30th - Losing my resolve

Stuart and I met with Dr. Hellner for about an hour this morning and discussed my history, her initial thoughts (lymphoma) and possible next steps.  She explained to us that there are two main types of lymphoma, Hodgkin's Lymphoma (HL) and Non-Hodgkin's Lymphoma (NHL).  She mentioned that at my age (36), I was certainly in the age group for Hodgkin's Lymphoma, although Non-Hodgkin's Lymphoma was certainly a possibility as well. 

For all the nerds in the group, Hodgkin's has a bi-modal distribution, meaning that it is most common (modal) at two (bi-) points in life.  It is most likely to be diagnosed in people in their twenties or thirties. It is less common in middle age and becomes more common again after age 60.  Non-Hodgkin's occur more often as your age increases.  The cause of Lymphoma is unknown, the prognosis varies based on type and stage, but inevitably the treatment is some type of chemotherapy.

Here are the websites that I have visited and would like to share.

Lymphoma Research Foundation http://www.lympoma.org/
The Leukemia & Lymphoma Society http://www.leukemia-lymphoma.org/
National Cancer Institute http://www.cancer.gov/
American Cancer Society http://www.cancer.org/

Both Stuart and I left Dr. Hellner's office glad that we went.  We both had a sense of realism that having cancer would not be ideal, but that Lymphoma is curable.

Next steps are to go forward with the mediastinoscopy tomorrow morning to try to get more biopsy tissue, as well as to schedule appointments next week for heart and lung tests (baselines prior to chemotherapy).

On a lighter note, my Mom came down this evening and will be staying with us through Sunday to help with the kids and the house.

24th - Time for a biopsy

I went into see Dr. Kersten this morning for the formal report out of the CT results.  Dr. Kersten walked my wife (Stuart) and me through the report and images, then told us that the next step was a biopsy, then a consultation with someone in Oncology (cancer doctor).

Later in the afternoon, we saw a pulmonologist named Juhayna K. Davis, MD for a consultation on the options available to obtain tissue for the biopsy.  Dr. Davis was fantastic, despite the fact that I told her she needed to have the picture on her website changed for the better.  I simply suggested that someone on the list of Charlotte's Top Doctors 2010 should have a glamour shot.  Back to the point, Dr. Davis recommended that I opt for a less invasive procedure first.  This procedure, called a bronchoscopy, is scheduled for 8 AM Monday morning.

23rd - Abnormal soft tissue

Dr. Kersten called me around lunchtime to tell me that I needed to come back in as soon as possible to see him and have a CT scan of my chest done.  The radiologist that read my X-ray after Dr. Kersten noted some abnormal soft tissue in my right paratracheal region. 

The CT scan took about 30 minutes and the results were ready right away.  The CT scan showed significant lymphadenopathy (a.k.d. disease of the lymph nodes) in the right paratracheal space and the right anterior prevascular space.  There were also mildly enlarged low right cervical/supraclavicular lymph nodes present and mild precarinal lymphadenopathy.  For those medically inclined, I have included a couple lymph node maps below (these are not images of me!!!).  For those not so inclined, suffice it to say a had a lot of enlarged lymph nodes on the right side of my lower neck and center of my chest...with the largest two the size of a golf ball (which is at least 1.680 inches or 42.67 millimeters in diameter for you trivia nuts).  These results were suggestive of lymphoma, but again, I was in denial.

Frontal view of Figure-D shows right paratracheal (2R and 4R) and low right cervical/supraclavicular (1) lypmh node spaces.  Diagram by Annie Frazier, MD.

Sagittal view of Figure-F shows right prevascular (3a) and precarinal lymph node spaces.  Diagram by Annie Frazier, MD.

22nd - Did I inhale?

My story started on a Wednesday afternoon, with a normal trip to the doctor's office.  As with many of you, I do not have a "primary care doctor" in the traditional sense, I usually just take my chances with whomever is available when I need to be seen.  Luckily for me in this case, I drew a wonderfully thorough gentleman, Brian P. Kersten, MD.  My chief complaint was a delicate matter and not very relevant to you, so I will leave it out.  As a secondary issue, I complained to Dr. Kersten of some chest tightness that had been bothering me for a couple weeks.  My hope was that the worst thing that it could be was a bad effect from my recent trip to Prague, CZ, where I rode in the front seat of an antique Praga Alfa car and inhaled fumes for hours during a tour.  Dr. Kersten ordered an EKG and an X-ray of my chest, which initially showed nothing noteworthy.


The pre-1940 Praga Alpha