Diehl Martin
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The
Cancer Blog - From Dec 1, 2006 to June 30, 2007 For the current page, please see: http://diehlmartin.com/cancer.html Update Diehl Martin passed away in October 2007. If you need to contact someone, please contact Monica Martin. Jun 30, 2007 It has now been nearly three weeks since the last chemotherapy infusion, and I feel pretty good. One thing which is obvious is that for me the symptoms of the pancreatic cancer have been less pronounced than the side-effects of the chemotherapy. Of course as time progresses this will change, and I am apparently not far from that time, assuming that I understand what Dr. Posey is telling me. I go back for my next infusion on Monday July 2, 2007, and that will end the respite. There are five more infusions scheduled, and then I do not know what exactly will happen. The chemo side effects now include the nearly total loss of taste and smell. Foods have textures, and that is all. Add that to the intense cold sensitivity and the attendant peripheral neuropathy caused by the Oxaliplatin. Then add to that the wild skin rash from the Tarceva. Then there is the total exhaustion from this level of poison in my system. With the rapidly increasing tumor marker indicating that the chemo is failing at controlling the rapidly growing and spreading tumors, I am beginning to forsee a time when the chemotherapy will be discontinued and hospice will be called. How long will that be? I do not yet know, but I would be surprised to last another year. The last couple of days have been productive. I fixed all of the computer problems from earlier in the week. I am working on a couple of minor projects on the house to make things better for Monica and the photo business. It is so very hot this week that I really have to stay inside, so I am working inside. Last night we had a violent storm here, and lots of rain. I have spoken before of our local downtown eatery, Wanda's Restaurant – well the storm took their roof off, and filled their building with water, so they will at least be out of business for a while. I went in today and the folks from the fire and water recovery business were packing up everything for drying. Wanda's husband Jim looked seriously pale. I would ask all of the prayer warriors to lift up Wanda and Jim Poole. They need divine help now to get through this. Jun 28, 2007 Yes, I am still alive. Circumstances have overtaken me, and I have not been able to blog this week. Saturday evening through Wednesday evening I was with Monica at the annual convention/seminars/ trade-show of the Professional Photographers of Mississippi and Alabama. There was internet access only if I were willing to pay dearly for it, and I could not afford to do that. So there were no updates during that time. No, this was not a vacation – it was exhausting. We learned a lot, though. When I got back I had to deal with a dead air conditioning unit (here in hot and humid Alabama that can be a real problem) and two inoperative computers. Both computers had been running Microsoft Windows, and both had Windows failures. I despise Microsoft and I despise Windows, because Windows has proven to be so very fragile that the slightest problem requires the entire operating system and all of the applications to be reloaded, and then Microsoft has the audacity to make it nearly impossible to reauthenticate Windows XP when it dies and has to be reloaded. They must really despise, loathe, disrespect, and hate their customers to treat us that way. But as long as they make billions and billions of dollars, they can do no wrong according to our government and the sycophant computer trade press. (By the way, I am writing this on an IBM ThinkPad laptop running Linux. It is affordable and has given me no trouble whatsoever.) I am enjoying an extra week without chemotherapy. The scheduling got reset because of the appointment with Dr. Posey, and so I ended up skipping a week. I have relatively few symptoms (yet) from the cancer, but the chemo side effects are pronounced. But by now, the chemo side effects are wearing off, and I am beginning to feel human again. Of course, the time off may accelerate the progress of the tumors, but I am still enjoying the change. Next Monday, I go back to Kirklin Clinic for the beginning of the next ten week series of treatments, and that is soon enough. Jun 21, 2007 The next phase of this cancer event seems to have started. Today I returned to Kirklin Clinic to have some more blood tests, and to see Dr. Posey. Most of the blood work showed expected things, caused by the chemotherapy (lowered hemoglobin level, fewer platelets, and such). However, the CA19-9 tumor marker had more than doubled since the May 7, 2007 tests. The CA19-9 was 160 last time, and this time is 349. This is a sign that in spite of the aggressive chemotherapy, the tumors have been growing rapidly. The road through the valley has started, and the end is in sight. One new side effect of the chemotherapy is that I can taste just about nothing now. Food has textures, and a tiny bit of smell associated with it, but even that is fading. When my dear sweet Monica asks what I want to eat, I do not know what to say, because the food I remember is not what I will experience. Last night was typical: we had to eat in a hurry, and stopped at Burger King. I had a Whopper with cheese, and the only thing with any taste whatsoever was the pickle, and even that was barely there. Eating an onion could just as well be eating an apple, and I would not know it, other than the different texture. What shall I do? I will trust my Lord and Savior, and not worry about a thing. When He calls me Home I am ready to go. Until then I will work as long as I am able. I have served Him all these years, and I am certainly not going to stop now. Jun 20, 2007 Today we received good news – Blue Cross Blue Shield of Alabama is paying for the full chemotherapy cost, including the horribly expensive Oxaliplatin. This had us concerned, as the folks at Kirklin Clinic made me sign a statement each time I went for chemo stating that I knew that if BCBS did not pay, that I was liable for the entire amount. At over $4,500 per treatment for the Oxaliplatin, this was not something I could figure out how to pay by myself. So once again the Lord has provided a way out, and I am very thankful. I am still very tired today, and a bit distracted as well. The neighbors are having the 100 foot high oak tree on our property line removed today, and it is so large that we wondered how they would be able to get it out without damaging things. So far, it has gone perfectly. Hooray for people who know what they are doing. Jun 18, 2007 Today I am telecommuting once again. There is enough energy to sit in the office chair and do CAD work on the computer. Life is good. Thank you, Lord Jesus! Jun 17, 2007 Ah, it is Sunday at last! I taught our adult Sunday school class, and thoroughly meddled. It was fun. Then we went off to sing in the choir at the late service. That was the end of the day as far as energy was concerned, but I had accomplished what I set out to do. I do not mind at all blowing the whole day's energy at church. My primary text for today's lesson is this:  Jun 16, 2007 Today Monica taught a portraiture class, and I used all my energy preparing for it, and then helping out for the morning session. After lunch, I went down for a long nap, and when I got up the afternoon session was just about over. I do what I can, but I still have to contend with the fact that the energy level is really low. Jun 12, 2007 I'm very flat today. Yes, the day after chemotherapy infusion tends to be the lowest day. Nevertheless, Monica says that I am doing better than after the last couple of infusions, so I am glad. Well, perhaps she was influenced by my behavior at lunch. Monica told me that the strawberries were at the point of eating them today, or tossing them tomorrow, at which point I launched into a bombastic verse of “It's now or never...” warped to speak of strawberries instead of love. She must be right. If I am able to sing Elvis songs, then I must be doing better than two weeks ago. Jun 11, 2007 Today was infusion day. I have had the Gemzar and Oxaliplatin pumped into me, and all of the energy pumped out. (I am also taking Tarceva orally.) The next few days may be very flat indeed. My good friend Richard Moebes drove me down to Kirklin Clinic today (bless him!!) and so there was good company and conversation all the way to Birmingham and back. It is great to have as generous a friend as Richard, who is willing to repeatedly take whole days out of his schedule to get me to my infusions. Today I took the laptop computer loaded with work for me to do. My day job is great, in that it is very distracting, and keeps me from thinking too much about the cancer or the treatment. So I used the laptop as a CAD system, and built parts for the parts library, put them on the new schematic, and wired things up. So in spite of it being infusion day, I still got a fair amount of work done. Jun 10, 2007 Today has been a good day, but then again Sundays usually are good days. We made it to Sunday school and then sang in the choir at the second service. For lunch we had our Sunday treat, tuna sandwiches. OK, that is our cheap lunch for Sunday, but some time ago our daughter Marie told us that for years she thought it must be something special because it was what we had after church on Sunday. Then it was nap time for me, and after that we went up the hill to O'Charley's for supper. The food was good, but I couldn't eat much of it. There was a salad which I ate most of, then a little steak and some broccoli, which was very good but which I could not finish. I ended up taking half of that home in a carry-out box. One of the side effects of the chemo is that my stomach area is always upset, and nothing feels good to eat. This is a lousy diet plan, albeit rather effective. Food? Well, I just really don't much care if I eat or not. I still weigh just a bit less than 180 lbs, so losing weight is not going to make me waste away any time soon. Still, food is as much a social event as anything else. I could just listen, talk, and not eat what is on my plate. I feel worse when I don't eat, so there is a limit here. Jun 9, 2007 Today I received email from the wife of a fellow pancreatic cancer patient, saying that he had gone Home to be with the Lord. I get rather a lot of emails from people with pancreatic cancer, and their caregivers, and there are some real heart-wrenching stories involved. It seems that most people are not diagnosed until their cancer is much farther along than mine, and so they only find out what they are facing very near the end. Yes, I apparently am going downhill too, but my hill is not as steep as theirs yet. My heart goes out to them all, but there is not much I can do. Pancreatic adenocarcinoma is a very harsh diagnosis, and one which offers very little hope of recovery. The most the medical folks can do is try to slow the progression and give the patient a bit more time. No one talks in terms of a cure. There isn't one yet. It spreads like wildfire, and destroys the internal organs one by one until the body cannot continue any longer. Without my Lord I do not know what I would do. He has carried me through this desolate land, and is still carrying me now. In the end, I get to go Home with Him forever. In the meantime, I may feel lousy, but I know that this too shall pass. The end of the story is written. I just do not know exactly what will happen between now and then, so I continue day by day clinging to my Lord and Savior. He knows what I am going through, and I trust Him completely. Jun 7, 2007 Yesterday was a very full day indeed. Derek, my supervisor, came out to the Guntersville office, and we spent a very intense morning going over the details of new designs which I am to begin shortly. Our talk extended through lunch (at Wanda's restaurant, in Beautiful Downtown Guntersville) and then I got back to work for the afternoon. I had a tiny supper – I could not bear the thought of much food by then – and had a brief nap before heading off to church for choir rehearsal. By the time we got home it was way past time to push me through the shower and off to bed. On the one hand, I do usually find the energy for the things which really must be done. On the other hand, I run so tired sometimes that I run the risk of quite literally falling over. But who am I to complain? I am coming up on three years since being diagnosed with pancreatic adenocarcinoma, which is usually fatal right away, and am still here and still joyful. Thank you, Jesus! Jun 5, 2007 This is the first day I have felt reasonable in about a week an a half. There is still not a lot of energy, but I can work here at my computer, and as long as I do not exert myself much physically, I feel almost normal. The Elidel seems to have knocked the rash down dramatically – the giant forest of pimples all over my face are almost gone, and with them the itch is mostly gone too. I am thankful for small things at this point. Jun 4, 2007 The Lord is very good to me. I am well enough to work today. The Elidel has reduced the rash on my face sufficiently that I can shave again, which makes me look much more normal. My beloved Monica is wonderful, and we are still very happy after knowing each other for more than 40 years. So life is pretty good today. Yes, there is not much energy, but I can still smile, and I do. Thank you, Lord Jesus! Jun 2, 2007 Dr. Posey prescribed Elidel cream to apply to the nasty rash, and after a few days, it seems to be helping. It is a topically applied immunosuppressant, and has quite an interesting bunch of warnings. For a Stage IV Pancreatic Adenocarsinoma patient undergoing truly nasty chemotherapy, I am currently just pleased to get some relief from the ugly, itchy side-effects of the chemo. Jun 1, 2007 I don't feel well enough today to say much. So instead I am putting here a hymn which everybody knows – but they really probably don't know the whole hymn, or its story. When you get to the end, perhaps you will understand why it means a lot to me. Jesus loves me! This I know, For the Bible tells me so. Little ones to Him belong; They are weak, but He is strong. (Refrain) Yes, Jesus loves me! Yes, Jesus loves me! Yes, Jesus loves me! The Bible tells me so. Jesus loves me! This I know, As He loved so long ago, Taking children on His knee, Saying, “Let them come to Me.” Jesus loves me still today, Walking with me on my way, Wanting as a friend to give Light and love to all who live. Jesus loves me! He who died Heaven’s gate to open wide; He will wash away my sin, Let His little child come in. Jesus loves me! He will stay Close beside me all the way; Thou hast bled and died for me, I will henceforth live for Thee. Here is the original last verse they don't print in the hymnals: Jesus loves me! Loves me still, Though I’m very weak and ill, That I might from sin be free Bled and died upon the tree. The story of how the song came to be written may be found here: http://www.cyberhymnal.org/htm/j/e/jesuslme.htm May 31, 2007 Yesterday was “the day after chemo” and it was the worst one so far. This round of chemo has hit me very hard. I succeeded in working (telecommuting) and got a bunch done, but by about 3:30 p.m. I could barely move. I felt extremely cold, and so Monica bundled me up in three thick layers in the big chair upstairs, and after about a half hour I stopped shivering. The day was essentially over at 3:30. A few hours later I got up, washed up, and went to bed for the night. As you might guess, I didn't make it to Wednesday evening church and choir practice. Chemotherapy is carefully dosed poison, which is given in sufficient doses to kill cancer cells, and hopefully not kill the patient. With three separate chemo agents in use now, I am in a world of hurt. The crazy part of this is that there is still no hope of a cure with this treatment. It is just a delaying action to delay the pancreatic adenocarcinoma from finishing me off. I have the advantage of knowing that the future is taken care of. My Savior took care of that long ago. Soon there are decisions which will need to be made concerning whether to continue this treatment, as the treatment is both awful and furiously expensive, with no promise of recovery. I do not worry about tomorrow, though. Jesus knows about it all, and so I do not need to worry. Where He leads me, I will follow. May 30, 2007 I am very low today. Yesterday's chemotherapy infusion drained all of my energy. May 29, 2007 Today I am at Kirklin clinic, and today is infusion day for me. Oh, trill of thrills! First comes the Gemzar, then a calcium/mangenese supplement, then the Oxaliplatin, and then more calcium/mangenese supplement. It should take about five hours. The blood test results were not too far off normal, but they indicated that I was a bit dehydrated. This is not from a lack of drinking enough liquid, as I probably drink two liters or more of liquid besides what I get at meals. I have scanned the blood test results, and the pdf file is here. If you look at the report, you will see that in spite of eating carefully, the blood sugar reading is still high at 108. I understand the significance of that number is that what is left of my pancreas cannot produce sufficient insulin to properly use the sugar, and as my pancreas gets further eaten up, this will probably get worse. According to the nurse, I have lost about 3-1/2 pounds in two weeks, which says that the high blood sugar is not the result of my eating too much of the wrong things. So I will have to watch this very carefully indeed. Today John Morris drove me to the clinic. Thanks, John! Monica would have driven me here today except that she has a big photography job this morning, and since there are 18 models hired for the event, it was not going to be rescheduled. This is the big summer clothing advertisement shoot for a local clothing chain, and Monica needs for this job to go well so that there can be future business there. I asked about the terrible rash, and Dr. Posey prescribed an ointment to apply to the affected area. I hope it works. Of course, what constitutes “working” is open to question as well. By now, the part of the rash that is on the back of my head makes my scalp sore to the touch. I described it to Monica as a case of my hair hurting. Hair, of course, cannot hurt, but the description is apt, nevertheless. One thing that the rash means is that I did not get a placebo. One of the oncology nurses said that the fact of the rash is telling me that the Tarceva is working on the inside as well as on the outside. Hmmmm..... what does this mean? Does this mean that I have a big rash on the inside, too? We shall see. The next doctor visit where the progress (or lack thereof) will be evaluated in on June 21, 2007, and Dr. Posey will get to determine how well things are working from the blood tests alone, since no other tests are allowed by the insurance company this soon since the last tests. This really is walking by faith and not by sight – or perhaps stumbling around in the dark. Prayer warriors: please pray that the insurance company will pick up the cost of the Oxaliplatin treatments. I cannot afford them by myself, that is for sure. The label on the infusion bag of Oxaliplatin says that I got 179 milligrams of this fine chemotherapy agent, and that is costs $4,475. It is so expensive that Kirklin Clinic made me sign a waiver before they would infuse it, saying that just in case Blue Cross Blue Shield of Alabama didn't pay for it, that I know that I have to pay for it out of my own pocket. One treatment at that cost is bad enough, but every two weeks? Oh my... May 28, 2007 In spite of it being Memorial Day, we have customers coming. We photographed a wedding two weeks ago, and today we have the couple coming to see their wedding pictures. These are fun events. The rash from the Tarceva (one of my chemotherapy drugs) is exceptionally nasty. It feels like a colony of large ants has taken up residence on my face, and the area on and around my nose looks for all the world like the results of ant bites. Ugh! I am fully capable of keeping my hands away from my face, but that does not stop the itching, and a look in the mirror is a frightening experience. The medical people have declared this to be “perfectly normal” for someone taking Tarceva, but “normal” is in no way what I feel. This stuff is nasty, and the rash is continuing to spread. May 27, 2007 Today has been a good day, although the energy was used up early. We started out in our Sunday School class, and I was teaching today. Since I am low on energy, I was not as energetic as I usually am. It went well enough, but by the time I was done speaking (about 35 minutes) I was totally spent. From there we headed to the choir room, and got ready to sing. I made it through the hymns and the anthem, listened to the sermon, and we headed home. I was almost too tired to eat, and headed off for a long nap. I did not make it back to church this evening, either. Once the energy for a day is gone, it does not just suddenly reappear. Monica drove us to Huddle House for supper, and I was really too tired to deal with it. I had their “crispy chicken salad” and I ate enough to have said I had supper, but did not get anywhere near finishing it. I was too tired to eat. The Lord is very good to me. In spite of this crazy cancer business, I have no real reason for complaint. Everything we have needed has been supplied. I have no reason to think that will change, either. The Lord is very good to me, indeed! May 24, 2007 I spoke late yesterday with Dr. Posey's office, and the nurse on duty stated that the wild rash and spontaneously bleeding spots are normal side effects for this set of chemotherapy drugs. She said to look around the next time I am in the infusion waiting room, and that I will see a significant number of people with similar side effects. OK, so it is normal. That makes it no less