Cleanliness Is Next To ... ummm... Never Mind

Week Two:

Went to the chemo bar for my 5-FU refill and had some blood work done. The individual counts are mainly OK. My platelets are good, so I can still clot after all those needle sticks. My white blood cell count is down, not very far down though, and this is expected. However, this means I'm on the way to being immunocompromised, i.e. less able to fight off infection.

We all live and work in places filled with germs. Both our kids are in elementary school, so they'll be bringing home an assortment of corona-, rhino-, adeno- and whatever other viridae cause the common cold. At work (and I don't have to tell you this), any number of people - who should damn well know better - don't wash their hands after using the restroom and make it a point to touch each and every door handle and light switch in the building. There are several of these people on each floor, so they can cover this 10-story building with an economy of effort.

So what steps do you take? Well, a popular infection countermeasure (sounds like a spy story now) is to buy the gel-based hand-sanitizer and neurotically apply it to your hands after any contact with the rest for the world. So I tried to buy a couple of big bottles at Target.

Couldn't find any.

Not a single bottle.

Why not? Because panicked parents, fearing a swine flu pandemic that will give their precious children a fever (keeping them at home and forcing the parents to stay home too), have stripped the store shelves of hand-sanitizer. You can identify the children of these parents because, in a few days, the skin on their hands will be dry and peeling due from repeated use of the alcohol-containing gel. The domino effect will then be evident as these parents return to the stores to buy every bottle of skin moisturizer. So, heed my warning, go buy your Aveeno now.

The take-home lesson is this: Don't get cancer when parents are doing their back-to-school shopping.

Week One

FIrst, thanks to everyone who has called, e-mailed, or posted a comment. Mrs. 270 and I greatly appreciate the emotional support and the funny remarks. Keep them coming.

The first week of therapy is over. Well, the first calendar week.

I only had four radiation treatments instead of five. When I arrived at the treatment center on Thursday, the technologist was sending everyone home because the machine wasn't working. Apparently they forgot the change the batteries in the linear accelerator. You can't get 200 D batteries at the store, not even at CostCo. The total radiation dose is cumulative, so they will tack an extra day of treatment on the end. It's like a snow day. Or, as with Montgomery County schools, a prediction-of-snow day.

I did get my week's worth of chemotherapy. The 5-FU reservoir ran dry on my way to work on Friday morning (down I-270, of course). When the happens, a really piercing alarm sounds. Flashing back to the lab days, I worried that the column would run dry. The nurse had locked the keypad on the pump so I couldn't turn off the alarm. I had to take out the 2 AA batteries. Ever tried to do that while driving, drinking coffee, and updating a blog? I exited the highway and drove to the office, where the nurse disconnected the pump.

Anyway, it's nice (at least for the weekend) not to wear the pump and be wary of the line and the tape that secures it firmly to my chest hair. I had told the boys that I couldn't play rough with them because of the pump. So the first thing I did at home was to play rough them, much to the consternation of Mrs. 270. While I was spinning Son 2 right round (like a record baby), he kept confirming my health by asking "Daddy, you feel better?"

The Really Short Reading List

There was a rumor that I’d grown a tumor, but I killed it with humor.
Sherman Alexie

At a recent Dr.'s appointment, I read Sherman Alexie's short story War Dances in the August 10th, 2009 issue of the New Yorker.

I know what you're thinking, "You're lying. No medical waiting room would have a current copy of any magazine." Well (and I'm an expert on this, having been to many waiting rooms recently), offices are keeping their magazine subscriptions current. That's why health care costs have skyrocketed. Read the Obama plan carefully, it includes subscriptions to pricey (and pretentious, east-coast, intellectual) magazines like Architectural Digest. Under the Republican plan you'd get five-year old copies of Guns and Ammo.

Now, where was I before I interrupted myself? Oh yeah, this short story made me laugh out loud (LOL for you kids). I highly recommend it. It was so funny that I plan to buy his new collection of short stories when it comes out next month.

Hey, I have cancer. I'm not taking a chance on finishing a full length novel.

I Want a New Drug

I was going to title this one "Go Ask Alice," But I just know that two of you (you know who you are) will fixate on the lyric "One pill makes you larger." So I chose the Huey Lewis reference instead.

For those who are interested the details of my therapy, there are three phases to it.

1. Neoadjuvant therapy (chemotherapy plus radiation therapy) for 6 weeks.
   
2. Surgery to remove what's left of the tumor.
3. More chemotherapy for 6 months to kill any residual cancer cells.
   

This is what I'll be on in phase 1:

• Chemotherapy: 5-FU for five days per week given as a continuous infusion. No, this is not the same "F.U." that you yelled at Beckham and Donovan on Saturday, it stands for 5-fluorouracil, which inhibits RNA and DNA synthesis in all cells. Tumor cells divide faster than most other cells and need to make DNA and RNA in copious amounts. The 5-FU will be preferentially taken up by the bad guys and slow their growth. Some of the good guys will die, but they will be replaced. The pump I'm wearing delivers the 5-FU at 1 ml/hour. If you were to drink beer at this rate, you'd finish a 12 oz. bottle in 14 days and 19 hours.
  

