Friday, February 5, 2016

So, what is this liposarcoma stuff anyway?

I'm done with chemo.  I'm 34 days away from surgery at Sloan Kettering.  I have no medical appointments related to the liposarcoma until I start my pre-op appointments at Sloan Kettering on 3/8, with surgery on 3/10.  I am finally feeling human again after the last round of chemo, although my taste buds are still way off, and I'm dealing with bone pain from the Neulasta injection on Monday.  But, those are minor issues compared to the big picture.  I thought I'd take this break to explain in more detail what I'm facing over the next weeks, months and years.  Maybe this post will be useful to patients newly diagnosed with liposarcoma in the future, and for now, it will explain to my friends a bit more about my prognosis.

Sarcomas, in general, make up about 1% of all cancers.  There are approximately 85 subtypes of sarcoma, and even though they are all linked together, they are many very different diseases.  This quote, from a recent sarcoma conference, sums it up pretty well:

"I also think that these studies show, especially the trabectedin/eribulin studies, show very nicely that we can parse out some subtypes of sarcoma. I’d like to see that go even further because lumping leiomyosarcoma and liposarcoma in a study together is still putting breast cancer and colon cancer together in a study."

Essentially, the doctor is saying that in a clinical trial where liposarcoma and leiomyosarcoma were studied together, it was somewhat absurd, because they are radically different diseases.  And, to the best of my knowledge, these two sarcomas are considered "similar" in many respects.  The drug trabectedin that is mentioned above has been used in much of the world to treat both of these sarcomas and it was recently approved for both in the US.  The other drug, eribulin, is a drug that has been used for breast cancer, and it showed recent promise in clinical trials for just liposarcoma.  To the best of my knowledge, its recent approval for advanced liposarcoma makes it the first drug ever approved in the US where the approval listed only liposarcoma.

So, there are 85 subtypes, most are very rare, and they really are very different diseases.   Liposarcoma is one of the more common sarcomas.  I've read that it's the most common, and alternatively, I've read that another sarcoma is the most common.  I think that somewhere around 15% of all sarcomas are liposarcomas.

But, it doesn't end there.  Liposarcoma has its own subtypes and it also occurs in very different body parts, and the prognosis and treatment vary a lot based on where the cancer starts.  The four most common subtypes are well-differentiated, myxoid, dedifferentiated and pleomorphic.  There are then variations beyond this.  There is a mixed diagnosis, where multiple cell types are found.  Within myxoid, there is a subtype called "round cell variation" as well.  Additionally, many dedifferentiated tumors start as well-differentiated, but over time, the cells morph, because the cancer is rarely found early.  That is what happened to me.  In general, well-differentiated cancer is the easiest to cure, pleomorphic is probably the worst diagnosis, and the other two are pretty bad as well.

I believe that liposarcoma occurs most frequently in the extremities - arms and legs.  The tumors can be hard to detect until they are very large, and surgical excision is difficult, often resulting in the loss of lots of muscle tissue to get clean surgical margins.  Amputations are not uncommon, to be sure that the tumor is fully excised.  After the extremities, the most common location is the retroperitoneal space. Think "close to the the kidneys".  That is where my tumor was located.

So, my final diagnosis, after my original surgery, was retroperitoneal dedifferentiated liposarcoma.  I think there are a few hundred such diagnoses made in the US each year.  Part of the problem with a diagnosis like this is the lack of doctors who really understand the disease.  My surgery last September was done by a urologist.  We didn't know exactly what the tumor was before surgery.  There were some indications that it was kidney cancer, but two different doctors, including my surgeon, had their doubts, because the CT scan didn't look "right" for standard kidney cancer.  But, because the tumor was so large that it was causing my right lung to collapse, it had to come out.  There wasn't time to do a biopsy, get the diagnosis, and then consider the options.  

