Sunday, February 16, 2014

Exercise: We Can Do This!

The 30-degree weather seems to have moved on. It feels like a warm, summer day, but the high 50's temperatures today are actually just average for February in west Tennessee.

I was so excited for the sun and warm weather, but it's been so long since I've seen the sun, I forgot what it's like for me. I can't let it shine on my eyes, and I have to wear sunblock all the time and stay in the shade as much as possible.

Doctors tell me "as much as possible." I agree, "as much as possible." I have a sneaking suspicion we don't mean exactly the same thing by that phrase.

So today I felt recovered enough to go to the gym. I am thrilled and give thanks to God because while I hoped to recover from pneumonia in a couple weeks or a little more, it seemed hard to believe that was possible for a beat-up, almost-old guy like me.

Possible.

I was very disappointed to find out my lower legs are still the same. I was fantasizing that because my feet felt so good, and so not swollen, while I was mostly laying down that it would translate into some full recovery of blood flow to the lower legs.

Nope.

I got on a treadmill, and I walked a half-mile at a 20-min/mi pace. I figured that was enough warmup, and I broke into a very slow jog (4.5 MPH on the treadmill). I had no problem with my breathing, but my heart rate jumped up to 144 after one minute.

I had to quit at one minute of jogging. The bottom of my feet were hot like someone was holding a candle under them, and my calves were beelining towards a good charlie horse.

Still, 30 days ago I was trying to find the oxygen and energy to roll over for the doctor. The roll was agonizing, and I was so miserable I was barely conscious. Today, I was on a treadmill! I ran a minute, and I walked a mile!

Small goals for a guy who ran 31 miles in 7.5 hours just 7 years ago. I was dream of 135 miles across death valley back then and hoping to do longer ultramarathons to work up to "The Badwater."

I put in a little weightlifting, including some 60-lb. lat pulldowns across from a guy who looked like he bought his biceps from a butcher shop and who was yanking his 250-lb. body up and down on the pullup bar. I thought, "Don Knotts would try to do something really impressive here and look like an idiot. That would probable be more fun than sitting here hoping he doesn't notice my tiny weights going up and down on the pole."

One good thing about the pneumonia. My oncologist saw me on Thursday, and now he was as concerned about unbridling my baby immune system so it can be strong enough to dodge the next pneumonia as he is about my recurring skin GVH. After six months, they let me go down 2.5 mg (about 17%) on the Prednisone.

Here's to a slightly less stimulated appetite and less muscle-eating steroids.

Yeah, we transplant survivors get steroids that cause weakness, not muscle growth.

This sounds like complaining, doesn't it?

I'm updating my friends, and hopefully, I'm encouraging other leukemia/cancer patients/survivors.

I'm not really complaining. I am incredible fortunate. I am in comparable shape to a lot of 52-year-olds that haven't been through what I've been through. I can work. I can easily spend 10 hours a day doing things, often more, without having to lay down. That's not amazing two-years post-transplant, but it is better than normal.

I have the best caretaker possible. My wife is wonderful, and she not only never accuses me of being lazy or useless, she even gets mad at me when I accuse myself of either.

I have great friends, and I can't even mention them here because if I mention one, I will leave at least 20 or 30 close friends out and many more good friends out.

I do not, and I have not at any point felt sorry for myself. I did pout one particularly bad day in November of 2012 (yeah, so bad I remember the month) and just cry out to God, "Please stop hurting me." I was exhausted, had an ingrown toenail that was throbbing, a painful blood clot in my right calf, and I had been forced to work because of a problem that arose. While working, and in a lot of pain, I scalded my hand with steam.

I may have been guilty of feeling sorry for myself at that moment.

Otherwise, it would be embarrasing to feel sorry for myself. I have been to slums in India, Kenya, and Ethiopia. I have been to small, poverty-stricken villages in Africa and Myanmar. Let's not stop there; I have talked to homeless people in California and west Tennessee. It's worse in Tennessee because it's colder and wetter.

I have not suffered, at least not much.

To Fellow BPDCN Patients or Survivors

Final comment, for those newly diagnosed with BPDCN. I love the fact that so many of you contact me. I love dispensing hope, and even my hope grows as I hear about the successes of others. There's a 65-year-old man in Kentucky being treated with glowing results so far. I just passed the two-year mark post-transplant without relapse, and many others have done so over the last five years.

