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.

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.

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.

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.

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.

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.

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.

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.

More like in my wallet. After worrying for the past 18 months about possibly losing my health insurance, I finally hit pay dirt - and it didn't hit back. I have received my Medicare card and after I "dissenroll" from my interim "Obama Care" within the next week or so, I will officially join the ranks of the millions who have insured their health - so to speak - with the Federal Government. No more will I ifs, ands, or buts about hospitals, doctors ("medical" actually) and prescription drugs (parts "A", "B" and "D" for those of you unfamiliar with the alphabet soup). Dental and vision coverage I'm not so sure about, but at present, I can live with the coverage that I know I have now because the worst case scenarios have been addressed. And as a former insurance broker, solving and/or protecting against worst case scenarios was always my main concern. To invoke "Speedy" from those long-ago Alka Seltzer commercials: "Plop, Plop, Fizz, Fizz. Oh, what a relief it is." And even though I'm not plopping or fizzing, I am effervescent nonetheless at my arrival.
Reaching milestones (even destinations, sort of) is a way I've measured and evaluated my cancer experience. Not that I keep a chart or even a calendar with Xs marking the days but "I've looked at life from both sides now" (heck, I've looked at life from all sides now and in between, too) and my glass is still half full. I remain positive about my negative and despite having never having seen Joni Mitchell in concert (although I did have tickets to see her at Cole Field House in the 70s; once on stage, however, she realized she was too sick to perform and stage right she went. Occasionally, her songs have spoken to me.
Right now, the United States Government is speaking to me in the form of a red, white, and blue card. They are telling me that I have made it to the promised land, a land whose existence was proposed in 1965 and which became law in 1966 fulfilling promises made to all Americans who reach age 65 that health insurance is their right and not because they were privileged. Nevertheless, I feel privileged to be "Medichere." For 10 years, 10 months and 20 days, dating back to late December 2008 when I first experienced the pain in my rib cage which precipitated my visit to the Emergency Room, I have been under the proverbial gun. Sometimes, it's been holstered. Other times, it's been locked and loaded. So far, no shots have been fired, even though occasionally I've been in very close range. I can't say for sure whether I thought I'd actually get here, but let's be realistic, we all had our doubts. But now it's time to gear up. A tremendous weight has been lifted from my shoulders. All I have to do now is live with the fact that I have stage IV, non-small cell lung cancer, an incurable disease if there ever was one. But here I am, alive and reasonably well.
No more will I have to worry about who, what and where I'm going to be treated. From now on, I'm in charge (like Charles). As a result, I feel as if I've regained a little control of my life. And for a cancer patient originally diagnosed as "terminal," this control is an extraordinarily wonderful feeling. I wish I could bottle it like "Brighto:" "Brighto, Brighto, makes old bodies new. We'll sell a million bottles, woo, woo, woo, woo, woo, woo." (The Three Stooges in "Dizzy Doctors," 1937.) And that's just the kind of silly enthusiasm I'll need living forward. Hardly is the lung cancer I have on the run. I wouldn't even say I have it on the walk. A stagger, maybe. (Or maybe that's me who's staggering when I lose my balance because of the neuropathy in my feet.)
Cancer is an adversary unlike any other. It's going to do what it does. I doubt Medicare is going to scare it into remission. Moreover, my not worrying about having health insurance anymore probably isn't going to have much effect on "the cancer" ("Forrest, Forrest Gump") either. The biggest effect will be on me, emotionally. I just hope that's enough. Because I'm going to need all the ammunition I can muster.

Not to be morbid in the least or self-indulgent in the most (last week's column, "Something or Nothing" not withstanding), but recently I've had cause to hear about the future and be more concerned about the present.
I have a homeowner problem that, like all such problems, is way beyond my limited skills: a crack in the concrete slab which "porches" our house, apparently caused by a very large and old tree growing way too close to this slab. This is not a water-leaking-into-the-house problem. This is a structural-type problem identified by a home appraiser whom I've paid for - but not bought - to process a mortgage refinance. Given the two-week  time-frame during which I was expecting to schedule this assessment - considering the time-sensitivity of these applications, I was flabbergasted to learn that my expectations were totally unreasonable. Two weeks! I might as well have been asking for two months, which is what I ended up getting.
After hearing the nearly identical appointment-unavailability story multiple times, and getting increasingly frustrated and impatient at the unlikely timely resolution of my problem in my lifetime (no joke), I finally heard from a company that was able to schedule an appointment which they did so with an apparent straight face (as much as I could glean over the phone): "I can have someone to your house on October 25." I snickered. "October 25! That's two months," I said. ("I could be dead by then," I said to myself.) To the woman I said, "No. I need someone sooner, in the next week or so. Good-bye." (I made this call on August 21st.) When I hung up the phone, I started laughing at what I didn't say and why I hadn't said it. Being that I have stage IV lung cancer, I am not exactly on firm footing. I didn't say to the woman that I could be dead by then because those words were figuratively speaking a bit to close to my literal reality. It was a case of fiction being a bit too close to fact and my mouth actually being able to cash that check. In addition to providing fodder for this column, my calls to miscellaneous home improvement/concrete/foundation repair companies left me not high, still dry, but totally unrequited. I needed help. I put myself out there and received practically nothing in return. It is a lesson I'll take to the grave.
I don't want to sound unreasonable because I still think I'm of sound mind (not so much sound body), but being diagnosed with cancer does, at least in my experience, move up your timeline, so to speak. There's a certain amount of patience and accommodation that is totally ripped from your subconscious. When your life is in jeopardy, dealing with the daily double life and death becomes extraordinarily difficult, regardless of whether your answers are in the form of questions. The uncertainty of it all is very off-putting. Sometimes, you don't know whether your coming or going. Trying to live a "normal" life under these kinds of constraints - and restraints, can make Jack a very dull boy. And very often this dullness manifests itself in one's inflexibility. When your life is at stake, it's nearly impossible to act as if it isn't. Your brain seemingly gets rewired and re-purposed. As much as you attempt to retain your old and familiar self, this newer cancer-affected version slowly takes over. You're not exactly in "The Twilight Zone," but "imagine if you will" at age 54 and a half, expecting to live into your mid-80's as your both your parents did, instead being told that you have "13 months to two years" to live? Though I've taken it mostly in stride and lived way beyond my oncologist's expectations, to say one's stride is not changed by the experience is to give naiveté a whole new meaning. (Not to mention the fact that the neuropathy in both my feet makes walking extremely difficult.) Nevertheless, life goes on.
As such, as much as I want to plan for the future, sometimes, it's the present for which I need to plan.

