Thursday, October 26, 2017

A week with the new medication

I've been taking Ibrance for a week right now.  I'm still shocked that my insurance company approved it so quickly, given that it's primarily a breast cancer drug, and not a liposarcoma drug.  But, they approved it and I've been taking it.

After a week, to be honest, the only side effect so far is some nausea right after I take it.  I'm taking an anti-nausea medication with it, and that seems to be working just fine.

I know the side effects tend to be cumulative, although some people see problems with white cell counts fairly quickly.  I am going to have a blood test done next week (CBC), just to make sure that nothing extreme is happening at the two week mark.  After that, we will do the test monthly, just before I start each round.

My local medical oncologist was surprised at the decision Sloan Kettering made when they gave me Ibrance.  She seemed to think that Yondelis or Halaven, both approved specifically for liposarcoma, even though Halaven is also a re-purposed breast cancer drug, might have been better choices.

But, I think she also understands that Sloan Kettering is calling the shots these days, and she didn't try to talk me into anything different.

I've noticed no effects in the gym so far.

I have been fighting a minor injury in the gym.  I have a few "knots" in my right quad, and they seem to be causing my knee to track improperly.  So, my right knee has been sore, mostly at the top of kneecap, but occasionally at the bottom of the kneecap as well.

I had been seeing a physical therapist to work on compensating for having lost most of right psoas muscle, but I think we are done with that aspect of therapy.  I'm doing abdominal work in the gym with very few problems, and the movements that were really troubling me in July and early August, such as running, burpees, rope jumping, and box jumps, are all better now.

So, I'm still seeing the therapist, but now we are focusing on the knee.  She's using a combo of dry needling, massage, ultrasound and Graston tools to work on releasing the knots.  On my own, I'm biking more before CrossFit, to loosen up the quad.  And, I'm using a barbell to roll over the knots in my quad.  It hurts like hell, but things seem to be getting better.  To be honest, the dry needling is the most painful of the treatments, but it seems to be helping, so I'm just going along with it.

I need my quad and knee to be better by the time I'm on snow for the ski season, and that could be just over 3 weeks away, although the long term forecast doesn't look great for snowmaking.

I'm hoping that just a few months of uninterrupted training will be enough to have me ready for the ski season.  I have a new job at the mountain this year, and I expect to ski a lot more this winter than the past two years.

Tuesday, October 17, 2017

Updates from my latest scan

Going into the scan, my brain was really in two modes.  It was all or nothing.  I'd either be clear, or it would be a horrible catastrophe.

I never really stopped to think about other options.  And, another option is what I got.

I got there as scheduled for my scan.  Got my serum creatinine tested (they need to know this to know how much IV contrast my one remaining kidney can handle), and then the scan. 

Then, we got some lunch, but I was so nervous I could barely eat.  I was just locked into this mindset that the scan had to be perfect or it was going to be a disaster.

We arrived for my appointment with the oncologist right at 2:00.  As usual, things were running late, and the later things get, the more my imagination pictures the doc and his staff in the back room going over my scan, trying to figure out what they can offer.

At 3:30, we got called into an exam room.  The first person who came in asked me how I was doing.  She wanted to know how I'd been feeling since my surgery in June.  But, the only thing I could say was  "I don't know; you tell me".  All I wanted were the results of the scan.

My oncologist's PA was very nice to me though, and she immediately let me know that they'd found one tiny new spot in my abdomen, but that it wasn't super concerning.  In a few minutes, my oncologist arrived and explained things in detail.  There was one new spot, not near any organs, and less than half an inch across.  There were three main options:


  1. Remove it
  2. Wait until it got bigger and then remove it
  3. Try a medication to see if we could stop the tumor from growing any more, and in the process, prevent any new tumors from forming.  The medication's brand name is Ibrance.


Option number 1 wasn't really an option.  You can only have surgery so many times, and this tumor isn't worthy of using one of those bullets.  Surgery would be overkill at the moment.

Option 2 was certainly an option.  We could simply wait for it to grow larger and operate when necessary.  The problem with that option is that new tumors might show up in the interim, and one might show up in a bad location.

