Sorry it's been so long since the last update. Here's the latest.
Insurance: It looks like they will pay for Avastin but not Oxiliplatin. We’re still appealing this, but I’m starting to have some pretty severe neuropathy from the Oxiliplatin. It’s pretty difficult to type these days – I have to do the two-finger peck while looking at the keyboard (and I still make a mistake with every-other word). So, perhaps there was a blessing in disguise in the insurance decision, because it turns out that the neuropathy is due to nerve damage, and it can take months or even years to recover. I’ve stopped taking the drug and will be glad when some of the feeling in my hands/feet starts to return.
Tumors: Had a scan 2 weeks ago. More “slow growth” I’m gathering information for NIH/NCI, but have been so distracted by the insurance fight that I haven’t gotten it in the mail yet.
Colon: I had some bleeding that gave the Dr. some concern that perhaps things had spread to the colon and weren’t showing up on the scan, so last Friday I had a colonoscopy and it turned out that everything was completely cancer-free and the bleeding was due to some small internal hemorrhoids that weren’t even worth removing.
I want to thank everyone again for your prayers and love and support and the many generous offers to help in so many ways. It seems like there's an new blessing almost every day -- I can't tell you how blessed and thankful I am.
Tuesday, December 8, 2009
Thursday, November 19, 2009
Insurance Update
Well, the news wasn't as good as I had hoped. The latest is that the insurance company is NOT approving new treatments using my current regimen. They've recommended a new regimen involving interferon, which is NOT appropriate for papillary Renal Cell Carcinoma according to every oncologist, report, and internet blog I read. Additionally, they denied coverage for prior treatments because it isn't the regimen that they recommend.
Secondly, the University of Virginia hospital is now saying "pay up or we turn it over to a collections agency." They aren't willing to wait for another insurance company appeal and they want me to pay "list price" which is about 160% of what the insurance company was paying (back when they paid for my treatment which, by the way, they say was their mistake and they never should have paid, but because they are so good-natured, they aren't going to come after me asking me to repay them... isn't that nice?).
Anyway, that's the news. I'm adjusting and still fighting. Although, I wonder, as I contemplate trying to come up with the nearly $100,000 for treatments so far, what right do I have to hold onto anything I've saved over the years? Do we really have any right to expect our treasures on earth to do anything but burn? Here's hoping for treasure in heaven and that, in the meantime, I don't get singed too badly.
Secondly, the University of Virginia hospital is now saying "pay up or we turn it over to a collections agency." They aren't willing to wait for another insurance company appeal and they want me to pay "list price" which is about 160% of what the insurance company was paying (back when they paid for my treatment which, by the way, they say was their mistake and they never should have paid, but because they are so good-natured, they aren't going to come after me asking me to repay them... isn't that nice?).
Anyway, that's the news. I'm adjusting and still fighting. Although, I wonder, as I contemplate trying to come up with the nearly $100,000 for treatments so far, what right do I have to hold onto anything I've saved over the years? Do we really have any right to expect our treasures on earth to do anything but burn? Here's hoping for treasure in heaven and that, in the meantime, I don't get singed too badly.
Monday, October 26, 2009
2 Prayer Requests
Well, it's been a while since the last blog. Sorry for the delay. Until a few weeks ago it was due to the lack of news, and lately it's been due to laziness. Ummmmm.... laziness.... feels so good to just kick back and read when I should be writing on the blog...
Slow Growth
First, the news related to my most recent scan in early October. The scan showed no growth in the lung nodules (yeah!), but "slow" growth of the nodules in the abdomen -- especially a mass around the abdominal lymph nodes which increased by about 20% -- their definition of slow growth, although 20% over 2 months adds up. And this gets us to my first prayer request. I'm wondering how long I put up with "slow growth" and simply stay the course. My Dr. says this is great news and since I'm feeling so good (which I am), we should continue with the current therapy. However, part of me wonders if we shouldn't be trying something else. Problem being, the last time I went off drugs that were working, things went crazy (that's how I ended up w/ the tumors in the abdomen in the first place). I plan on calling NIH and seeing what the Drs there think.
Insurance Fight
In other news, I received a letter from my insurance company about 2 weeks ago which said that they were not going to pay for my primary therapy, Avastin. Not only that, but that the decision was retroactive back to early August. UVA Hospital found out about it when the insurance company refused to pay in August, but we didn't know what was up (frequently there is a long delay or initial denial of payment because of miss-codings on the bills, etc.). UVA appealed the decision in August and the appeal was denied, but still, we didn't know anything until receiving the letter. The end result is that, at the time we received the letter, we were about $50,000 to $60,000 in debt to UVA. I'm appealing the decision one more time (with some mroe supporting material); however, at this time I have no idea what will happen. When I told the insurance company that Avastin is what helped get me out of the hospital and that without it, there is a good chance of a return of the ascites and more visits to the hospital, they said it was irrelevant and that they needed scientific evidence that Avastin was good treatment for RCC.
In the mean time, I'm continuing treatment (on my own nickle) and plan on cashing in on my retirement account to pay for it if need be (I'm getting an infusion right now). To their credit, UVA is still treating me even though they haven't been paid for the Avastin treatments since August (they told us that they would hand it over to a collection agency if we didn't pay, but i'm not paying until the outcome of the appeal, and the insurance company says the appeal can take up to 60 days!). Anyway, I think the prayer request is obvious --- that the insurance company would change their mind and/or that I would find another treatment that is covered in some way that is as effective (or more so!).
Sorry the news isn't better. The good news is that (a) my Dr. is ready to fight... take it to the media, etc, and (b) I'm not discouraged. I had a dream that folks were ringing my doorbell and when I answered they tried to hand me a pile of cash. I turned it down saying, "not until I've exhausted my own resources." It was a great dream -- it reminded me that I can trust God to provide in unexpected ways. I'm hopeful. -d
UPDATE:
Just heard from the insurance company. They accepted the appeal and will pay for 12 cycles of treatment from this point forward. We're still negotiating payment for prior treatments, but I'm hopeful.
Slow Growth
First, the news related to my most recent scan in early October. The scan showed no growth in the lung nodules (yeah!), but "slow" growth of the nodules in the abdomen -- especially a mass around the abdominal lymph nodes which increased by about 20% -- their definition of slow growth, although 20% over 2 months adds up. And this gets us to my first prayer request. I'm wondering how long I put up with "slow growth" and simply stay the course. My Dr. says this is great news and since I'm feeling so good (which I am), we should continue with the current therapy. However, part of me wonders if we shouldn't be trying something else. Problem being, the last time I went off drugs that were working, things went crazy (that's how I ended up w/ the tumors in the abdomen in the first place). I plan on calling NIH and seeing what the Drs there think.
Insurance Fight
In other news, I received a letter from my insurance company about 2 weeks ago which said that they were not going to pay for my primary therapy, Avastin. Not only that, but that the decision was retroactive back to early August. UVA Hospital found out about it when the insurance company refused to pay in August, but we didn't know what was up (frequently there is a long delay or initial denial of payment because of miss-codings on the bills, etc.). UVA appealed the decision in August and the appeal was denied, but still, we didn't know anything until receiving the letter. The end result is that, at the time we received the letter, we were about $50,000 to $60,000 in debt to UVA. I'm appealing the decision one more time (with some mroe supporting material); however, at this time I have no idea what will happen. When I told the insurance company that Avastin is what helped get me out of the hospital and that without it, there is a good chance of a return of the ascites and more visits to the hospital, they said it was irrelevant and that they needed scientific evidence that Avastin was good treatment for RCC.
In the mean time, I'm continuing treatment (on my own nickle) and plan on cashing in on my retirement account to pay for it if need be (I'm getting an infusion right now). To their credit, UVA is still treating me even though they haven't been paid for the Avastin treatments since August (they told us that they would hand it over to a collection agency if we didn't pay, but i'm not paying until the outcome of the appeal, and the insurance company says the appeal can take up to 60 days!). Anyway, I think the prayer request is obvious --- that the insurance company would change their mind and/or that I would find another treatment that is covered in some way that is as effective (or more so!).Sorry the news isn't better. The good news is that (a) my Dr. is ready to fight... take it to the media, etc, and (b) I'm not discouraged. I had a dream that folks were ringing my doorbell and when I answered they tried to hand me a pile of cash. I turned it down saying, "not until I've exhausted my own resources." It was a great dream -- it reminded me that I can trust God to provide in unexpected ways. I'm hopeful. -d
UPDATE:
Just heard from the insurance company. They accepted the appeal and will pay for 12 cycles of treatment from this point forward. We're still negotiating payment for prior treatments, but I'm hopeful.
Wednesday, August 19, 2009
My Unusual Problem
Here's the first line of the latest radiology report (Aug 2 CT): "Mr. Ward is a 46-year-old gentleman with very unusual problem related to metastatic underlying papillary carcinoma." "Unusual" appears to be the key word. The report is full of subjective comments related to how suprised the Doctors are that my cancer is responding the way it is -- specifically, that after the near total-body shutdown, that I have recovered as I have and, especially, that the ascites (abdominal fluid) has not come back. All of this, of course, is good news, and the fact that the Dr's are baffeled is a testimony, I believe, of the power of your prayers. THANK you!!
The report also said that I was "a slightly plethoric, alert, pleasant gentleman, in no acute distress." (I had to look up 'plethoric'). But beyond that, the report shows that in the 6 weeks between scans, there has been no significant growth in any of my metestatic tumors. That makes this the best radiology report since my first round of Sutent when it appeared that the cancer was actually shrinking. Anyway, while this report isn't as exciting as actual shrinkage...