If my primary care provider had tested my blood or done some imaging earlier, we might have had that option.  But, he thought my tiredness was due to stress, and didn't even find that I had anemia until months after I'd reported symptoms to him.  Then, I saw a hematologist to determine the cause of the anemia, but he never ordered any imaging either, despite my reports of diffuse abdominal pain.  All this time, the primary tumor was getting bigger and bigger.  I had no imaging until the tumor got large enough to partially collapse my lung, and then the imaging was only ordered after I went to the emergency room.

When I received my post-op pathology report, it was obvious that there were not clear surgical margins.  

Liposarcoma is a cancer that tends to recur.  And recur.  My oncologist has told me that there are two distinct styles to treating the disease.  On the east coast (think Dana Farber, Mass General, Sloan Kettering and Johns Hopkins), the standard is to treat with surgery every time the disease recurs.  For well differentiated types, this can lead to a cure.  Or infrequent surgeries.  But, it tends to keep coming back, and eventually, due to scar tissue or the cancer moving into an area that can't be resected, surgery is no longer an option.  At that point, chemo and radiation become the options, although neither work great, in general, for liposarcoma.

On the west coast, (MD Anderson, UCLA, and others I'm forgetting now), the treatment tends to be multi-modal - use everything right up front - chemo, radiation, and surgery.  Well, this might be a gross generalization, but it's how it was explained to me.  My oncologist spent a number of years at MD Anderson and has worked with sarcomas extensively.  It is only because of her prior experience in this area that I've let her direct my treatment, rather than going directly to one of the Boston or NYC facilities for all of my treatment.

In my case, because my tumor was dedifferentiated, the oncologist thought that my risk of recurrence was very high.  I've already had the primary tumor removed (in September) and I had a recurrence (or growth of cells missed in the primary surgery) by November.  My oncologist said that we could try the surgical route for the three new lesions that showed up in November, but she believed there was zero chance for a cure with this option.  She suggested chemo, surgery and possibly radiation as the treatment.  Given her experience, and an interaction with a local surgical oncologist that I didn't particularly like, I opted for her approach.

So, my chemo is done.  Surgery is coming up.  The surgery will be done by one of the top liposarcoma surgeons in the US, if not the world.  There might be some intra-operative radiation as well.  It depends on the CT scan that will be done 2 days before surgery.

So, what happens after the surgery?  What is my future going to be?  Remember that there may or may not be radiation, but I'm not going to focus on that now.

Approximately 3 months after surgery, I will have a CT scan.  That scan could come back as NED (No Evidence of Disease) or the cancer might have returned.  As long as I'm NED, the scans will continue quarterly, probably for 2-3 years, and then drop over time to every six months and eventually, a year.  The odds of a complete cure, to be honest, are pretty low.  Dedifferentiated liposarcomas are sometimes cured, but the rate is low.  The 5 year survival rate for my diagnosis (including some other details about tumor size, mitotic rate, etc.) is about 50-50.

It's a funny survival curve though.  It has a steep early decline and then a long downward sloping tail.  Many people are lucky to get 12-18 months.  With the new chemo drugs, I'm guessing that this will change to something more like 18-36 months over time, but in the worst case, the disease recurs over and over again, inoperability happens, and then you buy as much time as you can with chemo.  In some cases, each recurrence becomes more aggressive and organs (the lungs, liver, pancreas, etc.) are attacked, and the timeline and treatment options are grim.

My oncologist has said that a cure is possible, but I'd bet the chances are less than 10%.  Her real goal is to change the nature of the disease for me.  She wants to get rid of the dedifferentiated subtype, and hope that recurrences are infrequent and well-differentiated.  If this occurs, it essentially slows the timeline and gets me onto the early part of the tail of that curve.  Well-differentiated tumors are treated by surgery primarily, because they don't respond well to radiation or chemo.  So, the real goal right now is to use the non-surgical modalities to kill any peripheral dedifferentiated cells, and then hope the future recurrences, if they happen, are well differentiated - a less aggressive cancer.  If we can achieve that, the 5 year mark becomes realistic.  Ten years may be possible.  Maybe more.

