"Living Well With Cancer"

In April 2003, I gathered with an eclectic community of Christians and Sufi Muslims for a workshop under the leadership of American Sufi Shaikh, Kabir Helminski. Kabir is of the Mevlevi Order, a Sufi tradition tracing its roots to the 13th century Persian poet Rumi. During one lecture Kabir shared a short outline of “5 Spiritual Principles to Live By”.

I was struck by the simplicity of the principles and by the commonality they held with other faith traditions, including my own. Helminski’s 5 principles are:

1. Commit to Your Highest Possibility

2. Awaken Attentiveness and Appreciation

3. Cultivate a Spirit of Gratitude

4. Find the Still Point and

5. Radiate Blessing

Since being diagnosed, I have noticed how many cancer survivors have undergone personal transformations in line with these principles. The result is lives lived with a renewed sense of purpose and a richer appreciation for what is important. Many survivors speak of a deeper authenticity and honesty in their relationships and of a gentler pace of life, with more time spent “smelling the roses”.

I've reflected a little on each of these principles and present them here again as a summary. While I can’t do them justice in this short piece, I do hope that what I offer provides a faithful summary of “Helminski’s Principles” and a worthwhile basis for folks to reflect spiritually on “Living Well With Cancer”.

Be well... Rob; in Vancouver

...next: "Commit to Your Highest Possibility"

Commit to Your Highest Possibility

“I want my will to live to be strong. I want to get as much time out of this as possible. And so I need to work at that with complete focus and dedication and clarity and concentration, and right effort." Treya Killam Wilber

Committing to our highest possibility is about life's purpose and intention. It is to choose LIFE, even in the very imminent face of death itself. It is, for some, “to discover and fulfill their destiny”. It is, for others, “to become who God intended them to be”.

Committing our highest possibility is to live each moment to its fullest. It is to exercise our power of choice towards what is life-giving in the current situation. This universal theme is proclaimed in cultures around the world. The Latin expression Carpe Diem implores us to “seize the day”… for tomorrow we may die. The Japanese have a term, Ichi Nichi, Issho, “one day, one lifetime”, which reminds us to live each day as if our whole life is summed up in it.

I have come to believe that a healthy awareness of the “proximity of death” can lead us to living with a deeper commitment to our highest possibility. Often this means identifying and letting go of the things that are inhibiting us. Too often our lives are clogged and cluttered with the trivial and meaningless. We become limited by “false identities”, we are plagued by fear and anxiety, and we suffer cravings, addictions, and aversions. It’s amazing how quickly we can see and name this stuff for what it is when we become more acutely aware of our mortality. Once we’ve named that which binds us, we can begin the process of relinquishing it and turning towards what gives life.

Sometimes in the cancer journey the highest possibility is directed totally towards our own health and healing. That’s just the way it is. I’ve had to give over huge chunks of my life to coping with surgery and chemo, and to self-care. It has to be recognized that sometimes the "highest possibility" is just getting out for a walk, having a nap, or having a little bite to eat. But sometimes... it is much, much more!

Committing to our highest possibility is a deeply personal matter. It means being true to ourselves in terms of “who we are”, “why we’re here”, and “where we’re going”. It involves discernment in discovering what is important in our lives and how to respond to it. It entails courage and integrity to allow ourselves to be defined by our core values and our "essential self" rather than by the “cookie cutter” identities our culture seeks to impose on us by our roles, occupations, possessions, or physical attributes and deficits.

Living with cancer can help to clarify the vision of our lives, allow us to realize untapped possibilities, free us to live more richly, and to love more deeply… may it be so.

Rob; in Vancouver

“All of us have been dying, hour by hour, since the moment we were born. Realizing this, let all things be placed in their proper perspective… Remember, it is always later than you think. Og Mandino

...next: "Awaken Attentiveness and Appreciation"

Awaken Attentiveness and Appreciation

When the Buddha started to wander around India shortly after his enlightenment, he encountered several men who recognized him to be a very extraordinary being.
They asked him, "Are you a god?"
"No," he replied.
"Are you a reincarnation of god?"
"No," he replied.
"Are you a wizard, then?" "No."
"Well, are you a man?" "No."
"So what are you?" they asked,
being very perplexed.

"I am awake."

