Biopsy

This report will be as brief as possible concerning the experience of having the probable thyroid cancer in my 5th thoracic vertebrae biopsied.

Just to reiterate, the idea driving the biopsy was that, very few cases of papillary (my type) thyroid cancer have ever been reported going to bone in a young person. And since I'll certainly be having further treatments in the next few months, it would be good to confirm what the evidence supports at this point in time. To put it bluntly: world experts who deal with thyroid cancer all of the time, are surprised to hear about the 'appearance' of my vertebral met, so we just want to make sure of what we're dealing with.

My day started early. I didn't sleep well last night and decided that since I probably would be hurting after the procedure, that maybe I'd be more content if I get my ride in early. So, I was out and about on my road bike at around 5:40am. I went and did some sprints in forest park, then on my way home, as I was thinking about the big cup of coffee I was going to drink and the massive bowl of oatmeal which I was going to destroy, I remembered that I wasn't supposed to eat anything the morning of the procedure. Oops.

At 11am I was in my gown with my IV in, and I was kicking myself cus I was HUNGRY and seriously tired. The doc came in and told me all about the risks of the procedure...of which I immediately stopped listening since the first thing he said was, 'collapsed lung if the needle misses'. Yikes. I then asked for him to repeat the other stuff, since I had stopped listening, and he started talking about paralysis. 'Ok', I thought, that's enough...let's just get this shit over with.

For the procedure, I was told that I would be awake and would remain responsive but probably wouldn't feel much. Since that was a state of consciousness I was not yet convinced could actually be produced, I remained dubious and indeed rather scared about the idea of a bone marrow biopsy in my vertebrae since they hurt.

I have had a 'real' bone marrow biopsy before, which is a fabled procedure among medical people as one of the more painful procedures that patients can undergo.

When the time finally came, all I know, is that when I finally got on the table for the CT scan, I remember about 5 minutes of the entire 60 minute experience. They gave me Versed (fast acting benzo) and fentanyl (crazy strong opiod) and I don't remember a thing and didn't feel a thing. The insane aspect of that, is that I was told that I never actually fell asleep and that I carried on a conversation when engaged. Even my wife says that when I was brought back into the recovery room, that I did X, Y, and Z...yet I remember nothing.

I'll find out the results on friday. Until then, life goes on...

ps- I got another ride in this afternoon. I rode easy, but for a full hour and 50 minutes...so overall, managed over 50 miles today!

FoPo Crit

I raced today in the P/1/2 crit road bike race at Forest Park (StL, MO). I wasn't very well prepared for the race, having ridden 60 miles the day before and having had a few too many incredible beers from Avery and Founders last night. But, I had a lot of confidence given;
1. I had teamates there cheering for me. And,
2. That I had a job to do, and it wasn't to win...it was to work for my other teamates.

The race went well. I knew just about everyone there from cross and although crits probably won't ever be my strong suit, I had a great time and felt like I at least contributed (Dave H. won! and Shottler did well).


Ok, now I'm going to go drink some coffee stout and eat some Pi. I'll blog later this week about the biopsy which I'm having on my vertebrae. The basic idea about that procedure, is that no one has ever seen my type of thyroid cancer go to bone in a young person. At this point, given the evidence, we're about 99.5% or greater that it is indeed thyroid cancer. Although it certainly 'quacks like a duck' it is still sufficiently weird that we just want to make sure that we're dealing with thyroid cancer in my vertebrae and not something else.

Ok, one last thing that's been on my mind: I must vent.

Topic: Skins.

Despite this blog, I am generally a pretty quiet guy when it comes to differing opinions...but I'd like to say 3 things about these 'compression products'.
1. Since they are not tailored to individual anatomy, any claimed notion of 'increased blood flow' by 'holding the muscles in proper alignment' is nothing more than an unsubstantiated and out-right scientifically dubious claim. They can't do what they say unless, maybe (and this is a serious stretch, because they probably still wouldn't do what they say) they were tailored garments.
2. Fact: Veins and lymphatics, which remove metabolic waste products are aided in their flow by movement and restricted by compression. Why would you just compress them?
3. When people undergo surgery in hospitals, they get special socks which are electronically controlled to tighten and then release, creating rhythmic waves of restriction and compression. The idea is to assist in the known physiology of the circulation. They work. Just tightening doesn't.

