A talk at the Leukemia & Lymphoma Society

Last night I gave a talk at the Lymphoma and Leukemia Society (the LLS) at the Sales Force tower. You might have heard about them in context of Team in Training, or their Light the Night events. The LLS is a great organization providing access and information to blood cancer patients around the world. Thanks to my friends that were able to come out and support!

I usually like to be prepared for these kinds of events. I had written up some notes but ended up scrapping it last minute and speaking off the cuff about my experience. It just felt more appropriate to talk about cancer while throwing the script out the window.

If you weren’t able to attend here’s a video.

diet & health practices

I get asked this a fair bit, including from the doctors so I figure it’s worth posting (I also wanted to check myself to see if I stuck with what I said I would do, turns out it is consistent with an earlier post). Let’s start this with some caveats. This does not constitute medical advice. I generally followed Pareto’s law (80/20 rule), not getting fanatical about really anything. Generally what I’ve been doing is based on my readings of the literature, common sense and always via the lens of what works for me. What works for my body could be exactly the wrong thing for yours. That said I haven’t seen much negative evidence for any of this. For example I considered the Ketogenic diet after reading much about it re: curing cancer and etc. But on reading deeper into lymphoma specifically there is evidence suggesting possible negative effects of high fat diets. Also the studies I’ve read on Keto were mostly for solid tumors, I could find little to nothing on blood cancers. For that reason (and frankly the impracticality of it, especially with kids) I didn’t go down that path despite some initial interest.

What I can confidently claim is that in aggregate the below definitely had a placebo effect, might/might not have had some physical effects, and definitely did not have negative effects. With all that said here’s what I did most of the time:

Things I did consistently:

  • Green tea basically all day long. I brew it extra long so it’s extra bitter, frankly kind of gross.
  • fast until noon OR one meal at the end of the day. I would say I averaged 4 days/week pretty consistently here. My weight did not fluctuate much, interestingly. I also found that once I made it until noon that was highly predictive of going the full day until dinner. What the heck, I’m already here and I’m not hungry. I’ve always hated eating lunch anyway (slows me down), so actually it’s pretty easy.
  • If I did eat breakfast it was oatmeal. I can eat this all day long. It’s not your childhood sugary oatmeal. It’s steel cut/quick oats with cumin, turmeric, pepper, cinnamon, coconut oil, raisins, walnuts. Maybe a drip of honey. Gets me through the whole day many days. This might be an acquired taste but I love it.
  • Turmeric and pepper/oil on basically everything. Michelle is grossed out by it but I love it. That includes, soups, salads, oatmeal, stir fry, etc.
  • Workout a lot. That included track workouts, climbing (one evening/week with my friend Sean), strength training, etc. I workout most days fairly intensely.
  • Meditation/visualization. I’m not fanatical about this – walking in the woods counts. I would sometimes visualize the cancer melting away or otherwise being defeated. I would also visualize challenging scenarios (sometimes called negative visualization) considering worst case scenarios, often in vivid detail, toward getting myself present and appreciative for what I do have. And to prepare my mind for any eventuality. It’s not for everyone.

Things I consistently avoided:

  • No dairy (the occasional ice cream with turmeric turns out to be quite nice though).
  • Alcohol, though would drink with friends on occasion. Bonding trumps the negative effects of alcohol, assuming it’s moderated, IMO.
  • Low protein, almost no animal. I really cut most animal protein from my diet. For example I used to eat scrambled eggs for breakfast more days than not. They don’t work for me anymore. Fish on occasion. Chicken rarely. Beef almost never (but still if I feel like it). Overall my protein consumption is probably half of what it was before and I don’t feel any worse for it.
  • Coffee has been on the uptick lately after a big cut from what it used to be – my default is still mostly green tea.
  • I never was big into processed foods and sugar so that’s been a mainstay of my diet. Refined sugar is the enemy.

I think that covers most of it.

6 month scan results

Complete Remission!

I’ve been existing in this limbo state for a while. It’s been a particularly stressful day or so of waiting. Getting these scans has a way of making the abstract idea that one is sick much more concrete.

