My amazing, generous, understanding employer

    I am remiss in not acknowledging the unfettered support from my workplace during this journey with pancreatic cancer.  Many of you don't even know that I have been working in the billing/insurance department of a dental clinic called Smilebuilderz since July 2011. Our website is here. Don't look for me in the group photos as we just took new pictures last month and the website is undergoing a revamp which will include the new photos.
     Smilebuilderz is a full service, one-stop, one-shop, full service dental practice offering hygiene, periodontics, endodontics, orthodontics and oral surgery services. Dr. Anthony Skiadas, a Lancaster County native, and Temple University dental school grad, opened the office in 2006 that today - after only 5+ years - boasts 30,000 patients. Yes, you read that right.... 30,000! Needless to say, this business is on the fast track. As you can see below we were ranked #12 in the Central Penn Business Journal's Top 50 Fastest Growing Companies in 2010. We have since moved up in the ranking, but I'm not sure where. We now have over 140 employees, including about 15 doctors.
     We just opened the only urgent care dental clinic next to Lancaster General Health's urgent care clinic in Lancaster. We plan to open another clinic in Ephrata by Jan. 1, 2013. Very ambitious growth plan. As you may imagine, this kind of growth comes with some problems, so it is very interesting to be part of it.

As you can see, my job title is "Billing Specialist" which is a little far-fetched since this is whole new learning experience for me. My duties include sending claims, pre-determinations, entering payments, pre-determinations, reviewing ledgers, and answering phone calls from patients and colleagues. Although very fast-paced and working mostly with members of generation X and generation Y, it has been a great, although humbling, experience.

    Anyway, everyone working there from housekeeping to Dr. Skiadas has given me incredible support and latitude with my schedule to accommodate my daily radiation and weekly chemo treatments. I can't tell you how important it has been for me to have the freedom to work the hours that suited me. Being able to keep working gives me a sense of purpose and "normal" life. It would be tough to be unemployed, moping around at home. Throughout treatment, I've been working mornings totaling 25-30 hours a week. They also allow me to travel at will for family trips to Seattle and upcoming to Freeman the end of March and Adam and Annie's wedding in Mpls. in June. Pretty cool, huh?

     They passed the hat and gave Barb and me a variety of gift cards and cash. Dr. Skiadas gave us a very special gift of an iPad2. You just don't get that kind of support at every workplace. I feel very fortunate to have received this kind of encouragement.

      Also in the good news column. I had my last chemo of this regimen last Friday. HOORAY!!! I am off all the antibiotic pills and don't have any sideshows open except for nausea. I have only three more radiation treatments, the last on this Thursday. I am really looking forward to being away from treatment and allowing my body to "heal" for about four weeks.

     One frustration is that we don't know how I've responded to the treatments. We don't expect a cure, but would like to know if the tumor has shriveled up into a little crusty spot or is still fat and sassy. The docs say to wait until after the heal-time to have a CTscan to look inside me.

    Here is a quote that likely appears often in cancer blogs, but summarizes my thoughts about cancer treatment: 

    "If you're going through hell, keep going."  —Winston Churchill

     Thanks for all the prayers, food, gifts, cash, thoughts, etc. Very nice to have and sure do help me "keep going".

