Introduction to my journey (03/28/2020)

On Feb 14, 2020, I had a colonoscopy, suggested by my doctor because I'd reached 50 years old, and it's the suggested screening. After the procedure, doc told me I had a polyp, and it was shaped in a way that wouldn't allow him to clip it out during the colonoscopy. He did take a biopsy, and sent to pathology. He said it was small, and would be surprised if it was cancer.

On Feb 20, 2020, I got the call. Cancer. It was a surreal moment. I was driving to a work meeting. Doc said it was cancer, and next step was surgery was to remove a section of my sigmoid colon (that's near the end of the colon, last section before the rectum).

On Mar 4, 2020, I had surgery. I had an 8 inch scar down the middle of my gut, but recovery went well. 3 weeks later, I mowed my grass (I had my wife help me get it started, Doc warned about hernia, so no major lifting/tugging on the starting cord). I was tired afterward, but overall felt good.

On Mar 13, 2020, pathology came back from surgery. Good margins on the tumor removal, but unfortunately, 1 of 14 lymph nodes removed during surgery were positive for cancer. I get to partake in the adventure of chemotherapy. Not good news.

I'll post below with technical details of the findings.

I'll do another post about chemotherapy preparations so far, then will write posts regularly as I move through my treatment cycles.

My hope here is to have a place to share my story, and maybe provide some sort of catharsis from the stress of this. I also hope to use this to participate in a community of people going through similar circumstances.

I'll also warn that I tend to be transparent about things. I'm sure there will be a bit of discussion of unpleasant things like poop, nausea, etc... I'll try to spare you the most unpleasant or irrelevant details, but bare with me if I don't always find the right balance.

Lab Details of my Cancer (03/28/2020)

This post will be dense with details, but hopefully I can present in a way that's understandable.

Staging

People often ask what 'stage' my cancer is. I'm stage 3a, but there's a really wide variance between different stage 3 colon cancers, so it's worth exploring the details.

After my surgery, pathology reports revealed the following info:

• My primary tumor is 17mm x 15mm x 3mm. Think of a stack of 2-3 dimes. So, it's pretty small.
• The surgeon removed 14 lymph nodes around the area. 1 showed cancer.
• That cancer in my lymph node was 6mm (diamater of #2 pencil).

So, pathology reports will use the TNM staging system.

• T for primary tumor stage. T can be 1 through 4b. (this is often noted as pT for primary tumor)
• N for lymph nodes. N can be N0 through N2b
• M for metastasis(spread to other organs). M and can be M0 through M1c.

For me, I'm T1 (my primary tumor is small, and didn't spread through the colon wall). N1a (only a single regional lymph node impacted). M0 (no evidence of spread to other organs via pathology, CT scans, or visual inspection during surgery). 

So, this has me at the lowest risk stage 3 category, stage 3a (pT1 N1a). 

More details about staging colon cancer here. Cancer.net Link

Tumor Marker

There's a blood test that is a diagnostic tool in monitoring cancer. It's called CEA (CarcinoEmbryonic Antigen). Anything under 3.0 is considered normal (no cancer). [for smokers, anything under 5.0 is normal). 

Before surgery, my CEA was 1.1 (that's good). 

After surgery it was 0.9 (a bit better, I guess, but as long as it's under 3.0, doc is happy). 

Prognoisis

To be honest, I haven't asked my oncologist to give me a prognosis. If I did, I'm sure she'd give me some 5 year survival percentage. But the way my brain works, I know I'd be uncomfortable with it. Let's say she said 90%. In my brain, I'd hear I have a 10% percent chance of being dead within 5 years. So, at this point, I haven't asked that question of her. I may at some point. But I have done some research...

Colon cancer is tough. Even when you think you've got it beat, it can come back some time later, and show up as a new tumor in a remote organ (it seems to prefer liver or lungs first) or a new tumor in the colon, etc... I know I will have CT scans, scopes, and blood tests done regularly for the rest of my life, and the long days waiting for lab results that follows.

However, there are some good reasons to be optimistic. There are studies that indicate that Stage 3a that are pT1 N1a single lymph node patients are a unique category, and if they have a low CEA number and have enough (>12) lymph nodes harvested during surgery, predicts a more favorable overall survival prognosis. Normal pre-operative CEA levels also predicted much lower risk of tumor recurrence. National Institute of Health Link

This study supports the same notion. BiomedCentral Link, stating that survival rates are as high as 92.6% for T1 N1a patients.

