10/13/06 Good Day at the Hospital

Family and Friends,

Just a (relatively) brief note to let you know that today's procedure went very well. Dr. Handy didn't visually detect any signs of cancer in the lymph nodes and was pleased with how quickly I bounced back in the recovery room. He told us to expect to proceed with the surgery on Tuesday unless he calls Monday with biopsy results that are different than what he is expecting. We LIKE that optimism!

The procedure was quick, and I was out of the hospital 3 hours later. My throat is sore and I'm a little groggy from pain meds. However, we're happy to have a successful "dry run" at the lung surgery behind us, and to have the doctor's optimism to buoy our spirits.

Next step: This cancer is going OUTA HERE on Tuesday unless you hear otherwise Monday evening!

Love,

Dann and Genevieve

10/12/06 Next Step: FRIDAY!

Family and Friends,

After days of making increasingly assertive calls to both the oncologist and the surgeon to get them to talk to each other, we have results. TOMORROW (Friday) I will have a procedure to remove all the lymph nodes within reach of Dr. Handy's scope. They will biopsy the lymph nodes, and we will find out the results by Monday. If the lymph nodes are cancer free, my surgery will proceed on Tuesday as planned. If not, I will have 2 more rounds of chemo before the surgery, which would mean having surgery sometime around Christmas. Please send whatever prayers or positive energy you have my way for good results!

Dr. Handy will make a small incision in front of my trachea and remove the lymph nodes using the same minimally invasive technology that they will use for the main surgery. It should take about an hour, and is scheduled for 12:30 PM Friday. They will send me home a few hours later, after the general anesthetic wears off.

Love,

Dann and Genevieve

10/9/06 New Information/ Ambiguous Plans

Family and Friends,

Before sharing the latest update I need to share my own personal Top 10 Greatest Things About Going Hairless:

10. Gen doesn't pluck my eyebrows in my sleep any more.
9. My granddaughters don't ask why Grandpa Dann has hair in his nose any more.
8. Grooming time is cut waaaaay down.
7. No more wondering what it will look like one day...
6. Righteous salute of the brotherhood of bald men!
5. Easier to find in a crowd.
4. Great conversation starter.
3. Built-in, highly sensitive weather gauge.
2. Dandruff? What dandruff?
1. Endless tattoo possibilities.... See below for a sample!

Now for the latest news: We met with Dr. Ross, my oncologist, today. First, we found out that the location of the lymph node where the tumor had spread reclassifies my cancer as Stage III. She pointed out that the best part of this is that my tumor was so small, and it took 2 CT scans to even determine that it is Stage III, that we have caught the cancer at the earliest possible part of Stage III. In most cases it is easier to determine the stage because the cancer is more advanced.
Next, she said that the tumor shrunk by more than HALF, not the third that we had thought. (It pays to talk to an oncologist rather than a surgeon about these things!) She showed us the tumor on the CT scan after it shrunk, and YES, IT LOOKED LIKE A PRUNE!!!!! She laughed along with us when we told her all the people that were thinking prunes for me. Of course, she likes to think it was the chemo that did the trick. She is thrilled by how well the tumor responded to the chemo. This bodes extremely well for what impact chemo will have on stray cells.
Dr. Ross recommends that before the tumor is removed, I have a "sentinel lymph node biopsy". This would involve inserting a small tube through the front of my chest while I am under a general anesthetic, removing all the lymph nodes that can be reached this way, and doing a biopsy on them. It would take 1-2 days to get the biopsy results. If any of the lymph nodes show living cancer, surgery would be postponed until I have 2 more rounds of chemo. (I have had 2 so far.) If not, we proceed with the surgery. In any case, I would have 2 more rounds of chemo after the surgery. I handled the first 2 rounds relatively easily, so Gen and I are 100% behind anything that improves my odds.
All this means that we don't know if the biopsy will be this week or next. If it is next week, that may or may not delay my surgery for 2 weeks, since my surgeon will be on vacation. Once the oncologist and surgeon have a chance to talk we will know more, and will let you know.
Meanwhile, I consider myself to be in training for surgery. In addition to some form of exercise (weights, yoga, golf, walking) 7 days a week, I have added daily swimming. Being goal-oriented and focused on health rather than sickness, and having your support, are going to get me through this.
We will let you know as soon as the plan is a little clearer. For now, it seems like the more we learn, the less we know for certain. It's a bit like life.
Love,
Dann and Genevieve

10/5/06 Surgery Plans

Family and Friends,

Gen and I met with my surgeon, Dr. Handy, today. We now have a plan for surgery. Dr. Handy was so impressed with how quickly I recovered from the chemotherapy and how physically active that I have remained, that he moved the surgery to the earliest possible date. I will be having the surgery on October 17th, which is just 12 days away!!!!! It is also my son Matt's birthday, which we didn't want. However, the alternative was to put the surgery off for a full week, and getting the cancer out NOW has to be the priority.

