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Welcome to Part 2 of my blog post My Journey With Cancer. I’m blogging daily with no understanding of when or how my journey will end. It might be ten years from now or it may be much sooner. But then, again, does anyone know the measure of time they been apportioned on Earth? And what is time? And what happens to us when that time runs out? The reason I begin this way is that in foresight, there will necessarily be some chaos in organization as time goes by. Part I was becoming unwieldly as it grew larger and larger in size, especially with all the graphics I added. But graphics are important to how many people learn (including me) and they keep the narrative interesting and entertaining. For example, the feature illustration for this post show a cancer cell splitting off from another malignant cell. In our bodies, cells multiply by dividing.

In part 1, I discussed how I started having blood in my urine. At first, I wasn’t certain it was blood because I had started a new medication which I understood could change the color of a person’s urine, but after putting off any action for almost three months, I checked in with my doctor who quickly ordered a CT Scan and then in a matter of days found myself surrounded by physicians, anesthesiologists, and nurses about to be whisked away to a (hopefully) sterile operating room for bladder surgery. For cancer.

I’m going to begin this post with . . .

TUESDAY, FEBRUARY 7, 2023 (C DAY +8)

Today got off to a good start when I discovered I was struck from the list of jurors for the upcoming trial later this month. I had applied for an exemption last evening. Normally, a retired guy might love the diversion of a trial but the supervisor of jurors in my county granted me a medical emergency exemption, so I won’t have to serve later this month after all. Imagine being in my shoes, asking the bailiff how to get to the bathroom and being told “third floor, end of the hall.” And the elevator is out of order.

Late this afternoon

My surgeon called to talk. I have an appointment to see her on Valentine’s Day (a week from today.). She went over the signs and symptoms I’ve been having and she tends to think that the pain and minimal incontinence is consistent with the expected post-op recovery. She went over the pathology and there was nothing new except that she (1) classifies my cancer as Stage One and (2) categorizes my risk as “intermediate.” I’m not sure what puts me in the intermediate category. Perhaps my age, my comorbidities, etc. She plans to perform the second surgery this month, immediately after which I’ll receive immunotherapy.

Everything can be a learning experience

I have forty-three years of teaching accredited college courses, so I always look for opportunities to share some interesting tidbit.  In fact, that is what a good part of my blog is about as you can see from the photo slider on the home page.  We may all have seen brochures about diseases in medical offices.  Some are pretty much the same as others, and some are hard to understand.  Over the months ahead, I’ll try to tackle a few of the questions that people have about cancer.

How do normal cells reproduce?

While I’m waiting for some news, I thought I’d take a few moments to explain how normal, healthy cells reproduce and then what happens with cancer cells.

The National Center for Biotechnology Information (NCBI) notes:

Cells need to divide for your body to grow and for body tissue such as skin to continuously renew itself. When a cell divides, the outer membrane increasingly pinches inward until the new cells that are forming separate from each other. This process typically produces two new (daughter) cells from one (parent) cell.”

National Center for Biotechnology Information (NCBI)

The series of steps involving cell division (below) is called mitosis.  You can see this “pinching” effect in the “peanut shape” that occurs before the new cell splits completely off (anaphase.) Now on the far right, the one cell has become two cells, as the “daughter” cell has become a carbon copy of the “parent” cell.  If the parent or original cells was a muscle cells, then the offspring is a muscle cell.  If a skin cell, then the break-a-way cell is a skin cell.

Different cells live for different periods of time.  The cells on the outside of your skin live about two weeks. Your red blood cells live for 120 days.  Cells in your liver can survive as long as eighteen months.  Your brain cells do not reproduce, so your brain cells must last you for your lifetime.

Cancer cells, however, live indefinitely if left alone.  Of course, radiation and chemo can kill them, and they die when the patient that they are infecting dies.  But in a petri dish given nutrients, they just live on and on.  In fact, at Johns Hopkins Hospital, the same cancer cells have been living for 72 years after the death of the patient in whom they began their lives. They may very well live another 72 years, or 720 years as long as the get the nutrients that they need.

WEDNESDAY, FEBRUARY 8, 2023 (C DAY +9)

I had a dream last night

I woke up this morning catching myself talking in my sleep.  I dreamt I was in the back seat of a two-door sedan with the engine running and the car had somehow slipped into gear and was gradually picking up speed from the shoulder of a highway where it was parked.  I could reach the steering wheel from the back of the car, so I did have an input as far as what was happening, but I could not, of course, reach the pedals to slow the car safely to a stop.  I was vaguely aware of scattered debris on the roadway. I was able to avoid an accident when another driver pulled into my lane by steering around him, but I knew it was just a matter of time before there was a collision, since I could not stop the car, nor operate it safely from the back seat.

There is nothing cryptic here. It is perfectly clear to me what that dream was about.  The out-of-control car is my body and the predicament I found myself in is caused by the cancer. The cancer’s classification of “high grade” means that it spreads relatively fast as far as cancers go. One must be constantly vigilant. So, this may be one heck of a ride!

Through surgery, and whatever else my oncologist thinks of, along with my own determination to resist and the support of a loving wife with the prayers of our family and friends, we can “steer” the vehicle and “stay in the lane,” but there is no promise as far as how long the ride will last nor how the ride will end. And what do we do if there are sharp turns, stop lights, or limited visibility? Those concerns are for another day.

The obstacles in my lane that were in my dream (e.g. the vehicle that cut me off) may represent other health issues I have.  For example, only a few days ago my neurologist warned us that my cancer may exacerbate the early-stage Parkinson’s Disease I’m dealing with, which is currently responding to medication. The obstacles and highway debris may also represent future and so, as yet, unforeseen issues with family and others.

And why do oncologists refer to it as “your cancer?”  What makes it “mine?”  Did I earn it?  Deserve it? Did I ask for it? Was it bestowed upon me?  To refer to it as “your cancer” makes it very personal.  But then, maybe cancer is?

The American Cancer Society predicts there will be 1,958,310 new cases of cancer in the U.S. this year. Two million Americans will grapple with this disease. One of these cases is me. But these two million people do not include another three or four million people who will be also grappling cancer even though they are not physically stricken by the disease. These are the grieving family members and friends whose hearts are being broken by this disease, those who will be left behind to feel the pain of cancer after their loved ones have gone to a better place where there is no pain. Who will mourn for them? Care for them?

Planning a response to a cancer diagnosis

It seems to me as someone who was just initiated into the fellowship of cancer patients, sort of the “Class of ’23,” that different patients might choose different paths once they have their diagnosis. If I were ten years older and living alone with no family, perhaps already a resident in a nursing facility, I might consider other entrées on the generally unappetizing treatment menu. And then there is the question of what type of cancer one has, what body organ is involved, what stage their cancer is in, the resources you can marshal to deal with it and so on.

Christianity speaks of death as an enemy diametrically opposed to life.  Death robs parents of their children and children become orphaned through their parents’ death.  Husbands and wives are widowed and so on.  Plus, God wants humanity to live and to live abundant lives.  God’s desire is not to see us succumb to wars, plagues and pestilence.  Death is then more than just the antithesis of life. It is an enemy and we see it all around us. That suggests (to me) that absent any other information, we should resist death, including the harbingers of death–such as cancer–as best as we can.  This is fundamentally because life is precious–a resource that must not be squandered.  I also believe that God, alone, who is Sovereign has the right to choose the moment and manner of our death.  This is my philosophy, one in which you may differ, with my respect.

