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Local Interventional Radiologists Deliver Minimally-Invasive Solutions

From the very beginning of my new normal, which began on June 11, 2009 when Dr. Ken Ogan used a DaVinci robot to surgically remove my diseased left kidney and 12 lymph nodes, I was left with an incurable case of renal cell carcinoma (RCC) and the stark realization that my job was to seek out the very best medical care I, with my great medical insurance and the shallow pockets of a small business owner, could afford. I had to use whatever medical wisdom was in existence to stay alive long enough to be strong enough to endure a more meaningful treatment if and when it came along.

To date, an initial occurrence and six separate subsequent battles with RCC mets have not managed to take me out and one of those “more meaningful treatments” was available to me locally and I have been fortunate enough to have been rendered NED (No Evidence of Disease) for the 7th time.

Here is a brief recap of the procedures (except for listing all CT/MRI scans, which have continued to occur at about 3 – 6 month intervals, depending on what was going on) and decisions we’ve made that got us to the office of Dr. Nishant DeQuadros:

June 11, 2009: Dr. Ken Ogan at Emory University Hospital performed radical left nephrectomy + 12 lymph nodes (1 positive for RCC).

August, 2009:  Started ASSURE clinical trial (Sutent/Nexavar/Placebo) and ultimately completed trial.

September, 2010: Discovered 2 cm tumor in spine at L-2, and was unblinded from placebo arm of clinical trial. Drawing the placebo arm of the trial turned out to be the good news, in that going forward I would be drug naive, allowing me more access to other therapies.

October 21, 2010: Biopsy of spine determined the lesion is metastatic RCC.

December 2, 2010: Stereotactic Radiosurgery (SRS) at Emory Midtown Hospital in Atlanta

March, 2010: Radiation oncologist says that I’m NED.

August, 2011: Medical oncologist says the tumor at L-2 wasn’t completely killed and it is growing again.

August 19, 2011: Lumbar fusion surgery and fixation with pedicle screws and fusion with bone morphogenic protein at L 1-3. Three weeks post surgery, developed severe (#10) back pain. Treated with time-released morphine and dilaudid for breakthrough pain. These weeks of pain and insomnia were the darkest days of my life. As I write this, I’m having trouble conjuring what the pain felt like. What it was like to be just aware enough to see the little hand of the clock find every click on its way around the dial, yet gladly not aware enough to be forced to remember some of the truly stupid television shows and movies I watched. Alone in a dark room with my ever-present plastic trash can, a box of tissues, a glass of water and a sack full of narcotics. The world looks very different from that room.

October 8, 2011: Some time before 5 a.m., I bent over to remove power plug from wall socket and experienced a dramatic loss of strength on my right side. I contacted my neurosurgeon, Dr. Michael Gorum, early Saturday morning. He instructed me to get to the emergency department immediately. His partner, Dr. Marc Goldman met me and we went immediately to surgery, where he performed a lumbar laminectomy (bilateral inferior L1, complete bilateral L2 and bilateral superior L3). Pain was immediately gone and according to physical therapist, the strength can be regained in legs with therapy. Two major spine surgeries within 8 weeks and a quickly-growing kidney cancer metastatic tumor trying its best to put me down.

October 10, 2011: I was moved by ambulance to the John B. Amos Cancer Center, where I was evaluated for stereotactic radiosurgery to attempt to kill the tumor in my back and returned to my room at the hospital. Got food poisoning (Yes, the day after my second back surgery in eight weeks! Can you believe it?) from a non-hospital meal I ate on Monday evening, so we delayed SRS until Thursday,

October 20, 2011: 16-greys of radiation in a single one-hour treatment aimed to kill the tumor in my spine.

October 26, 2011: Started monthly Xgeva injections to prevent further bone mets.

December 7, 2011: CT scans show NED.

March 15, 2012: CT scans show NED.

June 21, 2012: CT scan showed 3.9 cm tumor on left adrenal gland and slight enlargement of cyst in right kidney.

July 16, 2012: Decided to confer with specialists at M. D. Anderson in Houston, Tex. and met with genitourinary medical oncologist Dr. Lance Pagliaro there at M. D. Anderson.

July 17 – 18, 2012: Had bone scan, brain MRI, CT of chest, abdomen and pelvis with no contrast and a chest x-ray.

July 20, 2012: Met with interventional radiology to discuss needle biopsy of adrenal tumor.

July 25, 2012: Still at M. D. Anderson and needle biopsy of left adrenal tumor confirmed it was metastatic renal cell carcinoma.

September 3, 2012: Started HD-IL2 therapy at Duke University Hospital under care of Dr. Dan George and Dr. Michael Morse. Received 9 doses and creatinine spiked and didn’t come back to my baseline of 1.8, so I washed out. They wouldn’t allow me to finish part B of round one.

October 19, 2012: Had CT of chest, abdomen and pelvis W/O contrast, because of high creatinine.

October 26, 2012: Met with Dr. Pippas and found out adrenal tumor and nodules in kidney are stable. He recommends starting a TKI and plans to confer with Dr. George to determine which one they recommend.

November 13, 2012: Started with 800mg daily dose of Votrient. Took for 2 weeks and high blood pressure and other side effects caused oncologist to reduce daily dosage to 400mg. On 400mg dose for 3 weeks, increased to 600mg dose for 2 weeks and now on 800mg dose daily and dealing with side effects well.

July 11, 2013: CT scan of chest, abdomen and pelvis (W/O contrast) showed 90% reduction in adrenal tumor, no sign of two small right kidney lesions. Have lost 80 pounds due to GI complications with Votrient, but getting along fairly well. Have been able to stop taking Norvasc completely and have halved my daily Coreg dosage. Getting great blood pressure control, likely due to dramatic weight loss. Creatinine also looks good at about 1.5. So, might be able to get CT scans with contrast next time out.