annoying, painful, and itchy. I looked up the documentation for these drugs, and what I see is research results which say that they tend to increase survival just a little bit – say from six months to seven, on average. I see no examples of cures being shown in their literature. So I really have to wonder at the cost and side effects of the drugs, if they are only marginally successful at treating the cancer. I have to ask the question: Is this sort of treatment something which makes sense? I have no answer for that question right now. As the patient, I do get at least some say in what is done, and so far I have gone along with everything which Dr. Posey has suggested. But I am reminded of my mother's experience, where she was treated for cancer over the course of a year, much of that spent in absolute misery from the treatment, and at the end of the year died anyway. That was 25 years ago, and my thought at the time was that she had been diagnosed with cancer, and so they tortured her until she died. Yes, that is a harsh assessment, but it sure seemed that way at the time. In retrospect, we might have handled things differently. So, where do I go from here? Right now I will continue the treatment which has been prescribed, which means two more infusions, and then another visit with Dr. Posey to see what has transpired. Beyond that, I do not know. I continue to seek the Lord's will in the matter. In Him alone I trust. May 23, 2007 I am very carefully keeping my hands away from my face. The latest chemotherapy is causing a nasty rash, which is first and foremost on my face (but is elsewhere too), and it itches furiously. The nurse who returned my call said I should try benedryl, and see if it helped any, and while it might be reducing the itch, I really cannot tell. Ugh, I feel like scratching the skin off of my face, but I know it would not help, so I just leave it alone. Even though I have been very careful not to touch it, the rash has begun to bleed in places as well. It looks as bad as it feels. Yes, I know, it could be worse. If I wait, it just may get there, too. I have put in another call to Kirklin Clinic to see if there is something else I should be doing. In the literature there are statements about the potential dangers of using these chemotherapy agents while using blood thinners, and I am still on Arixtra (a blood thinner) for the thrombosis they found earlier this year. I have to wonder if this is not adding to the difficulty. Did I mention how badly it itches? Owie.... Owie! Owie! Owie! May 21, 2007 I wrote last Monday that one of the nurses had asked me whether the skin rash from the Tarceva had started yet, and that it had not at that time. Well, it has officially started, and boy does it itch. I now have pussy little spots developing all over, and especially on my face. Now that I know what it is, I can live with it by knowing I should ignore it, but still, this level of itch is hard to ignore. Something tells me that this is not the worst it will get, either, as it continues to spread. Anyone local who reads this will understand why I have stopped shaving for the duration, and that yes I will look different for a while. I find it amusing that, from past experience, the older ladies here in Guntersville will come right out and tell me that I really ought to shave, that it looks better and such. Yes, I know that, but I am afraid that I will make the situation much worse shaving through this mess. I have one other observation. The Oxaliplatin was advertised as causing peripheral neuropathy, and that cold can bring on acute episodes of this. Well, it sure does. It was advertised as being a “pins and needles” sensation, and that does not do it justice. Mine is more like being stuck with cactus. Cutting up vegetables to make a salad causes this in my hands, and drinking cold liquid makes it feel like I swallowed the whole cactus. Yuk! So now I am even more careful to avoid all things cold. Oh, and it gets worse: the literature says that after taking Oxaliplatin for a while, I will probably develop chronic neuropathy, and that it can take weeks or months to go away, assuming it ever does. I am so very thrilled. I have my next appointment with Dr. Posey on June 21, 2007, and at that time he will determine whether this treatment is working, and whether it is rational to continue it. We shall see how this works out. There is no guarantee that it will have any positive effect whatsoever, although it does have real side effects. I am not worried, though. I am entirely in the Lord's hands, and that has not changed even one bit. He knows full well what I am going through, and I am satisfied that all is well even when my body is telling me otherwise. If life were all about this world, and nothing else, there might be cause for concern. But that is not the case. As a citizen of Heaven, I am not worried that here in this foreign land things are hurting and itchy. This too shall pass, one way or another. May 20, 2007 Perhaps you have heard of “Spoon Theory.” If not, click here for a quick overview of it, and then come back and continue. You're back? Good. Then we can continue. Yesterday, I used all of my spoons for Saturday, and some borrowed from today, by getting up bright and early, and doing all of the yard work. I ran the weed eater around everything, used the riding mower to mow the entire yard (it is 468 feet deep, and takes a while to complete) and then used the backpack mounted leaf blower to clean everything up. By the time it was over, I could barely move, and the day was essentially over, by 10 a.m. But the yard was done, and I could at least muster the energy to open the blinds and see that it looked good. This morning we got up and went off to Sunday school and the later church service. Monica had to rehearse through part of Sunday school for her ladies' group special music, while I simply sat through Sunday school. Then we left for the choir rehearsal before the service, and we did that. I did an extensive narration for an anthem (fun!) and that worked out well. Once again, though, it was quite draining, and by noon, the spoons were all used up. So I slept until supper, and then we went off to Sunday evening church, where Monica's singing group sang eight songs, and came home. What a weekend. Note that the energy level is lower than it has been, but if I am careful and think about it in advance, I can plan the use of my limited energy to do a few things I really need/want to do. May 18, 2007 The chemotherapy infusion was Monday. Today is Friday, and I am beginning to feel a bit better. The energy has returned sufficiently to allow me to work all day without a siesta. The Oxaliplatin has an unpredicted and unusual side effect. As I have written before, during the chemotherapy with Gemzar I have had continuing bouts with skin infections involving my legs (tinea of some sort) and it has never really gone entirely away. Well, it would seem that the Oxaliplatin poisoned the tinea, and that skin infection has cleared up completely. It makes sense. Platinum in a “heavy metal,” and that is quite toxic to living things. In this case, yes, the poison was meant for the cancer, but it wiped out the skin infection in the process. Thank you, Lord Jesus! May 17, 2007 The first few days after the new and improved chemo infusion have been spent in a state of exhaustion. Whatever else this fine medication does, it is an energy drain of the first magnitude. Yesterday evening, I almost put myself to bed without my supper, since I was really too beat to make or eat it. I did convince myself to eat, and then headed off to Wednesday evening church, but then was so tired that I was unable to stay through choir rehearsal. I feared that if I got any lower, that I would be unable to drive the three blocks back home again. This morning I have propped myself up in front of my work computer, and expect to get a full day's work accomplished. It will probably be all I do today, but it needs to be done. I have to keep working to have the health insurance to pay for the (fabulously expensive) cancer treatment. Note, though, that the exhaustion is the only major side effect from the new chemotherapy regime. That is a blessing, since these drugs are reputed to frequently cause much worse trouble than this. The Lord is very good to me indeed. May 15, 2007 Yesterday's chemotherapy infusion went as well as could be expected. It took all day, but at least there were no immediate adverse reactions to the new medications. Richard Moebes gave me his whole day, and drove me there, waited patiently, and drove me back. We talked, and talked, and talked some more. Thanks, Richard! So far, the only obvious side effects from the combined Gemcitabine, Oxaliplatin, and Tarceva are sore muscles in odd places (for instance, my jaw muscles ache) and more thorough gastric distress. I also seem to have a case of “chemo-brain” as evidenced by problems with vocabulary when I speak – I am not always saying the right words, and am often at a loss as to what the right words are. So I will have to be careful to speak even more slowly and carefully than I have been. I have made a pdf file of the blood test for 5/14/2007, and it is attached here. It provides a baseline of sorts, so that it should be possible to follow what changes occur over the course of this three-drug treatment. One positive thing to note is that the dietary change has made a positive effect on the blood sugar. See that listed under “Glucose.” It is still high at 102, (normal is shown as 70-100) but is down by twenty points from what it was the last time it was checked. One thing which I find educational is that in spite of the diagnosed stage IV pancreatic adenocarcinoma, and in spite of the increasing number of organs affected, I have nearly no remarkable symptoms other than those from the chemotherapy drugs. People sometimes ask why a relative's pancreatic cancer was not found early enough, and I now know the answer. Until some major organ gets so cancerous that it causes major symptoms, the patient does not know to go to the doctor and get any diagnosis. But furthermore, even then, the diagnosis is likely to initially be confined to something being wrong with that particular organ. So, for instance, someone who has symptoms of diabetes is likely to initially be treated for the diabetes, and not immediately suspected of having anything else wrong as a cause. So the pancreatic cancer continues to spread unnoticed. In my case, if the initial tumor had not blocked the bile duct and caused obvious jaundice, I would not have known something was going very wrong. So, here I am, 2-1/2 years after initial diagnosis, still living and doing remarkably well. Yes, I have had to slow down a lot, and yes there is absolutely no guarantee of what tomorrow will bring. The Lord is very good to me, and I have no reason to complain. He has His own purposes for my life, and I am pleased to have the opportunity to live out the life He has provided for me. May 11, 2007 Today we received the letter from Blue Cross Blue Shield of Alabama, approving the use of Tarceva in my treatment. I have attached a pdf file of that letter here. We then stopped at the pharmacy and picked it up, so I can start that later today. So that part of the process has worked. On the other hand, I got a call from Kirklin Clinic warning me that they had not received approval for Monday's scheduled infusion of Oxaliplaten, and that I will need to sign a waiver saying that I will pay for it if Blue Cross Blue Shield of Alabama decides not to pay for it. The nice lady said that they have never had BCBS reject this drug, but then again there was no guarantee about it. Health issues are bad enough, even without he uncertainties of the costs. Yes, I know that drug companies have to make big profits to pay for drug development, and to keep their investors paid off and happy. That does not make it one bit easier when it come time to pay the bills. The Oxaliplatin, by the way, is scary stuff. I have put the nurse's guide here, and it leaves me with the impression that this is the first chemotherapy drug I have faced which has been proven to accasionally just kill a patient outright, even properly administered. It has a truly remrkable set of usual side effects. Next week may indeed be different. Yesterday I drove the 90 mile round trip to Huntsville, so that I could work there for the day. I met some of my objectives by going, including speaking directly to a few people who needed to know what is about to happen with the changes in my chemotherapy treatment. I spoke to Steve Case, the CEO, about my changing medical condition, and what the next treatment would be. He is extremely supportive, and I really appreciate that. I work hard, and they know that – but quite frankly I have worked hard for several employers before who would have simply written me off as too big a risk to keep employed. So, thanks Steve. I enjoy still being able to work through all of this. UPDATE: Monica did some telephoning, and found that Blue Cross Blue Shield of Alabama normally covers the use of Oxaliplatin for cases such as mine. Itis off-label primarily because there is very little which is on-list for pancreatic cancer, since there are relatively few drugs specifically for it, as compared to the biggies like lung cancer, breast cancer, or colon cancer. So all should be well. This is a Very Good Thing, since each dose of Oxaliplatin for mewill cost about $4,650. That cost would be for each infusion, every two weeks, in addition to the $1,850 for the gemcitabine administerred at the same time. Add that to the cost of the Tarceva, which is $3,450 for a 30 day supply. Ouch! Without insurance, there simply is no treatment for pancreatic cancer, since so few of us could possibly affort it. May 9, 2007 One thing I have not mentioned in the blog is that, beyond the other things changing, that my blood sugar level has been slowly rising. This is checked every time I go for a chemotherapy treatment, and over the last several months it has slowly crept out of the normal range (70-100 mg/dl) and and has been rising. OK, after the Whipple procedure half of my pancreas is already missing, and so insulin production capacity is lower than it once was. But note that in the CT scan report from Monday it states that there appears to be cancer involvement in the pancreas area again, and this may mean that the insulin production capacity will fall some more. So now it really is necessary to get better control on the diet to make absolutely sure that I am eating right, since getting that wrong would make the situation worse. So what is the problem? I have control over what I eat, and so it should be possible to change things. That is all well and good, except that there are now two conflicting goals: one is to keep my weight up (which they urge on me about every time I go to Kirklin Clinic) and the other is to carefully control the caloric intake so that there is no extra insulin production necessary. I know how I will solve this, and it will probably mean that the weight comes down slowly. I remember when I was in junior high school that my grandmother Pauline Mast Wessiert Garrett came to live with us, and she was a brittle diabetic, albeit one who had a great weakness for her own cooking. My mom's solution was to make sure that there was not even anything in the house that Grandma could not eat on her very restricted diet. The whole family lost weight including Grandma, who I would estimate lost 25 pounds in six months. She also felt a whole lot better with her diabetes under control. During that period of time, I also learned to enjoy eating that way. So, the solution is a simple one, and is achievable. I have discussed the situation with Monica, and we will buy groceries accordingly. That is easy enough to actually achieve. Hymn time! This is one of my all-time favorite hymns. The words were written by William H. How, and were first published in 1864. The usual tune is called Sine Nomine (which in Latin means No Name), was written by Ralph Vaughn Williams, and was first published in 1906. If you would like to hear it, you may find it here: http://www.cyberhymnal.org/htm/f/a/fallthes.htm For all the saints, who from their labors rest, Who Thee by faith before the world confessed, Thy Name, O Jesus, be forever blessed. Alleluia, Alleluia! Thou wast their Rock, their Fortress and their Might; Thou, Lord, their Captain in the well fought fight; Thou, in the darkness drear, their one true Light. Alleluia, Alleluia! For the Apostles’ glorious company, Who bearing forth the Cross o’er land and sea, Shook all the mighty world, we sing to Thee: Alleluia, Alleluia! For the Evangelists, by whose blest word, Like fourfold streams, the garden of the Lord, Is fair and fruitful, be Thy Name adored. Alleluia, Alleluia! For Martyrs, who with rapture kindled eye, Saw the bright crown descending from the sky, And seeing, grasped it, Thee we glorify. Alleluia, Alleluia! O blest communion, fellowship divine! We feebly struggle, they in glory shine; All are one in Thee, for all are Thine. Alleluia, Alleluia! O may Thy soldiers, faithful, true and bold, Fight as the saints who nobly fought of old, And win with them the victor’s crown of gold. Alleluia, Alleluia! And when the strife is fierce, the warfare long, Steals on the ear the distant triumph song, And hearts are brave, again, and arms are strong. Alleluia, Alleluia! The golden evening brightens in the west; Soon, soon to faithful warriors comes their rest; Sweet is the calm of paradise the blessed. Alleluia, Alleluia! But lo! there breaks a yet more glorious day; The saints triumphant rise in bright array; The King of glory passes on His way. Alleluia, Alleluia! From earth’s wide bounds, from ocean’s farthest coast, Through gates of pearl streams in the countless host, And singing to Father, Son and Holy Ghost: Alleluia, Alleluia! Thank you, Lord Jesus! May 8, 2007 For those who may be interested, I have scanned the CT scan reports from May 7, 2007, and used Adobe Acrobat to turn them into pdf files.. The chest scan report is here, and the abdomen scan report is here. Of course these are not the CT scan slices – I wish I could see those and post them, but alas, that is beyond what Kirklin Clinic will give me. The description that the radiologists prepared is quite revealing all by itself, however. Yes, things are getting worse. This is the first real statement that the lesions (that is doctor-speak for signs of cancer) have spread to the liver. The spread in the lungs and lymph nodes in the lung area is another biggie. The “worsening of skeletal metastases” (that is bone cancer) is another biggie. This is also the first time that the cancer is stated to be back in the pancreas itself. This is still pancreatic adenocarcinoma, but in stage IV it has spread and continues to spread. So, the next issue is that the treatment is changing. Dr. James Posey indicates that what he wants to try is a much intensified and broadened chemotherapy, in order to see if he can get any response whatsoever. The Gemzar by itself, while it may be slowing the growth of the cancer, has not kept the spread from happening. So what he is prescribing is to use three chemotherapy agents simultaneously. The Gemzar will continue at the same rate and dosing. Also added are Tarceva and Oxaliplatin. The Tarveva is a daily pill, and the Oxaliplatin is another drug which will have to be infused. All of this depends upon approval from Blue Cross Blue Shield of Alabama, which is by no means assured. These drugs are in the new and expensive category, and their use together is experimental. So we shall see what actually happens. All of these new chemotherapy agents come with their own side-effects, and so the next few weeks may be, well, different. For now I feel better than I probably should, given all that is wrong. But the chemo agents will, in all likelyhood, rectify that oversight. What I find amusing is that our HR person sent out her annual health insurance renewal notice yesterday, and in it is the statement that the drug costs comprise about 25% of all spending, and that they had gone up more than expected, and more than on other contracts. Hello? Yes, that is probably my fault, since I am personally responsible for a significant fraction of that cost last year and this. This slow death of cancer is very expensive, and the only end in sight to the expense is when the treatment is finally unsuccessful at keeping me alive. For 54 years I was the world's cheapest with regards to health insurance, since I was never sick enough to see a doctor. Then I got hit by The Big One, and became the most expensive person on the plan. Ah well, this too shall pass. In a year or two, it will be someone else. That does not give me joy in the slightest, since I would prefer that no one have to go through this. On the other hand, there will be someone else to blame. So, fellow prayer warriors, now there is more to pray about. Once again, my main prayer is that whatever happens, the Lord will use me to glorify Him through any and all of this. I may have to live in this progressively failing body for now, but I am consoled by the fact that this whole cancer business is not about me – it is about Him. He is faithful through all of this. He supports me through this day by day, and when it is all over here, I get to be with Him forever. So tell me again, how can I possibly lose? May 7, 2007 Today was the day for the three-month medical tests and follow-up visit with Dr. James Posey, the oncologist, at Kirklin Clinic. We left home at about 7:30 a.m., and drove to Birmingham, found a parking space on the seventh floor of the parking deck, and started the process. Since I was scheduled for a chemotherapy infusion as well as the tests, they “accessed” my port, and drew three vials of blood that way. Those went off to two separate labs (the CA19-9 testing is done across the street at UAB hospital). Then we went directly to the radiology area, and checked in for the CT scan, which was not