Happy Anniversary!

Like a typical man, I forgot that today was my cancer diagnosis anniversary.  Not kidding, Holly had to remind me!  Yes, we all know that she is my “better half”!

It’s almost hard to believe that it was 2 years ago today that scans the morning of 01/15/2019 revealed a metastatic recurrence of liposarcoma in my right pelvis.  Things were going so well for so long being cancer free  (10 years) that I just couldn’t believe what I was hearing.  In the subsequent days and weeks, the news was devastating. Just a month earlier, Holly and I had visited Nocatee, Florida and were planning to move there after the boys were out of college (if not even earlier).  But with that news, all of those plans/dreams were put on indefinite hold.

The good news though is I’m still around and things have been “stable” for nearly 1 1/2 years.  I choose to think of this date not so much as a cancer anniversary but more of a survivorship anniversary.  Hopefully things will remain stable for years to come.  

More scans coming on 1/25, so please keep me in your thoughts.

Final thought: always out your spouse first, especially on an anniversary!

A New Wrinkle: Anemia

 In the last couple of weeks I've noticed myself feeling much more tired and colder than normal.  At first I figured it was me just being tired of 2020, Covid-19, and the shorter/colder days, as I'm sure many of you can relate.  But in my last round of chemo (on December 1), labs taken prior to the chemo showed my Hemoglobin hit an all new low of 9.5 gm/dL.  A normal reading for men starts at 14.0 gm/dL (according to Cleveland Clinic).  Previously my results sometimes ran slightly low (as in the high 12 - 13 range), but this represents a significant drop.

And of course for every symptom there are new tests that can and must be run.  In this case, it's an Upper Endoscopy combined with Colonoscopy.  Oh yeah!  I was overdue for that anyways (really)!  I am so looking forward to spending an evening in the bathroom followed by an outpatient procedure (yes, pun always intended).  I do have a bit of a reprieve though before this happens.  Apparently everyone wants to spend their flex dollars on doing this at the end of year.  So, this means they are booked well into January.  My appointment is scheduled for Friday, January 22, 2021, in the morning.

Finally, I wanted to mention that I went back and forth in my mind as to whether or not I should even do this post.  As you probably know, I don't often whine and complain (though wine and celebrate, yes).  But given that how I feel is apparently tied to a physical/medical issue, I opted to share.  My mission from the beginning of this blog (which is now well over 12 years old!) has been to show what really happens to people when they go through cancer treatment.  No sugar coating here, just the raw, unvarnished truth.  For the last 15 months, I've had nothing whatsoever to report other than things were remaining "stable".  This latest issue is hopefully temporary and not the result of something more serious.

Also pending for January is a new set of scans, but that date and type of scan has yet to be selected.

In case you don't hear from me prior to the January "festivities", I wanted to wish you all a Merry Christmas, Happy Hanukkah, and a blessed New Year!

Quarterly Update: Scans Remain Stable

Over the past month I've had two sets of scans: a CT scan of chest, abdomen, and pelvis and an MRI of my pelvis.  Both showed that the tumor has remained "stable".  That marks over year now that my tumor has remained stable, which is really quite amazing!

Next update will be after my next scan, which is TBD.

Take care, stay safe, and stay positive!

All is well!

It took a little longer than expected with my surgery today because they are required to first do a COVID-19 test prior to any surgery requiring anesthesia.  With all I've been through, I've gotten fairly used dealing with pain, especially pain that is temporary.  But I must admit that the Covid test is really not any fun at all.  They stick that thing all the way up and down your nose until you can feel it coming out in your throat!  It tickles in a weird/bad way and is very uncomfortable as it goes all the way down.  And just when you think it's over, it's time to repeat the process on your other nostril!

Thankfully they have the new rapid test there at Northside and can get results in just a little more than an hour.  At about the 1 hour 20 minute mark, the surgeon (Dr. Levy of Northside Radiology) came into the room to describe what was going to happen during the port replacement.  But given that I still had not heard the results of my test, I asked him.  His immediate response was "Oh you're positive".  "What!?!" I responded.  He went on to explain, with a wink and a smile, "you're positively going to get this surgery because your covid test came back negative!".  Yup, I'm a victim of my own sense of humor as this is exactly the sort of thing I would say if I were in his shoes.  But all kidding aside, he was great and his supporting team of nurses and techs were among the best I've ever seen!

New port in green, old port area in red, painful area in yellow

I stayed mostly awake during the surgery but felt no pain other than the initial incision.  Post Op was a breeze too; I scarfed down a turkey sandwich, drank a ginger ale, and took home a couple of packs of Oreos and other snacks.  Six hours later as I'm writing this post, I'm feeling the pain set in (especially in the area show in yellow), but it's not all that bad . . . I've had much worse.  It is important though to try to stay ahead of the pain, so I'll be taking another pain pill soon and head to bed.

Thank you everyone who said a prayer for me or sent positive vibes my way during this procedure.  I felt it all!  Between your support/caring and the awesome medical team at Northside, this was a big success and I can put it all behind me.

Have a great weekend everyone!

Port replacement surgery scheduled for Friday morning

So I ended up being sent to Dr. Ronald Trible of Georgia Infectious Diseases.  To him it was not conclusive as to whether I had a port infection, skin infection, or just a subdermal hematoma.  But, given the issues I've been having of late with my port not wanting to show a blood return (something not previously reported here), and given that I am just 2 weeks away from my next scheduled round of chemo, he said that probably the best thing we could do would be to replace the port.  Considering that I had already gone longer than most patients getting Yondelis, this feels like the right answer to me.  I especially like the fact that my chemo schedule won't slip!

I was also given a prescription to a more powerful antibiotic: Linezolid.  This will be of great benefit if what I have is either a port infection or a skin infection.

Surgery is Friday morning at 11:00am.  I'm not expecting this to be a big deal, though I am expecting to be sore for several weeks.  The best part though is that now I will have matching scars on both sides of my chest!

Florida Vacation, Infected Ports

Hello from sunny, hot, and humid Florida!

Siesta Key Sunset

That's right, Holly and I went on a quick vacation over the July 4th weekend to Siesta Key (just south of Tampa).  The beach was beautiful and the weather was nice, but nothing is really going to feel the same until the darn coronavirus thing is over.  With bars closed and us not daring to eat inside at any restaurants, pretty much the best we could do was takeout . . . and the occasional patio breakfast.  We did our best though to social distance and wear masks when appropriate.  Given that coronavirus cases were/are spiraling out of control there in FL, I'm just happy to have gotten back home safely and, two weeks later, still be virus free!

