Friday, December 12, 2008

Survey Says......

*ding-ding-ding-ding-ding!* It's a WINNER!!!!!

Dr. O'Reilly was "very pleased" with the results of Dad's scans. Despite the fact that adenocarcinoma is a chemo-resistant cancer, Dad has proven that he's a super-hero once again. He and the chemo have arrested the development of the disease - stopped it in its tracks, really - and even caused it to back up a bit. And all in only 9 weeks. I am totally in awe of him.

Basically, the scans showed no new cancer growth and his Ca 19-9 marker, which is the marker for pancreatic cancer, is down by more than 50 percent from its pre-treatment levels. The largest lesions are a little bit smaller and the small lesions haven't grown at all. His lungs are clear.

These are all HUGE wins for us. We're so happy!

We've got good momentum going right now, so we're going to keep it up and jump right into another course of chemo. Dad starts up again next week. This time we're going to do 4 sets instead of 3, again doing two weeks on and one week off, and we'll have another set of scans 12 weeks from now. I have high hopes that we'll see further regression after the next round, and maybe we'll get the main lesion to drop back enough that it becomes operable. That would be incredible!

After the appointment, Mom, Dad and I did something we haven't done in a very long time. We hung out. We went to St. Patrick's Cathedral and gave some heartfelt thanks and checked out the gorgeous Nativity scene:

and the Christmas wreaths:

Then we went to Rockefeller Center and visited with the Christmas Tree (it's very big and very pretty):

We watched the ice skaters slip and slide all around the rink (it's very small - much smaller than it looks on television):

We peeked at some of the department store window displays (much better this year than last), and then we went out for lunch.

I haven't gone out for lunch with Dad in MONTHS, and I have to say, although I've eaten in some pretty amazing restaurants, no meal has ever tasted better or been more enjoyable than the meal I shared with my parents today.
As soon as we finished lunch, I sent Mom and Dad home and headed back to my apartment. I was so excited to log on and share the good news with all of you! We have been so blessed with the support we have received - I know it has made a difference in our ability to march forward with this battle, so let me take this moment to say again to every person reading and praying and thinking good thoughts for us - THANK YOU. We could not be doing this alone. May you all feel as blessed this holiday season and throughout the coming year as we feel today.
Peace to you all, and Happy Holidays too!

It's Results Day!!!

I'm not excited or anything... although I did wake up, jump out of bed, plug in the coffee pot, turn on the shower and then notice that...

the dogs were sound asleep instead of staring hopefully at their food bowls...

the cats were were playing Kitty-Wrestlemania instead of snoozing on their kitty tower...

the windows of the apartments around my own were still pitch black...

and I realized that it was 1:00 AM and I was 5 hours early for the start of the day.

But I'm not excited or anything. Nope. Not at all.

I've gotten lots of e-mails extending good wishes. Thank you so much - I'll pass them on to Dad when I see him in a couple of hours!



Tuesday, December 9, 2008

The Scan is Done!

Now it's time to:

think your good thoughts,

say your prayers,

rub your lucky Buddhas,

tap your doorframes,

click your heels,

wear your rally hats,

shake your voo-doo beads and

do whatever else you do to channel good results.

All Eyes are on Friday at 10:45 AM EST!!!!!

Monday, December 8, 2008

Happy Holidays from Team Oberle!

We've finished our third set of chemo (I say, as though we're all popping the nasty little pills together), and overall Dad has tolerated the treatments remarkably well. He's had very little nausea, primarily because he has been vigilant about keeping food in his stomach, even when he hasn't felt like eating. Back in October, I looked up chemo nausea and found that chemo-related nausea strikes people as follows:

1. Young people get more nausea than older people. (What is the definition of "older"? That's anybody's guess. Now that I'm cruising down the south side of 35 and 40 is looming large in my sights, I'm going to draw the line at 65)

2. Women get more nauseous than men. (good news for Dad)

3. People with a history of motion sickness are more likely to have nausea. (again - score for Dad)

4. People who have previously had chemo are more likely to have nausea. (Dad's a chemo-virgin, so that cuts in his favor)

5. Non-drinkers of alcohol are more likely to have nausea. (I think we're all good here)

So I was pretty confident that Dad wouldn't spend his course of treatment with his head down the toilet, but it's been nice to have the reality comport to the statistics.

Chemo side effects are cumulative, so he was definitely feeling the drag of the toxins by the end of the set. Actually, he seemed more beat up over Thanksgiving, which was a tough holiday (it's kind of hard to get into a "feast" day when you can't eat properly), than he was this past weekend (when he was carrying Anna Lee around the house on his shoulders, even though she weighs almost 40 lbs!!!).

Although nights out usually cost him dearly in terms of recuperation time the following day, this past weekend he partied on Saturday night and seemed little worse the wear for it on Sunday. Mom was worried that he was quiet at the start of the evening on Saturday. She feared he wasn't feeling well, but I think his mood was more to do with me than with chemo.

We were all heading to a party, and after Mom and Dad locked up the house and pulled away, I decided I needed one more thing from the kitchen, so I used my handy-dandy house key to let myself back in. It took a few seconds for my pregnancy-addled brain to process the piercing beep-beep-beep that accompanied my opening the door, but then it hit me - "Holy @$#%! They set the ALARM!"

I tried not to panic. Mom has told me the code at least fifteen (million) times. I found the key pad, popped it open and with shaking fingers proceeded to key in... my ATM code. It didn't work. This seemed to irritate the alarm and the beeping got more insistent. I panicked and jabbed at the keypad again, but (not surprisingly) Dan's ATM code didn't work either. Neither did any of the other number combinations that flashed through my mind, which included: my birthday, our home phone number, my social security number and my old high-school locker combination. Time ran out and the evening air was rent by the deafening shrieks of the alarm.

"I am in SO MUCH TROUBLE," I thought as I clapped my hands over my ears and raced around the house in search of a phone with which to call Mom. I planned to get the code from her and set all to rights without Dad ever finding out that I tripped the alarm. I hit three cordless phone charging stations, none of which had phones on them. Where was the phone?!?!? I found one under the dining room table (random) and picked it up just as the security company called.

"I'm not a robber," I screamed. "I'm their daughter. I thought I knew the code but I don't and..." then the phone, which had probably been off the charger all day, went dead.

"I'm going to jail," I thought as I raced outside to where Dan and Anna Lee were all buckled into the car. I grabbed my cell phone and called Mom. Dad answered.

