I’m sitting in the waiting room to be checked in for surgery, the most negligent blogger ever. Wait, Amy, didn’t you already have surgery? How did we jump from lung nodule to surgery. Well … it hasn’t been a jump I’m afraid to report. It’s been a couple of months of tests and decisions and waiting. I had the biopsy, I’ll cut to the chase, it was inconclusive, suspicious for cancer. Normally a lung biopsy takes twenty minutes and there aren’t complications. Well, my nodule was so small that it was very difficult to get a sample of. So difficult that it took an hour and a half. Then, because it was on the periphery of my lung the needle ended up puncturing through the other side of my lung and I got a pneumothorax (collapsed lung). Collapsed lungs, believe it or not, do not feel good. I spent the day in the hospital with oxygen being monitored. All’s well that ends well.

I met with my oncologist to discuss the results and our game plan. Because my biopsy was inconclusive, but suspicious, I scheduled an appointment with a thoracic oncology surgeon to discuss the possibility of surgery. Long ago, during my last post surgical follow up visit, I had asked my surgeon when I could have my colostomy reversed. The reply was that once I didn’t need chemo and radiation and could be off treatment for about three months that I could have the surgery to reverse it. So I had this thought. If I need to be off chemo for three months for my lung surgery couldn’t they just double whammy it and do both surgeries? Good news, yes, they could.

I met with a thoracic surgeon and my original surgeon the same day. My hope, strangely enough, was that both surgeons would be agreeable to perform surgery. To cut to the chase, they were both agreeable! And Dr. Reeves, my champion surgeon, was even willing to go after some suspicious lymph nodes that were missed in the first surgery. He also said that even though I have some cancer that wasn’t there after the first surgery he feels better about my prognosis now, nine months after the surgery, than he did immediately after the surgery when I was supposedly cancer free.

It’s been a few weeks. I’ve had a PET scan, which was clear, nothing lit up positive for cancer! I’ve had a repeat colonoscopy, which was also clear, no new tumors or polyps even! That’s a really really big deal!

Here I am, laying on a gurney to go into the OR for another ten hour surgery. I’ve been through the spectrum of emotions but I’m ready to get past this.

About a month ago now (please forgive the infrequency of my posts) I had a panic attack during a workout. You’ll remember I have this slow growing nodule in my lung. When I last wrote, we had found that in a year, the nodule had grown from two tenths of a millimeter to six tenths of a millimeter, despite chemo. It’s still tiny but any abnormal cell growth is a concern with my history. I had discussed there were three options, biopsy, radiation and surgery. The morning of my panic attack I had met with my oncologist to discuss what we would do next. We decided to do a biopsy, determine once and for all if it was cancer or not and make our decision based off these results. She said, “Now Amy, if the biopsy is positive [for cancer], I’m going to recommend surgery over radiation.” That’s the aggressive course, don’t wait to see if radiation works, get the thing out. It made sense to me and I left her office in agreement and headed to the gym to meet up and workout with friends.

It was an intense workout programmed that day, an EMOM of thrusters and burpee box jump overs. (If you don’t do Crossfit and don’t have any idea what that means, it’s fine, it’s not important. Just know it’s an intense workout with a time component.) chemo has impacted my ability to workout A LOT. Often i get dizzy during rest breaks because my blood pressure can’t keep up and I’m still recovering from my massive surgery in February. This particular day, my body was tired and sore so I scaled the reps and was determined to give it my all. Here’s one thing you should know about Crossfit, the workouts are more than just physical. There’s a mental and emotional component that requires grit and commitment. If you’re having a rough day and your emotionally taxed going in, it’s going to manifest itself in the workout. As the workout progresses and fatigue set in you need mental fortitude. You need to say, “Keep going! Don’t quit! Finish this set! You can do it!” But when you’re already mentally and emotionally tired the reserves for positive self talk and determination just aren’t there. As I warmed up and didn’t feel great, a pitying thought entered my mind and nestled in my heart, “You’re so far from where you want to be physically. Look how tired you are! You’re not getting better.” So as I started the workout I was already feeling sorry for myself. As I got tired and was gasping for air, instead of pushing myself to stick with it, my thoughts went to cancer and surgery. “Just when I was starting to be able to push during workouts without being dizzy and lift heavier weights I have to recover all over again! Go back to square one!?” And that’s when the panic hit. I started hyperventilating and crying and fought my hardest to calm down and get back to the reps. I paced in circles in the corner during a rest period as my thoughts spiraled darker and darker. Then this inner voice cut through the panic, “Why are you fearful of what isn’t even determined yet? You don’t even know if it’s cancer, much more, you don’t know if you need surgery. Stay in the now!” And I took a deep breath and finished the workout.

