Wednesday, July 12, 2006

Sleep is over-rated, so I stayed up all night and this is what I learned.

Ryan's first night back to work and I, of course, couldn't sleep. Spent the early morning hours learning a lot about Hodgkins. Information can be scary. But mostly I think being informed is a good thing. And, it's high time I figure out what the heck has happened to my body.

Hodgkins Disease was first recognized, surprisingly, by Dr. Thomas Hodgkin in 1832. It is a lymphoma along with the other, more common non-Hodgkins lymphoma (nHL). Lymphomas are cancers of the lymphatic system - the body's blood-filtering tissues that help to fight infection and disease. Like other cancers, lymphomas occur when cells divide too much and too fast. Growth control is lost, and the lymphatic cells may overcrowd, invade, and destroy lymphoid tissues and metastasize (spread) to other organs.HD, unlike nHL, is hallmarked by the presence of Reed-Sternberg cells (named after Dorothy Reed (1874-1964) and Carl von Sternberg or George M. Sternberg (1838-1915)). Reed-Sternberg cells are also present in mono-nucleosis (kissing cousin's disease) and in Epstein-Barr infections. The lymph system includes the lymph nodes and other organs that make up the immune and blood-forming elements of the body.The lymph nodes are organs about the size of a pea and are found beneath along the route of large blood vessels. They are grouped in areas such as the neck, underarms, groin, abdomen, and hips and are linked by narrow tubes known as lymphatic vessels. These vessels carry the liquids lymph and chyle which in turn transport the lymphocytes (specialized disease-fighting white blood cells) and other blood cells. Other organs containing lymphatic tissue (and that may be affected by lymphoma) include the: spleen - the "ductless gland" that makes lymphocytes and other infection-fighting cells, stores healthy blood cells, and filters the blood); thymus gland - the gland that produces immature T-cells that eventually participate in immune responses; bone marrow - that makes stem cells and many blood precurser cells; adenoids - the lymphatic tissue behind the nasal cavity; and tonsils, the rounded mass of lymphatic tissue at the back of the throat (of course, I got my tonsils and adenoids out at age 16. Neener neener neener, Hodgkin's. You can't get my tonsils or my adeniods. Tough luck.)

Chemotherapy is a general term that is used to describe cancer-killing drugs but they can be used in other situations, too. Chemo is usually given intravenously (or if you are really lucky, through a port like I will get that is a portal right into the superior vena cava. Some forms may also be given orally. There are also other less common administration routes, such as under the skin, in the muscle or injected into the cerebrospinal fluid (CSF).Chemotherapy for lymphoma varies with the disease. Most forms of chemotherapy destroy cancer cells by preventing them from growing and dividing rapidly. Other cells in the body - other than cancer - also divide rapidly and are affected by chemo. These include hair follicles (cells) and blood cells including the white and red cells and platelets. When your white count is low, you are prone to infections. When your red count goes down, you get tired easily. Platelets are also harmed by chemo, but like the red count, my platelet count is fine. Finally, the cells that line the gastrointestinal system may be damaged or destroyed, causing side effects known as the 'hurl factor' (hf, for short). The chemo regimen that I will use is ABVD. The four drugs in ABVD are an abbreviation for doxorubicin (Adriamycin®), bleomycin, vinblastine, and dacarbazine (DTIC-Dome). All four of these drugs will be given via my port on days 1 and 15. Now for the fine print. The side effects may include: Doxorubicin - heart damage; Bleomycin - lung disease (pulmonary fibrosis); Vinblastine hair loss, low white cell count and nervous system effects; Dacarbazine - nausea, vomiting (aka HF).
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