Six Months Later…

Ahoy Crew,

It’s been a long time with no updates, I hope this message finds everyone in good health and happiness. After finishing my last round of chemo 6 months ago and getting a clean PET scan I was set on the path of recovery and allowed to return to normal life. I can not express how incredibly happy I have been to return to my normal life. I will go days without thinking of cancer, when someone brings it up it takes me a second to recall that it was me that was bald and sick and not some movie I watched. It really does seem like a different life, detached somehow from the one I’m living.

As the 6 month mark from my end of treatment loomed, however, uncertainty began to creep into my mind. I was told that as fast as my cancer grew, if the chemo didn’t kill it all, the 6 month PET scan would pick it up. If I am clean at the 6 month mark my chances of it coming back at all greatly decrease. Part of that uncertainty was also linked to the fact that toward the end of July I was having pain in my knee again, not nearly as intense but similar to the kind of pain I was having when we first found the cancer. I went in to see my oncologist and told him about the pain and he said that was concerning and that we should go ahead with the PET scan ASAP. We scheduled the scan for a week later, setting the stage for another month on the roller coaster of fear that plagues all cancer patients and almost causing me to write a blog entry with awful news. But before we go into that, let me catch you up on what I’ve been up to…

Less than a month after chemo ended I was shipped to South Korea for an exercise and able to enjoy the Cherry Blossom Festival in Chinhae.

(Rich and I took this picture mainly to capture the glory of the selfie stick action next to us, note that we just asked someone to snap our photo for us like normal people…)

Next we were off to Spain where we took a day to go climb the Rock of Gibraltar, a very cool experience and worth a day’s drive if you’re ever in the area.

(Beautiful hike up the cliff and a bunch of Barbary Macaques live at the top and like to accost people. He ran up behind me and climbed up my backpack, I’m waiting for him to bite my ear off here…)

Next adventure found me in Poland for a couple weeks working with some Norwegian and Dutch divers in the Baltic Sea. This is when Russia was making news buzzing by our forces during this exercise a few months ago…

(Winning the stare down with Russia one game of cribbage at a time in our sweet operations tent)

Straight from Poland we headed to Belgium for another couple weeks to play some computer based war games with a whole slew of NATO partners. Lots of hand shakes and a new found respect for the drinking stamina of your average Estonian sailor.

(Enjoying this solid Belgian Beer that was first crafted in the Market Brewery in Waterloo for the soldiers about to defeat Napoleon, and the resulting use of another brilliant Belgian development, street urinals. That looks like a manhole cover during the day and then rises out of the ground at around 9 oclock to make life easier for those of us drinking Waterloo… Oh Belgium, you think of everything.)

We took a side trip for a night in Amsterdam and it is my new favorite city in Europe… everyone is happy and energetic, food is great, scenery is incredible, puts Vegas to shame.

(Had an amazing boat tour through the canals, one of the more respectable adventures we had there…)

After basically two months of being gone for these trips I finally got a chance to spend some time with Crystal in beautiful San Diego.

(Even got invited to watch a Padres game from a private box for a friend’s going away party)

And then we went up to Sonoma to party with the Central California Civian crew.

(Our wives obviously dressed us…)

And last trip of the summer I went home to Hawaii to celebrate Big Kahuna’s 64th birthday with him.

(Now you can’t beat Mom’s Banana Cake but Stranahan’s Whiskey gives a good run for it)

And then most recently I had the chance to return the favor Cousin Bobby paid me sitting with me in the hospital through two chemo sessions by taking him to his ACL surgery and having him crash at our house for a few days afterward…

(Bobby riding confidently into surgery and the best thing to come out of it, Kona and Bobby bonding)

Alright that pretty much catches you up on the summer, thanks for sticking with me there. Forgetting cancer for a few months and traveling with my friends and family makes all the pain worth it. The end of the tunnel is a bright and beautiful place and while it can seem far away at times, the destination is worth trudging through the darkness to get there.

Now back to the cancer story… I left off at the 6 month PET scan scheduled for the middle of August to do our normally scheduled cancer screen and also to see if my knee pain was telling us something was going wrong. When we did that scan this is what we saw.

(Sept 2014 scan on left, Aug 2015 scan on right. Note the large glowing cancer in older scan, only small amount of activity in new scan that can be attributed to ongoing healing)

So the scan came back great, a little amount of activity that shows my leg is still healing but my oncologist said confidently that I have no cancer, awesome news, feeling pretty good at this point. Now this doesn’t give any hints as to why my knee is hurting again so we decide that we haven’t had an MRI scan since before treatment and that would show more details than the PET scan can. We can see how the bone marrow is filling back in and how the bone healing process is going. We scheduled that and two weeks later here is what we saw…

(Sept 2014 scan on left, Sept 2015 scan on right)

What we saw was very unexpected, we saw that I still have a large tumor inside of my femur. On the old scan you can see a lot of white cancer tissue surrounding my lower femur that is gone in the new scan. The doctor said that this tissue has a high level of vascular penetration that allowed the chemotherapy to attack the cancer. Bone has less and it’s possible that the chemo was unable to attack it sufficiently, so I may still have cancer inside my femur. I am not feeling very good at this point.

