Eating Well and Touching Myself   November 5th, 2011

Okay, so maybe the title is a bit provocative, but enough time has gone by, with enough changes, that I thought I should post an update.

On the recovery side of things, while I am still not at full energy, I do find that my energy levels are going up by a tiny bit every day, and in fact, I’ve not had a daytime nap in a week. I am making sure not to overdo things, but every other day I go for a pretty long (and slow) walk to rebuild my strength and stamina.

The dry mouth is still here, with some days better than others, and my foods still need to be well lubricated (sauce is good!) or moist for me to be able to consume them.

More importantly, my taste buds are healing, and I’m able to taste more and more foods. I still find myself very sensitive to very tart (acidic) ingredients as well as spice (of the chili variety), but am now able to manage most normal foods and enjoy them reasonably well. Black pepper is fine now too. For example, in the last week, we’ve had Indian, Thai, and Chinese foods, and I’ve been able to eat all but the spicy dishes. Plus, of course, the fabulous creativity of Linda and Krystyana have been a key component as well. For example, last night they made 40 clove chicken (I only had one garlic clove, but two large drumsticks with the lemon garlic sauce the chicken was braised in).

I know I am still quite far from getting the full flavor of dishes and foods, but that will all come in time. And considering where I am now, relative to where I was just three weeks ago, it’s a huge world of difference already.

So, onto the “touching myself” aspect of this post…

When I was starting my TIL/TBI treatment at the National Cancer Institute in Bethesda at the beginning of October, I had a number of very palpable melanoma tumors in my right thigh, and the area the tumors for the TIL harvest had come from felt like someone had buried a baseball in my thigh – it was rigid with small lumps around it as well.

Flash forward to the present, and I can only feel (by touching myself – get it?) just one of the smaller tumors (there were over a half dozen) in my thigh, and the baseball shaped mound in my thigh has gotten quite soft as well. Considering that my weight is down to a svelte 200 pounds (down from 225 when I started treatment) – meaning I have lost quite a bit of weight, which should have made the tumors more pronounced if they were not shrinking, this suggests that some aspect of the treatment is working, and working much more quickly than expected. It’s not clear whether the IL-2 or TIL cells (or the combination thereof) are the cause, but either way, Linda and I are pretty jazzed by these rather noticeable early result. We haven’t said anything publicly sooner (although we noticed the tumors becoming less palpable over a week ago) because we wanted to be sure that trend was continuing (and it is). My doctor did tell me last week (after getting my excellent blood work results), that I continue to be ahead of the curve. So here’s to being an overachiever with a type-A personality!

We’re expecting that the scans coming up this next week at the National Cancer Institute will give us some further insight as to what’s happening internally, but outward appearances suggest that I am slowly heading towards NED. And that means being able to going back to living at home on Bonaire on a more permanent basis once again down the road. Woo hoo!

 

Finally, Back in Boston   October 20th, 2011

I had a bit of anxiety this morning when my nurse wandered into my room to tell me the computer scheduling system was requesting a blood draw, which would have required getting punctured, since my catheter had been removed last night. Apparently it’s something that was scheduled automatically based on a past order by the doctor and didn’t get canceled. I declined as advised, and the blood work was marked as “patient refused”.

During rounds the doctors had a bit of a laugh about this, and I was wished a pleasant voyage home.

By 11:40am we were on the shuttle bus to Ronald Reagan National Airport, and by 12:45pm we were checked in and past security (in my wheelchair). I managed the meat, cheese, and mayo of a McDonald’s quarter-pounder, and the fried fish rectangle with cheese and tartare sauce of a Filet O’Fish. Both went down pretty well. Mayo makes a great lubricant, and tartare sauce is pretty good too. No buns because they are dry and I am still adhering to my low-carb lifestyle as best I can. I think broiled duck is on the menu at home for tomorrow, and perhaps the schweinshaxe (pork knee/knuckle) from the freezer (which my Dad had sent me for my birthday) a few days later.

We had arranged SUV transport to get us and our seven checked bags, and five carry-ons, back to our apartment in Boston, and things just barely fit, but by about 4:30pm, we were finally back in the apartment. I cried tears of relief, elation, and happiness – I couldn’t quite believe we were finally here again after 24 days.

