New Normal

If there are two words I am tired of hearing used together they are "new normal".  Over and over (and over and over and over) in the cancer community you hear people speaking of getting used to the "new normal".  Let me tell you about what is supposed to be considered "normal" for me now that I am supposed to accept and get used to;

• Severe numbness and tingling in my arms and legs that has been present and not let up since February 2011.
• Frequent headaches of varying degrees.
• A blind spot to my right due to losing the vision in the lower right quadrant of both eyes.
• Walking into stuff on my right side due to said blind spot.
• Blurry vision that varies in degree of severity day to day.
• Having my right testicle discarded with the trash.
• 22 residual tumor masses in my lungs.
• Having to answer "no, I was not a smoker" in regards to those 22 tumors.
• Seizures and losing my right to drive for six months.
• Re-growing a liver with the 10% of my original liver they were able to keep.
• A 9" scar down the center of my chest/abdomen.
• A 12 1/2" scar on the back of my head.
• 6 titanium brackets holding a major portion of my skull in place.
• Short term memory loss.
• Fatigue.
• Major losses in strength/endurance.
• Short term memory loss. (Did I mention that?)
• Having people tell me I could have avoided cancer if I had only eaten/not eaten "_____" or done/not done "_____".
• Balance issues.
• Cognition issues.

I guess there is a plus side though.  I can rant and rave and complain all I want and if anyone complains about it all I have to say is "sorry, it's my 'new normal', you'll get used to it."

The Reaper Came Knocking

December 17, 2011.

Patient is unresponsive, heart rate is in the 20's...

One emergency craniotomy later I am here to say nice try cancer.

On December 28, 2010 I was diagnosed with cancer. After that day my main goal was to make it to December 28, 2011 to be able to celebrate my "new birthday". One year as a survivor/patient. One year and still going strong.

I almost didn't make it to that day and the celebration.

11 days earlier a newly discovered 9 cm brain tumor in the left occipital lobe very nearly kept me from reaching a very important milestone.

I had been experiencing some vision issues as well as increasingly worsening headaches for a period of a couple of months which lead me to seeking an appointment with Ophthalmology. After a field of vision test it was determined that I had lost my vision in the lower right quadrant of both eyes, leaving me with a blind spot. The speculation was that, worst case scenario, I had a tumor in the occipital lobe of the brain damaging the optic nerve and an urgent MRI was scheduled to be conducted within 48 hours. Thus began a whirlwind 9 day period.

• December 8, 2011: MRI of the brain.
• December 9, 2011: Results confirmed and delivered, a 9 cm mass is present in my brain.
• December 12, 2011: Consult with Neurosurgery, surgery scheduled for December 20, 2011.
• December 12, 2011: Consult with Radiation Oncology, a course of radiation therapy recommended for post surgery.
• December 15, 2011: A series of worsening headaches brings me to the ER.
• December 15, 2011: I "black out" and have no memory of any event until December 20, 2011.
• December 15, 2011: Admitted to ICU.
• December 16, 2011: Surgery moved to December 19, 2011.
• December 17, 2011: Vital signs take a dive, I become unresponsive and my heart rate drops into the 20's.
• December 17, 2011: Surgery becomes urgent and a left craniotomy to resect my tumor mass is performed this day.

Surgery was a success, but this latest obstacle set me back a bit more and gave me more hurdles to overcome. Prior to discharge day I was evaluated by speech, occupational and physical therapy to determine what services I would need in order to regain my abilities and whether I would be able to be discharged to home or to a treatment facility. With sheer will and determination I was able to prove that I would only need physical therapy and that I would be able to be safe and function at home. When discharge day arrived I needed to use a walker to leave the hospital, but I was able to walk out. It was a slow walk and a bit unstable, but I was walking.

And now to the present day.

After a few weeks with the walker I was able to transition to a cane, presently I use neither.

The vision loss is permanent but I am making adjustments and learning to accomodate for it.

With the help of an amazing physical therapist I am regaining endurance, coordination, balance and strength. I have a ways to go but I am making great progress.

