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I've owed my readers some news for over two months now.  SInce I have been silent on this blog, some have worried if everything is OK.  The short answer is, yes!  I am recovering well.  The picture above was taken June 19 of me jumping off a 60' cliff called "Skydiver Leap" into a deep pool in Havasupai Canyon (a tributary of the Grand Canyon).  It was my ninth time there (first time in 1988).  On this expedition I carried a pack 20 miles and hiked an additional 15 miles on a great trip with over a dozen young adults, one of whom I was able to lead to Christ one night at Havasu Falls.

Just prior to that trip I had a good 3-day camping jaunt up the California coast with a friend from Australia, another hiking buddy and two nephews.  These were my first chances to get away since surgery.  I'm posting photos from these trips on my Flickr page over time: see them here-- http://www.flickr.com/photos/psa104/ .  One coastal photo caught the eyes of over 3,000 viewers.

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Mooney Falls is a 200-footer
Cancer Update

I'm feeling strong, walking 2-4 miles a day and eating healthy food.  Though I'm not out of the woods, I've recovered remarkably well so far, thanks to the prayers of many people and the grace of God.  Just 3.5 months ago I was helpless in a hospital bed, and now look!  When my oncologist saw these pictures of me hiking, doing handstands and cliff diving, she said it made her day! 

I'm on long-term treatment with octreotide, a chemical that mimics a natural enzyme with receptors for the tumor cells in my liver.  It's supposed to shrink the tumors, or at least inhibit them from growing.  In late May, I had to inject myself three times a day for two weeks.  Now, every 4 weeks I get a shot in the gluteal muscles that makes me sore for about a day, but then I feel fine.

Neuroendocrine tumors, like those embedded in my liver, are usually slow-growing.  The octreotide is probably just buying time until more targeted therapies become FDA approved.  Some of them look very promising.  One available already follows the octreotide to the tumors with a radioactive isotope payload that can kill the tumor cells without harming healthy tissue.  A better isotope is now undergoing a Phase III trial at Cedars-Sinai Medical Center.

The most interesting targeted therapies are the T-cell immunotherapies and oncolytic viruses. The T-cell therapy trains your own immune system to fight the tumors.  The oncolythic virus therapy uses a custom virus that finds the tumor cell and kills it, releasing copies that attack nearby tumor cells.  A test of this virus at the University of Uppsala in Sweden has proven effective in mice.  Researchers are seeking funds to begin Phase I trials in humans.  Unfortunately, these "miracle cures" are years away.  We should pray that they become available soon, not just for me, but for many others suffering from cancer.

In mid-July I will be meeting with my surgeons at City of Hope to learn about treatment options.  Most likely they will recommend staying the course with octreotide for now.  You can continue to pray that it will be effective, and buy me as much time as God's perfect will requires for me to work, and that I will use my time wisely.

 
 
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My sister Judy and me at the front entrance
(This is the first day after my surgery I'm feeling well enough to write, so I thought I'd share a few thoughts what God has been teaching me this week.)

St. Augustine was well known for his large work, The City of God, that compared God's domain with man's.  I don't suppose either Augustine or the designers of City of Hope Clinical Research Hospital had that in mind, but I think Augustine would certainly approve of calling the "City of God" a City of Hope as well.  For it is in Christ Jesus that we have hope of eternal life for this life and the next.  I have also found that God's hope is for this life as well. It's a hope that stems from the goodness of God – his affection for His creatures that moves him to act on their behalf, because it is His good pleasure to see them rejoice in Him.  He is good.  He has been good to me this week.

In rhe emotional distress I faced after the diagnosis on January 11, I first saw that goodness in God's leading to two of the finest clinical oncologists I could ever "hope" to have cutting me open.  It just so happened (I use that phrase advisedly) that my first oncologist said on my first visit, "You are fortunate that we have working in this area one of the finest surgical oncologists at City of Hope hospital, with years of experience specifically operating on tumors.  He has just opened up an office nearby.  I want to go over your scans with him in the morning, then I want you to make an appointment with him immediately."  It turns out that he is not only one of the finest in the area, but probably in California and the nation as well.  In his part if the surgery, Dr. Vijay Trisal succeeded in getting the entire primary tumor out, including the lymph nodes and associated tissue.  Then he carefully removed a foot of small intestine and sutured it successfully together allowing me to eat my first clear liquid food today.  In another answer to prayer and evidence of His goodness, He moved Dr. Trisal to go for primary tumor removal first--a good thing, because by Feb. 26 it was almost completely blocking my small intestine.  The Lord him make that critical decision in the nick of time.

