email sent April 22, 2015

Subject:  A Glowing Response…

… or, What, Me Worry?

Yesterday, I was dosed again and met with three docs, Dr. Weiss, Dr. Spierer (radiation oncologist) and Dr. Goldstein (thoracic surgeon), to discuss the treatment plan for the emerging tumor on my right upper lobe. Dr. Spierer presented the two radiation options I mentioned in my last email – a more aggressive one and a “safer” one. My situation is unique given the location of my tumor and the overly extreme wide field radiation exposure I received two years ago. The body fully heals after about 3 years; I’m at 2 years. Dr. Spierer presented my case to two of the top physicians in this field at a Las Vegas conference and spoke with another by phone. She also studied all of the summary literature available relating to re-radiating lung tissue utilizing this highly focused stereotactic body radiation therapy (SBRT). The more aggressive approach has a much better success rate of obliterating tumors (mid-80s to low-90s percent) than the safer one (about 40-50 percent). And the side effects are not significantly greater. If they occur they’ll show up between 3 weeks and 4 months. Neither treatment option has resulted in death. Dr. Spierer wanted to assess my lung function before proceeding. So at 3:00 a nurse determined that this special procedure is performed at the center and the test was initiated at 4:15 immediately after my meeting with Dr. Goldstein. How impressive is that?! I tell ya, CTCA can’t be beaten for not only the outstanding personnel but also its state of the art equipment and the ability to get things done really fast.

Next, I met with Dr. Goldstein. He specializes in video-assisted thoracoscopic surgery (VATS), a minimally invasive surgical technique. Long story short, the scarring resulting from my previous radiation and the pleurodesis procedure ruled out that option. Open surgery is the only viable surgical option. The procedure is much more demanding and lengthier. I’d risk having a sizable portion of my lung removed, possibly rendering me dependent on oxygen thereafter. I’d receive a drain tube through my chest wall for days, perhaps weeks. (My 2 previous experiences with chest tubes resulted in excruciating pain followed by huge and potentially unrecoverable depletion of lung capacity in the first instance and a pneumothorax in the second. I was dreading the possibility of another such adventure.) Given these circumstances and his reluctance to jeopardize what he referred to as my remarkable health, Dr. Goldstein suggested that I go the radiation route.

I next got an X-ray followed by a lung ventilation and perfusion (VQ) scan to determine the air and blood flow throughout my lungs. So, my lungs were photographed with a gamma camera subsequent to me inhaling gamma-ray emitting radioactive particles. My lungs were photographed again after a solution containing the same type of particles was injected into a vein. These images were basically overlaid onto the X-ray to determine my lung function. Specifically, Drs. Weiss and Spierer wanted to know whether or not the tumor was located in a healthy area of the lungs prior to initiating any treatment. It turns out that the VQ scan was very helpful in slightly modifying the SBRT plan in order to further minimize irradiating healthy tissue.

The verdict is in. I’m going with the aggressive radiation plan: 5 treatments spread at least one day apart, starting in 2 days. I love it! That’s it for the clinical update.

I continue to receive amazing responses to my postings. This is one of the loveliest. “I think you are right… treating each event or sensation as a privilege gives a great outlook on life. My mother is good at this… she is getting old but remains positive because there is always something giving her simple joy each day… particularly the flowering of plants in a garden. I sometimes used to think to myself… ‘so what… it’s just a plant.’ But now I begin to see how valuable it is to her day to day enjoyment of life, and the way others interact with her.” I also like this message because it describes Vicki so very well.

We’ve lost some exceptional friends just within this past month and we have also mourned with close friends who have recently lost others dear to them. As always occurs, the grief, emptiness, and powerlessness overwhelm all else during desultory moments. To try to focus on something else, I turned to thinking about mindfulness… as in being engulfed only in the rhythm of crashing waves without actually listening to the sounds. Or, staring into a flower and becoming enchanted by the shape and colors, rather than contemplating the actual blossom. Then I realized my folly of thinking about non-thinking, laughed to myself, and returned to basking in the rhythm of the waves.

I employed this approach in Mexico to delay pondering treatment choices that would have interfered with the now. So, instead, I enjoyed time with my lovely bride. And when thoughts and feelings about the losses arise, I can better focus on the good fortunes that these wonderful people have bestowed upon me and us.

I’ll finish with this. I was the only passenger on the drive from the center to the airport last evening. The driver and I had spoken at length once before. We picked up where we had left off… the best Chicago-style pizza to be found in Phoenix. Once that was settled we addressed more serious topics. At one point I blurted out, “If I worry about living, I’m dead.” That pretty well describes my attitude.

With continued love and gratitude and thoughts and prayers for the passing of loved ones,

Jim

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