Slouching Towards 2012

It's been quite awhile since I have written and it is not for lack of material.  The last month has been filled to overflowing with things I want to write about - participating in the Commonweal Cancer Help program,
having my three month MRI (no change),  getting a second and third opinion at Stanford and MD Anderson - but honestly my month has been dominated by one mundane, prosaic thing which has prevented me from writing - a bad tooth.

Thanksgiving/Advent

Thanksgiving 1971, I'm on my mom's lap in the middle-right of the picture sporting a red that I haven't worn since

With my grandfather at the same Thanksgiving

Thanksgiving has always been my favorite holiday. While it has slowly morphed and been perverted into the day before black Friday (aptly named even if it lacked irony), I've always thought of Thanksgiving as the most incorruptible celebration. It feels like a religious  observance but it is as secular  and universal as we can get in America - gather with friends and family, eat, and be consciously appreciative of the good things in your life.

Brainstorm

I woke up two mornings ago to the amazing sight of a fast moving rainstorm rolling toward us from the Pacific about a mile away.  The gorgeous but somewhat eerie light lasted only a few fleeting minutes but signaled that things were about to radically change.  A pounding rain lashed our building minutes later.  It rained most of the morning and then it passed.

Glass of Dirt

This has become part of my daily ritual (a twice daily ritual actually), drinking my "glass of dirt" as Walt has dubbed it.  It is part of the Traditional Chinese Medicine treatment which has been an important tool in my cancer fight.

If you are wondering, it looks like dirt and it tastes like dirt so Walt is a pretty astute observer.

Handshakes

Last week, the friends and colleagues I entered the Foreign Service with (the 133rd class of A-100 "Standing and Clapping") hit another milestone on the road of a State Department career as "handshakes" went out for everyone's third assignment.

The first milestone, in my opinion, is the opening day on A-100 when we all collectively and without much pomp and circumstance (standing in the lobby of FSI) swore an oath to uphold and defend the Constitution.

Summit Leads To Эпоха застоя

It was Always Sunny In Philadelphia until the last day of the conference and the 5K which is why Steph appears to be frozen in this shot.

We spent last weekend at the National Brain Tumor Society Summit in Philadelphia.  It is the annual meeting of the NBTS - part scientific conference part networking opportunity for patients (or "survivors" in their lingo) and caregivers.  We did learn a few things and connected with some very nice people but I left feeling dissatisfied - my perspective hasn't improved significantly but it hasn't gotten worse either.  Stagnation.
I'm not sure what I expected, certainly not a miracle cure that had somehow eluded me before, but I wanted something - some kernel of hope, some promising procedure that I hadn't come across yet - and unfortunately, that simply doesn't appear to be out there.

Noyo

I had the chance to take Walt to possibly my favorite place on earth recently - Camp Noyo - a former logging camp in the redwoods of Mendocino County which became a boy scout camp in the early 1930's.  Our family has been coming there for, after Walt's visit with his cousins, five generations now.  We didn't do much traveling as a family growing up (perhaps that's why the travel bug bit me so badly when it did) but we did drive up to Noyo and spend a few days on a fairly regular basis.  Our times there as a family are some of the happiest that I can recall - when it was clear the we all felt content and at home.  It was fun to see Walt's joy in experiencing it all for the first time.

Captain America vs The Hulk

I know this post is a little late as it has been a week since Captain America roamed the Avenues very politely  asking, "Trick or treat?"  Walt quickly surmised that wishing strangers "Happy Halloween" was also the way to go.  We had a fun night and I'm happy to say that all of the pleasure was going door to door, seeing the costumes and decorations (Walt generously wished a stick figure on a lawn,"Goodnight skeleton!") and filling the bag - actually eating the candy he is less interested in.  It was satisfying to watch the light go on and see him "get it" and throw himself into the weird fun of the day versus the bewildered and oddly serene Incredible Hulk that he was as a six month old in Moscow.

