by Albert E. Sanders, MD 

Early last fall, I experienced a change in my bowel pattern and saw my gastroenterologist, Dr. K.P. Ganeshappa, who found nothing abnormal on physical exam but scheduled a colonoscopy on Saturday, October 22. I remember the date because I still have St. Gerard’s football schedule from last year – I’d had a game to cover the evening before, had taken all of the bowel prep and remember how miserable I was on the sidelines. 

Having taken a little Versed, I have no memory of the exam but received a call early the next week from my gastroenterologist inviting me to breakfast at Mi Tierra. He explained that a number of polyps that he biopsied had abnormal lymphocytes. Because my bowel prep was not optimal, he repeated the procedure the following Saturday, again after a football game. 

The diagnosis was mantle cell lymphoma, a type of non-Hodgkins lymphoma. I visited with Dr. Dean McCracken, an oncologist and a friend for many years. Fortunately, there were no palpable nodes or organs and, in general, I felt good. The CT of my chest and abdomen, however, showed multiple enlarged nodes. 

We discussed treatment and I received literature covering this in detail. Fortunately, this is a tumor that is sensitive to chemotherapy but, without a stem cell transplant, almost always recurs. I visited with the transplant physician, Dr. Fred LeMaistre, who spent a great deal of time detailing the advantages of autologous and non-related donor transplants. 

My only sibling, a younger brother, had died a year earlier, so a related donor was not an option.

For an autologous transplant, one must be in complete remission. Daily injections of Neupogen are given until one has a high stem cell level. Then a central line is inserted, blood is withdrawn, and the stem cells are centrifuged off and frozen. The remaining products are returned. 

For some reason, the stem cells are healthy even though a few remaining tumor cells may remain in the bone marrow. 

The disadvantage of an autologous graft is that the long-term remission is lower than with a donor graft. The advantages include no host-graft rejection and a return to one’s normal lifestyle without the need for anti-rejection drugs. Almost no mortality is related to the procedure. 

My wife Shirley was out of town for these visits but when she returned we revisited both physicians, and they were great in explaining the disease, treatment and prognosis, and the fact that many patients and their spouses experience severe depression during treatment. At that time, my medical team also recommended that I have a port inserted to save my peripheral veins and make venous access easy. 

Before beginning treatment, I visited our oldest son, a pediatric orthopaedist in Pennsylvania, to attend a meeting for which he was sponsor. He insisted I take a half-day off to fish for steelhead in the streams around Erie with a guide. I had hooked a steelhead but never landed one before, which I did this time and it was a real thrill. This gave me a pleasant experience before the journey ahead. After a photo, I released the steelhead.

Dr. Boyce Oliver inserted the port under an anesthetic and it has caused no problems. I had it placed in the subclavian on the right so I could still swing a shotgun with my left arm, which I am doing once again. 

Every third Friday, I underwent a chemotherapy treatment, with a total of six treatments the first protocol. The treatment administration area is divided into cubicles, each with four comfortable, reclining chairs. The treatments lasted into mid-afternoon, which gave one plenty of time to become acquainted with the others in that cubicle. 

I was fascinated with the courage of the other patients, and how they shared their stories. 

Except for hiccups which occurred for three days following each treatment and loss of what little hair I had left, I – for the most part – did well. Shirley now calls me Mr. Clean. 

My total baldness made it obvious to my scoliosis patients that I had a problem, so I shared my story with them. The mothers of two patients were Christian fundamentalists and asked if they could lay hands on me and pray for me, which was a unique experience for a Methodist. 

The phone calls, notes and visits from physicians, patients, and friends; and in particular, the support from my wife really carried me through.

I also have a vascular surgeon friend, Dr. Ron Blumoff, who had the same diagnosis and treatment, and is now free of disease. His calls and visits were of real help. One card from another friend who had also had chemotherapy was especially meaningful: “The four things that help you get through the treatment are nutrition, rest, exercise and spirituality.”

On one occasion I used my problem to give a patient some insight. The patient had severe back pain, many emotional problems and an unhealthy lifestyle. The examination and x-rays were normal. I said, “Life has really dealt you a bad hand.” 

She smiled, glad I understood. I continued, “I don’t like the last hand I was dealt, either” and explained my situation. ”I have two choices, which are to stay in bed and feel sorry for myself, or try to do something productive.”

She replied, “I understand. What do I need to do to get back in shape?”

There were some times when I was not sure I would make it. One was a GI bleed, probably from a tumor sloughing off in my colon when my hemoglobin dropped to 4.9. I also had a couple of bouts of atrial fibrillation when I became anemic or my electrolytes got out of balance. One came on after working out at a gym, which I continued during treatment to stay as strong as possible. My wife took me to a restaurant after our workout and, as I approached the entrance, my legs buckled. Fortunately, a pole was nearby and, very ungracefully, I slid down it. 

It was also disappointing when the repeat CTs showed that, although I had improved, I was not in complete remission and required a second round of chemotherapy with stronger agents. The latter ultimately would bring me into complete remission as evidenced by new CTs and a PET scan.

I had been able to work until that time, but the more potent daily treatments and the stem cell transplant required that I be off from May through July. My colleagues in the orthopaedic department at UTHSCSA donated their sick leave, saw my patients and took over my committee assignments. I will be forever grateful to them. 

The transplant occurred in early July without incident. After donating my stem cells, I was admitted for five days at Methodist’s Bone Marrow Transplant Unit to wipe out my remaining bone marrow with high dose chemotherapy. Our 50th wedding anniversary occurred on June 23 during the hospitalization. Our oldest son, who was home for a meeting, brought in shrimp from Paesano’s and a bottle of wine and we had a great evening. 

Patients are kept on antibiotics, antiviral and fungal agents until the transplant begins to work. After the chemotherapy, I was discharged and returned as an outpatient the next two days to receive my stem cells through my port. Although I fatigue easily, I am again working out and seeing patients. 

I was very pleased recently to have received the Golden Aesculapius award from Bexar County Medical Society.

Dr. Sanders is a board certified Orthopaedic Surgeon and past President of the Bexar County Medical Society.

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