seven.

Today marks 7 years of (knowingly) living with metastatic lung cancer. 7 years since I was told I had 8 months left.

It also marks 78 days in lockdown because of Covid-19.

Why don’t I count the cancer life in days? If I did it would be 2,557. That’s a lot of days.

Things are bumpy on this roller coaster. My latest scans showed likely progression in both the brain and lungs, so we are mulling over next steps.

I’ve never been good at predicting the course of events - I never would have imagined, 1 (or 7) years ago what today would be like.

So, I hope to see you all back here when I write “eight.” Let’s hope we will find that things are sorted by then: vaccine widespread, lives calm, bellies fed, roofs over heads, justice served, and cancer cured.

Metastatic Cancer and Pandemics

As someone who has been living with the specter of death breathing down my neck for over 6 years, existing with an uncertain future, it occurs to me that the coping skills I have honed could be helpful to my dear readers.

As I said to my husband in the early days of the pandemic, “it seems that the rest of the world is learning what our life feels like.”

Those of us with metastatic cancer know full well the fear of not knowing what next week will look like, how uncertain the future is. We know the terror of seeing people in your community getting sicker and dying, wondering if you will be next. When every cough or ache could spell your greatest fear. Are you suddenly living a life totally different than the one you were on course to lead? Yup. Sadly, this is well-trod territory for us. I’m so very sad that others are feeling this horror.

Cancer also serves as a magnifying glass for the strengths and weaknesses in your life and society at large. We are discovering the same is true of a pandemic.

As I say whenever I meet someone newly diagnosed,
Welcome. I’m so sorry you had to join us.

So how have I managed to get out of bed every day with this weight on me for close to 7 years? (Well, on really bad days, I don’t.)

My overarching approach is compartmentalization. I take all those terrifying thoughts and pack them into a box and put them up on a shelf. I think in much smaller time frames, and generally avoid thinking into the future. How can I imagine the future when I was told I don’t have one?

There is a similar struggle in this CoronaLand. Who knows what things will be like in a month or even a week? Think smaller. Think about this day, this hour, maybe even this minute. I am breathing. There is sunshine. I can hear a bird. Right now I want to see how this episode of Property Brothers will end.

Sometimes I take the box of fear down off the shelf and sit with it for a while, going through each scary shadow, looking through each awful moment. During those times I find it helpful to seek out information. What new treatments are on the horizon? What glimmer of hope can I hold onto to push away the terror?

I like to call my next strategy Grief and Gratitude.

Make sure to let yourself grieve.
Grieve. Grieve. Grieve. This sucks. Acknowledge all the losses. Big and small. Grieve the future you thought you had. Grieve the missed class trips. Grieve the fact that your beloved small business is on life support. Take time to honor and grieve for it all.

Then when the grief lets up, discover something you can be grateful for. It can be big or small, but I find it enormously valuable to recognize the good things even when everything feels so hard.

People talk a lot about “after.” How we just need to get through this and get back to normal.

This may be harsh, but living with my diagnosis has taught me that what you have is THIS. Right now. This time IS your time. Don’t wish it away. What you have now might BE the good days. So enjoy what you can of THIS.

One of my mantras over the past few years has been “this is the life I’m trying so hard to stick around for.” It helps me remember to find something to appreciate even in the hard times.

And when the absolutely stark raving terror of it all becomes overwhelming, distraction is my recourse.

Watch crappy TV. Go outside. Sing really loud. Jump up and down. Go for a walk. Help someone else. Do something to change your surroundings and your focus so you can give your mind a break from it all.

This, too, will change. Parenting and cancer both taught me that. Just when you think you have it all figured out, it will change. Sometimes for better, sometimes for worse, but always different.

My wish for people in this pandemic is that the worst they get is really bored. It’s the same wish I have for my cancer buddies; that their scans may be boring. Their lab results a big yawn fest. That their consults are not even worth talking about.

Just nice and boring.

——-

I’d be remiss if I left this post without any sort of health update!

I am still on my fancy TPX clinical trial (cycle 16!), and it seems to be holding the brain mets steady. I’ve been having a recurring pleural effusion, and had been going into the hospital for regular thoracenteses. With the onset of the pandemic, I finally overcame my aversion to the pleurex catheter, so I now have a tube implanted in my chest so that I can drain my lung in the comfort of my own home. Actually, Jason gets the privilege of draining it every-other-day. He jokes that he is no longer brewing beer, so instead he monitors the flow rates of malignant fluid being suctioned out of my thoracic cavity. Gotta keep those skills sharp.

It’s funny what you get used to. The kiddos now run in and out of the kitchen arguing and asking for things while Jason and I are busy draining my lung. This is all par for the course in our lives.

As someone who is unlikely to survive Covid-19 should I catch it, I am deeply moved by all the people who are sacrificing to help others - and I’m not just talking about the amazing healthcare and essential workers.

I mean all the people who are selflessly accepting this great disruption to their way of life in order to protect others in society. People accepting hardships to help save other people.

Makes me proud to be human.

Bumpity Bump Bump

It’s about time I update this little blog.

