Good Doctor Visit

Saw Dr. R, the oncologist, this morning. The quick summary is that I'm stable -- no changes in my health, how I'm feeling, or anything physical or blood-related. That's all good news.

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These visits begin with my having a blood sample taken. They have blood techs and analysis equipment right in the office, so we get the results in five minutes. As with the last visit, Dr. R said my blood was "perfect." Certain cancers rely heavily on frequent blood analysis (Lance Armstrong talks about this in his book), but that's less true with some lymphomas, including mine. There are about 30 different types of NHL, and at least two types of follicular NHL. One type behaves more like leukemia, and affects the blood significantly. My version affects the lymph nodes. (In fact, he said today that I had a fairly straightforward "classic" type of fNHL. Some behave so erratically that they're kind of thrown when they need to decide what to do. Mine doesn't seem to be like that.)

So while I don't have a blood-focused fNHL, they can still find some clues in my blood about possible progression of the disease. Red or white blood cell counts may be low or high, platelets may be low or high, there may be some signal that my kidneys or liver are straining to do their jobs, that kind of thing. Any of that could be a signal that they need to run some other tests. None of that was an issue this time.

In addition to blood work, they do a physical exam, checking eyes and mouth, and feeling for various spots where a swollen lymph node might be close enough to the surface to be able to feel (neck, groin, collar bone, underarms). Nothing new there. The initial spot near my hip bone is still swollen. The bump I thought I had felt under my chin turned out to be nothing. Probably an English teacher's well-developed jaw muscle. (My joke, not his.)

The other way they indicate progression, besides blood and swollen nodes, is by checking "B" symptoms -- weight loss, night sweats and chills, fatigue. Obviously, that needs to be reported by me in order for the doctor to think it's an issue. I haven't felt anything like that.

So, he's pronouncing me stable. I'll go back in a month for a similar exam. He said after that, we may go every two months. We'll also do period CT and PET scans to make sure there's nothing going on that we can't see.

So far, so good.

And while we debated about whether it would be better to be stable for a while, or begin treatment and feel like we're doing something, I'd say I was happier to hear that I'm stable.

I had questions for him too, mostly about the nature of fNHL, just to clarify some of what I've been reading.

I opened with this: "I was reading an article called "Folicular Non-Hodgkins Lymphoma Revisited" by Saul Rosenburg in the Journal of Clinical Oncology's February issue...."

And I could see the look on his face. It said something like: "I graduated with High Honors from Case Western Reserve, then at the top of my class at Yale Medical School, then was awarded a prestigious fellowship in Hematological Oncology. I didn't kiss a girl until I was 28. And yet, this guy is a bigger nerd than I am....."

He admitted that he hadn't had a chance to read the article yet, and thanked me for pointing it out to him. But he was obviously up on the issues that were in the article, and that's what I was really interested in. In particular, I wanted to know about the transformative nature of follicular NHL. About 30% of cases mutate into another, more agressive form of NHL. My question was, if we're only doing blood and physical exams, how will we know it has transformed? We need to actually see the cellular structure of the lymph nodes, don't we? The article said that knowing when/if that happened was very important, so treatment could be determined as soon as possible.

Dr. R said, basically, if a scan or a physical exam shows a sudden large swelling in one or more nodes, it's a sign of a possible transformation, and that would need to be confirmed with other tests.

I think he was impressed. He suggested an online search engine for medical articles that I might want to check out. Isabel thinks I was trying to show him up (and she said the self-satisfied grin on my face confirmed that), but really, I figured if he had read it, he'd know what I was talking about. It wasn't a "gotcha" thing.

(But, truth be told, I think he knows now who he's dealing with....)

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Something to make a lot of you feel old:
I heard this morning that this year is the 25th anniversary of Michael Jackson's Thriller.
Is this still the greatest video ever, or what?