LCSC Blog

The non-stop - or, so it seems - television advertising letting all of us viewers know that the 2020 Medicare Open Enrollment window is about to slam shut is nearly over. For those of us age 65 or older, this is not an opportunity to ignore. And given the frequency and repetition (the commercials are repeated, rarely ever different), at least on the channels that I watch (maybe that's the problem?), I feel like Bill Murray reliving his previous 24 hours endlessly in the movie Groundhog Day. However, unlike the movie, I can't do anything to undo what is constantly bombarding me on television. Switching channels during the commercials wouldn't really help because usually I'm watching a specific program in between the commercials, and switching back and forth seems like too much effort. Besides, I might lose the continuity of the program I'm watching if I were to mis-time my switch. I suppose I could mute the commercial but I've heard Joe Namath and others talk about the "give back benefit," the "zero dollar premiums in your area," and the possible additional benefits: "vision including contacts, hearing aids and batteries, home-delivered meals, dental and rides to your doctor's appointment" so often that even if I couldn't hear Joe actually promoting, I would still hear what he's saying in my head since I've probably heard it already a hundred times since the enrollment period began. As I sit and write this on Tuesday, Dec. 1, the end is near, however: Dec. 7, 2020. On that day the senior-centric advertising party (solicitation) will be over. Then the commercials will cease and desist - for now, only to return next year in November when the 2021 Open Enrollment period begins anew. Perhaps I'll be more inclined to act then. After all, I am their target audience. However, my being a senior with a pre-existing condition (cancer) limits and complicates my options. In addition, changing plans means changing doctors and though change can often be a good thing, for me, considering my life occasionally hangs in the balance, change might not be a good thing. In fact, it could be a downright bad thing. I mean, my oncologist has kept me alive for almost 12 years since my Feb. 27, 2009 non-small cell lung cancer stage IV diagnosis. Granted, there may have been a slight revision of my diagnosis since three surgical biopsies performed earlier this year confirmed that what I actually have is papillary thyroid cancer. Nevertheless, changing now seems counterproductive, sort of. The damage is already done. I'm not sure there's much to gain now that a second opinion has similarly confirmed my updated diagnosis and has agreed with my current oncologist's treatment plan: Lenvima for me. But I do feel there's much to lose: nearly 12 years of treatment/experience with my present provider. And even though I understand that medical records can get transferred, I still feel I'd be putting myself at risk by forfeiting the knowledge that has been accumulated by the doctors who have been treating me/managing my care. I imagine it's typical that a patient's survival depends in part on their emotional and psychological make-up. And of course on the doctors and staff that have been responsible for their care. And though I am not unaware of the possible mistake/blip on my medical radar with respect to my actual diagnosis, I still feel that I should stay on the horse on which I rode in on, if you know what I mean? Switching plans would mean switching doctors, staffs, procedures, et cetera. And I'm just not sure if I'm emotionally (there's that word again) equipped to deal with such upheaval in my life/care. All of this being said - and sort of anticipated - listening to all those Medicare Open Enrollment commercials has made Kenny a very dull boy, and an aggravated one at that. I'm not sure I can take much more of it. Thankfully, mercilessly, the commercials will stop after Monday, Dec. 7. Although I think Joe did an excellent job promoting his cause, I'm afraid it's fallen on deaf ears. Now that I mention that, I wonder if my current provider offers hearing benefits.

Not that I'm the most-stressed about it, but I am at least stressed about a bone scan I'm having this week. The reason being that thyroid cancer that's metastasized - which mine has, sometimes moves to the bones. And since I have some knee-hip discomfort, particularly when I get up from a seated position, my oncologist ordered this two-step diagnostic process: an injection of something followed a few hours later by the actual scan to assess the damage. Not that I want to look for trouble (since it has already found me) but it's important - though scary, to tell your oncologist about any new symptoms, especially, if this new symptom has persisted for more than a few weeks. Rather than be an idiot and not mention the problem, I mentioned it during our last phone call on Thursday, the week before Thanksgiving and tomorrow, Monday, 10 days after the new fact, the bone scan will occur. I imagine I'll receive the results by the end of the week. Waiting for results all the time is another negative aspect of this disease. Very little happens while you wait, if you know what I mean? I wouldn't say exactly that common sense has prevailed here. It really doesn't take a genius to call a doctor when you're experiencing some new and unusual pain. In fact, the first lesson of oncology 101 is to contact your oncologist if any new symptom presents. It might actually be serious. Moreover, you're never to presume anything. You are to let the doctor know and let him be the judge. Keep the self-diagnosing and self-medicating to a minimum, if at all. You don't know best. In fact, you hardly know at all. Part of the occasional apprehension I've had in not sharing any new symptoms with my oncologist is fear. If I tell him about a new symptom, it might actually indicate a problem/complication with my disease/treatment. The illogic is: if I don't tell him, my overall medical situation can't get worse - which is obviously stupid, and not true. But since I'll never receive medical confirmation that my health situation has taken a turn, I can continue to delude myself. But my thought process - as a previously diagnosed "terminal" non small cell lung cancer patient stage IV, was just that. What I don't tell him won't hurt me. 'Hurt me' meaning leading to a premature death (I know, any death is premature). I realize even before writing this that it doesn't make any sense. As I have said on many occasions, I'll blame the cancer. And why I'll blame the cancer is because more than the damage it does to your body, it is the damage (effect really) it has on your brain. In a subconscious kind of way, your brain is totally rewired. After receiving such a life-changing/potentially life-ending diagnosis, you begin to think differently about life. Your obligations change. Your priorities change. Your responsibilities change. Your perspective changes. As such, your answers to questions and preferences no longer seem to be coming from the same place as they were before your diagnosis. It's not so much physically as much as it is emotionally, psychologically, spiritually. You're almost an entirely new person. At a minimum, you definitely become a variation of the previous you. You might look the same, but you don't exactly act - or sound the same. All your decisions become controlled by your disease, not literally, but made through the prism of your being a cancer patient. It's not that, if you're lucky, you need someone to prepare your meals/assist with your activities of daily living, but you do lose yourself in the disease with all the appointments, scans and treatments. And the worst part of it, none of it guarantees anything other than more appointments, scans and treatment. The bone scan I'm having is a perfect example. And unless I embrace the process, the stress and anxiety is likely to do as much damage as the cancer. Fortunately, I'm up to the challenge. Nevertheless, it's worrisome.

Let us presume, for the sake of this column, that I only have papillary thyroid cancer stage IV, and that my years as a non-small cell lung cancer patient, also stage IV, are over. If true, it begs the question, which I have been asked twice since this recategorization has become - in my circle anyway, public knowledge: how does it make me feel (to no longer be one scan result away from having months to live to now having years to live)? As obvious an answer as it should be: I can't exactly get my mind around it. I keep hearing that "If it's too good to be true, it is" advisory in my head. I realize medicine is different, and that's what scares me. Well, I can't really say I feel as if I have my life back because I never really lived like it was gone. I pretty much - treatments and side effects notwithstanding - tried to maintain my normal life and to continue my routine as well. I didn't stray too far from my well-established dos and don'ts. I didn't write down a bucket list and therefore spent no time pursuing long-standing goals. I just did what I have always done. I didn't want to be controlled by my cancer; doing things, taking trips, etc. just because I had a "terminal" diagnosis. To my way of thinking, that would have been akin to reinforcing a negative: a cancer that was likely to kill me sooner rather than later so I better do such and such or else. Instead, I just lived my regular life and felt no pressure to cross off items on a bucket list before I died. In spite of living life not as if I was dying, but as if I was going to be living, (unlike the country music song that expresses a different sentiment) I survived beyond my wildest timeline: so far, 11 years and nine months after initially being given a "13 months to two years" prognosis. Fast forward to the most recent - and amazing news: I hadn't miraculously survived non-small cell lung cancer after all, I had merely survived a very survivable and slow moving thyroid cancer (that has - or had previously, metastasized to the lung). Though my oncologist still thinks I have two types of cancer, my endocrinologist thinks I only have - and have had - one type: thyroid cancer. The Lombardi Cancer Center head and neck cancer specialist also feels like I have one cancer: thyroid. Her reasoning, after reviewing my medical records, was a bit more direct: "If you had lung cancer diagnosed 12 or so years ago, we wouldn't be here having this discussion. You wouldn't be alive." So being alive is proof, a type of proof I suppose, that I've had thyroid cancer all along and never had lung cancer. Not that I want to be thick-headed but after nearly 12 years of being told that I had lung cancer and living scan to scan every two to three months and anxiously waiting as well for my lab results every three weeks I find myself unable to let go of the worst case scenario that has been my life since Feb., 2009, and embrace this amended diagnosis. I can't seem to turn off my internal anxiety/fear clock. In fact, it's still stuck in its original position. I'm like an ocean liner headed out to sea. It can hardly turn on a dime and neither can I. Certainly I want to believe it and I don't really doubt the thyroid cancer opinions I've received, but it just seems that having your wildest dreams come true after almost 12 years of trying to accept the reality of your cancer situation/early death is too much good fortune for anyone to imagine/realize. It's the opposite of normal. As much as one might want it to happen, it's just not the way it generally works. I don't suppose doctors hand out terminal diagnosis before giving it extra ample thought. And yet, I'm about to be living proof. Nevertheless, every day, the shock of it begins to wear off and I can contemplate my future once again. No more will I count the days between scans. No longer will I dread reading my lab work and wondering what it all means. Oddly enough, what it all means is that I'll probably continue/resume my previous life, boring and mundane as it was because, well, it worked for me then so I imagine it will work for me now.

