The personal website of Scott W Harden

Scott Has a New Look

I decided a while back that I’d shave my hair off as soon as I first noticed it falling out, and that day has come! Almost every day before I go to sleep I give it a little tug and think, “still in there!”, but this morning I noticed it falling out in the shower. By lunch I was getting annoyed as hair kept landing on my keyboard at work. My coworker Jeff offered to shave it off at his place after work, and I couldn’t get it off fast enough!

My hair will start growing back a few months after chemotherapy ends, but I don’t think I’ll mind it being gone too much in the mean time. I’ve had several years to consider that “one day” I’ll be walking around without hair for a little while, so the fact that the day has finally come isn’t much of a surprise. For now I’m happy enough to save money at the barber and have a simpler morning routine.

The treatment plan for the next few few months is to get additional rounds of chemotherapy every three weeks. This website will probably be dormant for the next few months while I undergo these infusions, and I will start updating it again when I know more about the bone marrow transplant I will probably be having.

First Round of Chemotherapy

I started my first round of chemotherapy today! I expect to feel pretty lousy for the first few days after each infusion (the next one being 3 weeks from now), but I’m very happy that treatment has begun.

The chemotherapy regimen I am undergoing is called CHOP, an acronym for the combination of drugs used: The C (cyclophosphamide) is an alkylating antineoplastic agent which damages DNA by promoting the formation of interstrand and intrastrand crosslinkages leading to cell death. The H (hydroxydaunorubicin, or doxorubicin) is another DNA damaging drug which inserts itself between DNA bases and prevents the progression of topoisomerase II (which relaxes super-coils of DNA so it can be read or replicated), leading to cell death. The O (Oncovin, or Vincristine) binds to tubulin (the primary molecule comprising the cytoskeleton). During metaphase (when all the chromosomes are lined up and about to separate) the separation of chromosomes into two daughter cells is prevented, and an apoptotic pathway is activated killing the cell. Finally, P (prednisone) is a glucocorticoid immunosuppressive and anti-inflammatory drug commonly used alongside antineoplastic agents to reduce the likelihood of allergic reactions and to alleviate some of their side effects. Although these drugs seem like blunt instruments (broad spectrum DNA and cytoskeleton-damaging chemicals), rapidly growing cells (such as the tumors being targeted by this chemotherapy) are preferentially targeted for damage, resulting in the efficacy of this treatment. Other fast-growing cell types are damaged as the result of these drugs, one of which live within hair follicles. As such I expect to begin losing my hair at some point over the next couple of weeks.

Port Placed Today

I got my port placed today! A port is a medical appliance surgically implanted beneath the skin which is attached to a a tube which goes into a large blood vessel (a central venous catheter, CVC). Instead of poking my arms to draw blood, deliver chemotherapy medication, or inject IV contrast dye during medical imaging, my port can be accessed instead.

Update (2018-12-13): A chest X-ray taken today displays my port quite nicely! The white objects under my opposite arm are staple-like sutures used during my last surgical biopsy.

Update (2018-12-14): A CT taken today shows my port nicely too! This CT series was re-sliced, maximum projected, then windowed to maximize bone visibility and hide soft tissue. The port is visible on the left side of the image, but the contrast dye used during the CT is also visible coming through an IV line. If you look closely you can see where the IV line turns into a needle, enters my arm, fills the veins, and clears once it enters my heart.

PET CT Reveals Progression

In July 2018, after 6 years of careful observation while my disease rested in an indolent state, the lymphoma kicked into gear and started growing rapidly. I experienced an abnormal increase in generalized lymphadenopathy (beyond the level I had come to get used to as normal), and a CT revealed thoracic and axial lymph nodes which were significantly larger than typical. A PET CT revealed high metabolic activity in many chains of lymph nodes, indicating the disease had shifted in its behavior from indolent to aggressive.

On one hand it’s disappointing that the disease began progressing. On the other, it’s now in a state where it is more likely to respond to treatment. In August 2018 the decision was made to begin interventional treatment: chemotherapy to attack the actively-growing lymphoma, followed by an autologous stem cell transplant (treatment which includes very high doses of chemotherapy, total-body radiation, and a type of bone marrow transplant where I am both the donor and recipient) which may help prevent its recurrence in the future.

A Change in Symptoms

My first realization that something was changing in the status of my disease came while filming a YouTube video about FTDI microchips. I noticed the cervical lymph nodes on my left side were swollen, took a selfie to assess what they looked like, then kept shooting the video with my body turned in such a way as to minimize the notability of my left neck.

That picture was taken May 29 2018, and at my next doctor visit was 8 days later. The oncologist was concerned about the progression and ordered additional imaging (a CT) to get a better idea of what may be changing.

A History of my Cancer

It's been a few years since I've written about this, so here's the story.

In April 2012 I had some alarming symptoms (lymphadenopathy, weight loss, night sweats) and visited an oncologist for the first time. This picture was taken just before my first doctor visit, and I’m in scrubs because I was a dental student at the time (I hadn’t started the DMD/PhD program yet). After several blood tests and two surgical biopsies I was eventually diagnosed with non-Hodgkin’s lymphoma (NHL). More specifically, Lennert’s Lymphoma, a rare lymphoepithelioid variant of peripheral T-cell lymphoma in the not otherwise specified category T-cell lymphomas.

Of interest is one of K. Lennert’s early publications from 1986 (there are earlier ones, but this one is open-access). Its title describes condition as “a monoclonal proliferation of helper T cells“, and in its text further characterizes it as “special variant of Hodgkin’s disease characterized by a high percentage of epithelioid cells and rarely containing the Reed-Sternberg cells characteristic of classical Hodgkin’s disease.”

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