Marlin vs Ewing's Sarcoma
Phase I Clinical Trial

So I’m currently being considered for a Phase I Clinical Trial at MD Anderson’s Clinical Center for Target Therapy. The clinical trial is titled: A Phase I Study of MK-4827 in Combination with Temozolomide in Patients with Advanced Cancer.

For those of you who are interested, the clinical trial details can be found at this link:  http://utm-ext01a.mdacc.tmc.edu/dept/prot/clinicaltrialswp.nsf/Index/2010-0856


According to Dr. Ludwig, they are recruiting 2-3 Ewing’s Sarcoma patients for the study and I’m #3 on the list. I met with Dr. Razelle Kurzrock, the oncologist running the study, on Friday. It seems like I’ll be accepted into the study as long as I pass a few qualifying tests. I’ll need to have a blood draw, EKG and CT Scan of my abdomen next week to make sure I’m in good enough health to be in the study.

I’m really excited for this clinical trial though. They haven’t tested it in humans yet, but Dr. Ludwig said it has done amazing things in medical studies on mice. If accepted, I’ll no longer have to do chemotherapy either. I’d be on a 28 day cycle (similar to my current chemo treatment), but I’d only have to take one pill a day for Day #1 - Day #4 of the cycle, and then take two pills a day for Day #5 - Day #8 of the cycle. Day #9 - Day #28 would consist of doing nothing. I’d also only need to do four blood draws per cycle as opposed to the 6-8 blood draws per cycle that I currently have to do for my chemotherapy.

The other good news is they’ll only keep me on the medical trial as long as it is working. I’ll have a new CT Scan done every two rounds to check on the progress of my lung nodules. If the nodules are shrinking or staying stable then I’ll continue to do the clinical trial. If the trial medications aren’t working and the nodules are growing and spreading then I’ll immediately come off of the clinical trial and begin taking something else. I can also take myself off of the trial at any time if I don’t feel comfortable with what’s going on.

As far as what medications I would be taking for the clinical trial. One pill (Temozolomide) is already FDA approved and typically used to treat brain cancer. The other (MK-4827) is a PARP1 Inhibitor and is not currently FDA approved. I’ve included the wikipedia links for both medicines in case anyone is interested in reading further. It’s pretty interesting stuff, although most of what’s written is really scientific and way over my head.

Anyway, the current plan is for me to start the clinical trial on March 20th as they have to wait a minimum of four weeks from the completion of my last round of chemotherapy before we can begin.

Kickass - Egypt Central

Now is the moment
I waited for
I can’t be broken
I settled the score
I will not quit
So stand up, up, up

Stand up
Get your hands up
Move
Are you ready to
Are you ready to

Stand up
Get your hands up
Move
Are you ready to kick ass

Stand up
Get your hands up
Move
Are you ready to
Are you ready to

Stand up
Get your hands up
Move
Are you ready to kick ass

Conquer the weakness
Work through the pain
I can’t be defeated
I will remain
I will not quit
So stand up, up, up

Stand up
Get your hands up
Move
Are you ready to
Are you ready to

Stand up
Get your hands up
Move
Are you ready to kick ass

Stand up
Get your hands up
Move
Are you ready to
Are you ready to

Stand up
Get your hands up
Move
Are you ready to kick ass

Kick ass
Kick ass
Kick ass
Kick ass

Stand up
Get your hands up
Move
Are you ready to
Are you ready to

Stand up
Get your hands up
Move
Are you ready to kick ass

Stand up
Get your hands up
Move
Are you ready to
Are you ready to

Stand up
Get your hands up
Move
Are you ready to kick ass

Stand up
Get your hands up
Move
Are you ready to
Are you ready to

Stand up
Get your hands up
Move
Are you ready to kick ass

Stand up
Get your hands up
Move
Are you ready to
Are you ready to

Stand up
Get your hands up
Move
Are you ready to kick ass

Kick ass
Kick ass
Kick ass

Becoming the Bull - Atreyu

WARNING - Venting…DO NOT READ IF YOU GET UPSET EASILY

I should probably start this blog post with a word of warning - or else it could very well be taken the wrong way or misinterpreted. I am in no way surrendering to cancer. I’m not giving up my fight. I still have a VERY strong will to live. I don’t think I’m going to just fall over dead one day in the near future.