There is no place like home (“home” = Boston, and “home home” = Bonaire – hope to get there next spring, finally). Home is also where the cat is, and she was happy to see us and cuddle with all of us.

I rested for a while, and there’s been lots of unpacking going on, so I haven’t gotten to my steam shower yet, but we have two new humidifiers running now, and the dryness here is far less already than in my room at the clinic. The shower is coming before bedtime for sure, though…

This will probably be the last of my daily posts on the blog, as all I will be doing for the foreseeable future is continuing to heal and regain my energy and exuberance (but not too quickly, since that could set me back). I may provide occasional updates over the coming weeks as I discover something new to share. I will also once again notifying people on my e-mail list of updates to the blog starting with this post.

Also, anyone wanting to visit us at the apartment is welcome to do so providing they are not sick or have not been significantly exposed to sick persons within a day of visiting. Drop us an e-mail to confirm timing first though!

The next milestone will be my scans and clinic appointment on November 9th and 10th, and I will certainly post after that. I’ve been told not to have high expectations for the first scan, so please don’t get your hopes up either. Scan 2 in December will be a lot more telling, and should start to show my progression towards NED!

Signing off – tired but happy.

 

Day 12 – Happy, Happy Day!   October 18th, 2011

What a difference a day (and night) can make. My doctor came into my room early this morning to let me know that my neutrophil counts have soared to 6,960 from yesterday’s 1,960. As a result I was declared non-neutropenic, the warning signs were removed from my door, all my IV anti-biotics were stopped, and I’m down to a couple of pills a day. I will also no longer be getting the Neupogen shots, so my neutrophil counts will like drop a bit tomorrow, but will still be well above 1,000.

Also, my platelets are on the mend by my own body. I was at 20,000 yesterday, and 21,000 today. Still quite low, but improving on their own.

A little while later, during rounds, I was also informed I would be getting my Hickman port out, so I won’t have to deal with maintenance of the tubes in my chest anymore – because they won’t be there! I had expected to deal with them for another two months, but apparently they will no longer be necessary.

Talk about being surprised and elated!

I have also been scheduled to return for my first scan post-treatment on November 9th, so I will be flying in the day before with Linda and out on the 10th.

We fly home to Boston on Thursday afternoon. Tomorrow is a day of observation to make sure everything is still okay. It will also be a day of packing, as I have collected a lot of the comforts of home here – like towels, a bath mat, a duvet, collapsible notebook tables for use on beds, etc.

I also decided I need to get more protein and fat into my system, so instead of broths, I tackled a slice of pizza (managed to eat only the cheese, as the sauce was a bit too spicy for my mouth, the bits of sausage got too spicy over time, and the crust was too dry) and some reheated fajita beef (went down pretty well). The girls are out right now gathering a freshly roasted (to meet neutropenic diet requirements) chicken for us to share. I hope that goes down well too. And I started the day with a protein shake. So my food and caloric intake is improving, and I’m feeling more energetic for it.

Also, being non-neutropenic, I managed a nice couple hour nap this afternoon snuggling closely with Linda (who napped well too).

All in all, a wonderful day.

I’ve been told I can even have dinner off-campus with the family tomorrow night! So tomorrow should be a great day too (I will be getting my port out then as well, so perhaps a little bit of pain, but worth the reward of being free of alien parts in my body).

Yay!

 

Sadly the vaporizer did not work particularly well last night, so I will just have to try and hydrate more regularly. Linda already has some homecare vaporizer and humidifier equipment sitting in our Amazon.com shopping cart just waiting to be ordered once we know when we are returning to Boston.

And on that note, my nurse brought me glad tidings this morning. My neutrophils had sky rocketed from nowhere to 500! My white blood cells were at 740, and my platelets had stayed at 25 overnight. Woot!

I will probably need some more red blood tomorrow as my red blood cell counts are a bit low, but the doctors say that it’s quite likely I will hit 1000 on my neutrophils tomorrow, which means the countdown towards departure would start.