As my brother, Richard, has often said: "If the oncologist is happy then I'm happy." Let me update that sentiment slightly: "If the endocrinologist is happy then I'm happy." And so we should all be happy. Yesterday, I had my post CT scan telephone appointment with my endocrinologist to discuss the previous day's lab work and the two days previous scan. She was "very encouraged." "News," as I told her, "with which I can live." And more than just the words she spoke, it's the manner in which she spoke them. Her tone was positive, uplifting; she was very pleased. I could almost see her smiling. After hearing it all, she didn't need to tell me to have a nice weekend. I was well on my way. Oddly enough, I have learned to take good news in stride. It's the bad news that has a tendency to knock me off my gait. Prior to this Friday morning call, I had received, electronically, as I usually do, the automated releases of both my lab work and the radiologist's report. Having been down this road for nearly 12 years now, I am not unaware of discouraging results. The words I read and the numbers I see always tell a story. And even though I'm somewhat experienced, the interpretation and meaning of it all doesn't automatically jump out at me. Oh sure, I'm familiar enough and certainly know what lab results (levels) generally speaking are problematic (creatinine and bilirubin particularly). But there's so much more that I don't know. Moreover, there is no real breakdown-type summary to clarify beyond all my reasonable doubts as to what is happening in/to my body. I'm sort of left to my own devices. Devices which have proven to be unreliable - and certainly ones not very educated on the matter at hand. If this were about baseball, I wouldn't be clueless at all. But it's cancer and science and medicine; all the subjects I know very little about. Released automatically, I receive the same document that the doctors do. That means what I'm reading is the actual report, written by a doctor for a doctor. The report is full of medical jargon. And though there are "impressions," provided as well as an organ-by-organ characterization, until I speak with one of my doctors and have them review the report with me, I'm never quite sure if what I think I understand is wishful thinking or whether my worst nightmare is happening during the day. As a result, there are lots of words and medical assessments that are lost on me. It's not like reading a baseball box score when I know what everything means and its significance. Sure, there are many familiar words, but there are more that are not. Obviously "no new sites of metastatic disease I can understand and appreciate, literally. But "aortic athersclerotic calcification" and intrathoracic and axillary lymphadenopathy" I don't. Understand them? I can barely pronounce them, let alone spell them. And as much information is provided in these reports, I feel as if I need a scorecard to identify all the players and determine what it all means. Now when I have that follow-up phone call with the endocrinologist/oncologist, the report is explained. However, the explanations are not chapter and verse, they are more like sentence and paragraph. They're short and hopefully, as it was time, sweet. Of course, I could ask more questions but as the comedian Dennis Miller once joked on the radio: "I don't care how the popcorn is popped, I just want it to pop." So too am I less concerned with the popping (details). I want to know if I'm going to live or die. Unfortunately, the reports - and the conversations don't really offer a glimpse into the future as much as they attempt to clarify the present - which apparently is as good as it is likely to get. If 11 years - and nine months as a cancer patient has taught me anything, it has taught me to be grateful for any good news, however indeterminate.

... it was first-rate. A confirmation (of sorts) that I have (and have had in all likelihood) thyroid cancer and not non-small cell lung cancer. And I say 'sorts' because the medical records transferred did not include the original pathologist's report on the tissue sample taken in 2009 and not all the scans from the nearly 12 years of treatment either. Nevertheless, this second oncologist summarized my cancer as being thyroid, partially because I'm still alive. Generally speaking, lung cancer patients don't survive years beyond their prognosis. Addition by subtraction, you might say. Unfortunately, lung cancer does what it does: grows, and when it doesn't, it's reason to consider another diagnosis. My primary oncologist had often said that the tumors in my lungs never acted as he had anticipated. Good news then. Great news. I don't have the "terminal" cancer with which I was originally diagnosed. I guess that explains why I have lived so many years past the "13 months to two year" prognosis that I was initially given in late Feb. 2009. Rather than having an incurable disease, non-small cell lung cancer stage IV, I now have papillary thyroid cancer stage IV. Hopefully, I will be able to live with it much as I had lived with the apparent lung cancer: day by day, scan to scan. However, the day-to-day stress may be less because the worst case is not necessarily a scenario that I have to anticipate. Granted, it's still cancer, and from what I was told, still incurable, but for the moment, very treatable. Surgery is likewise not an option and there is still medication - with side effects, that will remain part of my life, but there is life that remains. Moreover, there also remains regularly scheduled CT scans and lab work that will monitor my condition. And it is not until I receive the results from these diagnostic procedures that I can truly appreciate the change in my diagnosis. It's not that I don't trust this second opinion, it's more that I've spent the last nearly 12 years thinking one way and changing how I think now after one 45-minute appointment is not quite how I can roll. Besides, my thyroid cancer has metastasized to the lung. And though it has been slow moving, it has moved. And it is rare. At present, it is responding to the medication but there are no guarantees in the cancer business, and I will continue to live from one scan to the next. I am grateful to be out from underneath, apparently, this terrible weight of fear and inevitability. However, as a long-time cancer patient, I can't simply presume that life resumes as per usual, with per usual being a pre-cancer-type life. Regardless of now being a thyroid cancer patient and not a non-small cell lung cancer patient, I still am a cancer patient. As such, I still retain all the feelings and anxieties. I will still attend all the meetings, if you know what I mean? I can't simply disconnect or forget all that I've endured these past 11-plus years And lo and behold, I have a CT scan this Wednesday. By the end of the week, I will likely learn if my newly diagnosed thyroid cancer is still responding to treatment or whether there is something rotten in Denmark (me being Denmark). Even though I have a new working diagnosis - thyroid cancer, which on the face of it, is much less serious, I can't approach my life any differently than I did before. Cancer is in charge, and until it tells me, so to speak, via scans and lab work, that it's OKAY to breath normally, I won't be able to. Now more than ever, almost, even with this new information, I can't forget where I've been and what I've been told. It was lung cancer once. Perhaps, it can be again. For the moment, I'm going to try and enjoy my new-found status. But with the incomplete medical records painting a less-than-definitive picture, I will go along with the second oncologist's assessment, but only from a distance. Unfortunately, having been told one thing before, and now being told another very different thing, doesn't change the facts on my ground. I still have cancer. And it's still incurable. That problem remains.

... to get a second opinion about one's first cancer, especially if there's now a second cancer to consider. For most of the nearly 12 years during which I've been a cancer patient, my diagnosis has been non-small cell lung cancer stage IV. Within the past 10 months or so, it has become apparent and subsequently confirmed by a surgical biopsy of a tumor located in my lungs that I have papillary thyroid cancer. The big question remains - and has not been agreed to by my endocrinologist and oncologist - is whether I have two types of cancer or just one. And moreover, whether I've always had two types or one primary (previously undiagnosed) that has now metastasized after 10-plus years from the thyroid into the lungs? From my understanding - or actually what I've been told - it's possible, though hardly prudent to biopsy all the remaining tumors in my lungs to confirm exactly what type (types) of cancer I have. According to my doctors, the medical risks to me are too great. Therefore, the decision has been made to treat the thyroid cancer and to monitor, for lack of a better description, the lung cancer. And I can live with that (hope to live with that I should say). Nevertheless, it seemed an opportune time to get, for the first time in my cancer life, a second opinion. This week, after waiting out the transfer of medical records and a thyroid cancer specialist's evaluation, Team Lourie will be going to the Lombardi Cancer Center at Georgetown University Hospital for an independent assessment. To say we are extremely anxious is an understatement. When I was initially diagnosed in late Feb. 2009, we did not get a second opinion. Perhaps we were naïve, but at the moment the oncologist told us my diagnosis and prognosis, he was not the least bit perplexed and the path forward seemed clear, and we didn't question him too much. A week later, I began chemotherapy. I have never wavered in this decision and I have no regrets about the path I chose. The fact that I have lived years beyond my prognosis has occasionally given me moments of curiosity as to why I was so amazingly lucky to have survived when so many others have not. Not wanting to look a gift oncologist in the mouth (if you know what I mean), I rarely thought to ask. I mean, I was doing so well. Then about two years ago, a lump appeared under my Adams Apple. Upon examining me/it, my oncologist characterized it as a clone of my lung cancer and did nothing more than note its size and shape when he regularly examined me until the first of three biopsies (of a lymph node) was ultimately performed. It indicated thyroid cancer. This was new information to my oncologist. And so I was referred to an endocrinologist. She took one look at my "Adams Apple tumor," as I called it, and did a needle biopsy right then and there - in her office. She called me two days later with the results. Again, it confirmed thyroid cancer, which subsequently led to the removal of my thyroid a month or so later. A few months after that, a hospitalization followed for radioiodine treatment to locate and kill any remaining thyroid cancer. Within another month, I began chemotherapy treatment for thyroid cancer, which is how I am presently being treated. Nothing more has changed. However, we wondered, what about my lung cancer? It was not being treated? As George Costanza asked after having sex with the cleaning lady on an old Seinfeld episode: "Was that a bad thing? And so we have taken steps to find out what it is we don't know that maybe the doctors know. Unfortunately, my original tissue sample is too degraded to re-biopsy, but all other relevant medical information has been transferred. I don't suppose we'll be able to go too far back in time, but given the future that I ended up having, there's no time like the present to review the past.

