White Water Ahead

One of the greatest adventures our family has experienced together was to shoot the rapids on the Arkansas River in Colorado during one of our many trips to that awe-inspiring part of the country. I well remember the terror and exhilaration we all felt as our guide navigated our inflatable raft through “The Toilet”, that part of the river that swirled and churned as if indeed we were all destined to be gulped into some unseen giant septic tank below.

Our recent days on this journey have seen both still and troubled waters:
· Sunday, 2/24/08 – Since I was too weak to attend church, our CARE group (a gathering of dear and faithful friends who have grown to love the Lord and each other as we have met regularly for Bible study and prayer) set aside time to pay a visit. It was a sweet time of encouragement, intimate worship, fellowship, and powerful prayer.
· Tuesday – The worsening pain and nausea finally got the best of me and I lost my breakfast. Hoping that would then provide some period of reprieve, we headed out the door for a scheduled MRI of the entire spine at the imaging center. En route, however, the abdominal pain worsened, nausea returned and I felt as if I would pass out. We diverted to the emergency room where, after IV fluids and more drugs, the symptoms abated. A repeat CT of the abdomen showed no change from the previous studies, no infection, and no obstruction (praise God!). An adjustment in the pain management regimen has since helped.
· Wednesday – The rescheduled MRI of the spine was performed. As both a physician and patient, I now have a greater appreciation of the trials I sometimes caused my own patients when ordering this test: two full hours of lying perfectly still, flat on one’s back inside a very noisy tube and very little cushioning can be grueling. The MRI shows that no part of my spine is spared from tumor involvement. Good news: there is no structural compromise or evident impingement of either spinal cord or nerves. It’s a miracle I am not a puddle of protoplasm!

We are now anticipating a week-long admission to UVA Health Center to undergo the high-dose Interleukin-2 therapy, which will begin Monday morning, March 3. The treatment is extremely toxic... white water ahead.

As in that little rubber boat being tossed by forces both powerful and exhilarating, I choose to enter this part of the journey as another adventure, with the reassuring knowledge that there are others whom I love and who love me right there with me – leaning in just the right direction, pulling their oar with mine, and all the time piloted by a strong and all-knowing Guide.

Thanks for sharing this journey with us,
Dan

Lord, We Need to Talk

Okay, it has been a little while since I have had the energy to provide an update on my condition, and since I’m not entirely comfortable just talking about me, you may have noticed that I have focused on just those things that have lifted my spirits or moved me to have hope and comfort in the midst of this difficult journey. But this time, I’m going to try to tell it like it is. For those of you who may not want to know some of the ugly side of this experience, close your eyes and drop down to the end of this entry.

Here’s a summary of what’s been happening:
· Without any specific treatment to date (apart from the gamma knife procedure for the brain metastases), the cancerous growths in the liver have apparently enlarged, resulting in more pain across the abdomen, complete loss of appetite, early satiety, constant nausea and frequent (painful) belching. All of this has been complicated by severe constipation induced by some of the medications I am on. For those of my patients looking for a successful way to lose weight, I now have a sure-fire strategy :-)
· For two weeks now, I have developed a daily pattern beginning at about 5pm of 12 hours of severe flu-like symptoms (fever, chills, soaking night sweats, weakness, and generalized musculoskeletal pain involving ribs, back, sacrum, hips, shoulders, forearms, and thighs), along with the background nausea. This has presented some difficulty in achieving any restorative sleep at night. Over time, however, and with the help of medications, we are learning to manage these symptoms.
· The results of the core needle biopsy of the left parotid gland confirmed that the growths there were metastatic melanoma all along – still no clue where it may have started.
· On Thursday, 2/21/08, we traveled to Charlottesville to consult with Dr Grosh. Although he assured us that the previous tests did not preclude my entry into the IL-2 treatment protocol, he seemed particularly concerned about the daily pattern of fever, chills, night sweats, etc. While acknowledging that these symptoms were most likely due to so-called “tumor fever” from the metastases in the liver, he wanted to be sure that there was no underlying infection. He also wanted me to have an MRI of the entire spine to rule out potential nerve-compressing metastases there. So I underwent a host of blood and urine tests and a repeat chest X-ray, and we returned home.
· Friday was spent recovering from the rigors of travel the day before and trying to arrange the MRI. Late that afternoon I received a call from my local oncologist’s office, indicating that Dr Grosh was concerned that I could have an early pneumonia based on the findings of the chest X-ray. He wanted me to undergo another CAT scan of the chest to be certain. Since I had experienced a dry painful cough that afternoon and a higher than usual fever, we made another trip to the emergency room that evening. Long story, short, studies showed no evidence of pneumonia, only some fluid collection around the lung on the right side. We are grateful for that.
· We now have the MRI scheduled for next Tuesday and if no other obstacles present themselves, we plan to return to UVA to begin the inpatient treatment program on Monday, 3/3/08.
· Today was not a fun day – the fever started earlier than usual, accompanied by worsening fatigue and nausea that would not respond to the usual medication and making it almost impossible to eat. So I told the Lord, “We need to talk…”

