Dan You Have Cancer - Chemo vs Immuno

Allow me to explain. Chemotherapy is defined as; the treatment of disease by the use of chemical substances, especially the treatment of cancer by cytotoxic and other drugs. Cytotoxic refers being toxic to living cells. So there you have it. At its basic, rudimentary level the chemicals in chemotherapy kills living cells. The human body, my human body, is comprised of trillions of living cells. When I have chemotherapy I am actually volunteering to have someone stick a needle in me to kill me. It’s a controlled kill but a kill none the less.

Immunotherapy is a type of cancer treatment that energizes one’s immune system to fight cancer. My immune system helps me fight infections and other diseases. The immune system is made up of white blood cells and the organs and tissue of the lymph system. That’s lymph not nymph. Nymph is a mythological spirit of nature imagined as a beautiful maiden inhabiting rivers, woods and other locations. When one fully understands the lymph system it may border on the mythological but it is definitely for real. My creator thought of everything when he made me.

Chemotherapy destroys all new cell creation in my body. Especially fast growing cells. This is why my hair fell out, scalp, beard, eye brows, chest, legs, you name the place, hair fell out. Only my arms seemed to retain any amount of hair that was worthwhile. God tells me in Luke 12:7 that “even the hairs on your head are numbered and that I am worth more than many sparrows”. For several months at the start of 2019 God’s job got somewhat easier as He had no hairs on my head to number. Now that I think about it there were more sparrows around my feeders during that time. Hmmm!

Red blood cells are also fast growing. That fact coupled with the knowledge that I had cancer in my bones was why I became extremely anemic during my 18 weeks of chemotherapy. My hemoglobin levels were in the Bear Market trend of downward from the very beginning. After two rounds my count was down to 9-plus on a scale where 14 is considered to be good. Next three rounds the count went into the danger zones of 7.7, 7.4 and 7.2. This meant I was ANEMIC. These readings brought a new course, a non-elective core course of course, Cancer 106 – Blood Transfusions, towards my degree in medical science. I affectionately called these days Blood Getting Days. Two units of blood would bump me up two points to 9+ but that would start to diminish as soon as they pulled the needle from my port as my body was still filled with enough chemo to choke a horse. Ann says it brought color back to my checks and I was ‘perkier’ so I believe those long sessions were worthwhile.

In a nutshell chemotherapy is the Great Destroyer. It does not distinguish bad from good. It seeks out and destroys all. Not some but ALL. I was only allowed to have six three-day sessions of chemo. Maybe chemo should be called ‘killmo’ since that is what it does. However, if part of me has to die in order for me to live, then whether it is ‘killmo’ or chemo pump it in to me. It’s sort of what God asks me to do. Part of me has to die in order to achieve eternal life. My earthly sinful nature must die by turning it over to God, in order to obtain eternal life. Once my sins are covered by the blood of Jesus they cannot be seen by the Father.

The Immunotherapy I take is a drug called Tecentriq (atezolizumab). My immune system is a collection of specialized organs and cells that protect me against infections and disease. A protein found on many cells can allow cancer cells to hide from my immune system. Tecentriq strips this protein from the cancer cells enabling my immune system to fight and kill the cancer cells. I know it works because my jaw tumor did not change until after I started Tecentriq. Additionally, when I have a treatment every three weeks it takes me seven to ten days to recover from the battle that ranges inside of me.

Since the cancer stripped the calcium from my bones combined with the wide range of places where the cancer attacked my bone I get a bone strengthening shot every six weeks. This drug is Xgeva (denosumab). It has a specific job, it helps my bones. It does come with a price however. The injection hurts like crap. Once in my body and active I ache as if I had the flu for several days. Bones hurt. Joints hurt. My energy is sapped. I am not complaining. If these are the steps I need to take to continue waking up every morning then a few days of discomfort every three weeks is a small price to pay and welcomed.

I promised myself from the beginning that I was going to share all that I go through not for sympathy sake but rather for the edification of those around me. For those that are praying for me you will know the specific things for which prayer is needed. For those, like myself, who had friends with cancer but never knew or understood the process because facts were never shared, I hope that my frankness is lifting that veil.

