Surprising Results

I had another scan and oncology appointment earlier in September. I hadn't been to see the oncologist since late May. At that appointment, he recommended I start a course of immunotherapy. My cancer is rare so there are not many treatment options, and no immunotherapy treatments that are specific to it. But he had seen some cases where this particular course of immunotherapy seemed to be therapeutically beneficial, and so he was recommending that I try it. I had mixed feelings about it. While the side effects are not nearly as nasty as they are with chemotherapy, there are side effects including some that are potentially quite serious. I decided to postpone the treatments until the fall so I could have the first "normal" summer since 2019. It was the right decision. I had a fantastic summer free of cancer treatment.

In September, I was stunned that my scan results showed the numerous small nodules in my lungs, almost certainly metastases of the cancer, had not grown at all since May. In fact, several of the largest nodules were smaller. This is not at all what I had expected. It was very surprising both to me and to my oncologist because I had done nothing since May to treat the cancer.

Because of this, the immunotherapy treatments that I was scheduled to begin this fall were canceled. I go back in mid-January for more scans. If the nodules continue to get smaller, then we just keep an eye on them every 3-4 months, and no treatment is needed. If they have grown and are larger, I may then begin the postponed immunotherapy.

I am cautiously optimistic that this is the beginning of a very, very good trend. I'm not cancer free, but things are going in a positive and hopeful direction right now.

I feel great. I'm running and active. I have no symptoms. And I turned 52 years old today! Maybe I'll be around longer than expected after all.

Cancer Isn't Done With Me Yet

I haven't written here in quite awhile. Enough people have been asking me how I am that I thought it would be helpful to give an update.

I had a CT and MRI in November and I met with both my oncologist and surgeon. The good news from that appointment was that I was (and still am) healing well from the surgery and there was no sign of recurrence where the tumor was removed. The unfortunate news is that the CT showed that the numerous very small nodules in my lungs had grown since the last CT in June.

I went to Seattle in early January to get a second opinion at the Fred Hutchinson Cancer Center. What the oncologist there said is that the nodules in my lungs are "highly suspicious" and "probable" metastases of the cancer that was removed from my pelvis. The only way to confirm that is with a biopsy, but they are too small for that. They are "indolent" (apparently the term they use) which means they are very slowly growing.

I had another CT in early February. It, too, showed that the nodules in my lungs continue to slowly grow in size. I have no symptoms at all from these nodules. Because I don't, and because they are still very small, at this point the plan is to continue monitoring them with scans every 3-4 months.

I was so hopeful that I would get an "all clear" at my November appointment. Unfortunately that didn't happen. This cancer isn't done with me yet.

And yet, I feel the best I have in a long time. I am back to running -- not as fast or as far -- but I can do it. Just today, for the first time since December 2021, I ran over 5 miles. It felt amazing. I am sleeping so much better without the sciatic nerve pain caused by the tumor. I am in the best shape I have been in a long time.

But I still have cancer. It's so strange to feel as good as I do knowing that the cancer is slowly growing in my body. 

This all means that my short term prognosis is good. Unless something changes, I have years in front of me. But it also means that my long term prognosis is much cloudier. Unless something changes, I probably don't have decades. Apparently, my type of cancer is "elite," meaning very rare, which also means that there aren't as many treatment options as there are for more common cancers.

I don't intend to pursue any clinical trials or experimental therapies right now. I feel too good to mess it all up with side effects from treatment. But when the cancer progresses to the point that I have symptoms, I'll hope that there are clinical trials that may have a therapeutic benefit for me.

What else to say? Of course I am wondering what's going to happen to me. I'm thinking about different scenarios and trying to be clear in my own heart and mind about what I do and don't want if/when I get sicker.

Lately, one (of many) prayers on my lips has been, "God, I'm grateful to be alive today."

One Year Ago -- The First Domino

A year ago today, October 12, the first domino tipped over and triggered all the cancer treatment that I've experienced over the last year. 

