Candi is Officially in Remission - Thanks for Your Continual Support
On October 25th, Candi and Tony traveled to the M.D. Anderson Cancer Center in Houston, Texas for re-staging of her disease. During this visit, the team of doctors performed a C-T and PET scan to determine if any remnants of the disease existed.
On October 27th, 2005, Candi and her husband traveled back to M.D. Anderson to receive the results of the re-staging scans. After a long four months of treatment, Dr. Fayad and his staff have declared Candi to be officially in remission, as the scans showed no remaining signs of the disease. It was a great day of relief for all of the family, friends, co-workers, and medical staff who have been involved in this fight.
Candi is feeling great, and is slowly getting back into regular physical activity. She plans to finish her Master of Arts degree in Counseling from the University of Texas at Austin this May, and is looking forward to obtaining a full-time counseling position for the 2006-2007 school year.
Special thanks go out to everyone who continues to support our family with e-mails, phone calls, cards, financial contributions, meals, and love. We will continue to update our site as Candi’s medical progress continues.
Round 6 – All I get is this lousy T-Shirt?
Round 6 took place on October 17 and 18, 2005. With the overall success of the last treatment, Candi was very apprehensive about this sixth and final round of chemotherapy. The apprehension was very short lived, and she got through the treatments with ease. The effects were a bit less in intensity than previous treatments, and she thinks this may be due to a tolerance issue or due to the fact that she just has way too much school work to do this week to be sick from chemo side effects. Either way, she pulled through like a champ.
It was a bittersweet climax of sorts at the end of her infusion. The nurse told us that she would see us “next time”, to which Candi said, “There will not be a next time!!” At this moment the nurse got Candi a victory T-Shirt, and then the other infusion nurses all seemed to perk their ears up and boast huge smiles. The nursing team of the SWRCC had hugs to offer as we made our way out of the infusion center for (hopefully) the last time, while applause was received from the fellow cancer patients who were being infused. As we walked out of that room, the sense of achievement, accomplishment, relief, and optimism set in as we pushed the button to go down in the elevator. If you have ever seen the T-Shirt that says, “My parents went to the Cayman Islands, and all they bought me was this lousy T-Shirt,” you can understand how she felt. We joked with each other that after our honeymoon we got to fight cancer, and all we got was this T-Shirt. In what is sure to live in infamy, that shirt will eventually be framed.
In a bit of irony, and as she finished up her chemo infusion, one of the nurses was taking a brand new cancer patient (a woman in her 60’s) through the whole “This is chemo. This is your body on chemo. Any questions?” routine. One can’t help to feel compassion for the woman and the troupe that was with her for their first infusion. All of the ills, questions, hospital visits, doctor’s appointments, scans, support, meals from friends and neighbors, astronomic medical bills, and the good stuff that comes with being a cancer patient is what awaits her and her family. At least she will get her T-shirt at the end of her chemotherapy journey, and be proud when she can say that she is a “survivor”.
Next Steps
On October 25 th, Candi will travel back to the M.D. Anderson Cancer Center in Houston, Texas to undergo a combination PET/CT Scan. This will be able to identify how small the mass has shrunk, and what the metabolic make-up of the mass is. Typically lymph nodes will swell up, and can give the illusion that there is still a “bulky mass” of sorts. The PET scan will tell her that she is “disease free”.
On October 27 th, Candi will travel to Houston again to have another visit with Dr. Luis Fayad. At this time, Dr Fayad will reveal the results of the scans, and will be the moment in life that the term “disease free” will be a reality for Candi, Tony, their family, friends, co-workers, and doctors.
Candi can expect to be living with cancer for the next two years. She will be considered a survivor of NHL (not hockey) when we receive the “disease free” staging report. After that, she will visit with doctors every three months, for the first year, and then every six months for the next twenty years or so. When Candi has been disease free for two years, she will be considered fully recovered, and cancer free. Get ready for the party.
Round 5 – Almost There
Round 5 took place on September 26 and 27, 2005. The rate of infusion for the Rituxan was sped up to “normal” rates, and this made the length of stay at the SWRCC a lot shorter. The chemo infusion went very well, and the accompanying side effects did not seem to be as bad as previous rounds. This was a somewhat hopeful sign for the upcoming round. Candi’s doctor’s changed some of her treatment protocol in relation to keeping her nausea and blood counts at manageable levels, and these are described below:
- The day before Rituxan, Candi takes Prednisone to help keep her strong during the infusion. Since this is a steroid of sorts, it makes her kind of wired, and actually induces fits of anxiety about the upcoming treatments. To treat the anxiety, Candi takes Adivan (Lorazepam 1mg), a mild anti-anxiety medication in the same drug family as Valium.
- On the day of CHOP, approximately 45 minutes before her scheduled infusion time, Candi starts another drug called Emend. This helps her with nausea, and this allows her to eat without feeling too nauseous. In addition to the Emend, she also takes Pepcid A/C to help keep her Gastro-Intestinal tract calm, and also helps with nausea. This continues for two days. She is also infused with a big dose of Adivan (we call this the La La’s medicine) and more anti-nausea medication the day of infusion.