That was a close shave, if I may euphemistically characterize my most recent, blade-free brush with cancer-like symptoms, especially considering that I thought my life was at stake. The pain was located around my left-side rib cage, exactly where the pain was on that fateful January 1st, 2009 day when I couldn't ignore it any longer and thus felt compelled to get off the couch and go to the emergency room. Though I didn't have any shortness of breath, or difficulty inhaling, exhaling and bending over (all of which I had back then); nonetheless, I thought the worst and didn't fool around this time and made an appointment with my primary care physician as soon as possible, which was for the following day. I didn't have a great sleep that night but it was somewhat improved knowing I might get an answer the next day.
To say that my life was beginning to pass by is a bit of an overstatement to be sure, but it was moving around a little bit. Trying to bury/compartmentalize what a possible recurrence/resistance to my current standard of treatment would mean before I actually met with a physician and received cancer confirmation was the immediate task at hand. Rationalizing that what symptoms I wasn't experiencing meant something positive/encouraging compared to what I felt 10 and a half years ago was one mental route I was traveling. The other was my usual and customary fall-back position: "It's nothing until it's something."
However, I have to admit 'something.' Though I can't speak for all cancer patients/survivors; for me, in spite of my inherited-from-my-father, positive attitude, being diagnosed with a "terminal" disease, as clearly described by my oncologist back in late February, 2009, creates a sense of inevitability, as does the "13 month to two year" prognosis that followed. Inevitability, as in one's demise (I'll never forget the walking-down-the staircase-with-a-yo-yo example he used) and then death is only a matter of time. Time which you don't have and quality of life which you'll never get back.
And when that 'inevitability' is most clear is when you have symptoms (related to your cancer or not; you don't know definitively, at least I never do), especially if those symptoms are identical to the ones that got you into this jackpot in the first place. So yes, I've had a difficult few days fighting the inevitable feelings and wondering if my amazing good fortune had finally run out. After all, a "terminal" disease doesn't generally mean you go on living a normal life expectancy. Au contraire. It means you don't! And at some juncture, the cancer spreads beyond modern medicine's ability to manage it. Then the patient is given a choice: stop the treatment and try to enjoy your remaining days without side effects, and thereby live a less cancer-centric quality of life with some freedom and independence - and hopefully feel some kind of better. And in those intervening days, try not to worry about the cancer doing what it inevitability (there's that word again) does, which is not cure itself. Or try some experimental treatment and hope for the best.
This is the emotional concern and challenge which hangs over my head. Never more so than when I have the symptoms that I did this past week. Fighting the cancer and fighting these feelings is two much. One at a time I can handle. Handle it I did as I sat in my doctor's office and in great detail, described my symptoms, and explained what I was feeling and what I wasn't. My internal medicine doctor listened intently as he has since the very beginning when I was first diagnosed. He was calm and reassuring in his assessment. My symptoms he said were not cancer-related. They "were muscular," he continued, "on the outside of my lungs." Not lung cancer at all. As such: No lab work. No X-Ray. No CT scan. No nothing. Another reprieve. Life goes on, until...

I mean, he didn't even examine me, which he rarely does. (The CT scan pretty much tells him what he needs to know, so he says.) In addition (or is that subtraction?), he didn't even ask me the standard questions he typically does about my quality of life, activities of daily living, and general health and welfare. In fact, near the presumptive end of our appointment, as peculiar and uncharacteristic of an appointment as it was, I felt compelled to blurt out the answers to all the questions that he didn't bother to ask that for years he's always asked: any pain, shortness of breath, coughing, headaches, neuropathy, muscle weakness or any new or persistent symptoms? All he could muster was a perfunctory, "Do you need any prescriptions filled?" And then the semi, out-of-the-blue-bombshell: "Are you familiar with Palliative Care?" Followed by the offer to refer us to a book that he thought we might find helpful/useful. Helpful? Useful? I didn't say it at the time because the entire appointment was so odd and almost impersonal. But WHAT?! Palliative Care? What are you talking about? He has never brought up palliative care before? (Although way back when, he had given us a brochure entitled "Final Wishes.")
You see, we know about palliative care. We've attended multiple conferences organized by LUNGevity, "the largest national lung cancer-focused non-profit in the country," where palliative care doctors often have spoken. Palliative Care is not hospice care but it's a transitional level of care to be sure. If I'm not transitioning, I wish somebody would have told me, and not by asking about my familiarity with this type of care. In a word, palliative care is a type of downsizing, as best as I can describe its subtleties; separate and apart from hospice care which is, if you don't know it, "the last train to Clarksville," if you get my euphemism (and hopefully someone is meeting you at the station).
But so far as I've been told, I'm not on the last train to Clarksville or any other final destination. In fact, I rarely take the train. Not that being on or off the train matters when one comes to the end of the line. Nevertheless, as I review in my mind what my oncologist said this past Monday, I have to wonder if he was feeding me a line, throwing me a line or just reciting a line that is required of oncologists in their regular communications with their cancer patients, a sort of caveat emptor for long-time cancer survivors who are inexplicably still alive (as evidence of such sentiment, my oncologist refers to me as his "third miracle"). But I didn't feel much like a miracle on Monday. I felt more like a dope. Like I was being told something I didn't realize, sort of a king has no clothes 'something.' It was a feeling I had never experienced before; during or after any of our appointments. Previously, even at the initial Team Lourie meeting in late February 2009 when the hammer came down, I had, though having it in utter disbelief, a grasp of the obvious: "terminal cancer," with a "13 month to two year" prognosis to boot. The particulars of which would be sorted out over the following weeks and months beginning with my first chemotherapy six days later.
And boy were they ever sorted. Ten years and almost six months later, I'm still sorting. Was I just given an updated "terminal" diagnosis/prognosis or was my oncologist merely having an off day? Obviously he knows that his words carry enormous weight and significance and create terrible burdens for his patients and their families. But he can't simply toss out the phrase palliative care like it has no impact. Its impact is huge. It's akin to being hit by a speeding train, the likes of which would prevent one from getting anywhere near Clarksville, let alone being on the last train.
 

