Paul's Heart

Life As A Dad, And A Survivor

Archive for the category “Cancer”

Well Read Or Do I Just Know Too Much?


You go to a doctor with a sore throat, a cut that needs more than a bandaid, or possibly recurring headaches.  When the office visit is over, hopefully you have gotten your diagnosis or treatment, and you are on your way to recovery.  But what happens when you are dealing with an issue that is not common enough or is something that your doctor or nurse practitioner has not seen since Med School?  Hopefully you are not brushed off with a “general” diagnosis and told to give it time.  If you are lucky, your doctor will refer you out to a specialist.  But even that is not a sure thing because your doctor does not know what is wrong with you, how will your doctor know what specialist to send you to?  And going to the wrong specialist will only continue the torment of “we really have no idea” and again, the cycle repeats.

The world of the long term cancer survivor turns just like that.  Looking at me, I appear like a typical 46 year old male.  Listening to my day’s activities, there is nothing that stands out to anyone.  But a couple of decades ago, I made a choice to undergo radiation and chemotherapy treatments so that I could survive cancer.  Normally, a side effect is something you experience while you are taking a treatment or remedy.  After all, when you look at the bottle of medicine, or watch the commercials, you get the information on “possible” side effects.  But there is a difference between short term and long term.  What you see on the bottle and hear on TV is short term.  These are the side effects that are known and must be revealed according to FDA regulations.  This way you know the risks involved with your treatment.

A little known fact?  Not all side effects are listed on the bottles or stated in the commercials.  This does not mean that they do not exist, but if the number of patients is so minimal, the side effects may not be required to be publicly stated when advertised.  But God help you if you develop one of those side effects.  Again, because it is not the obvious, a patient has the possibility of not being taken seriously.  And this is a mistake.  Sometimes, it can be a fatal mistake.

Then there are those side effects that do not happen for a long time.  Do you recall Three Mile Island or Chernobyl?  News programs raised the risks of lingering effects by simply saying, who knows?

With cancer, it used to be that patients were not expected to live too long after their remissions.  In fact, a mythical mark of five years to this day, is still a goal that survivors strive to achive because now, so many more people survive cancer longer than that.  And the longer you went past five years, the better your chances for survival.  With the good comes the bad.  Researchers never really researched the long term effects of radiation, chemotherapy drugs, and even surgeries (such as splenectomies).

When you go to the doctor for the flu, or a broken arm, you are followed up by your doctor until your deemed cured or healed.  After that, you are on your own.  Up until recent years, cancer patients were treated the same way, and it definitely seemed tied to the “5 year mark.”  Whether short term or long term, side effects need time to develop.  If you get nausea while taking an antibiotic, you complain about it, and perhaps something different is prescribed.  But this is only by diligence by you or observation of your doctor.

But what happens when you are exposed to all the toxicity, hazards, and challenges brought on by your cancer diagnosis and treatment, and you are not followed up on?  We all know, the sooner you catch something, the better, right?  That is the way it worked with my Hodgkin’s.  It was caught early.  But over the years, I had no idea that my body has been failing.  My cardiac system, respiratory system, muscular, spinal, and the list goes on, have all been affected.  Again, on the outside, I look like a normal 46 year old, and any doctor who were to look at me, or listen to a concern, would treat me that way.

But because of my ails over the years, I have learned so much about my health, my long term side effects.  My primary care physician relies on me to “teach” her this “new” medicine.  You cannot correct an irradiated heart like you would a normal abused-by-yummy-diet hearts.  A doctor who is not trained in these late effects (see other posts of mine under “Hodgkin’s Disease – Side Effects) who happens to stumble on my bodies ill effects, can find themselves in trouble, leading me to be at risk.  But these are things that I have learned over time.  I possess all records pertaining to my cancer past, and everything that has occurred to me since.

But the time does come, when I must deal with another ER doctor, express my latest concerns, trying to convince them that I am not a “typical” case, and again, when they cannot figure out what is causing the latest symptoms, in spite of my assertions, I hear “well, you are very well read”.  So on top of what is making me ill at the present time, the doctor-de-jur feels that I have planted the crisis in my head, “well read”.

Yes, I do know a lot about the human body, especially mine.  I know about everything that has been done to me.  I know of most of the risks to me from my past.  I question the risks that I am put in trying to correct new diagnosis as they come up.  But nothing is more frustrating, and perhaps risking mortality, than to just consider me “well read”.  Another term that gets tossed around like “well read”, hypochondriac.  Truth be told, I would rather be a hypochondriac.  And as each new issue is brought up, I breath a sigh of relief, that the right person listened to me, found my emergency alert bracelet, and my medical information cards in my wallet (what to do with me if I am unresponsive).

I will accept the term “well read” because that is a compliment to me that I know what I am talking about, I am knowledgable.  But I know what someone else might mean calling me “well read”.  I forgive you.

Hodgkin’s Disease – My Side Effects


The following are the side effects that I personally experienced during and after my battle with Hodgkin’s Disease.  The categories are summaries as details would make each issue their own post.

