The doctor’s appointment should have been over well before the evening anatomy lecture started.
Ashley Herndobler was confident she would be in and out, that the meeting with her physician would not interfere with her busy class schedule during her freshman year at the University of Indianapolis. She had gone to the school’s clinic for a routine rash, and nurses working that night had focused on a lump on her neck instead.
Herndobler had the strange lump for two years, and doctors repeatedly told her that nothing was wrong.
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“I wasn’t worried about it at all,” she said. “After all this time, I didn’t think it was anything.”
This appointment was different. Herndobler was stunned to learn that the lump was caused by Hodgkin’s lymphoma, a cancer that forms in the lymphatic system and white blood cells.
In a moment, concerns about final exams were replaced with thoughts of chemotherapy to fight off a deadly cancer. Herndobler expected her freshman year would be about making new friends, taking classes in anatomy and physiology and working towards her career in the physical therapist assistant program.
Instead, she found herself planning out chemotherapy sessions, suffering through nausea and losing her hair as the powerful drugs killed the cancer inside her.
Herndobler, 20, has completed treatment, is in remission and feels as healthy as she has in years. But going through cancer at such a young age has made a lasting impression on her life.
“It’s changed me into a different person. I’m much more appreciative of every little thing. I feel like I can do so much more,” she said. “Before, I didn’t think I was as capable of as many things as I am. Going through treatment, sitting in bed all day, that can change you.”
On a busy Friday morning on the University of Indianapolis’ campus, the energy of a new school year was still high. Rivers of students flowed into the school’s Health Pavilion, heading to classes, stopping to grab lunch or just to sit and talk with friends.
Away from all of the bustle and noise, Herndobler sat in a study room, going over pages of anatomy homework and open textbooks spread out on the table.
Her goal is to work in physical therapy. At times during her freshman year, Herndobler felt overwhelmed with the rigors of a college curriculum. She was wait-listed initially for the university’s physical therapy assistant program, and even after she was accepted, her confidence had been shaken.
But her career plans have only been strengthened by her unexpected cancer diagnosis.
“There were times last year that I asked myself if this is really what I want to do,” she said. “But going through all of this, it made me realize that I want to be in the medical field. I want to make patients feel like how my nurses made me feel.”
Herndobler can look back and pinpoint the moment her nightmare started. She was a senior in high school, living in Valparaiso with her family.
About midway through 2015, she noticed a large, golf-ball sized lump on the side of her neck.
Blood tests didn’t show any abnormalities in her antibody levels, and doctors assured her repeatedly it was nothing to be concerned about. Herndobler’s own doctor thought that it might be related to mononucleosis, and when treatment for that disease didn’t impact the lump, he thought it might be hormonal. Again, her blood tests all came back normal.
Throughout the rest of her senior year, and into the start of her freshman year at University of Indianapolis, the lump persisted. With her new roommate, she started exercising at the campus fitness center more, and at one point developed a minor rash after a workout. She visited the school’s medical clinic to get it cleared up, and a nurse practitioner immediately focused on the lump instead.
“She didn’t even pay attention to rash. Instead, she was very concerned about the lump, took pictures and sent it to the doctor,” she said.
Dr. Randall Lee, an internal medicine physician with Community Health Network who also treats students at the university health clinic, set up an appointment with Herndobler. From their first meeting together, Lee was very straightforward about all of the options of what the lump could be: from a fungal infection to a worst case situation of lymphoma.
Lee ordered blood tests, CT scans, X-rays and a biopsy to determine what the cause was. Again, blood tests were normal, and the X-rays didn’t show anything out of the ordinary.
But the scan and biopsy painted a different picture.
Lee asked Herndobler and her mother, Alicia Herndobler, to come to Indianapolis for a meeting in November to discuss the results. He explained that she had Hodgkin’s lymphoma. They talked about the implications of the disease, what the next steps for treatment would be and what her options were to get that treatment.
He offered to stay as long as the Herndoblers needed to answer questions and support them through this.
“We sat in the room, and I gave them time to digest. There was no rushed appointment at all. You don’t rush these discussions,” he said. “I told her that I was glad we had a diagnosis, and glad that we had a diagnosis that was treatable.”
But in the moment, Ashley Herndobler was dumbfounded.
“I didn’t have any questions, because I wasn’t expecting that at all,” she said. “My mind went blank. My mom asked all of the questions, because I had no idea.”
A PT scan and biopsy showed that she was in Stage 2 of the disease, as the cancer was found in her neck, underarm and chest.
“That was surprising to me. Having the lump for two years and it only being Stage 2, I thought it would be worse,” she said.
Her case was unusual. She wasn’t exhibiting any of the other symptoms of Hodkin’s lymphoma, Lee said. She was not experiencing night sweats, fever or weight loss. No other masses or lumps were found anywhere else on her body besides her neck.
“She was remarkably asymptomatic. It’s not like she had been sick,” Lee said
The only symptom she had was occasional fatigue. But as a full-time student, working two jobs and engaging in hobbies such as horseback riding, she thought she was just over-extended.
