Officially Done with Cancer Therapy; Now on to the Liver

I'm a little embarrassed to say that finishing post-transplant immunotherapy happened in July and I failed to blog about it. It was July 23rd. It was all so gentle: a final blood panel and the injection of the honey-like Rituxan Hycela (rituximab/hyaluronidase) into my belly fat. Proud to say: daily cycling (and now swimming) has given me less belly fat (still plenty adequate for injecting Rituxan Hycela) Anyway, when you're done with therapy, they have you ring a little ships bell as you leave. It happend kind of suddenly. I probably should have taken a selfie. But I rang it and was happy and was then fixed at getting downstairs, on my bike, and biking home. My fitbit reports that it was 43 minutes to get there, and 51 minutes to get home (probably because it was *hot* and I didn't have the opportunity to stuff ice cubes into my clothes like I did for the home-to-hospital stretch). It is about an 8-mile bike ride. So what's this about the Liver? Well, back in Sept 2017, when I first started the harsher Ara-C chemo (which requires hospitalization, where previous Bendamustine was outpatient), my liver freaked out, adn they had to reduce, slow, and spread out my treatment (took Fri-Mon instead of the intended Fri-Sun) The ruling was: MCL was going to kill me in the short term, so let's fix that while minimizing the unavoidable liver reaction, and worry about my liver later. So now it is later. For my liver, I'm in the care of the Tufts-affiliated system (my insurance, and local to me) rather than the Harvard. It's a real joy to live in a City where Tufts and Harvard can vie for my business. A couple of weeks ago they drew a "personal record" 11 vials of blood (1 just to throw away, and 10 to do about 40 different liver tests). Result: Liver enzymes still high. Mitochondrial Antibodies high, suggesting that my inflammation may have an auto-immune source. But the diagnosis, so far, is Primary Biliary Colangitis. Which is "doctor" for "his bile ducts look itchy" (Primary = no other evident cause", Biliary = Liver Bile, Colangities = Bile Duct Inflamed). Clear enough? In fact, it is a recently-coined name for a condition in which the patient has no other symptoms but has liver tests suggesting inflammation. (if it had symptoms, they might call it Cirrosis) That autoimmune source could still be related to Rituxan, which is immunotherapy. Or it could be my white-cells-and-lymph systems are still wonky. Or it could be a coincidence and the real cause may be the Bactrim (antibiotic) or Acyclovir. Or I could just be That Guy With High Liver Enzymes. The ultrasound-guided biopsy on Thursday will take a first look at the tissue itself. I expect it to serve as a baseline, and probably the first conclusion will be: 1) Let's wait until October, when the Rituxan will be "long over" 2) Let's wait until January (ish) when I'll likely be off the anit-viral and anti-biotics I expect we'll be testing liver enzymes periodically along the way. Cheers and good health to all!