As I mentioned in an earlier post, the other day I was feeling down with all the future planning parents around me were doing. I held back from planning anything, all the while thinking, hmm, there’s a real chance I’ll be in treatment while you’re doing that awesome thing.

So I got the results yesterday. Kaiser sent an email. It wasn’t clear to me how to interpret what they sent over (I guess the lesson is when you train your doctors that you’ll go into all the details yourself they don’t even bother walking you through it!). Still I wish the medical profession, especially oncologists!, would give this event it’s due. Some people call it Scanxiety, and it’s real. You should not simply send a patient an email even if you’re busy, even if the news is positive. This requires some bedside manner. This is not the point and will be a totally separate post.

So I called them to follow up. The nurse told me that all is clear. There is no ‘metabolic’ activity. I was about to thank her for the news but realized I was choked up. I couldn’t speak. The tears exited my eye sockets and gravity dropped them from my face, pebbles. Then an avalanche. This wasn’t shock (shock has a way of blocking emotions). No, this was relief. It all spilled out and I couldn’t fight it. Didn’t want to.

In contrast, nobody in my family was surprised at all, including Michelle. I had been stressing over these scans for months. It was weird. Everyone said the same things, that I looked too healthy, was too positive. My perceptions offered a stark contrast. To me: (a) my back still hurts suggesting residual tumor, (b) periodic flutterings in my abdomen were reminiscent of what I felt previously (are the cells morphing?), (c) with months of distance from chemo treatment, those drugs are flushed from my body, so the cancer could take root. All reasonable, albeit speculative, over-corrective biases of a mind that’s overly attuned to bad news, I guess.

While I trusted the first scan result part of me really thought it was a fluke. That the real scan, the validating scan, is the 6 month scan, the one I just had. And for the first time in a great while it actually feels like I can REALLY get on with life. Like I’m walking out of prison. I now believe that I’m healthy.

Michelle and I did a date night last night to celebrate.

Whew.

I’m smiling more on the inside than in this pic.

The first day of school, my 6 month scans

Yesterday was a strange day. The sun was shining. Still feels like summer. It was Saul and Lev’s official first day of school: Lev to kindergarten, Saul to second grade. I mentioned in an earlier post that we’ve moved across the bridge to Piedmont. So we’re in a new home, a new school district and all is well.

Except that I also had my 6 month scans in that familiar trailer. The juxtaposition of normal/happy life with this disease is almost overwhelming. In the morning I was chatting with the other parents and sharing excitement about the school year, logistics about after school programs, enthusiasm about our teachers. Hours later, instead of picking the kids up from school, I was getting injected with radioactive isotopes. I sat quietly, doing my best to still the mind from the swirl of future-oriented thoughts. Not much else to do. The timing just worked out that way and I don’t really feel like changing it.

Oddly, the familiarity of this position seems like a kind of home base. As much as I hate this process, my relationship to it isn’t antagonistic. I know that if my results are bad that I’m prepared to fight. I’ve done it, frankly at this point it’s a part of my identity. Actually this state of purgatory is the most anxiety-provoking. I can tell its been affecting me, thought I don’t like to admit it. And my thoughts go out to the millions of folks that need to deal with this on a regular basis. It’s excruciating. I do my best not to let it control me but it’s clear there’s background anxiety eating up cycles.

I did a hypnosis session the other day with a friend who is getting certified in it (she’s a top notch psychologist in her own right and taking on new skills). It was actually quite powerful, not because she put a spell on me or anything like that, but rather she enabled me to go deep into my own memory banks with skillful guided imagery; helping me pull dusty memories from forgotten shelves. One observation that stuck with me, largely because it was visceral/kinesthetic, in which I imagined some challenging times in high-school. I thought about the anxiety certain situations provoked. And the incredible part was that I felt that emotion manifest in my abdomen, around the location of the tumor. I don’t think I’m reading into it but there is a connection there worth exploring. It’s an interesting practice.

All of which is to say these appointments, this whole process, serves as a reminder. I find value in it. I’m forcing myself to but I also deeply believe it. We are mortal and fragile beings. So are our loved ones. It’s easy to forget or it would probably occupy all our thoughts (we would not get much done). And so I don’t see this as a diminishment of my experience but rather as an enhancement. It adds value to my life in the form of imparting gratitude and helping me get present. Value is a function of perception.

