Friday, January 30, 2009

History and the Future

Since this is our third opportunity to experience chemotherapy, we get to try new things! Actually, this is very different from rounds one and two.

Bryan's original cancer diagnosis came in February 2002 when he had his initial colonoscopy following his 50th birthday. The gastroenterologist was unable to complete the exam due to an apple core lesion in the colon. Surgery followed soon thereafter and chemotherapy began six weeks later. Bryan's staging was B-2 since there was no lymph node involvement, but the tumor broke through the wall of the colon. The decision for chemo was left to us; watch and wait or go on the offense. We chose the latter because he was young and had a young family. We felt it was better to be safe, than sorry. The treatment schedule, at one per week, was to last six months. Due to a non-cancerous mechanical bowel obstruction, in October of 2002, Bryan underwent surgery again and missed his final round of chemo. He then went five years cancer free before it returned in May of 2007.

The colonoscopy, to confirm the malignancy, wound up perforating the colon wall and setting cancer cells free into the abdominal cavity. This meant that Bryan was now stage 4, metastatic colon cancer, the most dangerous form of colon cancer. After surgery in June 2007, removing all of the colon, except the sigmoid, Bryan underwent chemotherapy again, this time with a whole new array of drugs, including targeted therapies which attack an individual tumor's blood supply. Chemo is very caustic on the veins and with so many medications to be infused, we decided to get a Power Port surgically inserted in Bryan's chest in September 2007. After ending chemotherapy in February 2008, Bryan was 30 pounds lighter, weighing in at 130, not much for his 5'8" frame. Since then, we have worked valiantly trying to get some weight on his bones, but to no avail. Little did we know we were working against our enemy for nutrition.

He began to experience abdominal pain in May 2008. After several scans confirmed no reappearance of cancer, it was assumed pain management was all Bryan needed. It was assumed the cause of the pain was scar tissue from his previous abdominal surgeries. Trial and error led us to the best pain solution in December, and Bryan was finally pain free. Monthly port flushes, to keep the line open, made regular lab draws easy. The rising CEA (tumor marker blood test) didn't alarm us because it didn't register when he had active cancer previously. December's reading of 7 was high, the doctor was assuming it was due to inflammation or even a peptic ulcer. We waited one more month and his CEA measured 14! Dr. Chen ordered a PET/CT scan which was scheduled for Monday, January 26, but Bryan ended up in the ER on the Sunday morning before. Again, we were still assuming peptic ulcer or possible another bowel obstruction. The ER doctor ordered a CT scan and the results were quite alarming--metastatic cancer to the lungs, liver, small bowel, mesentery. And here we are, back to chemo round 3.

As for the new pump, it is actually the 5FU which is in the pump. It is about double the quantity he had before thus the need to administer it over a longer period of time. Bryan didn't sleep well Wednesday night, I think it would be difficult sleeping with a tube coming out of your chest attached to a box that keeps making swishing noises. (I'll have to share pictures someday!) I am sure, by the time we are finished, he will be quite used to it and will be able to relax and sleep well.

Wednesday, January 28, 2009

Chemo Day One

Today was a very long day. We arrived in Tukwila at 7:43 for our 8:00am appointment. After the usual preliminaries delayed things a bit, the premeds finally got going about 9:00am. I am on every drug as before with the exception of Erbitux, the chemo med which gave me face and scalp lesions last time. They may start it later. Also, I am taking 5FU in a different way than before. They are giving it to me through a 24 hour pump. This allows for a larger dose of medication over a longer period of time, increasing benefit while decreasing side effects. Susan will disconnect me from the pump around 3:30 tomorrow afternoon. Part of our time today involved her training to be able to do this safely and efficiently. I married a wonderful "nurse" nearly 22 years ago and I have been very grateful ever since. "He who findeth a wife, findeth a good thing" Proverbs 18:22. So far, I have a lot of energy and no nausea, although I have had some stomach pains probably associated with the cancer. The major prayer request is that I do not lose a lot of weight during this ordeal since I do not have much weight to lose.

