On Thursday, my dad and I went to the Rocky Mountain Cancer Center to meet up with Dr. Alan Feiner to discuss the schedule of treatments that I would be receiving. Dr. Feiner seems like a pretty smart guy and someone to trust on this, even though he also seems to be a bit spacey. Spacey in the way a professor can be, but still quite intelligent and knows what he is doing.
When we got there, he did a basic examination, checking for lumps in the neck, armpits, groin area. He also went through the list of questions, "Do you have night sweats?", "Changes in eating?", etc. Of course, I've been asymptomatic, so most of the answers were basically, nothing unusual.
On Friday, I met with Dr. Alice Cook at Presbyterian St. Luke's to get a second opinion. I got the name of this group of doctors from my brother-in-law's father, who is a pathologist in Michigan, who contacted a friend of his in the Denver area. Again, we went through the question and answer sessions. Dr. Cook was very talkative and really described everything that we wanted to know.
Here's what we basically learned from both. The cure rates for Hodgkin's lymphoma is pretty high (as we all know). It's quite possible that it will only take 2 cycles of chemotherapy, and not require radiation. Of course, everything depends on how I react to the chemo. A chemotherapy cycle is 28 days, where most of the chemotherapy is done on days 1 and 15 of the cycle. The standard operating procedure is to use the ABVD set of chemo drugs. One thing is that pretty much all places follow the same flow of treatments. In fact, Dr. Cook gave a set of handouts showing the basic flow diagram from the National Institute of Health that all hospitals pretty much follow.
But everything first starts with tests.
Unfortunately, there are many different types of Hodgkin's lymphoma, and a needle aspiration doesn't tell everything. I have to go back to Dr. Reichman (ENT) to get either an incisional biopsy or excisional biopsy on the same lymph nodes. Incisional means that they take a slice out, where excisional means they take out the whole lymph node. In the end, they can look at the structures and tell what kind of Hodgkin's lymphoma it is.
With ABVD, there are a few things we need to keep an eye on. The first is the A drug, which can affect the heart. So, that means we need to get a heart scan to see how the heart will function. The B drug can affect the lungs. So, that will require the pulmonary function tests to see how the lung capacity changes. I've had plenty of these because of my asthma.
There will be plenty of blood tests.
This week, I'm going to have my heart scan. I also have a PET/CT scan. The PET/CT scan is a full body scan which they will use to see where else the lymphoma has spread, if it has. The CT scan is like an x-ray which they can see the structures of the body. The PET scan, they can see the composition of the body, which is almost like a heat map.
The next test is a bone marrow biopsy. They basically core a hole in the hip bone to extract a few cc's of bone marrow. From what I hear, this is not a pleasant experience. I look forward to writing about it afterwards.
Then the following week I have the port insertion. The port is a catheter which makes it easier to deal with repeated chemotherapy. Without the port, it would require using an IV which must be inserted everytime. And, while it would be annoying to be pricked every time, it also has risks in that it could damage internal cells, especially if the chemo sticks around for too long. With the port, the chemo would go directly into the bloodstream and be immediately distributed.
So, chemo is scheduled to start in mid March. Still trying to finalize the dates.
After both appointments, I think I'm comfortable going with Dr. Feiner. Both doctors said the same things, but in the end, it is just a matter of personal taste.
When we got there, he did a basic examination, checking for lumps in the neck, armpits, groin area. He also went through the list of questions, "Do you have night sweats?", "Changes in eating?", etc. Of course, I've been asymptomatic, so most of the answers were basically, nothing unusual.
On Friday, I met with Dr. Alice Cook at Presbyterian St. Luke's to get a second opinion. I got the name of this group of doctors from my brother-in-law's father, who is a pathologist in Michigan, who contacted a friend of his in the Denver area. Again, we went through the question and answer sessions. Dr. Cook was very talkative and really described everything that we wanted to know.
Here's what we basically learned from both. The cure rates for Hodgkin's lymphoma is pretty high (as we all know). It's quite possible that it will only take 2 cycles of chemotherapy, and not require radiation. Of course, everything depends on how I react to the chemo. A chemotherapy cycle is 28 days, where most of the chemotherapy is done on days 1 and 15 of the cycle. The standard operating procedure is to use the ABVD set of chemo drugs. One thing is that pretty much all places follow the same flow of treatments. In fact, Dr. Cook gave a set of handouts showing the basic flow diagram from the National Institute of Health that all hospitals pretty much follow.
But everything first starts with tests.
Unfortunately, there are many different types of Hodgkin's lymphoma, and a needle aspiration doesn't tell everything. I have to go back to Dr. Reichman (ENT) to get either an incisional biopsy or excisional biopsy on the same lymph nodes. Incisional means that they take a slice out, where excisional means they take out the whole lymph node. In the end, they can look at the structures and tell what kind of Hodgkin's lymphoma it is.
With ABVD, there are a few things we need to keep an eye on. The first is the A drug, which can affect the heart. So, that means we need to get a heart scan to see how the heart will function. The B drug can affect the lungs. So, that will require the pulmonary function tests to see how the lung capacity changes. I've had plenty of these because of my asthma.
There will be plenty of blood tests.
This week, I'm going to have my heart scan. I also have a PET/CT scan. The PET/CT scan is a full body scan which they will use to see where else the lymphoma has spread, if it has. The CT scan is like an x-ray which they can see the structures of the body. The PET scan, they can see the composition of the body, which is almost like a heat map.
The next test is a bone marrow biopsy. They basically core a hole in the hip bone to extract a few cc's of bone marrow. From what I hear, this is not a pleasant experience. I look forward to writing about it afterwards.
Then the following week I have the port insertion. The port is a catheter which makes it easier to deal with repeated chemotherapy. Without the port, it would require using an IV which must be inserted everytime. And, while it would be annoying to be pricked every time, it also has risks in that it could damage internal cells, especially if the chemo sticks around for too long. With the port, the chemo would go directly into the bloodstream and be immediately distributed.
So, chemo is scheduled to start in mid March. Still trying to finalize the dates.
After both appointments, I think I'm comfortable going with Dr. Feiner. Both doctors said the same things, but in the end, it is just a matter of personal taste.
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