I’m not sure the right way to approach this whole process. What I know for certain is that what matters is extreme honesty in going through this. It’s scary. I’ll deal with what comes. And I can’t sugar coat any of it.

Should get results today or tomorrow.

Schrodinger’s CT

That’s not a typo. I have my 6 month PET/CT scan coming up next week. I find myself existing in two simultaneous mental states: in remission or recurrence? Am I healthy? I told my doctor to get it scheduled asap. As much as I want to put this off (I really do) there’s really no sense in doing so. I need to face this thing head on. Thanks for the nudge to just do it Eli!

Last weekend I flew to Colorado to visit my brother Eli. We made good on a promise before my surgery in December to go camping when the ordeal was over. We climbed a 14k mountain, starting the day at 4:45am (ok, we started at 11.5k, but still!). It was great. He has a camper van that we slept in by the side of the road. I was pleased that there were no issues to report. This felt extra great given that I got altitude sickness going to Tahoe just a few months prior. So I’m feeling healthy.

Next week we’ll open the box and find out what the CT scan has to say.

Precious Cargo

What a shame to not fully bloom. Fear, apprehension, self-doubt cripple us. And they are an insult to our unique gifts. Because that part that wants to express is true, good and should live (even if the output is imperfect!).

Remember the morning demon that demands your review of the future day. It asks: would repeating this day be joyous, or miserable? That seems as good a scorecard as any in deciding what good one will make of the day.

Our days take on a rhythm. That rhythm might be inertia, based on days past. It might be twisted into a pretzel by the school or business culture. Or maybe it’s the rhythm of no rhythm, each day totally novel to bash routine. The day might be filled with wonder, or with trepidation. But whatever it is know that you have the space to change it if it’s not working. If it’s squelching the gift. Will you do it intentionally, or reflexively? Perhaps a set of rules would help.

  • if lethargic then walk
  • if overwhelmed then belly breathe for 1 minute
  • if indecisive then get action
  • ….

There’s an African proverb I heard from Jack Kornfield (a well known Buddhist teacher) in a talk he gave a few months ago:

Children are born with a precious cargo. It’s the job of a parent to help them deliver it.

The blockers to ensuring this happens are many, individual as fingerprints. But underneath most of them is a dampening of enthusiasm. How might we ensure that self-doubt, the (likely imagined) judgments of others, or anything else doesn’t creep into their psyches? Can you hear the brakes screeching?

If you’re a parent (even if you aren’t), try not to forget that you too are a child with cargo that needs delivering. A good way to ensure children can get there is to show them how. Let’s model that delivery process.

The path isn’t always this straight (taken in Whitefish, Montana)

A year since I was diagnosed

Here’s a quick update since it’s been a while and I’m getting the itch to write again.

There have been quite a few (great!) changes lately: I’m back at work; we moved the family to the east bay; kids are thriving. But I’ve also been feeling some uncharacteristic anxiety lately. I was attributing it to ‘life’, then it occurred to me that while all that is true the underlying reason is it’s an anniversary – a year since I was diagnosed (cancer is murky and these timelines are approximate; I had symptoms July 4 vacation then started chemo on 8/8). So this time last year I was going through a battery of scary tests to figure out what was going on. I have visceral memories of the uncertainty of it all. While I’m overall feeling quite excellent physically I do find myself often checking my abdomen, feeling for growth. Is that a lump? Am I cured? Am I fooling myself? The pangs of anxiety are good reminders not to take things for granted. This is a marathon involving both psyche and physique. These are not in equal proportion – for me at least the former is much more demanding. 

The thing that really stands out in reflecting back on the year is my support network. This was my unfair advantage over the disease: friends, family, colleagues, even strangers. I well up with gratitude and consider myself among the most fortunate men alive.

So if you’re reading this, thank you. 

3 buckyballs
Thank you!

writing again; 9 year wedding anniversary

Some of you have been asking so apologies for not writing lately…I appreciate the concern when folks ask if I’m ok…then tell me to write more! Truth is I’ve sat down many times in attempts to write over the past few weeks, only to find my motivation waning. I’ve been struggling a bit to figure out what to do with this blog now that I’m on the road to recovery. My goal is to continue writing (it’s highly therapeutic). So the solution I’ve landed on is to expand emphasis to meditations on other topics beyond the battle with cancer.  It feels like an obvious extension of the blogs focus.

