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.

Wednesday, February 11, 2009

Going to being heavy chemo

Dr. Eng and Dr. Hofstetter strongly recommended I go back on the strong chemotherapy that I took much of 2007. It's called FOLFIRI with Avastin. We need to shock this tumor activity back into submission.

I start Monday. It makes you feel very, very crummy. It is a fourteen day cycle I will repeat until May's reassessment. There are varying degrees of crumminess during the cycle.

I haven't really thought through how I'm going to tolerate this. My folks drove me back from our aborted Houston mission yesterday. I may need to call upon them to continue to care for me next week depending upon how sick this stuff will make me. Christine's parents have really helped out as they are currently caring for her. When you're our age, aren't we the ones that are supposed to be taking care of our parents? We're fortunate to have them.

Monday, February 9, 2009


I'm still groggy, so can write more later.

I remember getting the epidural, getting positioned on the tracheotomy table, getting the Versed high, and then I remember no more. It was very strange to wake from general anesthesia in the recovery room and not have been cut.

The cancer has invaded the wall of the trachea at the spot where it branches from two pipes to four on the left side. It is slightly into the upper and lower lobe pipes. Thus, the whole lung would have had to go. Dr. Hofstetter discovered it when he decided to do a quick bronchoscopy before cutting into me - just to see what he might be dealing with. He decided based on what he saw that the other plans are better.

It's a bummer. Surgery is the only sure way to completely kill a tumor. But this turn of events makes it clear that with all the back-and-forth of deciding on the best treatment plan, that this surgery was not the right plan.

I'm going to meet with Dr. Eng tomorrow to get the interpretation and new plan. I have two other weapons - FOLFIRI chemo, which last time we used it worked really well at knocking the tumors into nearly-dead state, and radiation, which two weeks ago was plan A.

I haven't really figured out what all this means in the loopy state of my mind. It hurts to talk - all scratchy and irritated. I'm going back to sleep.

Surgery not an option today

Dr. Hofstetter just came out to talk with Jim & Judy. Once he got in, he realized the tumor's position was more complicated than they had previously thought, and the risks of loss of an entire lung were much higher. The doctor decided he could not do the surgery because he was not convinced he could get all of the tumor out without serious consequences.

It's worth noting that the tumor is not any bigger than previously thought, but its position is just more complicated, so the original surgery plan is not feasible. Greg's doctors will get together and advise on next steps.

Greg will be coming out of anesthesia shortly, so I'll wait for him to provide more details. Thank you all for continuing to pray.

Sunday, February 8, 2009

Let's do it

The seventh night before surgery. Always an odd, quiet sort of night. My body so satisfied and at peace, not knowing what it is in for. My brain knows but cannot sound a warning because it speaks another language.

The only sound is the A/C and an occasional ambulance navigating the construction on Holcombe. Some poor guy must be in pain.

The seventh dinner before surgery. A little Greek at Niko Niko's on Montrose. Lung surgery is the best - they let you eat the night before.

For the seventh time, brother-in-law Mark will be updating this blog until I can get online. Stay tuned.

Not much left to do but get a good night's rest. The elders prayed for me today. Rally caps are on. Hope Hofstetter's resting well. Mom and Dad drove me to Houston. I'm at the Rotary House a few hundred yards from the operating room. My ride comes at 5.

This is my game plan. Time to move forward. Lord, have mercy.

Wednesday, February 4, 2009

Rally Caps

If you're on facebook, check out the group "Rally Caps for Greg." Several friends are pulling for the late-inning big hit.

You can post a rally cap image, like charter member David's below


If you're not on facebook, never mind.

Monday, February 2, 2009

Where's the problem?

PET Scans.jpg

Click image to enlarge.

The surgery will be on the left hilar lymph node and the little lung nodule on the left. (the two scans on the right of this overall image)

By the way, I hacked these images from the clinic computer, gmailing them to myself, from the screen in the little waiting room while I awaited the nurse to return. Don't tell anyone.