I got alone and we had a conversation. I want you to understand I have not been privileged to hear an audible voice from God, but somehow He makes His thoughts known, sometimes by reminding me of truths from scripture, sometimes by silence, and sometimes by deep-seated impressions that speak to my spirit. His first response: “Of course we need to talk. I’ve always wanted you to feel free to speak with Me at any time. You know I love you very much.”

I thanked Him for His love, acknowledged that I was counting on that, and simply pleaded for some glimpse into what He wanted me to learn through all of this, asking for a little break from the weakness and nausea so I could comfort my Linda. He did not respond right away but later this evening as Linda read me a passage from a book sent by an old friend titled The Shack, He gently reminded me that the basis of my question stood on a false (and doggedly persistent) assumption that I have RIGHTS. As difficult as it is (for all of us) to accept, all such rights are an illusion and a reflection of our inexorable tendency to want to wrest control of our lives out of someone else’s hands, even God’s.

The unspoken thought is that I have a right to grow old with my wife; I have a right to see my grandchildren grow up; I at least have a right to a few hours of relief from this progressive illness – right?? In some earlier entry I wrote: “None of us deserves tomorrow.” That is ultimately and absolutely true. And it is so, because we are created beings who have rebelled against a loving and holy Creator. When we did so, we lost all claim to any rights or expectations that would otherwise accompany an unbroken relationship with Him. But because we have a God who is also merciful and full of grace, we begin to think that somehow we deserve His blessings.

As Linda read on, the Lord continued His conversation with me (really with us), reminding me of His grace and love. Simultaneously I felt strengthened, the nausea subsided and Linda and I enjoyed a bowl of ice cream! This wasn’t a right, but a great privilege.

Grateful for another day,
Dan

PS -- It's not that God does not grant us rights. He certainly does -- we have the right to bless others, to help meet others' needs, even to overcome the forces of evil in this world (Matthew 10:1). And the greatest right He offers us comes ironically not from wresting control for ourselves, rather by surrendering all control to Him: "But as many as received Him, to them He gave the right to become children of God, even to those who believe in His name." (John 1:12)

Fair Days & Faithful Ways

Don't think for a moment (those of you who live locally) that all this recent sunshine was meant for you... No, it's a God-send meant to lift my spirits and remind me of God's faithfulness, awesome creativity, and penchant for the beautiful. I am blessed to live in a house on the Chesapeake Bay, and in over 11 years here, I have honestly never spent so much time gazing out at this panorama than in the days since my cancer diagnosis: the ever-changing hues and texture of the water, the soaring seagulls, the playful pelicans gliding in formation just inches above the shimmering surf, the shifting sands, the kaleidescope of colors at sunrise and sunset...* But then I realize, it is meant for ALL of us, to remind us ALL of His true nature. "For since the creation of the world His invisible attributes, His eternal power and divine nature, have been clearly seen, being understood through what has been made..." (Rom 1:20)

As I have received literally hundreds of e-mails, cards, comments and well-wishes from so many people with words of encouragement and a committment to pray for me, I have begun to see how God's faithfulness is also manifest in that beautiful creation called YOU. I do not have the energy to respond to each of you, but please know that because many of you have shared a bit of your story with me in the past, I have also been praying for you, specifically in most cases for those difficulties and challenges that could zap you of spiritual, emotional and physical energy. By so doing, I have been strengthened and renewed. "...pray for one another so that you may be healed..." (James 5:16) I guess this is how it is supposed to work!

Well, we crossed the final hurdle today to prepare for an all-out attack on the metastatic melanoma. This morning, I underwent a core needle biopsy of the original tumors in my left parotid (salivary) gland. Those who have followed our story know these were thought to represent parotid tumors (either benign or malignant) and had prompted plans for parotid surgery in January. But the surgery was cancelled when it was discovered that I had some (more agressive) type cancer already spread throughout my body, ultimately determined to be malignant melanoma. This left the nagging question of what these original tumors might be. If melanoma, masquerading as parotid gland tumors, then one course of treatment would suffice; if a separate form of cancer or benign tumors, then possibly a different approach. I tolerated the procedure well and we now await the biopsy results.