To awaken attentiveness and appreciation is to enter in to the realm of “mindfulness”. It is about being intentionally aware of thoughts and actions in the present moment. It is also about seeing deeply into the nature of things and perceiving and appreciating the connections that exist between all things. I see this happening at an “inner level” as we become more conscious of our mind/body processes, and at an “outer level”, as we develop the “ecological imagination” needed to see our relationship with the environment that surrounds us. These are not separate processes and both are important towards seeing the connections between our mind, body, and the world in which we live and breathe.

Mindfulness figures prominently in new approaches to stress reduction and healing as developed by Jon Kabat-Zinn at the University of Massachussetts Medical Center. The application of mindfulness in stress reduction is well covered in Kabat-Zinn’s book “Full Catastrophe Living: Using the Wisdom of Your Body and Mind to Face Stress, Pain and Illness”. Kabat-Zinn defines mindfulness as:

“…moment to moment awareness. It is cultivated by purposefully paying attention to things we ordinarily never give a moments thought to. It is a systematic approach to developing new kinds of control and wisdom in our lives, based on our inner capacities for relaxation, paying attention, awareness, and insight.”

Kabat-Zinn describes our usually encumbered minds as often preoccupied with regrets over the past and worry and anxiety over the future. This can be particularly true when we are suffering an illness such as cancer. Our minds become literally flooded with worries, fears, fantasies, and plans related to our diagnosis, treatments, and the possible course of the disease. The result is that we live in a state of unawareness, or un-mindfulness.

“When unawareness dominates the mind, all our decisions and actions are affected by it. Unawareness can keep us from being in touch with our own body, its signals and its messages. This in turn can create many physical problems for us, problems we don’t even know we are generating ourselves. And living in a chronic state of unawareness can cause us to miss much of what is most beautiful and meaningful in our lives.” Jon Kabat-Zinn

Awakening attentiveness and appreciation involves a discipline, or practice, of clearing our minds and bringing our attention to where it is needed, beginning with our breath. Mindfulness meditation, a practice that derives from the Buddhist tradition, is used to develop a deeper and more focused capacity for awareness and attention.

Awakening attentiveness allows us to enter into a deeper level of self awareness about our mind/body, its relationship to the environment, and its healing needs. It also leads us to places of profound awe and wonder as we begin to appreciate anew the incredible miracle of creation and life.

Rob; mostly napping; in Vancouver

“Mindfulness is the aware, balanced acceptance of the present experience. It isn't more complicated that that. It is opening to or receiving the present moment, pleasant or unpleasant, just as it is, without either clinging to it or rejecting it.” Sylvia Boorstein

...next: "Cultivate a Spirit of Gratitude"

Cultivate a Spirit of Gratitude

“Gratitude is not only
the greatest of virtues,

but the parent of all the others.”

Cicero

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An “attitude of gratitude” emerges naturally when we’ve taken the time to be attentive to, and appreciative of, life’s many gifts and blessings. Even in the midst of illness or trial, the heart responds with gratitude to gifts that embody love and blessing.

“Gratitude unlocks the fullness of life. It turns what we have into enough, and more. It turns denial into acceptance, chaos to order, confusion to clarity. It can turn a meal into a feast, a house into a home, a stranger into a friend. Gratitude makes sense of our past, brings peace for today, and creates a vision for tomorrow.” Melody Beattie

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For me, the practice of gratitude begins with this little lump of clay, my body… this incredible creation of earth, wind, water, and fire! Plagued, scarred, and diseased as it may be, it is still an awesome miracle in all of its mid-life glory!

“Real life isn't always going to be perfect or go our way, but the recurring acknowledgement of what is working in our lives can help us not only to survive but surmount our difficulties.”

Sara Ban Breathnach

I Give thanks for the gift of this day and for all of the possibility and potential it holds. I give thanks for the incredible blessing of love I have through family and friends and for the generosity and compassion of my church community.

I give thanks for the skill and the knowledge of my doctors, nurses and medical technicians; for the technology that makes cancer more treatable every day; and for a medical system in which access to care isn’t based on an ability to pay! I give thanks for the tears and the laughter that make life bearable even when the challenges of the day seem unbearable.

I give thanks for the patience, the humour, the strength, the wisdom, and the grace that are needed to face this journey afresh each day. In all these things, and so much more, I am richly blessed!

