The past month

The last four weeks of my battle with cancer has been exceptionally difficult. After receiving the third IV injection of my clinical trial drug, I elected to get a permanent pain block procedure on my back near the bottom of my left ribs. This surgery was on 25-Mar. The evening upon returning home from surgery I felt significant pain in my left lung area, ran a 102+ fever, and had uncontrolled sweating. When I went in for my fourth IV injection on 27-Mar I was in so much pain that Deb had to slow to a near stop over every bump and pot-hole on the road (which was quite frequent in mid-town Detroit).

The doctors were concerned about my pain, so a full array of tests were ordered. Deb and I were really anxious when the physicians assistant thought she heard a "gallop" in my heartbeat, so we went to another part of the hospital to get a heart echo. This test looked at the efficiency of my heart and thankfully it showed that my heart was still in great shape. A wonderful technician did this test and to pass the time we talked about faith and the wonder of life, uplifting my spirits on my difficult day. Chest x-rays were clear. The blood tests came back negative for a bacterial infection but due to a specific liver enzyme (and my pain), it was decided that I would not receive my scheduled treatment.

That weekend at home I was just miserable. I prayed constantly to the Lord for mercy (the pain medication wasn't doing anything). When I went in for treatment the week of 30-Mar my liver enzymes were still to elevated to receive treatment and my oncologist determined that I had picked up a nasty virus that was overworking my liver. Thankfully, it looked like the enzyme numbers were coming down and I was experiencing less pain, fevers, and sweats. We agreed that I would resume treatment on 13-Apr and fortunately the pharmaceutical company allowed me to stay in the trial (even though my results could not be used in the analysis of the drug).

We went up to Port Huron for Easter weekend (11,12-Apr) to spend time with my folks, my sisters Meg and Emily, and my brother Steve. My brother Charley and his wife Melissa had spent the first part of the week with us in Dearborn. Deb's mom also came out for a few days this week to help us during the kids Easter break week.
It was great to be able to spend time with family, especially since we are so spread out.

I went in for treatment on 13-Apr and felt relatively well. My spirits were high and my liver enzymes were low. I received my IV injection and went home. On Wednesday I began to feel a new source of sharp pain in my left side. When I went in for treatment on 16-Apr the doctors found that my hemoglobin (red blood cells) had fallen again. Unfortunately this may mean that I am bleeding internally, which is fairly common with Metastatic Melanoma tumors. I am going back in for treatment on Monday (20-Apr) and will also get a blood transfusion (two units). It will be a 10 hour day for us a Karmanos.

Deb and I appreciate all of the wonderful people that have prayed for and encouraged us through this journey. My primary prayer need right now is pain relief, so I can interact more with Deb, Morgan, and Landon. We don't know how much time I have left and every moment I can spend with my family is more valuable to me than gold.

God Bless you all.

Nate

Next Trial Selected

My oncologist team at Karmanos has recommended another phase 1 clinical trial that I will start next week. This experimental treatment is a drug designed to unbind a specific protein common in cancerous cells. In theory this would prevent cancerous cells from replicating. The drug will be administered by IV twice a week, which will require me to be at Karmanos for approximately 3 hours. There isn't much existing data on this drug for melanoma patients, so we really don't know what to expect from this treatment. Please pray that this treatment will be effective against my cancer.

When my oncologist was determining my eligibility for this trial she found that my hemoglobin was too low (but not dangerously low). Therefore I had to get my first blood transfusion. I received 2 units of blood, which took approximately 5 hours to administer. One thing I noticed after the transfusion was my energy level had increased.

I have been struggling more with physical pain, especially in my left lung (tumor location) and left shoulder (non-tumor location). I had a couple days early in the week that my pain medication was largely ineffective. I have shared this with my doctors so they scheduled me for a pain clinic. I have never participated in one of these clinics, but from what I understand there are a number of temporary and permanent solutions available. I will see a pain specialist on Monday, who will hopefully help alleviate my pain. After over a year of pain in my left lung, I am ready for relief.

Deb will be taking a medical leave starting tomorrow to provide care for me at home. It will be nice to have her with me during the day. The kids will remain in pre-school. Morgan and Landon have finished their swim lessons and are now trying soccer at the YMCA.