Thoracic Surgery Scheduled Feb 9

I will have thoracic surgery on Monday morning Feb 9 at MD Anderson Cancer Center in Houston, TX.

The story for how I arrived at the decision to move forward with surgery is a long one, spanning appointments with Dr. Eng (clinical onc), Dr. Hofstetter, (surg onc), Dr. Welsh (rad onc), and back to Dr. Eng over the course of the last three weeks. I've been up and down I-45 a bunch in the last four weeks.

I have right and left hilar lymph nodes that are increasing in cancerous activity and growing slowly. The hilar lymph nodes are above the heart, in Grand Central Station at the center of the chest, adjacent to the pulmonary arteries. I also have a small cancerous nodule in my left upper lung.

The options they wrestled with are:

1. Do nothing
2. Continue the "moderated" chemo plan I've been on for a year (XELODA+AVASTIN)
3. Take more severe chemo (5FU, Leucovorin, Irinotecan, Avastin)
4. Radiate both lymph nodes
5. Do surgery on one of the hilar lymph nodes and radiate the other.
They decided to offer me #5 as a reasonable approach. The background is as follows:
The default treatment for a guy like me would be to simply continue chemo. Hippcrates avers, "Do no harm." Surgery and/or radiation does a lot of harm, with uncertain benefit. If the cancer is going to kill you, why butcher the body on the way down? Good question.

* Due to my youth and personal approach, they are on board with my continued highly aggressive game plan, which has served me well so far. Three of my seven surgeries were unconventional for someone with stage four colon cancer. And yet, as we chip away at the leading tumors, it seems to me that I have been buying more years.
* There is some data to suggest that if a stage IV patient can get to NED (no evidence of disease on the scans), even though they figure there is plenty of microscopic activity, statistics show there can be extended life. So we would like a plan to get rid of both of those hilar lymph nodes.
* For a while, the leading candidate was #4. It would probably not kill the tumors completely, but would render them nearly dead for 2-3 years. And would not do as much damage to lung capactiy as the surgery. The problem is that all that radiating (beyond being painful for the esophagus) would make it impossible to ever do surgery in that area in the future. We don't like closing option doors.
* In plan #5, the surgery proposed on the left, more active, hilar lymph node is extremely challenging. Dr. Hofstetter said it is like working through a hole less than an inch across, and picking out a piece of sticky bubble gum that is wrapped three-quarters of the way around a wax-paper thin artery without tearing the wax paper. He believes it is very unlikely he can do it without having to remove half of the left lung. This will leave me with an overall estimated 49% lung capacity (it is around 80% now). He would wedge out the little lung nodule on the left while he's in there.
* Due to low remaining lung capacity, he figures it will not be wise to then remove the right one via the same kind of surgery. But, after consulting with the radiation oncologist, they think they can then radiate the right side. Dr. Eng told me she did not think they had ever taken the surgery-on-one-side-radiate-the-other approach before. We're on the edge of cancer research here! More than one oncologist I've talked to thinks this plan is a bit crazy, while others see it as a viable plan.
* If this surgery and radiation plan works, I will get to NED in a couple months.
* Then we'd follow up with more chemo just for fun.
The home run would be if Dr. Hofstetter, a surgeon I greatly respect, could cut out that hilar lymph node without removing half the lung. Then, we'd have the option for additional surgery on the right side instead of radiation. Pray for this guy's hands! I've had a couple of 9th inning home runs by other surgeons in the past.
I have been aggressive all along. Taking calculated risks, using my bargaining chips of youth, not-so-necessary organs, parts of organs, and pain toleration. That's the way I play ball. I am doing this because it is just too difficult for me to change my way of playing now. As my friend Tyler put it, "if you go down, go down swinging!" I am going to remain consistent to who I am and have been. So, Tyler, I'm going to swing for it.
As a Christian, my security lays in the resurrection of Jesus, which is a taste and guarantee of what will come for those who are in him. I do not want to recklessly test the precious freedom that comes with such security, but rather enjoy it while sharing in the fellowship of his sufferings. That probably sounds weird to some of you, but it really is at the core of my thinking about all this.