Of course, death is inevitable, and we also know from Scripture that our death to this existence, on this present world, is the consequence of sin.  Sin has a corrupting and corroding effect, on our longevity, as well as everything else, such as our motives, the choices we make and so on, and most (read “worst”) of all, our ability to be reconciled with our heavenly Father.  It’s a spiritual pox! Whether it is the sin we are born with (human nature) or the sin we eagerly embrace as we walk though life, it make no difference.  Philosophers have called our existence a “Vale of Tears” through which we go.  When we die, we pass through yet a different veil.

There is conventional treatment for cancer such as surgery, radiation and chemotherapy which are very problematic for some people in terms of side effects.  Then, then there are unconventional treatments.  Examples of unconventional treatment might be aroma therapy, the “Healing Touch” or Laetrile.  I remember when Ruth Carter Stapleton, President Jimmy Carter’s sister, was diagnosed with pancreatic cancer.  Ms. Stapleton was an evangelist and author of several books on healing.  She chose guided imagery as her unconventional approach and every morning she sat in a small tent in prayer and meditation.  She would visualize her cancer as a serpent, During her sessions, she would conjure up an imaginary eagle which would approach her, much like the mechanical eagle Zeus had contrived to punish Prometheus for giving fire to mankind.  She pictured the eagle reaching into her left side to clutch the snake (née cancer) and pull it out of her with its talons.¹ Day after day she repeated this ritual. The NY Times took note of her ultimate demise:

Ruth Carter Stapleton, the 53-year-old evangelist sister of former President Carter, is shunning conventional treatment in favor of faith, diet and exercise as she battles cancer of the pancreas. ‘Due to the nature of my illness, I don’t have a choice,‘ she said. ‘It would be different if I had a different type of cancer that could be cut out or treated with a great chance of healing.”’ 

Ms. Stapleton was not healed. She died within a year. And yet, if what she believed is true, she lives on.

I don’t fault or harshly judge those who made different choices than I, I can only do what seems best and right for myself and my loved ones. As we all must do.

My urine culture came back marked “no growth.” The pain, dysuria, frequency, urgency and spotting of blood is all secondary to the tumor removal a week ago.

THURSDAY, FEBRUARY 9, 2023 (C DAY +10)

I’ve tried to maintain a positive attitude in my life, especially as I’ve gotten older. This is one of my life hacks.  I’ve had varying degrees of success, but I try to keep working on it.  It’s not unusual for people to burn out at different points in their lives and for different reasons.  The job may become more of a grind.  Relationships may become strained.  In some cases, there may be financial problem or setbacks. Or, there may be a major health issue.  And these are just several of the possibilities.

I remember a student in one of my classes many years ago.  Let me call him Kurt.  Kurt was about twenty and confined to a wheel chair.  This wasn’t the sort of wheelchair that you find in hospital emergency rooms.  This one cost many thousands of dollars.  It was the Tesla of wheelchairs. You don’t see these chairs every day.  And it took three or four people to lift. Barely.

Kurt showed me once how it could elevate him a foot higher off the floor.  With the touch of another button, he could lay almost flat.  Another button would cause it to shift his weight to the left or to the right.  He needed a sturdy, padded, versatile wheel chair because for every waking moment of his life, he was in his chair.

Kurt took the same class with me twice.  The subject we covered was a difficult one for Kurt and his exam scores were disappointing to him.  The first time in the class he earned a “D” and the second time a “C.”

I remember a few other things about Kurt.  He was always on time for class.  And with one exception when the battery to his wheel chair died, he never missed a day of class. Rain or shine, he was also very cheerful and helpful to the other students.

The next semester I didn’t notice him around campus and I asked about him.  I was told he had died, most likely from complications of whatever catastrophic health problem he was dealing with.  I felt really sad to hear that.  I’ll never forget Kurt because that twenty-year-old young man was an inspiration to me, and at that point I was three times his age.  How could I grumble about having to wake-up, shower, get dressed and drive to work on a cold rainy day, only to find Kurt already outside my office with a smile on his face, greeting me when I arrived?

I spent twenty years in the military.  In that culture, people like to complain about their assignment.  But there is always a worse place to live.  I found this out when I had to travel to Thule, Greenland on a mission.  Thule is 700 miles north of the Arctic circle.  But during that week at Thule, I discovered there was a base even more dreadful than that at Nord, Greenland.  We were resupplying Nord before the arctic winter set in, and for most of the previous week the only food they had were eggs.  There are probably worse places than Nord.

When I first received my diagnosis of Parkinson’s Disease less than a year ago, I told Deena there were worse things than PD.  She asked me “Like what?”  “Cancer,” I replied.  This subject came up again in September when Deena asked my doctor how she understood what a PD diagnosis meant.  My doctor replied that there were worst things than PD for a senior to deal with.  When she was asked to name something worse, my doctor replied “cancer.”  Now that I have cancer, I’m thankful it’s bladder cancer and not pancreatic cancer, brain cancer, lung cancer, colo-rectal or bone cancer. What am I saying here? That I’m thankful to have bladder cancer?!! Hmm.

I realize this is all relative. But I wonder how provocative this all this sounds to an ordinary person?  I’ve actually reached a point where I’m developing a familiarity with a potentially deadly disease.  All my old reference points are gone.  Is this some sort of oncological Stockholm Syndrome where I’m starting to identify with my adversary, my cancer, the terrorist inside of me?  Am I indeed developing a coping mechanism to an abusive situation (cancer)  to which I am being held captive against my will? I don’t know.

This afternoon, I was scheduled for some new appointments. I see my cancer surgeon again this coming Tuesday, February 14th. I also get a COVID test then and a urine culture. On Friday the 17th I have my second bladder surgery. I’m hoping they got most of the cancer the first time and this will be more of a “cleanup” but I won’t know until next week.

Cancer and aging

Cancer and age

In the United Kingdom, half of all cancers are discovered in people over the age of 70.  Cancer in children is actually fairly rare except for those cancers that are found frequently in children, although there are many pediatric patients in hospitals such as St Jude.  According to cancercenter.com:

Nearly 60 percent of patients with acute lymphocytic leukemia, for instance, are younger than 20, and the median patient age at diagnosis is 15. But patients younger than 20 account for 1 percent of all new cancer cases and .3 percent of cancer deaths.”

There are two primary reasons why older people develop cancer at higher rates.  The first is that older people have a greater accumulation of cells damaged whether by smoking, radiation, toxic chemicals, etc.  The second reasons is that as we age, there is a decline in our immune system, and therefor cancer cells can proliferate without being noticed, challenged or attacked.

Type of cancer	Median patient age at diagnosis
Cervix	50
Thyroid	51
Breast	62
Ovary	63
Melanoma	63
Non-Hodgkin Lymphoma	63
Kidney	64
Leukemia	66
Prostate	66
Colorectal	68
Lung	70
Bladder	73

FRIDAY, FEBRUARY 10, 2023 (C DAY +11)

Cancer is expensive

The other day I was thinking about an incident from maybe eight years ago. I was sitting with my late wife in the waiting room of a cancer clinic. This sixty-something couple sat down across from (facing) us. There were dressed in everyday clothes. The woman’s eyes were wet and puffy. Her husband’s arms were folded and he was studying the ceiling. Periodically she would dab at her eyes with a tissue. He made no attempt to comfort her, even avoiding eye contact. I looked up to see what was so fascinating about the ceiling but nothing stood out. After fifteen minutes, the receptionist called someone’s last name and the husband stood and walked to the desk. After a minute of conversation that I could not decipher, I heard the receptionist say “I’m sorry sir, but we need thirty five dollars. . .” and then the volume trailed off again.