For the last few months, I have been receiving unsolicited emails from Tommy Chug; he being the other half of the 70's era comedy duo, "Cheech and Chong," with whom I spent countless hours in college laughing at their recorded routines, but beyond that I don't remember much. There were a few follow-up movies, which I never saw, and more recently, I have found somewhat belatedly a early 2000s cop show starring Cheech Marin alongside Don Johnson: "Nash Bridges." Nothing at all from Tommy Chong until these emails began arriving. The email is a solicitation followed by content about his life these last years, and the discovery he made after he had served a nine-month prison sentence for selling decorative bongs (there's a bit more to that story, but it's not particularly pertinent to this column). After being diagnosed with prostate cancer, Tommy sought help trying to mitigate the effects of his chemotherapy treatment and perhaps even improve his quality of life. (He's 81 now, by the way.) In so pursuing, he met a doctor from Utah while on a plane, and the rest is Tommy's email. The content is not exactly personalized but it does resonate. It resonates because it sounds reasonable and plausible and the remedy not too impactful to major organs, specifically liver and kidney, for which I'm very keen and concerned, given my nearly 13-year chemotherapy-plus treatment for cancer. However, the email has struck a nerve. It did so because as a cancer patient, it's easy to believe (or hope) there's a magic (often non-Western) cure to whatever ails you, especially when cancer is the culprit. I wouldn't necessarily characterize my feelings/emotions as susceptible but it's hard not to lean that way when you've been given a "terminal" diagnosis by your Western/conventional doctors. To say you have nothing to lose is a bit of a simplification. Still, hearing the words I heard on Feb. 27, 2009 (you bet I remember the date) at the initial Team Lourie meeting with my oncologist, does cause your antennae to go up and out and all-around seeking an answer to what might very well be, the unanswerable. When an oncologist tells you you're likely to die within "13 months to two years," all bets are off and caution no longer becomes an impediment. Standing pat and adhering exclusively to what your doctors are telling you seems like giving up sort of. For me, I didn't give up. I started trying alternatives, many of which I am continuing a decade-plus later. Now whether these non-conventional/non-Western methods have proven beneficial, I certainly can't confirm, but if living is any indicator, they likely did no harm (the crux of the Hippocratic oath). So yes, on the face of Tommy's email about improving one's quality of life, I am open to some other possibilities to prescription medication. In fact, to this day, I still consume about 60 pills a day and always wash it and most other things down with alkaline water. Moreover, I try to limit my sugar, which is impossible and I remain open to new ideas. Over the years, I have ingested spoonfuls of pureed canned asparagus, drank water with baking soda, drank water with apple cider vinegar, blended fruit and vegetable smoothies (how else does one tolerate kale?) and tried to be mindful of a maintaining an alkaline diet. The goal has been to enhance my immune system while eliminating toxins in order to enable my body to heal itself. Again, it's difficult to know what alternatives have worked and what hasn't. Whether it has been real or a type of placebo effect where I thought it was beneficial, I am not prepared to say. However, I am living proof of something. As concerns what Tommy is selling, the problem is, as it was with all my previous choices, there are no guarantees. Unfortunately, that was a problem at the beginning, and I fear it will be a problem at the end.

What I'm thinking about - and being thankful for, today, is the disappearance of all the side effects I've been experiencing during the last four weeks or so since I began my pill regimen for my papillary thyroid cancer treatment. Too many to list but upwards of a dozen side effects which encompass all activities from those of daily living to others pertaining to just plain living. Let me reprint the warning that came with the pills: "People using this medication may have serious side effects. However, your doctor has prescribed this drug because he or she has judged that the benefit to you is greater than the risk of side effects." Put that in your pipe and smoke it. That's what I have to smoke every day, if you know figuratively what I mean? The bigger question, the overriding concern/anxiety, is what exactly the thyroid cancer is doing now having been left unmedicated for the last nine days? How irreparable is the damage being done when the cancer has been left unchecked? Moreover, to the extent there has been some damage, is restarting treatment even an option or have I already failed the tolerance test? Being a cancer patient is a never-ending series of questions and/or concerns for which there is hardly clarity. As I have been led to believe/educated since my initial lung cancer diagnosis, there will be no more guarantees coming. But of course improvements in cancer treatment and ongoing research have improved survivability, and with many patients, myself included, turned the cancer treatment into a chronic disease type protocol, like diabetes. Nevertheless, cancer is in control, the doctors are not. There are no slam-dunks in cancer treatment. How would I ever be able to unwind myself from years of stress and fear just because? I couldn't. A cancer patient today sort of means, I'll likely be a cancer patient tomorrow. I don't see how I could shake that self-image. Somehow, I must, as I'm trying to do now, exult in the joy of a semi-uncomplicated, side-effect free existence because it's not guaranteed. I must try even harder to compartmentalize the unknown while savoring this known, relatively easy time. It's not promised and it's not necessarily likely to occur again, certainly not after I return to treatment. But maybe, my new normal will be switching on and off treatment, sort of like I did while being infused with alimta. Though I still had my CT scans quarterly, so long as the scans showed stable, we kept extending the interval between infusions. The goal being to balance effect on the tumors with the quality of life (freedom from side effects and infusion appointments). Eventually, we stretched the interval to as much as seven weeks from the original three enabling me to live - occasionally, a semi cancer-free life. Perhaps this on-again, off-again schedule might apply to this recent thyroid treatment. I have to hope because the side effects, as I alluded to initially, have been affecting my quality of life. And if there's one factor driving my better-than-expected survival, it has been my attitude, which has derived directly from my management of side effects. Anecdotally speaking (or presuming) being in a good mood, being able to function with normal parameters (to quote Data from "Star Trek: Next Generation") has been a tremendous contributor to my life expectancy (my oncologist refers to me "as his third miracle"). But I can't know for sure. And of course, that's the crux of the problem for many of us cancer patients. One can never know for sure if you're hindering or helping; and since guarantees stopped being made on the ground-zero day you were diagnosed with a "terminal disease,"' it's often difficult to know which path to follow. Right now, it's easy to follow the path which is creating a more normal/pleasant quality of life. But at what cost? I can't know what the tumors are doing. Perhaps, in taking a break from treatment, I have unleashed the cancer once again. That's my dilemma: reconciling the present with the future, the fear with the familiar, the hope with the inevitable. And it's likely I'll never know if what I've done has been a help or a hindrance. Yet somehow, I have to make plans and decisions. "Tomorrow is another day." Lest, I be gone with the wind.

As Jackie Gleason would say as he segued from his monologue into the sketch comedy that followed on his Saturday night entertainment hour on CBS. So too does my entertainment - or lack thereof, continue. Six weeks or so after my treatment for thyroid cancer (three pills a day) began, per doctor's orders, we have put a halt to the proceedings. Due to increasing values in my bi-weekly lab work (monitored exactly for this purpose), specifically my kidney and liver functions, I am standing down and standing by. We will retest this coming Thursday and then wait for further instructions (smaller dose, intermittent dose, no dose?). In addition, some of the side effects that I am experiencing (fatigue, shortness of breath, a little depression/a little malaise) also encouraged my oncologist to pause the treatment. Hopefully, it's "the pause that refreshes," as Bud Collins the long time tennis commentator for NBC once said to describe female tennis star, Amanda Paz. The lab work is the first line of defense and indicator, along with side effects as to what might be going on inside. A scan would be useful as well but due to the radiation exposure, the doctors try to keep its use to an absolute minimum. And since I'm not scheduled to be scanned for another month (every two months), my status is best determined by how I feel and what the lab work shows. In the interim, I will ride the roller coaster of emotions and fear and try to enjoy the reduction in the side effects (which I can do. I'm good that way). I just have to hope that the values in my next lab work go back down or I may very well go off the rails and onto some other ride that might not be so manageable. All that remains is "all that remains." Nothing in my life/caner routine is likely to change much. Again, what I have I've been told is that what I have incurable: stage IV papillary thyroid cancer, the kind that doesn't respond to radio iodine therapy, so every minute of every day will be spent hoping, praying, wondering and waiting to see if the end is near or thankfully not near at all, like a mirage, almost. Just another day in my cancer conundrum. As Tom Branson said on an episode during the final season of Downtown Abbey about something completely unrelated: "What a palaver!" But that's really what being a cancer patient is all about: confusion, lack of clarity, few guarantees and changes in your attitude along with your latitude if Jimmy Buffet were writing this column. If my wife were, it would be about going with the flow. However, since I'm writing it, it's about changes, constant change; sometimes more of the same, something completely different. and being prepared, always, to go up and down and all around and everything in between. It's highs, it's lows and its all-overs, too. It may not sound like a great way to make a living, but I can assure you, it sure beats the alternative. As my mother used to say: "enjoy poor health," especially since it doesn't seem likely I'll be changing horses anytime soon. But I can do it. I'm a Red Sox fan; I've lived with disappointment and determination my whole life - and thankfully, I've lived to see some World Championships, too. The goal is to try and keep moving forward and remain positive. Like my old friend Ray use to say: "my attitude is my blood type: B+." What's another blip on the cancer radar? I've been on it so long now, since Feb. 2009, that it would be abnormal not to appear. And since the experts have been telling me that it's unlikely I won't be off the grid until it's too there's either a new grid or a new drug, I am happy to take a break in the short term if it it helps in the long term. Because the goal is to finish, not to falter.

