Friday, December 11, 2009

Dr Giuliano and CIM

I know our visit to pursue the approach for Crea's cancer and CIM don't immediately leap out as fit material for the same blog entry but there are some similarities. At CIM, I ended up in the medical tent for a few hours so they both require a trip to the doc. Additionally, since hearing the news of my wife's cancer, most of my runs take me to a place of thinking about her and this race in Sacramento would be no different.

I will first venture to Cedars-Sinai where Crea and I were meeting with Dr. Giuliano. He specializes on thyroid and breast cancer. He operated on my mother in law for breast cancer and was the surgeon that operated on Crea during her first run with cancer in 2004. That surgery happened on November 11, 2004 which was a mere 13 days after my son Jaden was born. We had learned about the cancer in the summer of that year and had the difficult decision of whether to fight the cancer before or after Jaden was born. Humor would lead to surely risk the wife but reality makes things more difficult especially when you have already been to a memorial service for one of your children. We chose to attack the cancer after Jaden was born, which until recently seemed like the right decision. Jaden was healthy. Crea was healthy. That all changed in early November and it is hard not to question our initial decision once the cancer returned. I believe in a life of no regrets, though, and I believe it is really all in God's hands anyway but I am human and some of those human thoughts invade my head from time to time.

I remember both son being born........and my wife's first surgery very well. I was a train wreck for both. I was the nervous Dad on steroids when Jaden was being born. I had been in that same hospital in Santa Monica 1 year 2.5 months earlier watching nurses search for the heartbeat on my little angel Isabella all to no avail. Now I was back and I was paranoid. Every time the heart rate belt moved and the heart rate stopped showing on the monitors, I called the nurse. They must have readjusted that belt 20 times but they put up with me. I remember the same nurse that had been there for Isabella was back for Jaden. It was as if we were all coming full circle from a very sad day to a very happy one. I also know I wasn't alone in my paranoia because once Jaden was born and his cries were heard there was not a dry eye in the house. They were tears of joy and tears of relief all at the same time. I remember when the OB/GYN, Dr. Gonzales first saw Jaden she cried out "we have a chubby one". She was certainly not exaggerating. He was two weeks early and still over 9 pounds. He was enormous for the first year of his life and could have been on The Biggest Loser Baby Edition. He was amazing though...still is.

Shortly after Jaden was born, we were back in a hospital for Crea's surgery. She was to have her thyroid gland removed and would later receive radiation therapy. I remember thinking the surgery would go quickly and I remember thinking it didn't go quickly. I was pacing and pacing and pacing and worrying and worrying and worrying. Finally, Dr. Giuliano came out. He said everything went well but he did have to take out a few lymph nodes and he removed one parathyroid gland. I remember the 'lymph node' news rattling my brain but I stored it away for future use.......which happens to be when the cancer came back in November 2009. Crea went home and recovered and shortly after the holidays, she received radiation treatment where she was quarantined from all of us for a month....the hardest part of course not being able to hold our new addition.

That was 5 years ago and now we were back with Dr. Giuliano. He came in and talked with us. We shared all the facts. He exuded confidence but not in an arrogant was actually quite comforting. When he talks, you just feel like everything is going to be okay. Both of the first two surgeons believed we should operate.........with the ability to wait until January/February but not waiting so long as summer. One wanted to go in and remove the lymph nodes we knew were bad and any suspicious looking ones and the other wanted to take out every lymph node. I had expected the search for a surgeon to be more a function of personality and confidence level with the doctors all sharing the same opinion on how to proceed. I had been proven very wrong to date and Dr. Giuliano continued the trend. His opinion..........wait 6 months and do nothing for now. I couldn't believe it. It was yet another extreme. I tell people that if I had to rate the approaches of each surgeon on a scale of 1 to 10, I would give Dr. Adashek a 4, Dr. Yeh a 12 and Dr. Giuliano a 0. All are very good doctors. We are probably in great hands no matter which choice we make but the three different opinions are making this a challenging process.

