Thursday, July 23th: Oh yes, cancer is my Bitch

"This is the best possible PETscan result you could have."

Exact quote from Julie, the physician's assistant at Rocky Mountain Cancer Center at Pres/St Lukes Hospital in Denver.

Oh how sweet a morning Thursday, July 23, 2009 was - it's one of those new 'anniversary' days to add to my calendar, like many cancer patients do. For me, Wednesday May 20th will always be the day that Dr. Philippon told me I had cancer and, after I awoke from a passing out episode, offered me a beer. I love French Canadians, and I love having a good portion of their DNA in my veins. July 23rd is now the day that I found out the chemo is working, and the signs of malignancy have severely diminished since my last scan on June 4th. The following is a step by step breakdown of what has happened in each of my cancer locations, according to the doctor 'techno speak'. But first, I'll give you some definitions of a few confusing words thanks to the Google:

• Hypermetabolism is the physiological state of increased rate of metabolic activity.
• The acetabulum is a concave surface of the pelvis. The head of the femur meets with the pelvis at the acetabulum, forming the hip joint.
• Lymphadenopathy is a term meaning "disease of the lymph nodes." It is, however, almost synonymously used with "swollen/enlarged lymph nodes". It could be due to infection, auto-immune disease, or malignancy.

LYMPH CANCER/TUMOR IN HIP - "ReScans through the pelvis demonstrate a marked decrease in the hypermetabolic activity seen associated with a destructive lesion involving the inferior aspect of the right iliac bone, the right acetabulum, and the superior and inferior pubic rami on the right. There is now only mildly elevated metabolic activity along the medial aspect of the right acetabulum with peak SUV values ranging up to 3.2 compared to peak SUV values of up to 20.4 on the previous study. The residual metabolic activity may be related to bone reparative changes although low-volume residual malignancy cannot be excluded. The associated slight increase in soft tissue fullness medial to the right acetabulum has resolved. There are no hypermetabolic bone lesions on the current study."

WHEW, now take a break, have a beverage, and dive into the following results:

LYMPH CANCER IN NECK - "No residual adenopathy is seen in the left side of neck and left supraclavicular region where hypermetabolic adenopathy was previously seen."

LYMPH CANCER IN CHEST - "In the upper mediastinum metabolic activity is now normal. There is a residual mass in the anterior mediastinum measuring 24 x 31mm witih no associated elevation of metabolic activity. On the previous study the mass measured 50 x 28 mm with intense hypermetabolic activity and peak SUV values of 10.7. The residual soft tissue mass could represent scarring from treated malignancy."

LYMPH CANCER IN ABDOMEN - "In the upper abdomen, the hypermetabolic activity previously seen in the right adrenal gland has resolved. Hypermetabolic adenopathy seen in the periaortic region at the abdomen has been resolved."

LYMPH CANCER IN KIDNEYS - "There has been a resolution of the hypermetabolic activity previously seen in both kidneys and a decrease in the size of the kidneys. This suggests that the hypermetabolic activity was most likely related to infiltration with lymphoma."

ANYWHERE ELSE IN THERE? - "The liver and spleen are normal in appearance." HA- those years at Ball State in Muncie at the RKE house didn't do too much liver damage, eh?

So there you have it, the Cancer bitch's time is numbered on board of this Bakermobile. Everyone at the RMCC was really positive about these results, which indicate that the only area of potentially 'active' malignancy may be some resilient cells in the hip honeycombed bone & tumor area. That was to be expected, and if the next three rounds of chemo don't get it, then the radiation of my private locations (a.k.a. the 'inner pelvis) with the Three-Mile Island "Special" super-machine will. The down side is that I still have to go through the final 3 rounds - today's round wasn't too bad. My chemo nurse Emily (Go Huskers) has changed my chemical dosage around so they give me this powerful 'downer' called aderol which helps mitigate my reactions to the bag of Benadryl they put in my blood stream. It's kindof like the 'supersize' of valium - woo hoo! By the way, I'm not a Nebraska fan, but they are all so damn nice (seriously, look at Josh Vogel's facebook pictures about our trip to the Ball State - Nebraska game) that I have to give them props whenever I run into them in life.

So there it is, good news for now, but I must continue to be diligent as we go into these final rounds to snuff out this sonofabitch forever. My cousin Mike did it, my Mom did it, so the third round of the Baker Trifecta is on it's way to victory.