Option 3 was the most intriguing.  It's an oral medication, not a true chemo, and it targets a particular gene mutation in my tumors.  For some patients, it doesn't work at all.  For the average patient, the tumors don't grow for about 18 weeks, and then the drug begins to be less effective.  And, for some patients, the drug has fully arrested tumor growth for years.

I asked a lot of questions about side effects.  Would I lose my hair?  It might get a bit thin.  Would I be nauseous?  Possibly, but anti-nausea meds or just taking it with food would reduce that risk.  Would I become anemic and have troubles training in gym or skiing?  About 22% of patients see some level of anemia, and it's rarely significant.  Anything else?  Well, the most common side effect is suppression of white cell production, raising the risk of an opportunistic infection.  And, a few people notice changes in how food tastes.  A few get some mild neuropathy.

Oh, and it costs $10K per month and many insurance companies fight it because it's primarily a breast cancer drug.

After going through the likely odds for the side effects (pretty low, to be honest), I decided that I'd rather take the chance, and hope it can suppress any more growth for a while.  To be honest, this particular medicine had been my best guess going into the meeting.  It seems to be more and more commonly used for liposarcoma these days, and only 4 months after surgery, I wasn't really expecting a lot of new tumors.

I really like the medical oncologist that I'll be working with, and he seems to be very comfortable with this as the best option right now.  My surgical oncologist agrees.  And, they got the medication approved by my insurance in 2 days.

I should be starting it tomorrow.  Hopefully, side effects will be minimal, as they are for most people.  And, it would be great to see it work for a long, long time.  I'll take any time I can get, but being in that group of people who respond very well would be nice.

So, life moves on.  No surgery.  No harsh chemos.  No frequent hospital visits for infusions.  Just a pill, once per day for 21 days, and then 7 off.  Repeat until it stops working.

After 3 months, we will do a scan to see how it's working.  Yes, it would have been ideal to be completely disease free.  But, this is probably the next best thing.

So, let's run with it for a while.

Friday, October 6, 2017

Scan time again already

I've been working hard with a physical therapist for the past month, trying to overcome some of the physical deficits I have because of losing most of right psoas muscle.  Things are improving week by week.

Despite a business trip/vacation that lasted 9 days, I still managed 12 days of CrossFit in September.  I'm finally starting to feel stronger and my aerobic capacity is coming around.  I'm able to do workouts now that put me in serious aerobic debt, and get through them without excessively long recovery breaks.

I've been fighting a minor knee issue, but it's not hindering me at all in the gym.  Well, maybe a minor hindrance, but nothing significant.

My back squats, which started at 85# after surgery, have gotten as high as 235# recently.  My Oly lifting is progressing nicely.

And now, it's time for another scan at Sloan Kettering.

I read a number of blogs and publications related to cancer.  Many of them discuss the ongoing mental issues that patients have - either after being cured or as they still deal with the disease.  It is often equated to PTSD.  I can't say that I've ever seen combat or been involved in a shooting incident, so I can't honestly compare my feelings to those of a soldier or cop.  But, PTSD seems like a reasonable way to describe my mindset as this scan approaches.

My anxiety is through the roof.  My mind is full of "what if's".  To be honest, I feel like this scan will tell me a lot, and maybe that's why I feel so anxious.  The surgeon was very positive that he got everything out in June, with clean margins.  The best possible outcome.

If my scan is clean, that claim is pretty much validated.  And, to be honest, I fully believe that he did what he claims and he's given me the best chance that I could possibly have gotten.

But, if the cancer is back, I just don't know how I'm going to react.  I do seem to have a very aggressive version of this cancer, and my 3 surgeries, 2 bouts with chemo, and 1 course of radiation will attest to the fact that it's taken a lot to keep it at bay.

I so much want this scan to be clean.  It would mean I could teach skiing all winter long with no interruptions, something I've been unable to do the past two winters.  It would be good for my career as well, to be honest.  I need to demonstrate to my employer that I can go more than a few months without treatment and that they can count on me to be fully present in my job.

Also, as surgeries and other treatments mount, I never know when a treatment will change my life permanently, and for the worse.  Right now, I'm still able to train hard.  I'm able to fish when I want.  I'm able to ski and teach skiing.  But, more chemo or surgery could make those things difficult or impossible.  This last surgery took longer to recover from than the previous two.  It might have been related to the chemo I'd had before surgery, which was also pretty harsh.  But, getting back into the gym was harder this time.  Running is more challenging than ever right now.  Some movements that are dynamic or emphasize the core muscles are especially challenging.  Months after chemo and surgery, I still find myself sleeping close to 12 hours on weekend nights, just to recover from the stresses of the week.

