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Archive for November, 2009


The long road ahead

November 28, 2009

This morning I took the bike to go to the gym.  It was early, the air was cold, so I bundled up.  It was a just a short ride (about 2.5 miles) and I could have run it if my left knee was not injured.  I did that when I was in training but this morning the short ride seems to take forever.  I had lots of things in my mind.

First, there was the discussion with Dr. B (Interventional Radiologist) last Monday, November 23.

Chemoembolization or TACE is a reliable procedure that delivers chemo drug to the affected area only, your liver.  A catheter is inserted from your femoral artery in your groin to the liver.  Once there chemo drug is injected and the artery delivering nutrients to the tumor is closed or embolized locking the chemo drug in the area.  This procedure has lesser side-effects and minimally invasive. ” Dr. B explains as he drew a liver in the whiteboard showing me and my wife.

Chemoembolization to liver

He continues, “with your profile (healthy and young), we want to try something new.  We would like to use drug eluting beads or DEB.  These beads, coated with chemo, are left in your tumor.  Once placed, they will release consistent chemo drug to the area.  Since it is new we need to find out if your insurance will cover.  It is a two-hour procedure and you will be awake but given this PCA pump you can press to deliver pain medication.  It will require an overnight stay to recover and observation.

It sounds easy.  He also suggest doing this after the holidays to give time to coordinate with my insurance and for me to enjoy the holidays.  Since chemoembolization is a palliative procedure or not a cure, I need six-months of more chemo for any cancer cells left.  Ouch.

The second thing that bothered was fear.  Fear of the uncertainty or unknown.  I get them sometimes and this time fear was riding with me on the way to my yoga class.  Similar to running, you get this same feeling at the start of every race no matter how many races you have completed or not completed.  Sure, the goal maybe a simple one e.g. just to finish the race or a lofty one for personal record.  One thing I have learned training for the marathon is you have to respect the distance.  Likewise, since this will be my second go around with chemo I have come to respect this disease.  This cancer has taken hold of my life and my normal approach of getting through it may not be enough.

I have sought solace by running, doing yoga, reading, writing or blogging, seeing friends and family, and even working.  It helps me forget and cope until it catches me unaware like on my morning ride.  So I pedal…pedal…pedal to my Saturday morning ritual of sun salutations, down dogs, and om shanty.  Peace and solitude.  As usual, the teacher prompted us to find something or someone to dedicate our practice to.  I am stuck at this thought when it has been normal for me to name one instantly.

Connect the body and the breath” Tracy says.  “One more breath and reach….

Yes.  I breathe.  And one more.  Just one more until I can reach it.  Reach what? It does not matter because I am here with my cancer doing our morning ritual.  Om shanti.

Cheers.

PS:  It was so eerie and surreal to see the tumors in my liver.  I never got to see the PET scan image but when it was shown to me by Dr. B it was like seeing the enemy.

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Happy Thanksgiving

November 26, 2009

I was just reading my post last year (Happy Thanksgiving to Everybody), and I could not help but compare the difference between last year and this year.  This time last year, I had just gone back to work after six-months of chemotherapy.  I also signed up to be a member of CARA, my local running club, as a first step towards my journey to my first marathon.  I have completed that journey and I am grateful.

For this Thanksgiving,  I am still grateful inspite of the return of my cancer.  I am hopeful some day my cancer and I will be good buddies but right now he is a pain in the butt.  I think it is like having a Siamese twin: I want to run and he says, nope don’t feel like it or when chemo time comes he keeps me awake when I want to sleep.  We need serious talk, buddy. Since this is Thanksgiving, I am counting all my blessings.  I am here making the most of my situation.  I was able to run a marathon and raised money for American Cancer Society.  I still go back read my post that marathon week (The Finish) and relive the momery of that run.  My competitive nature tells me I can do better given the chance and I will take that chance.

But things are different this time.  Not only because of my cancer but I am still nursing an injury resulting from my failed New York Experiment.  I remedied that by seeing Dr. N, an internist and sports medicine doctor this week.  This time it was my left knee and his diagnosis was damaged ligament and fascia.  He told me to see Jamie, my PT, who nursed me back from my right iliotibial band (ITB) injury in time for the marathon.  I tell you I am a mess.  But you got to have goals when you have big challenges ahead.  Mine is to get back to running.  It is also I setup for my next “experiment”.  I am curious if I can run and do chemo.  Not during, but on my recovery days to help ease the pain and give me some sanity.  I guess we will find out together.

Thanksgiving is still my favorite holiday.  I am able to share this moment with you and maybe someday share a meal of turkey, pasta, salad, or tofu, etc. (but no red meat, ok).   Happy Thanksgiving.