I’m doing decently, much better than I was when I wrote the last post. The increase in steroids has proven to be incredibly helpful, making it much easier for me to function. My balance is still a mess, but I no longer feel motion sickness when I move my head (that was pretty awful). I’m embracing all the fun steroid side effects (hello again, puffy face), because I feel so much better thanks to these not-so-fun meds.

Currently, the main issue is my balance. I’m fine when I’m seated, but I feel wobbly as soon as I stand up. If I’m holding onto something, I’m pretty stable, so I casually lean on things like nobody’s business. Really, if there were a contest to see who could nonchalantly lean against any wall or ledge, I’d be the champ.

The general consensus from doctors across three states is that the changes in my cerebellum are treatment effect, rather than new growth. The trial drug is known for causing balance issues, so who knows what is causing what. The plan now is to watch and wait, and hope that my cerebellum can heal and nothing starts growing again.

Just another bump in the road.

Meanwhile . . .

My latest chest CT showed that I had a small pleural effusion. That was a shocker. These are not uncommon in the lung cancer world, but it was a brand new one for me. I haven’t had a thing wrong with my lungs since 2013 (kinda funny that my lung cancer has mostly caused brain issues for the past 6 years). I had a thoracentesis, which drained 240 ml of malignant fluid out of my chest cavity. It was much less scary than it sounded, though I had to go for the procedure twice since they told me you can take blood thinners the night before (you can’t). Reminder to self - if you are being given instructions over the phone about an upcoming surgical procedure and they sound incorrect, question them. Don’t become self-conscious about second guessing instructions too much.

The upside of having malignant fluid drained from my body was that I was able to ship it to Colorado and donate it to the ROS1 project, so they can grow cell lines for research. Precious fluid!

Another pothole in the pavement.

Also meanwhile . . .

My tumor markers continue to rise, so who knows what is going on, except that likely trouble is brewing somewhere.

Bump bump bump.

I recently read The Miraculous Journey of Edward Tulane, and it is hard not to feel grateful for what you have after reading that.

"Edward knew what it was like to say over and over again the names of those you had left behind. He knew what it was like to miss someone. And so he listened. And in his listening, his heart opened wide and then wider still."

"But in truth,' said Bull, 'we are going nowhere. That my friend, is the irony of our constant movement."

If you haven’t read that book, do yourself a favor and check it out. The world feels a little bit more doable afterward.

"If you have no intention of loving or being loved, then the whole journey is pointless."

I couldn’t resist that last one.

Unclear

Things are not great in CancerLand. My rising tumor markers and MRI changes have confirmed that the spot in my cerebellum has grown back and is starting to cause symptoms.

The great/terrible/ironic thing is that I’m not facing widespread cancer progression; the only spot causing troubles is the same bugger in the cerebellum that we tried to remove back in October.

My sense of equilibrium is off, and I was having headaches and nausea until we increased my steroids earlier this week. Now, some of the imbalance is likely caused by my trial drug - it is a frequently reported side effect - but certainly some is from the mass. Friends who knew me in my physical theatre / Dell’Arte days will find it strange that I now feel intimidated by a staircase lacking a rail. I reminisce about how I used to stand on someone’s shoulders without batting an eye. Flowers for Algernon’s Charlie comes to mind: I know I have done all sorts of physically challenging things in my life, but I cannot fathom them in my current wobbly state. To make things even more strange, when I sit down, I feel completely normal. It’s only when I stand up that I feel like I’m on a boat.

Where do we go from here?

The best case scenario is that I can get another brain surgery, and that they can remove the entire mass from my cerebellum. Waiting to hear from the neurosurgeon to see if that is possible.

The second option is to get another round of targeted radiation to the mass and hopefully knock it out. I’m doubtful that will be possible, since it has only been 9 months since I had radiation to that area.

If neither of those are possible, I will switch to a chemo that gets into the brain (likely Temodar).

For now, I wait for the experts to weigh in on what is possible at this point.

And we try to squeeze more fun out of the summer.

six.

“In five hundred twenty five thousand six hundred minutes.
How do you measure a year in a life?”
- RENT

I made it another year with metastatic lung cancer.

The past 365 days have encompassed....

A Phase II clinical trial
Brain surgery
Brain radiation
Brain swelling
Months of steroids
An Expanded Access clinical trial
A Phase I/II clinical trial
Bone radiation
Countless MRIs, bones scans, PET scans, EKGs, echocardiograms, and blood tests.


It was a tough year.


The past 365 days have also encompassed...

A road trip to Minnesota
Celebrating my parent’s 50th wedding anniversary
Seeing my eldest enter his final year of elementary school
A family visit to the Holiday House
A dreamy family vacation to California
My 13th wedding anniversary
Girl Scout camp with my daughters
A fancy trip to New York
Countless family dinners, holidays, scraped knees, homework sheets, movies, and school pick ups.


Strolling through my notes from the past year left me marveling at the juxtaposition of the monumental with the mundane. Surgery appointments and swimming lessons, PET scans and play dates, bone rads and birthday parties.

Raising young kiddos while living with metastatic cancer - while incredibly difficult - is also what keeps me grounded in regular life when it feels like everything is spiraling out of control. Regardless of how I’m feeling physically or my fear-addled mental state, they still need dinner, and rides to activities, and baths, and snuggles, and help sounding out words, and have questions about how everything works, and need help finding their lost shoe, and and and.