This mental/emotional and ultimately spiritual fight is my normal. I’m lucky enough to have people behind the scenes continuing to pray for me and wage this battle with me. I have excellent friends who talk me down and provide me with limitless support. I am anchored to this space of hope and peace.

I have lots more news but here’s an encouraging story to tide you over till my next post. Know with certainty that the voice that cuts through my panic is not my own and is equally available to you. We’ve all got dark thought spirals in our life, but there’s only one voice powerful enough to still the screaming panic and whisper calm. More soon!

A year ago, September 21, I got my diagnosis. After months of abdominal pain and bleeding I woke up in the middle of my colonoscopy to see a massive tumor and know it was cancer. I was told I had inoperable stage IV colon cancer.

I have discovered treasures of darkness. I’ve gone into deep darkness of the soul over and over. But I’ve learned how deep true friends will go with you. I’m learning how to see hope and love in pitch darkness. I’m finding the faith to not seek rescue from God but find refuge with God, letting him comfort me in it more than delivering me from it. I’m trying to see past circumstances to stay fixed on the character of God when I don’t recognize Him. I’ve found that worry and “what if’s” never really prepare you for the bad they only rob you of right now good.

I’ll be reflecting on this more… what are my “takeaways from the worst year of your life”? I will continue to declare Gods truth over myself even in my pain, and discomfort and sadness. I won’t be called a victim when The cross and His resurrection declares me a victor! The hope and good news I have is so much better and bigger than the darkness and loss.

To update you all, I’ve been taking chemo pills for… two months already? I get an infusion of Avastin once every three weeks, take chemo pills (Xeloda) for two weeks and then have a week off. Each cycle is three weeks (if that makes sense). It’s been… ok. Not as much of a respite as I had hoped. So much better than hard core chemo and the chemo pump, but no walk in the Park. Where chemo before knocked me on my butt for five days and then let me climb out of my chemo cave to feel good for a week, chemo pills leave me feeling mediocre constantly. I’m nauseous always, but it’s very mild. I’m consistently more tired than my good weeks during hard core chemo, I just don’t have energy. This makes my workouts more inconsistent. I’ve developed Foot Hand Syndrome (different from Foot Hand Mouth Disease). It’s cause by toxicity from the chemo pills, they think the chemo leaks out of the capillaries into the soft tissue on the bottoms of your feet and palms of your hands. This makes them bright red, hot, tingly, and progresses to dry, cracking, pealing, and burning sensations. It feels like walking on hot asphalt barefoot. I’ve had several days of limping and/or being too uncomfortable to walk. The other down side to chemo pills is I have a once a week episode of horrrrrrriiiible diarrhea. Mostly horrible because the intestinal cramps are so painful that I throw up and get lightheaded. It only lasts like six to eight hours though, not for days at a time. I still prefer it to hard core chemo even though the subtle feeling bad constantly is more demoralizing.

Pushing through all this to try and have normalcy has been increasingly difficult. Not being able to do things with friends or in the gym has been really disheartening. I’ve had several episodes of tears over “just wanting to be a normal girl”. I’m almost to the point where I can go back to work, do workouts as prescribed but then I’m struck with horrible cramps or can’t walk because my feet hurt. Until this week, I’ve had no concrete plan of how long I would need to take the chemo pills. It was a cycle by cycle basis. My body has been responding progressively worse to the chemo, side effects are becoming more debilitating and with quicker onset each cycle. My body has been telling me louder and louder, “we need a break!”.

I had another CT scan to check up on my cancer. There were a lot of questions. Had it spread on lighter dose chemo? Were there new tumors in my liver or colon? Was it growing in my lymph nodes? Did it grow in my lungs? This scan would determine if chemo pills were effective for managing my disease. Was radiation still appropriate? Could I go off chemo and have my colostomy reversed soon?

