"...that you may live a life worthy of the Lord and please Him in every way." Colossians 1:10. Yes, I am actually 31 years old! (um...not in the picture though)
Monday, February 22, 2010
February 22, 2010
Another year really is another blessing: "...that you may live a life worthy of the Lord and please Him in every way." Colossians 1:10. Yes, I am actually 31 years old! (um...not in the picture though)
"...that you may live a life worthy of the Lord and please Him in every way." Colossians 1:10. Yes, I am actually 31 years old! (um...not in the picture though)
Friday, February 19, 2010
Proton Power!
As any full-time law student with a brain tumor can tell you, things get kinda hectic at times. This past week has been no exception: Keedy Cup preparation (basically, researching and writing another 30 page appellate brief to be argued this coming Tuesday, February 23rd), several appointments with both my oncologist and radiologist, as well as three classes and a little laziness thrown in for good measure. However, I DID get my pathology report back from Johns Hopkins, and they supported UPenn Medical's diagnosis of an anaplastic oligoastrocytoma. So, it looks like I will be getting chemotherapy (Temodar) along with radiation for the next six-and-a-half weeks, followed by a six month, 5-day-a-month, chemo regime.
Probably the more interesting news is that my radiologist asked me if I'd like to take part in a "clinical trial," which tests quality-of-life issues surrounding proton-beam (new for brain tumors) radiation therapy as opposed to photon-beam (traditional) radiation therapy. "Clinical trial" raises immediate red flags for me-I'm no one's guinea pig. However, upon discovering that their relative efficacy at eliminating tumor cells is identical (ie, they both cook the brain) but that proton-beam therapy has the potential to leave the more "eloquent" (think memory, coordination, and the like) areas (relatively) unscathed, I agreed.
The process for approval is two-fold: first, my radiologist had to present my case before some shadowy, three-person "board" of approval; second, AETNA (or someone) has to pay for it. Thankfully, the first step was passed today, and the second is in the works. While I am not exactly sure what my chances are of having proton-beam therapy accepted by AETNA insurance, I do have to give them kudos for the amazingly inexpensive and wholly comprehensive coverage I have enjoyed through them so far in this process. I was told that once I reach my $1000 deductible, then I am 100% covered afterwards. Wow. I may have mentioned this before, but I will (maybe) never again complain about buying a top-quality health insurance plan. I will certainly post if and when AETNA makes their decision, because to avoid the potential and permanent loss of some very important cognitive faculties would be preferable. Apparently though, the proton-beam therapy machine runs about $150M (it's about as big as a football field and requires an entire "center" to support it!) which I guess is a lot of overhead needing to be recouped. I can't even begin to imagine what my medical bills are starting to look like! So while I could describe the differences and process to a degree, instead I've posted two articles and a video from MDAnderson (in Houston) that definitely explains everything much much better.
The first article: http://www2.mdanderson.org/depts/oncolog/articles/04/7-8-julaug/7-8-04-1.html
The second article: http://www.forbes.com/forbes/2009/0316/062_150mil_zapper.html
The video:
Probably the more interesting news is that my radiologist asked me if I'd like to take part in a "clinical trial," which tests quality-of-life issues surrounding proton-beam (new for brain tumors) radiation therapy as opposed to photon-beam (traditional) radiation therapy. "Clinical trial" raises immediate red flags for me-I'm no one's guinea pig. However, upon discovering that their relative efficacy at eliminating tumor cells is identical (ie, they both cook the brain) but that proton-beam therapy has the potential to leave the more "eloquent" (think memory, coordination, and the like) areas (relatively) unscathed, I agreed.
The process for approval is two-fold: first, my radiologist had to present my case before some shadowy, three-person "board" of approval; second, AETNA (or someone) has to pay for it. Thankfully, the first step was passed today, and the second is in the works. While I am not exactly sure what my chances are of having proton-beam therapy accepted by AETNA insurance, I do have to give them kudos for the amazingly inexpensive and wholly comprehensive coverage I have enjoyed through them so far in this process. I was told that once I reach my $1000 deductible, then I am 100% covered afterwards. Wow. I may have mentioned this before, but I will (maybe) never again complain about buying a top-quality health insurance plan. I will certainly post if and when AETNA makes their decision, because to avoid the potential and permanent loss of some very important cognitive faculties would be preferable. Apparently though, the proton-beam therapy machine runs about $150M (it's about as big as a football field and requires an entire "center" to support it!) which I guess is a lot of overhead needing to be recouped. I can't even begin to imagine what my medical bills are starting to look like! So while I could describe the differences and process to a degree, instead I've posted two articles and a video from MDAnderson (in Houston) that definitely explains everything much much better.
