Sitting in the chemo chair for round 14As I write this, I'm sitting in the chemo chair, waiting for the pharmacy to mix my chemotherapy for Round 14 of treatment.

During Round 13 of my chemotherapy treatment with Oxaliplatin and 5-FU, I had an allergic reaction to the Oxaliplatin which resulted in immediate discontinuation of the drug and administration of steroids and Benadryl to halt the reaction.

Last week, I returned to MD Anderson for blood work and CT scans, which confirmed that my cancer has continued to spread. The existing cancer sites in the lymph nodes have grown, and new potential sites of metastasis are appearing. Based on the progression of the disease, my oncologist at MD Anderson offered me the option of entering a clinical trial or trying a second-line conventional chemotherapy regimen. I spent some time doing research on the drugs being used in the clinical trial, and came to the conclusion that they were unlikely to be effective against my cancer, given the results of published research where the drugs were found to be of no benefit in treating cancers similar to my gastric adenocarcinoma.

As such, I elected to try a second-line traditional chemotherapy regimen with Irinotecan and 5-FU. I will have another CT scan in 4-6 weeks to determine whether it is working, and will switch to a third-line treatment if it is not. In the meantime, I am still hoping to get access to an immunotherapy trial, but must wait for the trial to open again.

Over the past week, I've been in significant pain much of the time, as the growing lymph nodes begin to put pressure on nerves in my back. I've been prescribed new pain medications that work well most of the time, but I've found that if I sleep through a dose, it takes quite a while to control the pain again. This has been a discouraging week, with the ratio of good days to bad days becoming increasingly lopsided in favor of bad days. It is hard not to view this as the beginning of the end, but we are hoping and praying that the second-line treatment will give me a little more time.

Over the past several days, I have had one Bible passage that keeps coming to mind:

Do not be anxious about anything. Instead, in every situation, through prayer and petition with thanksgiving, tell your requests to God. And the peace of God that surpasses all understanding will guard your hearts and minds in Christ Jesus.

Philippians 4:6-7

Note that this verse doesn't promise that our requests will be answered exactly the way that we hope they will. It doesn't promise that everything will be fine. It does promise that God hears our requests and promises us "peace... that surpasses all understanding."

I have known that peace during these past few weeks. As my condition worsens and the likelihood of long-term survival shrinks, there is no earthly reason for the peace that I feel. Certainly, we continue to grieve the loss of our future together, but we have faith in our Father who will supply all of our needs.

My wonderful wife, the love of my life, Melissa, has been such a wonderful caretaker over the past months. She is so strong, and patient, and kind, and loving. I can't imagine how hard it has been for her to watch her husband go through this cancer, but she has been my best friend and most trusted ally through it all.

Thank you to all who continue to lift us up in prayer, send meals, write notes of encouragement, and stand by our side through this trial. Please continue to pray for the following:

• For strength and peace for Melissa
• For patience in the waiting
• For uncommon effectiveness of this second-line chemo regimen
• For wisdom with all of the decisions we face in the coming weeks and months.

We continue to play the waiting game. As of now, results are still not back from the genetic testing of my cancer, and the immunotherapy clinical trial that I'm hoping to join remains on hold. 

We did get one bright spot in the waiting. Last week, I received word from my genetic counselor about the results of my genetic testing (different from the genetic testing of my cancer to see what targeted therapy trials I may be eligible for). MD Anderson conducted tests of seven specific genes known to increase the risk of gastric and related cancers, and all of my genes were normal. This means that I most likely developed gastric cancer by chance, and more importantly, this means that my beautiful children are not at any increased risk for cancer due to their genes. This was a huge weight off of our shoulders to know that there is no possibility I could pass genes on to Matthew or Raegann that would increase their chances of gastric or related cancers early in their lives.

Last week, I was fighting a bad cold, so my normally "good" days during the cycle were spent trying to get over a nasty cough and the fatigue that comes with illness. Thankfully, by Wednesday, I was nearly back to normal, just in time to spend most of the day in the clinic receiving chemo round 12. Each round seems to get a little bit harder, and the symptoms last a little bit longer, as the toxic chemicals used to fight my tumors take their toll on my immune system and the remaining healthy parts of my body. This round was no exception. I was able to teach my classes on Thursday morning, but spent the rest of the day sleeping. Friday was spent sleeping as well, and although I was up for a good bit on Saturday, I didn't really have any energy, and still napped for a large portion of the day. By Sunday (today) I was able to stay awake for most of the day, but my strength was still gone.

One of the common questions I get asked, especially by my students, is "What's chemo like?" I certainly can't speak for everyone who has been through chemo; there are a lot of different chemo regimens, and everyone reacts differently to the various drugs. I can say that my experience has been similar to that of Westley in one of my favorite movies of all time, The Princess Bride:

Chemo, like The Machine, feels like it is stealing your life away. You receive an infusion, and the next 4-5 days of your life are spent in agony, nauseated, completely drained of all strength and energy. Although I am without a Miracle Max who can bring me back from being "mostly dead," my wonderful wife and partner in life does a miraculous job each round bringing me out of the pit of despair and getting me ready to "storm the castle" with my students the following week. I am so thankful to have a spouse who loves me so much and demonstrates that love to me every single day.

Unless results come in sooner than expected from the genetic testing of my cancer, or the clinical trial reopens, my next appointment at MD Anderson will be on October 6-7. I am scheduled for CT scans and blood work on the 6th to see how the cancer is progressing, and for follow-up with my oncologist on the 7th.

As we continue to wait, our prayer requests remain the same as last time:

• For continued effectiveness of the Oxaliplatin and 5FU at keeping my cancer at bay.
• For sooner-rather-than-later results of the gene testing of my cancer.
• For a second-line treatment that will be uncommonly effective at fighting my cancer.
• For patience and peace as we wait.