The one caveat to my argument, is that I am not a trained sports physiologist. Just a dude doing a bit of thinkin. OK, rant over.

ps- Thank you to the photographer

Training and prepping

I love geeking-out over training information and sport physiology. This past week I rode:
Sunday 2.5hrs with friends on cross-bike: in the snow



Tuesday 3 hours w/ 3x10 FTP intervals on the road: in 70degree and sunny weather
Wed 2 hours easy on gravel roads with mountain bike: 50 degrees and sunny
Thurs 2.5 hours with 4x90 sec moderate-hard efforts 3 min recoveries: 20mph winds out of north, rain, 45 degrees


Interval 1: about 2 minutes @ 400w average
Interval 2: 90 sec 375w average
Interval 3: 90 sec 360w average
Interval 4: 90 sec 360w average

I love where I live. There's always people ready to ride, no matter the weather or the time of day.

I'm feeling good for my first mountain bike race of the season this sunday...if it rains and the race is called, then I'll probably go do a crit at Forest Park.

The next few weeks stand to be pretty difficult as far as doctor visits. Next Tuesday, at Barnes in St Louis, I'm going in to get a needle stuck into my 5th thoracic vertebrae in order to biopsy the thyroid cancer which is present there. As I was laying in bed last night, I got a little bit freaked out about the idea of physical discomfort and the drug-induced delirium associated with the dose of versed (short-acting drug in the benzodiazepine class that is used for treatment of acute seizures and for inducing sedation and amnesia before medical procedures. It has potent anxiolytic, amnestic, hypnotic, anticonvulsant, skeletal muscle relaxant, and sedative properties) and fentanyl (μ-opioid agonist and a potent narcotic analgesic with a short duration of action and rapid onset..approximately 100 times more potent than morphine).

Yes, that's actually how a dorky medical student like myself thinks when I hear the name of a drug. Man, I love me some pharmacology...sometimes I think it would be a shame to go into pathology or research and forget it all.

After the biopsy, I'll have a bunch of scans/blood tests in the next few weeks then go to MD Anderson on April 12th for an appointment with a guru. Interesting thing about big centers like MD Anderson, which see referred patients from all over the world, is that they tell you when your appointment is. It is sort of like being called to the principles office...you drop whatever you're doing and obey.

Wow, everyone I've spoken/interacted with today who is NOT HAPPY about the health care build has, in my humble opinion, probably got their news from a major news network. I actually watched a few minutes of 'coverage' on CNN...and I have to say, it makes me want to kill my television (if you don't know me, my wife and only recently got television after not having it for 6-10 years). First of all, no one on TV, except maybe Obama is speaking intelligently about the thing. If you haven't read a good summary, please do so here. And second, people are out-right lying about what the bill says.

We had snow in Columbia this past weekend and I only managed a 2.5 hour ride on gravel roads Sunday. There were 2 other crazy friends with me, but most everyone else took the weekend off. Strangely, my knee is a bit sore today...however un-scientific this sounds, I'm pretty sure cold weather irritates it. Plus, I actually managed 9-10 hours of riding last week, much of it at hard to moderate-hard tempos. So today is rest, stretching, and ice. I've been hammering the road bike lately and am starting to get excited about trying a few long road races.

I was bummed about Dogwood this weekend. Now my first road race of the season is looking like Hillsboro Roubaix. Again, the goal will just be to finish as I understand it is a pretty brutal race. If you have any advice about it, I'm all ears. In the meantime, I'm planning on racing this sunday no matter what, hopefully the mountain bike at Lost Valley.

