Background: Sore throat, absessed tonsil, and Halloween goblins

During September I noticed a minor but persistent sore throat, and although it was unlike anything I had experienced before it certainly didn't seem serious. By early October I was noticing that I was sometimes having a hard time swallowing and I suspected that I might have strep as it seemed to be going around. As my 'sore throat' worsened it started waking me up at night and so, after a particularly sleepless weekend, I went to urgent care first thing in the morning on Monday October 13th. Dr. Webster initially thought it looked like a particularly acute case of strep throat and indeed the culture came back as positive so I started what was to be 10 day course of amoxicillin. Tuesday morning I made my usual weekly commute to the University of Minnesota. By 7:30 pm when my class ended I was feeling bad enough that I decided to drive back to Bemidji that night rather staying with my gracious weekly hosts Jack, Cindy, and Rebecca Shelton. That night, I was having a very hard time swallowing and woke up in a panic a couple times feeling like I was suffocating. Next morning I went back to urgent care and Dr. Webster thought I might have a tonsillar absess (aka "Quincy") and suggested I might have to have it addressed sugically. He also thought the amoxicillin might have a positive effect given a couple more days.

I made it through the weekend but by Monday October 20th I knew that something needed to done ASAP since my sleepless nights were becoming sleepless for Lenore as well. When I arrived at Dr. Webster's office he immediately referred me to Dr. Mitchell Marion, an Ear, Nose and Throat specialist. Dr. Marion did a needle aspiration and found no sign of infection but rather some sort of tissue mass so I head down the hall for a CT scan. Dr. Marion also scheduled me for surgery on Thurday October 23rd. Lenore went with me to an appointment Wednesday morning to look at the results of the CT scan. The "thing" was huge -- kind of an ovoid cylinder just a bit under 2" in diameter and about 2" long. We were both pretty shaken by what we saw but still hadn't fully realized what was happening. I went in for surgery at 7:00 am on Thursday (more on that in another post) and was awake and aware by early afternoon. At that point, Dr. Marion told me that in his judgment the tissue was probably a lymphoma and that it had been split and and sent to Mayo and Fargo for pathology analysis. The lymphoma was well encapsulated and Dr. Marion feels confident that he 'got it all.' His initial guess was that I would probably need about five weeks of radiation treatment. After a full body CT scan on Friday I was discharged from the hospital and (thanks to lots of TLC and Lortab) spent a surprisingly comfortable weekend at home. Monday I found out that the second CT scan didn't reveal anything ominous so that was a great boost to our morale.

Later on Monday the 27th, Dr. Marion called to tell me that appointments had been schedule for Friday the 31st -- Happy Halloween! -- with Dr. Bollinger (a radiologist), Dr. Marion, and Dr. Shahiti (an oncologist). Lenore and I went in Friday ready to hear about how the radiation process would go but were not prepared to hear that the pathology had thrown us a curve. Instead of being the most common tonsillar lymphoma this was the second most common form and a more agressive treatment was in order. The more common form is what is known as an indolent lymphoma and as that adjective suggests it is not especially fast growing. My little goblin was what is known as a diffuse large cell B lymphoma (one of 20+ different kinds of non-Hodgkin's lymphomas). This ends up being sort of a 'bad news, good news' thing. The bad news is that it divides more quickly and thus has a higher probabilty of spreading to other tissues -- hence the need for chemotherapy rather than just radiation. On the positive side, this particular lymphoma expresses a unique protein (called CD-20) on it cell surfaces. A couple years ago, a new chemotherapy drug known as Rituxan was developed that has anti-bodies to CD-20. This means that the cancer cell killing drug can be delivered directly to the cancerous cells! Unfortunately, since it has yet to be established that Rituxin alone is sufficient treatment I will get it along with CHOP, a more conventional broad spectrum agent -- one that makes you sick and can cause hair loss. At this point there is no evidence that that lymphoma cells have spread to other locations in my body. However, Tuesday I have additional blood work and a bone biopsy scheduled with a endoscopic examinination of my stomach to follow on Wednesday. If these tests come back negative then I will have three courses of chemotherapy (one day every three weeks) followed by a couple weeks of localized radiation with an excellent prognosis. If some or all of these tests come back positive, I will have to go through 6-8 courses of chemotherapy without any followup radiation (and a slightly less favorable prognosis). Here's hoping for option one...

PS. I've healed up pretty well already from the surgery...testimony to Dr. Marion's incredible skills!