It's Benign!

Just a quick update to let you know that, as of this morning, the biopsy results are in and the tumor removed last week has been confirmed to be a benign Lipoma.  Apparently Dr. Monson removed a small amount of fat and a lymph node sample as well from that area, both of which also came back clean.  Yeah!

On a recovery note, I went back to work on Monday (a little earlier than originally planned) and have been doing fairly well.  However, over the last day or so, I've definitely noticed much more pain and swelling in that area.  I'll try keeping an ice pack on it today as Holly swears that will help more than anything.

And man do I ever need a full shower!

Colonel Mustard, in the Dining Room, with a Camera*

This is a picture** of my right arm & shoulder area from yesterday, prior to quite a bit of scrubbing to remove the Betadine.  I was covered with this stuff from my chest all the way up my right arm and getting it off was quite the trick.  Simple soap and water couldn't "cut the mustard" (so to speak).  It took rubbing alcohol and a few dozen cotton balls just to tone down the stain.

The good news though is that I'm doing just fine.  I've had no problems with bleeding and the pain has been manageable.  What pain I do feel can best be described as dull, achy, and sore; it kind of feels like someone punched me in the armpit repeatedly (not that this has ever happened before or anything, but I can only imagine it must be similar).

My mobility with my right arm is somewhat limited, though mostly by choice at this time.  I'm purposely not trying to do too much with it as I don't want to risk disturbing the incision area.  But after the bandage comes off (Saturday afternoon), I'll likely start doing more.  Even so, I need to keep that area clean and dry, which means avoiding outside work (especially in our Hotlanta 90+ degree weather) and not washing that area for the next couple of weeks.  I'm sure the guys in the office are gonna just love that when I return next week!

Overall, I've got no complaints and I'm quite relieved that this all went so smoothly.  And I promise to post updates in conjunction with my pathology results and my follow-up appointment in 2 weeks (Mom!), though I don't expect either to be eventful.

Have a great weekend!

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* For those who don't have a clue about this title, it was supposed to be a reference to the Clue Game, where Colonel Mustard is one of the characters in this murder mystery.  And given my mustard colored arm and the fact that I'm in my dining room . . . well I think you see what I was shooting for.  And yes, I know: if I have to explain it, then it must not be very funny.  :)

** Some email clients block pictures, so if no picture is present, you can click on the Bold Blue Title in the email and that will take you directly to this post at my blog site, where all will be revealed.

A little off the top, please

All indications are that the surgery was a complete success!  So far, my pain is quite manageable, though I suspect it will likely go up a few notches by tomorrow.  My marching orders (post-op) are:

1. Take the dressing off after 3 days.
2. Follow-up with the doctor on Friday, July 9.
3. Do not drive or operate heavy equipment in the next 24 hours.
4. No alcohol for the next 24 hours.

I’m good with most all of these instructions, though I did make it clear “no promises” regarding the 24-hour moratorium on alcohol.  J  The Lipoma itself was approximately 4cm x 6cm and I'm told that the pathology results should be available within 7 - 10 days (though nobody is really expecting this to be anything other than Lipoma, which is benign).

Prior to the surgery, I got a little bit nervous when Dr. Monson mentioned, “Yeah, that thing’s in there really deep.  Removing that huge Liposarcoma on your leg was easy given where it was at; this will be a bit more complicated.”  Moments later, the Anesthesiologist followed up with the comment, “Wow – that really is an unusual location.  Surgery there can really be painful.”  All I can say is I’m just glad that I’m the kind of guy that really likes to hear people tell it to me straight!  Otherwise, a “panic attack” might have been in order.

Seriously though, this medical team is incredible!  I’ve got one of the best orthopedic surgeons in the southeast operating on me, awesome nurses, and an Anesthesiologist (named Heather) who really listened to my history of getting sick after surgery.  She described this as PONV (Postoperative Nausea and Vomiting) and told me she had it covered.  And sure enough, for the first time I didn’t get sick following surgery!  Yeah!

I’ve rented 2 movies and plan to start watching them as soon as I get something to eat.  Plus I plan on playing with my new iPhone 4, which was delivered today (perfect timing I might add).  I'm such a technogeek!

Thanks to all for your support, comments, emails, etc.  You-all are awesome!

A Cut Above

Yes, the time has finally come to get a new scar “tattooed” to my body.  At high-noon today, I will go in for that lipoma surgery that I mentioned in previous posts.  And this isn’t just any run-of-the-mill, dime-sized lipoma either (I have several of those); this one is much bigger and buried deep within my right armpit.  The main reason it’s coming out is because the location makes it difficult to monitor and we don’t want it to grow unchecked and become a problem.

I’m not really expecting this to be a big deal or anything, but I do think this is gonna hurt!  I just remember the pain that Holly was in after she had her right axillary node dissection (15 months ago) and I think this operation will be very similar.  I’m just glad I’m in the capable hands of Dr. Monson, who did such spectacular work on my leg 15 months ago.  Don’t know if I’m going to need any drains yet for this procedure (I’m hoping I won’t).  The surgery itself will be taking place at the Emory Spine Center (Executive Park) on an outpatient basis.

Once this is behind me, the exciting thing is that Holly and I will now have matching scars under our right armpits!  Now how cool is that?!?  I know that some couples like to get tattoos and all, but we (apparently) do things a little more “out of the ordinary”.  And trust me, the experience we’ve been through is just as permanently etched into our bodies, hearts, and minds as any real tattoo.  I’d say we’re a match made in Heaven!

Well, here’s to careful cutting, a speedy recovering, and a scar that’s just slightly bigger than Holly’s (for bragging rights, of course)!   J

Recent CT-Scan.  The area circled in red is the Lipoma that will be removed today.

Gwinnett Relay for Life – What’s it all about?

Though the actual 2010 Gwinnett Relay for Life wrapped up a week and a half ago, a lot of people still have questions as to what Relay is and what makes Gwinnett Relay the #1 relay event in the world.  If you’ve never been, it’s actually difficult to describe what all goes on, but I found something that might help.  Please check out this 4-minute video that summarizes the happenings of that evening:

http://v1.as48.com/hxpp1_hd2.asp?MSGID=B2D7DF9C-DF46-4A64-99E6-2470FF8BAC8B

Enjoy!

Quarterly scans “all clear”

Just a quick update to let you know that I had scans this morning (MRI on my left thigh and a Chest CT-Scan) and both were clear.  Yeah!  It’s always such a relief to get that kind of good news, even though I typically don’t worry about it (except sometimes the night before a scan).  My next scans (CAP) have already been scheduled for August 12th.

Still to be arranged is a date for removing the rather large lipoma under my right armpit. Dr. Monson will be doing that surgery likely sometime mid to late June timeframe. I just need to sit down and look at my calendar, Holly’s calendar, the kid’s summer schedule, and then make that fit with Dr. Monson’s surgical schedule.  I’m told that the surgery will be done on an outpatient basis and that I will be out of commission for about a week recovering at home.  Holly’s axillary node dissection surgery was similar to this both in terms of complexity and location, and I know it took her a while to bounce back from that.  Dr. Monson also said that a full pathology would be ordered on what they remove (to rule out cancer).

The other thing I wanted to mention is our Gwinnett Relay for Life results this year.  Thanks to contributions from many generous friends and family members, Holly and I together raised around $3,500.  That is really awesome and it’s all for such a good cause too.  I would encourage each of you to participate in the Relay for Life event in your area.  It’s really quite an uplifting experience.

More updates in another month or so . . . once this lipoma-gone-wrong gets the hatchet treatment!

Kyle, Bryce, Holly, and Dave about to share their story at Gwinnett Relay for Life last Friday (click to enlarge).  