The man reluctantly walked over to his wife, whispered in her ear, and then the two of them walked out of the clinic towards the parking lot. In hind sight, I should have approached the desk to see if I could pay the outstanding fee (modest as it was), but I was too stunned at the time to respond and by the time it had occurred to me, they were gone. It was obvious that this woman had cancer and was scheduled for a treatment or a consultation with her doctor. It was also clear that they owed a whopping thirty-five dollars, which was the cost of many insurance co-pays back then, or maybe they had an installment agreement with the clinic and they were behind a payment? Perhaps a check from an earlier visit had not cleared the bank.

Cancer is expensive. According to NPR:

The National Cancer Institute calculated the average cost of medical care and drugs tops $42,000 in the year following a cancer diagnosis. Some treatments can exceed $1 million.

Usually, most costs are covered. But patients are increasingly on the hook for large bills because of annual deductibles and other health plan cost sharing. The average leukemia patient with private health insurance, for example, can expect to pay more than $5,100 in the year after diagnosis, according to an analysis by the consulting firm Milliman. 

Even Medicare can leave seniors with huge bills. The average blood cancer patient covered by fee-for-service Medicare can expect to pay more than $17,000 out-of-pocket in the year following diagnosis, Milliman found.”

A story in by the AARP notes that cancer patients who struggle to pay the costs of care because they have no insurance, or because they do have insurance but it doesn’t cover cancer are patients reluctant to 50

Patients were afraid that if they discussed their financial fears with their doctors, it would compromise their treatment. But oblivious doctors wouldn’t know that their patients might take their pills less often than prescribed. And those patients might choose to avoid follow-up therapies or tests.”

In the last twenty-three days, my medical charges for cancer have been $21,621.05. That’s $4,324. after Medicare and the clock is still running, plus next week I do it all over again! But, again, Deena and I have supplemental insurance as part of my military retirement (thank God.) And we are retired. There are many patients who have to work while being treated for cancer. They suffer the side effects of treatment and must leave work frequently at their own expense for appointments. Some of them are single moms with children. They struggle in ways I cannot begin to imagine.

I remember going to an event perhaps twelve or more years ago. It was a “Race for the Cure” event dealing with cancer and some of my students were involved as co-sponsors. There were maybe forty or fifty cancer survivors who signed up and lined up to run a single lap at a local high school track. There were men and women of all ages present. The first to cross the finish line was a girl who looked like she was about seven years of age. She appeared normal in every way and she was a cancer survivor, too. Her face beamed as she was hugged by other women of all ages with whom she shared a common experience. The last person to cross the finish line was senior citizen who was being pushed while confined to a wheel chair. If I remember correctly, she started off on her own, but eventually ran out of steam. Someone stepped up to help her. Everyone crossed the finish line, though some needed help. That’s what we are here for. To step up!

To find a race in 2023 near you, click on this link for details.

Today, my wife Deena found an excellent online resource for me from the Bladder Cancer Advocacy Network (BCAN ) at MD Anderson Cancer Center in Houston, TX. MD Anderson is one of the top three or so cancer centers in the U.S. I listened to a podcast on high grade, early stage carcinoma of the bladder and the so called slippery slope where the patient and the care team struggle valiantly and often futilely to save a bladder from a cancer that is totally intractable. A better way of understanding the issue might be in terms of cost-benefit analysis; the benefit of enjoying the extended use of your bladder versus the cost of potential metastasis by not removing it earlier. This podcast was particularly interesting to me because it deals with the exact same type and grade of cancer that I have.

This afternoon: The pre-op nurse called and spent more than half an hour quizzing me about my health history and medications in prepartion for next Friday’s surgery. Déjà vu?

SATURDAY, FEBRUARY 11, 2023 (C DAY +12)

WHAT TO DO ABOUT THAT 600 POUND ELEPHANT? FINDING THE WAY FORWARD

The elephant just appeared one day.  We didn’t know where it came from or why it chose to live with us.  It didn’t seem to present an immediate threat to us or to others who visited. So far, it hasn’t made a lot of noise or damaged anything outside of the room.  We went about our business as usual, but we did have to adjust our routines, especially where the living room was concerned.   Mostly, the elephant was just there, day-after-day, and over the past months it seemed to grow a bit larger.  Of course, it’s also difficult to sleep at night knowing that there is an elephant in your house.  One must also be careful when going about their business in the presence of the elephant.  We’ve all read stories about how dangerous an elephant can become if provoked.

The elephant is, of course the cancer that I and my wife must face.  That every home with cancer must face.  Our oncologist is trying to get it out of our house, but we won’t know for another week or two whether she has been successful.  We’ve also been told that if one elephant ever appears in your house, there is. good chance that other elephants will visit your house in the future.  Now, there’s a thought!

We’ve learned that when you live with an elephant, your life must go on.  You can’t stay locked in your bedroom.  There are errands to run, appointments to keep, birthdays to celebrate, and visitors to entertain.  You just need to make the necessary adjustments, scale your expectations to the new reality.  It’s just a matter of economics.

I was thinking this morning of the race I referred to yesterday, specifically concerning the contestants. I wondered what sort of cancers they had, and how it had impacted their families and their careers?  I wonder how those cancer survivors are doing? The little girl?  Has she remained cancer free or did her cancer return with a vengeance? The lady in the wheel chair?  How is she doing?

It’s a matter of dialectics (thesis, antithesis, synthesis.)  The lives of these survivors were on a certain trajectory when cancer knocked them off course.  Cancer isn’t the only disaster that strikes us in life.  It could be a car accident, the loss of a job, or a stroke. It could be bankruptcy, the death of a child.  Each of these tragedies creates a crisis in our life.  We can become stronger from it (Nietzsche), better adapted to handle future problems (Darwin), but a positive outcome is not guaranteed.

I’ll have more on this topic later. . .

SUNDAY, FEBRUARY 12, 2023 (C DAY +13)

Today is the first day of an important week for me. First of all, it has been two weeks since my first surgery and I’ve been forewarned to expect bleeding about now because this is the time the blood clots tend to slough off. So far, so good. Also, in two days I meet with my oncologist for a briefing on my upcoming surgery this Friday. Hopefully, it will be the last surgery for a while.

I’ve been focusing on my other health issues. A few which have been on the back burner for years (sleep apnea and COPD) are suddenly emerging as areas that need attention sooner than later. A good analogy might be to think of your other health issues as sharks that circle lazily around a swimmer in the ocean (imagine that swimmer is you.) In the deep, as opposed to the shallow surf, sharks will frequently resort to what’s known as “bump and bite.” Great White sharks and Tiger sharks are basically cowards. Rather than approach a swimmer head on, they’re take out a piece of flesh and let the swimmer slowly bleed out and weaken, rather than confront the swimmer in a knock down, drag out fight. For a long time (many years) my “sharks” have left me alone, circling from a respectable distance. I haven’t needed an inhaler for my COPD, my diabetes is diet controlled, etc. But as a person (swimmer) weakens, the sharks circling gradually close the distance to the swimmer until he or she is overwhelmed.

In the illustration below, again think of each shark as representing a different health problem you have. One shark represents high blood pressure, another Type II diabetes. A third shark represents an irregular heart beat, a fourth your vulnerability to stress and another perhaps deep vein thrombosis. Then, there is the shark that represents cancer (which hopefully you do not have.)

The shark representing cancer will profit from the other harmful variables in your life (stress, weight, hypertension, diabetes and so on) to weaken you at a moment you can least afford to be distracted, by presenting you with a chronic health issue flare-up requiring immediate attention. This attention comes to the exclusion of focusing on your cancer. The ever closing circle blocks any hope of escape.

