Saturday, November 29, 2008

A good start to a great day...

If any of you know me, you may know that I have a hard time being quiet. And, further, an even harder time being quiet and still at the same time. Well this morning, I was rewarded for waking up early and doing so. Bear with me; here is my reward:

--For God, who said "Let light shine out of darkness," made his light shine in our hearts to give us the light of the knowledge of the glory of God in the face of Christ.

But we have this treasure in jars of clay to show that this all-surpassing power is from God and not from us. We are hard pressed on every side, but not crushed; perplexed, but not in despair; persecuted, but not abandoned; struck down, but not destroyed. We always carry around in our body the death of Jesus, so that the life of Jesus may also be revealed in our body. For we who are alive are always being given over to death for Jesus' sake, so that his life may be revealed in our mortal body. So then, death is at work in us, but life is at work in you.

It is written, "I believed; therefore I have spoken." With that same spirit of faith we also believe and therefore speak, because we know that the one who raised the Lord Jesus from the dead will also raise us with Jesus and present you with his presence. All this is for your benefit, so that the grace that is reaching more and more people may cause thanksgiving to overflow to the glory of God.

Therefore, we do not lose heart. Though outwardly we are wasting away, yet inwardly we are being renewed day by day. For our light and momentary troubles are achieving for us an eternal glory that far outweighs them all. So we fix our eyes not on what is seen, but on what is unseen. For what is seen is temporary, but what is unseen is eternal.-- [2 Cor 4:6-18]

A guy named Paul, who started out his life as a pretty bad dude, having even murdered people who followed Christ, had a complete life-changing conversion in his heart and subsequently did some truly amazing things for God. He wrote these words and they are as alive this morning to me as they were two thousand years ago to those who seeded of the faith.

Thank you, Lord, for letting a fidgety and all-too-often distracted boy like me have time this morning to sit with you and hear what you're saying to me.

Thursday, November 27, 2008

Thanks. Given.

So I was going 78 in a 60? I was just passing that slow mini-van, really. But how was I supposed to know that spacious 4-lane road was only meant for 60 mph? Well the TN State Trooper decided it was pretty evident and let me have it. And why wasn't I able to find my current proof of insurance in the glovebox? I always keep that stuff in order, but today just wasn't one of those days. Luckily, I have rationalized the fine I will pay as a tax that serves the greater good of that beautiful state and therefore, I can rest.

In some reading today, I learned a bit more about how cancer treatment clinical trails work, what the success rates are, and a little more about other types of Lymphomas (Hodgkin vs. Non-Hodgkin, indolent vs. aggressive growth, follicular vs. diffuse large B-cell). A few noteworthy items: the overall success rate for curing my kind of Lymphoma with R-CHOP is about 50-60%. That's only a little better than the flip of a coin. What gives me comfort is that young age and general good health should take that number upward. I suppose one individual cannot really perceive on a daily basis a few percentage point movement for or against a successful outcome, but I hope to become one extra datapoint that keeps the trend moving upward.

One other interesting thought: most cancers, including prostate, breast, and colon, are on the decline. A few, however, are on the rise: Lymphoma, Myeloma, and Kidney. Lymphoma itself is increasing 3-4% per year, in fact. Why is this? The logical default (apart from people living longer) is there must be a social or environmental impetus. With a million different variables flying around us, we're certainly far too early in the history records to have a clue what it could be. Maybe sticking my head in the microwave wasn't such a good idea. I am kidding, of course. I take solace (sort of) in thinking that a few generations from now, we'll simply rub a topical cream on the area of the skin where the cancer lies within, and things will clear up in 48 hours or less. Won't that be the day. No more leaching!

A final point: in a recent sample of 600 cases referred to Memorial Sloan-Kettering for a 2nd opinion, 18% of initial cancer diagnoses were ultimately re-classified in a way significant enough to change treatment. Wow. That's more 'art' in this 'science' than I would've anticipated. Not that I suspect any changes, but I am waiting to hear back from the pathologist at Vandy who will re-cut my slides and echo a reading on things. Maybe it's benign after all? Either way, we'll be thankful and life will never be the same. For the better.

Well I better get to bed so I can wake up at 4:45am for those door-buster giveaways at Macy's. Riiight. You've got the wrong guy. I guess consumerism is more like cancer than we may realize. Thanks for the read, my friend.

Tuesday, November 25, 2008

A good day...

