Lymph nodes all over my body that were enlarged and opaque had returned to normal-sized translucency. My spleen has shrunk from enlarged-size to much closer to normal. Observe!

Spleen as seen in mid-June

Spleen as seen at the end of August

From what Dr Norman sees in the CT scan, he thinks that there is “a lot, lot less cancer. Practically nothing, if not nothing left.” If there had never been any splenic involvement, he’d call this a “complete response” — we can see through the lymph nodes and there is no sign of cancer left.

But since the spleen is opaque (even when healthy), and since we don’t know the exact size of my particular spleen when it isn’t chock-full of cancer, we need more data before we can say that it’s cancer-free. If we do more scanning after further treatments and find that the spleen hasn’t shrunk any further, we may be able to retroactively call this a “complete response after two treatments.”

The speed of this response is very encouraging; both cancers have been swatted down to nearly-untraceable levels. Just as with antibiotic treatment, you don’t stop when the infection appears to be gone.

We want it to go away, and we want to break its ability to come back. From Dr Norman’s interpretation of my response to treatment, this is a real possibility.

There’s still plenty of work to go:

• I may have developed some lactose-intolerance. Still investigating.
• Extra hot/cold sensitivity has shown up around some teeth, and I’m going to get it checked out by my dentist.
• One of the lymphomas may have spun off a diffuse large b-cell colony, which makes prophylactic intrathecal chemotherapy a (slightly frightening) consideration.

But even with all of that ahead, the (possibly) complete response after one-third of the treatment plan is a very encouraging sign. It’s good to get good news again!

After waking up I had the pleasure of finding that all attempts to get out of bed were met with intense pain. Pain that motivated me to stay in bed and not move a muscle. Except for the muscles used in taking two Percocet, and calling the oncology nurse (Sharon) that works with Dr Norman.

I described the pain (shoulder pain, likely because of spleen interacting with diaphragm) and she paged Dr Norman to ask his advice. She called us back with the request that we head to Urgent Care, where she’d ordered some pain medication and a CAT scan.

We also called our friend Lauren (an EMT) for backup.

I got into the car verrry slowly and Jana drove Lauren and I to the hospital post-haste.

We checked-in at Urgent Care and were admitted right away, skipping triage and much waiting. Vitals were recorded, a bit of blood was drawn, and then we got started on medication.

First was the awesomely-named anti-nausea drug Ondansetron, which would be a great name for a disco robot.

Then they got to the actual pain medication: Dilaudid. It’s just about as close as you can get to pure opium. I didn’t notice tremendous effect, but my dosage amount was pretty low.

Then: a surprise visit from Dr Norman! He stepped in to give us a briefing on the next steps. He didn’t have the full pathology report on the lymph node yet, but he was hearing unofficially that there appear to be colonies of more than one type of lymphoma. His suspicion is that I could have LPL that has spun off an instance of DLBCL along the way.

That’s right… I may have double cancer. Trump card for sympathy! Twice the bounty when I beat them both!

The chemotherapy would be intended to attack and destroy both cancers during the series.

We launch our attack tomorrow at 10am.

After some time to let the medication kick in, they took me downstairs for another CAT scan. We wanted to ensure that this pain wasn’t due to some sort of rupture or bleeding. Sure enough, my spleen is totally intact.

As the level of pain itself was not reduced, and judging from the serious effort it took to get out of bed this morning, the doctor in Urgent Care recommended that I stay in bed overnight in an observation room. A scant hour later we were on our way to the room.

And so here I sit, just about ready to fall asleep. Tomorrow will be a big day: the beginning of a long series of chemotherapy. I feel anxious about having my body burned from the inside, and dealing with sickness and reactions I’ve never known. But I’m ready to start removing uncertainty, to continue trusting in the support of friends, and to give these cancer cells a much-needed “etiquette lesson.”

Speaking of chest ports (and surgery to install them), my steri-strips have all come off. Now I just hope I can clean the adhesive off. The areas around a couple of incisions are real sticky!

More motivation: this morning I got a pretty intense pain in my shoulder. It wouldn’t go away unless I found just the right position, and breathing in was not allowed. Shallow, uncomfortable breaths.

I suspect this is a result of my enlarged spleen pressing up against my diaphragm. You see, in our very beginning stages of development, our diaphragms are all located very closely to our shoulders. They get linked into the sane nerve networks. Then, as we grow older, our bodies stretch and our diaphragms move further down our bodies. But the wiring still has them connected with the shoulders.

The pain from this morning eventually went away. We went to a movie, then to a friend’s BBQ. While at the BBQ the pain returned with significant vengeance! Such a buzzkill. And it is still making itself known right! Two percocet have been sent to die for their dear leader.

I am really looking forward to the start of treatment; the spleen returning to normal size, the night sweats going away, less (yaaaaawn) fatigue.

I know it’ll be like running a marathon. A six-month-long, poisonous marathon. But I’m still excited to hear the starting pistol, and to turn the first corner.

Bring on the chemo.

He says the evidence is pointing strongly toward lymphoplasmacytic lymphoma. It’s not an aggressive cancer, which is nice. But that very trait also makes it recurrent. You can treat it, most of it will go away, but it will eventually come back again and again.

It sounds like the evidence isn’t totally conclusive yet, though. He’d like to get a tissue sample from an affected lymph node, and so far the only ones we know of are in my abdomen. We’re going to do a PET scan to see if we can find any more accessible ones to remove and dissect. That PET scan isn’t until the beginning of July.

This is starting to take a long time!