Now, with that out of the way I can get to point of actually explaining some of my thoughts and realizations of the past month or two.

I’ve come to the realization that while I’m currently winning the battle, cancer is going to eventually win the war. Now let me explain that. Everyone tells me: “You’ll beat this thing!” or “You’re tough, you’ll get through this and live another 50+ years!” As much as I want to believe them, I know it’s not going to happen. I have metastatic Ewing’s Sarcoma in my lungs, hips, shoulder and spine. There’s no curing that. People like New York Giants linebacker Mark Herzlich (who beat Ewing’s and is cancer free) have simple localized disease - not cancer all over their body. They don’t have a chemotherapy resistant nodule in their lung. As much as I want to believe there’s a medical cure, or a higher power going to rescue me, or even a Christmas miracle in my future, realistically, it’s not going to happen.

I recently did some Googling on Ewing’s research just to see what all I could find out about the disease. I found two extensive Ewing’s studies in Europe and the U.S. (one of which listed my oncologist Dr. Ludwig as a source). One statistic said of the patients studied with metastatic Ewing’s Sarcoma - there was a 5-year survival rate of 0% from the date of diagnosis. It also said there was a 4-year survival rate of 0% from the date of diagnosis. This study was aimed directly at adults as children have a much better chance of recover. It also listed the factors which make for a poorer prognosis: metastatic disease (that’s me), metastatic disease in bone and not just lungs (that’s me), primary tumor in soft tissue rather than bone (that’s me), primary tumor greater than 8cm in size (that’s me). Basically, I hit every bad thing listed on the list. Really it’s a miracle I’ve lived 1-year and 4-months since my diagnosis. So as I said before, I’m going to keep fighting. I’m going to keep doing my chemotherapy and taking care of myself. I’m going to completely exhaust all of my options, so I can be around as long as possible. But at the end of the day, I’m probably only going to be around another 2-3 years, maybe 4 if I’m lucky. But that’s okay. The rest of you may only have 20-30 years left, or 50 if you’re lucky. Or we could all get hit by an asteroid and die tomorrow. No one knows - so there’s no point in getting all worked up about it.

The thing is, I’m okay with eventually dieing. I mean it’ll suck and I really hope it doesn’t hurt, but I’m not too worried about myself when it comes to that. I’m worried about my family - more specifically my kids. I know Hiedee, my parents, my brother, my grandparents, etc will all be extremely upset and it’ll be really hard on all of them, but they’re all adults and they understand how the world works and will eventually move on and keep living their lives. But kids don’t understand these things.

So that brings me to the thing that has really been bothering me lately. Worrying about my kids. I’m worried about Zoe, Zack and Eva - but at the end of the day, Bob (Hiedee’s ex-husband) will still be around to take care of them. So they still have their dad around to help them and give them guidance. Marlin IV on the other hand won’t have that. And that’s what really gets me upset. I’m afraid he’s going to be mad at me or blame me for not being around. I’m afraid he won’t even remember me. I always wanted to be the dad who got out in the yard and played sports with my boys or coached them in sports (the same type of dad my dad was for Kellen and I), but I’m not going to get to do that. I’m not going to get to teach the boys how to throw a football or baseball. I’m not going to get to teach the kids all of my nerdy history knowledge or goofy pop culture knowledge. I’m not going to get to take the kids all over the country on family vacations. I’m not going to get to see them be involved with school activities or sports. I’m not going to see them go off to college. I’m not going to see them get married. I’m not going to see my grand kids. And all of that is what sucks! I’d REALLY like to see and take part in all of that, but more so, I’m sure they’d love to have their dad around for it all.

So all of that was probably not what you were wanting to read. You were probably looking for something happy or cheery. I warned you at the beginning didn’t I? Just be glad it’s me and not you. You just have to read it. I am constantly thinking about it and have to live it.

Now to vent about some everyday type things that have been building up for a while and are really starting to annoy me:

#1: Question - “How much longer do you have to go to chemo?” Answer - I’m not graduating college, I’m fighting cancer. I have to go forever or until the chemo stops working and I die. Whichever comes first.

