Clinical Trials

Up until the middle of August I thought my chemo was effective.  However, as the most recent MRI at the time showed it wasn't even close.  The enhancing effect of my tumor (basically, the area of swelling associated with the tumor) showed that it had jumped to the right side of my brain from the left.  Hopefully this is not a sign of progression.  Anyway, my neurooncologist suggested that I look into clinical trials but closer to where I currently live.  After much back and forth between UPenn Medicine and a canceled appointment at Sloan-Kettering (due to neither my pathology slides nor my MRI records having been received at the latter), I was finally able to make a visit with S-K's Dr. Omuro for a clinical trial.  As I am now at S-K, I am no longer a patient at UPenn Medicine. 

Because I conveniently live right on the PATH line that shoots into the World Trade Center transit hub, making my monthly appointments at S-K is no problem at all.  Also, one of the benefits of participating in a clinical trial is that the medicine they give me is, well ... free.  My "every month-and-a-half" MRIs are covered by my excellent Essex County health benefits (except for a $5 copay), and I haven't received a medical bill in the mail for about 4 months now.  So I've been given free medication in the form of "Plexxikon 3397" (again, it's being tested in this Phase 2 clinical trial), of which I am to take five pills twice a day ... for the foreseeable future.  A Phase 2 trial basically means that the experimental treatment is given to a large group of people to see if it's effective and to further evaluate its safety.  Phase 1 is solely to determine the maximum safe dosage, and is usually preceded by various animal trials.  

So I've been on Plexxikon since the beginning of September.  Two problems however, are that within the past week I've had 5 stuttering-type seizures (where I am stuck on one syllable for about 5-10 seconds, am fully aware of what's going on around me, and I "emerge" as lucidly as when I went in), and my hair is turning completely white.  Right now I'm pleased with my salt-and-pepper gray look, as it lends a distinguished flair to my mane (see pictures on the sidebars).  But this probably won't last, because the roots of my hair are largely white.  However, the seizures worry me a lot more.

For example the last seizure was only about 5 seconds long, consisted of my repeating the same letter combination over and over, and sometimes ... laughing at the ridiculousness of my having this seizure.  No, it wasn't hysterical laughing, but rather a fully conscious of what's going on type-laugh.  It felt like I was stuttering for about 5-10 seconds, and if this happens in court one day then I'd be truly embarrassed.  It's kind of like when you're shivering, you just can't help from making noise while doing it.  I wonder what this is all about, but I still have appx 1 week to go until my next MRI (it's scheduled for Election Day) and I feel like I can wait it out until then.  I report all of my seizures to the doctor and so he decided to put me on Lamictal, another medication in addition to my 3000 mg Levetiracetam.  Although this remained a recommendation, I decided not to follow it because of its not-so-insignificant chance of causing a deadly rash and the fact that the Levetiracetam I'm on already makes me tired.  Fortune cookie wisdom: Deadly rash plus a generally hashed feeling make for bad bedfellows.

So, I pray that God will lessen the side effects of the Levitaracetam as after the first dosage increase (that is, after my first reported recent seizure) it hit hardest.  They increased my dose by 50% in stages (to the maximum) and while I still get that "spaced out" feeling every now and then, I can occasionally occupy myself with something mind-numbing to do until it passes.  Again though, if it occurs during court then I'll be in mild trouble.  I say "mild" because its occurring would in no way signal the end of the world, but it would be another uncomfortable reminder of the reality that I face when I'm just trying to be a good lawyer.

Also, my Race for Hope Team, Equipo de Tumores de la Cabeza ("Team Tumor Head"), is running a 5k to raise money for brain tumor research.  We've raised a little more than $4,000 at this point and raised the bar multiple times; this humbles me.  It begins at the Philly Art Museum steps November 4th at 8:00, and if you can make it I'd be grateful.  If not your contributions all help drive the research engine designed to fight this deadly disease.  If you wish to sign up, here's a link to the sign up info: http://www.braintumorcommunity.org/site/TR/Events/RFH-PA?px=2851178&pg=personal&fr_id=1910

