What would Spock do (WWSD)?

A colleague visiting from Japan brought me a nice single malt whisky this week, which is very timely since my whisky collection took a serious and unforeseen hit a few months back. I'll tell you how it happened, since you asked. 

Have you ever wondered what you would do if you were told you might only have a few months to live?  I'll bet you think you'd hire a boat in the Caribbean and sail off into the sunset drinking vintage champagne to a soundtrack  by Hall and Oates,  toasting the good times with all your friends around you. Or possibly you're one of those people that sees themselves finally getting around to finishing Finnegan's Wake or War and Peace? Or maybe finding a quiet mountaintop and meditating on the meaning of life is more your thing? I thought along these lines until November, when my doctors first suspected cancer and I went for a biopsy of one the lumps in my neck. The long conversation with the oncologist went basically like this: 

Doctor: "Well, we're almost certain it's cancer and we've taken some samples of the tumor in your neck."

Me: "This makes me feel unhappy. How bad is it?"

Doctor:  "Well, it's either Lymphoma, which is fully treatable in about 80% of cases, or lung cancer which has metastasized to your lymphatic system, giving you, oh, about 3-6 months. We'll get back to you soonish with the results. Have a great weekend!"

The reality is that when I was actually faced with that sort of situation, I ordered out for pizza, cracked open several prized bottles of whisky and proceeded to get blindingly drunk. Channel 4 was showing an excellent string of 80's movies. Top Gun, Breakfast Club, Star Trek II: Wrath of Khan. The one thing that really sticks out in my mind from that hazy weekend was the scene in Wrath of Khan where Spock saves the Enterprise but dies of radiation poisoning in the reactor room. This made captain Kirk and I very sad. I have a meeting scheduled with a radiologist this week to discuss irradiating my chest and neck with high energy x-rays and I'm wondering if Spock is trying to tell me something here.  And yes, cancer does make you a little bit crazy.

Dr. Mike: now 99.99 % cancer free.

I had my mid-treatment PET/CT scan this week and it came back good. Real good. You can see the before and after scans in the picture. Not a trace of cancer at all. All the tumors seemed to have melted away! What's really neat is that now that the tumors are gone you can see some other organs like the kidneys and liver on the scan, since the tumors 'outshone' the signal from them before. I had no idea livers were so big. Gross. You can also see the awesome sock/Toms/hospital gown/hairy man leg combo I sported to the scan.

Does this mean I'm cured of cancer? No. Cue the math. The detection limit of a PET scan is about 10^6 cells, so it's likely I still have on the order of 1 million cancer cells running around my body. Based on my initial scan and the relative percentage of cancer cells in a Hodgkin's tumor, I calculate that I started off with something like 10^10 cancerous cells. This means that after 4 treatments of ABVD chemotherapy we've killed off (1-1,000,000/10,000,000,000) X 100% = 99.99% of the monkey faced bastards. Amazing!

Where to go from here? I'm not in the clear yet since there is still a chance I'll relapse at some point, but things are going as well as they can. I'm down for at least 4 more treatments of ABVD chemo to mop up the remaining cancer and then I need to make some decisions about getting further chemo and possibly radiation. But for the time being I'm celebrating with some cancer-fighting beer and pasties.

Lymphoma's Greatest Hits

Today we're going to count down the top four all time great Lymphoma moments from television and film. Why not top five you ask? Because I could only think of four. But don't worry, it's going to be awesome!

Number 4: Party of Five

Here we see some serious overacting by Matthew Fox as he sits in the doctor's office and gets a diagnosis of Hodgkin's. I like the part when get gets all dizzy and his pupils dilate and the room starts spinning and there is a nice cut to his big, sad, watery, brown eye. Charlie, you need to wipe off those tears. I know it's tough that your parents died in a car crash and that you have to bring up Bailey, Julia, Claudia and Owen on your own, but don't worry - by the end of season four you'll totally beat this cancer thing and it will only make the bonds of your family stronger. What you should be really upset about is that after Fox cancelled Party of Five Neve Campbell and Jennifer Love Hewitt went on to make a shit ton of money in slasher films, but your forrays into Hollywood have been disasters. Speed Racer? Vantage Point? Eeeesh. That's the real tragedy here.