November 1, 2013: CT scan with contrast of chest, abdomen and pelvis showed NED! Have lost 90 pounds due to GI complications of 800 daily mg of Votrient. Creatinine at 1.32 and other labs looks fantastic.

January 14, 2014: Have lost 100 pounds. Blood pressure is rising and with weight loss, this shouldn’t be the case. Hovering at around 180/115. So, went by to see Dr. Pippas to check blood pressure and they decided to triage me and work me in to see the doctor. Warned me that if I’m developing liver toxicity, we’ll have to make some changes. Had liver panel blood work done in lab. Dr. Pippas TOLD me to stop taking Votrient for 14 days and to take 20mg Prilosec every morning for next 14 days. Says he hopes my body will reset and that I can go back on Votrient after 2 weeks. Also, he added back 5mg of Norvasc to my daily meds to see if we can drive back the elevated blood pressure.

January 16, 2014: Got results of liver panel and we’re in normal range, so stopping I’m stopping Votrient for 14 days and taking Prilosec, carvedilol and Norvasc.

February 7, 2014: CT of chest, abdomen and pelvis shows completely stable and normal. Dr. Pippas says I’m NED again. Still tired, so he suggested I go back on nightly CPAP therapy and start some kind of exercise regimen. Also, wants me to maintain good immune system boosting diet and to not gain weight. At 155 pounds, about what I weighed when I left high school. Options presented to Jill and me:

A) stay off Votrient, scan every 3 months for a year
B) restart maintenance dose (either 200mg or 400mg) of Votrient

I asked Dr. Pippas to confer with Dr. Dan George at Duke, a colleague of his and someone who knows my case quite well. Also, I called Dena Battle, who knows this disease better than most doctors on the planet to ask her gut reaction to what doctor has advised. Made decision to stop taking Votrient.

July 22, 2014: CT scan with contrast shows 2.5cm metastasis on left adrenal. Same side as nephrectomy.

July 23, 2014: Discovered 2.5cm adrenal RCC metastasis and Dr. Pippas said surgery would be best option. We left the next day for a long weekend with friends in Destin, Fla.

August 6, 2014: Met with local surgeon Dr. Andy Roddenberry to discuss adrenalectomy procedure. Here’s an excerpt from my blog:

August 21, 2014: Excerpted blog post named “Eight Months:”  There is considerable scar tissue left over from the massive nephrectomy that cost me my left kidney, twelve lymph nodes and a lot of digging around looking for cancer. Additionally, the organs in my body have recognized that there is some stuff missing now that used to be there and they’ve wiggled around and taken up that space in my abdomen. So, scarring, colon, pancreas and a mass of arteries and veins are all congregated in that area, as well as a vascular renal cell tumor that is very much like a 2cm bubble of blood inside the thinnest tissue paper you can imagine. The surgery has been described to me like a person trying to pick up a balloon full of blood with razor sharp pins. One prick of that bubble and I’ve got cancer cells released all over my body and my prognosis suddenly would take a big turn for the worse.

We left Dr. Roddenberry’s office feeling the dread of making a decision to opt for a surgery that, even if successful, would really take me down physically and could significantly compromise my immune system. This is where the story gets really interesting, if you believe in karma. If you believe in a god, or if you worship from the torn front seat of a 1960 rusted, formerly white Chevrolet pickup at the 2nd Dirt Road Church of What’s Happening Now — this was the perfect information for me to hear at exactly the right time….

My friend, Dr. Granville Batte, called me and suggested we might want to meet with new Interventional Radiologist Dr. Nishant DeQuadros. That contact from a friend helped us find clarity. I promise you this: If you are a cancer patient who doesn’t have full faith in your doctor, and/or if you can’t see your a clear view of your feet along the path you have chosen, you are surely miserable. It is bad enough to feel bad, but to feel bad and be weighted down by stress related to your treatments makes the journey that much more difficult.

Here’s what I did to find that sweet spot of clarity before a new therapy: We made an appointment to meet Nishant DeQuadros and my work began. My doctors are my business partners. They provide a service that determines what is wrong with me and the crystal-clear vision backed up with the talent, experience and will to deliver a treatment path that will, at the very least cripple and at the very best in my case, completely shut down the disease process. I, and my insurance company pay them, their professional assistants and clinicians, staffs, technicians, labs, bean counters and hospitals. Then, the real work starts — research.

I fill whatever amount of time I can carve out prior to the first meeting with a new doctor with finding out everything I can about them. Where they’re from. Where they went to school. I seek out their professional writings, look for any feedback I can get from ratings sites, inquire of them with every one of my trusted medical sources and see if they have any kind of social media paper trail I can follow. I also like to find out who their friends are and if I happen to know them, I can’t pick our mutual friends’ brains to find out if they would put their life in the hands of this doctor. Melissa and Jim Thomas are friends of the DeQuadroses. That was a great thing to hear, right at the start.

I got a sweet surprise when I started vetting Dr. Nishant DeQuadros. The more I learned about him and his company, Georgia Radiology Imaging Consultants, the more excited I got. The doctors in this practice are extremely well trained. They do the kinds of procedures that are hard to come by in a community hospital setting. Often these highly-specialized radiologists are doing these kinds of procedures in larger urban or university hospitals. I found out later, just how important it was that these superdocs were here and that one of them was able to take my case.