Dr. Giuliano felt that ultrasounds are not that reliable. He felt the tumors were small at just over 1 centimeter. He, like everyone, says this is a very slow growing cancer (he was a big part of us choosing to wait until after Jaden was born the first time). If you add all of this up, he concludes we wait and let things progress. One side of you wants to rejoice at the news and the other flashes to the doctors who said we should not wait until summer. I believe Dr. Giuliano saw some anxiety in our faces so he offered both an MRI and a biopsy in order to be absolutely certain as to whether we should move forward now or postpone. As of writing this, we really have not made a decision. I am not sure what we are waiting for. Maybe it is the Holidays. Maybe it is some comfort in Dr. Giuliano's words. Maybe it is the hope that some sign will present itself that guides us to the right decision. One sign tried to present itself when Crea was visiting Dr. Singer at UCLA for a running injury she incurred. During that visit, he asked about her general health to which she gave him more info than he bargained for. The 'sign' came when he heard Dr. Giuliano's name mentioned. He went into great detail of how amazing he is which is great when you get such a strong unbiased opinion. Dr. Giulano is very well known for being a great surgeon. His cost seems to go hand and hand with this news but when it comes to times like this, cost really isn't one of the deciding factors. In fact, I am the guy that gains comfort by a higher cost..........kind of like you don't want your sushi to be so inexpensive you worry it is going to be 3 weeks old and result in the removal of your intestine.

For now, we will keep talking about the decision and I am sure an approach will be reached by Crea and I. Truth be told, it is not really my decision. I can only offer my thoughts, my opinions and try to hear the things that perhaps she might have missed. Crea has to be comfortable with the surgeon, the approach and the time frame. She is a bright girl though so I have all the faith in the world she will make a good choice.........she married me after all.

Okay, on to the race. I really try my best during a race to zone out so I am very short with the race recaps. Truthfully, in my perfect race, I do not see a mile marker until mile 16 or so. I pull my visor down and just run. For CIM, I was in great shape. I really did not have a time goal but I did say to a few people that if I finish slower than 3:30, something went horribly wrong. My time was 3:37:07 and yes.......some things went horribly wrong.

The days before the race were uneventful. I arrived in Sacramento on Friday for the Sunday race. I checked into a Marriott Residence Inn a few blocks from the finish line (this is a point to point race) primarily so that I could have a kitchen and eat the foods I always eat. Based on this, I made a trip to Trader Joe’s and bought some pasta and pesto sauce that I and my family eat far too often. We are very busy so pasta always seems to be the economical meal from a time perspective. I went to the Expo on Friday so that I could take it easy on Saturday. I bought some extra warm weather gear because it was supposed to be around 35 degrees at the race start. From this point, I just did some work and chilled out listening to music or watching tv.... there was ton of good football on this weekend.

I do remember feeling a little more nervous than normal. Actually, nervous is probably not the right word. Anxious may be better. One reason was that I had been sick for about two weeks but the main reason I was feeling off was because of all the recent happenings surrounding my wife's cancer. This felt like a much bigger deal than just a race and that is something I preach all the time as a coach for Team in Training..........."Race day is much more than running 26.2 miles and crossing a finish is about all the training, all the hard work, all the lives saved". I don't think I have actually ever run a race just for myself. I don't think I ever will because I have so many motivating factors with my father, Isabella and the many many amazing people I have come to know over the years. There is always something to grab onto and this time it unfortunately happened to be Crea. This time it felt very real and very present. I think it was weighing a little bit on my heart but I can't really be sure.

Anyway, race day came. As usual, not much sleep the night before. Up at 3:30 to fix some breakfast in my Residence Inn kitchen. Same meal as always: 2 packs of oatmeal, 2 balance bars, 1 banana this time and 2 yogurts. I actually took the banana and 1 balance bar to the start with me. The bus picked us up at approximately 5:30am and drove us out to the start. Once we arrived, I just sat on the bus to stay warm. The race didn't start until 7:00am so I had time to spare. At approximately 6:30 I jumped into the bathroom lines and afterwards actually saw some great friends of mine....Todd Weinstein (Mamuute to me), Natalie Weber (Mamuute's fiancĂ©), Brian Raymond and Victor Perkel (Brian's girlfriend’s father and amazingly an Endocrinologist that had thyroid cancer many years prior). It was cool to see them but I quickly went on to my own space to zone out.

6:55 and I check my gear bag. The key point here, which is needed for later, is that in the bag I check was a ton of warm weather gear. A fleece hat. A jacket. Two pairs of arm warmers. All of these things remained in the bag and not on my body. On my body, in this low 30 degree weather was a sleeveless tri top, tri shorts and an Ironman visor. I did actually have on compression socks and I was wearing the ever so popular $2 gloves available at the expo. I sweat so rapidly and do so horrible in the heat that I went light knowing I would heat up quickly.

