Wednesday, March 30, 2011

New bumps: part 2

Biopsy is scheduled for friday. One thing we were taught in medical school is; order tests only when the result would affect the 'management', aka treatment, of the patient.

Just so that people are on the same page in terms of the information this biopsy will provide, here's the deal: Given the size and character of these nodes and the fact that they're in my neck (I've have 80-ish lymph nodes plucked out over the course of 3 surgeries and around 60 of them have had cancer in them), it is highly likely (maybe 95-98% certainty) that these two 'new' nodes will have some kind of cancer. The diagnosis I've lived with for the past 6 years, is a thyroid cancer sub-type called papillary. There's a few things important with respect to that subtype; it is typically a disease of females or those exposed to radiation, i.e. Chernobyl. Papillary has an excellent prognosis, however the following features each worsens the prognosis: being male, extensive metastases, poor health, or certain mutations beyond the scope of this post. Unfortunately, we know I have mets in my bone, lungs, and neck. And of course, I'm male.

That all being said, my own hope for this biopsy is for it to come back saying 'well-differentiated papillary thyroid carcinoma'. The other possibilities are considerably less pleasant to think about and the worst would be 'poorly-differentiated thyroid carcinoma'...which carries a very poor prognosis. So, the differentiation status is very important. The other kinds of cancers aren't very likely, but again, I don't believe this biopsy is being performed to ask the question: "Is there cancer?", instead the question is "What kind of cancer is this?".

The last thing I want to say that I've tried to make exceedingly clear in other posts, but some friends still don't seem to pick-up on this: I have never been in remission form thryoid cancer. It has been inside of me since sometime before I was diagnosed in 2005. And honestly, given what has happened in the last year, new bone lesion and increasing blood tumor-marker, I've been waiting for this too happen. Again, the question isn't 'if?' but 'when?'.

In the meantime, today's Wednesday and I've logged 10hrs and 45min on the bike this week. I feel OK, but definitely have very limited race-type fitness as all of my activities have been base-miles, yoga/stretching, and lifting weights.

Monday, March 28, 2011

New bumps

note: If you ever get cancer and decide to blog about it, don't ever write something on your blog before you tell your parents or spouse. Just trust me on that'll save you some headaches.

On saturday, I was driving and noticed my neck felt a little weird...stiff or something, similar to last fall. Because there are still known lymph nodes with thyroid cancer in my neck, I try not to feel around myself, all it does is provoke anxiety. Sometimes knowledge is not power. But, despite that, I poked around a bit myself and felt these two little buggers (about an inch in front of my scar and just behind my jaw line).

The upper one is the size of an almost and the lower a peanut. Neither are tender, both are firm and relatively immobile. I'd much prefer tender, soft, and mobile as each of those qualities would support a 'reactive process' where white blood cells are mobilizing in my lymph system in order to process antigens from infectious entities. But instead, I'm probably bound for a biopsy later this week.

Of course they're probably thyroid cancer, but because of the amount of radiation I've received since 2005, lymphomas and salivary gland tumors are unfortunate possibilities.

Monday, March 21, 2011

Late March

The build-up to my wife's headshave reached it's inevitable culmination on saturday night. Cassidy and I were there to support and cheer for what was and is Maggie's journey into the depths of herself...fears, hopes, constructed images, real images, and all. Of course, Cassidy just saw her momma getting a big hair cut. But I knew how deep we have gone with this one.

It is very cool and inspiring being around people doing that internal work that isn't fun or even necessary but always changes us....going deep, as they say.

Saw this quote copied and pasted by Mark Twight, not sure who said it:

I'm racing the dirt bike next sunday and don't have the focus as depicted in the above quote, but I will come May...when the racing get's frequent. After that, the plan is to do the state mtn bike race, take a break, and then start base miles again to get ready for cross next fall/winter.

Sunday was an awesome small-group ride on a regular-old BoCoMo route. Funny that I don't think of this (and I don't think others do either) as having a lot of climbing:

I still say cyclists who rag on Columbia, don't have a clue.

On the health-front, I go back to MD-Anderson in May for a full round of scans and tests. I still have a hard time believing that the course of my disease randomly veered off-the-road to produce a bone metastasis and increased tumor marker while not progressing in other ways. Unfortunately, cancer biology is a logical science despite it's complexities. And it doesn't take a genius to observe a pattern. I'm scared that the down-ward slope will continue in May and that there will be some other indication of shit getting worse. But, that's what meditation, bike rides, red wine, good food, coffee, family, friends, and graduate school are for...providing positivity in uncertain times.