The two studies above have some indication that pT1 N1a patients may not benefit much from chemotherapy because the survivability rates don't improve much for us(it's already pretty good). This study indicates less chemo (3 months vs 6 months) may be just as good. Cancer.gov link

I discussed this with my oncologist, and she said she was familiar with these studies, but admits that I'm a rare patient. T1 N1a is an unusual combination. So, she is comfortable dropping the most toxic of the 3 drugs after 3 months. 

Ok, this is drifting into the chemo topic, so I'll end here and post about chemotherapy next.

Chemotherapy Introduction (03/29/2020)

This is what I've been told by my oncologist.

The drugs

The chemotherapy protocol I'll be doing is called FOLFOX. It's the standard in the US for colon cancer. This has 3 drugs:

• FOLinic acid (aka Leucovorin); It's not a chemotherapy drug itself, but helps the next drug be more effective.
• Flourouracil (aka 5-FU ). Chemotherapy agent that hinders DNA replicaiton.
• OXaliplatin. Another chemo agent that hinders DNA replication. This one has the side effects we worry about. 

Along with this, I'll get two anti-nausea drugs through IV.

• eMend (aprepitant) 
• dexamethasone (a steroid)... The steroid helps improve the effectiveness of eMend.

I also have prescriptions for Zofran and Phenergan (both pill based anti-nausea drugs I can use at home to supplement the IV drugs).

The port

On April 6, I have to have a minor surgery to install a port. It's a small disk (about the diameter of a quarter) that will be slipped under the skin in my chest. It will create a raised ring on my chest that the nurses use to draw blood, infuse drugs, and blood transfusions if necessary. The disk will have a tube than runs to a vein into a vein in my neck, and will drop down toward my heart. So drugs that go in will get to the heart and distributed from there quickly. 

Timeline 

FOLFOX goes in 2 week cycles, and I'm scheduled for 12 cycles (roughly 6 months), which is the standard for all stage 3 CC patients. Cycle 1, Day 1 for me is Tuesday April 14. Here's what the cycle looks like:

• Day 1, spend most the day at hospital getting IV infusion of anti-nausea meds, and OXaliplantin and FOLinic acid. Leave the hospital with a pump setup to deliver 5-FU for the next 46 hours.
• Day 2. At home, with pump.
• Day 3. Brief appointment to disconnect pump, and another blast of anti-nausea drugs. Go home.
• Day 4-14. Recovery.

Side effects

I guess first thing to say is that side effects hit every patient differently, and as I'm writing this, cycle 1 is still a couple weeks away. So who knows how it will effect me. Having said that, my oncologist team has given me the following expectations for how it hits a majority of patients.

• Nausea/Vomiting - TV/Movie portrayals of chemo usually lead with this, and I'm like most people, HATE to be nauseous or throw up. However, I've been lead to believe that they do a pretty good job of controlling nausea with anti-nausea drugs. I'll be given IV anti-nausea drugs when the cycle starts, and also when the pump is removed day 3. I'll also have two prescription meds for home. For MOST patients, late day 3, and day 4 are the worst for nausea. I don't tend to get motion sickness, and I don't tend to get sick after anesthesia, so my doc said that lowered the risk for severe nausea for me. 
• Low energy/malaise - Again, day 3 & 4 are the worst for this, typically.
• Hair loss - FOLFOX usually doesn't generate significant hair loss. I guess that's a win, but I wasn't worried about this much, as I tend to keep a pretty smooth nugget.
• Red Blood Cells - A reduction in RBC count can happen. This will manifest itself as fatigue and shortness of breath, as RBCs move oxygen around the body. If it gets low, transfusion can help.
• Platelet count - This is the component of blood responsible for clotting. I'll need to be more careful shaving (switch to electric), etc... if it gets too low, again, transfusion can help.
• White Blood Cells - This is the infection fighters. So, as they reduce, my immune response gets weaker. If it gets too low, there are some drugs that can help. But I must be diligent about avoiding cooties.
• Neuropathy - This is the big one. OXaliplatin causes this, and it tends to get progressively worse each cycle, and for some, can become permanent. So, we'll be keeping a close eye on this one. The hope is this fades toward the second half of each cycle. Neuropathy manifests itself in these ways:
• Numbness/Tingling in hands/feet. This can create difficulty doing things like buttoning buttons, or I can stumble more while I'm walking, or have just general difficulty walking.
• Cold sensitivity. My understanding is that for the time I'm on OXaliplatin, I can give up drinking cold drinks. It can feel like drinking broken glass. Even reaching in the fridge to get something can feel very painful on your hands. I've been told to wear gloves to reach into anything cold, or having someone else do it.