So, I'd guess there's maybe a 10% chance for a cure.  Maybe a 30%-40% chance that the doctors can change the nature of the disease and extend me past that five year mark.  And, if I see frequent and early recurrences, I'll fall into the 50% that don't (or is it doesn't?  Is "50%" here singular or plural?)  see 5 years.  In that latter case, I will have to weigh options about quantity vs. quality of life.  I don't want to go through pointless treatments with a highly degraded quality of life.

But, some of the drugs that are available to me are due to previous patients, who participated in clinical trials.  I don't look at clinical trials as a last gasp for me.  I look at them as paying it forward - a chance to help future patients.  There are many patients in the past who participated in trials that didn't help at all.  Some participated in trials that did help.  Someone has to be the guinea pig for these trials.  Quality of life is important.  But, so is advancing science.  But, that chapter is for the future. 

In the interim, I've got a life to live.  I'll be on the treadmill at the gym tonight and I'll be out teaching skiing this weekend.  After my surgery in a few weeks, I'll need some time to recover, but trout season is coming soon.  And, if all goes well, I will meet my goal of 45 miles at the Ghost Train ultramarathon in October in NH.

Wednesday, February 3, 2016

Round 4 kicked my ass

By the second morning of my 4th (and last planned) round of chemo, I knew something was up.  Something was simply different from the previous rounds.

Maybe I even knew this earlier, when I complained that I hadn't recovered from round 3 as quickly as from round 1 or 2.  But, I was more tired early on, I had more nausea early, and I just felt foggy right from the start.

One of the barometers I use during chemo, at least in terms of nausea, is coffee.  If I wake up in the morning and I still want to drink coffee, I figure the nausea is under control.  In the first round, I drank coffee through Friday (each round starts on a Wednesday), but by Saturday morning, I was vomiting and coffee was far from my mind.

In rounds 2 and 3, I drank coffee every day of chemo.  Both times, I skipped coffee on the Sunday after chemo, but I was back to it by Monday.  This time, things didn't go well at all on the coffee front.  On Saturday morning, I found myself discussing nausea with the fellow, who happens to be a fellow CrossFitter.  I said it was worse than any previous round.  I'd been taking IV Zofran and Compazine (by pill) every 4 hours since things had started.  Plus, I'd had Emend right at the start of chemo - a multi-day anti-nausea agent.  The doctor suggested another round of Emend and I didn't argue.

I went home Saturday night, feeling just terrible.  For the third straight night, I slept for 11+ hours.  The nausea was no better on Sunday.  My niece and her husband were visiting from out of town and we went to lunch at one of my favorite local restaurants.  It never even occurred to me to order any food.  Food that I'd eaten at this restaurant just a week before seemed disgusting to me.  I did enjoy seeing my niece though, and everyone else seemed to enjoy the food.

Monday morning, coffee was still out.  I went straight to the hospital in the morning, for a scheduled IV hydration session.  I mentioned the nausea, but said it was manageable.  After the hydration, I headed to the office.  In the afternoon, I needed to take some pills.  I deliberately took the most effective anti-nausea medication (zofran) one hour before the other pills.  It didn't help, and shortly after taking the pills, I was vomiting.  Food wasn't something I could even consider.

By Tuesday morning, I think my Saturday dose of Emend had run its course.  When I got to the hospital for more hydration, the nurses remarked one after another that I didn't look like I was doing OK.  I ended up getting another round of Emend and another anti-nausea medication.  That held me for the rest of the day and I was finally able to eat something.  But, for the second straight day, I told my wife I was feeling too sick for her to go to CrossFit.  I simply needed to get home to get some rest right after work.

This morning, I felt a bit better.  I had a few sips of coffee.  The nurses said I looked better when I got to the hospital.  They didn't give me any extra medications today.  I'm far from 100%, but I'm slowly getting better.

I talked to my oncologist briefly on Tuesday and she said that this round is much more typical of how her patients react to these medications on a regular basis.  We both agreed that we were glad I was done with the chemo.