I didn’t get my barium smoothie this time. It was worse. The tech said “let’s have you take this solution, it visualizes the bowels better. Tastes worse than the barium smoothie but it’s lemon flavored”. Well, it tasted like cleaning fluid, no joke or exaggeration, literally soapy. It tasted like lemon cleaners smell, not lemon flavored. I had this thought of, “someone made a mistake, this is cleaning fluid, I’m poisoning myself”, but then acknowledged that they would know right away during the scan if the contrast didn’t work and could call poison control so I was probably safe.

The scan showed that seven months after my surgery there were still no new tumors in my colon or my liver. This is great news, as both the colon and liver have high tumor recurrence rates. All of my lymph nodes were still normal sized, meaning no measurable cancer. But one of the suspicious nodules in my lung had grown another millimeter. Last November it was two millimeters, July it was five millimeters and is now six millimeters. It’s still tiny! Not bad news, per say. Not the best news but no new tumors and treatable lung nodules is great in my book. This means we can plan.

Currently the plan is to revisit the possibility of radiation and get a biopsy of that nodule to be certain whether it’s cancer or not. If radiation doesn’t blast them enough I can have surgery to take out a wedge of my lung and get rid of it that way. Two treatment options, so treatable!

So I’m in a good space. Tired, sad, wanting to be past this, but still anchored to hope and truths bigger than my circumstances.

I want to leave you with something. There’s this great song by Ellie Holcomb, “Find You Here” that is just so good! Here’s the lyrics,

“It’s not the news that any of us hoped that we would hear

It’s not the road we would have chosen, no

The only thing that we can see is darkness up ahead

But you’re asking us to lay our worry down and sing a song instead

CHORUS:

And I didn’t know I’d find You here,

In the middle of my deepest fear

But You are drawing near

You are overwhelming me with peace

So I’ll lift my voice and sing

You’re gonna carry us through everything

And You are drawing near

You’re overwhelming all my fears with peace

You say that I should come to you with everything I need

You’re asking me to thank You even when the pain is deep

You promise that You’ll come and meet us on the road ahead

And no matter what the fear says, You give me a reason to be glad

Here in the middle of the lonely night

Here in the middle of the losing fight

You’re here in the middle of the deep regret

Here when the healing hasn’t happened yet

Here in the middle of the desert place

Here in the middle when I cannot see Your face

Here in the middle with Your outstretched arms

You can see my pain and it breaks Your heart

Rejoice, Rejoice

Don’t have to worry bout a single thing

Cause You are overwhelming me with peace

Don’t have to worry bout a single thing

You’re gonna carry us through everything

Overwhelming peace”

This is my real.

Where do I even start? It’s been a while. I haven’t wanted to put in the energy or emotion to update how things have been going. So here’s highlight reel of my massive surgery.

I had surgery on February 12. They cut me from sternum to pubic bone. They took out a pretty piece of my colon, the surrounding lymph nodes, and sixty percent of my liver. But they got all the cancer. After the surgery I’m now considered cancer free. Everything went as planned! The incision was straight which means the scar will be pretty. Initially there were some issues controlling my pain. Apparently most of the really intense pain medications (morphine, fentayl, dilaudid, tramadol, methadone, you name it they tried it!) I’m not very sensitive to. The nurse or nursing assistant would ask me my pain level on a scale of one to ten during their rounds. I’d generally respond, “Uhh around a seven or eight.” “Well are you pushing the button for your pain medication?” At the time I was on self serve dilaudid IV pain pump. “It just makes me fall asleep it doesn’t control my pain!” as I reluctantly push the button and drift off into a lethargic pain haze. But within the first week things were going as planned and I was stable. They had started me on a liquid diet and I was already walking almost a thousand feet in the hospital hallways. I was pretty excited, my parents were pretty excited, it looked like everything was going even better than expected.