So kiddos, when you are reading this one day, know how much your regular day-to-day stuff meant to me, and how it kept me sane (while sometimes driving me crazy). You made the ordinary extraordinary, and kept me going when it all felt like too much.

“The longer I can put up with this, the longer I get to stay with Jason and the kids.”

“This is the life I’m trying so hard to stick around for.”

Out, Damned Spot!

Clearly this cancer likes to keep me on my toes.

You may recall that I finally got some good news on my April brain scan, the first good news in a year or more. My May scan focused on my heart and bones. The heart looks just fine (yay!) but a spot appeared in my left shoulder blade.

Just when you think you can breathe easy for a bit.

It is a spot that was seen back in 2013, but that we thought was dead for all these years. I guess it wasn’t, or it is some sort of zombie cancer that is rearing its ugly head.

And I thought the pains in my shoulder were a pulled muscle from all my travel and camping fun!

The good news is that I can stay in the trial, and we are treating this spot like a single mutant clone and zapping it with targeted radiation. And I can do the radiation here in Michigan. All good things.

So on Monday I start three every-other-days of radiation. Not my first rodeo, as the nurse said, though my first time where I have to be aware of possible skin damage.

I’m going to assume the rads will take care of this Damned Spot, and that my newest magic drug will keep shrinking the cancer in my brain. May as well believe that until I hear otherwise.

My (Slightly) Glowing Report

The MRI was definitively stable, even slightly improved. Most of the spots have either gotten a little bit smaller (by about 1 mm - but I’ll take it!) and/or become less bright on the scan. I’m calling it “stable plus.” I was very pleasantly surprised by these results! Now I am only traveling to Colorado once a month. And that will feel like a breeze!

Catching Lightning

These past two months of treatment on my fancy new clinical trial drug have passed fairly uneventfully. Side effects here and there, plus massive amounts of travel, but all in all not too much to report. Mostly, I’ve just been trying to convince myself that everything must be fine, since I feel fairly decent.

But now scan day, April 8th (our 13th wedding anniversary) keeps marching closer, and no matter how hard I dig in my heels and try to make the world stop turning, the calendar pages continue to flip. Time for me to step up and face the truth that the scan report reveals.

The gravity of these upcoming scans reminds me of my August 2013 scans (on Jason’s birthday). Those were my first scans after starting chemo, and we knew that the report would largely foretell whether or not my cancer would respond to treatment. And the report was remarkable.

But that was my first line of treatment. I am on my ... fifth (or maybe sixth?) line at this point. The odds of a good outcome go down with each one, meaning I am now deep into the unenviable category of the “heavily pretreated” patient.

But, I’ll try not to think about the outcome until I have to.

For now, I’ll keep savoring all the little joyous occasions ... trying to hold on to these ephemeral moments that slip through my fingers like sand.

Dumbfounded

And humbled.
And stunned.
And grateful.
And relieved.

I spent a big chunk of February scrambling to find a way to fund the wonderfully intense clinical trial that I am so thankful to be in.

I have received some of the kindest rejections of my life, from organizations that truly want to help patients, but for various reasons were not able to help me. We were getting closer to March, and I hadn’t booked any of my March flights yet. I was starting to worry.

So when my dear friend Lily (the same one who gifted me the ruby slippers) brought up the idea of doing a gofundme, I initially balked. I was sure I could find a foundation to cover the expense. But the days marched on, and still nothing. Finally, I gave her my blessing to start it.

And HOLY MOLY!

If you are curious to see what I’m taking about, you can
check it out here.
I am so moved by the response.

What more can you really want from life than to love and be loved? To put some good out into the world? To have a life well lived?
(I just want many more years of all of this!)

The incredible response to this call for help accentuated the strength and the goodness of all the communities (both physical and virtual) that I am so fortunate to be a part of.

And all the notes and messages! Oh my ❤️!

My most sincere thank you.


Here is my view for today. Not too shabby. Those are the Rockies in the background!

My next scans are April 8. So, in the mean time I have decided to assume that the drug is working perfectly. May as well.

Clinical Trial Lifestyle

I successfully passed all the tests and got accepted into the study! There is a weird sweet spot you have to hit in order to qualify for a clinical trial. If you don't have enough cancer in your body, you will not qualify because you do not have "measurable disease." If  you have too much, you will be too unwell to be considered as a candidate. I hit the goldilocks level of cancer! Yay for having measurable disease?!? What a strange thing to wish for.

I took the first dose on Thursday and now I just hope (and hope and hope) that it works.

I got to see both of the Wizards on my trip to Oz (my ruby slippers were a hit), and as usual they impressed me with their intelligence and compassion. They both have the remarkable ability to treat a patient as an equal partner in their care, something I have rarely found elsewhere. I love that they take the time to explain the science behind the treatments. I asked what I could do if this doesn’t work, and he explained that a chemo/immunotherapy combo (carboplatin, pemetrexed, and pembrolizumab) would be the next step. While most drugs need to physically reach the cancer (a challenge with brain mets), immunotherapy just has to stimulate the body. Well, here’s hoping I don’t have to find out for a while.