So, to make a long story short, everybody gets knocked down. How quick are you going to get back up?

The Ugly Truth

I know I have been kind of silent the last couple of months in regards to my experiences but I will not apoogize for that. I have had the same thought playing in my mind the whole time, I have just struggled with the tone and the words to express it.

More than anything else since starting this blog many people have stated they have appreciated my honesty when speaking about my disease. Hopefully they will still appreciate it as my perspective has been shifting. For many months I found humor in what I am going through, laughter is the best medicine right? The thing is, I'm not laughing as much anymore.

The truth is, cancer is an ugly disease.

So often I hear "you're an inspiration" or "you're someone people can really look up to". If this is what it takes, I don't want to be a rolemodel, I don't want to be an inspiration. To be those things I have to be "the guy with cancer" and trust me, it is not all it is cracked up to be.

In the cancer community they talk about getting used to a "new normal". Personally, I liked my old normal. I liked not having toxic chemicals pumped into my body that will stay in my system for up to 15 years. I enjoyed being able to look in the mirror and not seeing a nearly foot long scar running down the center of my body. Being able to ride 100 miles on my bike beat the hell out of getting winded and having to sit and rest while trying to walk a mile. Full feeling in my extremeties and excellent coordination and balance was far more preferable when compared to the never ending numbness/pins and needles feeling in my arms and legs and the stagger to my gait and the balance issues I now have.

Yes, make no mistake about it, I am complaining but I think I have earned the right to do that at least once. I may keep a brave face on but it doesn't mean I am not angry about my situation and I think anyone dealing with cancer will tell you the same.

I know that in the long run I will learn a great deal about myself from this experience, truth be told I look forward to it, and I want to be able to do something positive to give back to others going through the same.

But today I am angry and that will have to be ok because that is the best I can manage.

Livestrong Challenge Philly

I laughed, I cried, I rode my bike.

In past years I cannot say that the reasons for riding the century distance (100 miles) at the Livestrong Challenge extended much past pushing myself a little while supporting what felt like a good cause. Cancer hadn't touched me or my family but I knew I could do a little something to help support and raise awareness for those whose it had. All I had to do was ride my bike, easy enough. December 28, 2010 that changed. That is the day I joined the cancer club. I hadn't been seeking admission, yet I was granted a lifetime membership.

Shortly after that diagnosis day I knew one thing, I needed to ride the Livestrong Challenge this year. I needed to be there to feel the energy and love and camaraderie that is always so present. The goal was to ride the 100 mile route, a route I had ridden and completed on two previous occasions. I just needed two things to happen, one which was in my control, regain as much fitness as possible post-chemotherapy and the other that I could not control, a scheduled date for surgery that was after the event.

By a stroke of luck, surgery was scheduled for four days after the ride, fate was telling me I was meant to be there and meant to participate this year. I worked hard on the fitness, I ran, I rode, I ate right. Unfortunately I was not able to get back to peak condition yet. I knew my rides were not long enough, my hill work was lacking and as it turned out, the stamina I had been rebuilding was not to a level to carry me through where I had come up short in training.

On the road I decided the 70 mile route would be more appropriate. However, to cover that distance I was going to need to rely on something bigger than myself, the kindness of others. In the days leading up to the event I was sharing some thoughts via Twitter and a simple #LSCPhilly connected me with two guys that ended up being my greatest assets and allies on the road. They pulled me when I couldn't hold the pace, they offered a hand on the back when the climbs got tough, when I fell back they waited and they let me share my story. I kick myself for not asking more about what brought them to this event, but I am eternally grateful that they were there when I needed them and there for all affected by cancer. I hope in future years we can ride together again and I can return the favor and inspire them the same way they inspired me.

In the end my ride day tally was 55 miles. I didn't make the 100 or the 70 but I rode, I rode on a day that eight months prior I didn't know for sure would exist for me. I shed a tear for a minute, frustrated with coming up short to the bar I had raised for myself, but then I wiped my eyes and gave thanks. Thanks to the family and friends that made the trip to be with me and participated in the event, thanks to those that continue to support me on this journey and thanks to those that I met on the road that kept me turning the pedals over.

