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 days.....my 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 way..........it 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 line....it 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 fiancé), 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 warm....my 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 well........no 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 http://pages.teamintraining.org/los/lavatri10/4mywife . Either way, I am very grateful to everyone on this journey.