Shrinkage
It's great news. So, we stay the course w/ Chemo every other week and I'll probably get scanned again in a few months (no set date yet). Also, for those who ask, I haven't yet talked to NIH. They called while i was in Chicago on business (yes, my first "solo" trip since being in the hospital), and I wanted to wait until the next scan before calling them back. I hope to talk with them soon.
Sorry for the long inter-post delays; there just isn't that much news between scans. Thank you all again for your prayers and support. I'll keep you posted...
Monday, July 20, 2009
Lymph Nodes
Well, I was hoping to show you guys a picture of the adnopothy surrounding my porta hepatis, but - alas - I sent them on up to NIH.
I had been a bit worried about them since the last week's radiology report showed that they grew in size by 50% in the 4 weeks between my pre-Australia and post-Australia scans. However, I looked at them w/ my Dr. today, and they don't look so bad. Also, he explained that these are, basically, enlarged lymph nodes. It could be tumors that's enlarging them, bit it could also be swelling caused by the body's fight against the cancer elsewhere - there's no way to know. Either way, it's not good that they're getting bigger, but it's not as bad as it could be. So, the deal is that we're staying the course w/ Avastin and 5-FU/etc.
In other news, this past July 4th, I helped my other cancer-budy Andrea check off one of her bucket-list items (not that I want her to get through the list... maybe just most of the way through). Here's before (check out the look :):
I had been a bit worried about them since the last week's radiology report showed that they grew in size by 50% in the 4 weeks between my pre-Australia and post-Australia scans. However, I looked at them w/ my Dr. today, and they don't look so bad. Also, he explained that these are, basically, enlarged lymph nodes. It could be tumors that's enlarging them, bit it could also be swelling caused by the body's fight against the cancer elsewhere - there's no way to know. Either way, it's not good that they're getting bigger, but it's not as bad as it could be. So, the deal is that we're staying the course w/ Avastin and 5-FU/etc.
In other news, this past July 4th, I helped my other cancer-budy Andrea check off one of her bucket-list items (not that I want her to get through the list... maybe just most of the way through). Here's before (check out the look :):
During....
And after...
We had a great ride. It was her first, ever, motorcyle ride and I know it helped that we were BOTH chock-full of opiate pain killers.
While we're at it. Mom and dad saw us on our open-air moterized vehicles and decied to ride their own down to the 4th-of-July picnic. It didn't seem like quite the same thing, but they seemed to be enjoying themselves.
Monday, July 6, 2009
We're back
Well, we're back from down under and had a great visit with the Montoya's. Here's picture from a rooftop restaurant in Sydney where we enjoyed our last 3 days.
The trip was great, and I felt stronger and stronger each day; my Drs are thrilled w/ how "healthy" I'm looking and feeling (I am too). The flight home was good as well. Getting into LA 6 hours before we left Australia was kind of weird, and then seeing the sun set a second time on the LA - DC flight was weird as well. We all adjusted quite quickly to the new time (I think the time change was so different and the trip home so long, that the body doesn't really know what to do, so current time is good enough.)
I'm writing this blog from UVA where I'm "catching up" on my chemo. Some tentative good news (remember the last good news) is that I had a scan this AM and it seems like all the tumors have remain unchanged in size. The exception, once again, is that the oncologist really couldn't find the 2 tumors in the abdomen, so we need to wait for the radiology report on those; however, this time I'm reasonably hopeful that the report will show no change. Of course, shrinkage would be the best news; but I'm very happy and thankful w/ "stable."
As always, thanks for your prayers; I KNOW that they make a difference.
The trip was great, and I felt stronger and stronger each day; my Drs are thrilled w/ how "healthy" I'm looking and feeling (I am too). The flight home was good as well. Getting into LA 6 hours before we left Australia was kind of weird, and then seeing the sun set a second time on the LA - DC flight was weird as well. We all adjusted quite quickly to the new time (I think the time change was so different and the trip home so long, that the body doesn't really know what to do, so current time is good enough.)I'm writing this blog from UVA where I'm "catching up" on my chemo. Some tentative good news (remember the last good news) is that I had a scan this AM and it seems like all the tumors have remain unchanged in size. The exception, once again, is that the oncologist really couldn't find the 2 tumors in the abdomen, so we need to wait for the radiology report on those; however, this time I'm reasonably hopeful that the report will show no change. Of course, shrinkage would be the best news; but I'm very happy and thankful w/ "stable."
As always, thanks for your prayers; I KNOW that they make a difference.
Thursday, June 25, 2009
Aussie Update #2
G'day mates from down under. Our friends the Montoyas finally arrived and we've been hanging out with them for a few days. The weather has been spotty; mostly rainy and cold. We've been walking a ton, and I have been feeling strong and healthy.
It's been a while since I talked about my GI issues. So... here goes... for the past month, the issue has mostly been figuring out how to keep things from getting stopped up.
I've got a routine involving softeners, x-lax, and Miralax that seems to work, but yesterday everything came undone and the pendulum swung so far the other way that I had to, how shall we say it, wrap up a bit to keep from exploding. I won't paint a more detailed picture than that, but it was humbling and disgusting. So, needless to say, I figured you'd all want to know about it. Today, however, things were better and I've been able to run about diaper-free. Another of the little things in life that I'll bet goes under-appreciated by most.
As a testament to how free I really was, here's a picture of me trying out Gabriel's (Montoyas' 16-year old son) Powerisers. For those who don't know, these are big springs you attach to your legs that let you hop around like a kangaroo... I'm pretty sure they were invented here. It was fun. Perhaps you can see the Fentanyl bag bouncing around in the picture -- I'm telling you, the narcotics REALLY do come in handy...
After the bouncing around like this for all of 5 minutes, I was ready for something a bit calmer, so we all walked down to the Swan River (which runs through Perth) and over to "Kangaroo" Island. The island has "wild" Kangaroo's running around that are like the deer at Loft Mtn.
One of the prayers someone prayed for me before leaving was that I would return feeling stronger and healthier than I left (unlike the Prague trip where I was vomiting in the airplane bathroom on the way home... not fun...). I know it's still early, but thank you for your prayers; so far, they're being answered and it feels great. I'm having fun here, but I really do miss you all and look forward to seeing you shortly.
It's been a while since I talked about my GI issues. So... here goes... for the past month, the issue has mostly been figuring out how to keep things from getting stopped up.
I've got a routine involving softeners, x-lax, and Miralax that seems to work, but yesterday everything came undone and the pendulum swung so far the other way that I had to, how shall we say it, wrap up a bit to keep from exploding. I won't paint a more detailed picture than that, but it was humbling and disgusting. So, needless to say, I figured you'd all want to know about it. Today, however, things were better and I've been able to run about diaper-free. Another of the little things in life that I'll bet goes under-appreciated by most.
As a testament to how free I really was, here's a picture of me trying out Gabriel's (Montoyas' 16-year old son) Powerisers. For those who don't know, these are big springs you attach to your legs that let you hop around like a kangaroo... I'm pretty sure they were invented here. It was fun. Perhaps you can see the Fentanyl bag bouncing around in the picture -- I'm telling you, the narcotics REALLY do come in handy...After the bouncing around like this for all of 5 minutes, I was ready for something a bit calmer, so we all walked down to the Swan River (which runs through Perth) and over to "Kangaroo" Island. The island has "wild" Kangaroo's running around that are like the deer at Loft Mtn.
One of the prayers someone prayed for me before leaving was that I would return feeling stronger and healthier than I left (unlike the Prague trip where I was vomiting in the airplane bathroom on the way home... not fun...). I know it's still early, but thank you for your prayers; so far, they're being answered and it feels great. I'm having fun here, but I really do miss you all and look forward to seeing you shortly.
Monday, June 22, 2009
Hello from Down Under
Well, we made it -- 36 hrs of travel and a missed connection in Sydney, but overall it went way better than I could have imagined. We all were able to sleep on the plane, and then stay up until (an early) bedtime and then get a regular night's sleep and wake up on Perth time. YWAM (the missions organization that the Montoyas are with) has done an amazing job hosting us with guest housing, meals, and lots of international hospitality.
I forgot to mention in the last blog that last Thursday while at UVA for chemo, i mentioned that i was feeling a tiny bit of pain in my abdomen and that i was a tiny bit worried that there might be some fluid building up again. I almost hesitated to mention it because it was so small and because my pain killers do such a good job of masking everything that I'm not as self-aware as I was (one drawback of the current strategy, but pretty much the only one :). Anyway, they said, "well let's get you down to ultrasound to be sure and have peace of mind before your trip." So they made a last-minute appointment for me. I got to see all my old friends down there (they all remember me), and -- the good news -- they could not find one drop of fluid in my abdomen that wasn't supposed to be there. I am thankful for the Drs and nurses who are working hard to give me peace of mind and who helped get me to AU.
Still haven't seen the Montoya's yet... they come in tonight from Tonga. I plan on giving them all big kisses from everyone at BRCC.
I forgot to mention in the last blog that last Thursday while at UVA for chemo, i mentioned that i was feeling a tiny bit of pain in my abdomen and that i was a tiny bit worried that there might be some fluid building up again. I almost hesitated to mention it because it was so small and because my pain killers do such a good job of masking everything that I'm not as self-aware as I was (one drawback of the current strategy, but pretty much the only one :). Anyway, they said, "well let's get you down to ultrasound to be sure and have peace of mind before your trip." So they made a last-minute appointment for me. I got to see all my old friends down there (they all remember me), and -- the good news -- they could not find one drop of fluid in my abdomen that wasn't supposed to be there. I am thankful for the Drs and nurses who are working hard to give me peace of mind and who helped get me to AU.