Jill and I walked into Dr. DeQuadros’ office and a young, handsome guy in a white coat greeted us. We sat down, looked at my scans and we talked about how the ablation would be done. He brings mad experience to the table. At the end of that visit, we had that clarity that is so important.

August 28, 2014:  Interventional Radiologist Dr. DeQuadros and Anesthesiologist Dr. Mark Pinosky performed a microwave ablation of my left adrenal and its encapsulated RCC met. Complications during procedure caused Dr. DeQuadros to have to make four passes to get enough of a burn to completely finish the job. Disruption of my adrenal gland and the presence of the RCC metastasis caused a 300/200 blood pressure spike during the procedure. Because of the fear of cardiac damage from the BP spike, I spent the night in an intensive care room, so I could be monitored.

In my intensive care room the next morning after the procedure, I learned how serious the situation became during the minimally invasive operation. When they saw that I was having a major hypertensive reaction, Dr. DeQuadros ran a central line to my heart from behind me left knee, and, along with Dr. Pinosky, they monitored my blood pressure with every beat of my heart, utilizing drugs and procedures they had at their disposal to control wild blood pressure swings while still completing the procedure.

August 29, 2014: I was released with an appointment to see Dr. Shane Darrah to determine whether the high blood pressure had damaged my heart muscle.

September, 4, 2014: Saw Dr. Darrah and had stress test.

September 8, 2014: Had echocardiagram in Dr. Darrah’s office. It was determined that no heart damage resulted from blood pressure spike during microwave ablation.

October 2, 2014: CT scan with contrast (80% of dose). Still NED.

February 12, 2015: CT scan with contrast (80% of dose). Still NED.

The microwave ablation therapy I received here in Columbus was one of those cutting-edge treatments that can extend the life and protect the quality of life of a patient. In this process, I appreciated the candid advice given to me from Dr. Roddenberry that I should seek another, less invasive option that wouldn’t expose me to such a large, dangerous surgery that might negatively impact my compromised immune system. The incredible truth is that the huge surgery and the minimally-invasive microwave ablation should yield the same results (if perfectly executed). One would have cost me six days in the hospital and another six weeks of recovery. The other was performed on a Thursday and I was back in the office on Tuesday. I would have returned to work on Monday, had it not been the Labor Day holiday.

The list of vascular and interventional radiology treatments that are offered here by Drs. DeQuadros, Hart and Vo is quite long. If you receive a diagnosis that might be remedied by one of the treatments from this list like I did, you’d be wise to do a little Googleing to see if you might be better served by this type of care. Here’s the best part: When the therapy is finished, you can go home and sleep in your own bed. That is a mighty good thing.

No Mo Hiphop Shows

Last Saturday night and on into the early morning Sunday was one of the best — and worst — nights of my life. The night was replete with psychedelic highs and muddy dub step lows, simply brought on by the music. The only weed I consumed was second-hand, hotbox-delivered dankness that was shockingly prevalent in that fairly small room. Yes, this was my first real hiphop show and there is no doubt I was the oldest person in the room. For every one of the many reasons I was glad I was there, there are at least three for the sweet knowledge that I’ll never have to do it again. All in though, I would not have missed this show for anything. I got to see one of our sons launch from being a regionally well-known DJ into the outer edges of hiphop stardom. After all, he was standing toe-to-toe with hiphop mega-star, Chuck D, of Public Enemy fame and DJ Lord, whose turntable talents have helped craft Public Enemy’s sound since the late ’90s.

If you’re a regular reader of my blog, you know I call it like I see it, boldly owning it when I’ve done something I shouldn’t have done. Let’s rewind the tape back to some time in 2006, and a phone conversation I was having with our son, Adam. The one when he told me he wanted to pursue a music career after getting some kind of a music degree in college. That was back in my unenlightened days when being a DJ meant spinning records on the radio. I knew Adam didn’t play any type of instrument and I never had heard him exhibit any noteworthy singing ability, so I started to form the words, “Don’t you have to have some kind of musical talent to have a music career?” Somewhere in the middle of that ill-contrived and woefully knee-jerk sentence was when Jill started miming a slicing motion across her throat, wild-eyed and willing me to shut-the-hell-up.

I knew Adam had been working on developing his DJ skills and I should have realized just how serious he was about collecting vinyl record albums and using them to deliver his art. Adam and I went down to our barn one day and I presented him with my entire, well-taken-care of album collection, consisting of a few hundred pristine vinyl records. I thought he was going to cry, he was so overcome with joy and appreciation. I remember thinking, “Damn, he really does love these records!” and I really had no idea what he was doing with them. Since that day, and up until Saturday night, I have seen Adam perform a few times. I get what music mixing is all about. How you can take a Tammy Wynette song that meters 85 beats per minute and mix it with an Ozzie Osbourne song, also at 85 beats per minute. And, when you come out the other end, the whole is bigger than the sum of those two parts. I get all of that.

What I didn’t see was how he was ever going to make a career out of this. How was he ever going to make any money, have a great health insurance policy, a 401k, a pension plan or a paid vacation? All I could see in my future crystal ball was a 40-something man still waiting tables and trying to juggle family commitments. It just didn’t compute for me. Thankfully, Adam is one of the least money-motivated people I know. His wants to be happy. He wants to be surrounded by people he loves. He has an easy smile and a big heart. All these characteristics are to be cherished. He also has a shiny, 24-karat work ethic. He has kept his nose to the hiphop grindstone for well over ten years, perfecting his turntable skills, writing lyrics and beats and trying to find a way to be in the right place at the right time.