Osteopathic physicians who treat cancer will be the first to remind you that you cannot just think of cancer of the bladder as a urological issue. This is where diet and healthy living comes in, and later this week I hope to address both of these two holistic issues.

These are the risk factors for bladder cancer according to the Mayo Clinic:

Factors that may increase bladder cancer risk include:

• Smoking. Smoking cigarettes, cigars or pipes may increase the risk of bladder cancer by causing harmful chemicals to accumulate in the urine. When you smoke, your body processes the chemicals in the smoke and excretes some of them in your urine. These harmful chemicals may damage the lining of your bladder, which can increase your risk of cancer.
• Increasing age. Bladder cancer risk increases as you age. Though it can occur at any age, most people diagnosed with bladder cancer are older than 55.
• Being male. Men are more likely to develop bladder cancer than women are.
• Exposure to certain chemicals. Your kidneys play a key role in filtering harmful chemicals from your bloodstream and moving them into your bladder. Because of this, it’s thought that being around certain chemicals may increase the risk of bladder cancer. Chemicals linked to bladder cancer risk include arsenic and chemicals used in the manufacture of dyes, rubber, leather, textiles and paint products.
• Previous cancer treatment. Treatment with the anti-cancer drug cyclophosphamide increases the risk of bladder cancer. People who received radiation treatments aimed at the pelvis for a previous cancer have a higher risk of developing bladder cancer.
• Chronic bladder inflammation. Chronic or repeated urinary infections or inflammations (cystitis), such as might happen with long-term use of a urinary catheter, may increase the risk of a squamous cell bladder cancer. In some areas of the world, squamous cell carcinoma is linked to chronic bladder inflammation caused by the parasitic infection known as schistosomiasis.
• Personal or family history of cancer. If you’ve had bladder cancer, you’re more likely to get it again. If one of your blood relatives — a parent, sibling or child — has a history of bladder cancer, you may have an increased risk of the disease, although it’s rare for bladder cancer to run in families. A family history of Lynch syndrome, also known as hereditary nonpolyposis colorectal cancer (HNPCC), can increase the risk of cancer in the urinary system, as well as in the colon, uterus, ovaries and other organs.

https://www.mayoclinic.org/diseases-conditions/bladder-cancer/symptoms-causes/syc-20356104

Of the seven markers above, I have four (age, male, chemicals–that is, Agent Orange–and family history.) Incidentally, a cancer is identified by the organ or area it first emerges from. If breast cancer spreads to the bone, it will still be classified as breast cancer even though now the bone is cancerous. Bladder cancer that metastasizes to the lungs will still be referred to as bladder cancer, even after metastasizing to a distant, unrelated organ.

TUESDAY, FEBRUARY 14, 2023 (C DAY +15)

Today, I received my COVID test and dropped off a urine specimen at the lab. Then, Deena and I walked across the campus to see my oncologist/surgeon.  We received some expected news as well as some unexpected news (which is a familiar and recurring motif in the lives of cancer patients and their caregivers.) True to our expectations, Friday’s surgery will be a “clean-up” procedure to hunt for and destroy any remaining cancer cells within my bladder.  However, as our doctor warmed up to the topic, she referred to the pathology report which noted the absence of muscle cells in the specimens she submitted when my doctor was positive she included muscle cells in the biopsy.  This suggested that the labs folks did not go through every piece of tissue or scan every slide if it was mounted. She plans to carve out some more of the muscle layer on Friday to be sure there aren’t some cancer cells buried surreptitiously out of view. It will take 7-14 day to learn the results of those findings.

If the subsequent pathology report is unremarkable, then she (and we) can breathe a bit easier and I would have to submit to several cystoscopies a year followed by whatever treatment is indicated.  If the new biopsy of mainly muscle cells is populated with cancer cells, then she will need to remove the bladder and prostate gland in a third surgery because at that point, the “cat would be out of the bag.”.

The other caveat we received is that the preferred Bacillus Calmette–Guérin (BCG) immunotherapy solution is currently in very short supply or not available in the U.S. (or in the Northeastern U.S. in any event.)  If this is true several weeks from now when she plans my first application, then I will need a cocktail of some other remedy in the meanwhile.  But as long as my cancer is not running amuck elsewhere in my body, chemotherapy is not indicated at this point.

So, in one way we’re are back to square one where three weeks ago we wondered what the extent of this 1¼ x 1 ¾ inch tumor is within my bladder, and that question has still not been positively cleared up.  Hopefully it has not invaded the muscle wall.

We also learned that oncologists use an algorithm to guide their way through the maze of possible outcomes in the area of bladder cancer.  I’ve included the algorithm with credit below.

Hernán Cortés destroys his ships

When the Spanish conquistador Hernán Cortés landed in Mexico with 500 men in 1519, he took stock of his men.  Many were demoralized, weak, with unquenchable fears as well as divided loyalties to haunt them. One night in July 1519, he ordered his most trusted officers to destroy his entire fleet except for one ship.  Some historians repeat the story that he burned his ships, but there is no contemporary account of this.  More than likely, he had his ships scuttled or driven onshore and made unseaworthy. This was to prevent any thoughts in the minds of his men of avoiding the dangers that lay ahead, namely the conquest of the Aztec Nation, by fleeing back to Spain.  By forcing his men to confront the problem at hand, they were able to marshal the courage to successfully meet the challenges that faced them and prevail. seeing that there was no other alternative.

This story reminds me that there is no going back once you have a diagnosis of cancer. You are in a brave new world beyond the reach of your past which is rapidly receding from view. But all is not necessarily lost. You just need to orient yourself to the new terrain and embrace the new reality, while there is still time. Time is precious. How can we make the best use of our time?

WEDNESDAY, FEBRUARY 15, 2023 (C DAY +16)

In the broader scheme of things . . .

Time. Another quiet day with my second cancer procedure less than forty-eight hours away.  My oncologist “hopes” I won’t be sent home with a catheter again, but if she will be cutting otherwise healthy muscle tissue away from inside my bladder, then I’m sure I may very well need a Foley catheter.  By the way, this cherished device gets its name from Dr. Frederic Foley who hailed from St Cloud, MN.  By the time this decade ends, his celebrated contraption will see the 100^th anniversary of its design.

Last night, Deena and I dropped by at a block party and ran across some friends and neighbors who are battling cancer.  I felt a strange kinship to others present who have this diagnosis, like we’re fellow travelers or pilgrims pondering this same perverse reality together.  Sort of like those who shared a common hostage experience.  I don’t think I’m the only one trying to make sense out of all of this.  I can easily picture them lying awake at night staring at the ceiling, or reading the same page in a book for twenty minutes because they can’t focus. Like them, I am trying to come to terms and find peace under these circumstances.

Terra incognita

I’ve been trying to understand how I feel about my surroundings since I received this diagnosis. I think one thought stream is that I feel a tiny bit less anchored to my life as if this were not the only reality. I remain engaged, by going to the gym, washing dishes, watching shows on television, going places with Deena, etc. But I’m also developing a vague sense of anticipation without knowing what to anticipate. Not foreboding or anything inauspicious, only that my next few years will be somewhat more unpredictable and much more interesting then I previously expected.

I also see some changes in people that I love over my circumstances, as relationships deepen and people follow my progress. I think that positive things can occur out of negative circumstances and that there is much more interconnectivity between those around us than before. Perhaps a better word is “communion.” Deena and I have had some heart-to-heart conversations recently and I/we will just have to see how it the everything falls into place.

