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.