A year ago today, I went in for a CT scan to try to find a reason for the persistent and problematic sciatic pain I had in my right leg for several years. There was something there -- I could feel the lump/mass in my upper right hip area. The CT itself was uneventful, but later that same day my doctor's office called and said that I needed to go to the ER immediately because the scan showed an incidental finding of acute appendicitis. I was skeptical and pretty sure I didn't have appendicitis, but I went to the ER anyway. I spent 5 hours there and, in the end, was scheduled for an appendectomy two days later as well as a biopsy of the mass in my upper gluteal area. Turns out, I was right. I didn't have appendicitis. I had a tumor in my appendix in addition to the much larger tumor in my...to put it crudely...butt.

Three days before my 50th birthday, I had the appendectomy and the biopsy. Two weeks after that, the pathology came back -- cancer, soft tissue sarcoma, sclerosing epithelioid fibrosarcoma.

After that, the dominos kept falling...tests, scans, doctors, procedures, chemotherapy, hospitalizations, transfusions, radiation, surgery, physical therapy.

I am so much better than I was a year ago. The cancer has been poisoned and zapped and surgically removed. I can walk without a limp. The sciatic pain is gone. I am even able to jog short distances which feels incredible. The physical therapy has been a huge help. My core is getting stronger and the muscles in my hip and pelvis are slowly healing and getting stronger, too.

In short, I am feeling the best I have in about a year, and I am incredibly grateful. I look back on it and marvel at it all. I know I could not have come through it without the help and expertise and support and encouragement of many, many people -- most of all my amazing wife, Allison.

Next round of scans and appointments is November 2. Here's hoping that the scans come back clear.

I don't know why exactly, but it felt important to mark this anniversary, because it's when my life took a turn and everything changed. Changed for the better or for the worse? I'm going with..."Yes."

Surgery Update III, What's Next

I had appointments with my oncologist and surgeon on Wednesday afternoon.

The good news is that my doctors are not recommending any further treatment at this time. My next scheduled appointments are in November, which will include another MRI and CT scan.

The pathology report came back and, as expected, the surgeon could not get negative margins in three places...but that was expected and the reason for the radiation treatment prior to surgery. There is always a chance of recurrence (somewhere in the 20-50% range) but she is cautiously optimistic that all the treatment I've done will (hopefully) mean that the tumor will not come back.

I had the drain tube removed on Wednesday, and that will slowly heal up over the next few days. The surgeon says my incision looks great. If I get through the next two weeks without developing an infection, then I should be in good shape. I have physical therapy appointments set up for August.

I still have the port in my chest. I'll go in every 8-12 weeks to get it flushed. But at some point it'll come out, too. Probably not until the end of the year or early next year.

The surgical site in my hip and gluteal area has been a bit more swollen, tender, and tight since the drain tube was removed. I'm hoping that will resolve over the next week or so. I continue to walk without a cane, but do have a slight limp. I took a "real" shower for the first time today since the surgery. That felt great!

Over the last nine months, the cancer was poisoned with chemotherapy, zapped with radiation, and then the tumor was cut out of my body. Here's hoping that's it!

Finally, Allison and I have a week on Maui booked for mid-November. It's been so hard to schedule any vacation time due to all the treatments, etc. We're really looking forward to getting away!

I'm not sure when I will post to this blog again. With the most intense days of treatment coming to an end (hopefully forever) I may not have much to share.

But if I do, I'll be sure to post it here.

THANK YOU to all of you who sent caring cards, left encouraging comments, sent supportive text messages, and showed me so much love over the last 9 months. One of the gifts of this unwanted diagnosis has been to experience God's grace through all of YOU. Thank you!

Surgery Update II

I'm now six days out from surgery. I think I'm making good healing progress! I've graduated from a walker to a cane. Today I've noticed that I am not relying on the cane as much as before. In the next day or two, I'll be able to remove the special dressing with the integrated pump device (an "incision management system") and see for myself what the incision looks like. The drain tube will stay in until my follow up appointment on July 20. It's been a little tricky to manage, but I won't go into details so I don't gross anyone out.

I'm still figuring out what my right leg can and can't do. It's hard to move it in certain ways, and it is weak in other ways. Time will tell how it will strengthen and come back from all of this. When I walk without the cane, I can take several steps without much of a limp, but after a few steps there is a noticeable hitch to my step. Again, time will tell...

