It’s Leukemia and Lymphoma Awareness Month. ICYDK, they’re both cancers that are not always associated with tumors. Lymphomas are cancers that affect the lymph system, while leukemia is a cancer of blood-forming tissues, including bone marrow and the lymph system.

Getting a cancer diagnosis is hard AF and can be really isolating. To get a personal perspective, associate ED Reina reached out to Veronika Cohen (she/her), a fitness professional and her college friend, to talk about what it’s like to get diagnosed and treated, which she’s dealing with (and kicking a*s at) right now.

How did you find out you had lymphoma?
The way I found out I had lymphoma is a convoluted story. In April, I went to my gynecologist for my annual checkup and as most doctors do during the exam, he palpated my thyroid gland (on my neck). He felt a small nodule and said it’s most likely nothing because I have no thyroid hormone issues and no family history of cancer. He did recommend I get some blood work and an ultrasound done. The bloodwork came back normal, but the ultrasound came back inconclusive. He referred me to a thyroid surgeon for a biopsy to confirm that everything was fine. The biopsy ended up coming back with an 80% chance of malignancy which was not a good result. This meant I needed to have my right thyroid lobe removed in a simple surgery. Thyroid “cancer” is only confirmed for 100% certainty after tumor removal. Surgery was scheduled for July 11th, but I went to get a second opinion first. There, they did another neck ultrasound and they found a 2 cm enlarged lymph node by my left clavicle. This was biopsied and came back (to my shock) as classical Hodgkin’s lymphoma, completely unrelated to the thyroid nodule. They told me I needed to find a lymphoma cancer specialist, put off the thyroid surgery, and get treated with chemo ASAP for the lymphoma.

You have classical Hodgkin’s lymphoma. What is the difference between the types?
There are many types. I do know I had “Reed Sternberg cells” present in my enlarged lymph node which was biopsied. That type of cell is a clear indicator of classical Hodgkin’s. Non-Hodgkin’s lymphoma tends to be a tougher type of lymphoma to beat, while Hodgkin’s Lymphoma has a very high survival rate (over 90% if localized) and it also has a low rate of recurrence compared to other types of cancer. Classical Hodgkin’s is the most common type of lymphoma and the treatment plan is highly tested and statistically highly successful at fighting the cancer off to remission.

Are there any common symptoms that people with lymphoma typically have?
Yes, there are some clear symptoms that usually show up before diagnosis, called B symptoms. B symptoms are those that you notice yourself without any scans or blood tests. For classical Hodgkin’s lymphoma the most common are extreme fatigue, unexplained fever, decreased appetite, night sweats, itchy skin at lymph node sites, abdominal pain, pain in lymph node sites (specifically after drinking alcohol), and significant weight loss. I actually did not have any of these symptoms before my diagnosis.

What has treatment looked like for you?
Treatment for me is a traditional course for this type of cancer. I was diagnosed with Stage 2A which means I have two lymph node sites with cancer present, but both are above the waistline. If you have two sites with cancer but they’re split above and below waistline—for example, groin and neck—that puts you at stage 2B. If you have more lymph nodes with cancer—like four—your stage would be 4 and then A or B depending on where they’re located. Staging for lymphoma isn’t as cut and dry as other cancer stagings and it doesn’t change treatment plans very much at all.

My chemo regimen is ABVD which stands for adriamycin (also known as doxorubicin), bleomycin, vinblastine, dacarbazine (DTIC). Every 15 days, I go in for an infusion. This is where it gets a little confusing, two infusions of the ABVD chemo equals one round or cycle. So, my rounds last 30 days total. I have been prescribed four rounds of this (four months of chemo with eight infusions in total). This is standard for someone with early stage disease who is not going to receive any radiation. My oncologist and I have elected to skip radiation because it’s safer as a young female with disease in the neck/chest to skip radiation and opt for slightly more chemo to lower risk of developing tumors or breast cancer. On an infusion day, I arrive at 8 A.M. at the chemo infusion center. I sit until about 1 P.M. receiving each of the four chemo drugs in succession. Then, I get picked up and go home!

Have you had to make any lifestyle changes since being diagnosed?
Yes, I have had my life basically put on hold. I’m a fitness instructor who works in a number of gyms. I’m not able to do any in-person work while my immune system is compromised during chemo. I have taken medical leave from in-person work for four months and have shifted to part-time admin work from home. The number of appointments I have throughout this process also makes it difficult to work a full-time job, so I opted for part-time.

I also am not allowed to travel by airplane or go to crowded events throughout chemo because of immune suppression. I have canceled a few trips, missed weddings, graduations, birthdays, and concerts over my treatment which is definitely a lifestyle change in its own way, but very do-able. There will always be more trips in the future.

I also have become so much more conscious about hand washing and wiping down high touch surfaces to prevent the spread of disease within my home. Lastly, I have made adjustments to my diet based on recommendations from my oncologist. You can’t eat any raw or undercooked protein while on chemo to prevent catching any foodborne illness. Cutting sushi out of my diet has been hard! I also wash all produce very well and I don’t eat any bagged lettuce, romaine lettuce, or raw spinach because those types of lettuces tend to have the highest rates of E.coli and other bacteria.

Is there anything that you’ve been doing at home to feel better?
I have certain routines I follow to mitigate side effects and the stress of this whole experience. I take a multivitamin, folate, zinc, and Vitamin B12 daily. I take a ginger shot every morning since it’s known to help reduce nausea. I’ve also been eating 100g of protein a day. I was told by my doctors that protein is very important throughout chemo. I also have started getting into bone broth. It not only has collagen protein, but is known to help with your gut biome which can get disrupted by chemo. I also drink so much water—like an obnoxious amount. Doctors/nurses have told me this helps to flush the system and reduce the risk of constipation which can be a chemo side effect. I can proudly say I have not experienced any issues in that department so maybe the obnoxious amounts of water are working!

What’s your advice for others who have lymphoma?
Get a therapist! One more time for the people in the back: Get a therapist! Having someone to talk to who’s not my direct family or romantic partner has been incredibly helpful for me navigating the mental gymnastics that cancer diagnosis and treatment throw at you. It’s so much all at once. I know this is a luxury and I feel so lucky I can afford a therapist, but try checking with your oncologist/insurance because there’s often a staff psychiatrist at the hospital who is covered by insurance and can provide counseling throughout cancer treatment.

I also recommend finding a routine of realistic movement/exercise that you can do as much as possible throughout treatment. I have always been a fitness person so I make sure to carve out time to walk, run, lift weights, and stretch. I think this has helped keep my body feeling as “normal” as possible throughout treatment. Plus, a little walk in nature does wonders for reducing anxiety. I have been told by the oncology nurses that increasing blood flow throughout chemo is good and will reduce the side effects. Specifically, ABVD chemo is harsh on lungs/heart so I try to combat that with getting my heart rate up daily and working on my VO2 max often! Who knows if it actually does anything to help, but I feel good so far in my treatment so I’m going to keep it going!

Is there anything else you’d like to share?
The post diagnosis, pre-treatment limbo period (before staging) of waiting was by far the scariest and hardest time of this entire process for me. When I was diagnosed I had just parked my car, thank goodness, and I had a panic attack for the first time in my life. I had a couple more small panic attacks before I was staged. The fear was debilitating for about two weeks. Just know if you’re going through that stage, it gets better. Let people help you! I have always been someone who prides themself on their self-sufficiency and this experience has forced/helped me to accept help from my loved ones, friends, and family.