Pretty Good, Not Bad, I Can't Complain

All things considered, our participation in the Silicon Valley Brain Tumor Ride was a big success.  As I wrote last week, I've been a bit foggy and lacking in energy since tapering down on dexamethasone a couple of weeks ago, so I had my doubts about having enough in the tank for a fifty-mile ride (kind of embarrassing since we used to ride 75 to 100 miles a day without giving it a second thought).  Happily, I felt great and even had enough for some unplanned detours - a combination of poor signage on the route and generally being unfamiliar with the  Peninsula - when all was said and done, I probably rode closer to 60 or 65 miles (including a few at the finish that I could have done without).

Swimming in Molasses

While I have written about this in the past, I am back to the same place so here we go again...I am tapering down to a lower dose of the steroid Decadron (wasn't he a Transformer?).  I am very, very happy to be doing this and I can't wait (actually, I can wait.  I will taper very slowly so my endocrine system doesn't go completely haywire) but it is leaving me feeling like I'm waking-up from a ten-year nap.  I'm sluggish, fuzzy, and living in slow motion.  It will pass but right now it makes getting through the day a challenge.

Happy Anniversary

It is hard to believe that it has been a year since we snapped this picture in front of our house in Canberra before we hopped in a rented car (our hastily packed nine suitcases somehow crammed in there) and headed for Sydney and home.  Looking back, I now realize what a complete altered state I was living in for the next six weeks.  Brain cancer, brain surgery, chemotherapy - the kind of words that make you do a double take - is this real?  Did I hear that correctly?  I was fortunate enough to have never had a serious illness in my life and so nothing compelled me to think about it too much.

Brain Tumor Ride

No, we are not going to use Walt as child labor during the Brain Tumor Ride in Palo Alto (I'm not sure if he is up for 50 miles but I know he would give it a go).
We've been looking for a way to become more personally involved in raising money and awareness of brain cancer and the Brain Tumor Ride in October seemed like the perfect way for us to do that.  The National Brain Tumor Society is an excellent organization and has been a great resource for both of us over the past year.

Fierce Ambivalence

"But Roseman had also spent a sleepless night, brooding over the Perry Mason television show the evening before, which his wife was fond of but toward which Roseman cherished a fierce ambivalence, wanting at once to be a successful trial lawyer like Perry Mason and, since this was impossible, to destroy Perry Mason by undermining him."
Thomas Pynchon The Crying of Lot 49
I had my MRI yesterday and saw my neuro-oncologist.  After standing for over an hour on a combo of MUNI buses headed to China Basin (hacking fellow passengers everywhere - anyone seen Contagion yet?), I arrived late for my MRI.  They pushed me back forty minutes but were able to get me in.

All Cancers Are Not Created Equal

Last week, I found myself with some time to kill at the Hellen Diller Comprehensive Cancer Center at UCSF's Mt. Zion Campus.  It is one of 39 centers around the country specially designated by the National Cancer Institute as institution that provides "laboratory, clinical, and population-based research, with substantial transdisciplinary research that bridges these scientific areas."  This is essentially where you want to be if you need cancer treatment in the United States.  

Devouring or Devoured?

I thought it was time to rename the blog.  Keeping Up with Chris, Steph, and Walt Van Bebber has done the job admirably since we started this last January when simple and literal seemed appropriate.  Getting overly  precious about what we called it just didn't feel right at the time.  But recently it's just seemed a bit too bland and descriptive - like a folder we have in the file cabinet labeled "Taxes 2006" or "Moscow Receipts."
I found out not too long ago that one of my oldest friends called me the "Devouring Mind" in high school I think mostly because I was curious about and interested in everything and I just had a burning desire to know and discover things.

Round 11

I've just finished my eleventh round of chemotherapy and, unsurprisingly, it has begun to take its toll.  I guess when you reach the 11th round of anything (a heavyweight prizefight, your turn to buy a round for the eleventh time), it is time to think about packing it in and going home for a rest.  I'm almost there.  When I swallow these seven capsules of poison for five days every month, I think - just attack the cancer.

Hooray for a home!!

