Kobro's Cancer Crew #6: First 2 weeks of Chemo

Lots to cover in this update! I'll be sharing how my first few weeks of chemo went, an update on additional drugs I'm taking, and some highlights.

For those of you who had any issues with email delivery (or some had duplicated sections) over the past 5 updates, let me know.

To kick things off, I have some good news to share!

NO MORE (or like 5x better) ITCHING! I didn't realized how bad the itching was until I stopped being itchy all the time. I've gotten back close to an hour of focus time each day simply because I'm not always resisting the need to scratch.

For a reminder of the itching situation (from the first KCC update): "In Hodgkin lymphoma, severe itching is one of the B symptoms, which also include fever and night sweats...Itching in lymphoma can be widespread and severe, significantly impacting the quality of life."

September '23 through March '24: I would have sever itches on a daily basis in multiple parts of my body (causing me scratch until I bled and created scars).

April 20th: Now I'm only itchy below my knees and it's far easier to stop itching than before.

I'm also starting to see the difference in the size of my visible tumors. Have a look below.

Mid March:

April 20th:

Mid March:

April 20th:

While these are big improvements, the tumors above are the smaller ones.

I still don't know how the orange-sized tumor behind my heart is shrinking. We'll have an update when I get another PET scan in about 2 months.

Thankfully, there are signs those tumors are also shrinking. My breathing has gotten easier, so Doctor Handsome thinks the bigger tumors that are pushing against my airways are getting smaller.

I don't think I mentioned this in a previous updates, but for the past 3 months I'd often start coughing when I'd lay down (not anymore though!).

Another good proof point here is I ran (jogged) my first mile in months.

In other news, Dr Handsome got up upgraded to Dr. Hottie this week.

The way this came about is I was considering a trip to a conference in San Francisco this coming week (before Dr. Hottie turned it down).

Mikayla and I were discussing the idea when Dr. Handsome's new name emerged.

Now, it's not all sunshine and roses. While I'm holding up well, chemo compounds on itself, which means it will get progressively harder over the next 6 months.

On top of that, I've had to start taking a handful of drugs to counter the side effects of chemo.

Nausea

On days of my chemo infusions, I'm given steroids, which does wonders.

On days 1-3 after chemo, I need to take Dexamethason, which also helps with Nausea.

Apparently this drug can cause other side effects...

Thankfully, I haven't noticed serious differences here. Maybe a little stomach pain, I'm a tad more moody, and I have been shoveling down more food than usual ... but those haven't impacted my quality of life at all.

After day 3 post-chemo round, I can take Ondansetron as needed (once every 8 hours). We want to avoid "Nausea creep". If these don't work, Doctor Hottie said:

"go to the emergency room"

I only needed to take this once last week.

Stomach Ulcers

I'm taking Pantoprazole each morning, which protects my stomach lining. I forgot these for a few days and got some bad stomach acid.

Thankfully, no issues since.

Hyperuricemia

Chemo breaks down cancer cells which leads to high level of uric acid in the blood (known as Hyperuricemia). When this happens, there's an increased risk of joint pain and kidney stones.

To prevent this, Dr. Hottie had me start on Allopurinol (only for the first round of chemo)

Cold sores:

I started to get sores about a week in, so I got some prescriptions for mouth wash (one called Lidocaine that numbs the mouth and another that's a steroid).

Things to watch out for, which haven't happened (yet 🫰)

Cough

If I develop a cough, go to the emergency room.

If I have an impression of a cold, go to the emergency room.

These could be a sign of an infection.

Fever

If I have a 100.4+ fever for over an hour or 101 at any point, go to the emergency room.

This could also be a sign of an infection.

Diarrhea

If I poop more than 4 times a day, it could mean inflammation of colon due to immunotherapy.

If there's inflammation of the colon and you don't get steroids on time, "things could get bad".

Dr. Hottie didn't say anything else on what that meant, but I nodded along.

Inflammation of the lungs

This one's rare, but it's called Pneumonitis. This can happen when I take the autoimmune drug.

A sign of this is if there's a chronic cough and shortness of breath.

