October 2014

Trev-MUNils_trevmun wrote
on October 12th, 2013 at 09:50 pm
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The game plan for cancer treatment.

Friday was a stressful, hectic day; after weeks of my internist, the surgery ward, and finally my own calls to the CCMH Cancer Center to get an appointment, I finally had one scheduled for 1:00 PM. This made the day "fun" since i had to figure out how I was going to also drive down to Texas to get my license renewed (I won't get into that here).

The important thing is, I have a rough idea of what to expect in the coming weeks, and what will happen to me. But I also plan on contacting MD Anderson for a second opinion on some of this.

The oncologist is going to put me on chemotherapy; specifically ABVD. All things being equal it'll start on the 21st of this month just after my birthday. But first, on the 14th she's going to do a bone marrow biopsy on me to make sure that the cancer hasn't invaded my bone marrow. If it hasn't, then it will be confirmed as Stage II Bulky. She said the specific subtype of Hodgkin's Lymphoma is classic nodular sclerosis, but she didn't specify which flavor it is. Apparently there's two forms of it, and one is more resistant to treatment than the other.

The surgery ward will also install a PICC Line in me on the 14th, which is a catheter that goes into my blood vessels at the arm, and snakes its way through them until it gets near my heart. Knowing that makes me a little squeamish, but the alternative was a permanent implanted Medi-Port. I'm not ready for that yet. If the tumor resists treatment and they have to go on to other chemo cocktails, then I'll get one installed ... but not yet.

On the 16th I will also have to have a PET/CT Scan and echocardiogram performed on me; the first will determine exactly where all the cancerous cells are by way of a radioactive sugar (cancer cells eat up stuff like glucose faster than other cells, so this lets them see where they all are) ... the latter test will be to determine the current state of my heart. Which brings me to the important part ...

Chemotherapy will permanently damage me, and cause me a lot of temporary grief during treatment.

During treatment, I can expect for certain the following to happen to me because of the cocktail of drugs they're using: Fever and chills, skin reactions (peeling, ulcers, thickening, darkening or reddening, stretch marks), complete hair loss, fatigue and weakness, low blood counts (my immune system will be shut down, and I'll be anemic), nausea and vomiting, poor appetite, mouth sores.

I may also, during the treatment, develop sensitivity to the sun, body and headaches, jaw pain, shortness of breath, and changes in taste.

But the thing that bothers me most are the permanent side effects.

There is a very real possibility that ABVD will cause nerve damage to my hands and feet, which will manifest as numbness, tingling, prickling and even impaired motor control. This was what worried me the most initially, until I found out that one of the drugs WILL destroy anywhere between 2% and 15% of my heart. It depends a lot on the dosage, but I could wind up having heart attacks and heart failure up to eight years down the road.

Both of these side effects are irreversible with current medical technology. There have been some encouraging medical studies done using cardiac stem cells to repair hearts with cardiomyopathy, but like most medical research, it'll be 15 years or more before it's approved as a standard treatment.

(EDIT: Even worse, a day after posting this I just found out that I can expect permanent brain damage, as well. "Chemo-brain," they call it. I can expect taking a hit in multitasking, reading comprehension, short-term memory, remembering words, and more. This is going to be devastating to me as a university student and in the career I want to pursue.)

Oh, and ABVD will put me at an increased risk for developing secondary cancers; leukemia specifically.

I can't help but think how lucky my mother was. All she had was a radiotherapy; they didn't do chemo on her, because the tumor was isolated on the side of her neck. Me, I'm going to be trading certain death at the hands of an untreated cancer for possible death in the coming decade and permanent damage from the chemotherapy. Assuming, of course, the chemo kills the tumor. The oncologist seems to think ABVD has a good chance of ridding me of the cancer entirely, no radiation therapy needed. I guess we'll see.

When I asked the oncologist if they can cryotherapy to help protect my scalp, hands and feet (cryotherapy uses a cold cap, as well as cold mittens and booties, to restrict blood flow and lessen the dose received by those parts of the body), she said they won't, telling me that she had been in a recent meeting where studies said cryotherapy may reduce the effectiveness of treatment.

That's one thing I plan to talk to someone at MD Anderson about. I know for a fact that MD Anderson does use chemotherapy before proton beam therapy, so even if I resolved to go down there I would likely still be put on ABVD and face the same problems. I may also ask if they do Stanford V, and if it's less damaging than ABVD (which was the impetus for its development).

So, that's how things look for me now. While I am on the treatment I'm going to be like a naked mole rat, hairless and easily burned by the sun. I'm also going to have to take my own temperature three times a day, since my immune system will be offlined by the drugs and I won't know if I may have an infection. I've also been advised to avoid large crowds and sunlight. Both of these things are impossible on an outdoors university campus, but I'm going to be talking with the university employees about things they can possibly do to help me there.

Coping with this while handling my near-max load at college is going to be really hard.