Speaking of time and eternity, there are two concepts that I used to teach my students; determinism and indeterminism.  I had very precise definitions of these terms in my lesson plans, but I’ll just put something together from memory.   The first was the notion of determinism which says that events are determined in advance.  These events might be past events such as the creation of the universe in which we live, Columbus sailing to the New World in 1492, the discovery of a vaccine for polio, the terrorist attacks on 9/11, and the fact that at age 73, I would develop cancer (an event that hardly registers if at all in the greater scheme of things.) Future events, according to determinism, are predetermined as well.

The second term (indeterminism, which is sometimes called volunteerism) says that humans have some fundamental or incidental control over events.  A person can lose weight permanently, stop smoking for good, etc.  With sufficient resources and the political will to make tough decisions, the attacks on 9/11 might have been averted.  It suggests that maybe President John F. Kennedy might have lived to old age instead of being assassinated in Dallas on November 22, 1963.  Perhaps the COVID pandemic could have been averted and over one million American lives spared from death if the Chinese government have been more transparent about the origins of COVID and what exactly happened at the Wuhan Institute of Virology in late 2019 and early 2020.  These two terms are required study material in college majors such as physics, philosophy, theology and politics as well, just to name a few.

These two terms work in opposition to each other and most people in the world fall somewhere in the middle.  When I was younger, I was very indeterminist.  Like other young people growing up in the sixties, I thought we could make the world a better place.  Half of a century before that, World War I was known as “The war to end all wars” but then came World War II, Korea, Vietnam and so on.  No matter what we tried, humanity could not solve those impulses in people that lead to war.  President Putin is a case in point.

Exceptions to the rule

Let me get a bit more personal now.  I have reason to believe that my late wife Cathy was “determined” before birth to live sixty-five years before her heart failure, cancer, and chronic kidney disease would take her life.  This understanding came to me as something of an epiphany which I discuss elsewhere on my blog.  According to Webster, an epiphany is “an illuminating discovery, realization, or disclosure.”  I also understood in that same instance that she was granted an additional three years of life in response to the outpouring of prayer over many years from family and friends.  She finally died at age 68, and she loved this life in spite of her many health issues to the very end.

Here is what I learned from this experience. I believe that in this universe, determinism is the rule, but there can be exceptions.  We believe that (1) God knows the future, else He wouldn’t be God, and (2) because He knows how we will choose and what will happen in the Ukraine, in the election of 2024, or when our grandchildren will get married, then, ergo, we really have no choice at all.  But there are Scriptural precedents that show that God is open to reason and is willing to modify events to some degree.  As an example, I would mention Genesis 18: 16ff.  This what intercessory prayer is all about—heading off some disaster in our lives or the lives of others. I wish it happened more often than it does, but again I don’t know why it does not.

It was and still is very difficult for me to explain about this “epiphany.”  Before I added it to my blog, less than a dozen or so people knew about it as I recall. I suspect some resented it.  “Where was God when my wife was dying?” or “What was so special about Cathy?”  But then that’s the problem with special revelation.  I can’t answer where God is when children are horribly killed at school or in their homes.  I don’t know the answer to that. I can only grieve. As far as the second question, there was nothing special about Cathy.  She laughed, cried, had dreams, fears, got angry when I didn’t pick up my dirty clothes, the same as all of us.  But her hope is my hope, and it’s also Deena’s hope: “ . . . that [God] exists and that He rewards those who seek him” (Hebrews 11:6.). That reward is not perfect health as some might claim, or material wealth as other might promise. The reward is eternal rest and peace with our Creator. Journey’s end.

Of course, I’d like to have as much time as possible with Deena.  God brought her into my life (or, maybe it was the other way around?) I’d also like my life to have some meaning, where I made even the slightest difference for good in someone’s life during my time on earth.  I won’t let cancer rob me of that. I’m determined not to let it define me.

THURSDAY, FEBRUARY 16, 2023 (C DAY +17)

Deena and I are having a quiet evening. My check-in time tomorrow is for 9:00 a.m. with OR likely scheduled for 11:00 a.m. or so. I’d like to thank everyone for their thoughts and prayers that have gotten us this far. Of course, everything that has happened thus far on this journey are merely “baby steps,” but nevertheless your support is greatly appreciated.

FRIDAY, FEBRUARY 17, 2023 (C DAY +18)

Dreamed I was stranded without transportation in the very rural New York state county I was raised in and I had to walk eight miles to a town nearby trying to get home. I took a “shortcut” through a theme park featuring an immense ten-story rock climbing maze along the way with gullies and dead ends and one hundred foot drops foot drops along with streams and other barriers.  You would think you were finally at the park exit, only to discover that was an illusion and you’d have to backtrack.  Everybody else in the park was lost, too, so it made no sense to ask for directions.  When I finally reached the exit to the park, it was getting dark and I was still quite a distance from home.  It was a long dream, and with six trips to the bathroom during the night, I woke up exhausted. Perfect for a surgical day when you really don’t want to be wide awake anyway, lol.

Morphine, Fentynol, Tramodol (Oh, My!)

The second surgery found some more cancer growing. The surgeon got the biopsies she wanted. Send me home without a catheter only to discover I could not urinate after arriving home. The pain was sufficient to make perspire profusely and nauseate me. I was transported to the emergency room Friday afternoon. They rechecked me for COVID and it turns out I was positive at that point. Had a good deal of pain as they inserted a triple lumen catheter and irrigated it. I was given Morphine, Fentynol and Tramodol. l went back to surgery on Saturday and they cauterized two areas on my bladder wall. Saturday night my blood pressure was dropping to 60/40 and my pulse ox hovered around 82. At the moment I’m home again.

MONDAY, FEBRUARY 20, 2023 (C DAY +21)

First night home. No blood clots and Foley seems to be working. But I had a very long night which seemed to drag on forever. There were landscapes, seascapes and skyscapes that seemed to have originated from Roger Dean pen. Meanwhile Lou Reed’s “Take a Walk on the Wildside” played over and over. My phone wasn’t charged so I had no way to know whether it was 10:15 p.m. or 5:35 a.m. Plus, Dee seemed to be coming down with (COVID?) I knew there would be nights and nightmares like this—I just didn’t think they would start so soon.

TUESDAY, FEBRUARY 21, 2023 (C DAY +22)

I’m starting to feel better during the days, but I feel the COVID at night. And actually, after both shots, three boosters and the Omicron variant last summer in Oahu, C-19 feels more like a “gunky” URI/sinus infection. I’m still concerned about Dee catching it. She’s being tested at this very moment.

My ER (or ED) report is out from last Friday. About 14 labs out of 50 were abnormally high or low or present. I had my highest creatinine ever (1.6), probably from my NPO status over the previous 16 hours and blood loss during and after surgery. Yet my hemoglobin and hematocrit were still in the normal range. My glucose was 136, predictably high (though really good for a diabetic under these circumstances.)

Still “limping” through updates to this post using my phone. Too uncomfortable to sit at my pc.

WEDNESDAY, FEBRUARY 22, 2023 (C DAY +23) CODA

For the first time in almost a week, I’m able to sit at my desk. I would not have made it nearly this far without the love and support from my wife Deena (aka Nurse Ratchet.) She definitely got more than she bargained for when she when she took in a stray like me. No one wants to be a burden on their children, but nor do they want their spouse to be overwhelmed, instead, as Deena has become.

