Superbowl Sunday

Random Bits Knocking Around My Brain

I was a little surprised when my sternum started hurting me after the last two chemo treatments.  But what I found out is, in addition to the femurs and hips of personal bone-ache fame, the sternum is one of the 3 go-to bone factories for the manufacture of the white blood cells.  Little did I know. So we're killing off the abnormal white blood cells that equal my cancer and then hopefully manufacturing lots of healthy ones to take their place.  It's a lot of work, I'm guessing.  So it hurts.  Like working out really hard at the gym--no pain no gain!

One thing I learned through all this is that "white blood cell" isn't just a singular thing--there are many different types of white blood cells, and while they share functions related to protecting the body from threats to your health, they each have specialized jobs and characteristics, too.  

From the morning of a chemo treatment to the morning after a chemo treatment, my body weight goes up approximately 8 pounds.  And it takes about 7-10 days for that to disappear again.  Now that's some water retention!

The chemo oral rinse recipe for mouth sores actually works really well when you bite your lip or cheek and it gets super painful and you can't even believe that little bite turned into the sore that it is presenting to you now:  1 cup warm water, 1/8 tsp. salt, 1/4 tsp. baking soda.

Not me but you get the idea.

A cat tongue licking your bald head is a strange sensation.

Compazine, one of my prescribed anti-nausea drugs, is also used in the treatment of psychotic disorders like schizophrenia and also used in the treatment of anxiety.

This blog has had page views reporting origination in: the USA, the UK, Colombia, South Korea, South Africa, Australia, Romania, Ukraine, Russia, France, Germany, Belgium, Poland, India, and Mexico.  Hello (and all blame goes to Google Translate), Bonjour, Buenos Dias, Hallo, annyeonghaseyo, sata sri akala, Halo, Salut, Zdravstvuyte, Namaste, Hyalo, halea, and my apologies for not being able to figure out how to type with a Cyrillic, Korean, Bengali, (or other main Indian languages) alphabet.

And now, with no transition whatsoever, I am turning this into Science Sunday!  (I know, I tricked you.)  No football here.  Whoo hoo! Hooray!  We love science!  Yes!! (Although I will say, just on one tiny football note, the quarterback for the Panthers is, to make a gross understatement, very easy on the eyes.) 

Questions you never thought to ask but are indulgent enough to read  the answers to, because you humor me with your attention to this blog.  And I thank you.

Why is Andrea a Rituxan Super Fangirl? (Seriously, how can I cosplay that?) The short answer is that it satisfies my inner science geek just as much as it kicks my cancer's butt--and not trying to downgrade the CHOP meds by any means, but I'll admit I think Rituxan works in a little bit cooler Fantastic Voyage kind of way. Rituxan was also the very first  monoclonal antibody approved  by the FDA for targeted cancer treatment--so that rocks in itself.  Team Rituxan:  We're Number One! 

     What follows is my best stab at trying to describe how it works in a way that I can understand (Google Medical Library again to the rescue--any misinformation is my failure to synthesize Internet material or my poor choice of websites).  Be gentle with me, oh teachers of science--maybe you can just give me an A for effort?  Let's break it down:

Lymphoma is cancer of the lymph system, your body's immune factory. Lymphoma comprises many different specific cancers that fall under two categories:  Hodgkin's and Non-Hodgkins.  Non-Hodgkin's lymphoma comprises maybe 60 different cancers, is one of the most common cancers in the US, and all together makes up about 4% of the total cancers in the US.  My type, mediastinal large B-cell lymphoma, is a rare subtype of non-Hodgkin's lymphoma that makes up 2.4% of all those non-Hodgkins cases. (Long-shot at getting it, but better odds than winning the lottery, I guess.)

What is  Rituxan?  It is a a man-made antibody that, when introduced into your bloodstream, races around your body until it finds its soulmate, the B-cell lymphocyte. And that is where I have cancer--in those B-cells.  For now the cancer just wants to hang out in the lymph nodes to the left of my trachea and in that tumor, which is an accumulation of those jacked up B-cells.  With lymphoma the cancer can jump the express train of your lymphatic system and set up shop in any other part of your body where there are lymph nodes...and your body has a whopping lot of them.  I've read 550 and I've read 1,000. Whatever.  A whole bunch of stations on the lymphatic railway.  Thank goodness my cancer cells just want to hang out in one place!