#2: Having EVERY conversation start off with: “How are you feeling?” I know people are just trying to be nice and show their concern, but when EVERY conversation you have with people starts off talking about your health it gets to be a little old. Some people truly are concerned about my health and how I’m feeling - and I thank those people, but for most people it’s just a conversation starter. I long for the days when people asked “What have you been up to?” Or “How’s it going?”

#3: People treating me like I have a disability or I’m broken. I have cancer, I’m not blind or missing an arm or something. I can do pretty much everything I did prior to getting diagnosed, with the exception of lifting really heavy boxes (can pull my CVC out). I also get winded a little easier than before. Other than that, I’m fine. I still go to work 5-days a week and then come home and help wrangle 4 kids and a wiener dog. A lot of healthy people have issues with that.

#4: Doctors not being on time. There have been times when Hiedee and I have had to wait 4+ hours past a scheduled appointment in order to be seen. It’s horrible. Yet we’ve been 10-15 minutes late for appointments and the doctor’s office calls us and asks if we plan on showing up for my appointment.

#5: People smoking at MD Anderson. You’re at a cancer hospital - resist the urge to light up a cancer stick!

Movie Trailer for 50/50. Preview starts at :13 seconds.

50/50

Yesterday, Hiedee and I watched a movie that I’ve REALLY wanted to see ever since the previews first came out. The movie is called “50/50” and it stars Joseph Gordon-Levitt (from the TV show 3rd Rock from the Sun) and Seth Rogen. Loosely based on the life of movie screenwriter Will Reiser, it’s the story of a 27-year old man who is diagnosed with Schwannoma Neurofibrosarcoma and his subsequent struggles to beat cancer with 50/50 odds of survival.

Talk about a movie that really hit home. Hiedee cried about 10 times and I choked up a couple of times. It’s just one of those movies that you can tell was written by someone who had experienced everything that we’ve experienced. The diagnosis scene in particular was like a flashback to my diagnosis in November 2010. Never smoked, never drank, and still got a rare form of cancer due to a repositioning of the chromosomes. The immediate checking of WebMD - true. The emotional breakdowns - all true. Heck, I’ve even had people offer to get me medicinal marijuana if I wanted it (never accepted that offer by the way).

All in all, it was just a really good movie about a subject we know all too well. So if you or anyone you know has cancer, especially an AYA (AYA = adolescent-young adult in the cancer community), then I highly recommend this movie to you.

New CT Scan and X-Ray Reports

Examination:  CT of the Abdomen and Pelvis, 01/11/2012 
  
Clinical History:  Ewing sarcoma, restaging.  
  
Findings:  CT of the abdomen and pelvis was performed with gastrointestinal and intravenous contrast. The comparison study is 11/15/2011. Diaphragmatic and lower chest wall reconstruction is noted. This is on the right. The liver has some tiny hypodensities that are stable and possibly cysts. Small focus of enhancement in segment III on image 79 of series 2 is stable. There is no biliary ductal dilatation. The gallbladder is present. The spleen, adrenals, right kidney and pancreas show no focal lesions. The left kidney has some probable cysts. These are stable. There is no lymphadenopathy. There are faint sclerotic areas, some with central lucency in the visualized bony structures. These are consistent with metastases. Some may have some slight increase in density. This could also be from the slightly different technique. Please see separate chest CT report of same day.  

IMPRESSION:  
Bone metastases are either unchanged or possibly show some interval healing.

Examination:  CT of Chest, 01/11/2012  
  
Clinical History:  Ewing sarcoma, restaging.
  
Findings:  CT of the chest was performed with intravenous contrast. The comparison study is 11/15/2011. There is no lymphadenopathy. Right chest wall reconstruction is noted. There is a central venous catheter from the right with the tip at the superior vena cava.
  
There are scattered lung nodules. One in the left lower lobe on image 107 of series 4 measures 0.9 x 0.9 cm. Previously, this measured 0.6 x 0.3 cm. There are some nodules that are slightly decreased in size. One such is a 4 mm nodule in the left lower lobe on image 60 of series 4 previously measured 5 mm. Some nodules are stable, such as a left upper lobe nodule on image 49 of series 4 that is subcentimeter. There are vague sclerotic areas in the thoracic spine consistent with metastatic disease, but these are grossly stable. Please see separate CT abdomen and pelvis report of that same day.
  