This article in Creative Loafing Atlanta tells the story about how the planets aligned to make this past Saturday possible. All the hard work. All the sacrifice. All the creative juice, the calendar and the place — ALL lined up. I’m reminded of a quote I once read, “Luck is what happens when preparation meets opportunity.” Being lucky is a good thing in the music world, I’ve found.

Here are my take aways from the show:

• Even though this is my first hiphop show, I now can tell the difference between sophomoric rap (the first opening act) and really good, sharp, percussive rap (like the kind Adam does).

• I heard the word “fuck” used more times than you’d hear it used in one of Dr. Carlton Savory’s operating rooms.

• I was shocked that 90% of the audience was caucasian. Turns out old school R&B shows are highly frequented by African-American audiences and hiphop shows are primarily attended by white folks. Who knew?

• Although it was loud in there (and I came prepared by taking my Hearos), the sound was really quite great.

• I couldn’t believe how much sound can emanate from the hands of a world-class DJ (DJ Lord). I give that man mad respect!
• After seeing this show, I know Adam is on a straight up trajectory toward something great. I couldn’t be prouder of him. I can’t wait to see what will happen next…..as long as I don’t have to go see it.

The Beat of My Life

Riding in to work this morning I was listening to the radio and the Christmas song, “Sleigh Ride,” came on. The strings, brass, woodwinds and percussion swirling in my head like a Colorado snowfall. I became aware that I was playing the percussion parts on the steering wheel. Beat for beat, especially the

“clip, clop
clip, clop
clip, clop
clip, clop
clippity clop

My underarms also began to get moist. I was that 16-year-old boy with moderate adolescent acne on the stage at Hardaway High School, watching George Corradino’s direction, surrounded by my friends, who were also nervous, waiting for their parts to play out.

We had so much fun traveling to football games, marching at Falcons half time, playing drum cadences at Christmas parades, pep rallies and concerts. I didn’t realize at the time that all this fun was giving me a wonderful education. The love of learning music continues to be one of the greatest gifts of my lifetime, right up there with reading.

As I drove this morning, thinking about all the ways music has influenced my life, my relationships, my every waking moment and even a couple of my idiosyncrasies. Especially the one where I pay attention to when my windshield wipers are perfectly on, or off, the beat and the times they leap — just ahead, or lag back ever so slightly from — the beat of the music. If it is raining and I’m in my car, I will most assuredly be thinking about windshield wipers and whatever music happens to be playing.

At Arnold Junior High School Larry Kirkland was my first band director. He was a wild man. Beat me with his baseball bat “esque” paddle. Threw a metal music stand over the heads of the clarinet section onto the wall where my head had been before I hit the deck. Despite his borderline psychotic demand for perfection, there wasn’t a single person in that band that would have hesitated to take a bullet for him. He died of a heart attack while in his 20s.

George Corradino was my band director at Hardaway High School. He was tough, but we weren’t afraid of him. We wanted to do well so as to not disappoint him. Like when you don’t want to disappoint your dad. Mr. Corradino still plays gigs around town and I saw him last night. He is still a handsome man with more talent in his little finger than most people have inside their whole being.

I thought today just how much my life would have gone missing without my music education in our public schools. I’m happy that our newly “PhD-ized” Dr. David Lewis is a musician and feels strongly about the good that comes from music and arts education.

Music gives me goosebumps. Music makes me happy. Music makes me sad. Music makes me angry. Music provides the back beat of my nearly 62 years of life. I owe my love of music and my arguably impeccable sense of rhythm to music education in the Muscogee County Public Schools.

I Want a Little Bit of Everything

I finally figured out to easily embed media files into my blog posts. I like the way this is looking, as you can either skip the file altogether, listen to it while you read the post or come back to it later. This song is by a new folk rock/indie rock band named Dawes. The song is called “A Little Bit of Everything.” I really like it. Sort of Jackson Browne. Sort of Wallflowers. At least those great performers come to mind when I hear this new music. If you want to listen now, you know what to do.

When you are first diagnosed with cancer, shock is the first order of business. When they start sticking you with needles and you begin to see the bills roll, the “awe” starts to kick in. As you becomes a seasoned warrior, you start to get angry about just how much time, money, opportunity, energy and actual tissue you have lost to this damn disease. In my last post, I reported that an adrenal ablation treatment, although hugely successful, shit-canned another of my organs. Killed it. Rendered it useless. Cooked it with microwaves. Between the adrenal gland, an entire disc in my spine, my left kidney, 12 lymph nodes and my thyroid, I’m running with a few less organs than the good Lord saw fit to give me at birth.

So here I am, almost exactly 5 and a half years into life with renal cell carcinoma, when the Internet said I’d have only a five percent chance to be here, I find myself in a situation where I want just a little bit more of everything, and this song resonates with me.

Here are the lyrics to the song:

“A Little Bit Of Everything”

With his back against the San Francisco traffic
On the bridges side that faces towards the jail
Setting out to join a demographic
He hoists his first leg up over the railAnd a phone call is made, police cars show up quickly
The sergeant slams his passenger door
He says, “Hey son why don’t you talk through this with me?
Just tell me what you’re doing it for””Oh, it’s a little bit of everything
It’s the mountains, it’s the fog
It’s the news at six o’clock
It’s the death of my first dog””It’s the angels up above me
It’s the song that they don’t sing
It’s a little bit of everything”

An older man stands in a buffet line
He is smiling and holding out his plate
And the further he looks back into his timeline
That hard road always had led him to today

And making up for when his bright future had left him
Making up for the fact that his only son is gone
And letting everything out once, his server asks him
“Have you figured out yet, what it is you want?”

