As mentioned in a previous writing, my medical team found and removed a lymphoma tumor from my chest. As far as they can tell, they got the whole thing, despite me imagining the process as using an ice cream scoop. The scans showed that tumor to be the only one noticeable, and there were no other signs of trouble. Cancer, however, can hide as a single cell waiting to do its thing. That calls for get back to the ship and nuke it from orbit chemotherapy, just to be sure.
To the Heart
In preparation, the cardiologist ordered a new echocardiogram. This is like a sonogram but for looking at the heart. Last May’s echocardiogram took just the regular measurements to check for my cardiomyopathy (enlarged heart). Since chemo drugs can possibly damage some parts of the heart, they wanted to take base measurements before treatment so they have something to check later.
The echocardiogram really worried me. The tech holds the sonic transducer (the wand) tightly against my chest to assure good signal transfer to the heart and back. At the time of this test, I was just a few weeks out from my chest surgery, and things were still pretty tender around there.
The tech turned out to be really awesome and caused me no discomfort. I expressed my appreciation for her light touch. She said she often works with patients who have had mastectomies, and that has taught her to be gentle. I hadn’t thought about that, but it made perfect sense. As I go through treatment at the cancer center, I’m probably going to see or hear about a lot of people who are far worse off than I.
Indirectly to the Heart
The following Friday, September seventeenth, they installed a special port that makes it easier to do all the chemo activities. Special thanks to my friend of the last 25 years, Marli, for driving me to the appointment at way-too-dark in the morning.
The port item, called an Infusaport, includes a smallish, round thing with guide pins that sits under the skin below my right clavicle. It is connected to a tube that goes over the clavicle (under the skin) and then connects to a blood vessel that leads to the heart. The pump connector for chemo can easily align with the circle and its guides and puncture the skin to get a good line to my cardiovascular system. The goal is to minimize finding new veins to poke every time the team needs to stick something into me.
The installation went smoothly. They wanted me to be awake, but still slightly anesthetized. They underestimated my ability to nap whenever I want. The anesthesiologist had to wake me several times to ask if I was okay. I answered that I was and immediately nodded off again.
The surgery site is still sore, but is getting better. By next weekend, it will be healed well enough that I can shower like normal… when I don’t have the pump attached.
The Main Event
On Monday, September twentieth, I went for my first chemo treatment. I checked in, had blood drawn (through the new port), met with the oncologist, and then started the treatments.
The first drug is apparently a tough one. It must be administered slowly and in their presence. They started at a slow speed, checked my reaction in half an hour, and then started the next part at a slightly higher speed for another half hour. That continued for most of the morning until about one in the afternoon.
Fortunately, the chair they put me in was a very adjustable recliner. Between that and the heated blankets they kept offering, I was able to nap through most of the procedure.
During the second drug, they had me watch a couple of instructional videos. One was about the medicines and the second was about the pump I would wear for the rest of the week.
The pump video showed the interesting fact that the medicine being pumped into me needs to be treated like a very hazardous substance if it spills. The pump comes with an absorbent mat and a plastic bag for cleanup. They said to wear two layers of gloves. Any mess must be gathered up and sealed in plastic and taken back to the hospital for proper disposal. There are first aid steps for if you get the medicine on your skin or in your eyes. Though I know all chemicals react differently in their intended environment than they do in other environments, it was still a little unnerving to see all the warnings.
So I now have a bag full of pump and medicine strapped around my waist like some sort of overgrown fanny pack. It has the option to use shoulder straps, but around the waist seems like it is going to be easier to manage, not flailing around and such. At the moment, I could only use my left shoulder because of the recent port addition on the right, but the hoses are connected on the right. Having the pump around my waist means I can put it on the same side as the port.
On this coming Tuesday through Friday, I must go in to have the oncology folks inspect and refill my pump. On Friday, they remove the pump, temporarily, and give me other medicines to help counteract the side effects of the chemo.
I repeat this procedure every three weeks, for six times. The last one will start on January eighth. Some time after that, surgery will remove the Infusaport.
About that Work Thing
Being in the hospital all day meant that I could not go to work. I only teach one course section on Mondays, but class can’t really happen without the teacher. That is an issue. Since I will need to miss several Mondays during the semester, we needed a plan.
The course in question is an introductory programming course. The students are all beginners learning this stuff for the first time. It is a lot like learning a foreign language. They learn keywords (vocabulary), syntax (language rules), and the customs of programmers. To do this, they often follow along with a native speaker (me) as I write programs. This comes in handy when I can’t be there. For this course, the following along meets the requirements of the “instructor-led lab”.
When the college first went remote due to Covid, I recorded my labs and the students thoroughly loved them. They liked that I took the time to address things people usually messed up. They also liked that they could pause the video while catching up, or replay something they didn’t understand.
