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My Lymph And Hard Times

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The headline is a riff on a James Thurber novel. This story involves baseball. Life is just what insists on happening in between baseball games.

The phone message

It started with a phone message from my primary care physician following the latest test — this one a CT scan with an iodine chaser — trying to figure out why my abdomen, and digestive tract, felt like Jed Lowrie looks when a fastball just off the corner is called a strike.

"I’d like to discuss the results of your latest test." No explanation, no information, just a desire to discuss the results. This is never good. Ever. Here are some things you never hear when you call your doctor back:

"Oh, we looked at the blood tests and you’re fit as a fiddle. I just wanted to tell you what a cool shade of red your blood is."

"Every single result wasn’t simply in the normal range — it was exactly at the 50th percentile. That’s so amazing that I had to call and tell you!"

"We’ve looked at the results of your CT scan and concluded that the insides of a person are pretty disgusting."

"You’re fine. I just kinda wanted to say hi."

It turns out that after years of hearing "Everything looks normal, you should be feeling fine. You’re not? Huh, go figure..." a test finally showed something: swollen lymph nodes in my abdomen. Oh, and my spleen is a little big too, but on that I blame my friends who weren’t truthful with me when I said, "Be honest: does this shirt make my spleen look fat?" I didn’t even know you had lymph nodes in your abdomen, but apparently you do. And apparently if they’re swollen it indicates that you could have lymphoma.

The "ruling out" phase

I wasn’t terribly worried about actually having lymphoma, partly because there is literally no cancer on either side of my family, partly because my color, strength, and overall health hardly indicate cancer, and partly because most of what I knew about lymphoma is that it tends to lead to your being offered $155M to pitch for the Cubs.

Nonetheless, you don’t mess around with "could be lymphoma..." so I agreed to do a bunch of painful and annoying further testing to find out. Two biopsies were scheduled for the first week of the baseball season, the first one — a sample of bone marrow — falling on Thursday afternoon right when the A’s were closing out their series with the Angels.

So I brought my transistor radio for the excruciating-but-brief 10 minute procedure, in which they drill a jackhammer into your bone but you can’t really feel the pain because they have sent anesthesia in first to delay the agony until after dinner. Andrew Triggs was pitching and when the doctor came in I asked if it was okay to keep the game on while he tortured me. No problem, he said.

There was a problem, though. As the nurses moved around the room to assist the doctor, the radio reception kept changing. So the doctor instructed one of the nurses to "act as the antenna" and make his job to re-position himself as needed in order to optimize reception. The procedure was successful, and by that I mean that the A’s went on to win the game.

Having traumatized the right side of my body on Thursday, I let them take aim at the left side on Friday, sampling a lymph node from my abdomen with a "biopsy gun" that apparently does not require a 5-day waiting period to procure. This procedure did not go as well, in that Raul Alcantara gave up 8 runs just a few hours later.

So as the A’s opened the season making errors like they were going out of style, and as I answered people’s polite "What’dja do over spring break?" with "Biopsies, and you?" I awaited the results. "Hopefully, when they figure out I don’t have lymphoma they will also figure out what I do have."

The waiting room

A waiting room is a big room that you sit in for a long time until you are invited to go wait in a smaller room for a long time. Eventually the doctor will come at a time completely unrelated to the time of your appointment, but first you will submit to yet another check of your vital signs as if they have changed since you were in two days ago.

I don’t know who these people are whose weight and height change dramatically between appointments ("Hmm...you’re 5’10"...that’s odd, because on Tuesday you were 5’6"..."), and I’m uncertain why your blood pressure is likely to be remarkable, or important to know, when your appointment consists of chatting with your doctor. I’m assuming that a test of your reflexes is part of "checking your vital signs," and is done simply by handing you the bill. The first two times in, when the nurse asked if I had a port, I said "No." The third time I said, "No. I mean I doubt it. What’s a port?" Turns out she was referring neither to sherry nor boats.

Anyway, I’m sitting in the waiting room in the cancer center with 15 other people whose appointment times are also in the rear view mirror and whose vital signs are also roughly the same as they were yesterday. I am struck by the fact that looking around I am far and away the healthiest person in the room. This is both reassuring (for me), and also very sad — I am not normally confronted by the harsh reality of the life so many people are living trying to battle a crippling disease with an even more crippling series of treatments.