You might notice that I'm wearing last year's shirt.  I like purple better.  :)

Gwinnett Relay for Life 2010

“Relay for Life” – what’s that? Isn’t that some sort of 10K race for charity? Oh, it’s for cancer victims? Well, I suppose that’s a good cause, though I don’t personally care all that much since I’m in perfect health and my family has no history of cancer. I don’t even know of anybody who’s fighting cancer. So, if you don’t mind, I’ve got lots of other things to take care of . . . .

Yeah, I’d say that would have pretty much summed up my attitude about cancer 2 years ago. To me, cancer was something that other people got, mostly due to family history of cancer, poor diet, a stressful job, or living too close to power lines. Given that I was clean on all of these counts, I figured “no way” was that in my future. Quite honestly, I had never even heard of Relay for Life back then.

Looking back, it was likely that same arrogance that led me to believe for almost a year that the bulge on my outer left thigh was simply a “big muscle”. Then came the shocking diagnosis: Myxoid Liposarcoma. A further review of my biopsy slides indicated the presence of the Round Cell component, which made my case “high-grade”. Because of the size of my tumor and the “high-grade” characteristic of the cells, my cancer was classified as Stage III. According to some sources, only about 1 in 400,000 people annually are diagnosed with my condition, yet somehow I drew the unlucky short straw here. It just goes to show that anyone (regardless of living conditions or pedigree) can become a cancer patient.

So, why do I Relay? Here are my main reasons:

1. I relay to honor and support my fellow brothers/sisters with cancer.
2. I relay in memory of those who have been taken by cancer.
3. I relay to raise cancer awareness as truly “sarcoma knows no borders”.
4. I relay to help find a cure.

Please support my efforts by making a donation to my Relay for Life team (or http://main.acsevents.org/goto/dave.novak in case your email client is hiding these links). Your donations go to the American Cancer Society (ACS) are tax-deductable. Click here to see how the ACS uses your donations. 

Incidentally, the Gwinnett Relay for Life Event (which is the largest such Relay event in the world), will be on Friday, May 7, or just a few short weeks away.  So, if you can, please make a donation by that time.  (And if you've already made a contribution to Holly, I thank you as this "counts" towards our team goal.)

Thank you for your consideration and support!

Holly and Dave at Gwinnett Relay for Life 2009 (click to enlarge)

For those getting e-mail notifications only . . .

If you receive email notifications about changes to my blog, my previous Happy 1 Year Anniversary post likely did not include the embedded music video links found on the actual blog site. If you're interested in checking these out, just go to my blog home here: http://dnovak-liposarcoma.blogspot.com/.


Alternatively, when you receive an email indicating that a post has been made, you can click on the Bold Blue Title in the email and that will take you directly to the post at my blog site.

Enjoy!

Happy 1 Year Anniversary!!!

Today (March 18, 2010) marks the 1 year anniversary of me being NED (No Evidence of Disease). It was a year ago exactly that I had surgery on my left thigh, removing what remained of my tumor (having already gone through both chemo and radiation.) So I am now 1 year NED! Yeah!

To help celebrate this first milestone, I’m doing a little happy NED dance here at home (with the curtains closed) while listening to some of my favorite “feel good” songs. These songs were really encouraging for both me and Holly as we both battled cancer during 2008 and 2009.

So, with great fanfare, I offer to you my top 3 most encouraging songs:

Nickelback: If Today Was Your Last Day

Another great Nickelback song that really gets you thinking.



My favorite lyrics from this song include:

My best friend gave me the best advice
He said each day's a gift and not a given right
Leave no stone unturned, leave your fears behind
And try to take the path less traveled by
That first step you take is the longest stride

If today was your last day
and tomorrow was too late
Could you say goodbye to yesterday?
Would you live each moment like your last?
Leave old pictures in the past?
Donate every dime you have?
If today was your last day

Against the grain should be a way of life
What's worth the prize is always worth the fight
Every second counts 'cause there's no second try
So live like you'll never live it twice
Don't take the free ride in your own life

If today was your last day
and tomorrow was too late
Could you say goodbye to yesterday?
Would you live each moment like your last?
Leave old pictures in the past?
Donate every dime you have?
Would you call old friends you never see?
Reminisce old memories?
Would you forgive your enemies?
…

So do whatever it takes
'Cause you can't rewind a moment in this life
Let nothin' stand in your way
Cause the hands of time are never on your side
…

New Radicals: You Get What You Give

Though I can’t say that I like (or even understand) everything about this song, it is definitely a very popular, fun, and uplifting song. The guy who sings it has a great haircut too. :)



My favorite lyrics from this song include:

…
But when the night is falling
You cannot find the light, light
You feel your dreams are dying
Hold tight

You've got the music in you
Don't let go
You've got the music in you
One dance left
This world is gonna pull through
Don't give up
You've got a reason to live
Can't forget
We only get what we give

…
But when the night is falling
You cannot find a friend, friend
You feel your tree is breaking
Just bend

You've got the music in you
Don't let go
You've got the music in you
One dance left
This world is gonna pull through
Don't give up
You've got a reason to live
Can't forget
We only get what we give

This whole damn world can fall apart
You'll be ok, follow your heart
You're in harm’s way, I'm right behind
Now say you're mine

You've got the music in you
Don't let go
You've got the music in you
One dance left
This world is gonna pull through
Don't give up
You've got a reason to live
Can't forget
We only get what we give
Don't let go
I feel the music in you

Fly high
What’s real can’t die
You only get what you give
You’re gonna get what you give [not in video version]
Just don’t be afraid to leave [not in video version]
…

Kris Allen: Live Like We’re Dying

This song actually came out after my treatment was complete, but it’s still a great song with powerful lyrics.



My favorite lyrics from this song include:

Sometimes we fall down, can't get back up
We're hiding behind skin that's too tough
How come we don't say I love you enough?
Till it's too late, it's not too late

Our hearts are hungry for a food that won't come
And we could make a feast from these crumbs
And we're all staring down the barrel of a gun
So if your life flashed before you,
What would you wish you would've done?

Yeah, we gotta start
Looking at the hands of the time we've been given
If this is all we got and then we gotta start thinkin’
If every second counts on a clock that's tickin’
Gotta live like we're dying

We only got 86,400 seconds in a day to
Turn it all around or to throw it all away
We gotta tell them that we love them
While we got the chance to say
Gotta live like we're dying

And if your plane fell out of the skies
Who would you call with your last goodbye?
Should be so careful who we left out of our lives
For when we long for absolution,
There'll be one on the line

Yeah, we gotta start
Looking at the hands of the time we've been given here
If this is all we got and then we gotta start thinkin’
If every second counts on a clock that's tickin’
Gotta live like we're dying

We only got 86,400 seconds in a day to
Turn it all around or to throw it all away
We gotta tell them that we love them
While we got the chance to say
Gotta live like we're dying

…

You never know a good thing till it's gone
You never see a crash till it's head on
Why do we think we're right when we're dead wrong?
You never know a good thing till it's gone
…

Right axillary lipoma to be removed

As a follow-up to my previous post, I wanted to let you-all know that I do indeed plan to have the large lipoma (located under my right armpit) removed sometime this summer. I had another conversation with Dr. Monson (my orthopedic oncologist) about this and he was able to clarify why this particular lipoma is “special”. (Please note that I have several other smaller, more typical-sized lipomas in other easily-accessible locations, but the doctor has no interest or intention of removing those.) I also got a second opinion from another oncologist, who said essentially the same thing as Dr. Monson.