With thanks… Rob; in Vancouver

“A sacred illness is one that educates us and alters us from the inside out, provides experiences and therefore knowledge that we could not possibly achieve in any other way, and aligns us with a life path that is, ultimately, of benefit to ourselves and those around us.”

Deena Metzger

...next: "Find the Still Point"

Find the Still Point

"Come and find the quiet center
in the crowded life we lead,
find the room for hope to enter,
find the frame where we are freed:
clear the chaos and the clutter,
clear our eyes, that we can see
all the things that really matter,
be at peace, and simply be."
Shirley Erena Murray


Our body and soul need times of quiet and rest to be whole and healthy. If this is true in our times of health… how much more so in times of healing and recovery! Finding the still point is about finding those quiet moments and places of stillness where we can regain a sense of equilibrium and help to create conditions more favourable to healing.

“Discontent creates a flurry of distraction in the mind. Worry, anxiety, doubt are just a few of the conflicting emotions that arise to erode my self-confidence. Focusing upon what is true offers me the opportunity to change my circumstances.” Sylvia Boorstein

Cancer came into my life with all manner of tyranny! Physical pain and bodily dysfunction; endless tests, scans, and appointments; relentless treatment schedules and debilitating side-effects; and a never-ending treadmill of anxious emotions and thoughts put cancer in the swirling center of a life that no longer seemed my own. Finding the “still point” in this vortex of crisis has been, and remains, an ongoing challenge.

“In the sweet territory of silence we touch the mystery. It's the place of reflection and contemplation, and it's the place where we can connect with the deep knowing, to the deep wisdom way.” Angeles Arrien

It is in times like this that I really appreciate the gifts that my faith tradition has provided. Particularly in its emphasis on Sabbath rest and in the many traditions it offers in the way of prayer and contemplation. Activities which have helped me to find the “still point”, time and time again, have included prayer and meditation, tai chi, healing touch, worship, long walks in the forest and along the seashore, reading and journaling, playing the guitar, and listening to music. I’ve enjoyed these activities both in solitude and in the company of friends and mentors.

Finding the “still point” grounds me in the landscape of God’s living presence and reminds me that all shall be well. Yah…

Deep peace to you... Rob

"There is no need to go to India or anywhere else to find peace. You will find that deep place of silence right in your room, your garden, or even your bathtub." Elisabeth Kubler-Ross

... next: "Radiate Blessing"

Radiate Blessing

“Blessing is a relationship between equals. When you bless others— you realize that your life matters. The people you bless can make you immortal."

Rachel Naomi Remen

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Blessing has to do with the richness and abundance of life. To be blessed is to be “full of life” in all of its wonder and grace. To bless another is to enrich their lives with gifts of goodness, truth, or beauty. The call to “radiate blessing” is a summons to let our gratitude spill over into generosity. Radiating our blessing may take the form of compassionate action or service towards another. It may be a sharing of knowledge, experience or wisdom. Or it could be a joining with others in seeking peace, justice or healing.

Dr. Rachel Naomi Remen is a leader in the realm of “integrative medicine” and author of “Kitchen Table Wisdom” and “My Grandfather’s Blessing” http://www.rachelremen.com/. Her thoughts on “blessing” are some of the most inspiring I’ve read. A sampling…

“A woman once told me that she did not feel the need to reach out to those around her because she prayed every day. Surely, this was enough. But a prayer is about our relationship to God; a blessing is about our relationship to the spark of God in one another. God may not need our attention as badly as the person next to us on the bus or behind us in line in the supermarket. Everyone in the world matters, and so do their blessings. When we bless others, we offer them refuge from an indifferent world.”

 "We bless the life around us far more than we realize. Many simple, ordinary things that we do can affect those around us in profound ways: the unexpected phone call, the brief touch, the willingness to listen generously, the warm smile or wink of recognition. All it may take to restore someone's trust in life may be returning a lost earring or a dropped glove."

So there you have it. "Commit to the highest possibility"; "awaken attentiveness and appreciation"; "cultivate a spirit of gratitude"; "find the still point"; and "radiate blessing". Living fully, with or without cancer, is as simple, and as difficult, as that!