7:00 - Gun goes off and I go running. As I cross the start line, I say to myself "I Love My Wife." This day is for her and I will give 110% for her. Things are going very well. I am keeping a 7:45ish pace and I feel like I am crawling. I had in my head that this was a very fast course but had been told the first half has a lot of rollers. On these rollers, I eased the pace and, again, was feeling great. I remember thinking this certainly wasn't that fast of a course as we seemed to be going uphill quite a lot. Nothing too steep.........just uphill. There is really only a few more things to mention for the first 18 miles:

1)I threw away those $2 gloves at mile 1.5. My hands were very warm and I didn't want any part of me overheating.........hindsight being 20-20........dumb ass move.

2)I somehow kept seeing every mile marker. I would be zoning out but amazingly would manage to catch the small sign indicating where I was on the course. That was not part of the plan.

3) I do remember crossing the half way point (very obvious point on the course) and thinking I am going to kill this race, pick up the pace and finish between 3:15-3-20.

4)Because of #1, my hands were beyond numb. They were all crooked like some horrible zombie creature and I remember looking around to find myself the only one NOT wearing gloves. Because my hands were so cold, I was not able to get to my food and open it up. I could have stopped and got help but that would require stopping so I pushed forward.

5)I spent all of these 18 miles thinking about various times with Crea........when we met.....dates we had......countries we had traveled to..........the good times........the bad times...........the life we had made with each other. This was how I passed the time and focused on why I was running.

Somewhere between mile 18 and mile 20, things changed abruptly. I began to feel very dizzy. My knees were hurting from the rolling hills but that was nothing that would stop me. I remember hitting a point where I thought if I took a few more steps I would pass out. So, with great sadness, I stopped to walk. I also remember being alarmed because I was not able to walk a straight line. The white haze passed and I started to run again but the haze returned and this really encompassed my road to the finish. Things were getting worse and worse. I stopped my watch and I remember feeling like I was letting my wife down. I knew she didn't care but this race was for her and things immediately stopped going according to plan. I remember turning my GPS watch back on and trying to run 0.25 miles with a 0.05 mile walk in between. You would think this would be easy but it was all I had to make it to the 1/4 mile mark on my watch. I always tell people to run the first 20 miles with your head and the last 6.2 with your heart and I was on all heart at this point. I really don’t remember too much. I remember being bummed at not being able to high five a few of the kids that were standing on the side of the road. That is always a big deal for my son and I know that simple gesture can make a lasting impression on a child but I just couldn't maneuver.

The next thing I really remember is having some women stripping off my clothes in the medical tent. I did not necessarily pass out and apparently had been talking and saying all the right things. It is just all a blur to me. They had taken my temperature and the reading was somewhere near 94 degrees.......which is apparently a little low. They were removing my wet clothes and putting on dry clothes from my gear check bag. Apparently a benefit to being in such bad shape is that they send a runner to get your gear bag (another is the green hat donated by Kaiser to keep me daughter Thalia looks much better in it than I). I also remember having a straw put in my mouth and being asked to drink. It was hot chicken broth. The first one tasted good but after the 6th and 7th cup, I was done with chicken broth and may be for the rest of my life. I think my temperature was taken about 3 times and it wasn't improving so I kept being given more blankets and I kept moving closer and closer to the heater. I also remember my feet being raised....not sure why but I wanted whoever was doing it to know I was not all that flexible. Those words never came out but I didn't break so I guess all is well. After a long time, I was able to sit up and was escorted to a chair directly in front of the heater. I remember shaking uncontrollably which is very odd for me because I am rarely cold. Just today no less than 5 people came into my office exclaiming "aren't you freezing"....NOPE. It was a couple of hours later that my temperature actually stabilized to a human level. Some blood had been taken that showed I was short on calories as big surprise since I couldn't really open my food. At this point I didn't even know my race time. That is a key point I failed to mention. Shortly after my clothes were stripped, I had to ask if I had a medal because I did not really remember crossing the finish line. The nurses looked into my bag and were happy to report that I had a medal..........I had finished the race!!! I very much look forward to seeing my finish photo to see if there was a blank stare.........did I raise my arms to celebrate.........I have no idea!!