At my follow up appointments on the 20th I'll find out if I will need any further treatment, or if I am done and instead will be monitored for recurrence.

Surgery Update

Surgery finally happened yesterday, July 7. I'm now home from the hospital after spending one night there.

The surgery was successful. They were able to remove the tumor. I'll know more about negative margins after the pathology report comes back, but they think they got "clean" margins everywhere except one place (which was anticipated -- right against the pelvic bone). The tumor was pushing on my sciatic nerve, but had not encased it, which was good. That should take care of the sciatic nerve pain I've experienced for several years. However, the tumor was very involved with the gluteus medius muscle, so that muscle is mostly gone now. That means I may have a limp and likely won't be able to return to running (although there is a chance I might be able to). That's disappointing, but I knew it was a possibility and it is worth it if it keeps the cancer from spreading and progressing.

I have about a 14 inch incision on the outside of my upper right thigh, hip, and backside. There's a drain tube and another device integrated with the bandage that helps the incision heal. I will have to carry around a little pump device with me for the next 7 days. The drain tube comes out after two weeks.

I'm up and walking (carefully) and using a walker right now. My pain level has been moderate, so I haven't yet resorted to any narcotics and hope not to.

The hardest part for me will be taking it easy! I'm used to being on the go and staying active. Now I'm forced to go slow until all of this heals up.

Fortunately, I've taken the next two weeks off from work, and summer is a slower time of year anyway, so I do have the time and space in my schedule to focus on healing up from the surgery. 

Surgery Rescheduled

This morning I found out that my surgery has been postponed two days and is now rescheduled for Thursday, July 7. Apparently the operating room was overbooked on July 5 and several cases had to be rescheduled, including mine.

I'm frustrated by this change because we (that is, Allison and I) have been making arrangements in our lives based on the July 5 date -- time off from work, visit from out-of-state family to help after the surgery, etc.

But it's out of my hands, and so I'm doing my best to practice "radical acceptance."

I have an MRI tonight, a CT scan tomorrow morning, as well as appointments with my oncologist and surgeon tomorrow afternoon.

This is also a bit more frustrating because my nighttime sciatic pain has been worse lately making it difficult to sleep. Getting the tumor out of there, I hope, will ultimately alleviate that pain. And so I'm anxious to finally have this surgery (which I've wanted since last November) and get on with whatever happens after that.

As always, thank you for your support, encouragement, and prayers.

Radiation is a Wrap, Surgery Next

Today I finished radiation treatments -- 25 out of 25. It feels great to have that behind me (excuse the pun). But it will also be a little weird not to rush off to OHSU every morning to get zapped. So far, the side effects have been minimal. Those I have had may persist for another week or so and then should get better. 

Next up is surgery. It's been scheduled for Tuesday, July 5. It takes 3-4 weeks for the healthy tissue around the tumor to heal from the radiation, which reduces the chance of infection after surgery. The week before surgery, I'll meet with the oncologist and surgeon, have another MRI as well as a CT scan. The surgery hopefully will be the last major cancer treatment procedure I have to do. After surgery, I move into the monitoring phase with scans every few months to make sure the cancer hasn't recurred anywhere.

Today I went to have the port-a-catheter in my chest flushed. It hasn't been accessed since the end of March with the last round of chemo. So today I had to go in and they stuck the needles in, flushed it with saline and put in the heparin that keeps it from clotting/clogging. I'm not sure how long I'll have to keep it in, but eventually it'll come out and I won't have this device protruding from just under my skin with a tube going into my neck. It doesn't bother me and I don't notice it much, but I'd rather not have it.

I don't have any medical appointments for the next three weeks. I'm grateful for the respite from it all. I'm back to running. I'm now able to run 4 miles without stopping, and my pace is picking up, too. It feels so very good to get back into a running routine that has been so important to me.

My eyebrows are BACK, baby! And hair is growing back just about everywhere I lost it. I still have a few lingering effects from all the various treatments, but lately I've been feeling the best I have since I started down this cancer treatment road last December.

Thanks to everyone who has been so kind and supportive and encouraging through all of this!

