Wednesday, January 27, 2010

Take Courage

Cowardly lion in The Wizard of Oz (Click here for video)

Courage: "the quality of mind or spirit that enables a person to face difficulty, danger, pain, etc., without fear; bravery."

From the very beginning of this journey with disseminated malignant melanoma, I have asserted that the loving God in whom I put my trust has our highest good as His aim. He has firmly established this certainty through the sacrifice of His Son, offering us an overcoming, transformed life that will last for eternity.

While we live on a fallen and rebellious planet, however, we will face difficulties, reversals, challenges and tragedies. In the midst of our struggles, He graciously provides strength and opportunities to grow in character and in intimacy with Him. I am convinced that these circumstances are a demonstration of the wise and irresistible love of a holy God -- He cares more about my character than my comfort or career; He values purity of heart over prosperity; and offers greater rewards in longsuffering than longevity.

One of the areas of character that He has been patiently working on recently is that of personal courage. Although I have already survived far beyond any reasonable expectations, there is evidence that the cancer is advancing. I have recently experienced bouts of rather severe pain presumably due to new or growing metastases of the brain and skeleton.

With the help of Hospice Care we are, of course, adjusting pain meds (and the meds to combat the side effects of those meds). Yet I find myself surprised by what I deem a deficiency of courage and endurance when the pain is severe. Although I have sat at the bedside of many a patient going through terrible suffering, there is nothing like personal experience. I am still learning...

As I study examples of courage in scripture, here is what I observe: Courage is a character trait that, when appropriate, the Lord commands. For example, when given a specific mission, the warrior Joshua is told: "Have I not commanded you? Be strong and courageous! Do not tremble or be dismayed, for the LORD your God is with you wherever you go." (Joshua 1:9) Or as He speaks to Daniel: "O man of high esteem, do not be afraid. Peace be with you; take courage and be courageous!" (Daniel 10:19) This implies to me that, in the face of adversity, courage is a choice I can make... and it is up to me to make that choice. It also made possible because God is with me in the midst of the challenge.

I also notice that, unlike some other character traits identified in scripture as evidence of the transformative power of faith (see the fruit of the Spirit in Galations 5:22-23), courage is more active determination than it is my surrender to a supernatural enabling. I must take courage. Of course, in the face of adversity a loving God makes His resources known with promises such as "Do not fear, for I am with you; Do not anxiously look about you, for I am your God. I will strengthen you, surely I will help you, Surely I will uphold you with My righteous right hand." (Isaiah 41:10)

I conclude that courage is a choice and a learned response, only evident in the face of threat or actual adversity. It is enabled by an ongoing intimate relationship with the One who, because of His great love for me, Himself endured incomparable suffering on a cross (Hebrews 12:2), overcoming death itself to ensure my eternal destiny: "He will swallow up death for all time, And the Lord GOD will wipe tears away from all faces" (Isaiah 25:8)

In spite of persistent and numerous metastastes in both brain and elsewhere I am truly grateful that I still have the capacity and opportunity to gain eternal benefits from the experience. Not to be compared with the difficulties faced each day by the brave men and women serving in active duty military, or the public servants who repeatedly risk their lives to protect or rescue those in need, this ongoing battle with advancing cancer is yet teaching me what it means to take courage. Thank you so much for your many expressions of love and support while on this journey.

May we all have the nerve to trust Him more,
Dr Dan

PS -- Thank you Lord for the new heart you gave me when I first trusted in you. Now I could also use a new (tumor-free) brain! (Or, like Dorothy, get to go home :-)

Saturday, January 16, 2010

Pestilence and Promise

My recent blog entry on "Whack-a-Mole" therapy reminds me of a refreshing true story of the power of child-like faith. Years ago, while living in Virginia Beach, our lovely (and rather large) yard was invaded with moles that eventually turned a fairly-well groomed and nicely graded lawn into an ankle-twisting, weed-choked, battleground. We did all the research on methods to rid ourselves of these pesky creatures and, one by one, tried them all.

I first tried flattening their tunnels (foolish and futile), then flooding them out (fun but never found any sputtered creatures surrendering themselves to me). Next I employed the mole traps -- and even bagged one of them this way -- but they kept on coming. Out of fear we may harm our dogs, we at first avoided the poison pellets, but eventually relented -- to no avail (fortunately the dogs survived). For weeks I could be seen stomping down mole tunnels in a ritual that must have caused the neighbors to think I had gone native American! Even our best efforts at grub control (moles' favorite food) did not stop the invasion. Meanwhile the yard and gardens were becoming an eye sore and risky to navigate.

Then one day our youngest daughter Christianne decided to take matters into her own hands. Inspired by the promises found in Psalm 91:1-6, she and her mother ventured out into the yard to face this pesky foe. The passage reads: He who dwells in the shelter of the Most High will abide in the shadow of the Almighty. I will say to the LORD, "My refuge and my fortress, My God, in whom I trust!" For it is He who delivers you from the snare of the trapper and from the deadly pestilence. He will cover you with His pinions, and under His wings you may seek refuge; His faithfulness is a shield and bulwark. You will not be afraid of the terror by night, or of the arrow that flies by day; of the pestilence that stalks in darkness, or of the destruction that lays waste at noon.

