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.

Friday, February 15, 2008

Surgery Cancelled

I got the results from the PET scan (which looked for signs of cancer around whole body) and pathology (which examined biopsy samples from hilar lymph nodes).

PET: No signs of cancer outside the two lymph nodes. In other words, the pulmonary nodule did not show up as cancerous. (doesn't mean there is no cancer there, only that if it is there, it is not big enough to register).

Pathology: Samples from only one lymph node were examined so far. There was a "few groups of distorted malignant cells in a background of extensive necrosis and microcalcifications." [necrosis = daed cells] In other words, mostly dead with a few stubborn cells remaining.

Result: Dr. Eng and Hofstetter consulted and, based on these results, cancelled the surgery. It is not even an option for me. Don't get me wrong - I'm not disappointed. The basis for surgery was weak to begin with. It was to get the lymph node (which is mostly dead, we now know) and the pulmonary nodule (which is not showing signs of being cancer - maybe scar tissue). They decided the right course is to continue chemo because it is currently so effective. Maybe it can keep killing the bad stuff. Surgery does not make sense right now.

I'll be in contact with Dr. Eng next week to find out what the plan is now.

Based on some emails and calls I've received from yesterday's entry, I believe I should clarify. Cancer is not gone until it is all gone - every little cell. The results yesterday did not suggest a 90% chance that cancer was gone from my body - just that it was gone from the lymph nodes. Stage IV cancer is a long grueling war. Currently, I've got some good momentum in the war. And that is great reason to celebrate. But no one has yet suggested cure with these recent events - even yesterday before there were a few cells discovered. I have found it useful to not overstate how good or how bad things are. As my good friend John told me about his experience with his wife's cancer: don't get too high in the highs or too low in the lows. Or as St Paul put it, let your yes be yes and your no, no.

Thursday, February 14, 2008

A bizzare day

I am emerging from sedation blur after a broncosopy today. They went into the trachea with a stiff pipe, through which they can do ultrasound and take needle biopsies into the neighboring lymph nodes. They extracted samples from the two "bad guys" threatening me. The result left everyone perplexed. Let me back up a bit and explain, as I have not written in a while.

I came to Houston last week for the big week of scans. I have been pressing for surgical removal of these two lymph nodes. The surgeon has been relucatant and I've been dutifully doing six months of chemo, hoping that a window of opportunity would open up.

The good news last week was that a window has opened to do the right nodule. This would be a right-side thorocotomy (basically, lung surgery). He would also remove the suspicious lung nodule that has appeared recently in the right lung

The bad news was that he told me that it would be all but impossible to remove the left lymph node. It is too deeply located and the risk of major problems (severing the pulmonary artery) is just too high. This was really the first time I have heard that a tumor was inherently inoperable due to its location, not just size. In the past I have heard "inoperable", but when there was shrinkage, I heard "operable" again. This isn't about shrinking, but where it is. Thus, this news about the left side means that the cancer is considered non-curable, and only manageable. Pretty devestating news.

Then came the very difficult decision - whether to do the right side surgery at all. The benefit is quite small because if you go in to deal with the right problem with no plan to go in and take out the left, then you are risking trauma and complications knowing there is no data showing any increase in life expectancy.

In other words, I asked, him, "If there are two Greg's in front of you - just like me - and you do surgery on one followed by chemo and radiation, and you only do chemo and radiation on the other, and you were a betting man, which would you put your money on to live longer?"

Photo_021408_004.jpg Photo_021408_004.jpg
Greg #1 and #2

"No way", he replied, "there is no way to tell." So if it is a toss up, why take the road that includes traumatic lung surgery (it is not fun). That is the big question.

One oncologist whom I trust advised against it. Others were open to it, but could not recommend it. No one encouraged it.

We went ahead and scheduled the surgery because I wanted to take out what we could while we have the chance. My logic is somewhere on the spectrum from brave to stupid to crazy. It is scheduled for for Monday February 18. So Tuesday night, I came down to Houston again for the biopsy, among other tests, etc. There is a "99.9% chance" we know what we are dealing with here. But a surgeon typically wants 100% certainty before opening you up. Thus, the biopsy. Incidentally, if I had chosen definitely against the surgery, they would go back to chemo and not waste time or effort on the biopsy.

BUT... back to the drawing board
So as Christine prepared to come down (she has been in a lot of pain recently), I came down early for the biopsy today. She was going to come down tonight and family members and friends were preparing to come down this weekend for the surgery Monday.

But when I emerged from the biopsy incredibly groggy (the procedure requires full general anesthesia), the doctor came to me with a smile and a perplexed look on his face. "We took three needle shots in each lymph node, which is the practice. And an initial look in the microscope revealed only a bunch of dead cells. So we went back and took a total of ten shots in each lymph node, twenty in all. All we can find is dead cells. No cancer cells. Apparently, the chemo has obliterated these tumors." I figured I was dreaming because I was in this sedated, dream state. But I heard right. They sent all the samples to pathology and they'll take an official, closer, look. I will hear the results come Friday or maybe as late as Monday. But there is a 90% chance, he says, that there are indeed no cancer cells in these samples. And that these two tumors are dead [or perhaps, "mostly dead" - Princess and the Bride]

So for now, it looks like there is not much motivation to do surgery if it is just going to go in and get a bunch of dead cells. The body will clean them up in a period of several weeks. Could there still be some bad cells in there? Yes, that would remain a possibility, and it only takes a handful. But I suspect the surgeon is going to rescind the offer tomorrow to do surgery - for good reasons.

I'll let you know what the results are. And what the plan is - everything is now up in ther air.

In the meantime I'll just soak in some good news and celebrate. So after two nights in a row of fasting for tests, I walked to Goode Company Seafood down the street for some oysters on the half-shell to celebrate.


Life is a roller coaster, isn't it? And we humans are so easily whipped around. I am once again reminded of a passage in St. Paul's letter to the Ephesians. In Christianity, there is a concept that God's blessing extends beyond what can be immediately seen. Paul writes, " Now to him who is able to do immeasurably more than all we ask or imagine, according to his power that is at work within us, to him be glory in the church and in Christ Jesus throughout all generations, for ever and ever! Amen."

I have been driving everyone crazy sending emails and calling, looking for advice in making the decision for surgery. I've written former doctors and family members. Several of you have written back very thoughtful, helpful things to think about in this decision, which seemed to be one of the biggest of my life. I have thought about every possibility, every detail, every if, and, and but. I rarely lose any sleep, but a couple nights this week I stayed up thinking about all the possibilities.

But I didn't consider everything! The thought that this biopsy would just discover a bunch of dead cells never even crossed my mind. It was indeed more than all I asked or imagined.

I'll probably have difficulty sleeping tonight again tonight - thanking God and wondering in amazement at what possibly could be happening here. I haven't a clue.