I want a little bit of everything
The biscuits and the beans
Whatever helps me to forget about
The things that brought me to my knees

So pile on those mashed potatoes
And an extra chicken wing
I’m having a little bit of everything

Somewhere a pretty girl is writing invitations
To a wedding she has scheduled for the fall
Her man says, “Baby, can I make an observation?
You don’t seem to be having any fun at all”

She said, “You just worry about
Your groomsmen and your shirt-size
And rest assured that this is making me feel good”
I think that love is so much easier than you realize
If you can give yourself to someone, then you should

‘Cause it’s a little bit of everything
The way you choke, the way you ache
It is waking up before you
So I can watch you as you wake

So in the day in late September
It’s not some stupid little ring
I’m giving a little bit of everything

Oh, it’s a little bit of everything
It’s the matador and the bull
It’s the suggested daily dosage
It is the red moon when it’s full

All these psychics and these doctors
They’re all right and they’re all wrong
It’s like trying to make out every word
When they should simply hum along

It’s not some message written in the dark
Or some truth that no one’s seen
It’s a little bit of everything


As we prepare for our eldest son’s wedding a little later this month. I realized that Michael is giving Janice “A Little Bit of Everything.” Marriage is way more than the ring.

The joining of their two lives has made me look back on my life and my vows to Jill. Living with cancer has made me want so much more — time, experience, travel, dinners, breakfasts, quick glances when someone in the room says something we both find funny or poignant, grandchildren, walks on the beach, pillow talk, time with our children, time with our parents, time with our friends, time with our pets, the smell of our pine forest, garden dirt, cold drinks in July, the occasional snow ball fight, a-n-y-t-h-i-n-g that gives me more face time with the people I love. That is what I want. And, we’re fighting like crazy to make it happen.

New Appreciation for the Microwave

Please accept my apology for leaving you all hanging. The pressures of helping to run a business, keeping up with all of the landscaping I’m responsible for (especially with diminished physical capability) and the sheer joy of returning to life have had me blocked beyond belief. Under normal circumstances, my brain lights up when I touch the keys on my MacBook Pro. Much like me, my “S” key is beginning to show some wear. Am I living my life too safely? Command-S is the keyboard command to save. Caution has been at the very front of my consciousness AC. After Cancer.


In the last post I described the adrenal microwave ablation procedure performed by Dr. Nishant DeQuadros and his team and anesthesiologist, Dr. Mark Pinosky. In order to assure us that no heart muscle damage or other cardiac damage had occurred with the 300/200 blood pressure spike during the procedure, Dr. DeQuadros ordered a full cardiac workup. Echocardiogram, treadmill test and lab reports later, the good news is that I suffered no damage from the spike in blood pressure.

So, all that was left was a follow up scan called an arterial phase CT scan with contrast. I had that scan done last Thursday, October 2 and was happy to have been able to have an immediate consultation with Dr. DeQuadros after the scan.

During that meeting he told us that he was looking for a short list of things (margin around tumor and adrenal gland, margin around pancreas and color (degree of dark shading) of fat layer around the site of the ablation) that would indicate how successful the procedure had been. He scored a trifecta with excellent skills, a great team and an anesthesiologist who reached for and got his hands on exactly the right mix of medications and mad skills to keep me from either cardiac arrest or stroke while the procedure was being completed under very scary and trying circumstances.

The tumor appears to be dead. The adrenal gland has been banished to a growing ash heap of my internal organs. Pitched into the black ether of my insides. A perfect gut shot, suitable for TV replay on The Medical Channel (if there is such a thing). My joints ache. I don’t move as well as I used to. My hair appears to be holding on, but irrevocably grey. Parts of my feet are numb. I get completely freaked out sometimes by a phantom pain, worrying that something is knocking on my cancer door again.

In spite of all this stuff, I could be arguably NED again, for more times now than I can remember. If I could live with all of these and maybe even a few more encumbrances for another 30 years, I’d take it and run! Chances are, we haven’t seen the last of this ugly disease. I’m ready for the son of a bitch, if it decides to come at me again.

Meanwhile, I will get to witness the marriage of our eldest son on October 25, wish my father a happy birthday on October 23 and get tuned up for my favorite holiday when we host another Thanksgiving Day dinner. With just a few modifications, life could really be good for us next year.

Microwave Ablation Completed Despite Blood Pressure Spike

Heartbeat ECG. Volumetric concept. VectorI have two new best friends as of this past Thursday. Dr. Nishant DeQuadros and Dr. Mark Pinosky.

Nishant is an interventional radiologist. He’s young, engaging, handsome, articulate and well trained. Here’s where he was trained:

Henry Ford Hospital/Wayne State University
Residency, Radiology, 2006–2011

Brown University
Fellowship, Vascular and Interventional Radiology, 2011–2012

Case Western Reserve University School of Medicine
Class of 2006

Mark is an anesthesiologist. I took an instant liking to him as he talked. He seemed focused and knowledgeable and because he is chief of the anesthesia group at Columbus Regional Health and is responsible for several offices in other states. He spent quite a bit of time with me before the procedure I had on Thursday morning, explaining what types of things they’re preparing for in a microwave ablation of a renal cell tumor in my left adrenal gland. He is board certified and licensed in several states. Here’s where he was trained:

Medical University of South Carolina
Class of 1989

Internship and Residency
Georgetown University Hospital

Thank God in heaven that my world intersected with these great doctors at just the right time. If not for them by my side on my case Thursday morning things would be very different in my world today. If I had a world at all.