To be clear, we might be virus free, but apparently not infection free.  It turns out that my chemotherapy port (surgically implanted in my right chest) appears to be brewing an infection.  I noticed several days ago that something was wrong because the skin was reddish in color and very sensitive above the port. 

My oncologist (Dr. Ummed) took a look at this last Thursday and confirmed that this was the early stages of a port infection.  He also pointed out that he has seen a number of port infections specifically with those getting Yondelis.  In fact, he added, I've gone longer (1.5 years) than most of his Yondelis patients with avoiding a port infection.  He then sent me to the infusion room for IV antibiotics and home with a prescription of oral antibiotics. 

As I write this post (three days later), I'm unfortunately not seeing any improvement.  In fact, it seems to have gotten slightly worse.  So I'll definitely be following up with Dr. Ummed tomorrow.

Barring some sort of miracle, I think that ultimately the port is going to have to be removed and replaced with a new port, this time in my left chest.  Normally I wouldn't be all that concerned about this sort of thing, especially since it is "common" with Yondelis patients.  But given this coronavirus thing that's going on, I really would prefer avoiding the hospital and surgery at this particular point in time.  Oh well, it's out of my control, and I'll just have to do whatever I have to do to rid the infection and stay on a chemotherapy treatment schedule.

Oh and one more fun fact worth mentioning: it is not possible to Yondelis administered by direct IV; you must have a port!  Why?  Because apparently Yondelis is very dangerous if it enters your body outside of the bloodstream.  The port guarantees that the Yondelis goes straight to the bloodstream whereas the needle with an IV could possible move outside of your vein during the 24-hour infusion process.  Think about it, you have to take your chemo backpack to bed with you at night.  Can you be sure you don't roll over strangely or do something to cause that needle to penetrate outside your vein and have Yondelis go directly into your body?  The port ensures that you don't have to take that risk . . . though it can get infected.  Always complications!

That's all for now.  I'll be sure to keep you posted with the outcome of this port issue.

Scan Results Remain "Stable"

I know it's been a while since my last update, but quite honestly, there's been nothing new to report.  I'm still receiving Yondelis treatments every 4 weeks and Yondelis and I are still getting along.

I did, however, have 2 new scans done at the end of last week:

1. A "head to toe" PET/CT scan, the first I've ever had
2. An MRI of my pelvis/sacrum

The results came in just today for those and both indicate:

1. No significant growth or evidence of disease progression of dominant lesion.
2. No evidence of further metastatic disease elsewhere in the body.

So things remain as they have since September 2019: stable.  I couldn't be happier with the results!

I also wanted to add a few more details about the PET/CT scan since this is such a unique scan.  Actually it's two different scans: a PET scan combined with a CT scan.  These scans are taken separately (minutes apart from each other), both from the same machine and with the patient unmoved the entire time.  Through some fancy software, these two scans can be viewed independently or together as a composite image.

About an hour before the scan starts, you get an injection of radiative sugar known as FDG.  Since cancer cells take up this FDG sugar, the PET scanning machine is able to measure the radiation signal and identify "hot" spots.  The more FDG the cancer cell takes up, the "hotter" it is on the scan.  The "hotness" of an area is measured as a Standardized Uptake Value (SUV), ranging from 0 to 16.  Anything with an SUV greater than 2.0 is suggestive of malignancy.

So if I haven't put you to sleep yet, you must be wondering: what is the SUV of your tumor?  It reported in at a relatively mild SUV of 2.5, which is not so hot (in all the good ways).  According to Dr. Ummed, this indicates that the tumor is not very active, further emphasizing the stable characteristics we have observed for the past 8 months.  Again, very good news!

In other news, Round #19 starts on June 11.  But no worries; all is good here!

"Stable" MRI Results; Round #15 Started Today!

Hello!  Long time, no post!  Yes, I am still alive and continue doing well with the treatment, working full time, and loving life!  Here's a recent picture of us while vacationing in Florida:

At JBs Fish Camp

Returning now to my treatment status . . . .

Back in December, I mentioned that I was due for a follow-up MRI here in February.  I had that scan back on February 16 and the results indicate that my tumor is "stable".  It was actually noted as "stable" back in December too, which is really just a nice way of saying that it hasn't shrunk (or grown or metastasized) since my September 2019 scans (5 full months).  I'd prefer to see shrinkage!

After having a long talk with my Oncologist (Dr. Ummed), he has convinced me that "stable" is actually a good thing and that tumors will stop shrinking at some point.  And given that I've been tolerating the Yondelis quite well now over the past 10+ rounds, he felt there was no need to either increase my dosage or frequency of chemo.  It's just not worth the increased risk of toxicity when we are already seeing stable/controlled results with the current dosage schedule.  I'm all good with that doctorly wisdom and all, so let's just hope that it remains stable . . . for years to come!

Also, in my previous post I mentioned that they had found a "new soft tissue edema enhancement".  This blip still shows up in my latest scans, though apparently "stable" as well.  So I'm just not going to worry about it.  Not now at least!

That's all I have for you!  Expect another update after my next scan, which is probably 2 - 3 months away (TBD).

Happy New Year!

2019: The Year in Review

What a whirlwind of emotions 2019 was after getting re-diagnosed with a disease I thought I had beaten 10 years earlier.  Shock, surprise, denial and disbelief: those words certainly all apply.  But as the year drew to a close, it has become clear that 2019 was not so bad after all!  Consider the following:

• Though diagnosed with Stage 4 metastatic cancer, there is currently no evidence that the disease has spread beyond my pelvic region.  Obviously that is a far better scenario than having it spread throughout my body.
• We have seen slow yet steady shrinkage of the tumor since I started on Yondelis back in February.
• The current treatment plan has been confirmed by Memorial Sloan Kettering (MSK), an NCI-designated facility and leader in sarcoma research and treatment.
• I currently have the best health insurance I've ever had in my life.  Few providers would cover out-of-state second opinions and/or treatment, but the plan I'm on now does!
• My mobility has thus far been unaffected by the tumor.  Furthermore, given how smoothly the treatments have been going these past 9 months, I have been able to keep working full time without the need to go on disability.
• Our family was able to go on a "trip of a lifetime" cruise to Spain, Italy, and France in the early part of summer.  Though expensive, I have no regrets whatsoever about going on this very special family trip.  Those memories will last a lifetime!
• My younger boy (Kyle) graduated from Brookwood High School and has completed his first semester in Art and Digital Animation at Kennesaw State University.  Both he and his older brother (Bryce) are doing very well in college.
• Had a wonderful time with friends, family, and neighbors over my birthday.  And just two months later, we had a fantastic Thanksgiving reunion with the Holbrook family here in Atlanta.  These relationships are priceless!

So yeah, not so bad of a year after all!

