The Proof is in the Pudding

Well Friends, I'm not really sure where that saying came from or really what it means, but this week I am thrilled to report that I have some delicious pudding for you--pick your favorite: chocolate, tapioca, rice, butterscotch, or all of the above... this is it!  I finally have confirmation of fantastic news; what we have been hoping for, praying for, anticipating and suspecting all along.  The MRI results are in, and the impression from my radiology report reads, "Persistent bilateral enhancing orbital masses right larger than left showing overall significant partial regression compared with the prior study."  The plain ol' English translation of all that medical mumbo jumbo is this:  The Rituxan is working, and the tumors are
SHRINKING!!!!!!!!!!!

Now brace yourself for another cliché: A picture is worth a thousand words (sorry).  A few weeks ago I showed you photos of what the Rituxan has done for my outward appearance, but now I'd like to share with you some pretty incredible images of the inside of my head.  Yesterday (Thursday) I went to see Dr. Suddesh, my ophthalmologist, and on his computer, he pulled up my MRI from August as well as my MRI from Monday so we could compare them side by side.  I took pictures of his computer screen so I could document these amazing before and after images and share them with you.

This first shot is a cross section--imagine my head is sliced vertically, like a loaf of bread--and this slice is about in the middle of my head, right behind my eyeballs.  In these images, you are looking at my face straight on, so my right eye is on the left side of the pictures (by the "R").  The left image is from my MRI in August, and the one on the right is from this past Monday, just three months later.  Here you can see that all of the white areas around my eyes are the tumors.  You can see how much more white there is in the left image than the one on the right; the grey and black areas around my eyes are what normal tissue should look like.  In the image on the right you can see the greyish circles in the center of my eyeballs are my optic nerves.  They had been completely enveloped by the tumors.

MRI images: Before (from August, on left) and After (from Monday, on right)
The white areas around my eyes are the tumors.

This next picture is another cross section--now imagine my head is sliced horizontally--and this slice is through the center of my eyeballs.  This view of my head is looking from the bottom up, so imagine I'm lying on my back and you are looking up toward my head from my feet, and again, my right eye is actually on the left side of the images.  These images are particularly striking to me, as this clearly demonstrates just how much my eyes were protruding and bulging out of my head before, especially my right eye.  Look how far forward that right eyeball is--it sticks out past my nose!  Notice the grey streaks from my eyeballs back toward my brain.  Those are my optic nerves.  Notice in the image on the left how the tumor is pushing my optic nerve and bending it toward my nose, and in the image on the right it is now straight and normal looking.  In addition you can see how much more white (tumor) there is in the left image.

Another before and after, here, a horizontal cross-section.  Notice the
dramatic protrusion of my right eyeball in the "before" image,
and how much it has regressed in the "after" image.

So clearly you can see that in three months time, I have made great progress!!  Though I will admit that I was a tiny bit disappointed to learn that the tumors still exist, I am very satisfied to know that they are significantly reduced, and the outward appearance of my eyes is pretty much normal.  Dr. Suddesh took measurements again this week, measuring the distance from the bone at the outer corner of my eye, to the tangent of the front of my eyeball.  In August, that distance was 27mm, in my right eye, and 25mm in my left.  Last month it decreased to 24mm in my right and 22mm in my left.  Yesterday, the distance measured was just 20mm in both eyes!  All of my friends and family members who see me all the time can't believe how different I look.

Today I met with Dr. Vempaty, my oncologist, who was extremely pleased with my response to the Rituxan, and said that my progress was better than expected.  She told me that the Rituxan will continue to work in my system for the next several months, and that I can expect that the tumors should continue to regress.  She said it is possible that they will be eradicated completely, but they may remain, or even grow back.  We must monitor them now, watching and waiting to see what to do next.  I will go back for another MRI in three months, at the end of February.  If the tumors haven't changed or are smaller, then I will not need to do additional treatment, and I will go back in another three or six months for another MRI.  If we continue to see changes for the better, and the tumors continue to shrink or go into complete remission, then we can go longer between check ups.  At any point if the tumors start to grow back or if the lymphoma spreads to another part of my body, then we will have to take action with more treatment.  

In any case, I am NOT going to worry about that last scenario for the time being, but I am going to continue to focus on the positive, as I have done all along throughout this journey.  I can't help but marvel at the appropriateness of the timing of this news, in that it is received so near to the most wonderful holiday where we express our deepest gratitude for our multitude of blessings.  I tell you, there is nothing like a cancer diagnosis to get one thinking about life's priorities, and to focus on appreciating all the gifts we receive, both tangible and intangible, on a daily basis.  Next week I, for one, plan to raise a glass with my closest loved ones, and celebrate the myriad of reasons why I am thankful.  But trust me, the celebration of my appreciation will NOT be limited to next Thursday, November 25.