UPDATE Monday October 08, 2007

Last Friday at 8:30 AM I met with Dr. Doty for my scheduled checkup. Lab reports were good (where we needed them before I could start the next round of chemo that was scheduled for the today). He suggested I go back to Seton that morning and start early.

I dropped everything and checked in by 9:30 and had the first bag of Rituxan hooked up to my chest before noon. That was finished by 4 PM and I started Zofran, Mesna and Cytoxan by 5 PM. I was well on my way with the second round of Rituxan + Hyper CVAD before I even had office things and clothes for the 5-day stay!

I will finish Wednesday about 6 PM and get two days in the office this week that I had not expected. We will try to schedule PET/CAT scans for next Wednesday and a meeting with Dr. LeMaistre in San Antonio for the following Friday 10/19. If we can get all our ducks in a row we hope to start the lease on the San Antonio apartment 10/26 and be ready to infuse Ann's stem cells on 10/31. That will make the week of 10/29 my "sick week" and, hopefully, I will be on a track for recovery the following week. Maybe I can be home for Christmas! Of course all of this depends on getting my ducks in a row (tests, good labs, coordinating with Ann, etc.).

Things are going well! Please keep sending up the prayers. He is listening.

RICK

Regan's Trip to the Farm

On September 29 & 30 (one week after Regan's birthday) I took Regan for an overnighter to the family farm in Placid. All the way there, while we walked around our farm, and while we walked around the farm the had belonged to my grandparents (Ma & Pa) the next day we recorded stories of when I was growing up. I showed her where siblings and cousins swam and played as kids, where I hunted rabbits, where Pa & I hunted arrowheads, and Bear Cave. I also attempted to answer "all her unanswered questions". It was a great trip for both of us.

The picture of me is in front Ma & Pa's house. I spent most of the first 6 years of my life and many summers after living in that house.

Seton Hospital #1

Well, last week was a bear! I was told to check in Seton Hospital on Monday at 7 AM and did so, but due to a few communications blips, didn't start the first bag of poison until about 5 PM. They were kind enough to start the saline drip much earlier, though, so I was attached to the IV tree (nickname "Charlie Tree") 24/7 for the whole week.

The last bag, Adriamycin or "The Red Devil", is shown here under the brown bag. It is so devilish that they are afraid for anyone to see it. It is super caustic so while it is dripping (the final 48 hours) they have to check vital signs and blood draw from the catheter every 2 hours (night and day !!). This gives me an opportunity to check the overseas markets throughout the night and stay on top of things for all my clients.

I really do try to get a decent day's work in. After Dr. Doty leaves in the morning I watch the opening bell. Gary/Norma/Nick will call about mid-morning to check in and I try to finish reading IBD and any market analysis reports Gary has sent up. Cindy brings the new stuff from the office around lunch. We discovered I can walk Charlie and Cindy down to the cafeteria where the food is better, so lunch will be there from now on. I try to shoo Cindy away after lunch so I can work/read/make phone calls. She usually shows up again by early evening.

At least I didn't feel too bad most of the time. I did start to get a pnemonia-like cough Friday that got progressively worse through Sunday. Sleeping Friday and Saturday nights was almost impossible and coughing began to hurt so bad it brought tears to my eyes. It is better now, but I can tell my blood counts are low. I expect to be near full speed by Wednesday.

The next hospital stay will be 10/8 through 10/12. I'll get the same sequence of poison, but the poison is cumulative so the week and few days following may be a bit tougher. Since the blood counts will be lower, company will be more restricted. Dr. Doty said I may have to have blood and/or platelett transfusions. But my email works and I will post my cell number if anyone wants to call. There is a phone in the room but it does not have voice mail. My cell does. And, since the doctors and nurses frown on me taking calls while they are poking around, leave a message and I'll get back to you.

Our goal is still Stem Cell Transplant starting early-to-mid November. That will put us in San Antonio through year-end. We will have an apartment at La Cantera and I will have an office set up there. Nick or a messenger will bring files from the office weekly and I will recieve lots of stuff by computer.

I apologize for the interruption to face-to-face meetings, but we will get back to normal in 2008. Please don't hesitate to arrange a telephone conference through Norma. I want this to be as easy as possible on all my clients.

As always, thank you for your thoughts and prayers. They sustain me.

RICK

From Seton Hospital

Well, it's 3AM Wednesday morning and the steroids have kicked in. I'm wide awake looking North out of a seventh floor window.

I checked in before 7 AM Monday morning and twiddled my thumbs all day waiting to get started. Things move slowly on Mondays. I finally started Rituxan about 5 PM and Cytoxan about 9 PM. The Cytoxan is administered over 3 hours every 12 hours (9 AM and 9 PM) for 6 rounds. I get Zotran and and Mesna to offset side effects of the Cytoxan.