"Damn!" I gulped over the same pit I used to get in my stomach when I was a teen, as though he was going to ground me or take away my telephone or something.

"I'm coming home!" he declared, and I had the mental picture of him doing a Dukes of Haazard-style fish-tailing U-turn in the middle of Phalanx Road.

I raced back inside, put the dead phone on a charger and found a working one, by which time Dad and Mom were back in the driveway. Mom was on the phone with the security company, trying to vouch for me (not an easy thing to do). Dad tore into the house and disarmed the alarm. The sudden silence was dizzying.

Dad turned to me. "I can't believe you didn't remember the code was..." and then he proceeded to rattle off a combination that he and Mom started using ten years after I moved out of the house. Thanks, Dad.

Never one to miss the opportunity to teach, he had me set and disarm the alarm twice before he would let me join my family in my car. I am now confident that I know the code, but just in case, I hereby vow that I will never key myself into their house again.

Mom was *still* on the phone when they pulled out of the driveway for the second time, and as Dan put the car into gear and started to follow them, we heard an unfamiliar phone ring.

'What is that?" Dan asked.

I dug into my pocket and withdrew... Mom and Dad's cordless phone.

"He's gonna kill me," I said.

"Probably," Dan replied, "but you're not going back to put it away. It's coming with us to the party."

And it did.

Sunday we celebrated Anna Lee's third birthday and the end of this round of chemo. Dad seemed to be feeling very well, and he was kind enough not to make a single mention of the alarm debacle all day long. Maybe he's getting mellow. Nah.

As I sat with him in the kitchen, I took a moment to marvel at how well he has tolerated his treatments. He hasn't gone bald, and I have to admit that at the start of this process, I steeled myself for him to look like:



His hairline got a little thinner on the sides, but frankly I have peers who have less hair and who are a lot more gray. It's getting harder and harder to convince people that Dad doesn't color his hair and he doesn't wear a piece. Perhaps he is part elf. I don't know, but he's looking very good.

Tomorrow (12/9) is the big CAT scan, and we'll get the results on Friday. I am confident that we are going to have a positive result. Even though Dad has suffered these past three months, we've seen a transition from him feeling cancer symptoms to him feeling chemo symptoms. I think this means he and the chemo are getting the edge on the cancer.

I'll be with Mom and Dad at the hospital on Friday, and will update the blog when we have news. In the meantime, please keep sending good thoughts and prayers our way - they're helping!!!



Thursday, November 13, 2008

Coming to the end of Set 2

We were back at Sloan-Kettering for IV treatment and to see Dr. O'Reilly on Tuesday. Being that it was Veteran's Day and 20,000 vets were scheduled to march in a parade on the East Side, I counseled Mom and Dad to take mass transit into the city. Dad, who would drive to the moon if somebody would just build the damned road for him, declined. After some extended debate, which took place over the course of three or four separate telephone conversations (once Dad's course is set, he changes direction with the agility and grace of a cargo ship), Dad saw the merit of my arguments and we agreed on a compromise. He drove to the Port Authority (thereby remaining the master of his travel destiny and satisfying his yen for zoom-zoom), then ditched the car for the subway. He and Mom got a glimpse of my version of Manhattan; they got from 34th and 9th to 53rd and 3rd during a midtown parade in 27 minutes and they never set foot above ground. I was so proud of them and more than a little bit smug about the success of my plan. Then, of course, Dad's treatment ran almost 2 hours beyond when we expected it to end, so he and Mom got crushed by commuters when they were making their way back to the Port Authority. He will probably never agree to take the subway route again, but I am proud of him - of both of them - for giving it a whirl.

Our visit with Dr. O'Reilly went quite well. Dad announced his much shortened list of symptoms and declared, with the pride of Sherlock Holmes solving a case, that he thinks he feels better because the chemo is working. Dr. O'Reilly paused but a moment before saying, "Well, yes - that was the plan from the outset, wasn't it."

I didn't laugh, but it took a lot of effort to keep a straight face.

Of course, with the symptoms abating, Dad wants to move at the end of December from the aggressive treatment phase of the chemo to the maintenance phase. Dr. O'Reilly gently encouraged him to be a bit more patient and to give the treatment phase some additional time. Patience, as I mentioned at the start of this journey, is not one of Dad's greatest virtues. There are those (Dan) who would say that this apple does not fall far from that particular tree, an allegation I could take plentiful time to rebut, but we're talking about Dad here, so I shall stay on point and deal with my husband off line. The encouraging fact is that Dad feels well enough to want to migrate down his dosage and, although it will take a bit longer than he would like, we are all confident that he will get to the maintenance level soon.

Patience issues aside, Dad is doing great. He looks really good, especially compared to how he looked a few weeks ago (no offense, Dad, but you were starting to look a little rough there for a bit). He's not the chubby teddy bear we all remember, but he still looks good. His ability to eat is showing considerable improvement, not just week over week, but even day over day. His tolerance of the chemo is remarkable. His side effects appear manageable; if they aren't, he's just not letting on about them (which I realize is not out of the question with him). Tomorrow we finish Set 2 and then he's off for a week. Even though his last "off" week was quite challenging, we are looking forward to this one because we hope he'll have an easier go of it this time and we all enjoy the times when he doesn't have to take the chemo meds.

I want to take a moment to thank all the people who are cheering us on. To those of you who post comments here, please know that Dad enjoys reading them. To all the people who have sent e-mails to me directly, please know that I do pass your words of encouragement on to Dad and he draws strength from your support. And to the people who have sent cards, books, encouraging articles, messages, notes, teas, foods, suggestions and kind words directly to my parents, we simply cannot thank you enough. If we judge a man's richness not in dollars but in the warmth with which he is regarded, Dad is the emotional equivalent of Warren Buffet. Thank you all for making sure we know how much you care!



Sunday, November 9, 2008

Let's Step Outside...

Dad has rolled up his sleeves and taken this fight out of the ring and into the streets. The venue suits him, since he's quite a bit scrappier than he appears at first blush. Hitting cancer with chemo alone is all well and good for a certain group of patients; it's just that Dad isn't in that group. So he's hitting it from all sides. He backs up chemo with diet and follows prayer with targeted determination. He makes me think of Indiana Jones - he's a little gray and ragged around the edges and has a trickle of blood at the corner of his lip, but he's smarter than the bad guy and still has that glint in his eye that says, "I'm not finished yet."