No news is not necessarily good news

     Just when I was thinking I had experienced most all the side effects possible from chemo and radiation three new sideshows opened their curtains this past ten days and have left me feeling mostly unwell:
     #1. Friday, Feb. 10, Dr. Yee said my white cell count was too low and I needed a series of five shots (Neupogen) starting Saturday and Sunday (two extra trips to Hershey) to stimulate proliferation of white blood cell out of my bone marrow. The last three of these shots where coordinated with my scheduled radiation trips.
     #2. Sunday morning, Feb. 12, I woke up with my right forearm feeling bruised. I looked down as I was eating a light breakfast and noticed this red patch over the "bruised" area and immediately recognized cellulitis .... AGAIN! This time in my arm. My head and heart dropped as I really was discouraged by this new issue. I called the on-call fellow at Hershey who prescribed more antibiotics (amoxicillin/clavulanic acid) for me to take for ten days. I picked up the Rx when I went in for my Neupogen shot.
    Tues., Feb. 14, I went to work but came home too sick to make the trip to Hershey. I keep busy dealing with and fighting diarrhea. I regularly take anti-nausea and anti-diarrhea pills, but I am feeling ill.
    Wed., Feb. 15, Dr. Mackley orders my stool to be checked for intestinal infection.
     #3. Thursday I learn that my poop tested positive for C. diff (Clostridium difficile). Those of you in the health care business know what this is, but it was all brand new term to me!!! --- an intestinal infection caused by the loss of natural gut flora when taking antibiotics. I was ordered to stop taking Imodium so the C.diff can "pass through".
     This has not been fun. I guess it DEPENDS on what you call fun. It DEPENDS how you like to spend much of your time. It DEPENDS on what level of dignity you can live with. I have been weak and really lacking any pep. Small tasks, such as making blog entries, loom large. 
     Yesterday I told Barb we forgot to ask the doctor what is left on the side effects plate for me to sample. Today she washed my bedding and found a bigger basket to hold all the damn pill bottles. What a sweetheart!!! Pray for her health as well as mine, 'cause I need her.
     I am very much ready for a week of simple nausea. I am supposed to be excited by the fact that I have completed 19 of 28 radiations (two-thirds over) and only one or two chemo infusions left until I get a four-week break for my body to "heal". I can't put my finger on it, but the toll of the treatments has failed to elevate my enthusiasm for these "landmarks" or supposed "feel good" points along the way.
     Good news: my arm cellulitis is 90% gone and my white cell count was up yesterday so I got chemo infusion, although reduced to 50% because my platelet count is low. I look forward to "eliminating" C diff.
     All this hoopla begs the question: Is the treatment working? We don't know and won't know until a CT scan near the end of March near the end of my healing time. Thanks again everyone for your concern. It helps me along this journey of dealing with the real and although this has been a "pity me" post, rest assured that your prayers and help have made the "real" easier.
     

Hardware implant

     We got home from a long day — with long waits — at Hershey to remove my plastic biliary stent (translation: bile duct tube) and replace it with a new one. The plastic one gets gunked up and has to be replaced every two months.
     Good news: I have a brand new good-for-life metal stent. It came with an important -looking official ID card to put in my wallet to show people whenever I feel like bragging about having an "Implanted device", I guess. It is 8 mm x 80 mm (.3"x3").
     Bad news: my pancreas is complaining. My hope is that it doesn't go into a full-fledged hissy fit and send me back into the hospital. I pray it will "cool down" overnite.

     Here are some photos of my beautiful bile duct. On top is the old worn-out stent. Below are pics of the new metal one. Notice that it is not a solid piece of pipe, but a mesh. The odds are very high (I forgot to get the actual odds) that this will never need to be replaced or fall out.
     Yes, I was sedated to sleeping to have this done. I was not intubated, but kept breathing on my own while they stuffed a tv camera and tools down my throat, esophagus, stomach and duodenum.
     I thought I might go to work tomorrow, but feel like staying home to recuperate. I am not supposed to make any important decisions until 24 hours after the procedure as it takes that long for the sedatives to wear off. So if this post is full of dangling participles, blame it on the drugs, please.

Goodbye leg infection.. hello compression socks...

     It appears the cellulitis in my left leg has faded away. And the rash caused by the cephalexin is gone as well. I finished the last of my amoxicillin pills today and hopefully I can take a long vacation from taking antibiotics as I don't like what they do to my GI tract!
     Yesterday I had radiation, chemo and a consult with Dr. Yee. He said we're sticking with Gemzar for chemo treatment but have to watch that my legs don't swell and get infected again. He asked me to wear compression socks to help the circulation in my legs and thwart future leg problems. It seems like every visit brings about a new adventure. I am ready for these new experiences to taper off/end.
     On the drive home from the treatments in Hershey yesterday I became quite alarmed when it appeared I was experiencing a new side effect from the radiation and or chemo. While I was riding in the very nice Honda Odyssey owned and driven by my friend David Fogarty-Harnish my ass started getting warm and feeling like it was aglow. First, I imagined that the radiation had gone amiss. Then other scary thoughts came to mind such as the chemo was settling in my arse and burning it up!!! The longer I sat there, the hotter it got. Finally I had to tell David about this phenomenon. He said the van has heated seats and it must have accidentally been turned on. I looked toward the floor and sure enough, I had accidently bumped a rocker switch to "on" when I laid my pocket folder on the floor. What a relief that was!
     Today I felt great all day. I took anti-nausea, anti-diarrhea, anti-gas, anti-blood clot, anti-itch, anti-bitch and anti-hypertension pills in the morning to prepare for an exciting day.
      Barb and I were treated to a Flyers hockey game at the Wells Fargo Center in Philly by our friends Dave and Bonnie Moyer of Souderton, PA. It was great fun even if the Flyers ended up in a deep hole 0-6 to the New Jersey Devils after the first two periods. (There were some officiating issues ... a "no call" [tripping] that turned the tide of the game). But the final period was very exciting with the Flyers scoring four unanswered goals. With five minutes to go in the game it looked like the Flyers may come back and tie or win the game. But it was not to be. Final score 4-6 Devils win.
     After the game we ate dinner at Flanigan's Boat House in Conshohocken, PA, where I had mussels for the first time in my life. I liked them very much.
     Thank you everyone for your support and kind words of encouragement. I leave you with a great quote shared with me by another friend, Ed Martin, while he drove me to radiation and back last week. It made my day.
           "Not everything you read and see on the Internet is true."
                                                                —Abraham Lincoln
   

Another sideshow.....