Chemo brain

Dr Hottie also shared how some patience complain with memory issues and focus called "chemo brain", so something to be aware of.

Now, let's get into the day by day overview!

Tuesday, April 2nd:

First day of chemo (covered in update #5).

Wednesday April 3rd - Thursday April 4th

Steroids are great, highly recommend.

I felt good until 4:00pm on the 4th when I had a bit of a crash and needed to nap. I'm typically a very high-energy person, so this was irritating.

Mikayla wrote me a friendly reminder on the mirror to close the toilet lid.

It turns out that if I go pee and don't close the lid, particles of Chemo can get in the air which can be bad exposure for the people you live with (only lasts ~72 hours after a chemo round though). I've been better at closing the lid ever since.

Friday April 5th - Sunday April 7th:

I'd say these were the toughest days. Steroids wore off, and I felt more woozy than the previous few days. Thankfully, I still was able to work at least half the day.

Mikayla and I had a break and walked around Prospect Park with Tupper.

It turns out that Mikayla has a stress fracture in her left ankle, which she somehow managed to run a marathon in. We discovered this fracture after the marathon (hence, the boot).

Mikayla also got her first Sweet 16 invite from her mentee at the Girls Club NYC.

Ron Miasnik came by the office to co-work on Sunday the 7th and proceeded to eat most of the fruit there.

I cleaned up the space a bit... looking fresh, intros AI office.

Monday, April 8th - Friday, April12th

I was feeling ambitious and told myself I'd work out every days this week. And I did!

They were shorter workouts, but I still got through them.

I still felt more tired than usual, but it was manageable.

On the night of the 12th, I was feeling bold, so went to my friend Daniella's birthday party.

I also stopped by Jamie's house warming for a few minutes, but needed to leave early because I was starting to feel nauseous.

Saturday, April 13th

I felt inspired on Saturday morning, so I wrote up a short analysis of this new app called Airchat that was built by one of my "idols" named Naval.

Naval reposted the write up to his 2.3M followers and it got over 100k views! I've been following this guy for 6 years, so that felt pretty cool.

He also DM'd me and told me he's heard about intros AI!

After showing Mikayla this for the 3rd time she said: "Babe you becoming God to a bunch of mega nerds is not on my list of priorities right now."

Mikayla and I decided to start "co-work and chemo" where every few weekends I have a few friends stop by and we co-work.

It's still in the works, so we haven't really started inviting folks yet (if you are on this newsletter and based in NYC, you'll hear from me on this over the next few months).

I can't be exposed to too many people at one time (immune system is out of whack), so this is a good way to spend time with friends.

Here's my initial 5-minute logo concept.

Sunday, April 14th

Our new couch came in!

Here's another view, thanks to Mikayla's long arms.

Monday, April 15th

I told all of my company's investors and advisors about the diagnosis. I also made a fun formula to determine how I anticipate this will impact my work output over the next 6 months.

They were all supportive.

Here's what I shared:

~ [I have cancer and basic info] ~ ...

Then...

"As for the chemo timeline: I started Chemo last week, and I'll have another round every other Friday from April 19th to September 20th (12 total rounds, 1 down and 11 to go). Here's a picture of me (with my mom and girlfriend in the background) for the first round.

I'm still unsure if fundraising rounds or chemo rounds are worse...

Personal productivity framework:

For those who know me well, you know I geek out on frameworks. So I made a framework to determine the impact I anticipate chemo will have on my individual output over the next 6 months.

David's output = * .

Time In

• Typically I'm able to work: 65-70 hrs a week
• 10:00am - 9:00pm Mon - Wed
• 10:00am - 8:00pm Thurs - Fri,
• Between 10 and 20 hours over the weekend
• Total of 65-70 hrs a week
• Now I'll likely need to work: 45-55 hours a week
• 10:00 - 7:00pm Mon- Friday
• Only 5-10 hours over the weekend
• Total of 45-55 hours a week

Energy Level

• Typically my energy is at: 100%
• Call it 100% with no energy dips (for the sake of a simple baseline).
• New energy average will be at: 65%
• Currently at around ~80% energy (80% of the time)
• I have occasional dips to 50% energy (20% of the time).
• My average energy is at around 74%.
• Chemo is cumulative, so each round will likely wear me down a bit more.
• If I drop around 2% energy each round, and my occasional dips are consistent at 50%...
• My average energy over the next 6 months will be right around 65% (68% for 80% of the time and 50% for 20% of the time).