We're in the middle of Chemo Set Two. Tuesday was another IV day, which meant that Thursday night / Friday morning through Saturday night should have been the "chemo crash" days. During Set One (which started four weeks ago - is it possible that it's only been four weeks? It's taken forever and gone in a flash, all at the same time.), those were the days when the chemo really hit Dad's system. He was tired and felt a bit on the crappy side. So we all viewed this week with a bit of trepidation, anticipating when he was going to crash.

He took the IV like a champ on Tuesday, but we've already come to assume that will be the case. Probably not a fair assumption to make, but we make it nevertheless. I have to admit that I wasn't paying too much attention to the election returns because I was thinking about Dad, and in retrospect, I don't think of Tuesday as the day the country elected it's first African American President. It's just another IV Chemo day. Bizarre.

Anyway, come Friday morning, I called the house to ask Mom how Dad was feeling.

"I have no clue," she said, her voice a mix of excitement and exasperation, like a mother whose teenage son is late coming home from his first school dance ("good for him that he's having fun, but when I get my hand's on him....") "He went to the aeroclub last night and didn't get home until after ten. Then he got up early this morning, went to the gym to meet his trainer and I haven't seen him since."

I almost dropped the phone. He's at the gym??? On a crash day???

He's looking to stay strong, and that means doing controlled exercise. It's ironic that he's trying to bulk up now, after all these years of mom trying to slim him down, but that's just life, I suppose. The day after you get used to things being one way, they switch around on you.

He apparently ran himself pretty hard on Friday and hit a bit of a wall on Friday night after dinner, but we still celebrated Mom's birthday on Saturday night (Happy Birthday, Mom!). The evening ran late and it was ten o'clock before I got Anna Lee into bed. I figured Dad would be tucked away in his bed by the time I actually kissed her good-night and came back downstairs, so imagine my shock when I walked into the kitchen and found him standing at the sink, up to his elbows in dirty dishes.

Poor guy. If cancer can't get him out of dish duty, nothing will. Which seems a little bit rough, in my humble opinion.

So I asked how it was that he was upright at ten-thirty at night on a Saturday during a chemo week. And was told that overall, Dad has been feeling much better this week. He's not taking much of the pain medicine the doctor gave him (he actually took none for almost a whole week), so I guess I won't have to fund his stay at Promises Malibu when this cancer adventure is done. Even more exciting than not having to put him through a six-figure stint in rehab (could you picture Dad hanging out with OxyContin-addled celebrities, drinking wheat-grass juice and doing yoga to find his inner zen?) is the idea that his symptoms are lessening because the chemo is working. He's still thin enough to challenge Kelly Ripa for Waif-of-the-Year, but he's not getting sick when he eats. That's huge. HUGE.

In addition to pumping himself up Schwarzenegger-style, he's loaded his diet with as many cancer fighting foods as he can stomach. He's been drinking a special juice called MonaVie, which my friend Christine turned me on to and I passed on to Dad.

It's a blend of berries and berry juices, based on the acai berry which is a cancer-fighting "super-food". It's supposed to help cleanse the body and push back the cancer. It's rough on his system if he drinks it straight, so he mixes it with grape juice. Of course, Dad has always preached the evils of grape juice and what it does to tooth enamel, so he sips his grapejuice infused cocktail from a straw. No matter what happens, he will *not* compromise his choppers.

He's also taking his tea green these days. Last night, as we were all having birthday cake and coffee, Dad was sipping from a mug of green tea.

"Is it good?" I asked the man who I always remember as a die-hard coffee lover. A few friends of mine have been touting the benefits of green tea to me and swearing that it tastes great. I haven't been able to bring myself to try it, but I was giving the idea some serious thought.

Dad paused to weigh his answer before he spoke.

"You get used to it," he finally said with uncharacteristic delicacy of phrase.

I decided to take another cup of decaf coffee and leave the green tea for another day.

So we're heading into Week 2 of Set 2. Keep your good thoughts coming - they're helping immensely. I'm looking forward to making another great report nest week!



Tuesday, October 28, 2008

I think the chemo is working.

It's far too early to know for certain - that scan won't be until December - but I still think it's working. During our last few conversations, Dad has been much more himself than he has was over the summer. All fired up. Full of piss-n-vinegar. Talking an unbelievable amount of trash about my ability to ski (bring it on, old man). Having more than a little bit of fun at my expense. Example: I called the house in search of advice on how to make a good (read: edible) pork gravy. Those of you who know me know I don't / can't / won't cook under normal circumstances, but I'm pregnant now and feeling like a bit of a failure in the whole wife/mother department, so I cooked a pork roast. Which I managed not to destroy. But when I took the roast out of the pan, there was all this... stuff... in the bottom. And I vaguely remembered seeing people on the Food Network stir the stuff over heat to make gravy. But beyond that, I was lost. So I did what any self-sufficient, married mother of one and a half children does. I called home.

"Talk to your father," Mom said (once she'd gotten over the shock of hearing me say I'd applied heat to raw ingredients thereby rendering them cooked). "He's the gravy man."

"Gravy?" Dad said when he got on the phone. "Sure. That's easy. Spoon off the fat. Put the drippings over heat. Add some flour. That makes gravy."

"Sounds easy enough," I said.

"Oh, there are a bunch of other things you have to do, but I'm sure you can figure that out on your own."


He was far too amused by himself to answer me when I tried to ask if cornstarch, corn meal and flour are interchangeable with it comes to gravy (answer: they're not - but I had to Google it). I think he was getting back at me for having paid for an education that left me able to interpret subtle nuances in the works of William Shakespeare but unable to prepare a simple pork gravy. And yes, he hung up without further elaboration, leaving me with my bewilderment and my naked pork roast.

Hence, I think he's feeling better. He's off from chemo this week and working crazy long hours, I think because he's covering for Dr. T, who is out of the hospital but unable to do so much as walk his dog without sending those around him into hysterics about his heart. Dad is also making plans for a trip to Charleston (Oberles of Charleston - consider yourselves warned) and is looking at vacation options for the spring. So all in all, things seem to be going quite well.

I want to take a moment to thank all the people who sent in book suggestions. Please keep them coming! Mom is already through "Sit, Ubu, Sit" and Dad won't be far behind.