Cheers.

PS:  This morning my wife ran a 5K race with her friends.  It was good to see the fun fare of the start and finish of a race once again.  Although I did not run, it motivated me to get back to running soon but for now it is gobble…gobble time.

From left: Tim “the coach”, Rosie, Shawn, my wife, and Jaclyn

Turkey Trot at Edison Park: Good job let's eat!

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Hope


Hope

November 22, 2009

“Hope.  It is a lot to ask of you right now.”  My good friend Karyn of Palm Coast, FL began her card to me.  I received it yesterday.  I have received similar messages during the week when others like you have learned of my new challenge.  They all express the same sentiment; hope, prayers, and comfort.  Thank you.  I really appreciate them.

Hope is a very hard to come by when you know you will be spending the rest of your life doing chemo.  It still resonates in my mind when my wife and I met with my oncologist last week to discuss the results of my liver biopsy.

“Your liver biopsy did not tell us anything different from the PET scan.  It confirmed the cancer.  Since the tumors are in two areas of your liver, we have ruled out surgery, instead we suggest going with chemoembolization or targeted chemo.  This treatment is not a cure but intends to shrink or kill the cancer tumor in your liver. We follow this with six-months of chemotherapy similar to the one you had last year.” Dr. M explains.

Ok, so far so good.  I have accepted the fact that I will be doing chemo for a second time.  This time I hope (there is again, hope) it will be my last.  I have met people, Karyn or SallyC, who have conquered their disease and I wanted to be counted among them—a cancer survivor.  I tried my best.

Then Dr M continues “once you have completed your six-months chemotherapy, we need to put on chemo maintenance.” He intentionally left it open and saw the anxiety in my face.

“For how long?” I asked holding my wife’s hand.

“For the rest of your life.” He drops the bomb, then adds.  “We need to do this because of the type of cancer you have which is aggressive.  We can arrange it in such a way you can continue with your normal life.”

There it is again.  This disease has totally changed my life.  I had convinced myself that the finish line is after my six-months chemo and I can do this.  Now it is gone.  My new normal life, after all this is done, is a monthly or bi-monthly chemo session to contain my cancer for the rest of my life.  It means I am tethered, limited, or chained by cancer.  It means I cannot travel for an extended period of time for work.  It means I limit contact with people to avoid getting sick when my immunity goes down from chemo.  It may also mean no more marathons.  What more can I say.

I took up running two years ago to contain my blood pressure problems and got myself weaned out of blood pressure pills.  I was on track to take the pills for the rest of my life.  Then, I try to eat properly to avoid diabetes, only to be caught by cancer.  Since when has cancer become a chronic disease in the same category of hypertension and diabetes?  I can already imagine the conversation during my class reunion in the future.

“So how many pills you taking, bro?”  “Oh yeah?  My chemo trumps your blood pressure or diabetes pills anytime.  See this gadget on my hip, it is not an over sized iPod, ya kno.” (That is how my kids called my portable chemo pump).

So Karyn (and everybody), I am not losing hope.  To lose hope is not to live.  I don’t like that.  You and others remind me that hope is out there, I just have to dig harder to find it.  I still have my lottery entry to NYC marathon for November 2010 too.  This time around I no longer aim to win it because my blood will be tainted with chemo and will not pass the required blood test.  😮 As my colleague Tim said “I just heard a collective sigh from the Kenyan runners when they heard you are out.” But I will be back.

Anybody for liver sandwich or foie gras on crackers?

Cheers.

PS:  This week I meet my new Interventional Radiologist to discuss when he can schedule chemoembolization.

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Another white wrist band bracelet

November 16, 2009

She asked me to extend my left wrist.  My nurse this time is Becky, who was about to put a white wrist band bracelet on me.

“What’s your name?  What’s your birthday?” I replied.  “Good.”

Satisfied, she proceeded to attach the bracelet on my left wrist.  She’s got her man now and I can’t escape.  The last time I had one of these bracelets was when I ended up in the emergency room after having an allergic reaction to chemo.  (See my July 23, 2008 posting; White Wrist band Bracelet).  This time around I needed to have an ultrasound liver biopsy.  After giving me the news that my cancer is back and is in my liver, Dr. M arranged for an immediate liver biopsy.  That was last Friday, November 13 or Friday the 13th.

Becky joked me about it too.  Stick to nursing, Becky.