Recent Scan Results Raise New Concerns

I had a Pelvis MRI this past weekend (on 12/28/2019) and just got the results back for that on Monday (12/30/2019).  Unlike all previous scans, which showed at least some shrinkage every time, this scan shows virtually no difference from my previous scan of 3 1/2 months ago.  Furthermore, the radiology report indicates some sort of "new soft tissue edema enhancement noted along the right lateral ischial tuberosity [i.e., bottom right butt cheek bone] of uncertain etiology.  A new focus of disease cannot be excluded."  This is definitely not the news we were wanting to hear.  So what changed?

One thing that has changed is that my chemo schedule has gone from every 3 1/2 weeks to every 4 weeks.  Originally I was getting chemo every 3 weeks, but that was just too hard on my body and my schedule, so Dr. Ummed (my Oncologist at Georgia Cancer Specialists) agreed it should be fine to stretch this from 3 to 3 1/2 weeks.  And with the results from my September scan still showing promise, the chemo schedule was extended once more to every 4 weeks.  Therefore, it is possible that perhaps I need to either up my dosage of Yondelis, or increase the frequency of my treatments (neither of which is easy).  For the time being, however, Dr. Ummed wants to stick with the current dosage and schedule and then rescan a bit earlier, such as in the February or March timeframe.  Based upon those results, we'll consider our options at that time.

Also a possibility is perhaps the tumor is building up resistance to Yondelis.  That would actually be the worst case scenario, so let's not go there quite yet.

And let's not forget that radiation at MSK is always an option for me to consider.  It's also an option I do not wish to rush, given the potential for life-changing complications.  I also need to stop over-analyzing the situation now and just sit tight until I get my next scan results, which will provide a clearer indication as to where things are headed.  Like many things in life though, this is easier said than done!

2020: "The Power of Hope"

Yes, "The Power of Hope"!  That was the theme for the 2020 Rose Parade . . . and it's a good theme for me in this coming year too.  With health concerns still abounding, I need a little hope this year to keep me going.  Don't we all?!?

But what is "hope"?  For me, I prefer to think of it as an action, something positive that a person does that makes somebody's day a little brighter:

• It's the friend that makes you laugh.  
• It's neighbors who smile and wave whenever you're around
• It's family who is always there when you need them most
• It's the beaming smile on your spouse's face
• It's people showing compassion to strangers and those in need because it's the right thing to do
• It's people who "pay it forward"

Perhaps most importantly, hope is not all about just receiving.  Hope can be found in the giving and the doing as well.  It's very contagious that way.

As we approach the year ahead, may we all find (and give) hope in large doses!

Same Ol' Same Ol' . . . Life is Good!

Having not heard from me in over 6 weeks, quite a few people have reached out just to check in and see how I was doing.  It's certainly fair to ask that question and it reminds me how much people really do care, but I'm happy to report that all is well with me!  I'm feeling fine, still on the "Yondelis for Life" program (Round #11 starts tomorrow), still putting off radiation (as the Yondelis is working), and still working full time (because I'm just too young and poor to retire right now).  I know that this might sound a little boring, but for a guy with Stage 4 metastatic cancer, it sounds like a dream!

I will add that these past 6 weeks have not been entirely uneventful.  I celebrated my 58th birthday back in late September at my favorite Mexican restaurant.  And though I knew that other people were coming to join us for dinner, I had no idea who was on the guest list.  Holly ended up surprising me with 30+ friends and neighbors who showed up to celebrate with us.  Some in fact drove (or flew) from great distances in order to be there.  Many of these friends also failed to follow the clear "no gifts" instructions . . . for which I am also grateful.  Best of all, some anonymous good soul even picked up the total tab, which I had planned take care of.  By my accounting, everyone seemed to be having a great time . . . I sure did!  It's events like this, with close friends and neighbors, that makes life so special and creates memories that last a lifetime.

Also going on, Holly and I celebrated our 32nd wedding anniversary earlier in October.  We ended up heading to our favorite new beach area: Ponte Vedra Beach, Florida!

I'll make no secret about it: one day I hope to retire and live in this community.  With 2 kids in college though, now is clearly not the right time.  I just hope and pray that things keep staying "normal" and "boring" for me over the next 4 years though because that's how long it's going to take before the kids are done with school.  Perhaps then we can head down to Florida.  Holly (who was born in Florida) keeps reminding me (almost daily) that she's "ready to move down anytime".  You'll get there eventually, Sweetie, and not alone, I promise!

TTFN!

Scanxiety!!!

What I have not publicly reported until now is that, since my first visit to MSK, their radiologists and those from Northside Hospital (my local treatment center) disagree as to what my previous scans show.  Though some of this disagreement might come down to semantics, the label used by MSK is at least different enough to make me nervous.  Here's an example:

What Northside radiology refers to as a "stable nonspecific bone lesions of the left ilium and superior right acetabulum", MSK radiology calls out as "bilateral several enhancing osseous lesions in the pelvis, consistent with metastases".

In fact, it turns out that one of the reasons that MSK said "surgery would not eradicate the disease" was because they had already concluded that I had disease progression on both sides of my pelvis.  Though it is true there is but one soft tissue mass, MSK believes that there is metastases bilaterally in my pelvis bones.  Obviously that's not the news anyone wants to hear.  Wasn't I dealing with enough already?!?  I have since accepted that they are likely correct in their diagnosis, though it may have little bearing on my situation.  The paragraphs that follow explain why.

Upon my return from MSK, I shared this news with my local oncologist (Dr. Kamal Ummed), who preferred the Northside interpretation.  He asserted: "Why call it a met[astases] when we don't 100% know for sure it is a met?  I think the only thing that is really important is to know if it is stable and know that it is not spreading.  And in the 5 months that you've been scanned, those 'bone lesions' have been stable.  But just to be sure, here's what we are going to do: I'm ordering a full body bone scan just to make sure these lesions were not found elsewhere."

My full body bone scan was performed the day after I returned from seeing Dr. Yamada.  Actually, one of the questions I asked Dr. Yamada was "why would you want to radiate the tumor if you believe there are metastatic bone lesions elsewhere in my pelvis?"  His response was "We would want to target the main source of the tumor.  As necessary, we could even 'spot weld' those bone lesions, but I think that the Yondelis will help with those too."  In other words, more points scored for the systemic treatment provided by Yondelis!  It is capable not only of shrinking/slowing the soft tissue sarcoma, but also the bone lesions!