Guess who has no signs of Lymphoma in his bone marrow?? That's right! We heard today these results from the biopsy and were elated. In additon we had a great afternoon with a very nice Oncologist at Vandy who echoed with almost perfect consistency the same treatment advice we had been told in Atlanta. Rather than elicit further doubts, I believe we're on the road to greater certainty and conviction.

One thing that is new info, but not too material, is that there is an indication of the cancer in the lymph nodes near my small intestine/upper abdomen. While this is a 'new' location for seeing the cancer, it still keeps me at a stage II and does not materially change the outlook.

Since this cancer has decided to attack my GI-tract, I will likely need a colonoscopy (a wrong way journey up a one-way street) and an endoscopy (tube going from the mouth down into the upper GI) mid-way through chemo in order to visually see those places, rather than rely on a PET scan.

All in all, the 'R-CHOP' chemo regimen will be the course of action. I will start as soon as feasible and can expect 6-8 sessions with a scan and the 'scopes' (mentioned above) after the 4th treatment to see how things are progressing. What scares me now is just how potent these drugs (poisons, really) are, and what are the lasting effects on the human body. I guess these lasting effects are at least better than those of untreated cancer!

Today, the doctor was very clear: if left untreated, I would most likely be dead within a year. Sobering, indeed. So let's get moving, right?

A reader's digest for R-CHOP:

R - Rituximab is a monoclonal antibody given as an infusion over several hours on the first day of treatment and more quickly with each subsequent treatment, once it's evident there are no allergic reactions. It is an immunotherapy that targets these cancerous B-cells. Side effects can include a harsh infusion reaction, fever, chills, nausea, weakness and headaches. It also can lower platelet and white blood counts, increasing the chance of infection. So, if you're sick or think you're sick, please do me a favor and stay away (for now).

C - Cyclophosphamide (also called Cytoxan/Neosar) is a derivative of mustard gas. It slows or stops cell growth. It also lowers the immune system’s response to various diseases. Side effects can include nausea, vomiting, bone marrow suppression, mouth sores, diarrhea, bladder irritation, alopecia (hair loss) and lethargy.

H - Doxorubicin (trade name Hydroxyldaunorubicin, hence the “H”) is an antitumor antibiotic known as “Red Devil” because it turns your urine bright red. Side effects can include nausea, vomiting, neutropenia (decrease in white blood cells) and hair loss. The main danger is heart arrhythmias and congestive heart failure, which is why there’s a lifetime cap on dosage.

O - Vincristine (trade name Oncovin, hence the “O”) is a “besicant” that causes extensive tissue damage. It interferes with cell growth, both cancerous and normal. Side effects can include peripheral neuropathy (nerve damage, usually temporary), hyponatremia (an electrolyte disturbance), constipation, hair loss, low blood counts and weight loss.

P - Prednisolone is a corticosteroid drug taken orally for five days with each treatment. It decreases inflammation around tumors by interfering with white blood cells. Side effects can include fluid retention of the face, acne, constipation and mood swings. It can also cause blurred vision, increased thirst, confusion, nervousness and insomnia.

So... so long as none of those side effects take hold, and I don't have permanent heart damage, and the chemo kills all the cancer, and I do not relapse, I should be all set. In other words, keep praying.

On a side note, forgiveness is a beautiful thing. I would encourage any of you who may be holding onto something, regardless of how seemingly insignificant, and take it to the place where it belongs: at the Lord's feet. Having a weight lifted from you and hearing forgiveness spoken aloud is enacting freedom. I have enjoyed some very tender moments with Candace today. I've been gifted with a wife who is understanding, loving, and very compassionate when it comes to my shortcomings. Maybe you, too, can re-connect with a friend or loved one (or maybe even un-loved one!) in any areas that need to be let go -- once and for all. I promise you will be lighter on your feet for doing so.

Onward and upward. Let's do this.

Monday, November 24, 2008

Half of something is still something...

Well maybe the bone marrow biopsy takes a little longer and so the verdict is still forthcoming on that front, but at least we got word back form the PET/CT scan. The good news: the cancer appears to be in my abdominal area only (more or less near my appendix), and is not in my spleen and not above the diaphragm! This is good. So, I'm a stage II if the bone marrow comes back clean. If not, I think I hop up to a stage IV (which I do not want).