Also, after more research and further discussion with Dr. Handy, I decided on the VATS (minimally invasive) surgery. The average length of stay at the hospital is 5 days, but Dr. Handy suspects I'll be out a little quicker. For one thing, I'm probably 25 years younger than that average patient. (That kind of makes the quick recovery from chemotherapy a little less impressive, doesn't it?) Most patients stay home from work for about 3 weeks after this surgery.

When we met with Dr. Handy we got the results from my repeat CT scan, which was done yesterday. The tumor shrank by about a THIRD. (I forgot to ask if the tumor appeared wrinkled like a prune from all that good energy you all have been sending my way.) On the not-so-bright side, one slightly enlarged lymph node shrunk after chemo, which they tell us means that cancer had spread to that lymph node. That makes my cancer Stage II. However, there is a definite silver lining. Because I did chemo before surgery, we now know that the chemo cocktail they gave me is effective on this specific cancer. If they had not done chemo prior to surgery, Dr. Ross (the oncologist) would have to guess and hope she had the right cocktail. Now we know that doing chemo after surgery will hit the target, and should catch any stray cells wandering around that didn't get picked up on any scans. We will meet with Dr. Ross next Monday to plan how soon/how much chemo I will have after surgery.

That's all the news that's fit to print for today. I'll send a brief update after meeting with Dr. Ross next Monday. After that, my next report will be AFTER the surgery.

Love,
Dann and Genevieve

9/26/06 The Current State of Affairs

Friends and Family,

I have now made it through 1 full round of chemotherapy, and we are making our way through the second and temporarily final lap. I had the second day of IV chemo last Thursday, but it's a three week recovery cycle, so I definitely don't consider chemo to be over yet. More on that in a minute.

On Thursday, October 5th Genevieve and I will meet with the surgeon (Dr. Handy) to plan a surgery date and to finalize a plan for which form of surgery I will have. There are advantages to the less invasive VATS surgery (shorter recovery time being #1), but there may be less likelihood of chronic pain after surgery with the more traditional surgery due to the location of the nerves that are cut. Gen is strongly leaning toward the VATS, and I'm becoming more convinced, but in my usual analytical way I'll do more research before coming to what is probably the same conclusion. I think it's the illusion of control that makes it worth the extra effort.

The surgery will likely take place 2-6 weeks after we meet with the surgeon, so between late October and late-November is Dr. Handy's target. Gen and I are targeting the earlier end of this, and I am doing everything I can to prepare for an earlier date. For example, I'm still lifting weights 3x/wk, doing yoga 2x/wk, golfing 1x/wk, and walking the other day. I take a few days off immediately after a chemo infusion but otherwise consider my body to be in training for surgery and for post-surgery quick recovery. With Gen's encouragement I have also added acupuncture with a naturopath as well as massage therapy, both of which are part of Providence's Integrated Medicine program.

We will meet with the oncologist a few days after meeting with Dr. Handy. She has already recommended that I do a couple more rounds of chemotherapy after the surgery because the biopsy showed that the tumor was growing at a faster rate than anticipated. This will be one more way of ensuring that no stray cancer cells are left to wander around my body looking for a home. It increases my survival odds once again and is very reassuring, at least when I'm not thinking about the chemo side effects.

Many of you have asked how chemo is going. The "big picture" answer is fantastic, because it is happening, and that cuts my chances of a recurrence in HALF. The "day to day" answer goes like this:

Day 1: Chemo infusion with steroids x 5 hours. Ho hum, read a few carefully selected magazines, work on laptop, chat with
new chemo buddies.
Day 2: Back to work. (It's Friday.) Energy good almost all day,
food tastes a little funny.
Day 3: Golf (Par 3 course): First 9 - Great, Back 9 - Semi-
horrible (same pattern both chemo cycles!). Tired.... bed
early... The steroids have worn off.
Day 4: Food tastes like a rusty spoon left in the yard all
winter, then used to scrape the gunk in the bottom of a
planter. Nausea gratefully dispelled by meds and sleeping
most of the day.
Day 5: Back to work and gym, hanging on at work for 3 hours,
then sleeping most of the next 18 hours. Less nausea, but
the rusty spoon lives.
Day 6: Giddy optimism returns, selective foods taste great. Use
spatula to get the last of the Fettuccini Alfredo sauce
out of the bowl. Lick the bowl. And the spatula.
Days 7-14: Decreasing fatigue, increasingly normal taste buds.
Day 14: Hair starts falling out!!!!!!!!! False sense of
security dashed!!!!! Embarrassment at the gym!!!!!
Day 15-20: Piles of hair floating down the drain at the gym. White (naturally) towels are then filled with black
hair and discretely chucked in the bin. Vacuum the
pillows and sofa every night to avoid dreams of
sleeping with Big Foot.
Day 21: New cycle. Repeat from Day 1 UNTIL....
Day 25: ABANDON THIN HAIR CHARADE!!!!!!! SHAVE HEAD!!!!!!!!!!!
Day 26: Get "Bald Power Solidarity" right arm salute from 3 bald guys and two thinning hair guys at work. 3 women at work
(and two men) tell me I have a shapely head. I'm trying
not to let it go... to.... my.... (for those of you who
know me too well, forgive me going for the way-too- obvious punch line.)

Actually, being bald is more fun, at least as a novelty, than I had imagined. Placing my hand on my head is like being stuck to Velcro, so I can entertain myself. It is also a much stronger look than a wispy massive comb-over, so I'm wearing it with pride. A great benefit is that it makes it easier for me to choose whom I tell that I'm having chemo, which helps prevent the dreaded pathetic "I'm so sorry" looks. (I LOVE the people who can see how lucky I am to catch it early, rather than focusing on a victim's outlook.) I can also lie and tell people my Olympic team is all doing this to show team unity.

I'm on Day 6 (licking spatula) today. As you can tell by the length of this email, my stamina is returning. I won't test yours any further today by writing more. Although I haven't responded to each email you have sent due to fatigue, emotional overload or both, every word means so much to both Genevieve and me. Thank you, and Love to you all.

Love,

Dann and Genevieve

8/31/06 Gentlemen, Start Your Engines

Family and Friends,

At last, treatment has begun!

I started chemo today and was pleasantly surprised by the lack of immediate side effects. It must be the steroids talking. They give the steroids to reduce or eliminate the nausea, which works for 2-3 days, and also helps with energy.

The next hurdle comes when white blood cell, red blood cell, and platelet counts all progressively decrease, reaching their low point in 7-10 days. My ability to fight infection and my energy levels will be impacted by this. The doctors and nurses recommend continuing with normal activities, don’t overdue it, and listen to my body. I will also need to be very sure to avoid sick people, even with sniffles, during the more vulnerable blood count times.

Today after chemo we met for the first time with the surgeon, Dr. John Handy, who does both the more traditional surgery and the minimally invasive surgery to remove the tumor. There is still not enough clinical data for a complete statistical comparison, but it looks like the tradeoff for having potentially a shorter/better recovery period using the minimally invasive procedure is the increased risk of chronic pain (less than 1% for the other procedure vs. “a little higher” for the minimally invasive procedure). There is also about a 10% chance that they will need to abandon this approach mid-surgery and separate my ribs to enter under my arm, which has a slower recovery rate and more chronic pain (13.5%) than entering from the front. We don’t know yet which procedure we want, but we do know we both feel very comfortable choosing Dr. Handy as the surgeon. He has an outstanding reputation, and we liked him a great deal.

Here’s the evolving timeline, as we know it today: Another day of chemo on September 21st. About 2 weeks later I have a follow-up CT scan to see if chemo shrunk the tumor, then see Dr. Handy to make sure he is comfortable that I am ready for surgery. Surgery would be mid-October to early November. However, we’re finding that just about any timeline we get is a moving target.

A friend and cousin by marriage, Dwayne Elan, has been going through treatment for lung cancer for the past 2 years. His cancer has metastasized, and he is fighting the good fight with a great attitude and a loving support system. Please send a prayer, positive energy, or even thoughts of shrinking his cancer like a prune if you can. He likes the prune image a lot.