After, I'm hoping to do:
April 18: Tour of Hermann Omnium (Saturday TT and crit, Sunday road race)

May 1: Haven't decided yet...either Mountain bike race or the Vino Fondo

May 8: possibly Joe Martin?
May 23: Tour de St Genevieve, State Road race

June 12: Mtb Missouri State Championship. Castlewood

July 4th: Mtb Firecracker 50, Brekenridge CO

Health care bill

Please educate yourself on what seems like the final version. Lots of good compromises:

http://www.washingtonpost.com/wp-dyn/content/article/2010/03/19/AR2010031900424.html

Items I'm pleased with:
1. INSURANCE MARKET REFORMS
2. Subsides
2. Medicaid expansion, the prior poverty limit was insane
3. EMPLOYER RESPONSIBILITY: As in the Senate bill, businesses are not required to offer coverage. Instead, employers are hit with a fee if the government subsidizes their workers' coverage. The $2,000-per-employee fee would be assessed on the company's entire work force, minus an allowance. Companies with 50 or fewer workers are exempt from the requirement. Part-time workers are included in the calculations, counting two part-timers as one full-time worker. (IMO: EXCELLENT COMPROMISE)

I think it is a much better idea how they're doing taxes, but I still fear that in 2018 it will hurt middle-class laborers.

On my mind

Disclaimer: the following is personal and graphic. If you're looking for non-cancer related material, don't read this.

I probably shouldn't be blogging about what I'm about to blog about. But I've said that before, and it ended up re-opening the door to my own writing...so here it goes.

Last night, I woke up in the middle of the night completely terrified after a dream. In the dream, I had gone to MD Anderson and was drinking a cup of coffee as the doctor was looking over my x-rays. He showed me that there was a huge tumor compressing and displacing my collarbone and I told him that it was too hard to believe, since I didn't feel any pain at all. All of a sudden, the doctor starting staring, horrified, at my mouth and coffee cup. Next thing I knew, I was puking into my coffee cup and all over the floor. He then told me that I was vomiting up pieces of bone. I told him I didn't believe it and he asked to see my coffee cup, then proceeded to remove large pieces of flat bone, covered in blood. Then I woke up.

Sub-conscious catharsis?

Fear?

Denial?

Who knows.

Needless to say, the dream was on my mind for much of the day. I really don't mean to be harping on it...or even calling out for sympathy. In fact, that is exactly what I don't want. Honestly, I just want this to go away and one of the ways I've found that helps is writing about the deepest, darkest fears. Beyond my control, I'm starting to not feel a great deal of hope for the next 20-30 years. Next year, no problem. But, age 50 would be something I'd consider a miracle to see. And I'm not sure I believe in miracles.

I have been thinking a great deal about the next 6 months and am feeling a bit lost in it all. Mountain biking is starting to feel like a bad idea given the number of falls I took last year. Med school is seeming like a huge, un-necessary and worthless stress next year, especially considering that it will be really hard to get time off during my clinical rotations...and I'll clearly require it for various health needs (scans, doctor visits, blood tests, possibly more treatments). Educationally and professionally, I'm at an impasse because my current research either requires a serious investment of time or should be abandoned. Tomorrow I go to speak with the head of my department about some funding ideas for the research, so hopefully he'll have some good advice about what to do.

My first cancer benefit!

I hope to do more in the future and am going to work with Mike Weiss about making a cancer-charitable component to next year's bubba cyclocross series. In the meantime, this friday, March 19th:

Happy Hour Benefit show for my buddy Ethan's co-worker, Tyler Hargis, this Friday at MOJO's. He is suffering from cancer and proceeds from the event will go to help his family deal with the incurred financial burden.

It starts at 5:00 pm and ends at 8:00 pm. There is music for everyone; Brass band sound to Bluegrass. I'll even get up on stage and play a song with Ethan's band on my mandolin.

Come enjoy some music, eat soul food, indulge in happy hour drink specials and help support Tyler!

$5 suggested donation and please pass the invitation on

Line up

1. Tempest Fugitives
2. Julie Gochenour
3. Show-Me Brass Band
4. The Derailed Commodities

Links
http://crushittyler.org/
http://www.livestrong.com/
http://www.mojoscolumbia.com/

Thanks

ps- Sunday I'm doing a long, hilly, road bike race down near Branson: the Dogwood road race. My goal is a pack finish in the 1/2 race and MAYBE if I'm feeling REALLY good, racing to the top of the second big hill @mile 30, which is the KOM competition.

Medical plan

Time seems to be escaping me lately...it is getting harder to write and life at home seems to be full of stress, fear, and a very tired couple.