IMPRESSION:  
One nodule has increased in size. Some nodules are marginally decreased and some are stable.

Examination:  PA and Lateral Chest, 01/11/2012  
  
Clinical History:  Ewing sarcoma, restaging.
  
Findings:  Current study is compared to that of 12/13/2011. Cardiac and mediastinal silhouettes appear within normal limits. Right central venous catheter tip is at the atriocaval junction. The visualized lungs are clear. Postoperative changes are noted in the right hemithorax. Please see separate chest CT report of same day.  

IMPRESSION:  
Stable appearance of the chest.

Christmas Thanks

I haven’t really posted on my blog much lately, but I just wanted to take a few minutes on Christmas Eve to pass along my deepest thanks and appreciation to some people and groups.

My Wife (Hiedee) - I don’t say it enough, but I’m extremely grateful, thankful and appreciative for Hiedee and all she has done to help and support me. Hiedee is always vocal and in my corner, especially when it comes to making sure I’m being taken care of and treated right. If the doctors or nurses did or didn’t do something they were supposed to, she’ll let them know it. If insurance is trying to screw us over, she’ll let them know it. If I don’t want to go to the hospital even though I probably should, she’ll let me know it. She handles scheduling all of my appointments, plays middle man between the doctors and I, and picks up my medicine from the pharmacy. Basically she takes care of everything that would annoy me like crazy and make my stress levels shoot up so I can concentrate on my health and getting better. If it wasn’t for Hiedee, I probably wouldn’t be alive right now. She’s the one who insisted that I see a doctor which ultimately led to me being diagnosed with cancer before it was too late to be treated. There are just so many things that she does that I didn’t list that I’m thankful for. Thanks and love you baby!

My Grandparents (Mimi & Poppie) - My grandparents have been so supportive throughout my cancer treatment…I never really doubted that they would be…they’ve ALWAYS been there for me and support me no matter what, but it’s just the point that they’re always there to lend a helping hand or volunteer to help us that I appreciate. Poppie has gone with me for chemotherapy for the past 3 or 4 rounds and is always willing to help get me things or bring me a drink when I’m stuck laying in a hospital bed for 6-7 hours. Meanwhile, Mimi makes me breakfast, packs a sack lunch, and has dinner ready every night when I get home from chemo. During chemo all I want to do is eat and sleep, so having meals ready so I can head to bed right afterwards is definitely appreciated. She also helps watch the kids while Hiedee and I go to chemo, which is definitely something to be grateful for. Thanks and love you Mimi & Poppie!

Clear Lake Church of Christ - I also wanted to thank the elders and members of Clear Lake Church of Christ. Not only have church members visited me on several occasions while I’ve been in the hospital, but they’ve also taken the time to pray for me each and every Sunday. Lastly, I wanted to thank them for the recent check they issued to our family to help us with Christmas. Things have really been tight lately with all of my medical bills on top of our usual living expenses, which really had Hiedee and I worried about getting the kids presents for Christmas. But thanks to the generosity of Clear Lake Church of Christ, we were not only able to give our kids a good Christmas, but also have some money leftover to help with our bills for the coming month. Thanks CLCOC!

Academy Sports + Outdoors - Next, I would like to thank everyone at Academy Sports + Outdoors. Not many employers would keep around someone who has to miss 5 days a month for chemotherapy, but Academy has been more than willing to work around my schedule and allow me to get treatment while still keeping the job that I love. I’d really like to thank everyone on our Promotions Team too. Most notably, my Senior Regional Promotions Coordinators Matt Gardiner and Ginger Middleton. Matt and Ginger have been really understanding about my health and treatment even going as far as telling me to stay home and rest more. I’m really glad I work for two people like them. I’d also like to thank my fellow Promotions Coordinator, Sarah Munson. Sarah already has a pretty full workload, but she’s often the one who picks up my workload while I am out for chemo. I probably don’t say it enough, but I really appreciate her following up on things while I’m out and not letting any of Matt or Ginger’s projects to fall through the cracks. Thanks AS+O!

Doctors and Nurses at MD Anderson - Last, but not least, I wanted to thank all the doctors, nurses and staff at MD Anderson. They have not only given me another year of life, but they have helped me stay on the winning side of my battle against Ewing’s Sarcoma. I know everyone at MD Anderson puts a lot of time and effort into their jobs, and I’m not always the best patient, but I just wanted to let them know that I appreciate everything they do for me. Thanks MDACC!