Once out of the med tent, I immediately called my wife. It had been a few hours so I knew she would be freaking out a bit. I am very timely with the calls home so to disappear for a few hours after my expected finish had to be a little nerve racking. I explained the story as best as I recalled. I remember breaking down and crying (not proud of this). I am not sure if it was because I felt like I let Crea down or just a combination of all the events we had been dealing with over the past month. Either way, my wife assured me that a)she was not disappointed b)she was proud of me and c)I would never go to a race on my own again. Time has passed now and I have come to terms with my race at CIM. I know I gave every ounce I had to get to the finish line. It didn't quite produce a time that made me happy but that is the beauty of the marathon and what keeps me coming back and what keeps me coaching others to do the same at Team in Training............on any given day, you can kick the marathon's ass but runner beware because sometimes the marathon just might kick yours. Each and every marathon and the journey to that marathon can change your life, teach you how to be a stronger person, teach that you are capable of anything. As part of Team in Training or any other amazing cause, it can also teach that each and every one of us has the ability to make a difference and change the world. On this particular day in December 2009, the marathon took it to me but I will be back and I will have my revenge.

Thanks for reading. Thanks for all the support you have shown to my family and I. My journey is now to the Lavaman Tri in March which I am competing in on behalf of my wife and her battle. I am doing this as a participant for Team in Training. If you are so inclined you can donate at the link above or you can go directly to my fundraising site at . Either way, I am very grateful to everyone on this journey.

Tuesday, November 24, 2009

Doctor Visit Number Two - UCLA

One week after visiting Dr. Adashek at Cedars Sinai, Crea and I found ourselves at UCLA visiting with Dr. Yeh. As I mentioned in the last post, the facts seem to be clear at this point and surgery appears imminent. Because of this, I did not anticipate a lot of new information coming from Dr. Yeh but merely Crea determining who she would be more comfortable with as a surgeon. As is with life and certainly this entire situation, reality was not quite as expected.

We arrived at UCLA and it was immediately a different feel. It was a much bigger facility with a lot more foot traffic so we began the process feeling somewhat part of a herd. I think we both were thinking the small office environment at Cedars with 6 or so chairs in the waiting room was a more inviting setting than the 40 chair waiting room we sat in at UCLA. We were greeted at the receptionist stand friendly enough. Crea handed over a packet of information that she had filled out prior to arrival and was then asked many questions........the answers of which were in this same package Crea had provided. I only mention this because it was very funny to watch my wife deal with the scenario. Crea is truly one of the nicest people I know. She is very caring, very welcoming and very friendly. She was trying to draw on all of these characteristics and hide the tremendous frustration she was feeling at having taken all the time to fill out the forms yet verbally have to respond to the same questions........just prior to each of her answers Crea would kindly point to the packet of information sitting on the desk. To the world, Crea appeared fine. To me, I knew she was boiling which for some reason struck me as funny. I could definitely see a Seinfeld episode coming out of the interaction...Seinfeld, Table for 4?

We were immediately called in to the office and were initially greeted by a student. The paperwork mentioned the possibility of student interaction which I know is vital to training our surgeons of the future but we still found ourselves a little frustrated. Funny enough, Crea was yet again responding to questions to which the answers were contained in the packet of information now residing with our student doc. Dr Yeh ultimately arrived and he had quite a personality. Dr. Yeh actually was a self referral for Crea and we were very unprepared. Crea didn't bring a lot of the medical records so we put the Dr. Yeh in the awkward position of having to rely on conversation. Funny enough, one of the papers we did have with us was from the recent blood tests which he noted were processed at a USC Lab. His comment was that the USC Lab is one of the best in the country for this type of test but he still managed to sneak in......."as much as it pains me to say that"........I love USC haters so we have to score one for Dr. Yeh at this point.

We walked Dr. Yeh through the entire history....cancer diagnosis while pregnant, surgery in 2004, radiation in 2005 and all the recent findings. He is very thorough but would definitely be a good addition to the Seinfeld episode. Add to this episode the fact that we were really not sure the proper protocol for getting the opinion of a second surgeon. Do we mention the prior visit? Would it offend Dr. Yeh? Were we committing medical adultery against Dr. Adashek? We were not sure so we remained silent on the topic. We just presented the facts and must have appeared to be medical geniuses with some of the questions we asked.

Dr. Yeh walked us through the evidence based theories on why to operate or why 'not' to operate. He said because of the suppressed growth, Crea might live to be 85 and die of a heart attack if we do nothing. He gave extreme examples where you would probably not operate on the 80 year old in bad health in which surgery posts many complications and you would clearly operate on the 19 year old in good health (minus the cancer) that could clearly tolerate surgery and has a long life yet to live. Enter Seinfeld as Dr. Yeh began to say that Crea is somewhere in the middle of very old and 19 (risky direction here) but then recovered to say she was clearly closer to the 19 year old scenario which would lean towards surgery.

