Surgery Day and “The One for the Thumb”

So, here we are, waiting. God has a way of making you “patient” when you don’t want to be. These days, waiting is hard. We rarely have to wait for anything. It’s the age of instant gratification, for everything! That is unless you have cancer. Then you wait, no drive thru, no car pool lane to get you there faster, just 6 lanes, rush hour, interstate traffic–stall. 

11:15: Mike and I went back to pre-op.

11:45: I said good-bye.

12:50: OR calls to say they have made the first incision, all is going well.
3:00: OR calls. almost done, about an hour left and we can see him in Recovery.

4:00 (ish): Dr. Chu. Our miracle! This man, and his staff, are most definitely angels sent by God. The tumor is out! It looks to be the same grade as before, we won’t know definitively until the final pathology comes back in 7 days. He didn’t see any spread of tumor. They acted aggressively and took more then the tumor. They did quickly sample some of the areas that highlighted near the tumor and on quick review they are normal, non cancerous. The metastasis area(s), well, they don’t see any of this on the latest scan, from last night. He sees areas of tissue changes, but this is due to prior treatments. He sees no sign of metastasis or anything alarming, other than the tumor–which gone! 

The prosthesis.. well, ladies and gentlemen, Mike had been spackled! Mike will LOVE this! They preserved the prosthesis, they fixed the screws and pins that have bothered him for 8 years and replaced them with more effiecent ones (medicine changes so fast in 8 years). The prosthesis was preserved in betadine during the surgery and they are pretty sure there won’t be any infection (let’s just say a little prayer that there isn’t while we are praying!) The edges and grooves were filled with spackle (not really, it’s a medical grade cement, but doc said for a lack of better terms–spackle!) 

Road ahead… no plans yet. They will sample the tissues and then decide. There are multiple new things they test for that they didn’t know about 8 years ago. This could open up new treatment options!

I have not yet seen him, but should in a hour or so. 

Right now, I am good! I am handing my love back his ring. It’s not “one for the thumb”, but it is his ring, and I love it most on his finger! So, here’s your sixth ring love. Keep it and wear it well! 😘

Pre-surgery

“The one for your thumb!”

One for the Other Thumb…and a Good Lesson in Thankfulness

Borrowing a motto made famous by the Pittsburgh Steelers in the 80’s, whose fifth Super Bowl championship drive was known as “one for the thumb,” tomorrow I head in for my sixth surgery — I suppose that’s one for the other thumb. My MRI is tonight at 8:15, and surgery is scheduled for tomorrow at noon. Angie, her family, and some good friends from Colorado are all here to support us, and I am ready. More than ready. In fact, I’m a little grumpy. So how does it feel to be preparing for such a major life event?  It’s a mix of emotions that is almost impossible to describe, but I’ll try. If you’re not interested in reading a sappy, emotional rant, stop reading now and just pick up the blog again during surgery tomorrow. 

I’m anxious. I just want to get it over with. Months of anticipation — since initial diagnosis of the recurrence in October — all culminate today and tomorrow, and it’s truly a peak of anxiety. Just get it done already. Get me to recovery, that’s what I’m good at!  That’s what I know, that I can handle. Once I wake up on the other side of the OR, it’s all downhill. Find me a marathon and let’s do this. But waiting?  Fasting?  Preparing?  You can have it. 

I’m frustrated. Although I’ve done this many times, I still can hardly imagine all the pieces that have to fit into place for this to happen. Pre-op clearance, scans, labs, appointments, doctor schedules, available ORs, insurance referrals and approvals, it’s a mess. If everything isn’t perfect, it doesn’t happen — and it’s very frustrating. 

I’m irritated. Just by the inconvenience of it all. This is the minor stuff, but you’d be surprised what bothers you most facing a major surgery like this. For me, it’s actually not the brain surgery part. It’s the fact that I won’t be able to run for weeks afterwards. It’s the sleepless night(s) in the ICU, where all you want to do is sleep and all the docs want to do is poke and prod and question and test. It’s the stupid, ridiculous leg massagers that you have to wear all the way up almost to discharge, designed to prevent DVT, but they also very effectively prevent sleep. I do NOT want a catheter. I don’t like all the meds — pain, seizure suppression, antibiotic, anti-inflammatory, anti-emetic, and a thousand other things. I hate them all. Once you’re in a regular patient room, it gets much better…but the night or nights in Recovery and ICU are miserable. 

