“David Foster's Kicking Kidney Cancer’s Arse”

Sutent and Oink, Oink, Oink

    (Disclaimer: I am a senior executive for a  large media company. What some might call a "suit." A man who hired and fired and had (until cancer) fiduciary responsibility for a large group of consumer magazines. Every day for more than 30 years I had to make decisions about what was "best" for the company, for our employees and our customers, not necessarily what was "good" for them. My job was to make as much money for the company as possible. It was not always easy to balance those roles and I certainly did not make all the "right" decisions. I have been cursed many times as a corporate greed master, mostly by disgruntled ex-employees and some customers when we had to raise advertising or subscription prices.)
   
    This essay is about the "greedy" pharmas, Pfizer in particular. I am not writing to necessarily overly praise Pfizer, nor am I writing in any whining attempt to bury it. On my lavatory counter is a bottle of Sutent. For more than a year, this drug has helped keep me and thousands of other Warriors stay alive. It is terribly expensive, some $8,000 a month. Many people on the message boards often question Pfizer's morality for charging such a huge amount for a life-saving drug (think oink, oink, oink). Further, many warriors are convinced that Pfizer and other companies are holding back on better treatments (such as the still experimenal Anixitib) until they have milked the financial value of Sutent and other drugs dry. In other words, for all the good Sutent does, the people who make it are corporate pigs, manipulating life and death for their selfish financial interests.
    I don't think so. There is much more to any business than meets the consumer's eye, so I will try to make an example of a big business that most have seen in action.
     Think about a major  airline, say Delta, which just emerged from bankruptcy. There is much more to the cost of that business than the fuel to get from here to there. Think of the overhead from check-in until the time you take your skinny little seat and watch the service trucks and people scurry around your plane. Many a time I have sat next to another passenger and listened to them complain about the cost of a ticket. One man had multiplied his fare (which was probably not the highest on that plane) by the number of passengers and came up with a gross of some $70,000  for that one short flight. "Rip off," he grumbled,  "just a rip off."
    Consider for a moment the deeper meaning of  that rip off. A Boeing 757 cost some $25 million, just the interest is a big bite, not to mention maintenance. The two pilots cost about $200,000 per year (and there are some 5,000 on Delta's payroll). And then there is the squad of flight attendants. There is the the ground crew that scurries around the plane like piggies looking for a teat and all that equipment they use (that little truck that pushes the airplane away from the gate, about $60,000 each).  There is the  baggage handling facility, the ticket sales operation and personnel, landing fees, the rent on the whole shebang, multiplied by every destination to which Delta flies. And no where did I mention the fluctuating price of fuel. There are the airplanes not flying (in repair or removed from the system, but the interest doesn't stop), the extensive maintenance system itself, the corporate staff that tries, not necessarily well, to keep the whole system humming. Oh, and those flights that have too few passengers to make the basic overhead for that flight. As I understand it, a trunk airline needs as least a 60% load factor to make a buck. And have you ever considered the costs for complimentary blankets and pillows. Millions, baby, millions. Hence, airlines for all their rip offs have one of the lowest margins (percent profit after expense) of almost any other business. How does one know this? Delta, and other trunk carriers, did not seek bankruptcy because they wanted to. That is a tough place to count your money.   
    Look at an airline that way and your ticket may no longer seem quite the rip off, especially since you are going to be somewhere in a few hours that 50 years ago would have taken a few days. Oh, yeah, that has a little value too.
    As consumers, we don't see the overhead of a pharma as easily as we can that of an airline. What we see is the pill and the bill. But the investment that went into that pill is way out of the range of any average well-meaning billionaire, especially if he or she had to start from scratch, not to mention the years and failures it takes in the drug business to come up with one FDA-approved winner (spend, spend, spend). Take the  airline example.  Any jet sitting at a gate today is, over time, a multi-million dollar bet, a bet that enough people will fly on it to help the company make money and often the bet doesn't pay off. But the plane, normally, still flies, money loser or not.
     It is pretty much the same for a new pharmaceutical product, often a far more expensive bet. If you can make it work, the world will beat a path to your door money in hand. If you can't, well, chalk it up to a very expensive education, sell more of something else and start all over again. For both airlines or pharmas, success is a big real dollar bet with only a so-so chances of winning. And when it comes to stakes like these only the really big boys can stand at the table--and must have a rock hard stomach while tossing those dice. In the pharma business, the old saying "hit me again," has a multi, multi million dollar meaning.
    Pfizer has an army of employees worldwide from sales reps to engineers to researchers to managers. And about as many research projects. And they do make good money ($19 billion last year before taxes). Oh man, that does sound like such greed. But just a cursory view of Pfizer's primary products in the United States alone for all manner of diseases is amazing..and long (www.pfizer.com).  And they make a lot of money because people need those products. And,  like it or not, that profit is normally much more effective for research than that raised by all the volunteer cancer-thons held every year.
    Only one of those products is our little darling, Sutent. And we think the shareholders must be rolling in the dough, the dough of poor sick people. Well, not really, since most shareholders are folks just like you and me who own a piece of Pfizer through our retirement plans, especially 401Ks. Therefore, a happy retirement requires that Pfizer and other public corporations make as much money as they can. We don't like it any better than their  Chairman when our investment portfolio loses money. Whew, how contradictory all this can be.
    One complainant asked why Pfizer would come out with specific medicines for kidney cancer when there are so many breast and other cancer warriors in greater need? The answer is simple:  Kidney is the cancer drugs like Sutent can fight today. If they had one for breast cancer--or so my greedy little corporate mind believes--they would be all over it and just forget us poor old kidney cancer warriors. Man, the money would roll in like water over a fall: party, party, party. Then again, Sutent may be the pioneer for other cancer drugs and profits from it helps fund greater research. Oh, and it is saving thousands of lives, over time hundreds of thousands. I have a feeling that is a motivation as well. Every employee and executive at Pfizer--and every other pharma--know people who have cancer or may have it themselves. Might be hard to be a corporate "pig" under those circumstances.
    But, you argue, for all my arguments based on business and other "non-humane" things, you are still convinced these people make too much money off  Sutent, charge ridiculous prices, are milking the system and their own financial statement indicates they don't need it. Where is the heart? The compassion? The desire to help their fellow man? 
    Me thinks you miss the point. When it comes to finding the cures for such complicated illnesses just being in the business is humane.  Most of the pharmas offer financial assistance to folks or at least temporary free product. But their primary job is to march forward in research and new products. Period.
    Sure there are greedy people working for Pfizer. As there are for most any corporation, as there are attending your church and teaching your children. You may be greedy yourself, perhaps one reason you may think Phizer is. And there is no doubt there is waste. However, regardless of what they charge or what your heart thinks of them, our world (mine and yours) is infinitely better off with them, suspicions of greed or no.
    Bottom line: The Chairman of Pfizer may have a wonderful over-sized home (0r two or three) and a big old yacht, maybe a private airplane as well, not to mention a steak every night. And a staff of valets and a yearly bonus that is 20 times what most of us will make in a lifetime.
     You and I have our lives and realistic hopes for more tomorrows we did not have last year. A better than fair exchange.

