Wednesday, March 7, 2012

Chemo is Over

Big cancer news everybody: I still have cancer.

Here's the scoop: my last PET/CT still showed uptake. In other words, the radioactive sugar that the cancer eats (thus lighting it up on the scan) is still being picked up in enlarged lymph nodes near my neck.

My doctor says that these sites are where the cancer started and they are resistant to chemo. This places me in a minority group of people with Hodgkin's lymphoma for whom ABVD chemo doesn't just melt all the lymphoma away. So I am done with chemo for now and maybe forever! Huzzah! (See how that good news is, like all of my good news, wrapped in bad news? Uncertain news at least. Like instead of a bacon wrapped scallop, imagine the bacon itself is wrapped in some kind of weird smelling fish.)

The positive spin is that radiation (which I start soon -- preliminary meeting is tomorrow) is still highly likely to knock the rest of the cancer out while being much less shitty to my body. My prognosis is still good.

Unless I'm in an even smaller minority of people with lymphoma for whom both these treatments are not successful, but why would I ever expect that to happen?

I can't do a follow-up PET/CT until 4-6 weeks after radiation treatment has ended. The treatment is every day for a month, starting next weekish. So I won't know if it worked until... June sometime? If I still have cancer then, I will need to restart an even rougher chemo, and I think I might lose my job at that point. FMLA only covers you for so long. Not sure what happens to my insurance if that happens. Let's cross those bridges when we never get there, thanks.

My doctor has confirmed that my "anticipatory nausea" hospital response (I puked when I went for my PET scan, so it's officially bad news) is Pavlovian and can be reduced with drugs (Ativan really doesn't seem to be helping) and maybe Cognitive Behavioral Therapy (CBT). The problem is not strictly psychological; my body needs to be trained to disassociate the hospital from the poison I got there.

CBT would mean probably exposure therapy: engage with the stimulus over and over (the hospital) separate from the associated condition (chemo sickness) until the connection between the two has become unlearned. This is basically my radiation treatment plan. I mean I *have* to go to the hospital every day for a month. So eventually I will break the conditioning as my body realizes that it is no longer being poisoned every time I go to MGH.

Or, you know, I will puke every day for a month. Whichever.

Since the advent of good, modern anti-nausea meds, this kind of conditioned reaction is very, very rare by the way. Only a small percentage of cancer patients have this problem anywhere near this severity.

Sometimes it sort of feels like the odds are against me by virtue of being in my favor.

4 comments:

Rosalie said...

Happy half birthday, marie curie.

Anonymous said...

Haahden the fuck up!

Anonymous said...

Just kidding mate. Stay strong!

Axldemic said...

You rockstar. Stay tuff.