I'm still feeling a bit rough, but gradually returning to normal.  If I'm lucky, I'll be skiing by the weekend.  But first, a nap.  After my wife does CrossFit.

Wednesday, January 27, 2016

Quick Update

Round 4 of chemo started mid-afternoon today. I managed to get a lot of work done at the hospital, and I feel OK so far.

But, after some whining in my last two posts, I got a good surprise in my workout last night.   We did Olympic lifting to start and my lifts went pretty well.

We started with 10x1 snatches. I did power snatches for shoulder mobility reasons. I started at only 63 pounds, but I worked up to 103 pounds. This is about 75% of my one rep max.

Next, I did 10 power cleans/push jerks. I worked from 83 pounds up to 143. That heaviest lift is 74% of my one rep max. The Oly lifts are more about technique than pure strength, and I was surprised to get that high of a percentage with these lifts.

On the power lifts, I'm currently maxing out in the 50%-55% range.

I looked at my training logs and the last time I did either of these lifts that heavy was 2/20/2015.  At that point in time, I felt fully healthy.

The second part of the workout was 10 ball slams, 10 sit-ups, and 10 burpees for max reps in 10 minutes. I struggled a bit on this, but I was happy enough with the Oly lifts that I'm not going to worry about it.

Time for bed.

Tuesday, January 26, 2016

Cumulative Effects

I'm not sure exactly what is going on, but I'm seeing some sort of cumulative effect from the chemo or my limited training schedule.

It might be that I simply can't work out enough days to maintain my fitness.  Or, it may be a true side effect of the chemo.

I skied over the weekend, but neither day was first chair to last chair.  To be honest, I was done by noon on Sunday - exhausted and ready for a nap.  My FitBit showed that when I got home from skiing on Sunday, I fell asleep pretty much immediately and napped for 2:15.

Despite that nap, I was still exhausted for CrossFit last night.  Just like last Monday, we started with back squats.  After being unable to walk due to heavy squats last week, I scaled the weights a bit and I still struggled.  I did sets of 8-6-6-6 for back squats and kept my max 20 pounds lower than last week.  I then did 4x5 front squats at 135# and struggled.  In March of last year, before I started to get sick, I took from front squat max from 275 to 305 and it felt almost easy.  I'm nowhere close to that after 9-10 months of sub-par training.

Next, the metabolic conditioning was 3 rounds of 30 kettlebell swings, 45 air squats and 90 jump rope reps.  I scaled this to 30-30-60 and still struggled.  This was a lung burner and I simply had no endurance.  Lots of people who did the full rep scheme beat me, despite my lower rep count.

Today, we have Olympic lifting, followed by 10 minutes to do as many ball slams, sit-ups and burpees (in sets of 10 each) as possible.  This will be another lung burner and I expect to struggle.

Is it the lack of training consistency since I've started chemo?  Or is the chemo's effects, gradually catching up with me.

I still hear words like "amazing" and "inspirational" from people at the gym.  I've heard similar comments from my doctors and nurses.  I don't think what I'm doing fits either of those descriptions.  I'm just trying to live my life as close as possible to how I normally live.  My doctors are amazed at how much fitness stuff I'm still doing.  When I start chemo tomorrow, I'll have 4 ski days, 4 CrossFit days, 2 walking days, and one rowing day in the 16 days since chemo ended.  And it's been a struggle.  It's also apparently a lot more than most people on my chemo regime are able to do.

So, I should probably just be happy, and then plan to use the 5 weeks between chemo and surgery to work as hard as I can.  But, if anyone read my last post, happy doesn't describe how I've been feeling recently.

I'm torn on starting the last round of chemo tomorrow.  Partly, I simply don't believe it will be my last round of chemo.  This insidious disease tends to recur frequently.  At some point, surgery won't be an option, and I'll probably be back on regular chemo treatments.  But, that is hopefully down the road a bit.