   

When 'The War on Cancer' is Forgotten

    Last night this sometimes orator gave the dinner meeting speech to the state convention of the United Daughters of the Confederacy..and may have come away with a nice premonition of our own war with cancer. Oh the ladies and I  had a hootin' and hollerin' good time as I told stories less than flattering--but in good humor--about our Yankee brethren. That's the good thing about being "losers" in a conflict like that. You never forget it. Overtime the loss becomes less hurtful and more humorous, but still, you never forget it. That is until enough generations finally pass that the old time-stained bell, while still ringing, is just more and more distant, finally so distant nobody much hears it.
    Southern young people, say under 40, don't much care. They study "the War" in school. The boys like it better than the girls because of the fighting, but few identify the Confederacy with any part of their heritage. Heritage for many Americans, north and south, has become just a "so what" experience.  A video game about the War for Southern Independence would die on store shelves like a flower would die in a drought, even in the South.
    I, however, am not of that generation. I was raised on stories of the war by folks so close to it they could still smell the smoke and feel the anger. I learned early about  Sherman's March through Georgia, of how the Yankee troopers looted the big house and the smoke house (not to mention digging up the outhouse in search of silver. Ewww!), how grandfather Nations limped on his shot-off  heel back to Georgia from the battle at Perryville, Kentucky, only to put in a crop and limp  back to the army in time to even the score at Chickamauga. My grandmother loved to tell of  how one of my Crawford grandfathers demanded that
General Robert E. Lee himself dismount, advance and show his pass...and got a commendation for it. And she would speak reverently  of four other Crawford/Nations/Foster men who were left forever in the vast burying fields that dot Northern Virginia. When I studied the War in high school history, many of the other students already knew the subject  intimately...and more than willing to fight the battles all over again.
    It has been, however, at least 20 years since I could find anybody else who much cared, not that they didn't have an academic interest in the war (that remains strong), but people who still have an emotional investment it it. Until last night. And what we enjoyed was not the maudlin, but the benevolent humorous, though still at the expense of the Yankees. There were some 150 ladies there, many who wore their Southron  genealogies on their sleeves (Southerners are much like the Chinese. We eat a lot of rice and worship our ancestors.). And happy to remember the Lost Cause and the soldiers who fought it at the slightest suggestion. And their number grows smaller every year.
     They came to Augusta primarily to honor Gertrude Clanton Thomas, who kept a journal of her life from 1848 to 1911. She was a die-hard Rebel in her youth yet died a national leader of the suffragette movement. Her journal, The Secret Eye (available on Amazon) is one of the best known, poignant and realistic journals of  private life during the war and after. Her husband kept them struggling in genteel poverty their entire marriage as she struggled to raise her surviving children, deal with the reality of her dead ones, find someway to fund their lives and maintain their social standing at the same time (which, in the end, faded away). So I made fun of her husband as well, Southerner or no. I am a very democratic fun maker.  The prim ladies loved it when I called him a "dumbass." He even sucked as a soldier and only served as an incompetent aide de' camp to a family friend. And the friend sent him home twice just to get rid of him, both times to Gertrude's chagrin. Yeah, Lord, what a dumbass. Gertrude's story, however,  of strength, commitment and resolve under incredible pressure would make any Knight feel proud and related.
    But as you can imagine, the UDC is not necessarily for the young. In some ways those nice, good natured--but older--ladies looking up at me were remindful somewhat of an old faded photo of a turn-of-the-20th-century Confederate or Union veterans reunion, where the old soldiers peer fiercely into the camera as they lean on crutches, support one another or just sit in wheel chairs. The fight gone, but the pride not.
   And that  made me think of our War on Cancer. How we  are in the vanguard of this mighty millions of conscripted soldiers struggling to win not just our battle but the war it self, to one day to be considered the veterans of a conflict future generations cannot imagine. How we are not only working to survive, but are blazing a way forward when the War on Cancer will be as out-of-mind as the Civil War. Just a dusty note in history. A subject whose only reference might be at some rostrum when a speaker says, "I am reminded of the war on cancer...." And some young listener thinks: "The war on what?"
    I doubt anybody will make light of cancer even then, not nearly as much fun as making light of the Northern aggressors 145 years hence. But what a great day it will be when that young listener wonders "The war on what?"
    Wouldn't you reader, like to join me there,  just to hear the awkward silence? 
    How sweet it would be, that ignorance, that inability to relate to our war. We will have fought it. They will live longer for it, other worries to occupy their time. There will be no memorials or medals or even great speeches about our unwilling, yet brave, army. But that is as it should and, I pray, will be. Just a job done, well done.
    Victory...at last.

   

Beyond the Needles, Machines and Pain

    Richard grinned like a kid at the fair when he saw Gracie, my little Brittany Spaniel. And her eyes brightened when she saw Richard, tugging hard on the lead to get over to him, toe nails barely finding purchase on the hard, institutional floor. Her excitement surprised me. They had only met once, back in the winter, when Richard went (somewhat unwillingly) down to Wade Plantation with me to photograph some pointing dogs. And Gracie about drove him crazy trying to get in his lap in the front seat. Finally, he and I conceded and let her come on up. And together they sat, quietly  watching the Georgia countryside roll by, his elegant fine fingered hand stroking her neck gently, but his mind far beyond the car seat, in some kind of deep reflection. Then a story rolled out of him about how he and his dad hunted quail and had dogs and how much fun it was.

