An Unwanted Journey: Day 0947 - The Gathering Clouds

We've had several days of stormy weather in south-western Ontario. Thunderstorms at night and showers during the day. The weather seems to be resonating with what's going on internally.

Today, our family was together to celebrate the wedding of the daughter of good friends, a young woman who we've known since she was an infant. She looked absolutely gorgeous today, and we all had a wonderful time looking towards a bright future for J and M.

But throughout the celebration, there was the hint of gathering clouds in my personal and family horizon. The threat of recurrence of cancer is something that I take very seriously, knowing full well that advanced colorectal cancer is very dangerous, even when the treatment initially resulted in no evidence of disease.

Now, there is evidence of disease. My CEA levels have more than doubled in less than five months and are well into the abnormal range. The cancer centre has scheduled an appointment with an oncologist to review my CT scan with me, and my family physician is scheduling another colonoscopy.

All of a sudden, coping with the side effects of my last set of treatments has become secondary to the prospect of metastases. If the recurrence is in the bowel, then perhaps we have a good shot at eradicating it. If it is in the liver or lungs or abdominal cavity...well, I'd rather not think about that too much. Yes, there are potential treatments for metastases to some distant organs, but none of them is attractive.

Until we know where the road ahead will lead, I can distract myself and make sure I'm doing now what I really want to do in my life, but the storm clouds still demand attention and preparation. If I could arrange for sunny weather, I'd do so, but it may be time to get out the umbrella.

An Unwanted Journey: Day 0944 - Poor CEA Results

Should I be nervous about a recurrence of cancer?

Today, my family physician gave me the news that my CEA (carcinoembryonic antigen) test results had more than doubled in the past five month (January to June) from 3.6 to 7.8. The CT scan results weren't back yet, but he has already requested another colonoscopy for me with my surgical oncologist and I have a follow up appointment with my medical oncologist in two weeks.

Maybe the reason for my anxiety last week wasn't entirely off the mark. As I've been looking at search results again today about CEA levels, I can't help but wonder whether I should have been more vigilant (after all, my CEA level in January was 3.6, higher than it ever was even prior to treatment). In fact, to be brutally honest with myself, what was I thinking when I was issued a follow-up CT scan and a request for extra blood work from the cancer centre last week? My family physician hadn't said anything to me about getting the cancer centre involved in my regular follow-up protocol again. So was their involvement just coincidental? I don't think so.

And so here I go again, worrying and researching colorectal cancer tumor markers instead of so many other things that I might otherwise be doing. I read about the American Society of Clinical Oncology's 2006 Guidelines for the use of CEA as a tumor marker for the recurrence of colorectal cancer at the Colorectal Cancer Association of Canada's web site. Or a case study about a woman roughly my age whose recurrence of colorectal cancer was caught by means of the CEA postoperative follow-up. I read about other people whose CEA kept going up and who ended up with adenocarcinoma in the lungs or liver, clearly evidence of micro metastases after "successful" resections like my own.

But there it is. I can't do anything, except start pestering for test results delivered in a more timely fashion. I can do some more research. I can review my medical records. Simple things like that. But probably most importantly, I can simply live my life.

An Unwanted Journey: Day 0938 - Feelings Flooding Back

I have many reasons to be happy and content with my road to recovery. First and foremost, I'm still here, walking around, doing my job and loving it, surrounded by a loving wife and two great sons, reasonably healthy, involved as much as is physically possible with my fellow IT professionals, playing the guitar again just a little...

But today, as I walked into the Grand River Regional Cancer Centre for blood tests, registered at the front desk, received my itinerary for the morning, climbed the stairs to Clinic B, waited my turn for the Blood Collection Team to do what they do best, and then wandered through the corridors back down to the Medical Imaging Registration Office and on to the CT/MRI scanning area, it hit me. The feelings all came flooding back.

I tried to explain it to friends and colleagues curious about my medical appointments today. Vulnerability, recollections of pain, uncertainty, helplessness - mostly inchoate, but clearly enough to make me feel totally fragile. To make matters worse, memory was resonating with a completely rotten week physically - rectal bleeding, restless nights with one-hour intervals between trips to the washroom, difficulty walking, a constant discomfort down below. And then a phone call from a friend who simply wanted advice on helping another friend recently diagnosed with terminal cancer.

On the other hand, there's nothing like helping someone else to get you out of a self-induced funk. It was good to offer advice and to share why someone with cancer might have a hard time reaching out for support, why sometimes you just want to be alone, and then a few moments later craving the company of someone who cares deeply for you.

Still, life conspired this week to remind me of so much that I've been trying to - pardon the irony - put behind me.

But even with the conspiracy, family members and colleagues reached out and made it obvious that they care. Those feelings were a welcome counterpoint.

Father Time

I looked across the small, round table where our paper coffee cups lay empty of the mild morning brew we had just consumed. He was looking old. A few minutes later, as he sat in the driver's seat of my new Camry Hybrid and looked at himself in the vanity mirror, he commented, "Getting old really does a number on your face."

A couple hours later, as we sat at lunch with my mother-in-law celebrating her eighty-fifth birthday at Swiss Chalet, after I had commented how she certainly didn't look eighty-five and she had responded how she certainly felt eighty-five, how using a walker to get around the nursing home and taking Tylenol 3 extra strength pills to calm the continual pain in her curving spine made her aging quite obvious to her, the best I could do was, "Yeah, but it sure beats the alternative." And she responded, "Yes, that's so true."

The day before, I smiled when a colleague spoke of someone in their mid-fifties drifting towards the sunset years and retirement, wondering if she recognized that I had recently celebrated my fifty-fifth birthday. And I thought of a friend whose father passed away before passing this milestone, a statistic of the same cancer I have apparently survived. And I thought too of three friends with whom I had sung in a gospel band, all of whom never made it past age fifty-five, two of whom were victims of colorectal cancer.

Whether it's drifting towards the sunset years and each new insult to the body or embracing the simple opportunities of time and energy still available, I guess it's inevitable that milestones and special occasions remind us of the passage of time.

Tomorrow is Father's Day. My sons are grown men now and both working all day. But they will join my wife and me in the evening for a BBQ, weather permitting, or a restaurant meal, weather demanding. I'll get a card and another reminder that time marches on, thankful that the march still includes me and so many that I love. I'll read Randy Pausch's book, The Last Lecture, about a father's tribute and legacy to his three young children with whom he almost certainly will not spend another Father's Day. I'll shed a tear or two, thankful for what I have, who makes my life so worth living, and for the hopes and dreams that sustain other fathers like Randy and me.