Still haven't seen the Montoya's yet... they come in tonight from Tonga. I plan on giving them all big kisses from everyone at BRCC.
Friday, June 19, 2009
Post-9/11 Securtiy Nightmare... or not...
Well, I'm in the C'ville airport, and we’re on our way to Australia… can you believe it?! Here are some conversations from the airport (Nicole can verify that these are word-for-word accurate).
At the checkout counter:
At the checkout counter:
- Question: “Hey, I’m bringing a ton of narcotics on an international flight, do you have a problem with that?”
- Answer: “Fine with us; talk to TSA.”
At the security checkpoint:
- Question: “Hey, I have this bag strapped to my body that has a big bag of liquid connected to a battery-operated electronic box with a digital timer and all of that is connected to this push-button right here. Do you have a problem with that?”
- Answer: “No.”
- Question: “Yeah, but it’s attached to my body and I can’t run it through the x-ray. You sure.”
- Answer: “Yup”
- Question: “What about this box full of hypodermic needles? Problem?”
- Answer: “Nope.”
Try as hard as I could, I couldn’t get any reaction out of anybody except kindness and professionalism. What's up with that!? Maybe it’s Charlottesville; we’ll see how it goes in AU.
Here’s a picture of the inside of my carry-on (fluid, electronics, wires, push button, and – if you look closely – an hypodermic needle).
Thursday, June 18, 2009
Anyone for a Fentynal-Powered Motorcycle Ride?
This pic is from the Murray's Memorial day pancake b'fast (mmmmm). Aggie needed a ride home, and... well let's just say that she was more willing than she looks. This time I didn't have to do the chicken dance to get her on the bike :).
Monday, June 15, 2009
Pray for my friend, Andrea
As many of you know, God gave me a cancer buddy, Andrea (not sure she wants to be called that, but that's what it is). I kind of knew her from a distance (friend-of-a-friend), but then one night I had a chance to pray for her w/ a group of her friends. "How wonderful to pray for someone else's cancer," I said (kind of a selfish, but true). From that point on, we've been trading stories and encouragement. It's amazing how similar our experiences and outlook are, and because she's been fighting cancer for 10 years; in most ways, she's "out in front" and can tell me what to expect.
Here's a picture of me and Andrea this past weekend commiserating about our shared fight with cancer. This was the first time I removed my IV pain killers, taped everything up, and got wet (or damp shall we say). Lots of painkiller-free jolts to the gut, but totally worth it emotionally!!
Anyway, she has a great prayer network herself, but this has been a week of pretty bad news for her and I wanted to ask you if you would join me in praying her strength, joy, wisdom, and hope.
Here's a picture of me and Andrea this past weekend commiserating about our shared fight with cancer. This was the first time I removed my IV pain killers, taped everything up, and got wet (or damp shall we say). Lots of painkiller-free jolts to the gut, but totally worth it emotionally!! Anyway, she has a great prayer network herself, but this has been a week of pretty bad news for her and I wanted to ask you if you would join me in praying her strength, joy, wisdom, and hope.
Saturday, June 13, 2009
Radiology Report -- Part II
Well, I saw the oncologist on Thursday, and we went over last week's radiology report that talked about two "new" sets of tumors (the subject of the last update). Well, it turns out that one of those "new" sets of tumors are the lumps on my belly that we've all known about and I'm tracking (using a high-tech measurement approach known as "poking 'em w/ my fingertips").
By the way, and I know this is weird, but hey I'll mention it anyway (butt-hay?). Anyway, our good friends the Higgens visited recently and decided that these tumors in particular needed names. After much debate, they dubbed them "tommy and timmy tumor." I think they're working on an children's book based on these characters (you can imagine the illustrations).
Anyway, these tumors don't appear to be growing. So, that's better news than last week's radiology report would indicate. The other "new" tumors mentioned in the report are between the kidney and pancreas. We did find one of these in the Dr. office on Thursday. It's the biggest tumor I have to date -- about the size of a kiwee fruit (i'm trying to pick creative fruit). I went back and looked at the reports from the scan i had in the hospital, and it turns out that at least one of these two tumors was there back then as well. So, a lot of the "new growth" that the radiology report mentions may not be so "new." (although some of it definitely is... that's the remaining "bad news").
Since every thing else is looking good, we're going to do another 6 weeks w/ the same treatment (all the other tumors are stable; my blood counts are the best ever; my leg feels 100% better; the clot may be breaking up sooner rather than later; i'm able to walk some without the cane; etc.). One encouraging note is that the Dr. I met at NIH who was conducting the study offered to continue to track my case even though I'm no longer eligible to be treated by him under the study. I faxed him the radiology report and he called me (at 7:30 in the evening on his personal time!!) and we went over my status. He said, "I would stay the course and rescan in 6 weeks." That was sweet to get such a consistent second opinion.
One quick story about how connected we are without even knowing it: Yesterday, Joanne was at the grocery store. The guy who bags the groceries (I don't even know him) says, "how's your husband?" Joanne gave a quick update. Then he said, "I pray for him every day. Tell him to keep fighting. If there's anything -- and i mean it -- anything -- I can do for you please , please ask." It made me cry.
Well, that's enough for now. More to come soon... i have some fun pics of recent activities that I need to post. Hopefully they'll show up later this weekend.
By the way, and I know this is weird, but hey I'll mention it anyway (butt-hay?). Anyway, our good friends the Higgens visited recently and decided that these tumors in particular needed names. After much debate, they dubbed them "tommy and timmy tumor." I think they're working on an children's book based on these characters (you can imagine the illustrations).
Anyway, these tumors don't appear to be growing. So, that's better news than last week's radiology report would indicate. The other "new" tumors mentioned in the report are between the kidney and pancreas. We did find one of these in the Dr. office on Thursday. It's the biggest tumor I have to date -- about the size of a kiwee fruit (i'm trying to pick creative fruit). I went back and looked at the reports from the scan i had in the hospital, and it turns out that at least one of these two tumors was there back then as well. So, a lot of the "new growth" that the radiology report mentions may not be so "new." (although some of it definitely is... that's the remaining "bad news").
Since every thing else is looking good, we're going to do another 6 weeks w/ the same treatment (all the other tumors are stable; my blood counts are the best ever; my leg feels 100% better; the clot may be breaking up sooner rather than later; i'm able to walk some without the cane; etc.). One encouraging note is that the Dr. I met at NIH who was conducting the study offered to continue to track my case even though I'm no longer eligible to be treated by him under the study. I faxed him the radiology report and he called me (at 7:30 in the evening on his personal time!!) and we went over my status. He said, "I would stay the course and rescan in 6 weeks." That was sweet to get such a consistent second opinion.
In the meantime, we went ahead and planned my upcoming treatment around a trip to Australia (June 19 - July 3) to visit our good friends the Montoya's. This trip has been on the calendar for months and months, and there was a long time when it seemed all but impossible; however, as things stand right now, we hope leave next Friday for Perth. My son looked it up on Google Earth... if you were to go to the Charlottesville airport and ask, "what's the absolute furthest airport on the planet that I can fly to from here, the answer would be "Perth, AU." Oh, and another interesting tidbit... my birthday is June 20, but we have to cross the international date line to get to AU, so it looks like I'll get about 4 hrs of b'day in from Midnight until 4am or so on Saturday and then, all of a sudden, it will be the 21st. What a rip off!! I'm going to talk to the flight attendants and see what they can do to help me pack 24 hrs of birthday celebration into those measly 4 hrs.
One quick story about how connected we are without even knowing it: Yesterday, Joanne was at the grocery store. The guy who bags the groceries (I don't even know him) says, "how's your husband?" Joanne gave a quick update. Then he said, "I pray for him every day. Tell him to keep fighting. If there's anything -- and i mean it -- anything -- I can do for you please , please ask." It made me cry.
Well, that's enough for now. More to come soon... i have some fun pics of recent activities that I need to post. Hopefully they'll show up later this weekend.
Friday, June 5, 2009
Radiology Report
Looks like the "hooray" was premature :(. I just got the radiology report and it says the cancer is spreading in my kidneys, pancreas, and abdominal wall. I don't know how bad it is yet, but the report uses words like "multiple new nodules" and "extensive new implants...". These could be very small, and it may not be that serious. The lungs are stable, and the "new" nodules are all at sites where there was already an indication of cancer. I have a call in to the Oncologist (who missed all of this yesterday) to see if "stay the course" is still the plan of attack. I did say to Joanne last night, "Even though Dr. T didn't see anything, I know there's something in my abdomen... i can feel it" ... so the news isn't totally unexpected, but it's still a bit discouraging after feeling so optimistic yesterday. I'm still trusting and fighting!! Thanks for fighting with me.
Thursday, June 4, 2009
Latest Scan
Well, I've been in the hospital since 7am, and am having chemo now. It all started with a scan this AM. I don't have the radiology report yet, but I looked at the images with my oncologist (who was frazzled, multitasking, and 2.5 hrs behind schedule... so we take his comments w/ a grain of salt). He (and I) couldn't find any signs of new cancer. The lung nodules are the same as before (and relatively small), same with the tumors near the surface of my belly. He didn't have the time to search around the bowels and find the stuff in there, so we wait for the radiologist, but a quick look through them, and he didn't notice anything dramatic. So, perhaps an early hooray is in order...
