Diehl Martin cancerblog@diehlmartin.com

The Cancer Blog Notes I was diagnosed with pancreatic cancer in September of 2004. There was a Whipple procedure surgery in October of 2004, radiation and chemo every weekday from the end of December 2004 to February 2005, two more rounds of chemo through the winter and spring of 2005, another hospitalization in the spring of 2006, and more chemo from June through November 2006. For much of this time, it has been assumed that I would not survive very long, but would be called Home within a matter of weeks. Since then, we have had a major miracle. The Lord has blessed me in every possible way. During November of 2006, there was a complete and total turnaround. I was back to the energy level I had before this cancer was diagnosed in September of 2004. The pain was gone, the tumor marker was back down into the normal range. For someone with Stage IV pancreatic adenocarcinoma, this was very unusual. Since then things have been up and down quite a bit. I trust the Lord fully, and am not worried about the ultimate outcome. In order to potentially help others through similar situations, I decided to post this cancer blog. As a Christian, I am not worried about my future. I have no doubt of being Heaven-bound. So I smile my way through life here, hoping to bring a few more along to meet Jesus. Resources What is involved in a Whipple procedure? Here is a page which describes it from the patient's perspective: http://diehlmartin.com/whipple.html I have assembled a web page which shows what a typical chemotherapy infusion involves, from start to finish. This page shows how simple it is once the patient has a port installed: http://diehlmartin.com/infusion/ What do the scars look like from a Whipple procedure? What scars are there from having a "port" installed? This page shows that it isn't all that bad: http://diehlmartin.com/scars.html Some of us cancer patients get nasty skin infections, due to our weakened immune systems. Here is a page on what I had to do to get control of mine: http://diehlmartin.com/sores.html What are the side-effects of the pain killers that cancer patients take? Here is an extremely frank discussion of some of the side effects and issues involved: http://diehlmartin.com/painkillers.html I have had requests for a link to our wedding pictures, which were mentioned in the Sept 19, 2006 posting. Look here: http://diehlmartin.com/wedding/ What am I praying about during this cancer incndent? The answer may surprise you. Here is an explanation of what I pray for, and why: http://diehlmartin.com/prayer.html So, you or someone you know has been diagnosed with pancreatic cancer. Besides the medical treatment, there are some more things which really need to be taken care of. Please, take care of the legal paperwork quickly: http://diehlmartin.com/legal.html There are so may pills to take! Why am I taking this one or that? Well, now you will know, since I have listed them all, and linked to sources as to what they all do. The list is here: http://diehlmartin.com/pills.html My time is rapidly running out. Here are my thoughts concerning my own end: http://diehlmartin.com/testamony.html As a fully committed Christian, I have a few thoughts on living the Christian Life. Since Jesus has been so very good to me, I simply must share this: http://diehlmartin.com/testamony2.html Oct 27, 2007 Diehl Martin passed away this morning at about 5:00, very quickly, in his beloved Monica's arms. UPDATE Funeral services will be held at 1:00 PM Sunday, November 4 at the First Baptist Church of Guntersville, 1000 Gunter Avenue, Guntersville, AL. Memorial contributions may be made to Diehl Martin Memorial Fund, First Baptist Church, Guntersville, or The Gideons International, or Hospice of Marshall County. Oct 25, 2007 I cannot recall ever being this tired. Over the weekend, the bottom simply fell out of all my energy. My lungs heave, but I am not getting the oxygen I need. Standing up and walking three steps results in falling down immediately. Without direct, immediate assistance, I almost cannot move at all. For the sequence of events through which I have come, I am amazed to still be here. In August of 2004 we had just been through one of the most awful real estate transactions imaginable. We had been cheated so badly in the deal, that we ended up having to bring very large amounts of money to sell the Huntsville house. It hurt very badly, but then again it was the right thing to do. I would so much rather arrive Home having forgiven everyone everything, trusting my Savior for everything, than to bear a single grudge against anyone or anything. So as of the end of August 2004, that matter was fully taken care of. It was done, forgiven, and no longer of concern. While we had been seriously cheated, yet we made sure to treat our buyer right. It is the proper, Christian thing to do. So this put us in a seriously hard financial position from which to recover. It was a major shock, then the next month, during September 2004 to be diagnosed with Pancreatic Adenocarcinoma. Dr. Stuart Foley (Lakeside Clinic, Guntersille) noticed my jaundiced eyes with no other pain, and referred me first to Dr. Winter Wilson (Marshall Medical Center North) and then on to Dr. Mo Eloubeidi (UAB Hospital, Birmingham, Alabama) who used visual and ultrasound endoscopes to inspect the area for tumor growth, They found enough evidence, both through imaging and biopsies to refer me to Dr. Selwyn Vickers (UAB Hospital, Birmingham, Alabama) for a major surgery called a “Whipple Procedure,” on October 21, 2004, wherein they removed all of my gall bladder, the head of the pancreas, including the bile duct, part of my stomach, part of my intestine, every lymph node they could reach, and anything else that looked even slightly suspicious. They sewed me back up a very different person, with much less digestive tract. As soon as the skin healed up a bit, the next treatments began. There were 28 days of radiation treatment combined with Xeloda, which is a systemic chemo drug, and then there was 28 days more of Xeloda by itself. This sequence of treatments seemed to help for a while. There were no new visible issues until pain developed in February 2006. From that time on, it became obvious that the cancer had metastasized, and that there would have to be a broadside-systemic approach to fighting it. At this point, Dr. James Posey (UAB Comprehensive Cancer Center, Birmingham, Alabama) was brought on as lead doctor, and as the oncologist. From Spring to 2006 then there were a series of tests (CT scan and PET scan of abdomen, chest, and pelvis, MRI of my head, bone scan) and from that information I was started on a whole series of chemotherapy agents. The first chemo agent was Gemzar. I had a port-a-cath installed to make the infusions work better, and the Gemzar seemed to keep everything at bay for six months or so. After that though. the tumor marker they watch (called CA19-9) started to climb, and so the decision was made to try two other chemo drugs simultaneously, these being Tarceva and Oxaliplatin. What awful stuff those are, and furthermore, beyond being impossibly expensive, they had no positive effect, so that has been cancelled along with all other cancer treatment, and I am now in the care of Hospice. My writing has slowed a bit, because the end-of-life drugs are meant to relieve the considerable amount of pain. My staying lucid is a secondary consideration now. Yes, when I cannot breathe, and the panic attack begins, I do not feel badly about taking the concentrated morphine sulfate. I am dying now, it is over. The Lord could call me Home today, and I will joyfully go. I want to be found faithful to the end, and for me the end is very near. So, in some form this is a bit of a a farewell message. My hands are so numb that typing this much took me several hours. I will continue to work as long as I can function, but that is not guaranteed past ten minutes from now. May My God most seriously bless all of those who have walked with me in this way, and held my hands up that I may continue beyond all rational time. May Jesus bless you mightily. Diehl Martin Guntersville, Alabama, Oct 25, 2007 Oct 23, 2007 Once again, the Lord allowed me make It through the night. I have a definite list of things to do today, and so there is a reason to get going, showered, shaved, and look at least moderately normal. We had multiple hospice nurse visits yesterday, and there have been several minor decisions made. The first decision is that my blood pressure has been too low (96/64) and that I should stop taking the lisinopril for now. In my case lower blood pressure is definitely not better, as it tends to weaken me even further. The second decision is to delay further treatment with the warfarin (Coumadin) until at least the weekend, as the amount blood I am coughing up, passing, and otherwise losing continuously is excessive. It is interesting to me to get this level of medical attention near end-of-life. There is no reason whatsoever for complaint. So my first order statement is that hospice care is not a thing to fear. I have no doubt that they vary quite a bit, but that the folks at Hospsice of Marshall County (Alabama) know what they are doing, and can deal very well with the sickest of us out here. Update In order to reduce that acute anxiety attacks, a pill called Lorazpam was precsribed last night. It may well work but it causes a real mental problem. I took one pill right before bedtime and was out past 8 a.m. Now I am tryng my hardest to get my engineering work done yet I know that mentally there is a big hole where my brain normally is. Maybe tonight I will take the Lorazpam, and skip it in the morning. Oct 22, 2007 I am alive today. This morning was very difficult, coughing up lots of blood, and I had a panic attack because the breathing was nearly impossible. That was treated with concentrated morphine sulfate. That acts to open the bronchial airways a bit, and reduces the stress level for an hour or two, but it also says how far things have gone. Not being able to breathe is very frightening. My beloved Monica and I talked about the situation last night. She is so very wonderful and supportive through this, the hardest of times. On Saturday, she finished putting together our wedding album (we had slides and negatives from our March 27, 1971 wedding, but this is the first time that there is a real album with printed out pictures and everything.) It is gorgeous, and it reminds us just how far we have come. We were so very young back then, and made this life-long commitment. The most notable thing is that although we had no idea the challenges we would face, and although we had a little inexpensive wedding with all of about 75 guests, we are just as married as if we had a really big wedding. We promised “until death do us part” and that is exactly where we have come. I have known Monica for more than 40 years, now, and have been married to her for 36-1/2 years, and I cannot imagine a more wonderful life partner. Hymn Time! One of our good friends (Emily Patrick, a fellow professional photographer) suggested this hymn to me for today, and it is indeed both highly applicable as well as being one of my favorites. I do not believe I have ever sung this one in church, but I have it on a recording featuring Tennessee Ernie Ford, and it speaks very well to where I am today. Precious Lord, take my hand, Lead me on, let me stand, I am tired, I am weak, I am worn; Through the storm, through the night, Lead me on to the light: Take my hand, precious Lord, Lead me home. When my way grows drear, Precious Lord, linger near, When my life is almost gone, Hear my cry, hear my call, Hold my hand lest I fall: Take my hand, precious Lord, Lead me home. When the darkness appears And the night draws near, And the day is past and gone, At the river I stand, Guide my feet, hold my hand: Take my hand, precious Lord, Lead me home. For more about this hymn, check out the Cyber Hymnal. Oct 21, 2007 Today is Sunday. Normally I would be getting ready for Sunday school and church now. However, my energy level is so low that just making it from the recliner to the bathroom, and then to the kitchen, has been just barely possible. The physical weakness is totally overwhelming. Yesterday evening, Carrie the night nurse from hospice came by, and talked us through some of what is going on bodily, to help me know better why I feel as I do, and what it means. So this sequence of events is not at all unusual, and indicates that my time here really is short. She brought up several things of interest. One is that the continued swelling of my legs is due to fluid retention, but that the fluid retention is due to the heart not being able to keep up. So the loop diuretic may help some by helping me get rid of excess water, but the heart issue is not going away. My heart rate is up from its usual 60 to well past 90 most of the time, and much higher if I actually stand up. With low oxygen, the heart malfunctions as well, explaining the irregular heartbeat. This apparently only gets worse, The biggest apparent risk is still that the blood clots are moving around, as the blood thinner (Coumadin) lets them loosen up. All it takes is one in the wrong spot, and I go Home Right Now. So far, the clots in the lungs (pulmonary embolism) are