Dwayne shared his observations about cancer with me. One of his comments was, “when one person in the family gets cancer, the whole family gets cancer.” In other words, everyone is affected. I thank each of you for how you have offered to be a part of the healing process for me in your own way, knowing that allowing yourselves to be touched by my experience exposes raw nerves for you as well. I am particularly grateful to Gen for this, as she has been side by side, and sometimes leading me, toward healing choices. I am also most concerned about the impact that this could have on her over the long haul. She shares in all of the struggles, yet most of the support comes to me. Of course, she denies any of this, and I will be lucky to get this email out without the paragraph being deleted.

I don’t expect to have any news to share from now until about the second week in October, when we get results of the repeat scan and a more firm plan for a surgery date. Until then, your love, energy, prayers, and support for both Gen and me, as well as thoughts of prunes, are very much appreciated.

Love,

Dann

8/28/06 At Last, a Solid Plan

Friends and Family,

Gen and I met with the oncologist, Dr. Helen Ross, for the first time today. The first news that we received was the results of the repeat CT scan, which was done to see if the tumor had grown, and the MRI scan, which was done to see if there were any tumors in the brain. Good news on all fronts – The size of the tumor in my lung was about the same, there was no tumor found in my brain, and they found a brain. Whewwwwwwwwwwwwwwwwwwwwwwwwwwwwwwww.

We got a much clearer picture of the diagnosis, treatment options beyond surgery, and statistics now that we are talking with the oncologist rather than a pulmonologist and a surgeon. The tumor has been identified as an adnocarcinoma, which is a fairly slow growing variety. However, there is a 50/50 chance based on the CT scan that there is a second tumor within the same lobe of my lung. It would come out just the same since that lobe will be removed, but the suspicion that it could have spread to a second site qualifies me for chemotherapy. Even though chemo reduces the odds of getting cancer again, it has only been approved for cases where it is suspected that the cancer has spread.

The surgeon will remove all the lymph nodes he can get during surgery, each of which will be tested for cancer that was too small to be picked up on the CT or PET scans. If they find any traces it means that I will have chemo after I have recovered from surgery to get the rest.

The “Saturday stroll in the park” version of chemo that the surgeon described to us is not quite the same chemo that Dr. Ross is recommending. Because I am so (ahem) young and healthy, Dr. Ross suggests taking a more aggressive cocktail of Docetaxel and Cisplatin. The upside is that we are attacking the little monsters with Shock and Awe. The downside is the national budget of white blood cells, red blood cells and platelets goes into deficit about 7-10 days later, leaving me more vulnerable to attack from other foreign bodies, but this passes shortly before election day. I’m also likely to lose hair, but Dr. Ross informed me that I had (ahem) plenty of thick hair to spare, so it may get thin rather than vanish altogether. It grows back, but 21 days later it’s time for Shock and Awe Round 2. About 21 days after Round 2 it’s time for surgery, and after that… possibly more rounds of chemo. If I go completely bald by Halloween I’m going to glue horns on my skull like Jai Dev did last year.

I’m likely to be energetic for a day or two after chemo due to the use of steroids, and then become very fatigued for an unknown number of days after that. Pacing will be the issue for me. Nausea is supposed to be fairly minimal. There’s a laundry list of other side effects, none of which is intolerable given the benefit that chemo brings.

Follow-up after surgery includes CT scans, lab tests and full physicals every three months for the first two years after surgery, then every 6 months for years 3-5, then annually. The surprising news from Dr. Ross is that about 1 out of 3 people who go into complete remission for 5 years end up with some form of lung cancer again at some stage of their life, and not necessarily the same type. With this type of close long-term care, it improves the chances of catching it early enough to prevent the spread again. Beyond that, we will deal with tomorrow when tomorrow comes.

After we go to chemo on Thursday we will meet with the surgeon who does the minimally invasive procedure. We will then find out if this procedure is a fit for me, and probably pick a tentative surgery date about 6 weeks out. We will have more news to share after that.

Thank you for tolerating my Encyclopedia of Cancer Treatment approach to keeping you informed. Some people want to know just the highlights, and others want all the details. Partly I write these so that Gen and I will have a way of remembering the entire process. There is so much to learn along the way, and so much to be grateful for. We were reminded of that by Dr. Ross, who said they NEVER catch lung cancer this early unless it is by accident, the way mine was found. How lucky can you get!!!!