And most importantly, if the cancer is back again so soon, it's a bellwether of the future.  It will really tell me that I'm probably never going to have long periods of time where I'm disease free, and that I'm truly moving along a timeline that is going to end badly, and more quickly than I'd like.

Of course, this might all just be the negative voices in my head.  But mentally, I really need this scan to be clean.  If it's not, I honestly don't know how I'm going to deal with more treatments so soon after the last.

This whole process is something I would never wish on any human being, no matter how I feel about them.  Sometimes, it's simply too much to deal with.  I've got the best possible medical team treating me, and I just have to hope that they can continue to keep the disease at bay.

Tuesday, September 26, 2017

No news is good news?

I had no idea it had been weeks since my last update.  I've kept my fly fishing blog up to date with my latest adventures, but nothing here.

September has been very, uh, busy.  I guess that would be the word.

I spent some time at a healthcare conference in Maine.  I got to see Tom Price speak (regretfully I didn't get to ask him any questions), and then had to laugh when he found himself in hot water for using charter flights to attend a private business conference.

I also got to hear Todd Park speak and I had a very nice conversation with him.  For those that don't know, Park served as the CTO of the country for President Obama.  He was also one of the founders of the company that was putting on the conference I was attending.  He focused on three things in a talk that was way too short.  Passion, diversity, and the need to make a compelling financial case in the healthcare software business.

That last point might seem obvious, but it's been a sticking point for my current company.  We sell a service that is provided through software.  We don't actually sell the software to people.  We sell them the service and then we get some data from the customer and run the software for them.  In our healthcare system, about 80% of all patients are still insured under the old standard "fee for service" model.  That is, you see a provider, you get a service, and the insurer pays for the service.

For about 20% of our patients, there are value based incentives.  That is, providers are paid not strictly for the services they provide, but rather based on patient outcomes.  It's easy to estimate what it should cost to cover a particular patient in a year.  The insurance companies have it down to a science.  If you talk to any insurance company, and you tell them you have a 56 year old male, diabetic, hypertensive, obese, but no known kidney problems, and no other diabetic complications, in a particular zip code, they can give you a quick estimate of what it would typically cost to care for that patient for a year.

Value based care is a system where we give the doctors leeway to try to improve patient outcomes.  If the outcomes improve, the doctors make more money.  If the patients get sicker, the doctor makes less.

My company's software costs money to license, obviously.  And, it increases revenue in primary practice and in the lab.  But, it also cuts revenue in the emergency department and reduces inpatient admissions.  For patients with kidney disease or diabetes, the use of our system improves the patient's health and reduces the cost of care.

In the fee for service world, this is actually seen as a negative.  With so many healthcare organizations now vertically integrated, the lab, primary care, ED, and inpatient setting are all part of the same organization.  In those organizations, when my company talks to the hospitals, we are frequently told that using our software is the right thing to do, but they can't afford to use it, even though it will make their patients healthier.  That is the absurdity of fee for service.  Hospital organizations, including places where I've gotten care, have basically told us that they would rather make more money than have healthier patients.

In the value based care world, our product is easier to sell, but it's far from an easy sale.

I got a chance to talk to Todd Park about this problem.  I've always been a dreamer, I guess, thinking that hospitals would do the right thing and use our system anyway.  But, we've been rebuffed so many times that it's shocked me.  And, Todd Park confirmed that he thinks it will stay this way.  He said that without value based care, dollars will always be more important than outcomes.  That is truly disheartening.

At the same time, he said that with 20% of the policies out there including some sort of value based care, the market for our products is huge.  And about 1/3 of those 20% are fully at risk, meaning that doctors get a fixed amount to care for a patient, and their profit is purely outcome driven.  So, that might be about 7% of the US market where our product is an ideal fit.  But, if we could get to 1% of the patients in the country, we would be wildly successful.  Our patient count is in the tens of thousands of affected patients, out of candidate pools of a couple hundred thousand patients.  One percent would be a candidate pool of 3.3M people - easily 10x what we support today.

