VATS that?

This Friday, January 9, 2015, I will undergo the procedures to check out whether the cancer is gone. Between 8:00 AM and 10:00 AM an interventional radiologist will place tracers near my left lung. The “dye” can be used by the surgeon to localize small-sized pulmonary nodules. Between 10:00 AM and 1:00 PM the thoracic surgeon will cut out the lesion in the lung and strip out some lymph nodes adjacent to the lung.

The surgeon will use VATS, or video assisted thoracic surgery. This should mean that my hospital stay (about 3 days) and recovery (about 14 days) will be shorter than busting open the chest and spreading the rib cage in the old way. By the way, I won’t know the full biopsy results for several days after the surgery. Blogging during this time will be sporadic (or perhaps more idiotic than normal).

Below, I have attached a video of a left upper lobectomy which is somewhat similar to the procedure that will be used in my situation. At about 1:14 and then again at 7:10 of the video, you can see where the three chest holes are used to insert the camera in one port, and the grasping and cutting (burning) devices into the other two ports.  I suppose ’cause everything is all about me and, as such, there can never be too much information, I find this stuff utterly fascinating. I am little nervous, however, that my surgeon trained at the Grace L. Ferguson Storm Door and Medical School.*


*Actually, he graduated from the Columbia University College of Physicians and Surgeons, New York, and completed a research fellowship and general surgery residency at Duke University Medical Center, Durham, N.C., and a cardiothoracic surgery fellowship at the University of Virginia, Charlottesville. Really nice guy, by the way.

PET scan results

After six months of treatment, I finished my chemo therapy about three weeks ago. This Tuesday, I had a PET (positron emission tomography) scan to see whether the cancer was gone. The news is not perfect but it’s not horrible either.

1. The follow-up PET scan shows two areas of continued metabolic activity: (a) the lung nodule biopsied by UNMC last February and determined to be a fungus. My oncologist was not in the least bit concerned with this spot. In fact, he said it would be very unusual for Hodgkin’s lymphoma to migrate to the lung. And (b) a small area deep in my groin, left side, where everyone suspects the cancer originated. This area is more of a concern.

2. The results of PET scans are measured in units called “Standardized Uptake Values.” My SUV was 3. According to Radiopaedia, “The cut off between benign and malignant lesion/nodule is in the SUV range of 2.0-2.5.” However, and for the purpose of perspective, my oncologist said that an SUV of 10 or above almost surely reveals cancer. That is consistent with the literature that I have read (“SUV >10 may predict for an aggressive histology.“).  Consequently, while I could have cancer remaining in the left side of my groin, considering the grand scheme of things, my SUV of 3 is relatively “low.”

Credit: CENTRE JEAN PERRIN, ISM/SCIENCE PHOTO LIBRARY.  This is an example, and is not my scan. The PET scan shows cancerous sites in the coloured areas for a patient with Hodgkin's lymphoma.  The cancer is present in the bilateral and mediastinal axillar lymph nodes.

Credit: CENTRE JEAN PERRIN, ISM/SCIENCE PHOTO LIBRARY. This is an example. It is not my scan. The PET scan in this example shows cancerous sites in the coloured areas for a patient with Hodgkin’s lymphoma. This scan was taken prior to treatment.

3. I will have another PET scan on November 17, 2014 and I will learn the results when I see my doctor on November 20, 2014. If the SUV increased significantly, then I am likely to undergo additional chemo therapy or radiation. If the SUV remains about the same, the doctor may advise “watchful waiting” or a more aggressive approach that would involve additional chemo therapy or radiation, depending, I suppose, on what he had for breakfast that morning.

4. For now, I may work as tolerated. The doctor advises that it takes 2 to 3 months to “recover” from the chemo I have just completed. With that in mind, I intend to reenter the assignment wheels and assume a regular case load starting December 1, 2014, subject, of course, to the November PET scan results. In the interim, I will continue to do work in the office and conduct short hearing such as sentencing proceedings.

The judges and staff at work have been great. In particular, I am especially indebted to Chief Judge Smith Camp, Judge Gerrard, Judge Zwart and the very special people who work with me on a daily basis, Jan, Jim, Kris, Gabi, Ryan and Connie. They have been and continue to be patient and supportive and seldom bark at me even though I whine constantly.


PS What Miriam Engelberg famously wrote certainly applies to me and I like that about myself:

Image credit: Miriam Engelberg

Image credit: Miriam Engelberg

Cancer and commitment

The garden post that I just put up is not complete. I just realized that as I went out to the garage to smoke my pipe.

Our old pickup is filled to the brim with all manner of sticks, cuttings, stalks, and such that Joan (JKK) pulled from the garden and loaded into the pickup for an eventual trip to the compost pile at the dump. She did all of that without complaint or help from me or anyone else.