Thanks to all for your continued prayers and support for my healing and family well being.

Nate

First Clinical Trial Ineffective

Deb and I met with my oncologist to discuss the progress of my first phase 1 clinical trial (Pazopanib). The CT scans taken on January 30th showed that the tumors in my left lung and next to my spine increased significantly in size. Interestingly the large tumor in my liver didn't appear to increase in dimension. Unfortunately this clinical trial wasn't effective, so my oncologist will investigate other open clinical trials for me to select from. I have to wait 3 weeks before I can start another trial, in order to ensure that the drug has been removed from my system.

We had hoped that the results were going to be positive, particularly since I have been feeling better the last month or so. I still get fatigued easily and have had problems keeping my weight on (I'm down to 175lbs now), but I've been able to manage my pain with medication. I've also been able to avoid catching a cold or the flu this year, which is amazing since our kids constantly bring bugs home with them from pre-school.

I didn't have any significant negative side-effects from the Pazopanib drug, which made it a nice alternative to the previous chemo and biotherapy treatments. One interesting side-effect of the drug was that the hair on my head, beard, and chest turned blondish-white. My dad and I have even more in common (which mom gets a kick out of). I expect the color will turn darker once the drug gets out of my system.



Our thanks goes out to all who continue to pray, love, and provide for us. We continue to hope that we will find an effective treatment for my cancer.

Nate

Happy New Year!

My experience with the clinical trial drug has been positive thus far. I really haven't had any negative side effects to speak of. I have finished the first phase of the trial, requiring me to spend a full day at Karmanos every other week. Now I am taking the drug orally at home every day, which is much more convenient. I won't find out how well this drug is working against the cancer until I get my next set of scans in early February.

A portion of my strength and energy has returned, but I still struggle to get myself moving in the morning. I thank the Lord that He has taken me to where am I now, compared to where I was just 2 months ago. We pray that the scans will reflect this also.

We went up to Port Huron to spend Christmas with my family. We were fortunate to have everyone there. Morgan and Landon were absolutely joyful when they saw the stack of presents under the tree! I was so glad to be able to spend another Christmas with my family, as this really wasn't expected. We always talk about the true value of Christmas. These past two Christmas seasons have given me a new perspective of celebrating the joy of our Savior's birth.

Happy New Year everyone, we wish all of you the best in 2009!

One Year Survivor

It's been exactly one year since I received my cancer diagnosis. I remember that day in Oakwood hospital like it was yesterday. My prognosis at diagnosis was a 50% chance of survival at one year. The past year has certainly been a roller coaster both physically and emotionally. Although I've endured some very difficult cancer therapies, the joy experienced with Deb and the twins has far outweighed them.

God is our anchor and we fully accept His plan for us.

Nate

The Next Step

After weighing a number of clinical trial (i.e. experimental drugs) and radiation options, I elected to participate in a phase I trial for the drug Pazopanib (produced by the GlaxoSmithKline pharmaceutical company). This drug isn't brand new, as this trial opened in July of 2007. I am one of the last patients to enroll in this trial of approximately 40 people.

This drug is designed to stop the growth of blood vessels. Cancer cells require new blood vessels to supply the energy required to grow. The intention of this treatment is to prevent the tumors from growing by taking away their food supply. In addition, the blood vessels produced by cancer cells are much weaker than normal blood vessels and can break down. I primarily selected this treatment because all 8 melanoma patients enrolled in this study responded positively to Pazopanib. In addition the side effects are considered to be quite low. The trial lasts about 10 weeks, but if I get a positive response I can stay on the drug as long as I like.

I had my first treatment on Tuesday (12/2), which required a full day at Karmanos. Everything went well aside from having to spend 12 hours in a hospital bed. The oncologists are careful to monitor how patients respond to phase I drugs, which required repeated blood tests. It has been a few days since getting my first treatment and thus far I have not had any negative side effects.

Overall I feel like my condition is improving slightly. My cough has decreased significantly. However, I am still very fatigued and cannot spend more than a few minutes walking and/or standing at a time. I spend about 75% of the day in my comfortable chair.


Thanks for the continued prayer support. Please keep our family in your thoughts and prayers as the next couple of months will be pivotal in my battle with cancer.