So now I set about trying to figure out the logistics of my new life, as an out of state clinical trial patient. With appointments once per week for the first two months, this is going to get complicated.

I have contacted several foundations to help shoulder the cost of all of this travel.

Here is a summary of what I have found (hopefully this will help someone else going through this). All of the folks I have spoken to in these organizations have been incredibly kind and helpful, even the ones that didn’t work out for me.

Air Charity Network
https://aircharitynetwork.org/request-a-flight/
This is a collective of independent pilots who will fly patients for treatment.
They need at least 7 days to arrange the flight.
Challenge: small planes can only fly about 250 miles, making longer trips (like mine) impossible.

Lifeline Pilots
https://lifelinepilots.org/
Independent pilots.
Challenge: same as above

Corporate Angels Network
http://www.corpangelnetwork.org/
This organization works with corporations to let patients fly along on their private planes for free.
Challenge: apparently no one is flying between Detroit and Denver for business.

Mercy Medical Angles
https://mercymedical.org/
They work with commercial airlines to give unsold seats to patients traveling for healthcare. They will provide a maximum of 3 flights per year, with at most 1 flight per month.
Challenge: they require a ton of paperwork (of the “prove you are poor enough” variety), and need at least 21 days advance notice. I am in the process of completing this.

Lazarex Cancer Foundation
https://www.lazarex.org/
Their focus is on helping patients overcome the financial burdens involved in joining a clinical trial. Exciting that they say they even help with the other costs, like hotels and taxis to and from the appointments.
Challenge: not sure yet, still in the process of completing paperwork.


In the mean time, I have had a few wonderful people reach out to help with flights. Emily Bennett Taylor, stage IV lung cancer survivor, offered to buy me a plane ticket to Colorado. (If you have never read her story, you should. It is amazing. https://embenkickscancer.wordpress.com/) She said that a lot of people helped her during her treatments, and she wanted to pass along the kindness.

And then! The awesome person and excellent musician Zoe Keating gave me some of her miles to help with flights. Zoe and I became friends when her husband was going through treatment for stage IV lung cancer. He has since passed away. Cruel disease, this is.

I’ve met some of the most amazing people because of this horrible diagnosis. It’s the club no one wants to join, as they say.

Enough

We returned from our marvelous vacation last night, the first time the five of us have taken a vacation together (please, please don’t say it will be the last).

My high point of the trip was visiting the beach where Jason and I got married, and introducing our children to the ocean.

I wanted to catch that moment and hold onto it forever.

If I stayed here all day, all week, all month, would it be enough?

When I was diagnosed, I hoped I would live long enough to see my son start kindergarten.

If only I could stay alive long enough....

Then I hoped to live to see my girls enter kindergarten.

Stay alive long enough....

Now I hope to see my son into middle school.

But I’ve realized it will never be enough.

Even if I make it another 11 years so they all become adults, I will still want more.

Being so very aware of mortality is painful and poignant and achingly nostalgic. There will never be enough of this life.

So I cling to the sunshine and memories from our glorious week and let those carry me into my terrifyingly hopeful week of testing and (if all goes well) experimental cancer treatments. Almost overwhelming, but fortune favors the bold, as they say.

I have a few good luck charms from our vacation traveling with me.

And then, these showed up on my porch this morning, from my dear friend Lily. Ruby slippers for my trip to Oz.

Last Great Hope

When I was first diagnosed with metastatic lung cancer in 2013, the situation was dire. Cancer has spread extensively throughout my body. The only option offered to me for treatment was chemotherapy, a triplet of chemicals which had a 1/3 chance of reducing the cancer, and a 1/3 chance of holding it stable. The last 1/3 was left up to my imagination. Even with treatment, they expected I had about 8 months to live.

Thankfully, fortune smiled upon me and we discovered that my cancer was driven by a ROS1 mutation. This meant that we had a whole new line of attack: we could try to stop the cancer right at the source.

Since November of 2013 I have been taking daily pills that target my ROS1 mutation: Xalkori for 4 years (which worked like a charm, except for a few pesky brain mets, the known weakness of Xalkori). Next were the 11 bumpy months on entrectinib, where slight changes in the brain mets left my doctors scratching their heads after each MRI. Progression vs radiation necrosis, so hard to tell. Then Lorlatinib which didn’t seem to do much of anything.

That brings me to where I am now: TPX. My Last Great Hope.

All of your star-wishing (and a fair bit of persistence) must have worked, because I have secured a spot in the clinical trial! That is, assuming I pass a battery of tests on February 12. And I won’t really believe it until I take the first pill.

I know that I am not completely out of options if this drug fails me, but it brings me to the end of the line for ROS1 targeted drugs. There have been great advances in immunotherapy since my diagnosis, so there are more thing to try. But I’m sure hanging a lot of hope on TPX.

So, wish me luck passing the tests to gain entry to the trial, and then hope it works!

But first - the family is headed to California to make some memories!! Cancer needs to take a back seat for a week. This is family time!

