email sent May 17, 2016

Subject: Immediacy and Uncertainty…

… or, The Best Fire I Ever Saw, By Far, Was a Rust-Oleum Plant

Could it be? Yes! Another short email. I’m gathering fodder at a faster rate. This time I’ll blame it on some excellent responses to my last two mailings and lots of down time, literally, on my stomach. Let’s just say that sitting has been a royal pain.

I qualified for re-entry into the clinical trial! Dosing began today. And the surgeon got all of the skin cancer last week – the margins were clear. The new spot on my right lung is a bit disconcerting. It’s adjacent to one that was obliterated with radiation last year. Weird. We’ll know lots more with the next scan which is scheduled for mid-July. With luck, the dosing will knock it out. We’ll see. I’m not worrying, I’m breathing fine. Besides, worry is boring, I have lots better things to do and think about.

I’m overwhelmed by the replies I receive. Thank you so much! Here is a sampling…

“Observers of miracles is our mantra should we take the time to see.”

“Well, right now in my reality, I am closing my eyes, envisioning our beautiful world, and channeling that immense force to you in beauty, love, and healing… Also as we age, I find myself outside more… looking up the heavens saying ‘it’s in your hands God, it’s in your hands.’”

“I was curious about the previous reference to achievement and the meaning of life. I think they are inextricably linked… is it not the case that if someone is to give up on trying to achieve then their life while perhaps enjoyable is somehow much, much less rich?”

My fellow engineers are going to love this one: “As a mechanical engineer always fixing old things I think of it [cancer] a bit like rust… it’s everywhere… and indiscriminate as to the beauty of the object.”

Another great friend really got me thinking. She sent me a Mark Twain quotation that was new to me. As I often do, I searched the internet to see what I could learn about its context. What I did find was another quote that one person coupled with the Twain quote to guide his life. This second quote is:

“A life is not important except in the impact it has on other lives.” Jackie Robinson (1st black American to play major league baseball) What a perfect message to pair with:

“The two most important days in your life are the day you are born and the day you find out why.” Mark Twain

I implore you to ponder why you were born and when you realized it. Please feel free to send along what your thoughts. I cheated and came up with two days, rationalizing that in some respects I’ve had two lives. The two were the day I started work as a biomedical engineer and the day I began sending these emails.

With love, gratitude, and a burning desire to vanquish rust,

Jim

p.s. Huge thanks go to Vicki who, once again put her life on hold and saw me through this latest round of immediacy and uncertainty.

 

 

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email sent May 12, 2016

Subject: Delete If Cancer Bores You…

… or, Finally, a Brief Email and It’s Only About Cancer?!

Yesterday, a wonderful friend from forever ago asked, “What causes that first cell to change?” It’s a tough question and a great question. Obviously, I’m no expert, not at all. But, as I am wont to do, I have formed opinions. After 5 years I should have some thoughts, right? I answered her mostly by digging up passages from what I have read.

  •  All of our bodies possess oncogenes that have the potential to induce a normal cell to become cancerous.
  • A cancer cell must acquire six characteristics as it develops: “It must acquire the ability to stimulate its own growth and to ignore signals admonishing it to slow down. That is where the oncogenes and tumor suppressors come in. It must learn to circumvent the safeguard of programmed cell death and to defeat the internal encounters – the telomeres – that normally limit the number of times a cell is allowed to divide. It must learn to initiate angiogenesis – the sprouting of its own blood vessels – and finally to eat into surrounding tissue and to metastasize.” [per Douglas Hanahan & Robert Weinberg, The Hallmarks of Cancer, 2000, excerpted from George Johnson’s The Cancer Chronicles Unlocking Medicine’s Deepest Mystery]

Along with smoking and obesity, the greatest risk factors are old age and entropy. Environment, genetics, and diet play a role, but a very small role in comparison. Every day, our cells are wildly mutating as they divide. As we live longer, the mutant cells have a greater chance of meeting the six requirements and forming tumors. And once formed, they are very adept at adapting to challenges to their survival. Sheesh, even dinosaurs had cancer!

“The infectious diseases we have defeated were each caused by a single agent – an identifiable enemy that could be killed or vaccinated against. With cancer we would have to seize control of a whole slew of factors, including the mishmash of symptoms arising from imbalances in energy metabolism. And the biggest risks will always lie beyond our grip: old age and entropy. Cancer is not a disease. It is a phenomenon.”

The author also made the case for how different cancer is from other maladies. Unlike the diseases that have been conquered in the past, there won’t be a single vaccine or a single antibiotic to vanquish cancer. Cancers vary greatly; it’s highly unlikely there will ever be a single panacea.