Not that I want to give you a blow-by-blow concerning my treatment switch over to thyroid cancer from lung cancer but the last two columns were written four weeks ago in the same week in expectation of a weekend away, so these observations will be new-ish in that they will be hot off the press, so to speak. Away with the kind of friends who are empathetic, sympathetic, and who never make me feel pathetic in any of my struggles. In short, the best kind of friends. This is important because when one in the group goes above and beyond in the wrong direction, like heading from one's present cancer direction to a yet all together new, less desirable cancer direction: stable non-small cell lung cancer stage IV being treated with immunotherapy to stage IV papillary thyroid cancer being treated with chemotherapy, is hardly a conversation that makes for fun even if I now have my own sort of "BOGO." And though the 'shopping 'buy' may be familiar, the cancer 'buy' is not nearly so familiar. Generally speaking, a BOBO offer is of interest, a cancer one not so much. In fact, it's not much of a bargain at all. The worst of now being treated for papillary thyroid cancer is the array of side effects which are manifesting. They're not exactly debilitating, they're just one big nuisance broken into about eight different nuisances - and I will spare you the details. The net effect of all these side effects is that for the first time in approximately two years, and I feel extraordinarily lucky to be able to say this, once again I feel like I have cancer. And though it's unlikely it's simply side effects which are doing all the talking, rather than the cancer metastasizing, which it already has anyway since the thyroid cancer is now in the lungs, it's impossible not to consider the consequences. I mean cancer doesn't just travel around to make new friends and influence people. It sort of has a task: to damage and destroy. And I have to admit: feeling as if I didn't have cancer is much more preferred than how I feel now. Nevertheless, it's not as if I feel at death's door (well, not the front door anyway). It's more a feeling of death being at the back door. Not a direct assault, mind you, more of an indirect one. And I'm sure they still count as much as all the others. Unfortunately, I fear an accumulation of these indirect assaults can cause as much cumulative damage as a direct hit. Ergo, I'm wondering if this rear-type assault/indirect-type hit is an indication of future/perhaps even present trouble? Moreover, I wonder if having to defend myself on two fronts (primary and secondary) will weaken the resistance. Because as many World War II movies as I've seen, the resistance rarely seemed to have enough supplies to carry out their mission. Being in a new battle, even it involves familiar elements: blood pressure readings, EKGs, CT scans, lab and face-to-face appointments, doesn't totally regularize the experience. The reason being that this familiarity is breeding contempt because I have been there and done that. Yet, here here I am having to do it all over again and I find myself quoting Shakespeare or the Three Stooges: "something is rotten in Denmark." Being a cancer patient is like being unable to send your legs out for a walk as Lt. Com. Henry Blake wanted to after a long period of surgery during a particularly high-casualty episode on the television series, M*A*S*H. And as a previously diagnosed as "terminal" cancer patient, neither can I disconnect from my mortality thoughts any more than Henry could exercise his legs. So what I'm left with is either bucking up or venting to friends and family. I'm lucky to have an outlet. I imagine it is much more difficult for those who don't.

Two-plus weeks into my thyroid cancer treatment, all is as I anticipated. I'm still not in a comfort zone, routine-wise, nor side effect-wise, I am feeling some predicted discomfort. I won't self-indulge and list the difficulties that I'm having. I will say that even though I'm extremely thankful not to have experienced any of the more severe side effects (blood clots, arrhythmia), I have felt something. The 'something' I've felt has been made more complicated due to the synthroid pill I take daily, since I had my thyroid surgically removed in late January 2020. The proper dosage, prescribed to replace the function of the thyroid is not easy to determine. As such, I'm not exactly feeling myself. I'm not sure who it is I'm feeling (as Groucho said because he could never get that close), but it's not who I've come to feel. The complication I refer to is the effect on my thyroid replacement medication (synthroid) by my thyroid cancer pills. What happens, I'm told, is that the synthroid's effectiveness is partially mitigated by the cancer medication and as a result, I need regular lab work to monitor the situation and maintain proper thyroid replacement. If my thyroid hormone is too low, I'll feel tired and unmotivated. And since a side effect of the thyroid cancer medication is, among others, fatigue, I am tired for two reasons: the cancer drug itself and the effect the same cancer drug has on the synthroid pill, which has everything to do with my energy level. Now, not only am I a two-for-the-price-of-one cancer patient (non-small cell lung cancer and thyroid cancer), I am also a thyroid cancer patient being treated for cancer and for the replacement of the thyroid. As a result, in addition to juggling two cancers, I am also juggling one cancer with two semi competing side effects: feeling tired due to low thyroid hormone and feeling tired as a side effect of the thyroid cancer treatment. I imagine one or the other would be manageable but simultaneously, not so much. (I guess it's another BOGO-type situation). Granted, it's a living and it sure beats the alternative. Still, I was hoping one set of side effects would be enough rather than having to consider a second set (side effects of the side effects, if you will). My concern is compounded by something my oncologist was wary of doing years ago: treating the side effects, in addition to treating the cancer. Moreover, he said that often it's the side effects that become so debilitating and harmful that the actual cancer treatment itself has to be stopped. And though your quality of life might improve - with the reduction/elimination of the side effects - the cancer is now left untreated and cancer left untreated generally speaking, doesn't usually mind it's own business, if you know what I mean? In either scenario, you're unlikely to be smelling any roses. And not 'smelling any roses' is what I'm most worried about. Stopping treatment for the thyroid cancer would be bad enough, but what about my previous pre-existing stage IV, non-small cell lung cancer diagnosed February 2009? I'm currently not receiving any treatment for that as we defer to the thyroid cancer. If I have to stop the thyroid cancer treatment because of the side effects, will I then re-start the lung cancer treatment for which I had very minor side effects? Is treating the back-up (so to speak) cancer better than not treating the new primary: thyroid cancer? As you can possibly tell, I am potentially between a rock and a very hard place. Nevertheless, as my oncologist emailed me a month or so ago when we received the results of my third tumor biopsy (which was taken from a tumor inside my lung rather than outside from a lymph node): "Thyroid cancer is better than lung cancer." And though I certainly liked the sound of that when I first read it, the present complications were not yet a part of the discussion. But that's what being a cancer patient is all about: an evolving existence of good, bad and indifferent information with nary a guarantee in sight.

There are two generic types of cancer: the cancer that you have, and the cancer that has you. And the yin and yang is what defines 'canceritis.' The internal struggle between being defined by your disease versus living a life in spite of your disease. The former is easy; you're a victim of an insidious, in some cases, incurable disease that causes myriad problems, shall we say; physically, emotionally and psychologically. The latter is hard. Sometimes, overcoming the former in order to live the latter is much easier said than done. The reason being, primarily, that cancer isn't a killer because symptoms, treatment, and side effects are always manageable and overall mental/emotional demands are easily compartmentalized. Nothing could be further from the truth. In fact, the truth is that if the disease, treatment, and side effects and/or anxiety/stress about your diagnosis doesn't get you, the total disruption of your life and/or routine will. Not that you lose free will, but you do lose a fair amount of control. While cancer is in the house, cancer rules the roost. Somehow, even though the disease and all is all about you, you must find a way (navigate) a path forward that enables you to set aside the physical and emotional demands of a terminator-type disease. With many patients, the cancer won't stop until it kills. And for the hundreds of thousands of cancer patients who die every year, wishing, hoping, praying and being compliant to their doctor's instructions, the outcome though hardly guaranteed is not particularly encouraging either. The disease takes its toll and despite all the efforts of the king's men to put Humpty back together again, the ravages of cancer often prevent the patient from ever being whole again. Sometimes, the damage is already done as it usually is for non-small cell lung cancer patients who often are asymptomatic until they're not (as I found out firsthand). Then you're told you have a "terminal" form of stage IV lung cancer thatis described as incurable, which meant for me, being told I had 13 months to two years to live. The question I asked myself back in Feb 2009: What the hell happened to stages I, II and III? This is what cancer can do: travel at warp speed and not leave too many clues. Finding some kind of work-around/plan "B" to deal with the loss of control and helplessness might keep the patient from descending into an emotional rabbit hole from which there's a scant chance of recovery. At this juncture, the cancer is in charge. This is the challenge: overcoming a disease which in many instances is beyond your doctor's/modern medicine's ability to control. Just imagine living with the knowledge that every day you wake up is a day borrowed against future days when you might not wake up or if you do, might feel so poorly that the point of trying to feel better becomes more of a fool's errand than it does a practical alternative. Cancer is not literally a four-letter word but it's most definitely in its own category: a six-letter word which makes all four-letter words meek by comparison. Somehow, you must restructure your understanding of your cancerous condition and philosophize: everyday you wake up and feel something isn't a day that's lost. It's a day that's found. Making the most of these emotional crumbs is not a guarantee of anything. Rather, it's an attempt to prevent things from getting worse. And as any cancer patient will tell you: it can always be worse. And until it's the worst, try to embrace whatever remains as the best.

