Thursday, March 26, 2009

It's All in Your Head!

Actual mapping MRI of Dr Dan's brain, horizontal cross-sectional view at the level of the orbits
(yellow spots represent melanoma deposits)

Truer words were never spoken. We just returned from Charlottesville after another round of imaging studies, lab tests and consultations with both the neurosurgeon, Dr Sheehan, and the oncologist, Dr Grosh. The PET scan indicates no evidence of active disease from the neck down, but the MRI of the brain demonstrates at least nine small tumors which have progressed in size since the last study. All but one of these appear to have been present on the previous scan (final report still pending). I remain remarkably free of any signs or symptoms from these metastatic deposits in the brain. So, indeed, it’s all in my head!

From a medical standpoint I appear to be somewhat of an enigma. It is unusual to demonstrate progression of melanoma tumors in the brain and yet have no evidence of active disease elsewhere, especially in light of the extensive metastases found throughout my body at the time of initial diagnosis.

Although it is clear we still face a formidable foe, it is also clear that nothing short of the miraculous could have brought me this far. One year ago I was immobilized with pain, emaciated, pale, unable to eat, hardly able to draw a breath at times, at the brink of death. Today I am pain-free with renewed energy, an insatiable appetite for all that life has to offer, and a little over-weight :-)

How we face the formidable foes in our lives is a matter of the head. The awesome reality of God’s peace that I have experienced through all this is a direct byproduct of how I choose to fill my head. Listen to these encouraging words: "You will keep him in perfect peace whose mind is stayed on You, because he trusts in You.” (Isaiah 26:3) "And the peace of God, which surpasses all comprehension, will guard your hearts and your minds in Christ Jesus." (Phil 4:7) I have put this to the test and know it to be true.

We have reviewed the treatment options with our consultants (whole brain radiation, stereotactic radiosurgery, ipilimumab infusions, or other investigational therapy) and have chosen to proceed with the gamma knife procedure. Because of the number of lesions to be treated, this will be done in two sessions, now scheduled for April 10 and April 20.

Meanwhile, I rest in this thought: “You, O Lord, are a shield about me, my glory, and the One who lifts my head.” (Psalm 3:3)


Monday, March 9, 2009

Living Life by the Slice

"Give us this day our daily bread..." Matthew 6:11

My wife makes the most delicious homemade breads. Mmmm… Just writing about it makes my mouth water: the fresh-baked aroma, steam wafting from a warm loaf as I sunder through the delectable crust and render that first slice. At times Linda would urge me to continue paring the loaf until it was thoroughly divided into nice even slices, ready to be packaged and placed in the freezer for later consumption. But I prefer to sever and savor one slice at a time, while it is still oven-fresh, moist and delicious.

Now that is the way we are living life – one slice at a time.

To catch you up, on Wednesday, February 25, my local surgeon, Dr Randy Gould, removed a subcutaneous nodule from my left posterior shoulder, about the size of a small grape. This appeared for the first time on the PET-CT done at UVA on February 11 and proved to be an isolated recurrent melanoma. Then on Thursday, March 5, we traveled to Charlottesville to consult with Dr Grosh once more. At that time he thoroughly reviewed the recent imaging studies, biopsy results, and treatment options.

Because of subtle, inconclusive findings on the last MRI of the brain, the appearance of this new lesion of the left posterior shoulder (now removed), my stable physical condition, and the lack any laboratory abnormalities, it was decided to simply arrange another series of studies at the end of this month. If at that time there is evidence of progression of the cancer, Dr Grosh is considering a tertiary referral for entry into a clinical trial that uses the monoclonal antibody, ipilimumab. If there are limited brain metastases and no new systemic metastases, repeat gamma knife surgery may be considered.

But you notice the sentence begins with ‘if’ – that is a slice we have not yet sampled. And so it is for all of us, is it not? "If I finish this course as planned... If the economy turns around... If my 401K doesn't completely tank..." Life revolves around 'if'!

Knowing our penchant to want the whole loaf divided for us in clearly defined slices, Jesus urges us to trust the Father for each portion on a daily basis: “Give us this day our daily bread… your heavenly Father knows… So do not worry about tomorrow; for tomorrow will care for itself. Each day has enough trouble of its own.” (Mat 6:11, 32, 34) This caution is not just an accommodation to the harsh reality of life – rather He is advocating a healthy diet, a way of living that nourishes and satisfies our soul’s deepest hunger pangs.

So these days we mark our calendar in pencil. We consciously live life one slice at a time and savor each morsel. Though we may not know what the future holds, we know who holds the future and are truly satisfied.

The Bread of Life is right – it’s fresher by the slice!


PS – To complete this thought, consider an earlier blog entry that includes a poem “To End with ‘And’”