We’ll see how it goes. Here’s an ice breaker…

Today Michelle and I celebrate our 9 year wedding anniversary!

In those 9 years we’ve birthed 3 kids, finished grad school; bought a home, survived cancer, worked on and with many companies & schools; good times and hard ones. It’s not been easy but the long arc of it has felt rewarding and meaningful. I’ve always thought of this phase as ‘life building’. And turns out those first turns of the flywheel are always hard. Feels like now we’ve got some momentum.

And joy matters so much more than it ever did. What really inspires me about where things are now – in part thanks to the perspective shift that tends to accompany scary disease – is that I can step back, witness the fruit of our hard efforts, and think; wow, we did that! This morning I sat at breakfast with the kids and just enjoyed them for a moment. They do the work, I get to watch it unfold. Nice.

Michelle – to say I’m proud of you does a disservice to words. You are strong. You build communities like nobody I’ve ever known. You nurture our family. You cared for me in dark times. You notice and appreciate the small details in everything you encounter, providing our family life with meaning and light. What we’ve been able to do together over these years makes me proud of us. And we’re just getting started! It’s easy to forget all these things in the grind of life. Three kids, aging parents, me getting sick, and all the rest of it is not easy. Let’s make it a priority to enjoy this crazy ride to the maximum. And to make it meaningful. It’s important. Happy anniversary baby. I love you forever.

Let’s party.

At my friend Carmel’s wedding last week. We don’t get many pics together without kiddos!

Spring cleaning; Lev turns 5; more notes on fear

Spring Cleaning

There’s a feeling in the air that I want to clean up all the old stuff. That includes things, habits/systems and thoughts. I’m knocking out the most mindless todo’s that I’ve had on my list for a long time: clean the office, the closets, ditch old clothes, maybe tackle the garage. Feels like I need to sweep around all the build-up from the past months. And it feels liberating. I’m going slow to go fast and this feels like an appropriate way to start revving my engine again!

Lev turns 5

It’s hard to believe that it’s been 5 years since that day. Lev was home birthed. It was not smooth. Michelle had what’s called back labor; think baby’s spine against mom’s. He had been oriented in a favorable position most of that pregnancy but turned last minute in the womb, and there was nothing to do but keep pushing.

Happy birthday Lev! We did some woodworking last weekend and he made a coaster. I love sipping my green tea while it sits on this thing.

Michelle had no anesthetics and the midwives really didn’t have much in the toolkit to support her. Neither did I. We were too far along to make it to the hospital so we hunkered down. I felt helpless to help and it was one of my worst fears – not being able to help in a situation like that. She was in the most excruciating pain one can imagine. It was traumatic. That was exactly 5 years ago.

But from this incredibly hard birth came this amazing child. Lev means heart in Hebrew. It’s a good name for him. He’s one of the most empathetic people I’ve ever met. He helped me get through my this hardship with the deepest compassion and tenderness I think I’ve ever known. He touches me to the core every day and reminds me of the special opportunity that being a father affords. The opportunity to nurture and bring these kids into the future is a miracle. Happy birthday, Lev!

Yet more on fear

What’s the right role for fear in modern life?

Sure, if the threat is real then go ahead and feel it. But fear misfires. Often. Anyway isn’t fear an intermediate step in the chain of survival instead of an end-point of it’s own? What I mean is fear leads to adrenaline/altered state, and that state change leads to action of some sort, presumably toward better survival outcomes over time; hence it’s conserved – fight or flee! The relevant question then, is what role does it, or should it play in our daily lives when (for most of us) 99% of the time there’s no actual threat to life or limb. We’re all dead in the long term so does that mean we should all be fearful about it too?

Useful to ask: what fruit might fear bear? If the answer is nothing, that it’s just a state we feel with no useful output then it’s probably worth swapping out for some better emotion. We should fear if the threat is real AND imminent. Else we should transform it.That’s easier said than done but still worth a shot. How? Can it be transformed into useful energy? Try to replace fear/anxiety with excitement to ‘get up’ for whatever it is that’s on the horizon. That’s easy enough to do when there’s a single event coming up. But how do you ‘get up’ for fighting cancer or for a chronic condition that’s always with you like a devil on the shoulder? It all starts with recognizing fear before we do something with it.