As I started talking about at the end of my Lab Details post, my lower-risk situation suggests that I can get by with less chemo. The oncologist has generally agreed with this notion, and we're targeting to drop the OX in FOLFOX after cycle 6. This will significantly reduce chances of permanent neorapathy.

That's what I know right now. I'll probably do at least one post per cycle, just to keep up with this blog. I'll also keep a daily log of symptoms in a spreadsheet, that I will share in this sidebar as well.

What about Covid 19?? (03/30/2020)

So far, coronavirus hasn't impacted my schedule for getting treated. But with the compromised immunity due to WBC count reduction, I'll need to be double diligent about avoiding the virus. Ugh.

Port installation surgery (04/07/2020)

Got up at 5:30am this morning, so that I could arrive at the hospital at 6:45am, for an 8:45am surgery. This was the same hospital/surgery ward I had my hemicolectomy just over a month ago (Mar 4). The differences were jarring. A month ago the surgery ward was bustling, with lots of people having surgery. Now, due to COVID19, only ESSENTIAL surgeries are being performed. So, it was much quieter, and a lot less hustle and bustle.

The surgery today is to install a Power Port by Bard. https://www.bardaccess.com/products/ports/powerport The purpose of this is to have a way to do IV infusion of chemotherapy drugs, blood transfusions (if necessary), and to draw blood for lab work. Before each chemotherapy appointment, I have a numbing gel to place over the port, then the nurses can access things quickly and conveniently.

The port is installed just under the skin of my chest, and is about the size of a quarter. It creates a raised surface on my chest, so it's easy for the nurses to find and work with. From the port in my chest there's a small tube that is inserted into a major vein that leads directly to my heart, so drugs go in and get distributed around quickly.

I was given ketamine and propofol for anesthesia. I like propofol in that it's quick to go out, and quick to come back to consciousness. That's the only drug I had for my colonoscopy back in February, and that was a nice experience. I didn't have any post-procedure drowsiness, or other issues. Ketamine, on the other hands, makes most people (including me) loopy. So, i say stupid stuff, and am generally more entertaining than I usually am.

The surgery itself went fine, and my port is now ready to go. I have two small incisions in my chest (about 1.5 inches in my chest, and a 0.5 inch small incision near my neck, to guide the tube into the vein). I can shower with it, etc... But I can't submerge in bath or swimming pool for 7 days. I can't lift anything more than 20 lbs for a week, and I'm trying to keep my right arm from doing any crazy maneuvers. The concern is that the port could slip around, and if it breaks loose from my vein, I could get some serious bruising and/or internal bleeding.

Got home before 1pm. However, the ketamine was still impacting me, and I ended up snoozing the rest of the afternoon. Ugh.

Chemotherapy Cycle 1 (Apr 14 - Apr 27)

Overall, it wasn't too bad, aside from an embarassing episode in the ER(details below). Just to re-cap, I get an infusion on day 1 for a few hours at the hospital, then leave with a pump that pumps a drug into me for 46 hours through my port. On day 3 I go back and have the pump removed.

Side Effects

• Cold sensitivity - noticed it in the parking lot walking away from my day 1 infusion. the OX drug creates a weird sensation where if my fingers or face got too cold, there was a weird tingle/pain/electrical type of feeling. 
• Gastrointestinal Symptoms - Almost no nausea, no vomiting, but my appetite went away around day 3-4, and recovered slowly day 5. No constipation or diarrhea, so that's a win.
• Fatigue/Malaise - This was the big issue for me this cycle. Started day 1, got bad day 3, slowly got back to normal by day 7 or so. 
• Embarassing Episode - So, on day 3, I got up feeling pretty bad. Exhausted, no appetite, and generally yucky. My right arm was hurting (my port is in my right chest cavity), and as I went to the hospital to have the pump removed, the pain kinda migrated to my chest. Don't be 50 year old chubby dude and say you're having pains center chest in a hospital, unless you really want to head to the ER. Yeah, my oncologist sent me to the ER, they did a bunch of tests, kept me overnight, I got up the next day to run uphill on a treadmill (Cardiac Stress Test). All imaging, stress tests, etc... turned out fine. To be honest, I get anxious/worry about medical stuff, and I think I got myself upset. Won myself a huge hospital bill, and a 24 hour period in the ER and hospital room all alone because there's no visitors during the apocalypse. Bottom line here is now that I've been through a cycle, while I know my side effects can get worse, etc, I'm not going to allow myself to get anxious and worked up again. Ugh.