Radiation Update, Two Milestones, Checkin' the 'Brows

I finally started radiation treatments on Tuesday, May 3. As of yesterday, I've had 8 out of 25. So far, radiation has gone smoothly. The appointment only takes about 10-15 minutes and the treatment itself is only 2-3 minutes. The technology is amazing. The machine rotates around my body and delivers varying amounts of radiation to the tumor. Apparently, it is accurate up to 1 millimeter, which blows my mind. The side effects I may experience include fatigue (not yet) and maybe a radiation burn on the skin (not yet). The treatments are cumulative, so I may experience the side effects more towards the end. The hardest part about it is going every single day. With travel time, it takes about an hour and a half. I can't complain too much. I live about 25 minutes away. There are people from around Oregon who travel hours to do radiation at OHSU.

The more time that passes since chemo ended, the stronger I get. I've been working to get back to running. These days, I jog more than I walk and my stamina keeps improving. I had an awesome milestone yesterday when I ran a whole mile without stopping to walk. I want to get as much of my strength back before I have surgery. That will be around the end of June or beginning of July.

The other day, I noticed hair growing back on my face. It was the strangest thing, as I haven't had to shave for about 4 months. It was just a bit of fuzz on my upper lip and underneath my lower lip. It was almost like I was 13 again, as the hair was the soft kind that boys hitting puberty get on their face. It got long enough I had to shave it...milestone #2.

Just yesterday, I noticed my eyebrows have a slight fuzz of hair growing in. I have exactly one old eyebrow hair on one side, and two on the other, so the signs of more hair growing back is a very good thing. I can't wait to get my 'brows back!

A Weirdly Normal Week

I'm writing this on a Friday of a weirdly normal week. I had no medical appointments this week nor did any cancer treatments cause me to feel lousy. I worked a normal 40-hour week, attending meetings, making pastoral visits, and wrestling with sermon preparation. Almost two weeks after the end of chemotherapy, I'm feeling a little bit better every day.

I went on my 4-mile running loop this morning. I still can't run the whole thing, but the sections that I jog are getting a little longer and the sections I walk a little shorter. I don't get out of breath going up the stairs. Since I am no longer severely immunocompromised, I did the grocery shopping for the family today for the first time in four months (but I do still wear a KN-95 mask). I haven't completely left the effects of chemo behind. The hair I lost won't come back for months. My fingernails and toenails turned yellow and are slowly growing back out again. But those are minor, and I'm grateful to feel the best I have for months. I'm most happy that food tastes right again and, because I don't have mouth sores, I can eat it! And I have been! I am TOTALLY enjoying every single thing I eat. I've gained back a few of the pounds I lost during chemo.

This brief window of normalcy has been so good. Radiation treatments begin next week, on Tuesday, May 3. While the side effects aren't as intense as chemotherapy, it does require daily visits to the clinic. After five weeks of radiation treatments, I'll finally have surgery to remove the tumor.

Finally, it does feel strange to have been through so many weeks of intense chemotherapy, and then for it to just be over with no obvious or visible results. Hopefully, those drugs killed a whole lot of cancer cells over those months. And hopefully the radiation will do the same.

A Change in the Treatment Plan

I had six medical appointments last week, including spending two and a half hours at the clinic on Wednesday afternoon.

The end result is that there has been a change to my treatment plan. I will not be having surgery on Thursday, April 21. Instead, I soon will begin radiation treatments. Surgery will be scheduled after radiation, later in June.

Initially, this change left my head spinning as I was preparing in a variety of ways for surgery. But ultimately this is a better plan. There is at least one place (and maybe others) where the surgeon will not be able to get negative margins when removing the tumor. The radiation treatments make it more likely that the tumor will not grow back in those places. Also, I would not be a candidate for radiation if the cancer had spread. But, because I have no other detectable tumors, I do not have "advanced disease," and thus radiation can be included in the overall treatment plan.

Once they start, the radiation treatments are five days a week for five weeks. The appointments are short. It takes just a few minutes to zap the tumor with the radiation. The side effects are not as intense as chemotherapy. I'm told the main side effect is fatigue. I think I'll take that over mouth sores, nausea, tasteless food, and neutropenic fevers that send me to the hospital.