Then… I started having more pain. I know I said that there were some issues controlling my pain but this was a nine out of ten pain that was constant and unrelenting. On Saturday night, five days after surgery, I “crashed”. It started with what felt like a maximal cramp of my lowest ab muscle that wouldn’t release and then worked its way segmentally up my entire abdomen. Maybe you can imagine, maybe you can’t, but at this point I have staples from my sternum to my pelvis so having every muscle in my stomach start progressively cramping was very uncomfortable, to say the least. Then, I started shivering. I didn’t have a fever, yet, but I’ve come to recognize since, that shivering is a severe pain reaction for me. The shivering just started in my jaw but then went through my entire body to the point where I was almost convulsing and it looked like I was having a seizure. I have a feeling it was a pretty intense scene. I’m convulsing and crying in pain, my mother is crying, my dad is threatening to call 911, the nurses can’t get the doctors on the phone, and I’m in the most excruciating pain of my life. After that things get fuzzy for me. I’m told I developed a 105° temperature and then my blood pressure started dropping and my oxygen saturation started dropping. They put me on an oxygen mask with six liters of oxygen and I was barely saturating at eighty percent. I was on my way out, folks. And by out I mean, dead. I literally almost died. I feel so good now it’s crazy to think of it as anything other than a scary story or a bad dream. I remember the following day in patches. I’m told I was “in and out”. There were lots of tests. One CT scan they tried to take me to, my vitals went unstable again and they had to wheel me back to my room so I wouldn’t die during the scan. Finally, I was transferred to ICU to await surgery the next morning. I remember having this thought as I lay writhing in nine out of ten pain, “People survive torture all over the world. If this were torture, would I talk to make the pain stop?” Sometimes my answer was “No, I can do this,” and I’d grit my teeth and pray. Other times my answer was “Yes, I’d tell them whatever they wanted to know.” In surgery, they opened me back up and gave me a colostomy inserted a J tube, and two drains. Turns out because of the chemo and my weakened immune system I got c-diff which caused the anastomosis of my colon to leak and form an abscess in my abdomen and I developed severe sepsis.

I distinctly remember waking up one morning in my third week of laying in bed in severe pain feeling miserably nauseous and this thought floated through my brain, “I’m not getting better and I’m going to die here.” No one had even mentioned the word “home”. I looked out the window of my hospital room and wanted to see the San Gabriel Mountains, my mountains. I wanted to think of home and have a hope of going home, an idea of being strong enough, well enough, to leave. It was an abstract thought. It was the darkest moment of my life. And believe me, I’ve had many “darkest moments of my life” the past couple months, this, by far surpassed them. I leaned over to my mom and said “I’m not getting better. We need people to pray.” Later that afternoon, I started to feel better, then the residents told me they were thinking of getting me ready to go home in two days. Coincidence?

I had made progress, I was medically stable and they had finally found a pain medication regiment that worked for me and my pain was controlled, like a four out of ten. After weeks at an eight or nine, four was a dream. I could go home on a feeding tube with some drains and my colostomy. Not ideal but doable. The morning I was supposed to go home I started throwing up and running a low grade fever. So they held the discharge, did another CT scan and found I had developed another abscess and there was some fluid collecting in my left lung. They put in another drain and a chest tube, while I was awake. That hurt. But they were still talking about discharge and home was a concrete realistic expectation.

That’s how my fabulous surgery and short hospital stay turned into a month long very complicated hospital stay. But I finally made it home, weak and pain ridden. My abdomen looked like a science experiment of dressings and tubes and bags. I had lost a twenty seven pounds. Turns out a couple weeks without food and having too much pain to get out of bed makes you ridiculously weak. I could walk about twenty five feet before things got painful and I needed to sit down. This was not how I pictured my life after that surgery. I was feeling sorry for myself, let me tell you! Let’s not forget the narcotic withdrawals that magnified everything negative and uncomfortable and made me emotional. It was a rough week.

My dad put the whole thing into perspective when he said, “You know, a lot of people climb mountains thinking the summit is the goal. They focus on it, and dream of it, they work so hard to get there. But afterwards, they still have to get off that mountain. More people die on the way down than on the way up. That’s where you are. ” I had spent so much time just trying to get to that surgery that I hadn’t planned much for my after surgery recovery. Certainly not mentally or emotionally!

Nevertheless, recovery, here I come.

