The Flight from Here to July

I'm sitting at the dining room table, listening to the outdoor background music: deep bellowing of horns from ship traffic in the harbor. The St Lawrence Seaway officially reopens for business yesterday, and here at the extreme corner of the system, they're not hiding their light under a bushel (much less their horns in a bell jar). There are one or two hefty ore boats freshly loaded with taconite outbound for steel mills somewhere in Ohio or Indiana, and away we go.

Just as the Seaway opens, Susan and I are at the cusp of segment two our four-stage journey through the gauntlet of cancer treatment. While I'd like to tell you that all will be smooth sailing, our journey comes with no such guarantee.

For a quick review of the bidding:

Segment 1
Discovery of the cancer, diagnosis, and initial treatment, to see if the bad signs can be turned around and if my body is sufficiently responsive to treatment (did we get there in time?). In my case this included collecting all the information of a complicated and aggressive cancer and its attendant side effects. While it's turned out to be a lot, my team of doctors felt we had good reasons to be hopeful of a positive response to immediate treatment and wasted no time in going there once they'd secured my approval.

To be clear, there was no certainty I'd come through this initial phase well, but I did. Without going into details, I've been able to turn around every single marker associated with the cancer, and it appears I have an excellent  chance of being able to come out of this with functioning kidneys (read no kidney transplant; no dialysis). My sense is that I was very close to not being able to come back from the kidney damage I had already suffered (about which I was unaware until I was hospitalized in late Jan and began looking under the hood), but it appears I've dodged that bullet (at least for now--my kidneys will be challenged again by the stem-cell transplant therapy in July).

So it's wonderful news to be in my position, having successfully ridden the storm-tossed seas of Segment 1, with all its uncertainties, and finding a stretch of calm water in front of me.

Segment 2
Relatively quickly, my oncology team agreed that my best long-term chance for turning the cancer around lay in a stem-cell transplant, where the healthy remnants of my bone marrow (ravaged by the cancer) could be salvaged and harvested from my system and then reintroduced to my bone marrow after wiping out the unproductive stew that was currently dominating my marrow (so that I can resume the efficient production of red cells, white cells, and lymphocytes—the things my bone marrow should be doing).

First though, I needed to stabilize and reverse the deterioration of my system, which included courting renal failure and heavy-duty calcium leaching from my skeleton. Having turned things around (as planned) it will still take a while strengthening everything for preparation for the stress of the stem-cell transplant itself (no point in undertaking the cure of it swamps the boat).

Thus, this is a purposeful pause between Segment 1 and Segment 3. While this is a relatively "quiet" time in the overall protocol, it's a needed step.

Segment 3
This is the stem-cell transplant itself and the immediate recovery afterwards. It should only take about a week to harvest the healthy stem cells, kill off what remains in my bone marrow, and reintroduce my stem cells. Thereafter it's a battle between my body, bolstered by the judicious application of myriad meds to reboot my system. It will basically be up to my body to handle the trauma of the transplant, to regenerate the stem cells, and to take advantage of the opportunity of a clean slate to push the cancer out of the way and proceed on a healthy path.

Segment 4 
The recovery from the transplant will happen by degrees and there is an important marker after 100 days, at which point I'll be thoroughly tested and evaluated for what we've achieved. It will be at this point (probably somewhere in October) where the oncology team will be able to offer a new prognosis about how much cancer-free time all this effort has earned me. I will be given no guarantees. I will simply have purchased a chance.

Based on what I learn at that stage, I can plan accordingly.

• • •

In meeting with Dr. Alkaeid Monday (who's playing point person on my Duluth oncology team), we went over where we were and where we were headed relative to the recommendations from Mayo (secured last Thursday in my meeting with Dr Buadi).

First off, the doctors were in alignment about the treatments and their timing. Whew. They further agreed that my responses to Segment 1 were strong and positive, which was what I wanted to hear, and they gave me permission to resume any aspect of my life that I felt healthy enough to attempt between now and the July transplant. While no one's thinking about sky diving, I'm toying with a modest resumption of consulting and teaching.

This last has been a great buoy to my spirits as I can now indulge in some proactive thinking about life as a cancer survivor. While I have little clue about long-term possibilities, my life doesn't not have to be on hold as I go through the calmer waters of Segment 2.

I especially enjoyed a metaphor about the first three segments of my cancer protocol that Dr Alakeid passed along to me in the context of Monday's consult. He suggested that I think about it in terms of learning to fly. All parts of flying are not equally dangerous. In fact landings are the most dangerous, with the challenges there being the only times that are more stressful than take-offs. Actual in the air flying is rarely a problem. 

Mapping that onto my cancer protocol, he was pleased to report that I had successfully negotiated the take-off (Segment 1) and was in the air! Not everyone makes it this far and he was quite happy with my progress. Now we're entering the relatively safer in-flight portion of the protocol, putting ourselves into the best possible position for the most critical step: landing (represented by Segment 3, the stem-cell transplant).

So hurray for where we are Serious works remains yet my current position is as good as I could hope for. I aim to make the most of this pause to have a terrific landing (and enjoy the flying time between now and then). As far as I know, everyone is down with that.