So far today, Deena has:

So far today Deena has:

• Checked on me while I slept during the night arranging things to be easily within reach.
• Emptied my catheter bag while I was asleep or awake.
• Prayed likely for the entire day.
• Coordinated my upcoming medical visits.
• Monitored my vital signs.
• Washed my clothing and bedlinens.
• Made up a fresh bed for me.
• Cooked my breakfast and fixed lunch for me.
• Cleaned up after me (discarded tissues, trash.)
• Helped me shower.
• Went to the pharmacy to pick up my meds.
• Helped me get situated (articles I needed, blankets to tuck me in, etc.)
• Plus many other things as well that I am probably not even aware of.

I hope to give Deena more and more well-deserved credit and hopefully, she might write some posts as well.

Tomorrow, at 10:30 halfway through a snow, sleet and ice storm, Denna will venture out to take me to the urology clinic to get my catheter removed.

I also want to mention what is happening at Asbury University in Wilmore, Kentucky. They are weeks into their second revival in just over fifty years. I don’t use the term “revival” loosely, but if anyone wants to see what was happening on a person-to-person basis in Jerusalem in 33 A.D., you can glimpse this on Youtube^TM here. I mention this here in my cancer post, because this full-accredited Wesleyan university has a prayer request link which I filled out concerning our present circumstances (i.e., cancer.) God and His Spirit are everywhere, so He doesn’t hear your prayers better if you are praying in Texas (supposing that Texas is closer to Heaver) or in Kentucky, but if you have anyone in your family who needs prayer and you wish to participate in some small way in this revival, you may. Also, interesting, is that Catholic clergy are informally attending this totally unscripted, unplanned, open-ended event, ministering to Catholic attendees seeking help. So it is drawing people from not only different cultures and nations, but from different faiths as well.

THURSDAY, FEBRUARY 23, 2023 (C DAY +24)

This is the sort of day when the National Weather Service advises motorists to stay off the roads unless they have urgent business. Having your catheter removed after almost a week of having it follow you around the house like a sea anchor or a social scientist conducting a time and motion study seems pretty urgent to me. Even more urgent is a blood clot that keeps you from urinating once the catheter is out, however. More on that in a moment.

Ice, ice baby

I slept soundly from 9:30 p.m. last night until 7:00 a.m. today. When I did awaken, I decided to “lay low’ and let Dee focus on getting the morning business done in preparation for my doctor’s visit without worrying about me rearranging the furniture in the Cuck Coo’s Nest or falling out of the tub. That “morning business” included the need for Deena to clear the ice and hard-packed snow from our Bronco with the temperature hovering several degrees below freezing. In his book White Lies written by John Steckley, the author points out that the people of the North are said to have dozens of words for snow and ice (the number 52 seems to be the consensus among the Inuktitut and anthropologists, according to Steckley. But this number may also be suspect.) The Canadian Encyclopedia mentions just a few descriptions:

• qanik snow falling
• aputi snow on the ground
• pukak crystalline snow on the ground
• aniu snow used to make water
• siku ice in general
• nilak freshwater ice, for drinking
• qinu slushy ice by the sea

Add to this list the term ugh to describe “ice firmly caked on the roof of your SUV, the roof of which is clearly out of your reach.”

Our dilemma

When I got up and went to shower, we noticed a blood clot in the catheter tubing. I tried squeezing my eyes shut and just wishing it away, but we had trouble even getting it to move. Dee had called her sister to ask if she could drive us up to the doctor, but then when Dee tested me for COVID again, I tested positive (again!) This is the fourth or fifth time since last Friday. So, here was our dilemma. We couldn’t skip the appointment that Dee fought so hard to get, and that I had COVID was documented in my recent medical record. So, we went masked to the appointment wondering if I’d have to keep the catheter a few days longer because of the clot. The doctor, who appeared to be somewhat younger than me (at almost 74, everyone seems to fit that description) proposed pumping 300 or so cc’s of saline into my catheter, and then yanking the catheter out (figuratively speaking and before I could muster some loud protest.) Then, we’d wait to see if it would drain naturally. If not, then another catheter would be handy to send me home with. But if so, then voilà (in the event your French is rusty, “Voilà is essentially a combination of two words: voir (to see/look) and là (there). So literally speaking, voilà is an instruction. When you use it, you are telling people to ‘look there’.” It’s amazing when you are a septuagenarian how something of so little consequence (like peeing) can give you a proud sense of accomplishment. I could almost hear the anthem to the movie “Chariots of Fire” playing through my head.

What if??!

I mentioned to Dee that maybe the second pathology report which is due imminently would be good. Maybe I’ll need just some outpatient treatments over the next few months along with a cystoscopy (or two?) A few months could be a year, maybe then a few years before another round of cancer? Maybe?

I was also taken by the image of being on a boat sailing through dark, rocky seas. Your don’t mind as a swell lifts your boat, but the problem is when you bottom out in the wave’s trough and the walls of water tower over you on each side. But sailors can fearlessly master this situation without thinking. Over time, it becomes second nature to them. Probably, cancer patients can master the swells of their rough seas over time, too?

And then, I remembered, I happen to know Someone who can calm the seas.

Why does cancer cause bleeding?

If you’ve read Part One of my cancer journal, you’ll recall that I overlooked a major warning sign of cancer–that of unexplained bleeding. I had erroneously attributed it to starting a new drug with a reputation of discoloring the urine of the person taking it. Perhaps I was frozen like a deer in the headlights, because it took me almost three months to report it.

The bleeding from my bladder was mostly when I bore down. I remember the very odd feeling when I passed what was my very first blood clot. That was a week or so before I spoke to my physician. By then, I could no longer discount what was happening to me.

My bladder would only bleed once or twice a week, but I know now that it was on these occasional weekly episodes that my cancer was growing, spreading. I also know that there is occult (unnoticed) bleeding for some time before a person notices blood, so I may have had cancer as early as 2021, but nevertheless I gave it three months of a free pass to continue its rampage. Think for a second what President Vladimir could do in Ukraine if the Ukraine Armed Forces refused to defend their country for the next ninety days and the invaders had a free hand?

The authoritative Merck Manual, sort of a first responder’s bible, speaks to the question of why does bleeding suggest the possibility of cancer, or more precisely, why does cancer cause bleeding?

At first, a cancer may bleed slightly because its blood vessels are fragile. Later, as the cancer enlarges and invades surrounding tissues, it may grow into a nearby blood vessel, causing bleeding. The bleeding may be slight and undetectable or detectable only with testing. Such is often the case in early-stage colon cancer. Or, particularly with advanced cancer, the bleeding may be more significant, even massive and life threatening.

The site of the cancer determines the site of the bleeding. Cancer anywhere along the digestive tract can cause bleeding in the stool. Cancer anywhere along the urinary tract can cause bleeding in the urine. Other cancers can bleed into internal areas of the body. Bleeding into the lungs can cause the person to cough up blood.”

https://www.merckmanuals.com/home/cancer/overview-of-cancer/symptoms-of-cancer

Eventually, clumps of cancer cells grow into tumors which need their own blood supply. Finally, cancer can cause bleeding as it physically invades healthy body tissue, According to Cancer Research UK: “As the cancer pushes through and breaks down normal tissues it might cause bleeding due to damage to nearby blood vessels.”

FRIDAY, FEBRUARY 24, 2023 (C DAY +25) CODA

Early yesterday, I looked up some of the more well known people who died from bladder cancer. Most were men, simply for that fact that bladder cancer strikes men much more so than it does women. Here are just a few of the many victims that you might know of with their age at death in parentheses:

• Warren Christopher (85), U.S. Secretary of State.
• Earl Henry Hamner Jr. (92), creator of “The Waltons” television show.
• Hubert Humphrey (66), Vice-President of the U.S.
• Jack Lemmon (76), actor.
• Phil Lesh (82), Grateful Dead guitarist.
• David Allen Ogden Stiers (75), actor in television series M*A*S*H.
• Frank Sinatra, Jr. (72), actor, singer.
• Margaret Thatcher (87), Prime Minister of England.
• Andy Williams (84), singer, music composer, television personality.