I got to refer one man to my own oncologist at Vanderbilt, where some of the leading leukemia research is done, and I got to refer another lady to an organization that helps cancer patients find help for their needs. My oncologist is helping with the treatment of the man long-distance, and the organization (UCAAN) was able to help the lady with her particular need.

So excited. And for you healthy folk, don't forget that you can BE THE MATCH and save a life ... like mine. Or maybe even like that guy in Kentucky, who still needs to find a marrow donor. Within a week, you could be on the list they're looking through for him. Ages 18-60 are eligible, and it's free and painless to sign up. If you actually become a donor (less than 1% chance), you're going to be pretty sore for a  week, but it is not dangerous.

Well worth it to save a life.

Sunday, February 9, 2014

Recovering Quickly

I don't remember what day I went in the hospital with pneumonia. My guess is that it was 3 weeks ago today.

I did exercises in sets of 2-3 minutes several times today. I danced, I jumped, I did pushups (up to 7 now). I did some squats (with no weight). I did a little work on the car.

To put it mildly, I am surprised at my recovery. My lungs feel great. My stomach isn't all the way better. I had a mild tear, and I'm 52. That doesn't go away in a couple weeks.

Also, a few months ago, the ball of my feet started tingling and growing numb. Not long after that my feet and ankles were swelling up.

The doctors told me the neuropathy (I think that's what it's called) in my feet was the result of the steroids we transplant recipients take to suppress our new immune systems. They said the fluid buildup (the "edema") in my ankles and feet were also from the steroids. They never gave me any advice about what to do about it.

In December sometime, the swelling and a lot of the neuropathy went away.

I'm really hoping that as I get back into exercise, I'm also going to find out that my calves no longer start giving out about a hundred yards into a jog.

We'll see. I can't jog a hundred yards at the moment, but I'm sure I'll be able to next week. I don't have confidence, my calves will be better, but I do have hope.

Thank you for those who have prayed for me. I say that a lot, but I think it makes a big difference. Keep praying for others, too!

Tuesday, February 4, 2014

Pneumonia and Keeping in Touch with All of You!

BPDCN and Counseling

I have gotten a lot of emails and comments on this blog the last couple weeks. I am reminded that there are people who are benefitted both by my stories and by the information on this blog.

I believe that most people in the world who are diagnosed with BPDCN (Blastic Plasmacytoid Dendritic Cell Neoplasm) contact me. A search for BPDCN will find this blog in the top 2 or 3 results almost every time. (BPDCN is pretty rare with only about 200 cases ever.)

I tried my own sun treatment on my skinny legs,
and my skin started peeling away.
Don't do that!


A couple months ago, I got a thank you from the uncle of a Lebanese man who wound up in France for his transplant. The uncle lives in Atlanta. Even though the uncle's family has not only lived in the USA for years and members of his family have served in the US military, the American consulate denied a visa to his nephew so he could be treated in the USA. Fortunately, France provided him with wonderful treatment.

It was a wonderful thank you letter because the nephew with BPDCN has now been released from the hospital ... just yesterday. One more survivor, at least so far. Terrific news!

There have been other not so pleasant situations. I got an email from the daughter of a man who didn't make it. It was a thank you email, too, for supporting her father through his cancer and treatment. Those letters rip my heart out.

Another person I walked through chemo with (by email) was the father of my daughter-in-law. I know all his children better than I know him, but I have known him for years. He's slightly younger than me, and he was in better shape. He had AML (Acute Myeloid Leukemia), which is not BPDCN, but is treated very similarly. He was a great trooper, made it to and through transplant, and then (in my opinion) got GVH (Graft Versus Host) of the lungs. That means his new immune system rejected his lungs and attacked them.

Note: That's how bone marrow transplants work. Unlike solid organ transplants, a bone marrow transplant (BMT) replaces the entire blood system, including all the white blood cells—our immune system. If a kidney is replaced, the recipient has to worry about his/her immune system rejecting the kidney. When we have a BMT, we have a new immune system, so every part of our body is in danger of being attacked.

Note 2: A stem cell transplant (SCT) is the same as a BMT. The difference is that rather than collect the actual marrow of the donor, doctors give the donor a shot that causess the marrow stem cells to multiply so much that they get into the blood stream. Those stem cells are then removed in a five-hour process using a machine very similar to a dialysis machine. Nowadays most marrow transplants are actually SCTs.