Of all the various scans I've had over the years, I never had one of these full body bone scans.  They inject you with some nuclear material, wait 3 hours, and then scan you.  Here's one of my images:

Good luck trying to interpret that image!  So grainy, so many dark spots, and they can't all be cancer, right?   Waiting days for the radiology report was difficult, and even then, the findings were inconclusive:

1. Focal increased radiotracer uptake posteriorly in the left ninth rib.
2. Nonspecific heterogeneous uptake in the calvarium.

In other words, they needed to take a closer look at my chest and skull.  Dr. Ummed ended up ordering X-Rays for those along with an MRI of my pelvis area as it had been nearly 3 months since my previous scan.  Based upon the uncertainty of the bone scan and some relatively new numbness and pain along my right lateral thigh, I ended up doing the MRI and X-Rays a few days earlier than planned, on Tuesday, September 10.  It wasn't until yesterday (Friday) that I got the results:

1. Normal chest.
2. No aggressive osseous lesions of the skull base or calvarium.
3. Interval decrease in size of soft tissue component.
4. No significant change in involvement or distribution of the right sacral bony involvement compared to prior.
5. No significant change involving the enhancing foci within the left iliac bone, left ischium, and right superior acetabulum compared to prior.

In summary, this means that my sarcoma has not spread to my chest or skull, that the soft tissue area shows shrinkage (of about 10%), and that the bony involvement (met or whatnot) is stable.  And that, my friends, is a huge relief and about the best news anyone can hope for!

In closing, I wanted to try to put together a series of images that show the shrinkage of my tumor since my first identifying scan back in January.  You can click any of these images to enlarge them:

Pretty incredible, right?!?  Things are definitely moving in the right direction.  Slow and steady wins the race!

Going forward, the chief concern Dr. Ummed has is with my kidney function and my sometimes spiking Creatine Phosphokinase (CPK) numbers.  He has ordered me to to cease all muscularly challenging work, especially chores such trimming the bushes with heavy cordless equipment (that previously pushed my CPK near 2500).  People can and do experience renal failure from this, even after just a single incident of high CPK.  And given my existing chronic kidney disease (believed to be the result of chemotherapy 11 years ago), it might not take much to completely kill them.

Do any of my neighbors have a recommendation for a reasonable landscaping company?  I can (and will) keep mowing my tiny yard, but bush trimming and heavy yard work will need to get farmed out (so to speak).

MSK Radiation Oncology Visit

My apologies for being such a slacker of late.  Things have been going so smoothly and work has been so busy that by the time I get to thinking about posting a blog update, I'm already drifting off and ready for bed.  But enough's enough -- there actually is some relevant news to post, so let me get straight to that.

1:30PM Wednesday (8/28): Dr. Yoshiya Yamada -- Radiation Oncologist Extraordinaire

As mentioned in my previous post, I had a day-trip planned to meet with Dr. Yoshiya (Josh) Yamada (of Memorial Sloan Kettering) to be evaluated for radiation therapy.  Honestly, given what Dr. Fabbri had said in my previous visit, I was hesitant (to say the least) about signing up for something that might really hurt me.  From my perspective, why should I take on any risk at this time if the Yondelis is working?  Well actually, that sounds like a great question to throw at Dr. Yamada!  So my plan was to go in there with my questions and doubts, but still be willing and open to hear what he had to say.

My flight to LaGuardia left on time at 7:30AM Wednesday morning from ATL, putting me in NYC by 9:30AM and Manhattan by 10:30AM.  Given that I had plenty of time to kill, I handled the temporary boredom like any good Novak would: with food!  First some coffee at Starbucks; next an early lunch at P.J. Clarke's.  Thankfully, there would be no splitting this Fish & Chips basket with a hungry sister (love you Deborah).  No, this one was mine, all mine!

P.J. Clarke's Fish & Chips!

With my stomach now content, and still time to burn, I figured I would walk the mile or so to the main MSK building, referred to as the Rockefeller Research Laboratories:

Memorial Sloan Kettering: Rockefeller Research Laboratories

Dr. Yamada works out of the building diagonally across the street from here, known as the MSK Haupt Pavilion.  Just after taking the above picture, I turned around to take a picture of the Haupt Pavilion and was quickly met with a very upset security guard:

Guard: You can't take pictures here!  This is a private facility!
Me: Not even the outside of the building on this public street?!?
Guard: NO, not even the outside!  We have cancer patients coming and going from this building constantly and you do not have their permission to take their picture.
Me: Which is exactly why I was waiting for them to clear the frame, and then I would take my picture of just the building.
Guard: NO, you still cannot do that.  You might accidentally get a patient in your picture and that is strictly prohibited.
Me: Well I'm one of those patients, and I respect their rights too.  Which is why I was waiting.
Guard: I'm going to have to ask you to leave this area.
Me: Actually, I have an appointment scheduled for here in about 45 minutes.
Guard: Well then please put your phone up immediately.
Me: OK, OK!  I'm not looking for any trouble and I don't intentionally want to break any rules.  I'll just head to my appointment now.
Guard: Remember, no pictures!
Me: Yup, got it!

I can't say that I blame the guy; he was just doing his job.  I don't even disagree with the spirit of this rule: cancer patients should have implicit privacy.  But what I don't like is a "letter of the law" guy trying to enforce a policy on a person who was clearly trying to stay within the "spirit of the law".  Oh well, an outside picture of the Haupt Pavilion really wasn't going to be that exciting and certainly was not worth all of this trouble!

I ended up arriving 45 minutes early to my 1:30PM appointment on the 2nd floor of the MSK Haupt Pavilion.  I figured that I would be waiting there for a while, but at least it would be quiet and comfortable there in the waiting area.  I found a great chair and had just unpacked my iPad and headset when my name got called.  Surprise!  Time to head back to the exam room.

I was met almost immediately by one of Dr. Yamada's resident doctors (whose name I've forgotten).  After spending about 20 minutes with me, he went to get Dr. Yamada.  About 15 minutes later, Dr. Yamada and two resident doctors appeared in my exam room.  And this part is hard to describe, but Dr. Yamada has a certain confidence and "air" about him that makes him immediately trustworthy.  It is clear that he is extremely intelligent and a leader in his field.  I just somehow knew I was in the right place and was being seen by possibly the world's best radiation oncologist for my particular case.

Dr. Yamada explained that, for my case, Stereotactic Radiation was the best option.  One appealing aspect of this approach is that the entire treatment would take just 3 days.  "You could fly in on a Tuesday and fly back home on Thursday" he explained.  There would be an 80% chance that such a treatment would be beneficial without any long-term side effects.  That said, there's a 5% chance that you could have some permanent damage, in particular to your sciatic nerve.  If that were to happen, you would have to wear a brace on your ankle and possibly need a cane as well.  This is a condition referred to as "drop foot".  My response: "well better to have 'drop foot' than a dropped foot!".  Everyone in the room politely laughed.