what is causing the intense weakness all the time. My oxygenation percentage has not been measured since I got out of UAB hospital six weeks ago, but then it was less than 85% without supplemental oxygen, and my guess is that I am seeing excursions way below that now even with oxygen. I can cough for ten seconds, and be left totally unconscious for several minutes thereafter. My lungs are failing. Because of the tumors in the lungs and lymph nodes/ducts around the lungs, there is no prospect of recovery from this. Now remember that this is pancreatic cancer doing this, and has spread all over, and continues to grow rapidly. Cancer treatment is over. So what is there to be done now? I am simply awaiting my time to go Home. Jesus is carrying me now, as I simply cannot go one step further. I am ready to go Home, Lord. I am ready, not because of what I have done, but rather because You have done it all for me, and have shown Your love and care for me throughout my whole life. What I could not do, You did for me. Thank you, Jesus! Oct 20, 2007 Prayer partners: I need your prayers right now. The breathing difficulties reached a desperate level last night and this morning, to the point where I was in shock. It took most of the night to come back out of it. We are not sure quite what happened, but not too long after supper I simply could not breathe at all. Monica turned the oxygen concentrator all the way up as far as it would go, and spoke with the hospice night nurse about the situation. After another nebulizer treatment, more Levsin and Mucinex, things calmed down a bit, but not much until 3 a.m. or so. So sweet Monica has been up most of the night trying to keep me going, and by now at 5 a.m. she is asleep while I prop myself up in front of the computer, able to breathe a bit better now, but totally unable to sleep. OK, now there were other symptoms also. Besides the breathing difficulties, there was a really exciting irregular heartbeat sequence that went on for an hour or so. Then there were visual migrane disturbances, with big bright sparkly light shows. So this was more than the ordinary little incident. So what happened exactly? I can only make a couple of guesses. One possibility is that I ate too much, or the wrong thing, and that this was simply my body telling me to not do that. Another possibility is that the sudden recent change in medications is more than I could deal with quickly. It could also be those blood clots in the lungs moving around as the blood thinner (Coumadin) works them out. Well, this is stage IV cancer, and anything could have happened quite frankly. So, please pray about this. The Lord hears all of our prayers, and is faithful to answer. I am willing to go Home when He calls me, but until that point, it would really help to be able to breathe. Update Yes, I can breathe. No, there is not a congestion problem today. The drug combination seems to have solved the congestion for now. The problem seems to be that the oxygen transpiration is very low, and though I am inhaling 5 liters/minute of concentrated oxygen, it just isn't getting into the blood stream like it should. With very great effort, my beloved Monica got me up, washed and dressed so that I look normal, other than being a lovely shade of gray/blue. If I sit here and do not move, I can get some computer work done, but I cannot even talk on the phone because it takes too much energy, and cuts into the oxygen supply. Quite frankly, the way things are going, I have to wonder if I will last the week. Oct 19, 2007 Over the last day or two the breathing issues have intensified. We called hospice and Daniel came back out to see what could be done, and it was decided that I should do several things. First is to increase the frequency of taking the hyoscyamine (Levsin) to four times a day, and the guaifenesin (Mucinex) to six times a day, to try to get the increasing amount of very sticky phlegm both dried up some and also out of the lungs. Also, they prescribed four times per day treatment with 0.5 mg ipratropium bromide and 3.0 mg albuterol sulfate, administered with a nebulizer. This is supposed to help open up the airways some. Those drugs are commonly found in thee pocked-sized treatment sprayers for athsma, only in this case the dose is larger, and the administration requires the nebulizer (it looks like funny plastic peace pipe) and an air compressor. So we shall see if that helps. Oct 18, 2007 Happy Thursday evening. I am still here. The breathing difficulties are getting yet worse, and I am nearly drowning again. Daniel from Hospice suggested that I might want to increase the dose of the Hyoscyamine (Levsin) and take more Mucinex in order to help the drying process. Well, it is worth a try. Right now there is so much phlegm to get up that it takes so much coughing that now I am coughing up blood as well. This takes a whole lot of energy. But at least it comes up and then I can breathe again. One breath at a time is all I get anyway, right? Really, things are going very well, all-considered. Let's face it – for a guy on severely borrowed time, I am glad just to be here and able to sit up in front of my laptop computer and continue being even a quarter normal, some of the time. I receive emails from caregivers every week about some other pancreatic cancer patient who lasted a couple of weeks or months, and went straight downhill immediately. Well, my initial diagnosis was in September of 2004, and while Dr. Foley gave me less than three months to live at that time, after three years I am still here. So, has the Lord been good to me or what? Every additional day is a gift, and I gladly accept whatever He presents me for the day. Hymn Time! This is one of those wonderful hymns which give all the credit to Jesus. I like that, since this whole life is not about me, but rather all about Him. OK, now most of us see maybe four verses in our modern hymnals, but the Cyber Hymnal shows nine verses, and it is commonly sung to at least three different wonderful tunes. All hail the power of Jesus’ Name! Let angels prostrate fall; Bring forth the royal diadem, and crown Him Lord of all. Bring forth the royal diadem, and crown Him Lord of all. Ye seed of Israel’s chosen race, ye ransomed from the fall, Hail Him Who saves you by His grace, and crown Him Lord of all. Hail Him Who saves you by His grace, and crown Him Lord of all. Sinners, whose love can ne’er forget the wormwood and the gall, Go spread your trophies at His feet, and crown Him Lord of all. Go spread your trophies at His feet, and crown Him Lord of all. O that, with yonder sacred throng, we at His feet may fall, Join in the everlasting song, and crown Him Lord of all, Join in the everlasting song, and crown Him Lord of all! Oct 17, 2007 It has been a busy day. It has been a long day. Fortunately, it was also a day with a 45 minute nap right after lunch. So this evening I am still going and feeling reasonably good. Yesterday I made mention of the number of drugs that I have to take on a daily basis, and so I have made a web page devoted just to pills. It may be found here. In essence, the list is long enough that I no longer can just keep it in my head – it must be written out, and the dosing schedule all properly watched over. Now none of these drugs are curative in nature. All of them by now are dealing merely with symptoms of the “dying of cancer” sort. But then again, I am thankful that they are able to deal with these maddening symptoms, so that at least I am not going out in a blaze of pain. One thing which has changed here is that since I am visited by Daniel the Hospice nurse twice a week, there are no longer any trips to Kirklin Clinic in Birmingham to take. That is saving some considerable amount of energy, since any trip to and from Birmingham started out as a minimum four-hour adventure just in travel and parking time. The people there are very friendly, hard-working, and competent, but a saving of nearly a day a week in travel and medical time sure does make life a bit easier to deal with. The Lord has truly been watching over us. We were discussing this evening after supper just how blessed we really are. Honestly, what have we needed that has not been provided? Yes, I am very sick, but then again we have been happily married for 36-1/2 years, and are thoroughly pleased with that fact. While we are both here we are happy. Then we get to go home to be with Jesus. I see no problem here at all. Oct 16, 2007 Today has been productive, but absolutely exhausting. The energy is, as always, limited, and then there is the matter of not being able to breathe very well. Ah well, that is just the way the pancreatic cancer bounces, I guess. The blood work from Monday's test indicated that I need to stop taking the warfarin (coumadin) for a couple of days. So does that means that there is actually a possibility of being too thin? It was also decided yesterday that since my legs are swelling up quite a bit, that they will put me on a diuretic to reduce the fluid retention that may be causing it. Well, that will raise the count to 13 pills first thing in the morning, plus more at lunch and supper. I may just make and post list of all of these. By the time there are that many, I cannot imagine a situation without interactions between them. Ah, it is such a delicate dance, trying to keep me going and comfortable while bodily systems are in full rebellion. The Lord continues to carry me long through this whole mess. While I feel less than wonderful physically at the moment, I am encouraged by Jesus and all of the people He sends my way. Oct 15, 2007 In some ways, I feel pretty good today. This morning was almost normal. This afternoon, there were multiple people from hospice here all at once, and that was harder. Daniel needed to draw blood so that they can measure the effects of the blood thinner (warfarin) and that was complicated by the fact that first he attempted to use my port, which wasn't flowing freely, and so he had to do it again with an arm vein. All the while the hospice chaplain was here, and that made for an extensive multi-way conversation. I do not that much energy, and so by the time they left I was beat. Aaron Cooper from church came by and helped with the lawn. Bless him. Some things are so seemingly mundane, and yet so necessary. I can look at a mower, I understand how it works, I might even be able to get out there and sit on its seat, but with this oxygen hose I cannot get out there and actually use the mower. Thanks, Aaron! Today's work time was spent building packages in the parts library for the CAD system. These are parts we have never used before, and are specialty devices with really odd footprints. Life is good. They are interesting to do, and I get to do them. Oct 14, 2007 Happy Sunday! Once again we reach the high point of my week. Saturday was difficult in several ways. Besides the physical challenges inherent as the pancreatic cancer finishes taking over, there has been an additional emotional component. Part of this is due to the simple fact of being so physically weak that I am requiring a lot of help to do much of anything. I really do not want to be a burden, and yet I know that I am taking rather a lot of time. In order to minimize my impact I have been trying to be as circumspect as possible about asking for help or to do anything but sit here quietly, and the result is a little self-made emotional prison which has been getting me down. So last night I broke down, cried a lot, and told Monica that I am going to need a bit more help yet. I want to not have a negative impact, but at the same time I really need to do what I still can in order to not hurt emotionally. At 4:30 a.m I was awakened by beeping somewhere in the house. We live over our photographic studio, and the noise was bound to be some unhappy computer device, telling us that it was very sick. It turned out to be our oldest uninterruptable power supply (UPS), which had power to it but complained that it was running on its batteries. So there I was, in my pajamas, on the floor, with my head under the desk rearranging power cables to route around the old UPS. I suspect that it needs a new battery set (I have a spare set just for such purposes) and that today or tomorrow that task will be accomplished. Computers! Stuff! We cannot do our jobs without them, but they sure can be a royal pain. On the ham radio front, I spoke with Stan Hurst (KG4NAE) during the last couple of days about the possibility of moving the antenna cables for the little ham rig in the house from upstairs to downstairs, so that it would not be necessary for me to get upstairs to use the radios. I do not know how much longer I have to live, but maybe for 90 days, this would be worth the several hours of help required to do it. I have been a licensed amateur radio operator since I was 12 years old, and I still enjoy it after all these years. I think I still have enough coax cable left over to make the cable extensions, and I can get the necessary connectors overnight from Huntsville or Atlanta, so it is a relatively straightforward business. We had major help this week from some friends from church. Monica had mentioned to someone that the wooden back steps were wobbling the last time they took me down those steps, and asked if someone could help bolt them to the wall so