285 to 390

From June 12-16, I took my first 5-night round of chemotherapy.  It's the same type of chemo I was prescribed two years ago, Temodar (that's the brand name, the actual drug name is Temozolomide), it came in a 3 pill "package" that cost me a $25 co-pay for each ($75 total!), but has the added bonus of being relatively well tolerated.  Together the 3 pills added up to 285 mg, with my next dose jumping to 390, an increase of roughly 36%.  My neurooncologist advised me to take a Zofran about an hour before popping them, just to ward off any potential nausea, although I chose not to based on past experience.  2+ years ago, it was just like taking 3 vitamins just before bedtime.  Though last time I initially took my chemo every day for 30+ days, followed by 6 monthly 5 night "maintenance phases," this time I jumped right into the latter; they have me on 5 nights chemo followed by 23 off ... indefinitely.  Between chemo prescriptions I'm required to have blood work done weekly at a local (Newark) lab, with the results being faxed to the same neurooncologist down at Penn Medicine.  On June 26th the neuro told me she does expect my blood counts to dip, and then recover, but they just wish to keep tabs on how far down they actually go.  Let's hope and pray that my counts recover quickly and without any real ill effect.

Also on the 26th, I met with the surgeon who cut into my brain and his nurse.  His nurse finally (FINALLY!) gave me the thumbs up to begin tapering off the Dexamethasone pills (steroids) I've been on since surgery.  They provoked a rash across my back and some severe cramping in my calves and hands (especially the heels of my hands).  But please don't get the wrong idea, these steroids are not "performance enhancing" by any means.  In fact, the only performance enhancement I've seen since taking them has been for "moon face contest" purposes only.  That's kind of a lame way to say they make my face look chubby, though it's mostly just water weight.  Anyway, as of this blog update I've been off the steroids for just over a week and yes, my face has thankfully returned to the ugly mug it was before.  I guess it was just water weight after all. So now I only take my monthly, 5-day chemo regime (only!) plus 2000 mg of Levetiracetam daily.  Levetiracetam is the generic equivalent of Keppra, an anti-seizure med and a financial Godsend due to its being ... well, generic (= lower copays).  Oh yeah, and I take vitamins too.

Another interesting thing that the surgeon who cut into my brain told me on the 26th was that my tumor, having risen from a lower grade mixed tumor-type, has the rare-ish characteristic of being a mutant.  It goes like this: some percentage (the percentage varies depending on whose study one reads) of lower grade tumors exhibit IHD1 mutations (for all you nerds out there, the technical name of IDH1 is "Isocitrate dehydrogenase") that carry into their higher grades.  My surgeon said it was "in my favor," which I took to be a good thing, and you can be sure that the whole way home, up the Parkway and everything, I was busy rooting out every nook and cranny on my phone's internet looking for more IDH1 information.  I probably wasn't very conversational during the 2-hour ride back to Newark, but boiled down I discovered that those with IDH1 mutations tend to live at least 8 times longer than those without (again, the estimated survival advantage varies by study).  Yes, I want to live and for as long as possible.  As Kenny Chesney most recently sang, "everybody wants to go to Heaven, but nobody wants to go now."

My next round of chemo begins the night of July 11th.  It'll only be for 5 nights and I expect to tolerate it well, but something about "cumulative toxicity" (my neurooncologist's term, not mine) has me a bit concerned.  I also looked up some reliable data that told me the likelihood of developing any new cancer just from taking Temodar increases with the first dose.  Sick.  Increasing the risk of cancer just to fight it.  If only I could have been born 50 years from now they'd probably have custom tailored cancer chemo already.  Your prayers in this regard are most welcome and absolutely appreciated.

Surgery Numero Dos

Since my last post I've had 2 grand mal seizures.  And since December, as a part of regular MRI monitoring, my doctors accelerated the MRI monitoring schedule to approximately every six weeks to keep tabs on "something suspicious" about which they couldn't come to agreement.  Finally, around the end of April and three days after my last grand mal, they did agreed on one thing ... that there was new tumor growth in my brain along the posterior portion of my original tumor cavity. 
On May 24 of this year, I went in for what's called an "awake crainiotomy." It was basically a four to five hour operation during which my general anesthesia would be "backed off" to allow me to come almost fully awake and answer several questions before being put back under.  It was preceded by a "functional MRI," that is, an MRI during which I would look at pictures, words, and sentences, while THINKing (not verbalizing) about what most appropriately follows.  One example is nouns.  During the MRI the doctors would show me several nouns and instruct me to think of a variety of verbs that associate with those nouns.  I tried to not think of swear words, but inevitably failed.  Just thinking of not thinking of swear words caused me to do so.  Another example is "fill in the blank," which is exactly what it sounds like, and another was "word-letter association."  During the latter I was presented with a single letter, say an "A," and instructed to think of as many words as possible that began with the letter "A."  This one was actually pretty stressful because the letter presentations were interspersed with very loud beeps that evoked some sort of pinball machine.  Regardless, they subjected me to this roughly 25 minute exercise in order to map my brain one week in advance of surgery and avoid any eloquent speech areas that could be affected by tumor removal. 