“Why didn’t the PET scan show it then?” I asked. Well similarly the radioisotope has a hard time getting into the bone marrow so wouldn’t necessarily show well on a PET scan. I ask about my transfer to an operational EOD command this month and my upcoming deployment to Bahrain. “You need to rethink those”, he said, “doctors here are conflicted on what to do, some say it might not be cancer and we need to do another biopsy to find out, other say if it was cancer a year ago it looks the same it is cancer now, we need to move to more aggressive cancer treatments immediately.” I ask if he thinks I really have cancer still, and he says “I’m not positive, but I think that is the most likely scenario.” I am not stoked, the more aggressive cancer treatment options are higher dose chemotherapy (awful), radiation (long term negative consequences), and cutting half my femur off and replacing my knee joint (just sounds horrible). I ask if we can do another biopsy, I want to know for sure it is cancer if we are going to move forward with more aggressive treatments. He says he agrees and we schedule a biopsy for Sept 11th.

I go home to break it to my loving wife. We spend the next week looking at options and I stall my transfer to my new command. If I give up these orders it will be a huge hit to my career in EOD. That is fine if I have cancer, my health is far more important, and honestly a second bout means the Navy will most likely medically discharge me anyway, but I want to know for sure before I pull the trigger. I really enjoy my job and the Navy.

They drill into my femur just an inch above the spot they did a year ago and pull out some bone marrow to send to a lab to test for cancer. A week later I go in to sit down with my oncologist to get the results. He said “The lab doctor called me to ask about what patient that sample came from, it is strange, no active cancer cells present, he describes the sample as “tumor debris”, whereas last year we saw sheets and sheets of replicating lymphocytes, obvious lymphoma, this sample we can’t find a single one, no cancer”. “…so I don’t have cancer?” I ask, “you don’t have cancer” he replies. I feel a huge release of stress and fear as I slowly exhale.

So apparently my 6 cycles of chemotherapy did kill all of the cancer, but my body is still working to re-absorb the “tumor debris” and to regenerate good bone marrow down into the bottom of my femur. If you look at the new MRI you can see the line between the dark grey bone marrow and the white tumor is a more defined line, this is probably my bone marrow growing down against the tumor and refilling the space, a good sign that it is regenerating and as the tumor shrinks it will fill back in. This healing process would explain the pain I’m having and is something that will come and go as it heals. My oncologist wanted to get all the doctors together for a full case review and come up with a plan for monitoring as we go forward. He said the reality is with so few cases of primary bone lymphoma in someone my age, there is no case study for how the healing process is supposed to look so they didn’t know what to expect and aren’t sure what to expect from here on out. I need to be careful not to over work it as it heals so still lay off the running but other than that I am free to transfer and deploy.

So that’s where I’m at now. This week I’ve been running around finalizing my transfer package and next Wednesday will be my first day at my new command and I’m looking to head out to Bahrain sometime in the middle of November. I’m incredibly excited to be taking on this new job, I will be the Operations Officer for EOD Mobile Unit Eleven here in San Diego. It is our next step up the ladder and will give me the opportunity to have a large influence on an operational command and be a mentor to a number of young EOD officers.

The roller coaster of the last month was pretty exhausting. I was close to writing a blog post after the MRI to update everyone on what looked likely to be a whole Season 2 of the Adventures of Capt D2 and his Unruly Pirates on the Stormy Seas in the Tropic of Cancer. (working title) But I just didn’t have all the answers yet so held it between Crystal and I until we knew more.

I think this is the true reality of a cancer patient, knowing how quickly things turn for the worse and taking good news as just a ticket further down the road until the next check up. For me not having cancer at this check point is great news, this was the most likely time for it to show again. I will have another check when I get home from Bahrain next spring and again 6 months after that. I will be incredibly thankful for each of those tickets further down the road, the last 6 months have been more vibrant and passionate than any time I can remember before cancer. Life is a beautiful thing and I hope I can keep enjoying it like I know how fragile it is.

Thanks to everyone who has supported me and is ready to do so again. I know you all are just Reserve Pirates and ready to sail again if I need a crew and I faced this situation knowing that all it would take is a call on this blog and you all would be there for me again which was comforting. So till next time, keep your sea legs steady and your swords sharp pirates!

Better to not know which moment may be your last. Every morsel of your entire being alive to the infinite mystery of it all.
-Captain Jack Sparrow