- Candi takes Ibuprofen to help with the impending headaches she receives for the three to five days following her treatments.
- During week two of the three-week cycle, Candi receives injections of Neupogen, a white blood cell booster. Her counts get dangerously low (below 1,000) and Neupogen helps to swing these back into the normal range of 3,000 - 7,000. When you dip below 1,000 (which has happened a lot), you can’t be in public places and interact with a lot of people because any slight invasion of germs could be a really bad situation. You often see patients wearing masks to filter germs so they can minimize the risk of catching something funky when their counts are too low. Tony injects Candi three times per week at home, so we can avoid the germs.
- During week three, Candi gets a red blood cell booster called Aranesp. This helps to boost the red blood cell counts, which helps to oxygenate the rest of the body. By this time, her white counts are usually back to normal.
This new combination of pre and post medication has seemed to help reduce the awful side effects of R-CHOP. Some days are good, and others are…well, not so good.
Round 4
Candi received round four of the R-CHOP therapy on September 6 th and 7 th, 2005. The Rituxan infusion was sped up and only took four hours this time (in opposition to eight) without any complications or reactions. It is a huge victory to have Candi take the Rituxan so well.
The CHOP session went fine. Her side effects of this treatment were not as severe, but did last awhile. She was very nauseous, fatigued, and just felt awful for the first 72 hours. She seems to feel better after four or five days, and is doing well. Candi also started her Fall semester at the University of Texas at Austin. She is enrolled in 12 credit hours, working 21 hours, and is fulfilling her practicum assignment at Texas State University for 10 hours per week. She is a busy girl; one who does not have time for cancer. The work load keeps her mind on positive, focused endeavors.
Re-Staging
On August 30 th, 2005, Candi visited the M.D. Anderson Cancer Center to undergo tests to determine if the chemotherapy drugs have been doing their job. She received a CT scan, and had to drink some real nasty barium, and was then infused with iodine so they could see the affected areas.
The results were overwhelmingly positive. The tumor mass has shrunk from roughly 7 cm in diameter to 2.8 cm in diameter. The tests conclude that this mass could be the residua from the tumor, and could possibly represent some type of scar tissue. Our doctor was highly encouraged by the findings, and prescribed two more rounds of R-CHOP treatment. He also stated that her prognosis was very positive, and he was overall very optimistic about our future.
Candi will travel back to M.D. Anderson on October 27 th, 2005 to have a PET/CT scan. This test will determine if the cancer is still prevalent or if the drugs did their job and killed the tumor. Also, at this time, we will discuss radiation options. The location of Candi’s tumor is right above her heart and lungs, and radiation therapy may not be an option for her. More to come
Round 3
Round three of the CHOP-R treatment was on August 15 th and 16 th, 2005 at the Southwest Regional Cancer Center in Austin, Texas. After firing their local oncologist for various reasons, Candi and Tony met with Dr. Jerry Fain. He is a very thorough doctor, and agreed to follow the protocol’s assigned by M.D. Anderson, and was able to oversee the infusion of Rituxan for this round. It took over eight hours to complete the infusion of Rituxan, but Candi presented no signs of allergic reaction, and that is good.
The infusion of CHOP went very well on August 16 th. Candi was very nauseous, and recoverd from this round of treatment in about a week. It seems as if the side effects get worse every time she receives treatment, which is not uncommon.
Round 2
Round two of CHOP-R occurred on July 26 th and 27 th, 2005, and was much more involved. Candi traveled to Houston for this round of chemotherapy, and was admitted to the M.D. Anderson Cancer Center hospital for a long, slow infusion of Rituxan. She presented no allergic reaction, and the CHOP was then administered on day two of her hospital visit.
Upon return to Austin, she became extremely ill, and the symptoms and side effects presented themselves in greater magnitude than before. Luckily, she was able to bounce back quickly, and finish her semester at the University of Texas at Austin. She is a Master’s candidate in the school of Educational Psychology, with an emphasis in higher education counseling.
Round 1
July 5 th, 2005 was the “day of reckoning”. Candi’s treatment for NHL consisted of infusing a monoclonal antibody called Rituximab. The drug Rituxan (the R in R-CHOP) is essentially an antibody that specifically targets the large B-Cells that have metastasized to present her cancer. The drug attacks these cells, and helps to destroy this one type of cell cluster, while the chemotherapy effectively kills all cells – good or bad. Rituxan was developed by using mice to help target the B-cells, and has a reputation of causing allergic reactions in patients, because the human immune system doesn’t recognize mouse antibodies, and you can figure the rest out. Candi had a real bad reaction to the Rituxan the first time, and the doctors had to stop the infusion. That was a real bad day.