Assisting Dr. Trisal on Tuesday was Dr. Gagandeep Singh, another outstanding surgeon--chief of surgery here at COH and one who knows the cutting edge science as well as the cutting edge of the scalpel.  Dr. Singh spent six of the eight hour operation removing as many liver tumors and tumor clusters as he could, including 86 from the surface.  Wisely he decided not to attempt a major resection, though, lest I face loss of function.  "You can survive without a kidney," he said, "but not without a liver."  In his meeting with me the prior day, he encouraged me with promising new treatments that may be ready when I need them – targeted therapies that can specifically target the tumor cells without harming healthy tissue.  I was very glad to know that Dr. Singh, Dr. Trisal and City of Hope are on the leading edge of cancer treatment.

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Helford Hospital at City of Hope, where I write from
I was reminded again how God's goodness is reflected in the goodness of His people.  While I have had to learn some patience with hospital staff some days (more about this in a satire perhaps tomorrow), I was glad to have regular visitors flow into my groggy field of vision, encourage me, and pray for me.  My sister would do anything she could, anything I asked; her family made arrangements to help free up her time so she could be with me the whole week.  

I will not deny that an operation of this magnitude is an ordeal.  Imagine every slight cough or hiccup leading to stabs of pain in the abdomen.  Imagine the struggle to breathe normally.  I tell you, when you lose your health, even temporarily, you understand what a precious gift it is.  So many people do the simplest, ordinary things every day in ways that would have caused me to shrink in horror at the thought of going through that pain again.  Health is itself a gift of God's goodness.  It is tragic to think of the many who, because of refusal to accept God's salvation from their sin, choose sickness over eternal life, pain over God's pleasure, tears over God's good gifts.

At this point I'm getting a little better each day.  The first 3 days after surgery were the hardest, but I'm making progress.  It was a great relief today when Dr. Singh gave permission to remove the breathing tube.  Now another day or two
 and I could be tube-free.    We celebrate the goodness of God by saying grace before meals.  I tell you, no clear broth and apple juice was better blessed!  Soon I hope I will be home, where challenges will continue in my City of Hope under God.

 
 
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Well, it's the night before I go to the hospital.  I'm having abdominal pains where the tumor is pressing against my intestine, and it's late.  I wondered what I could share quickly to encourage my friends and describe my meditations at this point.  I thought I would relate some clear evidences of God's leading me through this latest trial.

When you get a cancer diagnosis, or face an operating room, your emotions can go wild.  Most of the time I can act pretty stoic about my situation in public, but I haven't always been as brave and confident as I should be, knowing Biblical theology about salvation, sanctification, and grace.  One of the curve balls Satan tries to throw at you is the guilt trip.  "God is punishing you for your sins," he whispers.  Even though I know that my sins are under the blood of Christ, and there is no one, not even among the finest Christ followers, who never sins, that guilt trip can try to snag you, especially when the devil quotes Scripture to make his point.  He reminds me that God judges even Christ followers with sickness and death, as I Corinthians 11:29-31 teaches.  Then there's the "sin unto death" John warned about in I John 5:16-17.  Like JPL's lawyers, Satan is really good at hunting and pecking for evidence to use against me.

Intellectually, I can tell him, "Begone, Satan!  My sins are under the blood of Christ."  I can also point to Christ followers far more saintly than me who also got cancer.  Scientifically I know that cancer is common and afflicts people of all ages and backgrounds; God is not picking them out to judge them with cancer, is he?  But when I was having a particularly hard time with this mental battle some weeks ago, shortly after the diagnosis before many people knew, I asked the Lord for some sign that this cancer was not punishment for my sins.  It was a Saturday night and I went to bed with that hope.