Let me take you back through our decisions that led us to deciding to undergo microwave ablation to remove the renal cell metastasis in my left adrenal gland this past Thursday: My CT scan from July 22 showed that a tumor in my left adrenal gland had started growing again 23 months after I started a drug, Votrient, that kept the tumor at bay. I took the terrible drug for 15 months and stopped it in January of this year, after it became apparent that the drug might kill me. It robbed me of my dark hair, 100 pounds of my flesh, my taste buds, my favorable vomit streak and visited upon me some other even more awful things that I’ll spare you from reading.

Dr. Pippas said at the meeting after the scan that he felt a surgical option might be the route we should take. I visited with Dr. Andy Roddenberry at St. Francis Hospital and he gave us a good understanding of how serious this surgery would be: Open incision of 10″, 6 days in the hospital and a full six weeks of recovery. A lot of pain and a real solid blow to my already compromised immune system.

A few days later, after a lot of thought, Andy Pippas called me on the phone and said he had a change of heart about the direction he had advised me to take. He felt that a big surgery shouldn’t be done at this point. It was better to find a less invasive procedure that could take out the tumor, not negatively affect my immune system and still leave us with surgery as a next step if we needed it later.

About that same time, Dr. Granville Batte called me and told me about Dr. DeQuadros and his skills as an interventional radiologist. All my research told me that this young doctor had the chops to do this procedure. That he was highly skilled and he was the right person to choose to do the procedure. We went to see him and Jill and I both felt like I was in good hands with him. So we scheduled the procedure for Thursday, August 28 at Midtown Medical Center.

I had never met Mark Pinosky until Thursday morning, when he appeared at my bedside to discuss my case prior to surgery. I’m thankful he was there and all his excellent training was brought to bear to save my life when my adrenal gland sent my blood pressure into the stratosphere right in the middle of the ablation procedure.

The CT-guided microwave ablation takes place in a CT suite, not in a surgical suite. I was placed face down in the CT machine and Dr. DeQuadros used the CT to guide a needle-like probe into the tumor. In a discussion on Friday morning in his follow up visit after the procedure, he told me that he needed a four-minute burn to kill the tumor. He said he inserted the probe into the adrenal gland and started the burn.

My adrenal gland did what it does and ramped up my blood pressure and the procedure had to be stopped multiple times while efforts were underway to drive my blood pressure down. Dr. DeQuadros ran a central line into a vessel behind my knee that gave them beat by beat access to my heart.

They were able to deal with blood pressures that went as high as 300/200, the corresponding bottoms that would have followed with the introduction of powerful drugs to drive my blood pressure down, and still get the procedure completed. Both of these great doctors have promised me some time to talk about the procedure for inclusion in this blog. I want to be sure to capture my thoughts and the thoughts of the doctors about this promising minimally-invasive way to deal with RCC mets in the adrenal gland.

I’m writing this from memory and from audio recordings of my talk with doctors after the procedure, so I’ll likely revisit this after I have a clearer view of how the procedure unfolded. But, regardless of my description, the medical talent with me in that room on Thursday was brought to bear on a difficult situation to what will likely be a good outcome. So thankful to my God, my medical team, my family and my prayer warriors.

Needless to say, I’ll be in my pew this morning at St. Matthews in-the-Pines Episcopal Church. I have much to be thankful for. Please excuse this rambling post. I wanted to get something out and I don’t think I’ve been as articulate as I try to be in this space. Just wanted everyone to know that I’m OK and hopeful about what lies ahead.


Going Home

I’m waiting for a cardiac consultation before we can leave the intensive care unit to go home. I’m fine after the microwave ablation and my medical team here at Midtown Medical Center did a great job in spite of what turned out to be very dangerous circumstances during the procedure. I will write about this at length in a few days. For now, and since I’m typing on my iPhone, I wanted to thank everyone for prayers and concerns. May God bless you all for all those prayers.

Missed Opportunity

In the spirit of complete transparency, I need to mention something at the top of this post: I am working on a new digital magazine publication for the Georgia Fraternal Order of Police. For the past several weeks I have been immersed in all kinds of things about law enforcement officers — LEOs.  I have spent a great deal of time talking with members of the Georgia FOP who wear badges from either police, sheriff, marshall, campus police, military police, customs, corrections, CIA, FBI, ATF or homeland security.

Some of the stories we are targeting for future publications seem so much more important right now as our country has been watching the turmoil in Ferguson, MO and how that turmoil is spreading out from there to larger cities with large blocks of people who aren’t white Americans. There has been a great deal of discussion of the use of military gear and BDU-type uniforms, and whether or not to use vest cams to protect both the alleged perpetrator and the LEO involved in a dust up.

That has nothing more to do with this post than to give you a look into my mind over these past few weeks that culminated with the thing that happened out in our parking lot on Friday afternoon. I am really upset about it. I’m upset because I did something that my head told me to do, but my heart was tugging me in the other direction. Here I sit on Sunday afternoon looking back on my weekend and I’m sad that I might have missed an opportunity, and instead I might have perpetuated another stereotypical profiling episode that just didn’t have to happen.

I got a call on my cell phone late in the day on Friday and was notified about a group of young black men in our parking lot. The caller said they looked like they were just hanging around and might be up to no good. I grabbed my sunglasses and walked out our office front door and around the building so I could check them out. I made a pass by them on the way to do something I dreamed up so I could get a good look at them and try to determine whether or not I should approach them and inquire about what they were doing there.

A couple of them were shirtless and they were kind of lounging up against a car that I didn’t recognize and the other one was sitting on a parking bumper watching me. My heart told me that they were probably waiting on someone who was doing business with one of our tenants. My head told me to engage them and see if I could detect some kind of threat. As the property owner of that corner of our block, I have a responsibility to keep the place safe, well maintained and well lit.