I've been involved in this software for most of the past 15 years.  I've been with the company in some capacity or another for almost 10 years (I worked on the initial software at a prior job), and I've been here full time for 8 years.  I truly believe that we have a product that has a lot to add to the care of chronically ill patients, and I desperately want us to succeed.

I can go into our databases, and find patients whose lives are better because of our software.  Is there a better reason to get out of bed and go to work everyday than knowing you are improving people's health in the short and long term?  I honestly don't think so, which is why I love my current job so much.

And yet, we are not succeeding financially at the moment, and that bothers me.  I don't want to have to find a new job.  To be honest, the bias against people my age in IT is very real.  Finding a new job at my age gets tougher and tougher.  Plus, I love what I do now.

We just have to figure out how to get to the right people and convince them of our value proposition.

And, that was quite a tangent.

After the conference was over, I took a week of vacation.  It was my first real vacation time, one long weekend in NYC excepted, in about a year.  I spent my time, mostly alone, fishing in NH, and if you care to read about it, a link to my fishing blog is in the sidebar.  I would rather have been on vacation with my wife, but she knows how much I love fishing, and gladly supports this solo trip that I do every fall.

Now, I'm back at work and back in the gym.  Due to the time away, I won't do as many CrossFit workouts in September as I did in August, but it will still be a solid month.  I spent most of my vacation on my feet, and although fly fishing isn't exactly taxing, it can be a form of exercise.  I challenge almost anyone to walk 10,000 steps in a day in rivers, wearing big, clunky waders and boots, where half of your steps are against the current.  It's not a traditional workout, but it can be very tiring.

Right now, I'm trying to live with the heat in the gym as the month winds to a close.  I'll likely get about a dozen CF workouts this month, after 17 the month before.  I have some more vacation planned for October (a few days in NYC - my wife and sister are going to see Hamilton, I'm going to Sloan Kettering), and a weekend at a Penn State football game.  So, my October numbers for CF won't get to 17, but I should get more days than in September.

And, with October looming on the horizon, I'm starting to think about skiing.  If my scan at Sloan Kettering is clean, I will be able to ski the entire season, uninterrupted by any treatments, for the first time in three years.  That would make me extremely happy.

Friday, September 1, 2017

August Summary

I made it to CrossFit 17 times in August.  That was after one day in June and two in July.

The most I've ever done in a month is 18 days, and I came within one day of tying that record.

Since our gym opened exactly 7 years ago today, I have done 880 CrossFit workouts.  Tonight will be number 881.

Things continue to improve, but slowly.  My running is getting better, but it's far from good.  My squats this week were 20 pounds heavier than a few weeks ago, so that was good.  I did deadlifts last night at 185# - still less than half of my lifetime best, but I was happy with that number.  There was no doubt that I could have lifted heavier, and next time I do deads, I will probably shoot for 225.

But, I'm still the slowest runner at the gym, and I'm using fairly light weights for a lot of the workouts.  I feel kind of pathetic, but after the chemo and surgery I've been through this year, I need to learn to be grateful that I'm out there.  Many people I've met (online) who have liposarcoma have had treatments that make just walking a challenge.  I'm lucky that I'm still able to challenge myself this way.

Physical therapy is really exposing some imbalances and weaknesses, and I've got some work to do at home to work on that.  It's amazing how losing 2/3 of that one muscle can affect overall strength and balance.  At times, I can really feel other muscles being recruited to cover the muscle that's essentially gone.

My September totals for CF will certainly be lower than this month.  We have five weekends in the month and I rarely do CF on the weekends.  I also have a nine day trip that is a combo of business and vacation, and there will be no CF for those 9 days, most likely.

If I get 12 days in September, it will be a good month.

Right now, I'm hoping that a clean scan or two will let me stay focused in the gym, with no interruptions for treatments.  If that happens, I should do my 1000th lifetime CF workout sometime next summer.

Tuesday, August 29, 2017

Green Day

For the past few years, my wife and I have really increased the number of concerts that we attend.  Part of this is related to cancer.  In particular, I'm simply much more focused on experiences than acquiring stuff.  And, I greatly enjoy seeing live music.