scheduled for another hour. Their new procedure, however, had me called in immediately, stuck with an IV in the big vein in my wrist (up from the thumb) and left in a very cold waiting room for more than an hour, with no way to get my sweater back on over the IV. I was given a quart of water to drink, and then after the scheduled time was finally called back in to be scanned. Once that was done, we quickly walked to the car for a quick lunch of a sandwich and some cucumber slices (this was the only opportunity to eat) and then ran back to sign in for the oncologist visit. It did not take long to get taken back to the examining room, but we then waited for about two and a half hours to see thee doctor. That was probably a good thing, because this way there was time for the radiologist to read the scans, and for the blood test results to be completed, and all of this to be entered in the computer. After that, we headed straight home. What a day! The doctor read all of the reports, and told us the news. The cancer is continuing to spread, slowly, and now is firmly established in the lungs and liver, as well the other places mentioned so far. He specifically mentioned that there are significant signs of bone cancer growth in the area where the back and spine meet (which explains the growing soreness in that area). The lymph node involvement is now not only in the abdominal area but in the lung area as well. The peritoneal tumor is continuing to squeeze the inferior vena cava and aorta, in the area between the blood vessels to/from the kidneys and liver. The CA19-9 cancer marker is as high as it has ever been for me, at 160. Now for the good news: the thrombosis in the inferior vena cava is gone, which lessens the risk of an immediate stroke or heart attack if a piece of it had come loose and lodged in the wrong place. Believe me, I am thankful for such things. I have copies of the reports, and I hope to scan them and put them up here as pdf files. We can parse them together, and see what else was said but which Dr.Posey did not mention. Because of the above, Dr. Posey is changing the treatment. I willnow be taking three chemotherapy drugs, one orally and two by infusion. It would have been started today except that there was not enough time to get it all done by the time the other appointments were done. So I get this week off, and the new treatments will start on Monday May 14th. Once again, the new drugs are in the fabulously expensive category. We dropped the prescription for the oral chemotherapy drug with Buddy Bunch, our favorite pharmacist, and he first priced it ($3,400 for a 30 day supply) and then ran it through the Blue Cross Blue Shield automated system, which denied approval for payment. So Dr. Posey will have to personally argue the merits with the insurance folks for any of this, before it can be approved. Should I last the year, and should this new treatment continue, this year's pharmacy bill will easily top $100,000. I am very expensive indeed. The amazing part is that, in spite of the above, and in spite of the prognosis, I still feel remarkably good. Sunday I was able to teach my Sunday School class, and sing in the choir. I work every weekday that I am not in Birmingham for medical appointments. I still help Monica with the photo business, and actually get some other things done. The Lord is so good to me! May 2, 2007 Yesterday was unusual. Oh, the daytime things went normally, but then a few minutes after supper my cousin Peggy called and asked if were were available to photograph her daughter Melissa's wedding, this weekend. It seems that the previously arranged photographer is too ill to do it, and so Peggy was scrambling to find a replacement. Oh, I forgot to mention that the wedding is on the beach, on the outer banks of South Carolina. I really love my cousin, the wedding sounds beautiful, and this would have been a great opportunity, except that I don't travel well any more, and Monica has been really tired lately. So after some careful thought we had to decline, but Monica was able to arrange with one of her friends (an excellent photographer), Karen Simmons from Atlanta, to offer to drive up and photograph the wedding. All is well, now. One frustrating thing about being sick with pancreatic cancer at this level is that while I can do many things well enough that no one notices that I am sick, there are some things I really have to decline to do. No longer am I driven by what Imust do, but rather have to be governed by what Ican do. As long as I accept that attitude as my own, and do so without apology, I can carry on without trouble. I need no longer worry about what others have on their list for me to do, and they know this. I get a whole lot done, but I do not get worried in the slightest about what I can no longer accomplish. I sleep much better at night this way. I am joyful in the Lord. Thank you, Jesus! Apr 30, 2007 We had a very busy weekend. This was the 100th anniversary for our congregation, First Baptist Church, Guntersville, Alabama, and there was much activity regarding that. Furthermore, I did more computer troubleshooting (I have come to despise computers and software as necessary but unmanageable), photography business planning, book keeping, and such. Items that we had for sale on eBay sold, and so things had to be packed up for shipping. Friday evening was our “monthaversary” (it was the 27th of the month, and were married on the 27th of some other month) so we went to the nice restaurant for a celebration. I even sneaked in a Sunday afternoon nap. All-in-all, it was a good weekend. I get interesting emails from folks who are/have-been/care-for cancer patients, and some of them provoke discussions. This weekend brought one from a nice person with whom I discussed the difficulties of knowing what highly-touted research really means. My take has been that a lot of research results are statistically insignificant, but have to be spun in a highly favorable light in order to get the next round of funding (a process known as “grantsmanship”), and that then the press picks up on the highly positive blurbs that flow from this cycle, and tends to hype the latest little tiny result at the greatest cure-all imaginable. As a result, I do not get very worked up over what I see in the news about the Latest Wonderful Cure. When I see results locally, then I might believe. In the meantime, it is of no practical use. The Lord has given me another week with Monica, the Love of my Life. Am I happy? You bet! Am I thankful? Oh yes! Thank you, Lord Jesus! Apr 27, 2007 Yesterday I had a mandatory meeting at the Huntsville office, so Monica and I drove to Huntsville first thing in the morning. She dropped me off at the office, and then made some necessary purchases, and also photographed at an outdoor portrait session. She picked me up after work, and then we had supper at Little Rosie's Cantina (excellent Tex-Mex food in Huntsville, Alabama) and then headed back to Guntersville. We were both too tired to do much, so the evening didn't last very long. It would seem that the sulfa antibiotic may be working at dealing with the lung issues. I am off of the Mucinex, the lung filling has receded and things are rapidly improving. For this I am very thankful, as it has been difficult to breathe for some time. So, why did the sulfa work when the azithromycin didn't? Well, there is some thought that the problem was not a bacteria at all, but rather a mold of some sort. The sulfa antibiotics are supposedly much more effective at dealing with the mold than the azithromycin. So how did I get the mold in my lungs? My guess is that I was doing something outdoors without a dust mask, when I really should have used one, and inhaled some quantity of it. It could have been from pressure washing green stuff off of the north walls, or it could have been from the huge clouds of dust from mowing the yard. Who knows? But now I will be much more careful to wear the dust mask when I work outdoors. I know, I know... as a cancer patient with a weakened immune system I should know to do this, but sometimes I have forgotten to do so. Apr 25, 2007 The days immediately after my chemo infusion are days of flatness. This week it is no different. Yesterday I did not get nearly as much done as I would like, and went to bed early. I skipped the monthly meeting of the Tennessee Valley Professional Photographers Association, because not only was I too tired to drive, I was too tired to even ride along to Huntsville with Monica driving. Chemo is just that way. On the other hand, I am still here, and able to function for the most part. I will be working all day on the engineering job by telecommuting, and this evening will be church night, including choir rehearsal. Tomorrow will be a full day at the Huntsville office. So things must be going rather well. For someone who was diagnosed with pancreatic adenocarcinoma 2-1/2 years ago, this is very good indeed. The Lord is so very good to us! Apr 23, 2007 Today we went to Kirklin Clinic for another chemo infusion. Boy, were they ever overloaded! The appointment was for 11 a.m., and we arrived an hour before in order to get the blood drawn and the blood analysis done. We did not get out until after 3 p.m. for a 90 minute ling infusion. This is called “Medical Standard Time.” Things will be done when they are done, and no sooner. I cannot complain, though. They are overloaded with patients because they are very, very good at what they do. It is worth the wait. We spoke first with Jill the RN, and then with Dr. James Posey, the oncologist. The results from the MRI of my head ten days ago came back mostly normal. There are small blood vessel issues (normally seen in senior adults 20+ years older) but that is all. There is no sign of a tumor or other similar problem. Hooray! So the migranes will be treated with modern migrane medications. This is a relief. Since I have been having serious chest congestion problems since December, Dr. Posey got out his trusty stethoscope and listened to my breathing. His comment was that my right lung is being “musical” (not a good thing) and that since the azithromycin hadn't fixed the problem that he would put me on a ten day course using a sulfa drug instead. We hope and pray that this works. All in all, this has been a good day. Yes it was long and tiring, but things are really going well for someone with stage IV pancreatic cancer. In two weeks, I will go for another CT scan and they will get a good look and see what is changing inside me this time. Thank you, Lord Jesus! April 20, 2007 Was it flu? Was it food poisoning? We do not know the cause, but last night was very rough for both of us. I'll spare you the details, but let's just say that our gastric systems were very distressed indeed. So we are both a bit short on sleep today, but feeling much better. Out strangeness for the day is the closing of a large part of Guntersville, Alabama, for the duration. One of the big grain elevators on the other side of the lake caught fire, and the authorities have been really worried about the possibility of an explosion. Grain elevator explosions can be very powerful, and so this is no idle worry. So Alabama highway 227 from US highway 431 east has been closed, and that entire area evacuated. This has affected some of our photographic customers. Monica was scheduled to do a senior session at a home on the other side of the lake this afternoon, and that was called off. So we shall see how long it takes for the local fire department to decide that safety has returned to Guntersville. On a much better note, our daughter Marie is flying in this evening. We really do enjoy having her around, and so this is a wonderful thing. She apparently found a really cheap flight, and took the opportunity to come for a visit. More fun! Once again, the Lord is very good to us. Apr 18, 2007 We are back in town today. Nothing on the blog was updated for a few days while Monica and I were at the Southeastern Professional Photographers Association meeting in Atlanta. We attended the seminars and trade show, and learned a lot. We also had a lot of good conversations with great friends from the industry. So we are tired after all of the travel, but very pleased and rather jazzed with new business ideas. Travel is a frustration for me now, though. The drive to Atlanta is about 3-1/2 hours, and I have a very difficult time lasting that long in a car. Part of it is due to having a much shortened digestive tract, which makes frequent stops a necessity. Part of it is due to the soreness that comes from the “sclerotic lesions” in my lower back (those are the body's adaptations to spreading bone cancer). Part of it is due to having to haul around a large pouch of medications which must be remembered at various times during the day. Long distance travel is really out of the question any more. However, I am still here and feeling better than I have any right to under the circumstances. Thank you, Lord Jesus! Apr 13, 2007 The MRI of my head was this morning, at Kirklin Clinic in Birmingham, Alabama. We left at 4:30 a.m. and arrived in the parking deck by 5:55 a.m., and were the first in line at the MRI facility in the basement of the clinic. By 6:15 I was checked-in, changed, and ready to go. The MRI took about 45 minutes, and was definitely different from the previous scans I have been through: the bone and the PET scans are slow and silent; the CT scans are fast and the machine makes funny noises; The MRI was slow and as loud as a jackhammer. They issued me a set of foam earplugs, and then clamped my head in place with what appeared to be sound-absorbing pads over my ears. Then I had to hold my head as still as I could, with my eyes closed, while the machine did its very loud thing. There was a brief pause at about the 30 minute point, when the technician pulled me out of the machine and injected some contrast dye in a vein in my left arm. Then it was back into the machine for another 15 minutes of hammering noises. Once it was over, we drove back to Guntersville, and were back by about 8:50 a.m. So what are the results? Well, I won't know for a while. It will be at least two working days until the data is processed and available on the Kirklin Clinic computer system. Even then, I will not know what happened until either Dr. Posey calls, or until I get an appointment with the neurologist, whom I have never met. So, for all of those who thought I really should have my head examined, well, I finally did. Apr 11, 2006 Yesterday started normally, but had an unusual middle part. Derek, my supervisor at Aegis Technologies Group in Huntsville, emailed me and noted that the manager two levels above him was in need of some office space to place several new-hires, and so what would I think if they recycled my office in Huntsville? OK, well it is a very nice office as far as engineering office go: it is a single-person office of about 150 square feet, with a huge window and a view of the trees and grass to the north of the office, and had lots of working space with a large table, two desks, and two computers. There is one detail about it, though, which made their request perfectly reasonable: I telecommute from 45 miles away in Guntersville, and am virtually never in Huntsville. So, of course, I would be willing to give up my perfectly splendid office. All I had to do was to go to Huntsville and remove my stuff, which included nine large framed pieces of photographic art, my books, lamp, and other things which would be in the way. So Monica and I made the 90 mile round-trip, and accomplished all of that. I will still have my Linux computer there in a corner of the lab or somewhere so that I have something to use on the occasions I am there (every two weeks or so) and that is about all. So, I no longer have a real engineer's office in Huntsville. Note, though, that this is a de facto acceptance of my telecommuting from now on. I have been telecommuting for the last year, during the stage IV pancreatic cancer incident, and it works out well for all of us. So this is a Very Good Thing. So today I am once again working from the wonderful corner office in Guntersville. It used to be an apartment living room, in the building behind our photo studio, and I converted it to an office nearly 3-1/2 years ago. My commute is all of 100 feet from one building to the other, and in an age of sky-high gas prices, this is just right. It saves nearly two hours a day of commute time, and about 1600 miles of driving per month. Believe me, the savings in my energy is very helpful, and the savings in money just about pays for the cost of the co-pays on the drugs I need. Life is good. Thank you, Lord Jesus! Apr 9, 2007 Today was my usual infusion day, and it went well. We left Guntersville at 5:30 a.m., and arrived at Kirklin Clinic (In Birmingham, Alabama) at about 7:10 a.m. I picked up my blood test paperwork, proceeded to see Dana at the Oncology / Hematology check-in desk, and we waited a bit. Carmen called me in, access my port, and drew my blood samples, and then sent me back to the waiting room. After an hour or so, Donna called me in to the smaller infusion room (the one with no TV sets – Hooray!) and pumped the Gemzar into my port. We ate our lunch in the car in the parking deck, and then headed back to Guntersville. We were home by about 1:45 p.m. While we were there, we spoke to Dr. Posey (the concologist) and his nurse Jill, and talked to them seriously about the recurring serious migrane problems which have been so frequent during the last couple of months. They are scheduling me for an MRI of my head, and to see a neurologist at Kirklin Clinic. While it is possible that we are seeing medication-induced problems, there is some concern that there may be a tumor growing inside my head. This would be entirely consistent with the pernicious nature of pancreatic cancer; it spreads every which way. So, dear prayer partners, we have a request. Please ask the Lord that the doctors will accurately diagnose what is going on, and what is causing it. Apr 8, 2007 Happy Easter! We have had a most wonderful day. I felt well enough to teach Sunday School, sing three songs with the choir (I sing bass), and visit at a potluck with about 20 fine friends in Huntsville for part of the afternoon. I had made my specialty pie, with a filling which was 2/3 rhubarb and 1/3 red raspberries, and it vanished in an hour's time. We have no relatives here, so we are very pleased to have friends who invite us. Thanks Dan and Donna! Apr 4, 2007 Yesterday and this morning have been an adventure. Tim and Kelly Waterman met us for supper, and then again for breakfast, and we had a fun time. We finally got to meet Heidi, Annika, Micah, Wilson, Patrick, Rebecca, and Robert. All seven are children, of course, but are as polite and well-spoken as anyone that age can be. Thanks for coming so far out of your way to come and see us! After all of that adventure, I am a bit tired this afternoon, but I figure that after work I will take a brief nap and then head off to choir rehearsal. I have traded weeks for teaching Sunday school and so I am on this week rather than next. This should work out fine, since by Sunday I should feel pretty good, before Monday's chemo treatment takes all the energy back out. At least the two week cycle is sort of predictable, now. Apr 3, 2007 For those who have emailed or called during the last couple of days, yes, I am still alive. No, things have not become much better. There has not been enough energy during most of the last week to even consider adding to the blog. Last week's chemo treatment left me so low that I did not make it to Wednesday evening choir rehearsal, did not make it to Sunday evening church service, and really did not do much of anything but sleep, eat, and telecommute to the office. Cancer can be like that. The cancer leaves the patient low, and the treatment makes it worse. The chemo drugs may help slow the spread of the cancer, but not without a terrible cost. All of the above notwithstanding, today we have a treat. Tim and Kelly Waterman are coming to visit, all the way from Idaho. I have not actually seen Tim since 1976 (yes, 30 years ago) although we have corresponded since then. Oh, and they are bringing their seven kids along, too. This should be an adventure. Tomorrow I may not be able to stand up, but I will use every bit of energy I have to visit with these fine friends today. So, How did I meet Tim? Well, 30 years ago he was the most serious student in a young adult Sunday school class I was teaching. The Lord has provided some really amazing friends over the years, and Tim fits in that category. I suspect that we will pick up about where we left off 30 years ago. He said we could discuss the differences between John Calvin and James Arminius over supper. With seven kids along, I don't expect that to happen. I will have enough of a time trying to keep their names straight, since I have never met any of them. Mar 28, 2007 I'm tired... very, very tired. Energy level: -0. Gastric distress: plenty. I feel weak enough today that it is hard to stand up without wobbling. My chest hurts way down inside. Through all of this I know that the Lord still loves me. Yes, my body is failing, but it could be worse. At least it is not a moral problem. At least it is not a matter of unbelief. In the long term, the mortality rate is 100%, so it should come as no surprise that at some time our bodies fail us. It is still a surprise when it happens to us, though, because we get real used to waking up in the morning, and living life here. While I am in no hurry to depart, there is a part of me which would like to go Home. To quote Billy Graham, "I do not know what the future holds, but I do know who holds the future." I have never been to Heaven, but I do know who runs the place, and I trust that what He has prepared for us is a lot better than anything we see here. Mar 27, 2007 Today is our 36th wedding anniversary. Looking back at my life, there are some things I would have done differently. However, I