I also want to post the text of an article that Laura mentioned in her comment to my last post. It's about certain cancer-fighting foods. As Laura said, it's useful information for Dad, but it's also useful for all of us to know. I've boiled down the basics below:

The article was written by Dr. David Servan-Schreiber, who has been living with cancer (both in and out of remission) for years. He broke down his suggestions into food groupings and I've chosen to do the same. I have to admit, Mom has been following the bulk of this diet for years. I am sure she will relish the vindication the article provides. I'm sure the rest of us will find her smug satisfaction at having been right nearly intolerable.

Dr. Servan-Schreiber's best drinks:

Japanese Green Tea - known to encourage death of cancer cells.

Pomegranate Juice - drinking 8oz daily has been shown to reduce by 50% the growth of established prostate cancer.

Dr. Servan-Schreiber's best spices:

Ginger - fights certain cancer cells and helps slow tumor growth. Eat by grating into veggie stir-fry or steeping in boiling water for 10 - 15 minutes and drinking as tea.

Tumeric - enhances the effectiveness of chemotherapy, encourages death of cancer cells and slows tumor growth. Eat 1 TBS (if you have or have had cancer - 1 tsp if you don't) daily mixed with olive oil and ground pepper before being added to vegetables, soups and salad dressings.

Dr. Servan-Schreiber's best vegetables:

Cabbages and Cruciferous Greens - promote death of cancer cells and block tumor growth. Don't boil them. I have taken to sauteing broccoli with smashed garlic and olive oil, then baking in the oven.

Garlic, Onions, Leeks, Shallots and Chives - promote death of colon, breast, lung and prostate cancer cells. Need I even say it? Crush the garlic and cook in olive oil with some chives, then mix into mashed potatoes. Yuuuuummmmmmy.

Dr. Servan-Schreiber's best proteins:

Soy - prevents tumor growth. Drink soy milk, eat soy yogurt, add tofu to your veggie stir fry.

Fatty Fish - (Dad is going to love this - Mom, not so much). Fatty fish have been shown to slow growth of cancer cells in certain types of cancers. Anchovies (eeeeewwwwww) and sardines top the list, so long as they are packed in olive oil and not sunflower oil. Stick to small fish to avoid mercury contamination. Dad loves anchovies, so my recommendation to Mom is that she not share pizza with him on a going forward basis. Let him eat the hairy fish, Mom. You have a nice sandwich and try not to think about what your husband is gleefully gobbling up.

Dr. Servan-Schreiber's best fruits:

Citrus - Oranges, lemons, tangerines and grapefruit. Grated organic orange or tangerine zest is particularly good for fighting off brain tumor growth.

Berries - fresh or frozen - strawberries, blueberries, raspberries, blackberries and cranberries - these have been shown to inhibit tumor growth and promote death of cancer cells. I think some strawberries on angel food cake sounds just dreamy. I'm starting to get very hungry now.

Dr. Servan-Schreiber's best sweet:

CHOCOLATE!!! Dark chocolate, with a cocoa percentage of at least 70%, to be precise. I can say from experience, a block of dark chocolate accompanied by a hot cup of coffee is just fabulous.

Tuesday, October 21, 2008

Sit, Ubu, Sit...

A book so funny, it can make you forget you're having chemo.

No, really. It's true.

Mom and Dad were back at Sloan-Kettering for Dad's second round of IV treatments today. They saw Dr. O'Reilly, who made Dad's day by telling him that he is allowed to drink red wine in moderation (rare, indeed is the doctor who says to a patient, "by all means - go get wasted. Two Advil and a big glass of water before you pass out will ease the hangover"). She also told him he should feel free to make travel plans for next spring. Dad gleefully informed me that he and Mom will be in Paris when I deliver this baby but that I'm welcome to e-mail pictures to them. I assume he was kidding, but just in case they're actually going to Paris, I shall try not to take it personally. Even though they've been to Paris already. Multiple times. Harumpf.

Dr. O'Reilly said Dad has gained some weight, which is great news, and she was pleased with the results of his blood tests. She made some minor adjustments to his meds - little tweaks to get the best results possible out of them - and then sent him off to have his IV drip.

The drip takes an hour. As anybody who knows Dad can attest, sitting still for an hour is a near impossibility for the man. Mom said that last week, the time really dragged. This week, they each brought a copy of Sit, Ubu, Sit, by Gary David Goldberg. I have to credit Mom for Dad bringing the book; she started reading it last week and insisted that he bring his copy along for this session. Mom could nag for Team Italia if she put her mind to it, so rather than listen to her, Dad brought the book.

The nurses set up the IV and left Mom and Dad to their reading. According to Dad, the hour flew by and he was surprised with the nurses returned to change out his drip. Mom said he was reading with that funny little smile he gets on his face when he needs to laugh but is trying to hold it in. Mom doesn't stand on formality; she said she just laughed out loud. Right there, at Sloan-Kettering. Scandalous.

Anyway, Mom said they breezed through the rest of his treatment (it's hard to feel crappy when you're cracking up) and left the hospital in great form.

Great enough that once again, Dad drove himself home.

I guess that proves that laughter really is the best medicine.

So I'm putting out the call: If you have recently (or not so recently) read a really entertaining, funny book, please let me know by posting a comment here or by sending an e-mail to me. Reading is a great way to pass the time on these IV days, so I'd like to keep Mom and Dad stocked up on good material. Send your suggestions and save my parents from me bombarding them with chick-lit and Victorian-era mysteries. Dad will thank you. Profusely.

Sunday, October 19, 2008

Staring Week 2 in the Eye

Five days until the end of the first game. For reasons I can't explain, my head has cast this experience in tennis terms, which is super-bizarre because I don't play tennis and when I did (a million years ago), I was quite bad at it. Nevertheless, in my mind each two week course of chemo is a "game," each three game grouping of treatments is a "set" and the winner of the "match" will be declared when the adenocarcinoma is in remission and I am kicking Dad's arse up and down the Snowbowl at Dartmouth. This probably isn't the year to pursue our friendly little competition, what with him not feeling well and me being more than a little bit pregnant. But I've already got my eye on next winter - big time.