Peace and Blessings… Rob; in Vancouver


"I expect to pass through this world but once. Any good therefore that I can do, or any kindness that I can show to a fellow creature, let me do it now. Let me not defer or neglect it, for I shall not pass this way again." Stephen Grellet

Spontaneous Remission

"the disappearance, complete or incomplete, of a disease or cancer without medical treatment or treatment that is considered inadequate to produce the resulting disappearance of disease symptoms or tumor." Institute of Noetic Sciences

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Sometimes cancer just seems to miraculously disappear. Wouldn’t it be nice if this were more common! Or wouldn’t it be nice if we could put our finger on the cause and replicate it at will.  Caryle Hirshberg and Brendan O'Reagan of the Institute of Noetic Sciences conducted an extensive review of documented cases of spontaneous remission. Their research included over 1000 cases related to cancer. In reviewing the cases they were able to identify a number of common themes which seemed to keep coming up in the stories of survivors.

1. A change from dependency to autonomy combined with activities, attitudes, and behaviors that promote increased autonomy, awareness of themselves, others, and their environment, love, joy, playfulness, satisfaction, laughter, and humor.
2. Facing the crisis, the despair, the sadness, and the pain and discovering they have the power to find a new way of life that is fulfilling and meaningful.
3. Taking control of their lives, (personal, professional, emotional, spiritual, and medical) and living each day fully combined with a willingness to evaluate their beliefs and attitudes and change old beliefs and attitudes that are no longer appropriate or adequate.
4. Becoming comfortable with and expressing and accepting both their positive and negative emotions/feelings, their needs, wants, and desires (physical, emotional, spiritual); the ability to say “No” when it is necessary for their well being.
5. Having at least one strong loving relationship—a strong connection to another person, an activity, an organization(s), changing the quality of their interpersonal relationships with spouses, friends, family, neighbors, doctors, nurses, etc. in a positive way, and motivation to help others.
6. Working in partnership with their physicians and participating in decisions related to their health and well being.
7. Finding meaning in the experience of cancer, finding reasons to live, accepting the diagnosis but not the prognosis, seeing the disease as a challenge, belief in a positive outcome, and having a renewed desire, will and commitment to life.
8. Choosing activities and practices that promote increased awareness and reduce stress (imagery, stress reduction, yoga, etc.); showing renewed spiritual awareness (Soul) that often results in a spiritual practice (prayer, meditation, religious affiliation, connection to nature, etc.). http://www.noetic.org/research/sr/faqs.html#Character

What a great list!!

Live and love deeply... Rob

"You feel your own life - your heart, your mind, your body, your sexuality, the people and things you are connected to - and you spontaneously fill with the exclamation: "God, it feels great to be alive!" That's delight." Ronald Rolheiser

originally posted July 2007

Gno-sis

gno-sis. from Grk gnsis, knowledge, from gignskein, to know;
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di-a-gno-sis n., pl. -ses The act or process of identifying or determining the nature and cause of a disease or injury through evaluation of patient history, examination, and review of laboratory data.
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pro-gno-sis n., pl. -ses A prediction of the probable course and outcome of a disease.

For many of us the cancer journey begins with a "diagnosis". On the basis of various signs and symptoms, and with the help of scans, tests, and biopsies, our doctors will seek “to know” what is going on. Life before a cancer diagnosis (BC) can range from “blissful ignorance” to “anxious worry” depending on the signs and symptoms we experience beforehand. For myself, I was blissfully ignorant. Apart from some periodic blood in my stool I was symptom free. The bliss of “not knowing” came crashing to an end on August 23, 2004 after a colonoscopy revealed a large “mass”. Surgery conducted that same evening confirmed cancer. Life after diagnosis (AD) would be different.

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Determining the “Stage” of cancer is part of the diagnosis. Staging has to do with “knowing” how far the cancer has gone. In cancers like colon cancer it works something like this…
Stage 1 Non-invasive Local Tumour
Stage 2 Locally Advanced Tumour
Stage 3 Lymph nodes affected
Stage 4 Metastatic (liver, lung, brain, bone, etc.)

Staging can be a long, drawn-out process, or it can happen literally overnight, such as in my situation. During my surgery the surgeon was able to feel suspicious lumps in my liver. Biopsy results confirmed his suspicion that the cancer had spread to the liver. Stage 4!!

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"Prognosis" is another type of “knowing” having to do with the future direction of the cancer. Actually, it is more like “guessing” than “knowing”. A simple prognosis is often based on the statistical averages observed in the progression of the disease over a large population. This turns out to be “less than helpful” since statistics, in and of themselves, are poor indicators of individual behaviour. The outcome of an illness has to do with many things related to the particulars of the cancer and the individual involved. Predictions are not easy to make and are rarely helpful. My surgeon gave me the statistics but declined to make a prognosis. Instead he referred me to another surgeon who could take care of the tumours in my liver. Now that was helpful!!