      Just when I thought I had turned the corner on the cellulitis in my legs, something new rears its ugly head — an allergic reaction to Cephalexin antibiotic in the form of an unpleasant itchy near-full-body rash!!! Benedryl tabs are helping control the itch, but it is not pretty. This is my first every allergic reaction to any medication. I've always been able to say "none" to allergies to medications. Now I have a known allergy to a medicine.
      I have come to call these annoying ailments "sideshows". Cancer is the featured malady under the big tent, but I have collected a large assortment of sideshows:

• pancreatitis
• diarrhea
• headaches
• nausea
• cellulitis
• deep vein thrombosis
• itchy rash

Enough already!

I'm lucky I didn't have a heart attack to add to the list when I saw the cost of a 30-day supply of this blood thinner med. Holy Cow! The $ sign is missing, but you can see it's costing me only $1/day and insurance is picking up the rest. It's my contribution to hog farmers, as this generic form of Lovenox is "derived from porcine intestinal mucosa in Water for injection". I have to inject it into my "love handles" once a day.
Another pork product I am buying is Creon which is made from pork pancreases. I take one or two whenever I eat because it contains the digestive enzymes I now lack because my pancreas is sick. Thank you hog farmers everywhere.

On the other hand.....this is the drip antibiotic that was used to stop the cellulitis while I was in the hospital. While visiting me, Pastor Barry Kreider noted it appears to have been on sale for $1.28 at Ollies (sorry, it's a PA inside joke). 

      

On using the language of war ...

     Born and raised Mennonite, and attending Freeman Academy (a Mennonite high school) and Freeman Junior College (RIP), I learned and still espouse the fundamental peace and non-violence tenets of the anabaptist faith. I was reminded this week of the prevalence of war language in cancer blogs.
     So I find it fascinating how easily - maybe pleasurably? - I hear and use words of war to write about my battle with pancreatic cancer. Dealing with the real is to "fight" this Emperor of all Maladies (more on this fine book in another post).
     I returned from the hospital late Friday afternoon with much-reduced redness and swelling. While there, they brought out the big guns (antibiotics in the penicillin family) to fight and kill the infection in my legs. While there I learned I have another problem: deep vein thrombosis behind my right knee. But it was my left leg that was most infected and swollen. Both legs needed to be attacked with a platoon of antibiotics.
     When I was in the hospital last month with pancreatitis they brought out the heavy artillery to kill the pain.
     I take chemo to kill the enemy tumor. And I don't care if the chemo molecules urinate on the corpses of the slain cancer cells! In fact, I would take delight in that. My kidneys are still good.
     When radiation therapy radio beams are properly aimed, they hit the target, they bombard the adenocarcinoma with radiation to control and kill the cancer cells.
     You get the idea. While this language may imply that I have inner, cooped up anger and rage, in reality I am mentally and spiritually at peace with my situation. It's the language in common use, so I use it.
     Like many upstanding Mennonite men (maybe that doesn't include me, poor intro there...), I have pent up emotions about guns and violence. I think guns are cool and wish I had a collection of them to admire, handle and shoot. They really are fun to shoot. I think all Mennonites - men and women - should shoot guns frequently to release all those suppressed inner feelings of violence. I think church youth groups should have actual skeet and target competitions and make pledges to not play any video games.
     However, I also confess guilty pleasure in much theatre and film which has "meaningful" violence. I abhor the gratuitous violence of many films, tv shows and video games.
    Oops, I got waaaayyyy off track here. I am at home with Diarrhea while Barb is out leading a workshop. Don't tell her I am cheating on her.
     Thanks, everyone, for rooting for me. I know it helps.
     I leave you with this poem, extracted from Emperor of all Maladies:


               Physicians of the Utmost Fame
               Were called at once; but when they came
               They answered, as they took their Fees,
               "There is no Cure for this Disease."
                                                      —Hilaire Belloe

Back into the hospital

My legs are very swollen and infected so Dr Yee said I need an IV antibiotic. It looks like 2-3 Days in the Hershey horsepistol for me. I am doing this on an iPhone and my thumbs are WAY TOo BIG!! I have a long ways to go to thumb type like I've seen young folks do. Good night.