• Radiation therapy consists of X-rays beamed directly at my backside. This is also given five days per week. Radiation induces DNA damage. The tumor cells try to repair the damage, but aren't very efficient at doing that (especially poorly differentiated tumor cells like my adenocarcinoma). The goal is to use enough radiation to induce irreparable damage. Cells in the surrounding area suffer collateral damage. However, they say that normal cells recover faster from the radiation damage. Nevertheless, it's the collateral damage that leads to many side effects.

I referred to side effects in an earlier post. Those haven't started yet and may not begin until I'm on therapy for about 2 weeks, but why let the facts get in the way of a good joke (or even a bad one).

Same Thing Day After Day

I know that the Soccernuts among you are wondering why I don't post something new each day, like Steve Goff does. Well, he's paid to write a soccer blog. No-one pays me to have cancer, it's strictly voluntary.

Anyway, I start chemo and radiation therapy today. It will be the same regimen Monday through Friday for several weeks, so I won't write about it each day. Imagine how repetitive that would be:

Monday: Had chemo and radiation. Threw up.
Tuesday: Had chemo and radiation. Threw up.
Wednesday: Had chemo and radiation. Didn't throw up. Had diarrhea instead.

Yeah. It's not the kind of stuff you want to read, nor that I want to write. For those interested in the technical details, I'll soon post the regimen that I'm undergoing. It's pretty standard for colorectal cancer.

Just remember (and this is aimed at you, soccer fans), the bad side effects are to be expected. Don't demand that I fire my oncologist just because I have a few bad days.

We Win (?) Trophies

OK Soccerphiles. You already know that DC United's new motto, in the smack-talk with Seattle, is "We Win Trophies." That gives me an excuse to post the my colleague's observations on youth sports.(besides, I'm coming up short on material, so I have to steal some). Anyway, aforementioned colleague was a HS hockey player. Here's what she has to say about trophies:

What I don’t understand is how come all these kids’ soccer teams get individual trophies for just being in a tournament? My one niece has more trophies at age 13 (and nicer ones) than her mother, father, two aunts and one uncle have combined. (And we played on undefeated varsity field hockey teams that won Sectionals.) [Nowadays] They build their self esteem, give them individual Blue Gatorade bottles, have multiple outfits….

We had the hand-me down uniforms the school had. You tried to pick one that fit.

We all drank water from a single ladle from a single metal container. (Yet no one ever got sick.) On good days, there might be orange slices at half-time for games against our bitter rivals.

Heaven help you if you got hurt and needed tape since supplies in the first aid kit were generally used to hold together cleats or to wrap around a stick.

We knew how to improvise back then. Like fanning out across the field with our sticks going through the grass to look for a teammate’s front tooth that got knocked out (it was found and healed nicely) .

Have the coach go into labor during a crucial game? Not to worry. She already has a stopwatch to time the contractions.

Son 1 starts U8 soccer and Son 2 starts Tee-ball soon. I guess I should go buy a trophy cabinet.

Port of Entry

My Medi-port was installed yesterday. It took about 35 minutes, but don't take my word for it because I was drugged and not wearing a watch. I write "installed," because it's really a high-tech piece of plumbing that allows easy intravenous access for administering chemotherapy (prescription chemotherapy, dude, not recreational).

Funny thing though. When they sewed me up, they didn't actually sew up the incision. They used medical grade superglue. No-one sews anymore, it's a lost art. Ever ask your dry cleaner to sew on a shirt button? They just give you a blank stare. Surgery is headed the same way. Nicely starched collar bone though.

Tattoo You

To make sure that they're nuking my ass in the same spot each time, the radiation therapist has to tattoo reference points on me. Yesssss, I'm getting a tramp stamp!

As a soccer fan, I'm not sure whom I should emulate:

David Beckham

or Natasha Kai
























Too bad Heather Mitts doesn't have any tattoos that are visible when she's in uniform (hey, I'm trying to keep it clean here) . Otherwise I'd post gratuitous photos of her too.

Oh what the hell, it's my damn blog.

My Dinner with Adenocarcinoma

Mrs. 270 wants to set up a meeting with an onco-nutritionist and has already bought several books with names like What You Should Eat When You Have Cancer, Feed a Cold Starve a Tumor (or is it Starve a Cold, Feed a Tumor?), and Healthful Foods for Dummies Like Your Husband.

You know, if there really is a diet that prevents cancer from forming or growing, then there would only be a need for one book about it. But everyone has to get in on the healthful cookbook scheme. I skimmed through some of these books. They all say the same thing: eat fish and vegetables.

I don't like fish. Really, I'd much rather have a land animal.