We saw Dad this afternoon. He's looking really good and he is totally committed to beating this thing. He has been doing lots of research into different therapies and treatments, and he came across something very interesting called "cyberknife". It's a type of radiology based, non-invasive, super-precise surgery. Channel 7 did an article about it a few weeks ago. I copied the text of the article and pasted it below. It's pretty interesting reading. You can actually surf up the television report on Channel 7's website, but the written report says essentially the same thing as the television report, without the annoying "T.V. Announcer Voiceover" component. The video does, however, give you a nice shot of the front of Riverview hospital and a look at a successful cyberknife patient riding his motorcycle in Red Bank. I have to admit - I'm confused about the motorcycle. Why would you go through all the effort to kick cancer's butt only to risk your life on a Harley? Next we'll probably see the dude hanging off the side of a boat on "Deadliest Catch" or something like that.

Anyway - here's the article. It's something that I'm going to look into more fully during the week. After all, Partick Swayze is supposedly being treated with cyberknife and if it could help Mr. Nobody-Puts-Baby-In-The-Corner, then I'm all for checking it out.



There is a treatment for cancer that's becoming more and more popular.

It's called Radiosurgery, and several different high-tech machines are available to do it. One of them is called Cyberknife.

It's costly, but it's amazing. It's a radiation tool that functions like surgery, obliterating tumors with precision, without cuts and without pain. First, they were used only for brain tumors, then brain and spine. Now, they're expanding in use.

Motorcycle lover Tony Fusco has owned dozens of motorcycles. He's been riding since he was a teenager.

But it was only after the treatment of his pancreatic cancer that for the first time ever, he bought a bike that was brand new.

"It's like there's another life, you know," he said. "So I feel great, I really do."

Tony isn't cured, at least that's not the word yet. He's still being monitored, but he's had no cancer effects since he was treated with Radiosurgery three years ago.

He had gotten a very bleak diagnosis: inoperable cancer of the pancreas.

"So I said 'Doc, what does that mean?'" Fusco said. "And he said, 'I'm sorry to say that you only have four months to live.' And I just fell apart."

But Tony's close-knit family found an option for him at the Riverview Medical Center in Red Bank, New Jersey: a stereotactic Radiosurgery tool called the Cyberknife. It's a robotic arm that delivers very precise doses of radiation.

"We can give a high-end dose in such a precise manner than we get the same results as if we had cut it out," Dr. Nathan Kaufman said.

The arm movement allows for the radiation to be delivered from different angles, and the precision saves nearby organs from receiving radiation.

The robot is constantly adjusting, even to breathing movements.

"The robot is constantly imaging the target, so it's like a sniper fixing on a target," Dr. Kaufman said. "And even if there's a little movement, it will automatically move."

Not all tumors can be treated with the Cyberknife, but it's a growing option for many cancer patients. Radiation therapy is often one way to get rid of a cancer without surgery.

Actor Patrick Swayze, who has pancreatic cancer, is reportedly being treated with a Cyberknife.

Some hospitals have a similar system to the Cyberknife called the Novalis System.

Information from the American Brain Tumor Association:

How is Radiosurgery given?

There are several techniques used to deliver Radiosurgery. In the paragraphs that follow, we describe a typical day of treatment using the more common types of Radiosurgery equipment. Although the equipment or method you see may vary, the goal of the treatment is the same.

Your first contact with the Radiosurgery unit will likely be with one of the members of the Radiosurgery team. Radiosurgery requires a team of specialists. That team may include a neurosurgeon, radiation oncologist, radiologist, radiation physicist, neurologist, anesthesiologist, specially trained nurses, technologists and the unit support staff. Members of the team first review your medical records to decide if Radiosurgery would be of benefit to you. If it is determined that Radiosurgery is an option and you consent to treatment, the next steps will be obtaining the records and scans needed to plan your personalized treatment.

Your recent MRI scans, a current scan or additional images, biopsy or surgical reports, pathology reports, and specially designed planning software are used to precisely determine the plan for treating your tumor. The radiosurgery team calibrates the equipment to match your personalized treatment plan, including the area to be treated and the dose of radiation to be given. In general, the area radiated includes the abnormal area with a tiny margin of surrounding normal tissue. The dose of radiation is centered over the entire volume of the target area. The radiation dose decreases rapidly as the distance away from the target area increases.


  • National Library of Medicine

    CYBERKNIFE IN OUR AREA: Riverview Medical Center in Red Bank, NJ; Overlook Hospital in Summit, NJ; and Winthrop-University Hospital in Mineola, Long Island.

  • Thursday, October 16, 2008

    Interesting Article by Dr. Stephen Jay Gould

    I came across the below essay while I was doing some research into the statistics surrounding different types of cancers. I freely admit that the author is considerably smarter than me. Okay - maybe not smarter (like I'd actually concede that issue in print!) but his writing style is definitely more elevated than my own. I read the essay several times because I wanted to be certain I fully understood the author's argument before I re-printed it here. Yes, I had to use a dictionary one point (You can guess among yourselves which word I needed to look up). My ability and willingness to make use of a dictionary is testimony to the outstanding education Mom and Dad made available to me. Most people I know just skip over the hard words.

    But I digress.

    Boiled down, this article says the following:

    1. That in the fight against cancer, attitude is everything.
    2. That on some level, all cancer statistics are lies because they are, by definition, distorted both by the short end of the bell curve and by the law of averages, and that the ability to read through the averages is a crucial skill.
    3. That ultimately, there is no more powerful weapon on Earth than humor.

    Dr. Gould said it much more eloquently than I, so I won't deprive you of the chance to read his essay. It really is quite good.

    And yes, to those of you who went to Skidmore with me, we did read an excerpt from Dr. Gould's The Mismeasure of Man in LSI.




    Prefatory Note by Steve Dunn

    Stephen Jay Gould was an influential evolutionary biologist who taught at Harvard University. He was the author of at least ten popular books on evolution, and science, including, among others, The Flamingo's Smile, The Mismeasure of Man, Wonderful Life, and Full House.
    As far as I'm concerned, Gould's The Median Isn't the Message is the wisest, most humane thing ever written about cancer and statistics. It is the antidote both to those who say that, "the statistics don't matter," and to those who have the unfortunate habit of pronouncing death sentences on patients who face a difficult prognosis. Anyone who researches the medical literature will confront the statistics for their disease. Anyone who reads this will be armed with reason and with hope. The Median Isn't the Message is reproduced here by permission of the author.

    The Median Isn't the Message by Stephen Jay Gould

    My life has recently intersected, in a most personal way, two of Mark Twain's famous quips. One I shall defer to the end of this essay. The other (sometimes attributed to Disraeli), identifies three species of mendacity, each worse than the one before - lies, damned lies, and statistics.