During surgery I initially remember feeling loopy, once they began the IV that is, and then waking up with the very vague feeling of somebody being inside my head.  I recall them showing me a picture of a crucifix and then asking me to count to 10 ... followed by a "slow down" (apparently I was too fast for them) and repeat.  There were several other pictures too, but I can't remember them.  My recovery went well, and I'm now northward of 85%-87% on most days and steadily improving.  Additionally, my co-workers donated, DONATED, 111 sick days to my sick day fund(!)  Wow.  For this I'm very very grateful, humbled, and amazingly blessed.  God is SO good in that He expresses His generosity through others.  That's really all I can say.  I can't help but thinking about and dwelling on His provision, and it also means I'll continue to be paid a regular paycheck each and every two weeks until sometime in October (although I intend to return in early July), but the option is always there.

So, onto the pathology report.  I was diagnosed with what's called a Glioblastoma Multiforme, WHO grade IV.  That's right, the cancer's advanced to its final, most aggressive stage.  Now, it doesn't mean that death is imminent, although it does set a general outside parameter to my life.  To the left is a chart from UCLA NeuroOncology, reflecting the latest survival data.  I felt it best to post both, as their age ranges bridge the gap between my where I am now and were I'll be in a few years (the former being the bottom chart).  As you can see, only a very small percentage of patients diagnosed with a GBM live beyond 5 years, although the historical data going into these estimates is, admittedly, becoming obsolete.

Since May 24th my cognition has been steadily progressing.  I went for a jog today and hung out in NYC yesterday with Roman, my sister's boyfriend.  We had good conversation and lots of tasty food (thanks to my dexamethasone, which makes food both impulsively appealing AND delicious!).  We walked the entirety of High Line Park on Manhattan's West Side, and although one day a trend does not make, I feel like I've turned a corner.  Stay tuned for more updates. 

One Year-Wrapping Up.

It's been just over one year since my seizure, surgery, and diagnosis. Regular checkers of this blog have probably noticed that I haven't posted anything since early September, right after receiving news that there was no tumor progression per my first follow-up MRI. Health-wise that was undoubtedly good news, as was the identical report I received after a second MRI in early December. My next one is scheduled for late February. From here on out I can expect to have MRIs every 3-4 months or so, as the tumor Penn Medicine determined me to have almost invariably returns and catching it early affords many more treatment options. (but note that MD Anderson's diagnosis was markedly different and according to them it is much less likely the tumor will ever reappear)


Anyway, as you can probably imagine it's been an unexpected roller-coaster of a year. With everything happening medically, a wonderful summer out in Colorado, a taxing (but ultimately worthwhile) fall semester, a very relaxing Christmas break in both southern and northern California, and now an easy-ish semester focused almost exclusively on criminal law-related courses, the year began with a shock and ended on a note of cautious optimism. Through it all this blog has been instrumental for helping me process the emotions and thoughts I experienced, even if the words I typed did not seem to convey it. This blog was like a diary, I suppose, but with pictures. It was also a means for assuring me that Amanda, my family and friends, and I, were not all alone on this unplanned "adventure." You never can tell who stops by. Even if it didn't inspire any contemplative moments or stir any inspired intentions, it certainly was a huge help in that regard.

I don't plan to update the blog any further unless something significant (read: bad) comes up. So as long as you hear reliable rumors of my still roving the streets of Philly (or wherever we end up), it can be safely assumed that no news is good news and that my health is doing just fine. Thanks everyone for sticking with me and by me over this past year. I hope that, if nothing else, this blog has helped to foster an appreciation for what's really important in life, and how easy it is to take those things for granted.

"No Progress" Can be a Good Thing

Pretty much everything about Monday's doctor's appointment was uneventful, thank God. Upon review of last week's MRI, I got the "no progression noted" that I hope to hear time and time again going forward. This is certainly not meant to indicate that I'm cured or that the cancer has been otherwise eliminated. In fact, brain tumors of this sort are known to have vile little microscopic "fingers" snaking through the brain like the arms of an ugly little octopus. They're in there, and the goal is to regularly monitor my brain for an early catch of any attempted coup-de-tat. Most literature that I've found points to a pretty high rate of recurrence, but if caught early the options for removal can be relatively non-invasive, at least as compared to my initial surgery. So we'll just wait and see, with MRIs roughly every three months in the near future. This should then "taper" to MRIs about every six months after some point in time demarcating my passing the early stages when recurrence is a likelier prospect.

