The Treatment

My doctor is a slightly-disheveled busy-looking man, perhaps in his 40s, with round glasses and kind features. He speaks near perfect English and seems very competent. Both Aylee (my Dutch colleague who comes with me to this appointment) and I am relieved.

The treatment is standard R-CHOP chemotherapy, to be administered every 3 weeks for 8 cycles. Thus, 6 months in total. There are usually fewer chemo cycles involved, but my doctor thinks that for a tumor this size, 8 will be required.

After 6 months, I'll get a full CT scan and a bone marrow biopsy, to determine whether there's any cancer still present. If there is, then we'll discuss the possibility of radiation treatment.

The decision of when to receive the bone marrow biopsy resulted in a little mental tussle between me and the doctor. It's standard practice to have one at the start of treatment, but I didn't see the point. The doctor admitted that the results of the biopsy wouldn't change the treatment plan one bit; it would only change prognosis. In general, spread to the bone marrow with this sort of cancer is a rare occurrence. I didn't think it would benefit me much to find out that my prognosis was worse than expected; in fact, it would probably only serve to dampen my spirits. I argued instead to have the biopsy as a check at the end of treatment, and in the end, he agreed.

Because the cancer symptoms seem to be worsening so fast, and I am anxious to start treatment immediately, the doctor also agrees that I can start taking prednisolone along with alluprinol that very day. He schedules my first chemo treatment for Friday, which is the earliest I can get one. I have an appointment with the nurse to discuss the treatment on Thursday morning.

He also very rapidly fills two prescription pad sheets with an arsenal of the drugs that I am to take orally at home.

Prednisolone to kill tumor cells
Slow-release Oxycodon HCl Sandoz for the pain I was having at night
Fast-release OxyNorm, in case the Oxycodon wasn't enough
Kytrol to be taken against nausea and vomiting twice a day for the first 3 days in the chemo cycle
Metoclopramide HCl to be taken as needed for nausea anytime after Chemo Day 3
Magnesium Hydrochloride PCH, for the common side effect of constipation
Allopurinol Sandoz 300, to prevent kidney complications

Then, from the front desk, I get a thick binder listing pages and pages of potential side effects and what can be done to address them, all in Dutch, with a promise that all my other questions will be answered in due time during my Thursday interview with the nurse.