April - What is a Lymphatic System, Anyway?

 Writing this at Detroit Metro Airport as I await my flight to Houston. Tomorrow will be a blood test (excellent results expected), an appointment with Dr. Chien (also a runner), and a 5 hour infusion of obinutuzumab. 

If you're just tuning in, things have been going quite well for me in Houston and as a part of this clinical trial. My blood counts have rapidly normalized, I'm experiencing no side effects, and I feel like I'm in the best shape of my life. I ran 20 miles this past Wednesday like it was a walk in the park, and I'm officially ready for the Cincinnati Marathon coming up May 3rd. 

It's entirely possible that I'm already cancer-free - my blood tests would look exactly like this if I were - but I won't know officially until a bone marrow biopsy in July and another next January. For now, it's just fly to Houston every month, take a blood test, get the results, pump my fists in the air like Rocky and fly home. Maybe take in a Rockets game along the way, but it looks like I need to move onto the Astros now. Planning on attending the 'Stros game on May 4 - Go Dodgers!!

Anyway, the bone marrow thing is an interesting one. Like, what the hell is bone marrow? Apparently it's where your body creates blood cells, and it's a part of the lymphatic system. Your what? Oh yes, you have a second circulatory system that plays Scottie Pippen to your bloodstream's Mike Jordan. I'm just learning about this too. Like big brother bloodstream, lymphatic has a fluid in it - this one appropriately called lymph. Lymph moves in a low-pressure system that acts a a return vent - bringing blood, fats, and cellular debris from the extremities back toward the heart. Lymphatic is a low pressure system as it lacks a heart or pump to move things along. The thing that does move the lymphatic system? Exercise.

So I'm getting these great results, rapidly progressing toward remission if not already there, and wondering why things are going so well for me? Sure, I'm younger than the average CLL patient, but might there be some lifestyle factors contributing to this? I'm ketogenic, drinking two matcha/turmeric teas per day, intermittent fasting - all of which might be helping or might be doing nothing at all. But lymphatic system research has me thinking all this running must have somthing to do with my encouraging early results and, I believe, be what moves me from "years long remission" to "cured". 

From what I read about my clinical trial, the bloodstream is the first and easiest compartment to clear, but it is the lymph nodes and bone marrow (both part of the lymphatic system, mind you) are where leukemia cells can survive and slowly proliferate.

So those are the ones I'm going for when I run. I take these futuristic drugs, have a cup of coffee while they slowly enter my blood stream, then pump them through the lymphatic system repeatedly for hours on end. 

You picked the wrong dude, CLL.

Final Weekly Visit

 Sitting at Detroit Metro Airport right now, waiting to board my Delta flight to Houston, and I've had a little time to reminisce on treatment thus far.

In short, I don't things could possibly be going better than they are. The results are, thus far, tremendous. Blood counts are normal across the board - WBC, RBC, hemoglobin, platelets....and all the rest of them are normal. I'll take a more detailed blood test and bone marrow biopsy sometime this summer to get a more detailed look at how many CLL cells per 1 million blood cells (if any) remain in my bloodstream and bone marrow, but in the meantime my blood tests suggest the following:

1. Most, if not all, CLL cells have been cleared from my bloodstream (huge)

2. My bone marrow is also clearing. This is important because marrow is the last section to clear (after blood stream and lymph nodes). If the marrow was still crowded with CLL cells, my RBC and hemoglobin would likely be abnormally low (because they're crowded out). Further, this would suggest a shorter remission as the abundance of CLL in my marrow would soon multiply and return to the bloodstream. 

Who knows? I might be in remission already. What my elite early response also suggests, is that I'll likely be in a complete remission when all is said and done. In other words, undetectable cancer in the bloodstream and bone marrow. This would point to one of two outcomes:

1. Many years of remission, followed by a slow relapse and even more effective (maybe curative) therapies available when I need them in the future OR

2. A functional or true cure. Meaning we either got every last CLL cell (less likely) or we got just about all of them, and all that remains are weak ones that my immune system can contain (more feasible). The doctors at MD Anderson believe that the treatment I'm receiving will end up being a cure for some patients - why not me?

I realize, oh loyal reader, that I've been posting less frequently over the past month or so, and it mostly has to do with how clinically uneventful these Houston trips have become. I head in, get a blood test, sit around and wait for the reults, get great news, and head home. Rinse, repeat.

I've also learned that, as far as cancer appointments go, boring is good. I want these appointments to be as mundane and ho-hum as possible, and that's exactly what I'm getting.

And now I board the flight. Excited for this one, as I'll be able to watch the Michigan/Michigan State game in its entirety as it starts about 15 minutes after this flight takes off. I've reunited with some extended family in the Houston area, and they'll be waiting for me when I land.

Go Spartans!

Normal Counts and Sonic in my Bloodstream

 It's a beautiful day in East Texas, and the good news keeps coming - save for one scheduling snafu. I got in Sunday night, took the bus(es) to my hotel, then woke early this morning to go get a blood test. The blood test results are excellent, as my white blood cell count and absolute lymphocyte count are both in the normal range for the first time since before I was diagnosed. From what I understand, this is excellent news and means I'm well on my way to a complete remission - though it would be premature to unfurl the "Mission Accomplished" banner and give a speech.

As I was discussing the results with Meghan, the well-informed PA who works with Dr. Chien, she informed me that there was a scheduling miscommunication, and that I'd need to fly out Wednesday instead of tomorrow. "You could use the extra day to go for a long run around Houston," she suggested.

I saw an opportunity.

"Call me crazy if you will," I began, "but I have this unproven theory that if I routinely go running after taking the venetoclax and pirtobrutinib, that I'll be increasing my heart rate, stimulating blood flow, and distributing the drugs in and out of the lymphatic system, the bone marrow, and other harder-to-reach areas that CLL cells are known to hid in. This would - according to my unproven theory - lead to a deeper remission and a higher likelihood of getting every last CLL cell. Can you speak to this idea?"

Meghan's eyes widened (we both had masks on as it's required) and she paused before responding. "That's a great question!" She replied. "We don't get many marathon-runners in here, but I can see where that might make sense biologically."

That's all I needed. I went out and ran 10 miles right after the appointment. While I was running, I kept imagining that the little pirtobrutinib and venetoclax molecules were little Sonic the Hedgehogs. It's probably been a while since you've played that game, but my kids have gotten into it recently (you can play for free online HERE) and I've played with them.

In the game, Sonic runs around with his buddies Tails and Knuckles, gathering rings. I imagine that's pirto, ven and obin, running through my bloodstream and picking off CLL cells. Sometimes, Sonic can get a hold of his magic red shoes, which speed the game and music up like 5x, and Sonic and co. gather rings at lightning speed. That's what's happening with PVO when I run - Sonic's magic shoes, baby.