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.

Monday, February 2, 2009

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.

21 comments:

Shannon Geiger said...

Here's hoping and praying that you get to NED. He must be a coveted friend of many a cancer patient. Thanks for the update and the detail. Thanks most of all for your courage and courageous fight. It does inspire me and convict me to be more thankful. Love, Shannon

matt boulter said...

Greg,
Encouraging update. You remain in our prayers. Be strong and courageous!
Matt

Fran said...

I will pray that your "swinging for it" is the right path. Take care and God bless.

David Lieb said...

Greg,
As a ballplayer, I like our baseball analogy. In about half of MLB games, the winning team scores more runs in one inning than the other team does the entire game. One way to apply this to your situation is to look for that "big inning", or homerun, to win the game. The other way is to practice the "chip-away theory". When you get down big early in the game, scoring 1 run here and another 1 there often keeps you in the game long enough to come out on top. Cancer had a big inning early in the game, but you've been chipping away pretty well.
You'll be in our thoughts on Monday. (I was going to say that we'll have our rally caps on, but that was taking the analogy a bit far...) :)
-dave

Dan And Syd said...

Oh -My dearest Greg--you truly are a strong and courageous youg man.
Dan and I pray for you constantly and feel the pain and suffering your Mom and Dad must feel watching their son go though this :with pride at your courage and sadness at your suffering.
We pray and know Jesus is holding you and giving you the strength to continue.
Sweetie--you already have a halo :-)

Dave Belichick said...

Keep your eye on the ball, baby, when you swing. That's all it takes to connect.

Araz said...

I will surely pray for you Greg.
I am totally encouraged by your faith and hope. Keep on swinging and let us get another home run.

John Slaughter said...

Greg, keep swinging. As usual you are proving the "experts" wrong.

Jim Williams said...

In the 17th Chapter of First Samuel, we read of a shepherd boy who dared to do battle against a giant named Goliath. He went forth �in the name of the Lord of Hosts.� He killed the giant with one well placed stone from his slingshot, his great faith, and the power of the Almighty God. You have been battling your Goliath, Cancer, for a very long time. Through it all, you have remained faithful, steadfast, and unmovable. Like Paul, you have joined in the fellowship of our Lord�s suffering. You have expressed faith that the Lord will not only see you through the current situation but that He will give you the ultimate victory. Therefore, I am compelled to quote our Lord and Savior, Jesus the Christ, and proclaim, �I say to you, I have not found such great faith, not even in Israel!� My prayers are with you but more importantly, the Lord is with you!

Kristi said...

Hi Greg -- thanks for explaining all of this -- so helpful to know really specifically what we are praying about. And it makes a lot of sense to me for you to keep fighting the cancer aggressively -- praise God for giving you the courage and pain threshold to do it! blessings.

Verdell Lessman said...

Greetings, Greg:
Thank you for the update of the "journey you did not choose". Marilyn and I pray for you as you faithfully, spiritually and physically travel this road called "cancer survival". When we read this update we were reminded of the quote from the book entitled: HOPE IN THE FACE OF CANCER...a survival guide for the journey you did not choose...written by Amy Givler, M.D..."Smooth seas do not make skillful sailors," the African proverb goes.."and I do not want to become a skillful sailor..but given a choice I'd still choose smooth seas. I don't like to suffer, but I have to keep reminding myself that it's the only way to become a skillful sailor. God will be with me in the roughest seas and through the fiercest gales." I am finding that out as I travel that journey called "cancer" as well. I also think this is what James meant when he worte in the Bible, "Dear brothers and sisters, whenever trouble comes your way, let it be an opportunity for joy. For when your faith is tested, your endurance has a chance to grow. So let it grow, for when your endurance is fully developed, you will be strong in character and ready for anything."
Marilyn and I will continue to pray for you and especially asking for God's grace and mercy for you on February 9th as you "move forward in faith!
Marilyn and Verdell

Verdell Lessman said...

Greetings, Greg:
Thank you for the update of the "journey you did not choose". Marilyn and I pray for you as you faithfully, spiritually and physically travel this road called "cancer survival". When we read this update we were reminded of the quote from the book entitled: HOPE IN THE FACE OF CANCER...a survival guide for the journey you did not choose...written by Amy Givler, M.D..."Smooth seas do not make skillful sailors," the African proverb goes.."and I do not want to become a skillful sailor..but given a choice I'd still choose smooth seas. I don't like to suffer, but I have to keep reminding myself that it's the only way to become a skillful sailor. God will be with me in the roughest seas and through the fiercest gales." I am finding that out as I travel that journey called "cancer" as well. I also think this is what James meant when he worte in the Bible, "Dear brothers and sisters, whenever trouble comes your way, let it be an opportunity for joy. For when your faith is tested, your endurance has a chance to grow. So let it grow, for when your endurance is fully developed, you will be strong in character and ready for anything."
Marilyn and I will continue to pray for you and especially asking for God's grace and mercy for you on February 9th as you "move forward in faith!
Marilyn and Verdell

Annette Yudizky, RN said...

My prayers are with you Greg.

Miriam Patterson said...

Greg,
We will all be praying for you for Feb 9--may the Lord be guiding the surgeon's hands! May the Lord help you as you try to live in the tension of not recklessly testing your freedom in Christ while enjoying your security in Him (love that image)!
Love in Christ,
Miriam & Andrew

GL said...

Greg, praying for you.

John Ciavola said...

Greg,
You are my HERO!! That's the way to play ball!!
My man, pots and pans, knock it out of the park!
John

kim said...

i agree with all of it except for the more chemo just for fun! After my last surgery, I said "no thank you"!

Madeleine said...

The battle rages on! Continuing your aggressive approach does make sense; I'm glad the Lord is giving you strength to persevere. I'm struck with how close the Lord lets our enemies get to us at times. The Egyptians pursuit of the Israelites in the Red Sea; the devil and Christ in the desert; Saul and David on many occasions. Yet the victory is won. Your hope in the resurrection and your obedience to follow the Lord's leading through these battles are so honoring to Him and inspiring to us. Thanks for letting us have a part through our prayers and other forms of assistance. Love and prayers for you and Christine, Madeleine

winnie krienke said...

Hi Greg: Thank you for update. I will be praying for you on Feb 9 surgery, yes, I have greatly respect for Dr. Hofstetter too, you are a courageous young man, I pray that God keep give you strengh and courage to go through the journey and you will come out with Ned.God bless you.

Martin Ban said...

Greg,
Grace is big in you. Jesus redeemed you body and soul and I'll remind Him of that often between now and Feb 9. God bless you dear one.
Godspeed,
Martin Ban
Santa Fe

BoB & Sandra said...

Greetings My Man Greg,
It has been my good fortune to have sailed the seven seas, experiencing rewarding adventures, returning safely to port. Navigating the world involved depending on light houses to provide safe passage toward havens of safety. In preparing for my lesson today I came across this commentary, "The central feature of God's redemptive work is The Covenant. By the covenant with God, Israel was created as God's holy People, and by the New Covenant in Jesus, the New Israel - the Church - is called into being."
We see in you that light which gives consistent guidance toward a better appreciation of God's covenant and feeling of secureness in His presence. Know that our prayers will ask that your light be brightened and give thanks for your special message to us. If you have a need, call and we will come.
God Bless,
BoB E. & Sandra