Paul's Heart

Life As A Dad, And A Survivor

Archive for the category “Cancer”

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.

A Possible New Battle Looms


All I have of my battle with Hodgkin’s Disease are my memories.  The steps I took to recovery from my open heart surgery are undocumented.  I have no notes on the little side things that have occurred since that surgery, including a diagnosis of sepsis and pneumonia.  But for some reason, I will start now.  In preparation, I will designate this officially as “Battle #4″.  Not that the other medical things I have had to deal with are not as important, this has the potential to be a true game changer, like cancer, cardiac surgery, or a life threatening blood infection.

Two weeks ago, I received a phone call from a nurse at one of the doctor’s office’s  that takes care of my late term side effects.  Though my thyroid level has been checked every year through bloodwork, this year marked the second year in a row, that an ultrasound was performed on the thyroid.

Last year, it was noticed that I had nodules on a very small thyroid.  Everyone ends up with nodules at some point or another in their life.  But the small thyroid was due the extreme amount of radiation I had been exposed to when I was treated for my Hodgkin’s Disease.  To give you an idea of what I had been exposed to as far as levels, I received four times the lifetime maximum allowed of radiation to cure my Hodgkin’s.  Who am I to complain?  It’s been over 22 years!  It is quite possible I would have been safer reporting on Three Mile Island from outside the cooling tower back in the 1970′s.

Back to the phone call.  My results from the current thyroid ultrasound still reveal the small throid and three noticeable nodules.  Two are cystic at about 2mm on the left lobe.  But on the right lobe is a hypoechoic solid nodule, containing internal vasularity measuring at 5x5x4mm.  I am scheduled to undergo a needle biopsy on only this nodule (as far as I know).

I am actually quite calm about this, much like my heart surgery.  I was unconscious for the sepsis, but totally freaked out over the cystoscopy that I had done (Google it to see what it is if you must).  I will get this done on Tuesday, and hopefully have results before the end of the week.  Knowing so many before me, exposed to what I have been, I know the possibilities.

And so it begins.

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