The one that has Jay's chemo stuff.....

Well, I checked my email and Sheila sent an email update, but then she sent a file with all of Jay's chemo stuff. So I thought you might like to see it all...and it is probably very deep for those of you who don't know what is going on....don't fret....that is very deep even for me...but needless to say Sheila and Jay fully understand it all, heh. Yeah, they are awesome!

Well, today Sheila and I drove back to their home so we could pickup Jay's new Pocket PC's sync cradle so that I could pimp out his Pocket PC, heh. So...when I take his Pocket PC to him tomorrow there will be two new games and a few other apps, heh. We also had to go pick-up Jay's fav. Lobster Bisque! And Oh man, it is really good! I am still searching for the best bisque that I have ever eaten.....The Seafood restaurant @ Epcot in Disney World...oh man that is the best I have ever had...but this one was VERY close! Very good indeed!

Jay loved it...but could not eat too much of it because it is very creamy and causes him to cough. So we will try something else tomorrow...maybe Chinese fried rice? We shall see....

Well, Jay is feeling so much better...again. He is going to the bathroom by himself, and walking around the ward just for the heck of it, heh. He is great and man, I love visiting my brother! By far Jay is my brother, and best friend second only to Tiffany (my wife), and more importantly, Jay is my hero!

When I was in high school I would tell people that I had three heroes, and now I will add it to 4, Jesus, Albert Einstein, Weird Al Yankovic, and Jay Hollums, heh.

Well, I need to get my sleep so I can go to church....there is one right across the street from the front door of the hotel!!! heh. It is great!

Please KUTPs! Love yall! cya!

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Sheila's Email:

Jan. 8th Afternoon:

THINGS ARE SO MUCH BETTER!!!!!!

Jay is definitely back to Jay. This morning he got up and wanted to go for a
walk around the ward and he spent the entire time griping at me about "mother
henning" him. If you employ the transitive complaint property to his condition
you will know that the amount health is greater than or equal the amount of
complaining. So he is doing GREAT! :-) He actually played with his Pocket PC
and set up his computer on his hospital tray to watch DVDs. This is a major
improvement. He's walking to the bathroom on his own and is doing great! I am
so happy with his improvement in the last 24 hours.

Actually, they found a blood clot in his groin from the central line they had
put in and his temperature is from a staph infection due to the blood clot. He
is feeling so much better even with a 104 degree fever. They are giving him a
blood thinner injection to help with the clot and at the same time giving him
platelets so he doesn't bleed to death. He told me today he is convinced he is
going to beat this thing once and for all.

I have included a copy of his chemo regime. They may vary it slightly but this
is pretty much the idea. It is about twice as intense as his last very intense
chemo. They will do a bone marrow transplant when they have completed the chemo.

We have a lot to celebrate today.

Sincerely,

Sheila

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Jay's Chemo treatment:

CODE: Hyper-CVAD
CCO Formulary November 2002
A REGIMEN NAME Hyper-CVAD Chemotherapy
Cancer Non-Hodgkin’s Lymphoma (High Grade) Curative
Regimen
Category
Local: A regimen not widely used; used by fewer than four Regional
Cancer Centres
B DRUG REGIMEN
Course A
CYCLOPHOSPHAMIDE 300mg/m 2 IV over 3 hours Q12H x 6 doses
Days 1, 2, and 3
MESNA may be given as an uroprotectant at the same total dose as cyclphosphamide but
given by continuous infusion starting with cyclophosphamide and ending 5 hours after the last
dose. (Although Mesna is recommended in the cited reference (Kantarjian et al.), most RCC’s
usually do not administer Mesna with this dose of Cyclophosphamide.)
METHOTREXATE 12mg IT Day 2
DOXORUBICIN 40mg/ m 2 IV Day 4
(Some RCC’s has replaced Doxorubicin 40mg/ m 2 with Daunorubicin 60mg/ m 2 )
VINCRISTINE 2mg IV Days 4 and 11
DEXAMETHASONE 40mg/day IV or PO Days 1 to 4
Days 11-14
CYTARABINE 70mg IT Day 7
Course B
METHOTREXATE 1000mg/ m 2 IV over 24 hours Day 1
LEUCOVORIN 25mg/ m 2 IV 24 hours after the
completion of
Methotrexate infusion
Q6H X 6 doses
Sodium Bicarbonate 600mg PO (starting day
before Methotrexate)
TID X 4 Days
CYTARABINE 3gm/ m 2 IV over 2 hours Q12H X 4 doses
Days 2 and 3ഊCODE: Hyper-CVAD
CCO Formulary November 2002
C CYCLE FREQUENCY
A total of 8 cycles is administered (4 X A, 4 X B) with the goal to give treatment as rapidly
as possible.
D PREMEDICATION AND SUPPORTIVE MEASURES
ANTIEMETIC REGIMENS:
HESKETH LEVEL 5
· With high dose Methotrexate, give hydration with Sodium
Bicarbonate for 48 hours.
· Prophylactic use of Dexamethasone 0.1% or Pred Forte
Ophthalmic solution 1-2 drops q4h while awake for 7 days
(during high dose Cytarabine) to prevent conjunctivitis
· Antibiotic prophylaxis may be given (see reference)
E DOSE MODIFICATION
Doses should be modified according to the protocol by which the patient is being treated. The
following recommendations are in use at some centres:
Hematologic Toxicities
See Appendix 6 for general recommendations.
Renal Dysfunction
Creatinine Clearance
0.2-0.8mL/sec
<0.3ml/sec>3X ULN
>4X ULN
% usual dose
REDUCE Daunorubicin to 75% dose
REDUCE Vincristine to 50% dose, and
REDUCE Doxorubicin to 50% dose
REDUCE (Daunorubicin) to 50% dose
REDUCE Vincristine to 25% dose, and
REDUCE Doxorubicin to 25% dose
REDUCE Methotrexate to 75% dose
OMIT Methotrexate dose
OMIT (Daunorubicin) or Doxorubicin dose
(Suggested action)
Neurotoxicity
1. Mild motor neuropathy REDUCE Vincristine to 2/3 dose
2. Moderate motor neuropathy REDUCE Vincristine to 1/2 dose
3. Severe motor neuropathy STOP treatment with VincristineഊCODE: Hyper-CVAD
CCO Formulary November 2002
F ADVERSE EFFECTS
Refer to Cyclophosphamide, (Mesna), (Daunorubicin), Doxorubicin, Vincristine, Dexamethasone, Methotrexate, Cytarabine, and Leucovorin drug monograph for full details of
adverse effects.
Most Frequently Occurring Adverse Effects
· Myelosuppression
· Hyperuricemia
· Stomatitis
· Nausea and vomiting
· Neurotoxicity
· Stomatitis
· Vesicant
· Cardiotoxicity
· Hyperglycemia
· Gastric irritation
· Hemorrhagic cystitis
· Alopecia
· Insomnia
· Constipation
· Acute encephalopathy
· Pulmonary toxicity
· Pigmentation discorder
· Diarrhea
· Infertility
· Hepatotoxicity
· Fever
· Cerebellar toxicity
· Conjunctivitis
· Flu like syndrome
· Typhlitis and necrotising colitis
G INTERACTIONS
Refer to Cyclophosphamide, Daunorubicin, (Mesna), (Daunorubicin), Vincristine,
Dexamethasone, Methotrexate, Cytarabine, and Leucovorin drug monograph for full details.ഊCODE: Hyper-CVAD
CCO Formulary November 2002
H ADMINISTRATIVE INFORMATION AND SPECIAL PRECAUTIONS
Refer to Cyclophosphamide, Daunorubicin, (Mesna), (Daunorubicin), Vincristine,
Dexamethasone, Methotrexate, Cytarabine, and Leucovorin drug monograph for full details.
I CLINICAL MONITORING
· Clinical toxicity assessment (including cardiotoxicity, gastrointestinal, neurotoxicity,
cerebellar toxicity, sensory, local, cystitis and stomatitis).
· Routine blood glucose test.
· Baseline and regular cardiac examination for patients with cardiac risk factors (including
prior therapy with Doxorubicin or Daunorubicin, Epirubicin, Mitoxantrone, or other cardiotoxic
drug) and cumulative Daunorubicin doses > 600mg/m 2 or Doxorubicin doses > 450mg/m 2 .
· CBC before each cycle. Interim counts should be done in first cycle and repeated if dose
modifications necessary.
· Baseline and regular liver and renal function tests.
· Baseline and periodic pulmonary examination.
· Baseline and regular ophthalmic examination.ഊCODE: Hyper-CVAD
CCO Formulary November 2002
J ADMINISTRATION INFORMATION
Patient visit Should be administered in hospital
Approximate drug cost
(chemotherapy only)
$ 910.00 per Block A treatment cycle
$ 772.00 per Block B treatment cycle
Complexity Value
BLOCK A
Regimen
Pharmacy
Chemo Nursing
BLOCK B
Regimen
Pharmacy
Chemo Nursing
200 Per cycle (value normalized to 28 days)
68 Per cycle
132 Per cycle
97 Per cycle (value normalized to 28 days)
39 Per cycle
58 Per cycle
K KEY REFERENCE(S)
Kantarjian HM, O’Brien S. Smith TL, et al. Results of treatment with hyper-CVAD, a dose-intensive regimen, in adult acute lymphocytic leukemia. J Clin Oncol. 2000 Feb; 18(3): 547-61.
L OTHER NOTES
This regimen should only be given by hematologists trained in the care of high grade
lymphoma patients, and practicing in institutions with adequate acute care designed to support high grade lymphoma patients.

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Well there is all those drugs and I have no idea which ones are Chemo and others that are whatever...but all I know is that we can all continue to pray for all of them to work well, and then I can come in @ the end of the game and clean house with my stem cells, heh. KUTPs!!!!!!!!!!