But Dr. Yamada, why would I want to take any further risk at this time?  5% risk seems pretty low, but if I just stay with Yondelis and it continues to work, there's virtually 0% chance of further risk.  I'm walking and staying fairly active now, and I do not want to risk losing full mobility.

His response was perfect: "and that's why I'm recommending that you just stay the course with Yondelis, so long as it keeps working.  Think of radiation as your backup plan.  Should your tumor start to grow or show signs of further metastasis, I want you to get back here ASAP and get treated!"  And that was just about all there was to it.  He left me with his card and told me to send him my next set of scans (tentatively scheduled for 9/12/2019).

As I was leaving the building, I said a friendly "good bye" to the security guard I spoke with earlier and caught an Uber back to LaGuardia.  I ended up switching my flight to one three hours earlier than originally scheduled, which I really appreciated as it had been a very long day!

New Chemotherapy Schedule Starts Now

Round #9 of my Yondelis Chemotherapy began on Thursday, September 5.  Going forward, the plan is to have rounds scheduled for every 4 weeks.  This buys me a little more free time and fewer interruptions with my life and work.

New Round of Scans

I have a MRI of my Pelvis and Lower Back tentatively scheduled for this coming Thursday. Assuming that schedule holds, I likely won't get results from that for up to a week later. I promise though this time I'll do a better job of sharing the results in an expeditious fashion.

NYC Trip; MSK Advice

I've been back now 4 days from NYC and Memorial Sloan Kettering Cancer Center (MSK), and many people have wondering how the trip went and what I found out.  All I can say is, "What a busy week!"  I got home Tuesday evening and was back to work Wednesday - Friday for 3 very intense days.  Today I'm just breathing a sigh of relief that I don't have that much going on!  So, no better time than now to post a blog update.

Dave & Deb Hit NYC!

Given that I have not been to NYC in over 30 years (and I didn't want to get lost), I asked my sister, Deborah Novak Jagoe, to accompany me.  She enthusiastically jumped at the opportunity.  Being a veteran of NYC (with dozens of NYC business trips behind her), her expertise was invaluable.

We landed in LaGuardia airport Sunday morning (7/28), checked in early to our Manhattan hotel, and made it down to the 911 Memorial by noon!

911 Memorial with 911 Museum in background

One World Trade Center

Seeing "ground zero" was really quite emotional.  And I can assure you of this: the people of NYC have definitely not forgotten what happened there.  To them, it was just yesterday.  They (rightfully) take this all very seriously and are quick to point out if anyone is not being respectful in that area.

Our next stop was the One World Observatory . . . or floor 102 in the One World Trade Center.  What incredible views from up there!  I'll let my pictures do the talking:

Statue of Liberty and Ellis Island in the distance

Brooklyn Bridge

Deborah and Dave

Next was a visit to the 911 Museum.  Talk about intense and emotional, this place is the very definition.  Here's a few pictures from the 911 Museum:

After all of this on a very hot New York day, we found ourselves wiped out and hungry.  We ended up having dinner in Chinatown at a popular place named Wo Hop.  After that meal, the hunger was gone, but we were even more wiped out.  We ended up heading back to the hotel early and just relaxing.  This also gave me the chance to put together my list of questions for my doctor's appointment the next morning.

8:30AM Monday (7/29): Dr. Sujana Movva, Medical Oncologist and Sarcoma Specialist

My first MSK appointment was conveniently located in the same building as our hotel.  All we had to do is exit the building, go around the corner, and there it was!  After filling out a bit of paperwork and having my vitals taken in the lab, we were soon called back to meet with Dr. Movva.  Upon meeting her and sharing my cancer history, I quickly learned that I have met Dr. Movva years ago.  It turns out that she was the one who ended up replacing Dr. Gina D'Amato at Emory when she left there years back to go to Georgia Cancer Specialists.  I ended up meeting Dr. Movva at one of the Sarcoma Survivor group meetings that Emory used to hold.  What a small world!

Dr. Movva made it clear to me that I have Stage 4 metastatic disease.  At this time, there is no known cure for what I have nor (in her opinion) was surgery a viable option.  Based upon her experience, even the radical "extended hemipelvectomy" would only provide a 20% chance of eradication of the disease.  Having said all of that, she said that my case was not as bad as the typical Stage 4 case since mine appears to be localized in one area and is responding to the chemotherapy.

Dr. Movva went on to explain that there are a number of trials (ongoing or ready to start) for patients with High Grade Myxoid Liposarcoma.  Each of these trials, however, are fraught with the following complications:

1. They are all Phase II trials (none are Phase III quite yet)
2. Most of them have very strict qualifications, and my Stage II Chronic Kidney Disease (from chemo I had 11 years ago) and Secondary Adrenal Insufficiency (from benign Pituitary tumor 19 years ago) is probably enough to exclude me from most.
3. All of the trials would require that I live here in NYC and be treated at MSK for the duration of the program.  No way am I doing that for a Phase II trial.
4. Some of the trials (that make use of immunotherapy) also want to first suppress your own immune system.  By this, they mean to kill all of your white blood cells first before they give you the drug that (hopefully) will kill your cancer.  Again, no thank you for a Phase II trial.
5. Dr. Movva also stressed that the results from any of these trials are by no means guaranteed.  Compare this to Yondelis, which has already proven to be working for me.

After explaining (sometimes in great technical detail) all of the pros/cons of being part of a clinical trial, Dr. Movva went on to say that the common sense option for me is to stick with Yondelis.  This is the best option for patients with recurring metastatic myxoid liposarcoma.  It turns out that several of her patients have been on Yondelis for 4-5 years or more and that this treatment alone can keep the sarcoma from growing or spreading.  Apparently many patients are also on the same 1.0 mg/m2 dosage that I get, as higher levels often end up being too toxic.

Should the Yondelis stop being effective or my body can no longer tolerate it, Dr. Movva suggested looking into Radiation Therapy as an option.  Otherwise, just stick with Yondelis . . . forever!

Following our appointment, Deb and I spent the day seeing the sights.  Here was one of our first stops:

At Trump Tower, here to announce my "Yondelis for Life" program!

Having been reminded by the doctor how serious my case is, I had to stop here when we walked by:

Lit a candle and said a prayer at St. Patrick's Cathedral. All I ask is for 15 more good years!

15 years at this point sounds like a dream . . . but I have to dream big!

