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| December 1983 |
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| June 1984 |
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| February 2016 |
This post is about the above 3 head shots from 1983, 1984 and 2016, and how inaccurate appearances can be.
The first photo is from my brother Dan's wedding in December 1983. I was 26 years old, weighed 155 pounds, and had a BMI of 21.3 at a height of 5 feet, 11 1/2”. I looked healthy, but actually, I was dying. In 1980, as a second year medical student at the University of Michigan learning how to do physical exams, I found a small inguinal lymph node in the left lower quadrant of my abdomen. The Student Health Service told me it was a "shotty" (resembling gun shot) lymph node, of no significance. Perhaps they were also rolling their eyes, because second year medical students were always diagnosing themselves with cancer to explain their chronic fatigue. I continued to do self physical exams every few months. Three years later, in November 1983, I was finishing my first term as a law student, also at the University of Michigan, about to turn 26. I again felt the mass. Perhaps it was a little bigger. I didn't measure it, and didn't notice anything different about it. But, next to it, even today, it is hard to believe. In one instant, my entire life changed. One moment I was a first year law student studying for finals, the next I was not. I felt a huge (4-5 inches) rock hard mass in the left lower abdomen. I had no doubt what this was. It was a very big abdominal or pelvic cancer, that had no doubt spread extensively, and I was pretty sure I would not live long enough to graduate from law school. I certainly could not talk to my friends or relatives about it – I was in total shock (a belated “sorry”). At my brother’s wedding a month later, I looked at all my relatives thinking I would never see them again.
The most difficult telephone call in my life, at least up to then, was telling my parents. Then I scheduled a biopsy by Dr. John Niederhuber, the surgeon in charge of medical students when I was matriculating at UM, and who later directed the National Cancer Institute. Ironically, the diagnosis was confirmed before the scalpel hit my skin. As the nurse was draping me for the surgery, I noticed that the area being prepped was not over the mass that I felt, but in the upper thigh. I informed the nurse that this was a mistake. She checked with the surgeon, and said no, the drapes were in the correct spot.
The first photo is from my brother Dan's wedding in December 1983. I was 26 years old, weighed 155 pounds, and had a BMI of 21.3 at a height of 5 feet, 11 1/2”. I looked healthy, but actually, I was dying. In 1980, as a second year medical student at the University of Michigan learning how to do physical exams, I found a small inguinal lymph node in the left lower quadrant of my abdomen. The Student Health Service told me it was a "shotty" (resembling gun shot) lymph node, of no significance. Perhaps they were also rolling their eyes, because second year medical students were always diagnosing themselves with cancer to explain their chronic fatigue. I continued to do self physical exams every few months. Three years later, in November 1983, I was finishing my first term as a law student, also at the University of Michigan, about to turn 26. I again felt the mass. Perhaps it was a little bigger. I didn't measure it, and didn't notice anything different about it. But, next to it, even today, it is hard to believe. In one instant, my entire life changed. One moment I was a first year law student studying for finals, the next I was not. I felt a huge (4-5 inches) rock hard mass in the left lower abdomen. I had no doubt what this was. It was a very big abdominal or pelvic cancer, that had no doubt spread extensively, and I was pretty sure I would not live long enough to graduate from law school. I certainly could not talk to my friends or relatives about it – I was in total shock (a belated “sorry”). At my brother’s wedding a month later, I looked at all my relatives thinking I would never see them again.
The most difficult telephone call in my life, at least up to then, was telling my parents. Then I scheduled a biopsy by Dr. John Niederhuber, the surgeon in charge of medical students when I was matriculating at UM, and who later directed the National Cancer Institute. Ironically, the diagnosis was confirmed before the scalpel hit my skin. As the nurse was draping me for the surgery, I noticed that the area being prepped was not over the mass that I felt, but in the upper thigh. I informed the nurse that this was a mistake. She checked with the surgeon, and said no, the drapes were in the correct spot.
The surgeon was not stupid. He was removing
tissue from another location which was easier to access (below the skin of
the thigh is easier than entering the abdominal or pelvic cavity). This meant that it definitely was
cancer and it had spread. He was doing a biopsy to determine what type of cancer it was.