Number 3: Kindergarten Cop

Okay, this clip isn't exactly about lymphoma but it is about tumors. For any kid brought up in the 80's or 90's Arnold Schwarzanegger permanently ruined a serious discussion of cancerous growths. After watching this film it's pretty much impossible not to say 'tumor' in a thick Austrian accent. I think this should be made standard clinical terminology. "Mr. Sutherland - I'm afraid you have a number of large cancerous too-mahs in your chest" sounds a lot less scary to me.

Number 2: Curb your enthusiasm

The better Hodgkin's. Comedy genius, I must remember to use this. What's really great is that this clip totally references clip number 4 on our list. That's just like, so, meta. 

Number 1: Family Guy

Finally, Mayor West reveals the shocking truth about the cause of lymphoma. Now you all can understand why I have the Hodgkin's.

Ultimate get well soon card

When you get sick, people like to buy you get well soon cards. If you're really lucky they have hilarious cartoons on the front, like Cathy (chocolate, chocolate, chocolate ACK!!!!!!) or Garfield (if people were meant to pop out of bed, we'd all sleep in toasters!!!!!). Unfortunately my friends back in Canada are too lowbrow to have heard of these sorts of things, so instead they put together a little get-well-soon video. Yes, it is clear they have too much free time on their hands and should probably consider taking up a hobby, like lawn darts or vampire LARPing. But I laughed until my face hurt and am enormously grateful. The full video is far too hilarious/incriminating to post in its entirety so I've put up a clip from it.

Note: this clip is NSFW as it contains animated man balls and sweary bits. Unless of course you work as an animator of man balls and swear like a sailor, then it's probably just fine. 

Chemotherapy Round 4

I had round 4 of chemo yesterday. Not much to report, still feeling okay and I had a look at my blood test results. Both red and white blood cell counts remain normal, which is nice to know, since low red blood cell counts can lead to anemia, and low white counts can lead to nasty infections and fever. I just noticed that my nose hair has fallen out. Like all of it. I don't know where it went. Did I inhale it? No, it probably fell out in the middle of the night, like rats abandoning a sinking ship. That's okay, I was never really sure what nose hair was for and I don't miss it.

This marks the end of cycle 2 of my ABVD treatments. In 13 days I'm due for a PET scan, which lets me know how 'chemosensitive' my cancer is. If it comes back with no sign of the Hodge, it's a very good thing. There is a strong correlation between successful mid treatment PET scans and overall survival/freedom from treatment failure rates. If it comes back blobby, I get kicked up to another chemo regime called BEACOPP. It's like chemo on steroids. No wait, I'm already on steroids so I need another analogy. BEACOPP is like chemo engineered by Germans (which is true). Ruthless and efficient, like a Mercedes Sedan or Angela Merkel.

Know your enemy

There's nothing like curling up with a good book before bedtime, right? For the past few weeks I've been reading two real page turners - Hodgkin Lymphoma - second edition and The Biology of Cancer. I've come away with three amazing facts.

1. FACT:  Hodgkin's is one of the rare cancers that have been conclusively linked to infection by a virus (at least in some patients). In fact in about 40-50% of those with similar case profiles to mine the tumors have DNA from the Epstein-Barr virus inside of them. This is the same virus that causes mononucleosis, which as every teenager knows is caused by kissing. After I get better I'm totally swearing off kissing teenagers.
2. FACT:  Brazilians lead the world in the incidence of penis cancer. I would take the Hodge over penis cancer.
3. FACT:  Almost all cancers are monoclonal. That means that every cell in the tumor descends from a single common ancestor. At any given time there are something like 10 trillion cells in your body happily going about their business and it only takes one of them to go all monkey face and then you get cancer. I want to take this opportunity to thank the 9,999,999,999,999 cells that are carrying around oxygen and fighting off bacteria and turning pints of beer into beer gut and moving numbers around in my brain. You guys are great, I wouldn't be where I am without you. To the 1 slacker cell who decided it would be fun to make unlimited copies of himself I want to say ha ha, I know you've done the biological equivalent of repeatedly photocopying your ass at the office Christmas party, and while we've all had a good laugh maybe it's time to sober up and call it a day. You're embarrassing yourself, plus you made my Mom cry.