Eleven years, six months and two weeks, approximately, after being diagnosed with "terminal" cancer (stage IV non-small cell lung cancer), I have begun my treatment for stage IV papillary thyroid cancer. I'll be taking three pills a day, all at once, same time every day. The list of possible side effects are as long and scary as it presumably gets (blood clots, arrhythmia, to highlight just a few). I doubt its bluster. Likely somewhere between it depends and probably. Every patient is different of course so what happens next - to me, can only be forewarned. It cannot be foretold - with any kind of certainty, that is. What I've read about these straight-on effects so far is somewhere along the lines of the cancer untreated would be worse so pick your poison, I suppose. I didn't exactly pick, but the poison - euphemistically speaking - if not literally, which has been prescribed, arrived by mail at my home as of 1:30 this afternoon and I see no reason to wait. Gulp. Let us go forth in hope because there are no guarantees here. The guarantees left the building late Feb., 2009 with my initial diagnosis. Maintaining a positive attitude and a good sense of humor has to remain my not-to-so-secret weapon. Granted, wishing and thinking a thing doesn't make it so, but moaning and groaning about it will be neither productive nor prudent. It would simply reinforce a negative and as Brian Dennehy (a.k.a "Cobb") said in the movie "Silverado" about a completely different subject: "We can't be having none of that now, can we?" I think the reason I'm meandering about here and in life is that I don't have a clear understanding of my prognosis yet, though I have asked. Moreover, since my new normal has only just begun, I don't have my routine down and as a result, the treatment process has not become second nature. And until it's no longer first nature, I'll be more preoccupied and cognizant of what I'm doing and why, and when I should be doing it. Primarily, this confusion/series of arrangements has to do with coordinating taking the three thyroid cancer pills with my current and pre-existing - going back 11-plus years, pill regimen which involves upwards of 60 pills daily. It's not overly complicated. It's just new and some pills shouldn't be taken together as is the case with the synthroid medication, the anti-nausea pill and additionally, not all pills can be taken with food, without food and so forth. I realize this isn't rocket science, but my life sort of depends on it, so it's kind of important that I pay attention to what and when I'm ingesting. And it's this newness that is scary because it represents the great unknown - for me: Will the side effects be debilitating, life-changing? Will they be treatable/manageable? Will my life expectancy once again be front and center as I wobble back and forth from lab work, diagnostic scans and follow-up appointments? Previously I sort of knew where I stood. Now, I don't really know anything. Oddly enough, having been there and done that is not as comforting as I would have anticipated. Even though I've switched over - so to speak, from lung cancer to thyroid cancer, I can't really say I've experienced a "Serenity now-" type moment. I'm not nearly so confident in my outcome now as I sort of was when I only had lung cancer. Being diagnosed with a 'new' cancer, 11-plus years in the presenting, hardly reassures that all is under control. I mean, what about my "incurable" lung cancer? We're not treating it anymore. Is it going to now grow and reassert itself and if it does, will we then stop the thyroid cancer treatment? It seems that there could be a return to sender situation here where I'll be back and forth between oncology and endocrinology. I'll figure it out. I'm not afraid to ask the tough questions. It's the answers that might scare me though.

As I was telling my long-time friend, Rita, over the phone on Saturday afternoon, as a cancer patient - and I know this is going to sound ridiculous, short-sighted and stupid - I am not always forthcoming and honest when it comes to sharing new symptoms with my doctors, particularly my oncologist. Aside from the obvious discomfort neglecting a new problem would cause, not telling my doctors everything, all the time, prevents me from learning - for a brief moment anyway, exactly what either of my two types of cancer are doing to me. Out of sight, though not totally out of mind, provides a certain salve for what ails me. A mixed-up version of "what I don't know can't hurt me" - which, of course, it most definitely can. Still, after 11 and 1/2 years of walking this walk, I can't always get the message through my thick head. I'd rather rationalize and/or self-diagnose or attribute the miscellaneous maladies (aches and pains) to older age than I've ever been or due to the fact that I'm overweight and out of shape. And though my friend Frank might think that I'm in pretty good shape for the shape I'm in, the problem is that cancer has its own agenda and doesn't listen to anybody. Moreover, in my experience anyway, it seems to be able to affect one's judgment. But how else, other than in a roundabout way, does one deal with such weighty issues such as life and death? Granted, I can see how I'm working against my own best/self-interest here when I neglect to mention something now which could harm my future defense (a sort of British Miranda-type warning). Unfortunately, that's another facet of cancer's insidious toll: common sense. Your perceptions and all are altered as you look at your life/choices through this prism of cancer. If you're honest and upfront about your symptoms, it could hasten your death by confirming your progression. If you're not it could definitely hasten your demise. (Cancer symptoms generally don't just disappear.) Either way, you're in cancer's grip. Extricating oneself is difficult. Fending off the demons is a full-time job. I'm not exactly Linda Blair from "The Exorcist," but occasionally, I do feel as if I'm possessed and unable to right my own wrongs. You would think that eventually, one would be able to think outside their own box and realize that self-medicating/self-diagnosing and/or presuming one's age is the explanation for all the ifs, ands, or buts concerning one's symptoms/health is akin to taking a long walk off a very short pier. It may suffice for the present, but the future is hardly there for the taking, if it's there at all. Realizing that fact has been difficult for me to assimilate. Part of my survival strategy, if one were even to call it that, has been to try and avoid any rabbit holes of emotional despair. My thought has been that I'd rather deal with it later than deal with it now, and since it will be bad enough later, I'm not going to subject myself to it now. Ill-advised? Probably. Recipe for success? I doubt it. But that's how I've mostly rolled since my "terminal" diagnosis in late February, 2009. Well, better late than never. As I finally wake up and smell the coffee - which I never drink (smell the bacon would be a better example), closing my eyes to an impending disaster is hardly the stuff of dreams (more like nightmares). I imagine the stuff of dreams is more about admitting and facing adversity with your head on straight instead of facing it with your head on crooked. Pretending/hoping a problem/symptom doesn't matter/likely to go away on its own is not how proper health and hygiene works, especially not cancer. It has a well-earned reputation and one's prognosis would be better served by being proactive rather than reactive. Cancer waits for no man - or woman. It's on its own schedule. Come hell or high water.

If this past week's test results (EKG, blood pressure and lab work) pass muster, then I will join the ranks, full-time, of the thyroid cancer community. At present, the medical plan is to pivot, completely, from any lung cancer treatment - which for the past 18 months has been immunotherapy bi-weekly, and focus instead, exclusively, on my stage IV, papillary thyroid cancer. If I can go forward, I'll be taking three pills a day, at home. No more visits to the Infusion Center and, of course, no more infusions. And not that I'm paranoid about getting exposed to the coronavirus, but less exposure to whatever can be transmitted by droplets, door knobs, elevator buttons, etc., can't be a bad thing. The question remains however: Is the medication I'll be receiving likely to have a positive effect? As in, will it cure my thyroid cancer? What little I already know is that the type of papillary thyroid cancer that I've been diagnosed with recently - after three biopsies, is unfortunately not curable. It is treatable, though, just as my previous lung cancer diagnosis was described. I like curable much better. But, treatable I'll have to live with, hopefully for a long time, as I have for 11 and 1/2 years with the originally diagnosed stage IV non-small cell lung cancer. My attitude then, as it will be now, is to try and stay alive until the next new drug comes along which might actually cure my thyroid cancer. The interim goal, different from the ultimate goal is, stability: turning the incurable disease into a chronic disease, like diabetes, for example. And though curable is the preferred outcome, for those of us with our rear ends in those barcaloungers, stable is perfectly acceptable. In fact, for the many years I was treated for lung cancer, 'stable' became my new favorite word. Shrinkage, cure, remission and N.E.D. (no evidence of disease) was certainly the ideal. But for those of us in the trenches, our reality is often very different. Living, even in those trenches, is the best reward, and as cancer patients, you learn that any guarantees, presumptions or even entitlements are best left outside the examining room's door. Because once inside, reality takes over (as it likewise does late at night, as you're lying in bed contemplating your predicament, when it tends to get late, early, if you know what I mean?). My friend Sean often jokes by asking me if I'm still on the clock (meaning am I still terminal-ish). I'm on the clock, alright, as I have been since February 27, 2009 when my oncologist first told Team Lourie of my "terminal" diagnosis. Cancer then, as now, is the dreaded disease. Eventually though, the conversation ends and a treatment plan is initiated. Treatment is often predicated on a series of definite maybes/"we'll sees". Success is measured one lab result, one appointment, one scan and one surgery at a time. No promises are offered and rarely are other patient histories relevant to one's own circumstances. Patients have unique characteristics and it's never quite right to draw parallels. Being a cancer patient is the opposite of being on a "Merry Go 'Round." It's a "Not Very Merry Doesn't Go 'Round" - without the music. Moreover, there's never a brass ring to grab, only an intangible thing called hope. However, hope is a wonderful thing. Though it doesn't necessarily get you across the finish line, it does enable you to endure the journey. You're where you are and where you're going to be so any kind of assistance - mentally or otherwise - is greatly appreciated. In my mind, the only pathway is forward. And though the challenges seem endless, a proper positive attitude that leaves open the possibilities of living life with cancer rather than succumbing to it creates a kind of karma that reflects off of others and is reabsorbed back into you. It's this positivity loop which makes the unbearable a bit more bearable. At least it does for me. My father used to say: "Every knock is a boost." Imagine what every boost would mean to a cancer patient? It's almost like medicine, but without the negative side effects. And who doesn't need that? Those of us diagnosed with two types of cancer, that's who! Don't knock it if you haven't tried it.

Well, I certainly don't like the sound of that, and I especially didn't like reading it in the "impressions" part of the radiologist's report I received Friday summarizing the previous Wednesday's PET scan. Though hardly a surprise given a thoracic surgeon's description of my original PET scan 11 and 1/2 years ago: "You lit that thing up like a Christmas tree." Still, I would have rather read something a bit less ominous. But I don't suppose being diagnosed with two types of cancer (non-small cell lung stage IV and papillary thyroid, stage II) lends itself to a "bit less ominous." Besides, "less ominous" left the building in late February 2009 when I was first diagnosed with a "terminal" disease: non-small cell lung cancer. Not to make light of such a heavy dose of reality but, as Tom Sellick says on his recent television commercial for AAG: "This isn't my first rodeo." And neither is this statement of fact from the radiologist the first less-than-encouraging news I've heard and seen. To invoke Jack Palance (Curly) from "City Slickers" (1991): "I **** bigger than that." I've been living with a version of these words for 11 and 1/2 years. Tell me something I don't know. Nevertheless, I'll find out what it all means soon enough. Though it might be a bit of a re-hash from a few columns ago stating that since all the tumors in my lungs can't be biopsied, practically proceeding, my oncologist will never know for certain exactly how much of what type of cancer I have. And since one medicine - from what I've been told, can't treat both cancers, life expectancy, treatment protocols, etc., are likely unclear at best. Presumably, we'll treat the cancer which is most prevalent, most aggressive and most treatable/curable? I can only hope that as I sit and write this column, two days before my surgical lung biopsy on Monday, seven days, approximately, until I hear from my oncologist, I'll be able to compartmentalize the worst case scenarios - all of which are out of my control anyway, and try to live life as normally as possible and avoid any rabbit holes of gloom and doom. Right now, this is just another blip on the cancer radar that has been "blipping" for more than 11 years. Generally speaking, the medical feedback we receive almost always sounds mediocre (and I don't mean fair to middling either). And it never sounds worse than it did in February '09 when I initially was diagnosed and given a "13 month to two year" prognosis. Unfortunately, having outlived my oncologist's expectation by upwards of 10-plus years doesn't guarantee me any favorable news. That was yesterday (yesteryear, actually). This is today, 2020. However, much has changed/evolved in the cancer-treatment world. There have been more drugs approved for the treatment of lung cancer in the last few years than in previous multiple decades, including the introduction of an entire new class of medicine: immunotherapy. It's not exactly game and match, but it is night and day. Still, it's premature until I'm re-diagnosed and placed in a new protocol and see the results - in future CT scans. This pending biopsy may be the storm before the calm or vice versa, quite frankly. As I await results, my glass remains half full, as always. I just have to hope that while waiting for the cancer business to become clear, I don't get so thirsty/anxious that I empty my glass. That wouldn't help anybody, especially me.