So, It's Saturday Apr 25 as I write this, and it's my turn back in the barrel Tuesday Apr 28. Hopefully cycle 2 goes as well as cycle 1 did.

Want even more details? Check my daily chemo symptom log in the sidebar.

Chemotherapy Cycle 2 (Apr 28 - May 11) - More chest pains

So, last cycle, I thought I had worried myself into chest pains. Turns out that may not be true. This cycle I was calm, and things were going well, until the late afternoon of Day 2, where more chest pains arrived. I called the oncologist, and back to the ER. They weren't as bad as last time, and stopped on the way to the hospital. The ER doc said my EKG was mostly normal, but the EKG from two weeks earlier still had him concerned. He doesn't understand why the cardiologist didn't do a heart catheter two weeks ago. So, I spend the night in the hospital for observation, and met with a different cardiologist in the morning, who said he agreed based on the EKG from two weeks ealier, I should have a catheter, so I went down to the cath lab, and got that procedure. I will say that was an interesting experience, with very minimal pain and very low invasive. It was kinda like getting a big IV in my wrist (they almost never do this in the groin any more, as was standard a few years earlier), and taking a lot of images. Took all of about 20 minutes once the procedure started. Result: Again, all clear. The techs were giving me high fives as I rolled out of the procedure room.

My oncologist is doing two things

• Switching from FOLFOX protocol to CAPOX. Essentially I'm switching from 5FU 46 hour IV pump, to CAPecitabine pills for 14 days. It's essentially the same medicine, just trickled in more slowly, and taken in pill form. The hope is it will be better tolerated from a chest pain perspective. The CAPOX cycle is 3 weeks instead of two. Pills for 14 days, then 7 days off.  I still get the OXaliplatin infusion on day 1, so I'm still sitting at the hospital for half day with IVs, but I at least don't leave with that stupid pump hooked into my chest.
• She's sending me to a cardiologist who works with her frequently on the cardiac side effects of these drugs. It turns out these drugs can have these kinds of issues with a small percentage of patients. I'm seeing that guy on May 11. The obvious question is: Is this chest pain just an annoying side effect, or is this damaging my heart? Are there things I can be doing prophylactically, to avoid this in upcoming cycles. 

Other Side Effects

I have to admit, other than then chest pain/ER trips/cardiology tests, the first two cycles have been well tolerated. Details below:

• Cold sensitivity - This cycle was more intense, and lasted longer. As I write this on Day 10 of the cycle, I'm still having very minimal cold sensitivity symptoms. Last cycle it was all gone by day 5. 
• Gastrointestinal Symptoms - No nausea, no vomiting, but my appetite went away around day 3-4, and recovered slowly day 5. One 3 hour episode of diarrhea, that's it. 
• Fatigue/Malaise - I would say similar to last cycle, I definitely lost energy, and took until day 6 or 7 to get mostly recoverd. As I sit here on Day 10, I'm back to normal for sure.

Next week is a visit to the cardiologist for more questions and investigation on Monday, then Tuesday, starting cycle 3. Here's hoping for no ER visits, and a well tolerated cycle. The CAPecitabine can have some different side effects (more diarrhea, rash/blistering on hands/feet), but hopefully that can go well. 

Fingers crossed.

Want even more details? Check my daily chemo symptom log in the sidebar.

Chemotherapy Cycle 3 (May 12 - Jun 1) - Approaching half way point

Cycle 3 (of 8 total) is over now, and it did not include the drama of trips to the ER for chest pains. So, that's a win.