“I figured I was just tired,” she said.
With a diagnosis, the Herndoblers needed to figure out where to get treated. They have a family member who works with University of Chicago Medicine, closer to Valparaiso, and their initial plan was to have chemotherapy and other treatment there.
But because it was the end of the year — the busiest time for hospitals — University of Chicago Medicine oncologists were unable to meet with her for three weeks. The Herndoblers wanted to get treatment started right away.
“I wanted it done right now,” Ashley Herndobler. “My first question in all of this was, ‘What’s next?’ So I couldn’t wait that long.”
The Herndoblers decided to continue with treatment at Community Cancer Center South. They met with Dr. Anuj Agarwala, a medical oncologist, who laid out a plan for chemotherapy, as well as what to expect.
Ashley Herndobler would be taking a regimen of chemotherapy specially designed for Hodgkin’s lymphoma patients. A combination of the drugs doxorubicin, bleomycin, vinblastine and dacarbazine would be given to her every two weeks for six months.
“In early stage Hodgkin’s lymphoma, you can do a combination of chemotherapy and radiation. The reason I chose only chemotherapy is that we had to tailor it to her. She is a young female, one thing I wanted to avoid was radiation to the chest, because that can increase the chance for malignancies such as breast cancer in the future,” Agarwala said.
At the same time, she was scheduled to go through fertility treatment, because chemotherapy can damage the reproductive system and decrease the chances of having children. Being so young, that was a big concern, Ashley Herndobler said.
Her first chemotherapy session was Dec. 28, 2017. She had returned to Valparaiso for the duration of the treatment. Her family would drive her to Indianapolis to get the treatment. Afterwards, they would return to Valparaiso while she recovered.
When she was given the doxorubicin, her nurses instructed her to chew on ice chips to avoid getting mouth sores. The drugs made her lose her hair, and wiped out her white blood cells, making her susceptible to infection.
“That was the worst one for me, because it made me feel so sick. You could tell when I got that one, because I would just turn pale. It messed with my taste buds; my mouth would taste like metal,” she said.
Another one of the drugs, bleomycin, can cause lung toxicity if taken too long. Though effective in killing the cancer cells, she was taken off of it halfway through the regimen to prevent damaging her lungs.
Still, she contracted a lung infection that kept her bedridden in her home.
“It was scary. If I wanted to walk over the refrigerator in my house, I’d have to walk very slow,” she said. “It turns out I had a lot of fluid in my lungs. And that’s what I felt, with shortness of breath and coughing and gagging.”
But despite the harsh nature of the treatment, it did work.
“You could literally see the tumor melting away,” Agarwala said.
All through her treatment in late 2017 and early 2018, she continued to take classes full-time online at Ivy Tech. Her classmates and friends, as well as her boyfriend and his family, pushed her to stick with her schoolwork.
“I didn’t think I could do it, but I did,” she said. “Some days it got a little stressful, but I felt like it was a good distraction for me to not just watch TV. It kept my brain working.”
On June 14 — her 20th birthday — Ashley Herndobler finished her chemotherapy treatment. CT scans done on June 28 showed that the cancer was gone and she was in remission.
“It was kind of scary at first. (Agarwala) was looking at the chart and reading the results, and if you don’t understand everything they’re commenting on, it can be a little bit scary,” she said. “But then he said, ‘If you’re looking for the term, you’re in remission.’”
Moving forward as a cancer survivor, Ashley Herndobler has to go back every three months for the first year for check-ups and monitoring. Then for five years following it, she needs to see her doctors twice each year.
In mid-September, she made a surprise visit to the university health center on a day when Lee was working. She wanted to say hello and drop off a bracelet imprinted with “AshleyStrong” and a reference to Romans 8:18
“She wanted to tell me how great she felt. She was smiling ear-to-ear,” Lee said.
Ashley Herndobler does feel good. She has settled back into her studies, and is often too busy to think much about what the past year had been like.
On the worst of her days, when the chemotherapy was ravaging her and everything seemed to hurt, imagining this point in her life was the only thing that eased the pain.
“There were days that were really, really tough. You just have to picture yourself at the end. Before you know it, it’ll be over with,” she said.
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Ashley Herndobler
Age: 20
Residence: Valparaiso, but attends University of Indianapolis
Type of cancer: Hodgkin’s lymphoma
Date diagnosed: November 2017
Treatment: Chemotherapy given every two weeks over the course of six months
What cancer taught me?
"It made me a lot more appreciative of everything, even your health. That’s something that I didn’t even think about before.
How cancer changed me?
"I’m not afraid to ask questions. Before, I didn’t want to ask questions. Now, I’m not afraid any more. You have to believe in yourself, know that you’re going to get through this."
What I would tell someone just diagnosed with cancer?
"Ask as many questions as you need to so you feel more comfortable with the situation you’ve been put in."
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