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.