    It was quite the joyous reunion. Gracie had come with me to the oncologist 's office to provide a little doggy therapy, but we had a bit of trouble getting past Richard. Though he was hooked up to needles and tubes and covered in a blanket, he leaned over in the big oncology recliner, gave her a few pats while telling his other chemo Warriors--with more animation than I thought his weakened body had in it--all about their adventure back in the winter. How she sat in his lap and later pointed a couple of birds and reminded him of his own hunting experiences. The grin only got bigger.  That broke the ice with the other Warriors scattered around and soon Gracie was visiting with everybody, but always with an eye on Richard.

    LeRoy only knew Gracie by reputation. Oh, he had seen her and damn sure heard me brag about her, but she was nothing major in his life, just another hunting dog. Cute, but so what? He ran one of  the farming operations at Wade Plantation. His life was corn, soybeans and peanuts. Planting them, weeding them, harvesting them. He operated huge machines as if they were sports cars, lending them a nimbleness you might never imagine. Combines and tractors, the kind of massive machines that can rob the horizon from a 600-acre field. He knew the soils as if they were his pets. He understood moisture and when to plant and when to harvest and when not to. If drought got one of LeRoy's crops, he suffered. Not just at the economic loss, but at the loss of life, the vitalness of soil gone to too little rain...or too many bugs.

    During the past two weeks, both Richard and LeRoy died.  And during that little slice of time both of them taught me something about dying. Something positive. About how to fight the best fight you can, but in the end, the very end, it is time to gather your memories and let go.

    That hardly means they went without a fight. Richard had been battling blood cancer off and on for more than 10 years; LeRoy, with lung/brain cancer, for more than one. Though they were both very sick men, to the end they could find their humor and their will to live, their need for another tomorrow. It wasn't the lack of  fight that killed them. It was cancer, that bullet from the body that, if circumstances are such, no man can beat...at least forever.

Gracie and Richard had their happy reunion only ten days ago today, four days before he died. LeRoy tried to work up until two weeks before he died. He would call in and say he would be late that day; most of the time he never got there. For LeRoy work was life. When he couldn't even make it to the farm, it was the loudest of signals. LeRoy may be past the post.

Richard and I were sitting outside the chemo room one day, waiting to be called in for blood work. He said: "When I go, I want to be sure to have seen all my children and grandchildren before I close my eyes."

The oncologist's chaplain, who was with him when he died, said Richard held on for at least a day until that parade of loved ones from across the South had been completed. And then he closed his eyes, took one more breath and died. For his life, there was nothing left to do. The future was elsewhere.

LeRoy's story is not much different. When he was conscious, he wanted to see his family. As I understand it, once his parade of loved ones passed by, he passed as well. In the end, and here I mean the very end, it is all about who we love. All else is, well, just is.

Many of us so far from death, even those of us rife with cancer,  talk about going to our maker "kicking and screaming," or maybe we push the very concept of our death from our minds, that just thinking about dying is a sign of weakness, of  "giving up."  I am somewhat guilty of that as well. Maybe a lot guilty.

But over a period of only 14 days, I learned so much about dying from these two fine, brave, well loved and gentle men. They did go kicking and screaming. Up to a point. Up to the point when the body and mind said it is time to go, what some call the quiet message of departure. But that resignation set them on a different fight, the last of their lives. To see their loved ones, to have the final hugs, kisses and tears--then pass on without fear, without remorse to what both seemed sure was somehow a better place. Told me so more than once. A place where hopefully they could remember their lives before cancer and pain and needles and machines and weakness and so much unwanted dependence on other people. Where the corn fields were deep green and stretched to the horizon. Where the dogs pointed often and a dad's hands were on their shoulders. Where even a wife's superficial kiss carried so much of a lesson about love, care and nurturing. And a little ball game with the kids that so often made better a crappy day.

Bon Voyage, guys. I do so wish you well.

Free Kidney Cancer Book and NOVA Feature

                "Incidental Finding: Essays on Renal Cell Carcinoma, Second Edition."

This very nice book published by cancer survivor and activist Cynthia Chauhaun, is available FREE to warriors, knights and other interested parties post paid from www.ackc.org and www.birthoggdube.org.  It includes essays from medical practitioners and warriors and covers everything from dealing with the warrior issues to being your own best counsel when it comes to dealing with the medical community, not to mention insights from medical professionals on the disease. It is kidney cancer from A to Z and may be the only book available like it.

It is self-published, but nicely done, as the "second edition" part indicates. The new edition is updated to include the latest targeted treatments, such as Sutent, Nexavar and Torisel.

Cynthia came up with the idea in 2005 when a friend urged her to write a book that goes deeper into the issues of warriors. So she did, dipping into her life savings to publish it. She is a clinical social worker by profession, an artist and poet by avocation, and a volunteer by passion.  She  volunteers as the Co-chair of the North Central Cancer Treatment Group, a cooperative group based at the Mayo Clinic  She also directs a kidney cancer support group, and does other extensive work within the cancer community, building a community of warriors and professionals that is more than impressive, if not unsurpassed. If you have not yet taken advantage of it, this is a great deal.  Oh, don't you think she has earned a round of sincere applause for putting her money where her mouth is?

One more (and just as good). Reader Shaun, a great American, sent me this link to a NOVA program on PBS on the early work on the antiangiogenesis process. This work eventually led to our marvy medicines Sutent, et. al. And it will make you feel lucky (and I mean lucky) to be alive. In eight parts (about 30 minutes).

http://www.pbs.org/wgbh/nova/cancer/media/2805_01q.html

 

Deer Hunting, Bird Watching and Your Life

Deer hunting. That is what I was thinking about this morning. About how it really is not all that difficult, at least physically. You drive out to some predetermined place in the forest (in the Midwest and Mountain States, river bottoms are great), get in a nice safe stand and wait for the deer. Most hunters use "tree" stands or elevated stands that support themselves so they can look out over the fields and woods. Others, like me, are either too chicken to use an elevated stand or just don't think it necessary. We sit  next to a good tree, facing into the breeze. So why am I talking about this on a cancer blog? Well, I get e-mails from warriors who are deer hunters and/or their Knights talking about giving up that pursuit because of cancer, the side effects of medicines or whatever.