The reasons to remove this particular lipoma include:

1. It’s difficult to monitor – given its awkward location, it’s difficult to monitor this lipoma for changes. Physical examination of the area is not a reliable means of detecting change and CT-Scans are primarily focused on abnormalities of the chest, abdomen, and pelvis and, therefore, not always fully inclusive of this area.
2. It could become cancerous – though this lipoma is not believed to be cancerous, there’s a chance that it could become cancerous (in particular for someone already diagnosed with Liposarcoma). Having said that, however, I should also point out that I was told (by the doctor) that this would be “unlikely”. Even so, this motivates me all the more to have it removed.
3. Don't wait for it to become a problem – given that there are critical nerves, blood vessels, and lymph nodes in that area, it’s probably best to have this removed before it has a chance to grow and become all that more of a surgical challenge.

I should mention as well that both doctors said “no rush” on the surgery, which is why I’m waiting until the summer to have this done. All-in-all, I’m not too worried about it, though I’m well-aware that this surgery comes with its own set of risks (especially given all of the nerves in that area). Even so, I think that a good surgeon shouldn’t have any problems with it.

Bottom line – having it removed is the right thing to do.

Quarterly scans all clear, but . . .

Thursday morning I had both an MRI of my leg and the full set of Chest, Abdomen, and Pelvis (CAP) CT-Scans. These scans, of course, were preceded by a Wednesday evening “nightcap” of “Creamy Vanilla Smoothie” (a.k.a., Barium Sulfate Suspension), with the same for breakfast Thursday morning. I have to admit, the Vanilla was the best of all the flavors I have tried. That’s not to say that I liked it either, but rather that it was the most tolerable of the ones I’ve had thus far. Next time though, I think I’ll press my luck and go for the (even newer) Mocha flavor! Mmm . . . Mocha . . . I just hope I can stand the anticipation between now and then! [No, not really; I can wait. :)]

Now for the good news: my quarterly scans where all clear! Yeah!!! This leaves me sitting easy for the next 3 months. Honestly, I never really worry too much about what may or may not be going on in-between scans. Yes, I typically do get a little nervous the evening before my scans, but the truth is there’s really nothing I can do that will make my results either better or worse than what they are going to be. And that’s not fatalism or defeatism by any stretch; that, my friends, is acceptance.

So what’s the but about in the title? Well, way back in July, 2008 (when I was getting my first full set of scans), it was noted that I have a rather sizable lipoma under my right armpit (see dark area within the red outline in the scan picture on left). Though my latest radiology report describes this as “a right axillary lipoma, stable from the prior exam”, Dr. Monson (my orthopedic oncologist) recommended that I get it removed.  (Note that I also have several other smaller, more typical-sized lipomas in various locations, but the doctor has no interest or intention of removing those.)  Though his advice was couched with “no rush”, the concern is that a large lipoma could change into something cancerous. I suppose he’s probably right (he certainly has an amazing reputation and impeccable credentials). Even so, I’ll want to get another opinion as well as find out more details about the surgery itself, particularly the risks and recovery time. I think my main hesitation here is I'm not looking forward to any surgery, especially if it will take days to weeks to fully recover.  Furthermore, it's not currently bothering me or giving me any type of discomfort.  If anybody has any information or advice for me here, I’m all ears.

And there’s one more but worth mentioning here: all my scans this time were done without IV contrast. Why? Well, recent blood tests showed slightly elevated creatinine levels (mine is 1.5) and there was some concern that the powerful intravenous contrast agents (those used with the CT-scans especially) might send my kidneys “over the edge”. What’s surprising to me is that I’ve always been good about drinking plenty of water and I’ve made a point of drinking 2 – 3 bottles of water immediately after each CT-Scan in an effort to quickly flush these from my system (as suggested by the radiologist).  Even so, it's possible that the sum of all these dyes to-date has led to my elevated creatinine levels. But it's even more likely (as one comment below suggests) that in my case what I'm seeing here is a late effect of my chemotherapy drugs. Either way, I will need to avoid contrast agents going forward.

To be clear, I’m not blaming anyone for this. Dr. Monson never ordered any contrast with my scans and has long since preached against this practice, arguing that the risk outweighs any perceived benefit. Furthermore, in my case, I am told that about 80% of any Myxoid Liposarcoma recurrence would show up as “chest nodules”, which is something you don’t need contrast to see.

So why was IV contrast used in the first place? Well, it’s the radiologists who seem to prefer it. But even there, they were fine with skipping it knowing that my creatinine levels were elevated. In fact, they were very appreciative that I had my levels tested and that I brought this to their attention.

So why even mention this? The point here is that one needs to be aware that cancer treatment and/or prevention can lead to yet a new set of problems. Also, if you’re having MRIs and/or CT-Scans with IV contrast, be sure to drink plenty of water immediately after the exam to help flush these dyes from your system. Finally, make sure that your doctor monitors your creatinine levels (especially if you've had chemotherapy drugs) so that any issues are caught early . . . before they have a chance to become big problems.

OK – I’m done. I’ve rambled on long enough. Expect to hear from me in another 3 months.

Chemo Survival Guide (a.k.a., Therapy for Chemotherapy)

(originally written November 28, 2009; last updated December 21, 2012)

Introduction

If you’ve read my story, you’ll know that I had to undergo 6 rounds of intensive chemotherapy. Though that was quite the ordeal at the time, it now (not even a year later) seems like a distant memory. Today my health is fine, my life is great, and in many ways I’ve “moved on”. But yet I realize that for others, their journey is only beginning. Furthermore, in retrospect, I only wish I knew then (heading into Round #1) what I know now. Therefore, before I forget everything I’ve learned along the way, I figured it would be time well-spent to document my personal Chemo Survival Guide.

Disclaimer Section
The legal department asks that I make clear that I am not a doctor and that I am not offering medical advice. What I share below is what worked for me during my cancer treatment; your mileage may vary. Please do not rely on anything that is said (here or anywhere) without first consulting your doctor.

Also, having talked to quite a number of cancer patients and having exchanged many "war stories", the quantity and severity of the issues I experienced seem to be worse on average than what others have described.  I want emphasize this right up front as I do not wish to scare anyone or lead them to believe that "this is all going to happen to me too!"  Chances are you will have fewer and/or less severe side effects than what I went through.

My Chemotherapy Treatment
My chemotherapy consisted of 6 three- or four-week cycles administered over a four-month period. Each cycle included 4 – 5 days of inpatient treatment with the tough AIM regimen (Adriamycin [generic name: Doxorubicin] + Ifosfamide + Mesna [a urinary tract protector for use with Ifosfamide]) followed by 2 (and sometimes 3) weeks of at-home recovery. Over the course of these treatments, I learned about:

Battling Nausea
For me, dealing with frequent nausea was one of the most difficult parts of my treatment. The nausea would typically start the Tuesday of my hospitalization (after 1 day of chemo), would peak that Saturday (a day or two after my last chemo infusion), and would persist well into the next week. But by week three, I was generally feeling much better and could eat normally.

It’s really strange what the chemo does to your system. My sense of taste and smell were both greatly exaggerated (as if on steroids). So many foods were surprisingly different than what they were like prior to chemo (and often repulsive). For example, I couldn't let anyone drink coffee around me because it smelled so bad (especially flavored coffee), and I’m a coffee lover! I eventually did go back to coffee, but that was a month after all 6 rounds of chemotherapy. Today (post treatment), everything food-wise has returned to normal (though sadly this means that I gained back all 30 lbs that I lost during treatment).

