Monday, March 29, 2010

Breaking You Down, to Build You Back Up

One day in 6th grade, we were learning about weight training in gym class. I remember my teacher, Mrs. Deal, explaining that weight training, by definition, destroys muscle fiber so that it can build itself back up again to be even stronger.

At some point early on in my cancer experience, I began to apply this same paradigm to my treatment. I tried to accept the idea that I had to be broken down to be built back up. Chemo, radiation, transplants - these actions wipe out your system, debilitate you in order to debilitate the disease and give you the rest of your life to be stronger and better. Thinking about it in this way was a means of coping with the intensity and toxicity of treatment.

But I have always had questions about this basic premise. It seems counter-intuitive. Cancer patients are gearing up for a fight, so why deplete their system to such a degree that they feel demoralized, weak, and not at all like the warriors that their friends, doctors, families, and society as a whole, call on them to be. Diminishing all your body systems in the hopes of also diminishing the cancer in the process seems...inelegant. If I'm being completely honest with myself, this slash-and-burn approach has always felt wrong. Especially in light of the fact that my cancer has consistently responded well to treatment, I have often questioned the principle behind the aggressive nature of our approach.

I find myself questioning it most heavily now, as I weigh my options for the next steps in this fight against cancer, especially in light of my recent scans which showed no measurable cancer. I have suppressed this concern in favor of adhering to the standard medical protocol. I have, and continue to put my trust in my doctors to prescribe the best known treatment for me. I believe them when they say that even though they can't see it, they know cancer remains, because of the nature of how lymphoma behaves. Even as I follow their advise and acknowledge that my hunch should not prevent me from proceeding with treatment, I just can't help but feel uncomfortable with the aggressive nature of the standard course, and question whether there are limits to how much you can be broken down before you can no longer be built back up.

Thursday, March 25, 2010


Tomorrow, I begin my third cycle of GVD chemo therapy. GVD is an acronym for gemcitabine, vinorelbine, and pegylated liposomal doxorubicin.
This is a fairly new regiment, which works on a three week cycle of two weeks on, and one week off. Put another way, the cycle is 21 days long, and I take these drugs, via an IV drip that takes a few hours, on days 1 and 8. I have been doing this outpatient chemotherapy on Friday mornings to minimize work absence, and to have the weekend to rest. After four treatments, I'm happy to report that the regiment a) has resulted in fairly minimal side-effects and b) is working!

When I say "minimal side-effects", what I mean is that with the glaring exception of contracting meningitis because my immune system was compromised - a side-effect of all chemotherapy, by design - my life hasn't been too deeply disrupted by the chemo itself. No chemotherapy regiment is without its toxic side-effects, and I have felt tired and had my share of nausea, but otherwise am experiencing nothing too debilitating (again, besides that two-week hospitalization, which sucked hard) and I have been able to work and get out to have some fun on my better days.

And when I say that GVD "is working", what I mean is that my planned scans following the completion of cycle two, showed excellent results. I have had a "complete response" from treatment, with tumors/lymph nodes shrunk to normal size, and significantly lower amounts of cancerous activity. The cancer is still being effectively combated with treatment, which is a good indication, but still cannot be cured with chemotherapy alone.

As far as I know (the process is confidential) the pursuit of a bone marrow donor for me is still underway, and we're still well within the time frame in which I would not yet have heard back. I am also considering a promising clinical trial, prior to (maybe even instead of) the transplant, that I will write much more about once I know much more about it. In the meantime, I will be here in Washington for the foreseeable future, and will let you all know as plans progress.

A plug for two upcoming donor drives - if you are in New York or the Chicago area and are able to get registered/tell your friends and family, please do!

In New York - April 28th from 10 am-5 pm located at 633 3rd Ave, 7th Floor, New York. Please contact my friend Miriam Fink at to sign up and participate.

In Chicago - May 2nd at Temple Beth Israel in Skokie (details to follow)

Thursday, March 4, 2010

Two Ways

Albert Einstein is quoted as saying that there are two ways to live your life: as if nothing is a miracle, or as if everything is. While there are shades of grey in any situation, I think there's something inspiring about this quote. We can choose to view our lives - the blessings and challenges - through a positive lens, or through the eyes of a cynic. We can choose gratitude over anger. We can live as if everything is a miracle.

Last month, in a period of 36 hours, I integrated two huge new realities into my consciousness, my life and my future. First, I was accepted to Rabbinical school at the Hebrew Union College-Jewish Institute of Religion. In making the decision to apply for, be accepted to, and attend HUC, I was fulfilling a dream that I have had for most of my life. I was thrilled to be admitted to the program and excited to finally take the first steps toward getting the education and experience I needed to become a Rabbi. Opening that letter was an incredibly profound and exciting moment in my life, and one that I was glad to share with so many of the people that I love.

36 hours later, I went in for a check-up at my oncologist's office. It was just a few days past the one-year point since my autologous stemcell transplant, and three months since my previous PET/CT scan that had reaffirmed that my cancer was still in remission. Unfortunately, the scan showed ample evidence of a relapse.

What a relapse means, practically speaking, is that I haven't yet won my battle with Hodgkin's Lymphoma. I am back in chemothrerapy, and most likely will have a bone marrow transplant from a donor in the coming months.

There are two ways to look at this 36 hour period. I choose to see it as a blessing. This is not to say that I am not incredibly shocked, angry, disappointed and full of questions. And it's not to diminish my profound sense that it's not fair that just as my long-term future was taking shape in a way I had dreamed of and envisioned, factors beyond my control have turned my future into a dark and murky question mark once more.

There are also two ways to look at the changes that I've made in the last year of my life. I could choose to look at the decision to cut toxins and carcinogens out of my diet and home environment, and to work to live a healthy emotional, physical, social and psychological life, as a failed experiment. These choices did not save me, did not make the cancer go away, did not help me avoid this fate. I could look at these choices, which were sometimes more difficult and more expensive, and think that it was all for nothing. I choose instead to be proud of the attempts that I made to control the elements of my life that I felt that I could. I choose instead to be grateful to have the resources, access, and support that I needed to make those changes. I choose instead to acknowledge that I did nearly everything that I could do, but that sometimes controlling what few factors we can, will not influence the outcome of a situation. I am making the choice to view the last year of my life as a gift in which I was able to thrive, and embrace life.

When I first heard the Einstein quote years ago, it reminded me of one of my favorite passages from the book of Deuteronomy in the Torah, which Reform Jews traditionally read on Yom Kippur: "...I have set before you this day life and death, blessing and curse. Choose life." It's not a request - it's a command. So I have to strive to see everything as a miracle, even when it is difficult to do so, even when a huge blessing and a terrible curse are put before me in a matter of hours.