would pick Monica again in a heartbeat. I have known her for more than 40 years, and she is the one for me. Happy anniversary, Monica! On Sunday I got to teach my Sunday school class, and that was fun as usual. This particular lesson included most of John chapter 11 (the raising of Lazarus from the dead) and has plenty of great material to work with. Yes, those who are there know that I am going to teach some, preach some, and meddle thoroughly. I try to have the most interesting class in town, in the hope that it will attract more students to come. Some days it seems to work, and Sunday was one of the better days. Yesterday we went back to Kirklin Clinic in Birmingham, and I had one of my regular chemotherapy infusions. As usual, the 90 minute infusion ended up taking all day, simply because it takes an hour and a half to drive there, 45 minutes to wait for them to access the port to draw the blood sample, an hour to wait for the blood tests to be done, a half hour waiting for the pharmacy to mix the Gemzar soluiton, an hour and a half for the infusion, an hour for lunch in Brimingham, and another hour and a half to drive back home. The Gemzar leaves me very flat, so I typically need a nap in order to have enough energy to even consider eating supper, and by then the day is over. I cannot complain, though. I see people every time I go for an infusion who are there all day, for multiple days at a time, and then have to be hooked up to a pump that they take home with them to infuse more fine chemo stuff over another day or two. So, in fact, I have it very easy. I could list what hurts and what the problems are right now, but I will not bother. The Lord is good to me, and I have absolutely no reason to complain. Two and a half years after diagnosis with pancreatic adenocarcinoma, I am still here and able to function at some level. That is a better series of events than most pancreatic cancer patients get to experience. I hope to keep on going until the Lord calls me Home, and while I am here, will recommend Him to everyone who will listen. Thank you, Jesus! Mar 23, 2007 Today has been a good day. I got a lot of work done telecommuting, and I have come to a good stopping point for the week. That is most satisfying. I spoke with Jill, Dr. Posey's nurse, today and we rearranged the schedule for my chemotherapy infusions a bit. Beyond that, we discussed my continuing breathing difficulties, and she called in another round of antibiotics (azithromycin) to see if that cannot be tamed. Furthermore, we discussed the continuing visual migranes, and Jill indicated that she would let Dr.Posey know, and that some further diagnostic tests might be required. So that is taken care of. This morning, Richard Moebes came over with his chain saw, and helped me remove a couple of tree tops which have fallen over from the city property next door. He did most of the work, and I dragged some of the pieces to the brush pile. It is great to have as good a friend as Richard. So now it is possible to mow the back yard without having to avoid the areas blocked by the city trees. (There used to be a utility substation next door, and while the substation is now gone, the forest they planted years ago to hide the substation is pretty well overgrown.) Richard and I also talked a bit about this week's Sunday school lesson. It is based on John chapter 11 (where Jesus raises Lazarus, four days after Lazarus has been dead). Richard is one of the two other teachers who trade off teaching our class, and he has a real heart for it. I appreciate his input whenever I can get it. Today has been a wonderful day, and I thank the Lord for it all. Mar 20, 2007 Saturday I did some yard work. Running the riding lawn mower was no big problem, but doing some of the manual labor jobs was just barely possible. I got to a good stopping point and stopped. It does look better out there, and maybe later his week I can do some more of the job. Sunday was good as always, with Sunday school and then singing in the choir at the second morning service. I had a nap, and then headed back for the evening service. Yesterday I went in to spend the day at the office in Huntsville. It is necessary to do this at least one day every couple of weeks in order to coordinate activities and such. So, after a fitful night's sleep, I got up this morning, washed up, and came out to the office. I have a 100 foot commute for my telecommuting job, and that is much better than the long drive in to Huntsville. But this morning I had quite a “light show” - once again I had a visual migrane which ran for about an hour, and it obscured about 2/3 of my visual field this time. This is happening frequently now. I can usually wait it out, and get back to working without too much disruption. As long as I am not driving at the time, things end up OK. However, I have on occasion has this happen while I have been driving, and there is nothing to do but find a safe place to pull over, because the visual migrane essentially causes temporary blindness. Those rippling colorful lights completely obscure what is really there. As I indicated a few days ago, I need to convince Dr. Posey that it would make sense to extend the CT scan to include my head next time, since there are symptoms which tell me that something may be changing there. Mar 16, 2007 Last night was not good. Sometime around 3 a.m. my lungs were so clogged up that I was having serious problems breathing. I woke up Monica, and she bundled me up and put me in the upstairs recliner, and that helped some. After about an hour, I could breathe again, and came back to bed. I do not know how what is happening relates to the cancer, but it sure does get my attention. Not being able to breathe is downright frightening. Late yesterday afternoon Monica and I ran some errands. The trip took us to the post office, the bank, Staples, and Wal-Mart. While we were in the Wal-Mart, Monica ran into a couple of people with whom she needed to speak, and so they talked for about twenty minutes. I nearly fell asleep leaning on a freezer case, waiting for the meeting to end. The exhaustion is increasing, and it is becoming more difficult to do very much. The combination of pancreatic cancer and chemotherapy is wearing me out. This morning I am dealing, once again, with visual migrane effects. My vision is blurring, and there are one or more sparkly colorful spots which intermittently block my vision. This has been happening a lot recently. I have to wonder if this is related to the recurring major pain in the back of my head. I am going to ask the oncologist to extend the CT scan to include my head next time. So far the scans have included my pelvis, abdomen, and chest. My increasing symptoms tell me that they need to look farther. Even with all of the above, I consider myself most blessed every day I wake up. The Lord is so very good to me; He made me, He redeemed me, and He sustains me. When I am done here, He will take me Home to be with Him. So how can I possibly lose? Mar 15, 2007 Yesterday was a good day, but seemed awfully long. The chemo-induced exhaustion seems to be getting worse. Besides that, parts of my insides are hurting in odd ways, and the breathing difficulties are growing. All of this makes sense from the radiologists' reports from the cast CT scan, as it would seem that I am feeling some of what they are seeing – as the cancer spreads, more things get affected, and there is more to feel. In spite of that, I worked my normal hours yesterday, and then went off to choir rehearsal in the evening. By the end of the day, I was so tired that I could barely stand up. I do not plan to stop doing anything unless I simply cannot do it any more. As long as I get to bed early and get ten or more hours of sleep, I am able to continue to do much of what I have done in the past. I do have to do it more slowly, however. I find it amusing that every time I go to the Kirklin Clinic they weigh me, and tell me how good it is that I have not lost weight. Everyone else is supposed to lose weight, except for the cancer patients, for whom losing weight is a sign of trouble. Even so, today when we went to Wanda's Restaurant (the local downtown cafe) for lunch, I had them substitute tomato slices for the potatoes on the lunch special. The medical folks may tell me that I should not lose weight, but I certainly don't want to carry any more around than I already do. One peculiarity of having a particularly pernicious form of cancer is that it shortens my perceived time frame. When people tell me about something six months away, I have to consider what six months from now may bring. On the one hand, I am not by any means in a hurry to check out and go Home. The Lord will call me Home at the appointed moment, and that is fine with me. Nevertheless, this forces me to make few commitments, since there is no assurance that I will be here tomorrow, let alone six months from now. When asked about doing something, I am likely to say, “I would love to do that, assuming I am here and able to do so.” Life comes with no easy assurance of continuing. I know that now, and it is just as true for you as it is for me, although right now it is more obvious for me. So I do not worry about the future. The Lord will take care of that, and all I have to do is to trust Him today. Mar 12, 2007 Chemo day! Today we left Guntersville at about 5:45 a.m. and drove to Kirklin Clinic in Birmingham, so that I could have my chemotherapy infusion. Everything went as well as it usually ever does. Once again, the only real delay was in getting the lab test results after the blood was drawn. That is the normal course of events. So after the results came back, I was hooked up to the infusion pump, and they pumped in 1.8 grams of Gemzar diluted in what looks like about 500 mL of saline solution. With the port, this is a very straightforward process. We left the clinic at about noon, and were back in Guntersville before 2:00 p.m. The Gemzar leaves me very tired, and so after we got back I slept for a couple of hours. After that, we went to Huddle House for supper, and then came home. It is nearly 8:00 p.m., and bed time. There is no energy left to stay up any longer. But if exhaustion is the worst side effect of the chemotherapy, I consider myself most blessed. Mar 11, 2007 What a day this has been. Today has been the day we scheduled for the celebration of the 40th anniversary of our first date. OK, I know, that is an amazingly sappy, romantic thing to do, but we decided it would be fun, and it has been so. We had planned to have the big celebration last March for our 35th wedding anniversary, but due to the pancreatic cancer I was in the hospital at the time. Our 40th wedding anniversary is another four years away, and the statistics are very much against my being around for that celebration, so we did the next best thing, and celebrated today. More fun! Our daughter Marie is in town, and brought along her friend Victor. Marie provided rather a lot of her hand-made chocolates for the event. While she lived in Seattle, she learned how to make the high-end chocolates, and they are indeed amazing. Today started out with Sunday school, which I taught, and the late church service, at which Monica's octet sang, as well as the large choir in which we both sing. That was a full morning. Then the party was at Jim and Jenny's home on Lake Guntersville, and we had about 35 guests. There were friends from the arts community, friends from the photographic community, friends from the office, and friends from church. What an adventure! It would seem that the entire group got along rather well. Near the end of the festivities, Jim and Jenny got out their guitars and sang “our song” and Monica and I both cried our eyes out. What a blessing it has been. Many thanks to all who made this possible. We are honored by the presence of so many good friends. Mar 9, 2007 My slightly exciting week has caught up with me. This morning I woke up, but getting up was barely possible. I succeeded in washing up, giving myself my daily injection, getting dressed, taking all of the other medications, and very slowly walking the 100 feet commute from the house to the office. (I was honestly too tired to eat breakfast, so I didn't.) I even got a lot of work done, but it has been as if marching through a dark fog of thick molasses. Cancer and its treatment can be a real energy sink. Mar 8, 2007 Today is my birthday, and I am now 56. That is a treat, since no one had expected me to make it this long. Now for most purposes I am still considered a “Junior Citizen” (that is what we are before we graduate to senior citizen status, right?) and that is fine with me. For many things, young is as young thinks and does, and I am not thinking “old” in the slightest. Now, if I could just get around this minor detail of pancreatic cancer, I might make it to senior status someday. So I hurt in places – unusual, internal places – places I am not sure I have ever felt before this cancer incident. So what does a pain there mean this time? Is this the next tumor that the radiologist will talk about after the next scan? Who knows? This reminds me of the words of John Kelly, who was as fine a senior as I ever met. He said, “Old age isn't for sissies.” What he was saying is that we have to go through things as we age that we had never even considered when we were young, and we might as well just used to it. Every day I am glad to wake up and be able to thank the Lord for another day – a real gift. Mar 7, 2007 This has been a long but productive day. I got up extra early and drove the 45 miles to the office in Huntsville, and worked with Derek most of the day. We went over the design of my current major project, and other than a few minor things he approved it as-is. On the one hand, it is a great benefit to me to be able to telecommute on most days, because the extra energy necessary to drive the two hour round trip simply isn't there. On the other hand, it is very useful to get some things accomplished in person. I came home, had a tiny supper, had a nap, and then we went off to Wednesday evening church service and choir rehearsal. It was wonderful to be with my church family. The rehearsal was fun, and it made a splendid end to a great day. The Lord sure has been good to me! Mar 5, 2007 The severe respiratory problems seem to have left now. I still have one more azithromycin tablet to take (and they do urge the patient to take them all) and that will complete the course of treatment. It is very helpful to be able to breathe again. So now it is back to only dealing with four known varieties of tumors, and the chemotherapy necessary to keep them from growing any further. On Sunday, Monica and I will be celebrating the 40th anniversary of our first date. Yes we have known each other that long, and I first convinced her to go to a high school event with me on March 11, 1967. We might have celebrated our 35th wedding anniversary last year, except that I was in the hospital over that period of time. So this will be our big celebration. It is great to know each other that well. She is still my favorite and only. Mar 4, 2007 Happy Sunday! I have been much too sick to teach my turn in Sunday School, and so today Jerry Johnson did so in my place. I was also unable to sing in the choir. I would really like to do these things, but I am not doing well this week. The major cold/flu going around has been devastating to me, since the immune system is so low due to the cancer and treatment. I hope next week will be better. Mar 1, 2007 Today I am not quite as low as yesterday, but nearly so. This business of coughing up great gobs of green goo is exhausting. At times, I cough so hard that I literally cannot breathe. So today when Jill (Dr. Posey's nurse) called back about something else, I asked about the lung infection. She suggested two things, one being Mucinex, which is a modern expectorant, only recently available as non-prescription, and the other being Azithromycin, a prescription antibiotic. She called the prescription in for that, and we picked it up after supper. I do hope this treatment works. The other thing I discussed with Jill was the prescription for the blood thinner Arixtra. I had thought that the prescription was for six weeks, and it turns out it for six months. Well, I know why health insurance is expensive – it is at least partly due to people like me who end up using modern medications like Arixtra. Do the math. It costs almost $100 per injection, and I have to have 180 injections of it. That works out to nearly US $18,000 worth of Arixtra. I looked up the costing, and this is not considered expensive for a drug of this type, as the others cost even more. Add that to the cost of the other ongoing treatments (bi-weekly chemo with Gemzar at $1,800 per treatment, CT scan every three months at $3,600 per scan, plus the costs of the various other drugs), and we quickly get into the $75,000 per year range for someone who has pancreatic cancer and is really not expected to live all that long. As I have said before, for the first 53 years of my life I was exceedingly healthy, but then I got cancer and am making up for all of my inexpensiveness all those years. There is another point which makes modern health care more expensive that it used to be, and that point is that it is remarkably effective. The doctors have used treatments to keep me from immediate death several times, and each time has extended my life, but has also added to the bill. As I noted a couple of weeks ago, the “rational way” to cut health costs is to ration care, and let “grandpa” (that's me) die now, because he costs more than he will be worth from now on. I do still have a very personal interest in this case, and so I am very glad that the rationing has not come here yet. Feb 28, 2007 Well, today is a record low energy day. There is no major pain anywhere, but the total combination of the cancer, chemotherapy, and major chest cold has left me totally flat. I can prop myself up in front of this CAD system at which I work all day and do my circuit board layout work, but if I try to get up or even just cough hard, it feels like I just might black out. My vision pulses, and everything just fuzzes out. To get from one building into the other takes two flights of stairs, and if this continues, I may end up working from my laptop in the house. I can never remember being this low. What do I want out of life now? When I get Home, I want to hear “Well done!” from my Savior. That is it. When I am this weak I am reminded that my time here is limited, and that after that my Savior will take me Home. So, I am very weak today, but not in the least worried. Feb 27, 2007 My energy level is hovering around zero right now. Yesterday's chemotherapy treatment went as well as it possibly could, but the Gemzar (gemcitabine) drains whatever energy I might have. It could be worse, I assure you. Yesterday at the chemo infusion center there was a young man with no hair (some chemo does that) who was hooked up to his infusion pump on its pole on wheels, and was sprinting to the bathroom with this semi-mobile pole – yes they give us all drugs to fight the nausea, but some people have it harder than others. As I say, it could be worse. If the only bad symptom I get from the chemo is exhaustion, I consider myself most blessed. Richard Moebes drove me to Kirklin Clinic yesterday, and that was wonderful. I am not sure I could have safely driven back after the infusion, and I really needed the ride. Beyond that, it is wonderful to have such a person to talk to all the way there and all the way back. We discussed lots of things, including many involving our respective Christian walks. I treasure his friendship – he is truly a kindred spirit. I seem to have caught the ferocious chest cold that Monica has been battling, and last night I almost couldn't breathe. I coughed so hard and so deeply that it was hard to catch my breath. That will keep me awake big-time. With a half-functioning immune system (chemo wrecks that too) these infections are a problem. Besides that, the fungal skin infection is back, and although I treat it topically with the clotrimazole cream, it is very slow to heal. So I guess that besides at least four types of tumor right now, and ongoing chemotherapy, there is some other reason that I am a bit weary. On Sunday afternoon Monica and I received a phone call from Tim Waterman, a friend whom I have not seen for about 30 years. Long ago, I was teaching young adult Sunday School in a tiny church in Pomona, California, and Tim was a student in that class. We became good friends at the time, and have stayed in contact on and off ever since. It is good to be reminded that things we have done long ago still have serious significance to others. Things we do in the everyday course of our lives can have long-term effects. Most of those we will not know about until we get Home and can see the whole picture. But sometimes, every once in a while, we get a glimpse of how what we have done has affected others. We may not remember, and others may not either, but the Lord knows about all of it. He will not forget us. Feb 23, 2007 For the last several weeks it has felt like my neck was hurting. The CT scan results already show signs of bone cancer involving the pelvis and spine, and so seeing it elsewhere would not be at all unusual. However, thinking further about what I am feeling, I am not so sure that is where the pain is coming from. It appears to be actually coming from inside the back of my head. This is not a good sign. The pancreatic adenocarcinoma has been spreading through the abdominal and chest area, and something tells me that this new sign involving yet another area must not be ignored. So, it is one more thing to bring up on Monday when I go down to Kirklin Clinic for my next chemo treatment. When the oncologists say that pancreatic cancer is aggressive, they are not kidding. After watching my own illness, I can honestly say that there is a constant realization that, however well I am doing today, that