I’m scared. There, I said it. Take my man-card if you want. It’s scary. Every time, I’m never sure what it will be like when I wake up after surgery. Will I remember who I am?  Who my wife is?  Will I be able to see, speak, and move normally?  Will I still be me?  Will I even wake up?  Every one of those thoughts plague your mind a thousand times a day, and it’s a full-time job to suppress those thoughts. And yes, it’s scary. 

So all those emotions — anxious, nervous, irritated, frustrated, scared, and more — add up to one overriding sentiment:  I’m one grumpy dude. Just plain grumpy. Somewhat irritable, and just so ready to get this done. I expressed my overriding grumpiness to a friend, and she challenged me to list 10 things I’m grumpy about and 20 things I’m blessed by. Wow!  Of course, this exercise is designed to get me out of my funk by helping me realize how blessed I am…I have to confess that I didn’t even complete the exercise, and it had already worked. I’m grumpy about the surgery time, the inconvenience, the pain, the leg massagers, the catheter, the lack of exercise afterwards, the potential side effects, and the logistical nightmare of insurance, referrals, and so forth — but that only got me to 8, and already I’m struggling to get to 10. When counting my blessings, I’ll spare you the list but I blew past 20 in about 15 seconds, starting with my faith, my wife and daughter, my health, the presence of family and friends, an amazing doctor and medical team, tricare (yes, even that), a great job and a great boss, with a great team to cover for me while I’m gone, and a thousand other things…so, point taken. Sure it sucks. Sure it’s scary, and I might still be grumpy in some hidden places. But beyond all of that, I’m thankful beyond belief. 

Bring it on, I’m ready!  Next post from me will be as a tumor-free blogger ;-). 

Pre-Op Clearance Complete!

So, we arrived here in California on Friday and surprised our little E with a weekend at Disneyland!  After a weekend, with Mickey and Minnie, and an amazing fireworks spectacle and the Disney World of Color show (DO NOT miss it if you’re in town), we headed to Midtown LA and checked in at Cedars-Sinai Medical Center.  The Maxine Dunitz Neurosurgical Institute and the Johnnie Cochran Brain Tumor Center have moved into a beautiful brand-new facility called the Advanced Health Sciences Pavilion, and it is truly impressive. 

My first appointment was with Dr. Chu and his team, where I first met with with an attending nurse who did a basic neuro exam and case history. This was followed by the neurosurgical nurse, who talked about the scans we had sent and the plan for potential surgery, and did a bit more detailed neuro exam. After about 30 minutes, Dr. Chu came in and we had an outstanding conversation. He is so calm, confident, and reassuring…together, we looked closely at the scans, and agreed that surgery is the best option. He was actually willing to wait and watch it a while longer, but given the long history of recurrence and our general “lean forward” approach throughout my history, he agreed to proceed with surgery. Dr. Chu also saw no real reason for concern in the temporal lobe, or in the corpus callosum or other areas of the brain. His plan at this point is to go in and remove the bulk of the tumor, send it to pathology to determine grade, and while I’m still in the OR have a biopsy done on several samples from the areas elsewhere in the brain that showed up as highlights on the scan. If those areas also come back as malignant, then he may proceed to surgery there as well, or mark them as areas for future monitoring. He also agreed with NIH and Walter Reed that following surgery with radiation is a reasonable approach. 

Dr. Chu gave me an immediate referral to internal medicine and cardiology for pre-op testing. After a great lunch at Judi’s Deli in the hospital, we went to see Dr. Samadi, who did an EKG and took five vials of blood for testing. My favorite quote of the day was from the phlebotomist, who simply said, “Oh, I LOVE your veins!”  Happy to oblige, I suppose. With lab work complete, I saw Dr. Samadi, who did the heart stress test, respiratory rate, and other tests to ensure I will be able to tolerate anesthesia. The phlebotomists’s quote was quickly replaced by Dr. Samadi, who said, “Wow…you have an amazing heart!”  He cancelled the chest x-ray and cleared me for surgery, reassuring me that “I’ll be there in the OR the entire time, but you won’t need me.”  With that, a long day of pre-op, neuro consult, and labs was complete. I received a call later that day confirming the surgery date of Tuesday (luckily not Friday) the 13th, with an MRI the night before. Dr. Chu anticipates two nights in the hospital (the first in ICU), so discharge on Thursday, and a follow-up seven days later for wound care, staple removal, update prescriptions, and so forth. 