We've been reluctant to write since we left Canberra.  It has been a different transition.  And although we should be used to moving this has been a harder move than we've had in the last few years.  We've been staying with family and friends, we've traveled and we unfortunately even had a few days in the hospital (Chris coming down with pneumonia in Canada). But mostly, we've been superstitious, not wanting to share our news until it was for real.  After talking about buying a home in San Francisco since we first lived here we finally did it.

Headed Home

We finished the pack out this week and watched as our things pulled away in wooden crates down the quiet streets of Franklin, our suburb in Canberra.  For the first time Walt helped pick out what would go in his suitcase, the air freight and on the ship.  He was a trooper and although my patience was tested more than once I do think his being part of the action has made it easier on him that we are doing this again so soon.

Strikes and Gutters...

...up and downs.   This pretty much describes our last few weeks.  Three weeks ago, I made the long, and this time, stressful trip back to San Francisco for my regular two-month MRI and appointment with my neuro-oncologist  Casey made the trip down from Idaho to see me and go to the appointment with me since Steph remained in Canberra with Walt.  The news was good - stable, no new growth perhaps a slight improvement.  I was so exhausted from the trip and stress, it was hard to enjoy much about being home.

7 months

Chris just returned from San Francisco. A crazy, short dash to get his MRI done and the next two rounds of Temodar in hand.  Despite a lot of trepidation going into the trip, the news was once again a great relief: stable disease to possible response.  After two sessions at the Osher Center and a great visit to Dr. Chang we were fully satisfied that all the subtle symptoms that seemed to be creeping into our lives were the result of too little rest, many different medications and jumping back into full time work again for the first time in 6 months.

Settling In

We've been back around three weeks now and we are just beginning to feel adjusted.  The last three weeks have been such a rollercoaster, for both emotions and expectations, that we are still feeling a bit out on our feet.  Well, two of us do anyhow - Walt has never looked happier to be reunited with his toys, piles of sports equipment, books, and "his" backyard.  I wouldn't say that he was miserable in the City but I know that he sensed the uncertainty and temporary status there.  Being back together with his "stuff" has seemed to reassure him above all else that life is back to normal.  I wish it were so simple for adults.

Fall leaves and kangaroos meet Easter renewal

  We've had many emails from you to check in on us, thank you.
  We are happy to be back in Canberra and now approaching three weeks are starting to establish a routine that feels right.  For sure if we had any doubts about our return they were erased by the joy that has lit Walt's face since we landed.  It is a reminder of course that kids feel everything we do and the weight that lifted from both of us when we returned "home" was also lifted for Walt.

Heading "Home"

It looks like on Sunday the three of us will be boarding a plane bound for Sydney and heading back to our house in Canberra and my job at the Embassy.  The last few days have been a Through The Looking Glass inversion of our last few in Australia.  Fours days ago, it just did not appear to be a realistic possibility that I would be medically cleared to return to Australia.  Now that I've had a few days to process this and let it sink in,  I  couldn't be happier.

Crazy news!

If you can believe it the State Department gave us an option today to return to Canberra.  They called our oncologist and heard from her how well she thought Chris was doing on chemo and that she couldn't predict how long he would remain stable, that she thought there was no reason he couldn't work at full capacity and that she thought the care in Australia was good. She told him she would remain his primary oncologist and that we could continue to be seen by her even if virtually. All this changed the State Department's mind and despite saying he would highly recommend against going back that we would have that option.

Headaches and hiccups

With Walt & Dad on Bennett Ridge

I'm sorry to report that my headaches returned for the first time in almost ten weeks last Sunday.  I was hoping that the alternative therapies that I'm doing along with the apparent effectiveness of the chemotherapy were at the very least, controlling my symptoms.  After a rough night and twelve miserable hours in bed on Sunday, we spoke with the doctor and I went back on my favorite steroid.

Is February really the shortest month?

...because it has felt interminable.
To begin, I'm still feeling healthy.  It has been close to three months that I've been free from acute symptoms.  We started the month thinking that if the next scan showed improvement or even stable disease, we could head back to Australia, get back to my job, and regain a semblance of normal life.  After several weeks of back and forth with the State Department, it now appears that I won't be medically cleared to return overseas and I don't have much input on this.  In some ways, these last two weeks have been harder to take than my original diagnosis.  I suppose I didn't realize the extent to which I had equated returning to my job in Australia with having turned the corner with my cancer - somehow that was the milestone in my mind that would turn our upside down life right again.

