A chronology

If you'd have asked me on January 4, 2004, I'd have told you I was in the best shape of my life. I'd spent the previous several months living cheap, and eating well (in quality if not quantity). In August of '03, I'd started graduate studies in philosophy at the Catholic University of America (CUA). I'd secured a stipend from the physics department, doing bits of analysis with the nuclear physics group, but $1000/mo (before taxes) doesn't go that far in Washington, DC. I was walking everywhere, playing ultimate frisbee twice per week (football when the weather turned), eating low fat (pasta and rice are cheap) with lots of fresh fruits and veggies (surprisingly cheap, certainly compared to frozen entrees and the like). I'd lost a few pounds, could run non-stop for a week, and was feeling great. Then everything changed, literally overnight.

During the night of January 4, I'd started feeling sick -- pains in my lower right side, combined with a nasty queezyness. As things got worse during the day on the 5th, I called 911. As they brought me to the hospital, it became clear that I had appendicitis. I'd wake up in a few hours after a routine surgery, spend maybe 2 days in the hospital, then go home to continue studying. I woke up early morning on the 6th -- much later than the couple hours I'd expected -- and was told I had adenocarcinoma of the appendix. My cancer started in my appendix, but by the time we'd discovered it, had spread throughout my abdominal cavity, growing on the surfaces of my organs. They could remove the primary tumor and several of the larger chunks, but there were too many smaller tumors (not to mention the unseen microscopic elements) to hope that the emergency room surgery could leave me cancer free.

From here I'll just hit the highlights: in mid-February, I started a chemotherapy regimen called FOLFOX. I took three months of this, with a one-month break before undergoing cytoreductive surgery with hyperthermic intraoperative intraperitoneal chemotherapy with Dr. Paul Sugarbaker of the Washington Cancer Institute (coincidentally, just down the street from CUA) on June 30, 2004. The short of it is, Dr. Sugarbaker cut me open, then spent approximately 8 hours over my wide-open abdomen, meticulously stripping my abdominal lining (the peritoneum) of any visible aspects of cancer. Then, before sewing me up, he poured chemotherapy into my open abdomen, heating it so that it might penetrate more deeply into my organs. In this way -- and only in this way, according to what was then (and presently) known -- was there some hope that my cancer could be completely wiped clean.

In August of '04, as I recovered from this surgery, I began a second chemotherapy regimen, with a drug called irinotecan. I took this for three months, before seeing Dr. Sugarbaker again in mid-December for a "second look". After this "second look" surgery, all signs looked good -- in Dr. Sugarbaker's experience, I should have had something like an 80% chance of full cure.

In September of '04, I interviewed for a position in Munich, Germany. A return to philosophy was out of the question, as I needed work that would provide insurance to cover future medical expenses, and would also likely finish '04 with extensive medical bills. When given a positive outlook for recovery, after the struggles of '04, I figured a European adventure would be fun, while also getting myself back on a career track. I left for Germany at the end of February '05.

In May of '05, during a routine staging/check-up (consisting of blood work and a CT scan) we discovered that my cancer had returned. This time, inside my liver and lung -- once the cancer appears inside the organs, we are beyond the reach of surgery. And for that matter, beyond the reach of a known cure. From this point, I take chemotherapy and seek other treatments to keep the cancer at bay, to maintain some quality of life, and hope, in the meantime, that a cure presents itself (and, as a man of faith, I welcome a cure either by natural or supernatural means). Starting in June '05, I began a chemotherapy regimen in Munich with the drugs carboplatin and taxol. I took this regimen through November of '05. My disease stabilized, and I was went till June of '06 before any new growth appeared.

In August of '06, I underwent a 4th abdominal surgery to clean out some particularly troubling tumors, then began chemotherapy again, with irinotecan plus the anti-body erbitux. In January '07, I returned to the US, beginning work outside of Washington, DC. Through April of '07, I continued with this same chemotherapy regimen. A mid-April staging suggested that my tumors were again growing, motivating a return to the carboplatin/taxol regimen. Shortly after beginning this new/old regimen, I made the move to Knoxville, where I am today. A recent (June) staging suggested that, while the treatment was working on some of my tumors, it was not working on others -- in particular, the tumors in my liver (the more dangerous of my tumors) were still growing.

And that brings us up to date. There remains one last untried "standard" treatment option (xeloda), which I expect to begin in the next week. There's really no telling how well it will work. While I hope that it can arrest the growth of my cancer, perhaps even stabilizing it to where I can get an extended break away from treatment, there are no guarantees. Regardless, my personal ambitions really don't (or at least, they shouldn't) change. That is to be a good man, a virtuous man, a man of constant, humble, prayer. I'm far from being such a man, but I'm giving it a shot, so long as I have one.

A picture from Lucerne

Just wanted to post a picture from my time in Europe. This one is at Lake Lucerne. Last June, I took a long weekend to visit my good friend Zema, living at the time outside of Zürich. We got a day-pass for the rail, and managed to see bits of Zürich, Lucerne, and Bern in one day. Very cool. (And thanks, Z, for taking the pic!)

