Saturday, January 17, 2009

Treatment 8 of 8...yay!!!!

Well I have started my last in-patient chemotherapy, and as you can tell from the title I am excited. I am looking forward to getting with the in-patient portion of the treatment, but it looks like I still have about 13 more months of treatment left. I was originally told that I would get six treatments, radiation and then a stem cell transplant, but now it looks like I am going to get eight chemo’s, a month of radiation, and one year of what the Dr. called maintenance chemo. I guess the most important thing for me to remember is to stay flexible. There are so many ways to treat lymphoma and there is no one right answer. It is also reassuring to know that the Dr. increased my treatment length because I am responding well to the treatments, and not because they aren’t working.

The start of the eighth treatment took a while to get going. On Monday, January 12th, I had my blood drawn and then had an appointment with the Dr. My blood levels were in the normal range but close to the lower limits however, still good enough to start treatment. On Tuesday I was admitted to the hospital and I was expecting to receive chemo that day. The problem is that my urine pH has to be around 7 (neutral acidity/alkalinity), but my pH was 5.4 (acidic). They gave me sodium bicarbonate to raise the pH. At about 3:00 AM my pH was good enough to start. The nurse asked me if I was supposed to start chemo after the pH was neutral or in the morning. I told her that I was informed that the treatment would start as soon as my pH was within limits. She checked with the on-call doctor and that doctor said to just wait until the morning. The problem with that was that I had another blood sample taken at 4:00 AM which showed that my white blood cell count was no longer within limits and therefore they could not start chemo. The nurse told me that I was because this happened I now had to check out of the hospital and wait until my white blood cell count was back within limits. So, basically, I got a free night stay at a hospital. Actually I say free but the rooms are $1800 a night, so I kind of feel like it is the most expensive resort I will ever stay at in my life.

I was administered a shot called Neupogen, which increases my body’s production of white blood cells. I was given two days for my body to react to the shot and then I had a follow up appointment on Friday. When they rechecked my counts all of my blood levels were back within the normal limits so I was readmitted into the hospital as an inpatient. I guess that leads me to today, Saturday, I am now sitting in my hospital getting a chemotherapy called Methotrexate. This kind of chemo is sensitive to ultra-violet light so there is a brown bag over the chemo to protect it from breaking down. I like to say that it is so cool that it has to wear shades, but then again I am kind of a nerd so I say a lot of dumb things. It takes about 24 hours to transfuse the chemo and then I will get high dose cytarabine. This is the chemo that they have to give me a motor function test every 4 hours to make sure that too much of the chemo hasn’t passed the blood-brain barrier. What happens then is that too much chemo is in your brain and will more than likely cause death. I’m thinking that with something like that they should check my motor function more than every four hours. I want them to check it like every 15 minutes but apparently the nurses and Drs have more patients than just me. Therefore I think I am going to have to check myself and make sure nothing crazy is going with my coordination and motor skills. I’m going to have to tell my parents if I start to talk like I have been sniffing glue then they have to send for the nurses. What is reassuring is that all of the nurses that I have spoken to about it have said they have never seen that happen. My Dr. has been practicing medicine for over twenty years and he has only seen it a couple of times, and every time it has been an elderly person.

Another issue I have had to deal with here is that I can no longer handle the food here. It started out tolerable, but as the treatments have progressed the food has gotten more and more disgusting. It is now to the point where I don’t even want them to bring the food into the room. I think it is a combination of the fact that the food smells terrible and when they remove the lid it releases all of the smells of the kitchen. But what I think is a bigger factor is that I have a bad association problem with the smell and chemo. Whenever I smell that food I am already nauseous from the chemo. So whenever I smell the food I get even sicker. Last treatment cycle I had my parents sneak in In-and-Out Burger. That was awesome the first couple of times but after a while I got sick of that too. I was thinking that this might be good aversion therapy. I could eat food from all of the fast food restaurants until I got sick of them all. That way I would no longer crave that “Fourth Meal” or “The Golden Arches.” I don’t think I would want to ruin pizza but all of the greasy burger joints would be easy to let go.

Well I’m off to watch a movie. All of the rooms here are hooked up to video on demand so I can watch some current movies. I guess that is the least they can do for the cost of the room.

Wednesday, January 7, 2009

Treatment 7 of 8

Well it has been, what...three or four months since I last wrote on this thing. If you are reading it then I am surprised that you even checked back. And yes...no news is good news. I am doing great and I only have two to three months of treatments left.

So, here is what has been going on. When I was first diagnosed with lymphoma my doctor gave me a chemotherapy regimen with six treatments that were scheduled to take one month each. Last month I finished my sixth and what I thought was my final treatment. I went to my oncologist and he said that I have a decreased chance of relapse if I get eight chemotherapy treatments instead of six. He said that in order to establish efficacy, research shows that eight chemotherapy treatments is the best option. I told him that I would rather do two more chemotherapy treatments now than have to do six more later. I know that there is always a chance that it will come back but I want to do anything I can to decrease those chances now.