To combat nausea, I found that it’s important to:

1. Eat Something – eating on a regular basis and having some food in your stomach is very important to fight off nausea. Find the foods that you like and are agreeable with you. Whatever sounds good is what you should eat. If you can, try to avoid the smelly hospital food whenever possible (or at least be very selective with your ordering). During my hospitalizations, I would often have a Dark Chocolate Ensure (which I kept on ice in my private cooler) for breakfast. For lunch, my wife Holly would bring me a special meal of my choice (typically carry-out from a favorite restaurant). What a lifesaver!
2. Walk – light exercise is also good for helping to fight nausea. Each day I would try to walk 40-50 laps of the 7th floor (chemo pole in tow) there at Crawford Long (i.e., typically twice a day I would walk 20 – 25 laps). This may also help improve overall energy levels.
3. Take a nap – Chemo will wear you out, so it’s important that you get plenty of rest. I found that it was pretty much a necessity to nap for an hour or so every afternoon.
4. Find the drugs that work for you – I’ve always been a minimalist when it comes to taking drugs. The fewer the better! Despite this, I quickly learned that nausea was a major problem for me and that I needed to figure out what drugs were most effective in fighting nausea. For me, these were: 1) Zofran or Kytril, 2) Compazine, 3) Ativan, 4) Emend. I would generally alternate Zofran (or Kytril) with Compazine during the day and take an Ativan before going to bed. Many people (my wife Holly included) also had success with Phenergan tablets (especially at night), though it gave me weird dreams so I couldn’t take it (I used Ativan instead).
   
   During Round #4, I discovered Emend, which works in conjunction with these other anti-nausea drugs, but did way more for me than anything I ever tried. Emend is designed to be taken both the “day of” your chemo (for those lucky enough to be getting chemo only 1 day at a time) and afterwards for the two days subsequent. But my oncologist was concerned about the Emend impacting the effectiveness of the chemo and possibly even causing a rare complication called neurotoxicity. She was, however, willing to let me start the Emend the day after my chemo. And since I did not have Emend in the hospital, my doctor prescribed 4 pills to cover me for the next 4 days after chemo (please note that Emend is packaged as a 2-pack by the manufacturer). It’s also important to note that you cannot already be experiencing nausea when taking Emend or it supposedly won’t work. So, to meet that requirement, I ended up taking a Zofran around 5:00am - 6:00am (while in bed) and then took the Emend at around 7:00am - 8:00am when I got up. It worked!

Painful Neulasta shot
Most chemotherapy patients are required to get a Neulasta shot the day after chemotherapy (used to reduce the risk of infection by stimulating the production of white blood cells). Though the shot itself is relatively painless, a common side effect of Neulasta is bone pain and/or muscle aches. Though I was fortunate enough not to have experienced any such such side effects, my wife Holly and many others that I know had considerable bone pain.  For some, in fact, this can be the worst part of chemotherapy treatment.

One other thing that’s important to note here is that this Neulasta shot is very expensive (in the neighborhood of about $4,000). Even though I had great health insurance, my pharmacy co-pay for this was about $775. It turns out, however, that my co-pay would have been $0.00 (zero) had I simply gotten this shot in the infusion center rather than picking it up from the pharmacy. Why? Because I had long since met my out-of-pocket maximum for medical but I had not even come close to my max for pharmacy. Yup, these insurance guys have all the bases covered. With that painful lesson learned, I can assure you that I went to the infusion center for rounds 2 – 6. Please keep this lesson in mind as it is likely that your insurance works similarly.

Other side effects of chemotherapy treatment
Though nausea was probably the worst part, there are several other things in the “honorable mention” category, including:

1. Constipation – sorry, but I have to mention this one. Between the chemo, the anti-nausea drugs, and the iron pills my doctor had me take, it was difficult to stay "regular". Now normally I would take a fiber supplement to help (such as Metamucil), but my nausea was so severe that I simply could not stomach it. About the only thing that worked for me was the “red pills” (i.e., Peri-Colace or generic equivalent). I would take several of these each day. Turns out my doctor is a big believer in keeping her patients regular and, if I had not “gone” in the last 2 days, she would ask me to drink the better part of a 10 oz. bottle of Magnesium Citrate. Though somewhat unpleasant, it got the job done. I ended up purchasing several bottles of this over-the-counter remedy for my recovery time at home . . . just in case.
2. Mouth Sores – I never had too much trouble with this myself, but this is quite common for high-dose chemotherapy patients.  Why does it happen?  Possibly due to a condition known as Mucositis, which refers to the thinning of mucous membranes (as an adverse effect of chemotherapy) that can lead to inflammation and ulceration.  For those that I've talked to who experienced mouth sores, it typically peaks around day 10 of the cycle but then goes away once your blood counts return to normal.  If you experience this, please talk to your doctor as they may suggest a special mouthwash or other treatment to ease symptoms.
3. Pain in the butt (literally) – Yes, I know, this just keeps getting worse by the minute! But for the sake of "full disclosure", I think this one is too important to not to mention. I started feeling this pain sometime after my 4th cycle (during my worst neutropenic fever episode). As my counts continued to drop, my (is there a nice way to say this?) anus really hurt. The pain would last 5 - 7 days and was most pronounced when my counts were at their lowest (around day 10). I found that a sitz bath provided some relief for this discomfort.  Once my counts returned to normal, the pain would mercifully subside. Be sure to let your doctor know what's going on here.  If the pain becomes severe, they may need to prescribe something to help manage the pain.  This pain might also be related to Mucositis (described above).
4. Anal Fissures – An anal fissure is a (small) tear in the lining of the lower rectum (anus) that causes pain during bowel movements, which can also trigger anal spasms and, hence, more anal pain.  I wasn't aware of this condition during treatment, though (in retrospect) it may have been a contributor to the anal pain I described above.  Apparently fissures are very common among people going through high-dose chemotherapy.  Though fissures typically heal on their own between rounds of chemo, keep you doctor in the loop here as you do not want this to develop into a chronic problem.
5. Fungus – Once your counts start dropping, your immune system weakens, leaving you are susceptible to bacterial and fungal infections (the latter of which was news to me).  The fungus I had targeted the private areas below my waistline (both front and back side). Symptoms include: painful skin irritation, redness, burning, and general discomfort. I battled this as best I could with over-the-counter anti-fungal creams and had mixed results. Be sure to let your doctor know what's happening here, however, as fungus can quickly become severe and may even require hospitalization.  In my case, the fungus would subside once my counts returned to normal.
6. Eye Twitch – I had issues with this on and off over the course of my treatment and nothing seemed to help (in fact, the drugs only caused other problems). I quickly learned to accept the twitching and to ignore the problem. This all went away after treatment.
7. Fingernails – I never lost my nails (though some people do), but mine did get weaker and often tingled and ached. Several of my nails also noticeably loosened up from their nail beds. The other interesting thing was that each round of chemotherapy would put a white line on the base of my fingernails. Before all 6 rounds were over, I had some interesting looking fingernails with tree-ring-style white lines running through them. I regret that I never took a picture of my nails, but here's an example picture to show you what I'm talking about: Chemo Nails  Mine looked similar, just not as bad.
8. Chemo Brain – I'll be honest and say that I had Chemo Brain (think of it as a mental fog) for much of the duration of my chemotherapy (especially during the first two weeks of each three-week cycle). As a software developer, this was particularly frustrating as it made it virtually impossible to do any problem-solving. What's even worse is that I had no ability (or at least no desire) to read books, watch TV, or even play games on my computer or Xbox. Indeed the fog was thick, but it eventually lifted and I feel clear today.

Be prepared for the week after chemo
I originally assumed that if I made it through the week of chemotherapy in the hospital I was pretty much home free, but that’s simply not the case. For me, my white counts (in particular my neutrophil count) dropped to their lowest at around Day 10 of my cycle . . . and I could usually tell when I hit bottom because the negative side effects where at their peak. Typically, if I was admitted on a Monday (Day 1) and discharged on a Friday (Day 5), my worst day was the following Wednesday (Day 10).  You too will likely bottom out at about the same point in your cycle (give or take a day or two).  Given that an infection is most likely to occur when your neutrophil count is low, you'll want to make sure that you have a friend or family member “on call” throughout that time in the event you need to go to the hospital.