Cardiology Issues

I did have very minor chest pains during cycle 3, that were all brought on by exercise. My wife and I take walks around our neighborhood once or twice a day if weather allows, and generally, toward the end of the walks, I'd start to feel that familiar pain/pressure. As soon as I sit down it's gone in 30 seconds. 

I've been working with a cardiologist who works with chemotherapy patients and is familiar with it's side effects. He's assured me that my stress tests and catheter results look fine, and this is "just" vaso-spasms from the chemo drugs. I asked him if these spasms were doing any long term damage, and he basically said that to our knowledge, no, but let's try to prevent them so I can take walks or do chores without discomfort. So, my cardiology meds are below:

• Lisinopril (I've been on this for years to manage high BP with my family doc).
• Amlodipine (It's a different BP medication that helps prevent vaso-spasms).
• nitroglycerin tablets (It's a short acting tiny tablet I put under my tongue if I start feeling any pain. These have been around for decades).
• Imdur (isosorbide mononitrate) (it's a long lasting nitroglycerin drug that I take once a day, and protects against chest pains. It also lowers my BP).

I've been taking amlodipine for a couple weeks, I haven't needed to take the nitroglycerin, and today is the first day on Imdur. My BP was very low for me (103/57) today. Doc said to drop lisinopril first to try to get it back to normal, so I'll be monitoring and adjusting... 

New Protocol

As I mentioned last time, the oncologist suspended the 5FU through 48 hour pump infusion and replaced it with pills. The retail price on these pills are about $52 per pill. I take 8 per day for the first two weeks of my now three week cycle. I've included a pic of the pills, in case you were wondering what $52 pills looked like.

The pills are essentially the same medication, but trickled in over 14 days instead of 2. That combined with the amlodipine seems to have gotten the chest pains to a manageable level. Hopefully the Imdur prevents the rest of the minor chest pains I had in cycle 3, and cycle 4 can be 100% chest pain free.

Other side effects

Because I'm now on 3 week cycles instead of 2, the OXaliplatin drug has been increased by about 50% over the first 2 cycles. So, cycle 3 I was on full blast for the neuropathy side effects. Tingling in hands, severe cold sensitivity, visual disturbances, jaw pain during first bite of food (especially salty food), etc.

I also experienced a fair amount of suppressed appetite. I usually lose about 10 lbs on a cycle, but gain most back during my recovery week. There are smarter ways to lose weight.

Ok, that's the wrap up for cycle 3 of 8 total cycles. Fingers crossed for a smooth cycle 4.

Want even more details? Check my daily chemo symptom log in the sidebar.

Chemotherapy Cycle 4 & 5 (Jun 2 - Jul 13) Life happens, but keep fighting

Cycle 4 and 5 are in the books. They featured more of the same from a chemotherapy and side effects perspective, but a lot of life changes to deal with.

Cardiology Issues

The chest pains are still there, but mild, and I generally know what triggers them. Exercise and heat. So, I avoid those things when I'm on the pills and I'm mostly ok. It's frustrating though, as I enjoy taking walks with my wife, and exercise is otherwise good for me. 

I don't enjoy taking the new cardiology pills (I take 3 different meds per day). They have their own set of side effects, but my cardiologist assures me that when the chemo is over, we'll taper off the strongest drug, and just get back to common every day BP control medication(s).

Fatigue/Malaise

Every cycle, this is getting more severe, lasts longer in it's peak, and takes longer to taper down. Cycle 5 was particularly difficult, with me sleeping the day away on days 2-4, and some on day 5. I have little energy on these days to do much. Work is very difficult. I generally am lucky to get a half day's worth of work in.

Life

The biggest issue these last 6 weeks have been life events outside the chemo. 

• Our 20 year old daughter moved out, and our nest is empty. It's bittersweet, but takes some getting used to. I'm proud of her. She's doing great.
• My wife's sister lost her battle with muscular dystrophy at age 45. Jodie will be greatly missed.
• I had to undergo another minor surgery to remove to small lesions on my stomach (that proved to be non-cancerous).
• And of course, we're all dealing with COVID and other unrest in the US.

Bottom Line

I'm lucky. My prognosis is strong at this point. Chemotherapy protocols for colon cancer are "milder" than other protocols. And overall, for all the people getting this protocol, I'm handling it pretty well (setting aside the cardiac drama). I've had NO nausea/vomiting. no hair loss. no hand/foot syndrome.