This friend/in-law of mine had lung problems with lots of names, but in the end I think it was his immune system attacking his lungs. He didn't make it. It was a terrible thing for the family, but I think especially my daughter-in-law. She had to watch me go through all the treatment, then watch her dad go through very similar treatment and not make it.

I am calling and corresponding with another man with BPDCN who lives only about 6 hours from me. It is such a delight to be able to warn of things to come, give advice, and just chat as a person who's been through what they're going through. He's in his second round of chemo right now. It's always nicer when the outcome is good, of course.

Update on Me


I actually have health news this time. I'm pretty sure it was Sunday, January 12, when I first got sick. I felt miserable, threw up once, went home, and slept it off. I felt better the next day, but I developed a slight cough. On Saturday morning, I woke up, and I knew something was wrong. I can't say I had symptoms bad enough to scare me, but I knew something was wrong. I woke my wife up and said, "I think I need to go to the emergency room."

We made it to the hospital with no problem, but by afternoon I was basically unconscious. I made it through their tests—EKG, x-ray, CT scan—without any real problem, but I went down so rapidly afterward that I don't really remember anything the rest of the day except struggling to roll over when they told me to.



They determined I had pneumonia. Plain ol' no-GVH pneumonia.

I went through leukemia treatments for 10 months away from home in Nashville. (Thank you again to Open Arms, the American Cancer Society, and the apartments we stayed at for providing a home for my family for free for the entire 10 months.) I have fond memories of the whole process, of the people I met, of the family time we had, and of the grace of God that carried me through the process.



I didn't have any grace for pneumonia. The three days of pneumonia was worse than the 10 months of leukemia. Maybe that's just because the leukemia treatments are almost two years in the past, but I don't think so.

I wondered if I was going to die. I wondered if I had squandered the extra time on this earth that God gave me, so he was taking away the second half of my life.

I didn't die. I went in on Saturday, and I went home on Tuesday. My ribs and belly were terribly sore from coughing, but my ribs healed right up over the next couple days. Friday, however, the right side of my belly went to hurting more than ever. It got worse until I had to ask my wife to take me, again, to the emergency room.

It turns out that the antibiotics had thinned my blood so much that my INR was 7.1. Here's what that means. Normal is 1.0. If your blood is 2.0, then it's twice as thin as other people's blood. My blood is supposed to be between 2.0 and 3.0 because I'm prone to blood clots. They give me Coumadin, a blood thinner, to make that happen.

However, the dose I'm on of Coumadin is about as low as they give to anyone. I should not have spiked to 7.1, a dangerously thin blood level. They blame it on the antibiotics; I was taking 3 different ones.

What happened is that with all the coughing, I actually tore my rectus abdominus muscle (the one that gives you a six-pack if you're not as fat as me). The tear was internal to the muscle, or at least to the sheath around the muscle, and with my thin blood I bled into the wound until it was somewhat pressurized. Hence the intense and growing pain.

They gave me a good dose of Vitamin K and it dropped my INR to 1.7 in one day. The bleeding stopped, my tummy began to heal, and they sent me home ... I think on Tuesday exactly a week ago.

I lost 20 pounds during that process. That would be nice, but I'm sure half of it was muscle. Starting over on strength training again! It was already a slow process!

Two or three days ago I thought I would jump onto the first step of my stairs and back down again a few times to keep taxing and clearing my lungs, and to begin the process of getting some of the muscle back that I lost in my legs.

I didn't make it! I couldn't jump onto a 6-inch tall step! Aargh!

I made it this morning, though, and was able to hop up and down 4 or 5 times. I had to start over on the pushups, too. I did four on Saturday, five on Sunday, and six on Monday. I probably have to stay at six for a while because pushups require your stomach muscles to stabilize your body, and I don't want to re-injure that muscle.

Well, enough about me. I'm recovering. I went to work yesterday. I jogged about 50 yards there, taking 2 or 3 little jogs to reach that extreme distance (#sarcasm). I climbed the stairs a few times. I feel alive again, even if my 11-year-old daughter would have no problem beating me up right now. I'd have the advantage for about 10 seconds because I'm still stronger and much bigger than her, but then she could do whatever she wanted while I gasped for breath.

That would be dangerous, too, because she's really flexible and getting stronger because she's learning gymnastics. She comes up to my chin in height, but she has no problem kicking several inches higher than my head.

Okay, enough about me. Sorry for not staying in touch more. I'm going to back through this post and add pictures now.

Saturday, October 19, 2013

Is anyone getting stronger quickly?

