Mount Everest aren't great climbers. In fact, many had never climbed before at all and go to Mount Everest with brand-new gear they may have never even tried on. But they all have one thing in common, which is a total determination and drive to make it to the top of the mountain no matter what. Their stories include them going up with broken ankles, broken toes, splitting headaches, lack of food and water, and all kinds of colds and coughs and respiratory diseases, but it doesn't stop them from pushing to the top. So I was thinking, I bet these guys would just laugh off a urinary tract infection like it was a chapped lip. Anyway, I'm not sure I'll ever have that kind of determination and drive, but I am happy to report that the UTI has cleared up for the most part, which deserves a huge halle-freakin-lujah, and has put me in a much better mood the last few days. Guys, it's reported that women will suffer from UTI *50* times more often than men during their lifetime, so say something extra nice the next time they come down with it.

I've totally fallen off the bandwagon as far as my daily walks go, and it's affected my mood in a big way. Now that all these annoyances are finally clearing up, I'm looking forward to getting back into the swing of things. I'm way behind on my Planet Money and This American Life podcasts as well.

Here's what's has been going on.

Last weekend I came down with a nasty cold. Johanna picked it up from work, so it was pretty much impossible for me not to avoid it. The surprising thing is that I didn't come down with a fever, so other than dealing with a runny nose and a cough, it hasn't been unlike getting a cold when I've been healthy. I was worried that if I ever came down with a cold during this time, that it would be an immediate trip to the hospital along with shaking chills and awful fevers. So either the antibiotics or the new stem cells are doing their job. Yesterday was probably the worst day as far as cold symptoms go, so the cold may already be clearing up. The only annoying part about this whole cold thing is that when I go to the SCCA I'm technically in "Respiratory Isolation", so I have to wear a mask everywhere I go and all the nurses and doctors have to gown up around me. I also have to sit in specially designated areas in the waiting room, and people generally treat me like a pariah even though they don't realize it. It's understandable I suppose, since I was pretty paranoid too when I left the hospital, but it's hard to feel normal when all the formalities make you feel like such a sick person. I even got in trouble last Monday for entering a crowded elevator, since folks in respiratory isolation are encouraged to take empty elevators. Argh! The clinical trial that I'm on, the one where I visit the "snot guy" every week, detected that I had the virus last Friday before I even started having symptoms. So they immediately reported it to the clinic which called me to tell me about it right after, so it's impossible to try and hide it even if I wanted to :) I have to admit it is pretty neat to be under such a level of care that you're notified when you have a cold virus before you even know it.

My skin biopsy for skin GVHD came back positive last week, which wasn't unexpected. We assumed it was GVHD, but the main point of the biopsy was to rule out a rash due to the Voriconozole anti-fungal medication I'm taking. Between 50% and 90% of transplant patients get GVHD of some kind, so it's not really a cause for concern. I feel lucky since my GVHD seems to be only affecting my skin. Other organs that can be affected include the liver, the gut, the bladder, and the eyes. Gut and liver symptoms may come later for people that get acute GVHD, the kind that occurs within the first 3 months after transplant, so I'm keeping my fingers crossed. It can take up to 5 years to be fully rid of GVHD, but like I've said before, everyone who has it says they would much rather be dealing with GVHD and alive than the alternative. The best treatment for GVHD is prevention, which is why I'm on a cocktail of immunosuppressive drugs including the Prednisone steroid, Tacrolimus drug, the Methotrexate chemotherapy I received after the transplant, and other drugs like Ciclosporine. I'm also using a topical corticosteroid that I rub into my hands twice a day.

To help with the overall skin GVHD, we started something called PUVA therapy last Monday, which stands for Psoralen and UV-A light. Basically it's tanning bed therapy, which seems strange since they keep stressing that I need to use plenty of sunblock when I go outdoors, since even a small sunburn can cause GVHD to flare up which would require a bunch of steroids to get it back under control. So when they said they're going to treat me by having me take drugs which would make me extremely photo-sensitive then subject me to direct UV radiation, I was a little worried. But the UV radiation only lasts 30-60 seconds. It's just long enough to feel nice and cozy under the warm lights, then it's all over. I've had 2 sessions so far, and it takes longer to get undressed and dressed than the therapy itself. Each morning I take these funny-smelling green pills called Psoralen, the drug that causes photo-sensitivity, then I head down to the SCCA's tanning bed therapy room where I put on these tiny green swim goggles with UV protection and a special UV lip balm, then strip down and get in the tanning bed. It takes less than a minute and I'm done for the day. Unfortunately, the Psoralen drug stays in your system for 24 hours, so I have to be even more careful than normal about being in the sun for the rest of the day. They've been doing PUVA therapy for 20 years, and the results are pretty good. In some cases the skin GVHD has cleared up entirely after 5-15 sessions, so it's seems pretty worthwhile compared with the alternative types of treatment like steroids and other drugs. There is a small risk of skin cancer later, but again, the risks of steroids and the other drugs are relatively worse.

Not a lot else has changed in my schedule. We're trying to wean me off the IV magnesium and stopped it last week, so now I'm taking 8 tablets of the oral magnesium each day. Like milk of magnesium, this can affect your bowel movements in a not-so-good way (i.e. diarrhea), but luckily I've been able to tolerate the higher doses. Unfortunately, my most recent counts showed my magnesium levels starting to get dangerously low, so we had to order a one-time bag of IV magnesium yesterday to get it back up. Hopefully things will stabilize a little bit, but this is an example of how closely I'm being monitored. As another example, they noticed my phosphorous levels were low and recommended a change in diet for the next week. It definitely takes some effort to make sure I'm staying on top of this stuff. Even forgetting one dose or forgetting to flush my Hickman line can be a problem.

I was also a little depressed last week when I heard that a fellow blogger of mine, Michelle, relapsed at day 110 or so, after having perfectly good counts and an excellent prognosis during the entire 110 days after her transplant. She had already gone back to San Francisco to get back to a normal life, and is now having to deal with whether to come back to Seattle to re-do another transplant or start on more chemotherapy and treatment. My heart goes out to her. It reminds me that we can't take any of this for granted.

Anyway, maybe I'll have some pictures of me with a tan for the next post :)

Yum, home-made Pad Thai.

Blurry picture of Dad and Brian working on their basement.

Brian measures the insulation for the new walls.

Over and out.


George said...

I would have thought the first time you did the cell irradiation was the worst time you had.

They say a way to a man's heart is his stomach. But the way to your pain is your penis. Or something like that. I think Gandhi said it.

That is so neato that the snot guy found your virus before you felt it. Crazy!!

So how do you have to change your diet? More magnesium shakes?

rachael said...

I'm so glad the UTI symptoms are going away! Kick this cold's butt, and you'll be out walkin' in no time!
Take care, you are doing awesome!

Anonymous said...

That sundae looks awesome, and great to see your doing well Steve. Hope you fight off the cold quickly. Prayers are still with you man!

- Travis Storch

Cindy said...

Mmm, that sundae looks good.

Yay, great that the UTI is going away! I hope the cold goes away soon, too.

Funny that you get sporadic steroid-induced bursts of energy; gotta take advantage of those.

Sad to hear about the blogger, Michelle. I will look up her blog and see how she's doing.

You're kicking butt, Steve, no need to compare yourself to Mt. Everest climbers! It's ok to complain sometimes!