Thanks for all your prayers and kind thoughts. I am convinced that they are the the key to keeping the cancer from spreading -- this is what I have faith for right now... stable disease... some of you have a bigger faith ... a faith for total healing. Hooray for you guys and thank you for your big faith!!).
Thanks for all your prayers and kind thoughts. I am convinced that they are the the key to keeping the cancer from spreading -- this is what I have faith for right now... stable disease... some of you have a bigger faith ... a faith for total healing. Hooray for you guys and thank you for your big faith!!).
Sunday, May 31, 2009
A Quick Update
I started the anti-clotting drug; don't know how long it will take for it to work. There's still quite a bit of pain in my right calf; hopefully most of this is due to the clot and will go away shortly. Finished this week's chemo yesterday and it wasn't as bad as the last time. Still some nausea and fatigue, but overall it was okay ... I took lots of naps this weekend :). Thanks again to all for your prayers and encouragement.
Friday, May 29, 2009
Ode to my Blockages
While getting my chemo at Uni-V of VA,
The Drs. together were all wont to say,
“In general your health looks better each day”
but these blockages of yours, they must go away.”
What blockages? Ahh, yes, well that is the question
The first one relates to GI and digestion:
My bowels, ah my bowels, my long-lasting obsession
They seem to be stuck in a bit of regression.
“We declare war on this new constipation”
My Dr. she said with stern consternation
“You cannot regress – start massive hydration,
Colace and Miralax will be your salvation.”
“But there may be something else – something even more serious
We will need a new scan to see if it’s injurious”
It might explain the pain that's been so mysterious.
Yup, there's a clot in the calf… could be deleterious.
“You can go to ER or go home and rest”
I said, “Avoiding ER is always the best.”
The Dr. agreed (although he was a bit stressed stressed)
So home to my home group – I’m abundantly blessed.
Now it’s hang out with my leg in the air
Trying to get meds (can’t find ‘em anywhere)
Fragmin it’s called – stick it in my belly, bare
Once every day to receive adequate care.
So that’s all the news for my update sublime
As you can tell, I have a tad extra time
I’m sitting around -- feeling mostly fine
Waiting on Fragmin -- blogging in rhyme.
The Drs. together were all wont to say,
“In general your health looks better each day”
but these blockages of yours, they must go away.”
What blockages? Ahh, yes, well that is the question
The first one relates to GI and digestion:
My bowels, ah my bowels, my long-lasting obsession
They seem to be stuck in a bit of regression.
“We declare war on this new constipation”
My Dr. she said with stern consternation
“You cannot regress – start massive hydration,
Colace and Miralax will be your salvation.”
“But there may be something else – something even more serious
We will need a new scan to see if it’s injurious”
It might explain the pain that's been so mysterious.
Yup, there's a clot in the calf… could be deleterious.
“You can go to ER or go home and rest”
I said, “Avoiding ER is always the best.”
The Dr. agreed (although he was a bit stressed stressed)
So home to my home group – I’m abundantly blessed.
Now it’s hang out with my leg in the air
Trying to get meds (can’t find ‘em anywhere)
Fragmin it’s called – stick it in my belly, bare
Once every day to receive adequate care.
So that’s all the news for my update sublime
As you can tell, I have a tad extra time
I’m sitting around -- feeling mostly fine
Waiting on Fragmin -- blogging in rhyme.
Wednesday, May 27, 2009
Yardwork and IPODs and treatment continues...
Well, it's been a while since I've updated the blog. Sorry about that; in this case that's mostly good news. Over the last week, I've been getting stronger and better; the only downer has been some neuropothy and severe cramps in my right leg/calf, so please pray for those. I'll seee a Dr. about it on Thursday.
But, back to the good news, last weekend I felt positivly, "spry.” On Saturday I did some yard work, which these days consists of riding around in a golf cart giving encouraging instruction to a kid who is swinging around a spin-trimmer. Pretty sweet way to do yard work, eh? The kids, so far, have been great about it. We'll see how long that lasts.
Also, Caleb and I installed an ipod-adaptor in my car… what a job. I mention this because I have only recently become an ipod-user, and this is thanks to a good friend who decided I needed one for the long days in the Hospital or Drs office. It’s been great – especially in the infusion center (which is where I spend my Thursdays). It’s also great at home when I’m tired and can’t sleep but too I’m nauseous to read (which, thankfully, happens less and less – maybe a few times / week).
As far as the medical update, still no sign of ascites (abdominal fluid). This is great news. It definitely means one of the drugs is working (I think it’s the Avastin, but my Dr. won’t commit… that’s because the Avastin was NIH’s idea and the oxaliplatin/5-FU/leucovorin was his (that’s only partly true -- Avastin was first mentioned by NIH, and my oncologist agreed it was the best treatment option in a phone call between UVA and NIH the day I was told I was too sick to do the NIH study). By the way, one of oxaliplatin’s main ingredients is platinum… pretty cool huh. I’m not just silver- or gold- dude. I’m the platinum-dude (by the way, this is the hardest of the drugs I’m taking – I’ll get it again this Thursday. I’ll talk about the side effects in another blog sometime… some are pretty cool)
Anyway, back to the update, the ascites is good, but I have two small tumors (I think I mentioned them before) just under my skin that are easy to feel. These tumors these aren’t shrinking (they’re not growing real fast either), so that’s a sign that we may not be beating back the cancer. We won’t know for sure until I have a scan which (every one is asking) is scheduled for next Thursday, June 4. We’ve been putting it off because we need to give time for the Avastin/5-FU therapy to work. If I get scanned earlier and it doesn’t look good, we’d just say, “well, the treatment hasn’t had time to work, let’s give it a few more weeks.” So, an earlier scan is pointless.
About those grape-sized tumors (if you care – this entry is getting kind of long): They are on my lower-right side right abdomen – right where they removed my Kidney. Earlier scans showed that there was some cancer on the abdominal wall at the nephrectomy site (perhaps they didn’t get everything when they removed the kidney… it’s hard to say. There certainly wasn’t any detectable cancer at that location after the surgery). Well, it turns out that when they tapped me in this area (lower right side), they stirred things up and the cancer re-seeded. I noticed a small lump almost immediately after the tap, and I mentioned it to every Dr. (and Nurse) that saw me. Every single Dr/nurse said, “no, that’s not cancer, it doesn’t spread that way.” I kept saying, “ok, what is it?” They would mumble something about a scar or hematoma. It wasn’t until I had a CT scan in the hospital and the radiologist said that the tumors were consistent with metastatic PRCC that the Dr’s finally admitted that it was possible.
The plan for these is to probably radiate them at some point. Normally pRCC doesn’t respond to radiation, but these are so close to the surface of the skin that they might be able to really blast ‘em in a way they can’t if it’s inside the abdominal cavity or in/near a major organ. We’ll see. I don’t really care (as long as they don’t hurt, and they don’t). In a way it’s nice being able to tell easily if things are growing, shrinking, or staying the same. And, as I said, I think “staying the same” is where we’re at right now. Hopefully that’s enough for today.
Again… thank you all for your thoughts and prayers. I am constantly surprised and super-encouraged by the folks who tell me that they read the blog and are praying. It’s not just my friends (who are the backbone of my support) – it’s friends of friends, and relatives of co-workers, and parents of my kids friends… you are all amazing. I’m blessed and humbled by your love and concern – which, for me, is the one of the main ways God is showing me His love and concern. May he bless you as His love flows through you to me. Thank you!!
But, back to the good news, last weekend I felt positivly, "spry.” On Saturday I did some yard work, which these days consists of riding around in a golf cart giving encouraging instruction to a kid who is swinging around a spin-trimmer. Pretty sweet way to do yard work, eh? The kids, so far, have been great about it. We'll see how long that lasts.
Also, Caleb and I installed an ipod-adaptor in my car… what a job. I mention this because I have only recently become an ipod-user, and this is thanks to a good friend who decided I needed one for the long days in the Hospital or Drs office. It’s been great – especially in the infusion center (which is where I spend my Thursdays). It’s also great at home when I’m tired and can’t sleep but too I’m nauseous to read (which, thankfully, happens less and less – maybe a few times / week).As far as the medical update, still no sign of ascites (abdominal fluid). This is great news. It definitely means one of the drugs is working (I think it’s the Avastin, but my Dr. won’t commit… that’s because the Avastin was NIH’s idea and the oxaliplatin/5-FU/leucovorin was his (that’s only partly true -- Avastin was first mentioned by NIH, and my oncologist agreed it was the best treatment option in a phone call between UVA and NIH the day I was told I was too sick to do the NIH study). By the way, one of oxaliplatin’s main ingredients is platinum… pretty cool huh. I’m not just silver- or gold- dude. I’m the platinum-dude (by the way, this is the hardest of the drugs I’m taking – I’ll get it again this Thursday. I’ll talk about the side effects in another blog sometime… some are pretty cool)
Anyway, back to the update, the ascites is good, but I have two small tumors (I think I mentioned them before) just under my skin that are easy to feel. These tumors these aren’t shrinking (they’re not growing real fast either), so that’s a sign that we may not be beating back the cancer. We won’t know for sure until I have a scan which (every one is asking) is scheduled for next Thursday, June 4. We’ve been putting it off because we need to give time for the Avastin/5-FU therapy to work. If I get scanned earlier and it doesn’t look good, we’d just say, “well, the treatment hasn’t had time to work, let’s give it a few more weeks.” So, an earlier scan is pointless.