Carpe diem.

-Bill

P.S. - Thanks again from all of my teams, from the ORIGINAL original Jewish Team to the Society of Friends to the Professional Bartenders ...you represented in the clubhouse this weekend and as they say in the old Bartles & Jaymes commercials...."Thank you for your support."

Wednesday, July 22nd: Round 3

Right now I'm preparing for the big day Thursday: Round 3 of the treatments, and (most likely) 1/2 way through chemotherapy. The bigger moment will be tomorrow's 8:10 a.m. pre-chemo appointment where I get the results of Monday's PETscan, indicating whether the cancer has shrunk, stabilized, or spread. As I mentioned before, the orthopedic oncologist said promising things about the tumor site and the new bone growth where the tumor had honeycombed my pelvis - let's hope the lymph nodes and kidney activity has followed suit. If it has, it's a very promising few months ahead, with a bit of light at the end of the tunnel. If it has spread or not shrunk, then we'll work with the folks at Rocky Mtn Cancer Center to figure out another plan of attack. In reference from my previous "D-Day" posting, I'm including for your reading (and listening) pleasure part of Winston Churchill's famous 1940 speech to British Parliament which captures the emotion of this whole "fight for my life" experience:
http://www.bbc.co.uk/history/worldwars/wwtwo/av/churchill_on_beaches.ram

".....We shall go on to the end. We shall fight in France, we shall fight on the seas and the oceans, we shall fight with growing confidence and growing strength in the air, we shall defend our island, whatever the cost may be. We shall fight on the beaches, we shall fight on the landing grounds, we shall fight in the fields and in the streets, we shall fight in the hills; we shall never surrender. "

And don't you worry, the fight is on up here in the Mile High City....surrender is not an option.

Carpe Diem.

-Bill

Saturday, July 18th: D-Day cometh - calling all Teams

As I give you this update from sunny, cool Denver on a Saturday morning we're in the process of preparing for a fairly significant milestone in my treatment process, PET scan #2. Here's the wiki article about what exactly this test is: http://en.wikipedia.org/wiki/PET_scan I'll confess, I really didn't know what the heck I was doing sliding in and out of this big ring thing last time - the article is pretty informative, for a wikipedia article.

In the flurry of tests that occurred when I got back to Denver from Boston, they performed one of these to determine exactly where the cancer activity was in my body and to help confirm the B-cell non-hodgkins lymphoma diagnosis. The picture was pretty cool, a full size body view that resembled a fuzzy X-ray. But the moment I saw the image was a bit scary when Dr. Hinshaw said "anything that shows up as a black spot indicates cancer activity". I looked at the picture and there was a dark spot on my right hip (expected), some little spots in my chest and abdomen (lymph nodes - expected based on Mass General testing), but there was a massive spot in my head, two in my abdomen, and a big one right where my private parts are. I was in the process of feeling woozy (passing out, just like Vail) and pointing towards the big black brain spot when Dr. H said 'oh, don't worry, your brain, kidneys, and bladder show up as black regardless.' Whew - would have been nice to say that BEFORE the scan image was put in front of me, wouldn't you agree?

So Monday afternoon I go in for scan #2 - a huge milestone in my treatment to see how well the chemo is working. If last Tuesday's bone doctor appointment is any indicator I'm hoping the news is positive, but who knows - cancer is a strange disease that affects each person differently. After this scan I'll know more if my chemo treatments stay at 6 or increase to 8. From what I understand, this is the point where the radiation oncologist -the man/woman who will, frankly, nuke the living sh*t out of my pelvis & the tumor - will start to get involved and begin to develop the treatment plan. So, you can see it is a pivotal point in the treatment process.

I'm designating Monday as my own personal "D-Day" in my process, where we begin to know the plan for Team Baker's assault on the beaches of cancer. Like Ike & Churchill assessing Hitler's defense of the French Coast, we'll be looking at the defenses of this pansy *ss purple monster and planning the attack.