Two nice surprises today included a spontaneous visit from an old friend, Rebecca, who I had not seen in at least two years, bringing me one of her favorite books and a number of skin care (and head care) products for cancer patients who had had chemotherapy and/or radiation. I’m looking forward to trying them out (the company that makes these is Alra). We caught up on the last couple of years, including the update that her brother and his wife had returned from a vacation in Bonaire last night. Thank you for brightening my afternoon Rebecca!

If anyone else is so inclined, the best times to stop by are between 1:30 and 4:30pm, as I am least likely to be tethered to an IV or napping during those times. We can provide specifics of location on the NIH campus by e-mail to anyone interested. I expect to still be here through Wednesday at least.

The other nice surprise involved a 15-minute walk outside (with face mask on) absorbing the warmth of the fall sun. I was tired after the walk but just loving every minute of it. Unfortunately tomorrow is not likely to be as sunny but I will make the best of it.

My energy levels are definitely improving bit by bit, although I’m pretty sure I will be wheel-chairing it at whatever airports I fly through later this week getting back to Boston.

For tomorrow, the girls will be scoping out the new exhibits at the Newseum, taking advantage of the family membership I bought there last month when I visited that awesome museum. That means Bas will be my personal assistant for the day, and we’ll be watch more of the Farscape TV series he and I have been enjoying together.

Hopes are that neutrophils keep sky rocketing upwards and that all my other blood counts remain good, as I’m longing for a shower that produces steam (mine in Boston), no more IVs, no more middle of the night wake-ups for vitals checks, and no more having to pee into a plastic vessel all the time so my “liquid output” can be measured.

And I am also looking forward to the ability to fling (well, gently drop) a chicken into a pot of water and have it simmer for hours to create a fatty and delicious chicken broth of my own, as well as eat whenever I want to nibble on during the day or night instead of the limited hours and options of the room service I have here. Not that I’m complaining – the clinic has been wonderful, but some normalcy after nearly three weeks of clinical care would be nice too. I can see that normalcy in my future and it’s looking sweet.

 

Day 9 – Immune System Returning   October 15th, 2011

My hopes for a start to the recovery of my immune system have been fulfilled. Yesterday my white blood cell count was hovering between zero and 50 lymphocytes (4000-6000 is normal), and this morning I was at 130, and by evening up to 330.

I may or may not have any countable neutrophils, but with the WBC lymphocyte count increasing, I will start having them soon – tomorrow or Monday for sure. The neutrophils tend to be in proportion (70% or so) to the white blood cells (lymphocytes), but not necessarily when the numbers are small.

In order to be discharged I need to have three days in a row where my neutrophils number 1000 or more, or one day where they are 5000. And my platelet count needs to be steady above 20. I may be out as soon as Wednesday, but it could also be next Saturday, depending on how things go.

While I had a couple requisite naps, my energy levels were definitely a bit better today, and I even got to go outside (with sterile mask on) to enjoy a bit of the sunshine. Haven’t experienced any part of the outdoors in over two weeks at this point. I was pretty wiped out after both my slow walks with the girls (hence the naps).

After my afternoon blood work, I ended up with another 6 unites of platelets, as I was back down to 17,000 (from 23,000 this morning). And I was given magnesium via IV to compensate for a small deficiency earlier in the day.

I still am maintaining a mostly mild fever (99.0-100.6F/37.2-38.1C), which appears to not be unusual for someone who went through the TIL/TBI treatment (and is even considered a likely sign that the TIL are hard at work).

Several of you had asked question about broths and food in general with respect to my mouth dryness and soreness. I am finding I am having an easier time with warm liquids than with room temperature or cold. And thinner liquids create less of a mucous issue than creamy or thick ones. So clear broths with added material (meat protein, maybe some noodles) work pretty well as does warm tea (room temperature tea is not bearable). Solids outside the broths are not very good at this point because they get stuck in my mouth and require lots of water and gagging to get them down.

Linda had me try a thin butternut squash soup today, and I managed to get a fair bit down, but it was still too thick to do again in the next couple of days. We also experimented with apple juice. I couldn’t stand the bitterness and acidity of cold apple juice when I tried it this morning, but after Linda heated it up in a microwave, and it became more more palatable. Go figure.

