Today I got another PET scan to assess the effectiveness of the previous two chemotherapy treatments. The results look reassuring. I have not yet heard the official word from the radiologist, but it is obvious even to my unprofessional eye that chemo has had an effect. The major tumor in my right lung is no longer visible, and the other smaller tumors have decreased in brightness.
The pictures below show the scans from the initial diagnosis on the left alongside today's scans on the right.
These results mean that I will likely stay with the same set of chemo drugs for one or two more rounds. After that, I will probably get another scan, then switch to some alternate drugs for as long as it takes for the tumors to disappear.
On a private mailing list populated by my computer science friends, Sam asked the following question:
We're going to define the "future" as the first time a real space pirate hijacks a spaceship in space. The question is, how far away are we from the future?
A rousing and deep discussion ensued. Guesses ranged from 50 to 500 years, with an average around 200.
I think we are already in the future and better off not having to worry about space piracy, but that's a separate discussion.
The following is my slightly edited response to a comment about space pirates launching ships from the surface of the Earth (or another planet).
Let's address just the issue of getting into space. There are four ways to escape a planetary gravity well: chemical fuels, atomic energy, a space elevator, and some unknown future technology.
I always find it comical when science fiction writers send a small handful of people into space on top of a rocket. With the earth's dwindling reserves of fossil fuels and the rising environmental costs of burning them, I think one would agree that chemically-powered space travel will be limited in the future and certainly out of the economic reach of a small band of space pirates.
Since the atomic golden age of the 1950s and 60s, we have learned that atomic
energy is too dangerous for individual use due to the danger of
accidents and atomic weapons. (Aside: Find one of Eisenhower's
"civilian atomic energy" videos online. They're hilarious.) I don't
see this danger dwindling except by the invention of force shields or
other defensive systems. Atomic energy also has the same fuel discovery
and transportation issues as chemical rockets.
The deeper problem with both chemical rockets and atomic energy is that
the ship must lift both its own weight and the weight of its fuel. This
inefficiency makes a space elevator a much more believable method of
moving cargo into space. In that case, the energy source remains
stationary and must lift only the weight of the payload.
Thus, a space elevator removes the need for surface-to-space ships that
space pirates could board and loot. Criminals could certainly
infiltrate the elevator "cars" and steal cargo, but as I have explained
above, it is unlikely they could get the cargo into space without their own elevator. Furthermore, such a crime stretches the common definition of "piracy" in which criminals hijack an independent vessel in transit.
It is likely that future technologies will provide alternate
energy sources or completely new ways of traveling from a planet's
surface into space. However, there will always be a lower bound to how much energy is required to lift a certain amount of matter out of a planetary gravity well in a particular amount of time. This is a substantial amount of energy no matter where it comes from.
For these reasons, I don't expect that space pirates will launch from the ground to intercept interplanetary cargo shipments. Instead, if interplanetary commerce ever becomes widespread enough to support piracy, I would expect pirates to stay in space and smuggle stolen cargo through a space elevator or other public transport system.
While browsing Flickr, I came across some fascinating photos of Champaign and Urbana in 1975. Several images have then-and-now comparisons in the comments.
The following are my favorites:
Downtown Champaign – The streets look so open without warning signs, stop lights, or excessive striping.
Urbana Cinema – Now an art gallery, though I like that the owners have retained the classic sign.
Walnut Street Tea Company – I buy most of my caffeinated beverages from this store. On one visit, I mentioned that I had found this image from 1975. The proprietor told me she had bought the suite in the early 1980s.
A lot has happened since I last wrote about my most recent cancer diagnosis. I won't go into the grisly details, but a complex sequence of events led to more leg surgery. It was necessary to replace my entire right femur from the knee to the hip. Over half of my right leg is metal now! While lying in the staging room before surgery, I told my surgeon that I hoped this was the last part he'd have to take out of me.
They successfully removed the tumor in my leg. Fortunately, the bony portion was almost completely dead after just one chemo treatment. That makes me confident that the other tumors in my lungs are similarly affected.
Recovery has been difficult but remarkably quick. I am regaining motion and strength every day, can already put my full weight on the leg, and am getting around well with crutches. The downside of a quick recovery is that the doctors were eager to start chemo again. I started the second round of high-dose ifosfamide last week. It hit me pretty hard—I slept through most of the week—but I'm home now and feeling pretty good.