The past few weeks since my last visit to MD Anderson have been filled with activities and new beginnings. Last week we celebrated Matthew's 4th birthday with pizza, firetrucks, and very, very red cake with candy flames on it.

Matthew blows out his birthday cake candlesAs exciting as it was to celebrate another year of my son's life, it was a difficult day for me. It's hard to have celebrations like this without wondering whether or not you'll be around to celebrate the next birthday with them. These intrusive thoughts can certainly put a damper on what would otherwise be a joy-filled celebration of growth and learning.

The academic year has started back up at University of Dallas, and I'm teaching a full load of classes. It is really good for me to be back in the classroom. I miss teaching so much over the summer, so being back with my students really does give me some much-needed structure and a sense of accomplishment at the end of each week. I've switched my chemo calendar to better accommodate my teaching schedule. Instead of receiving infusions on Mondays, I'm now receiving them on Wednesdays. This means that I just have to make it through my Thursday morning classes after chemo, and then I have until Tuesday to recover before I'm back in the classroom again. For this first week, it seemed to work OK. The chemo symptoms have been getting more severe and of longer duration with every round, but I was able to teach both of my classes on Thursday without any major problems.

Friday after chemo was a rough day - I spent almost the entire day sleeping, and still have very little energy even now on Saturday morning after a full night's sleep.

Mostly, these past few weeks have just been characterized by waiting. We know that the cancer is growing (albeit slowly) even with this current chemo, but we are waiting for the genetic sequencing results and for the possible opening of an immunotherapy clinical trial before moving into a second-line treatment. The waiting is difficult, but we know that God is in control, and ultimately, my care is in His hands.

For those of you who are praying for us, thank you for your continued petitions on our behalf. Please remember the following requests:

• For continued effectiveness of the Oxaliplatin and 5FU at keeping my cancer at bay.
• For sooner-rather-than-later results of the gene testing of my cancer.
• For a second-line treatment that will be uncommonly effective at fighting my cancer.
• For patience and peace as we wait.

Today I met with my oncologist at MD Anderson to find out the results of yesterday's CT scan checking the progress of my cancer.

 My exam room at MD Anderson Cancer Center

The results showed that almost all of the lymph nodes involved in my adenocarcinoma have very slightly increased in size. She is calling it "stable" because the minor increases are within the margin of error you might expect when different people read CT scans. There was no evidence of any new cancer sites or of any spread, so while this isn't the great news we were hoping for of continued shrinkage of the cancer in my body, stability is definitely better than growth or spread.

I also learned today that the genetic sequencing of my tumor was unable to be completed because the biopsy tissue did not contain a large enough sample of cancer cells. As a result, I'll need to travel back to Houston sometime in the next few weeks for another endoscopic biopsy of my stomach tumor. 

My oncologist is currently working on an immunotherapy cancer trial that I am eligible for. It is currently on hold in the safety evaluation phase, but she believes it will begin enrolling patients sometime in the next two months. In order to preserve my eligibility for this clinical trial, she suggested a further four rounds of chemo with the Oxaliplatin and 5FU regimen rather than switching to a second-line chemotherapy treatment. My blood test results showed that I am tolerating the chemo well, so she believes additional rounds of the existing treatment are the best way to proceed while we wait for her clinical trial to open, or for the genetic sequencing results to come back on my cancer tumor which may reveal additional targeted trials for which I am eligible.

Although this news is not as positive as we had hoped, I am very excited about the possibility of an immunotherapy trial. In my research, immunotherapy is one of the most promising new developments in cancer treatment and has the greatest potential for my longer-term survival.

Ultimately, we know that all things are in God's hands and we trust Him completely, even in uncertain times. I have found great comfort over the past few weeks in the words from Psalm 91:4-6.

He will shelter you with his wings;
you will find safety under his wings.
His faithfulnesss is like a shield or a protective wall.

You need not fear the terrors of the night,
the arrow that flies by day,
the plague that comes in the darkness,
or the disease that comes at noon. 

We have been so blessed by so many people showering us with love and care in so many ways. For those of you who are praying for us, please remember the following requests:

• For continued effectiveness of the Oxaliplatin and 5FU at keeping my cancer at bay.
• For rapid completion of the safety testing related to the immunotherapy trial.
• For quick scheduling of the new tumor biopsy and no complications related to the procedure.

Chemo Round 9 was probably the easiest round I've had yet. All of the typical symptoms were there, but in greatly reduced intensity and duration. It was a nice ending to this chemo regimen to have it go out with a whimper rather than a bang.

Melissa is still experiencing some lingering soreness and pain from her surgery two weeks ago, but feels better and more like herself every day. 

Tomorrow, I will make the trek to MD Anderson Cancer Center in Houston for my second follow-up appointment. On Thursday, I will undergo CT scans to check the progression of the cancer, and on Friday I will meet with my oncologist to discuss my options for second-line treatment.

Overall, during my off-weeks from chemo, I have felt nearly normal, which has been a blessing. I know others in a similar situation who are completely debilitated by this disease, and aren't able to even come close to living a normal life during treatment.

In two weeks, classes start up again at University of Dallas, and I'm scheduled to teach a full load of classes. I'm so looking forward to begin back in the classroom and seeing my students again. This summer has been a wonderful opportunity to spend lots of quality time with friends and family, but I miss teaching and can't wait to get back to it.

I will post again this weekend and share the results of my discussions with my oncologist and plans for second-line treatment. Thanks again to all of you who support our family in so many ways. We love you all.

If you are praying for us, please remember the following requests:

• For continued recovery for Melissa, and no additional complications from her surgery.
• For good results from the CT scans this week at MD Anderson.
• That the second-line treatment we choose will be uncommonly effective.