I asked my Dr. why he initially prescribed six treatments if eight treatments are the best regimen. He said that eight treatments is not normally an option because most people get too sick after six. They either lose too much weight or the chemo takes too big of a toll on their health. He said that since I was doing so well physically that my body would be able to handle the additional two treatments. As a side note I am doing so well physically that I think I am one of the very few who actually gains weight during the treatments. The nurses always ask me how I feel, and what my appetite is like. I would tell them that I my appetite hasn't gone anywhere, in fact I'm just as hungry as I always have been, but I can't answer because my Dad beats me to the punch. He tells them sarcastically that he is worried about my appetite and that he wants something for it. Then he tells them it isn't something to get my appetite back, he wants to get me an appetite suppressant because I am eating him out of his house. I think that I have gained weight because despite the fact I am doing well, I am not working out as much as I used to. That coupled with the fact that I sit around and eat all day I have been able to keep my weight on.

I also asked my doctor if getting two additional chemo treatments would increase my chances of getting a thing called chemo induced lymphoma. I had read that one of the causes of lymphoma is being immunosupressed. Whenever you get chemotherapy you become immunosupressed. So by getting chemo you can actually later on get lymphoma. It happens to some people who have other types of cancer; colon, breast, lung etc. Some of those people go on to develop lymphoma as well, because the chemo has damaged their lymphatic system. My oncologist said that the damage to my lymphatic system has already been done, and that two more treatments of chemo would not change my chances of developing lymphoma later. That settled any concerns that I had about putting more toxic chemicals directly into my veins.

The week before my Dr.'s appointment I had had a PET scan. A PET scan is where they inject me with radioactive sugar and then give you a CAT scan. Cancer cells do not get the signal to stop growing and they use sugar in order to reproduce. A PET scan measures where the sugar goes in the body. Any spots that have a large uptake of sugar are cancerous. The Dr. had the results of the PET and it showed that the cancer has shrunken from the size of a softball to two centimeters and that there were no active cancer cells remaining.

I have also had a problem with my heart. Since starting chemotherapy my heart rate has slowly increased. My current resting heart rate is in the high 90s/low 100s. I went to a cardiologist and he said that I have tachycardia, which means I have a fast heart rate. With all of the chemo I am getting the doctor did not want to give me any additional medicine, but he gave me an echocardiogram, an ultrasound of the heart, to see if there was any damage to my heart from the chemo. The last thing the doctor told me at the appointment was that my heart was not damaged from the chemo and that hopefully once I am done with the chemo my heart rate will return to normal.

So I guess all in all things are going great. I am still here in Phoenix so if you see a fat bald chemo patient come by and say hi.


Noelle and I hangin'





At the hospital with my new hobby...knitting




The Mayo Clinic Hospital where I get all my treatments
My white blood cells were high enough for Noelle and I to sneak away for the weekend to the Grand Canyon.

Friday, September 5, 2008

Two Days in a row...what a miracle

Today was much better than yesterday. Yesterday my hemoglobin levels were to low and I required a blood transfusion. This isn't that big of a deal, it basically means that my red blood cells aren't able to carry enough oxygen so my heart has to beat more often to get the blood circulating faster. It was the second transfusion I have had and the biggest problem that I have with them is that they take four hours to complete, with all the blood screening and wait time included the total is about six hours. The other problem I have with them is that I am not real excited about blood sitting on an IV pole watching it go into my body. It is kinda gross. I mean when they initially put the stuff up it is cold but by the time the last bit of blood goes into my body it has warmed up to room temperature. I don't know why but the thought of room temperature blood just hanging out in a bag next to me does not excite me. I'm not one of these people that are afraid of blood but, seriously...this stuff has been outside of someone else's body for who knows how long and now it has been sitting at room temperature for several hours. That just sounds grody to me, and yes I did use the word grody. I don't think second graders should be the only ones that are allowed to use that word.

Right now I am outpatient. I was an inpatient for 11 days in phase 3 then they released me for treatment on an outpatient basis until phase 4 starts. I went into treatment yesterday as an outpatient expecting to get two IV antibiotics which would have taken 2 hours but after getting blood I was required to hang out for nine hours in the outpatient ward, or as I call it "The Nate Day Show." I call it that because it is my chance to entertain the patients and nurses that are there. Today I only had to spend 4 hours there. I had to get a dose of IV antibiotic, and they thought they heard fluid in my lungs so they gave me a chest x-ray. It turns out that the nurse was just hearing things, but I am glad that this hopsital is so precatious. Since I am still neutropenic aka immunocompromised aka I have no immune system, they make sure that I don't get any kind of sickness.