Next morning I walked into the church lobby, a few minutes late after the service had begun.  In the lobby are screens where the words for the congregational singing are projected.  The choir director was leading the audience in the familiar hymn, "How Firm a Foundation."  At the exact moment I entered, I heard the music and saw these words on the screen:

      When through fiery trials thy pathway shall lie, 
      My grace all sufficient shall be thy supply.
     The flames will not hurt Thee, I only design 
     Thy dross to consume, and thy gold to refine.

I stood there, amazed at the timing!  I followed as they sang the third verse:

     When through the deep waters I cause thee to go,
     The rivers of sorrow shall not overflow.
     I'll strengthen thee, help thee, and cause thee to stand,
     Upheld by my gracious omnipotent hand.

Tears started flowing as I walked quietly up to the balcony, as the words I knew by heart continued to echo through the halls:

     The soul that on Jesus has leaned for repose,
     I will not, I will not desert to its foes;
     That soul, though all hell should endeavor to shake,
     I’ll never, no never, no never forsake!

I took a seat against the far right wall, trying to hide my tears—tears of relief and comfort that this hymn, such a perfect answer to prayer, was the first thing to greet me.  But that wasn't the only sign of God's comfort that morning.  The next congregational hymn was "It Is Well With My Soul."  I could hardly sing, so I just listened and sang it in my heart.

     Though Satan should buffet, though trials should come,
     Let this blest assurance control,
     That Christ has regarded my helpless estate,
     And hath shed His own blood for my soul.

     My sin, oh, the bliss of this glorious thought!
     My sin, not in part but the whole,
     Is nailed to the cross, and I bear it no more,
     Praise the Lord, praise the Lord, O my soul!

Good old usher Bob could not help noticing my sniffling.  He came over and asked with a smile, "Everything all right?"  I forced a smile and we smacked fists.

The Lord must have wanted to make sure I was not going to fall for Satan's guilt trip.  It "just so happened" that the pastor's series on I Peter landed on chapter 1, verses 6 to 9:

In this you rejoice, though now for a little while, if necessary, you have been  grieved by various trials, so that the tested genuineness of your faith—more precious than gold that perishes though it is tested by fire—may be found to result in praise and glory and honor at the revelation of Jesus Christ. Though you have not seen him, you love him. Though you do not now see him, you believe in him and rejoice with joy that is inexpressible and filled with glory, obtaining the outcome of your faith, the salvation of your souls.

Comforted by this rapid-fire series of answers to my prayer, I remember the pastor quoting Psalm 23 with a comment; "The fact that you walk through the valley of the shadow of death does not necessarily mean you will leave it; just that He will be with you."

The Lord came through that morning for me with the assurance I needed, and He has continued to bless me with encouragement from friends far and wide.  Just last night, for instance, I lady I had not seen for some time walked up to me during a break in a meeting and went on and on about how much I had blessed her life and influenced many others.  I was reluctant to tell her about the cancer, but when she sensed "something else was going on," I told her.  She stopped and prayed fervently for me right then and there, asking for healing.  And tonight, my sister's family held a rich, sincere round of prayer for me.

I could tell more about God's comfort during this my new trial, but it's time to sleep and get ready for the hospital tomorrow.  I hope you will take heart at how God met me when I really needed hope.  When you face your next trial, and intellectual knowledge alone is not enough, will you lay it before the Lord and ask Him for guidance?  God is eager and willing to give wisdom to those who lack it, and ask without doubting (James 1:2-5).  You may not get an answer from an angel at the foot of your bed, but God has other "angels" (other believers) He can bring alongside you to pray for and encourage you.  Trust Him and see His perfect timing!

     O, what peace we often forfeit,
     O, what needless pain we bear;
     All because we do not carry
     Everything to God in prayer.
     --Joseph Scriven, a man who knew a lot about trials
     (see his story in the video Amazing Grace: Hymns That Changed the World).

Footnote: Tonight I ended a several-year chronological Bible study using the English Standard Version and Greek.  "It just so happened" that tonight's final text was Revelation 22: No more sorrow, no more tears, no more pain; the curse is gone, and the river of life flows by the tree of life.  Yes, come Lord Jesus!