Having this surgery feels like, what I would imagine, being shipped off to boarding school after the best summer of your life would feel like. I’m getting homesick for my life. When I think of all the things in my life that I love so much that I won’t be able to participate in for the next couple of months I get so sad. I’m just being petty I know. It’s temporary. I’ll get to do all these things again once I recover but I just wanna plop down in the corner and cry about how unfair it all is. If we stick to the above scenario my “best summer ever” has group dinners at Stonefire grill, brunch dates on days off or Saturdays after a workout, margaritas and chili verde burritos at El Patron, hiking in the Arroyo, sweaty workouts with my favorite workout squads, cheering on friends in Crossfit competitions, falling asleep on friends couches cause I’m having too much fun to go home, margaritas and laughing seizures at Mijares, coffee dates at Jameson brown or Seed Baking co, or Cafe de Leche, or Lavendar and Honey, wine nights with friends, weightlifting and two a days, beach days with my favorite crew, my beautiful little house, heavy Italian food shared with friends at a long table, driving my car with the sunroof open and worship music cranked up, and don’t even get me started on all the Crossfit. I know I’ll get back to all these things “next summer” but I don’t want to “go to boarding school” and leave these things behind. I live an amazing, full, jam packed, adventurous life! I didn’t take it granted before and I certainly don’t take it for granted now.

As I head into surgery in less than a week, I can’t help but look back on all I have been brought through and feel overwhelmingly grateful. I am so grateful for my God and His care through this dark journey. I’m finding a huge component of this journey has been all of you and the many prayers prayed on my behalf. I have felt the need to be strong and smile and stay mentally tough through all of this but you should know that does not make me exempt from experiencing the darkness. I am so grateful all of you have been willing to walk this road with me.

When I first got diagnosed I was on my phone for what felt like thirty six hours straight. It was important to me that people hear from me and know I was ok and had hope, because it’s scary. Cancer is so scary. I felt from the start that I would be ok. I chose to believe it. Of course the diagnosis kept getting more and more serious and my initial resolve of believe was threatened over and over. But I had this amazing support base in my friends and family and Crossfit family. They knew me and backed me and never wavered, never contradicted my belief that I would get through this, even when facts didn’t always support it. For that, my heart bursts with gratitude.

You might say “Amy, I didn’t do anything for you.” But you have. You’ve believed with me.

Every time you’ve treated me normally, encouraged me in a workout, prayed for me, smiled at me, wished me well, text me, written a note, or sent a package, you were doing something to my heart. Every high five, coffee, margarita, snack, burrito, and hug has been a really big deal to me. I know without these things I would have LOST it. Nothing breaks a person like loneliness and over and over that was the lie whispered to my heart. “You’re alone. No one understands what you’re going through.” But you have been such a gift to me and all those little things that meant nothing to you made it easy to discern lies from truth and say, “No matter how I feel, I am definitely not alone.”

He used all of you to tell me I am never alone and how much He loves me. All of you are a glimpse of the Lord’s goodness to me. Without it, let me assure you, I would have lost heart. I would have made lies and loneliness my armor in this battle and I would not be heading into this surgery smiling ready for a fight. (Some days I’m smiling more than others.) I’ve said it before and I’ll say it again, faith is exhausting, and I don’t know why more people don’t tell you that! Believing that something is true when everything you can see, taste, touch, smell, hear and feel says the opposite is just hard work no matter how you look at it. For me, that has meant trusting that my friends don’t need to understand what I’m going through to be with me in it and that God only has good things for me with this cancer and is doing big things in the midst of it. One of my verses through this, well for the last couple of years if I’m being honest, is “I would have lost heart had I not believe that I would see the goodness of the Lord in the land of the living. Wait for, hope for and expect the Lord. Be brave and of good courage. Let your heart be stout and enduring. Yes, I say wait for, hope for and expect the Lord.” I have seen and will continue to see His goodness. I’ll continue to try and be brave and stout hearted in clinging to the character of my God. I will wait for Him to do what He wants in this. I chose to believe that even with stage IV cancer, He has nothing but good intentions for me, even in all the darkness surrounding that. I will expect and hope for that goodness to become my reality, for vapor to have substance and the invisible become visible. (Go ahead, tell me that in believing that, faith isn’t exhausting!)

Thank you for believing impossible things with me, holding me up and supporting me, and laughing with me through all of it (even when it’s offensive). Thank you for being a tool of God to tell me how loved, supported and cared for I am. To my people, you know who you are, I love you and appreciate you with an intensity you will never fully know. I feel braver already. I’ll probably re-read this a million times this week to remind myself of these truths when I’d rather cry and skip surgery all together.

Again, I wont beat around the bush. I get to have surgery!!