Thanks again to the many of you who continue to send me messages, cards, the "pink republican" hat (thanks Rick Tripp), Facebook notes, etc. Almost all of you continue to ask "what can we do to help?". So to answer this question, I'm calling all of my "teams" out to help this weekend. You saw my post a few weeks back about the various religious (and non) groups who were in my corner, and hopefully saw me add the Society of Friends and Wesleyans a week or so (thanks Jill Grubb and Dave Dewitt for getting your teams on the roster). I'm asking all of you to get to your clubhouse this weekend and send a message to the Big Guy on my behalf. Even if you're a 'part time' player and attend on Christmas/Easter/High Holy days I'm asking you for a special favor to attend for this weekend to help me (and Amanda) out. I've been a pretty lucky man, and frankly without some seemly random circumstances and intervention from the Big Guy, I might be blogging about a much worse situation. So, here's my politically insensitive instructions for the teams who are on my roster for Sunday:

• Oh yeah, for my Jewish friends and extended family on the ORIGINAL original team, sorry I didn't post in time for Shabbat eve or morning service. Send up some messages on my behalf over the weekend.

Anyways, here's my request of my roster of teams:

• For my team (Methodist), I'll see you there, sing a hymn on my behalf.
• For my in-laws team (Presbyterian), let him know I'm predestined to beat this.
• For the Catholic team, light a candle for me.
• For the Northern (or Southern) Baptists, hit the altar call and send up the request, but don't tell the Southerners that the Northerners are up there too.
• For Team Lutheran, send your message in German (or Swedish, or Danish) while you're having some wine.
• If you're on the Evangelical team, raise your hands when you send the message.
• For the Atheists, think of me and turn on some classical music.
• For the Agnostic Team, look at something cool in nature and send up a message to the Universe.
• For the Mormons...heck, I don't know what you guys do in the clubhouse. - do whatever.
• For the Episcopalians...sing a good hymn, and give a polite nod to someone on my behalf.
• For the Disciples of Christ Team, like the Mormons, I don't know what you guys do, but in the words of Nike..."just do it".
• For team Quaker, send him some good vibes in a non-violent way.
• For the Wesleyans, give him a direct message Rev. Dewitt.

For those of you who are currently 'free agents' - take some time on Sunday to stop into a new clubhouse, if only just for this week - it would mean a lot to us out here a mile high.

Carpe diem.

-Bill

Tuesday, July 14th: Post #11 - Shrinkage

shrink·age (shrĭng'kĭj) n.
The process of shrinking.
The amount or proportion by which something shrinks.
A reduction in value; depreciation.

When you hear the word "shrinkage" what comes to mind? For me and many of my fellow GenXers, one particular scene from Seinfeld popped in the mind: http://www.youtube.com/watch?v=1cUNNKzj_Nc "I was in the pool! I was in the pool!"

Don't worry, I'm not going to inform any of you of the impact of chemotherapy & treatments on my unmentionables, and to be honest there hasn't been much to report. If there was, it would make this blog more inappropriate than it already is. ANYWAYS, after this morning the word shrinkage has new meaning to me.

Today I had an appointment with my Orthopedic Oncologist in Denver, Dr. Ross Wilkins. For those who don't know - he's the 'carpenter' who is there to keep my pelvis intact. He wanted to check on the status of my "honeycombed hip" (yeah yeah yeah) after the first two chemo treatments. For those who don't know, the tumor had burrowed into my right pelvis around the point of the 'socket' part of the hip, resulting in a 3" square (roughly) area of my pelvis that was 1/2 bone, 1/2 tumor. Fortunately, the tumor hadn't yet grown into the 'load bearing' area above the hip joint, so I had still been able to walk without shattering my pelvis, which was in hindsight a significant danger that could have made my situation even more dangerous than it is (was).

This 'honeycomb' action was the source of most of my pain since last summer. Those of you who are here in Denver know that I was dealing with debilitating hip pain to the point where I couldn't ski last season, which we thought was caused by my mountain bike injury. However, 99% of it was from the tumor burrowing into the pelvis bone. Two days after my first chemo treatment, most of this pain was gone - indicating that the drugs were attacking the fast-growing tumor cells.

My early June X-rays showed large areas of hollowed out (dark gray) bone where this tumor had honeycombed. The X-rays from this morning showed clear evidence of splotches of white throughout the area that previously was mostly dark gray. In the words of Dr. Wilkins "It's not getting bigger,and it looks like it's shrinking". We then spent 15 minutes going over the X-ray where he showed me the various areas of calcium deposits on the film.

What does this mean you ask? While I won't know more conclusive evidence until next Monday's PETscan (I'll explain later in the week), but all signs indicate I've probably got shrinkage of the cancer.

This man will take as much shrinkage as he can get, and I haven't even been in a pool!

Carpe diem.

-Bill