Having said that... this sucks. It's a marathon. The fatigue/malaise is awful. And maybe I'm simply a wimp, but I don't know how others handle the tougher chemo protocols. I guess you have no choice. And I admit that the life issues listed above put a further damper on these last two cycles.

Three cycles to go, then I move into the monitoring phase where I get tested and scanned and scoped on a regular basis... for the rest of my life. 

One day at a time, keep fighting, and carry on!!

Want even more details? Check my daily Chemo Symptoms Log in the sidebar.

Chemotherapy Cycle 6 & 7 (Jul 14 - Aug 24) Light at the end of the tunnel

Cycle 6 and 7 are done. After cycle 6, we dropped oxaliplatin. And that has made a ton of difference...

CT Scan

So, I had my first CT scan looking for cancer spread/re-occurrence. All clear. As I sit here today, my status is No Evidence of Disease (NED). Which sounds good, but that's really been my status since I had the tumor and lymph nodes removed back in March 2020. This chemotherapy, all along, is to chase down what may be floating around my system that we can't detect.

Cardiology Issues

The chest pains are still there, but mild, and I generally know what triggers them. Exercise and heat. So, I avoid those things when I'm on the pills and I'm mostly ok. 

Fatigue/Malaise

Cycle 6 was the worst for this. Day 2-5 were really rough. Very unproductive, and did a lot of sleeping throughout the day.

 

Cycle 7 was a LOT better from a fatigue perspective. We dropped oxaliplatin...

Oxaliplatin

After cycle 6, I found that my feet were continuing to tingle well into the cycle, and in fact, by the start of cycle 7, hadn't subsided. Based on this, and a clear CT scan at the end of cycle 6, and the fact that I'd gotten 6 cycles in with oxaliplatin, my oncologist decided to suspend that drug. 

My conclusion after working through most of cycle 7 is: oxaliplatin is the devil. Man, what a difference. In fact, if it weren't from the cardiac side effects from capecitabine pills, It's been really smooth. I feel mostly fine. 

Next Steps

Cycle 8 will be my last cycle. So, there's light at the end of the chemotherapy tunnel.

After that, it's CT scans every 6 months for 5 years, a repeat colonoscopy in Feb 2021, and if that is well, colonoscopies every 3 years for life. CEA Tumor Marker blood tests every 3 months for 5 years.

So, it'll be a little nerve wracking to get tested and wait for the results. But I have no choice, and ultimately, many others have been through what I have, and live to talk about it 20 years later. So, my prognosis is good, and I will remain optimistic. 

I'm trying to stay active, particularly on my off week.Here's a recent shot hiking in the woods.

Want even more details? Check my daily Chemo Symptoms Log in the sidebar.

Chemotherapy Cycle 8 (Aug 25 - Sep 14) DONE!!

Cycle 8 is done. 22 weeks of chemotherapy wrapped up. My oncologist and I have agreed to suspend treatment for now. Understatement of the year: I won't miss chemo.

My Status

TV/Movie cancer uses terms like "cured", "cancer-free", or "remission", etc... In the real world, those terms are used less often now. The status a cancer patient wants is NED (No Evidence of Disease). Theoretically, it's impossible to declare anyone cancer-free, because there's no guarantee that microscopic cancer cells were circulating around some system of the body. 

For me, I'm currently NED. After surgical removal of about 12 inches of colon and lymph nodes, 22 weeks of chemo, and CT and CEA tumor marker blood tests, There's no evidence of cancer remaining. That's great news, and what I was hoping for. 

Residual Side Effects

As I type this, my fingertips are numb, and several times a day I have further tingling/numbness in my hands/feet. This is normal, and while not debilitating, it's certainly annoying. I hope it doesn't get worse, and eventually fades away. My doc says for most folks it does fade, and exercise and drinking lots of water help alot.

Watching and Waiting

I'll have CT scans every 6 months for the next 5 years. I'll have CEA tumor marker blood tests every 3-6 months during that time. I'll have another colonoscopy in late winter 2021, and if that's clear, every 3 years for the rest of my life. My oncologist says that the next 2-3 years are the critical ones, when most recurrences happen.

So, the battle is won, but the war is not over. 