I do not fear cancer. It has brought me more blessings and closer to God than anything I have ever experienced. I am grateful for that. Now that I am in the fight I will not back down. I will battle every day to keep cancer down, to control cancer, to eradicate cancer from my body. I can only do that with the help of your prayers, the love of God and the peace I have about my future. In Billy Graham’s book “Angels: God’s Secrete Agents”, he writes:

They (angels) were commissioned not only to bar man’s return into Eden, but with “a flaming sword which turned every way, to guard the way to the tree of life” (Genesis 3:24) lest Adam by eating of its fruit should live forever. If Adam had lived in his sin forever – this earth would long ago have been hell. Thus, in one sense death is a blessing to the human race.

Because of cancer I am able to see the everlasting truth in words such as these. Thanks be to God! Every day I fight.

Dan You Have Cancer - Any Port in a Storm or Cancer Can be Fun!

In a previous blog I explained how it is very difficult to get an intravenous line started in my. This failing on my part has nothing to do with having or not having cancer. It has always been that way. That being the case my oncology nurses lobbied for me to agree to have a port put in my chest. This would save me from going through the struggles of having an IV started each time I needed any medicine or death chemicals dripped or pumped into my body. I cannot accuse anyone of having ulterior motives but it would also make their job infinitely easier too. No more poking, stabbing or goring of this patient’s arm, hand or ankle.  The Friday before my second round of chemo I am scheduled to have a port placed into my chest.

This ‘port’ is about the size of quarter. It is placed just under the skin on my chest. It reminds me of the prime-bulb on a lawn mower, chainsaw or other gasoline powered tool. The port has a tube that extends from the port upwards to my neck where the surgeon will attach it to one of the main blood vessels in my neck.

I report to the hospital early that Friday morning. I check in. I prep in and am laying in a hospital bed with curtain drawn on three sides. The foot of the bed is open and I can see that is taking place this day in the out-patient surgery room. Pretty tame stuff. The attending nurses are kid and very attentive to detail as well as my comfort. Ann’s comfort too. Then it happens! An infusion nurse comes in and sets up to start an IV in me. Before her rear end hit the chair Ann let her know in no uncertain terms that she was not going to be the one to start this patients IV, this day. Ann spoke the magic words, “IV Team”. In a move that one would normally associate with the finals of the women’s individual ice-skating at the Winter Olympics, that infusion nurse was “outta here’’; Gone!; Vamoose!; Made a run for it and beat a hasty retreat to where ever shunned infusion nurses go. After explaining the situation to my attending nurse, she said she would contact the IV Team. Mission accomplished.

The IV Team nurse showed up shortly thereafter. She was somewhat somber and cool towards us, very businesslike.  I can only guess what she had been told when she was summoned to the out-patient operating room. After a few minutes with us she realized that we had a legitimate reason for asking for her presence, that we were more Ma & Pa Kettle than Raymond Fernandez and Martha Beck. I was amazed by her because she reached into her Mary Poppins bag producing what I recognized as a Garmin fish finder. I’m sure what she had was way more sophisticated, more expensive and had never seen the inside of a jon boat or the deck of a Bass Tracker. I do know it worked! She greased my arm and within seconds found a viable vein to use. The hardest part for her was listening to the play-by-play delivered by her patient as I asked what kind and how many fish she was finding. She stuck that needle in, hit it on the first try and had a flowing IV in short order. She was carried out of the room upon the praises of her patient and his wife.

My surgeon, who had been pacing the hall that I could see from my bed, was my next visitor. He came in and after explaining exactly what he was going to do provided us with a bit of his surgical history. He had been a surgeon for over two decades but had fallen into the port planting business the past several years. He had done over a thousand of these or was it ten-thousand, maybe a hundred-thousand. My mind was become relaxed as the pills they gave me to relax me were becoming very relaxing. With a spin on his foot and clap of his hands I was on my way to the operating room.