That may not be such a good idea. Whether you hunt deer, enjoy the sunrise on the local hilltop or just sit with some binoculars and watch birds in the back yard (one of my favorite hobbies) doing something is important to beating cancer, especially if it is something you love or just different.  What I love is the forest and field and shamelessly try to find converts. One little bitty caveat: I am talking down in the woods and fields where the critters live, not some roadside over look. Almost every wild animal in America haunts what we call "edge cover." That would be the woods near a fallow field, a clear cut (because of the browse. This is especially fine for deer, song birds and other animals. You may hate the very idea of clear cuts, but that's the way the wildlife world works) or any brushy understory under hardwoods or a pine/hardwood mix. Another great spot is any mixed woods between two agricultural fields. You can't beat creek bottoms and swamps. Cover is wildlife's prime protection. Never leave your binocs at home, ever.

Anyway, the last six weeks I have felt as if I couldn't move past the bedroom, much less the house. But if you read my last post, you might remember some buddies basically pulled me out and took me down to their deer lease and helped me feel better than I had in weeks. Not just physically, but mentally. Three days later, the shortness of breath is gone and today I planned another trip to the woods for this weekend.

The reason I like the forest, whether deer hunting or bird watching, is that when you are there looking for something in particular  and not just looking at the woods, your concentration moves far away from cancer and how badly you feel. You have often heard the old saying, "not seeing the forest for the trees." How about not seeing the woods for the pageant of wildlife in them? But that takes patience, silence, an alert mind and a willingness to learn, not from a book, but from nature. It does not necessarily take a lot of energy (good for us Sutent ridden warriors). You don't move, the animals do. And when you come home from a three or four hour adventure (best very early in the morning or late in the evening), you talk about what you saw, not how you feel. I will never forget the bobcat that literally walked up to me one morning, no idea I was there. Problem was, I had no idea it was there either. When our eyes met its facial expression said "Oh, sh-t" and I said out loud "Oh sh-t." He jumped about ten feet west; I ten feet east. What a great moment. I wouldn't shut up about that bob cat.

And that doesn't include the myriad song birds, squirrels, foxes, coyotes, skunks, armadillos I've seen, enjoyed and carried home in my heart. And 90% of the time I am doing this with a deer rifle across my lap. Hunting is as much about seeing as it is about harvesting. I once watched a King snake hunt a chipmunk. The chipmunk lived for another day, but I got a whole new opinion about the intelligence of snakes. The only that saved that chipmunk was its own ability to escape that low-hanging maw, but the snake had its own tactics and they were impressive.

And nothing will wake you up faster than a flight of wood ducks whistling in low over your stand heading for a creek somewhere nearby. Or a pilated woodpecker wrecking some nearby rotting tree (what a magnificent bird, big as a chicken and when it feeds it sounds like a tympany drum. Or a hawk flying in through the trees twisting and turning as he goes for a squirrel or chipmunk (used to be, we thought most injured hawks found in the woods had been shot by hunters; actually, the great majority  injure their wings doing all that acrobat flying through the trees. Oops.).

There are, of course,  very real physical obstacles to this for many warriors depending on their general health, but in most states (even in the Eastern metro-plex) there are many quality public places to go, from parks to wildlife management areas. There are millions of acres of prime land for the casual hunter or the nature viewer. And plenty of state programs to help those of us with a little physical need to get to the right place with the least effort. Just call your state's game and fish commission. Or a friend who hunts or bird watches.

A friend pooh poohed the whole idea: " I can't imagine anybody just going into the woods to just take a look. Why do that, why not just read a book? Book? Hush your mouth! How about some good old fashioned reality, and not the kind on television? Once you are ensconced under your tree, say waiting for a deer, within seconds you are immediately sensitive to the breeze and which way  it is blowing, something you may never have considered in your life. The forest that was so silent when you walked in suddenly comes to life.  Song birds fly within a few feet of where you sit and as you watch them you see their community at work, oh can they be quarrelsome? (I always carry a birding book.)  Then something rustles (amazing how quickly your hearing sharpens) in the underbrush and you strain to see what it is. Could be "just" a squirrel. Could also be a rat or king snake out for morning snack or a coyote loping through or a group of wild turkeys eating mass or, if your reason to be there is more business like, that deer you want to take home to eat. And there is no greater time than the autumn to go out, sit under a tree and truly see your world. Not the world we have made for ourselves, but the world the Creator made for us. The world in which we warriors are really fighting so hard to stay.

(Note: I was going to write this "short," but I am beginning to believe short is just not in me. I will try harder in the future.)--DCF

Oh Those Prisons of The Mind

All of this still confuses me. Thirty months in the cancer maw, I still don't understand how it works, especially on the psyche. Here is an example. I have been dealing with muscle weakness and breathiness for more than six weeks. Some days no real issues, other days a shower just wears me out, and that's just the standing in it. I have to wait to catch my breath to find the strength to fetch the towel, wait another minute or two to regain my strength after all that drying and sometimes (and this is the Lord's truth) lay down a few minutes to recoup from the whole exercise. Feels like I have been plowing a mule all day (yes, I have done that. Don't recommend it for a healthy person.) Five minutes later I feel fine (or think I do), hop out of bed only to find myself fatigued again. Lord do I hate it. My wife calls: "Have you done any exercise?" "Yeah," pant, pant, pant, "took a shower."

Therefore most days I just come out on the back porch and work. When sitting in the chair, Jeb keeping guard in his doggy sort of way, I feel just fine, no breathiness or anything.

As I wrote yesterday, perhaps the somewhat final consideration for all this may be a lack of food. Eat, feel pretty good. Don't eat and I'm softer than a jelly fish without a stinger. But the eating part? Much harder conceived than done. Or it could just be stress. Take your choice. I am a cancer Warrior, not a cancer expert, if I had the answers, there wouldn't be so many seemingly contradictory posts here about me trying to work all this business out. Then today I get another view of the issue.