So that’s the latest…our goal remains, HOME FOR CHRISTMAS!

A “Ray” of Hope

Just a quick update from our last consult with NCI. 

The primary challenge that NCI saw was accessing and resecting the recurrent tumor. It rests among a bed of vessels and veins, making it a tremendous challenge for any neurosurgeon. Those who looked at the scans at NIH declined to do the surgery, ruling it too risky. Apparently, navigating through that bed of veins and vessels is playing with fire, and not the kind where you nick a vessel, cauterize, and keep going — nick a vessel or vein here, and you don’t get of the operating table. Ever. Leaving NIH, our primary concern was finding a neurosurgeon who would take the case. 

Then we received a call from Dr. Ray Chu, my surgeon from Cedars-Sinai Medical Center and the man who did my last two surgeries. “It’s not a problem, Mike. I’ve got this.”  His confidence was overpowering. What was impossible for most general neurosurgeons was routine for a brain tumor specialist. He also exhibited much less concern about the potential highlights in other areas of the brain, and saw relatively little evidence of necrotic tissue. After a month of bad (and progressively worse) news, this phone call was the little bit of good news we needed to step up our game and continue the fight. 

We will see Dr. Chu on 7 December, which will be treated as a pre-operative appointment. Surgery will likely follow somewhere around 10 December, with discharge about 14 days later. That gives us our second Christmas in Los Angeles, and a great way forward with a great team!  

The World Awaits its Hero

Well, the results of the consult at the National Cancer Institute are in, and it’s a mixed review at best. I had another brain scan on Tuesday, and today I handcarried that scan to NCI where Dr. Park and Dr. Theeler spent about two hours with a team of neurosurgeons, radiation oncologists, and neuro-oncologists reviewed them and compared them to the scan from October and June. NCI agrees that the cancer is returned, and is in the same general area as before (right side), only lower (temporal, not frontal). While there may be other areas of enhancement in the brain (indicating cancer or necrosis), it is not significant enough for the docs at NCI to be concerned about it. However, the tumor in the right temporal has already showed growth since October, which likely indicates that my cancer has upgraded — WHO Grade III now, it has always been Grade II in the past. 

That’s the basics, medically.  It was the first time I had seen this doctor, but he was very good. I did get the definite sense that he was trying to mask his concern — to put it bluntly, this is the first time since my first recurrence in 2005 that I actually felt the doctor was scared. He said this was a “very aggressive” tumor that was growing “very quickly” and is in a “very dangerous” area of the brain…and that’s a lot of “very”s. He had already placed a referral to neurosurgery for today, but rescinded it when I told him I already had one to Cedars. He was very comfortable with that, and knew both of my prior surgeons, Dr. Keith Black and Dr. Ray Chu. He closed with confidence, but also warned me that this surgery must be performed by an absolute expert with a lot of experience removing difficult tumors. He said there is a “world of difference” between a frontal and temporal lobe tumor. 

The road ahead remains the same. We will head to California on 2 December, and prepare for surgery in the days and weeks to follow. I’m doing okay…avoiding the Pink Floyd flashback, I’m comfortably numb. Really don’t feel anything right now, which is okay. More than anything, I’m ready to get this fight going. We have literally the best team of doctors in the world, and this beast has picked on one of the strongest men in the world. Apparently the beast “didn’t get the memo” the first three times.  I will fight, and I will win. It’s as simple as that. Closing with one of the most touching statements I’ve heard recently, from my close friend Linda — “You’ve got this, Mike…the world awaits it’s hero.”  Well, wait no longer…and prepare to be defeated by the killer combination of Faith, Family, and Fitness. 

The Return of the Beast

So, I haven’t blogged for a while – and there’s a good reason.  My cancer battle, for the last 8 years, has been comfortably and blissfully routine.  An MRI every 90 days or so, and that’s about it.  In the span of nine years, I had three brain surgeries, two reconstructive surgeries, 42 rounds of radiation, and 22 rounds of chemotherapy.  Then nothing.  For eight years.  Nothing.