Eventually my name is called and I remind myself that it's not very good form to suddenly start narrating in the present tense. "Maybe I’ll finally get some answers today. Either way I will revert back to the past tense as I finish the story."

Some answers

Every once in a lifetime or so, you get news that can put you, in 13 seconds, from

to


"You have a low grade follicular lymphoma," the oncologist told me in a rather matter-of-fact tone.

"Can I get a second opinion?"

"Yes. Your shirt doesn't really go well with your pants."

"Thanks."

OK, the last three exchanges didn’t happen but the first one did. Some clumps of cancerous cells were found in my lymph nodes and in 10% of my bone marrow. "It sounds worse than it is," he reassured me. Oh good, because it didn’t sound super terrific.

"This is the lowest of low grade lymphomas, so much so that if you weren’t having any symptoms we wouldn’t even treat it right now. These cells grow really slowly, so it’s something you need to manage more than something that is going to threaten you any time soon. You can’t cure it but it is very treatable."

Apparently, these are cells that will watch Billy Butler run to 1B and ask, "Geez, dude, what's the rush?" These kinds of cells are described, in medical terms, as "indolent". Essentially, what they mostly do is they shack up without paying any rent, are hard to get rid of and do nothing to help out. So basically they are a lot like Cindi’s older step-brother.

The treatment

"Because you’re having symptoms in your abdomen/digestive tract, I do want to treat this," he explained, "but it won’t be chemo or radiation. I’m prescribing a series of 8 infusions of an antibody that will attack these cells and hopefully relieve some of your symptoms."

8 infusions? I had just one question. "After these treatments, will I be able to play the violin?"

"Absolutely," he reassured me.

"That’s fantastic!" I replied. "Because I’ve never been able to play the damn thing."

OK that conversation didn’t really happen, but the infusions will, beginning May 1st. And learning about it, I have to say it’s a pretty cool advancement science has made.

Antibody infusions

The problem with chemotherapy and radiation is that they aren’t discerning enough. They attack the "fastest growing cells," which includes cancer cells but also includes quite a few healthy ones. It’s like being told that "Joe and Fred are cancers in this class of 24 kids," only you have no idea which kids are Joe and Fred and so you hedge your bets by throwing out all the boys. You’ve cured the room of the cancer (and in this case probably enhanced the class by curing the room of boys), but it’s a pretty inefficient classroom management technique.

Better would be to call in someone who actually knows who Joe and Fred are and tell them, "You two, out, everyone else stays." And that’s what antibodies are able to do: When CD20 is infused into my bloodstream, those antibodies won’t target "faster growing cells," they will target "those cancerous lymphocytes". You go, CD20!

The A’s

The A’s aren’t just for bone marrow biopsies. They’re also for infusions! Because it’s easier on the body for the antibodies to be infused more gradually into the system, the 8 infusions I have in May and June will each be done very slowly — meaning I will have to lie there for 2-3 hours while the antibodies go drip, drip, drip into my bloodstream, and then use (I assume) Siri to direct them to the offending lymphocytes. Just to hedge my bets, I am planning to swallow a smart phone and a map prior to the first infusion.

I don’t know about you, but when I think of "3 hours" I think of an A’s game. Then again, I also think of an A’s game when I think of a sandwich, a bath, a hardware store, or a ferret. My plan is to try to schedule my infusions concurrent with A’s games, hoping I can refrain from impulsively jumping up screaming, and accidentally ripping out my IV, when Trevor Plouffe bounces into a 6-4-3 DP. In my quest to be a life-long student, I will be trying to learn how to tear out my hair with one hand.

The bottom line

Too often you see obituaries that read, "Last Thursday, she lost her battle to cancer..." What you never see is, "Last Thursday, he won his battle with cancer when he was run over by a bus before the cancer could spread." I totally want to be that guy.

All seriousness aside, though, what does it mean to be an A's fan? It means that when in 2017, you are told that the A's are getting a new stadium and that you have "a touch of lymphoma," you know that you are going to look back and tell people, "2017? Now that was a good year!" So go hug someone, and let's get ready to infuse the Angels with a slow drip of runs beginning tomorrow night.

"LET'S GO, OAK-LAND {DRIP, DRIP, DRIP DRIP DRIP}!!!"