January 15, 2006 - Growth Is Optional

Today I’m thinking about a bumper sticker I see from time to time. It says, "Change is Inevitable. Growth is Optional."

For me, there surely are changes ahead. This morning I awoke in the wee hours and had a hard time going back to sleep, because those changes were preying on my mind. This coming Wednesday I’m going to spend the better part of my day sitting in a lounge chair in the doctor’s office, receiving 4 or 5 hours of Rituxan monoclonal antibody treatment, followed immediately thereafter by an hour or two of CHOP chemotherapy. As I get up from that chair to leave the doctor’s office, I will be a different person. I will have become a chemotherapy veteran.

Chemo changes the human body forever. The most widely-feared side effects of these medicines – fatigue, hair loss, nausea, mouth sores and the like – are transitory, but there is also the possibility of long-term effects. Some patients report that the fatigue associated with chemotherapy continues long after the treatments are ended. Both cyclophosphamide (also called cytoxan – the "C" in the CHOP acronym) and adriamycin (alternate name hydroxydoxorubicin – the "H") can damage the heart. Cyclophosphamide can also damage the bladder. Vincristine (or Oncovin – the "O") causes temporary neuropathy (tingling in the fingertips) that in some patients can become permanent. Prednisone (the "P") can permanently change the distribution of body fat, leading to changes in appearance. While only a minority of chemo patients experience any of these long-term effects, the possibility is still there.

Elizabeth Adler reports that, paradoxically, some of the lymphoma chemo treatments can themselves cause cancer further down the road (Living With Lymphoma, p. 90). This is truly ironic, but it’s a reality. A small but significant percentage of NHL chemo veterans will later come down with cancers like nonlymphocytic leukemia. Using these medicines is worth the risk, though, because the benefits of treating the lymphoma far outweigh the statistically much-smaller risk of secondary cancers.

Even though the chance of my undergoing permanent physical changes as a result of these drugs is relatively low, the possibility of those changes remains. And that in itself is a change. As a chemo veteran, I will forever after be inclined to wonder whether some future medical problem I experience is the result of my 2006 treatments. I’ll be like those Vietnam veterans who were sprayed with Agent Orange: I’ll never know for sure.

It’s also a fact that certain clinical trials (experimental treatments) are limited to those who have never received chemotherapy before. After this Wednesday, I will be ineligible for these. I will no longer be a chemotherapy virgin.

More than any other treatments I’ll receive in the future, I’m looking on this Wednesday’s experience as a threshold event. I will be crossing over into the world of chemotherapy, never to return.

I am reminded of a different spin on this whole issue of change as I read today’s blog entry written by my new friend Tarun Jacob – the young Indian physician who’s also receiving chemotherapy for NHL. After a "down" day of experiencing some pretty bad side effects, Tarun quotes the words of John Newton:

"I am not what I want to be.
I am not what I hope to be.
I am not what I ought to be.
But still, I am not what I used to be.
And by the grace of God,
I am what I am."

Newton, of course, is best known as the author of the beloved hymn, "Amazing Grace." In that hymn, Newton famously describes himself as "a wretch" who – before coming to a renewed commitment to Jesus Christ – "once was lost, but now am found; was blind, but now I see." For some people to deploy words such as these would seem overly theatrical – but, considering the facts of Newton’s life, they're right on the money. For many years, Newton served as a mate, and later a master, on slave ships. In 1755, inspired by an experience of spiritual renewal, he quit the sea for good and eventually became an Anglican priest. He became a crusader against slavery.

My experience in undergoing chemotherapy will of course be very different from Newton’s in quitting the slave trade. Yet this much he and I will soon have in common. We will have crossed a threshold. I will then be able to say, along with him, "I am not what I used to be. And by the grace of God, I am what I am."