If I were still doing chemo, today would be the first day of infusions. But because I've finished chemo, I didn't have to go in this morning! That feels fantastic. I'm going to be shaking off the effects of the chemo for a few months. I can tell that my red blood cells/hemoglobin remain low. Still, hopefully from here I'll get stronger in body--that is a priority for me, along with radiation treatments.

Finally, based on absolutely nothing scientific or medical, I have this deep sense inside that, after the radiation and surgery to remove the tumor, no more cancer will be found on future scans. Perhaps it's wishful thinking. But that's my story and I'm sticking with it.

(Almost) Post-Round 6, What's Next, Eyebrow Update

Well, I've just about made it through the round 6 nadir. I did not develop an infection/fever that sent me to the hospital last week. What a relief! The mouth sores and assorted other side-effects of round 6 will slowly resolve over the next week or so. I'll feel like chemotherapy is in the rear-view mirror when I start to feel more like myself -- some time in the next week, I hope.

Next week I have six medical appointments. On Tuesday I have another CT and MRI. On Wednesday, I meet with my oncologist as well as my surgeon. 

I'm scheduled to have surgery on Thursday, April 21 to remove the tumor. I'll know a lot more about that surgery after my appointments this week. Needless to say, I'm a little anxious about it all. At the same time, surgery is an important step in getting past this, and so even though I am anxious, I am also pleased that the surgery is happening. I'm planning to be away from work completely for two weeks, possibly more.

The six rounds of chemo definitely had a cumulative impact. I haven't been running for months. I don't have enough red blood cells to carry the oxygen around my body! I've lost weight. I'm weaker in body than I've been in a long time (but not in spirit!). A lot of my hair has fallen out...but not everywhere. It's strange. I still have hairy arms, but my eyelashes are gone. There's still a lot of hair on my legs, but the hair inside my nose is gone (which, by the way, is very annoying).

Oh, and yes, I still have eyebrows. They are very, very thin by now. 

But they are still there!

My Local Park is Saving My Life

I live less than a mile from Cook Park in Tigard. For those who aren't familiar with it, Cook Park is an 80 acre park that connects to both Durham City Park and the Tualatin City Park. In my pre-chemo days, my various running routes (whether a 4, 5, or 6 mile run) took me through both Durham City Park and into Cook Park. 

I took this photo on my walk on April 1.

I loved running through the park. In the mornings it was usually quiet without many people on the path. I ran on the trails through the trees and along the Tualatin River. I tried to keep running through chemo, but it got to the point where I just couldn't do it any longer. But I can still walk, and so now I walk to and through the park when I can, and it has become an informal, but important part of my treatment plan.

There's just something about being among the trees that is good for my soul. There's something about standing on the edge of the Tualatin River and watching the water eddy and swirl as it flows by downstream that is deeply good for me. I will confess it has brought me to tears more than once. There's something about the smell of the fresh, damp air, and the movement of walking, and the sound of my feet crunching on the path, and the birds singing, and through the winter and into this spring seeing the buds on trees and bushes swell and turn green and put out leaves, and the bright colors of the flowers blooming -- the whole combination of it all feels so healing, so nurturing, so good for me...I can't imagine going through all these rounds of chemo without it.

I wonder about people who receive treatment like mine who don't have access to greenspace. I've seen a couple of Department of Corrections prisoners come to the infusion clinic for treatment. I can't imagine receiving chemotherapy and then going back to a prison. I wonder about people who live in densely populated urban areas who might not have a local park to go to like I do. And I wonder if doctors should include in their recommendations and treatment plans regularly accessing a local park or greenspace. It could be, "Take your medication at this time, and go to your local park three times per week."

I think I took my local parks a little bit for granted before chemo. Now I see them as essential for my well-being. I am grateful for many things these days, but now every time I go for a walk in my local park, I am especially grateful that it exists, that I live so close, and that there are people who maintain it so people like me can be blessed by all that it has to offer.

Post-5, Pre-6 Update

My apologies for not updating the blog sooner. Lots going on!

The good news is that I was not hospitalized during round 5. It was a close call. On Tuesday afternoon of nadir week (week of March 14), I could feel myself sliding down into the pit. It's strange how I can begin the day feeling relatively normal, and the in the space of a few hours, feel my energy drain away, the fatigue creep up, and the generally lousy feeling descend.