Love,
Gen and Dann

8/22/06 Plans

Family and Friends,

We have our first appointment with the oncologist, Dr. Helen Ross, next Monday. We have been told by a couple of sources that she is a nationally recognized lung cancer expert, and that both her colleagues and her patients like her a lot. We have two goals for that appointment. First, we want to find out if she recommends the chemotherapy that we heard about from the surgeon. If so, chemotherapy would presumably begin within a few days of that time. Our second goal is to see if there is anything else that she recommends. If chemotherapy is recommended, it would happen before surgery. Because of this, it will probably be mid-September before I have surgery.

We have an appointment next Thursday with a second surgeon, Dr. John Handy, to consider a minimally invasive surgical procedure for removing the tumor. The first surgeon we spoke with does not do this procedure. Dr. Handy is also recognized as being outstanding in his field, not to mention having a great name for a surgeon. At this point Gen and I are both thinking that the minimally invasive option sounds much better, unless we hear something to the contrary from either Dr. Handy or Dr. Ross.

Although we have not yet met with Dr. Ross, she reviewed my chart and ordered two more tests. This Thursday I will have a repeat CT scan of my chest, and will also have an MRI of my brain. Apparently the MRI is much more sensitive to picking up cancer in the brain than the PET scan that I had two weeks ago, and Dr. Ross ordered the repeat CT scan to see if my tumor had grown in three weeks. This is very reassuring in one way, as it tells us how thorough Dr. Ross is, before we have even seen her. However, it is also a bit disconcerting after we thought all the questions about the potential spread of cancer had been answered.

Our friend Rebbecca offered this reassurance: As the former head nurse of an oncology unit, she said that it is common for oncologists and surgeons to repeat tests and find even more things to test. This is to make sure that they don’t miss anything the first time around. It reminds me of the old carpenter’s saying, “Measure twice, cut once.” Perhaps this saying is a little TOO fitting….

Thank you for your continued support, prayers, positive energy and prune thoughts throughout this challenging time for us. We remain optimistic through the process. I continue to feel healthier now than I did even a few years ago because I am in better shape. The only thing that hurts is a few sore ribs from a little incident on a ski boat a couple of weeks ago. I am convinced that I could have gone a few more years without ever knowing that I had lung cancer, but I had the extraordinary good fortune of having a sore back and a conscientious chiropractor. There is so much to be thankful for.

Love,

Dann and Gen

8/16/06 Improving Odds and a Course Correction

Family and Friends,

Gen and I met with Dr. Douville (surgeon) today and were given a lot more to think about. We learned of a new option that looks like it could improve my long-term chances of remaining cancer free, and also changes the anticipated timing for my surgery. That option is to have two courses of chemotherapy before the surgery. With surgery alone, there is a 20% to 25% chance of getting cancer again. Those chances are CUT IN HALF by doing this preventative chemotherapy. WE LIKE THOSE ODDS!

Each course consists of having an IV of chemotherapy for one day. We then wait about a week for my white blood cells to regenerate, and then have a second course. (Fortunately it’s only a two course meal.) After my white blood cells have regenerated again, I have the surgery to remove the tumor. Only 2-3% of people get very sick using this form of chemo, and usually don’t lose their hair. However, I’m blaming any future hair loss on chemo.

Dr. Helen Ross is the oncologist that we will be seeing. She came with very high recommendations from both Gen, who works in Rehab at Providence, and our friend Rebbecca, who used to be the cancer unit head nurse at Providence St. Vincent. Dr. Douville says that Dr. Ross is a nationally recognized specialist in lung cancer, that her patients love her, and that he very highly recommends her. We are trying to schedule an appointment with her to get her opinion and to begin chemo if it sounds as positive after talking with her. She’s out of town this week, so Dr. Douville recommended that we take whatever appointment with Dr. Ross that the scheduler has available, then get Dr. Ross to squeeze us in sooner when she comes back next week.

The surgery itself involves removing the upper lobe of my left lung, along with the lymph nodes. The surgeon told us that the surgery usually lasts about two hours, and I will probably be in the recovery room for about an hour, and will likely spend the first night in the Coronary Care ICU. I should expect to be in the hospital 4-5 days, then go home and need assistance for a day or two. I should be able to get up and down stairs as soon as I am home. I will likely be at home through about the third week, return to limited activity within 6 weeks, and have almost 100% of lung functioning and be pain-free in 8-12 weeks. There is about a 10% chance that my vocal chords could get nicked while removing the lymph nodes, which would leave me sounding constantly hoarse, but there are solutions that lead to a very good chance of full recovery from that side effect. There should be no other long-term complications to my health. “The only change you would see in your functioning over the long run is that if you were a marathon runner, you would probably run a little slower.” I think I’m safe there.