About those grape-sized tumors (if you care – this entry is getting kind of long): They are on my lower-right side right abdomen – right where they removed my Kidney. Earlier scans showed that there was some cancer on the abdominal wall at the nephrectomy site (perhaps they didn’t get everything when they removed the kidney… it’s hard to say. There certainly wasn’t any detectable cancer at that location after the surgery). Well, it turns out that when they tapped me in this area (lower right side), they stirred things up and the cancer re-seeded. I noticed a small lump almost immediately after the tap, and I mentioned it to every Dr. (and Nurse) that saw me. Every single Dr/nurse said, “no, that’s not cancer, it doesn’t spread that way.” I kept saying, “ok, what is it?” They would mumble something about a scar or hematoma. It wasn’t until I had a CT scan in the hospital and the radiologist said that the tumors were consistent with metastatic PRCC that the Dr’s finally admitted that it was possible.
The plan for these is to probably radiate them at some point. Normally pRCC doesn’t respond to radiation, but these are so close to the surface of the skin that they might be able to really blast ‘em in a way they can’t if it’s inside the abdominal cavity or in/near a major organ. We’ll see. I don’t really care (as long as they don’t hurt, and they don’t). In a way it’s nice being able to tell easily if things are growing, shrinking, or staying the same. And, as I said, I think “staying the same” is where we’re at right now. Hopefully that’s enough for today.
Again… thank you all for your thoughts and prayers. I am constantly surprised and super-encouraged by the folks who tell me that they read the blog and are praying. It’s not just my friends (who are the backbone of my support) – it’s friends of friends, and relatives of co-workers, and parents of my kids friends… you are all amazing. I’m blessed and humbled by your love and concern – which, for me, is the one of the main ways God is showing me His love and concern. May he bless you as His love flows through you to me. Thank you!!
Monday, May 18, 2009
My day at DMV, etc
So, I spent most of the day at the DMV getting a disability permit, and then at UVA getting an injection to help my white blood count (which, based on bloodwork I had at the same time, I may not have needed). Oh well... i'm getting used to hanging around in waiting rooms. I'm so excited about the permit, and then, as I drove away from my beautiful super-secret UVA handicapped parking space on Hospital Drive, the following question occurred to me: "where would you hang the permit on a motorcycle… and if you hung it on the handlebars, would it likely get stolen?” I’m sure I could “Housify” my motorcycle and find a place for the cane. 
Anyway, I actually looked it up, and there are a bunch of states that give out handicapped plates for a motorcycle, but as far as I can tell, VA isn’t one. I think the parking spaces would be marked like this =>
Speaking of House, My kids say every day I become more like Dr. H in every way. First, I am just plane ornery, then I get a motorcycle, then – after the nephrectomy – I regularly express my great fondness for opiate pain killers (mmmm... fentanyl). I tel nurses and interns what to do. And, I’m walking with a cane. What more is there?
Anyway, I actually looked it up, and there are a bunch of states that give out handicapped plates for a motorcycle, but as far as I can tell, VA isn’t one. I think the parking spaces would be marked like this =>Speaking of House, My kids say every day I become more like Dr. H in every way. First, I am just plane ornery, then I get a motorcycle, then – after the nephrectomy – I regularly express my great fondness for opiate pain killers (mmmm... fentanyl). I tel nurses and interns what to do. And, I’m walking with a cane. What more is there?
Friday, May 15, 2009
The Spigotless Wonder!!
Well, guess what? I went in for the spigot install. The plan was to put in the pleurex catheter and then use it to drain the fluid that built up since my last abdominal tap which was 1 week ago. BUT... there was hardly any fluid buildup!! This is great news. It means that, at the very least, that the cancer treatment is doing some good and keeping things under control enough to prevent the fluid buildup. All the Drs and nurses were surprised and thrilled!!After that, I went up to the oncology infusion center for 6 hours of in-hospital chemo treatments. Then they sent me home w/ a bag of chemo (5-FU) that I’ll do until Sat night. This is my second portable IV, so now wherever I go I’m carrying around two big shoulder bags of meds. It’s mostly ok, though, because so far “wherever I go” = “nowhere” I’ve been feeling pretty tired and nauseas, so I’ve mostly just slept since 9:30 last night (that’s why this blog is so late in coming).
Getting back to the spigot. Based on the overwhelming number of comments, I know that as exciting as the news of my lack of spigot is, the news you all were really hoping for would have been illustrated by this pic. Oh well.Next week should be a normal week until Thursday when I have, hopefully, a CT scan (I’ve asked for one), and another round of chemo (Avastin). Thanks again for the continued prayers and support.
Wednesday, May 13, 2009
Every day I feel stronger. Yesterday and today I ahve been able to work part-time and I'm slowly working toward being back to work something closer to "full-time" (whatever that ends up meaning :). Here’s what I’m especially thankful for today – I’m back at work because I want to be not because I have to. This is another wonderful gift from everyone at Barron Associates… they are the kind of people with whom I want to spend my days with; they are the kind of people who graciously took initiative to covered for me so I never felt the pressure of having to be there. They even watered my plants :). You folks at Barron are the best, and I count working with you all as one of the big blessings in my life. Thank you.
Tuesday, May 12, 2009
Psalm -- by Richard Wilbur
Give thanks for all things
On the plucked lute, and likewise
The harp of ten strings.
Have the lifted horn
Greatly blare, and pronounce it
Good to have been born.
Lend the breath of life
To the stops of the sweet flute
Or capering fife,
And tell the deep drum
To make, at the right juncture,
Pandemonium.
Then, in grave relief,
Praise too our sorrows on the
Cello of shared grief.
On the plucked lute, and likewise
The harp of ten strings.
Have the lifted horn
Greatly blare, and pronounce it
Good to have been born.
Lend the breath of life
To the stops of the sweet flute
Or capering fife,
And tell the deep drum
To make, at the right juncture,
Pandemonium.
Then, in grave relief,
Praise too our sorrows on the
Cello of shared grief.
Monday, May 11, 2009
Happy Belly
Well, back by popular demand... a fat man with breasts... Only this time in cartoon form. Things continue to improve in the belly/bowel front. I just got home from seeing Palliative care and my Onc. One of the biggest pieces of news is that that I’ve been up all day and am still feeling pretty good. The docs say my progress is amazing and they can’t believe how well I’m doing. My onc said it's great to see me feeling so much better. I said, "I don't want to feel better, I want to be better!" He kind of took exception to that (rightly so, I think) and said that feeling better was pretty important. And it's true, in all of the areas that put me in the Hosp, i'm much better. As far as the response of the Cancer to treatment, my oncologist says that, subjectively, things are looking good, but there won’t be any objective measure for 2 or 3 weeks. He really wants to give the new therapies time to keep working (but the abdomen is not swelling as fast, and that’s always a good sign). Of course, I’m always asking about other treatment options, and my doc was giving me a hard time saying that I’d be on 13 different drugs if he would let me. I said, “why not.” And he said that besides quality of life (which would be awful), there isn’t a lot of evidence that simultaneous is better than sequential…. Especially in my case where drugs tend to work for an period of time and then stop for a while. So, I think patience is the name of the game. Thanks again for all your prayers and notes, etc. You all are great.
there's a rumor going around...
For those of you who heard rumors about a motorcycle ride this weekend, I just want to say my pastor made me do it! "Are you sure I should do it?" I ask. "Sure," he says, "there's a long history of combining narcotics and Motorcycle riding.... go for it..." (or something like that... my memory is a bit fuzzy). Don't you all wish you had a pastor like that? God bless him. Anyway, D., C., and I hit the road for a wee bit on Sat and boy was it great. We stopped at a little VA back-country store, and I told the girl behind the counter that I wanted to treat these guys in the leather to a soda because "they made me feel like a real man for the first time in a month." Then I said, "and I'm not going to explain that..." But, before I could finish saying "I'm not going to explain that," my pastor was explaining like crazy... Anyway, I had to lie down for 2 hrs to recver, but boy was it worth it. Thanks guys. PS. That pic really is my Motorcycle - it looks cool as long as it's not parked next to Danny's.
Friday, May 8, 2009
I'm finally home -- thanks for everything
Well, I'm finally home, and first, and most important, THANK YOU to everyone for your support, encouragement, prayers, and love. What an experience, and I mean that in a good way. Thanks to the folks at work for covering me so well, and thanks to the folks on 3-East for their GREAT care. Can't say I hope to be back, but I will miss all the excellent Nurses and PCAs.
I got home around 5:30 last night (with boxes of hospital supplies, walkers, etc.). Spent a long time walking around w/ the kids amazed at what 3 weeks of spring rains will do! Ate a light dinner, had a short and very sweet and special visit with Home Group, watched a movie with the family, went to bed, and slept pretty well (as well as I did in the hospital). I'd say it's almost normal except for taking 10 times as long to do everything (I guess I'm living life at the speed of my bowels which continue to make slow progress toward normalcy).
I got home around 5:30 last night (with boxes of hospital supplies, walkers, etc.). Spent a long time walking around w/ the kids amazed at what 3 weeks of spring rains will do! Ate a light dinner, had a short and very sweet and special visit with Home Group, watched a movie with the family, went to bed, and slept pretty well (as well as I did in the hospital). I'd say it's almost normal except for taking 10 times as long to do everything (I guess I'm living life at the speed of my bowels which continue to make slow progress toward normalcy). Today it's in for an abdominal tap and another consult about installing a hose that I can use to drain the ascites fluid myself. Then back home for some visits w/ home health care workers. It's going to be weird (and I think hard) to adjust to a life at home that involves so much time resting, recovering, and continuing to manage health-care issues. We'll figure it out.