Although I've had a pretty good run of late not writing much about "the cancer"—to quote "Forrest, Forrest Gump"—the reality is, as you might imagine, cancer is ever present - in your head and in your heart (and for me, in my lungs). Never more so than when your quarterly CT scan is imminent. As I sit and write this column on a Sunday, Wednesday—three days hence—Is what you'd call 'imminent.' Not that there's much preparation; there's not. But with electronic media being what it is, one does receive multiple reminders: text, email, and the occasional call. And even though I don't actually have to do anything in advance, I am reminded nonetheless, in advance, what there is yet to be done: show up! (Apparently, many cancer patients, staff have told me, are not as compliant as you'd expect them to be.)
But it's not the 'advance' or the after that I'm addressing in this column. It's the way before and how a CT's imminence affects one's life. As much as I write and talk/act a good game, living one's life pretending to minimize cancer's presumptive/possible/"prognosed" impact is indeed make believe. Not that I'm a glass half-empty person; I'm not, as you regular readers know. However, there's nothing like a computerized tomography and a post-scan appointment with one's oncologist to focus your attention on the fact that you have been/are living with what your oncologist originally characterized back in early 2009 as a "terminal disease”: non-small cell lung cancer, stage IV (and giving you a "13 month to two year" prognosis to boot). A disease whose initial progression (doctor-speak for growth/movement) eliminated surgery as an option, but one for which there have been multiple lines of chemotherapy, none of which was ever been said to be a cure. In the spirit of that reality, how does one live in the present and plan for the future? (Jeez, that last line sounds right out of one of the Carrie Bradshaw's "Sex and the City" voiceovers.
On the one hand, the one with no sense of reality, I suppose one is simply to go about one's varied business with nary a care or concern in the world. On the other hand, the one with enough a sense of reality to choke a horse, I suppose I am to mark time, count the number of days until my next scan, plan for today and think about tomorrow - but not too many tomorrows as there's no sense getting ahead of oneself or else one will get behind. And if that sounds mixed up, it is. Because for cancer patients "time is a godforsaken paradox." As Captain Katheryn Janeway of Star Trek: Voyager further explained many star dates ago: "The future is the past, the past is the future. The whole thing gives me a headache." And if you do get any headaches, you need to contact your oncologist because in 30% of lung cancer patients, the cancer moves to the brain. A location which presents all sorts of treatment and quality of life challenges. And a manifestation there, should it appear, scares the living daylights out of me. But never mind. Just keep on planning and pretending that you don't have a "TERMINAL" disease. You know, the type of disease for which there's "NO CURE."
Then again, if I do get bogged down by certain realities, I'll be no work and no play - and no fun (neither do I want to be a dull boy). And no fun is no way to live - in the past, present or future, and that's no paradox. So if and when the chips and/or the "chippee" is down, one needs to be thankful for the chips that you do have and for the ones you hope yet to accumulate. Otherwise, you might as well see the cashier on your way out. Life's too short (don't I know it) to live only in the present and not consider the future. And if I don't consider the future, it's unlikely I'll have one. Just because I've now had a past that lasted years longer than I expected shouldn't mean I can't have a future I never anticipated.
 

Except I was not sitting in the audience for "The Price Is Right" when I heard my name called. Nor was I needing to guess the cost of my infusion with my treatment that day contingent on my guess not exceeding the "actual retail price." And neither were there any of "Barker's Beauties" to wave their hands and showcase what items I would be attempting to price right. No. There were only multiple oncology nurses standing in front of the Infusion Center's entry door calling out the names of the next patients lucky enough to begin their treatment. It wasn't exactly "Plinko," but once inside the Center, the fun, such as it is, really begins.
At least that's the way the activity appeared to me. The preceding day was July 4th so the Center was closed forcing those Thursday patients to be rescheduled to either Wednesday or Friday. As a result, the waiting area was particularly full with patients, along with their family and friends, all of whom are encouraged to attend. In the midst of this crowd, I sat and waited. We hadn't exactly been assigned numbers, but we were assigned oncology nurses and therefore could only enter the Infusion Center with their assistance.
Then, while all of us "waiters" looking at the entry door waiting for an oncology nurse to walk through and call our name, the door lock clicked open and out walked two oncology nurses. As soon as they cleared the door and entered the waiting area, they called out their respective patient's names (unfortunately not mine). Upon hearing their names, the two patients and nearly half a dozen of their supporters got up and moved eagerly toward the entry door. It reminded me of the beginning of "The Price Is Right" when three audience members' names are called in quick succession and implored to "Come On Down!" by George Gray (Johnny Olson, the original announcer, retired years ago) and officially become one of that day's contestants.
However, once inside the Infusion Center, It's dead serious. Your life is at stake, maybe even at risk, depending upon your cancer/treatment, and at this point, you're not playing any more games (although occasionally, you may be guessing the price of things and wondering how it all gets calculated). So you slide into your Barcalounger, hold out your arm to have your barcoded wrist ban scanned and prepare for your hopefully, life-saving infusion, and don't smoke 'em, even if you got 'em.
It's rare that you'll see your oncologist in the Center. Typically, they'll be seeing patients in examining rooms, performing surgery or rounding in local hospitals. But they're always a phone call away should the nurses need any additional instructions or clarification. Generally speaking, once inside the Center, all goes as anticipated for us patients: you're in, you're treated, you're out. And when you're out, new patients names are called and on and on it goes, just like "The Price Is Right," except the program doesn't end in an hour. And just like "The Price Is Right," where there are no shortage of audience members wanting to participate, at the Infusion Center, likewise, there seems not to be a shortage of patients wanting to be treated either. (Granted. it's not exactly the same thing, but you get my drift, I'm sure.)
Cancer is not fun, nor funny, and an Infusion Center is not filled with anticipation of cash awards and magnificent trips. There is however, lots of empathy and understanding - from your support system and from staff as well. But it's the last place you want to be, unlike "The Price Is Right."
 

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.

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.

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.

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.

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."

