No easy answers

It is late Sunday, and I realized I'd not updated my self-indulgent exercise in writing about my second experience with cancer. So with Vicente Fernández (R.I.P.) on in the background, let me update you about my recovery and the next steps in my treatment.

It is still quite remarkable to me how good I feel for the most part. I have been feeling good enough that I returned to work on Wednesday. Knowing that this is probably too soon to go back to work, I planned to work half days. However, business has been so good I could not, in good conscience, leave the team in the middle of the day. I have learned by working full days that fatigue and pain are cumulative. When I get home, I sit on the edge of my bed and think, "working a full day today is a mistake." Don't get me wrong; it feels good to be back. It feels good to see customers I've been helping for the past 11 years. Those customers who know about my condition have been genuinely surprised to see me back (I'm surprised too). It feels good to be back. Honestly, it does, until it doesn't feel good anymore. It's almost like I hit a wall of fatigue, and my gut starts to feel crampy. It is not cramps but a close approximation to them, and I find myself forcing myself to stand up straight and not carry myself with a slight hunch. Getting winded and elevated heartbeat is still a problem. Walking across a room still gets my heart pumping at over 120 beats per minute, and I'm breathing hard. If that wasn't enough, my gut feels like it has a low-level fire going on most of the time. Getting real rest is a challenge at best because of the kiddos. They are just kids and need their dad to help them with stuff. I'm happy to do it, but man, it's tough.

I know what you're thinking; why is this moron working? The truth is all of the pain is tolerable. I can push through it and, I do. Would I like to take a nap and work half days? Sure anyone would! I needed to get back to a routine. I watched a lot of quality T.V. and read a couple of books, which was nice. But, I can't read books and watch T.V. indefinitely. I will say I'm not pushing real hard while working, and I take every opportunity to sit and take my time with whatever I'm doing. There were a couple of situations at the office where I can honestly say, "God puts you where you need to be." I'm glad I was at the office to take care of business this week.

My surgeon said I looked good. I got to ask him a bit about the mechanics of the surgery—the why I was in stirrups and pointed head down for the operation. It's crazy fascinating. The confidence the surgeon exudes is excellent; that alone put me at ease, and I found that on this third visit, he had a bit of a warmer demeanor. He wants to see me post-chemotherapy.

*Already 500 words, I should go to bed, but I'll finish, I hope.*

As for my chemotherapy treatment plan, there is no plan yet. My oncologist wants more data to make a formal plan. Evidently, I'm complicated.

So to recap, and I'm digging deep here, so I may not be the most accurate. There are two complicating factors for me. Without those factors, I would be a stage 2A and done with treatment. See what I did there? The pathology came back as stage 2A. If you've been following along, you'd know that, but if you're just joining the rest of us, welcome. I don't think I said the official stage is on this blog. So there is it is, stage 2A. The oncologist said that if I were an older patient with comorbidities, they would say I'm cancer-free. However, since I'm young and 'exceptionally healthy,' i would tolerate chemotherapy well.

Now on to complicating factors.

The hypomorphic state of the tumor, combined with genetic testing, has some indication that my body may not be able to shut down cancer cells like ordinary people. My childhood history of cancer lends credence to this thought. Genetic counseling is the next step to confirm this theory. Unfortunately, that takes many months to get the results and will not benefit cancer treatment. It will be helpful to find out if I have Lynch syndrome.

The other complicating factor is the lymphovascular invasion noted in the pathology report. So the pathology was great, mostly; no cancer in the 17 lymph nodes that the surgeon removed. The margins were clear of any signs of cancer. Reviewing the pathology report with the nurse practitioner gave me a better understanding of lymphovascular invasion. The tumor did not spread outside of the colon. Even though the cancer was encapsulated, cells were found in the lymph and vascular system within the cancerous growth. Those internal vascular and lymph systems link up to the larger lymph and vascular system. The fear is that some cancer cells may have escaped and are floating around within my blood, waiting to attach to another organ and start doing its worst.

The suspicion that my body might not shut down cancer cells well gives the oncologist concern about just letting it go and not doing any chemotherapy to finish the job that my body SHOULD be able to on its own. But, unfortunately, there is no clear guidance on what to do in situations like these. I understand that with stage 3 and stage 1 cancers, there is a lot of clinical data on what to do, but there isn't much clear-cut guidance in complex situations like mine.

With complex situations and no firm guidance, more data is always good. So the oncologist ordered a 'liquid biopsy' test called guardant reveal. The test has only been out for about six months, which is incredible when you think about it. My doctors are genuinely using the latest scientific techniques to treat my cancer. This test measures the genetic traces of cancer in my blood. I will know the next step based on the test results. I am still reasonably confident that I will have to do chemotherapy, but maybe I will luck out.

As for my elevated heartbeat and getting winded, my blood panels show that I'm still low on hemoglobin and anemic. I am now taking iron supplements, and hopefully, that will help hemoglobin recover faster. So at least we have a plan, but I suspect I'm still looking at another two months of shortness of breath and elevated heartbeats.

So there it is! You've made it through another 1000+ word entry. If you're bored, check out some Vicente Fernández. His music brings me back to when I would listen to my grandfather play guitar and sing songs from Mexico. Usually, it was him and his guitar, but I remember him singing with his brothers on occasion, and I just loved it. Living in St. Louis, away from my family, who have connections to the motherland, makes me wish I spoke Spanish fluently. It is one of my many life regrets. However, that is for another blog post.

Thanks for following along. I hope my writing is clear. I hope you enjoy reading it. I try to keep it positive, but there have been many dark moments. I don't want to give the impression that it's been all sunshine over here. I would say mostly sunny. But, to write about those moments will have to wait for another time.

Keep the prayers and vibes coming; it helps.