that no one would fall. Well, the project grew a bit, and it sure sounded like a whole lot of sawing and drilling to do that much. By the time I looked out, they had basically disassembled the old steps and replaced the whole thing from scratch. Monica took pictures, and I plan to put up a web page this week to show what happened. Thank you! Thank you! Thank you! Oct 13, 2007 I woke up! It is Saturday, and there was light streaming in the window on my left, so I am still here on earth today. I need to do the week's financial paperwork, but that is all that is really scheduled. Last night I felt pretty good, without a lot of breathing difficulty, but there was not as much sleep as might have been. I sat there in the sleep chair, stared at the night light out in the hall, and prayed some. I may not be able to do much right now, but the Lord hears every word. I am His, and that is what counts. Today it is beautiful outside. Those who have been out say it is about 50 F, and that is very pleasant here by Lake Guntersville. If all goes well, maybe Monica and I can sneak out for a lunchtime date. Oct 12, 2007 Today has been productive. I got a circuit board design completed and sent off for a quotation, and the plots from it look good. So one more work project got done for the week, and that feels good. Being able to continue to work is a great blessing. Breathing difficulty is still increasing. The oxygen concentrator keeps me pumped up so that I can continue to function most of the time. It has a water bottle attached to it through which the oxygen is percolated to humidify the oxygen, and it makes it so my nose does not dry up and blow away entirely. That is a contrast to the portable oxygen tank on wheels which I need whenever I go someplace, which puts out perfectly dry oxygen. After about 30 minutes that makes me feel like I have swabbed my nose out with a cactus. We keep spray bottles of saline nasal spray to help alleviate the dryness, but that barely keeps it at bay. So, for the most part, I try very hard to stay within hose length of the big oxygen concentrator. Jesus has given me another day, and for that I am very thankful. I have my wonderful beloved Monica, and so many friends who help make life possible right now. Thanks to all who pray. Thanks who help in so many very practical ways. You demonstrate His love in so many amazing ways. Oct 11, 2007 Breathing is very difficult today. I wasn't sure that I would not drown in phlegm at supper time, as there were several minutes of coughing my lungs up, and still trying to keep my supper down. Monica got me out of the house, and over to Chic-Fil-A for a quick meal, and the combination of position change and weather change seem to have hit me very hard. Perhaps I can maintain my composure and it will pass – if I can maintain my consciousness long enough to attempt to play that game. I suppose I should be my normal joyful self, but right now I am feeling very low. I do not want to be a burden on anyone, and this whole series of events is slowing me to the point where I seem to be badly affecting those around me. I am supposed to be pulling my weight (I was brought up on a steady diet of responsibility and hard work) and yet here I am nearly totally dependent upon others to do anything whatsoever. OK, this is just a total body failure, and not a moral issue, but it still wears on me to know that I am in such a rapid decline that I really cannot do anything about it. I would prefer to be helping others, not on the receiving end, if I could possibly do so. The Lord knows how this all will end, and when. In the meantime there is absolutely nothing I can do but trust and wait. Oct 10, 2007 Today has been totally exhausting. A lot got accomplished, but by now in the evening I can barely sit up to write. This is normal now. One part of the symptoms I am dealing with is the continuing and growing peripheral neuropathy. I cannot feel much in my hands and feet now, which makes walking difficult, and typing/writing very frustrating. There is no assurance of this ever getting one bit better, either. I am on yet another drug to try to relieve that symptom, but I am now on so many drugs that it is getting hard to keep them all straight. The Lord gave me another day today, and it has been used in the best ways I have known to do. I am His, and am glad to know that. In spite of the fact that I do not feel at all well, I know that Jesus has this all taken care of. He is never surprised at the outcome, as He has been in it from the beginning. Oct 9, 2007 I am under hospice care now. Well, what exactly does that mean? The primary qualification (if you can call it that) is that I am expected to live less than six months, and that there is no real hope of a cure for my cancer. Under that set of rules, I would have qualified for hospice care several years ago, as they were convinced that I would not make it for three months, let alone the three years it as run so far. So there is another component they don't discuss, and that is that the doctors have given up on a cure, or even on keeping the cancer at bay, and are now sure that it just might, perhaps be over – sometime soon. Maybe. OK, I can deal with that. I get to go Home sometime, and that time is up to the Lord, and the doctors just don't know when that might be. So what are the consequences of being under hospice care? The first and most obvious consequence is that the hospice is the first line of medical care I deal with rather than calling the doctor's office directly. If I need help, I call hospice first, and they make the arrangements. They take care of the details. So yesterday, when Daniel the Hospice nurse came by, we mentioned that the monstrous amounts of phlegm were causing continuing breathing difficulties at night, and Daniel suggested that he contact Dr. Foley about a prescription for Hyoscyamine, which he did. We picked up a small supply from Bunch pharmacy, tried it last night, and it works rather well. So this procedure works. But it is well worth while to always remember that we are not talking about a cure, but rather a way for me to feel better on the way Home. The cancer continues to spread and do its damage. In the meanwhile, I am able to continue to work as best I can, write blog entries, and answer email. Such a deal. I am feeling better today than I have in a week or more. The blood thinners have apparently been breaking up the pulmonary embolism, and so I am getting enough oxygen to my brain to actually stand up and move around a bit. I am indeed being switched off of the Lovenox onto warfarin (Coumadin) which should help some. Yesterday evening I got very discouraged sticking myself with the Lovenox. The injection needle was plenty sharp, but just wouldn't go into my tummy like it was supposed to. What a mess. And then it all bleeds and leaves giant hematomas which last for a month or more. So changing over to the warfarin, which is a pill, is a much easier thing to deal with. I get rather a lot of emails regarding the cancer and the blog, and I do appreciate them. I cannot right now answer all of them, however, as I just do not have enough energy to devote to that right now. To all who would pray, thank you so very much. I am very aware of being supported by the Lord throughout all of this adventure, and I know that our prayers are being answered. Oct 8, 2007 This morning Monica and Marie succeeded in getting me to my office in the other building, so that I could do some computer maintenance, and also briefly get on the ham radio for the Alabama Day Net. I had not been able to get on that radio for a month, ever since the last hospital stay, and there were people who were concerned about me, so it was a good thing to be able to let them know I am still here. Daniel the nurse from Hospice of Marshall County came by this afternoon, and we went over the various medical issues. There is some hope that maybe I can get off of the Lovenox and onto a blood thinner which is simpler to deal with. The twice per day injection cycle of the Lovenox is messy, especially since it is a blood thinner, and I tend to not stop bleeding from the injection sites. So the question has been forwarded to Dr. Foley to answer. Maybe he will switch me back to warfarin, which as a once per day pill is an easier thing to deal with. Oct 7, 2007 Sunday is my favorite day of the week, and today has been a good one. Monica and Marie did the hard work of getting me to Sunday School and Church, with my wheelchair and oxygen tank. It is always a joy to be with my church family. Special thanks go to Reuben Fryer and Richard Moebes for getting me wheeled about. This limited mobility business is rather restricting, but with good friends, many things are possible which otherwise could not be done. Thanks! I am now totally exhausted, even after a long nap. The exhaustion is a regular feature now. Most of this is due to the declining lungs, which leave me permanently out of breath. The oxygen concentrator is pumping out 4 liters/minute, and yet there is not enough oxygen in my system to keep me from turning blue. As long as I just lie here, it is not too bad, but getting up is a challenge. Stairs are not quite out of the question, but require a long hard thought about the potential consequences of falling. Marie made us a great supper this evening. The nurses ask how my appetite is, and are sometimes surprised that I can still eat, and not get sick from it. Well, food still tastes good, and having it with friends and family is best. The Lord is very good to me. Through all of this struggle with cancer, He has been with me the entire way. Now I am being carried, since I am entirely dependent. I can do nothing on my own any more. Now I am nearly Home. How soon do we get to the point where it is closer to just take me Home rather than dropping me back off at my door? I don't know, but I am ready to go. Oct 6, 2007 Marie made it here from Dallas today. Hooray! I am almost too tired to do much but sit here, but it is a happy tired. Today's coughing fits have been just stupendous. There is always more phlegm to cough up, and it gets annoying very quickly. I have only approached unconsciousness probably twice today. Is that good? I cannot tell you exactly, but I am still here to ask the question. Oct 5, 2007 I am so very tired today. I got enough sleep, but it still is very difficult doing almost anything. The lung problems seem to be less than a few days ago, and I have not passed out in a couple of days, so that is easier to deal with. My lungs are still filling up, and I have to cough a whole lot to get rid of the phlegm. They changed one of my medications to see if it would help with the pain from metastatic bone cancer. Rather than using prednisone to reduce inflamation, they have substituted dexamethasone. Both are steroids, and have interesting side effects. The thorasic spine pain is down a bit, and I hope that continues. Amy Hawk at Bunch Pharmacy suggested we try the Curad cloth bandage strips to see if they would be easier on the skin, and they certainly appear to be. There is less of a tenacious grip on the skin, which makes it so they will come off without removing skin in the process. This is definitely an improvement. Oct 4, 2007 I continue to be able to work form home, which is a Very Good Thing. If all I had to do all day was sit here and think about being sick, it would be most discouraging. As it is, there is lots of work to do, and it is wonderfully distracting. Many thanks to my employer, Aegis Technologies Group, for continuing to let me work from home. The medical situation continues to evolve. Isn't that a nice sounding word? It allows me to speak of it as somehow a potentially positive thing. Well, going Home is positive, and it isn't that long, so things are fine, by definition. Now, there are some annoyances to deal with. Every day, twice a day, I have to give myself an injection of Lovenox, which is not a problem in and of itself, except that it is a blood thinner, and I bleed a lot. So I have been using a Band-Aid every day to slow the bleeding at the injection site, and the Band-Aid brand have this propensity for removing patches of skin when I remove them. Owie. Then the next time in that area the alcohol makes it sting wildly. Oh, such a thrill. Beyond this, the sores from sitting too much in one position are bleeding also. I am a mess. I am, however, a joyful mess, as the Lord continues to bless us in every possible way. Monica and I have been discussing the 40-1/2 years we have known each other and we have come to simple conclusion. The only real regret we have is not having been able to get married sooner. She is a real treat, and I am most impressed with Monica. It is great to know someone this well, and love her this much. Thanks, Love! Oct 3, 2007 Today, Daniel the nurse from Hospice came by for the weekly check. All of the medication was duly recorded, some of it was counted, and all of the vital signs were taken. So, unless something changes, I am set until next Monday when he will be back. I am nearing my earthly end. By this point, there is little I can change, but still a lot to look forward to. Every day is new, and every day is His. By now, my wants are few. What I really want after all is said and done is to hear this: “Well done, thou good and faithful