After much discussion, Dr. Yeh wanted to perform his own ultrasound. He actually insists on this so he can see the issues with his own eyes and draw his own conclusions. It is this ultrasound where things started to turn a little south from expectations. The outcome of the new ultrasound was actually the discovery of 3 more cancerous lymph nodes bringing the total identified up to 6. While the doctor was very clear to say this discovery does not change the fact that Crea will be okay, I found the news to be a little disheartening. Maybe 'disheartening' is not the right word. I am confident Crea will be okay but the knowledge that cancer is inside my wife is frightening thus the fact that more cancer is inside my wife than originally thought is even more frightening. I think the other issue is that as a husband, I feel helpless. I can not cure my wife. I can just get my arms around things and try to comfort the situation. When the facts change, it is hard to get to stable ground.

At the end of the ultrasound, Dr. Yeh showed us the pictures he captured. Unlike the ultrasounds I am used to seeing, there was no beating heart of a baby. Instead we had to look at pockets of cancer inside my wife's neck. It is not a lot of fun coming face to face with your nemesis but that is what it felt like. I was staring into the eyes of cancer and it was not a pretty sight. Dr. Yeh then drew a diagram so we could understand where the cancer is in relation to Crea. It is all contained in the right side of her neck. Some is fairly close to the original scar and some is extended a little farther out to the side. From this news, I asked the question as to whether the original entry into Crea's neck could be utilized. Please note I could care less about the scar, where it is or how big it is. I know my wife cares which is why I asked the question. I never even notice her current scar and I doubt others do either....unless they too have had thyroid surgery and are sensitive to the process (kind of like you never notice so many Honda Elements until you actually buy one and then thousands are on the very street you live on).

My question lead to the final detour from expectations. Dr. Yeh has a more aggressive approach and believes in taking out many of the lymph nodes in the area where the cancer exists. His analogy was that if one house in the area is on fire, remove all the houses in the zip code. He presented two scenarios. One was to extend the surgery both upwards and outwards which would remove multiple sections of lymph nodes from the entire right side of Crea's neck. The second scenario was to slightly extend the current scar and take out 2-3 sections of lymph nodes. He ultimately settled on the second scenario because of data which indicates the cancer does not tend to invade the upper section of the neck. Either approach seems more aggressive than Dr. Adashek who believed you go in and get as many lymph nodes that have cancer or look suspicious. Which approach is correct.............I wish I knew the answer but all of this information sent my brain into overload.

-why didn't the first ultrasound catch all of the cancerous nodes?
-would Dr. Adashek have done his own ultrasound to find the additional cancer and should I care?
-if no additional ultrasound was done, would the additional cancer have been found during surgery and, if not, what would the consequences be?
-Dr. Yeh said surgery could wait until January/February but again seemed to indicate not waiting too long. Why? If earlier we were told Crea could live to 85 and die of a heart attack, what is the rush?
-Dr. Yeh said there is a 1% chance of harming the vocal chords during surgery leaving Crea hoarse for the rest of her life. I asked about his personal history and he said it was consistent with the 1%. Dr. Adashek said his history was zero..........why the difference? Is it the aggressive versus non aggressive approach?
-Dr. Yeh would want to examine the vocal chords prior to surgery. I don't remember this being mentioned in the first visit.
-If you go with a less aggressive approach now, and more lymph nodes become cancerous at a later date, is the next surgery more risky due to scar tissue from what is now two operations?

All things to think about. All things that invade my thoughts throughout the day. I am sure both surgeons are fantastic. Maybe there is no wrong choice here but my wife is involved and I just want her to be okay. I want the cancer out and to stay out. I want my wife to know she is beautiful with or without a scar and I want a cure for cancer. That can not happen without all of us committing to making it happen. I am certainly not skilled enough to find the cure but I can run and I can bike and I can sort of swim. I need your help though on this little journey my family finds itself on. I am committed to raising $10,000. For my wife, I will raise at least that much. If you can help with a donation, please click on the link above. If the link is not working, you can go directly to my site at . If you are not in a position to donate, I completely understand and am grateful for your taking the time to read my long winded words.

Thursday, November 19, 2009

Surgeon Visit Number One

Very sorry for the delay with this update. The entire family is now in Fort Lauderdale visiting my Grandmother (Nannie) and Great Aunt Betty. They are both in their 90's and really the only family remaining on my fathers side. My original story started to some degree with my Aunt Betty back in 2002 because we were all flying in for my Aunt Betty's 90th birthday. 'All' really only represented my Mom and Dad from South Carolina and myself from Los Angeles. My father was an only child and that is apparently a genetic trait for I am also an only child. That does not lead to large family get togethers at least it it relates to my fathers side of the family tree.

