The 'boom-boom' protocol: Getting control over cancer - opinion

“Are you ready to ‘boom-boom?’” the radiation oncologist asked me.

This is not where I expected to be this summer.

My non-Hodgkin’s follicular lymphoma has been growing slowly but steadily over the past four years since I relapsed following chemo and immunotherapy.

I had hoped the cancer would continue at a snail’s pace and this period of “watch and wait” would last for long enough that researchers could come up with a cure – or at least an attractive alternative with minimal side effects.

“Watch and wait” describes the limbo that sufferers of a chronic cancer like mine must navigate. You only treat when the tumors get large enough or you notice unpleasant “B” symptoms. Otherwise, you monitor with regular scans and checkups.

When something changes with cancer

It was that unexplained edema, that developed in my left leg while my wife, Jody, and I were on vacation in the Amazon, that tipped me off that something had changed. (See “From Bother to Benefit,” The Jerusalem Post Magazine, May 5, 2023.)

I met with my hematologist upon returning to Israel. She saw that my lower extremities were still swollen and swiftly ordered a PET CT.

When the results came back, the reason for the swelling was finally clear: It was my cancer.

My main tumor, which is located in the pelvis region, had grown – not a lot, mind you, but just enough to press on a blood vessel that controls the flow of fluid on my left side. If drainage from a part of the body is blocked, fluid can back up.

This was a serious development, my hematologist intoned, eschewing her usual reassuring banter. If left untreated, I could develop a fatal blood clot.

She prescribed anticoagulants to lessen the chance of a thrombosis.

Unfortunately, the anticoagulant medicine was not a pill but a shot. Yes, I had to inject myself every morning. Ouch.

RATHER THAN recommending more IVs, pills, or immunotherapy, my hematologist had an idea: Maybe we could knock out the offending growth with radiation.

That’s how I wound up sitting across from the radiation oncologist who – in that weird way that everything overlaps in Israel – is also my downstairs neighbor.

The radiation-oncologist looked at my scans. Radiation could indeed work, he said. The usual course is 12 to 14 treatments, but follicular lymphoma was particularly responsive to just two quick sessions.

“After five years, if you do a dozen treatments, you’ll have a 90% control rate,” my neighbor/doctor explained.

“Control,” in this case, means the tumor hasn’t come back or isn’t growing.

“But if you do just two treatments, you’ll have a 70% control rate. That’s an excellent response with much less radiation. You probably won’t even have any side effects. It’s called the ‘boom-boom’ protocol.”

“’Boom-boom’ sounds good to me!” I replied enthusiastically.

The next step was to get a tattoo.

Now, I’ve never had a desire to get inked. But as I lay on the bed after being scanned in a CT machine for the pre-radiation “simulation,” I felt a brief but sharp pain on my left side, then another on my right.

“This is so we know where to direct the radiation beam,” the technician said.

“It will come off when I shower, right?” I asked, alarmed at this unbidden affectation of my body.

“No, it’s a permanent tattoo,” she said. “But you’ll barely notice it.”

Who knew cancer would finally give me hipster cred?

A week after the simulation, I arrived for the real deal.

The waiting room in the radiation-oncology department at Hadassah Medical Center was renovated a year ago. It now has calming pastel-colored chairs and couches, with paintings of pleasant landscapes on the ceiling. The lighting in the treatment rooms is bright, and they’ll even let you play your own music while being radiated.

I LAY down on the bed attached to the radiation/CT unit, which rolled me into the belly of its beast. There was a slight buzzing sound, almost like an epilator – or was that another tattoo needle? The machine repositioned me a couple of times. There was more buzzing. And then, 10 minutes after we started, it was over.

I didn’t feel any pain while it was going on. Afterward, though, I was hit by an intense wave of nausea. My brain was foggy, and I was loopy and tired for most of the day.

So much for “no side effects”!

On my second day of “boom-boom,” I popped in my AirPods. Steven Wilson’s Hand Cannot Erase was my album choice.

I got through all of two songs before it was done.

Six weeks later, I did another PET CT. The results were encouraging but not conclusive. The “boom-boom” gave me a partial response, meaning the tumor shrank, but it was still there. It could continue shrinking. Or I might require more radiation.

“We’ll be smarter after we do the next PET CT in the fall,” my hematologist told me.

I had almost not mentioned the edema to my hematologist during that checkup. I simply didn’t connect the two: What would my leg have to do with my cancer? But when I showed my doctor my then-slightly-but-still-swollen foot, she suspected the two could be related.

That’s an important lesson. I sometimes worry I should hold back more when meeting with my doctors; that I should just stick to the basics, the most immediate concerns, rather than review a laundry list of aches and pains.

In this case, though, sharing that information could very well have saved my life. To paraphrase Tony Soprano from The Sopranos (and Sonny Corleone in The Godfather before that), “Bada boom, bada bing” – that’s some good “boom-boom,” indeed. 

The writer’s book Totaled: The Billion-Dollar Crash of the Startup that Took on Big Auto, Big Oil, and the World is available on Amazon and other online booksellers. brianblum.com