Tell me what you guys want me to do with the blog. There certainly isn't the daily drama, but I'd be glad to keep posting health updates at whatever rate makes sense.
Thursday, May 7, 2009
Is it really freedom if you have to wear pants?
On the one hand, it looks like I really will get out of here this afternoon. Everything is set up for home health care, and I get a tap tomorrow (probably won't get the spigot until sometime next week). On the otherhand, I have to wear pants (at least that's what I hear).(Image: http://heliologue.com/2006/10/06/i-find-pants-confining/)
Wednesday, May 6, 2009
Out with the old ducts; in with the new
Well, the NG tube is gone! Thank you Dr. Tuttle!
I'm awaiting a bagle and soup for lunch... the first solid food in over 2 weeks. The GI is still recovering slowly, but it's on the mend and it looks like as long as I don't vomit in the next 24 hours, I'll be going home tomorrow midday after an IV avastin (anti-cancer) treatment.
I'll be doing IV pain killers (through my new central line catheter) and, possibly, nutrition at home (depending on how long it takes the bowels to fully recover). Then, it looks like it's back into the hospital as an outpatient on Friday for another abdominal tap and a PleurX catheter (TM). That is basically a DIY ascites kit so that I can do abdominal taps at home. It's pretty complicated, but for those who are interested in the technical details, I have included a picture (see below).
Picture courtesy of http://www.brucio.com/images/writing/gut_spigot_copy.jpg
Tuesday, May 5, 2009
The end of the tunel??
Well, there's some light up ahead. It's not real clear, but it's certainly there.
First, in the bowel department, still no real gas production (those who know me will know that this definitely is a sign that things aren't "normal" yet). But, I am eating food and keeping it down, and still having itsy-bitsy bowel movements from time to time. Hopefully all of this will continue. So, the plan is:
- “Full” liquids today – the UVA nutritionists think that means pudding and Ensure (yuck!). I, on the other hand, am arguing for homemade broth (JK Chicken and Revolutionary Tomato Bisque). So far, I’m winning (mmm)
- If I can keep from vomiting (and the nausea was much better today), Remove the NG tube tomorrow morning.
- Watch things throughout the day and consider going home tomorrow, OR stay around for one more Avastin treatment on Thursday and then go home. As far as the Avastin/Chemo goes, we’ll probably give it another 2 to 4 weeks before we really know how well it’s working, but there continues to be a reduction in pain and ascites buildup, so that’s all good.
I spoke w/ a social worker today about home health care and, apparently, I can do all my intravenous nutrition and pain management at home. Plus, I can do lots of the chemo at home as well. I think it “helps” that the insurance company has started calling the hospital daily and saying, “you know, it seems to us like you could do lots of this stuff at home…” Never thought I’d be thanking my insurance company for pushing me out of the hospital, but in all seriousness, they’ve been great. They push and then say, “of course, it’s up to you…” Pretty amazing, huh? Hooray for the last vestiges of private health insurance… not sure if the system can keep working much longer, but I’m glad I’m still part of it and that I’m blessed w/ good coverage.
So, keep praying. We’ll see. It’s been GREAT to have a day w/ minimal nausea and significantly reduced pain.
(Image from: http://revjavadude.files.wordpress.com/2009/03/light-tunnel-01.jpg)
3 liters ... not bad ...
Well, you asked for it. Here's today's paracentesis pic of the week. That’s me and the 3rd-year medical student who is doing her 2nd-ever abdominal tap. The resident is holding the syringe w/ my abdominal fluid in it… he’s showing her how to do the tap, although, if you can imagine, I spent most of the procedure telling her how to do it myself... "now remember, when you make the incision with the scalple, it's important not to be too timid... etc." The resident probably spent the next 30 minutes telling how evertything I told her that was completely untrue.
She got 3 liters off. I’m pretty sure there was another half- to whole- liter in there, but she did a great job. I gave her a B+.
I told the Drs that as far as I know, there's not one word in HIPAA that would prevent me from posting their pics on the internet :) ... hooray for one-sided legal agreements...
Monday, May 4, 2009
still holding
Still not much to report... some continuing signs (very small but positive) that the bowels are starting to work. It’s been a little bit of a roller coaster of nausea and pain, but during the “highs,” I feel better than I have in weeks. I had a really good luke-warm latte this AM (mmmmm...) and some broth tonight; otherwise, as far as solid food is concerned, i'm having to settle for the food network (man vs. food... my new favorite show). Might be able to get rid of the NG tube tomorrow.
Had a good walk today with Karisa and Nichole (which included some geometry and was STILL good). This is my second "long" walk (across the bridges to jordan hall and the west complex, etc... i don't think they really want me going that far, but i can't help it... all these secret tunnels and walkways...i feel like a hamster...)
Steve Hobeck is my sleepover guest tonight (thanks so much to everyone who has signed up and spent the night .. Mark, Bentley, Kevin, Walt, Derek, Tom S...…) -- I’m trying to decide if I should put Steve on hemorrhoidal duty tonight… I’m thinking not… thoughts?
Had to say "goodbye" to my Springsteen tickets tonight. Well, Sam (or should I say "goose"), that's 2 strikes... under no circumstances will I be signing up for a 3rd... who knows what'll happen. Oh well, the tickets are in good hands :).
Thanks again to all who have called, emailed, visited, posted to the blog, prayed, and shown love in general. I'm abudently blessed.
Had a good walk today with Karisa and Nichole (which included some geometry and was STILL good). This is my second "long" walk (across the bridges to jordan hall and the west complex, etc... i don't think they really want me going that far, but i can't help it... all these secret tunnels and walkways...i feel like a hamster...)
Steve Hobeck is my sleepover guest tonight (thanks so much to everyone who has signed up and spent the night .. Mark, Bentley, Kevin, Walt, Derek, Tom S...…) -- I’m trying to decide if I should put Steve on hemorrhoidal duty tonight… I’m thinking not… thoughts?
Had to say "goodbye" to my Springsteen tickets tonight. Well, Sam (or should I say "goose"), that's 2 strikes... under no circumstances will I be signing up for a 3rd... who knows what'll happen. Oh well, the tickets are in good hands :).
Thanks again to all who have called, emailed, visited, posted to the blog, prayed, and shown love in general. I'm abudently blessed.
Sunday, May 3, 2009
not much to report
I wish there was more to report. Not much action. Tried to eat a bit of jello today, but ended up vomiting (yes... with the NG tube in place).
I continue to wonder when I will begin to exhaust the vast ocean of love you all have for me and my family... there are no signs of it slacking... it is nothing short of a miracle. My heart is so unbelievably tender toward everyone who has been the hands and feet of Christ, Himself, to me. Thank you.
I continue to wonder when I will begin to exhaust the vast ocean of love you all have for me and my family... there are no signs of it slacking... it is nothing short of a miracle. My heart is so unbelievably tender toward everyone who has been the hands and feet of Christ, Himself, to me. Thank you.
Saturday, May 2, 2009
Some Tail Wind
In my case, it’s the other ‘way round. The Dr’s want to hear something, and it’s not my heart. For those of you who know me, I pride myself on a healthy, farty, digestive track. But, alas, it is failing me. While a bit of loose stool is a good start, what we need is some honest-to-god flatulence, and we’ve been waiting for days. So (and I’m not kidding), please fast for some gas. Pray for the sounds of the uncorked symphony -- a bratwurst bugler, a butt trumpeter, a trouser troubadour, a colonic calliope, a gluteal tuba, a toothless kazoo, and a turd whistling for the right of way. Seriously, I’m hoping for a major backfire, a bottom burp, a cheek flapper, and a visit from Grandpa. I want to go insane with the methane, and kill the canary. I’m hoping for a serious tail wind and a minor trouser cough. Ummmm….. HUMMMmmmrrhoids.
Friday, 5/1
After a somewhat difficult night, Dave was able to get some rest today (Friday). They seem to be doing a better job of controlling his pain and the hemorrhoids are getting better. He has had diarrhea, a sign that the lower half of his digestive track is working, but the upper half (stomach) has yet to kick in. He can't eat anything until everything starts working. It's been quite a while since Dave's had any food (in the meantime, he's been watching the cooking channel!); the doctors are going to start giving him IV nourishment.
He had to be tapped again today (they took off about 4 liters)- this is the first time in about 5 days so the fluid production rate has definitely slowed. They put in a central line which will make future blood draws, IVs, and rounds of chemo easier on both Dave and the hospital staff. Dave's finishing up a 2-day course of the new chemo and we can continue to pray that it goes to work on his cancer.
Meredith
He had to be tapped again today (they took off about 4 liters)- this is the first time in about 5 days so the fluid production rate has definitely slowed. They put in a central line which will make future blood draws, IVs, and rounds of chemo easier on both Dave and the hospital staff. Dave's finishing up a 2-day course of the new chemo and we can continue to pray that it goes to work on his cancer.
Meredith
Thursday, April 30, 2009
True or False
I am now the proud owner of a customized version of the book "Everybody Poops" that has a page about "Dave" in it. It was one of the proudest moments of my life. And to think that only days ago I said to someone, "do you know that book 'Everybody Poops?' It's a lie!" How quickly I've had to eat my words. Mmmmmmm.... they taste so good....
Brief Update (okay.... not so brief...)
Here's a brief update to clarify some confusion.
The process of recovering from the ileus is as follows:
1. Shut everything down (for the reboot). That includes the tube down the nose and into the stomach to pump stuff out from the top.
