Big Things.

If you didn’t hear, Chadwick Boseman died of colon cancer last month. He was diagnosed a year before me but was only stage III. That’s sobering. The temptation is to let it scare me. I was diagnosed September 21, 2017 with stage IV colon cancer with metastasis EVERYWHERE. Why should I survive and not him? When I look back, I don’t think I grasped how advanced it was …well, I knew even at the time I didn’t recognize it. I remember saying to myself, “I’m sure I’ll look back and think on how scary this really is.” Knowing now what I know, how serious a tiny one to two millimeter nodule of cancer is, the cancer I had was catastrophic. A tumor almost obstructing my colon, three masses in my liver, one ten centimeters, one seven and one four, it was in the lymphnodes of my pelvis and abdomen and what we didn’t know then was that it had scattered cells throughout both my lungs. It was inoperable. I had stage IV inoperable widespread colon cancer. It seemed like a bad dream and not real. Fighting it seemed impossible and inevitable at the same time. I wonder how Chadwick Boseman looked at, had it ever become real for him? Even though I’ve got crazy scars from multiple surgeries that prove I’ve put my body through hell and feel nauseous and sick most days indicating I’m still fighting… it still isn’t real for me.

Before my third round of Lonesurf we checked my labs (blood counts and tumor markers) like always. They look at the number of neutrophils (ANC) to get an idea of how my immune system is tolerating treatment. I’ve been shown to be very resilient when it comes to chemo. It knocks me down but in my off weeks I recover pretty quickly. It’s normal for my white blood cell (WBC) counts and ANC to get pretty low with the chemo. On the other hand, my tumor markers (CEA) usually reflect that chemo suppresses cancer activity and stays pretty low. My oncologist was not pleased that my WBC and ANC were suuuuper low and my CEA was elevated. No big deal. Don’t start chemo, come back to recheck labs. Per usual, I would probably look better the next day. However, this time that was not the case. My counts were even lower (normal is 1.5-8.0, I had dropped to .4). This happens with chemotoxicity, basically the poison you ingest affects your immune system cell production in your bone marrow (myelosuppression). The result is immunosuppression and neutropenia. Where this isn’t a big problem, it’s never a good thing to have during a pandemic, but all that you need is an injection that stimulates your bone marrow. For me, it had some other implications. Basically, my body wasn’t handling the new chemo well either. So we needed to give me the injection and reduce my chemo dose, making chemo even less effective. Reducing chemo dose in light of increasing tumor markers is not a good pickle to get stuck in. What was even worse, in my opinion, was the injection has a side effect of bone pain so I would have to cut back on training at the gym! Already, I had only been able to train two to three times a week, cutting it back further just makes me sad. Between, low ANC, low WBC, increasing CEA, throwing up, less time training, the theme here is chemo is not viable for me much longer and we needed another option.

Re-enter Dr. Zaheer, my thoracic surgeon that had taken out the first lung nodule a year an a half ago during my lung wedge resection and colostomy reversal surgery. My oncologist set up a referral and I got a consult with him the next week. I’ll say it again, I love my oncologist because she has never pretended to have all the answers for me. She has always been of the mind that the more brilliant minds we can have on this the better and consulting other doctors is the easiest way to do that. We were just going to see what Dr. Zaheer had to say about surgery. Was a lobectomy possible? Too risky? Was it worth it removing half my lung to get a majority of the nodules and leave the rest? What options did he recommend? It was just a consult. Or so I told myself… Of course the secret less rational me knew this consult was actually a really big deal. There was the possibility that he would say yes to surgery and I could turn a corner with cancer, get aggressive again and be done with all of it. But to say that out loud meant that the converse could also be true. He could say that surgery wasn’t an option and that I just have to take my chances with chemos that weren’t working and wait for things to grow and spread, and feel very helpless.

We drove back to Loma Linda to meet with him and hear his recommendations. Where I like Dr. Zaheer and recognize his skill as a surgeon, trust him with my life, know he is the surgeon for me, he lacks bedside manner. All my sarcastic responses and morbid chuckles fall on a dead pan face. He understands my humor, he can see and even recognize when I am joking and never laughs. It’s slightly daunting. As any good surgeon, he patiently went over the options, wedge resections, lobectomies, benefits, risks, approaches, techniques. “Looking at your scans, it looks like seven nodules are in the lower lobe, with one more in the upper lobe.” This sounded like good news to me. I thought there were only five in the lower lobe and a lobectomy would leave three nodules. But this meant there was the possibility of removing almost all of them in one felled swoop. Then he really made my day and offered to perform an additional wedge resection on the upper lobe to get the last nodule. Yet he seemed hesitant and noncommital. He said, “I am hesitant to recommend surgery because we don’t have a biopsy. It’s possible we do a major surgery and they are all benign, that would be no good.” Naturally, as is my way, I started laughing. Which confused him so I quickly explain, “Oh we’re confident it’s cancer. We’re not worried about that.” His countenance lifted, it was like we had given him permission to attack a hated enemy and he drew his sword. “Lets schedule you for surgery then.”

The plan was aggressive and yet simple, just the way I like it! The approach would be similar to the wedge resection surgery we did on the right lung. Robotic approach minimizes how invasive the surgery is. Instead of cutting me open and spreading my ribs they make five small incisions for tools and cameras. Turns out a lobectomy is a much lower risk surgery than the wedge resection I had already had. They follow the fissure lines in my lung and only cut the small part attached to the upper lobe. The risk of bleeding and collapsing my lung are far less. After the lobectomy they’ll go after the last remaining nodule in my upper lobe and perform a wedge resection there. If they can’t find it or “feel” it with the robot they may have to convert to an open approach and do the big incision and spread the ribs and go in to find it. However, they are fairly confident that they can remove it without all that. He was also recommending me to a different surgeon who specializes in a intra surgery chemo technique called HITEC (hyperthermic intra thoracic chemotherapy). FUTURE! It’s where they fill the lung cavity with chemotherapy drugs that have been heated, after the surgeon removes tumors. This way they can make sure no cancer cells that have been dropped or left over after the lobe removal survive. How cool is that?

Of course there’s the risk list that goes along with the benefits list. Pneumothorax, hemorrhaging, weird surgical complications, infections, and death (always on the table). There’s the risk that they don’t get all the cancer. There’s the risk it has already spread elsewhere and is still too small to see. There’s the risk that during my recovery it spreads and grows somewhere else. Risk, risk, risk… But there’s a hope that counters every risk! When that line gets drawn, I’m standing with hope every time! He’s never failed me yet!

At this point, I am two weeks out from surgery and I am only excited. I’m sure when it gets closer I’ll get nervous and nostalgic and start crying when I look at palm trees and mountains and while I brush my teeth, drive my car, open my front door and other normal everyday things. I am hopeful. Part of me really wants to be confident and say, NO MORE CANCER. And part of me doesn’t want to call the game early if there’s more battling to do. Where I am tired and want to move past this, I’m not at the brink of quitting and I am not yet too tired to fight like hell. I am very lucky because God designed me with a very resilient body and an even more resilient heart. I love a good fight, I am always down to get in the trenches and wage war with all that I’ve got. That’s actually a big reason why I love CrossFit so much. I have found that at the point when I most want to quit that I’m able to lift up my head. But guys, I want to be done and there is a possibility this surgery will take a bleak situation and completely turn the tables for me. Stay tuned folks!!