Whether or not I'm certain about my attitude toward being a dual cancer threat (non-small cell lung and papillary thyroid, cancer), only my subconscious knows for sure. This was recently made clear to when I provided my supermarket shopping preferences to my wife, Dina, who for reasons she takes very seriously (my health) won't let me go into stores to buy anything. Ergo, my list. And I may add, there is much adieu about those preferences. It's like a negotiation. Though not exactly partisan, the debates rage on and I'm lucky if I see more than a handful of requests honored from my list. In effect, Dina is my gatekeeper (you'll note I didn't say jailor). There are some requests which are rarely obstructed: health and fitness, fruits and vegetables, meat and potatoes and any other non-dessert/snack-type item. I'm not going to bore you readers by saying how long it's been since I've had a Hostess cupcake or an Entenmann's cake or a TastyKake anything; I wouldn't want you to feel sorry for me. In spite of this food censorship, I'm hardly wasting away. Though I've lost some weight, mostly due to my low iodine diet a few months back (as part of my thyroid cancer treatment), it was weight I could certainly afford to lose. Now that I've lost it, Dina doesn't want me to gain it all back. Which I can understand and appreciate. Overweight often leads to any number of problems: hypertension, diabetes and even heart disease, to name a few possible complications. Still, I have my food requirements (OKAY, needs) and unless I get them, Kenny will become even more of a dull boy than he already is. So far, Dina is not budging. I wouldn't quite say she's the immovable object, but she definitely remains an obstacle to my caloric happiness. And the 'caloric happiness' to which I refer are basically Kenny's four food groups: cake, cookies, candy, and ice cream, which also explains my presumptive epitaph: "He never met a carbohydrate he didn't eat." But when the conversation moves to other, less controversial items, the conversation is much less problematic and maybe even indicative of who I am, what I've become, and how I assess my future prospects (life expectancy). When one receives a cancer diagnosis, your brain gets rewired (figuratively speaking) and your choices become sort of a window to your soul. Things you want/don't want become tells of what's being debated in your brain. Initially, after hearing your cancer diagnosis, it's unnatural almost to want what you used to want. It feels trivial. Your frame of reference and context, narrow and shorten. When the future you anticipated is snatched away, it's not only time which is taken. Hopes, dreams, and normalcy are snatched away as well. And sometimes, without even realizing it, a request is made which inadvertently illuminates the route to the light at the end of the tunnel. That moment occurred for me during last week's supermarket list discussion. Aside from the usual stuff that likely would need to be re-ordered, I ordered something new, without it being considered in the context of cancer (basically an abbreviated timeline). I asked Dina to order me an eight-pack of soap bars, an amount of soap that would probably last a few months, at a minimum. A 'minimum' which you don't necessarily anticipate. Not that a cancer diagnosis automatically shortens your life, but generally speaking, it is bad for business, if you know what I mean? A business which, apparently, I'm now willing to invest in. Maybe time is on my side after all.

"Thyroid cancer." Again? I thought the point of last week's surgical biopsy was to genetically-sequence a lung cancer tumor. Now you tell me the radiologist/pathologist found more thyroid cancer. As it already has happened, my oncologist - in coordination with my endocrinologist, said that my most recent CT scan showed "excellent results" (from my previous thyroid cancer treatment - which ended with radioiodine therapy), and furthermore noted that the thyroid cancer was confined to my neck. Yet a few weeks later, the thyroid cancer is back in my lungs. What happened? Or more importantly perhaps, what didn't happen? Well, if I understand what my oncologist said to us over the phone on Wednesday, disappointing as it initially sounded, it might not be at all bad. Apparently, the dose of radioiodine (nuclear medicine) I received had been modified (reduced) due to my pre-existing kidney function issue. Since this modification was not a "normal" dose, it didn't locate all the thyroid cancer tumors; the smaller ones, that is, so the presumption was that all the thyroid cancer had been found, identified and eliminated. Until last week's biopsy found otherwise. What does it all mean? I'll try to explain, although I'm sure I'll get lost in the science somewhere. I still have two types of cancer: non-small cell lung cancer and papillary thyroid cancer. However, I may have thyroid cancer in the lungs which actually may be better than having lung cancer in the lungs. The reason being: papillary thyroid cancer is curable whereas non-small cell lung cancer is not (it is treatable, though). Moreover, thyroid cancer is slow-growing and at present, so small that there may not be any treatment to follow. To learn more definitively what is happening in my body, I'm scheduled for a PET scan this week and then another surgical biopsy the following week. This time the biopsy will be a lung biopsy. This will get tissue from within the lung (a bit of a lung-collapsing risk), not from the periphery (the lymph nodes). Presumably, this biopsy will provide some clarity. According to my oncologist, I have a dozen or so tumors in my lungs, some of which may be thyroid cancer. Unfortunately, it's not practical or prudent to biopsy all of them so a complete assessment will not be possible. Therefore, an educated guess will have to be made: continue to treat the lung cancer with immunotherapy or not, and/or only treat the thyroid cancer which given its small size and slow-growing nature wouldn't require any treatment - for now. And might not for years. But if there are more tumors that are lung cancer - which the doctors can't confirm, and I'm not receiving any treatment for them (because of the thyroid cancer diagnosis), won't my lung cancer tumors grow? And since one medicine doesn't work against two types of cancer, I may not be receiving treatment for the cancer that's really active and receiving treatment for the cancer that is not active. And the only way to find out what types of cancer exist is to biopsy each and every tumor - which is not going to happen. As my oncologist said in response to our characterization of this damned if I don't and damned if I do scenario as being very complicated: "Mr. Lourie has always been a complicated patient." As I review this column and reconsider what my oncologist has advised going forward, it's not only complicated, it's confusing and a bit disorienting. What exactly do I have and what are the risks, and more importantly: what is my life expectancy? Nevertheless, as my oncologist said: "I'm glad we did this biopsy." Me, too.

After more than six months away from the infusion center, due to the treatment for my papillary thyroid cancer stage II, I make my return on Wednesday, July 22. My non-small cell lung cancer stage IV, for which I have been treated since early March 2009, once again becomes front and center after having been back-burnered since early January while we addressed my thyroid cancer. Out of an abundance of caution and concern for the risk of miscellaneous drug/treatment interactions, both cancers couldn't be treated simultaneously. Now we go forward in hope, just like we did 11-plus years ago. Having completed the thyroid cancer treatment protocol after a recent CT scan showed no residual signs of cancer, I am now free - so to speak - to return to the scene of crime, to euphemise, and resume treatment for my underlying/pre-existing lung cancer. I am also returning for treatment because during the six month interval when I was not receiving any current lung cancer treatment, the lung cancer tumors grew. My oncologist was unable to characterize the growth, other than to say there was growth everywhere, (he didn't say a little; he didn't say a lot). For some context, he did read aloud some comparative tumor measurements written in the radiologist's report, which were less than ideal. No matter. Cancer is by itself less than ideal so that's nothing new, really. The theory of immunotherapy is that it trains your cells to fight the cancer regardless of whether the patient receives current treatment or not so the battle continues. Now, whether my six months of not receiving treatment was responsible for allowing this growth or kept it from getting worse, my oncologist wouldn't say. What he did say/recommend was that we restart the Opdivo (immunotherapy that I had been on for the previous year) since it had been effective for the year during which I was receiving regular bi-weekly infusions. However, I'm scheduled for my next CT scan in only two months instead of the usual three months so that my oncologist can make an assessment sooner rather than later. In the absence of any new symptoms before or at present, the scan becomes the arbiter of my destiny. (I imagine waiting for the results of that September scan will be stressful.) But this is life in the cancer world, and the longer I experience it, the luckier I'll be. In the interim, I am happy to go forward and resume my treatment. Nearly all the medicine that has previously been prescribed for me has been successful at managing my cancer (keeping it stable) so I have a reasonable expectation that my next two infusions will yield encouraging results. Nevertheless, I am well aware that any guarantees left the building on Feb. 20, 2009. That is when I first received a phone call from my internal medicine doctor advising me that the previous week's lung tissue biopsy had indicated a malignancy. Slow forward to the present (one does not go fast forward enduring cancer) and I will be back in a very familiar place: the infusion center. Though I don't view my return as one of a conquering hero, I am still alive and reasonably well after being treated for a second cancer while my original cancer was not in remission. (No small accomplishment.) Nor was it in hiding. To invoke one of my late father's favorite words: the treatment for my lung cancer had been held "in abeyance." Now the 'abeyance' is over and I am back to being a garden variety non-small cell lung cancer patient. The delay in my treatment caused some damage I presume but it doesn't really worry me yet (talk about naive). I'm glad to once again be current - and active, in my treatment and I continue to remain positive about the negative. My oncologist has referred to me as his "third miracle" (after having survived so long after an initial "13 month to two year" prognosis). However, that was then. This is now. I don't think my ship has sailed but there does appear to be some activity down at the docks. No matter, I'm an excellent swimmer.