Skip the next paragraph if you don’t want to know the gory details of the surgery options.

There are two ways that the surgeon recommends to perform the surgery. The method this surgeon uses for the surgery is to cut the breast bone and spread the ribs. This has a shorter and less painful recovery period than the more traditional method of entering from the side and spreading the ribs, which he does not recommend. The other option that he recommends is to make a small hole to insert a camera, and two more small holes to perform the surgery. Recovery time appears to be quicker with this method and there are no known increases in risk. He does not perform this surgery, but his partners do, and all have outstanding reputations. The only down side he sees is that there is a much shorter history of research on the effectiveness of this method (seven years). We will give these options further thought.

Now for the statistics. There is about a 2% mortality rate after this surgery. An extremely small (“infinitesimal”) percentage of that is from patients who die during surgery. The rest are patents who die of complications after surgery due to pneumonia, infection, heart attack, etc. That being said, Dr. Douville says that my chances are MUCH better than that because I’m in the top 5% of the patients he sees as far as condition prior to surgery: I’m young (no wise cracks – It’s all relative), healthy, exercise regularly, have an excellent diet, a great support system, and have a great attitude. I would add to that list all of the people that are praying for me, sending positive energy, or thinking dried prunes. Once again, we appreciate the love, support, and prayers that you are sending, and we strongly believe it makes a very big difference.

Overall we are very optimistic but drained after the appointment today. We were gearing up for the possibility of surgery as early as this Friday, and we’re having a post-meeting crash right now. However, I’m enlivened by one other upside to this new turn of events… There’s time for GOLF THIS WEEKEND!

Love,

Dann and Gen

8/9/06 Surgeon Appointment

Family and Friends,

We are now scheduled to meet with the surgeon next Wednesday, July 16th (Michele's birthday). We'll let you know the recommendations after that appointment. Meanwhile, we're still dancing after the good news!

8/9/06 Great News!

Family and Friends,

We received fantastic news this morning. The PET scan revealed that THE CANCER HAS NOT SPREAD!

The next step is to meet with the surgeon, hopefully within the next couple of days. Our understanding is that the standard procedure at this point would be to remove the tumor, and then keep a careful watch to make sure there are no surprises. We have no details of how the surgery would be done until we meet with the surgeon, but the surgery is likely to be done next week. We will share what we learn from the surgeon as soon as we can.

Love,

Dann and Genevieve

8/7/06 Good News Du Jour

Family and Friends,

Although I received the pathology reports on Friday, the info was relayed by a physician filling in for my own pulmonologist, Dr. Lafor. Today Dr. Lafor called and gave me more information to give a better context to the results. Dr. Lafor informed me that over 95% of the time, with this type of cancer caught this early, that the cancer will not have spread. We like those odds!

I will have the PET scan Tuesday morning to find out for certain whether it has spread, and if so, to where. We should get the results from this test Wednesday or Thursday, and we will share the news with you ASAP!

Love,

Dann and Genevieve

8/4/06 Dann’s Health: Phase 2

Dear Family,

We received results of my pathology report today. Though we didn’t get the near-perfect answer that we wanted, the results were still positive. We found out that I have malignant non-small cell cancer. What this means is that it is NOT the aggressive type of cancer, and I have a great chance of a positive long-term outcome.

On Monday I will have a Pulmonary Function Test to see how well each of the lobes of my lungs are working and to establish baseline functioning. On Tuesday I will have a PET scan. The PET scan will tell if the cancer has spread. I don’t know how quickly we will get those results, but I assume it would be within a day or two at the maximum. Next we will meet with an oncologist and most likely also a pulmonary surgeon, but I will get that sequence confirmed on Monday. After consultations with the oncologist and pulmonary surgeon, Genevieve and I will work with the doctors on the best plan of attack.

We are extremely fortunate that our good friend Rebbecca is the former Oncology Unit Head Nurse at Providence St Vincent, and is a resource both for treatment information and treatment providers. As a big bonus, she is now high enough up in the Providence health care system to carry a lot of clout if/when we need the system or providers to be more responsive. Gen is also knowledgeable about who the top physicians are in different specialties, so I can really trust that I will see the right people and that the right things are going to happen. Of course, Gen is so much more than the term “support system” conveys. She helps so much with my strength, attitude, and focus, and I am so blessed to have her in my life.