Anyway, it was a few days prior to departure for my aunt's birthday and I was struggling to get a response from my father regarding last second plans. This was very unusual because we talked literally every day and as it turns out, my worry was justified. When I picked up the phone, I could hear in the tone of my mothers voice that something was not right. She told me my Dad was in the hospital and had arrived with only minutes to spare because he was failing to get enough oxygen as his red blood cells were being suffocated from all the bad white blood cells being created from what would ultimately be diagnosed as leukemia. Anyway, I never made it to see my Aunt Betty and amazingly have not been back since. She is now 97 years old and has never seen my children so this trip is a very important and long overdue one. To be honest, she has only seen Crea one time and that was at our wedding 10 years ago. I have some amazing memories with my Aunt and Nannie and it was great seeing the spark light up in each of them today as they watched the kids running around their place. As it turns out, this trip turned into a needed break for Crea as well. The news we received regarding her cancer has been very tiring. I am exhausted thinking about it and can only imagine how exponentially more difficult it is on her.

So, back to my wife. As with the first diagnosis, the news is all good. I should correct this to say the news itself is horrible.......the chance for a positive outcome is very high. Here are the facts as I know them. Outside of the fact that I would have a hell of a bedside manner, I certainly was not meant to be a doctor so this will be written in a very elementary manner. Five years ago my wife was diagnosed with thyroid cancer. Albeit cliche, if you ever have a gun to your head, are being told you must choose a cancer and that you must choose a form of cancer without hesitation.........your answer should be 'Thyroid Cancer'. Whether that is factually true......I do not know. I do know the survival rates are extremely high. That is what we were told 5 years ago and that is what we are being told today. In fact, we are being told that 30% of the time, thyroid cancer will return after the first treatment. I am fairly certain that we were not told this the first time around. Had we been told this, we might have been less surprised on November 3, 2009. I want to add here out of respect for my wife that while the survival rate is very high, my wife still has cancer. Cancer takes lives. We all know it is horrible so I am not really sure how easy Crea rests at night with the news that survival rates are high. She has something inside her that ultimately can take her life and it is a scary place to be. She is not in control. Cancer is in control. I think the reason I say this is that I do not want to belittle the situation in any manner. I will digress slightly back to the loss of my daughter Isabella. While a very small minority of the population, I have encountered folks that seem to believe all should be fine since 6 years have elapsed since Isabella's passing. I know others that have lost children and they agree with the following statement as well: while time does somewhat heal your wounds, you are NEVER quite the same after the loss of a child. Things can be perfectly normal one second and in the next you see something that takes you right back to a hospital room watching your wife go through labor that does not conclude with the usual crying baby to let you know all is well. You flash back to holding this little angel in your arms screaming in hopes that it was all a bad dream and that she....or you....would open your eyes and everything would be okay. It can be as simple as the end of the movie, 'The Butterfly Effect' (watch it and you will understand) in which my wife and I instantly went from ok to hysterical. Recently it was a picture in the video for the song 'Trinity' by Paper Tongues. It was a baby's hand laying face up in the hand of an adult. I have that same picture with Isabella, Crea and myself. It instantly took me back........and solidified 'Trinity' as my anthem for this new challenge my family faces.

I am good at digressing so let me get back on track. We are visiting 3 surgeons during the month of November. The first was Dr. Adashek at Cedar Sinai on November 16th. He came highly recommended as one of the top surgeons in this field. My thought process surrounding the different visits was to be certain that surgery was required. After meeting with Dr Adashek, we are fairly certain surgery is required so now it will come down to Crea choosing which surgeon she is most comfortable with. Another self discovery from this appointment was how uneducated I think I was the first time around for Crea. I remember sitting in the waiting room with family and I remember being scared but when I look back, I think I was uneducated. It could have been my subconscious just trying to focus on 'survival rates' as that was a much more positive place to look than the bad things that could once again impact my family.

With the first surgery, I remember it taking far longer than I thought it should. I was beginning to lose my mind wondering what was going on when the surgeon finally came out. He said it went well but he definitely did not seem as upbeat as I hoped he might be. I think it was this moment.......when the surgeon shared his findings......that I let my mind go to the reality that could have come from my wife having cancer. He explained that the cancer had made it to several lymph nodes and he also informed us that he had to remove one parathyroid gland. 'Lymph node' echoed in my head. I let it rattle around and then I stored it for 5 years until the doctor told us the cancer had returned. I knew the 'lymph node' news was not the best news but chose to focus on the fact that my wife was okay. Regarding the parathyroid gland, that is important to know for the next surgery. We all have 4 parathyroid glands that serve the function of controlling the amount of calcium in our blood and bones. You can definitely function without one but calcium levels have to be monitored for Crea.