servant.” Oct 2, 2007 Busy, busy, busy. Between yesterday and today all of the hospice-related details have been finalized, the oxygen concentrator changed out to one from the hospice's vendor of choice, and two sets of friends have come both to visit and also to help me sort out things for the estate. I am flat-out exhausted tonight, but at least some necessary things on the list are accomplished. Soreness is the result. I have done too much today. Also, I have coughed up nearly twice as much phlegm as yesterday, and that has left me very sore in the ribs and back. I discovered today that the peripheral neuropathy has reached the point where my feet do not feel enough to know whether they are on a solid footing or not. Ah, the joys of continuing side-effects from past chemotherapy. Oct 1, 2007 So, it has been more than three years since the diagnosis of pancreatic adenocarcinoma, and I am still here – well at least enough to sit up and type. For what is usually a three-month cancer, that is not bad at all. It has required a lot of nasty, invasive treatment, but if life-extension is the goal, then I guess it could be called a qualified success. Given enough money for the best treatment available, sometimes you might live a while longer. Nothing comes without a cost, however, and the cost is more than just monetary. There are continuing side effects from every form of treatment I have had, and some of them are rather obvious. Since the Whipple procedure surgery, I have a much shortened, scarred, and problematic digestive tract. That is treated with medication, and I can quietly, privately deal with the lifestyle changes which come with it. I had the maximum dose allowable of radiation on my midsection, and yes it causes internal changes also. Those are in most ways inseparable from the surgical side-effects. The most obvious side effects, though, have come from the chemotherapy, and even after the chemo has stopped, some of the side effects continue to increase. The worst of the chemo drugs at the time I took them was Tarceva, which attacked my skin and gave me the most awful rash, all over. Even my tongue was sore from that stuff, and I lost most of my ability to taste anything. But the chemo drug with the most long-lasting effects is the Oxaliplatin, which has caused continuing peripheral neuropathy, and eight weeks after stopping taking it, the side effects are still growing. My hands and feet are numb and tingly, and it is continuing to worsen every day. Now it seems to spread up my arms and legs on occasion. I have no idea how much worse this will get. My hair is growing back now, but it doesn't look like mine – it is much darker and heavier than before, and growing happily in unusual places. My point is this: the cancer treatment has kept me alive, but cancer treatment is anything but a cure. The most obvious part of life today is growing weakness and dependence. As I near the end, my strength is decreasing daily, and I have to rely on Monica's help to do just about anything. She is spectacularly wonderful, and makes sure that I am doing OK, listening for the least little problem. Still, this is a strange point in life for me, where at the age of 56 I can just barely get up and dressed in the morning, and that only with much assistance. The situation is changing in other ways now, also. I have had two bouts with very severe pain this week, radiating out of my spine. The pancreatic cancer has spread all over now, but the part which is causing the pain is the metastatic bone cancer in my back. Dr. Posey indicated that my T-5 and T-6 vertebrae are particularly affected with sclerotic and lytic lesions, and that pain is entirely likely under the circumstances. The pain has been radiating out of the area between my shoulder blades, and has been extremely severe. I have medication for the pain, but I take it only when necessary, since I really do want to keep going mentally as long as I can, and the pain medication is very hard on me mentally. Last night's pain incident came after I was ready for bed, and it left me exhausted and also sleepless much of the night. So, in light of the above, you perhaps can understand part of the reason why I am looking forward to going Home soon. The medical personnel are very nice and helpful, but they have not been able to fix the problem. There is no cure for what I have. So I await the time when my Lord will call me Home, and from what I can see, that time is not very far off now. Even so, Lord Jesus, come quickly. UPDATE This evening, I have been under email attack, and so please bear with me if I am slow to respond to real emails. It would seem that one of those stock scam artists has been using my domain name as part of a return address for their latest stock scam, and has sent out probably tens of thousands of emails supposedly from my domain. Well, those emails are not coming from my domain nor from my mail server. They are coming from 84.148.103.104, with which I have no association. As a result of those spam emails, I am receiving about 500 bounce notices per hour, and have set up filters to make them go straight from the email system to the trash. The internet can be used for all sorts of purposes, but as far as I am concerned, the spam email stock scams are in the purest form of evil. They are based on multiple simultaneous lies, and are meant to separate the unwary from their money. There is no redeeming value whatsoever. So I apologize for any inconvenience caused by the spam (which is not from me, nor caused by my equipment configuration) and from the delays which it may cause in my getting back to your real emails. Sep 30, 2007 Ah, at last it is Sunday, my favorite day of the week. Monica succeeded in getting me to Sunday school and church, and that is exactly where I needed to be. It took all of the day's energy, but it was very well spent, being with my church family. After that there was a fancy lunch (one tuna sandwich) and then a three hour nap to recover from the very exciting morning. The Lord is very good to me, and let me see another day. Thank you, Jesus! Sep 29, 2007 Things are getting more difficult. This morning I did not so much wake up as regain consciousness. I went through the flashing color light show and the buzzing noise typical of coming out of shock, while I coughed up large amounts of phlegm. Not good. There have been several bouts with fading in and out today, with absolutely nothing that Monica nor I can do anything about. I really do expect to just not wake up one of these times. That's OK. Whenever the Lord wants me Home, I am ready to go. Today's task is to get financial paperwork up-to-date and entirely in-order. There really ought to be no excuse now for failing to get everything in order. There has been enough warning time to line things up. So as we close out the third quarter financial books, I am putting extra effort into making sure every piece of paper is in its place, and the computerized records are completely up-to-date, with freshly printed reports, all put together in a readily-understood comb-bound volume. I have been responsible for the financial paperwork for our multiple businesses for many years now, and hope that everything will be so blatantly obvious that any accountant should be able to take over with no real questions. One thing which I have discussed with Monica is that as far as I know there are no other surprises to discover when I am gone. One advantage of living a very straightforward life is that there are no lies to discover, no cover stories to unravel, and no unexpected unpleasantness to find. The Lord has been so very good to me, and I have attempted to follow Him as best I could. Yes, I have failed along the way, but everything has been dealt with quickly, and nothing remains to discover. Yes, I am ready to go – not because of what I have done, but rather because of what He has done for me. Sep 28, 2007 I am continuing to work by telecommuting, using the little IBM ThinkPad R-40 (running linux) sitting here on the kitchen table. I completed another schematic and printed circuit board layout today, and uploaded the design to get a price quotation on getting the bare boards built. There are several good things about continuing to be able to work: 1. It distracts me wonderfully from the cancer problems; 2. I get paid; 3. The insurance coverage continues. I really enjoy making progress and building things. That has been one of the great things about doing development engineering work for the last 30 years. The hospice people are coming out on Monday, and doing whatever they do for admissions. I get the distinct feeling that certain things are going to change with regard to how medical supplies are supplied and such. It will work fine, I am sure. Yesterday evening, Richard and Janice Moebes got me to and from the Gideon camp meeting. Getting me anywhere is a chore now, but they are so amazingly cheerful that I did not feel conspicuous. The only regret I have with the Gideons is that I wasn't asked to join 25 years ago. I don't feel well today, but then I am not surprised. There is still a tendency to cough, cough, and cough some more to get the phlegm up, and then be immediately knocked flat by the lack of oxygen. I haven't actually lost consciousness today, but it has been close a couple of times. I really do expect some time to simply go unconscious and not come back. There are far more difficult ways to go Home than that... Sep 27, 2007 Today has been wonderful. Today has been very long. Today is our 36-1/2th wedding anniversary, and so we are celebrating to whatever extent we can under the circumstances. We were married on March 27, 1971, (our wedding pictures are here) and we celebrate at every opportunity, and today we went out to lunch. That was hard work for Monica, but we had a very leisurely lunch, held hands, and had a good old time. That bloody spot at the injection site on my leg looks really nasty, and continues to bleed – black blood. The blood thinner must be working, which is what the doctors are depending upon in order to clear the arteries in my lungs. In the meanwhile, the side effects are most obvious. The Lord has given me another day, and indeed another milestone day with my beloved Monica. I no longer expect to see any given tomorrow, but am glad to get one each day it is provided. Thank you, Jesus! Sep 26, 2007 This morning I woke up, and there was the usual window on my left, with the sunshine pouring in. That means I must not have been Promoted to Glory yet. Last night's sleep was fitful. The prednisone I am taking to reduce the inflammation in my cancerous lungs and surrounding lymph nodes and ducts is apparently causing some insomnia. Nevertheless, I am still here, and able to function. There have been a couple of challenges today. One was that I noted what appeared to be a spill on my pants leg, only to discover that an injection site was continuously bleeding and the stain was blood. Blood thinners do have side effects, and such bleeding is to be expected. Nevertheless, it was an odd moment. A band aid stopped the problem for now, but I will have to watch more carefully for such things. Monica suggested taking me downtown to Barnes Barbershop, as the hair is growing back in earnest now, and she figured that I would be more comfortable with shorter hair. So she got the car out in the front turnaround, and helped me get in along with my oxygen bottle on wheels. Now for those who are not familiar with downtown Guntersville, there is this little matter of parking downtown, and the accompanying fact that downtown is anything but flat. We were less than half a block away, but in light of my twelve-step program (walk twelve steps and fall down) I almost didn't make it. We passed Cake Crumbs on the Square, and Terry Cowen noticed I was having severe trouble, and brought out a chair for me to sit on while I recovered. Five minutes later, I walked the rest of the way to Barnes Barbershop, and sat down. Monica went back to Cake Crumbs to confer with Terry, and soon Darren Barnes was available to do the hair trimming. He did a fine job, and now I look much more reputable. So I called Monica on her cell phone, to tell her that I was ready, and so she and Terry moved the car into an empty space in the angle-in parking in front of the barbershop (for the non-locals, this is on US Highway 431, and is on the approach to the first stoplight in about 20 miles). They succeeded in getting me into the car, and about then Lavon Stone came out of the barbershop to talk to Monica. He said that since I was so sick and all, that he would be happy to come to me the next time I needed a trim. Now, I don't know Lavon all that well, but I have noticed that he keeps his very well used bible on the top of the Coca-Cola machine, next to his barber chair. I sense once again someone who is living his faith, and I am most impressed. The Lord keeps sending amazing people my way. Sep 25, 2007 My unconscious periods are getting longer and deeper. Last night I had one for which I had to ask Monica what happened. I was aware for seemingly a very long time being unable to speak, wave, or do anything but shake. She told me that I yelled in pain, and when she came in to find out what happened, that my eyes were open, but I “wasn't there” for the longest time. I would guess we are