This morning some pals came over to take me down to see their new deer lease on Brier Creek (one of the most historic waterways of the Colonial and Revolutionary periods, but I have made a resolution not to get into those kinds of asides on the blog. But boy would I like to tell you about the stupid defeat of Patriot General John Ashe in 1779. What a dumbass. The British encircle him and attack and then he decides to hand out ammunition to his army. If there is a Hall of Fame for Idiots, General Ashe earned himself a very special place, complete with the gold dunce cap. Oh yeah, I said I wasn't going to do a history lesson, so pretend this aside is not here. On the other hand, if your interest has been pricked  just Google "Battle of Brier Creek." Engorge yourself on incompetence.).

Well, back to the cancer adventure. I wanted to go on this trip and yet felt like it might kill me, but I drag my poor breathless, wimpy weak self to the car, load up the dogs and off we go. Ain't much to the place, 1500 acres of scrub oak and pine, but there is an 1820s-1830s plantation house there that has sadly gone to hell. Well, we look at the house, BS about this, that and the other thing, ride around the property and suddenly, for the first time since I left home I don't want to go home. Just hanging with the guys lifts my energy--amazingly. I even try out a fellow's new shotgun, surprised as heck that I could lift it, not just lift it, but lift it three times. Wonderfully balanced gun, by the way. Finally, I round up the dogs and home we head...and I am feeling oh so recharged. So recharged that as I come into Augusta I spy a McDonald's. I think, a quarter pounder with cheese would be super. Actually Ego thought that. Id, as much a killjoy as Intellect,  is like, "don't be stupid. Why waste three bucks?"

But I do it anyway. And get a big ol' co-cola to go with it. And man, was it good. Like the way they tasted back in the day when I would meet my pals after a date. That kind of good.  I didn't even save a crumb for the dogs. I get home, put the garbage can  away (that has been a real project lately), climb the steps to the back porch and still breathing like a regular person. Even my muscles felt fine, none of that burning sensation. I had been thinking of taking a nap, but instead parked on the porch chair and listened to Old Time Radio. Didn't cut a wink of sleep all afternoon and finished the history column for Augusta magazine. For me, in the perspective of recent history, the whole thing was amazing.

I'm thinking: Either this isn't me, or it's the glowing dawn before the perfect storm. So I pinch myself. It hurt, so I guess it was me. But I can be pretty bad about thinking it is lightest before the dark. A half-empty paranoia I have toted around my entire life.

Tonight Sherry and I went out for dinner, a venture I have come to dread.  I whacked down an entire bowl of spaghetti. And some great soft Italian bread and, yes, a bit of the vine. We went to friend's house and I sat through the whole business without begging off.

Hot-toe-motty. What's the old saying, 'never say never?" Well, yesterday I was saying never, about how I hate food... and come the morrow I very well might again. But maybe something as simple as breaking the routine goes so far to interrupt our negative thoughts. Of course, that's not news, most any therapist will share that piece of advice right off the bat. But we forget so many of life's common sense lessons and we find  ourselves in a rut of thinking negative thoughts and doing it in the same place, day after day after day. And maybe, for some of us, like children, blame it all on "I don't feel good." Yeah, I much better see the downer side of that. Bet you can as well.

Key word yesterday, after eating, was stress, but on further thought, after this remarkable afternoon and evening in the real world, some of us may be building our own "prisons." Perhaps we warriors unconsciously build them around ourselves and in an odd, if not perverse sort of way, comfortably lock ourselves in with our discomforts. And not until someone comes along to break us out do we realize it.

Is this paradise going to last?  I don't know. Predicting this stuff is just impossible, at least for me. But I'm gonna try. I have made a decision that much of my poor health lately has been in my mind as much as in my body. I can't wait to see if I prove myself right.

Now I gotta go take a Sutent, a Decadron, nauesea medicine and two Dilantin. Might ruin the whole thing. Bad attitude? Nope. With all this stuff it is also a good idea to keep a realistic eye on it, otherwise it will sneak up on you from behind the way the Brits did General Ashe. I like to keep a little ammo in my gun. And that  dunce seat next to the Gen'rl empty.

Your Food or Your Life? 'I'm Thinking, I'm Thinking'

I know, I know, this food business may  be  sounding like a stuck record, but I can't help it, I gotta get it out of my system, one more time. So here it is--I am beginning to just hate food, don't even like the word, it sounds so damndably queasy (well, except for strawberry flavored instant breakfasts. They are pretty good, but can a Warrior live healthily on milk and powder? My mom would have fainted at the thought.). I went back on Sutent a week or so ago, after six weeks off, and it didn't take but a couple of days for the se's to kick in, the prominent one so far (and an echo from the not-so-distant past): "Nah, you don't want to eat that."

"But it's fried chicken and whipped potatoes and green beans and big old fluffy biscuits and brown gravy, what do you mean I don't want to eat it?"

Sutent tries to be sympathetic, which is the joke of the century. "Just trying to be your pal, little buddy, and you have gotten little. Goodness what skinny legs. Anyway, do what you want."

Thanks, I will. So I dig in and in fewer than three bites, off I head for the old hurl machine. A few minutes later I step back to catch my breath and Sutent says, "see, I told you."

And I say, "thanks for nothing sumbitch, why don't you go hurt somebody's foot."

I guess getting mad at food is as stupid as getting mad at Sutent. But I am (used to be) an eating kind of guy. I do take this high-priced nausea medicine and works great--unless I forget it. And too often I do. On the other side of the plate, even when I take it and think I am hungry and go into get something to eat, well, the appetite just slips away. These days I have to eat whether I like it or not. And most of the time I do not like it. How can this happen in just five days?

There is nothing less fun than having to eat whether you like it or not. And I am supposed to eat six a day because of the weakness I have been fighting since the end of August. And I've been really getting over that. Doing a great job, thank you...until Sutent entered the equation. No food, no strength. And no weight gain. All you really get out of this is another furrowed brow from the doctor ("you really need to get that weight up.").

Yeah well, you take a week of Sutent and let's go get a hamburger.