So I'm just sitting here in a Starbucks in downtown Philly on an almost 100 degree day, finishing a Frappuccino while completing my 3-credit independent study, considering next semester's class schedule, and looking forward to tomorrow's five-year anniversary of when I married the most amazing woman in the world. Wow, five years. Between now and our next five year anniversary, I intend to live life much more deliberately and with a greater attention to those in need. Life was never about what I achieve for myself, and it never should have been. But leaving a positive and transformative impact in the people who need me and what I can offer will indeed be a legacy to be proud of. It is 100% guaranteed that we'll all die sooner or later, and I definitely consider myself blessed to have had this wake-up call before it's my turn to go.

Summer Wrap-Up

Summertime in Colorado was, for the most part, amazing. Weather-wise, we had one or two 100 degree-plus days, several in the mid to upper 90s, and many more in the 80s. The nice thing about Denver's dry heat is that the only thing needed to beat it is a tree with some shade which makes it instantly tolorable. Dry Denver heat > humid (read: Philly) heat anytime. Work-wise, I've been plugging away at my three-credit, "Independent Study" summer paper to make up for some of last semester's credit loss, I worked on several legal briefs and research projects for the AG's office, and am still readying my applications for various post-graduation legal clerkships. Basically, and in addition to many other perks, legal clerkships are an excellent education in researching and distilling the law to its essence. They don't pay too much, are usually (but definitely not always) a law student's first job out of the gates, and in addition to amazing educational experiences they can be potent career-boosters.

Also, because I am certain that I want to litigate as opposed to write up contracts (an overly general description, but very basically lawyers are divided up into "litigators" and "transactional (contract writer-uppers) lawyers"), clerking after law school would be invaluable as litigation involves lots and lots and lots of researching and writing based upon statutes and past legal precedent (generally, cases). In addition to the wonderful skills I learned while working at the AG's Appellate Division, I sort of formulated my ideal career plan for the near future: clerkship, DA's office (preferably in Colorado, but Philly would be great too), and then either private practice or, ideally, into the U.S. Attorney's Office. So overall, and even accounting for my early June seizure, this summer's Colorado internship was very satisfying, just like last year's. I dramatically improved the quality of my researching and writing, I met wonderfully smart and interesting people, I was able to reconnect with some of my mentors from last summer, and I made it into the mountains several times. Though the economy has been rough for the legal field generally, and especially for the public sector, this summer experience has definitely solidified my desire to prosecute.


Health-wise, I've finished up three of my five-day rounds of chemo already, and my fourth will begin sometime in the next two weeks. I've had absolutely no problems so far, something that my doctor out in Colorado said is not uncommon at all for younger patients like myself. I've been exercising a lot, maybe four-five days per week, and biked about 30 minutes to/from work, as well as around Denver, pretty much every day. Amanda came out to Colorado to visit for two weeks, and our friends from California for one. Unfortunately the weather didn't really cooperate, but we did have a great time together and we were able to spend a few days up in the mountains. We even stayed at Estes Park's (unfortunately somewhat shoddy) Stanley Hotel of "The Shining" fame.

Also, I recently realized that one of the most important aspects of a doctor-patient relationship is based around active and open communication, especially when standardized methods of care are involved. Some of my Philadelphia doctors are disorganized, difficult to reach, and curt/impatient/borderline offensive when answering my questions. However, my neuro-oncologist out in Denver, though at times somewhat distracting to talk with due to his Tourette's, has been the most patient, informative, and caring of them all. Sure, it's nice to have doctors that are considered "the best in the business" due to their research prowess and high-level intellectual expertise. But when the standard of care for a specific cancer basically dictates the same therapeutic methods across the board, the best patient care is provided by the doctor who comes across as both accessible and compassionate.

Finally, now I'm back in Philly enjoying time with Amanda and our nephew who's come out from CA for a visit. Early tomorrow morning I have my first MRI scheduled to monitor the tumor and to "catch it" if it grows back and before it gets too large. This does tend to happen with brain tumors. The boyfriend of my summer internship supervisor had a brain tumor removed 4 years ago but it recently recurred, underscoring the importance of regular MRI's for early detection. Anyway I'll update again soon after tomorrow's MRI results come back...and hopefully with good news.

Imagine...