One week ago I finished the first chemotherapy treatment for my most recent cancer diagnosis. But this post is not about that. Knowing that I would be going into the hospital, I took the preceding week off, spent a day in Chicago, flew to Salt Lake City, then went on a long car trip through four western states, Yellowstone National Park, Grand Teton National Park, and several national forests. I saw some beautiful countryside and got to reconnect with my old friend Charlie.
I got the idea for the trip soon after the initial diagnosis. I was eating dinner with my family, and my father asked, "what would you like to do before you start treatments?" My thoughts returned to my cross-country trips to and from California. I greatly enjoyed these trips because they allowed me to be alone with my thoughts and pass through part of the country that I had never seen before. The trips also showed me how much I had left to see. Who knows when or if I would get another chance.
For this trip, I wanted to go on walkabout again and spend time in some of the national parks that I had been forced to bypass. I decided to fly into Salt Lake City and drive from there to Yellowstone. I left the rest of the week largely undefined. This open plan proved beneficial; it left time to take scenic back roads and do several things that I could have never expected.
I booked tickets just three days in advance. Three events coincided to make the trip much easier. First, a group of friends and I had already made plans to visit Chicago the day before my flight, so I was able to fly direct from O'Hare Airport. Second, Charlie and his family live in Big Sky, Montana, just north of Yellowstone. Despite such short notice, they eagerly agreed to let me stay with them for a few nights, removing the need to find a hotel. Finally, I arrived at the end of the summer tourist season, so I found superb weather, early fall colors, and minimal crowds everywhere I went.
And so, on Saturday, September 20, I began my week-long western vacation.
St. Louis is traditionally seen as the gateway to the west, but my trip began in Chicago. Alejandro's girlfriend Alejandra was visiting, so the two of them, Josh, Lucas, and I traveled to several of Chicago's traditional tourist sites. I am ashamed that this was only the second time I have been to downtown Chicago since becoming a UIUC student. Fortunately, I got to see a lot of what I missed last time. We had a full day, including a Segway tour of the waterfront, deep-dish pizza for lunch, the Art Institute of Chicago, Navy Pier, and a trendy Thai restaurant for dinner.
I could say more about Chicago, but this post is about my trip west. I posted pictures in the gallery. Alejandra posted her pictures on Facebook. At the end of the day, the group dropped me off at a hotel near O'Hare Airport, and I flew to Salt Lake City the next afternoon.
Day One and Two: Drive from Salt Lake City to Big Sky, Montana
My flight arrived in Salt Lake City shortly before dark, so I picked up my rental car and found a hotel north of the city. The next day, I took the scenic route north to Big Sky, Montana.
I woke at dawn so I could use every minute of sunlight for the drive. To my surprise, I found not sunlight, but deep gray rain clouds. The attendant at the visitor center in Logan said it was the first rain in a long time.
Near Brigham City, I entered Cache National Forest, the first of several national forests that I would pass through over the course of the week. Almost immediately, the road was surrounded by vibrant foliage contrasting with the gray cliffs and clouds. The rain only made the colors more vivid. Periodically, the cliffs would open up, revealing a sprawling basin lined with stands of pine and bright yellow birch.
The clouds began to part when I reached Bear Lake on the Utah-Idaho border. I stopped at a vista point overlooking the valley and was amazed at the surreal aqua color of the water. According to one of the information placards, it is caused by limestone leaching from the surrounding mountains.
Like my previous cross-country road trips, I was amazed at how quickly the landscape changed. I crossed several cultivated valleys in Wyoming and Idaho in which one side of the road looked up to a rocky hillside sprinkled with shrubs and pine trees and the other over a sweeping panorama of golden wheat fields. Several times I stopped, walked away from the car, and stood listening to the quiet hissing of the wind over the rolling hills. It made a different sound than the wind through Illinois' corn and soybean fields.
I never saw much vehicle traffic, but I was forced onto gravel farm roads near Ashton, Idaho ("Worlds Largest Seed-Producing Area") due to what appeared to be an alfalfa spill.
