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Received treatment for Classical Hodgkin’s lymphoma, mixed cellularity subtype.

The patient is my wife aged 29 years.

Background:

• About a year back (July 2018), my wife complained of burning sensation in her feet and described the sensation was like stabbing the feet with pins. We thought It was a classic symptom of being diabetic, so we did a random glucose test but it came back negative.
• Week after week, she was developing new symptoms, a little dizziness and feeling fatigue all the time. Then we consulted a near-by physician in Hyderabad who advised her few tests like cbp, cue and ultrasound. The blood panel indicated that she was low on hgb (10) and the urine cultures revealed no bacterial infections. The Dr said that my wife does not have enough Iron in her body and she is anaemic. He prescribed her Iron supplements for a month and to do a follow up after a month.
• She religiously took the Iron tablets daily and started on heavy protein diet, but after a month, the hgb levels reduced to 9.0. All her RBC component values were out of range. Although the WBC was in the normal range, but the neutrophils were high & lymphocytes were low. The ESR was consistently elevated. We went back to the doctor with the reports and he said, some-times one month of Iron supplements are not enough to bring the iron levels up and he put her on Iron tablets for 1 more month.
• I started consulting other physicians for diagnosis, but they too advised the same treatment. Even after 2 months of taking Iron tabs, her condition was not getting stable.
• The new symptoms were appearing each passing week. She developed shortness of breath, weight loss (6-7 kgs in 3 months), nausea and vomiting.
• Some of them said – all her symptoms were due to anaemia and it is considered normal for Indian women to have a hgb levels at a 9-10 range. And concluded that the ESR is a non-specific test and is generally high for anaemic patients.
• The other doctor ordered a ferritin (Iron stores in body), Vitamin b12 and a Vitamin D3 Tests to rule out any deficiencies in the body. To our surprise, there were enough Iron stores in the body. So, the physician concluded that the Iron stores are available in the body, but they are not getting absorbed due to Vitamin deficiencies. Thereafter, she was again put on the Iron Supplements along with Vitamin D3K tablets.
• She took these medications for another month and in the next blood report, the hg level further got reduced to 8.7 g/dl. We Immediately started consulting specialists.
• We consulted endocrinologist for hyperthyroidism, gastrologist for abdomen pains & for loss of appetite, ophthalmologist for any eye related head aches and a physician for general body pains.
• Even after 2 months of medications and series of consultations with specialists, we were no where near to diagnosis. We were getting quite frustrated and my wife was already giving up and was getting fed up with doing many tests but not getting any confirmed diagnosis.
• We knew, there was some underlying problem associated with my wife being anaemic. The doctors thus far, we consulted were trying to treat the symptoms but not the underlying cause. We started researching for specialists who deals in anaemia related issues or any blood disorders issues and every search was leading to only one doctor in Hyderabad “Dr S K GUPTA”.

Diagnosis:

• We consulted Dr S K Gupta after 3 months of our health situation. He was doing a consultation at Olive hospital, Mehdipatnam at that time.
• Dr Gupta sir was very patient and listened to all our problems, He evaluated all my wife’s symptoms and said she could require an Iron infusion need to be given intravenously. Even though he was a consulting doctor at Olive hospital, he ensured that she was given the proper treatment and as per our convenience.
• The Iron Infusion did help her to re gain some of her strength and hg level shot up to 11 g/dl, but still there were some other symptoms that refused to die down.
• For the first time in all our consultations with various doctors, Dr Gupta was the one who actually looked closely to elevated value of ESR and said this could mean there is some infection/inflammation in the body we need to find out it’s location and ordered for a CRP test.
• The CRP test result were high, and he directed us to a general physician in the same hospital who advised for a chest XRAY.
• The XRAY revealed some modulated opacities found near hilar region – likely lymph nodes.
• Later a CT with contrast of chest was performed – The result indicated there were several discreet enlarged lymph nodal mass and largest of them was measuring 6cms.
• A biopsy was conducted to determine the underlying cause of enlarged lymph nodes.
• We were hoping for a TB, but it came out to be a Hodgkin’s lymphoma.
• An IHC test was done on biopsy stains to determine the markers, type & sub type of lymphoma.
• Finally – She was diagnosed with a Classical Hodgkin’s lymphoma, sub-type: Mixed cellularity.
• Only, if had consulted Dr Gupta sir before, we wouldn’t have wasted 3 months.
• Now, all we needed was our treatment options.

Dr SK Gupta:

• After the diagnosis, we met Gupta sir in his office at American Institute of Oncology. He always greets his patients with smile and I must admire his patience and his friendly approach to the patient and as well to the attenders.
• Gupta Sir spent almost an hour in explaining us about the disease and the treatment options we could opt for.
• His explanation of disease in layman terms was exemplary and was extremely helpful. Only, if we understood what she was suffering from could we hope for a successful treatment.
• The more Gupta sir talked, the less afraid we felt. And even before starting the treatment, I could sense in my wife that she was already getting her confidence back. Due credit to Dr Sir.
• We could not have hoped for a better doctor than him.
• Not only does he explains the things in an easy way but also listens to our concerns and addresses our apprehensions.
• We were reluctant at first to go for any further tests, but he told us that it is imperative that we must go through a PET-CT scan and a bone marrow biopsy for staging.
• He mentally prepared my wife about the procedure and instilled confidence, that it is nothing more than a simple procedure.
• My wife tolerated the pain quite amicably as she was already prepped up mentally for this.
• It is that friendly nature and a confident approach made us believe in him more.
• PET-CT confirmed of mediastinum nodal masses and BMB came back negative (which was a big relief). The cancer was staged IIb non-bulky with no BM (bone marrow) involvement.