So, this white boy, against the alarms ringing in my head that were telling me these kids were just waiting on their mother, who was probably inside paying off a short term cash loan from one of my tenants and the reason they weren’t in the damn car is because it was hot as the hubs of hell out there on that asphalt. But no, I didn’t process that and walk on.

“Hey guys, you waiting on someone?” I said.

“Nuhuh,” mumbled the disgusted looking one with the reddish tips on his hair. “Someone in there?” I gestured at the loan company building. He mumbled something else that I couldn’t understand and I swear to God I could hear what he was thinking: “Listen you white asshole. My mother is inside paying a bill. Me and my boys are just too hot to sit in that car so we’re waiting here in your damn parking lot in the shade. You got a problem with that!!?!”

I am so sorry that I didn’t do what my heart wanted me to do: I should have gone over and sat down next to that angry looking young man and talked to him about what has been on my heart since this latest racial flash fire has boiled up in our country’s streets. I wish I could go back and ask him if he’d be willing to talk to me about my fears about about the anger that is boiling up around us and about his righteous indignation at feeling like he’s always got to explain himself.

I cannot imagine what it must feel like to be a young African American male and to see the look of mistrust or downright fear in people’s eyes as they are looking at you. If I looked up in my rearview mirror and saw blue lights and heard the click, click, click of boots walking up toward my car window, I would probably injure myself getting into whatever position the LEO told me to get into. Whether or not I was doing something wrong, my first thought would be, “Okay, I know how this is supposed to work. If I do what they say to do, everyone will be safe and if I’m guilty, I’ll have to pay for what I did. If I’m innocent, they system will take care of determining my innocence and I’ll go on back to my life.

That young black man that sees that same splatter of blue lights is bringing a whole different set of thoughts as he decides what he wants to do. I can’t put my head there, because I’m a white man who has never been subjected to any type of racial profiling. I’ve never had to explain to anyone why I was walking, sitting, standing, driving or doing a single damn thing. I can’t imagine how that must feel.

I know one thing, black men need to help rear their children. I have so many African American friends who are just like me except for the color of their skin. They are married to great women, they are terrific fathers to their children. Their children are educated, law-abiding citizens who are contributing to all the good things going on in our country.

Are these young black men who d0n’t have a father at home, imprinting on people at school or out in the streets who are not good, law-abiding citizens? Is this where that thuggish behavior comes from?

It should be obvious by now as you read this rambling column, that I have absolutely nothing I can contribute to this ugly situation. I am, however, going to look for every opportunity to engage with people and try to talk about these perceptions we have about people simply because of the color of their skin. There should never be a reason why someone should fear or feel anger toward someone they don’t even know.

To those young men in my parking lot on Friday, I am so sorry that I didn’t treat you like a human. I am so sorry that I didn’t offer you a bottle of water and a place to sit where it is cool while you waited for whomever you were waiting on. I am just so sorry I didn’t lead with my heart.

Now, let’s look at the other side of this. Let’s say you are a hairdresser and the newest thing in video games is a game where the people holding the controllers are racking up points bludgeoning you with tire tools or shooting you right in the middle of your well-coiffed forehead. And, they get extra points if your recently blown-off skull lands in that dumpster in the alley.

When an LEO comes upon a law being broken, his or her main job is to control the situation. Get people on the ground, while watching others standing around and might be involved with the perpetrator. They’ve got to watch for weapons, call for backup, watch the crowd, protect themselves and the innocents around them. That job is almost impossible, even if everyone is completely doing what they’re told to do.

Now, what if that perp decides he’s innocent and isn’t about to do what that cop just told him to do? Chaos happens. We see this now almost around the clock on TV. LEOs have one of the most difficult jobs on earth and that job is getting tougher by the day.

May God continue to bless the people whose job it is to keep us safe and protect the rule of law. May God also bless those whose tough upbringing  hasn’t given them the proper tools to live safely in this world. I don’t have any answers here. All I have to offer is a hopeful prayer that we can figure this out.

Eight Months

metal and wood figureThese past eight months have been like heaven on earth. Eight months without vomiting. Eight months without diarrhea. Eight months of razor-sharp taste buds. Eight months of date nights with Jill. Eight months of normalcy. Eight months of cancer on the back burner. Eight months without taking a medication that costs $10,000 per month. Eight months of sunshine without being afraid of burning my skin. Eight months of the occasional taste of beer. Or wine. Or bourbon. Eight months of being able to tell people I’m doing well and eight months to thank them for their continued love and concern. Eight months of being able to work, think and contribute to our publishing company.

July 23 was the day we had a follow up appointment with Dr. Pippas to get the results of the CT scan we had the day before. What had looked like another good, stable scan took a screaming left turn when Dr. P’s eyes took in the slice that showed my left adrenal gland. We both saw the lump at the same time.

Three years ago, a discovery like this would have set me on my ear.  But, these last three years have turned me into a tough sonofabitch. Yeah, I got a lump in my throat about the same size as that tumor. Yes, I could feel the dampness in the pits of my arms. Even before I knew what needed to happen next, I knew that when cancer’s in the house, ain’t nothing good comin’ from it.

Then Dr. Pippas did what he does best. He pushed back in his chair and we talked. With a waiting room full of patients, we talked. With treatment rooms full of patients, we talked. He gave Jill and me as much time as we needed to get our heads around the fact that some drugging, some cutting, some irradiating or some other, yet unknown medical torture, was about to visited onto our family in general and onto me specifically. He gave us time to see this new challenge from every angle while we were still in the room with him and able to ask questions of the leader of our medical dream team.