I laughed, I cried, I rode my bike. I was inspired.

Attitude is Everything

I refuse to lay down.

I will not throw in the towel.

I am not taking my ball and going home.

I will not quit.

Cancer has been one of the most influential teachers I have had in my life. The greatest lesson I have learned is that attitude is everything. If I say "I'm going to have a bad day today" I will most certainly have a bad day. If I let myself believe I am too tired to get off the couch my head will stay on the pillow and my feet will never touch the floor.

A month ago I got dropped by my cycling group when we reached the fast section on the route and I had to fight to catch back up to them and finish the ride. A day ago I got out alone on a breakaway at the same section and they had to chase me down and pull me back. I do not mention this to be boastful (truth be told, they did catch me, but I relished the period I was in the lead), I use this to remind myself to never quit, to not stop trying, to keep reminding cancer who is in charge. Attitude is everything.

When I lost my hair I embraced not having to shave or get haircuts. When chemotherapy robbed me of my palate I welcomed the opportunity to try new foods and flavor combinations. In a few weeks it will be time for surgery and I know it is going to knock me down. But when surgery knocks me down, I will get back up, come back stronger and dare cancer to try and push me down again.

I refuse to simply exist. Life is meant to be lived, that is my attitude.

...and attitude is everything.

Consults, Tests and the Waiting Game

If good things come to those who wait, I must have some good things coming my way.

It has been a couple of months now since I finished the originally scheduled course of chemotherapy, long enough that I can report that I once again have eyebrows, eyelashes, nose hair, facial hair as well as a lovely layer of soft fuzz growing on my head. So much for aerodynamics and being able to go for weeks without shaving. If my voice goes deeper I will officially call it puberty 2.0.

In the time since my last treatment I have been working hard to train and regain my fitness and endurance, it has been a mixed bag so far, cycling has been going better than running but I am consistently inconsistent at both. My efforts seem to be all over the place, the gains I feel like I make one day are gone the next and I am still nowhere close to my old form and rhythm. However, if my treatment schedule permits, I still intend to ride in the Livestrong Challenge. (Please use the link to help me support an organization that has been a great resource for myself and over 28 million others living with cancer. By following the link you can donate and/or sign up to participate in a great event and even join Team Dougan. Please also share the link with family, friends, co-workers, strangers...)

Ok, back on track, treatment schedule you say? Yes, I am waiting to find out the schedule for the next steps in my treatment plan. After a consult, some conference calls and a liver biopsy it has been determined that a retroperitoneal lymph node dissection, commonly referred to as RPLND is the next step in the process for me. It is now just a matter of it being scheduled, which is what I am waiting to hear back about. Ah, the waiting game, it still fails to get anymore fun, no matter how many times I play.

But...

My morning went a little like this; "good news, good news, good news, good news, good news, but....". It was a bit like taking a trip to your favorite restaurant, ordering your favorite entree, sides and beverage and when it comes to the table, there is a large hair of unknown origin cooked into your meal. It's everything you were hoping for and expecting. But....

Today was my appointment to go over the results of my latest CT scan and lab work. From very early in this process I knew today would be the day I would be discussing how my body responded to my scheduled course of chemotherapy and most likely be discussing surgery.

And the results were good, all of my blood work was excellent, my tumor marker levels are back within a normal range and my blood levels are improving, working their way toward normal levels. The tumors in my lungs and liver had reduced in size, they aren't gone, but good progress was made there as well. The abdominal lymph node masses had shown no reduction in size, but that was to be expected, I have known from almost the beginning that tumor masses of this type (teratoma) do not typically respond to chemotherapy and would need to be surgically removed.

But...

And there was the hair in my dinner.