A CT scan the next month showed that the tumor
had spread to lymph nodes throughout the pelvis and abdomen. I was scheduled for abdominal surgery. I left the law school dorm for the week
long hospital stay. I
had a splenectomy, liver biopsy and bone marrow biopsy, with a long abdominal
incision. The tumor involved the spleen, but spared the liver and bone
marrow. The pathologists gave me a
diagnosis of Hodgkin's disease, Stage IIA with splenic involvement (the same as
the biopsy, although I cannot find the biopsy report). Today, it is
called classical Hodgkin lymphoma, nodular sclerosing subtype.
After the surgery, there was a wound
infection. They left the incision
open to the depth of the abdominal musculature, where it healed “by secondary intention”. I did not like being in the hospital
waiting for discharge, so I wore my street clothes, and asked for a “day pass”,
so I could attend classes.
I would wake up in the hospital (the “Old Main” Hospital, now demolished),
see the doctors at morning rounds, have my tubes disconnected, and walk out the
hospital. I would take the UM bus
to main campus, walk to the Law School, stop at my dorm room and say hello to
my roommate (I did not tell him where I was, sorry Bill). I assume I looked like a wreck. Then I would attend classes, pick up any needed clothes, and
go back to the hospital.
Treatment was radiation therapy over the pelvis,
abdomen, chest and lower head and neck. Twenty years before, I would be dead, but with radiation therapy, there was a high cure rate (today, chemotherapy is the desired treatment). It was uncomfortable having the young female radiation technologists
carefully placing lead blocks to preserve my fertility (use your imagination),
but there was no actual sensation from the radiation. After the first radiation dose, I went to class, and threw
up during the lecture.
Fortunately, I brought a plastic bag with me, and other than leaving the
room, I am not sure anyone noticed (at least they didn’t mention it). After that, I changed the timing of the
radiation therapy appointments, so I was throwing up right after lunch, in the
basement bathroom of the Law School Commons. I got used to it.
I did wonder if it would ever stop, but of course I did not throw up at any
other time. I lost 20
pounds, and the tailor had to keep taking in my tux for the upcoming
wedding. In June 1984, when the
second picture was taken, I weighed about 135 pounds (BMI 18.5).
In April 1985, my oncologist Dr. Vi Dabich, a
seasoned physician, told me about the most recent CT scan. She had tears
in her eyes. The CT report, which I still have, indicated "multiple
new hepatic lesions most consistent with metastases." The tumor had
apparently moved to a new site, and liver involvement, although not necessarily
fatal, was not good. But if I was dying, I actually felt pretty good. I had an ultrasound guided liver
biopsy, which was inconclusive (no tissue was obtained, only blood), and then
had another operation to take a good chunk of liver tissue. The diagnosis was multiple hemangiomas,
a benign (i.e. not cancerous) tumor of blood vessels. I have not found any reports of hemangiomas caused by
radiation therapy, but that seems to me to be what happened. Every time I had another abdominal CT scan, the radiologists would stop the scanner when it was over the liver and they saw the "obvious" liver metastases. I had to tell them that this was not a new finding, and to look at the old films. I had many other side effects of the
radiation therapy, but fortunately none of them were life threatening.
Due to my own lack of sufficient exercise and
will power, and likely to my then wife’s spectacular cooking, I started gaining
weight, and reached 189.5 in spring 2008. I tried dieting for a dozen years, and could not lose the weight. I eventually got a diet coach through Health
Alliance Plan, my medical insurer.
At some point, I started using a smart phone app to record my caloric
intake and exercise, and bought several diet scales to weigh my food. It seems obsessive / compulsive, and
perhaps it is, but I did reach my target goal of 148 pounds (BMI of 21 at my
new height of 5 feet 10 1/2”), at least for one day (see my blog post about
diet by clicking here). The third photo is from today, weight
152.5 pounds, BMI 21.3. I admit my
face looks too thin – the fat has accumulated in other parts of my body where
it apparently does not want to leave.
I feel great and eat well, although healthy (mostly vegetarian, low fat
except for desserts), and exercise a lot (100-150 miles of bicycling in the
good weather). So
appearances may be deceiving.