there is no guarantee of tomorrow. It is as if something that I cannot see is chasing me, and is constantly gaining ground on me. It is something which I cannot outrun, cannot outwit, and cannot outlast. Sooner or later it will kill my body. At that point I am in the hands of my Savior, so I need not worry about the ultimate outcome. He already won the victory for me (and for you also if you will but accept it) so my salvation is assured. The process of living and dying with cancer is a messy business. It is no fun for the patient, and it is in many ways even harder on the caregivers. No one wants to see a loved one go through this. However, the force of love propels us to stick around and stay together even through this harshest of times. Always remember that cancer of any sort is merely a bodily failure, and not a failure of love. It is not as if cancer were a great moral failing. Cancer does not separate us from the love of God. He supports us even as we go through the valley of the shadow of death. That is where I am right now, and He is with me even now. I plan to continue to do everything I can for as long as I can through this process. The Lord is with me, and so I can deal with the failing body. As He gives me strength, I will continue, and when my time here is over, He will take me home to live with Him. How can I possibly lose? Feb 22, 2007 I get one day at a time, and was pleased to wake up this morning. Last night I was exhausted after spending the day at the Huntsville office of Aegis Technologies. Because of the ongoing pancreatic cancer treatment, they allow me to telecommute, which is very helpful, but every so often it is necessary to go in and coordinate activities face-to-face. For some discussions, there is more involved than mere technical detail, and it helps to have the give-and-take discussions in order to get things resolved quickly. One of the things I made sure to do was to have my supervisor read the radiologist's report from the latest CT scan, so that he has some hope of knowing what the short and medium term possibilities are. I am the electrical engineer who is designing some of the wonderfully complex electronics for a key piece of his current big project, and I try my hardest to make sure that he has not only all of my latest design files, but also every bit of insight I can give as to why things have to be this way. He needs to know this in case one day they call and say I didn't wake up, or that I am back in the hospital again. My employer has treated me as well as any employer ever could, and I believe it is my responsibility to return the favor and do whatever I can to make sure that my projects can be completed without me, should that become necessary. All it would take is for some part of that thrombosis to break loose and lodge in the wrong place, and I could be in the presence of Jesus my Lord in under five minutes. Yesterday evening Monica and I went out for a date (our 36th wedding anniversary is March 27th) and then after that we went off to both of our choir rehearsals. She is in the lady's octet, and they rehearsed before the main choir rehearsal. Besides singing, I also did the devotion for the choir, and by the time we got home at about 8:20 p.m. I just about had to be scraped up off of the floor to be put in bed. Every day I enjoy the day that the Lord gives me. Every day I enjoy the Lord who has given me the day. Feb 19, 2007 The Lord gave me another day to enjoy! Sunday was a lot of fun. I showed up for both church services, and sang at the later one. After all of that hustle to get to the early service, one of the other quartet members didn't show up, and so we didn't sing at the early service. Sunday School was great as usual – a wonderful opportunity to be with my favorite group of fellow believers. After church, Monica and I quickly headed home and got her set for a promotional event at La Strada (the fancy restaurant downtown), loaded up her vehicle, and set up with sample portraits and a computerized slide show of her work. Then I headed back to the house and collapsed for a couple hour long nap. After that there was a small supper, and then a return for the evening church service. After that, I washed up and headed off to bed. With the ongoing cancer and treatment, I just do not have the energy I used to. I cannot complain, though. I am still here and very pleased to be. The skin infection I dealt with last year has returned, and is just as pernicious as ever. Furthermore, the upper respiratory infection has held on since December. Chemotherapy can be expected to degrade the body's ability to fend off infections, and this is a prime example. I am going to see Dr. Foley (my GP) tomorrow, and I will discuss this with him. The other issue I am dealing with is that the Arixtra (blood thinner prescribed to help deal with the thrombosis in my inferior vena cava) is working sufficiently that I am dealing with an issue with nose bleeds. Furthermore, I have to give myself an injection of Arixtra every day, and the injection sites are bleeding a bit too, and then leaving rather ugly bruises. I am 15 days into a 40 day treatment with this stuff, and while I really hope it works for the intended purpose, the side effects are unpleasant at best. Having said all of that, I am still alive two and a half years after diagnosis with pancreatic adenocarcinoma, and that is remarkable. I have read enough about this disease, and met enough others who have been diagnosed with it to know that surviving this long is a great gift. I am very pleased. Thank you, Jesus! Feb 17, 2007 Weekends are very good things, as they usually allow me to catch up a bit on regaining some energy. So today I slept in a bit, and also had a nap mid-afternoon. Without the extra rest, there is no hope of feeling decent throughout the week. Tomorrow is a bit harder. On Wednesday evening I was asked to sing bass in a quartet on Sunday, and agreed to do so. Now when I was asked it was supposed to be for our 10:45 a.m service, at which I would be anyway as that is when our choir usually sings. But there was a message yesterday evening that now we will be singing at both services, and that there is an extra early rehearsal before the early service. I would love to sing, and will do so in this case, but I know I will pay the consequences for doing so. I can only run so long on adrenaline, and then I pretty much collapse. I love to sing, and take most any opportunity to do so, but I try to find out in advance what time commitment there will be, so that I can know whether to agree or not. I do wish that people would let me know in advance what is really expected, because dealing with the pancreatic cancer and the treatment has made it so that there is not nearly as much of me to spread around as there used to be. I have people tell me, “It is great that you have been cured!” Others tell me, “I hear you are in remission!” While this would be truly great, and I do feel so much better than I felt for much of last year, I have not been cured yet. Beyond that, the word “remission” is a technical term that the oncologist will use if and when I have been clear of cancer for about five years, and even if it were all gone, it would still be more than four and a half years away. No, what I have now is the opportunity to live one day at a time. If I can get up in the morning, I know that I have one more day, “today.” Today is the only day I get. Yesterday is gone and cannot be changed; Tomorrow may never come; but the Lord has granted me today, and for that I am grateful. The implication is that if something is important for me, I had better do it today. I cannot say that I will get to that yesterday, because I cannot go back and do yesterday over. I cannot in all honesty say that I will do it tomorrow, because it is only by the Lord's daily provision that there is a tomorrow, and then it only happens when tomorrow becomes today. So, as a cancer patient, all I have is today. But that would be true even if I were not a cancer patient, now wouldn't it? We all get one day at a time, if the Lord allows it. Feb 15, 2007 Life is good in so very many ways. I am being allowed to do things which I have wanted to do, which I had pretty much given up on being able to do. Last Sunday I did a solo in church for the first time in 30 years, and this coming Sunday I am scheduled to sing bass on a fast tune in a quartet. More fun! I am scheduled back into the rotation for teaching Sunday School (we are currently spreading the load between three people). As long as the energy lasts, I find it wonderful to be able to do this. As long as the energy lasts, that is. The exhaustion and the pain level are slowly increasing. With the chemotherapy the exhaustion is expected, but the spreading pain is not a good sign. Yes, pancreatic cancer is very aggressive, and yes it spreads, so I have to watch carefully to see what is going on every day. Beyond that, the skin infections are back, and I have been dealing with a respiratory infection since mid-December. Radiation and chemotherapy can hurt the immune system quite badly, and so fighting these infections is harder than it would otherwise be. So what now? I live day by day. The Lord gives me one day at a time just like everyone else. So today, while it is still today, I will happily serve Him with all there still is of me. He apparently still has things for me to do here, and as long as that is the case, here is where I will be. Feb 14, 2007 Exhaustion is the order of the day. With the cancer and the current set of medications, the energy level is very low. I feel weak, but mostly fine otherwise. There is stiffness, and increasing pain in the general area of the right kidney. I expect to make it to choir rehearsal tonight, but that is it. There will be no other activities. I have no complaints, though. I am still here, and the Lord is very good to me. Feb 12, 2007 This is being written from the infusion lab at Kirklin Clinic. Today is a chemotherapy day for me. Michael has “accessed” my port and drawn the blood samples (two vacuum bottles) and the blood tests have been done. Now I am sitting in the first recliner by the door, with a blanket to keep me warm (they keep this place downright chilly) and the little IBM ThinkPad computer on my lap. Kathy has hooked the initial saline solution injection up to the port, and now there is the inevitable wait for the pharmacy to mix the Gemzar (gemcitabine) with its dose of saline solution, so that can be infused over 90 minutes. This sequence of events has become rather routine since last June. I am privileged to still be alive after two and a half years with pancreatic cancer, and I suspect that this chemotherapy routine will continue on and off as long as I live. I am pleased to be able to continue to live and serve my Lord and Savior Jesus for however long He keeps me around. (Much later) Everything went well, and we are now back home in Guntersville. The chemotherapy treatments are pretty much painless, but sometimes, as today, they can be absolutely exhausting. By the time we got back I could barely stand up or keep my eyes open. So I crawled into bed for a two hour nap. After that I very slowly made supper, and we ate. So today has been successful, but at a great cost in energy. Part of this is because I just do not travel well any more. Part of this is because the Gemzar is quite potent stuff, and lays me pretty low. Part of this is because we had a very busy weekend, and used up all of my available energy before Monday even arrived. So I will head off to bed by probably 7 p.m., and sleep nearly twelve hours before tomorrow. By then, the energy should have returned, and I can do my telecommuting in order to pay the bills. Quite frankly, if this is the worst I see of cancer symptoms, I am most blessed. Feb 11, 2006 What a day. I really enjoy Sundays. Today the Lord allowed me to teach Sunday school, sing in the choir, and do a solo (for the first time in about 30 years). We ate out for lunch, came home, and after studying some in Paul's Epistle to the Colossians, I had a nap. After a light supper, it was back to church, and tonight we had our local quartet Four for Him sing for a while, and then Lulu Roman (remember her from the Hee Haw TV show?) came, gave her testimony, and sang for most of an hour. Wow! What a day! Tomorrow, very early, we will drive to Kirklin Clinic in Birmingham, for the first chemotherapy treatment of this next series. While it is not exactly fun, it is routine by now, as we pretty much know what to expect. The Lord sure is good to us! Feb 9, 2007 Chemotherapy begins again on Monday, February 12, 2007. Once again, I am scheduled to be given Gemzar (gemcitabine) which seemed to work the last time. I am scheduled to do this every other week for twelve weeks, when the results will be re-evaluated. I had asked Dr. Posey's nurse if she would be so kind as to send me the test result printouts, so that I might see them, and they arrived in yesterday's mail. In order to give all of the prayer warriors a better picture of what is going on, I have scanned them and turned them into pdf files. The CT scan report is here, and the blood test is here. When I spoke to Dr. Posey on Tuesday evening, he told me about what he thought was most important, and the reports fill in some gaps. There are a few interesting tidbits for those who can understand the medical terminology. The one I found most interesting in the CT scan report was the “new nonocclusive thrombus within the inferior vena cava.” That is a partial blockage of the big vein up the middle of the back, and that explains why Dr. Posey put me on the Arixtra blood thinner. If that blood vessel were to be blocked, it would mean an immediate trip to the hospital, as that blood vessel is the only way for the blood to return from the lower half of the body. This is treatable, but it is quite dangerous. On the second page, in the “Impression” section, point 2 summarizes “Increasing mesenteric adenopathy. Compared to June, multiple nodes have developed.” This would explain why I am being put back on chemotherapy. The lymph system is very susceptible to secondary cancer, and this is a sign that the spread is happening. On the third page is material that Dr. Posey did not discuss with me on Tuesday, but which I read as saying that there is increasing indication that things may be spreading to the lungs as well. Under “Impressions,” point 4 is almost humorous. The radiologist sees this as either cancerous, or I merely am dealing with pneumonia. Oh yeah. The blood tests are mostly within reason, except for the CA19-9 tumor marker, which is high. The other blood item I see is that the glucose is running at the top of normal range, which makes sense because I have only half a pancreas any more. There is always the risk, after a Whipple procedure, of having to deal with diabetes, because the pancreas is where insulin is produced. So that will have to be watched. So now there is something to pray meaningfully about. I am not worried, because I am absolutely convinced that the Lord has it all under control. I am His, and I live for Him. Yes, there are some bodily failures, but at least they are not moral failures. Whatever happens, whether I live here a long time, or whether I am called Home soon, I am satisfied. What He wants is what I want. So what do I pray for? I pray that He will glorify Himself through my life, whatever way that happens to take me. Thank you Jesus! Feb 7, 2007 The Lord has been very good to me indeed. I feel remarkably good, with just a bit of soreness in my back midsection. For someone who has been through all of this, I am extremely thankful. I had the CT scan on Monday, and yesterday evening Dr. Posey called back with the results of that and the blood tests. First of all, the CA19-9 pancreatic tumor marker is up to 94, which is higher than it was ever seen last year (it had topped out at 76 in August). The CT scan showed Mesenteric Adenopathy involving the Omentum. As he explained it, there are a couple of enlarged lymph nodes there, which seem to indicate a secondary lymphoma (secondary because this is the spread of pancreatic cancer, and not lymphoma). In order to combat this, he is prescribing at least twelve weeks of additional chemotherapy, using the same agent (gemcitabine) which was used the last time. I tolerate it well, and it seems to work. The bi-weekly chemo infusions will recommence as soon at they can be scheduled. The peritoneal tumor (soft tissue) seems unchanged from June, and the sclerotic lesion (bone cancer) of the right illium (pelvis) has not changed either. There is, however, an indication of blood clots in this area, and so he is prescribing a blood thinner called Arixtra. I will have to give myself daily injections of this. We checked with Buddy Bunch, our favorite pharmacist, and he indicated that Arixtra is one of those really expensive new drugs, and that he has never had anyone need it before, so it is on order. Dr. Posey noted that there is evidence of Fibrosis, which is a common side effect of the large doses of radiation and chemotherapy I have had during the cancer treatment. This could be the cause of some of the pain I have had, because it ties things together which are not usually attached, and thus makes it so that internal parts tug on one another, causing pain. So now I have gone eleven weeks without chemotherapy, and it appears that the gemcitabine was holding some things at bay, which have begun to grow as the chemotherapy was stopped. So now the treatments will continue, and we shall see what happens. I have no reason to complain. For someone who has been dealing with stage IV pancreatic adenocarcinoma, I am doing remarkably well. Feb 6, 2007 Yesterday was seriously long. I worked in my office as usual in the morning, and got a lot done. I made sure to finish eating by about 10 a.m., as the CT scan was scheduled for 3:20 p.m., and they ask that I not eat for five hours before the scan. I made a picnic lunch to take along, just in case things got crazy during the day. So at about 1 p.m. we started driving to Kirklin Clinic, in Birmingham, Alabama. The 75 mile trip was totally uneventful, and we arrived in plenty of time. When we checked in, it was obvious that they are remodeling the CT scan part of the radiology department, and the waiting area has been moved – I assume that they are trying to wring more working space out of a fixed amount of square footage in the clinic. After a very brief wait, I was called in, and given the usual large amount of water to drink before the scan. (Apparently they want to have the stomach and the first part of the small intestines “inflated” for the images.) The technician asked me the usual round of questions, and then I was called into the room with the CT scan machine. This machine is the latest model CT from GE, and is much smaller than the old ones. I climbed onto the sliding table, and the technician hooked up the IV (big stick!), and thetest was over in about ten minutes. The only semi-exciting thing about the whole event is that they pump in a large amount of “contrast solution” through that IV, and do it very quickly. For whatever reason, it immediately causes a “hot flash” feeling, and I feel like I am roasting for about one minute. The CT scan machine has a mechanical voice which tells the patient what to do: “Take a breath!” ... “Hold your breath!” ... “Breathe!” ... and all of this from a disembodied voice that sounds like the speaker is from near Chicago, Illinois. There is also a “Hold your breath!" smiley face (with cheeks puffed out) which appears where the patient can see it. I almost laughed when I saw it, but if I had laughed, I would not have been holding my breath, now would I?” Sot the scan was soon over, and we were free to leave. By now, it was time for rush hour in Birmingham, and we had already decided that rather than battling the traffic out of town that we would eat supper in Birmingham, wait around a bit, and leave for the 75 mile trip back to Guntersville after the big rush was over. So we headed down highway 280 for a couple of miles, stopped at the Brookwood Mall, and ate supper at Jason's Deli. After a leisurely meal, we walked down the mall for a ways, and spent about an hour in the Books-A-Million store. Each book store is different, and tells a bit about what the bookseller thinks will sell in this area. In this case, the most populous books were cookbooks, and they must have had 450 linear feet of them. I also checked out their technical book section, and there was a very small selection. As compared to the bookstores in Huntsville, this is just the opposite of what I would find. As I say, what they stock is what they think will sell, and I get the feeling that it says that food is a really big thing in Birmingham. After an hour looking at books, I was beginning to hurt rather badly, and so we left the mall and retraced our trip back to Guntersville. It was a bit slow, as the traffic out of Birmingham was only partly abated, but it went without incident. We arrived home by about 8:15 p.m. So now it is up to the radiologists to read the CT scans, and up to Dr. Posey to interpret what all of it means. Perhaps in a day or two he will let us know what is happening inside of me. Feb 5, 2007 This afternoon we will once again drive the 75 miles one-way to Kirklin Clinic in Birmingham, this time for a CT scan appointment. This is the CT scan that should have been done last week, except that the paperwork was not submitted to Blue Cross Blue Shield of Alabama for a pre-approval. Our prayer is that we get an accurate diagnosis out of this, since there is no real way to see what the pancreatic cancer is or is not doing except with a scan. The external symptoms do not tell the doctors much until things get way out of hand. The CA19-9 cancer marker gives some clue, but it is not particularly specific to pancreatic cancer. So we really do need an accurate scan and reading. Yesterday was most excellent. Sundays usually are. I really do enjoy being with those