Surgery may not end up being as straight forward as we originally thought. The issue is this, with surgery the goal is to remove all residual tumor masses, however, the concern is that I may have too many residual masses in the lungs and liver that would make surgery a challenge at the moment. One possible way of dealing with this is additional chemotherapy to try and further reduce/eliminate the lung and liver masses. It may entail more of the same regimen I originally had, more likely though I would need what was referred to as "high dose" chemotherapy which comes with it's own "but...". If I were to go the high dose route I would need to do a bone marrow transplant, giving my own marrow to be held in storage and then replaced in me after the high dose round because the high dose chemotherapy would wipe out my bone marrow.

All in all the news was good today, I just still have a ways to go in the process, it really is a marathon not a sprint. The next step is to have a consult with Duke University Medical Center where I am being referred to for this next phase in the treatment plan. Until then all I can do is stay positive and keep working out to be as strong as I can, physically and mentally.

A Milestone Reached

Saturday I reached a milestone in my cancer journey, I completed my fourth of four scheduled rounds of chemotherapy and I was able to ring the bell to celebrate my exiting of the chemo ward and the completion of this leg of my battle.

I truly owe a great deal of thanks, more than I can ever express, to all my friends, family, members of my medical team and the countless others along the way that shared encouragement, thoughts, prayers and support. You are all what gave me the strength to carry on.

Of course my battle is far from over, in some ways it is just beginning. Within the next month I will be heading in for further appointments, some to monitor the lasting effects of some of the various chemotherapy side effects, most importantly though I will be having another series of scans to see what residual tumor masses remain and then discussing what surgical options will be necessary to remove them. They say chicks dig scars right? If the bald look didn't do it, this should definitely make me irresistible. I'll have to see what Ellon thinks about that theory.

Cumulative Effects

Chemotherapy adds up. The recovery periods between rounds are not of a length to get one back to 100%, rather they are just long enough to get the body back to a point where it can handle another round being pumped in. The way that is done is by tracking thresholds, a measure of the minimal blood levels the doctors feel they can comfortably (safely) run another course of therapy.

Of course there is one hiccup in the process. As a course of chemotherapy is run, in my case over a five consecutive day period, blood levels drop. With each round they drop a little quicker based on the lingering effects of the previous rounds. Other than having blood drawn and scanned each morning (at 4 a.m.) to monitor for drops what does this mean? It means that occasionally a transfusion may be necessary, whether it be platelets, WBC's or RBC's.

While I have come close to being a candidate for a transfusion I had been lucky enough to avoid this, until round 3 day 4. My red blood cell level had dropped to a 7.2, with 7 being the target low where they transfuse at. However, since I was also experiencing periods of being light headed, along with some pretty major fatigue, that put me squarely in the parameters of someone who needed a blood boost, two units of packed red blood cells worth, which I was typed and matched for. I have given blood on many occasions, but it was a bit of a different experience being on the receiving end. But my donor blood did its job and my RBC's were back to a better level for the next mornings blood scan and I finished out my week. Now on with the recovery so I can get round 4 under my belt.

A Case of the Mondays

I think today I have a case of the Mondays. While there have been some aspects of cycle two recovery that have gone smoother than cycle one recovery, overall, I don't feel like I am bouncing back as well as I did after cycle one. Here is an overview.