Return to Oz

I woke up last Wednesday to a phone call from my oncologist confirming that the MRI I had just had showed that, while it was slight, my brain mets are progressing. My fancy new TKI (tyrosine kinase inhibitor - a drug targeted to my ROS1 mutation), Lorlatinib, was not holding my cancer in check. The next best chance for me was to get into a trial for the newest TKI in development, TPX-0005 (it is actually far enough along now in development that it has its generic name, repotrectinib, but I fell in love with it when it was just TPX, so it will always be TPX to me). The nearest site for this trial is at the University of Colorado, a powerhouse for ROS1 research. My longtime readers may recall that back in 2014 I took a trip there, my journey to Oz to meet the Wizards so that I could learn more about my newfound mutation.

With all of this on my mind, I got up and starting figuring out how to stay alive.

Actually, that’s not true. The first thing I did was get back in bed and get under the covers. Sometimes, this is a lot to take in.

THEN I got up, and called to get a copy of my latest MRI. My oncologist is wonderfully thorough, and asked that I take a disc to my surgeon at Karmanos, in case he had any other thoughts or ideas. I collected my disc and delivered it to Karmanos.

I actually managed to wait a full 24 hours before contacting the Wizards (who I have come to know in the years since my visit to Oz, because of my work with the ROS1ders). I knew my oncologist was taking care of setting up the trial for me and I was trying to let things happen the way they are supposed to ... but then I had to email them. This is my survival, after all.

And I got Out of Office replies from both! Crap crap crap. That is probably why my oncologist hadn’t given me an update yet.

And then, a few moments later, a magical reply came from one of the Wizards. He connected me with the people who do the enrollment for the trial and gave me some warnings for where things can get tripped up.

The next morning I was on the phone with the wonderful trial coordinator, my Glinda, going through part 1 of the trial consenting. One tricky part of this trial is that they want a tumor sample. No problem for me, I thought, I just had a chunk of tumor removed from my cerebellum. So I signed the consent to give Glinda permission to collect my tumor sample and get me ready to consent into the trial.

All signs are pointing to yes! I start busying myself figuring out how to manage all the flights I will need to take (anyone used Angel Flights?) and accommodations in Colorado.

However, I keep saying to myself, I’ll believe I’m in the trial when I swallow the first pill. You may recall when I literally had the pills in my hand and was not allowed in the entrectinib trial? Clinical trials are capricious beasts.

Unfortunately, tracking down my tissue has proven to be more difficult than I expected. I told her that my surgery was done at Karmanos, but my main hospital is the University of Michigan. She contacted them, but Karmanos said that they sent my tissue off for NGS (next generation sequencing, to see if I had acquired new mutations or if it was still just ROS1. Still just ROS1, by the way). She assured me that she can still collect it, but clearly it is becoming more time consuming.

AND THEN

Tuesday night I get an email from one of the Wizards saying that all of the trial spots are taken.

%#*%~%#?!

Total panic.

I’ve had my heart set on TPX ever since the summer of 2018 when my oncologist tested my cancer cells against all the current TKIs and found them most reactive to TPX.

I belong in this trial.

I reach out to my ROS1 sistas, Janet and Lisa (who I guess become the Scarecrow and Tinman in my analogy?). I get an appropriate string of swearing when I tell the news. Then they reach out to their connections to get the behind-the-scenes scoop about the trial. Their folks reply at lightning speed encouraging me to get on the waitlist; more spots are coming.

My oncologist confirms that he feels it is safe to wait a few weeks.

So now I wait. And dream of Oz.

When I’m anxious, I knit. Let’s just say I’ve been going through a lot of yarn.

My latest is a collection of octopus toilet paper cozies. I made one, then the kiddos wanted one in each of our colors. Then they wanted hats for them. M is excited that it matched the style of hat I made for her. The two in the back still need their hats. They will be done soon, trust me.

If you are wishing on stars for me, wish that I get a spot in the TPX trial, and that my cells were correctly predicting that this will be the drug that controls my cancer.

California Dreamin’

Jason and I got married in a perfect, tiny ceremony on the beach in San Clemente, California, then honeymooned in nearby San Diego. On each anniversary, we show our kids the wedding video, and every year they ask if they could see where we got married.

Our little crew has never been on a family vacation. Yes, we road trip to Minnesota every summer to see my parents, and while I find that wonderfully relaxing, it’s not really a family vacation.

There is an improv festival coming up in San Diego, and the League of Pointless Improvisers (the Pointless cast) got accepted to perform in it.

...do you see where I am going with this?

These past few months have been rough. Frankly, these past 5.5 years have been hard, but the last few months have been particularly challenging. And the road forward remains unclear.

So we decided, come hell or high water, we are going to California!

Jason pointed out to me that Disneyland and LEGOLAND are in California, too. I’m well aware what a challenging time this has been for Jason and I, but I’d be a fool if I didn’t recognize how hard this has been on the kiddos, too. They deserve some fun.

—

I spent today anxiously waiting for my MRI results, the first MRI after 6 weeks on my fancy new TKI drug, Lorlatinib. It is my third TKI, and I’d be lying if I said I wasn’t getting nervous that I’m on #3 of the 4 that have been developed for ROS1 (and #4 is only up to phase 1 in clinical trials). I called the cancer center and left a message, saying I was waiting for results. They said they would call me back when my doctor was available.