For 48 hours starting day 3 I'll get Adriamycin and on day 4 I'll get some Vincristine. All of the above are through the Groshong port so I am tied to a IV tree machine 24 hours a day. Of course there are various blood draws and vital sign checks throughout the day and night so I know all the nurses on all the shifts. But the steroids (Decadron pills) have kicked in so I am wired all night now anyway, so who cares?

This treatment has caused an elevated blood sugar reading so they also check that every few hours. I ate part of a candy bar after dinner last night so it spiked above 230. I had to have a insulin shot. Guess the sugars and starches are out for a while.

Hopefully, I can check out some time Friday.

Next week some time we'll check the heart to be sure these drugs aren't causing damage. Assuming that is OK I'll check back into Seton for another round of this treatment the week of October 8th. We'll probably let that soak in for a week and do scans to check progress the week of October 22nd. Assuming it will take a bit to get results, schedule events at Texas Transplant, and collect stem cells from Ann, I hope to check in at Methodist in San Antonio the week of November 5th or 12th.

Of course all of the above is conjecture right now.

Thanks for checking in and, as always, thanks for your thoughts and prayers.

RICK

My mother, Cindy & I went to Breckenridge for a long weekend and got to spend some of our time with good friends JT & Ashlee Tollett. It was a great weekend, but the altitude was hard on us lowlanders.

For more photos check out http://ashleetollett.blogspot.com/
Ashlee showed me how to create my blog and I am grateful as it makes it so much easier to push out current info to lots of friends at one time.

I had to use three different shotguns and shoot left-handed some, but I got a limit without damaging the catheter in my chest.

Well, a lot has been happening. Here is what I know today:

The R-ICE is not accomplishing what we need so Dr. Doty wants to change poison. This one will be a bit more caustic so I will receive it in the hospital. I check in Monday at 7 AM and will be there at least until Thursday morning. We will repeat this every 3 weeks until we get the necessary results, then I will move to San Antonio for SCT.

The poison cocktail I will start Monday is Vincristine, Adriamycin, Cytoxan, and Mesna. I think there is another ingredient or two, but I don't know what they are. Some of these were in the R-CHOP mix I took last year, though I suspect the quantity has been increased.

I'll post again when I know more.

As always, thanks for your prayers and good wishes.

RICK

Well, we had a setback yesterday. Dr. Doty said this chemo is not accomplishing what we need to get where we can start transplant. As sometimes happens with cancer, we need to find a new poison.

Doty will confer with Neelapu @ MDA this week. My next appointment with Doty is Tuesday the 18th. I will post again as soon as we have a new game plan.

Thanks for checking in.

Rick

NOTE: double-click on any photo and it will increase in size

Wednesday, August 29th

Well, this may be a hard report. There is more that I don't know than I do.

For the second time, I developed a pain in the left side of my stomach and chest about three days after the last day of chemo. We did CAT scans of the area and (thankfully) found no damaged organs. So, while the source of the pain is not determined we do know it is not being caused by something that would make us stop treatment. Just chemo; just deal with it. It does interfere with golf, though. Oh, well...

Dr. Doty and I agree that the lymph nodes are smaller, though no current scans confirm this. The real test will be the comparison between the 08/14 scan and the one we will do about 09/19. That will tell us the plan for the rest of the year. I still think we'll do 2 more chemos after that and start SCT about mid November.

I'll keep you posted.

RICK

This was Brady's first trip (her dad, Will's, too). The whole family was there: my mother, Sadie, Cindy, Regan and Will, Nick and Kendra, and Chris. They went on 3 float trips, played in the water, tossed washers, played cards and ate. It was a great family outing even though I didn't feel well. Expected, I guess, since it was only 3 days after chemo.

Fazio Canyons at Barton Creek the afternoon of the second day of my last round of chemo with my friend, Bart Couch. I felt pretty good that day. It didn't last. The poison soaks in by the weekend following chemo.

Latest Decisions

Cindy & I saw Dr. LeMaistre Monday and Dr. Doty Tuesday.

I had a PET/CAT scan last week but the only scan they had in Austin to compare to was done in February. As expected, that comparison showed disease progression. They have requested one done at MDA in June. Hopefully, that comparison will show regression since June. These comparisons will dictate plan of attack:

• If we have regression since June, I will continue R-ICE #3 and #4 and test/scan again about September 19th.


• If I am in remission in September we will stop R-ICE and go on to transplant about the first of October.


• If we have continued regression in September, but not remission I will take two more rounds of R-ICE and plan on starting transplant mid-November.


• If we have progression (now or mid-September) we will change bug spray and plan SCT at an appropriate later time.

Personally, I believe there has been regression of the disease since June and am on track for SCT. My sister (the "perfect match" donor) will do her prepatory tests August 30th and have cells collected soon after. I really need her to not have Hepatitis or any one of the many other "hidden infections" that are possible.