• Fog: Let me get this one out of the way first. The feeling of being locked in a fog was much less severe this recovery period vs. the first one and I am very thankful for that. I will attribute that to sticking to my goal of using very little to no meds (other than what is required) during treatment and recovery for cycle two. No four day gaps between days this time around.
• Fatigue: I am TIRED, constantly. Cycle two seemed to go after any reserves of energy I thought I may have tucked away. Waking up and getting going has been a bit more of a chore this time around. My days start a bit like this; Wake up, spend 10-15 minutes in bed trying to motivate myself to get up and get moving. Stop one, the bathroom to take care of business, and to sit for a minute to rest. Stop two, the couch. That's right, after my bathroom break (and break) are complete I stop by the couch to rest and regroup before I start to head to the kitchen to put breakfast together. Stop three, the dining room table. The reason I mentioned that I start to head to the kitchen is because somedays I take an extra break on the way to make sure I am fully ready to finish my trip to the kitchen. Now, before you paint a mental picture of my house being larger than it is, it is probably less than 60' worth of walking required to cover this entire path. Thanks fatigue.
• Lockdown: My recovery, and many of the things I am allowed to do during recovery, are tied to my blood counts. Fridays lab work earned me a period of lockdown. One of the main blood counts they are concerned with is my neutrophil count. Neutorphils are a type of white blood cell that helps cells to kill and digest microorganisms, important for fighting infection. A normal neutrophil count is 1500-8000. As of Friday my count was a shade over 400, leaving me susceptable to neutropenia, which lowers the immunolgic barrier to bacterial and fungal infection. What does this all mean you may ask? It means that, as of Friday, I was told I need to stay home, avoid public places and children, consume no fresh fruits or vegetables and limit any company that I thought about having until further notice. Hooray for sitting around the house every day. I don't like cabin fever, I love it.
• Sores: Speaking of infection and the attempts to fight it, another of the fabulous side effects of chemotherapy is the development of "sores". Now, as I have mentioned, my body is in no condition currently to fight infection and heal itself. I think that is description enough for this topic.
• Pain and athletic limitations: Early into a light yoga workout Thursday I knelt and one loud pop from the left knee later, my only form of exercise currently, other than walking, was taken away from me. I now have an extra pain to deal with during this experience which, hopefully, will clear itself up sooner rather than later, because compensating for it seems to have lead to a major cramp in my right leg that doesn't want to loosen up yet coupled with a new and exciting ache in the lower back.

So there you have it, I think somebody has a case of the Mondays. However, there is a bright spot today that makes most of this ok and not worth worrying about. Today was my midway CT scan, to check if progress is being made after two cycles of chemotherapy. And the phone call I got this afternoon confirmed that progress is indeed being made, my tumors are responding to chemotherapy and are reducing in size. Go team Dougan!

Maybe that case of the Mondays isn't so bad.

Emotion

Emotional, that is how I will sum up week 1 of cycle two. Now, I would like to say it was a week of highs and lows and a good balanced celebration of emotion, but I am not going to start lying for the sake of lying.

There were some highs to be sure, I set a goal of walking a mile per day while receiving the five days of chemo, as well as a session of yoga every evening and I accomplished that. The walks may have been a little slower and the yoga sessions a little more relaxed as the week progressed, but mission accomplished on that front.

The real emotion came with the in between times, when I had the most time to think. Previously, the longest I have ever been sick is for about a week, at most, the kind of lingering cold or flu that everyone experiences at one time or another. But today it hit me, I am coming up on THREE MONTHS with cancer and I don't know if I am getting better yet. I want to feel and hope and believe that I am making progress, but it will be another couple of weeks until I have my rescan and go over the results. Until then, it's a toss up, is my body responding to the treatments or isn't it? It is a bit of a cruel waiting game.

But I am holding my head high and hanging onto hope. I want to shock my doctors with how well I am doing. I want them taken aback by what great progress I am making. I have a 100 mile bike ride waiting for me August 21, 2011 and I want to be ready and be there.

I just need to remain patient, focused and determined and I need to listen to what my body is telling me as we heal. I would like to close this post with a traditional Tibetan prayer.

Grant that I may be given appropriate difficulties and sufferings on this journey so that my heart can be truly awakened and my practice of liberation and universal compassion may be truly fulfilled.

Chemotherapy Cycle Two

Tomorrow morning it begins again, I will be checking back into the hospital for the beginning of cycle two, which includes another week in the hospital with five days of chemotherapy treatments. There is the part of me that is not looking forward to being knocked down again, having every ounce of strength, energy and endurance taken away, but I know it is necessary. And this will be the beginning of being halfway through with chemotherapy, as long as everything stays on track.

Today I found myself to be particularly tired, but I have been sleeping well the past few nights, and have been able to nap as well. It has been pleasant to have my sleep schedule back to normal, even for a few days, we will see if it gets thrown all askew again after I get home from the hospital.

They say that laughter is the best medicine. I was lucky enough for a surprise visit from a couple of great friends and they provided me with a very large dose and I thank them for it. It was just the pick me up I needed to get me ready for Monday, along with my day on the couch and multiple naps today. I thank everyone for their continued support, thoughts, prayers and care packages, you all give me the strength I need.