The noncommitted have no idea how frustrating this feels. Just the thought of eating--high-priced nausea medicine or not-- just makes me queasy. And there is nothing less easy than doing it under orders (the doc's, my wife, my conscience, they are all keeping an eye on it). "You've got to eat" has become a mantra at the Foster household, as if I am some raging rebel against calories.  Intellectually I would love to chow down, love to, wish I could...but sadly, especially for me, too often I just can't.

But I have learned something.  You know the old cliche about horses and water?  Well, I don't know about horses and water, but  I  am learning about  the  old cancer warrior and fried chicken and mashed potatoes. However, a week ago, I could barely walk to the car without getting out of breath, but I can do the bathroom quick step in less than 15 seconds. Hurling as physical therapy. Never thought about that before.

Boy, talk about a conundrum. But eating solid food this week, even my favorite standby  pimento cheese sandwiches, has just been torture. If you face the same thing, have you ever thought in a strange moment, in a kind of bizzaro world, that you would rather eat happily for a little while without Sutent than live a long time without eating? I have. But only thought about it. I am, if nothing else, a chicken.

Plus, Sutent robs the taste of everything. So even if you can get it down, you don't really enjoy it. Like I said in an earlier post, cardboard over easy please.

I was reading through several of my older posts today and noticed how food is such a common theme, not only from the posts but the comments from readers. I also notice that a week or so ago, when I was off Sutent (just woefully sick from dehydration or whatever) I could eat most anything. Even the six a day wasn't all that awful. Heck, a hungry man can eat ten a day, no problem. Now I don't want to eat at all, except for the cold and sweet.

I've had a girlfriend once who was sweet, but sometimes awfully cold. I chose not to make a life with her either.

Gosh, we sutent victims, uh, I mean warriors, need some help here. Maybe Phizer can come up with a diet program for Sutent. Some way to keep it working...and us working as well. Maybe those of us who face this nastiness should start a letter writing campaign. You know, something like, "Hey guys, the medicine is useless if it starves us to death; find a way to help us eat!!!" (I normally abhor all those exclamation marks, but sometimes you just have to be brutal.)

And when it comes to Sutent, brutal can be good, kind of like a good ham and cheese samwich. "Samwiches" are much better than sandwiches, as in "Hey Mom, can I have a boloney samwich?" Now those were good. As for bologna sandwiches. I like the thought, but only when I don't have to look at one.

(Note: Forgot to thank the great Jack Benny, the world's stingiest comedian, for the title of this post. A robber stops him on the street and demands his money or he will shoot him. Benny does that famous look away stare. The robber then says impatiently, "Which is it, buddy, your money or your life." Benny replies, "I'm thinking, I'm thinking.")--DCF

Acupuncture and a Serious Wake Up Call

Yesterday, my friend Tom called and asked if I would like to do lunch. I begged off. For the first time in weeks I thought I was feeling very productive and figured I would just work through the day catching up on many undone projects. And I did...through the morning. I was setting up appointments, writing copy for the farm books, reading (cursorily) press releases and editing photographs. I was cooking. At noon, I ate a pbj and headed back for the porch. Unfortunately I walked past the bed and thought, well, I guess a thirty minute break won't hurt anything. Three hours later I awake. Only because Sherry called and reminded me of an acupuncture appointment.

So I go over, Dr. Yi sticks the needles in some ten or eleven places (no pain, at all). He then rubs my forehead with the gentleness of a mother soothing her child. When I got there I had a pretty good little headache across the forehead so the massage was  just wonderful. Then he turned on some heat lamps to warm my body and left the room. I lay there for some 30 minutes in a state of relaxation I can only attempt to  describe. It was different than sleep or enjoying a beer while watching a game. It was a deep relaxation that I could feel in the very recesses of my brain. Fulfilling, like just enough, as if one cannot be anymore relaxed than this and not be...well, you know. And that headache? Gone. I had been carrying it around for six or eight weeks and suddenly it was gone. I remember thinking, goodness, it feels so good not to hurt, and I didn't think it was hurting all that much.

I somehow found the energy to drive home. But when I got there all I wanted to do was lie down, not because I was tired (that is the strange part), but because I didn't want to lose the sensation. This morning Sherry brought me coffee. Said she tried to tell me about a neighborhood meeting last night and I told her to get the hell out. I don't remember any of that.

Now I am back in the reality of the world. Still have cancer (damn it!), but that headache is still gone. Deliciously so. And much more energy. I am kicking work arse today. I don't know if acupuncture can cure anybody of anything (however Sherry is convinced, why else would I have been there?), but it has other advantages, like helping helping us deal with the stress of all this. And believe me, if we warriors need relief from anything in these trying days, it is relief from stress. I tend to be a bit of a worry wort. I have a job to do, a family to love, a larger life to live, but sometimes all I think about is what I have not done, how the cancer is affecting me, the paranoias so common in the battle. Regardless of why I have not done those jobs, the stress can be overwhelming. That headache, without doubt, was a big symptom.

Oddly, during this entire experience, stress (or at least the verbalization of it) has never much come to mind. Now I know, or think I know, that stress alone can be cancer's greatest ally. Stress is a hidden enemy. You can believe you are being positive, that you are doing everything just right, that the battle is physical and the mental pain is all emotional. But stress is a cumulative experience; so cumulative that is difficult for psychologists to explain it.

My turn with the needles didn't change anything permanently, but even I, who thought he had a great attitude about all this yesterday, learned an important lesson, one I will keep in mind the rest of my life. The cancer and meds can make us feel awful, but stress, I fear, can, overtime,  rob us of our very strength to live or even want to live and we not not know why.

If three hours a week stuck with little flat needles can help keep that at bay, I'm doing it.

You might consider it as well.

(Note: The cost is $60 per hour-and-a-half session, but many insurance plans cover it, though the deductible is a little high.)

Thirty Months Old in Cancer Years

Just between you and me, I turn 62 next Monday. It will be exactly 30 months since the Internist called and said I had 24 tumors, kind unknown. It has been 30 months since I asked him if it was going to kill me. It has been 30 months since he said it was "dark and ominous." It has been 30 months since they stuck that needle in my chest and took out some cells. It has been 30 months since Dr. Shlaer surprised me (I thought at the time, pleasantly). "Well, it's not lung, it's kidney." It has been 30 months since I exhaled some well stored breath of a man who thought he'd just gotten a pardon and said, "Oh, hell, I can beat that." And it has been 30 months since I was so ignorant I had no idea what I was talking about. I didn't know kidney cancer from Aunt Flossie's teenage lover. But at that moment, it sounded a hell of lot better than lung, and I guess in many ways it is. I also had no idea of "Stage IV." Didn't even ask.

