Well first, some preliminaries:
THIS IS WHY CANCER WILL NEVER DEFEAT ME:
I had a dream about Sparky Anderson a few days ago. He looked old and his hair was brown, and I called to him, but he didn't recognize me. Only after I said my name did he smile.Hmmm. Mitch Albom has a dream about a guy; a few days later, he's dead. This is the Power of the Albom.
And then it ended.
"WIDESPREAD COMMUNITY CONCERN" IS SO WIDESPREAD
33% is now the threshold for "widespread." This comes from AnnArbor.com, based in a town that just banned couches on porches. The message boards (which I sometimes read to feel better about myself) on MLive and Freep are similarly against the ban.
And by the way, this was a blanket ban on all alcohol energy drinks. So whoever told me to shotgun a Joose on cancer-free day, I appreciate the effort, but thank god I have some prohibitionists looking out for my well-being. I wish they would do something about my cancer though.
OH YES, SPEAKING OF THE CANCER...
It's Friday. Three months since my diagnosis, two and a half since I started treatment, and two days after I ended treatment. So you know what that means: TIME TO COME UP WITH A NEW DIAGNOSIS!
I'll let the primary sources tell the tale:
From: Al-Katib, Ayad Fri, Nov 5, 2010 at 11:38 AM To: firstname.lastname@example.org
Have not heard from Dr. Anderson. The path review from NIH states that it is a special subtype of Burkitt lymphoma; one that is described by that group previously (2004 and 2005) associated with granulomatous reaction and has good prognosis. Will need to discuss with Dr. Anderson but my impression remains the same.AK
From: Nick Cheolas Fri, Nov 5, 2010 at 12:00 PM To: "Al-Katib, Ayad"
My one main question at the moment: if it is a "subtype of burkitts lymphoma," how does your impression remain the same?
So...that. Wait, where's my picture of Dr. Ihavenofuckingclue?
Al-Katib, Ayad Fri, Nov 5, 2010 at 12:07 PM To: Nick Cheolas
Nick: based on:
- Clinical judgement (early stage, favorable (low risk) group) and response to therapy to date.
- Very little data available on this subset (see attached); 2 of 4 such cases described (and I think that’s all there is) in the 2004 paper were treated with CHOP +/- radiation (before the rituxan era) and were in complete remission for 1 and 3 years+ as of the time of publication.AK
There he is. I think he's got the right idea. Onto the path report:
I've highlighted what I believe to be the important stuff in these documents, but I really have no idea what the important stuff is. But here are my thoughts on this:
- I am really glad we sent this out to Dr. Jaffe. Take a look at your right hand and count the number of fingers. That appears to be the total number of recorded cases - including my own - about which we have solid data. Fortunately, Dr. Jaffe is familiar with those cases. It appears this diagnosis differs from those offered by Henry Ford and U-M, but I'm not sure a) if that's actually the case or b) if it matters.
- My pathology report and both of the articles listed above repeatedly refer to the "good prognosis" for this diagnosis. Any way you slice it, that's good news.
- The interesting stuff is in the details: The first article concludes with the sentence, "In the future, it may be feasible to treat these patients with less intensive regiments." The second article - which highlights four cases similar to mine - shows that that two later-stage patients were treated with a more intense regimen, and the two earlier-stage patients (like me) were treated with CHOP. None of the patients had relapsed at the time of publication.
- Also, none of the patients in the two articles were treated with R-CHOP, as the studies were done in the pre-Rituxan era.
- The bottom line from Al-Katib: "my impression remains the same."
I think we're headed toward yet another week where the doctors duke it out, but I'm pretty sure I know how this will play out: U-M will recommend treatment as Burkitt's, Al-Katib will stay firm with his recommendation, and Anderson will lean toward finishing up radiation and being done with this. So this comes down to whose recommendation I place more weight on, and I really place equal weight on all three. U-M is an excellent hospital with great doctors and a top-ranked cancer center. Dr. Anderson knows more than anybody else about my history and has followed me throughout the entire course of treatment. Dr. Al-Katib is a nationally renowned lymphoma doctor who has been doing this for 25 years. I really can't elevate any one opinion over any other.
The way I feel now, I will almost definitely get a fourth opinion on this. Where that will be, I'm not entirely sure. But I will talk with my doctors before moving forward on that front. We'll see next week.
OH: AND ON THE BAR EXAM FRONT:
Remember that Philadelphia Phillies fan who stuck his finger down his own throat and puked on a little girl's head? That appears to be what the State of New York did to its bar applicants today. I'll probably post something about this on Monday.
And, of course, Maryland Bar Exam results will be released in about 45 minutes. The possibility of receiving two life-altering documents from the state of Maryland in a single day terrifies me beyond belief. If you think I'm going anywhere near that results page on a Friday, you're crazy.