We have met the devil and her name is Vincristine.

As lovely as it's been having Andrew home, he has had a very rough time of it.  The last little pop of chemo they gave him before he left the hospital had some crazy awful side effects. You know, you can read about it to prepare yourself, but until you experience it you have no idea what's really about to happen.  I keep telling Andrew that it's only because he's so Young and Virile that they're able to subject him to such a torturous regimen, but alas, Vincristine has also dampened his sense of humor. ;)

He was feeling pretty good those last few days at the hospital, up until around the last day.  Although all of his blood counts were fine to go home, he started feeling pretty low with abdominal pain and fatigue.  It's continued in different ways with each passing day.  We were a little befuddled at first, as well as a little freaked out (I wanted to call the doctor at one point, but Andrew was convinced they'd put him right back into the hospital so we practiced some "watchful waiting"). After a little additional research we realized that he was still having after effects from the Vincristine.  According to the literature, Vincristine can cause fatigue, constipation, painful extremities, hair loss, nausea, mouth sores, metallic taste, mental confusion, insomnia -- all of which Andrew got to experience!  But the freakiest part (for all of you science weirdos) was the 2 days of non-stop urination that follows the death of a billion cancer cells.  I made a few trips to the store for gallon jugs of Gatorade to restore the balance.  I had to reread my own blog to find the part where Dr. W warns us of this happening.  Now we know.

The other news is that last Friday we saw our WMC doctor, (Dr. Liu) in his office for the first time.  Andrew had to have another bone marrow biopsy to see how that situation is all progressing.  He was absolutely dreading it after the first painful experience, but Dr. Liu appears to have the magic touch because it was pain-free this time.  Dr. Liu was pretty adamant that Andrew will have to undergo a bone marrow (stem cell) transplant after the 6th cycle.  The purpose of the transplant is to help prevent the lymphoma from returning.  The hope is that after the 4th cycle of chemo, Andrew's own marrow cells will be clean and can be harvested for the transplant.  The riskier path is to have matched donor cells used -- this approach tends to have more complications.  But they said he's already had such a dramatic response to the first cycle, that I'm very hopeful that his own marrow cells will be good to go.  We were hoping to forgo the transplant, but apparently it's not advisable due to the aggressive nature of his lymphoma. So that should be fun.  :(

The other interesting bit, is that the WMC team of pathologists, as well as Dr. Liu are a bit confused by Andrew's particular cancer.  They wanted to re-examine all of the pathology slides to confirm the Large B Cell diagnosis, because it still exhibits many characteristics of Mantle cell. Ultimately, Dr. Liu told us that they couldn't really confirm that it's one or the other with 100 percent certainty.  He said it's like 2 different lymphomas at once -- it has some of the markers of Mantle, and some of Large B Cell -- a very rare case.  The treatment is the same, so that's not at issue.  The pathologist has a theory that it began as a low grade, slow growing lymphoma that for some reason, one day turned very aggressive.  Dr. Liu, said he's not sure if he buys that theory, but they really don't know, only that it's very unusual.  Maybe his case will end up in some textbook someday ...

We're back to WMC on Tuesday to begin round 2, which is the B cycle (of alternating A and B cycles).  The nurse told us that the B cycle is "really intense".  Umm, you mean more intense than A?  Oh Lord.