To Houston on a beautiful day

Today is a gorgeous day. Sprinkled clouds float above in this crisp spring air. The Denton jazz festival is playing live on KNTU. The past three weeks I have felt as well as I have in a year. I've been getting back into the regular flow at work. I even got in a little golf last Friday. As I drive around doing errands before my trip, it is hard to believe that cancer even exists. But cancer likes to lurk in the dark and come back uninvited. Is it hiding or is it gone? It's voice gnaws on me in the back of my mind, causing me to wonder if this beautiful day is a calm before the storm. But what can I do? - I shall enjoy the day and the Lord who gave it to me. I pause, "Have mercy on me, Lord". Now let's turn up that jazz and hit the road.

We're off to Houston today for a round of tests and consultations with my doctors. Two big issues are to be addressed:

(1) The first is the possibility of cancer recurrence. My CEA test results this week in Dallas were down to 6.4 (it was at 10 three weeks ago). That report made my week. But it is still high (should be under 4) and thus they are still concerned it could be recurrence. Tomorrow morning I take a PET scan to expose any cancer that could be causing it to be high. They will also retake my CEA again.

(2) The second issue is that of these strangely dilated veins connected to my liver. My case was presented at a MDACC GI medical conference of all the experts (so my doctor tells me), and they still don't know what is causing this problem. It is not at an alarming state of dilation, but if they continue to grow, it could be life threatening. Interestingly, they now notice that back on my pre-surgery CT scan in December, these veins were slightly dilated. I'm not really sure what this means. To get a better idea of what is going on and what possible remedies they might pursue, I am having an endoscopy tomorrow after the PET scan. This is a procedure in which they put me under general anesthesia (a bit stronger than that of a colonoscopy, but not like surgery) and then stick some sort of diagnostic contraption down my throat. They say that from inside, they will be able to get a look at these veins.

Then on Wednesday morning I will meet with Dr. Vauthey, my liver surgeon, to discuss the findings of these tests and we'll discuss the approach from here. Dr. Hoff may be there for the Wednesday meeting, as well. I really have no idea what comes after Wednesday.

O Death, Where is thy sting?

Easter Day, 2004. Today the church celebrates the resurrection of Jesus. Belief in the resurrection is not an incidental belief of the church nor even one of several key beliefs. More than any other element of Christianity, it has been, from the first generation of Christians, the defining belief from which all other doctrines flow.

It might seem to be somewhat odd that someone with extensive education in the sciences would believe such an incredible event. Yet I, along with men and women across history, education levels, cultures, and ethnicities attest to its truthfulness - even unto death.

How can someone possibly believe this? Science discounts the possibility of bodily resurrection and common experience reveals that no one comes back after death. I like to preface my response by first highlighting a couple of thoughts. One is that the absurdity of this event is fully admitted by the New Testament. Ancient people were not more gullible in this area than we - everyone knows dead people don't come back to life. In fact, the very idea that no one ever comes back from the dead is the whole point of this belief - Christ's resurrection was cosmically and historically unique. Second, when we ask for scientific evidence for his resurrection, we are resting on Enlightenment presuppositions of empiricism and rationalism, both of which are unquestioned belief systems that rule out a priori any unique, unrepeatable, miraculous event. It's like demanding that a sunrise be proven with an audio tape recorder. The very rules of "proving" rule out belief of the event from the start.

Beyond these introductory remarks, I do not have the time or space here to discuss why I believe the resurrection. However, I would like to say that my security rests on it. Since the day I was first diagnosed with cancer, I have found that my world has been overturned. I race through thought after thought that seems to slip away through my fingers. I come to rest, however, when thinking about Christ and his resurrection. Finding solace is not the reason I believe, but the result of believing.

One of the leading Christian apologists in our age is N.T. Wright. ("Apologists" are scholars who defend the truthfulness of Christianity). He has gone to great lengths to make a solid case for resurrection in his book, Resurrection of the Son of God. This is a rather large dense book, but if you honestly want to wrestle with this issue, you would do yourself a favor to read him (instead of conveniently writing off your local TV preacher or some simple-minded Christian arguments you may have heard). A more brief treatment of the subject can be found in the chapter "The Challenge of Easter" in another of his books, The Challenge of Jesus.

The day after I was first diagnosed with cancer, I was pleased and surprised to hear an extended interview of Wright on our local NPR station. This was a bright light on a very dark day. I have a recording of the interview and you can listen to it thanks to the help of a friend who made it available on line.

CT scans clear

I received news Friday that both my CT scans from this week are clear of evidence of tumors. This was relatively good news. The CT scan equipment can measure things reliably down to about a quarter of an inch. Thus, we ruled out anything big and vicious. So we can guess that the elevated CEA is either an early sign of some future recurrence or that the Xeloda is causing liver toxicity. We'll find out more in a few weeks when I retake the CEA.

Trouble, mystery and irony

I just returned to Dallas tonight after a rough week in Houston. Wednesday's lab work showed a CEA a about the same level (10.0), so it is indeed elevated. To be sure, this was quite discouraging. I wrestled with whether to ask Christine to come down because I knew how hard it would be for her and figured she would come if I needed her. I decided to ask her Wednesday evening and she caught the last flight down to Houston that night to be with me in spite of her own pain. Waiting for her and meeting her late that night at Hobby Airport reminded me of our courting days, when we lived in different cities and spent what money we had on plane tickets - money that was worth it when we saw each other in the terminal. In between all the appointments and tests, we had a wonderful time together - talking, comforting each other, praying, reading Scripture, laughing. And it made the trip back to Dallas much more enjoyable (although I still had to look at Pillsbury Sam-boy). The week was rough on her physically, but I'm really glad she came.

