Finally, a firm type and stage for the cancer and a treatment plan together with a case management approach

1. The nodule in my lung is probably a fungal infection that occurs frequently in this part of the country. The UNMC pathologist gave that tentative opinion this morning following a biopsy of my lung at UNMC on Friday. If that turns out to be true, the infection will be ignored for the time being and I will start treatment of the lymphoma.

2. From the bone biopsy last week, we now know that the bone marrow is free of the lymphoma.

3. Given the above, my cancer was firmly typed and staged today. I have stage III classical Hodgkin’s lymphoma.

4. Dr. Armitage, at UNMC, one of the world’s leading experts on lymphoma, and Dr. Green, my treating oncologist, both agree that I should start a chemo protocol developed here in Nebraska for people over 60. I will receive treatment in Lincoln.

5. I will go through six cycles of treatment. Each treatment cycle lasts 28 days. I receive chemo drugs on the 1st and 8th days by infusion into my port. On days 1-14, I also take chemo medications by mouth. Days 15-28 are for rest and no chemo is administered. Radiation is not usually required.

6. I will start the protocol as soon as the final pathology report on my lung is received by Dr. Green confirming that I have a fungal infection and not cancer in the lung. That is, I should start chemo in a week or so presuming the present shortage of some cancer drugs does not delay things.

7. Dr. Green advises that I should not plan on conducting trials during the first cycle. That is, for about a month after I start chemo, I should not plan on conducting trials because I could be very sick.* On the other hand, if the first cycle goes well, I might able to handle trials thereafter, particularly during the last 2 weeks of each cycle. But my functionality as a trial judge (always suspect in the minds of many) is yet to be determined.

8. With the marvelous help of Magistrate Judge Zwart and my judicial assistant Kris Leininger, we will manage my caseload with the foregoing in mind. At any time, concerned counsel should feel free to contact Kris or Judge Zwart with questions and concerns.

It is my intention to be utterly transparent throughout my treatment. I intend to keep the bench and bar advised as things progress.

All the best.

RGK

*Today, I asked Chief Judge Smith Camp to reassign a civil case set for April 7, 2014 that has twice been bumped. Judge Gerrard agreed to take that case and to do his best to try the case on the firm trial date I previously established. Of course, Judge Gerrard has my thanks.

18 responses

  1. I am sure you’re getting excellent medical advice, but I just want to emphasize taking it easy on yourself during all this. You’ve talked a lot on this blog about the sheer volume of workload that judges have to take on, and it can be really hard to switch gears when something like this puts you on your heels. Try to be conscious of that. And besides, what congressman would vote to impeach the guy who missed work because of cancer?

  2. Peter, good advice! As for what Congressman would vote to impeach me if I missed work ’cause of cancer? Oh, just about any rock ribbed member of the party I once belonged to with real pride, that’s who. Asses all.

    All the best.

    RGK

  3. I suppose all that knowledge at least deals with unknowns and maybe could be worse. For me it is a grim but welcome reminder to show up with some gratitude every day. Wishing you well.

  4. MJC,

    Yes, I don’t deal well with the unknown. So knowing made me almost giddy.

    Dr. Armitage, who is my age, and a bit of a philosopher, said something interesting. It went like this:

    As a result of what you are going through, you will see the world in a different way. The important things in life that you always promised yourself would be well attended will now, perhaps for the first time, get your attention. The sad thing is that, if we are successful in treating you, there is a good chance that you will forget what you have learned. Don’t let that happen.

    All the best.

    RGK

  5. I have been impeached. It sets you back for a while and then you realize there is a life beyond the bench. But, who am I to talk, now. I just have two artificial hips which allow me to walk. Just needed PT to live on.

  6. Judge – You are as brave and dedicated as they get! So often people with a serious illness hide it from others, particularly the public. Your candor will inspire other cancer patients to hang in and fight.
    Best of luck
    Richard Hirsch

  7. Jill,

    Your biology background is showing. Yes, indeed, that what I understand is in the lung. By the way, I grew up along the Maumee river in Ohio. “‘Histoplamosis capsulatum’ is found throughout the world. It is endemic in certain areas of the United States, particularly in states bordering the Ohio River valley and the lower Mississippi River.” Histoplasmosis

    All the best.

    RGK

  8. [I]f the first cycle goes well, I might able to handle trials thereafter, particularly during the last 2 weeks of each cycle.

    I worked with a lady who had breast cancer, successfully treated with chemo. She wasn’t too sick to work after her first round; you can look forward to more of your judicial drudgery. [g]

    Welcome back, by the way. I’d have been back sooner, but I haven’t yet received my personal, engraved, gilt-edged invitation. I assume it’s lost in the mail….

    Eric Hines

  9. Eric, you should know better. You never need an invitation, and besides I am too cheap to send the good kind.

    All the best.

    RGK

  10. Jill, I was slightly in error. I was able to read Dr. Green’s progress note today regarding my visit with him earlier this week. It indicates that I will be given the ChlVPP protocol rather than the ChlVPP-ABV Hybrid.

    From the 2010 Nebraska Lymphoma Study Group protocol book at page 55, I think this means that I will get the following drugs on the following intervals:

    1. Chlorambucil 6 mg/m2/day PO 1 – 14 (PO means by mouth)
    2. Vinblastine 6 mg/m2 IV 1 & 8
    3. Procarbazine 100 mg/m2/day PO 1 – 14
    4. Prednisone 40 mg/day PO 1 – 14

    Repeat cycle every 28 days for 6 cycles. Like the hybrid, this regimen is also specifically designed for people over 60.

    All the best.

    RGK

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