During my 6 rounds of chemo, I was hospitalized 4 times due to Neutropenic Fever, but recovered just fine from each incident. In fact, after Round #4, my Absolute Neutrophil Count (ANC) dropped to 18, which is about as bad as you can get without going all the way to zero.  I mention this not to scare you but so that you won’t be scared should you ever need to be hospitalized.  According to my oncologist, this happens quite regularly, yet her patients always seemed to bounce back just fine.  Even so, it can be a darn scary experience all the same . . . especially if you're unaware of just how low your counts can go!

Just don't let these "dire warnings" drive you into seclusion either.  From what I've read and been told, most bacterial infections result from your body's inability to fight off normal bacteria present in your gastrointestinal tract or skin rather than from being in a crowded place.  Even so, use common sense about where you venture when you know (or think) your counts are low.

Should complications arise . . .
Make sure you talk with your doctor and find out exactly what the procedure is if you have complications after chemotherapy. My doctor asked me to contact the "on call" doctor if I had a fever of 100.5 (or more). Based upon my current temperature and how long I had the fever, the doctor could advise me to go to the Emergency Room. But that honestly did not always work too well as it often took hours to go from the ER to actual admittance into the hospital. It would have been better if the doctor could have somehow admitted me directly, thus bypassing the ER altogether. Others in my sarcoma support group have similar stories and it is my understanding that the Emory hospital system is trying to improve this situation.

But the point here is that you need to know how this process works with your doctor, your hospital, and your health insurance. And if you do need to go through the ER (which is fairly typical), be sure to find out what your doctor can do to speed up the process. For example, on one of my unscheduled visits, the doctor called ahead to the ER and they got me to the back immediately and I was admitted to the hospital within an hour. Just be sure to tell them when you check in that you’re chemotherapy patient and that you’re running a fever. That alone should signal them to move you out of the waiting room ASAP.

Learn and know your body’s signals
It was important to me to be able to distinguish between a chill that might indicate a fever and one that could signal that my body was kick-starting its immune system. A simple thermometer, a little common sense, and going through a round or two of chemotherapy will aid you in making this important distinction.

For example, I've already stated that I was hospitalized 4 out of 6 rounds for neutropenic fever. The early onset of this includes general fever symptoms, such as extreme fatigue, chills, and high-temperature. But within days of each fever I also experienced some rather odd symptoms that at first I mistook for a recurrence of the fever. I would experience night sweats, often which was accompanied with a type of chills (or tingly wave) coming over my body, but all without any fever whatsoever. The sweating was quite strong and came from my head, chest, and back area while I was sleeping. I quickly learned, however, that this was my body’s way of telling me that it had begun the production of white blood cells. I also learned that I needed to sleep with a towel on my pillow and one on my bed since I would otherwise pretty much soak my pillow and my sheets with sweat!

Some doctors have seemingly validated my theory, stating that “everyone’s body signals them in a different way. For you it is night sweats; for someone else it could be something completely different.  Such sweats are likely the result of your body's engine firing up production of white blood cells.”  And for whatever it’s worth, at least one other person I know experienced something similar when when she was going through chemo.

The lesson: learn and know your body’s signals. For me, it was really encouraging to know that I was on the mend without having to wait for the doctor to tell me!

Attitude is important!
After only one cycle of chemotherapy, I found myself back in the hospital with neutropenic fever. I certainly was not expecting complications (at least not that early in the treatment schedule). The prospect of 5 more rounds of this was frightening.  But then someone left this simple, yet encouraging, comment on my blog: “it’s temporary, it’s temporary!” Indeed, the treatment is temporary, the nausea is temporary, and generally the other side effects are temporary (even the weight loss). It’s so important to realize from the beginning that chemotherapy does not go on forever, even though at the moment it might be overwhelming your life. Take solace in knowing that others too have persevered and remind yourself daily that it’s temporary.**

My wife and her cousin (both breast cancer survivors) used to refer to their chemo infusions as "Spa Treatments".  Their "code" for heading to the infusion center was "I have another Spa Treatment today". It makes me laugh most every time I hear it, and laughter is so darn important, especially during treatment.

A friend of mine (with an identical diagnosis) is currently going through the same chemotherapy that I had. And though nobody (that I know of) actually enjoys their chemotherapy or in any way looks forward to being infused, I have to say that this guy maintains a remarkable attitude. With his permission, please allow me to share a brief excerpt from our correspondence:

Spirits are still good and pretty even and did not need transfusion (though I was pretty dragging walking into the hospital I must admit). Man, being that wiped out gives me much more compassion for what many others, including the elderly, must be feeling much of the time. This said, I'm up for chemo cycle #4 on Monday! Bring it on, take me down, and send them sarcoma invaders to another dimension!

Attitude is also important to monitor because the chemo itself can sometimes trigger depression. One poster (who has worked with hundreds of sarcoma patients) made this comment:

Just so you know, the chemo can also cause changes that send some people into clinical depression, even people who have NEVER dealt with that before. If this happens, it's just a chemical thing and has nothing to do with "weakness" or "not being positive enough." So if Dave's overall mood changes, keep the docs informed. A LOT of the patients I know have gone on anti-depressants at some point in their treatment.

Find Support
Support (especially from family and/or friends) is essential for getting through your chemotherapy. Several sites are listed with this blog and local support groups are often available as well. If possible, try to find someone with a similar diagnosis and treatment plan but is months (or years) ahead of you in terms of treatment and recovery. This type of peer support can be a tremendous asset in that it shows you not only that people survive this, but also gives you some idea as to what to expect (short-term, long-term, etc.).

And speaking of support, I personally have found that music can be very inspiring. Recently, at my 1-Year NED (No Evidence of Disease) Anniversary, I put together a list of my favorite “feel good” songs, including lyrics. Though you may prefer a completely different genre of music, don’t underestimate the importance of music and how it can encourage and lift a person’s spirits.

Questions? Comments? Your suggestions?
I hope this article in some way helps you or a loved one better manage their chemotherapy. Again, this was my experience going through intensive chemotherapy; your experience may be different. If you’ve gone through a similar regimen and have constructive things to add, please post your comments below. Or, if you or someone close to you is about to start treatment and you have questions, please post those below or email me (scroll down to the Contributors section, click on Dave Novak, and you'll find an Email link there).


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** Though the symptoms and side effects described here are generally temporary, it should be understood that some people do, in fact, encounter long-term and/or "late effects" from chemotherapy. See http://sarcomahelp.org/treatment_side_effects.html for details.

Quarterly Scans

Yup -- another 3 months have flown by and it's time again for quarterly scans. So, this morning I had just a simple Chest CT-Scan (and no MRI). That procedure (once they get you in there) takes less than 10 minutes and did not include any contrast. But the best part about having a chest-only scan is that you don't have to chug that "Berry Smoothie" (read barium sulfate) crap the night before and the morning of your scans (which is required when I have full scans). Dr. Monson (who was cordial as always) said the scans "look great" and that they were all very pleased with my progress.

My next scans will be on 02/11/2010 and will include Chest-Abdomen-Pelvis CT-Scan plus an MRI on my left thigh.

Have a great Thanksgiving!

Quarterly scans "look good"

Wow -- what a long day. I had to chug a bottle of that barium “Berry Smoothie” stuff late last night and then another one this morning (in place of my regular coffee and bagel). This was necessary for my quarterly Chest, Abdomen, and Pelvis (CAP) CT Scan. I also had an MRI of my left thigh.