That you're sitting with roughly a dozen of your summer-internship co-workers at a local happy hour. As can be expected in Denver you're at a microbrewery, the beer is delicious, and you opt to try an intriguing and refreshing Left Hand Sawtooth Ale ... on draught, of course. Though you've been told that alcohol (ie, beer) can lower your seizure threshold (thus making a seizure more likely), you've had beer and other drinks several times since January, and a full pint on at least one other occasion since tapering off your anti-seizure medications.

You finish the satisfying pint in no particular rush, enjoying the beer's complex and well-balanced flavor, as well as the insider-joke-peppered conversation around you. You sit wondering at your good luck for landing such an internship where everyone is extremely smart, very personable, and also disarmingly nice, all while being willing to take a (serious) salary hit for rational working hours. As others at your age/stage in life work enormous hours for a commensurate paycheck, you realize how blessed you are to find yourself at 4:00 PM on a Wednesday with many of your co-workers, several blocks away from the office, drinking beer and discussing the upcoming weekend and everyone's planned adventures. You would love to work in an office like this one.

Then, imagine that without warning your vision/cognition immediately switches to the equivalent of an old-style film, not in sepia or black-and-white, but in color albeit with roughly every second and third frames removed. The world begins to stutter and, while you know that something is obviously very wrong, you're completely powerless to do anything about it. This lasts for maybe 5 seconds before you black out and wake up on the floor surrounded by paramedics asking you basic questions (like, "where do you work?") that you simply don't know the answer to. You just had (another) seizure.

This happened to me last Wednesday. Seizure numero dos. While the seizure itself is not really a big deal (as long as you don't bite your tongue or flail into something sharp/heavy then you'll likely be fine after your "post-ictal" phase completes), it's definitely embarassing to end up laid out on a barroom floor, while basic questions are asked to reveal to everyone that you are not even close to fully oriented. All in front of your co-workers. Regardless, after several attempts at trying to recall where I lived (it's crazy that I can even remember many of these questions!) I was taken to the Denver Health emergency room where they ran a few key blood tests and a CT Scan, neither of which gave any indication of tumor progression (thankfully). I wasn't admitted, and as a result of my seizure both Amanda and my dad decided to come out for a surprise (for everyone!) visit, which was great fun and unfortunately ended this morning. However, while they were here we walked all over downtown, over to REI, visited several coffee shops, and got to visit with Amanda's mom, aunt, uncle, and cousin, all who happened to be in the area at the same time. I guess I'll have to consider timing my seizures for bringing family together like's been happening these past 6 months. :) I'm a perfect excuse for a family-reunion, I guess.

Anyway, the doctors said that while seizure causes are not easy to pin down, it does seem that some residual swelling around the surgical site, the beer, the lack of anti-seizure meds, and a variety of other factors might have converged to make this one happen. They also called it a "partial" seizure, which I understand to be a milder form of the grand mal I originally had in January. Either way, it was an unwelcome event (and at a terrible time) but one which I'm confident is an ironic step in the right direction. No seizure is "good," but at least this one was milder than the previous, as well as a good way to get a CT scan showing no progression. Also, the next day I met with my summer-oncologist at The University of Colorado Hospital (who, very very interestingly, has full-blown Tourette's Syndrome) and am now almost finished with the first phase (five days straight/month=one phase; six phases total) of my maintenance chemotherapy. Once that's done they'll reevaluate and decide from there.

I hope to not have any more seizures if I can help it, or at least to have them at home would be preferable . Also, though I'm definitely not one to absolve myself or the world of responsibility and just say it happened because "God willed it," I do know that God has the ability and at times the will to make/prevent things from happening. Whether He wills my life to be one of tip-toeing on "seizure eggshells" or not, I'm sure it's a life that can be made into a beautiful purpose. It's that perspective that keeps me upbeat, the acknowledgment that, no matter what's going on in life, it could always be worse. There's always the potential to live a meaningful, joyful, and exciting life beyond ones immediate condition. Another seizure, even in front of a dozen or so coworkers in the middle of happy hour, is no exception.

Summer Time in the Rockies

On May 7th, this semester's final exams ended for me after I submitted a 10-15 page paper for "Death Penalty/Habeus Corpus," and a 13 page take home exam for "Corporate Tax." Neither was too difficult, though many days I had little motivation to actually work on either one. I guess every law student feels that way sometimes though, huh? I did well on both fianl exams, especially considering I just had brain surgery in January. I'll be sure to put that on my resume :) Anyway, almost immediately afterwards, Amanda and I visited family back in North Jersey. Amanda returned to Philly that Sunday to start work early the following Monday morning, but I took the opportunity to hang out just a bit longer and I returned later the next day. Finally, after a few weeks of relaxing, catching up on some pro bono work, and arranging for an oncologist out in Colorado, I left for the Colorado Attorney General's Office, Appellate Division, where I'm currently interning.