9:30AM Tuesday (7/30): Dr. Nicola Fabbri, Orthopedic Surgeon

I had the chance to hear all of the gory details involved with doing limb saving pelvic surgery.  Apparently this is THE most difficult surgery they do . . . and my tumor is in the worst possible location.  I'll spare you the details and jump straight to the conclusion from Dr. Fabbri himself: surgery (either limb saving or extended hemipelvectomy) is not going to be an option.  Why?  Because they will not be able to eradicate the disease with surgery.  Instead, however, Dr. Fabbri suggested that I come back to MSK and be evaluated by a Radiation Oncologist for radiation therapy.  Specifically, there are two types of radiation for which he thinks I would be a good candidate:

1. Stereotactic Body Radiation (SBRT) -- See What is SBRT? for more info.
2. Proton Therapy -- See What is Proton Therapy for more info.

Each has its pros/cons and it would be up to the Radiation Oncologist to determine what would work best in my case.  I've actually already confirmed my next MSK visit for Wednesday, August 28, with Dr Yoshiya (Josh) Yamada.  I can't wait to hear what he has to say.

Dr. Fabbri and his associate "fellow" doctor made it clear, however, that radiation was going to be no cakewalk for me.  In particular, my sciatic nerve cannot help but be damaged/irradiated during treatment.  Some people I'm told actually experience great sciatic pain as a result of such treatment.  Furthermore, given the sensitive tissues and organs in that area, I may experience other complications as well.  Why are there always complications?!?

Most importantly though, Dr. Fabbri felt as though it would be better for me to start radiation therapy sooner rather than later.  Why not wait?  Because I need to hit this thing hard before it decides to spread elsewhere is why.  Oh but if only the radiation were "easy", like it was 10 1/2 years ago.  But with this beast, nothing is ever easy . . . and there are always complications!

I elect to reserve final judgement on radiation therapy until after my appointment with Dr. Yamada.  Even so, my gut tells me to stay the course a bit longer before I double down with both Yondelis and Radiation.

Round #6 winding down, Round #7 in 1 week

As the expression goes, "No news is good news!"  And in my case, Round #6 has gone fairly smoothly.  This time I perhaps had a few more (minor) issues at about the 1 week point, but all is well now.

Going forward, each additional round of chemotherapy will be scheduled for approximately every 3 1/2 weeks.  Thus, Round #7 will start on Thursday, July 18th, and Round #8 will start on Monday, August 12th.  The dosage will remain unchanged: 1.0 mg/m2.  The reason for this minor alteration is because doing chemo every 3 weeks is noticeably harder than every 4 weeks.  I sense the difference with bloating, fatigue, and nausea.  Plus, it means making a few more trips to the oncologist's office.  So we're going to try it at 3 1/2 weeks and go from there.  If it's still too much (either physically or personally), we'll drop down to every 4 weeks.

Shrinkage

Several people have asked me about my total tumor shrinkage since I was diagnosed back in January 2019.  I'm not a Radiologist (nor should I play one on this blog), but using some basic mathematical stills, I believe the tumor has shrunk about 19% since January.  I think that's fantastic!

Start Spreading the News . . . I'm Leaving Today In About 2 1/2 Weeks!

For the last 2 months, I've been interested in seeking a second opinion about my treatment.  Given that it appears as though I will be on the Yondelis regimen for many months to come, I want to be sure this is, in fact, the very best treatment I can get.  If there are any Phase III clinical trials available, or even something on the horizon, I might just be interested.

The other reason for the trip is to get a second surgical opinion.  As you may recall, an extended hemipelvectomy was recommended in my case.  But given how radical that approach is, I wonder if there isn't some other option?  Perhaps it's just best to skip the surgery altogether and stick with chemotherapy.  Or, after a certain amount of chemotherapy, we switch to proton radiation.  I definitely want to get an answer to that.

So, with those goals in mind, I have selected Memorial Sloan Kettering (MSK) in NYC as the location for my second opinion.  MSK is a National Cancer Institute (NCI) designated facility that, as best as I can tell, leads the pack in terms of developing new drugs and treatments that specifically target a certain tumor type.  Furthermore, they have some of the very best surgeons around.  Tentatively, I am scheduled to see them later this month on July 29 - 30.  Details should get finalized tomorrow.

Likely the next time you'll hear from me is when I get back from MSK.  I'm sure I'll have plenty to share at that time.

Round #5 is Smooth Sailing; Scan Results Encouraging

As expected, Round #5 did indeed start on June 4th.  My CPK numbers were within range so there was no reason to delay my treatment.  My dosage was increased slightly this round to 1.0 mg/m2 (same as Round #3).  And fortunately for me, things have pretty much gone smooth as silk. No complaints or complications to report this round!

Scan Results

On Monday (June 17) of this week I had another set of follow-up scans.  They ended up doing a CT-scan of the Chest, Abdomen, and Pelvis (CAP) along with an MRI of the pelvis.  Just today I received the radiology report with the good news: about 12% shrinkage of the tumor and no further metastasis detected.  That's fantastic news and a huge relief for me!  The Yondelis is certainly working and (finally) I am tolerating it well.  I suspect we will "stay the course" with this Yondelis treatment until that tumor is shrunk down to next to nothing.

Round #6 Starts Tuesday

Assuming my counts all look good on Tuesday, I am expect Round #6 to begin that day.  I think there's a chance that my dosage might be increased slightly for this round, but I doubt the doctor will want to tempt fate too much (given my experience with Round #1 and #2).  I'll keep you posted.

That's it for now -- thanks for reading!

Back from Cruise; Chemo Starts Tuesday

Like most vacations, our days cruising on the Disney Magic just flew by!  It seemed nice and slow and leisurely at first, but once we started having port stops in Italy (which lasted the better part of a day), time quickly accelerated.  Before we knew it, we were on our last port stop in Nice, France and then headed back to Barcelona.  The weather was cooler than expected for the first few days, but then greatly improved about the time we hit Florence.  Our best days were the day in Nice and the day at sea following Nice.  The overall trip was wonderful!

Here is just a small sampling of pictures from the trip:

Sagrada Familia, Barcelona 

First night of the cruise

Naples/Sorrento -- it rained a little during our excursion

Triumphal Arch, Rome -- weather improving (no rain)

Colosseum, Rome

Florence -- weather getting good!

Florence -- our favorite city!

Nice, France -- nice weather!

Our ship in Villefranche harbor

Chemo Round #5 Starts Tuesday, June 4

Now back to the not-so-fun stuff.  Originally I was scheduled to start today (June 3).  I went in for my appointment as scheduled, bloodwork was done, but the doc was hesitant to start me today without first getting confirmation on my CPK count, a test which takes a full day to get results.  You may recall that my CPK spiked off the charts just before the cruise.  Well I did as instructed and drank a ton of water while on vacation.  I actually felt great the entire cruise!  But due to this high CPK number prior to the cruise, the doctor wanted to first verify that it has returned to normal ranges before dosing me with more Yondelis.  As he often says, "once we put it in, we can't take it out".  Therefore, out of an abundance of caution, it was decided that the best thing to do was delay until we have a verified good CPK number.  I return to the infusion center tomorrow morning with the expectation that I will start Round #5.