Support for a Shipmate

By MCSN Jared M. King

USS Enterprise Public Affairs

Enterprise Sailors stand together against cancer

USS ENTERPRISE, At sea – While life carries on throughout deployment aboard the aircraft carrier USS Enterprise (CVN 65), 25 Sailors from Combat Systems Department shaved their heads Feb. 22 in a show of support for their shipmate who was recently diagnosed with cancer.

Electronics Technician 3rd Class Brian J. Dougan never had the opportunity to join his shipmates on Big E’s 21st deployment due to the diagnosis of Stage III C testicular cancer.While being diagnosed with cancer would be an emotional experience for anyone, Dougan said part of the reason the news was so bad was because he knew he would no longer be able to join his fellow Sailors on the ship’s deployment. Not only did the cancer affect his health, it also affected his chance to see the world, make rank, and get dual warfare qualified –all of which were Dougan’s deployment goals. “I always tell him that he needs to focus on his current mission,” said Electronics Technician 1st Class (SW/AW) Michael J. Stanislow, Dougan’s leading petty officer. “Once he gets healthy he can worry about doing his job.” Dougan will be submitting a limited duty medical board report recommending that he be transferred to a shore command for chemotherapy treatment. He is seeking care at Portsmouth Naval Hospital in Portsmouth, Va., where highly trained doctors and medical staffcontinuously monitor his status through blood work and ultrasounds. Since a side effect of chemotherapy is temporary hair loss, Sailors in Dougan’s department decided that shaving their heads symbolized that they were there for him during one of his most difficult moments. “I thought it was a great idea and fully supported the decision to shave our heads to show support for our shipmate,” said Master Chief Fire Controlman (SW) John M. Mann, leading chief petty officer for Combat Systems Department’s administrative division. “I feel bad that it happens to anyone, but it hits a lot closer to home when it happens to an EnterpriseSailor.” Dougan said that once he is fit for full duty, he would love to be able to come back to Enterprise and reunite with the friends he made after spending time aboard the ship. “Thank you for your thoughts and prayers,” said Dougan. “I will beat this and I will return to the fleet. It means a great deal knowing people are willing to reach out on my behalf.” “The Sailors thatshaved their heads to show support are the kind of shipmates I’m proud to serve with,” said Stanislow. “Dougan is a great guy and I can’t wait to see him when we get back from deployment.”

24 Hours

I have a blank space where my mind should be.

24 hours. 1,440 minutes. 86, 400 seconds. One day.

I have spent the better part of today trying to convince myself that is all that has elapsed since this time yesterday. But it feels longer...much longer, closer to 3-4 days minimum. Yet I know what I am telling myself is true, I have checked receipts, e-mails, phone messages, my calendar (nearly hourly most of the day). Yesterday happened just yesterday. One day ago. 86,400 seconds ago. 1,440 minutes ago. 24 hours ago...yesterday didn't happen 3-4 days ago.

Let's see how quickly tomorrow comes.

Chemotherapy: Cycle One

I apologize for the delay in getting this latest post done, it has been a challenge to find the words and the energy to try and properly sum up what I am experiencing.

I am exhausted yet I have trouble resting, it is a mean double edged sword. My body wants to sleep, to push this all out of myself and wake up refreshed yet I lay there, unable to fall asleep, instead blankly staring at whatever surface is in my field of vision.

It has been a few days since cycle one, week one has completed, I received my fifth dose late Friday night/early Saturday morning. The job of the body is to now flush out all the nastiness, bring the blood levels back up and prepare for cycle two to have its turn.

There are definitely days when it is hard to feel strong and stay strong, I was aware this was going to be a fight, but it is going to be a tougher one that I originally anticipated.