 
 
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Standing by my cubicle where I worked at JPL for 14 years
Since at least 2008, I've had mysterious headaches that have grown in frequency and intensity.  My doctor said it was just stress.  True, I had a lot going on in my life: work and several ministries that kept me very busy.  Still, I sensed that there must a physical cause for these headaches, and I needed to know what it was.  

So we experimented with all kinds of medicines.  No luck.  He ordered an MRI of my skull; nothing specific related to headaches.  He sent me to a neurologist.  The first neurologist wasn't much help.  It could be this, it could be that, it could be a combination.  My cousin, a radiologist, gave me an MRI with higher resolution; still nothing: a possible tumor seen in the earlier MRI was only a tangle of blood vessels.  

So I went to a neurological institute.  The EEG looked fine.  My headaches didn't fit any of the typical classifications: stress, migraine, cluster.  They would come on and force me to lie down for anywhere from a half hour to 2 hours, usually once or twice a day.  Two neurologists at the institute were baffled after more medications had no effect.

In March 2012 at the courthouse, my attorney said, "Dave, did you know your face is beet red?"  No, I didn't.  That was the next clue.  I found that many times after eating, my face would get flushed.  I saw another neurologist my attorney knew; but once again, there was no definitive diagnosis.  We tried a really high-res skull MRI, but once again, no smoking gun was found in my brain.  He even suggested botox injections in my forehead might work.  I'm glad I didn't try that.

In late July, I had a bout of food poisoning that produced stomach pains and diarrhea.  My doctor gave me an antiobiotic that seemed to work after a week, but the diarrhea came back periodically.  That was another clue. By this time, I really wanted to know what was happening to me, so I went to a headache specialist, whose whole practice is curing headaches.  We tried an MRI of the whole spine, in case there was a leak of cerebrospinal fluid. Nothing definitive there.  Then for some reason he requested a 24-hour urine sample.  Something unusual turned up: serotonin levels that were four times normal.  He ordered a follow-up with a restricted diet; same thing.

I began reading about what can cause these symptoms.  That's where I first heard of carcinoid syndrome: a rare kind of neuroendocrine tumor, usually in the gut, that releases excess serotonin or other hormones.  The descriptions were somewhat alarming; it's usually slow growing but progressive, but can be cured if the tumor can be removed before it spreads to the liver.  The headache specialist and I wanted to "rule that out" if we could.  So he sent me to an endocrinologist.

The endocrinologist assured me that it was probably not carcinoid.  After all, it's rare; he had only encountered 4 cases in his 12 years of practice, and my hormone levels didn't seem as high as others.  More blood tests confirmed, though, that markers for carcinoid tumor were present.  He sent me to a gastroenterologist in November for a colonoscopy.  That produced a basically clean bill of health: a couple of benign polyps, but no tumor in the colon or upper GI tract as far as the duodenum. 

Still, the symptoms continued.  The endocrinologist said the only way to be sure would be with a CT scan.  On January 10 of this year, I went in for that.  The radiologist report came back the next day:

Enhancing mid mesenteric base ill-defined mass with extensive desmoplastic reaction and lymphadenopathy at the level of  the origin of the inferior mesenteric artery/L3 is  identified. The bulk of the mass measures approximately 35 x 20 x 30 mm.  Desmoplastic reaction causes significant retraction and thickening of the subjacent small loops of bowel.  There is·also innumerable metastatic hepatic lesions too numerous to count. The largest metastatic deposit is in lateral segment of the left lobe of the liver measuring approximately 25 x 25 mm. Differential for these findings include metastatic neuroendocrine neoplasm such as high-grade carcinoid tumor.

My endocrinologist called me in immediately.  I now had the physical cause of my headaches.  The bad news was, it was cancer.  (Note: "neoplasm" means cancer).   Not only was there a large tumor pressing on my small intestine, there were innumerable tumors, "too numerous to count" in my liver.  I was now his carcinoid case #5.

I was devastated.  I went home and cried.  For the next several days, I would spontaneously choke up and could not hold back the tears.  I could be perfectly fine one moment, then crying like a baby the next.  My MD cousin spoke with me for an hour on the phone about what I could expect, and said that I should prepare for bouts of depression.  I showed the gastroenterologist the report, and he furrowed his brow, saying, "I'm so sorry.   It's progressive, you know."  