Time stands still in a doctor’s office

As I laid on the treatment table waiting for the doctor, I wondered what some other people in my circumstances were thinking while they were on their backs? Celebrities? Heads of state? Athletes? Those on the Forbes list of wealthiest Americans? And what of people with young children, a promising life or career otherwise open to them? What was going through their minds? Maybe we shared few thoughts in common. Or, maybe cancer is the Great Equalizer?

Final pathology report arrives

The final pathology appeared on the patient portal this afternoon. It will be two weeks before my doctor is available to discuss it with me, but with a few caveats, it seems to be encouraging news as far as I can tell. The [redacted] report reads:

Final Diagnosis:
a. bladder, base deep, biopsy:  benign muscularis propria with necrosis.

b. bladder, posterior wall, transurethral resection: low grade papillary urothelial carcinoma, non-invasive
muscularis propria, negative for carcinoma.“

The caveats I have deal first of all with the necrosis noted. Necrosis refers to dead tissue. I suppose that the dead tissue in the biopsy was caused almost four weeks ago during the initial resection of the bladder (i.e., while scraping the tumor off the bladder wall.) Then, part b. in the diagnosis above refers to “low grade” cancer while the original biopsy from the first procedure stated that the cancer noted then was “high grade.” I wonder if there can be both grades of cancer in the bladder at the same time, or if the pathologist is correcting an earlier point, clarifying that the cancer is low grade and not high grade at all? The purpose of the first biopsy was to focus on the cancer cells and to report on any muscle cells found mixed with the cancer. The purpose of this biopsy was to focus on the muscle cells and to report and cancer cells mixed with them. This is like the days when we had to reconcile our check book each month. You could go entry-by-entry subtracting withdrawals from your balance while adding deposits, or you could total your checks and total your deposits and subtract the smaller number from the larger. That was sort of a failsafe system.

There was also a comment: “This case was reviewed in GU pathology consensus conference on 2/23/23.” Apparently, all or perhaps, only some of the more “fuzzy” cases are processed through a committee with likely two or three pathologists. Cancer cells can be like handwriting specimens, with some degree of indistinctness. Some handwriting (especially when printed) is crystal clear. Sometimes when someone scrawls in cursive (like doctors often do), nurses have to ask themselves “is that a “1” or an “l?” Grant proposals, magazine articles, and the medical records of patients wishing organ transplants are all peer-reviewed. It’s sort of a quality control procedure.

So, can I wait two weeks to hear it officially from my surgeon? Yes. But, God already knows what it is, so why should I worry which won’t change anything before then? Living in fear of some Sword of Damocles hanging over your head will rob you of any good times that might occur while waiting.

SUNDAY, FEBRUARY 26, 2023 (C DAY +27) CODA

So, to summarize, we’re waiting until Tuesday, March 7th to speak to my oncologist who will go over the second pathology report with us and lay down the last forward. The second report seems encouraging. However, I’m trying to keep an even keel here. My concerns and my hopes going forward do not depend on what I hear from the doctors and pathologists on any given day. I have to look beyond that, else the remainder of my life will be a series of highs and lows based on what my cancer is doing at any given moment. I do know that while cancer for most of my life so far once seemed peculiarly unthinkable or remote, it is now a reality. I won’t let it define me, and thankfully I have a wonderful wife to face it with me.

I am a fraud! A note from Deena

I am a fraud. I am not a wonderful caring nurse at all. I am a control freak and want to fix or have things fixed right away, if I was being truthful. I’ve taken many self-discovery tests through the years and one of my many weaknesses always fell in the medical field. This may explain a lot about why I never volunteered on Sundays in the Chapel nurseries, taught very long in an elementary school, or ran from lab units before the blood is transferred into the vials. Sickness scares me. Germs really scare me. And the idea of taking even a medical lifesaving course scares me. So how did I manage raising two sons as a military wife, often left on my own for weeks or months at a time? I’m honestly not sure, but my sons who are very close to me today might say, “She did the best she knew how to do.”

Only once, after the boys grew up, did I “take care” of anyone for a short term. My 92-year-old grandmother who lived in Maine (about an 8-hour drive away) needed my care so for three weeks, I stayed with her, sleeping on a fold up cot and nursed her as well as I could.  My husband, Jim, wanted me to come home because he missed me. Grandma knew she needed more care, so she agreed to move in with us in New York. It wasn’t easy, but we managed about a month more. Then, she showed us she was ready to go home, by leaving by my back door, walking up the driveway to my front steps, and then ringing the doorbell. She simply said, “I’m ready to go home!”

Looking back, I remember helping her in the shower, fixing her hair, making a perfect cup of tea the way she preferred, and making sure our golden retriever Katie didn’t knock her over. I knew her time was limited and I gave her my love in service even though it wasn’t easy. Later, that year in November, she did go to her heavenly home in peace. Our goodbyes, were tear filled, but she had it all planned out. I remember every detail. 

Nowhere in my mind was cancer ever thought about except annually when awaiting the yearly mammogram, I’ve had taken for 40 years. When my two older half-sisters had breast cancer, I’d wonder when do I get it? That was one of the reasons I was so diligent over the decades. I also found myself in a cancer clinic once in 1982. I had a large lymph node removed from the right side of my neck, which the doctors thought might be cancer. I was a very young mother and I bargained with God. If He would heal me, I’d spend the rest of my life serving Him and telling others my story. So, the night before surgery I prayed the “sinners’ prayer” in the hospital room by myself:

Dear Lord Jesus, I know that I am a sinner, and I ask for Your forgiveness. I believe that You died for my sins and rose from the dead. I turn from my sins and invite You to come into my heart and life. I want to trust and follow You as my Lord and Savior.”

I went home the next day with a bandage on my neck and not only was the biopsy benign, a second enlarged lymph node disappeared. This was at a military hospital in Hawaii. Patients were in curtained off into makeshift “rooms” with no privacy. I clearly heard the two patients on either side of the screen be given their “cancer news” and I thought I was next.  I can’t explain any of it, but I remember telling God my sons needed me because their Daddy traveled a lot in the Army. 

About 10 years ago, I had back pain, and after all the testing, the Pain Management doctor told me he couldn’t help me until I saw my gynecologist. He saw something and now, she saw it too.  It appeared to be tubular cancer. In fact, the doctor said the tests suggested that it might be the worst case of tubular cancer she ever saw in her entire career. Four days later, I had my tubes removed and wouldn’t you know it, this mass was benign as well. Another unexplained biopsy. Mysterious? Miracles?

Fast forward, 40 years. Here I am reflecting on all that God has brought me through and some say: “You are so strong. Look what you’ve been through.” I don’t feel strong, but I must admit that God is faithful and has never left me. So, I’m no Florence Nightingale and more like Nurse Ratchet, I have practiced a bit this month, and I know I can hone my skills and do a great job when needed. I guess I’m not a fraud, but just a woman who needs wisdom and God’s power to do anything that comes my way, whether with ease or with difficulty.  At least, that’s what I am learning. 

Cancer through the ages: (A brief and not-so-brief history)

With thanks to The Wiley Online Library

I thought I’d spend a little time discussing the early history of cancer. When I was in the military, we were taught to always know your enemy. To that end, here are some fact and factoids that you may find interesting.