The first article: http://www2.mdanderson.org/depts/oncolog/articles/04/7-8-julaug/7-8-04-1.html
The second article: http://www.forbes.com/forbes/2009/0316/062_150mil_zapper.html
The video:
Thursday, February 11, 2010
Record Breaking Snow
It's amazing that Philly just broke our single-season snowfall record. The previous record was set during the 1995-96 season at 65.5" but this last one dumped an amazing 15.1" on top of the 28.5" we just received last weekend. And this is on top of the 2 feet or so that we received in December, in addition to whatever incidental snow we've received along the way. Anyway, Philly's total (so far!) is officially 72.1" and we still have a few months of potential snow left. 100" anyone? That would be unbelievable.
By the way, if any "Climate Change Doubter" is interested in a good read on why this kind of record snow is fully in line with climate change theory, here's a link: http://blog.newsweek.com/blogs/thehumancondition/archive/2010/02/11/snowpocalypse-and-the-climate-change-debate-blogs-scientists-facts-defend-global-warming-as-blizzard-rages.aspx
Sunday, February 7, 2010
Mooting in Baltimore, Snow-Pocalypse 2010, and Scientific Subjectivity
This weekend we went to Baltimore, MD; ground zero for both the North American-Atlantic Regional Round of the Stetson University, International Environmental Moot Court Competition (for which we signed up and prepped last semester) and apparently, the snowstorm of the century.
Thankfully both were fun, relatively disaster-free, and we actually ended up winning the dang moot court thing (though we're still slightly unsure how, why, or what just happened).
The Team's Effort:
To be honest, I think that our victory was a combination of things. My teammates, Erika Fisher and Greg Katz, and myself listened well to one another, our judges' feedback, and internalized the suggestions and constructive criticisms of most everyone involved. But while these elements really came together and helped us synthesize our baseline knowledge/strategy with new information, we really were the only team (of 8) in Baltimore who attended simply to "work out our jitters;" jitters that we individually endeavored to work out for
various and personal reasons. The win was simply icing that we didn't expect, and I think this fact lent a certain flexibility to our team's demeanor and argumentation that none of us really expected. Anyway we did well, had a wonder
ful time hanging out getting much closer, and then we braved the treacherous roads of I-95 to arrive back in Philly a day later than originally expected. Oh yeah, we also spent $150 on a victory dinner (plus lots more later on really expensive Scotch/Martinis [don't worry, I didn't order any]) to celebrate-but hey, we deserved it, right? Meanwhile, our competitor teams all performed very very well, and it surprised us that we were able to pull out this big win from such minimal expectations. The next step is to head down to Florida from March 11-14 to compete against several other two team-contingents from both the North American-Pacific Rounds, as well as from around the world (I think there will be about twenty teams total competing in Florida). It'll be a great time, though it's certainly possible that my radiation therapy might interfere and not allow me to go. However if that's the case, I really am okay with it. Either way, constantly popping my pills with a ten-inch scar running across my head, while Erika laughed constantly and Greg told strange stories about...um, riding bears in front of the other teams was sure to have them convinced that Penn Law only lets in the most drugged up of law students. That's not always the case though...
My Personal Performance:
I performed adequately; even exceeding my expectations to a large degree. Before my seizure and surgery, I felt perfectly comfortable speaking in front of judges, professors, and others in a legal reasoning context. In short, I really had no problems with public speaking. But as one might guess, this whole process has shaken my confidence somewhat and left me a bit more than worried about whether or not I can continue as a future trial lawyer-preferably in a US Attorney's Office. Furthermore, "word finding" has been a persistant and somewhat bothersome problem for me at times lately. While public speaking might do this to most people every now and then, for me it seems to be more of a cognitive problem with actually finding the correct word stored somewhere in my brain. It's a very similar feeling to just knowing THAT word that one might try and find in conversation, only to then go completely blank when attempting to recall it. Thankfully this is improving rapidly, which is something for which I went to this moot court competition to test. Now while there certainly WERE a few mo
ments this weekend that forced me to pause and "find words" that I might have easily found before (in front of the judges!), I emerged with my self-esteem and composure substantially rebuilt. This weekend, while also a whole lot of fun, was a wonderful confidence builder that I am very sure helped my healing. Of course, it can definitely be said that I "played third fiddle" to Greg and Erika (who were also, admittedly, much better prepared than me). But I did argue two out of six "moot" rounds (for which there were two mooters/team/round), including a "rebuttal" that apparently went well.