In case I have not been clear, Crea's first surgery involved the removal of her thyroid gland. During that process, the cancerous lymph nodes were discovered and the parathyroid gland was removed. The next step of treatment involved radiation therapy administered via radioactive iodine. Removing the thyroid gland is not the same as removing an organ. You can not be certain you removed it all or that some thyroid tissue did not break off and land somewhere else in the body. It is because of this that the radioactive iodine is administered. Your thyroid gland absorbs iodine so if you add radiation to some iodine, go on a diet that deprives your body of all iodine and then take in the radiative should go straight to any remaining thyroid tissue and kill it. This is what Crea did. She went on a funky diet that had zero iodine and then took a little blue pill (not sure it was blue but you have to love The Matrix.....after reading this to her I was informed it was HUGE and ORANGE) and was then quarantined for what I remember to be a month. From there it has been maintenance and monitoring and until November 3rd, all was well.

What we learned on 11/3/09 was that over the course of the prior 12 months, what were minor abnormalities had grown to over 1 centimeter. Three lymph nodes are affected and there is one extra node that is not a lymph node but its very own growth. In addition to the growths is an increase in the level of of thyroglobulin in Crea's blood. Thyroglobulin is a protein that can only be produced by the thyroid gland. The fact that it increased, combined with the growths above are a very good indication that there are still thyroid cells in the body. The last fact is that the growths described above were only discovered via ultrasound. This is important because part of the maintenance is taking some doses of radioactive iodine for the sake of body scans. During these scans, nothing was ever seen. You might think..great news but, in Crea's case, it is not. Because there is thyroglobulin, there are thyroid cells. Because these cells are not absorbing the iodine, it is the last indication that there is something wrong with these remaining cells........i.e. CANCER. These are the facts. Dr. Adashek did a great job at being thorough and walking us through the trail of evidence. Unfortunately the evidence is clear. He added further clarity to the situation by giving the following information:

-the cancer inside Crea is suppressed. Because she has no thyroid, she takes medicine every day. This medicine, Synthroid, is a synthetic thyroid hormone that replaces the normal hormone her body would have produced. It also keeps any remaining thyroid cells in her body from actually working which keeps the cancer at a slow growth rate.
-because of the first point, he said we have the option of waiting until after the Holiday season for the surgery.
-most importantly, and this hit me like a brick, he said this is not something you would wait until Summer to remove. This put a very small band around the process and brings me back to the point that my wife has CANCER.....albeit the good is CANCER and it must be removed. I think the other alarming piece to this statement was that we waited so long the first time around so that Jaden could be born. Nobody gave us this Holiday versus Summer analogy and I am not sure if that makes me feel better or worse. Had someone given us the analogy, would we have acted differently. I am not sure. I do not like to live with regret but I also hate that tiny thought that asks.....did we do the right thing? As I am typing right now, my wife sits 10 feet away from me.....alive and playing with our little girl Thalia. Another 10 feet away is my son Jaden playing and watching television. All are with me of typing this......the right decisions were made and I can only pray that this next surgery is successful and my family stays intact.

The final points tie to the surgery itself. Dr. Adashek is going to look into greater detail at the results of the first surgery and have an expert look at the latest ultrasounds. Beyond the risk of cancer is the risks tied to removing the cancer. These risks are twofold:

1)Crea has already lost one parathyroid gland. The hope is that the one she lost is also the one near the current cancer. This would make it easier to get to the growths and remove them without harming another parathyroid gland.

2)The surgery entails being in close proximity to Crea's vocal chords. There is risk to harming the vocal chords especially because there is now scar tissue in the area that could make it more difficult to find the cancerous growths.

Thanks for reading. Thanks for all the amazing support. We have received very kind words, very kind offers and very generous donations that all mean so much. In the days since I communicated news of my wife's cancer (we have not named it for it is not a welcome guest), over $3,000 has been donated to Team in Training. That is amazing. People are good. People care. People can accomplish anything. People can change the World. It is because of this that I am certain CANCER will be beat.