up to six to ten of these events per day now. Some are more severe than others. They continue to remind me that I am very weak, and that my time here is short. The Lord continues to send words of encouragement through the cards, emails, and visits of faithful friends. The Lord provides the peace which I so desperately need at this point. My body is dying around me, but He is very much still in control. Sep 24, 2007 This morning we went to Kirklin Clinic (Birmingham, Alabama) and saw Dr. James Posey and Jill Owens, the Wonder Nurse. Richard Moebes took his whole morning and did the driving, hauled the wheelchair, and helped in every way possible. Logistically, today was difficult, and Richard's help was most appreciated. The CA19-9 tumor marker is up to 1887, from 908 on August 9th. So it is still doubling about every 40 days. Today's discussion went several ways. The first is that, so far, while most people's pancreatic cancer spreads to the liver, my case has followed a different path and has spread more to the lymph nodes and lymphatic ducts in the lungs. Combined with the pulmonary embolism, my breathing is difficult for very good reason. There was some discussion about using prednisone (a steroid) to help with the breathing, but Dr. Posey indicated he wanted to check with Dr. Johnson in Pulmonology first to make sure this made sense. The second is that there are no further chemotherapy treatments which would actually help at this point, and not potentially cause such side effects as to make things even more difficult. In fact, then, we are beyond all hope of a medical cure, or even a holding action. The third is that the intense pain in my back area may be caused by the lesions in my thorasic spine, and that as a pain reduction technique they may consider using an ablation technique based on radiation or radio frequency treatment. We shall see. So in light of the above, they are going to refer me to hospice. This is an end-of-life business, and about all hospice can do is to attempt to make me more comfortable on my way out. There is no time-table expressed or implied. The Lord is in control of all of this, and I am not worried in the slightest. That does not mean that I do not hurt, as sometimes the pain is overwhelming. Rather it is a indication that since the sin matter is taken care of, I need not worry about the timing. When Jesus wants me Home, I am going, and please don't get in my way. In the meantime, I am still His, and all is well. Hymn Time! These words were composed by Charles Wesley, and were first published in 1738. I love to sing this old hymn, and the only difficulty is that so few people know it, that when I request it on some Sunday Evening when the minister of music has a request night, I end up singing nearly alone. Nevertheless, it expressesthe wonder of my heart that Jesus would die for me. And can it be that I should gain An interest in the Savior’s blood? Died He for me, who caused His pain— For me, who Him to death pursued? Amazing love! How can it be, That Thou, my God, shouldst die for me? ’Tis mystery all: th’Immortal dies: Who can explore His strange design? In vain the firstborn seraph tries To sound the depths of love divine. ’Tis mercy all! Let earth adore, Let angel minds inquire no more. He left His Father’s throne above So free, so infinite His grace— Emptied Himself of all but love, And bled for Adam’s helpless race: ’Tis mercy all, immense and free, For O my God, it found out me! Long my imprisoned spirit lay, Fast bound in sin and nature’s night; Thine eye diffused a quickening ray— I woke, the dungeon flamed with light; My chains fell off, my heart was free, I rose, went forth, and followed Thee. Still the small inward voice I hear, That whispers all my sins forgiven; Still the atoning blood is near, That quenched the wrath of hostile Heaven. I feel the life His wounds impart; I feel the Savior in my heart. No condemnation now I dread; Jesus, and all in Him, is mine; Alive in Him, my living Head, And clothed in righteousness divine, Bold I approach th’eternal throne, And claim the crown, through Christ my own. For further information on this and other hymns, check out the Cyber Hymnal on line. Sep 23, 2007 With much help from Monica and from numerous other people, I made it to Sunday school today. I had to leave early, though, as the energy level was so low, and the breathing so labored, that I was having difficulty staying upright, and that was on oxygen, in a wheelchair. It has gotten to the point where I joked about my “twelve-step program,” you know, the one where I walk twelve steps and fall down. Yes, my condition is deteriorating. Tomorrow morning there is a scheduled appointment with Dr.Posey at Kirklin Clinic, in Birmingham. I suppose there will be some talk of further cancer treatment, but at this point I am declining so rapidly that I have to wonder what to say to such a thing. There should be no illusion of a medical cure now. It is not going to happen. We are in the “end-game” situation, and it is merely a matter of time before I am called Home. Jesus can heal me or call me Home, and either is fine with me. I am ready – not because of anything I have done, but rather because Jesus already did it all for me. I trust Him completely for my future. I am looking forward to finally being in a land where He runs the place. The whole concept of no more sickness and no more death appeals too, for some strange reason. During Sunday school, one thing which was discussed in relation to the lesson (from Matthew 8 and 9) was that everyone in the room is having seemingly insurmountable difficulties. Go down the list of health issues, and it is impressive to see what everyone is dealing with. And yet, I am reminded of the fact that if you compare the problems of physical health with the problem of sin, that physical health pales in comparison. We are subject to body failures, and though they be most discouraging, yet that is all they are: body failures. It is not as if it were a moral or spiritual failure. The former slowly or quickly takes our life, and sends us to our reward. The latter can go on forever, and adversely affect out reward. So my body is failing – that I can deal with, and then I get to go Home. How can I possibly lose? Sep 22, 2007 It's humorous in a way; sometimes I feel semi-normal, and then all it takes is one cough-myself-unconscious fit to quickly disabuse me of any sense of normalcy. This morning I actually made it upstairs, carefully making sure that the oxygen hose didn't kink along the way. I got there safely, and back downstairs, but the energy cost has been fabulous. My heart rate did not return to normal for nearly four hours. So things are fine – just fine I tell you – except when they are not. What will tomorrow bring? I cannot tell you. I do not know what the future holds, but I do know Who holds the future. I trust Jesus to get me through it all, and safely Home when the time is right. Until then, I am joyful that He is here with me all the time. Sep 21, 2007 Today is a bit better than yesterday. The breathing is a bit easier, although I am still nearly passing out, and am still coughing up outrageous amounts of phlegm. The pain is less, although at times it can keep me from doing much. I have had emails from folks who say I should demand better pain relief. Well, there are potent pain meds on-hand, but after last year's bout with pain killers, and the withdrawal symptoms of getting back off of them, I do not take them lightly. One thing which I pray about consistently is to be able to keep my mental abilities to the end. I want to be able to serve the Lord happily and knowingly, as that is my highest joy. Sep 20, 2007 I hurt. My chest hurts. My ribs hurt. My back hurts. My insides all hurt. I am coughing so hard and so constantly that it feels like I am going to rip something loose. I am coughing up more than half a cup of phlegm a day, and it feels like I am going to drown most any time now. Sep 19, 2007 The Lord allowed me to see another sunrise today, and it dawned bright and clear. Although the pain level is rising daily, and it is still very difficult to breathe, yet I am joyful. The Lord has this entire matter fully under control. Yesterday was much too intense. I won't go into detail, but very mundane things kept going wrong, and needing way too much attention. By the time the day was over, my midsection was in serious pain, and I was unable to sleep through it. For the first time since January it was necessary to take a major pain pill in order to mask the pain so I could sleep. I cannot tell if the pain is from my body's reaction to the breathing problems, or whether this is some internal organ complaining about the tumors taking it over. Regardless, it hurts, and the pain is increasing at a serious rate. Sep 18, 2007 Nunc dimittis servum tuum, Domine, secundum verbum tuum in pace: Quia viderunt oculi mei salutare tuum Quod parasti ante faciem omnium populorum: Lumen ad revelationem gentium, et gloriam plebis tuae Israel. Lord, now lettest thou thy servant depart in peace: according to thy word. For mine eyes have seen: thy salvation, Which thou hast prepared: before the face of all people; To be a light to lighten the Gentiles: and to be the glory of thy people Israel. ----- The Lord is my shepherd; I shall not want. He makes me to lie down in green pastures: he leads me beside the still waters. He restores my soul: he leads me in the paths of righteousness for his name's sake. Yea, though I walk through the valley of the shadow of death, I will fear no evil: for thou art with me; thy rod and thy staff they comfort me. Thou preparest a table before me in the presence of mine enemies: thou anointest my head with oil; my cup runneth over. Surely goodness and mercy shall follow me all the days of my life: and I will dwell in the house of the Lord for ever. Sep 17, 2007 Yes, I am still alive. Today has been good, but very long. We had four sets of visitors – all people whom I dearly love. Two sets came just to say hello and to offer help, one changed the battery in the pickup truck, and one brought supper. So it was a busy day. I also worked a full day for my employer, telecommuting, sitting here at the kitchen table with my laptop computer. So lots happened, and I am exhausted – too tired and wound to sleep. This evening, Monica put a three-CD set of Handel's Messiah on for us to listen to, and I am enjoying it immensely. The music is fun (even more fun to sing than to hear) and the words all point to Jesus. If I still cannot sleep, perhaps she will follow that up with Bach's Christmas Oratorio – all four CDs of it. It I am going to be awake, I might as well sing along and praise my Lord. Sep 16, 2007 So I cough. Then I cough a bit harder, and some phlegm comes up. One more cough and my head starts to spin. My hearing goes to a “buzz” and my vision narrows. I am going unconscious. I put my head down, and after a minute or so it passes and I am back to a very low normal in about three minutes. This has been happening repeatedly this week, and has happened several times today. I am on oxygen at 3 liters per minute, and yet the symptoms tell me that while I can breathe, it isn't working much, and is getting steadily worse. My beloved Monica got me to Sunday school and church today, and that was exactly where I wanted to be. I participated in class, and was able to sing a little bit of the hymns. As compared to last week, this was much harder. I spoke briefly to both Joel Samuels and Charles Watkins, and asked that whoever preaches my funeral should conduct a joyful send-off, sing great hymns, and preach the gospel message, because I expect that there will be a number of folks there who really need to hear that gospel message. This whole business is not about me – it is about Jesus. I am going Home soon, and I know that there are some others who really would like to do that too, but just don't know it yet. Please use my passing to introduce them to my best friend and savior. Sep 15, 2007 Something went further wrong last night. It looks to me like more pulmonary embola have formed, or it has otherwise progressed. I now have problems breathing while just sitting down, with the oxygen running. Getting up and going 20 steps exhausts me, and I get a heart rate of 160+, and become very dizzy immediately. If this goes one bit further, I could see going Home this week. The Lord is absolutely faithful. I have nothing to fear in all of this. This is merely a body failure, and says nothing negative about His love and care. I hear people say, “Why me?” Well goodness gracious, that is a crazy question. Don't you ever want to get to go Home? I don't know about anyone else, but I will be happy to be Promoted to Glory. So when I go, please have a rousing sendoff, and invite everyone who comes to meet Jesus. Because, after all, my life is not about me, it is about Him. Hymn time! As a very happy Baptist, I have usually heard this hymn as an altar-call, at the end of a service. However, during this very difficult time, it has become one of my all-time favorites. Softly and tenderly Jesus is calling, Calling for you and for me; See, on the portals He’s waiting and watching, Watching for you and for me. (refrain) Come home, come home, You who are weary, come home; Earnestly, tenderly, Jesus is calling, Calling, O