I have been struck by how much cancer resembles sin. It lies in wait to strike its host in unforeseen moments like sin crouching at the door of Cain's heart (Genesis 4:7). It can even disguise its appearance through mutation hoping to trick unsuspecting T-cells, the body's chief infection fighters, and wreak havoc. Sin, too, disguises itself in innumerable ways trying to trick us into calling it something other than sin. Modern heresies are a prime example. Most heresies are the lie masquerading as truth. This is why Paul warned the Corinthians of "false apostles, deceitful workers, disguising themselves as apostles of Christ. No wonder," Paul continues, "for even Satan disguises himself as an angel of light." He goes on to say that we should not be surprised that Satan's "servants also disguise themselves as servants of righteousness" (2 Corinthians 11:13-15). Sin can even play dead, like cancer, convincing the host that all is well and that caution may be thrown to the winds, and even this temptation is addressed in Scripture: "therefore let him who thinks he stands take heed that he does not fall" (1 Corinthians 10:12) . And sin, like cancer, seeks total mastery and ultimate destruction. Therefore, we should never spare it, befriend it, or otherwise compromise with it. Our only option is total war until the foe is destroyed. I am thankful for these parallels which can aid us in our daily "fight of faith!"

Tuesday, January 27, 2009

The Journey Resumed

Today, at the Seattle Cancer Treatment and Wellness Center in Tukwila, Susan and I both received the hope we had prayed for! In meeting with the oncologist, Dr. Chen, and naturopath, Dr. Reilly, it became apparent that my cancer is both aggressive and medically incurable. This is the nature of stage four cancer. But the good news is that even stage four cancer is medically manageable. So tomorrow, we begin to manage it with a resumption of chemotherapy. It looks like I'll be living with chemotherapy for the rest of my life. The strategy involves essentially the same battery of drugs as last time: 5FU Leucovorin (spelling iffy), the so-called "gold standard" drug for colorectal cancer, and Avastin. Since Avastin can raise blood pressure (as it did for me the last time) Dr. Chen said this time I'd be given a 24 hour pump to take home which administers a much slower dosage over a longer period of time, negating the unpleasant side effects of this powerful targeted therapy drug. Sounds like my bride will have to learn how to access my power port, a port surgically implanted in my chest in Sept. 2007 for the purpose of chemo infusions.

Susan and I continue to marvel at God's goodness in leading us to this cancer center in March of 2002! Their approach to fighting cancer is so totally patient-oriented that they literally become your coaches in the battle, and they recognize that every patient fights cancer in a different way, and they allow for this in their treatment plans. We left Tukwila greatly encouraged and comforted. The fight has just begun! And as we remembered the incredible outpouring of love and prayer that we've already experienced, we can confidently say that the battle before us has in a sense been already won! Our mighty God is faithful and merciful! And though the path before us will take some undoubtedly unforeseen twists and turns in the days and weeks ahead, still we can bank on the nearness of God which is our lasting good! (Psalm 73:28). Thank you all for joining with us in our journey of faith!

Monday, January 26, 2009


Have you ever played the game of Boggle? Letter cubes are shaken and then arranged in a square. Opponents try to form as many words as possible, in a given amount of time, from the letters. I (Susan) like it! You could actually say it is one of my favorite games. This morning, as I was lying in bed, I decided to scramble cancer and form as many words as possible. CAN, NEAR, CARE, RACE are some of the words I came up with. Isn't it amazing--such an awful word full of words of hope!!

We see the oncologist, Dr. Chen, tomorrow morning. Hopefully, we will have a game plan following that meeting.

"Therefore, since we have so great a cloud of witnesses surrounding us, let us also lay aside every encumbrance and the sin which so easily entangles us, and let us run with endurance the race that is set before us, fixing our eyes on Jesus, the author and perfecter of faith, who for the joy set before Him endured the cross, despising the shame, and has sat down at the right hand of the throne of God. For consider Him who has endured such hostility by sinners against Himself, so that you will not grow weary and lose heart." Hebrews 12:1-3