The respiration department here at NIH also dropped off a new toy which might make sleep easier – it’s a vaporizer that uses oxygen to mist sterile water into a tube and attached mask. It’s very loud, but I have high hopes for it working tonight now that I understand how it works (although I think I look a little alien with the mask on). Would be great to maintain moisture in my mouth and nasal passages while I sleep.

I will leave you all with a webcam capture of the latest evolution of my Mr. Clean look. And no, no plans for any earrings (sorry Dara) :-)

Going for the Mr. Clean look, sans earring

Going for the Mr. Clean look, sans earring

 

The doctors here say that boring is good. Alas, today was not quite as boring as yesterday. It started with a low-grade fever at dawn (38.4C/101.4F), which resulted in my taking Tylenol as well as being put on an IV drip with an even stronger anti-biotic than I have already been getting.

When the morning doctor rounds took place, I was informed that my platelets were at a very low 9,000 per cubic millimeter (normal is 140,000 and higher), exposing me to potential problems with respect to bleeding. Considering that I had bloody sinuses during the night, this was a bit scary. I was also told that there was still no measurable sign of any neutrophils in my blood. Maybe tomorrow?

I was given five units of platelets, and stayed on my IV most the of the morning. Getting another CBC (complete blood culture) this afternoon showed that the platelet infusion has bumped me up to 17,000. Much better but not great. So I’m getting another five units right now as I write this.

The fever has been gone since this morning fortunately, and I had a pretty good afternoon. I even had Linda take me out for a slow 15-minute walk around the clinic. Pretty tiring but it felt good to be moving. The rest of the afternoon was a nap-fest all around. I am coming to appreciate naps more than ever before. Naps are good!

The dry mouth is still a plague, although I have found that I can manage chicken and beef broths as my main forms of sustenance – they are among the least difficult foods to process as they minimize stringy mucous build-up, and cause the least mouth pain. I even managed to get some minced, steamed (over 165F because of my neutropenia) roast beef into me last night via the beef broth, which made my body happy (protein!). Warm herbal teas – blueberry and raspberry – are good too. And Hall’s Sugar Free Citrus Drops are helping a bit too.

I’m also coming to grips with the stubble on my head and face. The lightly-adhesive lint roller is coming in handy, but I still keep having tiny stubble hairs come off in my hands, shirt, pillow, etc. I will be glad when all the stubble is gone, so I can have a real Mr. Clean look, shiny head and all. I like that comparison (thanks Sam!) better than the Telly Savalas or Yul Brunner look.

I’m hoping for no fever overnight and the start of measurable neutrophils in the morning, as that would indicate my body is finally starting to make progress after the necessary destruction to my immune system caused by the chemotherapy and radiation.

Linda and the kids have been wonderful to have around to give me comfort, support, germ free hugs, and ruffles. I have no idea how someone without such a support network would handle this process. So, again, thank you Linda, Krystyana, and Bas. I love you all!

 

Day 5 – Off With the Hair   October 11th, 2011

I kept hoping I would be among the 1% of chemotherapy patients who wouldn’t suffer hair loss, but this morning as I scratched my head upon waking up, I managed to pull a clump of hair out. So put me on the 99% side of the hair loss column.

Pulling hair out of my head led me to figure out what other hair will fall out too, and some careful exploration suggests I will retain my arm and leg hair, I may keep my eyebrows and some of my already meager chest hair, but everything else is going.

My nurse this morning mentioned that a recent female chemo patient wore a shirt that said “Chemotherapy Gave Me the Best Brazilian” (I hope I don’t have to explain that further, but if I do, it refers to wax, hair removal, and pain in sensitive regions). It put a smile on my face.

Instead of having clumps of hair falling out all over the place, I decided to take some decisive action, and have Linda shave my head for me – that will only leave stubble to fall out in the coming days.

Linda starts shaving Jake's head

Linda starts shaving Jake's head

In the above image, and the subsequent ones, you may notice a dark mark under my right eye. That’s apparently a burst capillary from a coughing fit I had a few nights back. It is not the result of anyone beating me.