Couple-partner #1, Maggie takes her board exam in May and even more than many med students, she really stresses out about having to study. She hates it, but still feels compelled to do it anyway. My health situation and all of the uncertainty that it brings only adds to the problem. To some extent, my cancer is harder for her to live with and talk about than it is for me. It is that way for my parents as well.

For couple-partner #2 (yours truly), it is always weird to want for people who I love to understand what is going on but at the same time for me to feel torn between a spectrum of pushing it away and embracing the whole experience as the most powerful learning experience of my life. 2010 has been the most exhausting year of my life. I've tried to restore myself using the tools that I always have; exercising outside, yoga, cooking, writing, spending time with friends/family, but I just can't seem to bring back a sense of mindfulness into my relationship with those closest to me. I read this quote the other day, and really liked it:

Mindfulness is not simply a technique. It is an act of love. Our willingness to see clearly, to hold ourselves closely just as we are, while being this way with another, is a revealing and deeply healing expression of care – an embodiment of compassion. Compassion begins at home, with ourselves; whether offering or seeking care, we are all wounded and we are all whole.
-Saki F. Santorelli

Tuesday I returned to Wash U in St Louis for the first time in a few years. I met with 2 doctors, a radiation oncologist who specializes in vertebral metastases and an orthopedic surgeon who focuses on vertebral metastases. I was a bit worried, that both of them were going to 'see a nail with their hammers'...basically, feel like their modality would be the best option for my treatment.

Instead, a few days later, I'm in a familiar spot: not knowing what is going to happen.

I had anticipated the radiation oncologist to say that he would want to treat my back with steriotactic radiotherapy, so my visit with him was largely so that I can learn the ins and outs, risks, and efficacy of that procedure. It would involve a very powerful and focused X-ray machine that would essentially deliver a dime-sized dose of radiation to the problem area and in so doing, kill as many cells as possible. It wouldn't even break my skin and because the dose is so targeted, there are virtually no risks, barring an equipment malfunction or dose mis-calculation. The one thing that surprised me was that he is less than enthusiastic about treating me any time soon. He wants to wait to see the effects of the radiation treatment from January, which won't be apparent for 6-12 months.

The next doc, evaluated the structural risk which the small little nodule in my vertebrae poses. If it were bigger or if it involved a rib, then I probably wouldn't be biking any longer. And if either of those were true, I'd probably have a pretty serious surgery, where they actually remove the entire vertebrae then put in metal implants to fill up the space. Lucky for me, I won't be needing that procedure either and he thought the best thing to do was to wait and see how my last radiation treatment worked.

As of today, my medical plan is as follows:
April- @MU: blood tests, repeat spinal MR, cervical ultrasound, neck CT w/ contrast.

-if my condition is stable, then continue suppression therapy (the thyroid hormone pill I take daily) until July

-if progression (defined as an increase in size of the vertebral lesion), then unleash the radiation oncologist for steriotactic radiotherapy


July- @Hopkins- blood tests and spinal MR.

-if progression, then steriotactic radiotherapy with radiation oncologist

-if stable or improvement, then defer steriotactic radiation. Prepare for another I-131 treatment (the same radiation procedure I had in January) in August. Also a PET scan to detect any other disease present (sometime thyroid cancer hides in other bones or in brain tissue and doesn't show up well with the other scans I've had).

My doc at Hopkins, who is a world expert, also suggested that I see another world expert just to get another opinion, because my situation is so unique. So at some point soon I'll go to either, Memorial Sloan Kettering in New York or MD Anderson in Houston. Know any good places to eat in those cities?

Stupid cancer:


Biking-wise, I rode pretty consistently this past week, even managing a 2.5 hour 44-mile gravel ride mid-week. Today the weather is 40 and raining and no one seems motivated to get out to ride. Tomorrow looks better and I'm looking forward to getting back into the Columbia road peloton.