TTFN... Rob

“Accept the diagnosis. Defy the prognosis!”

originally posted June 2007

The Colonoscopy

As a colon cancer survivor I am well familiarized with "The Colonoscopy". This wonderful screening technology has saved many a butt, including mine!! The Colonoscopy is one of the recommended approaches to finding out what’s going on in your colon.

I have my colonoscopies in the “Minimally Invasive Surgical Suite” at my local hospital. “Minimally invasive” is a questionable term to describe the insertion of a six foot hose, complete with lights, camera, air and water jets, and surgical “snippers” into ones anus, up the rectum, and through the sigmoid, descending, transverse, and ascending colons, to map the inner regions of the bowels. Whew… Minimally invasive indeed!!

Actually, to be totally honest, the colonoscopy is a very simple, safe, and effective procedure. It’s done under a mild sedative which leaves you semi-conscious. I don’t remember my first colonoscopy at all and I have only vague recollections of seeing the viewing monitor during my second one. With a colonoscopy the doctor is able to visually inspect the lining of the colon, take samples of suspect tissue, and remove small polyps. It is really the best way to identify and analyse potential problems in the large intestine.

There’s lots of good information on the net about the colonoscopy. If you’re interested you could start with Wikipedia http://en.wikipedia.org/wiki/Colonoscopy . For an online tutorial on the colonoscopy check out Medline Plus at… http://www.nlm.nih.gov/medlineplus/tutorials/colonoscopy/htm/index.htm.

And for a humorous look... check out the awesome clip below!!

It’s not easy to talk about medical issues going on below the belt. We are unnaturally uncomfortable with the language that describes these “nether regions”. When we talk about our head we’re quite at ease with speaking of the eyes, ears, nose and throat. But when it comes to the lower GI tract we get a little tongue-tied. Get over it!! And get your colonoscopy… today!!

TTFN… Rob; in Vancouver

"Cancer of the colon and rectum often causes no symptoms, especially at first. Regular screening is the best way to prevent colorectal cancer."

originally posted in Jully 2007

Recurrence

One of the particularly nasty aspects of cancer is that it has a tendency to “recur”. I mean it sucks to get cancer to begin with, but to be hit with a recurrence after fighting it off once really sucks!! AND to be struck a third time... well, as many of you affirmed in your notes to me, "IT JUST ISN'T FAIR!!"

My original diagnosis was in August of 2004. I spent the rest of 2004 and the first half of 2005 undergoing surgery and chemo until I was finally found “All Clear”. Yee Haw!! It was a great moment to get CT Scans, PET Scans, and blood work results all back “negative”. I was celebrating what we know in cancer lingo as “No Evidence of Disease” or “NED”.

Then in the fall of 2006 I had another CT Scan. Initially it looked good and my surgeon and I were quite happy… then he got the radiologist’s report and I got the call to come back to his office (never a good sign!). The radiologist had seen things a little differently and a PET Scan was ordered to confirm if the “hypodensity” on the CT Scan was indeed malignant. Well it was… so, there you have it… a recurrence!!

Initially, the news of the recurrence was pretty devastating. But eventually, as hopeful treatment options began to emerge, a “we’ve been through this before, and we can go through it again” attitude began to take root. I had successful RFA (What is RFA?), another round of chemo, and once again emerged with "No Evidence of Disease"!

So... here we go again! This time a "local recurrence". Local recurrence is what we call a cancer recurrence that takes place at the original location. In my case it seems that some residual cancer cells grew to become a malignant tumour in the vicinity of the original site. This tumour then spread "posteriorly" to the sacrum. Ouch!

I met with the oncologists at the BC Cancer Agency today and they have recommended a 15 day course of radiation. I have decided to go with this and will probably begin within the next week. It is a "painless procedure" with "minimal side-effects" which should "significantly reduce" the amount of pain I am experiencing. (for which I will be most grateful!)



Living with the possibility of a recurrence is a challenge that all cancer survivors have to face in some way or another. Author, and cancer survivor, Vickie Girard has a great philosophy for living with that possibility. She says it is like planning for a picnic when the weather forecast includes a possibility of showers. Do you cancel the picnic and stay home, or do you go out and enjoy the day anyways, perhaps putting a tarp and raincoat in the trunk?