But 30 months ago, or maybe a week or two later, I learned that I was in deep poop. Really deep poop.

But , 30 months ago, I was a young and ignorant 59, a mere whppersnapper in the business of being sick, much less fighting cancer. Besides, Dr. Shlaer said he could treat it. Worked for me. Get out the chemo needles and lets get on with it. I have things to do. But we have a medical practitioner or two in our social  community, and one was much less sanguine. We got together privately. I told him I wanted his honest opinion. He asked if I was sure, that he didn't want to second my guess my doctor and his opinion was in general; he really couldn't comment on my particular case. I was, stupidly, insistent. He listened to the diagnosis, the spread of the disease and said, "You could have as little as nine months, Dave. That's a lot of cancer.  It's dang sure a tough one. Fortunately, you are in good health otherwise"

I was shocked. And acted like it. "Whatyoutalkin'aboutWillis?"

"You asked?"

"Well, next time I ask you anything keep your mouth shut. I'm going with Shlaer, we can treat it."

"Nobody hopes you can more than me." And he meant it.

So we did treat it. With once a week chemo (avastin and gemsar) and a pump of 5 F/U that I had to wear cowboy style on my belt. Dr. Shlaer told me there was really nothing else to do, though some new things were in the pipeline. So 30 months ago I also learned that most kidney cancer warriors get the old kidney excised pretty quickly, why not me? He shrugged and said two of my major tumors were outside the kidney, large and too close to other organs. He wanted to shrink them a bit. I, adolescent I was, had no idea about the chances of that. I mean it like worked for one, in say, 200 warriors. But I just assumed that it would work and got lucky, they did shrink and they popped that old kidney out 25 months ago (the surgeon was a nice fellow, but decided it was his job to tell me I basically was wasting my time; that "high dose" something or the other therapy might give me eight more months. From the moment of that interview. H'mmm, as I think on it, wonder if he knows my friend, the other physician. Sherry had to hold my hand a little more ( OK, hold me up) and Dr. Shlaer just said "oh pooh. Let me handle this."). 

I turned 60 a month later with one less kidney and  the knowledge that  because of my good results with "old fashion" chemo, my time of earth had been extended. Eight months my arse.

Or so said my best consultant, Intuition. Reader,  can you say "Hallelujah?" I can and do and mean it. I know a Blessing when I get one.  I was eating alone a month or so later in a crowded downtown restaurant, pretty much wrapped up in my good fortune, and somehow "Hallelujah!" just popped out loudly (man, I am so glad Sherry was not there). Anyway several diners looked at me as if I was a panhandling street preacher, but I just smiled, a very, very happy smile. I wasn't embarrassed at all. If any of them felt as I did at that moment, they would have exclaimed the same thing. No better feeling in the world than to know you are alive and have more time to go. "Hallelujah, Hallelujah, Hallelujah! And thank you, Lord." So there.

During my mid-sixtieth year, I got one of the wonder drugs, Nexavar. I have had some fights in my day and some crises that terrified me more at the time than cancer ever has. But Nexavar was like torture. I truly decided it was intended to make you feel so bad that you just forgot you have cancer and maybe it would go away. I certainly thought of the medicine more than I thought of cancer. I just wanted one or the other to leave me alone. Didn't much matter which. I couldn't imagine that something that made you feel so bad was worth it even it was saving your life. So Shlaer took pity and moved me to Sutent. Better, but still, they really need to work on that stuff. But it has gotten (knock on wood) rid or most of my body tumors and the others are "stable." I'll take it, even if I didn't have to.

On my 61st birthday, I was in Idaho shooting (at) doves. Not walking (too much foot pain), just shooting. I couldn't walk five feet. The other hunters had to lug me around. I love them for it, but didn't like being lugged around. I felt a helplessness I have never before experienced. More a victim than a warrior. That hallelujah turned into a damn, damn, damn. Sometimes at night, when I had to go the bathroom--my "attendents" were elsewhere--there was no choice, walk or crawl. After being hauled around all day like a side of beef, I rejected crawl (but not by all that much of a margin; you really have to experience that pain to understand).  And the floor was hard, so I turned the walk into a profanity laced cadence. Each step another expletive, loud and to the point. You know, I kinda enjoyed that. Maybe I am perverse.

A week later I was on the two week break from Sutent and the foot pain stopped almost immediately. Got up one mornng and it was just gone. I was at a fishing resort in British Columbia and decided to celebrate my birthday by taking a walk along the rocky shoreline. What a fine gift. Just walking. Now that is freedom, perhaps the very essence of it, walking. Forget the sea otters, the perching bald eagles, the jumping fish, the seals playing,  the float planes coming and going, keeping an eye out for bears, it was all about the walking. It was, I think, the finest birthday I ever had. I just wish Sherry had been there.

By December, the foot pain just ended, I assume forever (probably a bad assumption, but warriors take good assumptions where we can find them). And after a while walking became just walking. Five months earlier I would have paid all my assets to be able to walk, at least without pain. Suddenly, I was just doing it like everybody else. But the good news is, it was bird season and that was an extra blessing. Gracie was pretty much beside herself  as well. We had a great season. During those days I felt as though I was really kicking cancer's arse by living an almost normal life. And I felt the Lord was with me, really with me. Oh, I had the fatigue, the lack of taste and appetite and still had to take all those meds and nap at least once a day, but I didn't care. Me and the dog. That was all that mattered. I was able to contribute more to my company. Sherry and I went out a lot more and she commented on how much better my attitude was....until they found those brain mets. Damn, I hate to called out for a stolen base. That set me back in a funk for a while (and I do mean a funk). Even today, as we believe that crisis has passed, I try not to think about it. They can pop up anytime. I don't want them to. So, like Scarlett O'Hara, I'll worry about that tomorrow. This older, wiser Dave (30 months old in cancer years) is finally learning that brooding, for any reason, doesn't  do a thing. More mets mean more gamma-knives. Oh, do we have a surprise for you, Mr. Brain Met. Can you say "zap?"