I go to the hospital so much that I have lost that "Oh man, I hate going to hospitals" feeling I used to have. Now it is that "Oh, I don't feel like going to work today" feeling. 'Work' in this case is isn't that bad considering I don't have any homework, I don't work late hours, I don't even have to go in every day. Sure they fill me with weapons grade chemicals, stick me with needles, when I'm at the hospital they make me measure how much I drink and how much I pee to see if that there is an imbalance, and they wake me up every couple of hours, but I've actually had worse jobs in my life. I think getting up at 4am on Sunday mornings to deliver the newspaper was one of the worse jobs I have ever had. I mean who needs their newspapers that early in the morning? Can't people wait until 7am to cut their coupons and read the "funny papers?" Marmiduke isn't going to be any funnier at 4am than he is at 7am.

In order for you guys to understand the reason I even complain about going to the outpatient ward in the first place it that you must remember what I did for a profession before I was sick. The statement I told my doctors and nurses when I started treatment might put it in prospective, "I am a Pilot, therefore I am a prima donna and high maintenance. By that virtue I will complain a lot and I do not handle pain well, so you are going to have to deal with it."

Well that about sums up the last couple of days. I hope you all have a great weekend! Thanks again for reading!

I also wanted to thank all of you that have been able to come out and see me. Here are some pics of those of you who were able to make it out.



Mike Johnsno...aka M-Jack Spectac




Me and Renee Shapiro


Me and LeRon Hudgins



Me and Nick Pizii

Thursday, September 4, 2008

Back by popular demand.

I am back with another posting. I have been bad about letting you all know what is going on and I apologize in advance for that. I have received a lot of requests, actually some of them were bordering on threats, for me to keep updating my blog. Well you asked for it...you got it.

Before I begin...here are some pics so you can see what I've been up to.



This is my first treatment of chemotherapy. The orange sticker on the IV bag is a biohazard sticker. I thought it great that they had to wear protective equipment to administer the treatment but the end result was this chemical grade weapons poision going into my body.




Here it is...and I love the stuff. Makes you feel bad but it kicks cancer's ass!!!






Getting a dose of chemo called VinCRIStine. It is some intense stuff, which might account for the strange look on my face. Here you can see Angie all suited up to protect herself from the chemicals she is injecting directly into my veins.




Enjoying some delicious hospital food!

video

This is the squeeky treadmill they have in the room. I can't complain about it at all. It gives me a chance to get some exercize when I am an inpatient.

I am currently finishing phase three of treatment. You might ask yourself "what happened to phase two...I didn't even know he had started phase three and now he is done with it." Well I am in deed done with pahse two and nearly finished with phase three.

Some issues that I had with the first treatment were an elevated liver enzyme count. I did not get much of that for phase two but I am getting it now for phase three. The doctors are not too concerned about it because the problem corrected itself last time and they had no idea why it happened in the first place.

I mentioned before that I have a PICC (Peripherally Inserted Central Catheter) in my arm. This is a direct line that the doctors can give me an IV via a catheter in my arm. This is one of the greatest inventions in the world because it keeps the nurses from sticking me with needles. Well there was a problem with the first PICC so they gave me another one. Then gave me another one and that one crept out of my arm enough to make it no longer good for IV drugs so they removed that one. I was on my third PICC until two days ago when they found out that the line was infected. An infection is kind of a big deal for a guy with no immune system, so the nurses and doctors took extra care to make sure that I was getting the correct antibiotics. One of the antibiotics that I am currently on does not fight the kind of infection that was on my PICC so they are now giving me another antibiotic via an IV.

The phase I am currently finishing is the same as phase 1. I basically cycle between two different regimens three times for a total of six treatments.

The doctors gave me a PET Scan which is a scan where they inject me with radioactive sugars and then give me a scan. All cells like sugar but cancer cells love it. I mean they love it so much that when the radioactive sugar is injected in my blood the cancer cells absorb it in large quantities. This is because the cancer cells are rapidly dividing and when cells divide then need sugar. Once they put the sugar in me they gave me a PET Scan which tracks where the sugar went to. If there is a bright spot in the scan that means that I have cancer in that area. The scan is an excellent tool because it can let the doctors know if there is cancer in other places in my body. The results of the exam were a complete blessing and answer to prayers. The mass that was in my chest which was larger than a softball had shrunk down so that in the PET Scan it looked like scar tissue left over from the large mass. The other great news is that it is official...the cancer had not spread to any other parts of my body.

As far as my life outside my medical treatment the clinic has been extremely accommodating and has let me leave the local Phoenix area. After my second phase of treatment and my immune system returned I was able to travel to Colorado Springs. This was a great trip for me because I wanted to go back to my squadron and see all the guys out there. I was also lucky enough to hang out with my old roommate Mike Trodden. I call him my old roommate because when I was there I moved the rest of my stuff out of his apartment and moved it all into storage. When I was there I was able to go see how everyone in my Reserve unit was and it was so great seeing everyone there. It was nice to be able to hang out with everyone and it was great for my spirits to be with such fun and caring people.

