2. Wait for things to start clearing out from the "bottom up". The small, loose bowel movements are the first signs of this. I continue to have them (and some pee), and this is great.
3. Stop the suction for a period of time to see if the upper bowels are able to process the gastric juices on their own. At the moment, we have stopped suction a number of times, only to have to restart it after a while b/c I get more and more nauseous. SO.... as far as the ilius is concerned, the next step is to pray that my upper intestines will begin working on the gastric juices.
4. Begin to eat ... very slowly at first. Jello, etc. Then more and more solid foods. We're probably days away from this. FYI... it's probably been 5 or 6 days since I've eaten anything. Apparently, people go weeks, so it's not an issue.
The whole process can take days and days. Pooping is only the beginning, so keep praying. It's almost certain that I will be in the hospital through the weekend.
In the mean time.........
Tomorrow, I'll get a scan and possible drain of the abdominal fluid. The rate of buildup has slowed SIGNIFICANTTLY (hooray!), but it is still accumulating, and we don't want to get behind on that since that's what set all this junk off in the first place.
And... Today I start some xtra chemo. This chemo is a very very long shot at actually knocking out the Cancer (the other treatments are designed to shrink and slow it, but not to get rid of it). I'm glad my Dr. wants to be aggressive and take a shot at it. He's hoping that my cancer is "wierd enough" that it might just respond, whereas pRCC generally does NOT respond to Chemo.
And... a note on terminology. Chemo generally applies to toxic agents designed to kill the cancer cells. The other treatments I have had (including the Avastin) are not, properly, chemo since they are not really toxic to the cancer cells, but are designed to interrupt the biologic process by which the tumors grow.
OK.... I hope that clears things up and gives a clearer picture as to why I'm still here. Sorry for the boring post.
On a personal note, I continue to sleep ok, and my pain level is reasonable (some abdominal pain, but it's manageable). The tube down the nose is uncomfortable (especially when I swallow), but it's tolerable. And I continue to feel surrounded by more love and support than anyone could deserve. Thank you all.
The process of recovering from the ileus is as follows:
1. Shut everything down (for the reboot). That includes the tube down the nose and into the stomach to pump stuff out from the top.
2. Wait for things to start clearing out from the "bottom up". The small, loose bowel movements are the first signs of this. I continue to have them (and some pee), and this is great.
3. Stop the suction for a period of time to see if the upper bowels are able to process the gastric juices on their own. At the moment, we have stopped suction a number of times, only to have to restart it after a while b/c I get more and more nauseous. SO.... as far as the ilius is concerned, the next step is to pray that my upper intestines will begin working on the gastric juices.
4. Begin to eat ... very slowly at first. Jello, etc. Then more and more solid foods. We're probably days away from this. FYI... it's probably been 5 or 6 days since I've eaten anything. Apparently, people go weeks, so it's not an issue.
The whole process can take days and days. Pooping is only the beginning, so keep praying. It's almost certain that I will be in the hospital through the weekend.
In the mean time.........
Tomorrow, I'll get a scan and possible drain of the abdominal fluid. The rate of buildup has slowed SIGNIFICANTTLY (hooray!), but it is still accumulating, and we don't want to get behind on that since that's what set all this junk off in the first place.
And... Today I start some xtra chemo. This chemo is a very very long shot at actually knocking out the Cancer (the other treatments are designed to shrink and slow it, but not to get rid of it). I'm glad my Dr. wants to be aggressive and take a shot at it. He's hoping that my cancer is "wierd enough" that it might just respond, whereas pRCC generally does NOT respond to Chemo.
And... a note on terminology. Chemo generally applies to toxic agents designed to kill the cancer cells. The other treatments I have had (including the Avastin) are not, properly, chemo since they are not really toxic to the cancer cells, but are designed to interrupt the biologic process by which the tumors grow.
OK.... I hope that clears things up and gives a clearer picture as to why I'm still here. Sorry for the boring post.
On a personal note, I continue to sleep ok, and my pain level is reasonable (some abdominal pain, but it's manageable). The tube down the nose is uncomfortable (especially when I swallow), but it's tolerable. And I continue to feel surrounded by more love and support than anyone could deserve. Thank you all.
Wednesday, April 29, 2009
Wednesday, 4/29
Dave had a pretty good day today. The intestinal "reboot" shows signs of working. They removed the catheter and Dave produced a little bit of pee (the nurse said it wasn't enough to count, but Dave disagrees!). He also had a bit of diarrhea and some cramping of the lower bowel which, though uncomfortable, is a good sign.
Dave and Joanne met with his oncologist today and decided to start a supplemental IV chemotherapy tomorrow. The drug they plan to try is usually used for colon cancer (often in conjunction with Avastin) - it's a long shot, but it's worth a try. Pray that it works!
Meredith
Dave and Joanne met with his oncologist today and decided to start a supplemental IV chemotherapy tomorrow. The drug they plan to try is usually used for colon cancer (often in conjunction with Avastin) - it's a long shot, but it's worth a try. Pray that it works!
Meredith
We have ignition...
Hooray!!
While for most, this would be a complaint... for me, it's cause for great rejoicing!! I've been dancing around singing the theme to rocky... "feelin' strong...dum de dum..." And, of course, given my grand-teton-like piles, the looser the better!!
Now for the problem... the Drs are so encouraged that they want to remove my Foley Catheter! I'm a bit nervous about getting rid of that crutch... especially since this will be the THIRD time the catheter has been inserted and then removed!!
Oh, well..... once again, it's time to pray for pee. (chimp or race horse.... i don't care...)
Paralytic Ileus
This is the current diagnosis. Here's a pic:
Basically, it's when the intestines shut down and stop moving things through them. This can happen when they become distended, disturbed, or are subject to an electrolyte imbalance (my bowels have seen all three of these). The solution is basically a "reboot" of the whole system. First, clear everything out via stomach pump, then no food or drink, then a slow recovery process. It typically takes days to get them moving again. Laxitives, etc., don't help here b/c the nerves in the bowels aren't working at all, so there's nothing to "stimulate." So.... here's waiting... meanwhile, the pain is substantially lowered (thanks to the stomach pumping), and I'm able to sleep.
On the cancer front, it still looks like things are progressing reasonably well. The rate at which the ascites (abdominal fluid) is building up has slowed significantly. This is a very good sign that the new chemo is working. Meanwhile, I'm talking to my doc about some other supplementary chemo regimines; however, it's pretty important that my body be healthy when we start, so we need to get over this ilius hump (which should take a few days).
Thanks to all for the prayers, notes of encouragement, and visits. You guys are going above-and-beyond the call of duty when it comes to fellowshiping with me in my sufferings. Cancer doesn't really leave any room for pride or shame or anything else -- there's just the naked truth and the need for helping hands to serve me in my humility. I love you all for that, and pray that you will be blessed many times over.
Basically, it's when the intestines shut down and stop moving things through them. This can happen when they become distended, disturbed, or are subject to an electrolyte imbalance (my bowels have seen all three of these). The solution is basically a "reboot" of the whole system. First, clear everything out via stomach pump, then no food or drink, then a slow recovery process. It typically takes days to get them moving again. Laxitives, etc., don't help here b/c the nerves in the bowels aren't working at all, so there's nothing to "stimulate." So.... here's waiting... meanwhile, the pain is substantially lowered (thanks to the stomach pumping), and I'm able to sleep.
On the cancer front, it still looks like things are progressing reasonably well. The rate at which the ascites (abdominal fluid) is building up has slowed significantly. This is a very good sign that the new chemo is working. Meanwhile, I'm talking to my doc about some other supplementary chemo regimines; however, it's pretty important that my body be healthy when we start, so we need to get over this ilius hump (which should take a few days).
Thanks to all for the prayers, notes of encouragement, and visits. You guys are going above-and-beyond the call of duty when it comes to fellowshiping with me in my sufferings. Cancer doesn't really leave any room for pride or shame or anything else -- there's just the naked truth and the need for helping hands to serve me in my humility. I love you all for that, and pray that you will be blessed many times over.
Tuesday, April 28, 2009
Tuesday, 4/28
The good news is that Dave had a CT scan today and there doesn't seem to an intestinal blockage. The bad news is that his bowels are still not working and the hemorrhoids are extremely painful. Dave is hungry but he's not allowed to eat anything until things start moving. For now it's ice chips and sips of water...
He got some sleep last night and this morning (thanks to the Ativan IV) and hopes to do the same tonight. He's been moved to a private room (3101).
Thank you all for praying,
Meredith
He got some sleep last night and this morning (thanks to the Ativan IV) and hopes to do the same tonight. He's been moved to a private room (3101).
Thank you all for praying,
Meredith
Monday, April 27, 2009
Other facts
Dave now has an NG tube (down his nose into his stomach) in an attempt to drain the bile from his stomach and relieve some pressure. After a painful, sleepless night, Dave got an Ativan IV this morning and was able to sleep for many hours. This afternoon he went to radiology for an abdominal tap and they removed 4 liters of fluid. His last tap was on the 4/19, so the rate of fluid production seems to have diminished (Avastin appears to be working!). The most pressing issue (pun intended) is that his bowels aren't working and he has developed massive hemorrhoids. Please continue to pray for normal bowel and bladder function, relief from pain, and a good night's sleep.
Meredith
Meredith
How Strange
A few scenes from an evening of ineffective enemas and botched catheterizations:
A quote from maintenance:
"How did he get it on all three walls AND the ceiling?"
A poem:
How strange that pain
has pitched it's tent
at the place of excrement
Here's me as of 5pm on Monday...