So 2 hours later I called again (I am bad at waiting), and they said they know I called, and they will call me back.

An hour later I just about jumped out of my skin when my phone rang. It was a nurse saying that my doctor would call me tonight, after he finished in clinic. That sounded terribly ominous, and I was shaking so much I felt like I could barely stand.

Finally, tonight, my doctor called.

Frustratingly, we are back in the vague land of “slight enhancements”. My doctor feels (and I agree) that it is too soon to make a call whether or not this drug is working for me, especially with such vague results, so I am staying on the drug and we are rescanning in 4 weeks. Back on the emotional rollercoaster. This is exhausting.

But we are going to California, dammit! A week to forget about all of this and just be together! Fun, family memories, and adventures await!

Pause

I am now 9 weeks post brain surgery on my cerebellum.
And 1.5 weeks post targeted radiation to my cerebellum.
And 4 weeks post-entry into my second clinical trial, the EAP for Lorlatinib, which we hope will control (dare we say shrink?) the metastases in my brain.

Right now, we are in a very pleasant phase I am calling ...

The Pause.

I don’t have another doctor’s appointment until my MRI on December 17, so until that time I am going to assume that all of these treatments have done what they were supposed to do, that my new clinical trial med Lorlatinib is holding my cancer at bay, and all I have to deal with are some pesky side effects.

I’ll take it.

In the mean time, I am enjoying trying to get back to some basic level of fitness (brain surgery followed by radiation really knocked me down, and I find myself huffing and puffing just from walking fast). And enjoying movie nights with my kiddos, planning for the holidays, soaking up laughs at Pointless, complaining about my new diet*, and appreciating feeling relatively well. I’m sure hoping for a lot of boring news from the scan and lots of boring months to follow. These past two months have been the hardest two of the whole 5.5 years (and counting!) that I’ve been in treatment for metastatic lung cancer. Boring sounds really good to me!



*one of the side effects of the new drug is that it makes your cholesterol and triglycerides go astronomically high. I am currently on a low-carb diet to see if I can get them to come down. I never knew I loved carbs so much. Or not having to think about what I can and cannot eat.

Radiating My Brain

I have completed treatment 2 of 5 for my targeted brain radiation. You may recall that, since there WAS living tumor in the section they removed from my cerebellum, we decided to radiate the perimeter around what was removed, in case there were any tumor cells there.

Well, let me just say that

Radiation

Is

Kicking

My

Butt.

Check out the imprint the super-tight mask leaves on my face.

It wears off after about an hour.

I was mentally prepared to feel wrecked after surgery; I was not so prepared for this. In addition to the exhaustion, I have had awful headaches and nausea. I talked to my Rad Onc about this and he said it was from brain swelling, and prescribed a course of steroids. Yay, more steroids. But if they stop the headaches, I’m happy to take them.

The upside of spending my life on the couch is that I have been doing projects like teaching my kids how to use the sewing machine.

It’s still Lung Cancer Awareness Month, and I still have lung cancer, and I’m still raising money to fund research specifically focused on my rare ROS1 mutation. I’m trying to reach $8,000 by the end of the month. Here’s the link: https://www.supportalcf.org/ros1/ToriTomalia

If Brain Surgery Wasn’t Enough

The good news is that my brain surgery recovery is coming along really well. I’ve even been approved to start driving again, so Jason is taking me out for some driving practice this weekend.

However, life with metastatic lung cancer continues to keep me on my toes. I’ve been in seemingly endless doctor appointments, and the plan now is to do targeted radiation to the area surrounding what was removed from my cerebellum. I am also moving to a new targeted medicine, Lorlatinib. Hence, the endless doctor appointments.

I had my penultimate appointment for the Entrectinib trial, and I am currently going through the washout period in preparation for the Expanded Access Protocol trial for Lorlatinib. As you may recall from my Crizotinib washout, the withdrawal from these powerful meds is remarkably painful. Every muscle in my body is aching, even muscles I didn’t know I had.

On Monday I have the radiation planning appointment. There will be 5 radiation sessions, every other day, beginning the following week. The main side effect is fatigue (but I’m not even over the fatigue from the surgery yet!).

I am due to begin the EAP of Lorlatinib on Tuesday or Wednesday, with all the side effects that come along with that. One of which is fatigue. Oh my!

Don’t get me wrong - I am immensely grateful to have treatment options.

I am grateful there is another targeted med for me to switch to. (And another in trials after this one.)

I am grateful that I am well enough to withstand all this treatment.

I am immensely grateful for more time with my family.

But I have to admit that this has been a lot to deal with. I know that every day I am in treatment is another day I get to live, and for that I am grateful. But some days this is almost overwhelming.

I am very grateful for the support of my community - support that I am going to have to lean on again over the next few weeks.

Thank you so much to all the folks who brought meals to my family during my recovery. It is such a comfort. I can’t help but share this particularly adorable themed meal we received. Great work, Jennie, and it tasted great, too!

