My first appointment in oncology

Monday, January 11, 2010 was my first oncology appointment.  I went up directly after seeing the surgeon.  They had me double booked, but made plenty of time for me.  Although they told me to "cancel my afternoon," which I did, we never did end up starting treatment. 


It started with the standard doctor visit stuff:  height, weight, vitals.   I had in my hands my official P.E.T. scan report and printed pictures.   When the oncologist came in, I gave it to her.  I liked her immediately.  She was of good humor, but serious when necessary.  There was no sugar coating of anything.  We discussed my symptoms, some history, and she did a physical exam.   Meanwhile, Sarah was rushing from Aurora to get down for the appointment, since it was a surprise.  She got there about 30 minutes in, and then became involved in the discussion herself.


We discussed the treatment, what would be necessary and when, and prognosis/possible outcomes.  I would be getting a bone marrow biopsy that day.  I had been dreading this possibility for a month, but after a VATS surgery, the thought of it wasn't such a big deal anymore.   As noted, she was ready to treat that day, and the words "You have bad Hodgkins" came out.   However, waiting a week would not matter at all in outcome, and I wanted to pick out which day I'd be getting treatment.  The plan to treat was because she felt as though I was anxious to get going.   (Sort of).  Chemotherapy would start Monday, January 18, 2010, or in exactly one week.


Treatment plan for Hodgkin's Lymphoma is pretty standard.  The regimen used is called ABVD.  As a pharmacist, I (remarkably) knew nothing about these drugs.  Even with my 3 weeks to prepare, I didn't do much reading.   I knew they would likely cause some emesis.   At some later point, perhaps I'll detail each further, but for now, the link should suffice.    The plan is for 6 cycles.  Each cycle is a month, with drug on days 1 and 15.   (In other words, 1 cycle = 2 doses, so, I had 12 sessions of chemo planned out for me for my next 6 months).   After that, I would get radiation.  Radiation is used for "bulky" lymphoma since the drugs can only shrink so much.   The cutoff for "bulky" is 6cm, and my big node is 7cm across.   The plan for this was 20 days, minus weekends, to begin after chemo.


The chemo could wait, the bone marrow biopsy could not.  Sarah and I packed up to go into another room down the hall.  This room had a sort of bed/table on which I had to lay, face down.  I was instructed to pull my pants partway down, as the section of bone to biopsy was the top of the pelvis just around where the waist is.   After a joke or two, I was stuck with lidocaine.  I didn't enjoy it.  After the oncologist reminded me to resume breathing, she took some marrow and a small core of bone.   I obviously couldn't watch, but I experienced a wrenching sensation, which reminded me of one of those Amish-style, non-power drills.   I later asked Sarah, and she said that indeed there was a huge crank she was turning to get through the bone or draw out the marrow or something.


When that was finished, I was told to lay down on my back and some blood was taken.  Later, a nurse came in to talk a little about the chemotherapy.  She spared many details realizing how overwhelming our day was, but reminded us that on Monday (1/18/10), there would be a chemo class at 9am that we should attend prior to starting treatment at 11am.   She gave us the basics in terms of what to eat and what to expect.


On Thursday, we found out that my bone marrow was "clean."  This is important, because if the ABVD fails, one possible option would be using my own marrow for an autologous bone marrow transplant.  In the world of prognostic indicators, I also believe that this is a good one.


My afternoon was basically cancelled by this point.  I was told to go home by oncology, and not to go back to work.  I went back to my office to collect my things, and then headed off to McDonald's for some food.  In the excitement of the day, I hadn't eaten.