You wrote blah blah blah lymphocyte: So what is a lymphocyte?   A lymphocyte is a small white blood cell, manufactured in your bone marrow, that produces T-cells, B-cells, and killer cells, which work differently within your body's immune system to attack foreign invaders such as bacteria and viruses.  For example, a T-lymphocyte scans your cells for infection and, once it finds something, kills the cell.   A healthy B-lymphocyte can recognize millions of different foreign molecules by their individual antigen markers (the ID badge for molecules foreign to your bod); once it finds a foreign cell it can grab hold of it and make a citizen's arrest, waving a red flag to alert the other fighters in the body to come kill it. The way you have and build immunity to foreign gack that manages to make it through your body's external defenses (like skin, mucous, all that good stuff) is that these immune system cells not only can identify as foreign things that enter your body BUT they remember what they did before so they can respond faster the next time that same bad juju gets in.  

Because of cancer, my B-lymphocytes are not dying off when they are supposed to, are growing too fast and too big, and they cannot do the job they are intended to do.  And their job is important.

If only your B-cells are affected, why can't your body just kill the lymphoma with T-cells and killer cells like it does all the other bad stuff that is introduced into your body?  Okay, I'm not going to pretend I can explain that fully because I really can't.  Killer cells routinely go around and kill cancer cells (rapidly dividing cells, supergrowers) and other nasty things in your body.  (Give your immune system a big hug right now!)  What I understand with this lymphoma is that a cancerous B-lymphocyte contains a specific protein molecule that effectively shuts down your body's own surveillance system and inhibits your immune system's ability to kill the cell even if it found it...which it can't with the molecule cloaking device in play.

How does Rituxan work with the B-cells?  Rituxan is drawn like a moth to a flame to those B-cell lymphocytes AND it hooks up to that specific protein camouflage molecule that exists only on that cancerous lymphocyte and nowhere else. Rituxan can't fit anywhere or do anything else. It's like a key in a lock--Rituxan can't do anything to any other cell but that one.  When Rituxan finds the abnormal B-cell lymphocyte, it's an instant shotgun wedding. Once the Rituxan  seals the deal with that protein, it is believed to do several things to eliminate the cancerous cell it's doing the tango with (muah ha ha ha!):

• Rituxan waves the red flag:  Other cells of the immune system (natural killer cells, T-cells, and macrophages) can saddle up to attack and destroy the now antibody-labeled B-cells. Take that, cloaking device!  You are served!
• Rituxan calls in specialized immune system proteins that punch holes to destroy the now outed abnormal B-cell.
• Rituxan hits that red button on the bridge of the Enterprise:  It triggers an internal signal that tells the tagged B-cell to self-destruct.

Rituxan has dramatically and positively changed the survival rate for people with B-cell lymphoma.  The change from the CHOP protocol to the R-CHOP protocol has been a total game changer.  So on my side are the following awesome factors that make up the checklist on the prognosis charts:  I've got Rituxan.  I'm younger than the average age of 65 for patients with B-cell lymphomas (although I'm right on target for mediastinal peeps).  My lymphoma tumor and affected lymph nodes are located above my diaphragm (below the diaphragm is not as good).  I only have one tumor in one place.  And my treatment began when I was only Stage II.  These all add up to a projected extremely high 5-year no-recurrence survival rate.

But wait, I thought you loved the R2D2 patch, too?  Ah, yes.  The Neulasta patch.  I love the convenience and techno-cool factor of the patch, but Neulasta used to be available only by injection, and I would love it that way, too.  I've even seen Neulasta commercials on TV now--maybe they have always been there but I just have a heightened awareness now.


Neulasta stimulates the manufacture of a specific type of white blood cell called a neutrophil, which ingests and destroys invaders.  I've read that neutrophils are in the first responder ranks of white blood cells, and I picture them like the Fantastic Voyage foamy white intruder-killing blood cells:  I am going to eat you!  On days 7-14 after chemo, your body is at a low for white blood cells because, well, the chemo has been killing them all--both healthy and unhealthy ones.  So Neulasta turbo-charges your neutrophil production, reducing both the length of time you are so very low in white cells and how low you actually go; this makes you much less susceptible to all kinds of infection and possible complications that you would normally be able to fight off but would have a hard time doing being so white-cell depleted after chemo.  

So I've got the Rituxin shutting off the cancer cells' cloaking devices at the same time the Neulasta is cranking up the manufacture of these Berserker neutrophils--and they can go get at the newly unveiled cancerous B-cells. Nice how they play so well in the sandbox together, don't you think?


Chemo Jams:  "House" by Air Traffic Controller, "Run" by Amy Macdonald, "The Story" by Brandi Carlisle, "Worst Day Since Yesterday" by Flogging Molly, "So Rock On" by Luscious Jackson, "Centipede" by Knife Party (my cancer is the tarantula and the chemo drugs are the centipede), "Waiting for the End" by Linkin Park, "Timshel" and "The Cave" by Mumford & Sons.