This year, we've had a really good year.  Adrian Belew.  Dead and Company.   The Specials.  U2. Echo and the Bunnymen.  The Violent Femmes.  And, last night, Green Day.

To be honest, we've been traveling and driving too much recently.  My wife drove 10 hours on Saturday to take our daughter back to Syracuse and I'd driven almost 4 hours that day to do some trout fishing.  We'd been to Boston three times recently.

I had tried to give these concert tickets away, just to avoid driving 4 hours from our office to the show, and then 3 more hours to get home.  Getting home at 3:00 a.m. when you have to work the next day simply isn't a lot of fun.  But, in retrospect, I'm glad we went.

It was the second time we've seen Green Day.  The previous time was the tour for the 21st Century Breakdown album, and we saw them indoors in Albany that time.  It was a pretty straightforward show, with a focus primarily on playing their music, and playing it well.  Yes, they pulled someone out of the audience to play guitar for a bit, but they've been doing that for years.  Last night, they pulled someone to sing in one song and someone to play guitar in another.  The guy they picked to play guitar was only 15 and was pretty good.

This time, GD's lead singer, Billy Joe, seemed much more interested in audience interaction and getting the audience to respond to him or to sing the lyrics for him.  Maybe it has to do with some of his own personal demons, including a problem that he allegedly had with prescription pills of some sort. I simply don't recall him being this overtly interactive with the audience the last time we saw them.  He came across almost as a diva, demanding to be feted by the crowd.  That was my least favorite part of the show and the biggest change since we last saw them.

I told my wife after the show that 1990 Billy Joe Armstrong would probably hate the 2017 version of himself.  Coming out of the Oakland punk scene of the time, they played a lot of early shows at a place simply known as Gilman.  I think that the club is still there, and if I recall correctly, they had a rule against bands with major record contracts.  So, the early bands that played there - Green Day, Operation Ivy, the Offspring, and others, would no longer be welcome.

But, his desire for adulation from the audience is something that I imagine the old Billie Joe would not have liked at all.

Green Day is a big act these days.  They don't put songs in the Top 40, and they discussed that in a recent interview with Rolling Stone when they played DC on the current tour.  But, they still have quite a following, and I was amazed at an audience of teens to 60-somethings, where every single person seemed to know every single word to every single song.  Their fans are not casual fans.  I haven't purchased their latest album, to be honest, but most people there clearly knew it well.

And musically, they just plain delivered.  The setlist from last night can be found here

They played five songs from their newest album.  They completely skipped the trio of albums before that, a set of related albums called Uno, Dos, and Tré.  The latter one is not a misspelling, but instead the stage name of their drummer - Tré Cool.  I have the first two of those albums and I have to say that they aren't among my favorite Green Day albums.  But, if you read the interview I linked to above, Mike Dirnt of the band talked about how great he thinks they are.

They played 7 songs from their classic concept album American Idiot.  They used the title song to take a good swipe at the current occupant of the White House.

They played 5 songs from their breakout album Dookie.  And, they even went back to 1991 or so, playing a couple songs from Kerplunk.

I have to admit that I wish Billy Joe had sung every word to the songs they played, rather than asking the audience to do it.

But, they played 26 songs, and in many of them, there were new arrangements that greatly lengthened the song.  King for a Day was a perfect example of this and was one of my favorite songs of the show.  American Idiot also fell into this category and was amazing.

It's rare these days to get a 2.5 hour show out of any band that isn't a jam band or Springsteen.

We had purchased lawn seats at this venue.  I hate to use the newer corporate names of these venues, but I'll make an exception here.  The venue, the XFinity Center (which will always be Great Woods to me) was not sold out.  So, every patron who had a general admission ticket to sit on the lawn was upgraded for free to an actual seat.  I'd never had that happen at a show before and it was a nice gesture.

We have tickets for one more show yet this fall - the Psychedelic Furs.  I think it will be my 7th time seeing them, moving them past Bowie to number 2 on my all time list.  Only the Dead in their various incarnations have been seen more.


Thursday, August 24, 2017

Update

Life goes on.

I'm really enjoying the time away from the hospital, although I've still had 5 medical appointments in the past 2 weeks.