CT Scan Reports and X-Ray Report

Here are my three newest medical reports (two CT Scans and one X-Ray). I have bolded the most important updates and findings listed in each report.

CT SCAN - THORAX:

FULL RESULT:
Examination:  CT of Thorax with contrast, 11/15/2011.
  
Clinical History:  Metastatic Ewing sarcoma of right chest wall, followup.  
  
Findings:  The examination was performed following the administration of intravenous contrast. Images at 2.5 mm are reviewed from lung apices to the diaphragm.
  
Surgical changes involving the right chest wall with adjacent soft tissue density appears similar to the prior examination of 09/24/2011. There are small nodes in the mediastinum without interval change. No adenopathy is seen in the hilar or axillary region.
  
There are numerous lung metastases bilaterally. The largest nodule in left lower lobe (image 96, series 5) currently measures 0.6 cm compared with the prior measurement of 1 cm on 09/24/2011. A nodule in the right middle lobe (image 65, series 5) currently measures 0.5 cm compared to prior measurement of 0.8 cm. There are stable sclerotic areas in thoracic vertebrae that may represent bony metastases.  
  
IMPRESSION:  
There is interval decrease in the size of lung metastases in keeping with response to treatment when compared to the prior examination of 09/24/2011.
  

CT SCAN - ABDOMEN & PELVIS:

FULL RESULT:
Examination: CT of the Abdomen without and with Contrast and CT of the Pelvis with Contrast, 11/15/2011  
  
Clinical History: Metastatic Ewing sarcoma of right chest wall, followup.
  
Findings: The examination was performed following the administration of oral contrast, rectal contrast and before as well as after the administration of intravenous contrast; 2.5 mm images are reviewed from the diaphragm to symphysis pubis. Reformatted sagittal and coronal images were reviewed. Comparison is made with an outside CT of the abdomen performed at 5 mm intervals on 11/05/2010 and CT images of the CT/PET study of 09/07/2011.
  
Small areas of low attenuation are seen in the liver (images 135, 153 162 of series 4). There is a 0.8 cm area of early enhancement in left liver (image 157, series 4). These small lesions are not seen on the outside CT; however, this may be related to 5 mm thick slices on the outside study. These can be followed on future CT.  
  
The spleen, adrenal glands, and pancreas are normal in appearance. The right kidney is normal. An area of low attenuation in left kidney is stable and consistent with a cyst. There is no adenopathy in the retroperitoneum or pelvis. The bone windows reveal sclerotic metastases involving lumbar vertebrae (images 180, 187 192, 205 213 of series 4), left iliac bone and left inferior pubic ramus. There is greater sclerosis than on the bone window images of CT/PET study of 09/07/2011 suggesting changes related to healing.  
  
IMPRESSION:  
1. Bony metastases involving lumbar spine, left iliac, left iliac bone and left inferior pubic ramus show greater sclerosis than on images of a CT/PET study of 09/07/2011 suggesting changes related to healing.
  
2. An area of early enhancement in left liver may represent a hemangioma and can be followed on future CT. There are multiple small areas of low attenuation in the liver that are indeterminate and can be followed on future CT. These are not identified on an outside CT examination of 11/05/2010, but this could be related to technical factors.  
  

X-RAY REPORT:

FULL RESULT:
Examination:  Chest 2 Views, 11/17/2011  
  
Clinical History:  Ewing sarcoma of right chest wall.
  
Findings:  Since an earlier study done on the same day at 11:34 hours, a right subclavian CVC has been placed with its tip at the SVC/right atrial junction. The lungs remain clear. The heart is normal in size. Generalized osteoporosis is present. Mild scoliosis of the thoracic spine is noted. Prior right lower chest wall reconstruction with methyl methacrylate is again seen.
  

IMPRESSION:
1. Placement of a right subclavian central venous catheter. No complication.
2. No acute or metastatic disease.
  
Please refer to the previous chest CT report of 11/15/2011 which mentions numerous bilateral small metastatic lung nodules, poorly appreciated on the radiographs.

Not Falling - Mudvayne