who love the Lord. I really enjoy singing the great hymns of the faith, too. More fun! Feb 2, 2007 The miracle continues. My respite from the symptoms of pancreatic adenocarcinoma is most welcome. That is a miracle, to be sure, but it is not the big miracle. It sure is a good thing Jesus paid the price for my sin, because if I had to just be “good enough” I would have no way to make it. I am aware of some of my shortcomings and failures, and am confident that there are a lot more that I don't recognize. In my own strength, I will never be able to be “good enough.” I need His help every day, all day long. But even if I never failed, that would not put God in my debt. He does not owe me a thing, but through His grace He has loved me anyway. He made me, He redeemed me, He sustains me all day every day, and He has saved me from certain death multiple times. I am His. What about you? He loves you too, you know. Life is a whole lot easier once you figure that out, and hand it all over to Him. Feb 1, 2007 Today we were called by the scheduling desk at Kirklin Clinic, to let us know when the appointment for the CT scan will be. Blue Cross Blue Shield of Alabama approved the scan, and so the clinic has scheduled it for Monday, February 5, at 3:20 p.m. While we would always prefer an early-morning appointment, it is necessary to get this scan done, so that Dr. Posey can evaluate what my actual condition is. So we will go in next Monday afternoon for just the CT scan, and then have supper there before heading back home. That way we will avoid some of the worst of the traffic. Why is this scan so important to me? Well, my last chemotherapy treatment was on November 27th, and through December I felt nothing at all – the pain was entirely gone. Now, there is a continually growing stiffness and low-level pain internally in the lower back right area, which corresponds to the area where that peritoneal tumor has been found since last June. If it is growing, then treatment needs to recommence in some form. If what I am feeling is something else, we need to know. Pancreatic adenocarcinoma is pernicious, and while it may sometimes respond to treatment, it can quickly get out of hand if there is no treatment. So we shall see what happens. Jan 30, 2007 I got to thinking recently about rationing healthcare, and quite frankly, it leaves me with a very uneasy feeling. If you look a my condition, and the statistics surrounding it, you can see how a rationing plan would probably affect me. I am over 55 years of age (read that as “old”) and I am dealing with a diagnosis of pancreatic adenocarcinoma (cancer). Now, someone who has a diagnosis of pancreatic adenocarcinoma is statistically extremely likely to die within less than four months, regardless of the type of treatment he receives. It would make sense, then, in any rationing system to not put resources into a pancreatic cancer case, because the patient is most likely destined to die quickly anyway. Everyone else I personally know who has had pancreatic cancer before me or since has already met their maker. My case, where I have survived two and a half years so far, with aggressive treatment, is very unusual.. In any rationing plan, at my age, after the diagnosis of pancreatic adenocarcinoma, the “authorities” would have logically determined that I was as good as dead, and the cheaper solution would have been selected, which is to say that they would simply call hospice, and not treat me other than to drug me so that I would not die in terrible pain. They would not have had to spend that quarter of a million dollars (so far) on me, because I would be determined to be not worth the cost. In short, they would have left me to die. As strange as Blue Cross Blue Shield of Alabama is (and they can be very strange at times) they have not just left me to die. The coverage is expensive to everyone who participates in their coverage, and after 53 years of being extremely healthy and thus costing them virtually nothing, I finally got the really big cancer and am costing serious money. Under this system, I at least am being treated with the hope that I will recover, a hope that is statistically unlikely, but seems to be within reach now. Under a rationing system (typically a state-mandated “single-payer” plan”) I almost certainly would have already been medically abandoned, as simply too expensive. So rationing healthcare may save money, but the tradeoff is that “grandpa” has to die, along with a lot of others who are simply “not worth saving.” Jan 29, 2007 Today is being spent at Kirklin Clinic, in Birmingham, Alabama. I have an appointment to see my oncologist today, and already it has been a bit of a run around. Everyone here is very friendly, which really helps deal with the issues. We arrived early, because we had not heard back about if/when there were lab tests scheduled. Our first stop was the lab desk in the oncology/hematology area, and they had my appointment listed, but no lab paperwork to tell them which blood tests to perform. The very nice lady at the desk sent us to the waiting room for the doctor, where we saw another very nice lady who checked me in, took the copayment, and volunteered to go back to see the nurse for the oncologist, in order to get the proper paperwork. In about fifteen minutes, she returned with the paperwork which says to do the normal panel, plus check the CA19-9 tumor marker. This is a good thing, as it is the only real sign whether there is any ongoing cancer growth. So from there we headed back to the lab desk in the oncology/hematology area, and picked up the labels for the blood vials. From there, we headed to the infusion area, for them to use my port to draw the blood. On the one hand, it would have been quicker to just have them draw it from my arm, but on the other hand, the port will plug up if it is not occasionally used, so we decided to have them use the port. So, what should I hope for today? Well, my hope is that the Lord will be glorified through whatever happens. Whatever happens, I am entirely satisfied that the Lord knows it all already, and has the best interest in heart. I am content to watch and wait. If the result is a trip through the valley again, so be it. If the result is a trip to the mountaintop, well that is fine by me. Something tells me that I will be told to wait... (Much later) Sharon, the chemotherapy infusion nurse, drew the blood using my port, and that went perfectly. The port worked the first time, and she had the several vacuum vials all filled in a jiffy. The process was nearly painless. The folks who work that lab are all pretty good, and Sharon is way above that high average. We got to see Dr. Posey about two hours after the schedule said. Even so, only part of the blood test report was finished; the regular blood tests were absolutely normal, but the CA19-9 tumor marker reading was not yet done. Furthermore, it turned out that Dr. Posey had indeed intended for there to be a CT scan this morning, but somehow the paperwork never was processed, so it never happened. So Dr. Posey had me take off my shirt, did the normal stethoscope tests, and that was the end of the exam. As we suspected might happen, there were no results to discuss. Even though there were open slots available today at radiology on their CT scan machines, since there had been no Blue Cross Blue Shield of Alabama pre-approval for the scan, that could not happen. The nice scheduling lady entered the request for approval for the next scan in the computer, and assuming that approval is received, then and only then will a schedule for a scan be made. After the CT scan is done, we are to call Dr. Posey's office to let him know to read the report, and call us with the results. Other than that, we now have a return appointment to see Dr. Posey three months from now. Health insurance: you can't live with it, and can't live without it. Considering that we are dealing with pancreatic cancer, which can turn around and kill you in just a few weeks, their approval process is amazingly irrational. I am so very glad that the Great Physician does not require even one approval from Blue Cross Blue Shield of Alabama. Jan 27, 2007 The miracle continues! After two and a half years of battling pancreatic cancer, I am so very pleased to feel this much better. My energy level is still rather low as compared to what it was before this whole cancer incident began, but I feel good, which is a real relief. The Lord continue to be so very good to me. This morning I was writing checks and paying bills, looked at today's date, and thought about what is peculiar about January 27th. It seemed important, but it took me a minute to remember the significance. On January 27, 1981, my mom died of the complications of lung cancer, at age 51. We sent her Home with her favorite hymns, and had a send-off party. Her future was assured by her Lord and Savior, and so while we missed her very much (and still do) we are confident of seeing her again when we finally are called Home. So it has now been 25 years since then, and now at age 55 I have been dealing with my own cancer for some time. While I am in absolutely no hurry to be called Home, it is good to know that there are those I know and love who will be there too. Yesterday we had a most unusual event. Monica was interviewed for a local TV station news program, on the subject of being an honest photographer. Apparently the news folks have been dealing with the case of a photographer in Northern Alabama who was failing to deliver pictures after being paid, and so they needed to interview a good photographer, and through an interesting series of events, they decided to interview Monica. She apparently presented herself very well, from what we have been told by those who saw the newscast. On the other hand, we have not seen that news segment, because we do not own a TV set (and haven't since 1989). Why not? Well, ours burned up in 1989 when the tornado came through Huntsville, and we never replaced it because we are too busy to watch it, and find that much of the programming is simply disgusting. Why pay good money to have that forced upon us? Jan 26, 2007 Note to prayer partners: Monica and I will be driving down to Kirklin Clinic in Birmingham on Monday, January 29, 2007, for an appointment with my oncologist, Dr. James Posey. If all goes well, there will be a blood test, and from that and my current small symptoms, he will determine what is going on. My midsection is a bit sore when I stretch or cough, and that is the total extent of remaining pancreatic cancer symptoms right now. There will be no CT scan this time, as none has been scheduled. Anything known in this case will come from the reading of the CA19-9 tumor marker, which has been as high as 76 last fall, and the last time it was measured had dropped to 30 (high in the normal range). Please pray that the test and diagnosis are accurate, as we need closure on this whole event. Today I drove to the Aegis office in Huntsville, and worked there all day. After getting up extra early, doing a full day's work, and commuting both ways, I am exhausted. I am very glad that most days I can telecommute, because it cuts the energy drain significantly. Today was amusing in one way in that my company supplied computer, which had died with smoke last week, is off for repair leaving me to use a computer I supplied. I keep a Linux-based computer on the table behind my work desk, and it does what I need to do without ever having to run Windows. I like that. It is good not to have to pay the Microsoft tax in order to get my work done. Linux meets my mother's cost criterion. She said, “For free, take; for money, waste time.” She has been gone for 25 years now, and many of her cultural assumptions will be with me until the day I join her in heaven. Monica and I are busy planning the 40th anniversary of our first date, which will occur on March 11, 2007. We are hopeful romantics of the first magnitude, and are wonderfully enjoying our unexpected extra time together. On March 27th, we will then celebrate our 36th wedding anniversary. We have every reason to celebrate. Jan 23, 2007 The miracle continues, and I am still doing very well. There is some residual soreness in the lower back area, but other than that, there are no symptoms left. I have an appointment with the oncologist on Monday January 29th, but apparently there will be no scans or anything for him to see. Monica spoke with the scheduling person, and she indicated that she had no record of anything being sent to Blue Cross Blue Shield of Alabama for approval of those tests, and so there is no chance of them happening as far as I can see. Well, if the CA19-9 cancer marker continues to drop, then that may tell us all we need to know. That is worth praying about. I have been spending entirely too much time this past week fixing computers. The systems we use for the photo business are now about five years old, and have been one-by-one failing in most fascinating ways. Since these are business systems, we have to quickly get them going again, and as the resident geek I get the task. It is time consuming, and requires replacing things. In the case of Monica's main computer, in the last six months I will have replaced everything except the case and the floppy disk drive. Ugh. I am so very glad that my salvation is not entrusted to a computer like any of these! It pleases me to be able to work nearly full time once again. I enjoy what I do (designing electronic devices) and I work with great peoplefor a most excellent company. The contrast with being very sick is major, and I am very thankful to be back in the land of the living. Pancreatic cancer is a terrible thing, and after being told I had just a few months to live, multiple times, I am still startled at this recovery. “One day at a time.” I get one day at a time, and that day is today. Yesterday is done and I cannot change it. Tomorrow is still out of reach, and I do not know what it will bring. But today I have, and this is my opportunity to make all of it that I can. I thank Jesus for one more day - today. Jan 21, 2007 Today I was able to teach in our adult Sunday School class, for the first time in nearly a year. This is “Sanctity of Life Sunday” and I was given the charge to teach on this subject. I find that I get rather emotional, and meddle thoroughly when I teach in Sunday School, and today was no different. When it all was done, and my time was up, I closed with a prayer from the Book of Daniel. It seemed to me that we as a nation have a lot to repent of, and to confess before the Lord, and this passage seemed to fit. Now, this prayer is aimed at a specific place and time, but the spirit of it is exactly that with which we need to approach the Lord, as we deal with the outrageous behavior which we see all around us in this nation. Here is the prayer of Daniel: Daniel 9:3 So I gave my attention to the Lord God to seek Him by prayer and supplications, with fasting, sackcloth, and ashes. 4 And I prayed to the LORD my God and confessed and said, “Alas, O Lord, the great and awesome God, who keeps His covenant and lovingkindness for those who love Him and keep His commandments, 5 we have sinned, committed iniquity, acted wickedly, and rebelled, even turning aside from Thy commandments and ordinances. 6 Moreover, we have not listened to Thy servants the prophets, who spoke in Thy name to our kings, our princes, our fathers, and all the people of the land. 7 Righteousness belongs to Thee, O Lord, but to us open shame, as it is this day-- to the men of Judah, the inhabitants of Jerusalem, and all Israel, those who are nearby and those who are far away in all the countries to which Thou hast driven them, because of their unfaithful deeds which they have committed against Thee. 8 Open shame belongs to us, O Lord, to our kings, our princes, and our fathers, because we have sinned against Thee. 9 To the Lord our God belong compassion and forgiveness, for we have rebelled against Him; 10 nor have we obeyed the voice of the LORD our God, to walk in His teachings which He set before us through His servants the prophets. 11 Indeed all Israel has transgressed Thy law and turned aside, not obeying Thy voice; so the curse has been poured out on us, along with the oath which is written in the law of Moses the servant of God, for we have sinned against Him. 12 Thus He has confirmed His words which He had spoken against us and against our rulers who ruled us, to bring on us great calamity; for under the whole heaven there has not been done anything like what was done to Jerusalem. 13 As it is written in the law of Moses, all this calamity has come on us; yet we have not sought the favor of the LORD our God by turning from our iniquity and giving attention to Thy truth. 14 Therefore, the LORD has kept the calamity in store and brought it on us; for the LORD our God is righteous with respect to all His deeds which He has done, but we have not obeyed His voice. 15 And now, O Lord our God, who hast brought Thy people out of the land of Egypt with a mighty hand and hast made a name for Thyself, as it is this day-- we have sinned, we have been wicked. 16 O Lord, in accordance with all Thy righteous acts, let now Thine anger and Thy wrath turn away from Thy city Jerusalem, Thy holy mountain; for because of our sins and the iniquities of our fathers, Jerusalem and Thy people have become a reproach to all those around us. 17 So now, our God, listen to the prayer of Thy servant and to his supplications, and for Thy sake, O Lord, let Thy face shine on Thy desolate sanctuary. 18 O my God, incline Thine ear and hear! Open Thine eyes and see our desolations and the city which is called by Thy name; for we are not presenting our supplications before Thee on account of any merits of our own, but on account of Thy great compassion. 19 O Lord, hear! O Lord, forgive! O Lord, listen and take action! For Thine own sake, O my God, do not delay, because Thy city and Thy people are called by Thy name.” Jan 19, 2007 Yesterday I drove the 45 miles into the office in Huntsville, and worked there for a change. The company-supplied computer died yet again – this time emitting acrid smoke as it went dark. That computer has died one way or another at least three times in the last month. Fortunately I keep one of my own computers at the office (running Linux – but that is a subject for some other blog!) and was able to continue working with only a small disruption. While I was there, my supervisor and his supervisor agreed that I can be put back on the 32 hour per week schedule that I have been on for much of the last year. I had been put back on a 40 hour per week schedule, but it appears it was due to a database corruption in the payroll system, and not intentional. So I can still be able to go to Kirklin Clinic for appointments and not have to take sick leave to do so. This is a Very Good Thing. For someone with medical issues, it really helps having a decent and more than reasonable employer. On the way home, I stopped at the really nice grocery store I pass on the highway, and picked up materials for our Saturday event, when we will have a friend over for supper. He is here without his wife (who is staying behind in Virginia until the school year is over) and so this is an opportunity for hospitality. It is good to be able to do this sort of thing again. The Lord has really blessed us in a big way, and I am so pleased. Thank you, Lord Jesus! Jan 17, 2007 Today is a regular work day, and I am doing regular work things, but from home. My employer (Aegis Technologies Group, headquartered in Huntsville, Alabama) allows me to telecommute most of the time (Bless them!) which cuts down on the drain on energy that a 90 mile round-trip daily commute involves. They also have arranged for me to have a 32-hour work week, with full benefits, which helps also. This provides the time for medical events (doctor appointments, chemotherapy treatments, tests, or whatever) without having to take the limited amount of sick leave to do so. Besides this, they have a particularly stellar medical insurance plan, which has allowed me to go through test after test and treatment after treatment without breaking the family financially. That brings up an interesting point. Treatment for pancreatic cancer is expensive. My Whipple procedure had me in the hospital for a week, and cost about $140,000. Each CT scan cost about $3,500. Each radiation treatment (there were 28 of them) cost about $1,000. Each chemotherapy infusion cost about $1,900. Last year's week-long hospital stay where they did three endoscope treatments cost about $26,000. All of this was for someone diagnosed with pancreatic adenocarcinoma, who was not expected to live six months. This adds up to some seriously big numbers. For my first 53 years I was amazingly healthy, and my medical costs were next to nothing, and then with one illness I have so far cost more than $250,000. I have to wonder if I am worth that much. The Lord continues to bless us. The miracle continues, and I am feeling very good indeed. There may indeed be life after pancreatic cancer! Jan 14, 2007 Today has been simply wonderful. I am so thankful to be able to do all of this again. The Lord has singularly blessed me, in returning me to the land of the living. Early in the morning I put a boneless turkey breast roll in the crock pot, so that we can have turkey for various meals over the next few days. Then, this morning we had Sunday school and church, and then a lunchtime surprise 60th birthday party for a good friend from my Sunday School class. I made an experiment to bring for the lunch - orange rolls, using a recipe I made up on the spot. Someone must have liked them, because the tray was empty by the time we cleaned up. After all of this there was time for a Sunday afternoon nap, which really does help make it through the week. Next, I got the turkey out of the crock pot, cut it up, and cleaned up. Monica made us a small supper, and then we went back to church for the evening service. After that, I was on my