In other news, November is Lung Cancer Awareness Month. The ROS1ders are raising money for more research into treatments for our rare cancer. I started this fundraiser back in 2016, for my 40th birthday - and we raised over $6,000! I am reviving it, and hoping we can hit $8,000. Here is the link to donate: https://www.supportalcf.org/ros1/ToriTomalia

Also - make sure you get out and VOTE on Tuesday. As a naturalized citizen, I take voting very seriously. So seriously, in fact, that I voted absentee and mailed in my ballot at 4 am, just before we hit the road for my surgery. I didn’t know what kind of shape I would be in on November 6, and there was no way I was going to miss voting!

Home Home Home

I made it home Saturday afternoon and am now slowly rebuilding my strength surrounded by my beloved family.

The surgery went well and without complications. We won’t know for sure until we get the pathology report but the surgeon said the feel of the tumor led him to believe there is still live cancer in the section he removed, rather than all necrosis. So that’s a bummer, and may mean more targeted radiation to the area left behind. But we will cross that bridge when we come to it.

This was one of the scarier hills I have tackled over my 5+ years with metastatic cancer. There is an awful calculus that patients go through, deciding what we would be willing to give up for more time on earth. What deficits will we accept for more days? What makes life worth living? What risks will we accept for the hope of another year?

The amazing Jason stayed by my side at the hospital, sleeping (or attempting to sleep) in a non-reclining chair, which frankly doesn’t seem possible at all. But I dearly appreciated his company as I transitioned out of the weird post-surgery twilight into the early steps of recovery.

Now that I’m home, I’m totally focused on recovery. The main things are regaining my steadiness, balance, and coordination. There are subtle changes that I’m noticing, like how my handwriting looks different, though I am very pleased to see that I can still knit. Overall, I’m having to learn to move at turtle pace, rather than my preferred lighting speed. An interesting perspective shift which is probably a good life lesson. As always, I’m not sure why I have to find such hard ways to learn these lessons.

I am looking forward to tapering off these steroids and the messed up sleep and puffiness they bring.

Check out my amazing post-surgery hairdo! My Mum spent a solid hour soaking out the glue that had held the sensors in place, and which had dried into gooey, itchy chunks. She is staying with us for a bit and her help has been invaluable (far beyond just getting glue out of my hair).

The support from folks has been absolutely vital and humbling. The meals, the puzzle books, the well-wishes and prayers. All of these have allowed me to focus on healing, knowing I have a community pitching in to help! If you still want to sign up, I’ve added a few more meal requests to the Lotsa Helping Hands site. We are the “Tomalia Support Team” and our zip code is 48104.

Batten Down the Hatches

I saw my surgeon on Monday and all systems are go for brain surgery on Thursday, October 4.

I’m oscillating between being incredibly nervous and remarkably calm.

Acute recovery will be anywhere from 2-5 days in the hospital, and he estimates 4-8 weeks of slowly rebuilding my strength. His calm demeanor is buoying my optimism; he kept saying this is straight forward and he doesn’t anticipate any problems.

In the mean time, we have been trying to get everything ready at home, for the family, the kiddos, the business. I’ve been feeling a very literal need to get my house in order to prepare for this event. As a fairly behind-the-scenes person, I feel like most of what I do is make sure things keep moving smoothly - like a player in curling, rushing about sweeping a clear path for that granite stone to get where it needs to be.

As the surgery nears and my to-do list gets shorter, the primary thing I need to do is hand over the reins to all the trusted members of my team. A strange and liberating feeling.

Many heartfelt thanks to all the people who have reached out to offer help, meals, prayers, and well wishes. My friend Meriah is organizing all of this through Lotsa Helping Hands, so if you would like to join the “Tomalia Support Team” to learn about practical ways you could help, visit the website and you can learn more (our zip code is 48104).

I will happily accept any thoughts and prayers for strength to me and my family, and for my surgeon to have steady hands and a clear mind on Thursday!

It’s been a rough year.

For those of you dear readers who have been following my ongoing health drama, you may recall that in December 2017, a new little brain met showed up, a known weakness of my 4 year awesome medicine, Xalkori. Rather than use the fancy SRS I had the previous 3 times this happened, we decided to take the leap and join a clinical trial of a new ROS1 inhibitor designed to include the brain in its field of treatment, as it is designed to cross the BBB.

You may recall the agonizing washout period required by the trial (and of questionable value) plus the added complication that my liver values shot into the stratosphere and forced me to be off all cancer treatment for an awful 18 days.

You may recall that I happily popped those first clinical trial pills (good old RXDX-101) on December 26, 2017.

You may recall that there was a huge clusterf&@$ in March when my brain MRI was misread and I was unceremoniously ejected from the trial without a follow up plan.

And you may recall that I fought my way back onto the trial, finally getting people to listen to me and re-evaluate that MRI.

Since then there has been an ongoing debate about those pesky old brain mets.

Settle in, this is a long story.

Every 8 weeks I have a battery of tests, per the clinical trial. And every 8 weeks a panel of experts convene to mull over my puzzling MRI results. The mets don’t really appear to be growing the way tumors would, but they haven’t been shrinking either. And there is quite a bit of swelling around each, which can either be a sign of tumor growth or radiation necrosis (sort of like scar tissue caused by the SRS treatments). Each time the experts have agreed to stay the course and see what the next scan reveals.