Hair Loss (radiation and chemotherapy) = The hair loss from the radiation therapy is permanent.  Annoying that I lost arm pit hair, and hair along my jaw line, but nose hair grew back!  The hair loss from chemo came around 4 weeks into it.  It was very quick and a lot at a time.  I wish I had gotten my head at least buzzed because it was really kind of nasty to have clumps of hair in the shower, on my pillow, or in my comb.  Though the follically challenged may be used to precipitation hitting their bald scalps, I was not crazy about it one bit.  So, I stuck to hats.

Hypothyroidism(radiation therapy) = My thyroid is almost competely useless.  I take levothyroxine to help out.  According to medical reports, I now possess a small thyroid.  My guess it is compared to a “Shrinky Dink” (do you remember those?).  I gained quite a bit of weight by the meds have not helped losing it.  My thyroid at this point only serves to freak me out when I have scans leading to other scans or biopsies (just to rule out).

Immuno-compromised (surgical and chemo) = The main cause of this condition was the removal of my spleen.  Some decades ago, splenectomies were done routinely, especially during any particular trauma.  The good Lord created us with all of our parts for a reason right?  But supposedly we could live without the spleen.  Today, the medical society knows this was not a wise concept.  While removing the spleen was critical in the staging process of my diagnosis, it has been determined how important a role that the spleen plays in fighting infections, diseases, and even heart attacks.  Each time I am taking to the ER or undergo a procedure, it may seem as if I am being paranoid or afraid to the level of Chicken Little.  This behavior has a tendency to cause medical personnel to drown me out.  All I have to do is say “I’m asplenic” and all kinds of precautions are taken.  Annual flu shots, multiple annual pneumococcal and meningicoccal vaccines, avoidance of severely ill friends and co-workers, and definitely use asceptic procedures to clean up wounds.  Any fever over 100 degrees and all kinds of bells and whistles go off as I must be treated with multiple antibiotics while blood cultures must be done to determine what is causing the fever.  The possibility of developing sepsis is multiplied and the mortality rate if untreated within 24 hours is well over 80%.

Infertility (chemotherapy) = Just one of the side effects of the drug Mustargen.  There were concerns that infertility could be determined by the number of treatments of Mustargen.  But the protocol back then was definite.  I received 8 cycles.  Just years later, it was figured that less than six treatments would leave a male the possibility of recovery.

Radiation Fibrosis Syndrome (radiation) = You get radiation exposure from the sun, a microwave, dental x-rays and more.  At no point is someone really at any opportunity to reach their maximum lifetime exposure.  Even those living near nuclear power plants.  But until recent years, radiation therapy was the sure thing to throw Hodgkin’s Lymphoma into remission, lots of radiation.  And so, in just 30 treatments equaling 30 minutes over 6 weeks, I received four times the lifetime exposure to radiation.  Obviously I survived that treatment, but they call raditation therapy “the gift that keeps on giving” for a reason.  The “half life” of radiation is the amount of time it takes for the radiation to dissipate from your body.  When you go for a scan, you may be given an isotope that may last for hours or maybe a day or two.  I will never see the day that they radiation will be gone.

The damage created from my radiation therapy has only recently been discovered in the last few years, and several things are definitely impacted.  I have lost muscle mass in my neck and shoulders, pretty much in fact.  I am in the beginning stage of “drooping head syndrome” because the muscles in the back of the neck have been destroyed leaving the muscles in the front left with no resistance pulling my head forward.  It gives the appearance that I am often sulking and mostly I am not.  I have an increased risk of tearing my rotator cuffs or any other damage to my shoulders.

Restrictive Lung Disease (radiation and chemo) = I am pretty sure that the crux of damage was done by the radiation more than the bleo of chemo.  Defined by a number, my lung capacity has been reduced to 76%.  It was also confirmed that the lower left lobe is pretty much useless.  There is a spot on the left lung which is being scanned annually (no clue what it is).

Cardiac Issues (radiation and chemo) = It is an even draw what has caused various cardiac issues.  Most notably, the LAD (main artery going to the heart) had been destroyed to a 90% blockage requiring emergency life saving bypass surgery.  There are also valve issues which will some day have to be dealt with, along with the fact that the walls of my heart move in the opposite direction than they are supposed to.  Both carotids are not in good shape with the left side more than 50% narrowed.  Again, due to high risks, this is something that they will watch and do something when something HAS to be done.

Gastrointestinal (radiation) = Around five years ago, I developed issues with swallowing.  Last year, it finally developed to where I was not able to even swallow water.  Mulitple testing would reveal Esophagitis and severe reflux.  High acid content was noted in my stomach.

Spinal/Skeletal (chemo) = Prednisone is a great drug and it is a bad drug.  When in doubt, knock it out with this super steroid.  Unfortunately, high doses for long periods of time have consequences.  Besides messing with the immune system, it can cause osteo related concerns.  I have been diagnosed with osteopenia in L1-L4 and recently arthritis has been noted through the next vertebrae as well.  Result, pain in my back which can extend into my legs.