So… do we let the possibility of a recurrence diminish our lives, or do we “seize the day” and live life to the fullest? Cancer be damned!!

Carpe Diem… Rob; in Vancouver

“You may have to fight a battle more than once to win it.” Margaret Thatcher

Down Days

Don’t let anybody kid you! There are lots of down days on this journey. Yesterday was a particularly tough chemo day. The nausea was bad and I spent a good chunk of the afternoon and evening chatting with Ralph on the great white telephone!

Surgery, radiation, chemo… they each take there toll. Recurrences and metastases contribute their own special horror. Add to this the stress of scans and blood tests, the emotional rollercoaster of fear, frustration, anger, and despair alternating with relief, joy, peace, and hope… well you get the picture. It’s tough on survivors, and just as tough on their loved ones.

Don’t get me wrong, I’m as positive as the next person when it comes to living with this beast. I think the right attitude and the “will to live” are important. But so is honesty and authenticity. Part of the reality of this disease is that it knocks the stuffing out of you!! Some days are really dark and tearful. We need mechanisms to release our sadness, fear, anger, and despair. It is not a sign of weakness, of losing, or of giving up. It is a sign that we are human, and an acknowledgement that letting go and release are part of the journey.

Music, meditation, and movies can be helpfully “cathartic”…
Catharsis : a Greek word meaning "purification" or "cleansing" derived from the ancient Greek kathairein "to purify, purge," and adjective katharos "pure or clean".

My colon cancer friends will appreciate that this word has also found its way into the medical lexicon as a bowel cleanser or purgative, cathartic. But I’m thinking of it more in terms of the emotional cleansing, or catharsis, that can happen when we are moved through compassion by tragedy, death, love, redemption, hope, or any of the other "really real" things in life.

TTFN… Rob; in Vancouver

“I cry a lot. My emotions are very close to my surface. I don't want to hold anything in so it festers and turns into pus - a pustule of emotion that explodes into a festering cesspool of depression.” Nicolas Cage

Chemo Day

Well the Chemo holiday is over and I'm back to the clinic today to start round 4 of 6. I'm now over the hump in this short program and I have the end in sight. I had my blood-work done on Thursday and saw my Oncologist on Friday. Everything looks good. My platelets were a little low so he prescribed the steroid Prednisone to help boost them. I'm not sure how that works but we did it several years ago and it seemed to do the trick.

Here's a flowchart of my chemo program. You can click it to get a larger version. Please disregard the many spelling errors!!



I'll start the day at the clinic by giving a blood sample. The lab will do up a complete blood count and if it looks good I'll start the intravenous drugs. If my platelets are still low I may get a reduced dose of a couple of the drugs. Prior to the chemo starting I'll have two anti-nausea medications, Kytril (oral) and Decadron (IV). Then I'll get my Avastin over about 1/2 hour. Before they start the Irenotecan I'll get an injection of Atropine to prevent an early onset of diarrhea (we like to get home before that business starts!!). I'll carry on with the Xeloda (oral chemo drug) twice/day for the next two weeks. Then I'll have a week off and start over again.

Our Chemo Clinic is a bright comfortable facility. Patients can receive their drugs in recliner chairs or on hospital beds. Volunteers provide refreshments, social workers and dietitians are available for consultations, children and families visit, there is a resource library, dvd players, AND jigsaw puzzles!

The highlights of the Chemo Clinic are the other patients and the Nurses. I find the other patients I meet at the clinic to be a great source of inspiration. Here we all are plugged into our IV machines chatting away. People from all walks of life, every age, gender, and culture, bound together in a common journey of healing and life! The Chemo Nurses are some of the angels who meet us on this journey. They review our blood-work, ask about any side-effects, make suggestions for dealing with side-effects, administer our various drugs, and respond to our many questions. They are models of nursing competence and compassion!!

As things are currently scheduled, and barring any deferrals to accommodate side effects, I'll have this all wrapped up and be back in the pulpit by September!!

Living in hope... Rob

"The dream of wellness sustained me throughout the reality of the treatment." Vickie Girard

What is RFA?