So far as I can tell, I'm being treated as per usual. Meaning, treatment for my recently diagnosed thyroid cancer is on track. On track meaning multiple hospital visits at two health care facilities (some even on the same day) over five consecutive days to include four radioiodine injections, pre-and post-treatment CT scans, lab work, miscellaneous other medical appointments and a low iodine diet to boot spread out over a nearly six-week interval including one over-night at the hospital.
To say I'm looking forward to the experience would be naïve. To say I'm looking forward to killing the remaining thyroid cancer in my body would be more accurate. The thyroidectomy I had in late January was very successful but approximately 15 percent of the cancer remains, embedded under my collarbone and elsewhere. Consequently, treatment of my pre-existing/underlying stage IV non small cell lung cancer will be further delayed while we address the thyroid cancer which the surgeon was unable to remove. And now that I have my schedule, as of March 27, I now know when and where and how the process will play out.
One potential major complication: the coronavirus pandemic. Given the screening questions I have been asked of late when calling for medical information, if I am unlucky and somehow become infected or come in contact with someone who has been diagnosed or travel/have traveled to an area of the country/world particularly hard hit, I am guessing my treatment stops/never gets started. And not to be too paranoid about something which hasn't even happened yet but, I'd just as soon not become another statistic and/or not get my cancer treatment and allow my two types of cancer to live on without any checks or balances. (Generally speaking, if the cancer is left alone, it likely won't spontaneously go into remission. Quite the opposite in fact and therein lies my fear of having 'cancer in a pandemic.)'
I imagine that at any time over the next six weeks, a hundred things could change that could adversely affect my treatment/schedule, many of which are beyond my control. And not that I'm a controlling person, but when it comes to medical treatment that might actually be saving/extending my life, I do become a bit preoccupied. And if push does come to shove, so to speak, there's not much that I can say or do about circumstances (staffing issues, medicine shortages, reduced hours, increase in patients, etc.) which might affect the availability of health care. As a cancer patient, you 'd like to have a little predictability given that your normal routine is hardly what you anticipated. However, none of us anticipated a pandemic and now all us patients are waiting for chips to fall and wondering/hoping our names will be on the treatment list.
Unfortunately ,cancer treatment is not hit or miss. It mostly needs to hit. And if some of the hits can't happen when protocol says it should, there is reason to be afraid. But being afraid now, before any of these pandemic-related complications have even occurred, is a waste of time, energy and emotional wherewithal. I don't need to worry yet. If any of these worse-case scenarios do happen, there will be plenty of time to worry later. At the moment, I'm scheduled, I'm not sick and I'm able to social-distance, self-isolate and shelter-in-place until further notice.
I just wish 'further notice' wasn't a month from now. So much can happen to so many at so many places, most of which I can't prevent. And yet, if these happenings are not prevented, it's possible the powers that most likely be will inform me that circumstances have overtaken their plans and my treatment will have to be delayed. I'm so close. Thirty days, however, is an eternity for a cancer patient. Somehow, I have to stop watching the calendar. I have to watch my "ps" and "qs" instead and avoid any unnecessary social interactions. I'd like to think that come the end of April, I'll be ready, willing and available. I just hope that I can say the same thing about the medical professionals and hospitals where I'll be getting treatment.

In a peculiar way, my cancer treatment and all has sort of gotten lost in the coronavirus talk. With so many changes to our regular lifestyle occurring on a daily basis, it feels as if nothing else matters. Granted, one's health is the most important consideration, but now the talk is about everybody's health. Nevertheless, how do I throw caution to the wind and interact with my environment when doing so might endanger the very stability I've worked over 11 years to maintain? I mean, I have to live my life, but will there be a cost to do so? I realize that the good of the many outweigh the good of the few but Spock was speaking from outer space. How do I, while in and out of treatment down here on Earth not worry about myself?
I realize life will go on for almost all of us, but will there be consequences for those unable to secure proper care? Will decisions be made about allocating resources because demand has far outstripped supply? How does life for cancer patients undergoing treatment fit into this new paradigm where so many people might need some kind of medical care? Will there even be enough health care professionals to administer the kind of life-sustaining treatment many of us seriously-diagnosed patients have come to expect and need?
Unfortunately, only time will tell, and there may very well be little of it in the interim, during which we can anticipate and plan accordingly. So many decisions will likely be made by the powers that be that might not exactly consider my set of cancer circumstances. In a way, I might be collateral damage. There simply might not be enough room and medicine and staff and all to accommodate my needs. It's nothing personal. It's just business, or rather the lack thereof. With so much of the world's population affected while going about their usual and customary routine, who, what, where and how will there be any prioritization? Moreover, what about people who are already sick and challenged by a weakened immune system (like yours truly), will the competition from newly diagnosed coronavirus patients overwhelm our health care system?
I can't assume that life will go on as it always has. That would seem to be incredibly naive. I need to proactively make the necessary arrangements and/or contingency plans. I can't presume that being a cancer patient will always get me through the door. I'd like to think I take priority. But it might not be about priority, it might be about availability and a dwindling supply not able to keep up with demand.
Still, going down this rabbit hole of fear, anxiety and worry doesn't help either. As I have since the date of original diagnosis, back in late February, 2009, I need to make the best of a bad/challenging situation. I need to roll with the punches and be prepared for any eventuality and take the good with the bad and vice versa. Normal left the building a long time ago for me. The problem is that building to which I metaphorically refer is the very building where I get my ongoing medical treatment. And though I don't anticipate being kept away from that building, the reality is that it's out of my control.
As with anticipating the results of CT scans and lab results, all in good time, or bad. I need to keep the same positive attitude as I always have because though I might be at greater risk than many of you regular readers, we are all at risk, apparently. As such, if there is indeed anything to be gained by so many people being so similarly affected, the reality is that there are strength in those numbers and even though it may feel that right now the whole world is upside down, things eventually will right themselves. They always do. I just hope I'm still smiling when the dust settles.