Soon after, I avoided bovine traffic plodding slowly down the road.
The wheat fields returned to pine forests as I rose into the Greater Yellowstone region. The road crossed into Montana, then jogged in and out of Yellowstone and Wyoming. This stretch, lined with rock outcropping that reminded me of aged faces, was Charlie's daily commute.
I almost missed Big Sky. My GPS did not know it was a city because, I would later learn, there were ongoing incorporation disputes related to liquor licenses. Fortunately, as Charlie told me on the phone, "there's not much to Big Sky", and I was able to find the appropriate street by zooming in as close as possible. After about 11 hours of driving, I pulled into Charlie's driveway at sunset.
Yellowstone is spectacular. Since returning home, I have been telling my friends to do whatever they can to visit. After my father saw the pictures, he said succinctly, "that looks a lot like my happy place."
The park is famous for its geological features, and the loop took Charlie and me past many otherworldly thermal basins.
My favorites were the paint pots. The bubbles in the thick liquid were fascinating to watch and made entertaining burbling noises.
The bacterial mats and mineral deposits surrounding the geysers and hot springs exhibited deep fractal complexity and were just as interesting to examine at as the thermal features themselves.
Charlie and I stopped for lunch at a restaurant near Old Faithful. Unknown to us, we were eating during an eruption. When we passed the next day, we would have had to wait another hour. We finally saw Old Faithful's famous plume on day five while returning from Jackson, Wyoming.
Old Faithful, like the other thermal features we saw, was surrounded by a raised boardwalk. These boardwalks and the amount of driving made Yellowstone much different from most other nature parks that I have been to in which the best attractions are visible only to hikers on backcountry trails. In Yellowstone, I was amazed how easy it was to simply drive, park, and walk a hundred paces to a natural wonder of the world. Is this good or bad? On one hand I was dismayed to see a miniature freeway overpass leading to Old Faithful. On the other, I am thankful that so many people—including the old, young, and handicapped— are able to experience Yellowstone. I, for one, feel fortunate that I could see so much so quickly, even though it only accounts for a small sliver of the park's total area.
The wildlife, at least, lacked boardwalks. We saw mostly Bison and Elk, often standing in a far-off meadow. The closest we came to Yellowstone's fauna was when we rounded a turn and saw several Bison slowly walking down the road.
The highlight of the day's trip came near the end of the loop when we stopped at the Grand Canyon of the Yellowstone. It was then that the inspiration for the park's name became apparent.
There are more pictures of the canyon and the rest of the park in the gallery.
Day Four: Grand Teton and Jackson, Wyoming
On day four, I had originally expected to drive alone through Grand Teton National Park and spend the night in Jackson, Wyoming. From there, I would circle back to Salt Lake City via Flaming Gorge National Recreation Area and Dinosaur National Monument. However, Charlie also wanted to see Grand Teton and Jackson, so we devised an alternate plan in which both of us would go to Jackson and return to Big Sky the following day. This plan worked especially well since I would then be in town for Charlie's birthday party. I didn't know it at the time, but it would also prove fortunate that I had someone with which to enjoy Jackson's night life.
One of the guide books—I can't find it now, so I'm paraphrasing—accurately described Grand Teton National Park as "providing many angles and vistas from which to view the mountains of the Teton Range". And what angles and vistas they are! The park doesn't have the thermal features of Yellowstone, but that hardly seems to matter. The views of the Tetons are noteworthy in that the mountains lack foothills and instead shoot up from relatively flat surrounding land.
As for the vistas, Signal Mountain, overlooking the Snake River from 7,593 feet, was one of the most impressive of the entire trip. I had my binoculars with me and must have spent 30 minutes surveying the miles of breathtaking landscape.
Charlie and I got a closer look at some of the park when we took several short hikes at various points along the banks of Jackson Lake. At one, Charlie decided to chase a flock of geese.
At another, I left a small cairn at the trailhead.
It seemed like no time at all before we reached the park's southern entrance and Jackson. You can find more pictures of the park in the gallery.
Jackson, Wyoming
Jackson, Wyoming is an unapologetically goofy western-themed tourist town. Western outfitters, taxidermists, and souvenir stores line the main square. The park inside the square has four arches made of discarded elk antlers. Unfortunately, I do not have pictures of the town since I left my camera at the hotel.