BTW... It has been great to run into old friends from high school on facebook. Thanks for the words of encouragement and support.

Nate

Facing the Beast

I've had 6 CT scans over the past year to track the growth of my cancer. Although I've received the summary reports for each of these scans, none of my doctors had shown me the actual images from the CT scanner. When we met with the radiation oncologists from U of M Hospital they took us through the latest CT scan of my largest tumor in my liver. It was overwhelming to see how large this mass had become. The image below is a cross section of my torso at the stomach (I've labeled things to make it easier to orient the image).


The cancerous mass in my liver is not currently blocking any of the ducts of the liver that effect liver function, but the size of the tumor is putting pressure on other organs like my pancreas and stomach. Hopefully the next round of treatment will reduce the size of this mass.

Thank you so much for your continued encouragement, thoughts, and prayers.

Nate

Rough Last 2 Weeks

I caught some kind of upper respiratory infection a few weeks ago. Since then I have had a persistent cough that has culminated in severe back pain. I had to go back on medical leave and the past few days I have spent mostly in bed. I have medication that relieves the pain. Deb and my parents have been with me this week, helping me during the day.

We are not certain what path of treatment is next for me. I have a clinical trial consultation on Nov 3rd at Karmanos. We have also investigated targeted radiation therapy at U of M and will be meeting their doctors on Nov 4th.

Today is Halloween... Landon's costume is a Transformer (robots in disguise) while Morgan is dressing up as a ballerina.

Nate

Scan Results after Biotherapy Treatment

Deb and I had our follow up visit with Dr. Flaherty this morning to discuss the results of my MRI (brain) and CT (abdomen) scans. The good news is that there is no evidence of metastatic tumors in my brain.

Unfortunately we didn't get the positive news we had hoped from the CT scan. The tumor in my liver remains ~ 9cm in diameter, which is slightly smaller than a grapefruit. The official analysis of the scan states the liver tumor is larger than my last scan (July 11), but the reported measurements are nearly identical. I suppose it really doesn't matter if it is slightly larger or not, since I still have to deal with it regardless. The pre-existing tumor in my lung remained the same size as before ~ 3.5cm in diameter, which is slightly smaller than a ping pong ball. However, an additional tumor in my lung was detected in this scan, also measuring 3.5cm in diameter.

The bottom line is IL-2 biotherapy was ineffective in treating my Stage 4 Metastatic Melanoma. We are now going to look at my experimental drug options (known as Phase 1 trials). Deb and I will be meeting with doctors from Karmanos who specialize in selecting specific drugs for cancer patients who haven't responded to existing therapies. This meeting will be in the next 2 weeks and treatment will start soon after. If I decide not to enroll in a Phase 1 trial or if I have to wait for a trial to open, there are chemotherapy drugs that are available, but these would only be for slowing the progression of the cancer.

As you may imagine, Deb and I returned home with heavy hearts this afternoon. We had felt that my recent improvements in health would be reflective of my internal battle with cancer.

HOPE STILL REMAINS
- I have a very small risk of near-term organ failure
- I have a number of options in my next "at-bat" against cancer.

Please keep us in your prayers as we have difficult decisions to make in the next few weeks.

Nate

Pushing Scans and Results Back a Week

Ever since I returned home from my second stay in the hospital for IL-2 treatments Deb and I have had in our minds that my follow up scans were on Friday October 3rd. When I was getting all of my paperwork together on the evening of October 2nd, I noticed that my scans were actually scheduled for 7am that morning! Deb and I couldn't believe that we missed this. I guess we just got on with our life during this period of time and didn't think too much about these tests.

My MRI and CT scans have been re-scheduled to next week. We will be reviewing the results of the scans on October 14th with Dr. Flaherty. Basically everything has been moved back 1 week.

I am feeling the healthiest I have been since my diagnosis last December. Nearly all of the residual pain in my left lung has vanished. My strength and stamina grows every day. Last weekend our family spent time at a cottage on Lake Michigan. I bounced on a trampoline with the twins, took them on a kayak ride in the great lake, and we all climbed up / ran down a sand dune together. I thank God for giving me the strength to make such joyful memories.


Thanks to all for keeping us in your thoughts and prayers. Please pray specifically that the scan results will be unbelievably positive.

Nate