Until last month.

I went to Walter Reed on Monday as always, with a brain scan that night and neuro consult in the morning.  I walked into the neuro-oncologist’s office like I had done a hundred times before, and my scan were clearly displayed on the light board, just as always.  But there were two big red arrows drawn on the scan.  I’ve been playing this “game” for 17 years.  I know what that means.  “Wow,” I said.  “That doesn’t look good.”  The doc – one of the reasons I like him so much – got straight to the point.  “Mike, recurrence looks obvious to me (image above has the right frontal tumor circled).  But there’s more.  It looks like the cancer has spread.”  I suppressed a swelling panic in my chest.  In all my years of fighting cancer, it has always been localized in the right frontal lobe.  I looked more closely at the scans, and it was almost undeniable.  Left frontal.  Right temporal.  Corpus callosum.  Between June (a completely normal scan) and October, my brain had lit up like our neighbor’s Christmas tree on Halloween (don’t get me started on that one).  Recurrence I could handle, and had handled several times before – metastasis is new, something I’ve never faced.  The look on my face certainly gave away my distress, but the oncologist wasn’t done yet.  “Mike, I hate this as much as you do…but there’s more.”  The doc pointed out a white band around the outside of the brain, which was clearly absent in the June scan.  “Not only has the cancer recurred, it has also spread – and it’s killing the brain.”  The white band we were looking at was most likely necrosis (dead tissue), caused by either high-dose radiation several years ago or by the cancer (in the image below, the June scan is on the right — completely clear, with no white parts in the grey matter — and the October scan is on the left, with the temporal tumor circled).

The “triple threat” of recurrence, metastasis, and necrosis is nothing short of devastating.  Mentally, emotionally, spiritually, in every way imaginable, I was crushed.  We made tentative plans to get a second opinion from the National Institutes of Health in November, and I walked out the door, down six floors, and collapsed onto a sofa in the main lobby of Walter Reed’s America Tower.  I cried.  In fact, I cried for 11 straight days, many times each day.  I removed myself from work, and when I returned I spent six hours with the chaplain in my first two days back.  Angie and I talked (more crying) until well after midnight the first two nights, reminiscing about the last time we faced this and trying to remember how we handled it.  It feels different this time.  Options are limited – my cancer has proven to be chemo-resistant, and radiation accelerates necrosis – leaving us with surgery as the only conventional option.

So, the beast is back.  And he means business.  Somehow, we will have to find the strength to fight again.  Soon, I’ll tell more about the road ahead, and about the tremendous spiritual and emotional struggles we’ve been through over the past two weeks.  Until then, just pray.

Stuart Scott — Fighting Through Fitness

I love SportsCenter.  I’ve probably watched it for at least 15 years, and it has become a landmark sports newscast.  Its clever blend of dynamism, humor, commentary, and analysis is simply unmatched in the sports world.  If you’re like me, you have favorites — I love Scott Van Pelt, Kenny Mayne, John Anderson, Dan Patrick — and who could forget those that are almost household names, like Keith Olbermann, Chris Berman, and Craig Kilborn.  But there’s one that stands out head and shoulders above the rest…

Stuart Scott.  BOO YAH!  Drop it like it’s hot.  Like gravy on a biscuit and butter on a roll, Stuart Scott’s catchphrases have been heard around the world, and are repeated so often many don’t even know the true source.  But today he’s on my mind for a different reason.  Stuart Scott has cancer — again.

Diagnosed with cancer in 2007 (he has politely but consistently declined to say what kind of cancer), he beat the disease only to have it return in 2010.  Again he defeated the beast, only to announce last month that it has returned again.  “There have been a lot of people who’ve said I’m courageous.”  He told USA Today.  “I’m not.  I’m scared.”  Already three rounds into his chemotherapy treatments, he battles nausea and fatigue.  “It drains you…but what are you going to do?”  Well, what Stuart Scott does is exercise — immediately after his chemo treatments.  “I can take this, deal with it easier than some people I see.  So for the one who cant…I’ll do it for you.”

Incredible.

Motivational.

Inspirational.