For now, I want to just get through this latest round and start getting ready for surgery next month.  I have 5+ weeks between chemo and surgery, and I'm hoping I can train hard enough to feel like I'm making some positive progress in those weeks.

Friday, January 22, 2016

A rough week

Out of every 21 day period right now, I can do CrossFit an absolute max of 8 days.

I check into the hospital on a Wednesday (day 1).  I'm there through Saturday or Sunday.  If I go home on Saturday, Sunday (day 5) is purely a rest day.  The same is true for Monday, because I can never sleep on Sunday nights.  By day 7, I can walk for up to an hour on a treadmill.  If I'm lucky, I'll do that 2-3 times through day 10.

On days 11 and 12, I can ski, but I have to take it easy.  On day 13, I can return to CrossFit.  I did that this week.  And, I wrecked myself for the entire week doing squats.  I managed to get through the workout on Tuesday, but on Wednesday, I could barely walk.  My hamstrings were so sore that bending over to pick something up would tweak the muscles.  If I was working out every week, this would never happen.  Yes, I would get sore from some workouts, but not so sore that I can barely walk for days.

On Thursday (day 16), I couldn't do the workout again.  I rowed 6000 meters, but it wasn't the same as a real CrossFit workout.  Today, day 17, I did the warm-up and started to warm up for deadlifts.  On my 4th rep at 135 pounds, a weight I use as my starting point in warm-ups, I tweaked my right hamstring.  I had to bail on the workout.  So, instead of 4-5 CrossFit workouts this week, I got about 2.5.  I'm guessing my skiing will be somewhat compromised this weekend.

If I'm lucky, I'll be able to do CF on Monday and Tuesday (days 20 and 21) before I re-start chemo on Wednesday.

As I sat there this morning, unable to do the workout, knowing that consistent training would have allowed me to do the workout, I was angry.  For the first time in the past 10 months, through this whole ordeal, I was just plain pissed off.

It's bad enough that my body wants to kill itself.  It sucks that I've lost so much fitness, endured a really painful surgery, and I have another on the way.  My quality of life (QOL) is so compromised that I'm just pissed off.

And, the way this stupid disease works, it may never get better.  I have an aggressive form of liposarcoma.  Even after chemo and surgery, I imagine the odds for a clean scan in June aren't that favorable.

So, I found myself daydreaming of walking away from it all.  No more chemo.  No more surgery.  No more scans.  No more doctors.  Yes, I know what the end result would be.  But, I'm really torn on the issue of quality of life vs. quantity of life.  I want to know what would happen if I refused any more treatment.  Is it that much worse than if I continue?

I know I'm venting.  But I'm pissed off, angry, frustrated, etc.

Why did I bother to spend the last 30 years working my butt off as an athlete only to have 2 cancer diagnoses in my early 50s?

I'll probably feel better in a few hours and then I'll want to delete this post.  But, right now, I'm just so filled with raw emotions that I needed to write them down.

I have time to change my mind on my future treatments.  I doubt that I'll do that.  But, if today was day 1, my wife and I would be arguing, most likely, as I tried to simply skip the next round of chemo.

Monday, January 18, 2016

Round 3 - A week later

My fatigue and nausea ended up being a bit worse after round 3 than after round 2.  But, it didn't take long after my Saturday discharge for things to start to improve.

I did my normal IV hydration visits on Monday, Tuesday and Wednesday last week.  On Monday, my weight was low and I felt tired.  They gave me some extra fluid because of the low weight.  Tuesday morning, I felt a lot better and managed to walk 2.5 miles on the treadmill.

Then, more saline, and I walked 3.0 miles on Wednesday.  The nausea was dissipating quickly as well.  By Friday, other than some bone pain from the Neulasta, I was feeling pretty normal.

Saturday, I taught skiing, and for the first time all year, I skied all day.  I was tired at the end of the day, but I made it through just fine.  We even had some funky new wet snow that made the skiing challenging, and I felt good in those mixed conditions.  Certainly, the fact that I'm skiing 35 pounds lighter than last year helps, but I've been pretty happy with my skiing recently.