Treatment:

• Dr Gupta sir set up a treatment plan for my wife that was comprising of chemotherapy of 6 cycles and a radiation(if required).
• Each cycle was administered in two sessions with 2 weeks apart. The chemo drug “ABVD” was given intravenously by trained nurses in haemato ward at AOI.
• The Treatment plan also included an Interim PET-CT scan to evaluate how the treatment was working. The Interim PET-CT was done after 2 and half cycles and the result was considered on par expectation as per plan.
• She underwent a full-fledged chemotherapy without a break in 6 months’ time.
• After the treatment, we were advised for Complete blood picture test and a final PET-CT scan after 6 weeks of completion of treatment.
• After a long time, we could see all her blood components were back in normal ranges and ESR was also normal.
• The PET-CT showed Inactive nodal disease, however there were still few residual nodes in the mediastinum. We though It could be necrosis/fibrosis mass. The patient is now under observation and praise be to GOD, showing no signs nor any symptoms of the disease.
• We will be doing regular follow ups now with blood tests to ensure everything is under check.

PICC Line:

With the administration of chemo given intravenously, my wife developed a severe phlebitis at the injection site. It was very painful for her, and It became impossible to continue the chemo via intravenously.

Gupta Sir advised us to go for a PICC line insertion. It is peripherally inserted central catheter –a surgical procedure where in a vein like tube inserted into a body from arm’s veins to the greater veins inside the body. The thin tube will be inside the body and it will be connected to the extension pipe hanging out, through which the drugs are given and blood is drawn.

We started noticing that there were few air bubbles forming inside the picc line extension tube after some time and every 2-3 days, we had to go to hospital to do the aspiration of the bubble and flush/clean the tube. We brought this to Gupta’s sir notice. He informed us that, though it’s a problem, but it was not life threatening, and it only required some maintenance. We needed to weigh in the risks/benefits of having a picc line. We felt it would be better to continue with the picc line with a replacement of extension tube.

Even though the replacement was not much help, but we could not help but admire and commend the commitment of Dr Gupta for his zeal to resolve even a trivial issue associated with his patients.

Side Effects:

• The side effects kicked in immediately for my wife. She would feel nauseous for 2-3 days after every chemo session. But they got subsided gradually due to pre-medications that were given before chemo to relieve the nauseated feeling.
• She started losing her hair after the 2nd cycle. There was little discolouration under her finger nails, but these did not deter her to fight this disease off.
• Gupta sir warned us not to fall for any other herbs or outside medicines/supplements that are marketed as cure for cancer.
• There were some side effects that were greatly managed by Gupta sir and his team by giving us appropriate guidance.
• She never lost any weight, instead she gain weight.
• No Vomiting occurred during the treatment course.
• No complains of dizziness or headaches.
• Less fatigue than before.
• Over All, the side effects never did bother her to continue with the treatment.

As her husband, I feel proud that she fought this disease very bravely and had never let the burden on any one else. She was always extra cautious to ensure that she does not catch any infections. I also had to make our children to keep distance from her for some time. She withstood all the side effects and always hoped and prayed to GOD to see the light at the end of the tunnel.

Conclusion:

Never ignore a febrile fever, anemia, un intentional weight loss or any swollen lymph nodes.

Instead of doing a self-treatment by taking over the counter medicines, consult a doctor or a specialist and get the tests done. The early this disease is caught, higher the chances of beating it and reduces a whole lot of financial burden.

Hodgkin’s lymphoma is one of the most curable cancers now a days if caught early.

In our country, we have people believing in rumours than fact. We have people trusting in non-proven medicines than in well researched medicines.

When we started our journey into this, many of our well-wishers advised us not to go for chemotherapy related treatment. They cited examples of their loved ones who succumbed to this treatment 10 year or 20 years back. But they failed to realise that these drugs are well researched and are getting better and better over the years. Few years back, sure they might have been less efficient and could have had higher side effects, but it’s different now and the drugs are always improving year after year. Today’s chemo drugs go through rigours researches and they go through many phases of trials before they could put it up on market for further use.

One more a very basic thing I learned from Dr Gupta sir and felt it worthy to share is – there r 2 types structure/organ in our body—solid vs liquid . Doc who treat solid organs (breast, lung, mouth, brain, prostate excetra) disorders – are either medical oncology or surgical oncology or radiation oncology based on requirements. Liquid organs (blood cells, their producing factory –bone marrow cells , their storage area – spleen, their developmental area – lymph nodes ) in our body are very much inter-linked to each other, disease can easily compromise their vital function leading to life threatening situation – so handle there 4 liquid organ disorders a very super specialised branch in oncology – HEMATOLOGY/HEMATO-ONCOLOGY is there. So before going to any oncology branch think which organ disease is there and who is best suitable oncologist.

The treatment is safe and effective and this cancer is even curable if diagnosed in its early stage and is treated by a “Gold Medallist”.