So...

Previous David output = (67.5 hours * 1.00) = 67.5 output units

New David output = (50 hours * 0.65) = 32.5 output units.

All that said, this means my output is going to be about half what I would typically produce.

• Thankfully, I'm not the only one working on Intros AI, so this won't slow us down too much.
• Who wouldn't benefit from an excuse to better prioritize?

What you can do to support: continue helping me build Intros AI. Be extra supportive when I ask for customer intros, talent suggestions, etc.! Yes, I'm pulling the cancer card to get you to be more active investors. I would be doing my stakeholders a dis-service by not using this to the company's advantage when possible.

I casually mentioned having cancer to the head of entrepreneurship programs at Yale the other day and you'd be shocked at how quickly the conversation turned from "should we buy this thing?" to "We're in for a trial, how will we implement this product?".

Don't worry, I'm only going to use the cancer card weekly to biweekly.

Serious side-note: there was a short period there where we weren't sure what the diagnosis was. There was a real chance that it could have been far more serious (ie. Non Hodgkin Lymphoma or Grey Zone Lymphoma).In that time period I came to terms with the truth that if the doctors told me that I had 5 years to live, rather than another 80 years, I'd still spend my time building Intros AI. There is nothing else I would rather do."

One of my investors named Morgan replied: " David! I almost feel bad for lymphoma - you're going to kick its ass."

Morgan knows me well.

Tuesday, April 14th - Thursday April 18th

I started to more-clearly lose my hair. Granted, I've been balding for a minute now.

In order to get mentally prepped, I tried a bald face filter.

Second bike-to-work day of the season was on the 16th of April.

Sleeps gotten much better.

Overall sleep is up 17%, and slept debt is down 20% from last month.

Resting heart rate is starting to trend back down towards the 50s range where it was before symptoms started in August '23.

My Heart Rate Variability is about 2x higher than it was before chemo started, and 65% higher than a month ago. This is a crazy improvement, almost back to where it was prior to cancer symptoms in August '23.

I've also finally stopped my nightly melatonin, which initially helped me ween off the previous sleeping pills a few months back!

This brings us to my second round of chemo.

I'll be covering some of the drama there in the next update, so stay tuned.

Shout-outs

I still can't thank everyone enough for their endless support <3.

These care packages and letters make my day!

CC Gong sent over a beautiful assortment of wellness stuff.

Mikayla's Grandparents (who gave me permission to also call them Memaw and Pappap now) sent along a comfy blanket.

Eliana Berger sent me this wicked comfy hat, some card games, and a blanket, and a Visa gift card to go towards a house cleaner.

My cousin Andrew sent over a few of his favorite books around getting through hard times. Planning to pick up Alone at Dawn this week.

Aish Rathi got me a ton of stuff -- from Pringles and face masks to an iconic "fuck cancer" bracelet.

[I would have a picture here, but I already ate all the snacks already & the bracelet is in my backpack with a few other good luck charms].

Brooke Presten sent along dinner for Mikayla and I the other day.

Philip Ruffini sent along some of the world's best face moisturizer (along with one of his favorite books and some other goodies).

Nisreen sent over a ton of stuff including a waffle blanket because my nickname in the community world is "the brunch guy". She also sent a DoorDash gift card for Mik and I to grab some dinner!

Mikayla got me some slip on crocks - big fan.

Mr. and Mrs. Luongo for sending over a delicious assortment of fruits and nuts.

Benny Fellows, Michael Ioffe, and Brandon Beckhardt stopped by to co-work.

Benny mentioned how "Cancer is the ultimate excuse" to get out of anything. He's so right.

Sam and I started talking about ways Hospitals could use Intros AI. It slowly turned into some golden cancer comments.

Thank you for making this period of my life as easy as possible.

I'll be sending the next update over the coming weeks, covering my second round of chemo and more reflections to come!

Love,
David