Karma

When I left the hospital they gave me a page of written discharge directions which instructed me to 'ambulate', so I've been making an effort to get out and walk regularly. I started with jaunts around the block, Van pushing his bubble lawnmower along beside me. I've been building up to longer, albeit slow walks a few miles across the park. These are usually followed by a nap, but I digress.

On the east side of the park, just below the Museum of Natural History, there's a fountain - around the fountain are a series of benches, one of which is dedicated to our friend Greg, who succumbed to colon cancer in February of 2009, after a truly valiant battle.

I've been finding myself drawn to the bench lately. About a mile and half from the house, it provides a perfect pit stop. And it boasts arguably the most stunning view in all of Denver. It overlooks the lake and pavilion on the west side of the park, backed up by the downtown skyline and beyond that, the Rocky Mountains, the peaks still frosted with the last of Spring snow. In the summertime, the fountain alongside will be surrounded by picnicking families, giggling children dashing through the water spouts.

Sitting around in the sunshine, there's a lot to think about. On my last visit, I mused a bit about karma. Greg's diagnosis had derailed what was a faint interest/belief in the idea. I certainly appreciate the Hindu concept of an immortal soul's journey to a higher spiritual existence, but I really didn't like the idea that his cancer in this lifetime was cultivated through some past life action. Oddly, I've been rethinking the concept lately and it doesn't bother me as much in the context of my own diagnosis. I'm actually OK with the idea that I might be paying off some grand debt to the universe. I feel like I'm generating good karma in this life, and if conquering cancer now makes me square for any past life transgressions, I think I should be solid as I approach the next spiritual plane. In the meantime, I'll do my best not to screw up this power position as I enjoy the next 50+ years of this lifetime...

Post Surgery Report

Surgery went very well - my doctor called it textbook perfect. My insides apparently look great post radiation, with considerably more healing and less scarring than expected. While the pathology report indicated nothing left of the tumor but a mere pin head sized spot, unfortunately there were also four positive lymph nodes so the cancer remains stage III. This stung. Although I understood that there would be no change in the post surgery chemo regimen regardless, knowing that the tumor had all but disappeared entirely I had convinced myself there would be downstaging - and all along we had thought there had been only one or two suspicious lymph nodes, so I hadn't prepared myself for the higher count. Ultimately though, its all gone and that's what counts.

Recovery from surgery itself hasn't been difficult. I was up and around the next morning, out of the hospital a day early and ditched the Vicodin within 36 hours of being home. Learning to live with my new Frankenstein abdomen however has been very difficult.

Because radiated tissue typically does not heal as quickly as normal tissue, the standard treatment in a case like mine is to create an ileostomy - similar to a colostomy but further up in the intestine, this bypasses the surgical site and allows it more time to heal. This is short term and will be reversed in about six months after chemo is over, but that hasn't made it any easier. Its changed what and how I eat, what I can wear, how I sleep. But this is all physical and easier to move past than the mental bruising. Learning to care for and live with this has raised more stress and anxiety in me than I have ever experienced - frankly more than I thought I was capable of.

Early on, outlining my course of treatment to Kristy, she quickly put it in perspective - 'Ok, so you'll poop into a bag for a few months, big deal - you'll watch Van grow up, graduate college, get married.' I think about this every day - I can live with this, to live for that.

Age is Not Just a Number

Van turns two tomorrow, and we had a party for him this weekend. I learned my lesson after last year, when I spent hours and hours making star-shaped melon skewers, potato salad, and blue cupcakes for nearly 40 people, and was then exhausted before the party even started - this year, another year wiser, I opted for a keg, pizza and bakery cake.

I am so very grateful that I was able to celebrate his birthday in these last few weeks pre-surgery. I know that next Monday is the start to several very challenging months for Steve, Van and me, and so this has been the perfect time for us to feast and be merry. Though hectic, it's been so much fun. Teaching him to sing happy birthday, helping him unwrap presents (each one gets a 'WHOAAA', even if it's socks), watching him load raisins from the new bulldozer into the dump truck while wearing his little hard hat...

Of course, there's a new level of emotion tied to birthdays for me too, because every year passed for all of us seems that much more precious. I used to say that age was a state of mind and the number didn't matter. I had started to joke the last year or two that I was going to pick an age and just stick with it - 31 sounded pretty good to me. I do still believe that age is a state of mind, because a lot depends on what you do with all of those years of experience - but the digits do matter. I will never again lie about my age. I will do my best to stay young at heart, but I will embrace the number, too. I will share it proudly, boast of it even. And someday when blowing out the candles on my 80th birthday cake, I will insist that there actually be 81 candles (one for good luck!) and it will be a beautiful sight.

Shrinking...Violets

During radiation treatment, I would lay on the table and try to find something positive to wrap my head around. Often I thought of the tumor dying and dissolving, and yes, sometimes I even imagined it squealing 'I'm melting, I'm melting...' Wicked Witch style as it went. I tried to picture healthy tissue springing forth and blooming in its place, like a beautiful garden. As far as actual probability, I was told that the tumor will go away only about 20% of the time, with another 20% experiencing no measurable change. The majority, about 60% of people, fall somewhere in the middle.

