My name is Michael and I am the friend of, Bishop, a recently diagnosed Burkitt's Lymphoma patient.
Bishop is 25 years old and was diagnosed in mid March 2010 with stage IV Burkitt's after an emergency room visit due to an acute episode of being unable to breathe normally.
At the start January of 2010, Bishop started to complain of a pain in his back/shoulder area that felt similar to a muscle ache or pinched nerve. He was able to get short term relief from the pain by using analgesic creams. But the pain persisted, none-the-less. In mid January he started to experience periods where he would become short of breath. Being only 25, we found it odd, but the shortness of breath was intermittent and we both dismissed it as a respiratory ailment of some sort.
I should ad that Bishop is HIV positive and until January had gone without treatment for the virus since his diagnosis 20 months earlier. That is until he was convinced to seek clinical help in January 2010. Bishop went to a clinic and had labs drawn in mid January and was to get the results in March.
Sometime in mid February, Bishop sought clinical help since his bouts with shortness of breath were not subsiding, but rather increasing in frequency. He was examined by a nurse practitioner and told his issues were a result of allergies and was prescribed ear drops and an allergy medication, but neither provided him with any relief.
Late February thru mid March brought increased and more severe bouts of breathing issues. On March 13th, while at work, Bishop experienced an acute incident where he could not breathe and felt as though there was a one ton weight on his chest. He was driven to the emergency room where, upon initial examination, the attending physician could hear no air movement in his left lung. X rays revealed his chest cavity was filled with fluid and the pressure had collapsed his left lung.
At that point he was admitted to the hospital, placed on O2, and a tube was placed in his chest to drain the fluid. In a 24 hour period, 5 liters of fluid had drained and showed no signs of letting up. At that point, Drs. indicated they suspected some sort of cancer, likely a lymphoma, was the cause of the continuing fluid production and a biopsy of his lung was ordered.
On March 18, Drs. noticed the chest tube had clogged and needed to be replaced. Two pulmonary physicians did the procedure bedside and almost immediately, large amounts of fluid were draining from his chest again. Additionally, Bishop began to cough almost uncontrollably and was bringing up a very viscose phlegm.
Within 30 minutes, more than 3 liters of fluid drained from his lungs. Suddenly his blood pressure with the top number maxing at 50, his pulse was at a steady 245 and his O2 saturation was dangerously low. The pulmonary Docs rushed into the room and through a series of procedures were able to stabilize him after about 30 minutes. Bishop was then taken to the ICU for 36 hours.
During his stay in ICU, a bone marrow biopsy was done, the results of which confirmed a B Large cell, stage IV lymphoma. Further studies would follow and a diagnosis of Burkitt's came when a test for a mutation of the MYC gene on the 8th chromosome proved positive.
Further complicating matters, the 2nd chest tube became clogged and corrective surgery was necessary before a treatment regimen could begin. It was explained be a Thoracic surgeon that future chest effusion would be needed unless the definitive surgical procedure was done. This would include making an incision between Bishops ribs to drain all of the fluid from his chest and placing talc on the pleura of the lung so it would attach itself to his ribs once re-inflated. The surgery was scheduled for the following day.
On the day of the surgery, once in the pre-op area, the Dr. phoned and asked to speak to the family. Further study of his medical condition gave concern that the relaxation of the chest wall muscles that occurs under general anesthesia, would allow a huge mass in his chest caused by the lymphoma to shift and suffocate the bottom two chambers of his heart. If that were to happen, the condition would be irreversible and cardiac arrest would follow. When asked about using a local anesthesia, we were informed they cannot numb the chest area sufficiently to do the needed procedure. In short, the surgery was necessary and there was no choice but to proceed. Fortunately, all went well with the surgery.
Prior to the surgery it was decided the the Oncology team, in consultation with the Infectious disease Drs., that Bishop would 1st be placed on what they referred to as Chemo Light before receiving a chemotherapy regimen titled R+R Hyper CVAD. (The "R" is for the addition of the immunological agent Rituxin added to the standard Hyper CVAD therapy.) The Chemo Light would be 4 days of 30 minute infusions of cytoxin, the need for which was created due to the large size of the tumor masses created by the lymphoma. If the tumors are destroyed too quickly, a condition known as tumorlysis, can lead to rapid destruction of the kidneys.
Chemo Light was initiated on March 31st. Schedule A of the R+R Hyper CVAD, a 14 day period of various chemotherapy agents began on April 4th. As of today, Bishop is on the 1st day of a 7 day rest cycle. Schedule B of the R+R Hyper CVAD treatment will begin on April 20th and last for 7 days, ending on April 26th. That will be the end of the 1st full cycle of chemo. Bishop will have to endure 8 full cycles of his chemo regimen and may need to have a stem cell transplant along the way as well.
This seems like an appropriate place to stop for now. It is my intent to discuss the emotional elements that have and will occur along Bishop's journey as well the medical challenges sure to arise. My hope is that others will post here and let us know what to expect as well as offering words of encouragement. In turn, we hope that our posts will help others in the future and be therapeutic for us at the same time. Until our next post, be well.