I was down all day Wednesday. I kept a close eye on my temperature, and while it was elevated,  during the day it didn't get too high. But by Wednesday evening, it crept up higher and almost crossed the threshold that sends me to the hospital. Wednesday night was a restless, uncomfortable night. Thursday I was down but my temperature was OK. By Thursday night I started to feel a bit better, and by Friday I continued to improve. Again, I could almost feel my bone marrow pumping out white blood cells and fighting off infection. The mouth sores this time weren't quite as intense and were much more manageable. Through the weekend, I continued to improve and entered this past week feeling pretty good.

This past week (week of March 21) was spring break in Oregon. Our family went to Seattle on Tuesday for three nights and had a great trip. I had blood work done on Monday before we left and got a call from the nurse saying my red cells were low. They wanted me to get another transfusion, but there was no way it could happen before we were planning to hit the road. Because I was feeling OK and didn't have any symptoms of low hemoglobin, they somewhat reluctantly cleared me to go without the transfusion. And so we headed off to Seattle on Tuesday morning. It was so refreshing to be out of our house where I spend so much time these days, out of Tigard, and in a new place. I almost forgot I have cancer and am undergoing chemotherapy. I needed that break from my life, and it came at a good time.

Now I am anticipating round 6 of chemo...the final round! As always, I really don't want to do it. But knowing it's the last time I have to go through it all definitely makes it easier. I have another MRI and CT scheduled for mid-April followed by appointments with my medical oncologist and the surgeon to talk about what comes next.

The stack of cards I have received from so many people continues to grow. Thank you for praying for me and for all of your support and encouragement!

Round Five Infusion Update

There isn't much to say about round five infusions. Thanks to Colleen, I got there each morning. Thanks to my friend Donna, and Kristin, and Allison, I got home each day.

Everything went as usual. Now I'm just in recovery mode, keeping nausea at bay and wondering what will happen next week when I enter the nadir. The doctor prescribed a prophylactic antibiotic that may help keep me from developing a problematic fever and infection - and thus prevent another hospitalization. He also reduced the dose of one of my chemo drugs with hopes that it would lessen the mouth sores I experienced last round.

I'll post next week when I have more information to share. Thanks for your continued concern and care!

Round Five: "Thank you sir, may I have another?"

Animal House Kevin Bacon GIFfrom Animal House GIFs

Round Five began today. I think this GIF from the movie "Animal House" (filmed in Oregon!) says it all.

Round Four Update

 I didn't restart this blog to solicit sympathy, but just to share information widely with anyone who is interested in keeping up with my treatments. So here's the facts on the aftermath of round four infusions.

I developed another fever and went to the hospital. I was there for four days and nights for IV antibiotics. I also had pretty intense mouth sores, so I was swishing regularly with the magic mouthwash. (If it really was magic, it would make them go away!) I was anemic so I received two blood transfusions as well as a transfusion of platelets. I went in on a Wednesday evening and finally returned home on Sunday afternoon.

The week after that my mouth sores mostly healed. I was more weak and tired, but I started to feel stronger as the week progressed. 

My time in the hospital was a bit of an ordeal as the hospital was full so I had to stay in the ER longer than I wanted to. I didn't have a window so I didn't see outside for a couple of days (a big deal for me). But I eventually got into a regular hospital room. Anyway, a story for another day...

On to round five...

Round 4/"Magic Mouthwash"/Eyebrow Update

I completed round 4 of infusions this week. There's not much to add as it all went as it usually does. I'll have the usual after effects as I've described before. I'm really hoping I can get past the nadir next week without going to the hospital. Now that four rounds are done, I've got just two remaining. It makes me so happy to think that, next round when I finish my three days of infusions, I'll be able to say to myself, "Just one more round!"

I had a CT scan and saw my medical oncologist last week. The scan revealed no additional cancer, which is a great result. It also showed that the tumor I do have is about the same size. The doctor told us early on that it wasn't common for tumors like mine to shrink very much, so it wasn't unexpected. He recommended we continue with the chemotherapy treatments. Once I've completed all six, then we'll assess next steps for other possible treatment, including surgery and radiation.