More like in my wallet. After worrying for the past 18 months about possibly losing my health insurance, I finally hit pay dirt - and it didn't hit back. I have received my Medicare card and after I "dissenroll" from my interim "Obama Care" within the next week or so, I will officially join the ranks of the millions who have insured their health - so to speak - with the Federal Government. No more will I ifs, ands, or buts about hospitals, doctors ("medical" actually) and prescription drugs (parts "A", "B" and "D" for those of you unfamiliar with the alphabet soup). Dental and vision coverage I'm not so sure about, but at present, I can live with the coverage that I know I have now because the worst case scenarios have been addressed. And as a former insurance broker, solving and/or protecting against worst case scenarios was always my main concern. To invoke "Speedy" from those long-ago Alka Seltzer commercials: "Plop, Plop, Fizz, Fizz. Oh, what a relief it is." And even though I'm not plopping or fizzing, I am effervescent nonetheless at my arrival.
Reaching milestones (even destinations, sort of) is a way I've measured and evaluated my cancer experience. Not that I keep a chart or even a calendar with Xs marking the days but "I've looked at life from both sides now" (heck, I've looked at life from all sides now and in between, too) and my glass is still half full. I remain positive about my negative and despite having never having seen Joni Mitchell in concert (although I did have tickets to see her at Cole Field House in the 70s; once on stage, however, she realized she was too sick to perform and stage right she went. Occasionally, her songs have spoken to me.
Right now, the United States Government is speaking to me in the form of a red, white, and blue card. They are telling me that I have made it to the promised land, a land whose existence was proposed in 1965 and which became law in 1966 fulfilling promises made to all Americans who reach age 65 that health insurance is their right and not because they were privileged. Nevertheless, I feel privileged to be "Medichere." For 10 years, 10 months and 20 days, dating back to late December 2008 when I first experienced the pain in my rib cage which precipitated my visit to the Emergency Room, I have been under the proverbial gun. Sometimes, it's been holstered. Other times, it's been locked and loaded. So far, no shots have been fired, even though occasionally I've been in very close range. I can't say for sure whether I thought I'd actually get here, but let's be realistic, we all had our doubts. But now it's time to gear up. A tremendous weight has been lifted from my shoulders. All I have to do now is live with the fact that I have stage IV, non-small cell lung cancer, an incurable disease if there ever was one. But here I am, alive and reasonably well.
No more will I have to worry about who, what and where I'm going to be treated. From now on, I'm in charge (like Charles). As a result, I feel as if I've regained a little control of my life. And for a cancer patient originally diagnosed as "terminal," this control is an extraordinarily wonderful feeling. I wish I could bottle it like "Brighto:" "Brighto, Brighto, makes old bodies new. We'll sell a million bottles, woo, woo, woo, woo, woo, woo." (The Three Stooges in "Dizzy Doctors," 1937.) And that's just the kind of silly enthusiasm I'll need living forward. Hardly is the lung cancer I have on the run. I wouldn't even say I have it on the walk. A stagger, maybe. (Or maybe that's me who's staggering when I lose my balance because of the neuropathy in my feet.)
Cancer is an adversary unlike any other. It's going to do what it does. I doubt Medicare is going to scare it into remission. Moreover, my not worrying about having health insurance anymore probably isn't going to have much effect on "the cancer" ("Forrest, Forrest Gump") either. The biggest effect will be on me, emotionally. I just hope that's enough. Because I'm going to need all the ammunition I can muster.

More like in my wallet. After worrying for the past 18 months about possibly losing my health insurance, I finally hit pay dirt - and it didn't hit back. I have received my Medicare card and after I "dissenroll" from my interim "Obama Care" within the next week or so, I will officially join the ranks of the millions who have insured their health - so to speak - with the Federal Government. No more will I ifs, ands, or buts about hospitals, doctors ("medical" actually) and prescription drugs (parts "A", "B" and "D" for those of you unfamiliar with the alphabet soup). Dental and vision coverage I'm not so sure about, but at present, I can live with the coverage that I know I have now because the worst case scenarios have been addressed. And as a former insurance broker, solving and/or protecting against worst case scenarios was always my main concern. To invoke "Speedy" from those long-ago Alka Seltzer commercials: "Plop, Plop, Fizz, Fizz. Oh, what a relief it is." And even though I'm not plopping or fizzing, I am effervescent nonetheless at my arrival.
Reaching milestones (even destinations, sort of) is a way I've measured and evaluated my cancer experience. Not that I keep a chart or even a calendar with Xs marking the days but "I've looked at life from both sides now" (heck, I've looked at life from all sides now and in between, too) and my glass is still half full. I remain positive about my negative and despite having never having seen Joni Mitchell in concert (although I did have tickets to see her at Cole Field House in the 70s; once on stage, however, she realized she was too sick to perform and stage right she went. Occasionally, her songs have spoken to me.
Right now, the United States Government is speaking to me in the form of a red, white, and blue card. They are telling me that I have made it to the promised land, a land whose existence was proposed in 1965 and which became law in 1966 fulfilling promises made to all Americans who reach age 65 that health insurance is their right and not because they were privileged. Nevertheless, I feel privileged to be "Medichere." For 10 years, 10 months and 20 days, dating back to late December 2008 when I first experienced the pain in my rib cage which precipitated my visit to the Emergency Room, I have been under the proverbial gun. Sometimes, it's been holstered. Other times, it's been locked and loaded. So far, no shots have been fired, even though occasionally I've been in very close range. I can't say for sure whether I thought I'd actually get here, but let's be realistic, we all had our doubts. But now it's time to gear up. A tremendous weight has been lifted from my shoulders. All I have to do now is live with the fact that I have stage IV, non-small cell lung cancer, an incurable disease if there ever was one. But here I am, alive and reasonably well.
No more will I have to worry about who, what and where I'm going to be treated. From now on, I'm in charge (like Charles). As a result, I feel as if I've regained a little control of my life. And for a cancer patient originally diagnosed as "terminal," this control is an extraordinarily wonderful feeling. I wish I could bottle it like "Brighto:" "Brighto, Brighto, makes old bodies new. We'll sell a million bottles, woo, woo, woo, woo, woo, woo." (The Three Stooges in "Dizzy Doctors," 1937.) And that's just the kind of silly enthusiasm I'll need living forward. Hardly is the lung cancer I have on the run. I wouldn't even say I have it on the walk. A stagger, maybe. (Or maybe that's me who's staggering when I lose my balance because of the neuropathy in my feet.)
Cancer is an adversary unlike any other. It's going to do what it does. I doubt Medicare is going to scare it into remission. Moreover, my not worrying about having health insurance anymore probably isn't going to have much effect on "the cancer" ("Forrest, Forrest Gump") either. The biggest effect will be on me, emotionally. I just hope that's enough. Because I'm going to need all the ammunition I can muster.