(To better describe the process, moot court competitions basically go like this: the whole thing is an hour of oral argument, supported by facts and legal reasoning, which is broken up into two half-hour sections per team. The "applicant" goes first, dividing their half-hour in whatever way they prefer and reserving time for rebuttal at the end of argument if they like. The "respondent" goes second, dividing their half-hour time in the same way but without any left over for rebuttal which, while the luxury of the applicant, helps to balance the burden the applicant faces in court for bringing the suit in the first place).
Thankfully both were fun, relatively disaster-free, and we actually ended up winning the dang moot court thing (though we're still slightly unsure how, why, or what just happened).
The Team's Effort:
To be honest, I think that our victory was a combination of things. My teammates, Erika Fisher and Greg Katz, and myself listened well to one another, our judges' feedback, and internalized the suggestions and constructive criticisms of most everyone involved. But while these elements really came together and helped us synthesize our baseline knowledge/strategy with new information, we really were the only team (of 8) in Baltimore who attended simply to "work out our jitters;" jitters that we individually endeavored to work out for
various and personal reasons. The win was simply icing that we didn't expect, and I think this fact lent a certain flexibility to our team's demeanor and argumentation that none of us really expected. Anyway we did well, had a wonder
ful time hanging out getting much closer, and then we braved the treacherous roads of I-95 to arrive back in Philly a day later than originally expected. Oh yeah, we also spent $150 on a victory dinner (plus lots more later on really expensive Scotch/Martinis [don't worry, I didn't order any]) to celebrate-but hey, we deserved it, right? Meanwhile, our competitor teams all performed very very well, and it surprised us that we were able to pull out this big win from such minimal expectations. The next step is to head down to Florida from March 11-14 to compete against several other two team-contingents from both the North American-Pacific Rounds, as well as from around the world (I think there will be about twenty teams total competing in Florida). It'll be a great time, though it's certainly possible that my radiation therapy might interfere and not allow me to go. However if that's the case, I really am okay with it. Either way, constantly popping my pills with a ten-inch scar running across my head, while Erika laughed constantly and Greg told strange stories about...um, riding bears in front of the other teams was sure to have them convinced that Penn Law only lets in the most drugged up of law students. That's not always the case though...My Personal Performance:
I performed adequately; even exceeding my expectations to a large degree. Before my seizure and surgery, I felt perfectly comfortable speaking in front of judges, professors, and others in a legal reasoning context. In short, I really had no problems with public speaking. But as one might guess, this whole process has shaken my confidence somewhat and left me a bit more than worried about whether or not I can continue as a future trial lawyer-preferably in a US Attorney's Office. Furthermore, "word finding" has been a persistant and somewhat bothersome problem for me at times lately. While public speaking might do this to most people every now and then, for me it seems to be more of a cognitive problem with actually finding the correct word stored somewhere in my brain. It's a very similar feeling to just knowing THAT word that one might try and find in conversation, only to then go completely blank when attempting to recall it. Thankfully this is improving rapidly, which is something for which I went to this moot court competition to test. Now while there certainly WERE a few mo
ments this weekend that forced me to pause and "find words" that I might have easily found before (in front of the judges!), I emerged with my self-esteem and composure substantially rebuilt. This weekend, while also a whole lot of fun, was a wonderful confidence builder that I am very sure helped my healing. Of course, it can definitely be said that I "played third fiddle" to Greg and Erika (who were also, admittedly, much better prepared than me). But I did argue two out of six "moot" rounds (for which there were two mooters/team/round), including a "rebuttal" that apparently went well.(To better describe the process, moot court competitions basically go like this: the whole thing is an hour of oral argument, supported by facts and legal reasoning, which is broken up into two half-hour sections per team. The "applicant" goes first, dividing their half-hour in whatever way they prefer and reserving time for rebuttal at the end of argument if they like. The "respondent" goes second, dividing their half-hour time in the same way but without any left over for rebuttal which, while the luxury of the applicant, helps to balance the burden the applicant faces in court for bringing the suit in the first place).