Dr. Pippas said he thought surgery was my best option. “Local disease requires a local treatment. Systemic disease requires systemic treatment,” Andy would always say. So we planned to scan again in five weeks time to see if the tumor was moving fast or hanging back, growing slowly like my disease has pretty much always done. We left his office feeling like a surgery to take out the adrenal gland would be a piece of cake. Probably a robotic, laparoscopic kind of thing that I would get over quickly and get behind me.

I made a decision to consult with Dr. Andy Roddenberry at St. Francis Hospital. He is a young surgeon. Full of promise and not full of himself, which made me instantly like him. I wasn’t real thrilled with what he told me, though. Dr. Roddenberry is a skilled surgeon and after a good bit of discussion, he concluded that if we wanted him to perform the surgery, he would begin the procedure hoping for a minimally invasive operation, but we needed to know the surgery would likely not be able to be completed that way.

There is considerable scar tissue left over from the massive nephrectomy that cost me my left kidney, twelve lymph nodes and a lot of digging around looking for cancer. Additionally, the organs in my body have recognized that there is some stuff missing now that used to be there and they’ve wiggled around and taken up that space in my abdomen. So, scarring, colon, pancreas and a mass of arteries and veins are all congregated in that area, as well as a vascular renal cell tumor that is very much like a 2cm bubble of blood inside the thinnest tissue paper you can imagine. The surgery has been described to me like a person trying to pick up a balloon full of blood with razor sharp pins. One prick of that bubble and I’ve got cancer cells released all over my body and my prognosis suddenly would take a big turn for the worse.

That surgery, if it turned into an open procedure, would land me five to six days in the hospital and would require about a six-week recovery. UGH! I’ve been doing research. Asking questions of people I felt might have answers. We have been fearful of a surgical option because of my weakened immune system. Andy Roddenberry explained the concerns of surgery with a weak immune system better than I have ever heard it explained.

I know this post is getting long, but I’m on a roll now and you can just close your tablet and go to bed if you’re tired of me.

Here’s what Andy Roddenberry said. “Chances are that you have small clumps of cancer cells in other places in your body. Your immune system is standing guard over them and keeping them in check. Then, you get a big 10″ incision across your belly and suddenly those immune system guard cells leave their post and race over to the site of the incision to help your body heal. The cancer cells are left alone and they have the chance to begin to grow unchecked.” That makes a hell of a lot of sense to me. Suddenly, surgery isn’t such an elegant solution to my problem.

A couple of weeks after our meeting with Andy Roddenberry, I got a call from a radiologist friend of mine who suggested that we take a look at microwave ablation as a course of action. We met with a young interventional radiologist at Midtown Medical Center named Dr. Nishant deQuadros. Much like Dr. Roddenberry, Dr. deQuadros took us through our options in a calm, thorough discussion. We left his office feeling good about him and interested in the possibility of a minimally invasive option to remove this tumor.

In the meantime, last Friday I got a phone call from Dr. Pippas. He wanted to discuss our last office visit and his comments about surgery being my best option. After a great deal of thought, he said he wanted me to look at another option than surgery. He felt surgery would be better left as a next step, after a less invasive attempt to remove the lesion.

So, we’ve listened to all of these experts and have come to a decision. We’ve made plans to go the microwave ablation route this coming Thursday, August 28. The plan is for me to spend one day in the hospital and if all goes well, I’ll be back at work on Monday, September 2. I’m nervous, not so much about the procedure, but that this disease might be about to kick it up a notch. I have enjoyed these last eight months and I want to keep living just like that — free.

So, don’t give up on me. Keep the prayers coming and pray that the microwave ablation is a success and that it kills the only remaining disease within my body.

Now, let’s go kick cancer’s ass for the seventh time!

1) nephrectomy, 2) metastasis in spine, 3) radiosurgery in spine, 4) metastasis in spine #2, 5) radiosurgery in spine #2, 6) chemotherapy, 7) microwave ablation


Things are Looking Up

I’ve been wrasslin’ with myself for the past few weeks about this blog. If you are a regular reader of my blog, you know that the number of posts I make is inversely proportional to my general state of health. If I am sick and scared, I write. So, in these darker times of my life, my writing is selfish. I write because I need to write. To cope. To push away that creeping fear that is crawling up the various parts of my body that have been left numb and tingly from surgery, drugs and radiation.

When I’m feeling well, I get back to my life and my writing is harder to come by. And, I’m busy at work. We’re launching a new digital magazine this fall that is for and about Georgia’s Fraternal Order of Police members. Building a new publication from the ground up is really exciting!

This is my conundrum: I know that a few thousand people have closely followed my journey with cancer. When I don’t write, I know people miss hearing from me. I feel like I’m being selfish again. I am sitting in an infusion chair at JBACC with a needle in my arm, hydrating and preparing for CT scans of chest, abdomen and pelvis tomorrow. Being here, surrounded by stuck figures, it is hard not to think about the disease that has made our lives so difficult for the past five years.

My “God-is-choosing-my-next-adventure” story has taken a decidedly upward turn. We are now six months out from the decision to stop taking Votrient, the drug that is helping to save my life. Continuing to take the 800mg daily dose had become impossible to deal with. The drug healed me (for now) but was making me sicker than the cancer.

My tumors are gone. I’m able to eat and have gained back 60 of the 100 pounds I lost. I was able to go whitewater rafting this past Saturday and I am able to think clearly without pain and without those heavy-handed cancer drugs. Wednesday is the day when I’ll know if we’re still NED (No Evidence of Disease).

If you’re one of those that wants to see more regular posts, please forgive me for not writing. I’m hoping that I’ll be able to write less about cancer and more about our business growing and going. That would make me very happy.