One was with a psychiatrist assigned to the cancer unit at UVM Medical Center.  He manages a couple medicines for me - medicines that help me mentally to deal with disease that is trying to kill me.

One was with a therapist who I see regularly. She only sees cancer patients, and her presence in my life is impossible to measure.  There are things you deal with when you have cancer that are too much to even put on a spouse.  Sometimes, I just need to vent.  Sometimes, I need help on how to communicate effectively with someone in my life.  She is always there to listen.  Mostly to listen, but she also offers up great nuggets of wisdom at times.

I have a chemo port and it needs to be flushed periodically.  That was last Friday.  This is just done to prevent clots from forming around the lines from the port.

I had to see my primary care provider, who takes care of most of my medications, including pain meds.  A new VT law requires that I see her every 90 days now, instead of the six month schedule we had been using.  So, that appointment was required by law if I want to continue using pain meds.

And, my physical therapist, who is coming back from two knee injuries, saw me yesterday.  She is just starting to ease back into work, and I was her first patient on her path back.  I mostly wanted to talk and not put too much stress on her after all that she has been through.  She is a top level athlete in her own right, and this major knee injury has been a terrible thing for her.  Having had an ACL replaced (her injury was much more extensive than mine), I've been trying to be a supportive friend.  But, it was also nice to know that she's on the comeback trail and is up to seeing patients again.  I am sore today from the work she put me through yesterday, so I'm sure she hit the right spots.

I'm sure I'm a complicated case for her.  There just aren't many people walking around who have lost most of a core stabilizing muscle, so there are not really any fixed protocols for making this better.  She's making up a lot as we go along, based on how my work in the gym is going and how I perceive the work she gives me to be helping.

But, she's a Ph.D Physical Therapist, a smart lady, and an athlete herself.  I couldn't have a better PT.

On another note, my all time record for most CF workouts in a month is 18.  This month has 31 days and only 8 weekend days.  I rarely do CF on the weekends, so months with 5 weekends usually see me with a lower number of CF days.

So far this month, even though I've really just returned to CF, I've done 13 CF workouts already.  Today is a rest day, but I'll get number 14 on Friday.

Then, I would need four more in the last 6 days of the month to tie my all time record.  Regretfully, I have a concert next Monday and plans next Thursday, so even if I go this coming Saturday morning, a rarity for me, it looks like I'll only get to 17 days.  Still, 16 or 17 days in August, after major abdominal surgery in June, makes me pretty happy.

My goal, as I returned, was to use a 50%, 60%, 70%, ..., 100% rule.  My first week, I tried to use 50% of the prescribe weight and in some cases, 50% of the prescribed reps.  Each week, I'm trying to do a few more reps and a higher weight.  I'm currently in the 90% week, but last night, I didn't really do 90%.  It was a really tough workout:

In 10 minutes:
Run 800 meters
50 wall balls
short rest
5 heavy push presses

In 10 minutes:
Run 800 meters
50 kettlebell swings
short rest
5 heavy push presses

In 10 minutes:
Run 800 meters
50 box jump overs
short rest
5 heavy push presses

In 10 minutes:
Run 800 meters
50 push-ups
short rest
5 heavy push presses


Our Wednesday workouts have been really tough recently, and this one was no exception.  Running has been especially difficult for me on two fronts.  First, I have a lot of pain when running, even though I'm wearing compression shirts to "hold everything together".  I have some problems bringing my legs through, and catching my feet on the ground.  I'm always afraid I'm going to trip if I don't .  This is all tied to losing so much of psoas muscle, and I have to be very aware of every single step when running so I don't trip over my own feet.  This is such a change from the days when I could mindlessly crank out a 30 mile training run, and feel fine for the rest of the day.

Also, during chemo in the spring, I was anemic, and my ability to do aerobic work suffered.  Then, I had two months off after surgery.  So, over a period of six months, my aerobic capacity dropped to perhaps its lowest point in the past 35 years.  It's getting better slowly, but I'm in woefully bad shape at the moment.  My strength work is a struggle, but nothing like the struggle I face as my heart rate gets pushed up.