Mike, Noelle, and me in Colorado Springs

I was also fortunate enough to get a chance to go fly fishing on the Colorado River. My girlfriend, Noelle's sister's boyfriend and his family were kind enough to arrange a trip for Noelle and me. They organized for us to go down the Colorado River in a float boat with a guide. We were able to fish and float on some of the most beautiful parts of the country. I had never gone fly fishing before and neither had Noelle. I'm not going to say I'm a quick learn, but by the end of the trip I looked like Brad Pitt in "A River Runs Through It." Well that is almost a good allusion to Brad Pitt but I think I look better than him in waders. I also want to take this opportunity to say thanks to the Reeder Creek Ranch as well as the entire Bruchez family for making this opportunity possible.




Noelle and her 16" brown trout




My 6" brown trout. Not much of a showing for someone who claims to be a fly fisher, but you can see I'm excited none the less.

My plan was for me to fly to Colorado Springs and then drive my car back to Phoenix with Noelle and she would fly back. The plan was going well up til the point that Noelle and I got on the road for the trip back. Well that might be a slight artistic use of the words the plan was going well because I had several problems. The first one was that the rear window of my car had fallen out. I have a convertible and the window ripped out and there was no way for me to replace it. The fix for that was for me to use my car cover and I put it in the rear window as a cover. This worked but it made a lot of wind noise. The other problem which was much bigger was that once we got outside Colorado Springs the car started leaking anti-freeze fluid. We had to stop at a truck stop and have a couple of local truck mechanics look at it. They said that they could fix the problem but that was just prior to them asking me "What kind of car is this...I've never seen anything like it before" That is when they said that they could fix it in a day. I didn't have much faith in them so I had the car towed back to Colorado Springs and had it fixed there. The problem was that since I had the delay, Noelle wasn't able to go with me, because she had to go to work and this delayed her too much. I made the trip by myself and now I have my car in Phoenix. I love having my car back because it gives me some of my freedom back.

I don't know how many of you have had to move back home but it take some adjustment. I am used to doing what I want when I want without having anyone second guess me or keep track of me. I have an extremely nomadic lifestyle anyway. I usually travel between New York and Colorado about 4 times a month. Then between that I usually try to take two trips to go see friends or family around the country. I find that I have stability in that volatility. I move around so much that I am used to it and I like it. Now that I am in lockdown in Phoenix it becomes easy to get stir crazy. I love my folks and I love being around them, and I am thankful everyday for their support and companionship, but that being said it was nice to be able to get away and spend some time on the road.

I will try and update some of the photos and I will try and update my blog again as soon as I can. Thanks again for reading and thanks for all your guys support.

Thursday, July 24, 2008

Thank you all for checking in on me and reading my blog. I have not contributed anything new in a while. I have been focusing on updating the old blog as well as putting up some pics. I do not have the current pics of me but once I find my camera I will post some current pictures. If you want to find out some of the history of what has happend to me in the past, read my older post.

I just finished the first treatment of chemotherapy. It was a 28 day treatment and was the A course. I am currently undergoing chemotherapy in the B course. Once I am done with the B course I will start the rotation again and do the A and B courses two more times. The first set of chemotherapy went well and I want to thank you all for your support!!!! Thanks for the words of encouragement, phone calls, the gifts, the cards, but most of all thanks for your prayers. You all have made this experience easier and have helped me along every step of the way. Because of the intensity of the chemotherapy that I received for the A course they were expecting mouth sores, nausea, loss of appetite, peripheral neuropathy (numbness of the fingers and toes), and of course hair loss. It also intentionally kills off all of your white blood cells, so you become neutropenic (no immune system). The doctors gave me medicine to prevent nausea and it worked amazingly well, because I did not get any. I also did not have any mouth sores. I did however, get some numbness of my fingertips, but it is minimal. I did not lose my appetite and I was able to eat the entire time. Despite the fact that I was eating I did lose about 20 pounds. I had some weight to lose so losing 20 pounds wasn’t a big deal at all. I also lost my hair…well I didn’t lose it in the traditional way that chemotherapy patients lose it. I knew that it was going to fall out so I preempted the hair loss and decided to get a mohawk. I will include pics later so you can enjoy the look. I had red, blue, and green colored styling glue (also known as “gel” for your older types and “product” for all you metro’s out there) so I would change the color of the Mohawk daily. It was good to keep the doctors on their toes every day. The mohawk only lasted for about two weeks before it started falling out so I shaved my head. Because I still have my eyebrows and eyelashes so it looks like I shave my head to hide the fact that I am balding. I was also neutropenic for the last 15 days of the treatment. That meant that I was not able to interact with public or go outside without wearing a mask to prevent getting any kind of infection or sickness. They gave me a shot called neulasta. It increases your body’s ability to produce white blood cells and increase my immune system. The problem with the shot is that since your bone marrow is producing more blood my bones started hurting. It wasn’t that bad because I had my good friend by my side…Mr. Oxycodone. He was by my side for three days and I appreciated every minute of his company.

