The Struggle Has Ended

Greg Hewlett passed away on January 17th after nearly eight years of battling colon cancer. While we grieve his loss, we are comforted to know that he is with his Lord.

If you would like to leave your thoughts on Greg, please see this thread.

If you would like to make a charitable donation in Greg's honor, please see this thread.

Thursday, October 28, 2004

Installation complete

Dr. Walkes successfully replaced my port this morning. There was a possibility that he would have to take out the existing one on the left side and place the new one on the right. While I may have enough scars to compete with a Deep Ellum sporter of tatoos, I am not exactly looking for more. Fortunately, he was able to clean out some internal scar tissue around the old port and put the new one in the same place. This keeps a clean shoulder pillow for Christine's head on my right side - something we were glad to keep.

I'm now playing the ol' familiar game of vicodan+drowsiness vs. pain+alertness. After recovery, we went back to MDACC for an appointment to learn details about the chemotherapy administration and side effects. I had popped a vicodan and was in drowsiness mode at the time, so I don't remember much of what was said. Christine took notes, so I'll ask her about it and get back with you on that later.

Wednesday, October 27, 2004

Port-o-cath surgery in the morning

I cannot remember having medical scheduling run more smoothly. I was able to get in touch with Dr. Walkes, the surgeon who did my port-o-cath surgery last year. He remembered my case and opened up a slot to do the replacement surgery tomorrow morning. His assistant was able to get the insurance and hospital surgical reservation all set up. He will perform the 10a.m. surgery at Houston Methodist hospital, which is near MD Anderson. It should be a day surgery this time. This is all good because it will have time to heal before chemo administration on Monday.

New plan of attack

Dr. Hoff and his colleagues have decided upon the new plan of attack. He would like for me to do 4 rounds of chemotherapy. If the abdominal tumor shows a reduction in size, then surgery would most likely follow. Because the cause of the lung spot is not certain, we'll wait to deal with that later.

Apparently, traditional thinking (up until about 5 years ago) is that if colon cancer has spread beyond the colon and the liver, then it is incurable and is only treated with the goal of extending life. But Dr. Hoff says that attitude is changing, although the issue is still debatable in the field. He assured me that he is still approaching me with the hope that we will be able to get rid of all the cancer and I will have long-term survival. To that end, the plan he has for me is the most aggressive.

The chemo protocol is currently the front line drug combination they give to new patients. The protocol is called FOLFOX with Avastin. It was experimental when I began this 19 months ago and has since been approved by the FDA. I had tried to get on that trial, but was unable to do so because I have had allergic reactions to a related drug. So I was on another regimine.

I am hoping to begin the chemotherapy on Monday. I am glad to see they are taking every precaution in my case. They want to admit me into the hospital for the first day of round one so they can carefully observe me and deal with any allergic reaction I get. Part of this will be premedication with some special drugs to prevent or mitigate any reaction. Some of the possible reactions are serious - they have to do with my ability to breathe.

My port-o-cath is not working well. (This is the pod - connected to a catheter to my heart - that is surgically placed under my skin. Chemo is injected into it.) I am scrambling to get in touch with the surgeon who placed it back in July '03. If I succeed in getting it scheduled, I will have port-o-cath replacement surgery done at Methodist Hospital here in the Med Center Thursday or Friday.

I am viewing all this as simply taking care of an area of cancer in my body that was not dealt with yet. There is no evidence the cancer has not spread to anywhere new since I was diagnosed in June 2003. I am still fighting the odds here, but fight I will. I have won some major battles in the past 19 months against this stupid disease. I just need to win some more. If the Red Sox can win 7 straight in the post-season, anything is possible.

I appreciate your prayers that the chemo will not cause any major problems and that it will sufficiently shrink the tumor towards the end of being cancer free.

Monday, October 25, 2004

More battles ahead

The biopsy returned positive - the nodule in my pelvic region is cancerous. I'm not considering this a remission. There still is nothing new that wasn't there at the beginning. It was there in June 2003, only no one really noticed it because it is in a very rare place for my type of cancer to spread. So I am hoping and praying that they will agree to surgically remove it.