Happy Birthday Barbara!

There's another big thing that's happening tomorrow as well.  My youngest sister is having a birthday.  She has been with me at every significant step in my treatment . . . even back 11 years ago when I was first diagnosed.  Love you Barb!

"Cleared" for the Cruise

In general, I've been feeling a lot better starting around last Friday.  Thank you everyone for your well-wishes, prayers, and words of encouragement.  I think those all worked wonders for me!

With our vacation starting tomorrow, you can only imagine how busy Holly and I were over the weekend.  Come Sunday afternoon, I ended up spending over 3 hours outside working on the yard and landscaping.  This was the first of such work since my diagnosis and it was overdue.  I felt strong going into it, but by the time I was done, my arms were very sore, burning in fact, from holding the large bush trimmer for so long.

The doctor has warned me to stay away from "extreme exercise" or spending hours in the gym doing heavy weightlifting as this can lead to elevated Creatine Phosphokinase (CPK), and possibly even Rhabdomyolysis, both conditions that I had back in late March.  Never though would I have thought that simply "trimming the bushes" would have been something equivalent, but apparently I was wrong.

Tuesday Labs

I had my final pre-cruise labs taken yesterday (Tuesday), and all seemed to check out OK, so they "cleared" me for the cruise.  But one of the labs (the CPK) takes a full day to get results.  I got a call mid-morning today from Nicole (the NP) and immediately suspected that something must be off with my CPK, or otherwise she would not have called.  She informed me that my CPK had jumped from 91 last week to a critical 2416 in yesterday's lab.  Holy crap!  My CPK number was less than half of that back in March and they were ready to put me in the hospital.  Keep in mind that the "normal" range for CPK is 24 - 204.  So yes, my numbers are off the chart!

She then asked me to come into the clinic today for more fluids, which is what is necessary in order to drive that number back down.  I refused, citing too many schedule conflicts for today.  I believe I can get the same thing here at home by simply drinking lots of water.

This is nothing to take lightly either.  As I reported back on April 1, high CPK levels can cause the release of potentially toxic muscle cell components into the extracellular fluid and blood stream.  This, in turn, can result in renal/kidney damage and, in extreme cases, renal failure.  But rather than go down that dark road, I'm going to focus on drinking fluids . . . lots of fluids.

Doctor's Orders: Heavy Drinking Required on the Cruise

Rather than revoke my cruise card (yeah, like that's going to happen), the doctor has ordered me to make it my mission to stay extremely well hydrated on the cruise.  I'm pretty sure he was referring to water, but I didn't seek clarification on that point.  Seriously though, I plan to do my best to stay hydrated on the cruise and during our excursions.

"Don't Kick the Bucket" Bucket List Cruise

This cruise is definitely a once-in-a-lifetime sort of thing, though nothing I thought I would get to do until after retirement.  But once your life is threatened, you begin to reevaluate your priorities and time-table for "Bucket List" items.  That's the short version of how we decided to go on this cruise.

I give credit to my younger son, Kyle, for coming up with the "Don't Kick the Bucket" Bucket List Cruise line.  After all I've been through with Yondelis, even the critical CPK count I learned about today, I really want to just enjoy this cruise without overexerting myself in the process.  By the way, he graduates tonight from Brookwood High School.

Back to the cruise, we fly out tomorrow for Barcelona (where, sadly, Friday looks to be a rainy day) and board the Disney Magic Saturday around 12:30.  We should all be back safe and sound Saturday evening, June 1.

More Chemo on Monday, June 3

Assuming I'm still healthy and my blood counts look good, I am scheduled for Round #5 of Yondelis right after I get back.  But I don't even want to think about that right now.  All eyes on having a great vacation and some good family time.

Round #4 a Bit of a Roller Coaster

So here I am, at Day #11 in Round #4, and I have to admit that things have been a little up and down this past week.  Starting last Friday (and lasting throughout the weekend), I was simply wiped out!  Of sure, you can call this a "baby dose" if you'd like, but I can say for certain that it still feels like I've had chemo.  I did rebound on Monday, but these past 2 days now have been very "low energy" days for me.

With only 7 days before we fly off for the cruise, I hope that this thing turns around . . . and soon!  I certainly can't afford to either get sick or feel bad while on vacation.

Wish me well -- I need all the well-wishing I can get!

Surprise! Round #4 Starts Tomorrow!

First off, my apologies for not posting an update earlier.  In general, "no news" means things are either going exceedingly hard or smooth as silk.  In this particular case, it means the latter.  Everyone (especially me, the oncologist, and my family) has been positively shocked at just how easy this round has gone for me.  I didn't have a single complication and have been able to work the vast majority of this cycle.  I'm honestly surprised that just a mere 16.667% dosage reduction has made such a difference, but it did.  Also helping (I think) was a single round of Lasix on day #5, when my body was showing signs of fluid weight gain.

Originally Round #3 was intended to be my last round before the cruise (now just 2 1/2 weeks away).  But since "no good deed goes unpunished", the doctor feels strongly that I should get another "mild" round of Yondelis prior to the cruise.  Part of the reasoning (and I agree with him) is that you don't want to give the cancer a chance to rally back during the month of "chemo vacation" resulting from the cruise schedule.  And speaking of schedule, the goal is to dose me with Yondelis every 3 weeks.  Thus far, due to overdosing and other complications with Rounds #1 and #2, those rounds lasted 4 and 5 weeks respectively.  But I'm back on schedule now . . . and will pretty much stay on schedule for Round #5 (post cruise), all because of getting this "surprise" dose tomorrow.

Nervous?  Not too much.  If I can manage to have another round that goes as smoothly as Round #3, I still should have plenty of fun on the cruise.  There's a chance, in fact, that the oncologist may even slightly reduce my dosage (just this one time) in order to ensure there are no pre-cruise complications.  I plan to negotiate a "reasonable" dosage with him tomorrow.

Happy Cinco de Mayo!

Round #3 Started Monday

Round #3 started as scheduled on Monday, April 15, Tax Day.  Though I had some (unexpected) issues with nausea Monday evening along with some serious night sweats that caused the right side of my Tegaderm Transparent Film port covering to come undone (compromising the seal around my port), Tuesday and Wednesday have thus far been uneventful.  The nurses at the infusion center said that any seal compromise can lead to port infection, though they suspect I'll be just fine.  My port IV line was detached as planned on Tuesday following the completion of my 24-hour Yondelis infusion.