I need to talk about operating rooms. For the first fifty-five to sixty years of my life my experience and my recollection of operating rooms on a first hand observation and by what I have seen on TV has been of cold, tiled rooms, green or blue, somewhat cold, a narrow table in the center with a big round light attached to a moveable arm. This day I was wheeled into what appeared to be an oversized closet. Possibly a very small kitchen as I could see from my prone position cabinets hanging on the wall. Maybe this was the operating room used for cancer patients because statistics showed that until any real legal litigation could unfold, the patient would be no more. In the room that day was the surgeon, whom I previously met, an anesthesiologist, who shook my hand and into whose hands I was placing my life, several men and women young enough to be my grandchildren and one student surgeon, to whom I was introduced but her name resides in the same place in my brain as the number of ports my surgeon had placed. Darn! I just had a thought. When he told me how many he did I should have inquired about his success rate. Next time.

Those in attendance helped me go from my narrow hospital bed to the eight foot long two-by-six being used in the closet operating room this day. “Are you comfortable?” they asked. Break multiple ribs, one sternum and several vertebrae; then lie down on a two-by-six board and tell me how comfortable you are. I replied through clenched teeth, “Yes”. Several of those in attendance this day in the phone booth covered me from head to toe with a sheet. I was asked to turn my face to the right. Upon doing that I could look out under the sheet and see light and the knees of the anesthesiologist. Then a flap was opened that exposed the “field” where the procedure was to take place. A quick rinse, a shave and the application of orange stuff that had to be forcefully rubbed off, followed. All this time there was a din of conversation by everyone as well as the step-by-step explanation from teacher to student. I was not asleep. It was twilight time. “Heavenly shades of night are falling, it’s twilight time…” is how The Platters described it.

From the conversations I knew the surgery was underway. I could feel fingers in my “field”. Then it hit me. It wasn’t sit-straight-up-and-scream pain nor was it the gentle pressure of a loved one hands. It was the cutting edge of a very sharp scalpel being drug across my chest. My subconscious registered as pain. My conscious registered it as really weird pain without the hurt. Had someone asked me what my pain level was at that moment I would have said, “One, no four, no six, no I have no pain”. I do remember saying, “Ouch!” Upon the utterance of that world the room fell silent. Think how it would sound if suddenly without warning the water was shut off going over Niagara. Silence. My surgeon broke the eerie silent spell with the words, “Did you feel that?” No doctor that’s the new ring tone on the anesthesiologist’s iPhone. No I have programed my mind to randomly say words beginning with the letter ‘O’, my next random ‘O’ word is ‘over’ as what this surgery is going to be if it happens again. No I’m sorry I was reviewing the tenets of onomatopoeia in my twilight state and the word ‘Ouch’ came to mind and slipped across my lips. YES IT HURT! YOU JUST CUT ME WITH A SCALPEL!

The surgeon requested that the anesthesiologist give me “a little more”. We were once again back in the saddle heading towards a western sunset only a bit more subdued than before. After a brief recovery time I was returned to Ann at the point of origin. The surgeon stopped by on his way to his 10,001^st port surgery to see how things were going. I do not remember us reminiscing about being wide awake during surgery but what’s a little slip up among friends. He did ask if I had any questions. I don’t know if this surgeon was caught unaware, if he was trying to humor me or if in his haste to get past recent events he slipped up but I asked the same question of him that I ask every doctor who asks me that question. “Will I be able to play the piano when I get home?” He immediately answered, “Yes there is no reason you shouldn’t unless you find it uncomfortable.” I was thrilled. If I was able to I would have gotten up danced around the bed and do-si-doed Ann at each corner. I replied, “Good! Because I couldn’t play it before this surgery!” Cancer can be so much fun! I couldn't choose not to have cancer but I can choose how to live with it. Thank you Jesus for the attitude you have given me.