During the last round of chemo my mouth got pretty sore. This is a common side effect of chemotherapy. The chemo drugs target fast dividing cells and, as it turns out, that applies to the cells in our mouths. During the first two rounds, my mouth got a little sore but it wasn't significant. With round 3, the soreness was definitely more pronounced, and made it a little hard to chew and swallow for a couple of days. When I reached out to my care team to ask for help, I discovered something informally known as "Magic Mouthwash." (I don't think the pharmacists call it that.) 

Magic Mouthwash is a mixture of lidocaine, Maalox, and Benadryl. The ingredients are meant to numb the mouth and give protection before eating and/or to give pain relief after eating. My mouth soreness resolved on its own before I could get this concoction, but I now have a bottle at the ready. If the soreness gets to the point that it did last round, I'll definitely be swishing and spitting with this stuff for a day or two. I sure hope it lives up to its (informal) name, "Magic Mouthwash."

Finally, what you've all been waiting for: Yes, I still have eyebrows! They have thinned, but they are definitely still there. My hirsute ancestors' genes are robust, apparently. (It's strange. The hair on my head, except for the eyebrows, is gone. I haven't shaved my face in many weeks. The bit of hair on my hands is gone, but not my arms. Same for my feet/ankles, but not my legs.) I just may get through this with my eyebrows intact!

The Nadir Strikes Back

On day 10 of this round of chemo, which is when I would expect to be in the nadir with very low blood counts, especially white cells -- I developed a fever. This isn't necessarily a problem unless it gets too high for too long.

It got too high for too long.

After that initial fever increased and dogged me all night long, my care team told me I needed to go to the hospital. I also had an infection on my right ear, near the top where the cartilage curls over. I went to the hospital and was admitted. 

I started on IV antibiotics, the doctors took care of the infection on my ear, and my fever finally started to come down and my ear began to heal.

I spent two and a half days and two nights in the hospital. My white blood cells finally rebounded. However, my hemoglobin and platelets were still low, so I had a blood transfusion and platelet transfusion.

A huge shout out to all of you who regularly give blood!!

So now it's time to both recover from this and begin to gather my strength for round 4 which starts in a little over a week.

Round 3 Wrap Up - plus chemo theology

I finished round three of chemotherapy infusions last week. That means I'm almost halfway there - 3 of 6 rounds done.

I'm learning the pattern of how the whole cycle plays out. I receive the first infusion on Monday, and I feel OK, for the most part. Infusion two is on Tuesday, and I'm definitely feeling it by Tuesday afternoon. Infusion three on Wednesday, and I feel lousy. There's fatigue, the nausea that lurks around the edges even when under control, the fogginess and lack of energy. That lasts into Friday morning, and then once the infusions are 48 hours behind me, I slowly start to feel a bit better. By Sunday, I'm off almost all of the drugs to control nausea and side effects, so I'm a little clearer, less fatigued, and generally feel a lot better.

Then a few good days before the nadir hits (see below and above). And then, if I'm lucky, a good week before I go back and repeat the whole process all over again.

I have a CT scan scheduled for the first week of February as well as an appointment with my oncologist. Hopefully that will allow a mid-treatment assessment of how it's all going.

Finally, I've been using this space to share information and how I'm experiencing all of this. Though I am a pastor, I haven't offered up any theological or spiritual reflections. I may get to that later. You never know.

But I was struck with my colleague and friend Brian's comparison of the nadir to "the depths" in Psalm 139:8. That happens to be my favorite Psalm. It's all about our inability to escape God's loving and gracious presence...even when we make our bed in "sheol" (the Hebrew); that is, in the depths. 

That's exactly what the nadir is...the depths, a pit, a place that we sink into and imagine God can't or won't follow. My experience has been that I feel the ordinary, daily sense of God's gracious presence (nothing flashy!) through all of this. That presence is always there. It follows me wherever I go, even when I descend into a chemo-induced nadir. And it's there when I go for a walk around the block. And it's there when my hands are twitching from the drugs. And it's there when I send emails, or make the coffee in the morning, or go to the bathroom for the upteenth time. Nothing dramatic. Just there. Gentle. Present. Steadfast. Strong. 

God's gracious presence -- always, eternally present.