QUESTIONS ANSWERED: EXPERT PRESENTS HIS ASSESSMENT OF THE CASE

Kenneth Zamkoff, M.D., is an energetic man of about fifty—about six feet tall—with a salt and pepper beard that is half way between full and a starter. He is direct, energetic and even loud. Only someone who was stone deaf would have a hard time hearing Dr. Zamkoff. He is now my oncologist, as the oncologist originally assigned to me at Baptist Hospital in Winston-Salem, North Carolina, Denise Levitan, is out on maternity leave.

I didn’t know what to make of him during our first meeting a month ago, but he made a much stronger impression during the meeting in October. Along the way, I had become aware of the fact that Dr. Zamkoff was a specialist in lymphoma and was specifically very knowledgeable about Mantle Cell B Lymphoma, my disease. When I first saw him in the examining room this time, he disappointed me with the news that he had never gotten my letter, that is the letter containing the questions that I presented in the last posting. He then heard me out as I put each question to him, and he provided the answers I was seeking.

First Question: Lymph Node

My first question had to do with the continued presence of the cancerous lymph node in my abdomen. What did this mean? The second bone marrow transplant had not eliminated the lymph node in my mesentery. Because it had not gotten rid of it, was this second bone marrow transplant a failure? “No,” Zamkoff answered, “the lymph node is smaller than it was, and it may be less active than it was or not active at all.”

So should we do something right away to find out about the activity level? “Should I have another PET Scan?” I asked. “Another PET Scan or a laparoscopic biopsy,” he answered. I wasn’t happy to hear the reference to laparoscopic surgery, which I had already tried, as reported in a Mind Check posting in the fall of 2007. The laparoscopic procedure, although short in duration, had come complete with its own memorable trauma. And so I pushed the idea of a PET Scan. Then he surprised me by turning the tables on me by confronting me with a couple of questions I was ill equipped to answer.

Already Tried Velcade

“And what is that going to tell us?” he asked. “How active it is.” I answered. “And if it is active, what are we going to do about it?” “I don’t know,” I responded. How could I answer such a question? “You’ve already tried Velcade, right?” he asked referring to the so-called wonder drug for relapsed lymphoma that had been administered late last year.

“Yes,” I responded, “and it didn’t do a thing.” “In fact, the node was larger after Velcade treatment than it was before,” he interjected while flipping through a sheaf of paper which must have been my medical records. “That’s the problem,” he responded. “We’re running out of options. I’m going to do some research and see what else we could try, but we’ve already done the obvious things.”

Go Home And Forget About It

He looked right at me. “My advice to you is that you go home and forget about it. My advice to you is that you go home and live your life.”

In other words, he was advising me not to think about the finger nail size thing inside me—the dangerous lymph node—but to get on with my life, that nothing was to be gained by worrying about it. However, just so I would not go home and become too complacent he risked contradicting himself by asserting, “ I can tell you this, it will come back.” Then to make sure I did not miss what he had said he repeated it. “Based on my experience with this disease, it will come back.”

Remission First Time

Any reason for hope then? “How much of a remission did you get from the first bone marrow transplant?” he asked. “Five years,” I responded. “Five years, okay,” he was almost shouting. “Now that is a reason for hope. Maybe you can get almost as much time out of this bone marrow transplant as the first one.”

And what about my knees? Could I or should I consider knee replacement surgery? “We can’t make that decision now,” he answered. ‘You’re not ready now. Let’s wait three months and see how you’re doing. If you’re doing okay, and you still think you want and need to do something about the knees, that will be the time to consult with an orthopedic surgeon.” Then he added for emphasis, “That will be your decision.”

That was my meeting in October with Kenneth Zamkoff, M.D., oncologist. What did I learn? Frankly, very little that I didn’t already know, but I heard it from an expert in my particular disease, and I heard it without hedging or cant. That gave me a lot to digest.

For an overview of the various writing projects I am involved with, please see the website http://www.sasaftwrites.com. My latest book Murdoch McLoon And His Windmill Boat is available from the website http://www.Xlibris.com.

Copyright © 2008 by Stephen Alan Saft