This summer I'll be researching and writing various appeals for the state of Colorado, a skill that I really look forward to improving and (hopefully) at a place I'd love to work sometime after graduation. So far, it's been wonderful. The "dress code" (very casual, the first day I wore a nice shirt and tie and they told me I was too formal!), the attorneys (all very smart), and the hours (bliss!) are all relaxed and close to ideal. I hope to make some good contacts for post-graduation employment while I'm here, including clerkships, even though I've found that I can say awkward things sometimes that make me laugh afterwards while probably making others cringe. I'd like to blame that on my surgery too but I imagine it was there all along and I just didn't notice it.

Lawyers don't make nearly as much in public service as their corporate firm counterparts, but we do get weekends and holidays (both state and federal) off, and our workdays usually end around 5 or 6:00-ish. Basically, government lawyers have lives, but without the money to live them. While some of my classmates will be buying gold-plated first editions of the latest Harry Potter book, I'll be heading to the local library to check one out. Then again, though "providing for ones family" definitely includes being able to pay the mortgage and put food on the table, the more important facet of "providing" means actually being present and available for one's family. As long as I can afford the former, it certainly looks like I'll have the latter taken care of.

So here I am, in the land of lunatic Second Amendment libertarians, marijuana-dispensary "wellness centers," crazy limo-liberals, ranchers, cowboys, and amazing mountain sunsets. Living in the heart of Denver is not bad at all. I can walk to work in about 20 minutes, passing several very decent coffee shops along the way. I am only about a 10 minute walk from three major grocery stores. And I'm surrounded by a gorgeous collection of late-Victorian homes: it kind of reminds me of Philadelphia but without the good Italian food, though with amazing outdoor opportunities that Philly couldn't even approach. Amanda is still in Philly, sticking with her personal training clients, and I can't wait for her to come out June 26th for a two week visit. I couldn't imagine being able to get that much time off this summer if I was working for a major law firm. Government lawyering is definitely for me...

One More Day!

That's right! Treatment ends tomorrow and then Friday it's margarita time, baby!

More than 2/3 of the way done

This morning I was thinking of what it will be like to wake up, on Friday, April 29th, and not have to take either my chemo pill or walk down to the Penn Medical Center for my daily radiation treatments. I'm not sure what I'll do with myself except eat a huge breakfast, during regular breakfast hours of course (remember, I am currently not allowed to eat "breakfast" until after treatment- which invariably means 10:30 or so at the earliest), and then maybe go back to bed for a nap. Though probably the more likely scenario is that I'll wake up, eat a big breakfast during normal breakfast hours, and then get going on the final paper that I have only worked on sporadically over the past few weeks. It's due on May 6th, and I still have about 15-20 pages to write! This semester has taught me that I'm either an "on" or "off" type of person; unfortunately there's no "half-way" with me. If I can find any reason to procrastinate then I often do. Sometimes it's nice to have a full agenda because then it's much easier to get things done.

I also recently spoke with my radiologist, who told me that a likely side-effect of radiation therapy (proton included) is a minor loss of "processing" ability. He said that this effect will likely continue for the next 4-6 months or so (even after treatment has concluded), but then hopefully will return (potentially back to normal) by 12 months out. So if you've had any weird conversations with me since January where I'd stare, drool, or simply not answer in the same way that I used to, blame my depleted processing ability. It HAS often impacted my ability to study. I get distracted/bored frequently with what's in front of me, but this has also been somewhat ameliorated by having a much lighter schedule than normal. Reading 5 pages of Corporate Tax per day makes my absorbtion ability much easier and, given the fact that it and some research in preparation for this summer is almost everthing for which I am responsible this semester, wholly manageable. Lesson: if you're a grad student and find yourself with some kind of brain tumor/other serious malady, do yourself a favor and at least lessen your semester credit load a bit.

Also, thank God that, apart from a little fatigue every now and then, my reduced processing abilities, my inability to stop talking sometimes, and my loss of hair, my treatment regime has not been nearly as bad as I had originally thought it might be. I've been able to finish a full semester's worth of law school credits, I've been able to take a reduced load and will still have no problem graduating with my class in 2011 (due to my summer research papers-God willing, of course), and I've been able to work on substantive areas of law that really interest me this semester (specifically the classes that I'm currently taking and the papers I intend to research and write this summer). I've had my 15 seconds of fame with a local news station, and I've even been allowed to drink a few glasses of beer/wine every now and then. I've become much closer to friends and family, my church and God, and my relationship with my wife has improved significantly. I guess the only downside is the fact that I have a brain tumor but really, on balance it almost sounds like a wash to me :)

More Than Half Way Done!