When I tell people I had RFA to treat a metastatic tumour in my liver they invariably ask... “What the H--- is RFA?” When I tell them that it is "Radio Frequency Ablation" they nod politely. When I try to explain by saying… “an alternating current is sent though electrodes inserted into the tumour resulting in coagulative necrosis of the malignant tissue” their eyes glaze over and they wish they could change the subject.

But RFA is just too cool not to talk about! It is one of those great new techniques that is changing how we approach small tumours in the liver and other locations. So here, in a nutshell, is a concise description of RFA. (with help from Medicinenet.com)

First let’s unpack the term.

Ablation: “Removal or excision. Ablation is usually carried out surgically. For example, surgical removal of the thyroid gland (a total thyroidectomy) is ablation of the thyroid. The word ablation comes from the Latin ablatum meaning to carry away.” Medicinenet.com

The geologists among us will of course recognize "ablation" as also referring to the erosional processes by which a glacier is reduced, thus yielding… “ablation till”. Fascinating as this is, I digress…

Radiofrequency ablation: “The use of electrodes to generate heat and destroy abnormal tissue. In radiofrequency ablation (RFA), heat is generated locally by a high frequency, alternating current that flows from the electrodes. A probe is inserted into the center of the tumor and the non-insulated electrodes, which are shaped like prongs, are projected into the tumor. The local heat that is generated melts the tissue (coagulative necrosis) that is adjacent to the probe. This results in a 3 cm to 5.5 cm sphere of dead tissue per treatment session. The probe is left in place for about 10 to 15 minutes.” Medicinenet.com

One of the really great things about RFA is that it can often be administered "percutaneously", or through the skin, making it a “minimally invasive” procedure. In my case, because of the tumour location, RFA was administered within open surgery. Several deployments of the probe were needed to create a "zone of ablation" large enough to encompass the whole tumour and allow for clear margins. A follow-up CT taken a couple of months later showed that the "zone of ablation", or "sphere of dead tissue", did completely encompass the pre-existent tumour (whew!!). I’m now taking Chemo to clean up any microscopic metastases that may be in the area. I'll be having regular CT scans down the road to keep an eye on things.

Now when people ask "What is RFA?". I just say... "We burnt that little sucker right out of there!!"

Enjoy the solstice... Rob; "The Cancer Geek"

"What is not cured by the knife may be cured by fire." Hippocrates

Chemo Strikes!

Finally!!
A new way for me to get around town while I'm on Chemo!!

Chemotherapy is standard fare for many survivors. Any cancers that have spread, or are at risk of spreading, beyond the local site seem to be candidates for chemo. Just the very thought of chemo conjures up feelings of nausea and dread for many. Horror stories abound!! Many, but not all, of them true!

I'm currently in the midst of my second round of chemo treatment. My first round, in 2004/05, lasted for 6 months and included the intravenous infusion of 3 or 4 different drugs administered for 2 days every 2 weeks. My current regime includes the intravenous infusion of 2 drugs and a 2-week cycle of an oral chemo in tablet form, all followed by a week off. My current chemo program is to reduce the possibility of future recurrences.

I'm amazed at the incredible variety of chemo drugs that are being used to fight cancer. And there are new ones coming online all the time. One of the new drugs I am taking today wasn't even available 3 years ago. It is the job of the oncologist to pick from these various drugs and to plan, prescribe, and administer the chemo program. A good oncologist is vital to an effective medical team. I'm lucky to have one of the best!!

It's the side effects that get us!! And how!! Side effects can include nausea, vomiting, diarrhea, constipation, hairloss, mouth sores, hand and foot sores, anemia, low white blood count, and low platlet count. Side effects vary widely from patient to patient and drug to drug. There are very effective drugs to counter the various side effects and the chemo dose can be reduced if side effects get too bad. My side effects have been varied. I've lost my hair, nausea and diarrhea are pretty standard, and my white blood cells and platelets have both declined. I'm taking another drug (Neupogen) to boost the white blood cells. Overall, though it's not too bad. My appetite is good, I have many good days, and CANCER IS BEING BEATEN!!. YAH!!

I remember a young women at a cancer workshop reflecting on the chemo program ahead of her. "I've got this horrible disease but there is this medicine that can help me. It may have some nasty side-effects but it can help me to be well again. It is the medicine I need."

Have a great weekend!.... Rob

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"Yesterday I decided to go to the office. I got as far as the bedroom door. Chemo strikes." Peter Jennings