As mentioned as last week, my dosage was reduced from 1.2 mg/m2 to 1.0 mg/m2, a 16.667% reduction.  Furthermore, everyone involved with my treatment (doctor, nurses, even me) are all vowing to carefully monitor my weight and treat with Lasix at the first sign of any fluid weight gain.  In general, the plan is to be more proactive with any health issues that may arise.

Well, that's pretty much it for now.  Hopefully the remainder of this week and the following weeks will be as boring at this update!

Tumor Board has Met; Chemo Regimen Unchanged

The Northside Hospital tumor board met last night and reviewed my case.  Just as I predicted, they have decided that the best course of treatment for me at this time is to continue with Yondelis . . . though with a slight dosage reduction (from 1.2 to 1.0).  Hopefully this reduction, in conjunction with well-timed usage of Lasix (to help jump-start my kidneys and rid my body of excess fluids) might just be the right combination to keep the tumor shrinking and my organs healthy.  I can assure you that my organs (liver, kidneys, lungs, and stomach/GI in particular) have suffered tremendously after just two cycles, so I don't want to push them over the edge with Round #3.

Speaking of Round #3, that starts this next Monday (04/15/2019).  Hopefully it's neither a bad omen to have chemotherapy on Tax Day nor a predictor of yet another "taxing" cycle for my body.  Thankfully, this will be all the chemo I will be receiving prior to my cruise (starting on 05/23/2019).

I've been feeling pretty darn good these past couple of days.  This is likely due to being 4 1/2 weeks out since my last cycle and the Atlanta weather being warmer and beautiful.

Next update on Tax Day!

MRI Results Are In: Tumor Shrunk About 12%

I received my MRI results today and the new tumor measurements indicate that it has shrunk about 12% from my original MRI back on 01/15/2019.  Unofficially, I think it has actually shrunk even more than this given that the tumor went unchecked from 01/15/2019 - 02/11/2019 when my first cycle of chemotherapy started.  Certainly the tumor must have grown during that time, but given that I did not get a new baseline MRI immediately prior to treatment, this is pure speculation on my part.  Even so, the Nurse Practitioner (Doc was away) was pleased with the results.

So the plan going forward is for the doc to present this information to the Tumor Board this Wednesday evening.  Part of this discussion will be an examination of the complications I have experienced while going through Yondelis.  It's possible that they might move me to an entirely different chemo regimen, but my prediction is that they're going to want to stick with Yondelis.  This of course would require yet another dosage reduction, but I somehow think that even a reduced load will still be effective on the tumor.  We'll know for sure after round #4 when they remeasure the tumor again.

I follow-up with my doctor this Thursday to get my new marching orders.  I suspect that whatever chemo they want to give me won't start until the following Monday (04/15/2019).  Because of this late date, there's no way I'll be getting a 4th round of chemo prior to my cruise starting May 23rd.  Worded differently, this means I should be quite healthy for the cruise and able-bodied to work in the weeks prior to the cruise.  Honestly, this is a huge relief as being sick/weak would jeopardize the trip.

Expect another update Thursday after I speak with the good doctor.

Round #2, Weeks 3 - 4, Trouble Continues

Within an hour of posting my last update (on 03/24), I found myself on the way to the ER with severe abdominal pains.  They gave me some great drugs (Dilaudid) that temporarily killed the pain (thank God).  They ended up keeping me there about 8 hours, running various tests and scans, but never came up with anything definitive/obvious as to the source of my pain (which is both good and bad news).  Therefore, they sent me home around 3:30am Monday morning to continue my recovery from home.

I had a standing appointment with my Oncologist later that Monday.  It turns out that one of the possible side effects from Yondelis is Abdominal Pain.  This pain can be caused by liver complications or it could even be the chemotherapy drugs eating away at the lining of my stomach and GI track.  Mercifully, the abdominal pain slowly started to improve over the days that followed.  Even so, nearly two weeks later, I still have some, albeit minor, abdominal pain remaining.

I ended up seeing my Nephrologist (i.e., Kidney doctor) on Tuesday (03/26), who actually had a number of practical suggestions to pass along to my Oncologist:

1. Oncologist should slow hydration if my body starts collecting fluids.
2. Oncologist is free to use Lasix as necessary during infusion if my body is collecting fluids.
3. My kidneys are likely "shocked" by the chemotherapy and temporarily shut down during the first week of my chemotherapy cycle.  Again, Lasix can help jump-start them.
4. Oncologist needs to take regular Creatine Phosphokinase (CPK) blood tests to measure muscle breakdown.  Severe muscle breakdown means I'm getting too much chemotherapy and can even lead to kidney damage.
5. Nephrologist suggested that I drop my usage of Lipitor for now since it too can cause muscle pain.  Since I'm already battling this to some degree with the chemotherapy, there is no need to exasperate the situation further by taking a Statin drug.

Turns out that he was spot on with suggesting that CPK test.  With my abdominal issues reaching the tolerable point, the very next thing I felt was extreme weakness, fatigue, and muscle pain/weakness/tenderness across my entire body.  At the time I was unaware that this could become serious.  I compensated by simply napping more and laying low for the next couple of days.  On Friday (03/29), however, I had another Oncologist follow up and they wisely drew blood for a CPK test.  Apparently though this is not a STAT test, so I had to wait until Monday for the results.

Come Monday morning, April Fools Day, I got the call from my Oncologist's office that my CPK levels were very high (1181, with "normal" range being 24-204).  They were actually ready to admit me to the Hospital again when I told them I was feeling better today than last Friday.  Therefore, they are going to try to treat this on an outpatient basis . . . with me making daily trips to the Oncologist's office during the week.

I've since done a little reading on my diagnosis, Rhabdomyolysis, which is an injury of skeletal muscle that releases potentially toxic muscle cell components (e.g., myoglobin, other intracellular proteins, and electrolytes) into the extracellular fluid and blood stream, which can result in renal/kidney damage.  My research shows that about 0.7% of Yondelis patients experience this rare condition, and most recover just fine.  That said, some have actually died from complications related to this diagnosis, so it should not be taken lightly.  I remain optimistic that I'll have a full recovery.

This Friday (04/05), I actually go in for a follow-up MRI of my right pelvis to see what impact Yondelis is having on my tumor.  Given that the drug is practically killing me, I can only hope that my tumor is doing far worse than I am.  Results from that MRI, however, will not be available until the following Monday (04/08).  This will also be a good indicator as to whether or not we stick with Yondelis (despite how brutal it is), or move on to a different chemo regimen.  All answers will be known soon enough!