Well, I'm off to Day 2 of R-ICE #3. Another fun morning at the Chemo Country Club!

Thanks for all your good wishes and prayers. They are working.

Rick

Monday, August 13th

I saw Dr. Doty Saturday night at his home. He and Cathy were hosting our Sunday School class kickoff party. We watched the movie "Inherit the Wind" for discussion the next morning.

He said he and LeMaistre agreed we may do as many as 4 more R-ICE chemos here in Austin (for a total of 6) before starting stem cell transplant (SCT) in San Antonio. He said the goal of SCT was to "step on the last cockroach." Consequently, we will "kill as many as we can here - as long as the bug spray we are using is working and as long as the bug spray we are using doesn't kill me, too." Dr. Doty has certainly mastered the art of communication!

I have a PET scan tomorrow. Next Monday we see Dr. LeMaistre and then spend the rest of the day with his staff. I think that will be SCT Class. Next Tuesday we see Dr. Doty (to discuss PET scan results) before starting chemo #3. I will post new info by Wednesday of next week.

RICK

at my desk 08/09/07

Well, I finally clipped off the few remaining stubborn hairs. You can officially call me "Slick" again. It is amazing how much cooler it is in an air conditioned room without hair. Perhaps we should require everyone to shave their heads in the summertime so we can turn the a/c up and save the world from global warming?

news as of 08/07/07

Well, the good news is that the chemo is working. Lymph nodes are clearly smaller and blood flow has returned to the right arm. I can grip the club and I can finish the swing; I just can't remember where the ball went!

Chemo side-effects are cumulative, so I am feeling it more as we progress through the series. The most prominent side effects are fatigue (like jet lag) and a weak, raspy voice. But no nausea so far.

The doctors want to take advantage of this so we are scheduling 2 to 4 more rounds of R-ICE here in Austin. Since those are 3 weeks apart I may not start transplant until early November now.

Thanks to all of you for caring enough to check in on me. I sincerely appreciate each and every one of you.

Rick

R-ICE round 2 at The Chemo Country Club

R-ICE is a a combination of Rituxan, Ifosfamide, Carboplatin, and Etoposide with a little Diphenhydram and Mensa thrown in for good measure. Strong side-effects were predicted but, so far, mine have been mild. I've had some indigestion/heartburn/hiccups/reflux but no nausea. The reflux weakens my voice some and causes me to sound a little hoarse, but you'll be happy to know (or not!)that I can still talk. As of yesterday my hair is falling out again so I'll answer to "Slick" again soon.

These treatments come in threes - 3 days in a row, 3 weeks apart, so I will be at the Chemo Country Club again today and tomorrow (about 3 to 4 hours each day). The first day (yesterday) they give me the Rituxan so they add Benedryl, which makes me loopy. The first day takes 7 to 8 hours - a long day.

The first day I miss a lot of calls because I sleep a lot (Benedryl), but days 2 and 3 I have my cell phone and use it and I'm back in the office in the afternoon. The first couple of weeks of stem cell transfer calls may be more challenging, but I will have a computer and email, and I will return calls as quickly as I can, and I will be checking with the office several times a day. Please send business email to the Retirement Counselors site as Norma will be checking that too. Or better yet, CC: Norma@RetirementCounselors.net

The game plan is to achieve as much remission as possible with R-ICE (administered in Austin at SWRCC - the Chemo Country Club). This stuff is working well so we are considering a couple of extra rounds before stem cell transplant. The decision will probably be made August 21st. That means transferring to San Antonio to start stem cell transplant will be anywhere between August 27th and October 1st. We will be in San Antonio for about 2 months, but most of that time is just to keep me close to their hospital (Methodist) in case I experience "Graft vs. Host Disease" or "GVHD" which is really my body rejecting my donor's cells. Very understandable considering that my sister is my donor. Man, is she going to be hard to live with after this!

Enough for now. I'll post again in a few days.

Thanks to all of you for your prayers and good wishes. They sustain me and the prayers are being answered every day.

RICK

07/30/07 with Brady Lynn Ouellette (#1 grandaughter)

schedule as of 07/23/07

07/31 CHEMO starting about 9 AM (6 hours ??)

08/01 CHEMO starting about 9 AM (5 hours ??)

08/02 CHEMO starting about 9 AM (5 hours ??)

08/03 Neulasta shot

08/14 PET scan @ 8:30 AM (3 hours ??)

08/20 Dr. LeMaistre @ 10 AM (decide on treatment protocol)

08/20 rest of day at Methodist meeting with members of the team

08/21 Dr. Doty @ 2 PM (discuss treatment)

08/25 move clothes, etc. to San Antonio apartment

about 08/27 ??? start stem cell transplant process at Texas Transplant

Sister is a match!

My sister, Ann Kilmer-Robinson, is a genetic match! This means she can donate stem cells which the doctors can use to replace my immune system.