But it was a lucky day for me since I was on a waitlisting for the unscheduled biopsy that day.  A time slot opened for me so Becky and I are now getting to know each other now.  Since it was unscheduled, I did not know who was going to be the doctor performing the biopsy.  I was stripped down to my waist and was cold inspite of the warm blankets she piled on me.  She had managed to access my port-a-cath in my right chest for medication, when a lady entered.

“Where do you want me, dear?” She’s from pathology, Becky explained.  “Over there’s fine” replied Becky.

She was a modest size lady in white gown.  She navigates her rolling lab table with a microscope and several slides to a corner near my bed.  Her role in this cast of thousands was to check the liver sample tissue.  But where is the doctor?  With that thought, he walks in and goes about his business.  He checks the ultrasound gadget, dabs a cream, and puts in my right rib.

Boy,  that cream is cold.  As if reading my mind, he asks “is it cold?” What can I say…duh!  He then proceeds to clean my right lower rib with betadyne and explains the procedure.  He injects local anesthetic where he plans to make entry, then makes a small incision.  So far so good.  I see him holding what looks like a barbeque skewer with a corded handle at the end.  With a serious voice, he said.

“I want you to breathe in deep and hold.  Ok?  Ready.  Go.” My chest expands.

Then holding the skewer-looking probe with his right hand, he plunged it through the incision just below my right rib.  With his left hand he holds the ultrasound gadget to guide him.  What happened to the sedative, I thought.  No pain killers!  I feel the probe puncture in my liver and go deep.  I hear the rising beeping noise of the heart monitor as he tries to reach the tumor to get a sample tissue.  Becky notices I can’t hold my breath any longer.

“Ok, breathe.  When ready take a deep breath again and hold” he said.  The probe is still inside me.

This is counter intuitive, I thought.  You breathe to relieve pain just like when giving birth, right?  But hey, what do I know, I am just a slab of meat being poked.  So when I was ready I took a deep breath and hold.  Then…click.  He removes the probe and hands the sample to the microscope lady.

After a while she says “not good.” What the fart!  Did I just drew a rookie doctor?  I did not have a choice since I was not scheduled but this is ridiculous.

I hear the doctor discuss with Becky about getting a longer probe to reach the tumor.  I was no longer cold.  He returns and says…”we have to do it again.  I want you to breathe in deep again and hold.” I obliged just to get it over with.  I don’t think we are bonding good, doc.  He plunges it again with determined heaviness to get his pound of liver.  I hear the beeping sound of the heart monitors again…beep..beep..beep…I can do this…beep..beep..beep.…then…click.  I breathe.  This better be good or I have to do it myself, this time with morphine.

He hands the sample to microscope lady and I lay there waiting and sweating in a cold room.  Becky tells me I did good.  I was praying the microscope lady would say the magic word because I don’t I can do it one more time without passing out from pain.

“Its good” she says.  Alleluiah!  Praise God! (choir singing in the background)

The doctor tapes me up and checks for any internal bleeding.  The liver if full of arteries and there is a risk of internal bleeding if the biopsy is done wrong.  He tells me I am going to feel sore as if somebody punched me in the stomach.  Well I got punched twice.  He adds that the results of the biopsy will take time and not to expect it until Wednesday, Nov. 18.  In the meantime, I need to stay in the recovery room for four hours in case of fever or bleeding.  He cleans up and signs some paperwork.  But before he leaves, he tells me to call him if there is any problem.  I am sure I will receive his bill for stabbing me twice in the liver.  Maybe I get a discount from not having pain killers.  Oh well…

Becky cleans me up and calls my wife.  Together they take me up to recovery.  Now we wait.

Cheers.

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It’s back


It’s back

November 13, 2009

My cancer is back.

It was like a freight train when it hit me….again.  Dr. M (my oncologist) tried telling me in an easy manner but he knew there was no way to soften the blow.  I sensed he tried choosing his words carefully but somehow he could not find the right words.  He hid behind his professional facade and said;

“Your PET scan showed three lesions in a cluster in your liver.  The biggest of which is 2.7 cm.  Dr. B (Interventional Radiologist) is positive it is malignant.  There is also a thickening of bowel wall in the cecal tip area.”

There it is.  Liver.  Lesion or tumor.  Cancerous.  A major organ this time and possible recurrence in the colon area.

My brain could only absorb a few bad signals at a time but when it registers it numbs you.  I thought I was prepared for anything, I just completed a marathon.  But you can’t prepare for bad news even if you knew it was coming.  After two elevated tumor counts (August and October) from my blood tests and a sense of urgency in his voice in wanting to see me at the hospital, I knew it was going to be bad.

I asked my daughter, Talia, to accompany me since my wife had worked the previous night.  Now, holding my hand we absorbed the news.  In one swift moment everything had changed again.  My cancer is back.  Now I have to deal with it again.  This sucks.