And then I get hit with what-the-hell-ever this August. Could have been a weird reaction to the gamma-knife or dehydration, heat exhaustion, nobody seems to know, but I suddenly was weak as the proverbial kitten, muscles atrophied to nothing in less than two weeks. Oddly, I felt just fine when I was in bed. But I have gotten much better. I've got to admit, however, it was a lesson in paranoia. I don't want another lesson in paranoia. I'm sick enough with the real stuff and intellectually I know I shouldn't allow Emotion to add other evils to it, but that's much easier said than done, just ask any other warrior.

But come Monday, I will begin my 62nd year in this life, looking forward to 63. (Cancer Warriors celebrate another year, doesn't matter which one. We quickly get over the superficial buggerboos of "aging.") Best of all I am still a contributing member of my family, a part of their daily lives. I can work. I can write. But some days it feels as if I was born at 59, that all my life is somehow encapsulated in these 30 months, mainly making it over one more hump with cancer, large or small, while doing my very best to be productive as possible. Oh, I am still a very sick man. I don't forget that...and the weakness in my body wouldn't let me anyway. But it has been 30 months since I decided to kick kidney cancer's arse. Some people bet I wouldn't do it. Well, 30 months from "its black, it's ominous" to celebrating another birthday is, in my mind, a pretty good game. I think most other warriors would agree and they know how this disease affects one.

Sherry asked today what I would like to do for my birthday, thinking a nice dinner or something. She was wearing some cool shoes and that, I guess, brought back the memory of that that foot business with both Nexavar and Sutent. And my  little sojourn on the rocky beach in British Columbia. So I smiled and said, happily:

"Sugar, let's just take a walk."

Hallelujah!

A Bird Dog and 'Job' Motivation

Several times on the blog I have mentioned I am doing a coffee-table book on some plantations. It will feature a year of the pageant of agriculture, not to mention the turn of life in the oxbows and swamps. That includes the photos and the copy. And I am covering a lot of stuff, from row cropping to timber management; from wild bob white quail management (my fave) to cutting horses; from native flora and fauna to a history that goes back more than 200 years. Most of the photographs have been done and that took a year in itself. But the copy has been a different story. Now, here is an admission: I have done very little on it for the better part of six weeks. I just haven't felt like it. So there, it's out. I may be a bit of a wimp. Now to make up for lost time. Today, I have spent six hours on copy and concept. Tomorrow I will drive down to one of the row cropping operations and learn all there is to know (well, OK, not all) about the commercial sod business (Bermuda). And I am really interested in the soils and how our managers choose the crops. I will stick around (if I have the strength) until well into dusk in hopes of a nice buck photograph. They are still in velvet right know and a buck in velvet makes a great picture.

Wednesday I hope to photograph some cowboys working cutting horses at the ranch. I am also not very happy with my photographs of the corn harvest last year (they work, but are not spectacular; I want spectacular. That ain't easy. Corn is corn.). In the meantime I will continue my research into the complexities of the modern farm. While farmers today have many tools with which to combat nature, trust me, nature still wins a lot of them.

Last week, I made the same resolution, but just could not get the motivation(or maybe the strength). Instead I spent it at my advising  job on the management of magazines. Lot easier to make declarations on how to run a business than getting out in a hot field and walking and looking and listening to the pros. But of all the projects I have worked on over the  years, the farm book is the most satisfying. But I needed just a touch more motivation (OK, and maybe a tad more strength).

Got it today. I loaded Gracie up and took her down to the onc's office. On the way, I relished the cooler temperatures and the clear sky. It was almost neon. That alone gave me a lift. Anyway, the idea was a little doggy therapy for the warriors lining the walls, taking in chemo. And it worked. They loved Gracie and she let them pet and coo and  offer her treats (how do so many people just happen to have dog treats in an oncologist's office?). All that led, of course, to what breed she is? I said Brittany Spaniel. One lady asked: "What does she do?" I said she is a hunting dog...and very good one. Her life, her reason to live is bird hunting. A man across the way said, "Well, I hope you get her out a lot, because a hunting dog's job is to hunt. Can't imagine having such a fine looking dog and not hunting it. Be cruel."

Boy, did that hit a nerve. It took a lot out of me getting her down there, but lately I have been wondering if some of my weakness might be from a touch of guilt for not working harder on the farm book, for not doing an important part of my physical job.  And there is no place in the world where I feel more alive than riding the roads of the farms, visiting with the managers and workers, just seeing the wildlife and thinking about from where the subsistence of all humans comes. So I am getting back to it. My bet is the first three or four trips will not be easy (but much easier than they would have been two weeks ago), but there is nothing more therapeutic than doing what you love. Beats the hell out of sitting on this back porch. If I get a little tired, well, I will just recline the seat and take a break (and maybe sneak in a nap in all that fresh air). Whatever, I have to get out of here so I can build my strength, get my job done and get ready for bird season so Gracie can do her job.

We all have jobs, even if it is beating cancer (huge job). And if we are physically capable, those of us with other options should exercise them, even if we need to create new ones. As my dad told me: "If people didn't have a job, son, something to do, then why be here at all."

I understand as well as anybody there are way too many warriors who simply can't do a job, other than beating cancer (again, huge job). However, I am blessed not to have reached that point (or so they tell me). I do have two friends who have reached that point, but they still have the spirit.. They most enjoy hearing about my hunting and fishing adventures, complete with the big arm gesticulations, including bringing the imaginary gun up on a bird flying only in our minds. Vicarious can be almost as good as doing it.

So here we come birdy birdy. Just imagine: My little Gracie on a hard point at birds I would otherwise have no idea are there. The pulse breaking flush and, maybe a good shot. Gracie will bound out, bring that bird to hand. Every time. Just doing her job.  But she gets a good scratch anyway. I believe in rewarding your help. Later, Sherry will serve us up a plate of quail on grits. Oh, and I really enjoy a well-worked bird dog napping happily by the fire, while I nap on the sofa dreaming of points well made. When I started this post it was about a little motivation. Now I am flooded with it.