I drove down to Loma Linda Tuesday in the pouring rain to meet with my surgeon to discuss the next step. I’m telling you, I like that facility. Free valet parking for cancer patients? Clean facility? People who smile at you, look at you when you speak to them, walk you to where you need to go? It’s pretty great. Checking in, easy. Long wait for the doctor? Not really, (normal amount of time I’d say. I mean there was waiting but I didn’t even get through my instagram feed).

If you remember, last time I spoke about surgeons it was depressing. The atmosphere was one of bad news and solemn outlooks. This time was different. The atmosphere was one of congratulations and hesitant optimism. But it was definitely still very sobering. My surgeon was very pleased at how my tumors had responded to the last two months of chemo. He highlighted the fact that when he first saw me I was not a surgical candidate. The disease outside my colon was too extensive, and where it continues to be extensive, my tumor markers indicate I have about ten percent of the disease I had at that time. A ninety percent drop in metabolic activity of my cancer is a really big deal. Now he can confidently say that I am on a “curative pathway”. Which means I am now on my way to completely eradicate my cancer. Man, that made me smile.

Then we went nitty gritty, what does the curative pathway entail, the steps to take, all the risks, and what’s next. As I try and explain all of this it gets jumbled in my head. I hope its not confusing and that I can explain and organize it in a way that it makes sense! This is a very long post and kinda complicated. I’m so sorry I’m a writing processor because I processed and made sense of a lot of things while writing this! (Some of this will be redundant and a review from previous posts but its important to get the full picture.)

The primary tumor in my colon is smaller. It will need to be taken out. It will require the portion of my colon with the tumor to be taken out and the remaining colon will need to be reattached together. (Like taking out the middle of the colon then sewing the top and bottom together.) This may require a temporary ileostomy. Which is an obvious disappointment. An ileostomy creates an exit point in my abdominal wall with the part of my intestine above the colon, the ileum. This may need to take place in order to allow the colon to heal. When you separate something then reconnect it there is potential for it to leak. Leaking would be horrible!! This causes infections and prevents the body from healing and all kinds of awful complications. Not to mention the theoretical concept of  my excrement floating around in my abdomen! If that happened it would require an additional surgery to open me up and eliminate the leak. So yeah, give me an ileostomy if you have to in order to decrease risk of that happening please! This would mean there would be a “poo bag” outside my abdominal wall for a while. My thoughts are these… “ummm… gross” and secondly, “this is going to get in the way of all my CrossFit. How can I weightlift with that!?” Great.

Next lets look at the secondary tumors in my liver, also smaller. This is where things really get “fun”. All four of these tumors also need to be removed. I mentioned last time that every time we go over the scans I get a better idea of where the tumors are oriented within my liver and also in relation to each other. He described the one big one in my right lobe, simple yeah. But he corrects my understanding of the three smaller ones. Apparently what makes surgery so complicated is that they are not completely contained within my left lobe. He describes them as more scattered within the left lobe and the central part of my liver. Couldn’t this cancer have just been a little more considerate and stayed in one part of my liver? If they were isolated within the left lobe a lobectomy would be easy, however, since they are also in the central part of my liver a lobectomy would just be taking out too much liver. It is safest to resect the three smaller tumors from my left lobe individually and in the same surgery get rid of the primary colon tumor and create a temporary ileostomy. Then have a second surgery once the liver has regenerated and my body is ready to go through it all over again to undo the ileostomy and remove the larger tumor in the right lobe of my liver. Spoiler alert, this is the plan we are going ahead with.

[Side note (skip if pressed for time as this has no relevance to the report of my surgical consult): In high school my brother’s friends and I used to do a lot of hiking in the local mountains. There was this beautiful waterfall we would hike up to and jump off of, blah blah lots of irrelevant details… Well one hike we were up there jumping off the cliff into the pool below when this troop of beginning rock climbers or something comes down the stream and proceeds to repel down the waterfall. They all had matching helmets and brightly colored brand new gear. As they were beginners they were clearly not adept at the task they were undertaking and very uncomfortable.  At the time, we felt very much superior and intruded upon, a bunch of high schoolers cliff jumping versus this organized, uneasy, overly, cautious troop. So what do we do? Start a chant of course. “Safety first! Safety first! Safety first!” And then proceed with our daredevil activities. I feel very much like I joined the troop of beginning rock climbers. Not that I mind, this is my life. So yeah let me strap on a helmet, clip into the ropes and repel down the waterfall instead of carelessly jumping off the edge. But I feel very out of place.]