sinner, come home! Why should we tarry when Jesus is pleading, Pleading for you and for me? Why should we linger and heed not His mercies, Mercies for you and for me? Time is now fleeting, the moments are passing, Passing from you and from me; Shadows are gathering, deathbeds are coming, Coming for you and for me. O for the wonderful love He has promised, Promised for you and for me! Though we have sinned, He has mercy and pardon, Pardon for you and for me. You can find more about this and other hymns in The Cyber Hymnal. Sep 14, 2007 Today has been better than yesterday. The intense feeling of coldness has gone, and I have been able to sit at the kitchen table and work at the laptop computer. Nevertheless, I am profoundly tired all the time. Richard Moebes came by and brought his battery charger to see about getting the pickup truck going, so we can go take the gas cans to fill them, so that we can run the lawn mower. Dick Danhof brought by supper that Eloise made – very tasty. So besides feeling a bit better, there was the opportunity to visit a bit. That always makes days brighter. This stage of the cancer has meant that I cannot get out as much as I used to. It is not quite a matter of being “home-bound” but it comes close. We might have gone somewhere for lunch today, but the combination of the oxygen hardware and the rain made it less than reasonable to attempt it. Fortunately for me, Monica is very helpful in making things happen. After 36-1/2 years of marriage, we get along very well. As I tell her, by now I look back at my life and see somethings I would change, but I would pick her every time. Last night, Monica put on one of our favorite CDs, Ralph Stanley's “Sunday Morning” from his Saturday Night & Sunday Morning set. There are some wonderful songs on there, in mountain folk style. My favorite is “I'll pass over thee,” which Ralph and his band sing acapella. Highly recommended. Sep 13, 2007 Today is a very difficult day. Monica got me up early and we went to the local clinic, and saw Dr. Stuart Foley. He conferred with Dr. James Posey at Kirklin Clinic in Birmingham, and they are keeping me on the current dose of Coumadin and Lovenox. I asked how long it might take to work, and he seemed to indicate that the very earliest I could expect to see any reduction in the pulmonary embolism is a month from now, if everything goes just right. In the meanwhile, I am off all cancer drugs, and the tumors are very active, growing lots, and spinning off more clotting compounds. So things are a bit messy. Additionally, the symptoms of the pulmonary embolism are increasing, and the blood oxygenation is dropping even on oxygen. I feel so cold I could just shiver the building apart. Monica has me wrapped up in many layers, starting out with long thermal underwear left over from when we lived up north. The Lord knows all this. For Him there are no surprises. Whatever the outcome, I will praise Him for His most excellent greatness. So I have no worries at all. Perhaps you might want to trust Him with all of your life, too. Sep 12, 2007 My impression this week is that of total dependence. What do I mean? Well, think of it this way. I used to just go places and do things, but now I am really and truly dependent upon others to do almost anything that needs doing. While I could, in theory, drag my oxygen tank to the car and go, in fact I am not really well enough to drive right now, even with the oxygen. I can barely breathe much of the time, and nearly black out with minimal exertion. Thus I need help doing things, and constant supervision is a very good idea. On the other hand, the Lord has shown me just how many friends I have, who are willing to help out with those things I cannot do. I am amazed at how His people are willing to help out, and make possible what otherwise would be impossible. So while I am dependent, there is no reason to also be despondent. The Lord has provided, and I am satisfied. I only hope that I will be able to shine His light through all of this, as He gives me strength. I am His and He is mine. So I need not worry, now or ever. Sep 11, 2007 There was no blog update yesterday because yesterday's medical events were so discouraging that I simply could not write. I wrote the first paragraph four times, and threw it out every time because what I was writing sounded so accusatory and bitter. The doctors have not been communicating with each other during the last week, and now they are disagreeing with each other as to the medication I should be taking, how much, and when. In lieu of the feeling of being a patient I am getting the distinct impression of being someone's science project, a warm body upon which to experiment. This is not even a part of any clinical study, but rather as a part of normal treatment. The Lord has all of this well in hand, I am sure. What I ask of Him is that His will be done in my life, whatever that may be. So it would not surprise me to find that by going through this particular set of strangeness that I have been protected from something, and that this crazy medical business is all a part of how He has chosen to accomplish His plan. So He teaches me another fresh lesson, and puts me in the right place at the right time for something I haven't seen yet. That is fine, as long as Heis in it all. UPDATE Jill the Wonder Nurse emailed me a copy of some recent doctors' notes on me, and they are worth sharing. If nothing else, it gives a flavor for what the doctors are thinking out loud, and what gets on the record. Note that this is from early September, and things have changed since then. The file is here. Sep 9, 2007 Today is Sunday, and thanks to a lot of hard work on the part of Monica and Marie, I made it to Sunday school and church this morning. I had an oxygen bottle on a roll-around cart, and that allowed me a bit of mobility. On the one hand, I succeeded in participating in everything, spoke a bit in class, sang all of the hymns, and shook hands with a whole lot of wonderful prayer partners. On the other hand, by the time Monica and Marie loaded me into the car to get me home, I had nearly fallen twice. This was not the trip-hazard problem, but rather the legs giving way with no warning whatsoever. So I am here, determined to participate, but also so weak that I really cannot be left alone. The oxygen supply is helping immensely. The only difficulty is that the oxygen is dry, and dries out my nose. Besides, the cannula makes me constantly aware that there is something sticking up my nose. OK, so it just feels weird, and that is not a bad trade-off for staying conscious rather than blacking out on occasion. With a long oxygen hose I can make it all the way to the front door if I have to, which is the farthest place on this floor. No, I am not going upstairs at all, since it is just too dangerous right now. Marie headed back toward Dallas, Texas, at about 2 p.m. local time. This is a 13 hour drive for her, and she may have to stop for a sleep break somewhere along the way. She has a couple of places she has stopped in the past, in Louisiana and east Texas, and she assured us that she would stop before she was too tired to drive. She was so helpful, and we are very thankful that she took time off of work and came all that way. The Lord gave me another day today, and I am rejoicing in it. I may be very sick, but that does not stop me at all from my desire to be with Jesus and to serve Him. I am, of all men, most blessed. Sep 8, 2007 I had a friend come over to talk today, and I was startled when he offered what sounded like a final farewell. I know my prognosis is lousy, but I was not expecting that. I believe that he didn't want to leave things unsaid, which I fully understand. Still, I have no immediate plans for going Home. When the Lord calls, I am ready. While I am still here I have work to do. This brings up one bit of wisdom which we all need to take to heart. Make it a point to let the people you love know that you do indeed love them, and never leave those words (and actions) remain unspoken. People who are far healthier than I are called Home every day, without warning, and so the opportunities that both they and their friends otherwise would have had pass with the passing of that person. Any thing left unsaid then becomes unsayable. Don't let this happen to you. Sep 7, 2007 Yesterday evening's release from UAB Hospital was a long, ugly, messy event. Their part was merely very slow. My part was messy, as I got thoroughly sick on the way out of the hospital, and then again on the way home. We had to stop on the side of the transition road between Interstate 20/59 and Alabama Highway 79 so I could lose the rest of lunch/dinner/whatever. I had to fight the car door open, because the manufacturer is so very much smarter than mere car riders, and the electronic locking system would not let me out immediately, even though we had stopped. So there was a bunch to clean up inside the car too. Our wonderful daughter Marie was in her car behind us, and stopped to help. She had paper towels and plastic bags, and we had a tub of baby wipes, and so after a while the mess was mostly gone. Ugh. When we finally got home, the driver from the company which supplies the oxygen equipment was waiting in the driveway, and so very quickly all of that was set up. I now have an oxygen concentration unit sitting next to me whirring away, as well as a few separate oxygen tanks for the times when I need to go somewhere, or the power goes off. Under the circumstances, the oxygen is helping, and there is a bit less of a tendency to fall down. The family figured out that the best place to put me for the time being is in the recliner in our music room. We live over our photography studio, which was converted from a fine old house. There are a couple of non-business rooms on the first floor, those being the kitchen, laundry area, and music room, as well as a there being a full bathroom. So for the time being I am in the back of the business, propped up in a comfortable chair, with my oxygen generator and a long enough hose to move to those few rooms, without having to negotiate any stairs. Such a deal. The new treatment for the pulmonary embolism has begun. I injected myself with the Lovenox this morning, and took the Coumadin pill. So far the only visible effect is that my nose is tending to bleed. Considering the descriptions of the drugs, and how they work, that is no surprise. I hope that the treatment works at getting rid of the blood clots in my lungs and legs. Maybe I will feel a bit better then. Hymn time! This is what we sang a few weeks ago as the Martin Family Trio. These words mean more to me now than ever. When peace, like a river, attendeth my way, When sorrows like sea billows roll; Whatever my lot, Thou has taught me to say, It is well, it is well, with my soul. Refrain It is well, with my soul, It is well, with my soul, It is well, it is well, with my soul. Though Satan should buffet, though trials should come, Let this blest assurance control, That Christ has regarded my helpless estate, And hath shed His own blood for my soul. My sin, oh, the bliss of this glorious thought! My sin, not in part but the whole, Is nailed to the cross, and I bear it no more, Praise the Lord, praise the Lord, O my soul And Lord, haste the day when my faith shall be sight, The clouds be rolled back as a scroll; The trump shall resound, and the Lord shall descend, Even so, it is well with my soul. For more about this song, check out the Cyber Hymnal Site. Sep 6, 2007 They are releasing me from UAB Hospital this afternoon, and sending me home. Thanks to everyone who stopped by. At the very least my new treatment includes industrial strength doses of the blood thinners Coumadin and Lovenox, and a Combivent inhaler that is the same as is used for asthma. They have me on oxygen until things improve. We do not have results from today's echocardiogram test, and they say that we should have the results tomorrow some time. I watched as the test was done, and noticed that the technician spent nearly half of the session checking and rechecking the wall between the left and right ventricle. It looked ragged, and I have to wonder what she was seeing, and because she is "just" a technician, she was not allowed to comment on what she saw. Thanks to everyone who has held us up in prayer. It is not over yet, so please keep praying. Sep 5, 2007 I am being admitted to UAB Hospital in Birmingham with pulmonary embolism in both lungs. Dr. Foley says that it is all over the lungs, which would explain my extreme shortness of breath. Normal treatment would be to use Heparin and Coumadin, but there is no telling what they will, in fact, do. I have every confidence that the Lord will take care of this. I pray simply for whatever His will is in the matter. If I get to live, then I can live for Him, and if I get to go Home, then I go Home to Him. I simply cannot lose. UPDATE It is now 5:25 p.m. local time, and I have been admitted to UAB Hospital (Birmingham, Alabama). I am in Spain-Wallace Room P338. This is an ICU area, and visitors, while allowed, are given a questionaire to fill out, and must wash up before entering. No flowers are allowed. Only two adult visitors at a time, also. I have seen the resident and the intern this afternoon, and I get to see Dr. Falkson (the