I will post again when my eyes have dried and my mind is clear.  I have to undergo more tests.

Sincerely.

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His name was Anthony

November 10, 2009

He does not remember me.  By this time we should be buddies.  Anthony is the PET scan technician who did my two previous scans.  For this third one, I reminded him that he did my two other scans.

He is a nice guy, in his mid-twenties I think, and cute if I was a girl or gay.  Nonetheless, he was very professional.  He when through his checklist of questions e.g. did I eat or take any medication, etc.  He then proceeded to prick my finger for blood.

“Got to check your blood sugar”, he said.  With a gadget, he adds “91”.

“What’s normal?” I asked.  “Between 90 and 110.  Perfect”, he replied.

Then he gets serious with this IV needle looking for a vein in my left arm.  This time around he is not cute anymore.  He managed to find a good vein.  Funny how you notice these things the third time around.  He proceed to move this lead panel beside me and went in the back.  He came back with a cylinder he held with a thong.  Good stuff, baby, at least it is not bubbling.

The metallic container contains a syringe holding the radiated glucose.  He stays behind the lead panel protecting his waist-down and reached over.  Something is wrong with this picture, he is behind the lead panel and I am exposed.  With swift movements, he gets the syringe and injects it in the line he got.  Bam!  Dinner time cancer cells…klang..klang…klang (banging pot sound).

“Try not to move for the next 45 minutes.  We want the glucose to circulate and be absorbed.  If you move, like stand or walk, the glucose goes to the muscles, and we don’t want them there.”

“Got it.”

After 45 minutes he brings me to CT scan room, a massive magnetic contraption.  I lie down and told not to move for the next 45 minutes.  I think, that is about 4 miles of running at 12 minute pace.  If you are claustrophobic this is one place you do not want to be.  They try to make it comfortable with neutral colors and flower prints in the ceiling.  For me, I just meditate and concentrate on even breathing, before long it is over.  Not bad, really.

As I leave, Anthony, bids me goodbye.  Well, Anthony, you did good by my book but I hope this is the last time I see you.

Now we wait…..

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Define Yourself


Define Yourself

November 8, 2009

That was what the motivational poster said at my health club.  I was attending a group ride cycling class and I could not help but think of that poster afterwards.  The poster was intend to make you think about yourself and be a motivated to reach your goal.  On that early morning, my goal was just to push this stationary bike to its limits, as the instructor barks…. ‘push, push, push…stay with the group’.  His voice well above the staccato of techno music in the background.  Boom….boom… repeated rhythmic cadence.  I digress.

But the poster, also, aptly applies to everyone.  I see how people have come to define themselves in the clothes they wear (football or soccer shirts or Gucci or Nike vs Addidas).  One can also define themselves by the way they introduce themselves.  “Hi, I am Bo from Chicago (by location)” or “I am Sally, your English teacher (by occupation)”or when you are in trouble “Open up, this is the police!”  Oh no….

You choose to define yourself.  It makes us complete.  After completing a marathon, I defined myself as a marathoner.  But there is one part of me that chose to define me: a cancer survivor.  This is one part of me that I am reluctant to be identified.  You don’t actually go out there wanting cancer so can be a cancer survivor.  But I am one among them, at least for the past year.  Sometimes we do not get to choose how we define ourselves but when it does, you just got to have faith that everything will be fine.

We define ourselves multiple ways to many people.  However, it is important to know which one we really are.  The real one is what really defines us.  I am a Dad, a husband, a brother, an employee, a volunteer, etc., but one thing is real—cancer.  It made me a better Dad, husband, employee, volunteer, etc., but at the same time lousy runner.  I suck.

This Tuesday, November 10, I will have my PET scan.  It was due last month but I had postponed it in preparation for the Chicago Marathon last October 11.  It has been a year since my last chemo and my oncology nurse has been calling.  The scan will determine if any cancer cells are back.  They do this by injecting radiated sugar in my blood and let it be absorbed by my body.  You see cancer cells like sugar, they have a sweet tooth.  Once fully circulated in your body, they do an imaging scan of your body.  You have to lie still for almost an hour. (Ohmmm….)  If they see a clusters of radiated sugar activity, they got their killer (figuratively).  Caught red-handed with their hand in the sugar jar.  Hehe…

I am looking for a clean scan so I can continue to waddle on.  I am also hoping my tumor count has stabilized since my last two blood tests (August and October) were elevated.  Beyond defining myself, I have accepted what is given.  Moreover, I have embraced myself completely.  How about you?

Cheers.

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