One year mark

So what was this recent rise and fall of my CEA? Apparently, CEA can do that due to a lot of reasons and no one seems to understand or trust it that much when it bounces around at these levels. The important thing for now is that it went back down and is certainly not on a continued rise, which is when it does mean something. I am so deeply relieved that it went down. When the lab technician called me I made her spell it out about three times - "Four, as in four calling birds? Yes, four... F-O-U-R" I cannot describe the feeling of relief those letters gave me.

This week, I paid a visit to my Dallas oncologist, Dr. Perkins, who I hadn't seen in about a year. Dr. Perkins said if he were me, he would take Xeloda for at least for the rest of the year to do everything possible to kill off any microscopic cancer left in my body. (And he also indicated he wouldn't be off it right now). This makes me think Dr. Hoff will recommend I be put back on it when I visit him in Houston in a few weeks.

Dr. Hoff did not say much to me about the CEA or my treatment plan (he had his P.A. call me this week). The message there is just to enjoy the next few weeks and then go down to Houston to discuss where to go from here. The week of June 21 I'll be taking the CT scans, x-rays, a bone scan, and another CEA reading. Then I'll meet with my surgeon, Dr. Vauthey, and finally with Dr. Hoff.

All of this talk about CEA this week reminds me of the meanness of this disease. Less than 50% of people at my stage of treatment ultimately survive the disease. That is why the doctors want their patients to take chemo even when they don't feel anything wrong and when tumors can no longer be seen on the scans. On the other hand, this reminds me of how far I've come. A year ago yesterday I was diagnosed and it looked quite bleak. Step by step I made it through this year with you all at my side and with my God giving me strength. I am so deeply thankful even to be writing this today. My prayer is that he who sustained me will spare me from this disease.

I spoke with a friend this morning who was asking when I'll know that the cancer is not coming back. Depending upon who you ask, I hear that I can be pretty confident I am cured after 5 or 10 years. This cloud will be following me for a long time - I hope!

4.1

Just called the lab technician to get my CEA results from yesterday - 4.1! That's down again from three weeks ago and now is nearly normal (under 4.0 is considered normal). For those who don't know, when the CEA goes above normal it is a sign of impending recurrence of the cancer.

It is a baffling thing for my CEA to go down when I'm not on chemo. I'll speak with the doctor or his P.A. soon to find out what this could possibly mean, but I can guess that this has to be a good sign. Perhaps I'll be able to get back on the preventative chemo plan again after aborting it 6 weeks ago? I'll write more when I find out how to interpret all this and how this affects the treatment plan, but wanted to share some joy with everyone who has been so kind as to share my burdens.

Today is a sunny day for my soul.

A "regressive" state

This week went quite well at MDACC. On the cancer recurrence issue, my CEA was down to 7.5 from the 9.5&10.0 it was three weeks earlier. (The 6.4 level in Dallas in between was measured on a different kind of machine, so they don't take it as a precise comparison) In addition, there is a liver enzyme level that also tends to be high with metastatic cancer in the liver and it was down this week for the first time since the surgery. CEA levels above 10.0 "almost always" indicate that a recurrence will show itself in something like 6-8 months. Levels between 5 and 10 can be due to other things besides cancer. In summary, Dr. Vauthey said that we indeed might not be seeing recurrence here. He is considering the disease right now as being in a regressive, rather than progressive, state. I'm liking the sound of that word - regressive. The PET scan matched the CT scan three weeks ago in revealing there are no measurable tumors in my body right now. After consulting with Dr. Hoff, they decided we would wait another three weeks before retesting the CEA and making treatment decisions. So no more chemo for now.

On the dilated veins, it was described to me in laymen's terms. There is an interstate vein going through the liver. It has a traffic jam on it, the cause of which they think is a clot from the surgery or healing process, and the blood is taking back roads to get to the heart. These back road veins are thus overcrowded and have expanded. This can be dangerous, but not at the level they are seeing in me. This was all confirmed by the endoscopy on Monday. By the way, that procedure caught me and Christine by surprise because there was significantly more risk than the other time I had this done. In the procedure, the doctor could accidentally pop one of these veins, causing all sorts of serious problems. We had to sign some extra release forms due to possibility of emergency surgery, receiving blood transfusion, etc. One form had a list of the possible side effects of the endoscopy. He was crossing out the lines with side effects that could not happen with this procedure. I asked him if he would cross out the line that said "death." We smiled at each other, but he did not cross it off. In the end, the procedure went very smoothly. Dr. Vauthey believes that we can address this vein problem with drugs and that the body figures out a way to heal itself by repairing and increasing the number of back road veins. He also said there was nearly no risk of that clot moving to the heart or brain. He told me that of all my problems right now, the vein thing in his mind was pretty far down the list now.

We enjoyed our drive back, and with the extra time took the long way home to enjoy the blue bonnets that are in full bloom here in Texas right now. Only now as I write am I realizing the irony of taking the back roads back home.

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.