I did have a couple of complications. The doctors installed what is called a peripherally inserted central catheter (PICC). This is a catheter that they insert in my arm to allow them to administer medicine via an IV as well as draw blood. The PICC was my favorite addition to the treatments. They would wake me up at 4am every day and draw blood for lab work, and without the PICC they would have to stick me with a needle every time. Getting up at 4am and getting stuck with a needle isn’t very fun. In fact they were taking so much blood that at one point I accused one of the nurses of trying to clone me. Once they inserted the PICC they could take blood without having to stick me with a needle. The PICC was in my body for about a week when my body decided that this foreign object in my arm didn’t belong there and it tried fighting it the only way it knew how…by clotting blood around it. This slowed the blood return in my right arm and prevented some of it from getting back to my heart. This in turn caused my right arm to swell to about two times its normal size. The nurses were measuring it every day to make sure that it didn’t get too big. It got so big that at one point when they were measuring my arm it got so heavy that I could barely hold my arm up. In order to fix this problem the doctors gave me a drug called Lovanox. It is a blood thinner that prevents and breaks up clots. Lovanox did the trick. It was able to break up the clot in my arm and within a couple of days my arm was back to its normal size.

The other problem that I had was with my liver. I have lab work done on my blood every day to see what my platelet, white blood cell, red blood cell…well there is probably 50 different things they check for in my blood. One of the things they check for are the liver enzymes. About a week and a half into my chemotherapy my liver enzymes started climbing. My liver is still functioning normally but what elevated liver enzymes means that something is aggravating my liver and causing it to be inflamed. The doctors checked to see if it was a viral infection, but they found nothing. I am still waiting to find out what is causing my elevated liver enzymes. They think that it might be a reaction to the chemotherapy. They gave me a liver biopsy on Jul 23. The biopsy will tell the doctors what is causing my liver inflammation. When they figure out what is wrong with my liver they will be able to correct the liver enzyme levels.

Right now I’m on my first day of Chemotherapy of Course B. I am currently getting a chemical called Methotrexate. It is getting pumped into me via an IV. It takes 24 hours for all of the chemotherapy to be pumped into me. Then they will give me two other treatments called Leucovorin and Cytarabine. They are both Chemotherapies but the Cytarabine will be given to me intrathecally (that means they will give me an injection of Chemotherapy into my spine).

The room I am staying in is great. I am the only one in my room because of the fact that I will eventually have no immune system and they do not want to risk anyone else infecting me. That does not mean that I can not receive visitors. There are no visiting hours here so my family has been able to stay here with me. I have not felt lonely here at all because my family is always here to support me. The nurses were able to find an extra treadmill that was in one of the empty rooms. They moved it into my room so I am able to get exercise and keep my energy levels up. It is difficult to get on it some times but I find that when I do work out it makes me feel better a couple hours after I am done walking. I think that walking on the treadmill has also helped me recover quickly from the side effects of the chemotherapy.

I am excited about this next phase of chemotherapy. Once I am done with this phase I only have four more treatments of chemotherapy!

Thanks again for reading and I will try to keep you all up to date as much as possible.

Thursday, June 26, 2008

Whats going on with me.

Well…I’m not exactly how to start this blog but if you are reading this then you have probably already heard that I have some medical condition going on. I thought a blog would be good because I can explain exactly what is going on with me so there will be less confusion. I envision the “telephone game” where the original story morphs into some strange aberration of the original story. So in order to prevent any convoluted story I figured I would write it down. The other reason I think this will be good for me is that when I do talk on the phone I will not feel like I have told the same story a hundred times and give you guys a super watered down version of what is going on.

So if you haven’t heard I have been diagnosed with Acute Lymphoblastic Lymphoma. It is a non-hodgkins lymphoma. It has affected my lymph nodes in my chest, but has not spread to any other lymph nodes in my body. The CAT scan shows that the mass in my chest is approximately 10cm x 12cm x 14 cm (3.9in x 4.7in 5.5in). That roughly translates into the size of a softball. They have done a bone marrow biopsy which has shown that it has not spread into my bones. They are going to do a spinal tap on Monday June 30th and see if it has spread into my nervous system. As far as treatment I am going to be getting a type of chemotherapy called Hyper-CVAD.