The first step in the head shave was to achieve equilibrium, in the form of a mohawk, as pictured below:

The interim phase of the head shave - a mohawk

The interim phase of the head shave - a mohawk

After that it was a matter of simply shaving off everything that was guaranteed to be falling out anyhow, including my mustache and beard – facial features my kids have never seen me without. Krystyana was cool with that (all these photos are hers), but Bas was a little creeped out.

The final result is below, taken while I was in bed getting yet another blood transfusion (after getting platelets this morning).

Jake with a baldish head while getting his latest blood transfusion

Jake with a baldish head while getting his latest blood transfusion

A couple of things I have discovered with my new-nearly bald head: First, my head gets cold quickly. Linda got me a skull cap a few weeks ago, and that is helping. I also bought myself a monkey head cap (like little kids might wear in winter) at a state fair several weeks ago for when I need to amuse myself. I also have a baseball hat, and a good friend is knitting me another cap.

Second, I now find myself baffled by whether I should use shampoo or soap on my head. I stuck with shampoo this morning only because it was the comfortable, safe option (plus it’s Baby Shampoo, so no tears). But if any of you who are bald or have gone through chemo have input, it would be appreciated.

My understanding is that over the coming few days all my stubble will be falling out. One friend suggested (coming from her friend who had undergone chemo herself) that one of those lint remover rollers that uses light adhesive tape might be a good way to assist the process. Linda and Krystyana are out exploring, so hopefully they will bring one back so we can experiment.

Other than the hair loss excitement today, it’s a pretty routine day: Platelets, blood transfusions, lots of drugs, rest, and struggling with dry mouth. One interesting (although obvious) note: if you get a nose bleed when your platelet counts are down (I was at 13000 today) the bleeding doesn’t stop very easily. I’ve been told my blood counts should start showing a slow increase in a few days, and as with everything, it’s only a matter of time.

While I try to express my thanks privately, I want to give many public thanks to my awesome family caregivers – Linda, Bas, and Krystyana – and to the excellent nursing staff here at the clinic.

 

Day 3 – Slow Recovery   October 9th, 2011

After Linda and the kids left last night, my plans for a restful night kind of came to a close with the introduction of a high fever and chills. The fever lasted most of the night and finally broke this morning. I kept telling myself that fever was a sign of the on-going battle of TIL vs. evil cancer cells, so in a way it was a good thing. And my doctors later confirmed that probably was the cause too.

However, it should be noted that the TIL attack is something that goes on for weeks, and it’s generally not clear until the second of post-treatment scans (which would be early December) of how well the treatment works. So feeling tumors from the outside to see if they have gotten smaller is something of a pointless exercise, at least this soon after the TIL was administered.

From the comments that Linda’s post received yesterday it might not have been clear that the 5kg of water weight I needed to drop was to ensure proper organ function, as much of that weight was in my organs (such as my lungs), and not any sort of vanity. I’m close to half-way there, and my lung capacity seems to reflect that.

The other side-effect of treatment that has been increasingly frustrating is that I have “dry mouth“, meaning that my salivary glands simply don’t turn on. So, to eat most things that don’t have a thin gravy of their own, I have to keep my mouth lubricated with water in between bites, and sometimes combine the two. That turns something like a protein bar into mushy cereal – not a great texture sensation.

A related symptom of this whole dry mouth situation is that my ability to taste has gotten terribly screwed up. Certain foods have no flavor (like Chef Boyardee single-pack macaroni and cheese – though Linda says it doesn’t have much flavor to start with), foods that should have quite a bit of flavor (Chef Boyardee single-pack Beef-a-Roni) are bland, while for other foods, even a few flakes of black pepper can make the dish inedible. I can taste sweetness to some extent though, so I’m thinking once I’m back in Boston I may have to work my way through Ben & Jerry’s collection if it looks like ice cream is edible to me.

I also learned that the carbonation from carbonated beverages is actually painful to my mouth.

I have some various dry mouth rinses, gels, and sprays – all of which work, but only temporarily, and being a mouth breather, things get dried out pretty quickly.

Hopefully my salivary system and tongue will heal up soon enough (it could be months) and I can start enjoying food again as opposed to having it be a torturous necessity for survival.