Barista love

None of my baristas in Munich ever called me "sweetie". But they were totally hot for me, this I know. Unlike this poor guy.

I'm Superman...

...or is it Spiderman?

Which superhero are you?

Quote for the day

My soul proclaims the greatness of the Lord,
my spirit rejoices in God my Savior
for he has looked with favor on his lowly servant.

From Mary's prayer of praise (the Magnificat), during her visit to see her cousin Elizabeth, then carrying the unborn John the Baptist in her womb. One suspects that she knew -- if not specifically, at least in a general way -- that her "yes" to God, her agreement ("let it be done to me according to your word") to carry and raise the salvation of the world -- would be a great struggle. She accepted such responsibility and considered it a favor -- knowing that faithfulness to God offers its own reward, though as yet unseen.

I don't claim to have the faith or courage of Mary, but I use this as my sig to remind myself of my ideal. I can, in more reflective moments, see my cancer as a "favor". Virtue is both brought into being and revealed through struggle. In my struggles with cancer, I can see a little more clearly just who I am, while I approach (God willing) what I wish to be.

E-mail update from July 14, 2007

Just wanted to pass along the latest news from my recent CT scan and blood work. As I mentioned in the last e-mail, we were expecting good news -- the near-the-surface tumors were clearly smaller, I was cutting back on my pain killers (suggesting improvement in the bones), and had the experience of this treatment working previously. I was feeling pretty good, too, for the most part.

Anyways, I had a CT scan a week ago, and got the results on Wednesday, when I went in for what should have been a treatment. In something of a surprise, given how good things were looking, it turns out the tumors in my liver have been growing. I guess they've adapted to and are no longer responding to the treatment. These are, of course, the dangerous ones...the ones that really dictate when a change is in order.

So, what's next? We've got one (maybe 1.5...depending on what kinds of drugs we can add to the supplement one) more standard and approved treatment option to try. It's a pill form of a drug I'd taken back in the Spring of '04 at Northwestern. We have no way of really guessing how well that regimen worked -- we weren't yet checking my one good tumor marker (that showed up as a good marker with the first Sugarbaker surgery), though we can say that there wasn't great growth during the months I took it (nothing was popping up bigger on the CT scans during those months). I suppose taking it orally allows it to be absorbed into the system in a different way...not sure how that might make it more effective, but I suppose it could.

Beyond that, we're looking at clinical trials. Given that my cancer is pretty rare, I'm not gonna qualify for many of the experimental options out there -- at the "trials" stage they're looking to accumulate data on how well a given treatment may take out a particular kind of cancer. There just aren't enough folks with appendix cancer to warrant a full scale study of treatment options specific to it. This means that my "experimental" options are mostly going to be limited to very early trials...where they're still looking to establish the dose levels and things like that they'll use for a bigger and more specific trial. I've called the folks at Vanderbilt University, in Nashville, and they said they've got 5 or 6 such trials happening right now that I'd qualify for. We're not running there next week -- we'll give this last "approved" option every opportunity first -- but it's worthwhile to start asking around and seeing what's available.

We've actually decided to take a short break from treatment. Dr. Grapski (my guy here in Knoxville) is going to call Dr. Marshall (my guy at Georgetown) and see if he's got other ideas besides Xeloda (that pill treatment I'd mentioned). In the meantime, we'll take a couple of weeks and see if we can't do something about those cryptic "issues" I'd mentioned...problems in the lining of my digestive tract and bladder that have arisen since the surgery in Munich last August. If we can do something to get this to heal up, we open up one possible option to add to the Xeloda (a drug called Avastin, which I'd taken a bit at Northwestern. It gets in the way of the cancer cell's ability to create new avenues of blood supply. One possible side effect is the creation of or making worse of such problems as I've already got -- the issues I'm having would potentially go from mild nuisance to a big deal).

I'll probably be starting up on Xeloda (and whatever else) come the start of August.

No sugar coating this, folks -- this is bad. But we'll do what we always do when we get punched in the gut. We'll get back up, catch our breath, and resume the fight. And we'll pray. Lots.

Thanks as always for all your prayers and support.

E-mail update from June 30, 2007

In health news, recent complications arising from the surgery of last August notwithstanding (more an annoyance than anything life threatening, and it's something that hopefully is readily fixable...but in the meantime it's making life uncomfortable), things are going well. I've got a CT scan scheduled for next Friday which should confirm what we already know -- the new/old treatment is working, with the tumors near the surface (which I can feel, just beneath the skin) clearly smaller. This 4 treatments in -- if I remember right, when I took the same stuff during the fall of '05 in Germany, I took about 8 before getting my extended (6 month) break with no growth. If all goes well, I may get to enjoy the fall without treatment. No expectations here, just a modest hope.

This treatment, as I probably mentioned before, is a bit easier to take than the last, too. It comes every 3 weeks, and while that first week is probably tougher than the worst days of the last treatment, I then get 2 weeks to feel like a normal human being. I suppose back in the day, I'd be complaining about feeling like crap 1 out of every 3 weeks...these days, I'm happy to enjoy feeling good 2 out of every 3. Nice what a little struggle can do for the attitude...