http://en.wikipedia.org/wiki/HyperCVAD

This article says that the treatment is given in eight stages but I will be getting only six different stages. They are given in two separate courses A and B and then repeated three times. The length of treatment depends on how I respond, but for now it looks like it will be about a year. After the chemotherapy it looks like I will be getting radiation therapy focused on the mass in my chest. After all the therapy is done they are looking at giving me a stem cell transplant. The focus of the chemo is to break apart the mass as well as break down the bone marrow so that it can be replaced with new bone marrow that does not produce these cancer cells. They used to do bone marrow transplants in order to replace the bad bone marrow. As you might have heard this is a long and painful transplant. However, now with the advances in medical technology they are able to do stem cell transplants. When they do a stem cell transplant they find a donor that matches your DNA. The doctors then give the donor a drug that increases the donor’s bone marrows production of stem cells. The stem cells are then harvested from the donor and then injected into the recipient (aka me). The stem cells then swim around me until they find something to do. In this case the stem cells see that I have no bone marrow and they swim their way into my bones and the stem cells become new bone marrow cells. The problem is finding a donor that is a DNA match. The first step in finding a donor is checking to see if one of your siblings is a match and then if they aren’t the doctors go to the donor bank and see if there are any matches there. If you think back to sixth grade biology class you might remember Gregor Mendel and the Punnett square you will remember that there is only a 1 in 4 chance that your sibling will be a DNA match. In my case my sister and my brother were both tested and my sister ended up being a match.

Here is a link if you want to read what the internet has to say about my type of lymphoma.

http://www.cancerbackup.org.uk/Cancertype/Lymphomanon-Hodgkin/TypesofNHL/Lymphoblastic

The doctors have told me some encouraging words about my prognosis. The first risk factor that I have to my advantage is my age. Since I am 32, I am still considered young which will be advantageous to my recovery. The next thing is that when they discovered the lymphoma I was (and still am) healthy. This is a rapidly developing form of lymphoma and many people do not get diagnosed until they are forced to the hospital due to complications. I was diagnosed when all of my vitals and my blood levels were normal, so I am at a great starting point for combating this disease. The next factor in my favor may not at first present itself as an advantage. As I just mentioned, and alluded to by the name Acute Lymphoblastic Lymphoma, this form of Lymphoma grows quickly. When the doctor told me this it didn’t seem like that was good news, but he quickly explained it to me so I will try my best to do the same. The reason that this is a good thing is because of how the treatment works. Chemotherapy is most effective against cancers that divide rapidly and have a good blood supply. Therefore my chemotherapy treatment should be extremely effective in curing this cancer. I have heard and read a bunch of numbers about the success of chemotherapy in the treatment of my type of lymphoma and the numbers are extremely encouraging. The stats say that the number of people cured by chemotherapy range from the low to high 90 percentile. What is also encouraging about these statistics is that they take into account all the people who have this type of lymphoma; elderly and those who are already immunocompromised (sick). So, theoretically my percentages may be slightly higher.

I am currently in Phoenix, AZ at the Mayo Clinic Hospital. It is considered one of the best hospitals in the country for the treatment of Lymphoma. The doctors do not know exactly how long the mass has been growing in my chest. They do know that it is a fast growing type so they told me that they do not think that it has been there for an extended period of time. After much consideration and referencing the book of Doctor Double Speak I think that means that it has been there for over six months. However, this number can not be substantiated. One of the side effects of the chemotherapy is that it will impair my immune system. Because of that I have a room to myself, which I cannot complain about. There is a treadmill in my room and I can have visitors 24/7. Right now the only visitors I have energy to see are my family and my girlfriend.

If you guys are feeling silly and want to mail me something my parent's address in Phoenix is
1846 West Sunnyslope Ln
Phoenix, AZ 85021

Since all of the patients on my floor have weakened immune systems I am not allowed to receive any fresh flowers because they could get some of the other patients sick. I have been asked by many people if I need anything. Right now everything I need has been taken care of. My family has been able to get me everything I need here and the 731st Airlift Squadron has been there for me every step of the way. I know it goes without saying but if there is anything that I would ask of you guys is that you keep me in your prayers. I am also asking for your guys patience when it comes to me returning your phone calls. I love that I have gotten so many calls and I can’t thank you for that enough. I do not want you think that I am using one of my standard screening processes to avoid your calls. I am in an extremely busy phase of recovery and that makes it difficult to talk. I promise that I will get back to you guys as soon as I can. If you do want to try to get a hold of me you can try my cell number at 830-734-7009. It sounds stupid but when I do get a chance to check my cell phone and I see that I have missed calls, text messages, and voice mails, from you all it brings a smile to my face to know that you are thinking of me. Also if you guys know anybody who doesn’t know my blog address feel free to let them know that it is http://nathantday.blogspot.com/ I know it is kind of silly telling you guys this information since you are already at the website address reading the blog. That is the quick and dirty of the story.

If you are extremely bored and want to read some of the background of how I got to where I am now, then feel to press your luck and read ahead.