Perhaps I should be glad that this is the only side-effect from treatment that has clearly manifested itself, as I’ve had virtually no nausea (although in part that could be contributed to by the thrice daily infusions I get of Zofran), and while my energy levels are low (lots of naps), I don’t seem to actually be suffering from extreme fatigue (again, knock on wood). This may still change, but I’m hoping it doesn’t.

Today has been mostly spent connected to my IV drip system, first getting potassium phosphate to replenish my electrolytes (a four hour drip), then followed by two units of blood (two hours each – just finishing my second unit now) to boost my hemocrit and hemoglobin counts. I may also get more platelets tomorrow.

The family was with me most of the day, and during the points I wasn’t napping we took advantage of the rather decent WiFi connection here to watch a couple of streaming TV shows from Amazon (and yes, I have an Amazon Fire on order :-) ).

They (the nurses here) expect I will be under their care for another ten days or so, so my immune system can get built up enough that I can safely (with face mask on) travel back to Boston for a couple of weeks before coming back down for my first post-treatment scans in early November.

One ambling day at a time…

 

My battle against melanoma is about to take a dramatic turn today – this time finally in my favor. Everything I’ve been working for since being diagnosed with Melanoma less than seven months ago comes down to today – more specifically – around 1pm today.

This truly is Day 0!

My secret weapon? Specially harvested, cultivated, and trained t-lymphocytes know as Tumor Infiltrating Lymphocytes (TIL).

My dear friend Cynde Lee found the work of Jerry Kong on-line (please support his work if you can), and my creative family has taken his original image and added some personalized touches to show what a TIL cell chopping down an evil melanoma cell might look like:

A drawing made by Linda, Krystyana, and Bas for me, inspired by Artist Jerry Kong. Shows my TIL cells in Ninja mode assassinating those dastardly melanoma cancer tumor cells in my body once my TIL is introduced mid-day or so today. (Links to the original this image is based on.)

A drawing made by Linda, Krystyana, and Bas for me, inspired by Artist Jerry Kong. Shows my TIL cells in Ninja mode assassinating those dastardly melanoma cancer tumor cells in my body once my TIL is introduced mid-day or so today. (Links to the original this image is based on.)

In addition to further encourage my TIL cells to take no prisoners, I have, with the help of many friends on Facebook, compiled the following music play list, which will be started as soon as the TIL cells have entered the wing my room is in here at NCI. The playlist actually goes for over an hour, but the most key fighting songs are in the first 30 minutes after the introductory march. It will about that long for all the TIL cells to enter my body and start their slow inexorable march throughout my body and into every nook and cranny over the coming weeks and even months.

The TIL Playlist

  1. “Ride of the Valkyries” – Richard Wagner
  2. “Eye of the Tiger” – Survivor
  3. “Invincible” – OK Go
  4. “Whip It” – Devo
  5. “One Way or Another” – Blondie
  6. “Another Bites the Dust” – Queen
  7. “I Won’t Back Down” – Tom Petty
  8. “We Are The Champions” – Queen
  9. “Run Like Hell” – Pink Floyd
  10. “Persuasion” – Carlos Santana
  11. “Hungry Like The Wolf” – Duran Duran
  12. “Don’t Stop ‘Til You Get Enough” – Jackson
  13. “Magic Carpet Ride” – Steppenwolf
  14. “Pump it Up” – Elvis Costello
  15. “With A Little Help From My Friends” – Joe Cocker
  16. “Cream” – Prince
  17. “Get Me Bodied” – Beyonce

Copyright laws prevent me from making the music listed here available, but if some kind soul reading this has a way of making this list available through legal sources on-line, please do!

I don’t know if I will be able to make the “Later in Day 0” post based on how I might be feeling after my first IL-2 treatment. But if I can’t, Linda will post to give you an update.

 

I have successfully finished being exposed to 1200cG (centi-grays) of radiation over the course of the past three days thanks to an awesome team of specialists. And I even have a certificate to prove it!

The wonderful certificate of appreciation I received this afternoon after my sixth and final course of full body radiation. Even got a hug from my radiation nurse!