Sunday morning, I went out with a new instructor to help with an issue with one student.  Regretfully, that student didn't show up, but I still think I was able to help her out.  She is a very good skier with a great personality for the job, and I was just trying to offer some tips to overcome some obstacles she has faced so far this year.  I love teaching, whether I'm helping a ski school student or another coach, and this was a satisfying morning.  I was tired from the day before, so I only worked half a day and then headed home to take a nap.

When I woke up from my nap, the bone pain was pretty intense.  Luckily, I have pain medication for precisely that problem, and I used it yesterday, overnight and again this morning.  The pain was more intense than the last time around, but the pain medication did its job and I'm feeling OK.

At lunchtime today, I made a second trip the medical MJ dispensary.  After my first trip, I found that some of the products I'd purchased helped a lot, while other weren't as good.  I had two primary goals for the medical MJ.  The first was relief from the nausea and the second was relief from the never-ending anxiety that goes along with a diagnosis like I have.

I have found that when I'm in the hospital, getting the chemo, the medical weed doesn't really help with the nausea.  It's pretty bad, and the pharmaceuticals seem to do a better job.  After I'm out of the hospital, as the nausea lessens, the medical MJ works better for nausea.

It definitely helps with the anxiety though, and that is nice.  It's amazing to eat 1/4 of  a small brownie and have the anxiety simply disappear for a few hours.  At the dispensary today, I told the people there that one medication isn't my favorite because it doesn't seem strong enough.  They offered me a lollipop that has 4x the normal dose as an alternative.  I asked if I could just use what I have and try a double-dose first, rather than jumping straight to 4x.  They said that made sense.

This is really nothing like those days many years ago in college, where the goal was to get as stoned as possible.  I'm looking for something that leaves me lucid, but reduces the other symptoms I'm having.  So far, it's been a mixed bag, but I'm slowly figuring out what works best.  Today's purchase was a couple new items plus more of the things that have worked in the past.  To be honest, I'm just glad that VT has this option.  I know that patients in many states don't have this option.  Overall, there have been no negatives, and some things have helped a lot.  It's not necessarily cheaper than the pharmaceuticals, but it's a good alternative at times.

Tonight, I'll be back at CrossFit, trying to get in as many workouts as possible between today and next Wednesday morning, when I start my final round of chemo.

Saturday, January 9, 2016

Chemo Round 3

It's been a whirlwind of a week.  Monday, I had a blood draw for something completely unrelated to cancer, but it still required a quick trip to the hospital.  I did this on my way to work, right after my wife and I had done CrossFit.  We've been playing around with the 7:00 a.m. classes and liking them.  It gives us more time at home with the kids at night, and we don't have to get up all that much earlier.  So, we will see if this becomes a new habit.

But, Monday we did CF early because we had such a busy week. Oh yeah, my workout on Monday went great - best in a while - which is always a sign that I'm recovered from one round of chemo and it must be time for the next.

But, before the chemo, we had to make a trip to Memorial Sloan Kettering Cancer Center (SK in the future for brevity) for a consult with a surgeon.  We drove to Saratoga on Monday night and stayed with college friends.  They were kind enough to feed us a late dinner and some nice wine despite our late arrival.  It's amazing how many good friends we have.  The help and thoughtfulness through all of this ordeal is something I can't even explain.  Things that might seem trivial in a normal day to day life just become huge gifts at a time when you really need them.

We were up by about 4:00 on Tuesday morning and we arrived at Rensselaer in plenty of time for our train to Manhattan.  We mostly dozed on the way in, although I watched the scenery more as it got light and we approached the city.

A quick cab ride from Penn Station had us to SK earlier than we needed to be there.  But, in NYC, you are never more than a block from a Starbucks, so we enjoyed a leisurely cup of coffee before the appointment.