Some Interesting Stats

On October 6, 2020, I'll have the port/catheter removed from my chest. That's the device used to pump chemo drugs into a vein that leads directly to my heart. That will be surgery #8 in the last 12 months, and hopefully my last for a while. 2 of those surgeries were dental/oral, and not related to cancer.

This year I've had several deaths in my personal network, 2 from cancer. I've said before, 2020 has sucked for everyone, and has been especially for me and my family. 

But I have to recognize that even in these difficult circumstances, I'm very blessed. Here's some positive news on the home front:

• My parents survived their COVID outbreak and after a few weeks of sickness, seem to be on the mend.
• My immediate family is in good health.
• I get up and work every day, earning a living.
• I can get up and run personal errands without help.
• I can walk, hike, and pursue hobbies and interests.
• I recognize not everyone can do these things after a cancer diagnosis. I'm very blessed.

What's Next????

While my doctors will keep an eye on test results, etc... It's time to get back to living even more. I'm going to pursue the following:

• Catch up with friends as much as I can during the pandemic.
• Lose some weight (while my weight fluxuated some during chemo, I'm ending it on the heavy side). 
• Continue to pursue exercising in as many ways as I can. 
• I've recently been doing some wood working, and I want to continue to learn and grow on that front.
• Enjoy some sports events that are starting back up (football and golf still hold my interest). 
• Maybe plan a vacation of some sort within the bounds of the pandemic.

I'll update this blog as news event occur, but I suspect less frequently. 

Finally, a big thank you to everyone for their continued support and encouragement. It has meant a lot to me.

Want even more deatils? Check my daily chemo symptom log in the sidebar.

Clouds and Silver Linings (April 2021)

It's been a while since I updated, so I thought I'd post what's been happening over the last several months. 

After chemo wrapped up in September my oncologist ordered a CEA test (blood test for tumor marker). 0.0-3.0 is normal range. I got 1.6, and texted my wife and said, "normal CEA test results". 20 minutes later my doctor's office called and said that since my previous CEA was 0.9, it had nearly doubled in a few months, even within the normal range, she wanted to order a new colonoscopy and CT scan out of an abundance of caution. Ugh. Bottom line: false alarm, all were clear. 

January 2021 CEA was 1.3 (good). April 2021 CEA was 1.1 (good).

April's CT scan shows a 3mm nodule in my lower right lung. That's the thickness of 2 stacked pennies. Tiny. Colon cancer often metastasizes in liver or lungs. I get my test results on the patient portal, so I got it Friday evening, and had the weekend to stew about it until I met with my oncologist the following Tuesday. Being a worrier, I googled and researched. Research showed that if you pulled 100 people off the street and gave them a CT scan, 50 of them would have a tiny nodule like this in their lungs. But, this is also how cancer metastasizes... they start small and grow. 

I visited my oncologist Tuesday for our normal appointment. She was very dismissive of the lung nodule. Her reasons are:

• They are common, and 99% of the time, nothing meaningful.
• This is tiny, not big enough to biopsy, or run a PET scan on, etc... Needs to be 9-10mm to do anything about it.
• The standard approach for an incidental finding of a micronodule like this is repeat CT scan in 12 months to see if it's grown... I'm already doing full chest and abdomen CT scans every 6 months, so we'll check it then.
• If, in 6 months, its doubled in size or more, then we'll be concerned. But these micronodules are almost always nothing. If it is something, it's treatable. Surgery to remove a small chunk of lung tissue, then more chemo, then carry on. I've been on this battlefield before.

So, given that she's proven herself to err on the side of caution in the past, and she was so dismissive of this, I left the appointment feeling better. 

Having said that, it's obvious to me now that for at least the next 3-4 years, this is going to be the routine, run a test, maybe get a weird result, run more tests, have more discussions, and hopefully avoid bad news about recurrence or spread... But the thought will be a constant cloud hanging over my future. Sitting here in mid April 2021, my next tests are October 2021. So, the clouds are off in the distance.

In a strange way, one of the silver linings of facing your mortality with a disease like this is that your focus changes. That's not to say I'm some sort of Zen font of wisdom now. Far from it. But, I value time much more than things now. At 51, I'd love to have another 30-40+ years of life with my family and friends. But, I can't guarantee I'll live another 30-40 minutes. So, I'll end this post and resist the urge to give you a string of platitudes about life and love. You know.

Next post probably in October 2021.