The Blog

The Hodge

Hodgkin's is rare - there are only 1600 or so new diagnoses in the UK each year. So I feel pretty unlucky. But then again it's not rare to get something. And in fact the lifetime incidence of Hodgkin's is in the region of one in 500.

Well, where does one start with something like this? I guess I should introduce myself. My name is Youssef. I'm 34. I'm a doctor working in London. Now I'm also a patient. I've decided to write a blog on my illness and treatment.

They say life can change in a flash; in the blink of an eye. It's one of those clichés. Well it was certainly true in my case. My life changed in the space of a phone call - some time in between breakfast and lunch - towards the end of September. I was informed that I had cancer - Hodgkin's lymphoma. They don't normally break bad news on the phone - I of all people know that. But I was on holiday waiting for the results and well I couldn't wait any longer - I feared the worst so I rang up.

That's one of the strange things about being a doctor-patient. It's a double-edged sword - knowledge is power but it's also pain. Maybe ignorance really is bliss.

Anyway skip to today - it's a rainy Saturday in November. I remember flicking through the calendar a few months back - it's a ritual I have, where I mentally fast forward a few months and think about what the future holds. Little did I know that it would be this.

I was at a friend's wedding in the Cotswolds over the summer. It was an idyllic weekend full of joy and happiness. I was there with my girlfriend - in the prime of life seemingly invincible. If a voice - like in the movie Meet Joe Black - had boomed, "By the end of the year pal, you'll be having chemotherapy" I would have been shell-shocked. Well, I'm still in a state of disbelief. This is the kind of thing that happens to other people, right? It doesn't happen to you or me. Surely not at 34? Well it still feels like it's happening to someone else; to another body. As if your life has taken a massive deviation from its natural course and you have no control over it. But I guess all that I had before - all that we ever have - is the illusion of control.

It was back at the August bank holiday that I first noticed incidentally a lump in my neck whilst shaving. It was the size of a walnut or a golf-ball - being a medic I was worried. I guess anyone would have been worried. But my first thought was that's a lymph node and my second was "Oh my God it's Hodgkin's". I remembered the monograph on Hodgkin's from my medical textbook about the classic presentation being an enlarged, firm, painless lymph node in the neck. Of course, people get lymph nodes all the time in the neck for example when you have a cold or a sore throat. Usually they're quite small - we tend to say pea-sized. But this one was a corker - it was about 4 centimetres across.

I was on the conveyor belt now - first a trip to my GP then investigations - in this case a scan and a biopsy where they stick a needle into the lump to get a sample of tissue - then sweating it out waiting for the results. Luckily, we'd booked a holiday in France for two weeks the day before the lump came up so this took my mind off things. In fact, whilst in France, the lump came down and we were over the moon. Except, what we didn't know is that, in Hodgkin's lymphoma, lymph nodes can fluctuate in size.

Anyway, I'm now at the end of my first cycle or month of chemotherapy. Hopefully I'll only have one more cycle. Then after that an interim PET scan then radiotherapy in the New Year.

It's been an eventful and dramatic week. Last Wednesday, a blood test showed that my neutrophils - those are the white blood cells that fight bacterial infections - were close to zero. In fact, they were 0.3 X 109. Just to put this in perspective, they were over four before the treatment started. By which we mean 4 X 109. That's when it hits you how vulnerable you are - any common or garden bug could make you very ill. In fact, it's usually your own bacteria, inside the body, which do this. This is due to the chemotherapy as it hits the bone marrow and temporarily affects the production of new blood cells. I was started on growth factor injections to help my bone marrow produce more neutrophils. I just hoped it would kick in fast enough. Then, the following evening, what we were dreading happened. I spiked a fever of over 38 and was rushed into A&E for assessment of what is known as neutropenic sepsis - in other words a life threatening infection. Everything that has happened since this all started has been scary but this was perhaps the moment I was most scared. I was given intravenous heavy duty antibiotics straight away. Luckily, my blood tests showed that my blood count had picked up slightly and I was allowed to go home. By the following day, my neutrophils were back to normal and we all breathed a sigh of relief.

Hodgkin's is rare - there are only 1600 or so new diagnoses in the UK each year. So I feel pretty unlucky. But then again it's not rare to get something. And in fact the lifetime incidence of Hodgkin's is in the region of one in 500. The remarkable thing is that everyone seems to know someone who's had it and who's doing just fine. When I went into the hospital, the paramedic told me that his mum had it when she was younger and one of the A&E nurses told me she'd had it fifteen years ago - "I'm your cancer cousin!" she exclaimed as she gave me a high five!

Each person reacts in their own way to life changing events like cancer. Some people prefer to keep it private like Jackie Collins the writer, who passed away recently with breast cancer. I certainly find that it helps to share it and to be open - the support I've received from friends and colleagues has been wonderful. One of the main reasons for writing this blog is to dispel some of the myths around cancer and cancer treatment. It's important to demystify the subject as it carries enormous stigma and there are some real misconceptions.

And it's important to take inspiration from the millions of people all over the world, who have been through or are going through cancer. So here's a fantastically uplifting quote from Michael Douglas to finish on. He came through Stage IV tongue cancer:-

"Cancer didn't bring me to my knees, it brought me to my feet."

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