Dan You Have Cancer - The Pain of Pain

The scan I had during my week vacation at Community General Hospital revealed not only cancer under my jaw, in bones and on my liver but it also shared with those reading the results that I also had a broken sternum and multiple broken ribs. These were explained to me as being possible due to the amount of calcium leeched from them by the cancer.  Knowing this did not account for nor did it make sense of the amount of pain I had in my back. I had a spot on my right side below my ribs and above my hip that was excruciating. There were several things that made it worse. First was the fact that I could be pain free and then suddenly without warning I didn’t know if I should sit or stand, laugh or cry. If you’ve ever walked barefoot through a dark room and stubbed you toes on the coffee table that isn’t there during daylight hours you sort of, kind of relate to my situation. One minute you’re whistling the next minute your saying words you had no idea were in your vocabulary. Sit? Stand? Laugh? Cry? Feel my pain yet. This same spot on my back limited the time I could sit at the kitchen table, sit at my computer or sit pretty much anywhere. It also limited the time I could stand at the kitchen table; stand at my computer; stand pretty much anywhere.  The pain of getting in and out of cars was greatly surpassed by the pain of riding in a car. Every dip, rumble, pot hole, manhole or patch in the road provided me with more pain and discomfort than I ever imagined having. I always felt bad for Ann as I knew she was trying to avoid the road hazards that caused such discomfort but her chances of doing that were equal with her chances of hitting the Irish Sweepstakes. To be more relevant I should say Power Ball or Mega Millions. I believe this pain was nerve related, generated by a combination of the cervical fractures I had in my spine and the tumors growing there.

My oncologist sent me to a pain doctor better known as a palliative care physician. I had originally spoken with others from the same practice in the hospital but this was serious stuff now. Quality-of-life they call it. The theory goes that one heals better when they are not in pain.  I whole heartedly subscribe to that theory, even more so now that I look back on it through a clear, pain free mind. In the moment everyone seemed more concern about my pain level than anything else.

“Daniel, how would you rate your pain?” Do you mean right now or when I can’t stand, sit or see straight because it feels like someone is using my back for a dart board or worse yet rattan cane practice. “Zero means you have no pain and ten means well let me just say; do you have a living will and medical power of attorney papers with you?” The more I was asked this question the more obstinate I became in answering it. I became so irritated with the question I refused to provide a straight answer to it no matter who asked. I never said I had pain greater than four (4) only because at some point in a hospital hallway while I was lying on my back, yes, yes, yes in severe pain, I looked up and there on the wall was a poster asking, “What is your pain level today?”

I could relate to the dark green face on the left and to the light green face labeled 1-3. Yellow moderate even made some sense. From there on I struggled. What If I said my pain today was 10 and tomorrow it was worse. Where do I go then? Does that invalidate all my other pain ratings. Can I be charged with “Pain Fraud” or perjury by my palliative care physicians when that happens? Oh, the pain of it all! God have mercy! Cancer sucks!

I hesitate to tell anyone how much pain I have for several reasons. First I think Gibbs has a rule saying to share that information is a sign of weakness. Secondly, as soon as you say you have pain someone with more college loans than you or I have wants to give you a pill to ease the pain. Not make you better but make the pain go away. For me most if not all of those narcotics provide me with my very own version of Nightmare on Elm Street. Sleep, which is brought on and lengthened by those magic pills, unleashes ugly, flesh-eating monsters that always chase and catch me in the dreams I can’t wake up from. I’d rather have the pain. Pain and prayer.

Taking this all in my palliative doctor prescribes a mild pill, an opioid that lasts for 4-hours. The four hour time frame described was right on. I’d take the pill. Forty-five minutes later I could feel it working as the pain rapidly subsided. I was the pan free for two hours and forty-five minutes until I could feel the effects of the magic pill wear off. What I learned through this process is that there is truth in advertising. The TV and magazine ads say take our product if you are taking opioids as the will make you constipated. This is the truest thing I’ve ever heard on a TV commercial. The price of each hour an opioid relives your pain is equal to one full day of being full. Bowels shut down. Close up shop. Leave town. Go on vacation. Whatever, they cease to work. So the algebraic equation goes like this:

excruciating pain + opioid = excruciating pain relief + pain and discomfort of another kind

Needless to say I only used the opioids for about two weeks. They tried to counter the opioids damage by giving me one that was milder over a longer period of time. I still couldn’t say how bad my pain was because I made pain a relative thing in my life. I simply refused to accept it. When I hurt badly, I thought of something else. When pain came knocking at my door I refused to answer it. When it showed up in my in-box I redirected it to Trash. Doctors and nurses had a difficult time excepting or believing that but that is exactly what I did. Other than Tylenol I didn’t take any pain medication after Ground Hog day.  I told anyone who asked that I really could not say what my worst pain was as I had yet to experience it. Four was my apex, my zenith on the pain scale.