Inspired by the wildlife in Yellowstone, Charlie and I wanted bison burgers for dinner. We expected they would be easy to find in a town like Jackson. We were wrong. The receptionist at our hotel suggested a restaurant that was split down the middle: one side was a sit-down steakhouse and the other was a short order diner. Neither side had bison burgers. The next place we found was much fancier, but while it had elk steaks ($35), it lacked bison burgers. Finally, we found a family-style grill with bison on the menu. I told Charlie, "food tastes better when you hunt for it."
After dinner, Charlie and I went to the Million Dollar Cowboy Bar. Like the town itself, the bar flaunted its western theme with a wonderful lack of subtlety. The wood-paneled walls supported display cases containing Winchester rifles and Native American artifacts. Charlie and I got a table next to stuffed mountain lion. A lanky singer who sounded like Weird Al with a southern accent led a country-western band on the main stage. It was entertaining, but Charlie and I eventually decided it wasn't our scene. Fortunately, I had picked up a local paper at the front door and read that a nearby coffeehouse was having an open mic night.
The laidback open mic night could not have been more different than the over-the-top Cowboy Bar. When we arrived, there were maybe eight people in the dimly-lit coffeehouse. One was singing and strumming a guitar in the corner of the room, while another in the audience provided rhythm with a small djembe drum. None had cowboy hats or boots. The singer completed several songs, then asked if anyone else wanted to play. When no one replied, Charlie stood up.
Charlie regularly plays shows around Big Sky, so he essentially had a set list prepared. The small audience was surprised, I think, to see how well Charlie played, having just walked in from the street. At one point, he had everyone laughing at an improvised song about the cowboy bar.
I, too, got a chance to play. The crowd was very receptive, but my guitar-only songs did not captivate them like Charlie's singing had.
After we left, Charlie and I reflected on how fortunate it was that I had noticed the event in the paper. Who knows how different the evening would have been otherwise?
Day Five and Six: Charlie's Birthday, a Horse Ride, and Return to Salt Lake City
Charlie bartends at a tourist ranch near Yellowstone. On the evening of the fifth day, after returning from Jackson, I helped the colorful staff of the ranch celebrate Charlie's birthday. During the party, a discussion with the stable master—who I managed to beat at pool—led to Charlie and me join a group of other visitors on a horseback ride the next morning. Unfortunately, I did not get pictures of that trip, either, but I was left amazed not only at the scenery but at how well the horses navigated the rocky trails. Neither a person nor an ATV could have made it up the steep and rugged ravines that we followed. I am convinced that horses provide the best way to see the backcountry and hope I get a chance to ride again (with a camera, of course).
On two occasions my fake leg surprised the guide. The first occurred when I mounted the horse at the stable. The guide adjusted the position of my leg in the stirrup and noticed that it didn't move normally. Later, when we were an hour into the ride, I noticed the toe of my left leg was pointed 90° to the right. The stirrup had pressed the release button without my knowledge. I called out, "I need to stop. My leg fell off." After reattaching the leg, I removed the release button, and the rest of the ride passed without incident.
The horseback ride occurred early enough in the morning that I was able to return to Salt Lake City by sunset. I said goodbye to Charlie and his family, thanked them profusely for their hospitality, and set off down the interstate.
The drive was less scenic than the back roads I had taken driving north, but I did get to see some volcanic flows and and the back side of the Teton Range.
Conclusion
Cancer motivated me to take this trip, but it wasn't the reason for the trip. I have wanted travel west again for months; Cancer just gave me a deadline after which a week-long vacation would become much more difficult. Did it make me more ready for cancer treatments? I don't think so, but it did give me time during which I didn't have to think about the disease and could instead enjoy the beauty of nature and reconnect with an old friend. Those qualities would make any vacation a success regardless of the motivation.
The tower was funded by H. Richard McFarland, a 1952 UIUC graduate and owner of McFarland Foods Corporation [1], in memory of his wife Sally [2]. Right now it is an ugly and imposing mass of gray concrete, but it will eventually reach 185 feet, be painted to match the surrounding buildings, and contain 49 bells controllable by computer or keyboard [3]. Opinion is mixed, though I agree with others that it looks like the Tower of Barad-dûr from Lord of the Rings.