    Consider the standard example of stretching the truth with numbers - a case quite relevant to my story. Statistics recognizes different measures of an "average," or central tendency. The mean is our usual concept of an overall average - add up the items and divide them by the number of sharers (100 candy bars collected for five kids next Halloween will yield 20 for each in a just world). The median, a different measure of central tendency, is the half-way point. If I line up five kids by height, the median child is shorter than two and taller than the other two (who might have trouble getting their mean share of the candy). A politician in power might say with pride, "The mean income of our citizens is $15,000 per year." The leader of the opposition might retort, "But half our citizens make less than $10,000 per year." Both are right, but neither cites a statistic with impassive objectivity. The first invokes a mean, the second a median. (Means are higher than medians in such cases because one millionaire may outweigh hundreds of poor people in setting a mean; but he can balance only one mendicant in calculating a median).

    The larger issue that creates a common distrust or contempt for statistics is more troubling. Many people make an unfortunate and invalid separation between heart and mind, or feeling and intellect. In some contemporary traditions, abetted by attitudes stereotypically centered on Southern California, feelings are exalted as more "real" and the only proper basis for action - if it feels good, do it - while intellect gets short shrift as a hang-up of outmoded elitism. Statistics, in this absurd dichotomy, often become the symbol of the enemy. As Hilaire Belloc wrote, "Statistics are the triumph of the quantitative method, and the quantitative method is the victory of sterility and death."

    This is a personal story of statistics, properly interpreted, as profoundly nurturant and life-giving. It declares holy war on the downgrading of intellect by telling a small story about the utility of dry, academic knowledge about science. Heart and head are focal points of one body, one personality.

    In July 1982, I learned that I was suffering from abdominal mesothelioma, a rare and serious cancer usually associated with exposure to asbestos. When I revived after surgery, I asked my first question of my doctor and chemotherapist: "What is the best technical literature about mesothelioma?" She replied, with a touch of diplomacy (the only departure she has ever made from direct frankness), that the medical literature contained nothing really worth reading.

    Of course, trying to keep an intellectual away from literature works about as well as recommending chastity to Homo sapiens, the sexiest primate of all. As soon as I could walk, I made a beeline for Harvard's Countway medical library and punched mesothelioma into the computer's bibliographic search program. An hour later, surrounded by the latest literature on abdominal mesothelioma, I realized with a gulp why my doctor had offered that humane advice. The literature couldn't have been more brutally clear: mesothelioma is incurable, with a median mortality of only eight months after discovery. I sat stunned for about fifteen minutes, then smiled and said to myself: so that's why they didn't give me anything to read. Then my mind started to work again, thank goodness.

    If a little learning could ever be a dangerous thing, I had encountered a classic example. Attitude clearly matters in fighting cancer. We don't know why (from my old-style materialistic perspective, I suspect that mental states feed back upon the immune system). But match people with the same cancer for age, class, health, socioeconomic status, and, in general, those with positive attitudes, with a strong will and purpose for living, with commitment to struggle, with an active response to aiding their own treatment and not just a passive acceptance of anything doctors say, tend to live longer. A few months later I asked Sir Peter Medawar, my personal scientific guru and a Nobelist in immunology, what the best prescription for success against cancer might be. "A sanguine personality," he replied. Fortunately (since one can't reconstruct oneself at short notice and for a definite purpose), I am, if anything, even-tempered and confident in just this manner.

    Hence the dilemma for humane doctors: since attitude matters so critically, should such a sombre conclusion be advertised, especially since few people have sufficient understanding of statistics to evaluate what the statements really mean? From years of experience with the small-scale evolution of Bahamian land snails treated quantitatively, I have developed this technical knowledge - and I am convinced that it played a major role in saving my life. Knowledge is indeed power, in Bacon's proverb.

    The problem may be briefly stated: What does "median mortality of eight months" signify in our vernacular? I suspect that most people, without training in statistics, would read such a statement as "I will probably be dead in eight months" - the very conclusion that must be avoided, since it isn't so, and since attitude matters so much.

    I was not, of course, overjoyed, but I didn't read the statement in this vernacular way either. My technical training enjoined a different perspective on "eight months median mortality." The point is a subtle one, but profound - for it embodies the distinctive way of thinking in my own field of evolutionary biology and natural history.

    We still carry the historical baggage of a Platonic heritage that seeks sharp essences and definite boundaries. (Thus we hope to find an unambiguous "beginning of life" or "definition of death," although nature often comes to us as irreducible continua.) This Platonic heritage, with its emphasis in clear distinctions and separated immutable entities, leads us to view statistical measures of central tendency wrongly, indeed opposite to the appropriate interpretation in our actual world of variation, shadings, and continua. In short, we view means and medians as the hard "realities," and the variation that permits their calculation as a set of transient and imperfect measurements of this hidden essence. If the median is the reality and variation around the median just a device for its calculation, the "I will probably be dead in eight months" may pass as a reasonable interpretation.

    But all evolutionary biologists know that variation itself is nature's only irreducible essence. Variation is the hard reality, not a set of imperfect measures for a central tendency. Means and medians are the abstractions. Therefore, I looked at the mesothelioma statistics quite differently - and not only because I am an optimist who tends to see the doughnut instead of the hole, but primarily because I know that variation itself is the reality. I had to place myself amidst the variation.

    When I learned about the eight-month median, my first intellectual reaction was: fine, half the people will live longer; now what are my chances of being in that half. I read for a furious and nervous hour and concluded, with relief: damned good. I possessed every one of the characteristics conferring a probability of longer life: I was young; my disease had been recognized in a relatively early stage; I would receive the nation's best medical treatment; I had the world to live for; I knew how to read the data properly and not despair.

    Another technical point then added even more solace. I immediately recognized that the distribution of variation about the eight-month median would almost surely be what statisticians call "right skewed." (In a symmetrical distribution, the profile of variation to the left of the central tendency is a mirror image of variation to the right. In skewed distributions, variation to one side of the central tendency is more stretched out - left skewed if extended to the left, right skewed if stretched out to the right.) The distribution of variation had to be right skewed, I reasoned. After all, the left of the distribution contains an irrevocable lower boundary of zero (since mesothelioma can only be identified at death or before). Thus, there isn't much room for the distribution's lower (or left) half - it must be scrunched up between zero and eight months. But the upper (or right) half can extend out for years and years, even if nobody ultimately survives. The distribution must be right skewed, and I needed to know how long the extended tail ran - for I had already concluded that my favorable profile made me a good candidate for that part of the curve.