I have already told this to some of you, but I want each of you to know this. I am in an extremely good position to be one of the success statistics. You are part of the reason. I have everything going for me. Here is what I know that works, and that I have working for me:

• A strong will to live
• A positive attitude
• A healthy lifestyle
• An outstanding support system, including each of you. It makes a tremendous difference in outcomes, and I appreciate you very much.
• Many people of all faiths are praying for me.
• Visualization: I have been visualizing shrinking the tumor up like a dried prune, and tying this in with meditation.

Your prayers are very much appreciated. And if you don’t pray, think dried prunes.

Love,

Dann and Genevieve

7/16/06 Dann's Health

Dear Family,

Some of you have already heard that last Monday I went in for an x-ray due to recurrent back pain, and found that I have a spot on my lung. The x-ray was ordered by a chiropractor, who was concerned that the back pain wasn’t going away after continued treatment. I’m very fortunate that this was picked up on an X-ray, or I may not have become aware of any problems in my lung until much further down the road.

That X-ray bought me a quick ticket to the hospital for a CT scan last Wednesday. Genevieve and I met with pulmonologist Dr. Michael Lafor today to review the results and implications of the CT scan, and to plan the next step.

Dr. Lafor said that the mass is about 2 cm X 3 cm, or slightly smaller than a golf ball, and is located in the upper portion of my left lung. He cannot imagine what else it would be other than cancer due to the characteristics that he can determine from the CT scan. However, this may not be all bad. Based on the CT scan, he thinks that it is most likely to be either an adnocarcinoma or a carcinoid carcinoma, in that order. He believes it is unlikely to be small-cell carcinoma, which is another category of cancer, and it’s not worth going down that road of discussion unless we hear otherwise.

If it is a carcinoid carcinoma it is very likely to be benign, but should be removed anyway, as they can become malignant if left for a very long period of time. If it is an adnocarcinoma, the five year survival rate is about 70% for Stage 1 cancer and 40% for Stage 2 cancer. “Staging” is basically categorizing how fast it grows and how fast it spreads. Based on size and shape, and the fact that the CT scan did not reveal signs of any other masses in other parts of my abdomen (heart, liver etc.), he would expect it to be Stage 1 or 2 if it is an adnocarcinoma.

As with most good doctors I have ever met, Dr. Lafor qualified everything I have described above, beginning with, “The first rule of cancer is that there are no rules.” Therefore, we can’t count on any of the above until we get hard data. That brings us to the next step.

On Wednesday afternoon I will have an outpatient bronchoscope, where a narrow flexible cable with a camera and a pincher on the end will be guided into my lung. A sample of the mass will be taken for a biopsy. By Friday we should have results of the biopsy, but it could be Monday. Also, he said that about 20% of the time they can’t get a good sample, and will have to either try a needle biopsy through a puncture in my back, or surgery. This is another road we won’t go down until we know if it is necessary.

Two more steps will take place throughout this ongoing process. First, I will have a pulmonary function test on Monday, which will be needed as a baseline in the event that I have the mass removed from my lung. Next, a PET scan is being ordered. That will take another 7-10 days because it requires pre-authorization from the insurance company and a note from God. (Son Mike, put in a good word for me.) The PET scan involves sending a few radioactive sugar molecules into my system. They “light up” in areas where there is metabolic activity, such as the lymph nodes, which is an indicator of cancer. That will tell if the cancer has spread.

All of this sounds much further down the road than we may actually need to be. We may have just tuned in to the worst case scenario and gone too far and too fast. Hopefully we’ll have a more realistic picture Friday or Monday.

One of the first things I started wondering was how I got this mass to begin with. The doctor dismissed out of hand the possibility that this is related to my having smoked for a few years ending in 1981. He said that he considers me the equivalent of a non-smoker because the length of time and amount that I smoked were insignificant. Further, only small-cell lung cancers are related to smoking. His only explanation is genetics and bad luck.

As soon as we have an update we will email you. I find it hard to share this info without getting too choked up if I try to tell the story verbally. I’m happy to hear from you, but it’s easier to share the hard stuff this way, particularly when it means telling many different people.

There are a few people we wanted to email, but all the contact info is on Gen’s computer. Of course, it is now at the computer hospital, so we’re both getting our diagnostics run. Bad timing for the computer. Bad timing for me too – I think about January 2051 would be a better time.

Love to all, and we welcome all prayers.

Love,

Dann and Genevieve