~ 70 million B.C. Cancer fairly common in the hadrosaur (dinosaur) population. Mostly fibromas, hemangiomas and osteoblastomas. These “duck-billed” dinosaurs ate mostly plants, though it is uncertain whether they browsed or grazed. Osteochondrosis, a noncancerous developmental disease that pains many people today was also common among them. At one point hadrosaurs were among the most dominant herbivores in Asia and North America. So, long before we had manufactured chemical waste dumped into the environment, and other synthetic carcinogens, we still had cancer in nature.

~30,000 B.C. in the Smith papyrus, there appears to be the first note of chest or breast cancer. The reference says that if the mass is cool to the touch, bulging or has spread elsewhere, then it is impossible to cure and the patient will most likely succumb to their illness.

~15,000 B.C. Tumors are found in Egyptian and Peruvian mummies. One Egyptian mummy in particular (of a mature, male) which was subject to a CT scan revealed legions in the mummy’s spine, pelvis and extremities which would seem to suggest that the person suffered originally from prostrate cancer which had metastasized.

Hippocrates (c. 460 – c. 370 B.C.) coins the term “Cancer” which comes from the Greek word for “crab.” He noted advanced breast cancer in a woman which showed swollen blood vessels flowing from the cancer’s central core to be tentacular in nature (like the legs of a crab.) Hippocrates, called the Father of Medicine taught “at the famed medical school in the island of Kos in the Aegean Sea, during the Age of Pericles.”

Roman physician Aulus Cornelius Celsus (25 B.C.- A.D. 50) is the first to use the term carcinoma to define tumors that cannot be healed. Apparently, he could not distinguish benign tumors from malignant tumors by examining them, nor could anyone he claimed no matter how skilled, but over time the difference became clear, and by then it was too late. Celsus also describes cauterization as a possible treatment, but warns that even if one cauterizes a malignancy, it is prone to return.

Archigenes of Apamea, Syria (A.D.75 – A.D. 129). Another Roman physician. Archigenes wrote of the need for early detection of cancer, before surgery is necessary. He knew two things: The first was that the sooner the cancer was discovered and treated, the better the prognosis for the patient. Secondly, very few people requiring cancer surgery survived the procedure.

Galen (c.A.D. 129 –c.A.D.216): Highly educated as a child and teenager. Galen had hands on experience performing autopsies. He was the Army Surgeon to Emperor Marcus Aurelius (left) and personal physician to Marcus Aurelius and his son, the infamous Commodus. While Galen made countless advances in the understanding and practice of medicine, few dealt with cancer. However, “his greatest contribution to understanding cancer was by classifying lumps and growths into three categories ranging from the most benign to the most malignant”

A.D. 476 – A.D. 590: You may recall that A.D. 476 is an important year because that was the year that Rome fell. During this period, several relatively unknown physicians produced descriptions and observations of cancer including cancers of the face, breast, uterus and genitalia. Breast cancer in women was considered to be the most common form of cancer in the Middle Ages.

Gabriele Fallopius (A.D.1523 – A.D. 1562) Gabriele Fallopius:

Is credited to having described the clinical differences between benign and malignant tumors, which is largely applicable today. He identified malignant tumors by their woody firmness, irregular shape, multi-lobulation, adhesion to neighboring tissues (skin, muscles and bones), and by congested blood vessels often surrounding the lesion. In contrast, softer masses of regular shape, movable, and not adherent to adjacent structures suggested benign tumors. Like his predecessors, he advocated a cautious approach to cancer treatment.

https://onlinelibrary.wiley.com/doi/full/10.1002/ijc.29134

Noted surgeon Henri François Le Dran (A.D.1685 – A.D.1770) broke from the traditional thinking of the ancients and declared that cancer is spread from place to place through the lymphatic system, and not via the heart and liver. Jean-Louis Petit (A.D. 1674 – A.D. 1750) who lived and practiced the same time as Le Dran pronounced that the only sure cure for breast cancer (as if any cure for cancer can be a sure cure) is a total (radical) mastectomy to include the removal of the lymphatic glands in the armpits.

I think this is a good place to pause the timeline. I may come back at a later date to revise or embellish it.

Thanking my lights

There are many friends and family members who offer me encouragement, sagacious advice, wisdom that came to them at the cost of troubles and tears over many years and many miles. They have different names; Kathryn, Janice, Debbie, Chase, Matthew, and others as well. I think of these friends as my lights.

Look at the dreamscape in the photo below. You are one of those stars in that heaven. Perhaps this is not too different than the “cloud of witnesses mentioned in Hebrews 12?” The brightest star, however, is that of my wife. As the Bard once wrote:

The skies are painted with unnumbered sparks,

They are all fire and every one doth shine;

But there’s but one in all doth hold her place.“

Julius Caesar, William Shakespeare, Act III, Scene I, 64-66

MONDAY, FEBRUARY 27, 2023 (C DAY +28) CODA

Tomorrow, I will likely transition to a third post, i.e., “My Journey with Cancer (Pt 3).” This is because this file is getting a bit unwieldly and it’s time for a “blank slate.”

I’m feeling maybe ten percent better a day since emergency surgery on the 18th. Some discomfort, and only occasional and mild problems urinating. I suspect this may be the residual effects of the trauma from repeated catheterizations and cystoscopes over the past month. I’ll ask my PCP what she thinks when I see her on Wednesday. I hope to ask her for a urinalysis and a urine culture to check on microscopic bleeding and infection. One concern I have is how well I’ll be able to travel. In the past, I could control the urge to urinate for a good 20-30 minutes, but now it may be much less than that. I can explore any limitations I may have when my daughter and granddaughter arrive next week. We’ll likely be making some trips around the county.

I’m still having night sweats. Apparently, this is a hallmark of the Omicron variant, though I’ve had them in the past few years, and I’ll be visiting my PCP about them as well.

Deena and I have been having heart-to-heart talks about the future, the stress, the uncertainty, of some catastrophic event. Other families would have even more burdens in our circumstances, such as raising small children (or worse–being a single parent with cancer), crushing financial debt, and so on. We are truly blessed in this regard. When the sky comes tumbling down on me, my “go-to” verse is in Job where he says (19:25): “I know that my redeemer lives . . .” That’s all I need to know.

There is always a possibility of reaching a “tipping point” in your health when you get older. You have a problem with one body system such as your G/I system (e.g., adhesions, polyps, or necrosis, gall stones, liver disease or the need for bowel surgery) and then another system (such as your endocrine or cardiovascular system–or both) winds up out of whack as well. The body is like a mobile that you probably saw as a child. Everything from your bones and muscles to your nerves and psyche are precisely balanced. The mobile is pretty sturdy when you are young and healthy, but as you get older, the possibly of some cascade failure increases. If you lose one hanging piece of the mobile, the whole contraption can come crashing down on your head.

My cancer blog resumes here (PART 3).

Footnotes

¹In the case of Prometheus, the eagle would remove Prometheus’ liver each morning, whereas it would regenerate overnight in order for this repetition of divine judgment to be repeatedly played out.

²This work is in the public domain in its country of origin and other countries and areas where the copyright term is the author’s life plus 100 years or fewer

This work is in the public domain in the United States because it meets three requirements:

1. it was first published outside the United States (and not published in the U.S. within 30 days),

2. it was first published before 1 March 1989 without copyright notice or before 1964 without copyright renewal or before the source country established copyright relations with the United States,

3. it was in the public domain in its home country on the URAA date (January 1, 1996 for most countries).