But the good news is that Dr. Monson (my Orthopedic Oncologist) reviewed both sets of films and says they “look good” to him. The official radiology report should be back by end of week, though I trust the result will be the same. Just keep that good news coming and I’ll drink a bottle of the barium “Berry Smoothie” every week if it helped! I just can’t figure out how I managed to ever stomach that stuff when I was going through chemo. I was very fortunate I suppose to keep it down.

Later in the afternoon I drove downtown for routine labs and my quarterly appointment with Dr. D’Amato (my Oncologist). I’m just glad that this isn’t more frequent than quarterly as these scans and appointments took literally all day. But it’s done now and the results were all good.

And speaking of good news, I wanted to mention that my wife Holly finished up her 6th and final round of chemo last Tuesday. In fact, she’s out tonight with several of her "church friends" having a “no more chemo party” (or so she tells me). I’m so happy for her and glad that she never had any serious complications (not to say that it was “easy” for her either). Like I told her when she headed into round #1, she will be amazed at how quickly the 6 rounds will go. Sure, it may seem to drag on while you’re in the middle, but you’ll be surprised at how quickly the last round comes and what a minor blip on the radar it feels like in retrospect. My chemo days seem very small to me now (almost a repressed memory), but that’s fine by me since I’d rather remember all of the good times instead!

Walk for Sarcoma Awareness Tonight!

Well, the family heads out tonight at around 5:30 to Piedmont Park for the annual Walk for Sarcoma Awareness event at 7:00 (http://www.team-sarcoma.net/tag/georgia). It should be fun. Being the local "poster boy" for Sarcoma, I certainly don't want to miss it. This will be a nice way of wrapping up International Sarcoma Awareness Week (http://team-sarcoma.net/).

In case you wanted to understand more about why such events are held, please see this helpful video.

One Year . . . and Counting!

It was just a year ago today that I got the call from Dr. Monson's office to tell me that the biopsy results had come back and that I had been officially diagnosed with Liposarcoma. It took a few more days, however, before I actually met with the doctor and learned exactly what my treatment plan would entail. (See http://dnovak-liposarcoma.blogspot.com/2008_07_01_archive.html for all of the details.) I would have never imagined that such a thing could happen to me. Little did I know that the (benign) brain tumor I had 8 years prior was not my “big event” but rather just a warm up for the main act that was to follow. Unbelievable!

Certainly a lot has happened during this past year and I'm just happy to be alive, doing well and back to a “normal” lifestyle. Not all Sarcoma patients are as fortunate, so I have nothing to complain about!

Moments in Sarcoma

How's this for a shameless, self-promoting plug: http://www.team-sarcoma.net/category/moments-in-sarcoma

Yup -- this is my week to be published (and 4 others). It is interesting to to hear from people all around the world sharing their "Moment in Sarcoma". It brings home the clear message that Sarcoma Knows No Boarders.

My port is out!

As expected, the operation was a success, though I required more sedation this time than when the port was installed about a year ago. Both procedures used "conscious sedation", where Doctors apply a local anesthetic (Lidocaine cream) to the surgical site to numb it and then give you some other drugs to make you relax and feel good, yet you're awake and moderately alert during the procedure. I still remember very clearly "Dr. Best" (the doc who installed my port) asking me tons of computer questions during the operation, so yes it's definitely "conscious sedation".

This time, however, the Lidocaine cream didn't seem to do its job (not on long enough?) as I could feel the incision as it was being made. No problem -- nurse, more IV drugs! Problem solved. By the time I got home this afternoon I felt like I had about 6 margaritas too many and crashed in my bed for 4 hours straight. Now that I'm up, the "hangover" has started. Yup, they definitely gave me more stuff this time!

But I give the team at Emory credit for getting everything prepped and ready so quickly. I checked in around 9:00am and I left there just before 11:30. That's incredibly fast turn-around given that the bulk of this time was spent drawing blood work and waiting for labs results prior to the operation. I'm quite impressed.

My freshly re-opened scar (i.e., they reused the incision from my port placement operation) will need to stay covered for the next 10 days.

As some have already noted on Facebook, "the meaning of this is HUGE!" Indeed, as it means "no more chemo" for starters and cleary shows that my doctors feel that I'm on the road to a full recovery. Yeah!

Port removal surgery Thursday morning . . .

Just a quick update to let everyone know that I’m having my port removed tomorrow morning. I’ve had a port in my right chest now for about a year and I’m ready to have it taken out. Hopefully I won’t need another one anytime soon (if at all). This should be a simple outpatient procedure. I’ll let you know later tomorrow how it went.

Also, I wanted to let you know that the CT-Scan I had back in May came back clean. “No significant changes” were noted. My next scans are in mid-August (lucky me).

Finally, I had a brain MRI done just a few weeks back (on June 26). I recently got word that the Radiologist has given me a clean bill of health on that. It turns out that I had a 5cm pituitary tumor (benign), which was removed back in October, 2000. I’ve just never mentioned that here since it’s unrelated to my sarcoma.

Update on scans

Mmmm . . . berry smoothie (flavored barium sulfate). It goes down smooth and easy (aside from the tingling sensation I feel in my throat). Unfortunately, it doesn't "agree" with me. Tomorrow morning I'm switching back to coffee!

Well, I at least have some preliminary results for my CT Stan. Dr. D'Amato looked at the scans and said they "looked good". Of course the official radiology report could say otherwise, but usually D'Amato and Monson are accurate with their readings. There are a couple of "spots" they are keeping an eye on (one on the liver and one on the chest), but these have not changed in over 9 months, so the docs have not been concerned.

Well, this should be one less thing to think about while on vacation next week. I can't wait to do something fun!

CT Scan Tomorrow

Yup, it's that time again. Three months have elapsed since my last CT scan, so I'm due for another one tomorrow (Monday) morning. This one will be a Chest, Abdomen, and Pelvic scan (the same as what I had back in February). Immediately following the scan I go in for a port flush and a visit with Dr. D'Amato. I likely won't get any results, however, until Wednesday.

Though I expect the results to be positive (err, I mean negative . . . I mean no metastasis was found), I'm not sweating it in the meantime. All I know for sure is that I have a vacation coming up over Memorial Day weekend (and the week following) and I'm going to relax (one way or another). It should be a lot of fun and the family is looking forward to it.

Well, I've got to go now and choke down a bottle of barium sulfate suspension (Berry Smoothie flavor). I can't wait to have the second bottle in the morning instead of my usual coffee. :)

Expect another update on Wednesday after I find out the results.

Relay for Life

Holly and I had the privilege of attending Relay for Life this past Friday night up here in Gwinnett County, Georgia. Supposedly Gwinnett has either the largest or second largest “relay” in the country. This event, sponsored by the American Cancer Society, brought in nearly $2 million dollars from the Gwinnett event alone. I wanted to thank all of you who contributed to Holly’s goal of $1000. She was able to exceed her goal.

I think the most striking part of this event was just the sheer number of people participating in the “survivor lap”, which kicked off the event early in the evening. Seeing that many people, all wearing survivor t-shirts, makes it hard to ignore the epidemic nature of cancer. As recently as last year, both Holly and I were in that group of people who believed that cancer was something that other people get, but certainly not us. I honestly doubt we would have given “Relay for Life” any serious consideration as no one in our immediate family has even had cancer. All I can say is what a difference a year can make . . . and what a year it has been. Our attitudes have certainly been changed through the experience.