Together they claimed the promises, walking the perimeter of the yard as they prayed against this pestilence. Within days the most remarkable phenomenon appeared at the borders of our property: While no new tunnels emerged in our yard, suddenly fresh trailing mounds popped up in our neighbors' yards on both sides! These fresh mounds literally stopped at the edge of our lawn and gardens. (I honestly don't recall if we ever apologized to our neighbors, but we certainly empathized with their plight :-)

We live in a fallen world... one beset with troubles, disasters, famine, floods, earthquakes, devastation, enormous needs and neglect... and yes, with mortal bodies that are subject to decline, disease and death. Countless times God has intervened in our lives, in response to informed child-like faith, to stave off or reverse these destructive forces.

Ultimately, as we put our full trust in Him, we are promised a bright future secure in His love: For this perishable must put on the imperishable, and this mortal must put on immortality. But when this perishable will have put on the imperishable, and this mortal will have put on immortality, then will come about the saying that is written, "Death is swallowed up in victory. O DEATH, WHERE IS YOUR VICTORY? O DEATH, WHERE IS YOUR STING?" (1Cor 15:53-55)

Armed with many such experiences that confirm His faithfulness, we are resting confidently in His love.

Dr Dan

PS -- The fact that melanoma usually starts out with a pesky "mole" on the skin has nothing to do with the moles mentioned in this story -- or does it??

Wednesday, January 13, 2010

Whack-A-Mole Therapy

My recent experience with targeted radiation therapy for several symptomatic metastases scattered throughout my body reminds me of the popular (and personally frustrating) "Whac-A-Mole" game that I have played with my grandchildren at the pizza parlor or video arcade. The grandkids can usually beat grandpa at this game :-)

With the decision not to pursue additional forms of chemotherapy (each of which offers diminishing likelihood of remission of the cancer accompanied by increased likelihood of significant toxicity), we continued to pursue targeted radiation therapy for the more symptomatic lesions (outside the brain). I have had several of these (including lesions located over the left cheek bone, both arm pits, left medial thigh, and a more recent particularly troublesome one deep in the left pelvis). The left pelvic lesion caused rather severe episodes of pain, prompting ER visits to rule out diverticulitis or kidney stones. It ultimately showed up on a PET-CT as a growing lesion deep in the pelvic musculature.

Consultation with the radiation oncologist led to consideration of yet an additional targeted course of radiation therapy to the left pelvic region, but by the time the mapping imaging studies were completed, the pain had substantially subsided. I am grateful for the reprieve but fully understand that this or any of the other dozens of metastases could become more symptomatic at any time.

So I have decided it is time to stop trying to whack each mole as it sticks its ugly head out of yet another susceptible recess of my body. We are transitioning to hospice care with home health nurse visits to assist in pain management and other supportive services as needed.

In the midst of these circumstances I am reminded of a tender conversation between Jesus and Peter along the shores of Galilee shortly after His resurrection (John 21:1-19). Jesus prepares a grilled fish breakfast for His disciples and during an intimate conversation with Peter reveals something of his future: "Truly, truly, I say to you, when you were younger, you used to gird yourself and walk wherever you wished; but when you grow old, you will stretch out your hands and someone else will gird you, and bring you where you do not wish to go. Now this He said, signifying by what kind of death he would glorify God. And when He had spoken this, He said to him, "Follow Me!"

We are not promised a future of our choosing, but urged to choose to follow the One who holds that future in His loving hands. Recognizing God's sovereignty in our lives and His active grace that has brought me through many more months of quality and enriching life experiences over the last two years while battling this devastating cancer, I am constantly seeking the best path to glorify Him. Resting in His faithfulness, I have abandoned the strategy of anxiously whacking each mole and look forward to the challenge and promise of what it means to simply follow Him each new day.

Thanks for your companionship on this journey,
Dr Dan

PS -- Linda has been a steadfast, encouraging, energetic and wise companion through these recent events. I could not be more grateful for the gift I have in her.

Wednesday, January 6, 2010


WISDOM [wiz-duhm] -- knowledge of what is true or right coupled with just judgment as to action

I have just made one of the most significant decisions of my life. Having recently completed another round of imaging studies that show remarkable progression of the metastatic melanoma both in the brain and elsewhere, I was offered yet a third alternative of chemotherapy (paclitaxel). After extensive research into its limited efficacy in stage IV melanoma with central nervous system disease, recognizing the likelihood of significant side effects, and having invested time in prayer, reflection, consultation with physicians and loved ones, I have decided not to pursue this option.

I will complete the current course of radiation therapy for local symptomatic metastases in the left thigh and left cheek and continue medication to prevent seizures, relieve headaches and treat other symptoms as they arise. If and when appropriate, I will enter hospice care. As always my life is in God's hands. All along I have sought His wisdom and I believe He has delivered on His promise (James 1:5). Both Linda and I are at peace.

I have already survived far beyond any early predictions of my longevity, given the extensive disease present at the time of diagnosis. And I continue to function remarkably well in spite of over 52 previous and numerous active brain tumors and multiple systemic metastases. I am surrounded by a loving, supportive family, attentive and adoring wife, numerous faithful friends, and a God whose grace and mercy strengthen me each day.

I cannot tell you how grateful I am for all your prayers, expressions of support, and practical acts of kindness toward me and my family. May you know God's richest blessings in this New Year.

Dr Dan