I’ve actually come to equate (my) cancer with fear. Or maybe it’s the other way around. In asking the question of which degrades quality of life more it’s actually not clear which is worse: cancer or fear?

One of my working hypotheses is that I’ve experienced a high amount of low-level fear and anxiety over my lifetime; that’s contributed to compromising my immune function, thus setting the stage for cancer to take root. To be clear I have little evidence for this causality but I don’t imagine much of a downside to believing it anyway (placebo!) and making some changes in support of that shift. Living without fear seems a reasonable bucket-list item, probably for most of us.

So what am I anxious or fearful about? I just got some amazing news! I’ve been thinking a lot about this lately. Oddly I feel I’ve been handed a precious gift in getting this cancer and I do not want to squander it. One part of that is it’s afforded me an opportunity to address fear (of cancer, and anything else) head-on, with urgency. I believe this is of vital importance toward keeping cancer at bay. I’ve spoken much about fear through this journey since it’s such a central theme in battling cancer – for anyone. I’ll take this a bit further in hopes that it’s helpful for others, and as a reminder to myself.

Should I feel self-conscious, fearful even, about sharing these? TMI? Maybe. But addressing fear starts with mini steps. Laying them out for others is an act of doing something scary. So I’ll go first and pay it forward in hopes that you too, reader, will also do something that makes you scared today!

And while these feel deeply personal, in-fact they are generic. They are instantiations of categories, variations on a theme. Fear is in all of us, part of the operating system.

I’ll list these out, something akin to Selichot (סליחות‎, loosely translated as apologies) that Jews recite as repentance for transgressions. These are done with a light ceremonial fist punch against the heart. I’ll call it the fears (but it sounds better in Hebrew, The Pachadim, הפחדים).

So, the fears:

fear of taking more than I give OR the fear of forgetting:

I’ve been shown such love and support, and been given so much that I don’t want to forget and move on. And I certainly don’t want to lose the momentum of dealing with this to start all over. It’s a hard headspace to occupy, that of fighting cancer – as anyone that’s been through this ordeal would attest. But I hear plenty of stories about recurrence, specifically regarding follicular lymphoma. The odds of recurrence are high but over what timeframe is not clear – is it months, decades? This experience has changed me and I’d be remiss if I didn’t reflect and integrate some updated habits/systems into my routine to ensure that expanded awareness and focus on giving remains accessible amidst the insults of daily living; I want to quickly rub my sleeve against the dusty buildup of the day and access that polished state of awareness. Also, this fear is related to the fear of judgment (below) in that we live in such a high-stakes environment that it’s easy to turn our focus inward on ourselves and lose sight of others.

SOLUTION: (1) Adopt mindfulness practices e.g., meditation, yoga, being with nature, etc. to stay grounded; (2) Give back! Contribute & support people/patients going through hardship. 

the fear of being judged by others (inadequacy)

This is a biggie. I could label this the fear of not being good enough, or imposter syndrome. Sometimes I don’t care what others think – in fact that’s my natural state. Generally I don’t care what people think. Until it matters and I feel I’m being judged (which is compounded by me judging myself more harshly than anyone else ever could or would – it would just be mean). I’ve valued independent thinking and not giving much of a shit what others think. That’s when I do my best – when I have energy-plus stemming from a focus on outcomes. With that the ‘people in the room’ become fuel stoking the fire of positive outcomes versys draining fuel in unnecessary mental overhead in the form of recursive judgments (what I’m thinking about what they’re thinking about what I’m doing etc. – have you ever been there?). Of course I’m judging myself more than anyone else is – such is life for perfectionists. I don’t do well when I’m focused on myself – most of us don’t. Things are better when I connect and charge with larger contexts and outcomes that extend beyond my small self. Optimal performance comes when I get lost in the work and the joy of the doing it, flow (vs. over-emphasizing how things might be perceived, what’s called ‘optics’, they matter sometimes, but not much).