Like Stuart, I’ve fought through multiple recurrences and chemotherapy.  I know how completely defeated you can feel when you learn of a recurrence.  And I know how, sometimes, exercise is the greatest thing you can do for your body and for your cancer battle. Sometimes it’s all you can do and sometimes it’s all you want to do.  In less than six weeks, I’ll return to the National Cancer Institute in Bethesda, Maryland, where doctors will conduct a full cancer screening to see if my cancer has returned.  Maybe I’ll enter my fourth year of remission.  Maybe I’ll have my fourth recurrence.  Either way, I know what I’m doing when the screening is over.

Anyone up for a run?

You’re Wrong

Often when I’m speaking in public, people get the impression that I’m young and in shape, so it must be easy for me.  First, I’m not that young (40), and second, it’s never been easy.  Although I enjoy it, marathon training and 40+ miles-per-week running is just as hard for me as it is for anyone else.  But that’s not what bothers me most — it’s the unspoken assumption that somehow you’re “too old” or “too heavy” or “too out-of-shape” or “too busy” to get in shape.  You’re wrong.

You’re not too old.  I had never run more than a mile until I turned 30.  I didn’t run my first marathon until I was 33.  That’s still young by many standards, but what about Fauja Singh?  You can read about him here.  He’s 101, and ran a marathon in October.  Still think you’re too old?

You’re not too heavy or out-of-shape.  I saw this great graphic on the website of a formerly obese fitness fanatic:

I have some experience here as well — though I’ve never been overweight, my best friend and best man, James, was once at least a hundred pounds overweight.  As we discussed my cancer battle and fitness passion, I challenged him to lose the weight and run the Seattle Marathon with me the following year.  He lost over a hundred pounds in ten months, and we ran the marathon together (you can read the story on my previous blog here).  It’s not about how much you’re overweight, it’s about how much effort you’re willing to put in.  Like I told the MOPS group today, you don’t have to run a marathon — just go out and walk a mile.  Then walk two.  And never, never give up.

Too busy?  Please.  I’ve got a full-time job, a wife and baby girl, I’m working on a Ph.D. (taking 10 credit hours this semester), and I’m trying to manage a startup nonprofit.  I also exercise six days a week, usually three runs and three cross-training days with an off day.  I know that’s not realistic or practical for everyone, but it can be done.  I get up early (about 4:30 – 5:00 am), and often exercise then.  Other times, I take a bag lunch in to work and use my lunch break to exercise.  It’s not about time, it’s about priorities — if you make fitness a priority, you’ll find the time.

So, I hope I don’t offend — but you’re wrong.  You’re not too old.  You’re not too slow or out-of-shape.  You’re not too busy.  Decide, today, that you will make fitness a priority and a lifestyle choice.  You’ll never regret it.

MOPS and The Biggest Loser

Great day today!  It started with a good cross-training workout (P90X Back and Biceps followed by Ab Ripper X), then a great talk with a local church’s Mother of Preschoolers (MOPS International) group.  I started with a motivational video, then followed with about a 20-minute talk on my cancer battle and the mantra of Faith/Family/Fitness and fighting.  These great ladies are kicking off their “Biggest Loser” campaign today, with a year-long challenge to see who can lose the most weight.  I think this sort of competition is a great way to motivate each other and keep each other accountable throughout the year!  This was a dynamic, interactive group, and they had some great questions.  Excellent way to start my speaking schedule for the year.  Stay tuned!

Welcome To Fighting Through Fitness!

Did you know that according to the American Cancer Society’s 2012 report, the leading cause of cancer death in America is obesity, poor nutrition, and lack of physical exercise?  For the first time, these factors — broadly characterized as “healthy living” — surpass tobacco use as the leading cancer killer.

Did you know that according to CNN, obesity is now a bigger health threat than hunger?  Are you old enough to remember the massive push to solve the problem of world hunger?  Well, now world obesity is an even bigger problem.  Where is that same groundswell of emotion and support to address the obesity problem?

If these facts shock you, or if they hit a little too close to home, then welcome to Fighting Through Fitness.  We are a small team with a big vision — to change people’s lives through fitness.  Whatever you face — illness, addiction, dependency, depression, obesity — we can help.  Our goal is nothing short of making these statistics a distant memory through motivation, education, advocacy, and raising awareness.  Our team consists of a few cancer survivors, professional athletes, and personal trainers, but mostly everyday people who know that the simple decision to eat well and exercise can change your life.  It can change the statistics.  It can change the world.

Welcome.