History: I had had my annual Air Force physical in May and they did not find anything out of the ordinary. On 8 June my squadron set off for Al Udeid Air Base in Qatar. Qatar is a small country next to Saudi Arabia. Here is a link about the base.

http://www.globalsecurity.org/military/facility/udeid.htm

I was scheduled to be deployed there for thirty days. I was excited about the deployment because, not only was it only going to be a short deployment, but I was going to be in Qatar, which is a modern Muslim and has little threat of terror attacks.








Noelle and me the day I left for Qatar








The facilities are excellent on the base. We stay in trailers with individual rooms, there is a dining facility that is open 24/7, multiple gyms, an indoor and an outdoor gym, and we even have shopping facilities to get any amenities that you might need. Like I mentioned earlier we departed for Qatar on 8 June. We flew out there on our own C-130s from Colorado Springs. The C-130 does not have not have enough range to get us all the way there so we made planned fuel stops in St Johns, Canada; Mildenall, England; and Souda Bay, Greece. It was a great way to start a deployment. The problem was that we had to get there in a C-130. It is an extremely versitle airplane, however it wasn't built for speed or comfort.























The spacious accomidations of the C-130. As you can see there isn't a lot of room to lay around. That led me and my friend Eric Swartz to climb on top of the large conex we were transporting and sleep on top of it.












Glacier watching in St Johns, Canada



















Flying over the Swiss Alps












Suda Bay Greece














What time we wasted getting there we quickly made up for because we hit the ground and started working immediately. My assignment for the deployment was to work in the Tactics Office. My job there was to plan the missions that all the C-130s there were to fly. My schedule was from 5 pm until 5 am. I was working that shift for about five days when I developed a chest cough. I also developed night sweats. If I took any kind of deep breath I would start coughing. After one of my twelve hour shifts I decided to go to the clinic there to have them check me out.

The doctor gave me a brief inspection, however, when I described my cough with the associated chest pain they sent me to the main hospital. I actually thought this was hysterical because they picked me up in an ambulance, then they had me climb up into it myself, and then proceeded to strap me into a stretcher and put me on oxygen. What made it comical was that after making me lie down in the ambulance they had me get off the ambulance myself and then I walked into the hospital on my own.


I thought it was so funny that I had Eric take a picture of me getting on the ambulance.




The doctor there gave me a preliminary exam and told me that I probably had asthma. He was about to give me an inhaler and send me on my way but because of the chest pain he decided to give me a chest x-ray. Once the doctor examined the chest x-ray he came back to my waiting room and started taking the exam seriously. He re-asked all of the same questions he had asked earlier, and gave me an exam of all of my lymph nodes. That is when he told me that I had a mass growing in my chest. He wasn’t sure what the mass was but he told me that there was no reason for me to be getting exams there in Qatar. I was immediately sent to be outprocessed and sent back home. The trip back to the US seemed like it took forever however in actuality I was quite proud of the AF for getting me back so quickly. After the initial discovery, it only took about 5 hours to get me outprocessed, packed, and on the first C-130 out of Qatar. What was rewarding for me was that I had worked the night shift so I had actually planned the flight that was now about to take me back to the states. As a side note I am proud of what the C-130 does. It moves cargo, soldiers, we drop men and equipment with parachutes into remote locations, and obviously in this case we are more than suited for our life saving mission of aeromedical evacuation. I was now on one of these life saving missions. No longer was I in the cockpit wondering how the wounded in the back were doing, now the roles had reversed, and it was me that was using the services of the mighty C-130 Hercules to bring me quickly to medical care.

The trip out of Qatar took a while because we had to stop at four other airfields and pick up other wounded soldiers. After about a four hour flight we arrived at an airbase called Balad in Iraq. The base is about a hundred miles north of Bagdad, and is a large Army base, home to about 50 thousand soldiers. From there I was put on an Air Force C-17 airplane and took the five hour flight into Ramstein Airbase, Germany. They put me on a litter. Which is basically a stretcher that they suspend from supports in the middle of the airplane. I’m not sure if it was comfortable or not but it must have been because I slept the entire time over there. Once I arrived in Ramstein, they put me on a 30 minute bus ride over to another Army facility there called Landstuhl Airbase. This is where they did preliminary tests to see the extent of my condition. If you need immediate care they can do it there or if the condition does not require immediate attention they can send you back to the US for further diagnosis and treatment. Most of the medical facilities in theater are Army because the Army is the branch that is receiving most of the injuries and therefore is best equipped to provide medical care. I was admitted to the ICU and they quickly gave me another chest x-ray and CAT scan. When they admitted me they were a little surprised to see that I was the patient going to ICU. The ICU patients they normally receive are in stretchers and usually are not walking on their own. Once they got back the initial results of the x-ray they decided to send me to the US for treatment and I was moved out of the ICU into a regular ward of the hospital. I actually missed being in the ICU because as you all know already I am a little high maintenance. ICU was great for me because I had two nurses that would get me anything I wanted, plus I had a room to myself. Once I was moved from ICU I had to share my room with two other people and there was no personal flat screen TV. I had to walk like four rooms down the hall in order to watch movies and play xbox on a 55” flat screen TV. Man was it rough.

