Hodgkin’s Lymphoma: Jonathan's Story
Jonathan Angulo
Glendale, California
Hodgkin’s Lymphoma
Transplanted in 2023
Many thanks to USC Norris Comprehensive Cancer Center and the American Society for Transplantation and Cellular Therapy for helping us share Jonathan’s story.
Can you share what was happening in your life, prior to diagnosis?
Everything was perfect. I was working in the same doctor’s office where I’ve been for the last 10 years, I had a new desk and I was happy; it’s a great atmosphere. Also, I was going to the gym all the time and I had no idea that anything could be wrong. I was 25 years old and had just become a licensed paramedic. I felt amazing.
Then, I noticed a lump near my clavicle. I made excuses for it, at first. I thought it was from the repetitive motion of archery, or maybe a reaction to the Covid vaccine – this was 2021, the middle of Covid. The clinic where I worked was being swamped by people worried about these types of nodes, as a possible vaccine side effect. So I didn’t want to waste the radiologist's time.
Given your hesitance, what eventually pushed you to get it checked?
It just wouldn’t go away. I showed it to my boss, who is a doctor, and he ordered an X-ray and ultrasound. I got the call with the results one day before my 26th birthday. Being a paramedic, I knew that when a doctor calls that quickly, it’s never good news. The radiologist found a suspicious mass.
When the pathology came back on April 12th confirming Hodgkin Lymphoma, I told my coworkers, "It’s Hodgkin!" I was happy because I knew Hodgkin had a high cure success rate. I told everyone, "If there’s a good cancer and a bad cancer, I got the good one!"
As someone who had worked in a busy medical practice for so long, can you describe what that was like at first, being on the other side of the patient/provider divide?
I remember my first oncology appointment and how odd it felt. I was used to seeing patients carrying these big folders full of labs and reports into our practice. Suddenly, I had my own folder. The tables had turned; I was the patient now.
Initially, the chemo wasn't too bad, it was mostly just a struggle to keep my appetite. But at the six-month mark, we did a PET scan, hoping to be able to remove the most toxic drug from my remaining treatment protocol. Unfortunately, that PET scan showed no real improvement. I was shocked. I thought, Wait, I have the ‘nice’ cancer, what is going on?
At that point, my oncologist suggested a standard escalation in chemo drugs, but as a paramedic, I knew "usual" didn't always mean "best." I did my own research and decided my oncologist’s recommendation was too harsh for my body. For the first time, I decided to get a second opinion. I was hoping for the best, but it was not the best. My case was assigned to a general oncologist rather than a practitioner specializing in Hodgkin. He recommended the same old protocols – no new ideas.
That sounds really discouraging. How did you eventually find the right path forward?
I went back to my original oncologist. He was young and respected my medical background, so he transferred me to a colleague, a ‘big brain’ kinda guy. This new doctor reached out to the "big fish" in Hodgkin research across the country.
Together these doctors came to a consensus on the right (nicer, more gentle) chemo regime. I had no side effects whatsoever! The only side effect was from the steroids I had to take, I got so chubby. I would eat anything. In total, I gained 20 pounds. But the chemo worked to bring me into full remission.
Once you entered remission, you were encouraged to get a stem cell transplant. What was that process like?
Well, first, for transplant I went to the medical center at the University of Southern California (USC). The team at USC was incredible. My doctor and my oncologist were often texting each other about my case! Seeing them collaborate like that gave me so much peace of mind.
I had an autologous transplant, using my own cells. The preparation involved injecting growth factors to boost my stem cells. These drugs mobilize stem cells out of the marrow, into the bloodstream! Once you’ve got enough in circulation, they collect the stem cells. The entire process took about four or five hours. Basically, your blood flows into a machine, that machine collects the stem cells and then returns your blood back again. It was so easy, I spent the whole-time playing video games, while the machine was doing its thing!
Beyond such an amazing care team, what were your main sources of support during this time?
Family and friends from work, for sure. After the collection, I was sent home to prepare. One day before my birthday, my family held a big gathering, to wish me luck. We were aware that there could be serious complications, including death. At the party, I had my cousins, my mom, aunts, uncles, nephews, a huge group of us. I like to play poker, so mostly we played poker. On my actual birthday, my co-workers came by my house with gifts. And, the very next day, I was admitted for transplant.
I can’t emphasize this enough: my bosses and coworkers are family. They let me
work from home and called me every day in the hospital to give me a hard time, in a fun way, to keep my spirits up. When I was down after that one bad PET scan, they organized a surprise picnic near my house. Seeing the doctors I work with there with their families, all cheering for me... it was a moment I'll never forget.
You grew up in Mexico; were any of your family from Mexico able to be there during the transplant period?
Yes, my mother. She was living in Mexico then, but she came to stay with me during the transplant. After my mid-treatment PET scan came back negative, we just said "screw it" and went on a road trip up the Pacific Coast Highway to Monterey Bay. She loved the ocean. She passed away recently, but I am so grateful she was able to be part of my treatment and that we had those trips together.
Our condolences, Jonathan. In the wake of her loss, and your illness, is there anything that has helped you honor your mom’s memory, or keep your spirits up, more generally? 
Work is my coping mechanism. Even in my hospital room at USC, which had a great view of the mountains, I was writing. I had been working on writing a guide to help other people become certified in phlebotomy. I finished those guides and even started on something new. I noticed people on Facebook groups had so many questions and fears about the transplant process. So, I wrote The Autologous Stem Cell Transplant Companion Book. It covers everything from what to pack to the medical nuances. I wanted to use my "Type A" personality and my medical knowledge to help others navigate the system.
Looking back, has this experience changed your perspective on life or on medicine?
In terms of medicine, my biggest advice to anyone going through this is to advocate for yourself. Don't take a doctor's word as final if it doesn't feel right. Seek the best care, including second opinions, and stay on top of the insurance side of things.
In life, I hope my illness has made me a better person. I learned that life isn't always fair and no one is invincible. I also learned that “you can't love the rose without the thorns.” This made me appreciate the flaws in myself and others. You have to take the flaw, to really know and love the whole person.
Jonathan’s Published Works
- How to Become a Phlebotomist in California
- A Day in the Life of a Phlebotomist
- Autologous Stem Cell Transplant Companion Book (A comprehensive guide on hospital essentials, medical expectations, and recovery).
The USC Norris Blood and Marrow Transplant and Cell Therapy Program (USC BMT), part of Keck Medicine of USC and the USC Norris Comprehensive Cancer Center, brings together hematologists, oncologists, pulmonologists, cardiologists, radiation oncologists, neurologists and surgeons to safely deliver a wide range of treatment options.
The American Society for Transplantation and Cellular Therapy (ASTCT), formerly known as the American Society for Blood and Marrow Transplantation, is a professional society of more than 2,200 healthcare professionals and scientists from over 45 countries who are dedicated to improving the application and success of blood and marrow transplantation and related cellular therapies. ASTCT strives to be the leading organization promoting research, education, and clinical practice to deliver the best, comprehensive patient care.