The Medical Details...

Late February-
Bryan found a lump in his neck while shaving. After waiting two weeks to see if it would go away on its own, we made an appointment to get it checked out.

March 6-
Dr. Chuma, an ear, nose and throat doctor orders a CT scan followed by a needle biopsy of the lump.

April 9-
Needle biopsy

April 20
Results from the needle biopsy confirm large cells with a suspicion for lymphoma. We are told it can be one of three types: the first, Hodgkins, has a good prognosis; the second, non- Hodgkins has not as good a prognosis, but still good; and the third, squamas cell with a bad prognosis.
A surgical biopsy is scheduled for the next week to ascertain which kind it is.

April 28
The whole lump is removed and found to be the size of a small lime. Non-Hodgkins lymphoma is the preliminary diagnosis. We're told there are many types, and final diagnosis with the exact type will take another week. The doctor makes an appointment for us with a local oncologist in two weeks.

April 29
Dr. Chuma calls one day after the surgical biopsy with the final diagnosis- Diffuse Large B Cell non Hodgkins lymphoma, which is an aggressive cancer. He moves our oncologist appointment up a week sooner.

May 5
We see the local oncologist, who tells us the type of treatment she will use. She explains that the standard treatment is called R-CHOP, but she will leave out the one drug that is known to cause heart damage since Bryan's heart is already slightly damaged by a virus he got three years ago. This treatment is called R-CVP. She will administer 4 cycles, three weeks apart, followed by radiation to his neck.
She orders a PET scan and a bone marrow biopsy in order to stage the lymphoma, and a MUGA scan to check the pumping efficiency of Bryan's heart.

May 6
Second opinion at John's Hopkins.
We see Doug Gladstone, (he tells us to call him Doug!) who tells us that R- CVP is not effective to beat the cancer, and that it brings a high risk of relapse. He recommends beginning chemo within ten days, and using the standard treatment of
R-CHOP which consists of five different drugs. He says we must treat the cancer first, and hope for the best with Bryan's heart.

He also explains that it's important to moniter Bryan's Hepatitus C viral load as the weeks of chemo go on. The chemo is not selective in what it kills- the white blood cells, which make up the immune system and hold the Hep C virus in check, will be killed off along with the cancer cells. This will leave Bryan at risk not only for an outbreak of Hep C, but to any other illness.

He also tells us that Bryan will lose his hair with this type of chemo.

He recommends 6 cycles of R-CHOP, possibly using a less cardio-intensive drug after staging, and a review of the heart test. He orders blood work, and then the bone marrow biopsy is done at this time. (Ouch!- Bryan wasn't prepared for this, but is glad to get it over with! )

May 7
Cardiologist appointment- Dr. Podolsky reassures us that we must treat the cancer first, and not worry about the heart. He shows us Bryan's recent echo cardiagram report that revealed that his heart has actually improved in functioning over the last year. Praise God! It's pumping at 49% efficiency up from 32%!

May 8
We see Dr. Brown, our family doctor, who will oversee everything.

May 12
Sloan Kettering in NY for a third opinion-
Dr. Gerecitano gives us three options for treatment. He recommends one called E-POCH. It's the standard treatment (R-CHOP)with the heart damaging drug given slowly over a period of five days. He says this will reduce the possibility of heart damage. Bryan would have to wear a bag strapped to his waist to have it administered. He would give the chemo for 3-4 cycles, every two weeks.

May 13
Back to John's Hopkins... (Phew, we are tired....)

Test results are in- Bryan is in Stage 3 because it has spread to his spleen, but not his bone marrow.

Doug Gladstone says they will not administer E-POCH (with the slow drip over 5 days) unless Bryan agrees to be admitted for those five days. He recommends again the R- CHOP since it has the best prognosis for beating the cancer. We decide to go for it (we've already decided that we really like Johns Hopkins) and Bryan starts chemo.

The administration of R-CHOP chemo is a six hour procedure as they monitor Bryan each time a new drug is added. He falls asleep for about an hour and a half when they put Benadryl in his IV. Other than that it is uneventful and he feels pretty good.

May 17
Haircut!
Our long time friend and barber, Phil Saggesse (who is also the one who brought us together after Bryan lost my phone number!) , cuts Bryan's hair short for the first time in 30+ years. I actually had the honor of cutting the 16 inch braid, before Phil styled it. Bryan almost backed out at the last minute, but is glad its done now. I can no longer tease him about making us late because of all the time combing his hair took! He's amazed at how easy it is...