Please allow me to share some pictures from the event:

Holly and me (click to enlarge)

Note the caption: “My Chemo SUCKED. How was yours? :)” Irreverent? No -- just trying to be lighthearted (please note the smiley face). Most people laughed, some said “yeah, mine sucked too!” But one person actually told me “mine was fine!” Obviously that person just wasn’t getting enough chemo and should try the “intensive” chemo regime given to sarcoma patients! (click to enlarge)

Holly “deer in headlights” look :) (click to enlarge)

Thank you Nathan Horton for thinking of us when making your custom "Relay for Life" T-Shirts! Cool! (click to enlarge)

Though this was an excellent event (and one I plan to attend every year), the event near and dear to my heart is the “Team Sarcoma Initiative” taking place July 18 – 26, 2009. The Atlanta event for this will be the Walk for Sarcoma Awareness that Friday, July 24th, at 7:00pm. Sarcomas are rare, deadly, and don’t get nearly as much publicity or research funding as other “popular” cancers (such as breast cancer), so awareness is a big issue.

How you doing???

I know I haven’t written much about my status lately, but you can pretty much assume with me that no news is good news. I’ll be wrapping up my physical therapy within the next week or so and both strength and range-of-motion have returned to my leg. The only problem to speak of is that fluid keeps building up in my leg at the surgical site. The problem, as explained to me by Dr. Monson, is that the tumor left a cavity, which my body wants to keep filling. About 2 weeks ago he drained 140 CC’s from that area and since then it has filled up again. He said it’s something they might not be able to fix, but they will try staying on top of it by draining it every 2 weeks for the next month or so. But no guarantees that this will resolve the issue. The good news, though, is that the fluid is causing me no discomfort or real problems (from the best I can tell). It just sort of looks like I have a saline implant in my thigh. :)

My Staples are Out!

OK – they actually were taken out back on Tuesday, but I’ve just been too busy (or lazy) to make an update. Steri-Strips have replaced the staples. In any case, it’s adiós “Zipper Leg”! The best part about having the staples out is that I can now sleep on my left side (something that was just too painful to do with staples).

I mentioned to Dr. Monson the issues I continue to have: 1) the buildup of fluid in my leg, 2) loss of flexibility, and 3) numbness around the surgical site. He responded to #1 by putting a huge syringe in my leg to suck out the fluid (yes that hurt . . . a lot). For #2, he has prescribed physical therapy (3x a week for 4 weeks). PT starts next Wednesday. I should be able to get that done and out of the way before heading into the office each day. As to the numbness, well that is “normal” and should go away over time.

It seems hard to believe that I’m already 3 weeks plus 2 days out from surgery. I’m still using a single crutch at this time (now mainly just for balance in case my leg gives out while walking, which it does occasionally). And I still have to do stairs “old man style” (meaning one step at a time). But I’ve been seeing tremendous improvement recently (especially over the past 2 days), so I think I’ll be losing that crutch within a week.

Finally, it’s worth mentioning that Dr. Monson reiterated on Tuesday that “We hit a homerun” regarding the pathology report on my tumor. I’m relieved to see (and report) that this story will most certainly have a happy ending.

Update on Holly
It turns out that Holly is going to need chemotherapy, hormone therapy, and radiation treatment to fight her breast cancer. You can follow the details of her journey here: http://hhnbreastcancer.blogspot.com/

My drains are out!

I'm now 9 days post-op and Dr. Monson's office called me to get my drains removed. They were taken out this morning, and man did that hurt! There's a lot of pain and a burning sensation while they get pulled out, but the whole thing is over in about 15 seconds. I'm just glad to have them out and not taped to my knee any longer.

The PA also took off the other gauze pads covering the incision / staples and said that it would be best to just leave those uncovered. I was also given the "all clear" to take a shower, which is really nice since I've had to take bird baths for the last 9 days.

With my incision now clearly visible, I was able to measure it and it is exactly 12 inches long (not 16 as previously reported). Evenly scattered throughout those 12 inches are 34 staples, which come out in another 11 days (April 7).

"Zipper Leg" -- That's gonna leave a mark! (click to enlarge)

Are you ready for some good news?!?

I know that my family sure could use some . . . and this afternoon that good news finally came. I got a call this afternoon from Dr. Monson’s PA to say that “we got it all!” Yes, the pathology came back today and I indeed have negative margins and the high kill rate everyone was praying for. I was told that the kill rate was determined to be 95%, which I was informed is a very high percentage. Yeah! I couldn’t be happier (at least not without taking a few more Percocet)!

This means that my treatment is essentially over (all but the healing) and that I will now shift from active treatment into close monitoring. Yes, I will need full CT Scans and thigh MRIs every 3 months for the next 2 years, but the chemo, radiation, and surgery should all be over (forever, in fact, if I they find no recurrence). I for one can’t wait to put this all behind me.

As to my recovery from surgery last Wednesday, my pain seems to be fairly well under control, though my drains are still in. Once the drains slow down sufficiently, the doctor will remove them (likely Wednesday or Thursday). My only concern at this time is that my leg has noticeably stiffened over the past few days. As of last Friday, I could bend my leg 90 degrees without any problem; today, I can hardly bend it even half that distance. That and the area up to two inches left of my incision feels almost numb (kind of like I got a Novocain shot in my thigh). I attribute the numbness there to the surgical requirement of removing the thin layer of tissue between the tumor and my skin. (Here’s an old MRI showing how close the tumor was to the surface.) But the PA was not concerned, so I have to assume that this is all within the range of normal and expected consequences (hopefully all temporary) of this sort of surgery. But otherwise, I’m doing fine and getting around well with just one crutch.

Thanks again, everyone, for all of your care and support. I’m so glad to be able to say that this story is going to have a happy ending . . . and I owe so much to you for helping me to stay strong throughout.

I'm back home now and have a new “tricep”

Yeah, the “tricep” comment in the title is another lame attempt at humor on my part (i.e., 4 muscles [quad] – 1 muscle = 3 muscles [tri]). Yeah, still not funny . . . especially if I have to explain it . . . but I’m trying.

As Holly mentioned yesterday, the surgery went well. In fact, Dr. Monson said that the surgery was made easier by the fact that there was no surrounding nerves or major blood vessels. I take this to mean that my recovery time could be even faster than normal, with fewer long-term complications.

But what really shocks me is that after just one night in the hospital, I'm back home and feeling much better than I could have ever expected. Yes, the Percocet does help, but I have fairly good mobility too, being able to walk with crutches and even climb stairs. With any luck, I should be able to shed the crutches within a few weeks.

Funny thing is I have not even seen the incision itself. That’s all carefully wrapped up within several layers of dressings, the topmost of which is an Ace bandage. I suspect that they will change that when I have my drains removed next week. From what I can tell though, my guess is that the incision is about 16 inches long.

The worst part of the entire experience was the nausea I experienced after the surgery. I ended up getting sick a couple of times yesterday and really could not eat anything all day. This was likely the anesthesia, morphine, or both. But I’ve been fine in this regard since last night. I owe a lot to my sister Barbara (the Oncology nurse), who spent the night with me in the hospital and helped me with countless issues, including pushing me with the Physical Therapy. When you're stuck in a bed with nowhere to go, this type of support is priceless.

And speaking of family, everyone in my family has come into town to show their support. My Mom and Dad from Knoxville, my sister Diane from Lexington, and my sister Deborah from Cumming. All have been tremendously helpful. And many thanks to the rest of you for your emails, letters, and words of encouragement and support. Encouragement and hope really is the best medicine!

The Tumor is Out of Here!

Hey there - this is Holly...I can honestly say that today such a huge weight has been lifted from my shoulders. Dave's surgery went off without a hitch...we were at the hospital at 6:30 AM, surgery started right on time at 8:30 and was finished at 10:00 AM. Dr. Monson told us that the surgery went so well he was ready to go and do it again on Dave's other leg! No need, one was enough! Instead of a quadricept (sp?), Dave now has a 3 and 3/4 cept...just a small part of one of the muscle had to be taken, but nothing significant. We'll have to wait a few days for the pathology report, but the doctor said that he felt really good about what he got out so hopefully this will be it and all the bad cancer calls are gone!