Tomorrow is a big day for us. We're heading out early to drive to the Vanderbilt-Ingram Cancer Center in Nashville for another opinion on treatment. From what I've read and seen (a la Google searches), Vandy is a regional leader in cancer treatment and education, and they have some docs who know a thing or two about Lymphoma. We'll be in the car for the first half of the day, and then with the oncologist the second half of the day. What's more, I'm from Nasvhille, so I'll be in the company of my family and some long-time friends.

I've been requested to give 4-5 samples for cryogenic sperm freezing at $300 a pop. Why do these chemo drugs have to be so indiscriminate? I mean, people, please. The prospect of having to wait an indefinite amount of additional time to only have a chance at having children saddens me. I've not yet even begun to allow myself to think about what that grief would look like. My dear wife has to carry this burden with me, and I think it's safe to say that she is as uncertain and unsure about how she feels as I am.

Candace came home today with oodles and oodles of selected 'goodies' from Whole Foods. Everything from vitamins to something that says on the label "Increases Natural Killer Cell Activity". This must be like lightning in a bottle. I'd love to take these horse pills but some of them are so large they could float the Panama Canal. Nooooo way. Maybe with a little yogurt I can coax them down. I am new to pill swallowing, but that's another story for another day.

On another positive note, I was able to connect with a friend of a friend who beat his Lymphoma. He had it 10 years ago, got some chemo + radiation, and has been in remission ever since. There's an unspoken connection when you're able to share stories and fears with someone who has been in your shoes. I imagine that many of you can echo that sensation, for one reason or another.

Rest well, all of you.

Sunday, November 23, 2008

Let Monday bring good word...

Well the weekend fared well, as I am healing from my appendectomy incisions and feel fine overall. Surgery is an easy way to lose a little weight, but it sure isn't the best way! This one will be quick: tomorrow I should find out, based on the PET/CT scan and bone marrow, what stage this little bugger is. It'll be anywhere from Stage I (localized), Stage II (in multiple areas, all below the diaphragm), Stage III (on both sides of the diaphragm, which must be the Mason-Dixon of cancer staging), or Stage IV (in my bone marrow).

Come on, low numbers, low numbers. We'll see. While the staging most likely won't change the treatment protocols, it will have a bearing on our likelihood of success. So, to me, Monday is a big day.

While I feel less and less that I'm writing about someone else and am coming more to a realization that this is a fight I cannot avoid, I know that any fear can be met by the Word and presence of the Lord. And that is my focus. Goodnight for now.

May the Lord bless and keep you.

Friday, November 21, 2008

Bringing up to speed...

After lunch last Wednesday (11/12/08), I got what seemed like a stomach ache. Thinking it was something simple and temporary, I stuck around the office... in modest discomfort. When I got home, I laid on the couch but just couldn't seem to get comfortable. A close friend of mine who is an ER doctor was kind enough to come by and take a look at me. I was very tender to the touch in my lower right abdomen. He suspected that it was either gas lodged in my digestive system that would eventually pass with time, or less desirably, it could be my appendix.

I tried to fall asleep, despite the discomfort, only to wake up an hour later just after midnight with the most intesnse and uncomfortable pain I've ever felt. It was a combination of being kicked full-on in the groin plus having a thousand pound weight sitting atop my bladder. Natually, I hobbled to the bathroom, trying to go. No such luck. When I stood up, the low blood pressure, coupled with the intense pain, caused me to pass out briefly -- only to utter to Candace to I needed to get to the ER - and quickly.

I was unable to walk down the stairs, so I had to scoot. I must've yelled out to Jesus, audibly, a hundred times. Despite that unbearable pain, He guided me one baby step at a time to the car. Once at the ER, being unable to get vital signs on me, they proceeded to hook up an IV and deliver some pain meds. This was a nice surprise. Five minutes later, I felt neutral to good. Wow. I remarked on how happy I was that someone, somewhere, figured out what we can put in our bloodstream to disconnect us from our pain. What a concept. It took on a whole new importance and relevance when it was me who was being guarded from the pain.

After a CT scan confirmed that it was indeed appendicitis, I was eventually rolled back to a pre-op area and then finally into the OR around 4:45am. The general anesthesia was, again, a marvel to me. They removed the appendix laprascopically. One incision at my belly button to insert a cauderizing cutting tool, another small hole below my belly button to insert a camera/scope, and finally another small hole below that to pump my abdomen full of CO2. Wow.

I was fortunate enough to be the only male who was admitted to the OB/GYN floor for my recovery. Got some funny looks when people would come in and wonder why the male was tucked in bed, while the female was sitting bedside in the chair. Surely something wasn't right about that. I spent a day there. Walking to the bathroom was pretty much the highlight of the day. Oh, yeah, and throwing up was an added bonus. Once able to keep down a little cup of sugar-free jell-o, enough progress was made to get the clearance to head home... which we did.