    The distribution was indeed, strongly right skewed, with a long tail (however small) that extended for several years above the eight month median. I saw no reason why I shouldn't be in that small tail, and I breathed a very long sigh of relief. My technical knowledge had helped. I had read the graph correctly. I had asked the right question and found the answers. I had obtained, in all probability, the most precious of all possible gifts in the circumstances - substantial time. I didn't have to stop and immediately follow Isaiah's injunction to Hezekiah - set thine house in order for thou shalt die, and not live. I would have time to think, to plan, and to fight.

    One final point about statistical distributions. They apply only to a prescribed set of circumstances - in this case to survival with mesothelioma under conventional modes of treatment. If circumstances change, the distribution may alter. I was placed on an experimental protocol of treatment and, if fortune holds, will be in the first cohort of a new distribution with high median and a right tail extending to death by natural causes at advanced old age.

    It has become, in my view, a bit too trendy to regard the acceptance of death as something tantamount to intrinsic dignity. Of course I agree with the preacher of Ecclesiastes that there is a time to love and a time to die - and when my skein runs out I hope to face the end calmly and in my own way. For most situations, however, I prefer the more martial view that death is the ultimate enemy - and I find nothing reproachable in those who rage mightily against the dying of the light.

    The swords of battle are numerous, and none more effective than humor. My death was announced at a meeting of my colleagues in Scotland, and I almost experienced the delicious pleasure of reading my obituary penned by one of my best friends (the so-and-so got suspicious and checked; he too is a statistician, and didn't expect to find me so far out on the right tail). Still, the incident provided my first good laugh after the diagnosis. Just think, I almost got to repeat Mark Twain's most famous line of all: the reports of my death are greatly exaggerated.

    Wednesday, October 15, 2008

    Day 5 - Slow down? Fuggedaboudit.

    Dad is such a rock star. When I spoke to Mom this morning and asked how he was feeling, she said, "How would I know? He got up early, ate breakfast and went to an all-day course. I haven't seen him, and I don't expect to see him until dinner."

    Oh. Well. How's Dr. T, then? Might as well ask about the patient who is willing to hold still and be looked after, right?

    When I spoke to Dad this evening, he sounded great. He was very pleased with the course (Heaven forbid we waste our time at a crappy dental course) and quite satisfied with how he is feeling overall (although still mounting arguments against taking the pancreas meds). He has put on some weight, which is attributable in part to his fantastic attitude about eating. It's also attributable in part to Mom, who has pulled an overnight, 180 degree attitude adjustment about food.

    After more than 40 years of pushing salads with balsamic vinegar and steamed vegetables, she's suddenly jamming macaroni and cheese and ice cream at him. As she entreats him to eat more and more still, she breathes life into every single "Italian Mother" stereotype ever created. He likened himself to Gulliver in Lilliput, strapped to the ground while people march up his chest and pour food into his mouth. I don't think he'll eat foie gras again without having some pang of sympathy for the goose. He said something tonight about Mom holding a funnel. I have to admit, I was intrigued. Although I've seen Uncle Pete do a keg stand in the back yard, I'm pretty sure that memory would pale when set beside the image of Dad funnelling a milkshake.

    I think Dad is planning to cover Dr. T's patients tomorrow. There is a chance that he will feel poorly tomorrow night or Friday, as the side effects of Tuesday's IV chemo hit his system. But there is also a chance that he will feel fine. Some chemo patients never experience chemo-related side effects, just like some expectant mothers never experience morning sickness (poor dears - they don't know what they're missing).

    Were I a betting girl, I'd bet Dad is going to be one of those patients who continues to tolerate the chemo well. He just doesn't really "do" the whole "I'm sick" thing. He is far too busy finding new and interesting ways to risk his neck in the plane, on water skis and by suggesting to Mom that they get a puppy.

    The puppy. He *really* wants a puppy and he's not known for his impulse control. If he comes home with a puppy, Mom might kill him with her bare hands.

    Then I'll have to start a "Team Temporary Insanity - Blogging Through Mom's Murder Trial" blog.

    Tuesday, October 14, 2008

    Day 4 - First Day of IV Chemo

    Ooooooh - cancer is scary!!! NOT.

    Dad totally opened the can of whoop-arse today. His attitude rocks and he's tolerating the treatments very well. Saturday and Sunday were a little bit rocky. Okay - a lot rocky. I'd say the low point was when he decided that his pancreas meds weren't working so he just wasn't going to take them.

    "Uh, Dad - I'm pretty sure they're not optional."

    Happily, he was in the mood to be convinced, so it only took Mom and Chris and me to change his mind. If he hadn't been in the mood to be convinced, Mom and Chris would have been forced to pin him to the ground, plug his nose and shove the pills down his throat. I don't think they would have had to truss him, but he *can* get fiesty when he's ticked off, so I wouldn't rule anything out.

    Monday he was back at work, feeling good and happy to be there. He was looking forward to getting through today's IV treatment, getting through the rest of the week and going flying with his friend, Dr. T.

    Dad and Dr. T (another flying dentist) have flown together off and on for years. They've done so consistently since Dad started feeling poorly because Dad hasn't been been comfortable going up alone. Dr. T is there to be the healthy Right Seat (that's "co-pilot" to the rest of us), ready to spring into action, take the controls and land the plane in an instant if something were to happen to Dad.

    Which made Dr. T's heart attack this morning quite troubling on a number of levels.

    First, it's clear that they won't be flying this week. After they got him to the hospital, Dr. T had his daughter call Dad to cancel their take-off slot. Dad, who was sitting at Sloane-Kettering having his chemo cocktail mixed, was pleased to see that Dr. T's priorities were in the right place: plane first, everything else second. Dad agreed that perhaps this week's flight should be postponed. He also agreed to cover Dr. T's patients on Thursday. Talk about not letting your condition get in the way. Something tells me I won't be complaining about my pregnancy flatulence and my flat arches to Dad.

    Second, and far more worrying to Dad: Who will be the healthy Right Seat now? Even with a brand-new stent successfully clearing Dr. T's arterial blockage, his health is suspect at best. Each of them is probably as likely as the other to keel over at the controls, which makes neither of them a good Right Seat to the other. Will they keep going up, with a portable defibrillator in Dr. T's lap and a vial of smelling salts in Dad's? Will they bring on a Third Seat - perhaps an EMT? It's a mystery.