I tell you my story so that you learn to pay attention to your body. During the years my doctor was experimenting with every known headache medicine, or telling me it was stress, precious time was wasted.  I knew there had to be a physical cause.  Something was wrong; I could feel it.  Those headaches were not normal. I had dealt well with stress all my life without headaches.  If that primary tumor had been found early on, I could have had hope of a cure, but once it spread to the liver, my hopes diminished rapidly.  Even if most of the tumors can get removed in my surgery 3 days from now, it's unlikely the surgeon can get them all-- and they come back.

Of course we can get paranoid or hypochondriac, but I wish now I had insisted on a scan earlier.  Who would have expected something in my gut to cause headaches, though?  At the time, none of 8 doctors thought of it.

I also wonder if there had been anything I could have done to prevent it.  I admit to having been a fast-food junkie for years: burgers, fries, cokes have been a mainstay, even though I exercise often.  Yet there are people who live healthy and get cancer, and obese people who live long.  Nothing is guaranteed.  One thing I started immediately, though, is a radical change in my diet.  No more red meat and sugar; it's all fruits and vegetables and limited amounts of white meat.  I'm taking seriously the reputable claims about proper diet helping the immune system fight cancer (since we all have incipient cancer cells in our bodies).  I'm reading up on anything I can do to fight this, even if the eventual outcome is grim.

This brings us to the mystery of God's will.  There are things we can do, and should do, to stay healthy, but God works His plans for us invisibly in the background, for our eventual good in heaven, no matter what we decide.  Sometimes God calls us to suffer, or educates us on weak spots in our lives by forcing a change of direction.  I've always been the guy in charge, leading the pack, making my plans, serving God by my own choice.  Now, I am subject to forces beyond my control.  In a few days, I will be submitting my body to surgeons who will cut me open while I'm asleep.  I can't give them any help or advice.  My survival depends on them -- ultimately, on the Lord working through them.  After that, the best I can expect is a few more years of productive life, living with my carcinoid syndrome, injecting myself with octreotide to suppress the symptoms until the cancer catches up with me some day.  And there are worse outcomes you can imagine anytime undergoing major surgery.

Between tears, I've been ashamed.  Lots of people get cancer--even children.  I've had a really good life for 62 years.  I have eternal life in Christ; what is there to be afraid of?  I've thought about times when I didn't show enough empathy with those getting bad health news.  I think about all the saints through the ages who suffered martyrdom, and fates far worse than mine.  And intellectually, I know all the theological answers about God's will, the purposes of suffering, the right responses (after all, I helped on The Case for Faith).  I can tell you, though, when it hits you in the gut, your emotions can still overwhelm what you know in your head.  The first few weeks were the hardest.  Lately I've been getting more of a grip, in no small part to the outpourings of encouragement and support from friends and family far and wide.  That's another new trail for me; accepting sympathy.  Larry Burkett's book Nothing to Fear, with his own story of facing cancer, has been helpful in guiding my attitudes away from fear and despair to confidence and hope.

In a way, I've been blessed by this bad news.  I now know what will probably take me down, and I have some time to prepare.  I'd rather know than drop unexpectedly of a massive heart attack, or fade away with dementia as both of my parents did.  It's causing me to focus on the things that matter in life: my walk with God, my spiritual influence on others.  I can't take time for granted any more.  I probably won't live to see my 70th birthday.  But that's OK; every day is a gift, and I've received plenty of gifts already.

Every one of us has a terminal illness: it's called living in a sin-cursed world.  We all know we're going to die; we just don't know when.  We avoid dwelling on it.  But if you knew, like me, that you had maybe 5-8 years, or potentially a few days, what would you change?  I encourage you to think hard about that.  Start living like this year will be your last.  Make every day count.  If you're not on the right path, I urge you to follow the signs to the trailhead right now.  If you are, remember the old saying: "Only one life; 'twill soon be past.  Only what's done for Christ will last."  Thanks for your prayers, and may God bless you on your trails and trials.