You know I'm an atheist, but bear with me on this one: If God wanted you to eat so much fish, he wouldn't have put them all under water. I mean, you can just walk up and kill a cow, but fish? You have to get in a boat, go out on the water (and we humans are not natural swimmers), and wait for hours until something jerks your line. Then you'd better hope it's a good fish and not a three-eyed mercury-laden mutant.

In fact, if you read your Bible carefully, you'll know God did not want people to eat a lot of fish. But then his rebellious son came along and worked a miracle to feed throngs of people with just a couple of fish and some loaves of bread - just to piss off his old man.

Placing Sports in Context.

Athletes and sports fans like to throw around the word "war" gratuitously and irresponsibly. The US-Mexico match may turn into a street fight, but it is not a war.

We have a close family friend (I'll call him Joe because that's his name) who is deployed in the Middle East, where we are at war. Joe has been my bro-in-law's friend and a friend to our family for over 20 years. What Joe is doing is serious and any attempts to draw a parallel between sports contests and actual war is wrong. We wish Joe and his 34th "Red Bull" Infantry Division a successful mission and a safe return. They are the only Red Bulls I'll ever root for.

Post-match update:

Well, that sucked. Giving up a goal in the last 10 minutes was awful. Say what you want about the altitude and the smog, but Donovan and Dempsey were both absent for much of the match. Save for Davies' goal, we gave the ball away each time we entered the final third.

Frequently Asked Questions

So here's where I anticipate your questions and try to answer them.

Q. How old are you?
A. Just turned 43 - days before the diagnosis. I really wanted something else for my birthday and this tumor didn't come with a gift receipt. Oh well.

Q. Isn't that too young to get colorectal cancer?
A. Thank you! That's what I've been telling the docs. But noooooo! Just because they went to medical school and did oncology residencies, they think they know more than I do.

Q. Any family history?
A. Lots of heart disease, but no rectal cancer.

Q. What’s the treatment?
A. Roughly it's 6 weeks of chemo and radiation, 3-4 weeks to recover from the radiation, surgery to remove the tumor, then more chemotherapy to make sure none of the cancerous cells escape.

Q. What's the stage?
A. Stage III (T3N1). It's invaded the tissues and has spread to the local lymph nodes.

Q. What's the survival rate?
A. It's hard to say exactly, because the available data are all in aggregate, not stratified by stage and age. The five-year survival rate (post-diagnosis) is 70%. In other words, colorectal cancer patients have a 7 in 10 chance of being alive five years after the diagnosis.

Q. Is that your survival rate?
A. I’m shooting for 100% (n=1). I'm younger than the vast majority of patients, in Stage III, and have a microsatellite instability (genetic anomaly) in the tumor that suggests a better than average response rate to therapy. Also, I'm confident that I'll be around for a while because I'm supposed to die of heart disease, not cancer.

Q. Did you look into any clinical trials?
A. Yeah, but I'm not eligible for the interventional ones in the local area. Many trials, especially the ones at NIH, are for Stage IV patients who have not responded conventional therapy. The oncologists think that this thing will respond to the standard treatment.

Q. Why did you call the blog "The Local Lanes"?
A. "I-270, Exit 1" is my alias on the soccer blogs. The Local Lanes seemed like a good variation on that theme. Besides, I couldn't have my mother tell her friends that her son's blog is called canceruptheass.com.

Finally, in response to a real question:
No, I will not send Twitter updates from surgery.

Freedom Overspill

Washington Freedom 3 - Sky Blue 1

Washington beat the orange-clad Sky Blue (?!) at the Maryland Soccerplex and earned a playoff spot in the WPS. The whole I-270 family attended. My favorite part of the game was the three goals. The boys' favorite parts were eating hot dogs and rolling down the hill behind the north goal. Mrs. 270's favorite part was sitting on the grass watching them roll.

Met another Soccer Insider regular, Joe Doc. He was surprisingly unarmed, which is rare in his neck of the Virginia woods (just pulling your leg dude). We had a beer and started yelling "Free Bird!" at the guy playing the bagpipes.

Why do the Sky Blue wear an orange uniform? Are they Dutch? Gator fans? From the Protestant part of New Jersey? These are the deep mysteries of soccer.

Match report

Testing, testing. 1-2-3

All tests are over (for now). Sure, I'll still have blood drawn a few million times per week, but the big tests, the scans and probes with the fancy equipment of the multisyllabic nomenclature (which are then distilled to acronyms), are over for now. Let's see, I've had a:

• Colonoscopy
• Computerized tomography (CT) Scan
• Positron emission tomography (PET) Scan, and
  
• Endoscopic Ultrasound (ESUS, I asked them not to tell me the sex of the tumor, I want it to be a surprise).

All of this tells the oncologists that my tumor is in Stage III. It has breached the intestinal wall and has invaded the local lymph nodes. This, and the location of the thing, fixes the regimen: pre-operative chemo/radiation therapy, surgery, then more chemo.

I had a pet scan. I named him "Spot." Ha ha ha.