Monday, November 26, 2012

The Cancer Forest


 I've been at a bit of a loss for blog posts this past week but if I look back over the last three months, I find even that is a familiar pattern as I cycle through the "good" weeks -- about as predictable as lingering nausea and fatigue.

When I was first diagnosed and in watch-and-wait mode, the goal was to progress from days in which cancer was part of every waking thought, to a point at which a day would go by and the thought of cancer hadn't even drifted into my view. We were making our way to that goal. 

Being in active treatment and working at Dana-Farber Cancer Institute combine to make that goal somewhat impossible. But I'm happy to say that during a busy Thanksgiving weekend full of family, food and football (with a couple of runs thrown in for good measure), cancer was about the last think I was thinking about. That's good, but it makes it hard to post to a blog about cancer. 

Now as I enter good week #2, I'm in a decidedly weird place. While I'm thinking about the logistics of the treatment-- what time do I need to leave? Do I have all my scrips? Have I moved all my meetings off those days? etc. -- I'm not thinking about the treatment itself. I'm focused on the narrow path that lies immediately ahead, but not focusing on the larger cancer forest, or jungle, perhaps. 

Occasionally, I find my hand making its way to the right side of my neck where I first noticed a swollen lymph node nearly two years ago -- ground zero, if you will. I feel around, all but unconsciously confirming what I've felt since after the first chemo round;  that the swollen lymph node has receded, beaten back by three months of chemo and Rituxan. And less subtly, cancer makes itself know occasionally even in good weeks when a mild bit of nausea will show up at my door, an unwanted visitor who lingers for a few minutes -- enough to remind me, but not enough to make a lasting impression.

For the most part, though, I'm thinking about what lies ahead in February and beyond. Treatment cycle four begins on 12/6, which means I'm three cycles and just about 2 months to the end of treatment. It will come as no surprise that making it beyond the halfway mark is psychologically critical for me -- like being beyond mile 13 in a marathon. I know now not only that I've less left than what's come before, but I also know what effort the remainder of the course requires. 

This next round begins for the first time with imaging. For the first time, we'll take a look to see what all this effort is doing to the various bits of lymphoma growing inside me -- a somewhat more scientific gauge than my two fingers checking my neck. I'm not really sure what to expect from the CT scans (well, I know what to expect from the scans themselves -- they're painless and easy. The hardest part is being hungry and waiting my turn.)  Should I expect all the affected nodes to have shrunk down to normal size? Should I expect the favorite phrase: No Evidence of Disease? Or should I have more modest expectations? And what is the course of action depending on what we find out?

This leaves me with a small dilemma. Should I ask Dr. L what the range of expectations are ahead of time or wait until we see the results and calibrate my expectations accordingly? 

I think I know what I'll do. 

--michael