As of today, I have officially passed the half-way point of my treatment, which ends on April 29th. Only 16 more radiation-days to go (23 chemo-days). So far I have experienced no negative side-effects from the chemotherapy, but as I noted in my last post, my hair has begun to fall out from radiation. Basically, I just end up wearing hats most of the time (which I'm prone to do anyway) just so that I don't freak people out too much. On the rare occasions when I must remove my hat (like in our mock trial yesterday at the Federal Courthouse in downtown Philly), I try to convince myself that everyone staring at my head is either (a) intimidated by the combination of head-scar and bad-ass mustache, or; (b) feeling very sympathetic for whatever they perceive my condition to be. I'll take either, though I definitely prefer option (a). Interestingly, though I still have most of my hair in the front, a simple pinch takes pretty much all of it out from where I've pulled. Thus my hair in front of my scar has been becoming patchy and sickly-looking, not the sort of look that one necessarily strives for.

Thankfully though, I've been recently approved for 2 "Independent Study" papers for over this summer which will be done under the supervision of two professors and for 3 credits each. These 2 papers are life-savers, as their collective 6-credit load will significantly help to reduce the graduation-credit burden that I would otherwise face next year (since I'm taking a lighter credit load this semester, I would otherwise be looking at a virtually impossible 33 credit load next year!). This way, I'll only have 27 credits to complete for next year, I'll be able to graduate with my class without any problems, and the papers are both very interesting topics that will easily motivate me to get them done. Now I just need to motivate myself to get going on THIS semester's workload which, while only four credits worth, has become somewhat of a significant challenge to complete! :)

Bald is Beautiful, and Apparently Works for Hollywood Too.

So, as if my thoughts and words brought about some kind of profound change in the way God works, as soon as I realized that the "sun burn" patch on the top of my head was a precursor to my hair falling out...it began; to fall out, that is. While it's not yet at the critical stage, I'm pretty sure that everything from the mid-point of my head (basically, the scar) forward is ready to go. I can even pull it out in clumps, which I'm sure will make for a neat party trick sometime in the near future (though there is a definite life span to this type of party trick, as once it's all gone, it's all gone!) If I get bored with a party conversation, I can pretend to get super stressed out and just start tearing my hair out in front of whoever it is I'm stuck with (or...whoever happens to be stuck with me as it turns out!). Maybe this is not a "trick" per se, but at least it's a good way to end pretty much any uncomfortable scenario.So picture this: everything they've been zapping with proton radiation for the past three weeks will shed which, having tested various aspects of my hair and scalp, apparently does not include sideburns, the back of my head, or the sides up to the crown. Yep, only the front of the top of my head, which will be very strange to look at. This is not a natural balding pattern. I have considered shaving the whole thing with a razor, but my eyebrows and scar make that an unlikely (though still possible) scenario. Any suggestions are welcome. (I was considering a powdered wig just like the European "Barristers") That said, while the hair is likely to grow back 2-6 months after the end of radiation therapy (April 29th!!), vanity says that this first outward sign that I am a brain cancer patient makes me uncomfortable. Then again, if I can keep the hair off until Halloween, it will certainly make my costume cheaper. Also, thank God the mustache has been left unharmed.

1/3 Done, and 2/3 To Go!

Today marked my "1/3 of the way finished with treatment" day. Very exciting. Though I really don't have any seriously negative side effects from either the chemotherapy or the proton radiation, I am starting to develop a "sun burn" patch on the top of my head which I am told can be a precursor to hair loss :(

Apparently it's a not-to-uncommon side effect of being shot through by protons five times a week. Though I'm told it's temporary (and may even grow back a different color!) it will feel a bit strange walking around with a bald patch on the front of my head. All of those "weird-O" people I wondered about as a kid have come back to haunt me just as my grandma promised they would. Oh well, apart from a few awkward stares for a few months, I suppose things could always be much, much worse.

A Funny Thing Happened on the Way to the Particle Accelerator...