The wonderful certificate of appreciation I received this afternoon after my sixth and final course of full body radiation. Even got a hug from my radiation nurse!

And still, beyond a dry mouth, and a bit of fatigue, not much wear to show for all that, yet. Hopefully the radiation did its job in killing off all my bone marrow – that’s what the main purpose was of getting the radiation.

The oncology radiologist I spoke to this afternoon after my final treatment commented that I went through the radiation treatment amazingly well, and while he doesn’t know exactly why, perhaps my relative youth, good health, and good energy levels might have helped. He also indicated that there is a chance that some of my organs may have been damaged a bit (which would be fixable or heal-able), but only repeated testing (urine and blood samples) will determine if any such situations exist. So far so good (and please continue knocking on wood – it’s definitely been helping.)

On to what’s next…

One of my favorite movie quotes is from the 1980 version The Blues Brothers:

Elwood: It’s a 106 miles to Chicago. We got a full tank of gas, half a pack of cigarettes, it’s dark and we’re wearing sunglasses.
Jake: Hit it!

There is the absurdity of wearing sunglasses at night, but in reality is it a checklist in the pursuit of a goal. In Jake and Elwood’s case, that is to deliver concert proceeds to a tax collectors office in Chicago, while being sought by the police, and an extremist group.

My current version of this movie quote is:

Jake: I’ve just been radiated and chemo’d. It’s five more days until the treatment is over. I have a couple small bags of Haribo gummi bears, a full jug of water, no idea what I am facing and am covered by a fluffy duvet.
Jake (speaking to myself): Hit it!

Okay. Maybe not as memorable, but to me it has the same feeling. And in my case the ultimate goal is NED – No Evidence of Disease.

To get there I need to get through the next five days of treatment with IL-2 in the form Aldesleukin. From what everybody has said, intensive IL-2, which will start to be administered few hours after my TIL cells are administered tomorrow in order to super-charge the TIL cells and help them achieve their cancer-killing task. (But, as a caution, it will not be clear for at least a month how effective they were, and may take many months to verify total shrinkage and disappearance.)

After the first administration of IL-2 I will continue to receive 15-minute infusions via IV every eight hours until my body just cannot handle it anymore (based on physiological responses related to breathing, organ function, and also on mental function). There are a maximum of 14 doses of IL-2 that will be administered, but my nurse has never heard of anyone that has even gotten close. IL-2 comes with fevers, chills, rigor (shaking during chills), and all sorts of other pretty scary things – more details in the fine print available here.

Whenever it is that my IL-2 treatment ends, I will be a bloated wreck for a bit (an IL-2 side effect is the release of stored water in the body being pulled out of its regular places, resulting in a 20-30 pound “bloat” – and yes, I will have someone take pictures of Puff Daddy Jake :-) ). But I’m betting on being a bloated Jake on his way to NED.

And, speaking of photos – I know I have been remiss in providing images with posts lately, so below are several images to captured over the last week:

Linda and the kids move in to my hospital room to keep me company. Here everyone was getting their wifi connections working. Honestly, they really do pay me a lot of attention when I'm not sleeping

Linda and the kids in to my hospital room to keep me company. Here everyone was getting their wifi connections working. Honestly, they really do pay me a lot of attention when I'm not sleeping. We play games, watch movies, talk, and even torture the kids with doing their more traditional forms of schoolwork.

My IV tree the night they were administrating my first dose of Cytoxan to kill my current immune system. Festive!

My IV tree the night they were administrating my first dose of Cytoxan to kill my current immune system. Festive!

 

Cyclophosphomide a.k.a. Cytoxan, close up.

Cyclophosphomide a.k.a. Cytoxan, close up.

Linda and the kids enjoying a take out meal which I got to try part of with doctors' permission. I managed two wings and two fries before I was full.

Linda and the kids enjoying a take out meal which I got to try part of with doctors' permission. I managed two wings, a small chunk of dark meat, and two fries before I was full.

 

Here I am in my hospital room working on this blog post about Day -1, after finishing my final radiation treatment. That's Renaissance Bear next to me.

Here I am in my hospital room working on this blog post about Day -1, after finishing my final radiation treatment. That's Renaissance Bear next to me.