Yesterday at Vanderbilt, I read about a lady who had breast cancer. They had a picture of her, so I'm guessing she is about 50. Of course, the picture was of her competing in a bodybuilding competition, after chemo and in remission.

Inspired by her, I came down this morning to the kitchen and realized that I really didn't have enough energy to make coffee. In fact, I couldn't really think straight enough to decide on what to have for breakfast.

"My wife will do all that for me," I thought.

I laid on the couch. I took a few deep breaths, and they made me cough. "Rough morning," I thought.

As I lay there, my son, who is visiting from college for the weekend, runs up the stairs shouting to his sister, "I have so much energy this morning. I just went and did a bunch of pushups just because I have so much energy."

Wow.

Then he went out to the car with a friend to get a screen protector for his phone. I thought, "I should do something." I forced myself off the couch for a new workout I read about. It's a 3-minute workout. In this case, I chose deep knee bends. I do as many as fast as I can, then pause for 10 seconds, do it again, and try to keep that up for 3 minutes. I've never made it past two.

In this case, it totally energized me. My youngest son saw me gasping for breath, and he asked if I was okay, but all the deep breathing cleared up my lungs.

Usually, when I try exercise to kick the doldrums out, it fails miserably. I just end up in bed, unable to do anything. This morning, though, I'm up and typing this blog now, feeling pretty good.

Of course, my wife has made me coffee by now, along with a bagel with egg and cheese.

Question


So, my question is, if you've survived cancer, how are you doing at recovering energy, and what are you doing for exercise? How is the exercise working for you?

Exercise Story


I was feeling like my stamina was improving. I was walking on the treadmill at the gym and monitoring my heart rate. Over a couple of weeks, I had to go up in speed a little to keep my heart rate above 120. That was exciting.

Inspired, I walked several days in a row, and my body crashed. I slept all day one Friday, and then had little energy all day Saturday. I was on my feet most of that day, so I know it wasn't the result of being lazy and laying around.

So I have now limited myself to 3-4 days per week of walking 2 miles, keeping my heart rate above 120.

So here's the story. Last week, I decided to time myself walking around the block (big block). I started up the street, and I was quickly gasping for breath. By the time I rounded the corner and started down Strawberry Rd, I was wondering if I'd relapsed.

Really. I made myself come to grips with the possibility of relapse and be ready to give thanks to God in all circumstances.

Then I turned onto Dartford, which was downhill, and I realized just how uphill the start of walk must have been. My breath quickly came back, me feet felt lighter than they've ever felt, my heart stopped pounding.

The second lap, I took the uphill much slower. I felt MUCH better.

Earlier this week, walking laps at work, in the rain, I ran a little (very little) just because I felt like it.

Progress is SLOOOOW. But it's progress.

Again, I'd love to hear your plan, your success and lack thereof, and whether you're headed for a bodybuilding contest post-chemo or just struggling along like me.





Thursday, October 3, 2013

The New Normal Is a Lot Like the Old Normal

I was told to be prepared for the new normal. I had a good attitude about it. Leukemia, a slightly off version of Blastic Plasmacytoid Dendritic Cell Neoplasm (see tab above), chemotherapy, radiation, and a bone marrow transplant, and I was still alive. I'm a Jesus-follower. If my life were going to be marked by naps, day-by-day medical treatments, and a much slower pace, then it must be his will. All things work together for good for people like me, says the apostle Paul in Rom. 8:28. Life for me is about pleasing God. I'd like to do that without too much pain, but we all must accept the lot assigned to us unless God has given us the grace to change it.

I'm finding, though, that my new norm is not much different than my old norm except that I have to put on sunblock every day and exercise is nearly as effective.

  • I still am obsessed with work. My work involves not just running my warehouse in Selmer, and being a boss to the best crew of employees in the eastern United States, but also involves writing, which I love. I have so many writing projects that it is impossible I will ever get to them all. Thank God I have such a wonderful family, a lovely and enjoyable wife, and such a cute youngest daughter. (To my other children, you're wonderful, too, but most of you have moved out! Shame on you! Manu, you're not cute, just remarkably creative and becoming more responsible and reliable every day.)
  • I worked in the warehouse packing product a couple weeks ago. I only worked a half day, and I'm sure I was much slower than the younger guys, but it was apparent that I could have worked the whole day at that packing station.
  • I cover my arms, face, scalp, and neck in sunblock every day.
  • On a semi-regular basis I forget my past, stay busy from dawn to dusk or even later, and then, one morning, I can't get up. It used to take at least 24 hours to recover from such an episode, but now I'm usually okay by afternoon if I stay in bed all morning.
  • I have tried a couple times to get up, exercise, and thus overcome a "fatigue day" like that. Exercise is possible, and the ability to fall asleep standing up afterwards is impressive, but results have shown this to be a really bad idea.