And not just Tuesday, either. All week in fact, I'll be waiting to hear the music. One day, I'll hear from my oncologist and on another day, I'll hear from my endocrinologist. What I'll hear first is the status of my underlying non-small cell lung cancer, stage IV (diagnosed Feb. 2009) and later in the week, I'll get results concerning my most recent party crasher: papillary thyroid cancer, stage II, diagnosed Jan. 2020. This will be the first time I will have been waiting for results simultaneously, concerning TWO cancers that I now have. (What? One wasn't enough?) And B.B. King thought the thrill was gone. For those of us unlucky enough to have been diagnosed with two different and active cancers, this is the kind of week which tests your mettle and is as far away from thrilling as one could possibly imagine. C'est la vie, or at least it is because I'm not ready to be morte. Who says taking five years of French between seventh and eleventh grades was a waste? Here I am 50+ years later and I'm still able to dip into that old bag of tricks. I fear, however, that the longer I'm still living as an active, still-being-treated cancer patient, the more my health is at risk. Cancer is not exactly a friendly visitor. Rather, it's the kind of uninvited guest that takes up residence in your home and never leaves, like dust mites, fleas and mold. In some instances, you know they're present; in other cases, you're told. And the longer they stay, the worse the situation becomes. My cancer diagnosis was sort of like that, a surprise. A lifelong non-smoker with no immediate family history of cancer, I woke up one day with a pain in my left rib cage. A few days later, after the pain had migrated to the other side, combined with difficulty I was having catching my breath, I decided to go to the Emergency Room. A brief examination followed but revealed very little to the doctor. He suggested I return in a week to see the pulmonologist. Which, of course, I did. By that time, the pain had totally subsided and I remained pain-free for the next eight weeks until I got "the call" from my internal medicine doctor advising me that the previous week's biopsy confirmed a malignancy. Then I was in pain, emotionally - and afraid, as you can probably imagine. But here I sit, 11 and a half years later, living proof that a "terminal" diagnosis is not necessarily terminal. Somehow, through a combination of conventional wisdom/treatment, some non-Western alternatives in the form of pills and potions and a good attitude, which has meant keeping my glass half full while trying to maintain a good sense of humor, I have been lucky enough to see my beloved Boston Red Sox win their third and fourth World Series Championships of the 21st century. (Their first two championships in 2004 and 2007 were pre-Kenny's cancer diagnosis.) But looking backward, as gratifying and rewarding as it can sometimes be, has not been my modus operandi. My 'operandi' has been to walk quietly, laugh heartily and be positive (like our friend Ray's blood type) and not presume any facts which are not yet in evidence. Moreover, try taking any and all news in stride and be a patient patient (which is not double talk) and put one foot in front of the other and see where it leads. For me, it has led to a future that I wasn't supposed to have and a present for which I am eternally grateful, even during weeks such as these when I'm about to enter when my life, vis-a-vis what I am told by my oncologist and endocrinologist, is hanging in the balance not once, but twice. Really, twice is a bit much, don't you think? I mean, I think I'm doing my unhealthy bit by having one type of cancer. There's really no extra credit/extra benefit in having two types, especially at the same time. Nor is there any BOGO-type discount on my health insurance costs. Quite the contrary, actually. But if I'm still alive to complain about it, then I'm still alive and that's nothing to complain about.

"Very interesting," to quote Artie Johnson from "Rowan & Martin's Laugh-In," that "crazy-kooky" comedy show from the 70s. What's interesting is what my oncologist will say concerning the July 6th CT scan of my upper torso (lungs), the first such scan I will have had in almost six months. That interval being twice the usual and customary three month schedule I've been on for years. The reason for this abnormally long interval? As you regular readers know, I was being treated for my second cancer: stage II, papillary thyroid cancer. Now that the treatment and all is complete, we can return to the scene of the original crime, if you know what I mean, and begin assessing/treating my underlying cancer: stage IV, non-small cell lung cancer, which presumably has not disappeared in the last six months. To say my life depends on these findings is a bit obvious. Nevertheless, keeping one's eye on the ball is what us characterized-as-"terminal" patients have to do. (We're in constant touch with our mortality.) Losing sight of the obvious is the ultimate presumption, not unlike one being innocent until proven guilty. In the cancer world in which I live exists the exact opposite: your cancer is never in remission (innocent). Ergo, you are always guilty (of having cancer). Now whether it moves or grows, the results of one's scan will confirm. It's challenging to not expect the worst, even after 11+ years of experience often receiving good news; the inevitability of the eventual bad news is occasionally overwhelming. I mean, one is not characterized as "terminal" because they're expected to live. The writing may not exactly be on the walls, but apparently it's in the handbook that oncologists use to determine the proper protocol to treat their patient's cancer. Generally speaking, a serious/terminal diagnosis is rarely affected by the advances of modern medicine and/or a patient's disparate hopes and prayers. For us cancer patients, we're only as secure as the results of our most recent diagnostic scan says we are. So yes, July 6th is an important date for Team Lourie as will the follow-up telephone appointment with my oncologist on July 13th. That's when we'll learn if the road is hitting back at the rubber and whether or not I go forward in hope or backward in despair. As much ado about something as I am making this situation to be, it's not as if I haven't been down this road before; many, many times since my original diagnosis in late February, 2009. This is just "another day in paradise" to quote Phil Collins. And though this road is the one most traveled, it still doesn't minimize the stakes. It just means that I've been incredibly and amazingly lucky not to have succumbed to this killer disease (lung cancer is by far the leading cause of cancer deaths) as so many hundreds of thousands already have. And though experience helps, it doesn't really change the stakes; it sort of maintains them. All I can do in the interim is try not to consider the negative and recommit to the positive. That positive mantra for me has been, "it's nothing until it's something." And if it is something, it will be bad enough to hear about it then so I don't need to hear about it (presume) it's bad now. For the moment, to quote Sergeant Schultz (John Banner) from Hogan's Heroes: "I know nothing!" For some reason though, and I may be reading more into it than is appropriate, this July 6th scan seems to be carrying some additional weight. Not that there's anything different in and of itself with this scan compared to the previous one hundred or so that I've had - with or without symptoms, it just seems as if I'm spending more time trying to convince myself that it isn't.

We had to euthanize Biscuit, our oldest cat on Saturday, June 20th. He would have been 14 on September 20th. Biscuit is survived by his half-brother, Andrew and his two half sisters, Sloane and Twinkle. Biscuit's litter mate and brother, "Chino" preceded him in death in November, 2019, after succumbing to diabetes. Biscuit had likewise been diagnosed with diabetes around the same time as "Chino." However, as occasionally happens, according to Biscuit's veterinarian, some cats "spontaneously" overcome the disease, as Biscuit miraculously did, and go on to live relatively normal lives. Biscuit lived approximately one year after his diabetes went into remission, which ended up being about seven months longer than "Chino." Not exactly relatively normal; nonetheless, we were grateful for the extra seven months. Biscuit was "the senior man," as we called him and we typically left him in charge of the other four cats when both Dina and I would be away from home. Of all five cats, Biscuit was the most present in our lives. He was also the most social, the most fearless, and the most affable/tolerant of all our cats. An indoor cat like our entire herd, Biscuit was most likely to be around and to socialize. He would greet visitors within a few minutes of their arrival and invariably introduce himself by jumping up on the coffee table in front of the couch and staring at the newcomer. He was also the first in line for breakfast and dinner, first in line for treats, and whenever my wife, Dina, made a tuna fish sandwich for lunch, Biscuit was, you guessed it, first in line. Topping out at 15 pounds, somehow he managed to keep his weight down. He was a sweet, adoring and talkative cat and we loved him, and of course, we miss him terribly, especially Dina. Over the last few years, particularly, Dina and Biscuit had formed a bond. He was her cat, just as "Chino" had been mine. Not that Biscuit ignored me, hardly. But when he made his requests, verbal or otherwise, Dina was almost always the intended requestee. Moreover, as Dina's schedule changed, she became Biscuit's primary caregiver, feeder, litter-box scooper, and groomer, and more interesting for Biscuit, became the one to let him outside to take in the sights, sounds and smells which enthrall cats. She was, on these special occasions, daily of late, his constant companion, which is how they spent his last Saturday morning, together, outside. What has made Biscuit's passing so difficult is how quickly he declined, always a bad sign, our veterinarian said. Biscuit stopped eating on Friday after barely nibbling on Thursday. He even turned away from treats that I offered him and tuna fish that Dina placed in his bowl. Though still engaged with us, we could see his haunches and feel his boney spine. He had lost two and half pounds in the last three months. That Friday night, Biscuit had trouble settling down and whimpered off and on through the night. I called the veterinarian first thing Saturday morning and we were fortunate to secure an appointment at 10 am that very morning. Biscuit was clearly struggling and probably even suffering as his zero interest in breakfast confirmed and his sounds not of silence continued. We didn't want to be selfish this time as we had been with "Chino." We kept him at home far too long before taking him to the veterinarian and have regretted it ever since. We just couldn't let go. We weren't going to make the same mistake with Biscuit. That Saturday, we drove to the animal hospital and dropped Biscuit off to be examined while we waited in the car (per phase 2 rules). Ten minutes or so later, the veterinarian called with her grim assessment: Biscuit was failing and was not going to recover. Through our tears, we then made the decision to end Biscuit's suffering. We took his body home that day and buried him on Monday next to his brother "Chino." It was a private service attended only by family members.