SOLUTION: Identify and surround myself with energy-giving vs. energy draining people/contexts. Bias towards situations where authenticity isn’t something to be cast aside but rather celebrated over posturing (what I try to do in my writing; and why silicon valley tends to be a great place for independent spirits). 

fear of not making my future self proud

God made each of us for a reason; it’s our job to find that and do it. There’s a saying that hell is to die and meet the best possible version of oneself. That gap is suffering; the pain of what could have been! So strive to minimize that gap. This is another way of saying opportunity cost.

Also, I hate repetition but I love routine. It’s not as weird as it sounds. To my mind repetition suggests no growth (in tech we have a mantra called DRY – don’t repeat yourself!), like you’re an animal that can’t learn. Routine, in contrast, is a scaffold we build (using our big brains) to support our growth. The fear is of NOT growing, of being left behind in repetition while others around us grow. Maybe a bit esoteric but I think of it like: fomo => fomoog (fear of missing out on growth)

SOLUTION: Be confident that the future is hopeful despite the inevitable hardships. Remember we only see a small piece of reality. Enjoy being on the steep part of the learning curve and meet hard things head-on. If you do things with the right motivation (know your ‘why’) then aiming high is easy!

fear of insufficient means

If I were to step outside myself and the bubble of good fortune in which I live I would be quickly reminded that we live in a time and place of great abundance, with greater means, prospects, good fortune etc. than have the majority of humans through history. There’s a saying (I think from the Rebbe) that resonates: He who has enough to sustain him for the day but is apprehensive about the morrow is considered to be wanting in faith. For me it’s about creating that desired future with force of will/certainty versus building a wall to to ensure all is protected.

SOLUTION: Mindset shift of abundance over scarcity.

fear of recurrence

This news of remission does not erase the fear of cancer. Paradoxically if not heightening it, at least it’s morphed. Why? Maybe because the scary monster has moved into hibernation – what you can see is less scary than what you can’t. I suspect that’s why the movie Jaws worked so well: fear was something sub-surface, rendering it more frightening because it’s fueled by the imagination(archetypes and all the Jungian stuff), a machine that is nothing if not great at concocting-very-scary-shit. What’s interesting to me is that it’s not quite dying that scares me so much as not living well. Fear of not leaving a mark, enjoying myself fully, or doing what needs doing from this tiny vessel of mine is all wasted opportunity and that’s where the fear resides, in living sub-optimally.

SOLUTION: make what I do deeply personal and resonant with meaning (whatever it is I’m doing) and love it/find my way in. Or, better, burn that shit bright! No regrets. Note the opposite is to live for the money so you have security – blech! 

Using fear as a tool to optimize outcomes (a feature of the operating system, not a bug!) comes in 2 parts. The first is to understand and classify the fear type. Second is understanding the right thought to replace the fear with, that will come with reps. Finally, understanding what emotion to replace the fear with (unless the fear is helping). Generally I’m finding that enthusiasm or excitement is a better way to handle fear and anxiety. So it moves from useless into useful energy; fear/anxiety => excitement.

Decompression

Access

I now have 4 aligned oncologists all in agreement that I’m in complete remission. It’s not clear how this happened. There are several competing theories that I won’t go into here for purposes of brevity. I think the most likely explanation is that first line was effective in killing the scary stuff. Then, by some mechanism, my immune system got a boost and pushed follicular cells into remission (possibly by recognizing, and subsequently weaponizing against proteins that were released in the massacre – it’s all speculative). I wish doctors were willing/able to dig into the post-treatment details to really understand what happened but retrospectives like this seem to be a casualty of warfare.

There is loose agreement on the monitoring schedule. At this point it stands at 6 months for the next scan. UCSF suggested 3 months. Stanford suggested 3-6. Dana-Farber suggested 12 months or whenever I feel symptoms. I pushed back on UCSF suggesting that taken together the combination the false positive rates, radiation exposure, and general anxiety of waiting for these scans were all good reasons to hold off longer, 6-12 months. No issues as there are no hard/fast rules for my situation! Also, Stanford suggested that blood tests are coming online soon, at least for dlbcl (the scary type) which makes me want to wait as long as I possibly can in hopes of that technology coming online.