oncologist running the show) in the morning. In the meanwhile, I have had blood tests, an EKG, X-rays, and they have been monitoring my blood oxygen level. Since it was running low, they put me on oxygen, and I feel fully awake now. I do not expect them to have a treatment plan for me until I see Dr Falkson in the morning. In the meanwhile, they are treating me very well. As you may have guessed by now, I have my IBM ThinkPad R-40 along (runninglinux) and can access the internet so that I can update my cancer blog, and actually do work for my employer while I am not otherwise occupied with treatments. This should work. The Lord has supplied everything needful. Even though I am very sick right now, I am satisfied that the Lord has everything fully under control. I am His, and He is mine. Such a deal! Sep 4, 2007 Today I had an unscheduled medical event. I have been very short of breath, accompanied by rapid breathing, with some chest pain. I have been coughing heavily, and my coloration has been running blue. This has become much worse over the weekend, to the point where a single flight of stairs is enough to make me simply fall down. My beloved Monica called Lakeside Clinic again this morning, and Dr. Foley saw me by about 11:00 a.m. The nurse who took my vital signs noted the low blood oxygen reading (92 resting). Dr. Foley saw that my August 9, 2007, chest CT scan showed a pulmonary embolism (blood clot in a lung artery) and hypothesized that this has become a major issue for me, perhaps a new clot in an even worse position than before. So he sent me to Marshall Medical Center North, and they performed a chest CT scan with contrast, just after noon. I will see Dr. Foley first thing in the morning, assuming that he does not call me back this afternoon after the radiologist reads the scans. Blood clot issues are evidently very common among cancer patients. Something about the cancer activity spins off compounds which cause blood clots, and so there is a very much increased risk of the sorts of things which blood clots in bad places may cause, such as thrombosis, embolism, heart attack and stroke. I am already on a blood thinner called Arixtra, chosen because it has relatively few drug-interaction problems to worry about. This was not enough to keep the embolism from getting worse. Ronda the Trial Nurse called today, and I am scheduled to meet with Dr. Posey and her on Thursday morning to sign consent forms, and to then have a chest x-ray and an EKG. The phase-I drug trial is to begin on Monday. Oh thrill. No, I am not looking forward to any of this. During our waiting time at the clinic and then the hospital, Monica and I read through Heavenly Highway Hymns and had a good old time. This is an old-style shape-note hymnal, and has some hymns that just aren't printed elsewhere. I even found one hymn by Thomas J. Laney, who was my friend Tom Curlee's grandfather, called “I'll Live On.” I assume no one else in the waiting rooms minded our very quietly singing hymns. We sure enjoyed it. Sep 2, 2007 Sunday is always the best day of the week for me, and today is no exception. Monica and I sang a duet in church today, and it went better than I could have hoped. My breathing difficulty has made it hard to sing, and there was the danger that I could have a serious coughing fit in the middle things. The Lord was good to us, and so we made it through without incident. This is a Very Good Thing. The breathing difficulty continues. Today it is obvious that I am short on oxygen. My fingernails are blue, and after the slightest exertion I get dizzy, and then breathe hard and may end up coughing frantically, coughing up yet more phlegm. It is not normal to be this gray, but this may be the new normal for now. I need to call on Tuesday and see if about getting a medical prescription for oxygen. A big activity this week has been putting together the list of things to do upon my passing. There are people who must be called and told the arrangements. There are medical appointments to be canceled. The employer must be notified. My professional associations need to know. There are life insurance policies to be dealt with. There are lots of things, and they need to be neatly listed, complete with all of the contact information, so that whoever does the calling (whether Monica or some good friend) has everything needful to just go right down the list. Some folks will consider this morbid, or a sure sign of my giving up, but I consider it part of being well-organized, and doing what is best for Monica. Why make a difficult time any more difficult? I am weak, but in that weakness the Lord's strength shows through. So be it. Aug 31, 2007 Today has been long. We got up early, so that my beloved Monica could drive me to Huntsville in order to spend the day at the office. I am so tired now that I am not sure that I could be safe to drive that distance. We passed multiple accidents, and I am glad not to have subjected anyone to such a thing. I helped Derek with some analog system troubleshooting, and found a couple minor errors, one mine and one not, so it was well-worthwhile to have gone. Over the last several days I have spoken with numerous people about whether or not to participate in the phase I study of Ascenta's AT-101 cancer drug. I am ambivalent about it, since this is a very early test meant to determine the pharmacokinetics (the study of the bodily absorption, distribution, metabolism, and excretion of drugs), and not test how well the drug may work. It is a lot of time and energy spent for some unknown benefit. I have been worked over by well-meaning people (“So, you are considering giving up?” “This sounds like a once in a lifetime opportunity!” “You might save someone else's life!” and such) and really I am not liking the direction of this. Nevertheless, I called Ronda the Trial Nurse, and told her that I will participate in the trial. This whole cancer experience is not about me, and never was. But sometimes it would seem that “avoiding the appearance of evil” (1 Thessalonians 5:22) causes me to do strange things, and this may be one of them. I will keep the blog readers posted as much as I am able. Last night I had horrible difficulty breathing again. I would cough, and cough, and cough up phlegm, and cough so hard that my head would spin. It used a lot of energy, and this increased my heart rate, thus waking me up fully. Then the difficult breathing would make the coughing worse. This is not a good way to get significant amounts of sleep. Derek had a thought, though. He suggested that I call Jill the wonder nurse and ask if I could get a prescription for medical oxygen. He is right that this just might reduce the cycle somewhat, and so I may do that on Tuesday, after the long weekend. This not being able to breathe business, and feeling like I am about to drown, is getting old very quickly indeed. The Lord gave me another sunrise this morning, and that is a very good indeed. And tomorrow, I hope to have it happen again. As long as that continues, I am able to serve Jesus, by His strength. He has taken care of everything, and I am so thankful. Aug 30, 2007 Did you ever wonder about the drug studies and how they are conducted? Well, I have digitized the information and consent form for the study I am considering, and you may find it here. It tells everything and nothing all at the same time. My beloved Monica wants me to consider every option, and this is a real option. The problem is that I am having a hard time discerning the difference between an opportunity and a temptation in this case. This is decidedly a case of giving my body for science, but while I am still alive in that body. A very technical description of how this agent is supposed to work may be found here. Please pray about this with us. Aug 29, 2007 Exhaustion is mandatory by now, I guess. I can sit all day propped-up in front of this nice GNU/Linux-based computer, and get a lot of office work done. But let me go down a flight of stairs, outdoors to the other building, back up the other flight of stairs, and I am barely able to stand up. The world just spins and I have to sit down immediately. Now I have been doing stairs frequently, since we live in a multi-story building. It is not as if I lack that sort of exercise. Nevertheless, stairs are a problem right now. I suspect that the cancer growth is taking all of the energy, and leaving all other activity with nothing to work with. It is funny that, in spite of being very, very sick, that I still look like absolutely nothing is wrong with me. At Kirklin Clinic, one of the nurses told me that I looked good. I replied with my standard joke that cancer must have been good to me because before no one said anything to me about it, but now people tell me how good I look. Well, I look fine except that I am gray much of the time. Most of the hair loss was not from what was left on fringes of my head, so no one noticed that lots of hair fell out elsewhere. Now my skin is peeling all over just like after a very bad sunburn, but once again, as long as I leave my shirt on, who would ever know? So as long as I don't fall down from slight exertion, who is ever the wiser? Today I spoke with Ronda the Study Nurse, and spoke some about the potential phase-1 drug trial using Acenta's AT-101. My biggest concern right now is that the trial, for the first couple of weeks, takes three days a week at the clinic, and then alternating between one and two days a week thereafter. I still have to work for a living, and that impacts too much work time to work well. Besides that, all the travel will leave me even flatter than I am now, with a minimum four hour per day commitment for any time spent there, considering that we live 75 miles away, which includes downtown Birmingham. So Ronda told me she would tell Dr. Posey. Well, at lunch, I told my Beloved Monica, and she seems to be all for keeping that option open. Maybe I could take vacation? Ugh. I am trying to hold on to every hour of sick leave and vacation to use during my now inevitable downward slide, as I absolutely need health insurance to pay for the cancer treatment, hospice care, and whatever else comes along. Monica suggested I could take along my laptop and cell phone, and work from the clinic, which I have done before, on occasion. Yes, that might be possible, if I have the energy, and am not even more exhausted. Now, reread the first paragraph for today, and think that one through. So no final decisions have been made yet as to the next form of treatment. Please continue to pray that the Lord's will be done in this matter. I have no strongly-held opinion in the matter, and want whatever He wants for me. I trust Jesus for everything. Aug 28, 2007 That Zometa has some nasty side effects. By a few hours after the infusion, my bones were beginning to ache. I lay there last night with my neck, back, ribs, and hips yelling at me (loudly) plus I was coughing uncontrollably to get up the phlegm from the chronic bronchitis. I probably slept a little, but this morning just moving is difficult. - * - * - * - Bluegrass time! For those who may not know, I am very much into bluegrass music, and most especially bluegrass gospel music. This bluegrass song pretty much sums up my feelings at the moment: I'm waiting at the gate looking for my ride, Soon to take me to my home on high. Angel bands a coming from the other side. I don't want to be late, I'm waiting at the gate. I can hear the thunder the time's at hand, Joybells are ringing in the promised land. Jesus is a coming my soul to take. Yes my Lord sees me waiting at the gate. I'm a' leaving the world, no more to do, All of my work on earth is through. I've fought the fight I've kept the faith. Well I'm ready to go, I'm waiting at the gate. - Paul Brewster as sung by Ricky Skaggs & Kentucky Thunder Aug 27, 2007 This has been a long day, I am very tired, and so this report will necessarily be brief. We drove to Kirklin Clinic in Birmingham, I had the blood drawn for the blood tests, saw Dr. Posey and Jill the Wonder Nurse, and was infused with the Zometa which I mentioned recently. That is not a chemotherapy agent, but rather is to strengthen the bones which the metastatic bone cancer is weakening. Dr. Posey mentioned two possible treatments for me. The first is Irinotecan (Camptothecin-11) which is approved for colon and rectal cancer, but which could be used “off-label” in my case. Apparently, Dr. Posey has been using it for pancreatic cancer and has had some success with it. The challenge would be to get approval from Blue Cross Blue Shield of Alabama to covers off-label use in my case. The other possibility is to participate in a phase-I trial for Acenta's AT-101, which I might qualify for, maybe. By the way, there was no CA19-9 tumor marker measurement, so I cannot tell you the number. Sigh... So that is the news for the day. I would request that all of the prayer partners pray specifically for the Lord's guidance in this case. I do not know what path is right, so I leave the matter in His hands. Aug 26, 2007 Breathing is getting harder. Yesterday evening, we had a special choir rehearsal to practice with the candidate for our church's minister of music position, and there was a bit of fun at the start as he proceeded to memorize everyone's name and recite them back. I laughed quite a bit, but