Wednesday, December 11, 2013

For One Cancer Patient, Diagnosis to Recovery in Four Months...



(Cancer survivor and Wall Street Journal writer Geoffrey Rogow in his own words)
New York City
Intense pain, shooting down my neck and side, woke me from a deep sleep one night last spring. I wasn't able to lift my arms and every breath was a struggle. After rousing my wife, her first words were: "We're going to the emergency room. Now."
My face and neck were severely swollen, my wife, Erin, told me. The two-block walk from our apartment to New York University's Langone Hospital took about 15 minutes, as each step left me out of breath.
When we arrived at urgent care the morning of March 21, the doctor ordered up a chest X-ray, one of the few tests I hadn't been given over the previous six weeks as I'd complained of breathing issues and chest pain. Within an hour, the doctor told me there was a blood clot in my neck. By the afternoon, after ordering a CT scan, she told me the cause of the blood clot: a 10-by-10-centimeter tumor in my chest.
There have to be a million ways people first react to learning they have cancer. Erin and I cried. Then pretty quickly a light flickered on that as scared as we were, we couldn't be paralyzed by fear. There was too much work to do.
It was nine months ago. I was 31 years old, married just four months. My biggest concern up to then had been continuing an upward trajectory in my career as a journalist at Dow Jones & Co., publisher of this newspaper. Now my focus had to shift. I might not be able to have children and would need to plan for that possibility. Treatment decisions I had to make quickly would be critical to ensuring I didn't just live, but thrived.
My wife and I discussed what kind of oncologist we would need. I took a medical leave from work. I told my parents, who reached out to an oncologist they knew for guidance. My brother, an athletic trainer, reached out to his network of doctors. My sister began her own research push.
The urgent-care doctor recommended an oncologist affiliated with the hospital, Dr. Karen Haglof. Chest surgery was scheduled for the next morning to determine what kind of cancer I had. A few options were curable, another was treatable, I was told.
Surgical rooms are freezing. When they rolled me in I asked one of the nurses if she took a wrong turn and we were at the morgue. Not even a giggle. The anesthesiologist was a different story. He could tell that the bad jokes and bug eyes were reflective of a scared kid. Then the drugs kicked in.

Four months after treatment ended, the author rests after a long day. Erin McCaffrey
When I woke up, I was in intense pain in a recovery room, pushing my pain button as much as allowed. It did little. For two days, every breath and word I spoke delivered monster pain. My no-nonsense Russian nurse helped push me through. No excuses, no complaints. Just do it.
As my health improved, a new issue surfaced. Because of the lengthy regimen of chemotherapy to come, there was a distinct chance I wouldn't be able to have children. To prepare for that possibility, one must "bank." For my wife, banking meant a race against the clock to carry our future child down Manhattan's First Avenue in a plastic cup.
A few days after surgery, I got the diagnosis from Dr. Haglof: primary mediastinal B-cell lymphoma, a rare form of non-Hodgkins lymphoma that can present in one's chest. The usual treatment is a chemotherapy cocktail called R-CHOP, where each letter stands for a different drug, followed by radiation.
Studies show that R-CHOP with radiation successfully cures my type of cancer in about 80% of patients. So I was surprised when Dr. Haglof and the on-staff hematologist said they wanted to try a different treatment. They recommended a chemotherapy regimen called dose-adjusted R-EPOCH, which added another drug—etoposide, the E in R-EPOCH.
The treatment would greatly increase the chemotherapy dosage I received, but hopefully would mean I could skip radiation, the doctors told me. Their reasoning: Radiating my chest would nearly guarantee heart disease later in life. Avoiding that risk was worth the higher dose of chemo, which they figured I could withstand because I was relatively young.
I had to decide whether to take my doctors' advice and go with the less typical treatment. As a journalist, my instinct was to learn what I could from whatever past research had been done. A landmark study in British Columbia in 2006 examined several types of treatments for my cancer.
I discussed what I'd learned with my doctors and then we decided: For round 1, I would go with the recommended R-EPOCH treatment. But I continued to research other options. A month later I caught a lucky break in a study published in the New England Journal of Medicine. The research, funded in part by the National Cancer Institute, showed survival rates above 90% with my new etoposide-aided regimen for my exact type of cancer.
"Digging into the research available is an important step with this kind of illness. It opens up the discussion to disease states, status and treatment," says Dr. Haglof, my oncologist.
Over the next few months I underwent chemotherapy at Dr. Haglof's outpatient facility. Some weeks were largely a blur, between discussing treatments, understanding my take-home pump and near-constant sickness as I began fresh rounds of chemotherapy.
Just weeks earlier, I was working out by running and going to boxing classes. Now, I was barely able to walk more than a block. At times I felt like I was losing my mind. A psychiatrist friend helped me understand which parts of the changes I was going through were drug-induced.
At work, I'd been lucky enough for a decade to have one great reporting assignment after another. After my diagnosis, my editors checked in with me often and visited when they could. They also suggested an occasional reporting assignment might aid my recovery.
I wrote some small articles. Then, in late April, a hacked message on the Associated Press Twitter account, claiming there had been explosions at the White House, hit the stock market. Editors at The Wall Street Journal reached out and asked if I wanted to help cover the story, since I had covered exchanges and trading for three years. Anxious to do anything, I called a slew of sources and dug deep into the nuances of what had happened. By 4 p.m., I could barely keep my eyes open but had filed 1,000 words of what I thought was strong reporting. The next day, it appeared on the front of the Money and Investing section. I'm back at work full time now.
For four months I had been battling cancer. I worried about death daily and the little things in life a lot less. I got a hobby—cooking—and far flung friends sent lots of well wishes. In late July, I got good news: A PET scan showed there was zero cancer activity in my chest. I haven't beaten cancer; it's a daily part of my life from now on. But today, I sit in remission.
Write to Geoffrey Rogow at geoffrey.rogow@wsj.com


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