We met with Dr. Vauthey and Dr. Hoff together Wednesday morning. They only had preliminary results from my liver/abdomen CT scan. They saw no evidence of tumors to explain the high CEA. But they gave the disclaimer that the radiologist is better at examining the scans and his report had not yet been written. While no cancer was apparent, they did notice that the veins around my spleen were quite enlarged. Both Dr. Hoff and Dr. Vauthey were very perplexed by this and said they had not seen anything like it before. (One friend told me later in response, "see what a special guy you are, Greg!") Every week there is some sort of MDACC oncologist conference in which they participate, and on April 14th the conference will have some outside "experts" attending. So Dr. Vauthey decided they will discuss my case at the conference on that day to determine how to further investigate this blood vessel mystery.

Meanwhile, my doctors called for two things as a result of these findings. One, they had me take a CT scan Wednesday night of my lungs to see if anything evil is going on there. The official results of this and Tuesday's scan should be ready Friday. Two, they told me to stop the chemo. There is some chance that the Xeloda can cause some elevation of the CEA due to liver toxicity. So after three weeks of no Xeloda, we'll retake the CEA. If the number is down - terrific. If not, and if this is a recurrence of cancer, then the Xeloda is not working anyway so it is not useful to be taking it. They wouldn't really address any what-if's because there are too many uncertainties right now. So we wait.

The short term positive of all this is that for the first time in almost a year, I will be off chemo and not recovering from some major surgery. I'll probably appear and feel as healthy as I have in a long time. Such is the irony of cancer.

Possible troubling news

I am back in Houston for tests and visits with Dr. Hoff and my liver surgeon, Dr. Vauthey. Today was supposed to be an uneventful visit with Dr. Hoff, who is monitoring my health during the chemotherapy. However, my CEA level, which is the blood marker that shows cancerous activity, was up significantly. It has been in the 3�s and 4�s since it first came down when I started chemo last summer. Today, it was 9.5. Dr. Hoff was perplexed by this, and said he would not have expected it at this time. He asked me some questions about what I had eaten before the blood was taken and said he wanted to retest, as this could be a fluke. He seemed concerned, but didn�t want to conclude anything until we retest. To say that I hope that it is a fluke would be a huge understatement.

Tomorrow, then, I will redo the blood work and will get a CT scan as originally planned. Dr. Vauthey ordered the CT Scan � it has been three months (plus some) since the surgery and he wants to examine how the liver is doing. I will try to find out what the blood work result is tomorrow afternoon, but will find out for sure on Wednesday morning with my appointment with Dr. Vauthey.

Unfortunately, Christine is not with me. Her health was particularly bad this weekend and we decided it was best if she rested this week instead of trekking to Houston. We really hoped this would be an uneventful week.

By faith, I have accepted my remarkable progress thus far as the Lord hearing the cries of his people on my behalf. Please continue to pray that I will remain free from this disease and that the tests tomorrow show me clean of cancer.

Visit from Sarah, Margus, and Mati

Last weekend we enjoed a visit from Christine's sister, Sarah, and her husband, Margus, and little 20-month old Mati. We had a good, if short, time together. We had not seen them in quite some time because of our surgery-altered Christmas plans. Mati is such fun. He really liked the pigs and ducks at Spring Creek Farm. Here we are enjoying dinner and jazz at Terilli's. Mati was home asleep with a sitter. We didn't think he'd be in the mood for the night out. You can view the album here.

Meanwhile, I'm recovering very well from the surgery. I haven't had any significant pain for a couple weeks now. I began another round of chemo this week. It is beginning to wear on me somewhat - sort of a low-grade sickness and fatigue. The best thing for this seems to be sleep.

A bicycle ride

It has been a while since I have written. I have been fighting a cold of some sort, and now Christine has caught it. The chemotherapy is tolerable although the "yuck" symptoms are beginning to occur. I am able to do some normal things, albeit with limited strength and as long as I take lots of naps. I can definitely do this for a few more months. It is good to think that this may be all I have to endure of this treatment.

I must tell you about my first bicycle ride after nearly a year. A couple of weeks ago, I got a strong urge to ride my bicycle. This was odd, for it was about 40 degrees and drizzling outside. Nevertheless, I had an unexpected burst of adrenaline that demanded to get back on that bike.

I pumped the tires back up - they had gone completely flat. I wondered if all the requisite parts of my body would coordinate properly to ride. As I left the garage and got as far as the next door neighbor's driveway, I came to my senses and marveled at my own stupidity. Had I forgotten that I was on chemotherapy? Had it slipped my mind that my abdominal wall was sliced several directions and filled with scar tissue? The rain was so cold as it hit my face. I turned around, wondering what ill-conceived idea had gotten into my head. But as suddenly as I turned around, the urge to press on returned and I turned around once more. I'm going to ride this bike no matter what, I resolved. This brand new liver needed a test-drive.

My leg began burning - the kind of feeling that I would not have experienced in the past until after miles of cycling. I pressed against the wind and rain for about a half-block when an unexpected joy came over me. I could not stop thinking about how two months earlier I was lying in ICU in great pain wondering how I could muster the strength to exist through each creeping minute ahead of me. How far I had come! I rejoiced as I pedaled. How far I had come! My life had hung on edge just months ago and here I was riding my bicycle in ridiculous conditions. I laughed to myself. I thanked my Creator. "Let all who take refuge in you be glad; let them ever sing for joy." I continued to press on. Am I free from disease, or am I in a break during a losing battle? At this moment, who cares? I'm riding my bike in the rain! How odd it was that this could be an enjoyable experience. In all, the trip lasted a block. But it was indeed my most enjoyable bike ride. The rain on my face was exhilarating. Am I mad? I came back wet and freezing, but in a great mood.

Joy, it seems, sometimes depends upon which side of suffering we live.