Snow-Pocalypse 2010
The snowstorm itself WAS actually somewhat apocalyptic. We stayed at the Lord Baltimore Hotel, right smack dab in downtown Baltimore, a stately old building built in 1928 (en.wikipedia.org/wiki/Lord_Baltimore_Hotel) and placed on the National Register of Historic Places in 1982. It's an amazing place absolutely soaked in history, though its interior sort of reminded me of the Overlook Hotel (or rather, The Stanley Hotel if you're considering the TV show) of "The Shining" notoriety. The overall effect was one of a once-industrial-but-now-kinda-dystopian c
ity (of "The Wire" fame, nonetheless), an old but beautiful hotel, and a massive snowstorm that dumped more than two feet of snow on the entire region in about 24 hours-leaving only the city's streets "cleared" for walking ("cleared" as in, pressed down from snowplow tire tracks). Strange and beautiful, just like I imagine the end of the world will be...with a definite emphasis on "strange." I know that Philadelphia was walloped even worse than us in Baltimore though (by two inches), and the word is that more snow is coming tomorrow night. What an odd winter; I think we're even likely to break a seasonal snow record this year, which is crazy since it was so beautiful outside today and somewhat hard to imagine. Anyway, get ready because the next wave is on its way-up to two feet apparently.
ity (of "The Wire" fame, nonetheless), an old but beautiful hotel, and a massive snowstorm that dumped more than two feet of snow on the entire region in about 24 hours-leaving only the city's streets "cleared" for walking ("cleared" as in, pressed down from snowplow tire tracks). Strange and beautiful, just like I imagine the end of the world will be...with a definite emphasis on "strange." I know that Philadelphia was walloped even worse than us in Baltimore though (by two inches), and the word is that more snow is coming tomorrow night. What an odd winter; I think we're even likely to break a seasonal snow record this year, which is crazy since it was so beautiful outside today and somewhat hard to imagine. Anyway, get ready because the next wave is on its way-up to two feet apparently.Scientific Subjectivity:
So everything else aside, dur
ing the competition I learned a bit more about scientific subjectivity and the general idea that pathologists' assessments don't always agree. Apparently, MD Anderson in Texas has one of the best tumor pathology departments in the country, just as does Penn Medical. However, MD Anderson's pathology department determined that my tumor is actually what is called a "glioneuroma," which is basically a much more benign tumor than an anaplastic oligoastrocytoma. The problem is that these types of brain tumors are rather rare. However, their prognosis for long-term survival is quite good-something like 90% (depending on the source) of patients with this type of tumor end up living greater than 10 years, which is usually the maximum time frame for when statistics like these are kept. While the prognosis/lifespan for a patient with an anaplastic 
oligoastrocytoma can vary quite dramatically, it generally seems like the glioneuroma is the better way to go.So now we have two very prestigious pathology departments saying two very different things-and with Johns Hopkins on the way with our third opinion (probably to come back within a week or so). The sorta bad news in all of this gray speculation is that my 1p/19q came back undeleted, which means radiation therapy is guaranteed. At least that's not really a decision anymore, and it does feel good to have locked myself into that option. However, if my tumor is a glioneuroma as opposed to an anaplastic oligoastrocytoma, then it would seem that I may not need chemotherapy after all-which while systemically non-toxic, is not something to which I necessarily wish to subject myself (because of the possibility of systemic toxicity down the line).
