Goodbye Voriconozole

What with the slight trauma from last week's "face fry," which, by the way, is now peeling like a bad sunburn would, I didn't get around to mentioning some news from my Dana-Farber visit.

Dr. Alyea and Dr. Marty said they were letting me stop the Voriconozole, aka Vori, an anti-fungal drug I have been taking for more than three years. Anyone who takes a lot of pills knows that it lightens your load to get rid of any of them. This one, taken twice a day, felt especially weighty, tied as it was to the fungal infections I repeatedly got.

It makes your skin especially sun-sensitive and is partly responsible for the dark spots on my neck and face. Last spring and summer I got a lot of sun exposure from dog-walking, running, and, of course tennis, often played where there was no shade. I wore a hat and applied sunscreen, but there's only so much you can do.

Alyea's stated reasoning: "We have to get you ready for outside tennis."

Gotta love that guy.

Back home when I pulled out my bag of pills to put them in their boxes for the week, I took out the Vori and slid it to the end of the table. Woo hoo!

I also got to decrease my dose of magnesium from one pill three times a day to just once a day. I took magnesium for support starting during my hospitalization and just kept taking it. Another sign of forward movement.

But then there's the prednisone, which I won't be able to stop for quite a while. My liver function is better, and I asked if I could go down from 5 mg. a day to alternating 5 with 2.5, which I did once before.  Alyea pointed out that when I did that, my liver got worse again. I know that 5 is a small dose, but I still would like to get off it, which would mean lowering my pill load even more because then I could get off the preventatives Bactrim and Valtrex.

He pointed out that he treats some bone marrow transplant patients who stay on prednisone indefinitely.

And, he reminded me, "This is a long haul."

That was sobering to hear.

I don't think I'll ask about the prednisone again. I'll just be thankful it is keeping the GVHD of the liver in check and that at this low dose, I don't have any of the side effects I had when I took more.

Clinic: The good and the annoying

Monday was another rare no-transfusion day, but it was still interesting.

While waiting for my appointment with Melissa, I went into the infusion room to get my egg salad sandwich and bag of chips from the cart. I need to get it before I am scheduled for an infusion, which is usually around 3, when the sandwiches are gone. So I go in and get it from the cart and usually eat the sandwich in the waiting room.

A few different volunteers push the cart around. The main cart lady, whom I shall not name, is very moody. Once she told me to leave because sandwiches were for patients only and I couldn't take it out of the room. When I told her I am a patient, she said OK. Still, she makes me wait near the nurses' station because she doesn't like me following her cart. Last week I came in late, and she was very concerned about me. She had taken out my sandwich and chips and set them aside specially for me – good mood day.

Then on Monday she growled at me and said I couldn't come in and get my sandwich because most patients get theirs at the time of the infusion, and I should be sending someone from the desk in for the sandwich. I hadn't thought of bothering someone at the desk to get my sandwich, because I could get it myself. I explained that I couldn't pick it up at the time of the infusion because it would be too late. "I'll give it to you just this once," she said, gritting her teeth.

Subtext: "I am the cart Queen and you shall not come near my cart if I am not in the mood to let you near."

Geez. Everyone is nice at the Dana-Farber Cancer Institute, and so it's especially jolting to bump into someone who seems mean-spirited. It's small potatoes, but everyone is under stress, and it just adds to it to have to dance around someone's moods.

Weird episode number two: I got my good report from Melissa (details just below) and I was talking to my sister and laughing over the phone about the sandwich incident. I also told her that at the end of my exam with Melissa, when she told me I could go home, I said, "I guess I'll have to return my sandwich."

The patient sitting next to me laughed. After I got off the phone, he said, "I'll take that sandwich." We started talking about why we were there and he said he was being treated for one of the chronic diseases, CML – chronic myeloid leukemia.

When I told him I had been treated for acute myeloid leukemia (AML), he said,

"When I was diagnosed they told me it was better to have the chronic. They said the "C" was so much better. They kept saying 'It's good you didn't get the "A," the "A" is much worse."

I gave him a look. I think he realized what he had just said. I had previously told him I was doing well. "Oh, but it's great you're doing well," he said.

I cut off the conversation, turned to my newspaper and wished him luck.

My thought bubble: "Hey, buddy, turn on your filter. It's not that hard to do."

It didn't bother me that much, but it made me think about the need for more people to put those filters on. I won't get into the difference between acute and chronic and which is considered "better." I guess you can put a spin on any illness and say one is "better" than the other. But voicing your spin to someone who has the other is just not the thing to do.

It goes into the category of unhelpful (or, frankly stupid) things people say, not just pertaining to cancer. I remember when I was pregnant, there were people who just couldn't help telling me disastrous pregnancy stories. For that matter, it goes for many problem situations, as in, "I had the same thing happen to me and it turned out terribly!"

Anyway, back to the good part of the day, my appointment with Melissa. My white count was 7.5 (high normal!), my hematocrit was 28.2, and my platelets were 26. Those were still below normal, but they were good for me and high enough to avoid transfusions.

I also had an appointment with Dr. Francisco Marty, the infectious disease specialist who's followed me since my first fungal pneumonia in 2003. He examined me, looked over my numbers and said I could stop taking Voriconozole, the anti-fungal drug I've been taking since my long hospitalization last winter, when a got another fungal pneumonia. My liver function is slightly elevated, and it might be from the "Vori." So at this point it may be hurting me, and it's not helping me, because the fungus is gone now. To compensate, I need to double my Prograf to 1 milligram once a day.

Dr. Marty always makes me smile. Monday was no different. The "good vibes" I got from him stood in contrast with the bad vibes from the moody volunteer and the overly-talkative patient.