Induction Week 2/4: Ommaya and Bone-Marrow. Bone-Marrow Scan: Clean.

Over the hump now of the week, had the 3rd of 5 Ommaya port taps this morning, so past the hump on that one. On Monday, I had one infusion to treat the bone-marrow part, the Daunorubicin, but the team held the Vincristine because of an increasing amount of neuropathy in my hands over the previous week. An interesting aspect of the Daunorubicin is the red-color of it. This week I went pee 20 minutes after the infusion, and my pee already had red tinge to it. Shows how quickly the bodily systems work: from blood stream to urine in 20 minutes. Fascinating. I took Dexamethasone (20mg, two-days in a row) to start the week, This week I experimented with taking the full dose in the morning, instead of half in the morning and half in the afternoon, which was better because I felt sleepier at bed-time. I didn't do this the first week because I tried morning-loading two years ago, and I thought the all-at-once cortical steroid rush to be too unpleasant.  However, this week taking it all in the morning felt fine. While not the biggest victory, achieving minor victories is what its all about in the reduction-of-side-effects game. Unfortunately, a decent amount of my planning and mind-wanderings go to tinkering my schedule and methodology to reduce side-effects. And that's just how life goes when in treatment.  

I received some good news on Monday related to my bone-marrow scan a week ago: that it was absent of leukemia cells at the molecular-sensitivity level. In recent years, technology has advanced and molecular-genetic testing has become more common for scanning for leukemia cells. It's ten times more sensitive then flow cytometry, what we had been using before this test. As Dr. Shustov was explaining it, I found myself rapidly dusting-off the memory from freshman year genetics.  As I understand it, the lab can sequence the exact leukemia mutation I had to a confidence of two base-pairs and then test specific, probable b-cells for that mutation . What does it all mean? It gives us more confidence that the marrow is clean, but still doesn't give absolute certainty. But in this marrow sample taken from my right-hip, they found none, and that is some information to go on.  As with any new, complicated technology, I'm putting some blind trust in it.  I really hope the lab techs were paying attention when they were sequencing my mutation. I don't know whether this information will change the treatment plan, I doubt it, but it might change it a little bit in terms of dosage and length. Knowing how to treat leukemia when you don't see it in the scans is tough: it's less stick-to-the-book than the traditional treatment plans. Knowing how long to treat is a complicated judgement call, and I'm relying on the expertise of the team for that one.  

The UW quarter starts up next Wednesday, and I'm thinking I'll enroll part-time. It will be nice to get out of the apartment more and get the community of my classmates and campus-life.  We've been having some excellent fall weather this week: 65 and sunny, just a bit crisp, and clear air. I'm adding a pic of Mt. Rainier I took from the apartment kitchen last night as the day was ending.  The mountain was out and looking great!