July 6 th, 2005 was Candi’s first chemotherapy infusion. After a nightmare afternoon the day before, Candi and Tony were not very excited about the CHOP infusion. Here is the drug combination that affectionately known as CHOP:
Cyclophosphamide – The “C” in CHOP, Cyclophosphamide belongs to a general group of chemotherapy drugs known as alkylating agents. Cyclophosphamide stops the growth of cancer cells, causing them to die. This is the drug that causes infertility and hair loss. Candi receives the drug Cytoxan.
Doxorubicin – Doxorubicin hydrochloride, the “H” in CHOP, belongs to the general group of chemotherapy drugs known as anthracycline antibiotics. It is used to treat non–Hodgkin’s lymphoma. The drug given to Candi is called Adriamycin. This is also known as “Big Red” from the color of the drug.
Vincristine – This is the “O” in CHOP because the drug name is called Oncovin. Vincristine belongs to the general group of chemotherapy drugs known as plant (vinca) alkaloids. It is used to treat lymphoma and leukemia. Vincristine stops cell division, resulting in cell death.
Prednisone – Prednisone, the “P” in CHOP, is a glucocorticoid steroid used to treat anorexia and cachexia and some cancers. It is similar to a steroid hormone made by the adrenal glands in the body. Prednisone decreases inflammation by preventing white blood cells from completing an inflammatory reaction. This drug can cause lymphocytes, a type of white blood cell, to break apart and die. Thus it is an important drug used in combination with other chemotherapy agents to treat many different cancers. This is like taking legal speed, and the house is super clean when she takes this one.
Comparatively, the chemotherapy infusion went fairly quick and easy. Candi was expecting to become very sick, but never really had any illness, and she was in great spirits – until week two of the three-week cycle. Candi described having pain in her lower back and hips, and described it as feeling like her bones were scraping together. This was due to her bone marrow contracting and expanding from producing healthy white blood cells. It was not fun. Week three was exponentially better, and Candi was feeling great, but began to lose her hair at a very rapid rate.
Losing her hair was a process (see picture gallery). Candi had the most beautiful long, brown hair imaginable. As Candi tells it, “My hair used to define me. It was what made me stand-out.” She decided that it would be easier to watch her hair come out at a shorter length, and had a real cute bobbed haircut. Then, almost overnight, her hair began to fall out very rapidly. Finally, her husband came home from work on a Friday night (July 22), and buzzed her hair off with hair clippers. She was a sexier version of G.I Jane (Demi Moore style), and was coming to accept her short hair. However, really short hair still falls out of your head, and she decided to go completely bald the following week.
As one of the bumps in the road, losing her hair was a very traumatic experience for this beautiful, young adult. She has since obtained a couple of wigs that really compliment her natural beauty (Picture gallery). Through all of this, Candi’s attitude and spirits were lifted high, and she was excited to create the hair loss photo gallery.
Candi’s Progress
On Friday June 3 rd, 2005, Candi Bell was diagnosed with a Stage II, Mediastinal Large B-Cell Non-Hodgkin’s Lymphoma (NHL). The diagnosis and testing took place at the M.D. Anderson Cancer Center in Houston, Texas, under the supervision of Dr. Luis Fayad. According to statistics, this is a rare form of NHL, with only 2.5% of all NHL being diagnosed as this type. This diagnosis is common primarily in women ages 30-40 years old, and has a 40 – 70% five-year survival rate (depending on what study you read).
Candi was prescribed a treatment regimen known to oncologists (and now you) as R-CHOP. This regimen is repeated every three weeks for four to six cycles. Her treatment is approximately two days long per cycle. Day one is the infusion of a monoclonal antibody called Rituxan. Day two is the infusion of the chemotherapeutic drugs (CHOP). The subsequent weeks are an endless rollercoaster of low blood counts, fatigue, loss of appetite, and feeling extremely good. To learn more about her staging and treatment protocol, visit www.nccn.org, and navigate around the NHL area. She has a non-bulky mass.
After her diagnosis, things got a little fuzzy for a few days (as you can imagine). The doctor informed Candi and Tony (her husband) that one of the chemotherapy drugs, Cyclophosphamide, could possibly cause Candi to become infertile. They sought the advice of Dr. Andrea Milbourne, and were eventually led to the Texas Fertility Center and Dr. Thomas Vaughn. They were informed that they had about two to three weeks to harvest Candi’s eggs, and that they needed to begin hormone injections of gonadotropin and high doses of estrogen to stimulate her follicular development. Two weeks later, Candi underwent a surgical procedure to remove her eggs, and harvested 27 eggs. From these 27 eggs, the doctor took a sperm sample from Candi’s husband, and underwent in-vitro fertilization techniques to produce 13 fully fertilized embryos. As we like to say, “we have thirteen kiddos in the freezer, how about you?”
The next day, Candi had to have another minor surgery to implant a catheter line for her chemotherapy infusions. This was a relatively minor procedure, but caused some real discomfort from being anesthetized two days in a row. This took place on June 29, 2005. All of this was in preparation for the real deal; chemotherapy treatment.