[George Johnson, The Cancer Chronicles: Unlocking Medicine’s Deepest Mystery]

  • ŸA Johns Hopkins news release from January 1, 2015 stated, “Scientists from the Johns Hopkins Kimmel Cancer Center have created a statistical model that measures the proportion of cancer incidence, across many tissue types, caused mainly by random mutations that occur when stem cells divide. By their measure, two-thirds of adult cancer incidence across tissues can be explained primarily by ‘bad luck,’ when these random mutations occur in genes that can drive cancer growth, while the remaining third are due to environmental factors and inherited genes.” And, of course, the random mutations accumulate as we age, which isn’t bad luck, but we are taking our chances.
  • 1 in 2 American males develop cancer, 1 in 4 die from it (mostly lung/bronchus and prostate). 1 in 3 American women develop cancer, 1 in 5 die from it (mostly breast, lung/bronchus, and colon/rectal). [as of 10/1/14]

[http://www.cancer.org/cancer/cancerbasics/lifetime-probability-of-developing-or-dying-from-cancer]

My conclusions… Cancer is prevalent, far more so than you may think. There are three major risk factors. We can increase our risk by smoking and becoming obese. The third major factor is living longer. For this reason, we are almost predisposed to develop cancer. The mutations accumulate with time; the longer we live, the higher the risk. The randomness of mutations, combined with the ingenuity and resiliency of cancer cells, make this disease so exceptionally difficult to conquer.

With love and gratitude,

Jim

p.s. Bonus quotation for those of you who read this to the end:

“The best remedy for those who are afraid, lonely or unhappy is to go outside, somewhere where they can be quiet, alone with the heavens, nature and God. Because only then does one feel that all is as it should be.” Anne Frank

p.p.s. The alleged 2.5 inch suture line turned out to be 5 inches long. Owie!

email sent May 10, 2016

Subject: A Tasty Recipe…
… or, It’s Not What You Think

When I left you last, not so long ago, Vicki and I were faced with a treatment decision. One option entailed radiofrequency ablation (RFA), which involves inserting a probe or two into the center of the tumor then burning it from within. The small size of my tumor and its location near the surface of the lung made it an ideal candidate. Pneumothorax is the most common complication of RFA. I was told to expect both it and a collapsed lung. Those events come with the added excruciating pain of the later removal of a dreaded chest tube (think, yanking on a wound without pains meds). Been there twice. They were among my worst experiences… ever. I didn’t wish to risk an encore, thank you. We passed on this option. Another option consisted of the combination of an immunotherapy drug and a chemotherapy drug. The chemo drug is more benign than the two I had previously received, but still offered many similar potential side effects: hair loss, nausea, vomiting, diarrhea or constipation (huh?), etc. It also is administered with the steroid that robs me of sleep. No thanks. And Dr. Spierer ruled out radiation, I had already reached my glow limit. So, thankfully, the choice of treatment ultimately became an easy one, re-enter the infusion phase of my current study. It’s back to treatment every two weeks, for up to a year.

I hope to weather the current storm with this wonder drug (and its absence of side effects and untoward consequences) until the next, improved wonder drug is available.

And if the recurrence of lung cancer weren’t enough, I learned the following day that a growth on my thigh was squamous cell cancer. Oh great, more cancer stuff to investigate. Surgery had to be performed before I could resume immunotherapy treatment. During my consult, after viewing the growth, the surgeon called it a “pretty straightforward” procedure, a “slam dunk.” It’s always nice to hear such confidence, especially from the national director of surgical oncology. And he’s very tall – perhaps he really can dunk.

On the positive side, wow, I did make it to five years post-diagnosis, and therefore reached the 3% (or 1% depending on the data base) survival milestone. (Five years is the longest follow-up for which I have found survival data.)

Later that day, on the drive from Cottonwood to Flagstaff, I stopped in Sedona for lunch. I chose that stunning route through the luscious Oak Creek Canyon to become imbued with the scents of spring with windows down and moon roof open, to process the events of the previous 24 hours. In Sedona I saw the perfect bumper sticker, for me at that moment and for that of the land of harmonic convergence…
REALITY
IT’S NOT WHAT YOU THINK

The surgery went well today. A 2.5-inch battle scar. Not too bad. In 2-3 days, I’ll hear about the pathology results on the margins to ensure the doc got all of the malignant tissue. (At least I won’t need to wear a bag over my head to hide the stitches and incision, as I long ago recommended to a good friend after her skin cancer surgery. She often reminds me of that well-intended suggestion. I wonder why. Last week, she even went so far as to tell me that I should wear a bag!)

I received many wonderful responses to my last email. I’m always gratified to learn that they are being passed on, especially when at least portions are shared with children. I also enjoy that I can in a small way remind all of us to live in the present and appreciate all that surrounds and infuses us. One great friend wrote of our symbiotic relationships, that the email recipients and I give each other strength. Nice.

It’s time again for some quotes…
“Perfection is not attainable, but if we chase perfection we can catch excellence.” Vince Lombardi
“Hope is a waking dream.” Aristotle
“I find hope in the darkest of days, and focus in the brightest. I do not judge the universe.” Dalai Lama
“Life is really simple, but we insist on making it complicated.” Confucius
“Life is a series of natural and spontaneous changes. Don’t resist them – that only creates sorrow. Let reality be reality. Let things flow naturally forward in whatever way they like.” Lao Tzu
“Faith is taking the first step even when you don’t see the whole staircase.“ Martin Luther King, Jr.

Hope, faith, excellence, simplicity and flow… they comprise pretty good ingredients for cooking up a fine life. But let’s not forget what Mr. Lennon told us, “All you need is love.” Without this icing, the cake is dry and not quite sweet enough.

With immense gratitude and lots of icing,

Jim