I visited with my surgeon end of last week, and although formal downstaging cannot be done until after surgery and pathology, the tumor is gone! This does not mean I'm cancer-free (yet), and both surgery and post-operative chemo are still necessary because treatment is based on the initial stage III diagnosis - but this simplifies surgery a bit and long term survival rates are positively impacted by significant downstaging.

I'm proceeding with cautious optimism until we do have pathology, but this is a great boost as we prepare for surgery on May 3rd!

The Breath of Spring

I must admit, updating when everything seems so status quo seems a bit odd, but this period of normalcy is so refreshing.

Keith, Kerry and Keira have come to visit for the week, and though I think we're all suprised that two small children can run four adults so ragged, it has been pure joy. Being only two months apart Van and Keira make perfect playpals - even when squabbling over whose turn it is with whatever the toy of the hour is, they're hilarious to watch. And when they're done fighting and they hug and kiss, it is precious.

They couldn't have come at a better time. I'm still very tired but all the burns and other discomforts are over with, and I feel mostly like I did before this all began - minus all the symptoms that suggested a problem in the first place. I've entertained guests on the back patio, cooked a few delicious meals, slid down the big slide at the park over and over, dyed eggs, and had an Easter morning egg hunt for half a dozen munchkins!

Surgery is scheduled six to eight weeks after radiation treatment is over, as it gives the radiation time to continue to work, but precedes any significant build up of scar tissue. My surgeon has tentatively scheduled surgery for May 3, although I'll see him in the coming week to firm that up. Though I dread they may tell me that Van will not be permitted to visit during my six day hospital stay, the May date will at least allow me to celebrate his second birthday at the end of the month! And the sooner surgery is behind me, the sooner the third phase of chemo can begin and the sooner we can all put this behind us and go on counting birthdays!

Today's Blog is Brought to You by the Number 6...

Phase I of treatment is a wrap - radiation finished up last Wednesday, and the chemo pump came off Monday. I wish I could tell you that the last few days treatment free have been blissful, but alas, no. As I had been told all along, despite the relief of being at the finish line, physically, the end is the worst. But, as I've also learned, treatment pushes you until you are teetering on the edge, and than its over and you recover - quickly.

Donovan has been learning to count - goldfish, stairs, the number of tires on the school buses we pass on our way to work. So lately I've been finding myself counting things, too.

Over 6 weeks of treatment I've had:

• 28 radiation treatments, with 3 shots of gamma rays each time
  
• 200 ml of Fluoroucil (chemo), pumped in slowly in tiny batches every 10 minutes, 6 times an hour, 144 times a day, for 28 days
  
• 6k ml of leucovorin, a reduced folic acid used in conjunction with the chemo to enhance effectiveness
  
• 9 prescriptions and 6 over the counter medications to address side effects
  
• 16 doctor appointments
  
• 6 blood tests
  
• 1 abdominal ultrasound
  
• 1 grey hair

Of course, there are also all the things I lost count of - the meals, cards and emails, and other thoughtful gestures from family and friends, the kisses and hugs from Van and Steve, the simple pleasures because I was finally too tired to over-complicate things.

So, now I have 6 glorious weeks off before phase II. Surgery and recovery will undoubtedly be a new challenge, but for now, I can just relax, heal, get back to running and skiing, and continue to count all the simple pleasures.

Blood, Sweat and Tears

Early on a friend told me that I would find a little bit of good news in each visit, and he was right.

The chemo pump went back on yesterday after a two week break, and during our visit my doctor had plenty to share. First, my white and red blood cells, platelets and various other blood components have all stayed very stable - on the mid to very low side, but all still in the normal range. As chemotherapy drugs can't distinguish between healthy and evil cells it attacks them all, which naturally results in these various counts dropping. The ability to fight off infection and stop bleeding is pretty critical, so these complete blood counts (CBCs) are closely monitored each week. Beyond the normal range is the 'lower-than-normal-but-we'll-still-treat-you range', followed by the 'so-low-we-can't-chemo-you-up-this-week-and-don't-cut-yourself-shaving range'. I hope to avoid both.

More importantly, they shared the results of the genetic testing they had performed on my biopsy. They were looking for the five genetic mutations commonly associated with hereditary nonpolyposis colorectal cancer (HNPCC), which is a syndrome that puts people at higher risk for colorectal cancer. Some studies indicate that without screening as much as 80% of people with HNPCC will develop this cancer, compared to about 4% of the general population, and at a much earlier age.

I tested negative for each, meaning that mine is assumed to be just a sporadic cancer. Given the maze that cancer is, there are likely other hereditary genetic mutations that simply haven't been isolated yet, but I'm willing to take these results for what they are, which is good news. For me, while it doesn't rule out a recurrence, people without HNPCC tend to respond better to treatment and have slightly less risk of recurrence. Most importantly, though Van will still have to go for regular screening at an early age now that he has this dreaded family history, I did not pass any known genetic mutation on to him - and it is unlikely that my brothers carry them either.

I don't think I realized how heavily this was weighing on me until Dr. Conlin shared the news and I promptly broke down in tears. This is rare for me, and based on her pie-eyed, mad scramble for tissues, I know I surprised us both - but I imagine oncologists don't get to see happy tears as often as they would like, so I don't think she minded.