As for the quality of Johns Hopkins' pathology department; while I have been assured that their pathology department is "very thorough" and definitely also "one of the best five in the nation," I can imagine that whichever way their pathology report comes out, the gray area of scientific subjectivity will not be eliminated one way or another by whatever they conclude. Similar to legal reasoning on a right-wrong/
yes-no spectrum, a good argument can be made for either diagnosis. That possibility is what makes me think that simply taking the additional chemotherapy might not actually be so bad of an idea after all, something which may actually be precluded by the legal obligation a physician has to not contravene "best practices" in light of overwhelming (or at least "more likely," evidence). 2 against 1 is apparently pretty important even in an extra-legal context, and at least in part because of lawyers no less. It's amazing how much influence lawyers have on decisions that are not always obviously (but still are) related to matters of legal analysis, but for which they (we?) might sue if there are any resulant debits down the road. My preference at this point would be for the tumor itself to be a glialneuroma, but for Johns Hopkins to determine it as an anaplastic oligoastrocytoma, which would kick me back into chemotherapy-land. Like my neural-oncologist told me, "this isn't your grandma's chemotherapy." I guess that's good, though my grandma still beat the heck out of their life-span prognosis. 
So, What Now?
We wait for Johns Hopkins pathology department to get back to us and let the doctors decide from there. Because to be honest, at this point that is really all we can do.
The Erie Grave of Edgar Allan Poe
Wednesday, February 3, 2010
MD Anderson, Dexamethasone, and the Wild, Wild West
First of all, I wish to apologize to the many, many friends and family for whom I have yet to return calls and/or e-mails-I promise that, once things begin to settle down around here and cease being so hectic, I will. It's been great to hear from all of you and your thoughts, prayers, and well-wishes are very much appreciated. That includes everyone from Hawaii, Wisconsin, Texas, New Mexico, Colorado, Panama, Florida, California, New Jersey and everyone else within that big, massive loop.
This past weekend and up through today has been another somewhat predictable convulsion (no pun intended)-albeit with some potentially good news mixed in. First though, we had another great weekend with family back home in New Jersey. It's up in North Jersey which is a bit of a drive, but my dad seems to enjoy setting speed records so while the way up was a bit stymied by traffic, on the way down we set a record of just under 1.5 hours-assisted by the
complete absence of traffic. Well done, dad. While up in Jersey we were blessed and able to see my sister Caitie, who teaches at an American School in Cali, Colombia. While she loves the job (and travel opportunities) generally, I think that both she and her boyfriend, Scott, are ready to move on already. Anyway, it was very very nice to see her again and I am so happy that she came up to see us. Additionally, Amanda's brother, Tim, and his wife, Tara, from Brooklyn came in to see us with their baby boy, Conlin, (who gets cuter every time we see him!) on Saturday. Also, one of Amanda's chi
ldhood friends, Emily, came in from Queens to see us briefly on Sunday. In addition to these peeps are thrown my own brothers and sister, and we generally had a wonderful time just hanging out and shooting the breeze around the house as well as at a family reunion of sorts at my Aunt/Uncle Daley's place. Like I said, a whirlwind, but while hanging out with family has always been such a blessing, it really has taken on an incredible new meaning for me since my seizure and diagnosis.
ldhood friends, Emily, came in from Queens to see us briefly on Sunday. In addition to these peeps are thrown my own brothers and sister, and we generally had a wonderful time just hanging out and shooting the breeze around the house as well as at a family reunion of sorts at my Aunt/Uncle Daley's place. Like I said, a whirlwind, but while hanging out with family has always been such a blessing, it really has taken on an incredible new meaning for me since my seizure and diagnosis.After our wonderful weekend at the family pad, my dad drove us back down to Philly and we flew to Houston two days ago for a quick trip down to MD Anderson Cancer Center, reportedly one of the best in the business. (http://en.wikipedia.org/wiki/Md_anderson) For all you ranking-obsessed law students out there, MD Anderson is apparently ranked #1 by US News & World Report in cancer care in the US, something which puts it right up there with UPenn Medical in my opinion (which apparently is a top research and practitioner facility as well - see http://www.penncancer.org/ for a bit more info) and which seems to make my condition extra serendipitous. I must admit how blessed and fortunate I am to have the resources and wherewithal to even travel down to Houston for this second opinion (all covered by only a $25 copay-sorry about your premiums, guys, but I am SUCH a loss for AETNA!), something which many many people do not, very unfortunately, have.