So we have a surgical plan but how complicated is it? And what are the other possible options? And most importantly, what are the risks? I mean it could make a person dizzy going over all this stuff. If you are content with the plan as is and the risks and confusing options aren’t necessary for you, dear reader, you have my permission to go no further. Just stop reading. We’re good. I will be in the ICU for one to three days (what?!!!) and be in the hospital for seven to ten days (if there aren’t complications). February sixth I go in for pre-op and February twelfth is the surgery. Mark your calendars folks this is terribly official and I will be counting on support and prayers to make impossible things my reality. Buuuuut if you want the full picture this is where things get interesting.

Now mind you what follows is my understanding of things I was previously unfamiliar with so I hope it makes sense… Removing the tumors will most likely require two surgeries. As previously stated, this is the safest option. However, the surgeon wont really know until he opens me up and gets in there if one surgery is preferable. Two main things determine one versus two surgeries. How much of my liver is left after removing the three smaller tumors and how long it takes to get all three tumors out. He does not want to do a lobectomy and simply remove the left lobe of my liver, he plans to go in and individually remove each tumor from my left lobe leaving as much of my liver intact as possible. I will be put into a semi dehydrated state to decrease the amount of blood loss (there was a fancy acronym for this that I can’t remember), but this only lasts a short time because it’s really not good for me to be in that state for too long. If there is enough liver remaining after removing the three tumors in my left lobe and enough time left for me to still be in the dehydrated state, he will go ahead and remove the larger tumor in my right lobe at that time. Then he might say, “Ok, thats’ enough for her body to handle she can come back for the colon surgery once the liver and her body heal.” Or he can say, “Let’s get after it and get the primary tumor out of her colon too.” What I have just described is highly unlikely and best case scenario for me, one massive surgery with no temporary ileostomy.

But one thing we know is chemo works, it keeps the cancer shrinking and manageable. Another thing we know is when I am not on chemo tumors grow fast and aggressively. So to be off chemo while I’m recovering from the surgery means any tumors left will grow and potentially spread. To avoid surprises and ensure that there isn’t cancer anywhere else I need a repeat PET scan (you may remember, it’s the isotope injection one). This is the one of the last hoops to jump through before surgery. We know that staged surgery is safest for my liver but there is also increased risk. One reason why the liver regenerates is it gets a flood of growth hormones, which means the tumor in my right lobe also gets growth hormones and without chemo keeping in check… well, it’s going to grow. There is the potential for it to grow to the extent that when it comes time for the second surgery there isn’t enough good liver and removing it then would mean… certain death. Then of course theres the risk that the liver wont regenerate at all and again if the liver doesn’t grow back and the tumor grows there wont be enough good liver and… certain death. You may think, “Oh Amy, that’s silly. You would just get a liver transplant!” Well, there’s this whole “cancer disqualifies you from a liver transplant” thing that means I’m not a candidate for a liver transplant and if my liver goes into failure… certain death.

My poor surgeon was confused by my reaction innumerous times.  I’m certain he’s not used to discussing risks with people as healthy and young as I am, and apparently, he’s also not used to discussing risks with people who have a sense of humor. He is probably more accustomed to emotional break downs when certain death is on the table. Instead he got me, repeatedly laughing at how absurd it all is. I smothered so many giggles that some couldn’t help but escape. I mean it’s so ridiculous that all this is real sometimes that it’s legitimately funny to me. I’m not talking nervous laughing or filler laughing. I’m talking this is very humorous to me that I am in this position shake my head, slap my knee, laughing. I kept the knee slaps out of it while he was in the room, however.

More risks did you say? Heres one. The metastasis in my lymph nodes are still there. The radiologist says they aren’t there but thats because on a CT scan the lymph nodes have returned to normal size. Chemo is working all the cancer is shrinking. However, my surgeon could still see the cancer because he knew where to look and what he was looking for (or something). This is an area of concern, however, when I’m off chemo for those months recovering from surgery. No one has time for the cancer to spread to my lungs or my brain via my lymph while I’m recovering. No one! He casually mentioned perivena caval radiation as an option to address this. However, this is another reason the PET scan before surgery will be important. We need to assess the extent it is in my lymph nodes and in addition to the no surprises part, there is the possibility that the cancer in my lymph nodes is secondary to cancer somewhere other than my colon as the primary. But all will be made clear with a PET scan. In conclusion, he said, “So as you can see this surgery is very risky, you could die, but when you compare it to the risk of not having the surgery, this cancer would with 100% certainty take your life. The risks of surgery are minimal by comparison.” This was another part where a laugh escaped me and I said something synonymous to “duh” (much more eloquently of course).