The blisters, which I think I mentioned in the last post, went away within a few days of stopping my sunbathing program. I guess I'm going to be out of the sun forever.

My running program has been a disaster. For a while, I would run on the treadmill real slow (about 14 min/mile pace) for at least 4 minutes. I worked that up until I could run about 9 or 10 minutes straight, but it was torture. It was terribly painful, especially in my calves. After my last injury, where my left lower leg knotted up terribly and it took four weeks to get the pain out of my foot, my ability to run had dropped back to 2 or 3 minutes, still painful.

So I dropped that program as unsuccessful. Because we moved to Cordova (suburb of Memphis), we were able to get an inexpensive gym membership. I started to lift weights, and after six weeks I am very, very slightly stronger. That doesn't feel very successful, either.

But here's a program that appears to be working well for me. I was stunned on Sept. 6 that I was able to mostly walk, with a few 30-yard runs thrown in, a 5K in 47:18. That is under 16 minutes per mile. When I ran a mile back in June or July, I was only able to run it in 13:59, even though I ran the whole thing. The mile was really painful. This 5K wasn't really painful at all. It was hard, challenging, and I was sweating and breathing hard, but it was like a difficult workout, somewhat pleasant.

This gym has treadmills that keep track of my heart rate. I started walking at 2.6 mph (slower than 20 min/mile), and after a few minutes my heart rate would be up over 110. I sped up to 3.0 (exactly 20 min/mile), and my heart rate reached 120, which was my goal. Just over two weeks, I have had to speed the treadmill up to 3.4 to get my heart rate over 120. Clear, noticeable progress! There has been very little of that in my exercise programs up to now.

I'm sorry for those of you that have had a rougher route. I hope my story gives hope of things getting better, especially if you're careful about what you eat and stay active. Make friends; be outgoing. The statistics on the health of those with lots of friends and a few close ones versus loners are amazing. One study showed that loners were FOUR TIMES more likely to get a cold when a rhinovirus was dropped in their nose than those with strong social ties.

Why not be outgoing? If you have had a bone marrow transplant, and you can read this, you are a survivor. You have peered at death and walked away, probably not unscathed. You have a story to tell, and you are a conqueror. You have been victorious in battle, just like our soldiers in Iraq and Afghanistan and just like King David and so many other great warriors of the past. Hold your head high, make good use of your second life, and give everyone "what for."

And I'm thrilled for those that have done better. I'm still on daily Tacrolimus and steroids to stave off the rash that covered much of my body for over a year. My lower legs were completely covered in rash that entire time. Tamera is completely off her Tacro, and her last post said she's only been taking it once a week up to when they took her off of it.

Another GREAT story is Lexe Selman, who is PLAYING SOCCER FOR THE UNIVERSITY OF ARIZONA LESS THAN TWO YEARS AFTER BEING DIAGNOSED WITH AML. Come on. How can you beat that? I love her story. You MUST see the video and photos on her June 3, 2012 post. I cannot imagine playing in a soccer game between rounds of chemo, much less doing what she did.

Actually, yes I can. I could not play anything like my former self, much less like a young soccer star, between rounds of chemo, but I did play. Everyone was worried about me, but it was a lot of fun.

I remember a game of softball, after the transplant, when my thighs were skinnier than my knees. I had been walking stairs, so I could jog really slow. I hit the ball, thinking that I would surely remember that I couldn't run, but I didn't remember. My subconscious remembered the old days, commanded my body to take off, and my upper body was several feet down the baseline before my brain realized that I had left my legs behind. Somehow, I managed to turn sideways and roll as I hit the ground rather than faceplant.

I had someone run for me, even from home plate, the next time I came to bat.

Not being very smart, I went out and played soccer with teenagers and young men and women a couple weeks later. Same thing. "I have to beat her to the ball," and my body took off with my legs flailing behind me. I didn't roll, I sprawled. The moment when everyone looks at you and says, "You okay?" is pretty embarrassing.

Anyway, I thought y'all were due a little update. Back to the doctor on Oct. 11, when maybe I can go down on at least the steroids.