Spring

Forget Groundhog day, it has already felt like spring in San Francisco for about a month.  While the "best" (warmest in this context) weather in the City comes in the fall, I can't help but get swept up in the glories of the false spring even if it is destined to come to ruin in a few weeks in the form of premature dropped blossoms and second base marooned in a gigantic puddle.

The Emperor Of All Maladies

Perhaps this isn't a title which would catch your eye in a bookstore - The Emperor Of  All Maladies: A Biography Of Cancer by Siddhartha Mukherjee - but I can highly recommend it.  It was a Christmas present (ha!  Having trouble deciding what to get the recently diagnosed in your life, how about a 571 page history on cancer?) but I just got around to reading it last week.

Qualified Good News

Is there any other kind when dealing with health (or doctor's pronouncements)?
I had my four-month MRI yesterday and saw my oncologist.  I can say for the record that what began as an hour of torture in the Sci-Fi machine has become old hat.  I found myself drifting off, looking at my reflection in the control room window via a mirror attached to my "Hannibal Lecter goes out for the day" mask, wondering if GE was consciously channeling 2001: A Space Odyssey when they designed this MRI machine.  I used to find the hour of lying immobile in a small, noisy (imagine R2D2 getting slowly crushed in the Death Star's trash compactor) metal cylinder was an unpleasant experience that required visualizations (trying to recall the run in Hance in every detail) to endure but honestly, it doesn't seem like a very big deal anymore.  

A good laugh and a long sleep

There is an Irish proverb that says,"A good laugh and a long sleep are the best cures in the doctor's bag."  I have been laughing plenty but sleep has been hard to come by.  One of the most effective medications at helping to reduce brain swelling is the steroid decadron.  It seems that all brain cancer survivors spend some amount of time on decadron.  Unfortunately, decadron comes with a litany of unpleasant side effects - anxiety, irritability, elevated blood pressure, weight gain, and worst of all in my case, insomnia.

The Osher Center for Integrative Medicine

One of the most amazing aspects of receiving treatment at UCSF is that not only do we have some of the best oncologists in the world, we have the possibility of getting holistic, clinical care as part of the same medical system.  Rather than having to seek out treatments outside of the usual health care systems, UCSF offers integrative medicine under the umbrella of the rest of your care.  This also means that the practitioners can access your medical history and contact your other doctors as colleagues.  A few months ago, I wouldn't have appreciated what a profoundly revolutionary idea this is.

Treatment

We discussed our treatment options with our doctor - we could simply monitor the tumor with regular MRIs and hope that it is in fact a very slow growing cancer and discuss treatment when the tumor showed change.  It is a strange thought that I may have been carrying this cancer in my brain for a very long time without showing any ill effects.  We will never know this.  The doctor thought this wasn't the best option in our case and this made sense to us given that I had started to show some symptoms.

Diagnosis

Pre-surgery haircut - I only needed a small patch shaved

The day after my MRI, I saw a GP in Canberra who sent me to see a neurologist. While ruling out a diagnosis strictly from a scan, it appeared that my "migraines" were being caused by a brain tumor.

After talking with the doctor, we decided to return to the U.S., specifically to the University of California, San Francisco Medical Center (UCSF), for further evaluation and treatment.

The next few days were a bit of a blur. Colleagues at the Embassy could not have been more helpful and supportive and by some minor miracle, thirty-six hours later, we were boarding our San Francisco bound flight in Sydney having spent about an hour packing our bags.

When and how did this all start?

We began noticing that something was up around the time we returned to Washington for training after our posting to Yekaterinburg, Russia in March of 2010. I felt exhausted and could never catch up and feel rested. Given the circumstances - a mid-winter move from the edge of Siberia to a demanding training schedule at the Foreign Service Institute (FSI) in Arlington - it didn't seem too unusual and we just plowed ahead.