More like in my wallet. After worrying for the past 18 months about possibly losing my health insurance, I finally hit pay dirt - and it didn't hit back. I have received my Medicare card and after I "dissenroll" from my interim "Obama Care" within the next week or so, I will officially join the ranks of the millions who have insured their health - so to speak - with the Federal Government. No more will I ifs, ands, or buts about hospitals, doctors ("medical" actually) and prescription drugs (parts "A", "B" and "D" for those of you unfamiliar with the alphabet soup). Dental and vision coverage I'm not so sure about, but at present, I can live with the coverage that I know I have now because the worst case scenarios have been addressed. And as a former insurance broker, solving and/or protecting against worst case scenarios was always my main concern. To invoke "Speedy" from those long-ago Alka Seltzer commercials: "Plop, Plop, Fizz, Fizz. Oh, what a relief it is." And even though I'm not plopping or fizzing, I am effervescent nonetheless at my arrival.
Reaching milestones (even destinations, sort of) is a way I've measured and evaluated my cancer experience. Not that I keep a chart or even a calendar with Xs marking the days but "I've looked at life from both sides now" (heck, I've looked at life from all sides now and in between, too) and my glass is still half full. I remain positive about my negative and despite having never having seen Joni Mitchell in concert (although I did have tickets to see her at Cole Field House in the 70s; once on stage, however, she realized she was too sick to perform and stage right she went. Occasionally, her songs have spoken to me.
Right now, the United States Government is speaking to me in the form of a red, white, and blue card. They are telling me that I have made it to the promised land, a land whose existence was proposed in 1965 and which became law in 1966 fulfilling promises made to all Americans who reach age 65 that health insurance is their right and not because they were privileged. Nevertheless, I feel privileged to be "Medichere." For 10 years, 10 months and 20 days, dating back to late December 2008 when I first experienced the pain in my rib cage which precipitated my visit to the Emergency Room, I have been under the proverbial gun. Sometimes, it's been holstered. Other times, it's been locked and loaded. So far, no shots have been fired, even though occasionally I've been in very close range. I can't say for sure whether I thought I'd actually get here, but let's be realistic, we all had our doubts. But now it's time to gear up. A tremendous weight has been lifted from my shoulders. All I have to do now is live with the fact that I have stage IV, non-small cell lung cancer, an incurable disease if there ever was one. But here I am, alive and reasonably well.
No more will I have to worry about who, what and where I'm going to be treated. From now on, I'm in charge (like Charles). As a result, I feel as if I've regained a little control of my life. And for a cancer patient originally diagnosed as "terminal," this control is an extraordinarily wonderful feeling. I wish I could bottle it like "Brighto:" "Brighto, Brighto, makes old bodies new. We'll sell a million bottles, woo, woo, woo, woo, woo, woo." (The Three Stooges in "Dizzy Doctors," 1937.) And that's just the kind of silly enthusiasm I'll need living forward. Hardly is the lung cancer I have on the run. I wouldn't even say I have it on the walk. A stagger, maybe. (Or maybe that's me who's staggering when I lose my balance because of the neuropathy in my feet.)
Cancer is an adversary unlike any other. It's going to do what it does. I doubt Medicare is going to scare it into remission. Moreover, my not worrying about having health insurance anymore probably isn't going to have much effect on "the cancer" ("Forrest, Forrest Gump") either. The biggest effect will be on me, emotionally. I just hope that's enough. Because I'm going to need all the ammunition I can muster.

That was a close shave, if I may euphemistically characterize my most recent, blade-free brush with cancer-like symptoms, especially considering that I thought my life was at stake. The pain was located around my left-side rib cage, exactly where the pain was on that fateful January 1st, 2009 day when I couldn't ignore it any longer and thus felt compelled to get off the couch and go to the emergency room. Though I didn't have any shortness of breath, or difficulty inhaling, exhaling and bending over (all of which I had back then); nonetheless, I thought the worst and didn't fool around this time and made an appointment with my primary care physician as soon as possible, which was for the following day. I didn't have a great sleep that night but it was somewhat improved knowing I might get an answer the next day.
To say that my life was beginning to pass by is a bit of an overstatement to be sure, but it was moving around a little bit. Trying to bury/compartmentalize what a possible recurrence/resistance to my current standard of treatment would mean before I actually met with a physician and received cancer confirmation was the immediate task at hand. Rationalizing that what symptoms I wasn't experiencing meant something positive/encouraging compared to what I felt 10 and a half years ago was one mental route I was traveling. The other was my usual and customary fall-back position: "It's nothing until it's something."
However, I have to admit 'something.' Though I can't speak for all cancer patients/survivors; for me, in spite of my inherited-from-my-father, positive attitude, being diagnosed with a "terminal" disease, as clearly described by my oncologist back in late February, 2009, creates a sense of inevitability, as does the "13 month to two year" prognosis that followed. Inevitability, as in one's demise (I'll never forget the walking-down-the staircase-with-a-yo-yo example he used) and then death is only a matter of time. Time which you don't have and quality of life which you'll never get back.
And when that 'inevitability' is most clear is when you have symptoms (related to your cancer or not; you don't know definitively, at least I never do), especially if those symptoms are identical to the ones that got you into this jackpot in the first place. So yes, I've had a difficult few days fighting the inevitable feelings and wondering if my amazing good fortune had finally run out. After all, a "terminal" disease doesn't generally mean you go on living a normal life expectancy. Au contraire. It means you don't! And at some juncture, the cancer spreads beyond modern medicine's ability to manage it. Then the patient is given a choice: stop the treatment and try to enjoy your remaining days without side effects, and thereby live a less cancer-centric quality of life with some freedom and independence - and hopefully feel some kind of better. And in those intervening days, try not to worry about the cancer doing what it inevitability (there's that word again) does, which is not cure itself. Or try some experimental treatment and hope for the best.
This is the emotional concern and challenge which hangs over my head. Never more so than when I have the symptoms that I did this past week. Fighting the cancer and fighting these feelings is two much. One at a time I can handle. Handle it I did as I sat in my doctor's office and in great detail, described my symptoms, and explained what I was feeling and what I wasn't. My internal medicine doctor listened intently as he has since the very beginning when I was first diagnosed. He was calm and reassuring in his assessment. My symptoms he said were not cancer-related. They "were muscular," he continued, "on the outside of my lungs." Not lung cancer at all. As such: No lab work. No X-Ray. No CT scan. No nothing. Another reprieve. Life goes on, until...