I asked hard questions of Dr. Hoff. The discussion was odd because I sounded to myself like I was arguing ideas back and forth with him as I normally do with others in life. Only here I was arguing for my life. I get the feeling the normal approach in my situation is to avoid the risks and hardships of surgery and just try to slow the growth of the cancer. But I am young and healthy and just the kind of patient they treat aggressively. He understands my desires and is approaching this as aggressively as necessary. In other words, he is still shooting for long term survival - getting rid of all the cancer.

The lung spot cannot be biopsied because it is too small. So it is impossible to know conclusively whether it is cancerous. But there are some good reasons to begin by taking it out first, which is where Dr. Hoff seemed to be leaning.

Dr. Hoff took my case to conference this afternoon to discuss with his colleagues. There are not many precedent cases, which I take as a positive - they are paying close attention to my case and are willing to shoot for curing this. By now the conference is over, but I won't find out until tomorrow their conclusions. The next step, to begin as soon as possible, will be either pelvic region surgery, lung surgery, or chemo followed by surgery. Sounds like fun.

Tuesday, October 19, 2004

Biopsy complete - no problems

They gave me plenty of drugs, so I was quite comfortable during the biopsy. I was just awake enough to follow what was going on. I found the gadget and process to be quite interesting. Then again, I might have thought anything was interesting in my inebriated state. The doctor guided a long narrow sleeve needle into me bit by bit, each time taking another CT scan to make sure it was going into the right place. Then at the end he shot the biopsy syringe needle through the sleeve to get the sample. We'll hear the results Monday. Meanwhile, I'm feeling a bit loopy and I have a big patch on my rear.

Biopsy today

The biopsy is today at 1:00. It is not as risky as the liver biopsy, and they said they always give the patient enough system anesthesia to make him comfortable. So I do not think it will be like the one in Dallas last summer. They are going into my lower abdominal area from behind and below. In other words, recalling Forrest Gump, I am going to get shot in the buttocks.

Dr. Hoff, who is usually very slow to speculate, said this nodule, as well as the nodule in the lung, is very likely cancerous. I will meet with him Monday to get the biopsy results. If it is positive for cancer, I will likely begin another regimen of chemotherapy. The hope would be for shrinkage and surgical removal - much like the plan for the other tumors. These are not really "new" spots, as if the cancer is spreading. They both show on the CT scans of June 2003, when I began all this. So I'm just going to view it like we haven't finished the job we began.

Enough speculation... Step one - get through this biopsy and then wait for results next Monday. Step two - another PET scan on thursday. One step at a time.

Saturday, October 16, 2004

Disappointing news

The disappointment sitting heavy within me is keeping me from being able to express much today. I'll try to cover the highlights.

Dr. Vauthey seemed quite concerned. The nodule has grown. This is the spot that they tried to biopsy back in July, but which showed negative for cancer. It is in my lower abdominal area just outside the intestinal track. This thing - whatever it is - seems to have have grown significantly to 2.5cm. So they are going to do another biopsy this week.

In addition, there is a small spot on my lung that was not there in July. It is too small to say anything conclusive about it. We'll be keeping our eyes on it.

Monday, I will meet with the biopsy doctor to find out more about the procedure, including when it will be. They will do a CT-scan-guided external biopsy this time, so they can be sure they hit the nodule. I imagine it will be like the liver biopsy I had last year, but I hope not.

There are a few encouraging signs. The intestinal nodule is in a place Dr. Vauthey has never seen colon cancer spread. And the PET scan in July showed no signs of cancerous activity, even with the nodule present at that time. Also, my CEA remains a somewhat low 4.5.

Christine and I are thankful to all of you for your support in prayer.

Wednesday, October 13, 2004

First tests during remission

The days have turned into weeks and months since last visiting MD Anderson. (And yes, since I have written!) I am now in Houston for my first full round of tests since going into remission. The last few months have been full of relief and thanksgiving. Christine and I have enjoyed the time together at home without the chaos and uncertainty that filled our lives the past year.

Our trip to Yellowstone was wonderful. We did not want to come home. I hope to put some pics up soon. Last weekend, I traveled to Catalina Island for a little fishing and golfing on the occasion of my brother-in-law's birthday. Michael Murray is 40!

I will hear the results of these tests by Friday. Lord, have mercy on me.