To pull on that thread a moment, through my network I got connected with a company called Natera (thanks Alex!) that have consumer blood cancer detection tests in development. While it’s still for research use only and only validated for a handful of solid tumor types I jumped on a call with them the other day. It’s obvious they are still in early days. They are currently running a trial to validate other cancer types. I’m leaning towards joining this trial because in part because it’s just a blood draw so no big deal for me (assuming there’s enough biopsy tissue to share). More importantly I would do it to get them get more data to support follicular lymphoma detection. Maybe it’s a small way to give back – even if the data is too noisy/inaccurate to use for my own clinical diagnostics (that is, I’ll still need to get the PET/CT scans for any diagnostic decisions).

In a nutshell the way it works is they match up tumor DNA (taken from the biopsy tissue) and match it to DNA that’s ostensibly shed from the tumor and that circulates in the blood. They have algorithms to look at sensitivity levels and mutations to draw conclusions re: progression. This would be particularly useful for Follicular Lymphoma as the nature of this disease is that it waxes and wanes. And a blood test would obviate the issues mentioned above with scans and would (in theory) have a higher sensitivity, meaning they can see circulation of tumor DNA in the blood months faster than a scan would pick it up.

I’m constantly thinking and reminded about how much access I have. I do my part as a patient and advocating for myself, but to be perfectly honest if I didn’t have access to the doctors and network that I do then it’s clear my advocacy would have been a much lower-leverage activity. I would almost definitely be in a much worse position.

It’s so easy to lose sight of the fact that so much of our circumstance is dumb luck: shit fortune for getting cancer; good fortune to have resources to fight it well; dumb luck of the PET/CT coming back clean. I have no idea how can we level the treatment field but it seems an important activity for us (humans) to consider with an estimated 2-3 billion more humans coming into being within then next 50 years?

  • What if I couldn’t afford to pay out of pocket for 3 separate opinions?
  • What if I didn’t have the time to dig into all this research (I barely knew what lymphoma was a few months ago!) to nudge the direction of treatment?
  • What if I didn’t know the right people to talk to? Or have the network to connect with the best oncologists at the top hospitals in the bay area? Three of the four oncologists in my panel came through my connections.
  • What if I didn’t have such supportive colleagues supporting me through my journey? 
  • What if my wife Michelle, kids, and broader community weren’t so amazing?
  • etc.

Decompression (in pause)

I’m exhausted. My tank feels depleted. My back still hurts. I’m building back up slowly but I’m letting my body tell me when I’m ready to move ahead with life. I’m in pause.

The top question I’ve gotten over the past week is some variant of: “…are you feeling elated”. Actually, no.

Viscerally, it feels like I’ve run a marathon. Metaphorically, it feels like I was thrown off of what I took as a sturdy ship into the roiling nighttime ocean. I was tossed around in freezing water of uncertainty for months. Then – miracle! – I’m heaved onto the shores of some anonymous island. The constant motion of bobbing on waves has given way to the stillness of land. Instead I feel like I can barely move as I think: what the hell just happened? where am I? Is this stable? what’s next? 

I’m picking up the pieces back up and I’m trying to be methodical about how I do that – slow and steady. If you’ve reached out and I haven’t gotten back to you please don’t take it personally!

I’ve been spending time with the kids. For example hanging with Lua in the backyard one afternoon. We just sat in the bench under a large spruce tree. It was heaven. Seriously, for the few minutes she sat kind of still, her tiny body in my arms, I was flooded with gratitude for just being and not doing anything. I’m wired to do and it’s nice to NOT do for a bit, to just be and let things sink in. It’s happening slowly and I’m not rushing anything.

I’ve never been to burning man but all my friends that do go spend a week in ‘decompression’. Observant Jews have been resting on the Sabbath day for a long time. Not sure the science behind 1/7, but 14% seems reasonable. Modern society has implemented a version called screen-free Saturday; same thing, new marketing. In all cases there is a period of intensity followed by pause/reflection. I’m sure there’s some good studies of which I’m unaware suggesting the benefit of decompression but I haven’t researched it.

For now it’s clear that my mind is screaming at me to rest and recover as I take in the new vista.

Meditations while battling cancer