Not to be morbid in the least or self-indulgent in the most (last week's column, "Something or Nothing" not withstanding), but recently I've had cause to hear about the future and be more concerned about the present.
I have a homeowner problem that, like all such problems, is way beyond my limited skills: a crack in the concrete slab which "porches" our house, apparently caused by a very large and old tree growing way too close to this slab. This is not a water-leaking-into-the-house problem. This is a structural-type problem identified by a home appraiser whom I've paid for - but not bought - to process a mortgage refinance. Given the two-week  time-frame during which I was expecting to schedule this assessment - considering the time-sensitivity of these applications, I was flabbergasted to learn that my expectations were totally unreasonable. Two weeks! I might as well have been asking for two months, which is what I ended up getting.
After hearing the nearly identical appointment-unavailability story multiple times, and getting increasingly frustrated and impatient at the unlikely timely resolution of my problem in my lifetime (no joke), I finally heard from a company that was able to schedule an appointment which they did so with an apparent straight face (as much as I could glean over the phone): "I can have someone to your house on October 25." I snickered. "October 25! That's two months," I said. ("I could be dead by then," I said to myself.) To the woman I said, "No. I need someone sooner, in the next week or so. Good-bye." (I made this call on August 21st.) When I hung up the phone, I started laughing at what I didn't say and why I hadn't said it. Being that I have stage IV lung cancer, I am not exactly on firm footing. I didn't say to the woman that I could be dead by then because those words were figuratively speaking a bit to close to my literal reality. It was a case of fiction being a bit too close to fact and my mouth actually being able to cash that check. In addition to providing fodder for this column, my calls to miscellaneous home improvement/concrete/foundation repair companies left me not high, still dry, but totally unrequited. I needed help. I put myself out there and received practically nothing in return. It is a lesson I'll take to the grave.
I don't want to sound unreasonable because I still think I'm of sound mind (not so much sound body), but being diagnosed with cancer does, at least in my experience, move up your timeline, so to speak. There's a certain amount of patience and accommodation that is totally ripped from your subconscious. When your life is in jeopardy, dealing with the daily double life and death becomes extraordinarily difficult, regardless of whether your answers are in the form of questions. The uncertainty of it all is very off-putting. Sometimes, you don't know whether your coming or going. Trying to live a "normal" life under these kinds of constraints - and restraints, can make Jack a very dull boy. And very often this dullness manifests itself in one's inflexibility. When your life is at stake, it's nearly impossible to act as if it isn't. Your brain seemingly gets rewired and re-purposed. As much as you attempt to retain your old and familiar self, this newer cancer-affected version slowly takes over. You're not exactly in "The Twilight Zone," but "imagine if you will" at age 54 and a half, expecting to live into your mid-80's as your both your parents did, instead being told that you have "13 months to two years" to live? Though I've taken it mostly in stride and lived way beyond my oncologist's expectations, to say one's stride is not changed by the experience is to give naiveté a whole new meaning. (Not to mention the fact that the neuropathy in both my feet makes walking extremely difficult.) Nevertheless, life goes on.
As such, as much as I want to plan for the future, sometimes, it's the present for which I need to plan.

Although I've had a pretty good run of late not writing much about "the cancer"—to quote "Forrest, Forrest Gump"—the reality is, as you might imagine, cancer is ever present - in your head and in your heart (and for me, in my lungs). Never more so than when your quarterly CT scan is imminent. As I sit and write this column on a Sunday, Wednesday—three days hence—Is what you'd call 'imminent.' Not that there's much preparation; there's not. But with electronic media being what it is, one does receive multiple reminders: text, email, and the occasional call. And even though I don't actually have to do anything in advance, I am reminded nonetheless, in advance, what there is yet to be done: show up! (Apparently, many cancer patients, staff have told me, are not as compliant as you'd expect them to be.)
But it's not the 'advance' or the after that I'm addressing in this column. It's the way before and how a CT's imminence affects one's life. As much as I write and talk/act a good game, living one's life pretending to minimize cancer's presumptive/possible/"prognosed" impact is indeed make believe. Not that I'm a glass half-empty person; I'm not, as you regular readers know. However, there's nothing like a computerized tomography and a post-scan appointment with one's oncologist to focus your attention on the fact that you have been/are living with what your oncologist originally characterized back in early 2009 as a "terminal disease”: non-small cell lung cancer, stage IV (and giving you a "13 month to two year" prognosis to boot). A disease whose initial progression (doctor-speak for growth/movement) eliminated surgery as an option, but one for which there have been multiple lines of chemotherapy, none of which was ever been said to be a cure. In the spirit of that reality, how does one live in the present and plan for the future? (Jeez, that last line sounds right out of one of the Carrie Bradshaw's "Sex and the City" voiceovers.
On the one hand, the one with no sense of reality, I suppose one is simply to go about one's varied business with nary a care or concern in the world. On the other hand, the one with enough a sense of reality to choke a horse, I suppose I am to mark time, count the number of days until my next scan, plan for today and think about tomorrow - but not too many tomorrows as there's no sense getting ahead of oneself or else one will get behind. And if that sounds mixed up, it is. Because for cancer patients "time is a godforsaken paradox." As Captain Katheryn Janeway of Star Trek: Voyager further explained many star dates ago: "The future is the past, the past is the future. The whole thing gives me a headache." And if you do get any headaches, you need to contact your oncologist because in 30% of lung cancer patients, the cancer moves to the brain. A location which presents all sorts of treatment and quality of life challenges. And a manifestation there, should it appear, scares the living daylights out of me. But never mind. Just keep on planning and pretending that you don't have a "TERMINAL" disease. You know, the type of disease for which there's "NO CURE."
Then again, if I do get bogged down by certain realities, I'll be no work and no play - and no fun (neither do I want to be a dull boy). And no fun is no way to live - in the past, present or future, and that's no paradox. So if and when the chips and/or the "chippee" is down, one needs to be thankful for the chips that you do have and for the ones you hope yet to accumulate. Otherwise, you might as well see the cashier on your way out. Life's too short (don't I know it) to live only in the present and not consider the future. And if I don't consider the future, it's unlikely I'll have one. Just because I've now had a past that lasted years longer than I expected shouldn't mean I can't have a future I never anticipated.
 