Well, Dave can write more when he gets home and is up to it...he may be discharged as early as TOMORROW! The Physical Therapist had Dave standing up about 4 hours after he got in his room and he was doing leg lifts for her and for Dr. Monson...I was absolutely amazed at how well Dave was doing and am so thankful everything went well...Thank you for your prayers and ongoing support!

Hoping for negative margins and high kill ratio

The clock is ticking and I am now only 12 hours from surgery, which is scheduled for 8:30 Wednesday morning. Though I am confident the surgery itself will go well, I just hope that the pathology for what they remove all looks good.

When the surgeon removes the tumor, they remove a little extra tissue surrounding the tumor as well, which they call the "margin". The margin is then tested for any signs of cancer and the hope, of course, is that these tests are all negative. A positive test here would indicate not only that the margin contains cancer, but also that my leg still contains some cancer. Bottom line -- we want to see negative margins here.

The tumor itself will then go though testing where the Pathologist will determine the "kill ratio" of the cancer cells. Obviously the chemo and the radiation killed some or all of the cancer cells, but we just don't know how much at this time. Though I don't know what a good kill ratio is (90%?), the more dead cancer cells they find (or the fewer living cancer cells they find) the better! So, please pray for a high kill ratio.

Should the margins end up being positive or the kill ratio be lower than expected, chances are good that I'll be asked to go though more chemotherapy. I for one would like to avoid that.

I should know more about the pathology either late this week or early next week.

Like a surgeon

Hi Everyone --

Well, I'm just a day and a half away from my surgery now and feeling a little nervous. BUT, I found the following video on YouTube and it helped lighten up the mood:



Crud, it won't let me embed this video. Well, you don't want to miss this one, so just click here, http://www.youtube.com/watch?v=WFkgbK7VTmY, and view it directly from YouTube.

Enjoy!

Damn . . . Just Damn

Hi folks – sorry to start a new post off with that sort of tone, but I’m not sure there’s really any nicer way of putting it. My wife (and co-editor of this blog) Holly was recently diagnosed with Breast Cancer. A routine mammogram revealed the abnormality a few weeks back but it wasn’t until last week that we got the results of the biopsy, which showed the lump was cancerous.

Yesterday Holly had a lumpectomy at Gwinnett Medical Center, under the care of Dr. Wallace Martin. The surgery went as well as could be expected. The surgeon removed only 3 sentinel lymph nodes (the fewer the better), all of which (at the time) were negative for cancer. The tumor itself was about 2 centimeters in size and was removed along with the surrounding tissue (a.k.a., the margin). No drains were installed, which should make the healing easier or at least less complicated.

The lymph nodes, margins, and the tumor itself were then put though more exhaustive tests in the lab. We got a call back from the doctor’s office this afternoon with the pathology of these tissue samples. The good news is that the margins were negative, though we learned today that the surgeon had to cut into the chest muscle in order to ensure negative margins. The bad news, however, is that the lymph nodes were positive for microscopic cancer cells. As a result, she will need to go back in for a lymph node dissection, where they’ll surgically remove more lymph nodes and then put drains in. This is scheduled for next Tuesday (3/10).

Prior to that, however, we have a follow-up appointment with Dr. Martin on Monday (3/9). It is then that we should learn more about the type of cancer cells we’re dealing with and learn of a proposed treatment plan. All indications are that she will likely undergo radiation therapy, though chemotherapy has not been ruled out.

All I can say is it feels different when the shoe is on the other foot. I’ve accepted the fact that I’m fighting (and I believe winning) my battle with Sarcoma. That was OK with me. But now Holly has breast cancer?!? That really hurts. I guess I never really understood how she felt when she learned of my diagnosis until just yesterday in surgery when her diagnosis began to sink in.

I’m sure many may wonder why this is all happening to us. Some may even speculate various environmental theories as to the cause of a husband and wife within the same household both going through cancer at the same time. Yes this is rare and it’s only natural to think along these lines. However, to be quite frank, I really don’t care why this happening or what the cause might be since nobody can definitely answer such questions. I’ve never seen anything good come out of pondering such topics (especially as a cancer patient), which was one of the themes of my post on 2/23/2009. Instead, I’d much rather focus my energies on beating this thing and being a supportive, compassionate husband.

My next challenge will be to figure out a way to break this news to my two boys (neither know anything beyond the surgery). If I can just manage to hold them off for a few more weeks (until after my surgery), perhaps then it will be easier for them to bear such news (knowing that I’m nearing the end of my battle). But I think I should just stop overanalyzing the situation and take my own “one day at a time” advice here. I just pray that my kids will have the strength to handle such news . . . whenever it comes.

I’m planning for this to be my last post regarding Holly. Hopefully she will start a blog of her own, which I will add to the list of blogs that I follow.

Stay of Execution

Brief Update --

I got word today from my doctor's office that my surgery has been postponed for a week. My new surgery date is March 18, at 8:30am (which means I have to be there at 6:30am). It was kind of funny because they offered to do it on the 13th (Friday the 13th to be specific), but I said "no way".

Oh well . . . at least now I have an extra week to wrap up on stuff at work and on the home front.

Moments in Sarcoma

The Team Sarcoma Initiative (http://www.team-sarcoma.net/) has recently put out a request for Sarcoma patients and their families to write "Moments in Sarcoma".

This is a new project that will publish moments from the lives of patients and their families, doctors, researchers, and friends. Submissions are invited during the month of February. Then one submission will be published daily on the Team Sarcoma Website starting in May or June, continuing through the International Sarcoma Awareness Week in July and ending when all chosen moments have been published.

As a part of this very special project, one patient or survivor who submits a Moment by March 1 will be awarded a sponsorship of at least $2,000 (there may also be the possibility of some travel assistance) to participate in the 2009 "Core" Team Sarcoma Bike Tour during July 18-25, 2009.

For more details, see http://www.team-sarcoma.net/moments.html. All submissions must be 300 words or less.

Weighing in at 297 words, here is my submission:


“One Day at a Time”

So I’ve been battling Myxoid Liposarcoma now since July, 2008. I probably had this condition a year prior but just never knew it. Life was good and everything was easy. Then came the rather shocking diagnosis and even scarier “treatment” plan. At the time I wondered, “Why did this happen to me? Am I going to survive this ordeal?”

I’ve since endured 6 five-day cycles of intensive chemotherapy (over 4 months), numerous emergency trips to the hospital, 25 rounds of radiation (over 5 weeks), and surgery is only days away. I’ll be honest: the chemo sucked . . . and the smelly hospital food was even worse! My strong recommendation is to order takeout from your favorite restaurants instead. Whatever sounds appealing is what you should eat.

In contrast, the radiation treatment was a cakewalk. Sure, I now have funny tan lines on my left thigh and a little “sunburn”, but who cares! Life is good again, my appetite is back, and I’m even working fulltime (which I find quite therapeutic). It turns out that I work with some pretty darn funny guys . . . and it does feel good to laugh again.

If my sarcoma journey has taught me anything, I’ve learned to cherish the good times, enjoy my family and friends, have a few laughs, and even appreciate a fine meal. I refuse to dwell on the negative or live in fear. Yes, I concede that I am not in control of my destiny, but I am steadfast in my resolve to enjoy life and be thankful for all of the “easy times” that come my way (like now). I no longer grapple with questions that cannot be answered, but instead take things one day at a time.

http://dnovak-liposarcoma.blogspot.com