I also completed a cardiac stress test (normal) and pulmonary function studies (showing mild restrictive lung capacity, likely due to the multiple metastases in my lungs). All of these have been forwarded to Dr Grosh at UVA and we will meet with him this Thursday, 2/21/08, to review and establish a firm treatment plan. At this point, he is still recommending the high-dose interleukin-2 therapy.

In all of this, we are grateful to you for caring and by so doing, reflecting His faithful ways.

Dan

*PS -- Did I mention the night-time beauty of the bay? Like the scene last night: The bright string of pearls formed by the lights of the Chesapeake Bay bridge tunnel adorning the horizon, the shimmering river of moonlight emanating from a break in the pearls (the Thimble Shoals Channel), streaming straight to our shore, and above a large pale yellow orb veiled seductively by lacey clouds that gracefully and silently slip by to reveal a stunningly star-studded sky. Linda and I are standing on the deck and hold each other a little tighter to brace against a chill in the air. Gazing up, our visible breath rises as a single offering: "Father, thank you." (Sorry, I couldn't capture any of this with a camera)

My Valentine

At the risk of embarrasing everyone I know, including myself, I want to share with you a poem I wrote for my wonderful wife this Valentine's Day. This story is not just about me, for I am no longer one... not since I married Linda. In this covenant called marriage we have plumbed the mystery, pain, and joy of what the Bible means when it declares "and the two shall become one flesh." I am grateful to God for this gift.

MORE

She’s not just a friend, a buddy, a pal,
A companion with whom you want to share all.
Not just a girlfriend who hates to be teased
But laughs just the same to put you at ease.
Not a confrere you can trust to the core,
She’s not just these things, she’s more.

When friendship had deepened to love that endures
Her notes never closed with “Sincerely yours”
Not willing to bridle true love and devotion,
Her fathomless passion’s like sounding the ocean.
Lost in the depths of this intimate ardor,
I declare that my lover is more.

Nearly forty years now, I’ve called her my wife,
As two became one and promised for life
To share in all things, through sickness and health,
We’ve known joys in want and blessings of wealth.
Mom to three girls, ever praised and adored
Her worth's not yet measured, there's more.

Her laugh lifts me up in this friendship so rare,
She has passion and warmth and beauty to spare.
An incomparable wife with wisdom like gold,
A life lived for God, both humble and bold.
E'er I leave this world, whatever's in store,
I want all to know this woman is more.

More than a friend... a lover... a wife…
She’s my flesh, my soul, my Linda, my life.

With all my love,
Dan

Gamma Rays & Grateful Days

100... 93... 86... 79... 72... 65... See! I can still count backwards by sevens :-) Sunday evening Linda chauffered me back to Charlottesville so that I could be admitted early Monday morning, 2/11/08, for a procedure called 'gamma knife surgery' to destroy several metastatic lesions in my brain. Mission accomplished and I can still recognize loved ones and even prepare our tax return!

The procedure involves securing a cage to my head (with several screws into the skull), followed by a very high resolution MRI of the brain, then targeting the lesions with a cross-fire of highly precise and focused gamma rays for about an hour, destroying the abnormal tissue in each location. Interestingly, the MRI found a total of five very small lesions (the previous MRI had only spotted three). The placement of the cage was painless with the help of some drugs and local anesthetic. While in the cage, I wavered between feeling like Tweety Bird and Frankenstein.

The procedure is capable of targeting lesions as small as 0.5 mm and none of my lesions was greater than 3 mm in diameter, so the doctors feel confident that the operation was successful. I did very well post-operatively, aside from a transient killer headache after the cage screws were removed. We stayed overnight, reviewed the findings with Dr Grosh, the oncologist at UVA, and returned home this morning.

Dr Grosh has now given the green light to proceed with the high-dose Interleukin-2 therapy, with the following conditions: I must pass a comprehensive lung function test, as well as a cardiac stress test, and arrange a more definitive biopsy of a nodule in my parotid (salivary) gland to ensure that it does not represent a second unrelated cancer. We hope to complete all these tests this week. If these tests are satisfactory, we will then be placed on a waiting list to enter the very aggressive IL-2 protocol at UVA.

Meanwhile, we are enjoying some quality family time, basking in the love of so many friends, and continuing to trust in the One who holds us all in His loving hands.

Gratefully,
Dan

Blessings Beyond Belief

The following is an abbreviated version of an address I gave to our church congregation at the invitation of our pastor today 2/10/08. Several have asked that I post these thoughts.

