In January 2023, 70-year-old fitness coach Howard Aaron was preparing for the Arnold Classic, an international weightlifting competition—one of the many he has participated in throughout his nearly 40 years as a fitness coach. In March, training came to a sudden halt.
After several months in which he exhibited signs of confusion—often forgetting where he was on routine drives to work and errands near his home—Aaron’s family and friends urged him to go to a hospital where he received a shocking diagnosis. He had intravascular B-cell lymphoma, a rare form of blood cancer that infiltrates the blood vessels, which has fewer than 0.5 cases per one million annually.
“I knew the downside—cancer winning this battle,” said Aaron. “But for any competition I’ve competed in, I’ve adapted a method of mental, emotional, and psychological preparation to handle it. I took on this cancer as if it was another competition.”
One in a million chance
Intravascular B-cell lymphoma is a condition that affects the lumen—the passageway for blood flow—in blood vessels. This aggressive and fast-growing lymphoma can often be difficult to diagnose as it comes with a slew of complex symptoms, such as memory loss, fever, and unexplained weight loss, that can be associated with other conditions. Because the disease is along the blood vessels, it can also cause clots or ischemic episodes that are similar to a stroke, resulting in loss of cognitive ability. Since a biopsy is typically required for diagnosis, this condition was previously only discovered in a postmortem examination.
It was Aaron’s friend, a thoracic surgeon, who recommended having brain matter tested, leading to his rare diagnosis. Once he learned what he had, Aaron transferred to Penn Medicine for his treatment.
“Howard will tell you that he was doing great and then, suddenly, he wasn’t. The symptoms are subtle, unlike other lymphomas where you may have a big mass,” said Sunita Nasta, MD, a professor of Hematology-Oncology in the Perelman School of Medicine at the University of Pennsylvania, who was part of Aaron’s care team. “I tell people that lymphoma is like a roller coaster. You can go up the hill with it for a while before your body hits its limit. You want to catch the lymphoma early before it goes down the other side.”
Aaron recalled his first meeting with Nasta, over a video call with his daughter, before arriving at Penn. Nasta described how in her more than 20-year career, she has treated seven cases of intravascular B-cell lymphoma, and all seven patients are in remission. She told Aaron he would be the eighth.
“If my oncologist believes I have the strength to go through treatment, that gives me the mindset that I can do this,” Aaron said. “I wasn’t going to let her down."
Becoming ‘Ocho’
Aaron scheduled video calls to train his clients from his patient room.
By April, Aaron started calling himself “Ocho”—the Spanish word for “eight,” designed on t-shirts worn by him and his family—and embarked on his journey to become Nasta’s eighth patient treated for this rare condition.
As he underwent an accelerated regimen called R-dose EPOCH chemotherapy, which requires a six-cycle treatment of infusions—traveling from his home in Penn Valley, PA to Philadelphia and staying in the hospital for five days, every three weeks—he documented his experience through a series of Facebook videos. He uploaded videos to share the status of his treatment and motivational messages with his followers.
“Some of my followers were people who were also battling cancer,” he said. “They apparently saw my videos and put my positive thoughts into practice. They told me that it helped them.”
Although treatment paused Aaron’s training for bench press competitions and going to the gym to coach his clients as a personal trainer, he still made fitness an essential part of his life. In between appointments at Penn, he scheduled video calls to virtually train his clients from his patient room, instructing them on how to perfect their form during a workout. He wanted to continue helping them achieve their fitness and nutritional goals.
“I tried to make myself as busy as possible. It helped me get through everything,” said Aaron. “I kept my commitment to my clients, and I appreciate them for sticking with me through the most challenging time of my life.”
Nasta described Aaron as the “poster child” for this treatment, inspired by his determination to maintain his fitness: “He kept himself active, exercising and eating well, which has been shown to improve outcomes in patients with lymphoma. Resting when you need to is fine, but if you can stay active, that’s key toward long-term survivorship.”
Good news and gratitude
Aaron recently got a tattoo to commemorate his journey to becoming “Ocho.”
In August, after four months of the rigorous six-cycle regimen, Aaron received good news. His body had responded well to the chemotherapy and there was clearance of any sign of the disease on his scans.
“I took a big sigh of relief. I know I’m not in the clear just yet, but I’m moving in the right direction,” Aaron said. “I’m so fortunate and blessed that a place like Penn is in Philly. From the student nurses to the doctors, I had the best caregivers out there.”
Now in remission, Aaron has a new perspective on life. He has reorganized his work schedule to relax and spend more time with family. He has also resumed his training for bench press competitions, hoping to attend an upcoming event in spring 2024. While he has reduced his number of training sessions with clients, now working only a few days a week, he has no plans to retire anytime soon.
“I’m here to help people,” said Aaron. “And I’ll be doing that as long as I can.”