Except I was not sitting in the audience for "The Price Is Right" when I heard my name called. Nor was I needing to guess the cost of my infusion with my treatment that day contingent on my guess not exceeding the "actual retail price." And neither were there any of "Barker's Beauties" to wave their hands and showcase what items I would be attempting to price right. No. There were only multiple oncology nurses standing in front of the Infusion Center's entry door calling out the names of the next patients lucky enough to begin their treatment. It wasn't exactly "Plinko," but once inside the Center, the fun, such as it is, really begins.
At least that's the way the activity appeared to me. The preceding day was July 4th so the Center was closed forcing those Thursday patients to be rescheduled to either Wednesday or Friday. As a result, the waiting area was particularly full with patients, along with their family and friends, all of whom are encouraged to attend. In the midst of this crowd, I sat and waited. We hadn't exactly been assigned numbers, but we were assigned oncology nurses and therefore could only enter the Infusion Center with their assistance.
Then, while all of us "waiters" looking at the entry door waiting for an oncology nurse to walk through and call our name, the door lock clicked open and out walked two oncology nurses. As soon as they cleared the door and entered the waiting area, they called out their respective patient's names (unfortunately not mine). Upon hearing their names, the two patients and nearly half a dozen of their supporters got up and moved eagerly toward the entry door. It reminded me of the beginning of "The Price Is Right" when three audience members' names are called in quick succession and implored to "Come On Down!" by George Gray (Johnny Olson, the original announcer, retired years ago) and officially become one of that day's contestants.
However, once inside the Infusion Center, It's dead serious. Your life is at stake, maybe even at risk, depending upon your cancer/treatment, and at this point, you're not playing any more games (although occasionally, you may be guessing the price of things and wondering how it all gets calculated). So you slide into your Barcalounger, hold out your arm to have your barcoded wrist ban scanned and prepare for your hopefully, life-saving infusion, and don't smoke 'em, even if you got 'em.
It's rare that you'll see your oncologist in the Center. Typically, they'll be seeing patients in examining rooms, performing surgery or rounding in local hospitals. But they're always a phone call away should the nurses need any additional instructions or clarification. Generally speaking, once inside the Center, all goes as anticipated for us patients: you're in, you're treated, you're out. And when you're out, new patients names are called and on and on it goes, just like "The Price Is Right," except the program doesn't end in an hour. And just like "The Price Is Right," where there are no shortage of audience members wanting to participate, at the Infusion Center, likewise, there seems not to be a shortage of patients wanting to be treated either. (Granted. it's not exactly the same thing, but you get my drift, I'm sure.)
Cancer is not fun, nor funny, and an Infusion Center is not filled with anticipation of cash awards and magnificent trips. There is however, lots of empathy and understanding - from your support system and from staff as well. But it's the last place you want to be, unlike "The Price Is Right."
 

Except I was not sitting in the audience for "The Price Is Right" when I heard my name called. Nor was I needing to guess the cost of my infusion with my treatment that day contingent on my guess not exceeding the "actual retail price." And neither were there any of "Barker's Beauties" to wave their hands and showcase what items I would be attempting to price right. No. There were only multiple oncology nurses standing in front of the Infusion Center's entry door calling out the names of the next patients lucky enough to begin their treatment. It wasn't exactly "Plinko," but once inside the Center, the fun, such as it is, really begins.
At least that's the way the activity appeared to me. The preceding day was July 4th so the Center was closed forcing those Thursday patients to be rescheduled to either Wednesday or Friday. As a result, the waiting area was particularly full with patients, along with their family and friends, all of whom are encouraged to attend. In the midst of this crowd, I sat and waited. We hadn't exactly been assigned numbers, but we were assigned oncology nurses and therefore could only enter the Infusion Center with their assistance.
Then, while all of us "waiters" looking at the entry door waiting for an oncology nurse to walk through and call our name, the door lock clicked open and out walked two oncology nurses. As soon as they cleared the door and entered the waiting area, they called out their respective patient's names (unfortunately not mine). Upon hearing their names, the two patients and nearly half a dozen of their supporters got up and moved eagerly toward the entry door. It reminded me of the beginning of "The Price Is Right" when three audience members' names are called in quick succession and implored to "Come On Down!" by George Gray (Johnny Olson, the original announcer, retired years ago) and officially become one of that day's contestants.
However, once inside the Infusion Center, It's dead serious. Your life is at stake, maybe even at risk, depending upon your cancer/treatment, and at this point, you're not playing any more games (although occasionally, you may be guessing the price of things and wondering how it all gets calculated). So you slide into your Barcalounger, hold out your arm to have your barcoded wrist ban scanned and prepare for your hopefully, life-saving infusion, and don't smoke 'em, even if you got 'em.
It's rare that you'll see your oncologist in the Center. Typically, they'll be seeing patients in examining rooms, performing surgery or rounding in local hospitals. But they're always a phone call away should the nurses need any additional instructions or clarification. Generally speaking, once inside the Center, all goes as anticipated for us patients: you're in, you're treated, you're out. And when you're out, new patients names are called and on and on it goes, just like "The Price Is Right," except the program doesn't end in an hour. And just like "The Price Is Right," where there are no shortage of audience members wanting to participate, at the Infusion Center, likewise, there seems not to be a shortage of patients wanting to be treated either. (Granted. it's not exactly the same thing, but you get my drift, I'm sure.)
Cancer is not fun, nor funny, and an Infusion Center is not filled with anticipation of cash awards and magnificent trips. There is however, lots of empathy and understanding - from your support system and from staff as well. But it's the last place you want to be, unlike "The Price Is Right."