then I started coughing and basically could not stop. It was very difficult to sing through this, but I stayed to the end. This morning I taught my adult Sunday school class (the adrenaline was flowing, and I was very much on) and then left for choir rehearsal and the second service. By the time the singing part of the service was over, I was so weak and wobbly that Mike Reeves and Bill Cain had to help me get down the stairs from the choir loft. (Thanks, guys!) The day was over, and it wasn't even noon yet. Tomorrow Monica and I will go back to Kirklin Clinic, and once again I get to provide blood for the blood tests, and then see Dr. Posey. I have some idea what the results will be, and assuming that the CA19-9 tumor marker test is done, I will be able to adjust my expectations to reality. If it is under 1200, then things have not accelerated any further; if it is about 1600, then the rate of tumor growth and activity has about doubled; if it is over 2000, then the tumors are basically exploding. We shall see. Regardless of the results of the tests, I rest in the assurance the my Lord has all of this well under control. He is never surprised by any of this, but has my future entirely under control. I am willing to stay as long as I am able, and I am willing to go Home when called. This is truly wonderful. Aug 24, 2007 The chronic bronchitis is causing difficulties again, and so this morning I started on the first round of antibiotics in order to see if it can be tamed. I do hope it works, since I really do not enjoy the drowning feeling. Last night's Gideon Camp meeting went very well, although I was so tired by the time it was over (8:30 p.m. - this is not a late meeting) that I was glad that Richard Moebes would be driving me home. I was too tired to drive myself anywhere. It feels crazy to be this tired, but it is absolutely normal now. Since I cannot blame this on chemo (the chemo has been discontinued) it is probably due to the cancer itself. Cancer can grow rapidly, and that takes lots of energy, and that is the most likely cause of the constant exhaustion. I am still here, and the Lord is so very good to me. I may be barely able to stand up sometimes, but I am joyful nevertheless. Every day I wake up and see a new sunrise, I am reminded of the Lord's greatness. I am His, and that is enough. Aug 23, 2007 Thursdays have historically been my low days, partly because Wednesday night church activities borrow energy from the next day, and partly because my resting on the weekend has worn off. So I usually end up in bed even earlier on Thursday evenings than on other days. However, tonight I have a Gideon Camp meeting which does not even begin until 6:30, with supper and a speaker. I may fall asleep with my nose in my plate, but probably not. So I probably will borrow further energy from Friday to get through Thursday evening. It is somewhat amusing to go through life with zero to negative energy every day. This morning I woke up at 6 a.m., and felt like I simply could not move. I got going alright, but wobbled through my washing routine, and felt absolutely no enthusiasm for a perfectly fine breakfast. I commuted the 100 feet to my office in the other building, and fortunately could sit all morning doing computer work, and getting lots done. It is not my mind that is tired, but my body is being dragged behind like some foreign object. This is absolutely normal for me now. I am looking forward to this evening's meeting. I know some of the people I will see, and will get to meet some others, and that is good. I really do enjoy being with those who love the Lord as these folks do. Aug 22, 2007 In spite of being seriously tired, I have been able to get yet another big schematic and circuit board designed for my employer. It turns out to be possible to spend hours at a time in front of the CAD workstation in my Guntersville office, and as long as I do not have to do anything in the way of physical labor, and as long as I stay in the cool air-conditioned building, that I can still get a lot done. This is a Very Good Thing, since this cancer event has cost outrageous amounts of money, which I can only pay because of a very good health insurance policy. In order to keep the insurance, I have to keep working, and because my employer has been gracious enough to allow me to telecommute, I can actually do so. They let me work 32 hours per week, which allows me one day a week for medical appointments without having to take any extra time off, and I still get full health benefits. Blessings be upon them! I do not usually talk about the financial end of pancreatic cancer treatment, but for the sake of those who are facing this, perhaps it is a good thing to do. (All figures here are in US dollars.) In rough numbers, the Whipple procedure surgery cost about $150,000, the radiation treatments cost about $25,000, and the first round of chemotherapy with Xeloda cost about $6,000. Every time there is a CT scan the bill is about $3,500, and this has happened about 16 times so far. Each treatment with Gemzar is $1,825 (every two weeks), every treatment with Oxaliplatin is $4,475 (every two weeks), and a one month supply of Tarceva is $3,450. The Arixtra blood thinner costs $100 per day. I never saw the bills for the bone scan, PET scan, or MRI, but they each cost more than the CT scan. So do the math; surviving pancreatic cancer is expensive. I have one of the best health insurance policies possible, and the out-of-pocket expenses left each year are probably about $3,500. That ispossible to pay, because I am still employed. So life is good! The Lord has provided everything we have needed, in a most magnificent way. I am thankful to be His, and to know for a fact that He already knows what I will need tomorrow, next week, next month, and forever. There is no need to worry, so I just trust Him. Aug 21, 2007 Recently I have had a couple of people who do not know me very well accuse me of “giving up.” Those who have watched this cancer process for the last three years know that is not true, but it would seem that an honest admission that the doctors do not have any more treatments to try elicits this “giving up” claim from some people. Yes, I have already taken the matter to the Great Physician, but I do so in the humble admission that what I want is what He wants for me, nothing more and nothing less. If He finds me useful here and keeps me going, then that is fine. If He wants to call me Home, well that is just fine also. I am not demanding a healing, as if I could snap my fingers and cause the Almighty to do so. It is just plain blasphemy to go in that direction anyway. So I continue in His strength day-by-day, and do not worry about the matter. But do not be surprised to hear that I am content with whatever the Lord provides. Everything is in His hands. I would want it no other way. Aug 20, 2007 The weekend was wonderful, but exhausting. Now I get to try to get in gear for Monday, and the normal work schedule. There are no scheduled medical events this week, which means I may actually get a bit done. We shall see. The next medical appointment is next Monday, August 27, 2007. I am scheduled to go back and see Dr. Posey at Kirklin Clinic, and discover what he will suggest for treatment, if anything. So far, I have pretty much exhausted all of the normally tried remedies, including every approved chemotherapy treatment for pancreatic cancer. So maybe there is a study of something he will want me to try. Studies are no panacea, since half of the people in any study get a placebo, and of those who don't, there is no guarantee that the new drug will do anything positive whatsoever. So I see no big opportunity here. One thing to watch, though, is the level of the CA19-9 tumor marker. On August 9 it tested at 908 (which is quite high) and was increasing at a 1.63% per-day rate. If that rate of increase were constant, then I would expect that the measured value would be about 1215 on August 27th. Since I am no longer taking any chemotherapy, that rate of increase could easily double to 3.26% per day, and if so then the measured value would be about 1618. (At that rate the cancer doubles about every 20 days.) Yes, it could easily rise that quickly. We are dealing with a geometric increase in cancer activity, and so these numbers are entirely likely. My best-guess estimate for the point at which the cancer side effects begin to be really obvious is when the CA19-9 hits 10,000 or so, and at a 3.26% per day increase rate that would be reached in two months or so. So this is a rather critical time. My Lord is carrying me this week, as I do not have the energy to do much by myself. I have every confidence that He will keep carrying me, right up to the point where we are at His House. My friend in Huntsville who spent a lot of time with Salvation Army folks told me that when one of theirs is called Home, they refer to it is being “Promoted to Glory.” I like that most-apt description. While I am not going to do anything to hasten that day, yet I am looking forward to my promotion. How about you? Aug 18, 2007 The hair is beginning to grow back, now that the chemo has ended. I don't believe I ever mentioned the hair-loss side-effect from the chemotherapy because, let's face it, I am nearly bald as a cue ball to start with. But there was a great thinning everywhere, and it is odd to have new, very dark hair growing again on places like the back of my hands and my eyebrows. What brought the whole matter to my attention was that the backs of my hands seemed unusually rough, and it was not because of the super-dry skin which the Tarceva caused. So I got out my magnifier and looked, and there is a very short forest of dark hair starting to appear above the skin line. It is quite a contrast to the nearly white hairs that remained from the old batch. What interests me is that there are undoubtedly internal changes just as remarkable, but which I cannot see. I suspect that the chemo had some positive effect of at least retarding the growth of the tumors, and that restraint has now been lifted. So what was a 1.63% per day tumor growth rate could well double now. We shall see. The next visit to see Dr. Posey is at Kirklin Clinic on August 27, 2007. Today was an unusual day, in that I got to go to the big ham radio event of the year, the ARRL National Convention, in Huntsville, Alabama. I was too tired to drive, so Stan Hurst (KG4NAE) picked me up and took me along. Thanks, Stan! The ride was as interesting as the convention, and part of the discussion revolved around how some of their so-called Christian acquaintances were involved in some rather evil behavior. It is a reminder that we as Christians need to walk the walk in order to properly represent our Lord and Savior. People are watching, and evaluate Jesus on the basis of who we are and what we do. This is both our blessing and responsibility. We have the opportunity to represent our Lord and Savior. Make the most of it! Aug 17, 2007 Wednesday was very long, and wore me out. I drove the 90 miles round-trip to Huntsville and spent the day at the office, and then we had a special called church business meeting, and then choir rehearsal. I was severely wobbly by the time I got home, and Thursday I was very tired from the start. However, Thursday was Monica's birthday, and so there was lots to do to make that go well. We went out for lunch to celebrate, and ended up at Lumpkin House in Albertville, which is a really nice place for lunch, and had a good time. By mid-afternoon all energy was gone, and so I spent the rest of the afternoon asleep in the recliner, had a tiny supper, and went straight to bed. All considered, it is amazing that I could do what I have described while dealing with stage IV pancreatic cancer. The Lord has truly provided, and I am very glad to still be able to get around. As a side note for those who correspond with us by mail, our postal address has changed. The old Guntersville post office (completed in 1940) has been replaced with a new one, and some PO box numbers were changed. The new mailing address is PO Box 1192, Guntersville, AL 35976-7992. Aug 15, 2007 Yesterday evening, Jill (Dr. Posey's nurse) called back with the results from the skeletal survey, and there are no real surprises. There are sclerotic lesions (bone cancer) in the pelvis, ilium, sacrum, lumbar spine, and thorasic spine. There has apparently been no spread beyond that about which we already knew. Dr. Posey is considering treating the current bone cancer potential problems with Zoledronate (Zometa) in order to reduce the probability of bone fractures due to the cancer. This is a non-trivial problem, as it would seem that last year's eight-month terrible pain was due to a minor bone fracture in my lumbar spine. If it can happen once, it can happen again. One thing I have to remind myself is to physically be careful what I do. Yes, I may have the strength and stamina to do something, but due to the spreading secondary bone cancer, there is the risk that I can easily break a cancerous bone, and then my problems are multiplied. When we are dealing with the pelvis and spine, any fracture could effectively immobilize me. So continued care is absolutely necessary. It is not easy to ask for help doing things which normally I would just do, but really there is no choice.