Truly the fear pit falls are crrrrazy!! It’s definitely a “don’t step here”, “jump over that”, “duck under this”, “dodge those” way of life, let me tell you! Staying within the boundaries of what you know to be true and having faith for what that whispering voice of God tells you is true despite contrary evidence is exhausting! Why don’t more people say that? Faith is exhausting!! Don’t play the what if game. Don’t take the what if’s into your heart or even your mind as tangible fears. The what if game has no winners. It never prepares you for reality, it only feeds fear. I have primary colon cancer that is resectable. The tumors in my liver are also resectable. The cancer in my lymph nodes that has been responding to the chemo for my colon cancer, is secondary to my colon cancer and will continue to respond to the treatment for my colon cancer. Fear thoughts are to be banished and not entertained for a minute! So if you had any doubts about what to believe or worry about on my behalf let me set you straight. First off, let me tell you now this surgery will be a raging success! Any thought that opposes that is to be dismissed! No, my colon anastomose will not leak excrement into my abdominal cavity. No, the liver resections will not be so extensive that I go into liver failure. Yes, my liver will regenerate, it will not be his third case in twenty years of surgery and six hundred liver resections where the liver didn’t regenerate and the person died. No, the tumor in my right lobe will not grow to the extent that it wont be resectable for my second surgery. No, the second surgery will not have to be delayed because of complications. No, the cancer in my lymph nodes will not spread while I recover. No, the cancer in my lymph nodes is not secondary to another cancer that hasn’t been diagnosed yet. Most importantly, no, certain death is not on the table for me. Everyone understand? Those fears are truly laughable and are to be treated as such. If you want to worry about those things I just feel sorry for you.

Also please understand in healthcare “Risks and Benefits” is a mandatory part of any medical intervention. Meaning my surgeon is legally required to explain every single possible risk with me before the surgery. I knew this going in which is also why some of it was so funny to me. I know, or have faith, that a lot of what was discussed really isn’t possible for me and is a generic risk that needs to be discussed as a formality. How hilarious that I fit into that level of formality?! The part of the conversation that was the most sobering to me was discussing what “recovery” would entail. The conversation went something like this. “Doctor, you mentioned one to two months between the two surgeries. What determines when I will be ready for the second surgery?” “That will depend on how your body recovers. Once you can eat, drink and walk you’ll be recovered enough for the second surgery.” This was where I started laughing at how absurd this was. Was he really saying it might take me up to two months to be able to eat drink and … walk? I thought of how I was planning on at least walking through the upcoming CrossFit Open workouts a couple weeks after my surgery. I think he got a little offended at my humor because he followed up with, “You need to understand this is a major surgery and will take a tremendous toll on your body. Essentially this surgery is four parts, your colon, the left lobe of your liver, the center of your liver and the right lobe of your liver. Any one of those components is enough to keep you recovering for a month but your surgery will require four.” I stopped laughing. I knew how to block my mind from fear but I don’t think I was quite prepared for the gravity of how truly extensive this surgery would be or how great a toll on my body it would take. But in the war for optimism, I don’t think I fit within the demographic that generates these projections. I think he isn’t used to performing this surgery on anyone as healthy as I am or on anyone as comfortable and familiar with pushing themselves as I am. I expect all of his projected time frames to be exaggerated. I think I’ll be out of ICU faster than he projected and out of the hospital faster than he projected and I will most certainly be eating, drinking and especially walking much faster than he projected. In fact, I’ll take it so far as to say challenge accepted sir! So I’m sticking with the perspective of I am so excited for this surgery!!

The absolute best news in all of this, with the exception of being on a curative pathway, is that I have only one more chemo before surgery!! Which means I will have three whole weeks of feeling amazing before surgery! Bring on weekend trips, beach days, painting, gardening, poetry, hiking, and most especially workouts with a little intensity!!