Sunday, March 13, 2011

St Baldrick's and bikes

After cyclocross nationals at Bend this past year, I spent sometime evaluating my relationship with bicycles, bike racing, and my friends surrounding those activities. My intention was to make some changes for 2011 including racing less throughout the year but still focusing on cross. The past few months, I've been riding a bunch but mostly intentionally keeping things very easy, going as far as to ride with a HR monitor to ensure that I'm staying aerobic in my efforts.

For this post, I'm going to try and include all three areas of my target blogging audience:
1. Biochem/science geeks
2. cyclists
3. curious family and people interested in my cancer story

First, aerobic base isn't just something for old-school endurance athletes. Developing a solid base as an endurance athlete basically means that you adapt your body for the metabolic pathways that utilize oxygen, mainly burning fat to fuel cardiac and skeletal muscle at alactic, oxygen rich efforts. No matter how many threshold intervals you do, nothing substitutes for base building in terms of the biochemical mechanism. For cyclists, the best way to do this is to ride at somewhere between 70-75% of max-heart rate (zone 2) for a large percentage of riding volume. Doing this while fasting or while eating a diet pretty high in fat and low in crappy carbs also helps (although this can be debated, I remain pretty convinced that a relatively high-fat diet during base-building is where the money is in terms of aerobic progress).

Anyway, after cross season I decided I'd try and spend as much time as possible in 2011 building base prior to the 2011 cross season. I sold my road bike and told myself I wouldn't race on the road. Instead, I'm logging the miles on this beauty:

(please ignore the naked 2-year-old doing yoga in the background)

The nice thing about base building is that I don't feel as burnt-out and have time to climb a bit, eat well, hang out with the family, and and also to work.

This next week is a pretty big one for the Miller's. My wife Maggie is taking a stand towards something which is almost too-hard for the parents of a two-year-old to think about: childhood cancer.

Before I go on, I must re-iterate what I've said on other occasions of blogging, I really am not a t-shirt wearing, lance-worshiping, support-group kind-of cancer guy. In fact, the more I read mission statements along the lines of 'eradicating cancer from the planet' the more I want to crawl into a hole (what I mean by that, is that from a biological perspective, cancer represents the pinnacle of Darwinian evolution, and I don't think it will be eradicated basically ever). In other words, I often find cancer advocacy fund-raising to be slightly dubious.

Despite all that, I'm proudly standing by my wife next weekend when she takes part in a fundraiser for St Baldrick's foundation. Next saturday, she'll shave her head to raise money and to stand in solidarity with those affected by childhood cancer.

Wednesday, March 9, 2011


One of my best friends in Columbia has been trying to get me to see 127hrs. It had been high on my list for awhile and I couldn't wait til it finally came out on itunes (when you have a 2 year old and your wife is a med student, netflix and itunes are the lifelines to pop culture).

The story is well known and the while idea is something that both medical and out-doorsy adventurous types talk about all the time: mostly the logistics and the decision. For me, the story was interesting from those perspectives but really hit home as a humanistic story. And for me, the cancer experience is the path by which my qualities and resources as a human being are most challenged.

Living with chronic disease has brought me face to face with many of the same questions in the movie:
-How bad do I want to live?
-What are the consequences of my actions on a daily basis, both with others and within myself with respect to psychology, biochemistry, physiology, and pathology?
-How far will I go to preserve the chance, opportunity, and true gift of my life?

David Brooks wrote a great piece today where he discusses qualities that really help make us more grounded as people. He suggests that the following qualities trump I.Q., professional merit, and academic achievement:

Equipoise: the ability to serenely monitor the movements of one’s own mind and correct for biases and shortcomings.

Metis: the ability to see patterns in the world and derive a gist from complex situations.

Sympathy: the ability to fall into a rhythm with those around you and thrive in groups.

Limerence: This isn’t a talent as much as a motivation. The conscious mind hungers for money and success, but the unconscious mind hungers for those moments of transcendence when the skull line falls away and we are lost in love for another, the challenge of a task or the love of God. Some people seem to experience this drive more powerfully than others.

Attunement: the ability to enter other minds and learn what they have to offer.

Very cool movie and article. Pass them on!