At SK, things don't always go fast, but they are well organized.  We arrived half an hour early and we were immediately sent to Patient Financial Services.  I filled out a couple forms and they needed our new insurance cards, because the appointment had been made in 2015 with older cards.  But, most of this interaction was transcription - me just answering some questions and a PFS rep typing my answers at lightspeed.

Then it was back upstairs for some more waiting.  First, we met with a nurse.  Then, an oncology fellow, and then finally, the nurse, the fellow and the surgeon. He was very pleased with how chemo is progressing, and offered 3 options post-chemo.  The first was "watch and wait" or what some cancer patients call active surveillance.  You do nothing but monitor, and react when something changes for the worse. The second option was to participate in a drug trial, but it was a drug that would only halt progression of the cancer, at best, and not get rid of any remaining cells. The third option, and the real reason we were there, was to talk about surgery.

Given my age and level of health beyond the cancer, everyone seemed to think that this was the best idea.  We talked about some of the details of the procedure - how long will it last, how much of my colon will I lose, how will the liver resection part work, etc. In the end, I really liked the surgeon.  There were no bombastic promises.  No Rah Rah Go Team! type of stuff.  This is a serious diagnosis and the odds for a cure are slim.  The goal is to get as much out of there as possible and buy me some quality years.  Some more years of fly fishing, skiing, time with my beautiful wife, see my kids graduate from college.  I'll take that right now.

Then, I had to ask a silly question.  We need to wait some time after the 4th round of chemo for my immune function to return.  The question was about the ideal time to do the surgery.  I am done with chemo on 1/31, and figured he would want to do surgery the week of 1/21.  I have tickets to see one of my favorite bands ever, on 2/26 in Boston.  I wondered if we could wait a week so I could see the show.  The surgeon had a conference the next week, so that wouldn't work.  I asked if waiting another week would make any difference.  I told him that the concert was a "want" and the surgery a "need" and doing the surgery the correct way took precedence.  He told me to enjoy my concert and then we got down to details, setting up surgery timing.

I will return to NYC on 3/7, late at night.  SK has arranged a great price for a 3 night hostel stay for us.  On the 8th, I will have another CT scan, an EKG, blood work, and a meeting with the surgeon.  That night, my wife and I may actually be able to go out for a fancy dinner somewhere in Manhattan.  On the 9th, I'll work remotely while doing a bowel prep.  That is needed because they need to resect some of my colon.  Surgery will be on the 10th, and I should be out of the hospital by the 15th or so.

My wife can stay with me in my room at the hospital.

After the appointment, we went to a nice whiskey bar that a friend had recommended for a late lunch.  The bartender was young but knew his whiskey, and the food was solid.  Our train was delayed, but it wasn't a big deal to just switch to another train.  We got home about 11:00, got some sleep, and I headed to the hospital for round 3 of  chemo the next morning.

It's never going to be fun doing this inpatient  chemo thing.  Just being on an oncology wing of a hospital, where death is all around you, can be depressing.  I feel terrible for the families I see here, knowing that they are congregating and suffering as they lose a loved one. I am determined that this is not how I want my end to happen, but also hopeful that I don't have to worry about that for a long time.

Today is discharge day.  The nausea hasn't been too bad.  I have used some medical MJ to combat anxiety and nausea, but it's worked  better for the anxiety than the nausea.  It's nice to have that option for both of those issues.  The doctors think that the anti-nausea lozenges will work better when I'm at home, and no longer getting IV Zofran.

I declared round 1 of chemo a "tie".  My nausea was worse.  I felt sick and not up to walking around.  The second and third rounds, with more of an idea of what to expect, I'm declaring myself the winner.

The surgeon in NYC was amazed I was skiing and doing CF between  chemo rounds.  I asked him if there was anything special I should do after the 4th round and before surgery.  His response was to "get as fit as I can", which I'd planned to do anyway.

So, exciting news with my chemo working and the big surgery date is set.  My company is still in business, although they haven't paid us in a month.  Hopefully, that will change this coming week.  We just keep marching forward, hoping this is all worth the effort.

Time to go do some laps in the hallway.