Each week is getting better though.  A few weeks ago, on a set of 3x400 meters, with some other work mixed in, I had to walk part of every single 400.  Last night, I opted for 600s rather than 800s.  Not 90%, but it turned out to be a good choice.  On the first three, I ran (slowly) every step of the way.  On the fourth, I walked the last 50 meters.  On that rep, every person running 800 meters finished before I could finish 600.  But, it's getting better, so I'll take that.

On the second movement in each round, I opted for 40 reps instead of 50.  Again, not 90%, but this was the correct scaling.  On the push presses, I picked a weight that I knew would be challenging on the first set, and really difficult by the last set.

The sets progressed as I expected.  I was glad to do wall balls first.  They were the toughest of the four high-rep movements.  I finished all the work in the first round in about 7:30 and I got to rest for the remaining time.

In the second round, my 600m run was about the same time, the kettlebell swings were faster than wall balls, and I got about 3:00 of rest.

In the third round, my running began to slow.  Suddenly, I was last of the entire class.  In the first two rounds, I had been slightly ahead of a couple people, but not many.  For the box jump-overs, I did step-overs - stepping on the box and then over it.  The pain in my stomach is really limiting 4 standard CF movements - running, rope jumping, box jumps, and burpees.  I noticed this week that rope jumping has improved, so that one is now less of an issue.  Running is getting better.  Burpees and box jumps are lagging.  Box jumps are the only movement that I was doing previously that I'm not yet doing at all.

In the final round, the wheels kind of fell off.  On the run, I was absurdly slow.  I walked the last 50 meters.  Compared to two weeks ago, the running was a major victory.  Including the warm-up and my scaling, I had 2600 meters of running last night, and I ran (slowly, but it was running) all but 50 meters.  Two weeks ago, going 400 meters without walking was nearly impossible.  So, even though the wheels were falling off, it's still an improvement.

The push-ups were brutal.  I think I started with 8.  Then 5.  Then 4.  After that, I did mini-sets of 2-4 with rest in between.  I got to 35 before I was forced to go to singles.  The last 5 were all done as single reps with rest.  At that point, I had used 8:50 of my 10:00.  I decided that my best chance of finishing the push presses under the 10:00 mark was to wait until I had 30 seconds left, and try to complete them all in that time frame.  I made it with about 5 seconds to spare.

I had gone into the workout sore and tired from Monday and Tuesday.  I felt some fatigue from my PT session as well - just some isolated muscle fatigue that affected a few things, running included.  I think I scaled it perfectly.  I was really hard, but it was manageable.

CrossFit truly is infinitely scalable.

After Friday, I will be done with my 5th week of my comeback.  In some ways, I'm disappointed.  I don't think I realized how much fitness I had lost during chemo.  In my first chemo, I was hospitalized for a four day infusion.  Then, I could only walk for the next 5 days or so.  But, after that, I had 10-11 days where I could train hard.  I didn't lose much fitness during the four rounds of that chemo.

The chemo this spring was six rounds.  The acute symptoms right around the infusion were less severe than the previous chemo.  But, the cumulative fatigue was far worse, and I lost more fitness than I realized during the three months of that chemo and the time period after chemo when I was still recovering.

Even now, almost 4 months after the chemo ended, I am still dealing with some side effects.  I'm convinced that the chemo made my recovery from surgery more difficult.

But, in the immortal words of Jim Valvano, "Never quit, never surrender".  That's my attitude.

And, my friends at the gym have been great.  I've been frustrated a lot.  When you have a back squat PR of 375 (done since I turned 50), and you are squatting 95 pounds, it feels pretty pathetic.  When you have a lifetime PR of 2:21 for 800 meters and you can't even run that far unbroken right now, it feels kind of depressing.  But, my friends at the gym remind me that I'm out there and I'm working hard.  They remind me that I've been through a lot.  My body has been through a lot.  I'm a cancer patient and I have a serious disease.  They remind me that most people in my situation wouldn't be out there at all, and that every single workout I do is a victory.

At times, it is frustrating.  But, I am lucky to have some great friends on my side.  Where I see "pathetic", they see "heroic".  I don't think either word is really correct, but I'm glad to still be out there.  And, I'm especially glad for my friends and my wife, who encourage me on a daily basis.  There are a lot of things I can't control right now.  I don't like that at all, to be honest.  But, I can choose to go to the gym and give the best effort I've got in me.  As a lifelong athlete, that's good enough for now.