To fast forward, after some shaking (rigors) and a fever north of 101 and change, I had to head back to the ER two days later for an x-ray and some blood work. This revealed an infection due to the catheter used in the operation. More meds - yyyeah. So back at home, I slowly got back on my feet. I even hobbled into work the Tuesday after. Daytime TV made me do it.

Wednesday of this week is when it got interesting. I went alone to a simple post-op doctor visit at Piedmont where they were to make sure my incisions were healing nicely. And they were. The doctor then added that they had sent the appendix off to the pathology lab, as is customary, and the results had come back abnormal.

In addition to being "extremely enlarged" (instead of being pinky-sized, was >5" long by >1" wide), the cells demonstrated an abmormally active growth pattern consistent with a blood cancer called DIFFUSE LARGE B-CELL LYMPHOMA. Simply put, your lymphocytes are white blood cells that travel in a unique network among your numous lymph nodes, fighting infection and bacteria in your body. Mine are abnormal and propagating much too rapidly. This hyper-growth caused the appendicitis, and was indicative of cancer being in my body.

I spent the rest of the afternoon telling close friends and family. I am ever-grateful to all of these people who droppped what they were doing, sat with me, listened, prayed, and reflected on what I had just learned. Thank you, thank you. While this is only the very beginning, I trust you will be alongside me every step of the way and cannot thank you enough.

The very next day, I had a long afternoon with an oncologist. He said that my type of Lymphoma is a 'good' one to have, as it grows very aggressively, making it more responsive to treatment. While he would stage it (I, II, III, or IV, an indicator of how extensive the cancer has spread), the treatment protocols would largely be the same: chemotherapy.

The spcific regimen is called 'R-CHOP'. This are a cocktail of chemo drugs designed to attack all of the growing cells in my body. He wants us to start in the next week or two. In addition to losing all my hair, it will kill my sperm count for an indefinite period of time. Candace and I have been trying to conceive for a few years now, so this is a particularly harmful side-effect for us. I am hoping I will be able to freeze some ahead of time to have on backup. In addition, nausea and immune system depression are the obvious side effects to chemo that I don't like to think about.

In order to stage the cancer, I needed to have a PET/CT Scan (which I did today) and a bone marrow biopsy, which I went ahead and had done right there and then when I was speaking with the oncologist yesterday. I wanted to check a box -- anything -- to make some forward progress in my journey!

Having a bone marrow biopsy kinda feels like someone sticking a big needle into your pelvis and sucking out some of your bone marrow(!) I just hate it when they do that. I was lying on my stomach, making awkard noises and making rapid jittery movements -- anything to distract me from the sensation of a needle thrust through the walls of my bone or the very life being pulled out, 5 ml at a time! One point worth mentioning, as the doctor's muscles quivered to push the needle through my pelvis, he said, "yep, yep, good strong bones here..." I got a laugh... well after the fact, however.

The PET/CT scan was fun. I got an IV with a radioactive glocose inserted into me. It is a fluouride solution mixed at a nuclear pharmacy within hours of being administered into the bloodstream. After 45 mins of sitting still (no reading or iPods allowed, as the mental activity would draw too much blood into your brain), I laid on a thin gurney, with my arms above my head, for 30 mins in 'the tube' -- completely still. It was interesting to see just how stong the mind can be when you feel the urge to scratch several itches -- yet cannot.

And so here we are. 48 hours +/- after my world got a little more interesting. Thanks for sticking it out thus far. This blog will probably be the place to get an update on how things are progressing with my chemo, and hopefully I will be able to capture some of the sweet moments, called life, along the way.

I feel, at the outset, that this entire experience will be a faith-building (and strengthening) experience for me and hopefully those around me. Having no choice but to slow down in life will force me to connect my head to my heart a little better, and really tabernacle with the Lord in the here and now. That's really the only place that He can meet us: not in the nostalgia of the past, or the fear of the future... but right here, right now. There is no grace for events that never come about, so let us not spend any time worrying about whether they may come or not.

Let us just sit for a moment, at these crossroads of uncertainty, and meet God right here. To Him be all the glory. It is well.


Well I suppose getting cancer is enough of a reason to start a blog, eh? So, here we go... more to come. Thanks to all who have taken a moment to read along...