For this section, where I am missing some Mondays, I’ve scheduled their instructor-led lab for Mondays. The section meets in person, generally, but the students will receive a lab video for the days that I will miss. Normally, the lab is due the same day as class (to ensure that they show up for class and participate) but it is due a day later for the video version so the students have time to ask questions. The video went up last Wednesday.
By luck, it turns out we won’t have to do this very often. Remember, it’s only every third Monday where I will be out. One of those Mondays is Thanksgiving week, and there is no class that week. Another falls on the last day of class for this section when the students take their final exam. The exam is online, with open book and notes, so any staff or teacher can proctor. The students just can’t talk to other people while taking the test. They also must complete the exam in two hours or less, meaning that looking things up slows their progress.
The dean of the department and I discussed this ahead of time. She checked with the appropriate administrative types and got it all cleared. It should work out.
The unusual part is that, with the lump removed, my voice is much stronger and records better. I may have to take up singing again, much to the dismay of the Boy Scouts in my old Troop 504 in the 1980s. “All together now!”
Going Forward
For the week, I will get my refills each afternoon, about forty minutes after my last class. Then I will be without the pump for a couple of weeks. The pump will be inconvenient, but nothing more.
The bigger worry is the side effects of the medications. Despite having a large, extended family, I don’t know the stories of many who have undergone chemotherapy. Even if those histories were available, there is so much variety between the mixtures of medicines, the history of one may not mean much for the experience of another.
I typically hover just over anemic, and one of the possible side effects is anemia. That will require watching.
Prednisone, a steroid that is part of the treatment, can cause an increase in blood glucose, which is a problem for someone with Type II diabetes. Normally, I control my blood sugar with diet, exercise, and some pills. The oncologist suggested that those efforts may not fight what the prednisone does. On the other hand, prednisone can only increase blood sugar by converting body fat to glucose, which may mean I’ll lose more weight… in an incredibly unhealthy way. Still, my doctors want me to drop another ten pounds; 170 here I come!
The Well-Wishers
I appreciate all the people who expressed concern over the lymphoma and have wished me well. Thank you for your sentiments.
Please understand that I am a very fortunate person. For whatever reason, I have experienced very little major illness or damage in my life; still no broken bones, for example. The damage I have taken has been hard for doctors to find because I seem to be a bit robust. Those of you from the family know that robust-ness seems to be a family trait.
My cardiomyopathy (enlarged heart) had symptoms going back to the age of eleven but was not diagnosed until my early thirties, back in 2001. At that time, the doctors expected me to live a couple of years. The following year, my cardiologist was so excited to see the improvement.
By 2013, my new cardiologist showed me the Seattle Heart Failure Model, a statistical model used for determining the likelihood of success for various heart treatments. He pointed out that, for people with my symptoms, there was a 97% mortality rate in fifteen years. He asked if I knew what that meant. I said, “It means that if there were one hundred people with my same heart condition, in fifteen years ninety-seven of them would be dead, and that I could probably get the other two as well.” When I last met with him, he said my last echocardiogram required an expert to find the damage, and that my current state is no longer covered by the Heart Failure model because I am a statistical anomaly.
Type II diabetes showed up some years later. The main issue was lack of energy burning exercise. A bad heart will slow a person down a lot. Having a job that requires sitting does the same (welcome to a career in I. T.). So, I started the treatment with pills, but the big determinant in my diabetes is diet and exercise. If I exercise enough during the day, I can eat anything and have normal blood sugar. If I eat almost no carbs during the day, even with no exercise I will have low, possibly dangerously low, blood sugar in the evening. Unfortunately, there are Bavarian Cream filled pastries out there that must be destroyed.
Now we find the lump. The symptoms of the lump have been there for several years at least. That means it has been big enough to cause trouble for a while. During that time, the material did not spread enough to cause other tumors. This suggests that it is unlikely that there is any other material. I still must undergo chemotherapy to be on the safe side, but the side effects of that are my only real concern. The likelihood of more cancer is pretty low at this point. Just lucky, and a bit durable.
In Conclusion
Things are progressing and they will all be fine. It is, at this point, an expensive nuisance. It probably keeps me from spending money on something stupid. Life is like that sometimes.
I’ve often joked that when my treatment for enlarged heart started, “I am too big hearted, but the doctors are working on that.” When the diabetes started, the joke included, “…and I’m too sweet as well.” Now, with the tumor I must add, “Now they’ve started treatment because I experience too much inner growth.”
Many people worry when they hear about any sort of cancer, and though the worry may be well intended and appreciated, they should take some time to think about the fight as a noble effort. If I can stand in a blizzard and laugh at the North Wind, challenging it to do its worst, a little exhaustion and hair loss isn’t going to dampen my spirits. Even if something goes horribly wrong, and I lose the battle, I will go down fighting and making bad jokes. Not to worry, though; I have many more years and many more minds to corrupt before I return to the dirt.