Wednesday, July 22, 2015


"I want to take a minute to thank my cells.

I began treatment for metastatic papillary renal cell carcinoma in September of last year using a targeted therapy drug called Pazopanib. I take three pills a day, and without them I would be dead. Since then, I've had new scans about every two months. My scan in November showed that my healthy cells had recaptured a huge amount of territory, with all of my tumors shrinking by 40 to 50 percent. Since then, the story has been different.

If you've never seen a CT scan, the liver is the easiest organ to spot. It's huge, and it's a dead-even shade of gray from one side to the other. And if you happen to have cancer that has metastacized to the liver, the tumors are easy to spot, too. They are a darker gray with a well-defined border. I have at least six spots between the two sides of my liver, but there's one in particular which has been my benchmark because it is the largest and easiest to spot as my doctor scrolls through the cross-sections of my body. I'd like to talk about that spot.

Since that second scan in November, I've grown very accustomed to the phrase, "It could just be slice variation." Every time Cristina Renfro and I go to Highlands to learn the results of my latest scan, we hear that I had some slight shrinkage in a few places and the rest stayed the same, and that we should be very glad for that. We have been!

As it turn out, though, all those instances of, "It may have shrunk a millimeter or two but it could just be slice variation," have added up to real millimeters. When I was at M.D. Anderson, my doctor pulled up my original scan from September, my June scan, and the scan they took in July, and put them side-by-side on one huge computer monitor, all showing that one big spot. The difference between my original scan and the recent scans was very obvious, but then my doctor dragged measurement lines in an X across the spot on my June and July scans. The long dimension was 48mm on my June scan and 46.5mm on my July scan. I beat my doctor to the punch by stating that it could just be slice variation, and she agreed, but then I told her I very specifically remembered that spot being 51mm on my November scan. We didn't have that scan to look at, but I am positive that was the number. Going from 51mm to about 47mm is not slice variation; it is shrinkage. That spot has been shrinking half a millimeter per month for eight months. Take a second to let that sink in.

That number, half a millimeter per month, got me thinking about what is happening inside my body at the cellular level. I'm seeing the most horrific trench warfare imaginable, where both sides are being bombarded with a powerful chemical compound that strangles the life from the sickest cells but torches the healthy cells at the same time. It is a bloodbath happening on a hundred fronts, day after day, month after month, with years to go before it will be over. It is a terrible fight.

I'm doing what I can do here on the outside. I make a conscious decision to keep living every day, no matter what I feel like. I exercise. I eat. I'm kind to every person I meet, or at least I try to be. I love my wife and my son with all of my heart. I surround myself with people who give me energy and try my best to give the same energy back. These are the things I can do on the outside. The real heroes, though, are on the inside. The real heroes are my cells. They are soldiers on the Ostfront, dying by the billions but slowly beating back a strong and determined enemy inch by muddy inch. I want to thank those cells. I want them to know that I understand the horror they are facing. I want them to know how huge half a millimeter is to me and how much I appreciate every day of life they give me. I don't know what else to say to my cells before sending them into the meat grinder. I can't give them any more courage than they already have. I can't make their fight any easier. All I can do is honor them by living every single day as well as I can. It's not much, but I will definitely do that!"

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