And then I got a good piece of advice this week and I wanted to include it here;

"I think the hardest thing people who have a strong work ethic have to do is to allow themselves to rest. We push ourselves over and through our illnesses to keep doing doing doing and to be productive that we do ourselves a disservice. Even in our play and recreation we go for it and push hard. I have to remind myself that it is OK to occasionally sit on my deck with a book, or to sit and stare at trees with a cat asleep on my lap. As I get older it is easier and easier to do this without feeling guilt, like there is "something I SHOULD be doing", like it is not acceptable to just sit. Brian, you are going to feel like crap. Just allow yourself to feel like crap and know that you are going to get through it. Sit, breathe and find your center and remember it is OK to sit. Your body is doing enough. Take the time to really listen to the lyrics of your favorite songs. In the spring listen to the birds. Listen to the drip of water as the snow melts. Hear spring. Sometimes life is so noisy we miss these things..."

Countdown to Chemo Day 1

Monday February 14, 2011. For most it will be celebrated as Valentine's Day, for me it will be Cycle 1, Day 1. The past few days have been spent taking care of final tests, scans and procedures to prepare me to start chemotherapy. It has been an interesting and exhausting week.

One of the issues I have been dealing with is a progressively worsening back ache because of a tumor mass that presses against my spine. By Wednesday it had morphed itself into a pain something akin to a hot knife being twisted into the base of my back, which in turn sends waves of pain shooting down through my right leg. It would be nice if the pain came and went but at this point it is present close to 24 hours a day.

Wednesday was also the day of "the phone call". The results of my pulmonary function test had come back and the lung tumors were causing some airway obstruction which means I will need a different regimen of chemotherapy drugs so as to not do further lung damage (thankfully, post treatment with a good workout schedule, lung function can be regained). I will no longer be receiving BEP (Bleomycin-Etoposide-Cisplatin), instead I will be receiving VIP (Vinblastine-Ifosfamide-Cisplatin). Along with the drug change I will also now be receiving my regimen as an inpatient instead of outpatient so I will be spending the week in the hospital vs. coming home every afternoon.

Thursday was a day of procedures, a biopsy of my liver and the insertion of one of the most important pieces for my chemotherapy, my Xcela Power Injectable Port (mediport). The mediport is for patient therapies requiring repeated access to the vascular system which will prevent, as a friend put it so well, "shaky Irene" attempting to start an IV on me every day. While the procedures were fairly straight forward they do leave you with the feeling of being punched repeatedly in the side.

Friday was bone scan day, a head to toe imaging of my skeletal system to check for any metastases. The scan itself was very relaxing, I nodded off on the table while they took their images. However, I think the combination of the previous days procedures, sedatives, medicines and the dyes injected for the bone scan were a little more than my body wanted to deal with. Friday turned out to be a pretty rough day with nausea, headache, body aches and a low grade fever, possibly a preview of things to come this next week. It made for a pretty sleepless night.

But I made it through the night and I am bouncing back decently today. I'm not feeling 100%, but I definitely feel better than yesterday. And that is an important lesson for me to keep in the back of my mind. I may feel beaten at times while receiving my chemotherapy, but I am good at bouncing back.

I Will Ride Again

The century ride.

100 miles, the marathon of bicycling.

In the past I have trained for and ridden the Philadelphia LiveStrong Challenge because I wanted to push myself, I wanted to see what I was capable of and I wanted to support a worthwhile charity while doing so. I never saw cancer in my future and a piece of me always hoped that my participation in this event could make sure that one day no one saw cancer in their future.

On December 28, 2010 it wasn't about the future anymore, cancer became my present, but I will fight this and I will win. While doing so I will also condition and ready myself to cover 100 miles on my bicycle at the 2011 Philadelphia LiveStrong Challenge, August 20-21, 2011 with a smile on my face, I'm too stubborn not to.

Cancer is my present, but maybe it is also my gift. This is my time to dig deeper, push harder and give more. This is my chance to give back to an organization that is giving so much to me and this is my opportunity to inspire to a level I never dared dream of. I will ride again and it will be for all of you.

Please consider supporting me or joining and/or supporting Team Dougan for the 2011 Philadelphia LiveStrong Challenge.