After my July scan, my oncologist called on a trusted colleague from Karmanos, asking him to meet with me and review my brain met history and puzzling scans. We meet in August and he suggests we gather more information about what we were actually dealing with, suggesting I get a PET scan of the brain. But wait, you ask, in all these years of cancer treatment, they have always said that PET scans don’t give enough detail of the brain to determine if there is cancer since so much of the brain lights up from basic activities of living. His suggestion to use a PET scan involves a clever bit of reverse engineering: if the spots in question have LESS than normal uptake, that would give us a clue that they were in fact dead tissue (meaning the spots are radiation necrosis).

So, I had my PET scan. But they actually just did a PET of my body, not the brain.

Ha ha ha. Of course.

They did the wrong scan.

Seriously.

The good news is that the PET of my body showed no increased uptake, meaning the clinical trial drug is doing just what it is supposed to be, and is effectively inhibiting the cancer in my body.

Let’s pause and appreciate this really good news.

Now back to the scheduling fiasco. They need to do a BRAIN specific PET scan, and the first available is on September 10. I take it.

My regularly scheduled August 31st MRI raised a few more eyebrows, in part because the radiation tech put actual measurements in the report (instead of the infuriatingly vague words like “enhanced” and “increasing”). They measured the met in the cerebellum as 2.4 cm, increased from 2.0 cm in the last scan. Well, this was a surprise to me, to see some actual significant numbers. When you are talking about the brain, 2.4 cm is into territory where you might need to make some serious moves. Specifically, brain surgery.

I spend the final holiday weekend of summer trying to soak up as much relaxation time with the family as possible. And trying not to think about a growing mass in my brain and the prospect of brain surgery.

My oncologist again connects me with his most trusted surgeon at Karmanos, who asks that I deliver the most recent MRI films to him on Tuesday so that he can get a look at what we are facing. I try to keep my wits while my daughter has a meltdown at drop off on the first day of school. I calculate how long it will take to get to the U of M, get my scans on disc, and get them to Karmanos and into the surgeon’s hands.

I successfully deliver the goods. (And my daughter loves school and her new teacher by day 2.)

Meanwhile, I am scared out of my mind, knowing that there is something growing in my brain, something big enough that they feel it needs to be surgically removed. I am told that if it isn’t causing symptoms yet, it will. And let me tell you, that if people keep asking if you are having any neurological symptoms, it’s really hard not to start wondering if maybe you ARE. Is my balance off? Why am I getting a headache? What is that pressure in my sinuses? I ended up calling into the hospital Saturday night because I had a headache and didn’t know how seriously I should be taking it. (She reassured me that the pain I was describing was not the sort of neurological symptoms that would warrant rushing to the ER.)

I am scheduled to have a consult with my fancy Karmanos neurosurgeon that Monday. He confirms that I am not having the troubling neurological symptoms that would warrant immediate action. He plans to take my case to the tumor board on Wednesday, and wants to know the status of that brain PET.

If you have been following this lengthy story with a calendar at your side, you will realize that my brain PET is scheduled for the next morning. “Is it possible for you to get me that scan so that I can review it before the tumor board meets on Wednesday?” Of course it is.

So I do the PET scan bright and early Tuesday morning, wait several hours for it to burn to disc, then head to Karmanos. I walk the disc to the front desk, and plead my case, reiterating that this NEEDS to be uploaded and available for my doctor by the end of the day, so that it is ready for the tumor board meeting. They assure me it will happen.

Wednesday passes without incident.

Thursday morning I get a call from my neurosurgeon’s PA, asking why I never delivered my PET scan.

Ha ha ha ha ha ha. You can’t make this stuff up.

She eventually tracks it down (it was still sitting at the front desk), and says that the tumor board discussed my case without the PET scan, and felt that even if it is 100% necrosis, it is just too big to leave sitting around. So, brain surgery it is, first week of October.

As a side note, I did eventually get that brain PET read, and this line was music to my ears: “sites identified in the MRI do not have distinct increased metabolic activity, in fact, metabolic activity is at or below the level of cerebral white matter.” Which means there is decent reason to believe that the drug is working in my brain, too, and the remaining spots on the MRI are just necrotic tissue.

Now I am on a cocktail of dexamethasone, trental, and vitamin E to try to bring down the edema before surgery.

In addition to the mind boggling logistical nightmare of having cancer (it really is a full time job), these past few weeks surprised me in how absolutely shaken-to-the-core terrified this made me. I thought I had developed a thicker skin after five years dealing with metastatic cancer, but the prospect of brain surgery really shook me up. There is that familiar, unsettling feeling as I look around at everyone acting so normal. Don't they know the whole world is being turned upside down?

My kiddos' responses were each so completely them.

• (Eyes filled with terror) No Mama! I don’t want you to have surgery!!!

vs.

• (With a casual shrug) It’s okay, I know they’ll be careful.

vs.

• (Long pensive moment, eyebrows raised) Brain surgery. (Thinking, thinking) Well, these are trained professionals, right?

Now I am going through all that I do, trying to put plans into place to make sure our little ship keeps sailing even when I check out for several days/weeks.

This is a very long post. Well done, those of you that have made it this far. It has been an enormous amount for me to process and I am only really coming to terms with it now.

Wish me luck.