    Nevertheless, Dr. T survived his heart attack and is resting comfortably. Dad is suddenly feeling much more satisfied with his own situation. He may be having chemo, but at least he isn't keeling over on top of bales of horse feed like Dr. T and he doesn't have a stent in his chest. No, sir. Dad's ticker is doing just fine. In fact, Dad is doing just fine.

    Fine enough that when he finished his chemo today, he picked up the car keys and drove himself home.

    If that isn't Art Oberle behavior, I just don't know what is.

    Sunday, October 12, 2008

    Day 2

    It's Day 2 and Dad has started as he means to go on. He's taking his GTX (the common name for the three oral chemo drugs he's on because someone, somewhere decided "gemcitabine," "capecitabine," and "docetaxel," was too much of a mouthful), resting when he's tired and getting outside when he feels like doing so. He went to a cocktail party with a bunch of his friends last night and sounded in good spirits when I spoke to him today. I think he knows that when it comes to fighting cancer, chemo only takes you so far. The rest of the battle takes place in your head and in your heart.

    Being so new to this, I am doing a lot of research. Today's cancer lesson: excess simple sugar feeds cancer cells and helps them grow. It's not as simple as "sugar feeds cancer," which is what I first thought. It's actually excess insulin, which is produced when the body gets a lot of simple sugar, that causes the spike in cancer cell growth. So I guess that means no Jolly Ranchers and Tootsie Pops for Dad. Not that the Flying Dentist is a hard-candy junkie - that's hardly the case - but it's hard to take anything off the menu.

    Dad's first intravenous chemo session is on Tuesday. We've got our fingers crossed that he handles the drugs well and that the cancer proves reactive to the chemo. We won't actually know how we are progressing until the middle of December, which seems like an awfully long time to wait (patience is not a strong Oberle trait - we prefer quick (okay - immediate) gratification), but we will just have to grin and bear it.

    Thanks to all the people who have sent warm wishes, comments and e-mails of support. We appreciate each and every bit of positive energy you send our way!



    Saturday, October 11, 2008

    Day 1

    I forgot to mention one person - probably the most important cast member of all: Dr. O'Reilly from Sloane-Kettering. She's the Captain - the Director - the Driver of the Oberle Express. She'll be steering us through this process.

    We met her on Thursday.

    Her voice is soft and the lilt of her brogue makes even the most difficult of phrases easier on the ears. Phrases like, "sneaky, aggressive cancer," and "cannot be eradicated," somehow didn't sound catastrophic when she said them.

    She did not sugar coat the truth, but she also did not drop us into a pit of despair.

    She made sure we knew that in some cases, adenocarcinoma can be controlled with chemotherapy.

    That she would not let the treatment of the disease become more of a burden than the disease itself.

    That she would help us to keep the Dad we know and love doing the things he knows and loves.

    That chemotherapy and a good quality of life, complete with part-time work (focused on the days farthest from his intravenous chemo days), is very much so a possibility for him, especially because Dad is a relatively fit, healthy, active man. I say "relatively" because he's a bit on the thin side right now and... well... not to point to the elephant in the room but he does have cancer after all. Cancer and the cover of Men's Fitness don't exactly go hand-in-hand.

    So today is Day 1. Dad started his chemotherapy this morning. The pills have to be taken with meals, which is ironic because the inability to stomach food is what brought us to Sloane-Kettering in the first place. Nevertheless, I know Dad will do what he needs to do to poison the cancer, and I know that the rest of Team Oberle will do whatever we need to do to outsmart, outflank and overpower this enemy.

    Once more into the breach! Charge!!!

    Friday, October 10, 2008

    Countdown to Chemo

    T-minus roughly 12 hours until the gun goes off and Team Oberle starts the race of all races. It's been about 34 hours since the oncologist told us that Dad has cancer. Of course, that was 4 days after the preliminary biopsy of the spots on his liver came back with the "M" word: Malignant.

    October 6, 2008. Dad's 70th Birthday. The day Dad's cancer crashed the party, kicked him in the nuts and announced, "I am here. I am called adenocarcinoma. Cower before me."

    Oh yeah? Well guess what, adenocarcinoma. You can go piss up a rope. You hear me?



    Salient details - the cast of characters:

    Dad: Art Oberle - age 70. Thyriod cancer survivor. Adenocarcinoma fighter. Dentist. Recreational pilot. All around good guy.

    Mom: Lee Oberle - age sixty-somethingish but looks fabulous, and no, she hasn't had work. Much to her chagrin.

    Younger brother: Chris - age 33. Tall, good-looking, intense. Newly married, but robbed of that blissful first year of marriage by a cratering economy and Dad's cancer. Chris is Team Oberle's designated Cancer-manager. I'm his wingman. I'm...

    Middle child: Connie - age 36. Pregnant. Prone to emotional outbursts, melodrama (I am a middle child, after all) and periods of thinking deep thoughts on normal days. I'm a nightmare when I've got a bun in the oven. Hubby Dan calls me "Angry Pregnant Woman," and that was before Dad got cancer. I can't imagine what he'll be calling me by the end of the first round of chemo - probably "My Ex-wife...."

    Older brother: Kurt - age 38. The Cool Dude. Lives in Charleston. Tall, good-looking, not intense. Permanently tan from a lifetime of sailing boats and generally being outside. Kurt has always been a calming influence for me. I'm going to need him to get through this.

    The Cat: Zinny - age almost 18 (yes, you read that right). I think she's on her 29th life. I gave her to Mom (the world's most unwanted Mother's Day Present) when I was a freshman in college. I can honestly say I never thought I'd be 36 and pregnant with my second child and that damned cat would still be around. Just goes to show you - you never know. Anyway, right when Dad's biopsy came back, Zinny got an abscessed tooth. The side of her face blew up like she'd eaten a tennis ball. So in the middle of our cancer crisis, Dad had to take Zinny to the vet for oral surgery. Honest - he did. I couldn't make stuff like this up. I'm not that creative.

    So I started this blog as a place to keep a log of Dad's treatments as well as updates on his health and on how we're all doing. Chris will get mad because it's not "discrete," but I'll have to live with that. It's a lot easier than having to have the same phone conversation fifty times with fifty people who want to know what's going on. That just gets exhausting.

    So let's all fasten our seat belts and get ready to launch the Team Oberle Express!

    Adenocarcinoma - you're in grave trouble. I suggest you start running NOW.