Bite the Bullet

"Be of good courage, and let us play the men for our people, and for the cities of our God: and the LORD do that which seemeth him good." -2 Sam 10:12

[View from Table Rock on a recent hiking/camping trip]

High Level Process Update

Liver surgery was performed Nov 9 without incident (that I'm aware of). I resumed chemo this past Mon, Jan 9. The regimen as of now is only Panitumumab (Vectibix), the monoclonal antibody I've had before that causes the skin rash, which is technically not chemo. The plan is to take another CT scan around April and determine whether this maintenance regimen of one infusion every 4 weeks is enough to maintain status quo. CEA is 9.2 (up from 7.2 a few weeks ago, which was up from 4.9 before liver surgery - not very bad).

Why Liver Surgery?

In the past we were debating on whether liver surgery was a good idea or not. Oncologists we saw from Duke and the Mayo Clinic did not recommend it because it is risky and statistically does not prolong life. Those involved in my personal treatment locally, however, recommended it as a good next step when I got to the point of wanting to stop chemo again late this past summer.

It became apparent that continuing chemo indefinitely was not going to eliminate the large lesions in the liver, but could probably kill the liver itself. So it seemed the better option was to confront the risk in the short term through surgery instead - the primary risk being that I would either bleed to death on the operating table or that the liver wouldn't recover and regenerate itself after surgery. Or, that surgery would not eliminate all the cancerous areas, so I would be continuing chemo afterwards anyway, but with a compromised liver... 

The verse above reflects the surgery decision. Those words were spoken by Joab to his brother Abishai when he was between a rock and a hard place (Syrians on one side and Ammonites on the other side). All we can do is our best judgment with limited information, and trust God to do what seems good to Him.

The surgery experience itself was a breeze as far as I knew. The original plan was to remove the entire right lobe, but Dr. Yi realized during the surgery that there were more lesions than what showed on the scans beforehand, so he could only remove parts of the right lobe and parts of the left lobe without removing too much in total. He ended up removing about 30%, which is exactly the amount my sister Heather was praying he would remove.

Recovery was faster than I even expected. I was discharged directly from ICU after 2 days instead of going to a regular room. My incision was I guess about 9 inches long from my sternum around the bottom of my right rib cage and to the side. It healed instantly into a perfect little pink line - very much opposite of the gaping wounds Christina had to pack for weeks after my abdominal surgery in May. Christina had prayed before that we would be blown away by how easy it was, and we were. It was amazing.

This is what I meant by the title "Bite the Bullet" - What was dreaded as a high risk turned out to be basically a non-event. Ironically, as my kids pointed out, the idiom "bite the bullet" originates from war-related surgeries in days prior to anesthesia, when they gave the patient a bullet to bite down on during the procedure. Often the patient would open his mouth to scream, choke on the bullet and die. None of this is what I meant - I only meant to confront a challenge head-on when it seems like the wisest course of action. If we lived at any other time in history this surgery would have been a totally different experience, for which I give thanks to the Lord. It was extremely easy.

Post-Surgery CT Scan

My original plan was to recover from liver surgery, take some more chemo for good measure, then have the simple procedure to remove the remaining tumor in the left lung, and finally abdominal surgery again to remove one last lymph node and reverse the colostomy. Dr. Yi said he would be happy to proceed with these steps if the liver was still cancer-free after a few months. Turns out it won't be quite so simple...

The CT scan after surgery on Jan 3 revealed that one lesion remains from before surgery, and two new ones have appeared. The nodule on the lung is larger than before, and a second one has appeared (or reappeared from before, I'm not sure). Also the remaining part of the colon still attached to the rectum looks suspicious for malignant growth at the original tumor location.

My first thoughts were that I didn't want to leave Christina alone. And I didn't want to leave my kids yet with so much work left to be done. Then I really didn't want Dr. Yang to go all in with chemo as a last-ditch effort to get this under control, which could kill me by itself given my post-surgery liver. And, of course, being a baby, worst of all was the prospect of feeling bad!

The Clouds You So Much Dread

You know Dr. Yang has never been optimistic at any time in the past year, but this time he had a much more laid-back attitude about what we should do next. CEA shows a relatively low disease burden, he said, so we should try Panitumumab every 4 weeks and see if that's enough to maintain status quo. It would be pointless to ruin quality of life with heavy chemo in an attempt to work a miracle here. Nothing so far has surprised him, and his view is that I am par for the course so far in typical disease progression. So, he says, I should have fun and do my bucket list, and not worry much about what the scan said.

You can hear both the positive and the negative in what he's saying. But remember, we are mainly interested in buying more time while feeling well enough to function - Eternal life is in the world to come, not here. 

And I take some exception to Dr Yang's opinion that this is all par for the course - I know my God has moved in specific ways and answered specific prayers to make my personal experience much better than average.

I think at some point I've talked about God Moves in a Mysterious Way, which even if you're not familiar with the hymn, or even if you're not religious at all, you've probably heard the words. One verse says, "Ye fearful saints, fresh courage take; the clouds you so much dread, are big with mercy and shall break in blessings on your head." This was our prayer before this past Monday's appointment, and this is what we received.

Panitumumab/Vectibix by itself turns out not to be bad at all. I was tired afterwards and have been a little tired since Monday, but none of the nausea or terrible feelings that come from other chemo I've had. I hope to manage the skin rash by starting the antibiotic and lotion now instead of waiting until after the rash is at its peak.

The truth is that I feel MUCH better than I did a year ago. For the past few months (except a couple of days for liver surgery) my day-to-day life has been very ordinary - really a state of quasi-denial. I thank God for this.

But on the other hand, a state of quasi-denial can make me lose track of time and not do my bucket list or anything else really useful that has to be planned intentionally. I don't really have a bucket list... I've always wanted a grand piano which I now have, and I've wanted a Jeep for a while which I now have. Not that you can ever have enough cars (my secret plan is when Grace and Emma need cars then we get them cars that I actually want)... These are hardly bucket list items. Grace is probably right that a good bucket list contains experiences you want to have with other people, not stuff. Christina wants to go on a cross-country road trip this spring, which would certainly be a bunch of experiences with people... My parents did that with us twice when I was 8-9 years old.

All the World's a Stage

"All the world’s a stage" - Shakespeare probably didn’t realize how true that statement was. The God of the universe is carrying out His own will over time and in dramatic fashion, even though He could bring an end to the world in an instant. As long as I play my part willingly and thankfully as directed, I know He will take care of me. 

But I’m not entirely a passive actor - I just have to make my hypothetical future life worth living, in God’s opinion. This was the last thing Dr. Yang said to me on Monday... the question is if the extended life I live is worth it? I take that as, worth it in others' opinions and in God's opinion. My own selfish experience really has no meaning at the end of the day... "His breath goeth forth, he returneth to his earth; in that very day his thoughts perish (Ps 146:4)."

Plenty of fathers have died before their children were grown, including better men than myself. Those events were used for good as well. It's not up to me, I just want to do my part, with whatever time I have left.

This is the point of life - To know God and His Son Jesus Christ, to do His will, and to help other people know Him.

Thank you for all your support, prayers, and generosity to my family over the past year. Every act was meaningful and lightened the burden. Until next time!

[Table Rock... Raining and cold]

[I somehow had the idea of frying chicken thighs in bacon grease - they were pretty good]

[Selfy by a person with shorter arms]