...I was interviewed by one of Philly's major news networks on how Proton Therapy affects budding law students. The whole interview lasted about a half hour or so, but as you can expect they spliced and diced and came out with about a minute of footage. Apparently it was aired twice, once at 11 PM on March 24th, and again on the 25th at 4 PM. Check out the link below if you're interested. You may have to wait a bit for the video footage to appear on the right hand side of the screen, but it's worth it to see what a proton therapy patient undergoes each day. Plus, maybe I'll finally be "discovered;" Hollywood, here I come!!

http://cbs3.com/health/Health.Alert.Proton.2.1587415.html

Perspective & Proton Therapy

While I've suspected it for a while, the other day at church I noticed that my conversational style has changed. Whereas before I would engage with other people in a much more direct and deliberate way, I now find myself to be somewhat of an "affable chatterbox." Not that it's a bad thing by any means. But sitting or standing in wandering conversation with others without much sense of urgency is a big change from before. I l like it. In a way it's comforting and dramatically reduces any stress of having an agenda to my discussions. The only downside is that I sometimes find myself caught in conversations in which I'd rather not be, with no easy exit strategy. Of course, I'm guessing that we all find ourselves there sometimes and "easy exits" might be rare anyway. See? I'm rambling now. :)

Anyway, one's perspective is a difficult thing for one to change, but it is so important to our general state of happiness. It also seems that, due to a dramatic shift in perspective (or maybe rather a reduction in credit load?) my general interactions with the world have definitely changed for the positive. The other day I was given a free, labor-intensive decaf coffee at Starbucks. I now notice when crossing the street how cars stop on time, or when a song on my iPod ends perfectly as I step to my apartment doorstep. I am even able to better appreciate emergent birds, the weather, and other aspects of life that I only kind of noticed previously. Why this is I am really not sure. It could be my post-surgical cognitive state, medications, or even just a reprioritization of...priorities. Whatever it is, I consider it a positive change; a change that I wouldn't give up for anything. Perspective and attitude are essential to appreciating life. I can make no claim that such attitudinal shifts are solely achieved through choice, though bucking the "rational materialism" of Spinoza (which instead reduces every human "choice" down to a predetermined "impulse") I believe that choice is an essential element of the human condition. Though of course there are many factors that feed into such a claim, I simply can't accept that we're mere products of our make-up; that would absolve us from any sense of responsibility at all. Thus I choose to believe that I am at least partially choosing to appreciate life's small things through a new perspective. I have been amazingly blessed by a great surgical outcome, as well as a wonderful set of family, friends, and of course an amazing wife. All of these factors feed into why and how I can even make this choice. But the choice is there nonetheless and people in far more dire situations make the same choice every day. I definitely think that a few of my classmates could benefit from this perspective. (or maybe an elective brain surgery?)

Anyway, I suppose I'll end this section by saying that one's perspective on life is so important to how much joy and satisfaction one draws from it. Life is about many things. But one of the principle things it is about is appreciating the blessings that we encounter each and every day. Many of us have a difficult time with this, be it through physical, mental, or emotional conditions, or simply because we choose to view the world through a scratched and shaded lens. One result of this whole operation has been that I now notice God's blessings to a much greater degree, a degree which before went largely unnoticed. My only real concern at this point is that, when it comes time to land a job and begin paying back my law school loans (!), will I have the concentration to actually focus on the nitty-gritty or will I be distracted for hours on end by the beautiful sunshine? :) We'll see.

I also wish to reiterate why I appreciate AETNA Student Insurance, which just so happens to be (at least partially) connected to Proton Therapy and all of the other flexibility they've shown me over the past month and a half. To make a long story short, AETNA has finally agreed to cover my Proton Therapy treatment, for which I am very excited. This is the second step of two which now makes me eligible to begin my chemo and radiation-combined treatment on March 16th, after a quick "set-up" on the 15th. If anyone wishes for an update on what exactly this all entails, I've covered its basics pretty well below, but it's important to highlight that the Proton Therapy costs a bit more than twice as much as traditional Photon Therapy radiation (remember, we're trying to cover the costs of a massive, $150M machine here!). That said, it's also much more precise, and the anticipated negative side-effects of Proton Therapy (fatigue, hair loss, and some secondary cognitive effects) are hoped to be dramatically reduced from its traditional, Photon Therapy (x-ray) counterpart. So the final word is that a) I will begin Proton Therapy radiation (along with Temodar chemotherapy) on March 16th after a brief set-up the prior day and, b) AETNA will pay 100% of its associated costs. Blessed? I think so.

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)

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:

http://www3.mdanderson.org/streams/FullVideoPlayer.cfm?xml=communications%2Fconfig%2Fpencil_proton_cfg

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

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 wonderful 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 moments 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 city (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, during 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

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 childhood 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).

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.

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.