A Clear Head

I was told I need be sure to embrace and celebrate every milestone and that first milestone came yesterday, via a clean MRI of my brain. The cancer has traveled many places in me, but thankfully the brain is not one of them.

Next stop, chemotherapy (with a few small steps on the way). I am currently scheduled for four cycles of BEP (Bleomycin-Etoposide-Cisplatin). Before I can start there are just a handful of tasks to take care of first, they include;

• Hearing test
• Pulmonary function test
• Bone scan
• Pre-surgical consult
• Mediport insertion
• Chemotherapy school (a one on one walk through the treatment rooms and procedures to prepare me for cycle one)

Thankfully, I have a really great Oncology Nurse Case Manager that put together a very detailed to do list for me that listed the contact number for every department I needed to visit to schedule these as well as a date that everything needed to be completed by. In addition to all the great support from family and friends a really good medical team is making this process so much smoother and less stressful.

Are You Claustrophobic?

"Are you claustrophobic?" It seemed like an innocent enough question as I filled out the paperwork before the MRI of my head (to see if the cancer has spread to the brain as well). Am I claustrophobic? I immediately check "no", I have been under buildings, worked on plumbing in crawl spaces, squeezed through some tight spaces rock climbing, been in caves...the list could go on. No, I am not claustrophobic.

I am also not entirely convinced that is the best word to describe what I was about to experience.

After removing all metal objects and placing them in a locker I am escorted into the room and instructed to lie down on the table as I am handed a pair of earplugs. I am told that I need to place my head in what could be best described as a box and told to slide up until my shoulders were firmly against the braces. After I am situated, chocks are placed around my head to help hold it firmly in place. I am then told that they will be locking on a face shield that helps them with taking the images. The "face shield" was more like a 1970's Doug Favell goalie mask (minus the nice paint job) and it truly did lock into place.

I am then told that I will be spending 25 minutes in the tube, coming out briefly for an injection, then going back in for another 8 minutes. 33 minutes I will be like this, locked to a table by my head and lying motionless. At this point I decide the best course of action is to close my eyes and try to zone out for the duration of the scan.

Of course there are two problems with that line of thinking.

First, the noise. An MRI does not sound that much different than a jack hammer, a very rhythmic pounding that lasted most of the scan. Second, I opened my eyes. There, right in front of my face, about an inch away was my face shield, and about two inches beyond that (I could see through some slits) was the wall of the tube itself. At that moment I thought, "I actually wouldn't mind getting out of here now." Luckily I only had about 31 minutes to go.

I guess "Are you a bit apprehensive about laying on a skinny table, having your head, neck and shoulders braced, a face shield locked onto you and being slid into a tiny tube to listen to construction noise for the next 33 minutes without moving?" was too long of a question for the form.

And I might have checked "yes" for that one.

The Mental Side of the Early Days of Cancer

Physical vs. Mental:

It is hard to say during these early days which will be the harder battle, the physical one or the mental one. The outpouring of support since Friday has been truly incredible, I have said it before and I am sure I will say it many more times during this journey, but I feel blessed to have such great support in my corner.

So many of you mentioned how strong I am, yet today I let a 56 hour battle with nausea and headache ground me on the couch when I really wanted to get out for a run. Treatment hasn't even started yet and I am already letting the mental fight take an early lead, I am going to need to address that with myself and correct it. Others of you spoke of me being a kind and decent person, but I know I am guilty of muttering rude things under my breath (as well as shouting them out loud, let's not kid ourselves) and having a temper. These early days of cancer make me question where I could have been better or kinder, or tried harder in life, or reached out to more people.

And then there was hope, so much hope in so much of what you all said. And that is what I need to do, keep the flame of hope burning bright, beat this physically and mentally and get busy getting myself to the point where I talk about being a cancer survivor, not a cancer fighter.

In the mail today I received a catalog from Harley Davidson with the tag line "Kick-Start Your Next Adventure". I am one step ahead of you. They were probably thinking that adventure would be on the back of a brand new motorcycle, not fighting cancer, but maybe my next, next adventure Harley.

I think I have just enough daylight left to get that run in.