I have truly lived a charmed life. I honestly do not know another man who has been so blessed. Given the grace to make some right choices early in my life I have been preserved from many a heartache that I have observed others experience. One of those choices was to marry Linda, the wife of my youth now for nearly 40 years – and just as beautiful now as when I first fell in love with her at the age of 16. I was given the opportunity to enter the medical field and have enjoyed enormous fulfillment in literally thousands of meaningful interactions with patients over the last 30+ years. I have been blessed with three beautiful daughters, each of whom has married wonderful godly men and together given us eight awesome grandchildren (one of which is still in the hopper). I have also been blessed with great health and a low risk profile for most life-threatening illnesses, a wonderful church family... the list goes on and on.

I have been so blessed, that I have often pinched myself and prayed a kind of preventative prayer: “Lord, I am so grateful for the life you have given me. I know your Word says that we are drawn closer to you through suffering, but if there is some way I could accomplish that without the suffering part, teach me that way…” It seemed to be working, until two and a half weeks ago when I learned unexpectedly that I have disseminated cancer. Then a little over a week ago I learned it is an aggressive form of metastatic malignant melanoma for which there is no cure and which, without treatment, would take my life in less than six months. In my case there were no warning signs, no abnormal mole, nothing to alert me to the danger. And none has yet been found.

I stand before you seemingly intact, and indeed today I feel pretty strong, but all the imaging studies show that inside I look like Swiss cheese! The cancer involves my spine, long bones, lymph nodes, liver, lungs and even brain. Well, after absorbing the initial shock, let me share with you some things the Lord has taught me. He is teaching me so many things through this experience, but let me share just four:

#1 – It is an enormous blessing to be given the opportunity to anticipate the very real possibility of an early promotion whereby I may be ushered into the presence of Christ! Not many are given that opportunity. I have been overwhelmed at the outpouring of love and support by family and friends (from all over the globe!) and opportunity to cut through all the mundane topics of conversation to those things that really matter. I am extremely proud of my wife and daughters for their faith and fidelity during these precious days together.

#2 – In these last two weeks I have come to know our Lord by experience in ways that before I could only proclaim by faith. He is the ground reality, altogether holy, righteous and just, yet full of mercy and compassion. He is not some paper god I make up to suit my own sensibilities. He is both Elohim (the Sovereign One), El Elyon (the Almighty One), and at the same time El Roi (the One who really sees me in my need) and Jehovah Jireh (the God who provides for my every need). He is well described by C.S. Lewis in the Chronicles of Narnia as the lion, Aslan, not a pussy-cat, certainly not “safe”, but both fearsome and full of compassion, willing to suffer and sacrifice His own life that the traitor (in each of us) might be saved. He is the One who:
· Cares more about my character than my career
· Cares more about my purity than my personal peace and prosperity
· Values longsuffering more than longevity
I have been blessed to know Him in this way, so that I can say with Job: “Though He slay me, yet will I trust in Him”.

#3 – God is up to something! This is no accident. Over the last year here at Tabernacle Church He has removed several spiritual leaders from effective ministry, either through sustained illness (like fellow-elder Howard Douthit) or through death. With my illness, we have now lost two volunteers (myself as elder, overseer of our small group ministry, and Bible teacher, and Linda as director of Women’s ministries). Dear church family, I believe He is saying it is time for those of you who have been sitting on the sidelines, to step up to the plate. I am already seeing many of the women step into positions of leadership. Now the men need to do likewise. May your many gifts be fanned to flame and many assume positions of leadership and productive ministry. We need to give of both our time and our resources. This church of nearly a thousand has relied on the time and talents of only two pastors, when it is clear we need at least one additional pastor to effectively disciple this congregation. We cut our ministry budget last year for lack of funds. The resources are here – we all need to GIVE. It is time…

#4 – There is a spiritual battle going on. At first I entered this situation thinking I just need to learn how to suffer with grace. But lately I have been impressed that I need to engage in the battle, and by faith take aim against those things that oppose God’s purposes in all this. I invite you to join me. In addition, however, I believe there may be a spiritual battle going on in the body of Christ here at Tab. Like the cancer that insidiously grew in my body over a period of months without symptoms, there may be dysfunctional cells in this body that are not connected to one another, that want to go their own way and not yield to the direction of the Head, who is Christ. It may be some disgruntlement over worship style, a personality conflict with another member, a dispute over a minor doctrinal issue, or simply a lack of commitment to risk honestly relating to one another in small groups. My friends, we need to expose ourselves to this reality and allow Christ to heal us that His Body may be healthy, strong and truly redemptive.