Training weekend

This weekend was my second weekend back on the bike. I haven't done any serious training yet, but I got a good 75 miles on the road bike between friday and saturday. It feels great just to be riding but it is really hard to play by the rules which I've laid down for myself. After an overuse injury to tendon or ligament, the rules laid down for safe recovery are:

-Always warm-up before sport. That includes a dynamic warm-up to activate muscles in hips, hamstrings, and the weaker parts of quads. The foam roller is also excellent here to work the IT band and get some 'knots' out.
-Return to riding using the 10% rule: first week back, reduce volume and intensity by half. Throughout late December and all of January, volume for me was 13-18hours/week. So this past week, I rode 6.5 hours divided between 4 riding days with the longest ride being ~42miles. Next week, increase volume and intensity by 10%, so total ride time next week will be 7-ish hours and longest ride will be ~50miles. etc.
-After riding, stretch quads, IT band, hips, and hammies. Then ice massage the part of my knee that had been hurting.

I had really wanted to do the Dogwood road race, but right now, I'm thinking that 80ish miles at a cat 1/2 pace isn't in the deck of cards for me. Oh well, better to get healthy now and return to form slowly than go out and re-injure myself. Lost Valley however, looks like it will be a go.

Tuesday I head to St Louis to meet with a spine doctor and another radiation oncologist to talk about the metastasis in my vertebrae. The weight of the situation continues to loom and Maggie and I (as well as my parents) are still trying to comprehend.

On another note, here is the newest edition to the Miller family:



His name is Zulu. He thinks he's a dog.

Mud baby

I stayed home sick from work Tuesday and Wednesday of this week. It was some kind of GI thing in addition to a pretty high fever. Pretty nasty stuff and terrible timing since this week is Maggie's finals. Plus, I was presenting a bunch of background literature to my 'boss' and lab-mates on Tuesday, so waking at 3am to a rushing impulse to evacuate both ends of my gut tube of their contents, with the later development of a 103-degree fever was quite painful. Mid-day yesterday I started feeling better and managed to get a bit of work done before preparing a delicious dinner of Tempeh and veggies for my exhausted wife. I kept thinking how terrible it would be if Cassidy caught what I had, so had kept my distance to the best of my ability.

This morning seemed like a normal day, Cassidy was wailing at 4:30am as per usual, ready to start the day! It wasn't until about 7:15, when I realized that our nanny was 15 minutes late when things got interesting. Turns out, the nanny has what I had! So, she was home sick. Maggie was on her way out so I resigned to spend the day home with Cassidy. After about 20 minutes, I decided that since it was such a nice day outside, that I should give the bike trailer, aka Burly, a second try and head in to work for a little while.

The first try was last fall, when Cassidy was a little under a year old. She wasn't such a fan. This time, she was giddy with excitement as I was putting it together. Maybe she has learned enough about bikes to know that she should by psyched to get towed by a 9-speed dura-ace equipped, steel road bike? Such a suspicion would be confirmed first as she declared 'weeee' as I rode down the steep gravel hill leading to the MKT trail behind our apartment. And second, as she seemed to much prefer the smooth roads of the University of Missouri Campus (again, declaring 'Weeeeee') and the high velocities in which they allow, relative to the old-railway-line turned gravel bike path of the MKT (where she cried a few times on the bumpy parts and REALLY didn't like having her baby-doll get muddy).

Of course, any self respecting off-road cyclist has to be a little bit concerned in such a situation and wonder, will my child grow up to be a roadie? Such were my thoughts as we arrived at the med school. All in all, the trail was mostly still frozen, so only a little mud had adorned our (including dolly's) facial areas and cycling equipment. Interesting note here: Cassidy hates mud. Every time something gets dirty we have to calm her down and she insists on it being cleaned as soon as possible.


At the med school, we ran around to talk with a few people about work and Cassidy seemed to enjoy the large number of doors that are in hospitals. Yes, doors. I don't know, she is who she is...

The way home, was a bit more interesting. Fears were slain and conquered. The trail was muddy as all hell. The choices, which of course I didn't give to Cassidy, were to ride on a busy road or the muddy serenity of the MKT trail....see for your self as to what transpired:








I promise I had the screen on her trailer down, but it is a mesh screen and I didn't realize how much mud was getting in. I guess she didn't care too much, because she fell right to sleep and in fact, is asleep in her bed as I type all of this! I wonder what'll happen when she wakes up and sees her pants? Maybe cyclocross will be a good compromise for her...

BoCoMo is still the best, but Portland is amazing!

The cool part is that the hill he is riding up is actually the hill to get to Oregon Health and Sciences University...