Special thanks to Roger Brooks who flew down all the way from NYC to sit watch with me through a sleepless night of screaming, moaning, and pain.... patiently praying and reading from the book of common prayer rite for the sick... what a good friend.
A quote from maintenance:
"How did he get it on all three walls AND the ceiling?"
A poem:
How strange that pain
has pitched it's tent
at the place of excrement
Here's me as of 5pm on Monday...
Special thanks to Roger Brooks who flew down all the way from NYC to sit watch with me through a sleepless night of screaming, moaning, and pain.... patiently praying and reading from the book of common prayer rite for the sick... what a good friend.
Update
Good news: adrenal gland appears normal.
Bad News: more abdominal discomfort than ever before. difficulty managing pain. Much is due to problems in GI tract (urnation/defication). Drs are trying what they can. I will NOT try and go home tomorrow.
Thanks to all who gave up afternoons / evenings to be with me. Tonight, especially, thanks Anne B. for letting Roger come down from NYC just to visit and hang and help (he really is a big help!).
Bad News: more abdominal discomfort than ever before. difficulty managing pain. Much is due to problems in GI tract (urnation/defication). Drs are trying what they can. I will NOT try and go home tomorrow.
Thanks to all who gave up afternoons / evenings to be with me. Tonight, especially, thanks Anne B. for letting Roger come down from NYC just to visit and hang and help (he really is a big help!).
Sunday, April 26, 2009
Sunday Evening Post
I was able to get by the hospital to see Dave before church and again mid-afternoon today. This morning Dave discussed with the doctor the goals for his day - get his "digestive system" moving better, perform and analyze some tests on his adrenal gland to see if it is working properly, and do another tap to drain any excess fluid.
As of 4:30 this afternoon, Dave has ingested plenty of laxative and was still waiting for positive results. The tests on his adrenal gland had been performed, also with results still pending. The tap was not done, as they were unable to find a pocket of fluid large enough to do one, which Dave is embracing as a good thing.
I asked Dave about his nutrition, and whether he had eaten his breakfast this morning. He said that he had a couple bowls of cereal, twice in fact. The cereal ultimately stayed down.
Dave has discussed with the doctors his desire to become an outpatient and return home tomorrow, so that is a goal they are working on.
Thanks for your continued prayers.
Mark
As of 4:30 this afternoon, Dave has ingested plenty of laxative and was still waiting for positive results. The tests on his adrenal gland had been performed, also with results still pending. The tap was not done, as they were unable to find a pocket of fluid large enough to do one, which Dave is embracing as a good thing.
I asked Dave about his nutrition, and whether he had eaten his breakfast this morning. He said that he had a couple bowls of cereal, twice in fact. The cereal ultimately stayed down.
Dave has discussed with the doctors his desire to become an outpatient and return home tomorrow, so that is a goal they are working on.
Thanks for your continued prayers.
Mark
Adrenelan
When I had the nephrectomy, they also removed one of my adrenal glands (the one near the infected kidney). Recent scans have shown some cancer activity near the one remaining adrenal gland. Today, this gland is being investigated as a possible source of a lot of my problems here. Please pray that either (a) the gland would check out OK, or (b) that they find the problem there, but that it’s something easily treatable/fixable.
Saturday, April 25, 2009
UPDATE
Blood chemistry is improving... that's good news and was one of the key worries, but the abdominal pain is back and with a vengence. Also, lots of coughing, gagging, etc. Can't really eat or drink (both desire and dr. orders).
Friday, April 24, 2009
Thanks HG
Some of the home group came by tonight. We went into the day room next to my bedroom and had a good visit. Thanks, guys.dinner is served
Hospital meals aren't quite as bad as everyone says they are... it's just a matter of forcing your abdomen to find room for all that food...
... it's makin' me wait.... it's keepin' me wa-a-a-a-aiting
Felt better in the AM.
Increased pain -- tried to do a tap, but they didn't find enough fluid to drain.
Still need to fix my sodium / potassium balances before they'll even talk about releasing me.
Thursday, April 23, 2009
pee time
Hooray... i just peed like 2 cups, and while it's not "race-horse" quantities, it feels GREAT and is a pretty good sign that we might be turning the corner.
Also, I wanted to thank again everyone who came to visit yesterday... there were so many unexpected visitors, and you brought such messages of hope, love, and support. You guys are the best.
Started Avastin
About to start my 2nd anti-cancer drug, Avastin (90 min IV every other week).
But, I'll probably be in the hospital for a while longer trying to fix the blood chemistry (very high potassium plus very low sodium... wierd combination).
But, I'll probably be in the hospital for a while longer trying to fix the blood chemistry (very high potassium plus very low sodium... wierd combination).
thirsty
Thanks for the notes on the last blog.
Still no news. Blood chemistry is out of whack (high potassium, very low sodium). They've got me on tons of IV fluids, but I'm not allowed to drink.
I think there is a way to "follow" this blog if you create your own blogspot account ... that would mean you'd get an email saying when there's a new post.
-d
Still no news. Blood chemistry is out of whack (high potassium, very low sodium). They've got me on tons of IV fluids, but I'm not allowed to drink.
I think there is a way to "follow" this blog if you create your own blogspot account ... that would mean you'd get an email saying when there's a new post.
-d
GENERAL UPDATE & CURRENT STATUS
Hi folks, I thought I'd try and use this blog to give folks an update on my situation. Between posts that I make and are made on my behalf, hopefully it will become an easier way to keep track of what's going on. Thank you all so much for your kind demonstration of support via letters, prayers, cards, notes and visits. I can't say how much that means to me.
CURRENT MEDICAL STATUS
The current challenge is managing the fluid buildup in my abdomen (ascites). This is caused by the cancer and, possibly, by a reaction to the initial anti-cancer drug I was on (Sutent).
At first, we thought this might be an opportunity to jump ship on the Sutent and get in on an NIH trial drug (XL880) that I've been following since the first diagnosis; however, it turns out that I'm not healthy enough to be a lab rat! Bummer. This isn't just temporary; the XL880 study allows you to have ONE prior therapy for kidney cancer. Once I put that drop of Avastin in my body, I'm no longer eligable for this, particular, trial.
The NIH/NCI oncologist spoke with my Drs here at UVA and together we decided to try an IV drug called Avastin, which works similar to Sutent, but they have actually seen it help clear up Ascites. It also has less side effects, but the downside, is that it's kind of an outdated drug and isn't used much b/c it hasn't been that effective OVERALL in treating pRCC (and even for RCC, there are much better drugs out there). But, again, the main reason for going w/ avastin is the hope that it will clear up the ascites by attacking the cancer (vs. being drained every 36 hours.... ugh!). Once I'm stable, I imagine we'll be looking at some other non-Avastin options.
The insurance company approved the use of this drug, but I'm waiting for the gears to start turning here so I can start taking it.
One minor complication is that a side effect of Avastin is that it can cause bleeding and/or make it hard for your blood to clot. The reason that's a complication is that it makes any procedures related to draining/managing the Ascites much more risky. So.... the goal is to have one really good abdominal tap just before starting the drug (and, once again, I'm waiting.... waiting..... waiting....
I slept well last night (better than in a long time). We've finally got the pain/nausea managed reasonably well (mmmmmm..... narcotics....).
Well, that's probably enough for now. We'll fill in some of the back story shortly and, please, feel free to post/ask questions in the comments section you might have (others might have as well), and I'll do my best to answer.
Once again, thanks to everyone for your love and support. I’ve gotten lots of comments by visitors, roommates, and staff about the quality of the folks who are hangin’ around. You guys are great.
CURRENT MEDICAL STATUS
The current challenge is managing the fluid buildup in my abdomen (ascites). This is caused by the cancer and, possibly, by a reaction to the initial anti-cancer drug I was on (Sutent).
At first, we thought this might be an opportunity to jump ship on the Sutent and get in on an NIH trial drug (XL880) that I've been following since the first diagnosis; however, it turns out that I'm not healthy enough to be a lab rat! Bummer. This isn't just temporary; the XL880 study allows you to have ONE prior therapy for kidney cancer. Once I put that drop of Avastin in my body, I'm no longer eligable for this, particular, trial.
The NIH/NCI oncologist spoke with my Drs here at UVA and together we decided to try an IV drug called Avastin, which works similar to Sutent, but they have actually seen it help clear up Ascites. It also has less side effects, but the downside, is that it's kind of an outdated drug and isn't used much b/c it hasn't been that effective OVERALL in treating pRCC (and even for RCC, there are much better drugs out there). But, again, the main reason for going w/ avastin is the hope that it will clear up the ascites by attacking the cancer (vs. being drained every 36 hours.... ugh!). Once I'm stable, I imagine we'll be looking at some other non-Avastin options.
The insurance company approved the use of this drug, but I'm waiting for the gears to start turning here so I can start taking it.
One minor complication is that a side effect of Avastin is that it can cause bleeding and/or make it hard for your blood to clot. The reason that's a complication is that it makes any procedures related to draining/managing the Ascites much more risky. So.... the goal is to have one really good abdominal tap just before starting the drug (and, once again, I'm waiting.... waiting..... waiting....
I slept well last night (better than in a long time). We've finally got the pain/nausea managed reasonably well (mmmmmm..... narcotics....).
Well, that's probably enough for now. We'll fill in some of the back story shortly and, please, feel free to post/ask questions in the comments section you might have (others might have as well), and I'll do my best to answer.
Once again, thanks to everyone for your love and support. I’ve gotten lots of comments by visitors, roommates, and staff about the quality of the folks who are hangin’ around. You guys are great.
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