ham radio for a while, and then retired for the evening. Now, reading the above, you can see just how good the Lord has been to me. Several months ago, due to the ravages of the pancreatic adenocarcinoma, I was in terrible pain, and could barely get around. Today I feel great, and am back to using every waking moment to do something. You can easily see just why I am so very thankful. Thank you, Lord Jesus! Jan 13, 2006 I really do wonder just what happened to make the pancreatic cancer pain go away. Yes, this was a miracle sent from God, and I am very thankful for that. But as a certified westerner, and an engineer, I cannot help but wonder what the mechanism was. In this day and age, most of us cannot leave a mystery alone, but have to pick at it to see what makes it work. Until the medical tests and scans are done and interpreted at Kirklin Clinic (late this month or maybe next month) I have no way to know what exactly happened. I would like to know if the cancer went away, or whether it is simply pain relief regardless of what else is going on. And then again, maybe I will never know in this life, because some medical things are not really explainable. One thing I am still having to watch carefully is what I eat. After the chemotherapy, I still cannot stand even the though of fish. It consistently makes me ill. Some things, such as pork, tie my digestive tract up in knots. Chocolate reduces motility to near zero, and causes serious pain. So now I am eating beef, chicken, and turkey in moderate amounts, and am eating salad with virtually every meal. I suppose the whole diet is actually healthier this way, but it does require some thought, especially when eating out. I am still working on putting my house in order, in spite of getting a whole lot better. Whatever else happens, doing so helps. If I live a long life, then I get to enjoy having things well-organized. If I have a short life, it makes things easier for Monica. It is interesting to make the lists of “stuff” that I would know all about, but she would not, and for each item list what it is, what it cost, when it was bought, and what it might sell for today. This is “stuff” that I can use while I am here, but will leave behind whenever I am called home. Someone else gets it. That is one of the interesting parts of being called home. The “stuff” does not matter at all any more, and someone else gets it all. It puts the priority on what I have heard called “sending it all ahead.” That means doing things today which are useful for the Jesus. That is where I want to put my emphasis while I am still here. Jan 12, 2007 The miracle continues! Jan 10, 2007 Yesterday afternoon we received a call from my oncologist, Dr. James Posey. After some discussion, he told us that he will arrange the next set of blood work, CT scan, and perhaps a PET scan as well. The results are necessary to determine just what has happened, and what is going on now. All of this may or may not coincide with the next appointment at Kirklin Clinic, currently scheduled for January 29, 2007. In any case, the results of the tests are necessary so that he can know what further treatment, if any, is advisable. Dr. Posey made an interesting comment. I had noted that I was so glad that most of the terrible pancreatic cancer symptoms had gone away, and that whatever that really meant, that I was very pleased about it. He replied that, statistically, about 25% of pancreatic cancer patients die of the symptoms directly, as opposed to the action of the cancer, and that yes indeed it was a good thing to have that relief. Having been through some of the possible symptoms, I can see how this is probably true. So now all of the timing is back in the most gracious hands of Blue Cross Blue Shield of Alabama, who will, in their own sweet time either approve or disapprove the scans. Until they do, everything comes to a full stop. Jan 9, 2007 Last night, Monica reminded me that I need to not take on too much in the way of outside duties for a while, and she is quite right. During the last two and a half years, many necessary things have been delayed, and I need to make absolutely sureto get caught up on them before I add to my load. When I feel really good, there is a part of me which wants to go and do it all, but I really should know better by now. There is another matter, and it is that we really do not yet know what has happened. The visible changes have been very good. Who can argue with a lack of pain? This is great! However, we do not yet know what has happened. After two and a half years of fighting pancreatic cancer, I know full well that anything can happen, and that things can change very quickly. I also know that what I feel is not necessarily a totally correct indicator of what is going on. The fact that the pain is gone can mean any of several things, not all of which are indicative of long term health. I am very thankful to the Lord for the respite from the pain, whatever that may mean. This has been the best Christmas ever for us, I can assure you. I am confident of the Lord's love and presence now, more so than I have ever been. So whatever happens, I am satisfied. I am His, and that is enough. Jan 8, 2007 Richard Moebes recently asked me if I was disappointed at not getting to go Home last fall, as everyone thought might well happen. It is an interesting question, because the answer tells a lot about what I believe. I told Richard that, no, I was not disappointed because I am confident that the Lord will call me Home when the time is right, and that the fact that He has left me here tells me that there is still more for me here. Perhaps that “more” is what I need to learn; perhaps that “more” is someone I need to influence; and perhaps that “more” is something I cannot imagine. I am satisfied with His will in the matter. What He wants is what I want. I am reminded of the Apostle Paul, who stated in 2nd Corinthians 5:5-9: “Now He who prepared us for this very purpose is God, who gave to us the Spirit as a pledge. Therefore, being always of good courage, and knowing that while we are at home in the body we are absent from the Lord - for we walk by faith, not by sight - we are of good courage, I say, and prefer rather to be absent from the body and to be at home with the Lord. Therefore also we have as our ambition, whether at home or absent, to be pleasing to Him.” So, yes I am looking forward to being at Home with the Lord, but more than that I seek to please Him in all that I do. I am satisfied with His timing in all things. One thing I have learned is that He does indeed have our best interest at heart, and that I can trust Him completely. Truly our Lord shows His love to us in every way. Jan 7, 2007 Today has been very good indeed. I really do enjoy Sunday, and this one was even better than many. It looks like I may indeed have the opportunity to return to teaching occasionally in my normal Sunday School class, which would be a treat. Our choir (I sing bass) sang a fun piece, which got a great reaction. After a two week hiatus, we are back to having Sunday evening services, and this one was simply wonderful, with duet keyboard music played by Sandra and Kay, lots of familiar hymns to sing, and a great sermon from 1 John. I was asked if I could help out with Christian Men's Job Corps, and that brings up some interesting possibilities. Steve, who asked me, was not aware that I also have a full time job (he thought I must be retired by now) and so I probably will not be able to do the big job he initially asked me to do, but there are other things where I may be able to be involved, given the amount of time I actually have available. We shall see how this works out. In the meantime it will be a subject for prayer. Many people commented on how good I look. This is somewhat humorous to me, in that as an aging bald guy, the concept of looking good is rather far from my consciousness. On the other hand, yes indeed a I look very much alive right now, as opposed to the nasty shade of gray I was three months ago. The color difference is remarkable all by itself. The miracle continues. The Lord has been so very good to me. Thank you, Jesus! Jan 4, 2007 Today, Monica succeeded in getting at least a preliminary appointment for me with my oncologist, Dr. James Posey, at Kirklin Clinic in Birmingham, Alabama. After the first chemo treatment in December, it was kind of like we dropped out of their awareness entirely. There were no new appointments for anything – no more chemo, and no follow-up. Phoning their number and asking to be called back simply did nothing. OK, it was approaching the Christmas period and some people may have been on vacation, I understand, but still it is strange to have no one call back at all. The new appointment for January 29th is contingent upon getting approval from Blue Cross/Blue Shield of Alabama (BCBS) for a CT scan. BCBS has decreed that CT scans more often than 90/120 days (no one seems really sure which it is) are wasteful, and so since my last one was on October 30th, this is about the first tentative opportunity. In my situation the doctor is not sure what is going on, and the scan is really the only way to achieve any visibility inside to find out. Now BCBS has taken it one step further, and has outsourced the approval process to an outfit with an office in New York. Something tells me that this is a front for an offshore office (India? Bangladesh? Zimbabwe? Who knows?) in order to cut costs further. In any case, past experience with this particular outfit has shown that there is absolutely no hurry to make decisions, and if they decide against you, well it is just too bad. So that January 29th appointment really is very tentative indeed. Until the scan is run and the radiologists read it, there is absolutely no sense in tying up Dr. Posey's time. Blood tests alone will not tell him enough to say anything with certainty. We have been there before, repeatedly. The October 30th 2006 scan showed that the peritoneal tumor (or scarring from where it died – no one is sure) is still there, wrapped around the blood vessels up and down my back, and into the kidneys. The sclerotic lesions (bone cancer) signs were still there on my pelvis, and there were signs of spread to the lower area of the lungs. But every comparison the radiologists made was to much earlier CT scans, before the last big cancer incident, so we have no idea what the significance of the findings is. In the meantime I feel fine. There is a bit of residual abdominal soreness, but not even enough to take a Tylenol. So the miracle continues, and I am very grateful for that. Anyone who has been through major cancer pain will appreciate how wonderful it is to have it vanish. God is good! Jan 3, 2007 One of the hardest things I do is field questions from fine folks whose loved ones have pancreatic cancer. I am not a doctor, and all I can do is tell them what I have found worked for me, and that is not necessarily much help. It is hard for these fine folks to deal with the pain of seeing a loved one that sick, and getting sicker by the day, with no recourse. I simply pray that the Lord will help them through this. I can say for my own sake that I am satisfied with whatever the Lord has in store for me, but I fear that if I wish that for someone else that they will be hurt by that statement. I know that at some point the Lord will call me home, and I am ready to go – but not everyone is ready to go, and most certainly most people are not ready for their friends and loved ones to go. This is a very painful thing, and there are no good words to minimize this. As strange as it may seem to some people, it is harder to deal with the passing of a loved one than to deal with one's own passing. I hope to be able to say the right thing at the right time, and to be silent when that is called for. The miracle continues here. There is a bit of residual soreness when I inhale all the way, or when I stretch in some unusual direction, but that is the sum total of all of what I can feel wrong. After the pain of the last year, this is a most welcome relief. It is such a major change to be able to lie down flat and not hurt at all. We still have no word from the oncologist about when the next checkup will be, or if there is anything else they want to do. At some point, there will be more blood tests and another CT scan, but before that anything that the good doctor says is basically conjecture. The Lord has been absolutely wonderful to me. I am so very blessed. Jan 1, 2007 Some Thoughts for the New Year I never thought I would get to see this day. The Lord is good! Other people have new year's resolutions; I have a new reality. Having been saved by the Lord from certain short-term death from pancreatic adenocarcinoma, I know even better that I am His. So what shall I do about it? The first realization is that there are a lot of things I have been spending time on which really do not matter so very much now. Yes, I still need to do the things which are necessary to live, to pay the bills and such. But beyond that, what is important enough to replace my past activities? It is much like the concept of having been not just set apart from something, but set apart to something. The first part is fairly obvious, and latter one is much less so. The matter at hand is not somehow what should I give up, but rather what should I be doing. Where shall I be headed? The answer is not yet entirely obvious, but we continue to seek it. One realization is that I should live more lightly in this world. What I mean by that is that I need to not form such attachments to things and situations, things which are of this world and may change at any time. As a citizen of heaven, why should I be so very attached to these things around me? I most certainly cannot take any of this material world with me (not that I would want to, quite frankly) to my Heavenly home, so there is no reason to be overly concerned about “stuff.” Another realization is that I now know for sure that I want what Jesus wants for me, whatever that may be. I am assured that He has me very best interests in mind, so why should I get all willful and want or work for something other than what He has in store for me? That would be crazy. Assuming this life to be a brief warm-up and learning experience for eternity, then it would make sense to learn the lessons put to me, and recognize them for what they are. He intends to bend me to His shape, and I need to be willing to be bent. This week I was reading in a commentary about the First Epistle of Peter, and the author made the point about our tendency to want to hang on to certain things in our lives, even after the Lord has saved us. He called them our “special sins” and pointed out that Peter was urging his readers to rid themselves of these. So my question for myself is whether I have put my all on the altar, so to speak. What is there in my life which needs to be weeded out, that stands between me and a closer walk with Jesus? I want to see it for what it is, and be rid of it quickly. Once again, what He wants is what I want, and I have every bit of confidence that He will help me with this. I really enjoy singing for my Lord, and have led choirs at several churches in the past. Right now singing makes good sense, but not music leadership, as I am really not well equipped for that. I never was a music major, and the cases where I have led in the past have been cases where there simply was no one else who was willing to lead, and I felt led to step into the breech and do what no one else would. This is not that situation. I enjoy teaching Sunday School and Bible classes, and the response has been uniformly positive when I have done so. I have the gift of teaching, and I have known it for about 25 years. I attended seminary many years ago (and did not graduate because I was too poor at the time to finish) and have all of the resources I need to do that. So that is a much more likely place of service, when the Lord provides the opportunity. We shall see. In any case, I want exactly what the Lord wants for me. I do not know the way yet, but I have confidence that He will guide me exactly where He intends me to serve. But what if I should get sick again? Well, so what? The Lord has brought me this far, and He will bring me Home when he chooses to do so. My part is not to second guess Him, but rather to follow and live for Him. That is a real opportunity. Dec 29, 2006 The miracle continues, and gets better day by day. Thank you, Jesus! Dec 28, 2006 It is good when we get visitors. We love to have our favorite people come and see us, and we do our best to make them feel at home. We also enjoy it when people go home, as we have come to enjoy ourselves, just the two of us, since we have lived long enough to have that opportunity again. We know how blessed we are to have this opportunity, as so many have relatives or acquaintances who live with them until their last days. We are both still alive, now we are both doing well physically once again, and we are very happy together. Life is good! Our daughter Marie left for Dallas this afternoon, first driving to Birmingham, and then flying to Dallas, and then driving some more to her home (which is actually in Plano, which is near Dallas). She packed up the Christmas presents so that she would have less to carry on the plane, and sent them to her address in Texas. We really enjoyed having her here. Life is very good indeed. As the chemotherapy recedes into the past, I feel better day by day, as the chemo is no longer reducing my blood count. It is great not to feel anemic all the time. God is sure good to us! Dec 27. 2006 Today was an adventure. We had very welcome visitors, who drove about seven hours from Greenville, South Carolina, to get here and then after staying for a few hours, drove right back. My cousin Connie Evans and her mother (my aunt) Joan Martin came to visit and to check out the miracle, and we all had a great time. It is good to see such fun relatives. We talked non-stop for their entire visit, and caught up on all sorts of family matters. Now Auntie Joan actually lives in South Bend, Indiana, and had driven twelve hours to get to South Carolina. With Marie here from Texas, it was quite a gathering. More fun! Dec 25, 2006 Merry Christmas! Yesterday I told my Sunday School class that it was worthy of note that, after a major miracle, I do not find myself thanking that fictional character Santa Claus. No, rather I find myself praising the Lord God Almighty, who made me, redeemed me, sustains me, and has this year saved me from an immediate and nasty death of pancreatic adenocarcinoma. Accept no substitutes for the real thing. We don't want Santa, we want Jesus! Last night our own church cancelled services, and so we went off to visit some fine friends in Huntsville, and enjoyed their 6:30 p.m. Christmas Eve service. That was a fine event, with lots and lots of Christmas carols, a great little children's choir, a fun children's sermon, and an excellent message for the adults. Combine that with the opportunity to see many friends whom we have not seen much since we moved from Huntsville, and it was a fine evening indeed. The miracle continues, and I am continuing to get better. I am still startled by this recovery from certain short-term death. I am hoping that the Lord has something useful for me to do while I continue here, as this recovery has redoubled my devotion to Him. Happy Holidays Cool Yule Great Solstice Wonderful Retail Money-Making Event Super Santa Claus Day Merry Christmas! Dec 24, 2006 Our daughter Marie arrived noonish after a flight from Dallas to Birmingham, and a drive from Birmingham to Guntersville. We always enjoy her visits. Tonight Monica and Marie plan to finish decorating the tree, which is upstairs this time. For the last several years, all of the decorations have been downstairs in the photo studio (we live over the store, and have a commercial photography studio downstairs). It has been very pretty and all of that, but we have had to not use any of the glass ornaments because of the risk of injury to small children in the studio. So this year there is a little photographic prop tree in the studio, and the big one is upstairs where the customers never get to go. This should be fun. This morning we went to Church and Sunday School, and had a wonderful morning. The choir in which we sing did a fun Christmas anthem. We cannot help but sing, and so this was an opportunity to enjoy. It is interesting to be up front, and sing, where we can see the entire congregation. Some folks obviously enjoy, and others not so much, but we have the opportunity to try to connect the message with the hearers, and sometimes, like today, it seems to really work. Many thanks to everyone who has prayed for us during the recent medical trials. The Lord has answered your prayers in a remarkable way, and Monica and I are most blessed that you all cared enough to make it a priority. It is great to be back among the living. Dec 20, 2006 The miracle continues! Yes, things are getting even better, day-by-day. I do not know what tomorrow will bring, but today is great. The Lord has been so very good to us! Today is my last work day of the year. My employer (Aegis Technologies Group – a great place to work) has next Monday and Tuesday as holidays. There are two discretionary holidays per year, and I am taking one of those (Wednesday). Since I am working 32 hours per week, all I need is one vacation day to complete next week. This week I will take Thursday as vacation, and once again at 32 hours per week I would have Friday off anyway. Monday, January 1st is a holiday also. So, I can take two days of vacation and have 12 days off in a row. Such a deal! Tonight we plan to go carrolling with the choir. We will meet at the church and leave from there. When Monica asked me what I wanted for Christmas, I told her that I wanted to sing, and I get exactly that this year. This is a Very Good Thing. Dec 17, 2006 Yesterday evening, Monica and I attended our Sunday School Christmas party. It