None of us deserves tomorrow. Each day is a gift from the Giver of Life. No matter what the future holds for me and my family, I want you to know – honestly – it is well with my soul. Thanks so much for your partnership with us on this journey.

Dan

Gifts from God

God has given me so many surprising gifts lately: a surprise visit by my big brother, Dennis, from Colorado, summer-like days in early February, pain-free days with strength to fully enjoy my daughters and grandchildren (pictured here in our "front yard" facing the beautiful Chesapeake Bay), and an unbelievable out-pouring of love and prayers from family and friends.

Since our last entry, much has happened. Let me summarize briefly:

• An MRI of the brain shows 3 tiny tumors there


• A Bone Scan shows multiple tumors involving spine, ribs and long bones


• I met with my oncologist, Dr Burton Alexander, who provided a thorough and realistic appraisal of my condition. He explained there is no "cure" for this advanced form of melanoma. Without treatment (or miraculous intervention), I could expect to survive six months.


• I met with Dr William Grosh of the Melanoma Center at UVA on 2/07/08. Dr Grosh offered a small chance of remission with a very toxic treatment protocol, but I would first need to treat the brain metastases and pass other tests to ensure I qualified.


• I underwent additional Xrays, lab studies, and consulted with a dermatologist at UVA who found no primary source for the melanoma.


• On 2/08/08 we went back to UVA to consult with Dr Jason Sheehan, a neurosurgeon, had additional tests, then hurriedly returned home to meet with Dr Alan Wagner, retinal specialist, who graciously worked me into his schedule. He found no ocular source for the melanoma. Apparently I fall in the ten per cent of metastatic melanoma patients who never demonstrate a primary site.


• After all the travel, I experienced a flare of "pleurisy-like" chest pains and spent some time last night in the emergency room. Further studies showed no evidence of a blood clot to the lungs and the pain is now improved.


• We will now return Monday to UVA to undergo a "search and destroy" procedure on my brain called Gamma Knife surgery by Dr Sheehan. This no-incision operation uses highly focused gamma rays to destroy the 3 lesions in my brain. We are not certain if we will be staying in the hospital overnight, or for the week to enter the treatment protocol outlined by Dr Grosh.

I have been buoyed up by the prayers and support of so many people, and by the loving care provided by my wife and children. I told Linda that at times I am actively engaged in this battle and at other times feel like an observer while others wage war on my behalf. I am grateful to God for all these gifts.

Celebrating each day,

Dan

The Discovery Cruise

Months ago Linda and I had arranged to go on a much-anticipated cruise to the western Caribbean leaving January 25, 2008. Then just two weeks before the cruise we learned that I needed to undergo surgery for a tumor of my parotid (salivary) gland. The risk of post-poning surgery (ONE of us felt) was greater than the risk of delaying the cruise, but when we finally tried to cancel, we discovered it was too late and we would forfeit the entire pre-paid amount.

In the meantime the pre-operative workup led to an unexpected discovery that there were numerous small tumors spread throughout my body. On January 24 enough information had been gathered to make it clear that the proposed surgery would not be helpful and the operation was cancelled. My oncologist advised: "Go and enjoy yourselves! You will need the R&R for what lies ahead."


The trip was a gift from God! How many people do you know who are told they have disseminated cancer and immediately get to go on a cruise??
We thoroughly enjoyed the precious time with each other and our dear friends, Paul and Judy Spoelman. I had enough energy to do a myriad of fun things including snorkeling, zip-lining through the jungle canopy, cave-tubing, dancing and dining with my Linny.


During the cruise, the results of a liver biopsy proved that the cancer is an aggressive form of malignant melanoma. Since returning from the cruise, the physical effects of this rapidly spreading malignancy have zapped me of energy so that it became clear that I could not return to full-time practice. Fortunately, one of my colleagues, Dr Sheri Marshall, a very competent and caring family physician, has made herself available to manage my practice while we search for a permanent replacement.

I have completed many imaging studies and will soon consult with a specialist at the Melanoma Center at the University of Virginia. I cannot tell you yet about a specific prognosis or treatment options.

I want you all to know that I am confident in God’s goodness and that He let’s nothing happen to His children except that which first passes through His loving hands. We are fully dependent on Him and looking forward to the things He is going to show us through this experience. I commented to Linda that He must really trust us to allow such a challenge. Regardless, Linda and I and our daughters covet your prayers for grace, courage, wisdom and strength.

I will keep you posted as I learn more.


Dan