Saturday, November 14, 2009

Good Plus One

I have shared my story many times. It has always been a 3 pronged one:

-My father was diagnosed with leukemia in September 2002 and battled until January 2004 when he passed away.
-A few months prior to his death, my daughter Isabella passed away at birth.
-A few months after my father passed away, my wife became pregnant again. While pregnant, she was diagnosed with cancer.

These are the simple facts that have a lot of complexity built into the detail. My daughter Isabella passed away 1 day after my fourth wedding anniversary. The only reason it wasn't actually on my anniversary is that my wife fought with all she had to push until after the clock struck midnight. Either way, instead of having a romantic evening with my wife to celebrate our marriage, we were in Santa Monica finding out our precious girl didn't have a heartbeat.

Regarding my wife's cancer diagnosis, we had the very difficult task of deciding whether to have the baby before or after attacking the cancer. The difficulties that accompany such a tough choice are far reaching. Your life or your baby's life....which do you risk. We chose to have the baby first and on October 29, 2004, my son Jaden was born. Less than two weeks later, my wife was in surgery to remove the cancer and immediately after the Holidays she began radiation treatment. This radiation treatment forced my wife into quarantine. We had a new wife could not hold him. I remember standing in the doorway of her room holding Jaden up just so she could see him. No hugs, no kisses, just a look from 25 feet away.

On November 3rd, my story took a little detour. I have always shared my wife's portion of the story as having beat cancer.......with the caveat that she has beat it 'to date'. I am not sure why I ever added this caveat. Was it because it wasnt official? Was it because I lacked faith or was afraid? I am not sure I will ever know the answer but as it turns out, the caveat was unfortunately justified. November 3rd was supposed to be the day my wife, Crea, and I learned about the very last follow up to her cancer diagnosis 5 years prior. Instead, in a very surreal way, my wife and I learned the cancer had returned. No follow up. No maintenance. Treatment must begin again. Am I mad.......I would be lying if I didn't say 'Yes'. My wife and I have endured our fair share of hardship and live to tell about it. Am I sad.....I would again be lying if I didnt say 'Yes'. I am sad because I know my wife is scared. I am sad because my wife has to go through more surgery and treatment and there is not a thing I can do about it. We were told about an optimistic outlook and I am grateful for that. The truth, however, is that cancer is inside of my wife. The truth is that cancer is a horrible thing and until someone looks me in the and tells me my wife is cancer free.......I will be uneasy.

So, my story continues and you might ask why I call this Blog - Good Plus One. The answer is this:

If you focus on just the facts of my story, you only see hardship and loss. Hardship is not where I choose to focus. Loss is not where I choose to focus. I choose to focus on my belief that Blessings come from even the most trying of circumstances. After my daughter passed away, I had to give the hardest speech of my life at her memorial services. I spent so much time on writing and practicing the speech. When I came out from the back of the church, I was amazed at how many people had showed up. Truly overwhelming to see so many friends and family (unfortunately none of my family could make it as my father was 3,000 miles away fighting for his life). I stood in front of everyone acknowledging we were all together for a sad circumstance but instead of spending our moments together in sadness, I wanted to focus on the blessings that came from the loss of my child. I think this was my definining moment....everybody has one......this was mine. After the service was over, I was thanked for my speech by many. Folks had come not knowing what to say. Folks had come wondering how they could help me and my family. was my words that helped them. Blessings come from the most trying of circumstances.

Shortly after my daughters' passing, doctors told us that my fathers leukemia was terminal. I had to sit with my father and watch a video of Isabella's memorial service. How do you sit with your best friend, watch a memorial service for someone else's passing knowing the future holds the same outcome for you. My father could have been sad but instead gained comfort in the belief that Isabella would be waiting for him in heaven. Blessings come from the most trying of circumstances.

Because of Isabella's death, my wife had to undergo many medical tests to determine if something was wrong. While the cause of my daughter's death was not necessarily determined from these tests, the fact that my wife had cancer was discovered. If not for these tests, the cancer could have grown undetected and my wife might not be alive today. We like to believe that Isabella volunteered for Heaven knowing my father needed her and so that my wife could live. Blessings come from the most trying of circumstances.

So, for me, Good Plus One means that although bad circumstances will present themselves, Good will always be on the winning side. When tough times appear, be patient.......the blessings will be there in time. Keep your eyes, your mind and your heart open. The Blessings are there or will be there in time. For now, I will pray that my future holds the blessing of a healthy wife. I would appreciate those same prayers from you and if you would like to join me in the fight against cancer, please click the link at the top of the page.