was a fun event, with the opportunity to get to know people better. I appreciate the opportunities to do this. So often, as church members, we get used to an “everyone shut up, face forward, and just listen to the leader” mode, and while that may be an acceptable way to disseminate information, it is no way to learn to love one another. I have come to really appreciate the opportunities be be in the lives of our friends, and to get to know them so much better. That way there is some hope of being able to help one another, because it is only through knowing each other well that we can discern their needs. Once again, I am having a wonderful Sunday. We started out with Sunday School and the later church service this morning. This evening we have the Christmas program, and our choir is a part of that celebration. This is where I want to be. After a very wild year, I am extremely grateful to once again be able to participate in worship, and especially to do so through music. Dec 15, 2006 The Problem with Miracles – or – So I Will Die Anyway Modern day miracles are hard things for us to deal with. We know they happen, but being skeptical modern people we cannot just accept them. There has to be something, some root cause, which we must understand. Faith was great for our grandparents, but now we know better, and have to have a rational, scientific explanation for everything. That is how our western culture is rigged. We think we have to know it all. So, I have had an obvious miracle happen to me. While two months ago I was rapidly dying of pancreatic adenocarcinoma, today I am doing better than I have in years, and there is no good rational, scientific explanation. The oncologist cannot point to any reason why this should have happened, but it has. Now, it could be claimed that good doctoring made this happen, and I will be the first to admit that I went to the best facility I could find, and had the best doctors available. The care has been stellar. And yet I was told that this chemotherapy treatment I have been undergoing (statistically speaking) might extend my life by six weeks. That was all they could hope for. So now that things are going so well the oncologist simply calls what happened “highly atypical,” and I am positive that he is right. What has happened never has happened in his experience. So, I am the beneficiary of a scientifically unexplainable event, which I will call a miracle simply because that is the best word I have for it. How it happened I cannot tell you. So today I am feeling better than I have in years, and am most pleased. I happily attribute this “miracle” to my Lord and Savior, whatever anyone else may say. I am most blessed, and I know it. OK, all that is well and good, but I have news for you. I am going to die. Even after the miracle, I am still going to die, if not this year or this decade, then soon enough. That is the peculiarity of the miracle – this return to life is still only a temporary thing. Every one of us faces this issue: we are mortal, and even given that miracles do happen, we are still going to die, if not this year or this decade, then soon enough. Nevertheless, that does not minimize the miracle at all. I have been given so much more time (and how much time I have I do not know) and now have the responsibility to use it wisely. I have been spared this time, and now with my eyes wide open I can make the next set of choices which will shape what I am yet to become. So, I have had this miracle. I was as good as dead, and now am alive. But what if I were to get sick again tomorrow, and I quickly die of it. Well, so what of it? To quote Job on the matter, “The Lord had given, and the Lord has taken away. Blessed be the name of the Lord.” He is no less Lord if I live a short life than if I live a long one. I am content to serve Him, and to glorify Him through my life and death, in and under any circumstance. He made me, He redeemed me, He sustains me, and He saved me from a certain death this year. I am His. When I am done here, He has promised to take me Home with Him. So how can I possibly lose in this deal? I am content to be His, and leave the entire matter in His hands. So, no, I am not worried that the miracle is somehow incomplete, because the real miracle is not that I have recovered from a certain near-term death of cancer. No, the miracle is that the Lord would love me, and claim me for His own. So I ask the question, “Why me?” Why would He love me so much? I do not know the answer to that question, but I trust Him fully, and know that whatever is in store for me is entirely consistent with His love. He loves you too, you know. Trust Him for everything. Dec 14, 2006 Last night I went to choir rehearsal, and enjoyed it as always. We have a wonderful substitute director who is only supposed to stay until the end of the year, and so I have to wonder who will follow that. He suggested I might have to do that next, and that is more of a challenge than I would know what to do with right now. Yes, I have been choir director for three other churches over the years, but that is a big job, and one which takes a whole lot of work. There is a search committee for a new permanent minister of music, but there is no telling how long that is going to take. We shall see what happens. For now, I am so glad to be able to sing again. This morning I got going early, and put a pot roast in the crock pot, first thing in the morning. It is nice to know that supper will be ready this evening, and that we have little to decide about what to eat. By noon, the aroma will be overwhelming. For those who may not know this, I spend most of my days sitting in front of a Computer-Aided-Drafting (CAD) system, doing electronic design. It is a very good thing to have lots to do to occupy my mind, as well as to pay the bills. Working at home, it also makes it possible to go in and turn the crock pot down to low once the liquid reaches a full running boil. Once again yesterday, our calls were not returned from the Kirklin Clinic oncology department. Their phone system is set up to take messages, and have them call you back, which is fine when it works, but is frustrating when there is no reply. There has been no reply after several calls over the last two weeks. I am not terribly concerned, but Monica is not going to just let it go by. Last night she told friends at choir rehearsal that today is the day she will call patient services, to see if she can get answers. I will simply stand by and watch now. My condition continues to improve. I feel great now, and the strength is returning. The appetite is definitely back, and now I have to watch what I eat so as to not overload my limited digestive tract. The Lord continues to bless us wonderfully. Dec 13, 2006 This would be humorous, if it were not important. We have noted that the fine folks at the oncology department at Kirklin Clinic have stopped returning our calls. We can accept the fact that they do not know right now what to do with me, since my amazing recovery is apparently completely atypical. However, there is still at least some measure of responsibility involved to, at the very least, follow up and see what has actually happened. I do hope that they will not simply ignore this. One challenge right now is to figure out how to eat. After that Whipple procedure in October of 2004, my digestive system is very much shorter and strangely arranged. The recovery from the pancreatic adenocarcinoma has not changed this fact. The new arrangement has made it so that I can eat about half what I could before, at any one time. I should probably just accept that fact, and get skinny, eating half what I used to. But eating out is a problem. Have restaurants given up on the entire concept of portion control? The typical servings are huge, and even under more normal circumstances are more than I would normally choose to eat. So, for instance, last night we went out and asked for our dinners to be accompanied by take-out boxes, so that we could put half of dinner in the box before even getting started eating. Even so, the half that was left was still more than is reasonable for me to eat. Maybe next time I should ask for two take-out boxes, and portion it into thirds, and eat just one third of it at the restaurant. I would almost certainly feel better that way. Dec 11, 2006 What is unusual about this Monday? If you carefully check my past postings, you will see that this would have been the day for my usual chemotherapy treatment, but today there is none. I am very happy not to go, I can assure you. As very nice as the staff is at Kirklin clinic (and they are stellar) it is great to have this week off. OK, now why do I have this week off? Well, it would seem that Dr. Posey is not sure what to do with me now that I am getting so much better. No one ever recovers this way from stage IV pancreatic cancer, and so there is no pre-established script as to what to do in such a case. I have a couple of calls in asking for some sort of an answer as to what they want to do (if anything) and would be perfectly happy to be told not to come back until a month or two from now for another blood test and CT scan to see what is going on. But as of right now, there is no answer. I am so very blessed! The Lord has done an amazing thing, and no one really knows what to do about it. I will simply be vocal about it: We have a Lord who is alive, well, and doing most interesting things to get our attention. Thank you, Jesus! Dec 10, 2006 Ah, how I enjoy Sunday! Today we went to our usual Sunday School class, and then changed into our choir robes and sang in the choir for the late service. It is so wonderful to be able to sing the praises of our Lord once again. After that we made lunch from the leftover roast and trimmings, and then it was time for the obligatory Sunday afternoon nap. Then there were cookies to bake (the favorite chocolate chip recipe that my Mom always made) and some more relaxation. Marie called us this evening, and confirmed her itinerary for her visit over Christmas. We are thankful that she comes this far. Maybe soon we will be able to reciprocate and visit her again. What was out of the question a couple of months ago is now looking like it may be perfectly reasonable to do. Marie noted her musical schedule, her various performances before Christmas, and she is quite versatile. Her normal instrument is a trumpet (Bb or G) or perhaps a flugelhorn or cornet. Well, she has been playing mellophone this year with a small group from a drum and bugle corps, and that is a bit different. But then she noted that she will be borrowing a baritone to play in a tuba Christmas event in a couple of weeks. That is amazing to me. She has musical skills that neither Monica nor I ever achieved. The Lord is great to us. I am so amazed at His grace shown toward us at this time. To feel this much better is a real treat, after just knowing that I would not make it this long. Dec 9, 2006 Today, after the usual morning chores, we went into Huntsville to meet with the David and Carol Blue, to transfer some photographs into their possession. We judged the year-end black-and-white photography for the Huntsville Photographic Society, and the Blues will make sure the pictures get to the meeting on Monday night. We met at Little Rosie's Cantina for lunch, and the food was excessively good. (For the non-locals, that is the best Tex-Mex restaurant in this part of Alabama.) What that means is that I finished the whole taco salad, and I really should have put half of it in a box and carried it home. Well, I will survive, but I should know better. After that Whipple procedure two years ago, the digestive tract does not handle that sort of gastric assault particularly well. Smaller meals are highly advisable. But it sure tasted good! OK, and now it is time for a siesta! Dec 8, 2006 I got to looking more closely at the most recent CT scan reports, and I find it interesting that the radiologists have not been comparing to the next most recent CT scan (August 14th) but rather back to either the next previous one to that (June 9th) or to the one from January 2006. That interests me because if you go back far enough, you will find that things look poor by comparison to the scans with little or no evidence of cancer. If the gemcitabine has succeeded in killing off the cancer cells, there will still be scar tissue which will be visible on the scans, where before the cencer there was nothing. So what are they seeing? I honestly do not know, and I am not so sure they do either. For anyone who is interested, the latest blood tests are here, the latest abdominal scan is here, and the latest chest scan is here. You will see what I mean when I say they are comparing way back to get some difference to talk about. Scars just don't go away. The ones from the surgeries are all still there, and the ones from dead cancer will be there also. I am not a radiologist (nor do I play one on TV) and I do not even get to see the actual scans. All I get are the reports you see here. I can sympathize with the oncologist. He called my situation “highly atypical.” As of last week, he couldn't tell me what was happening. He told us that he was going to be in conference with the radiolosts last Friday, but I have not heard any result back yet. I have called and left messages for Jill, the Wonder Nurse, but I have not heard back yet. We shall see. In the meanwhile, I am rejoicing in the miracle that the Lord has provided. The doctors may not know what happened, but they may not know much about the Great Physician. He has done a wonder right here, and I am very thankful. Dec 6, 2006 Yesterday was great, and today is even better, because today I get to go back to choir rehearsal this evening. I really do enjoy singing with my church choir, and my opportunity has returned. I am so very thankful to be well enough again to sing the praises of our Lord and King. This morning it was cold enough that my office (in the outbuilding, behind the main house) was cold again. I have to repair the big fan in the heat pump compressor, as the old fan blade broke and the resulting imbalance and vibration caused stress cracks in the outer case. It appears to have been a manufacturing defect – poor metallurgy in the made-in-China fan blade and case – but it has been too long for it to be under warranty now. The HVAC man cannot get a new case top, and so he is stymied. On the other hand, I see a way to fix it with a couple of pieces of reinforcement material around the cracked area, some epoxy glue, and some minor hand work. It just needs to warm up enough for me to get out there to do the job. Hymn time! Thine is the glory, risen conquering Son; Endless is the victory Thou o'er death hast won. Angels in bright raiment rolled the stone away, Kept the folded grave-clothes where thy body lay. Thine is the glory, risen conquering Son; Endless is the vict'ry Thou o'er death hast won. Lo! Jesus meets us risen from the tomb; Lovingly He greets us, scatters fear and gloom; Let His church with gladness hymns of triumph sing, For her lord now liveth; death hath lost its sting. Thine is the glory, risen conquering Son; Endless is the vict'ry Thou o'er death hast won. No more we doubt Thee, Glorious Prince of Life! Life is naught without Thee; Aid us in our strife; Make us more than conquerors, through Thy deathless love; Bring us safe through Jordan, with Thy power and love. Thine is the glory, risen conquering Son; Endless is the vict'ry Thou o'er death hast won. - Edmund L Budry, translated by Richard B. Hoyle Dec 5, 2006 What a beautiful day. It is cold, but absolutely gorgeous outside. Today is a work day, and I am telecommuting from my office in Guntersville. For the time being, I am continuing to telecommute, and work 32 hours per week, so that any continuing medical appointments may be reasonably accommodated without requiring me to use the very limited available sick leave. It is great to have all of the necessary tools to work from home. I continue to get better day by day. What a treat it is to recover this far from pancreatic cancer. Dec 4, 2006 It is review time. For those who have not read the whole blog, or do not know about my adventure with pancreatic adenocarcinoma, there is a brief chronology: Summer 2004: I felt very low, but had no real symptoms other than being really tired all the time. September 2004: One morning I noticed that the whites of my eyes had turned yellow. I immediately made an appointment with Dr.Foley, and his first diagnosis is pancreatic cancer. I am yellow because the bile duct is blocked where it passes through the pancreas. October 21, 2004: Dr. Selwyin Vickers and his team perform a Whipple procedure on me, at UAB Hospital in Birmingham, Alabama. I survive the surgery, and the pathologist says they got most of the cancer. However there is some sign that it may have spread via lymph nodes and nerves.. December 2004 through February 2005: I go through radiation and chemotherapy. March through May 2005: I go through more chemotherapy. June 2005: My checkups with Dr. Vickers and Dr. Posey look clean. January 2006: My checkups with Dr. Vickers and Dr. Posey look clean again. February 2006: Midsection pain begins. I can no longer lie down without excruciating pain. March 2006: I spend eight days in UAB Hospital while they treat me for what they think may be pancreatitis. Nothing improves. June 2006: I am diagnosed with progressive recurrent pancreatic adenocarcinoma. Chemotherapy begins. I continue to get worse. Summer/Fall 2006: The assumption is that I will not make it to Thanksgiving, or maybe Christmas. October 2006: The pain vanishes. With the Lord's help, I get off of all pain medication. The pain is still gone. November 2006: The blood tests show that the CA19-9 tumor marker has fallen from 76 to 30 in six weeks. Dr. Posey, the oncologist examines me, and declares the change in my my condition “highly atypical.” That is doctor-speak for “This is a miracle for which I have no medical explanation.” December 2006: Things continue to get better, day-by-day, as I regain my strength. The short-form statement for the above is that what has happened to me just never happens to patients with progressive recurrent pancreatic adenocarcinoma. I was in stage IV, destined to die shortly, and here I am feeling better than I have at any time in the last three years. I call this a miracle, and am extremely thankful to my Lord and Savior for making this all possible. There have been a world of people praying on my behalf for the last two and a half years, and their prayers have been answered in a major and very visible way. OK, there are some who will tell me that, first of all, it's not over until it's over. Well I am happily living day-by-day, and get one day at a time just like everyone else does. The oncologist will not declare remission until at least five clean years pass, and that is nearly five years from now. In the meanwhile, I am very thankful to feel this good, and have the opportunity to live again. There are also some who will say that the good doctoring did the trick. Yes, I went to see the best doctors I could find, and did exactly what I was told to do. Yet, they are startled by the outcome, because from their experience, no one get as far along as I did and survives this long, let alone gets this much better. From what have been told, I am at least six sigma out of the norm, and that means that this is a truly exceptional case. What has happened to me is what the doctors do not dare to hope for. So I call this a miracle, whatever anyone else may say. I thank everyone who has prayed. Please keep praying for me, because it really is not over until it's over. And more than that I thank my Lord and Savior who made me, redeemed me, sustains me, and now has given me my life back. I was as good as dead, and now here I am, brought back to life. He is great, and is faithful beyond all human words. Amen! Dec 2, 2006 Yes, things continue to improve at a rapid pace. My strength and stamina are returning, as I work harder every day. The change is so very dramatic, that I am still somewhat in a state of shock. I am extremely thankful for this, but sometimes I stop and wonder why I was chosen to get better, against every prediction. The initial pancreatic adenocarcinoma diagnosis is now more than 27 months ago, and I had been feeling poorly for months before that. Everyone else whom I know who has been diagnosed with this before and during that time has already been called home. So why was I chosen to get better? I hope all the more now to learn the lesson of Hezekiah (II Kings 20) and to not only get better, but also to serve the Lord better now that He has blessed me in this way. Today has been interesting. I started out very early, washed up and made breakfast. Then there was a scheduled ham radio CW contact with a friend who is trying to get faster at his Morse code. Next I did all of the financial work for the home and business, reconciling all of the accounts, and paying all of the bills. After Monica got up, we went over to Wanda's restaurant (a Guntersville institution, and a pretty good place to eat) to make sure she had breakfast also. There was a trip to the post office, and I then took a brief nap. We then went grocery shopping at the Publix market in Hampton Cove, since the new kitchen needed to be stocked with food, so there would be things to make this week. Everything was put away, and now here I am in the late afternoon in front of the computer. There is still much to do, and I will tackle it one thing at a time. Tomorrow I get to sing in church with my choir, which I have not been able to do since February. This is great. I have been wanting to do this for many months. The Lord has blessed us exceedingly, and we are most joyful. Amen! The blog was getting so long that I had to move the older section to a separate page. To see the previous section, containing entries before December 2006, please see: http://diehlmartin.com/cancer-old1.html |
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