Joan’s commitment to her garden is not to be believed. Her labor is like that of a farm worker. All by hand. Stoop labor. She orders compost by the yard, has it dumped on our driveway and lugs it back to the garden with a 30-year old wheelbarrow. Then she spreads it shovel by shovel to enrich the soil that will produce her flowers.

Less than two years ago, cancer attacked Joan. It was colon/rectal cancer. The cure was chemotherapy and radiation of every organ below her pelvis. Both occurred at the same time. The skin on her abdomen turned red, burned and blistered. Internally, the radiation fried most of what it touched. Thankfully, and just several days ago, the doctors announced that the very nasty burn spot in her bowels had finally healed.

And still she gardens, filling up an old pickup all by herself and by hand. JKK is one tough old broad. Cancer and commitment.



The grind

Did my jury orientation yesterday preparatory to voir dire. For the lecture part, I sat in a chair in front of the panel as I was slightly out of breath. Was able to walk around the courtroom with the prospective jurors as I conducted the courtroom “tour” I always give during orientation. (See here and here for a brief description of my “walk about.”)

At the last moment, and while I was doing the orientation, the defendant decided to plead guilty before Magistrate Judge Zwart. (She is such a great help.) Trial cancelled and jurors excused with my thanks. I was relieved. Summoning the energy to try this little criminal case loomed larger than expected. Get my second infusion of the second cycle in a few hours, may have to rethink my stamina when it comes to daily work. We shall see.




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As expected, my hair began to fall off such that Joan complained that I was worse than our old shaggy, long dead, and much beloved dog whose ashes we keep in a cedar box in the den. She was horrible dog, but we loved her dearly. My mind wanders.

Given the wifely complaints, I shaved the rest of my hair off. I am now as bald as Korey Reiman, a great young criminal defense lawyer who is bald (I hope) for reasons unrelated to ill-health.

I start the second cycle (round) of chemo on Tuesday. The first cycle (28 days) was pleasantly tolerable. The severe pain in my left leg is gone. I stress this point only to piss off the few crazoids who wish fervently for the cancer to eat me up. My mind wanders.

The worst part of the treatment is fatigue. While I work most everyday, I go home in the early afternoon when the fatigue rolls in like morning fog. A kindly nurse at the clinic told me that the fatigue caused by chemo drugs must be experienced to be understood. She is right. When the fatigue hits speaking out loud feels like lifting heavy weights. Walking seems like a death march. You put one foot forward but doubt that you can lift the second one to continue.

Five more months to go.




Looking for causal connections

Last night, I came upon a good legal blog that I had not previously read with any regularity. See Tanya Gee, Women’s History Month and Stilettos in the Courtroom, Noticing Appeals (March 30, 2014). Ms. Gee just returned to blogging in February after a very nasty bout with cancer. For obvious reasons, that struck a chord with me. Of course, I wish her well. I also look forward to reading more of Noticing Appeals.

But, I wonder:  Does blogging cause cancer?*


*Warning: That is not a serious question. Request: Please, God, don’t write back and tell me cancer isn’t funny. Dated Reference: Speaking of God, didn’t you just love Alanis Morissette in Dogma.


It was this time last year when my wife, Joan, began to lose weight.  I tossed it off to being exhausted as we prepared to see all three of the kids (and their kids) for the first time in a long time all together at our home.  The wry New Mexico oldest and her wonderful husband (plus their canine terribilis),  the group from China (with P and M from a recent post), and Fletcher (from a recent post) and his parents from Australia.

In August, the day after everyone left, Joan went to our family doc.  He took one look at her, and sent her to the gastroenterologist. A hurry-up colonoscopy followed by further probes at the hospital that same day revealed cancer. A rush to the medical oncologist followed by a visit to the radiation oncologist mapped out an aggressive treatment regimen. Then months and months of chemotherapy and radiation therapy followed. The chemo and radiation therapy were administered together.  The chemo was awful but the radiation, literally frying the lower abdomen and the nether regions, was far worse.* But, it worked. The cancer is gone, at least for now.

Below is a photo of flowers Joan picked yesterday in her garden.  She loves to garden, and she is very good at it.  With her strength returning, and although remaining very thin, Joan spends hours on her knees in the dirt.

Some things are more important than others.


*Being a good Catholic, Joan never complained, not even once.  This was just another “gift” from God.  It took all I could to restrain myself from saying, “If cancer, chemo and radiation are gifts from the almighty, he is one sick son of a bitch.”  But, then again, I accept all gods, even ones from Rome, at arm’s length, sorta like the way I approach everything else.

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