For those of us living in states where mask-wearing is mostly mandatory (indoors: yes, outdoors: not nearly as much), it is very easy to hide one's emotions. If your mouth is undercover, and being that it is located under your nose and above your chin, it most definitely is, communicating with the public has become strictly verbal. Body language as personified by the expression on one's face has become non grata. All that remains above the mask are your eyes and - to a much lesser effect - your ears, your hair, and your forehead. If words are not spoken when passing by, either within the six-foot cone of safety or not, no one knows whether they've been greeted with a smile or disparaged with a frown. Still, I can't help doing either the former or the latter which invariably leads me to remind myself that what can't be seen must either be heard or not considered part of the new social-distancing equation. After a few months of donning the mask and viewing others donning the mask, I can't really see how I'm able to read the tea leaves, so to speak--that is, one's eyes. And how frustrating, because eyes have often been described as "windows to the soul." Unfortunately, without one's other facial features visible to the naked eye, interpreting one's eyes has become the only clue in conversation. I refer you all back to the early game-show television, specifically to "Make a Face," which aired between 1961 and 1962. In the game, contestants attempted to name the famous celebrities after seeing only a portion of their faces. Of course there was a revolving wheel whose spin would provide clues to the celebrities being featured that day. I vaguely remember anything more, except I thought the host was Art James (who was actually the host of "Say When," another gamer show from the same era). The host was actually Robert Clayton, for whom I have zero recollection. I can still see the wheel however, sort of, and I can recall seeing images of eyes, ears, noses, etc., and contestants trying to guess identities based on these facial fragments. Life is sort of like that now. We're all receiving incomplete information. The masks are hiding all manner of interesting and identifiable characteristics which we've all spent years interpreting. Just the other day, I met a woman from the local tree-service company offering free quotes to me and my neighbors. As she walked around our property with us, mask on and clipboard in hand, she identified trees which needed to come down and limbs which needed to be trimmed back. And while she spoke, naturally there was eye contact, from which I developed an impression. A few days later, she was back in our neighborhood supervising her company's work cutting down some neighbor's trees. I inadvertently bumped into her while she was driving up the street just as I was at my on-street mailbox. She stopped her car and when she rolled down the passenger window to say "Hello", I could see she was not wearing a mask. I saw her entire face and I thought she was older than her eyes had led me to believe ("not that there's anything wrong with that"). It only confirmed my suspicions of just how poor my judgment had been after initially having only seen her wearing a mask. And then later I realized that just as I hadn't seen her face entirely, so too would other folks not be seeing mine. So regardless of any facial gesture I had made, it was only my words that mattered, not my deeds. But since I hadn't "deeded" anything, I realized that an entire level of communication and impression is now missing. It feels like a combination of Halloween and Stanley Kubricks' "Eyes Wide Shut" where you're not sure who you are, but neither is anybody else. And in that anonymity breeds some contempt and lack of need for any familiarity. It's that lack of familiarity while quarantining at home which has led to the infrequent opportunity to interact socially - from distance or not. As a result, I believe I've lost some of my humanity, some of my dignity and perhaps even some of my friends.

Apparently, I'm back in the lung cancer business. According to the video visit I had June 8 with my endocrinologist, my thyroid cancer has not moved into my lungs where my oncologist thought it might have - given the results of a previous biopsy and some surprising tumor inactivity in my lungs. The 'surprising inactivity:' the tumors didn't kill me. Living, as they say, is the best reward. And it sure beats the alternative. Nevertheless, I can't say I'm thrilled with the outcome. All the tumors in my lungs still being non-small cell lung cancer squashes my dream that those tumors were curable papillary thyroid cancer (as it had been suggested by my oncologist in a previous phone call) that had moved rather than the originally diagnosed incurable lung cancer which itself had metastasized. In fact, papillary thyroid cancer is called "the friendly cancer, " according to one of my oncology nurses at the infusion center. There's nothing friendly about non small cell lung cancer, stage IV. I was hoping that the diagnosis of thyroid cancer was going to change my life from being cancer-centric to being thyroid-cancer-are-you-kidding? You mean to tell me, after 11 years and four months living as, and being treated for, lung cancer, the actual diagnosis is thyroid cancer? But alas, poor Yorick, 'twas not to be. If what I've been told recently is the absolute-without-a-doubt truth/accurate diagnosis, then I am back on the emotional precipice waiting for the other shoe to drop or, at the very least, have one of my socks fall down around my ankles and get all balled up in my sneakers. (Which I hate, by the way, when socks get all rearranged like that. I like the heel of the sock to be lined up properly with my heel and the toe of my sock not twisted away from the toes and so forth.) Once again, I suppose I'll have to pull myself up by my own boot straps, which I don't even own, and step lively, putting one foot ahead of the other and trying not to back up one step for every two I take. I've progressed too far for too long to backslide now. And even though my working thyroid-cancer-instead-of-lung-cancer narrative is now a thing of my medical past, it was sort of fun and uplifting - while it lasted. Now, I have to reconnect with my previous lung cancer reality and try to find some new approaches to living with a "terminal" disease. It reminds me of what Cpl. Klinger (Jamie Farr), the cross-dresser from the television series M*A*S*H, once did when he returned to camp after assisting the doctors off-site at an aid station. He was all business away from the 4077th, but upon his return, a few hundred yards outside "the upholstered toilet seat" as Trapper John (Wayne McIntyre) once called it, Klinger put his female nurses cap back on and reverted to his previous form as a skirt-wearing Section 8 wannabe, and life for him and all the other M*A*S*H personnel returned to their abnormal. So too must I return to mine: as a stage IV, non-small cell lung cancer patient who hasn't died and somehow has managed to keep under the reaper's radar. I mean, how else does one live so far beyond one's original "13 month to two year" prognosis? Granted, I have a good attitude and have made some changes to my diet and lifestyle, but hardly would I characterize my behavior as any kind of poster-boy status. Sure, I've tried to make light of an extraordinarily heavy burden and made lots of jokes in the face of what I was led to believe was certain premature death (what death isn't premature?), but that's more about personality than procedure. I was up for the challenge is all. Not everybody is. As Kenny Beatrice, a long time sports talk-show host in the Washington DC area used to say: "You can't teach height." Lucky for me, as my late father often said, I was "born with broad shoulders."

... is greatly exaggerated." So said Mark Twain. So said W.C. Fields. And so said Kenny Lourie. And the reason I am now saying it is because of what correspondence I received in my personal inbox accessed through my HMO's online site. What I received was a condolence letter (sort of a form letter, quite frankly), addressed to the Lourie family from my oncologist expressing his sadness at my "passing" and his "privilege to have participated in the care of Kenneth Blacker Lourie" (me). Then, a bit later in the day, I received a cell phone call from an unknown number (so I didn't answer it) but apparently, it knew me as a voice mail message was indicated. I entered my code and listened in associated shock as I heard my oncologist speak in a very heartfelt way about his "sadness" yet again concerning the death of yours truly. He spoke for nearly a minute, hemming and hawing and occasionally hesitating as if at a loss for words. Compared to the email, this message was personalized. Reading and then hearing what I have just written was an out-of-body experience of sorts, almost as if I was attending my own funeral and listening to the eulogies while standing off in the distance. This experience was not totally unfamiliar to me. In fact, once before, pre-cancer, something similar happened, though it was more curious than morbid. Scanning the Obituary section of The Washington Post, I noticed, for the first time, photos of the many of the deceased were a part of the page. They were located above the agate type and mostly in black and white. Catching my attention as they did, I randomly went to the top right corner of the right-side page where I saw a photograph of an African-American man. Unknown to me except for one extraordinary fact. Printed below his photo was his date of birth: 9/30/54. The same as mine. It took my breath away. I have to tell you, seeing one's date of birth listed in the obituary section is a peculiar kind of the-future-being-now. Subsequently, I was diagnosed with "terminal '' non-small cell lung cancer, stage IV, and given a "13 month to two year" prognosis. And though my presumptive death was not listed in the obituary section, its inevitability was implanted in my brain where it has been gnawing at me since late February, 2009. And for the last 11-plus years, as you regular readers know, I have ebbed and flowed with the varying medicines and protocols, which have amazingly managed to extend my life way beyond my oncologist's expectations, and never once had I being given last rites, so to speak, or advised to "get my things in order." Until today, that is. After I thought a bit about what I had read and heard, a part of me drifted back in time to the 1999 Bruce Willis movie "The Sixth Sense" and whether unlike Haley Joel Osment, I was actually dead already. Being alone in my house with nobody to snap me out of my delusion, for all I knew, this is what death feels like. Nevertheless, I continued with my normal routine, presuming I was still alive and sure enough, it soon became clear that I was indeed still alive. But my oncologist and maybe even my endocrinologist - with whom I have an appointment Monday, June 8th, might think otherwise. And not that their thinking 'otherwise' will change their lives, but knowing what they think they know rather than what is actually true might blip their radar and cause some emotional misdirection. After all, they're only human and even though I might not be their most memorable patient, given my unexpectedly long life post-diagnosis, I feel I'm not so easily forgettable either. Not dying does that to a person's "pagh," to invoke "the spiritual force inherent in all sentient beings" as believed by the inhabitants of Bajor. (See Major Kira Nerys from "Deep Space Nine.") For the moment/immediate future, though, I am still present and accounted for. I just hope all my medical appointments haven't been automatically cancelled since I'm still a living and breathing cancer patient, and that's no exaggeration.