Urinary (radiation and chemo) = This kind of gets an asterisk because my issues did not develop as a direct result of the treatment, but because of the treatments for the other effects.  Two years ago I got hit with my first kidney stone, and it was huge.  It was believed to be calcium based, and several of the prescriptions I was taking increased risks of kidney issues.  A complication of this was hematospermia (hema means blood and guess what the “spermia” refers to?)  That will be another blog story.

Emotional(everything) = Eight of the ten issues have been discovered over the last four years.  Have I earned the right to be moody, sometimes down, scared, stressed, misunderstood?  Was the battle with cancer not enough?  If you personally know me, you may have heard of these things, but I have done more than I am able not to expose you to them because I know how scare people can get when they hear bad things.  Right now, I need everyone in my life, not running from it.

While I Wait


The only thing worse than being told by your doctor than “I want you to have…” is waiting after you have had…

I am probably well into triple digits of medical tests done to me over the years.  To the uneducated and ill-informed, I would be one of those patients putting a strain on medical costs.  To my daughters, the tests are what keep their father alive.  So for the fifth time in four years, and the fourth time over the last year, I am faced with the possibility of another medical malady thanks to the cancer treatments that saved my life.  Of course, that means another expensive test.

Admittedly, I can be a bit of a baby, in fact, go into a full-blown panic attack when it comes to the sight of a syringe.  Surgical stuff, no problem.  You want to go in through where?!?  Problem.  Needle what?  Uh oh.  There are countless stories of my scenes with syringes.  But for this particular test, the needle will be going into my neck.

An ultrasound of my thyroid reveals a nodule, a solid something something with vascular yada yada.  I actually lost all track of what was being said to me, once I heard the word biopsy.  But having had exposure to radiation to treat my Hodgkin’s Disease decades ago, especially to my neck area, left me with an increase risk of thyroid issues.  Out of all the late side effects I have had to deal with over recent years, the thyroid has not really been on the radar before.  I have been on Synthroid (Levothyroxine) for hypothroidism courtesy of my treatments, even before I finished the treatments.

A needle biopsy (technically referred to as a Fine Needle Aspiration – FNA) had been ordered a couple of weeks ago.  Clearly the needle would be going into my neck.  I had a needle in my neck before, actually it was a port, during my heart surgery, but I was out cold for that.  I knew I would be awake for this one.  It can take up to a half an hour just to draw blood from me because of my irratiional aversion to needles.  But in spite of the circumstances, there is a calmness about this particular test.  I have done my research, anesthesia, the biopsy lasts less than a minute, extremely small gauge needle (thickness).

I arrived at MSKCC yesterday, not having a good start to my day.  I overslept in spite of two alarm clocks.  So I missed my train, to catch my bus to NYC.  I now had to drive, and because it was later in the morning, I was going to hit major traffic, especially at the Lincoln Tunnel.  I needed to get to this appointment on time.

I did arrive on time, in fact a little early.  Okay, got the karma back on track.  I put the robe on so as not to get my shirt messy.  Why is it that in the same hospital network, there are different quality gowns you make us wear?  Anyway, the tech comes in, does another ultrasound to show the doctor, and then the doctor comes in.  I’ll call him, Dr. G.  He proceeds to tell me what he has probably told hundreds of patients, “I do not like to use anesthesia.”  Cue the tire sounds of screeching to a screaming halt.  Normally, I would have been back on the NJ Turnpike before he even got to the next sentence.  “It is a very small needle.  If I inject an anesthetic first, there is a chance that could cause a pocket of air, which would make it difficult to guide the needle with the ultrasound wand.  Besides, does it make sense to give you a needle (a bigger one) just to do the small one?”

Surprisingly, it is harder for me to eat vegetables than it is to have tolerated this particular test.  Although clearly one thing that made it easy, I did not check out the surroundings before I got on the table.  The last thing that I wanted to see was the equipment that would be used on me, especially the needle.  Prior to my radiation therapy, I had four tatoo dots placed on me to line up the linear accelerator (the radiation machine).  I assumed this would be the same level of discomfort, but maybe a little more intense as I have had a bone marrow biopsy and know what is involved in aspiration.  All that had to happen then, was make sure the insertion point did not swell up with blood (a hematoma), or get infected (something I do not take for granted not having a spleen).

I will be okay with any diagnosis or none.  I will be okay with any plan of treatment or correction, or none.  But some things do concern me that this has the potential to be something serious.  A needle biopsy on a smaller sized nodule than usually performed.  A phone call from a very close, trusted, and valued family physcian following up on a report for a test that was not ordered by her, but results shared.  I am trying not to get ahead of myself.  You would think with my being so cooperative in such a potentially stressful situation, karma would give me a break, and an earlier phone call with the results.  Yet here I wait.  As long as I get them before the weekend.  That really would suck.

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