Is there such a thing as chronic bone cancer? If there is, then I have it. A routine checkup last week found metastatic bone cancer tumors in both of my lungs. An extensive battery of additional tests confirmed that a minor pain in my right thigh is caused by another tumor. It is unclear whether these occurrences are related to last year's diagnosis. I also don't know yet what the exact treatment will be.
I wish I were a more skillful writer so I could better express how deeply frustrating and discouraging it was to learn I have cancer for a fourth time. Having passed my qual, this semester was supposed to be the first that I could devote solely to research; now I will have to split it between research and cancer treatments. After going to the gym nearly every other day since mid-February, I had finally passed last summer's best bench press; now vicious chemotherapy drugs will knock back any gains I made. An unlucky combination of genes has eaten away at my legs for the past eight years and now it has decided to go after my lungs.
All this came as a complete surprise. Unlike my previous diagnoses, I didn't have an enormous lump or stabbing pain anywhere. The only indication that something was wrong was a slight soreness in my right leg. Random aches are normal with that leg, but a spot near my hip had been bothering me since I bruised it while rock climbing. I drove to Indianapolis for my standard every-three-months-post-cancer checkup, hoping to get confirmation that the pain was harmless and expecting to return to Champaign by lunchtime.
I got several x-rays of the leg and my chest. After the scans, my surgeon very directly stated that the chest x-ray looked abnormal.
I didn't get back to Champaign. In the week since that initial x-ray, I have had a litany of additional scans. First, my surgeon ordered a CT scan of my chest and an MRI of my hip. Then, my oncologist ordered a full-body PET scan—my first—for Friday and a bone scan on Monday. Today I had another MRI of my leg, slightly lower than the previous one to better show the tumor.
Unlike my previous diagnoses, I was able to keep CDs of images for nearly all of the scans. The PET scan was particularly interesting. It is used to gauge metabolic activity. I was given an injection of radioactive sugar and told to lie still in a dark room. The important thing was to keep nonessential metabolic processes to a minimum. No movement (and no thinking) for two hours. I fell asleep, which I am told was probably the best thing to do. Then, I was taken to another dark room with the scanner. The tumors showed up as small bright blobs in the resulting images.
The bone scan shows bone growth. The leg tumor appeared, but the lung tumors were hidden.
The MRI showed the position of the leg tumor at the top of the femur. It is difficult to see much detail because all the metal in my leg interferes with the scan.
Lung tumors are undoubtedly a Very Bad Thing, and with my history, treatment will be a challenge. Fortunately, there are medicines and techniques available that did not exist just five years ago. I will write about the particulars once the plan solidifies.
I greatly value the love, support, and kind wishes that so many have sent. Thank you all.
Last weekend, Vilas and I went climbing at Upper Limits Rock Gym. The gym, located in Bloomington, Illinois, is held in a converted grain elevator. What a great way to reuse an old building!
The warehouse-sized main room is covered in climbing surfaces.
But most impressive are several silos containing routes along their inside walls.
Unfortunately, Vilas and I could not go all the way to the top since we were not trained to belay back down. Nevertheless, we both enjoyed the routes available to us and left the gym thoroughly exhausted.
I got my first migraine in high school. A blinding aura exploded in my vision, the entire left side of my body went numb, and I couldn't talk. I was afraid I was having a stroke. It took several years for me to put a name to the headaches. Since then, a migraine has knocked me out for a few hours every few months.
Something changed recently. I am currently recovering from my third migraine in a week and a half. Before this latest string of occurrences, it had been about a month. Before that, three months. I hope this is not the beginning of a trend.
It turns out that in many the pain is preceded not by a decrease in blood flow but by an increase—an increase of about 300 percent. During the headache itself, though, blood flow is not increased; in fact, circulation appears normal or even reduced.
...
The phases of hyperexcitability followed by inhibition that characterize cortical spreading depression can explain the changes in blood flow that have been documented to occur before migraine pain sets in. When neurons are active and firing, they require a great deal of energy and, thus, blood—just what investigators see during brain scans of patients experiencing aura. But afterward, during inhibition, the quiet neurons need less blood.
