Chronic Illness — Ur Doin' It Rong!

The only thing normal about today is that I laughed when I heard. Then I felt weird about laughing, mainly because I thought I should feel weird about it, which isn’t normal.

So my cute nerdy surgeon was correct — cells quite identifiable. They are b-cells. Remember those b-cells? Those b-cells that kind of lend chutzpah to the statement, “My immune system has a posse?” The ones that blew up Don Thymus, causing his removal from my thoracic cavity? Remember how when Don Thymus was yanked, my electrolytes went whack, and my central diabetes insipidus decided to go back to sleep, but despite everything, my blood sodium levels plummeted to the “I can’t believe you haven’t died yet” levels? That generally, I hear, is associated with underlying malignancy. Except… Don Thymus wasn’t malignant. And the little buddy in my posterior pituitary and my right lung both look fairly well-behaved… Generally pituitary tumors mirror what one sees in someone’s thymus, and truthfully, I don’t want them digging in my brain. The lung is a more negotiable point, but truthfully — I’ve had surgeries before. And the lung would be much like the thymectomy in terms of access (same way, different side) and procedure. And I’d like to pass on doing that again if possible.

But I have a pretty damn significant cluster of b-cells in my fairly small (2-3 cms as opposed to some of the 20 cm behemoths that can pop up) tumor in my left ass cheek and hip region. Truthfully, it’s deep. It’s really not my ass cheek except for the gluteus minimus/medius monnikers of the surrounding area. It also sounds funny. And that’s not okay.

So here’s the deal: The biopsy wasn’t enough tissue to test for the sixty plus types of lymphoma it could be. So we’re kind of thinking that taking the little bastard out is best. Learning opportunity: Buttockectomy is a medical term! I don’t think that’s what’s being done, truthfully, as I think it only pertains to the gluteus maximus. My gluteus maximus does not, as yet, have a posse. But I like the word, just like I enjoy saying that I have a tumor in my left ass cheek.

I go see the lovely orthopedic oncologist tomorrow. I think he’ll do that part. I mean, he didn’t do the CT guided stuff and I have just seen him and he orders these tests and I am damned if I know what he really does, but I imagine he does actually do something more than order tests — otherwise, who the hell would go through that much schooling? So maybe he cuts the big’uns out. Then they’ll look more at the b-cells and tell me what they think.

I kind of know what they think — to the tune of Mr. Shoe and I might just ask if there’s a way, since they’re going right by my hip anyway, they could rationalize doing the bone marrow biopsy right then when I’m all unconscious and messed up to start. But today’s discussion had a few moments with a doctor going back and saying, “I am not saying it is lymphoma, but…”

And I said, “In my ass cheek. All of this, and it is something we find the key to in my ass cheek? Is that… right?” (I love this guy at Dana Farber, and the sad fact is, all bets are off now, my friends. All bets are off. Ass tumors are the great equalizer, it seems.)

His take was that while it isn’t the usual manner, chronic, indolent forms of lymphoma are just weird little animals, and sometimes they don’t act like they really should. They often don’t act like anything at all. I can’t get a lymph node to look overly impressive if I have the friggin’ swine flu on top of mumps and kennel cough, but hey, my immune system has a posse in my left ass cheek and my brain.

To quote Tracy Morgan, it’s just like the joke my kidneys are playing on my lungs. If you know what he means, you know it makes way more sense than the heart and head cliche.

So I have a feeling this might turn into a “name that lymphoma” as opposed to an “is/isn’t it” deal. And the sad fact is that even if it’s merely a bunch of very normal looking b-cells… They keep doing this, and that’s a problem. It’s a problem that causes other problems (like the ones I have, alas) and in some cases the concept of a benign vs. malignant cell posse is just… irrelevant. I think that what this comes down to is more figuring out how conservative we can be (or aggressive we’ll have to be) in dealing with this. If nothing looks overtly amiss, it’s steroids and then, should things continue (and while I feel better with steroids, I can attest this will continue. Sorry, folks) it might mean scaling up to biologics. If it looks nastier and is a chronic form that they see, then I’ll probably start in chemo land and then tune down. By and large, however, most cases of slower stuff like this get a middle of the road treatment that is ongoing.

So it gets treated a lot like histiocytosis, or more nasty manifestations of immune diseases, and it is played by ear.

It’s still stupid though. I mean… So they find some people’s lymphoma in their necks, or their armpits, or even their groin… Am I really going to have to tell people that I don’t have any significant amount of slow wave sleep, my blood pressure whacks up and down at random and my extremities are often a mottled purple color because of the lymphoma they found in my ass cheek? I must have been a horrid person in a past life. Thank God I’m so awesome in this one, huh, Penny?

You Still There? Good.

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