The only test results that they gave me while at Landstuhl were the chest x-ray results which only showed a mediastinal mass (that is fancy doctor speak for a lump of something in my chest). At this point the doctors didn’t have enough information to make a diagnosis. This was probably the most emotionally tasking part of the situation so far. Not because I was scared about the test results but I was concerned as to what to tell my parents. You see I was waiting to tell them what was going on until I got some kind of diagnosis. I did not want to scare them too much but I did want to tell them as soon as possible that I was going to be coming back from Qatar to receive treatment for a mass in my chest. Well since I did not get any further information from the doctors in Germany I was forced to keep this little secret from the ‘rents. My flight back to the states was scheduled for the next day. We departed Germany in another C-17 and made the seven hour flight to Andrews Air Force Base, MD near DC.

I was only at Andrews AFB for one night and in the morning I was off again on a C-130 on my way to Wilford Hall Medical Center in San Antonio, TX. This flight was only a 5 hour flight but it felt like it took forever. I think it had to do with the fact that I was getting excited about finding out exactly what was wrong with me and more importantly getting the treatment started. The trip onto and off of the C-130 was as comical as the initial ambulance ride I had in Qatar. The medics would let me walk up to the airplane and then they would load me onto a liter, they would carry me onto the plane and then strap me into place on the liter. Once I was loaded on the plane they would let me walk around and use the bathroom on my own, but when it was time to deplane they restrapped me on the litter and then carried me off. The last ambulance ride I took from the C-130 to the hospital was the coup de grace for the entire trip. They moved me off the plane and put me on a stretcher on the ambulance. When we got to the hospital I asked the nurses if I could get off the ambulance myself. They told me that they are required to take me off in the stretcher. Well, when they pushed me off of the ambulance they didn’t let the legs of the stretcher lock and I ended up falling about 4 feet to the ground. They didn’t injure me but it was definitely a surprise, and as it turns out much less safe then just getting out of the vehicle yourself.
It felt good finally being somewhere where they could make a determination as to what was wrong with me. Once I was finally checked in they immeadiatly had another chest X-ray and a CAT Scan. The X-ray was the third one I had had in at least four days and every time I had an X-ray the technician would think there was something wrong with the equipment. They would see this unexplained spot on the film and make me take a couple more shots. I just got used to telling the X-ray technicians that they didn’t need to take another X-ray and that the spot was supposed to be there (well, it actually wasn’t supposed to be there but it was supposed to be on the X-ray.) It took the doctors two days to make a final diagnosis. I called my parents immediately and told them what the prognosis was and what the treatment was going to be. They grabbed what clothes they could, clean or dirty didn’t matter, and any thing else they could need for the two day drive out here. Not thirty minutes after I told my parents the news a social worker told me that the Air Force would pay to fly out my parents to San Antonio. I quickly called up my parents and told them about the flight arrangements. I caught them just in time because they were in the car on their way to see me.

That afternoon the doctor came in and told me that they were going to start treatment as the next day. This was great news because I was excited about getting better as soon as possible. They also told me that treatment would be about two years and that all of the treatment would take place in San Antonio. This bit of information was not as well received as the first piece of information because that means that my parents would have to be away from their home in Phoenix for quite some time, and when they weren’t there I would have to be alone in San Antonio. The doctor added one caveat to my treatment. They said that if I could coordinate with a hospital in Phoenix that my insurance, TriCare would pay for treatment at a civilian hospital. Well with the help of my social worker the flight surgeon at Peterson AFB, and my Oncology doctor at Wilford Hall they were able to find a doctor at the Mayo Clinic that promised to admit me and immediately start treatment without doing any extraneous testing and blood work.

I had mentioned that if I received treatment in San Antonio that I would be alone. That is not true because I had the generous and amazing help of my roommate’s parents, Deanne and Mike Trodden. As soon as I was admitted to the hospital they were there to visit me and bring me anything that I needed. More importantly that that they were there for emotional support when I was finding out all this information out about my health.
Once my doctor and my social worker at Wilford Hall Medical Center were able to coordinate with the Mayo Clinic and find a doctor that would treat me, the Air Force was able to get me on a flight in less than four hours. I think that was the fastest that I have ever seen the Air Force accomplish anything. Because I was still in good physical condition they let me fly by myself to Phoenix. Once I arrived in Phoenix I was admitted to the Mayo Clinic for treatment. They immediately admitted me and began treatment the next day.