more dominoes fall, and the right way. But how do I do this when I have so little control? That is the question with which I am currently obsessed. I haven’t spent much time basking in the joy of a clean surgery. I’m already thinking about the next move, trying to figure out what I can do to hold back this disease. Because in looking at the situation clearly, looking at those often-dynamic numbers, you realize that metastatic disease abides, and is resourceful. I haven’t researched the likelihood of recurrence for me, but whatever it is, it’s quite high, as it is for anyone with Stage IV disease. Dr. D.L. told Josh on Friday that the next three years are the critical period, that if I can hold back the disease during that time frame (even if I were to have a recurrence at some point afterward), my odds of long-term survival will increase significantly.
After I was first diagnosed, I asked my colorectal surgeon in a fit of desperation what I could do differently in terms of my personal choices to beat this disease, like exercising more than I had been (which was already a lot) or changing my diet, or taking supplements. He told me that when something like a cancer diagnosis happens, people try to find ways to control the disease in a world that seems to have gone crazy, but that anything a person could do would make very little difference.
In part, the answer to how I can make more dominoes fall is to rededicate myself to evaluating those things that might make a difference, however little. Since I have no control over the factors that will have a dramatic impact on my odds, then I will work at the margins on the theory that certain personal choices might lead to the critical tipping point. However, I am unwilling to subject myself to some life changes or financial expenditures without sufficient medical evidence. I intend to bury myself in research and studies in much the same way I once buried myself in school and legal work to determine for myself, notwithstanding the inconclusive evidence, whether a low-carb diet, cannabis oil, veganism, supplements, herbs, use of particular off-label drugs, maintenance chemo, experimental drugs, and other nonconventional treatments will make even a small difference by incrementally improving my odds of winning this war.
Beyond this, I can do nothing to make more dominoes fall. I must accept that I have no control over the factors that will really determine whether I live or die from this disease, that whether more dominoes fall is about God, faith, luck, prayer, hope, sheer randomness, or some combination of the above. And therein lies the intersection of Josh’s science, studies, and statistics and my belief in those unquantifiable forces. If we can find the sweet spot in between those poles, I may beat this cancer yet.
Happy anniversary, darling.
21
Take Your Victories Where You Can
After my clean MRI scan in early October, my oncologist, Dr. A.C., gave me four options: (1) continue with full-blown chemo, (2) go on maintenance chemo of 5-FU and Avastin, which inhibits the blood flow to cancer cells, but can also cause blood clots and hemorrhaging, (3) stop chemo altogether and proceed to a “wait-and-see” approach with monthly CEA testing and quarterly scans, or (4) take the rather unusual step of undergoing a “second-look” exploratory surgery to visually inspect my insides in what would be the most accurate and reliable form of monitoring (better than any scan). In light of the minimal risks involved, and the tremendous amount of information to be gained through Option 4, I decided to go with a second-look laparoscopy.
That surgery happened on Halloween Day 2014, and revealed that not only was I free from visible disease within the abdominal cavity, but based on the washings, or “cytology” in medical parlance (i.e., fluid flooded into the abdominal cavity, sucked out, and then tested), I was also free from microscopic disease, at least inasmuch as such a test could tell. It was not a result I or Dr. A.C. or my surgeon, Dr. D.L., expected. We were all prepared for the cytology to come back positive, so when it didn’t, even though the results are only fifty-fifty reliable, we were all thrilled.
As Thanksgiving approached, I saw both Dr. A.C. and Dr. D.L., and they both hugged me, beaming. Dr. A.C. told me, “Good job,” as if the outcome was something I had determined, and in that moment