Our arrival at George Bush Int'l in Houston was relatively uneventful. In fact, interestingly, I no longer fear flying at all. Not a bit. Turbulence (we had a bit)? No problem. Pitches? Rolls? No worries, I just turn up my iPod. Whether this is merely a result of my general realignment of priorities I am not exactly sure. But while before the seizure and surgery I would usually give a brief sigh of relief upon landing, now I am absolutely and completely unaffected. Hopefully this is a personality improvement rather than a sign of some new kind of death wish. I suppose only time will tell. I'll let you know if I begin to tempt fate by randomly running between cars on I-95. If this doesn't happen then maybe brain surgery of my type will become elective one day, somewhat along the same lines as Botox or breast augmentation. Anyway, I digress. So when we arrived at Houston's International Airport, my Aunt Pat picked us up and brought us back to her home in Katy, TX-a spread out and easy-living suburb of greater Houston. Unfortunately, Houston's outer reaches are pretty much a 
mess; an unfortunate result of having zero, that's right, zero municipal zoning regulations (though there do exist individual, but not relational, housing/business zoning regulations). But as we've learned time and time again in the more conservative-leaning environs of Penn Law, zoning regulations wrench away some kind of God-given right to property, which of course then begins to unravel the "bundle of sticks" upon which rests our sovereign right to dispose of/modify our properties as we please. Whatever...but once again I digress. (this may very well be the dexamethasone again).
mess; an unfortunate result of having zero, that's right, zero municipal zoning regulations (though there do exist individual, but not relational, housing/business zoning regulations). But as we've learned time and time again in the more conservative-leaning environs of Penn Law, zoning regulations wrench away some kind of God-given right to property, which of course then begins to unravel the "bundle of sticks" upon which rests our sovereign right to dispose of/modify our properties as we please. Whatever...but once again I digress. (this may very well be the dexamethasone again).Once picked us up we went to Katy and enjoyed a wonderful and relaxing evening with my Aunt (my dad's sister) and her dogs (don't worry, she has kids and a husband but they were all either at school or working at Campbell's in Camden, NJ at the time). We even went to eat Mexican food, where I was very surprised and happy to meet a buddy from high school days who just happened to be staying 
across the street (definitely one of the more random experiences of my life!) with one of my dad's former co-workers from Exxon (very weird, I know). It was great catching up with him again. We went to bed early and slept well, waking at 7 AM for my appointment with Dr. Yung.
across the street (definitely one of the more random experiences of my life!) with one of my dad's former co-workers from Exxon (very weird, I know). It was great catching up with him again. We went to bed early and slept well, waking at 7 AM for my appointment with Dr. Yung.The next day we arrived at MD Anderson Cancer Center, located within a HUGE conglomeration of dozens of very major medical centers. We parked with the (validatable) valet and headed inside MD Anderson's massive main cancer center building (of which there are many). Once inside we were herded through the lobby up to floor 7, where I was quickly processed and herded into the appropriate waiting area. We visited with Dr. Yung's "fellow" (basically a NeuroSurgeon who plays second-fiddle to Dr. Yung's first-string), a gent from Germany named Dr. "Something German that begins with a 'W.'" Since I don't remember his name exactly, we'll just have to call him "Dr W." So Dr. W let us know that my tumor slides had, in fact, arrived from Penn medical but had yet to be completely read. That said, he had the chance to look at the MRI/CT scan slides which I brought, and noticed that the lack of Blood-Brain Barrier leaching suggests a lower-grade, grade III tumor than previously thought. That was the good news. The other news is that since my tumor's pathology had yet to be read, we don't yet know exactly what the method of treatment will be.
When Dr. Yung came in to speak with us, he was very careful to explain that if a 1p/19q chromosomal "deletion" is present (details aren't really that important here, but suffice it to say that such a "deletion" means that the 1p and 19q chromosomes basically have "shorter legs"), then the cancer patient is much more likely to respond better to just chemotherapy, making radiation less necessary. This could potentially be a good thing, as radiation more or less acts as a searing device which destroys tumor cells around from where the cancer was extracted, but which can potentially lead to irreparable neurological deficits. "Irreparable neurological deficits." Well I guess that's what we're trying to avoid here, especially since many of those potential deficits are exactly what trial lawyers might rely on, such as short-term memory, concentration, and ethical behavior (just kidding about the last one-losing it might actually push me right up to the top of my chosen profession).
And that was my trip to Texas. I actually have a lot more to write since a lot has happened since then, but here are some pictures for the more visually-aligned among us.
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