Friday Revue and Christmas Surprises; Life Lessons

I was up blogging my last blog until 2 AM last night. (Day of treatment syndrome; steroids and too much sleep during the day I guess.) Anyway, I made it to bed by 2:30AM and was up again by 7:30AM. After radiation I got to work just before the market opened at 9:30. (We had a good week in the market. I am hoping we get a Santa rally leading up to Christmas.)

I spent the morning taking care of all the voicemail messages from Thursday when I was out doing chemo. I had to skip lunch to prepare for my first appointment, which was at 1 PM. That appointment went to 3 PM so I was late for my 2:30 outside appointment (who, it turns out is seven year Stage IV breast cancer survivor) but Ryan covered for me; I got back to the office just in time for my 4 PM appointment followed by dinner at the Isle Yacht Club. Yoko and I got home from dinner tonight at 9:30PM. Coincidentally, while we were at the Yacht Club, we were introduced to a man who had just lost his wife to lung cancer. After the poor man left, the comment was made that "she smoked like a chimney" with, of course, the implication that she brought her demise on herself. All the while I am thinking...OK...but at least she was in her late sixties! Is that how people will remember me? The stupid idiot ...he smoked like a chimney!? God, I hope not!

During dinner Yoko let me know that Mom had called to tell us that she has arranged to send tickets to both Paula and June to come here for Christmas! And I thought Santa was a childhood fantasy! What a wonderful surprise! This is sure to be a very special Christmas, thanks to Grandma. And thank you Paula and June for making the time to come! Mom plans to join us here on the 19th; the girls follow on the 21st. We will be at full capacity and there should be plenty of blog material forthcoming. Anyone reading this is also welcome to come visit us here in Florida this winter.

It has been great to see comments coming in from different family members. If you go back and look, there is a message from Joanie on the Uncle Sam Letter blog. Thanks Joan...I love you too! The best part is knowing that people are taking time to read it out of concern and caring.

For me, blogging has been a great way of documenting what I am doing and feeling each day and reflecting on how I am leading my life and using my time. I would like to set a good example for my children, in the time I have, to show them all the possibilities that a full life offers. On this topic, Ryan told me about a great video on YouTube you should see. It is Jimmy V announcing the start of the Jimmy V Cancer Research Foundation at the Espy Awards in 1993. It is a nine minute talk about life and how to lead your life...when you have time click on this link to watch it. http://www.youtube.com/watch?v=ePXlkqkFH6s

My sister Peggy sent me an inspirational video called "The Last Lecture of Randy Pausch." He was a computer science professor at Carnegie Mellon who was diagnosed with terminal cancer of the liver. This was a kind of living memorial service put on for him by the University. It is a very moving talk about the fulfillment of his childhood dreams. The video goes for about one hour. It is something worth watching when you have the time. The link is: http://cmu.edu/uls/journeys/randy-pausch/index.html

I was talking with Scott Lunin today and I said to him that your view of life changes when you know your time on earth may be limited. It changes your perspective and suddenly you want to go out and do good. I think this is natural and is reflected in these kinds of inspirational talks by people diagnosed with a terminal disease. Love and care for your family, help others, and do something to make the world a better place before you leave it.

I think most people living their daily life don't recognize all the capacity we have to love, do good and change the world for the better. I thought the Jimmy V comments said it all when he said, if you laugh, think and reflect, and cry once a day, you are living a full life. By those standards, I am living a very full life these days!

Before I learned that Mom had arranged to bring the girls here, I was thinking of making my Christmas gift to Yoko a trip in January and go somewhere. Problem is, after looking around, there is no place we would rather be than in sunny South Florida during the winter.

I would really like to take a trip across the USA in an RV or take a trip to Italy with Yoko. My retirement dream was to spend a year in Italy (Tuscany) with Yoko studying Italian and art... Anyway, we have been talking about a trip to Italy, but we both decided against another winter trip to Europe. The best time to visit Italy is in the spring; we'll have to see what kind of physical condition I will be in by then. I do need to find out from Uncle Sam the name of the town where my grandfather was born. I know he went and I would like to see it too.

It's hard to plan any travel when you have this condition, since I need to be around for the needed treatments. Hopefully by spring, Scott will tell me the cancer is gone and I am in complete remission; the only thing left to do will be to wait and see what happens. That is when will feel like a cancer survivor rather than a victim. So I am planning to take trip somewhere with Yoko in the spring to celebrate....I found a cruise aboard the brand new Queen Victoria that would leave from England and take you around the world for only $22k per person (drinks and excursions fares separate). Aside from the fare, the only problem is the 106 days you need to make the trip.

It IS a luxury cruise... I wonder if they offer chemo on the boat?

November 29th Chemo; The Blood Count and Thoughts About Cancer Research

Scott was not going to be around tomorrow, so he moved my treatment up one day. Today was my seventh chemo (and hopefully last) treatment. I left the house at the usual time...8:35, had radiation at 8:50 and went to chemo by 9:15. I got home at 3:30 PM and took a two hour nap. I feel fine. I am starting to wonder if they put any drugs in those bags! Actually, I got pretty sleepy from the benedryl and slept for a large part of the time. The treatment room was busy and I could not get my usual chair in the sun, so I sat in a chair near the nurses. The room was freezing and, even covered in a blanket, I was cold. Those nurses are wonderful. I can't imagine doing what they do all day everyday...but I must say they are very professional and competent and treat you like you were the first patient they ever had.

Not being able to find a chair made me think of all the people being treated for cancer. You have to wonder where the incentive is to find a cure. This is very big business. I never really realized just how big a business cancer is -- I might have intellectually known it was big, but I never really saw it on a day to day basis as I am now. The sheer number of cases out there is amazing. The incentive to find a cure I suppose is the dollars that will be saved in the health care system. We need a cure rather than a treatment.

In the meantime, Scott and Dave have a business model that just won't quit. They don't have to go out and do seminars and scratch and claw to find new business like I do; it comes waltzing in the front door every day. Their waiting room is bigger than the Morgan Stanley office in Punta Gorda! (I should ask both those guys to put their money where there mouth is and let me manage their retirement programs!)

Anyway, I was thinking about all this and, after watching the ridiculous Republican presidential debates last night, it occurred to me that our national priorities are really screwed up. According to the National Cancer Institute, estimated federal funding for cancer research by type of cancer in 2007 was as follows:

• Breast Cancer: $560 million
• Colo rectal Cancer: $253 million
• Lung Cancer: $260 million
• Prostate Cancer: $309 million

These were estimated numbers in 2006. I think the actual numbers this year are somewhat higher, but the point is how much is being spent per cancer type and that ratio has not changed.

The National Institute of Health has a $28 billion budget. Over $2.3 billion is going to AIDs research; all cancer together is about 4.3 billion. Lung cancer kills more people than all other cancers combined, yet has the lowest funding. Try these statistics on for size: The 5 year survival rate for breast cancer it is 88%; for prostate cancer it is about 98%; for colo rectal cancer it is about 63%; for lung cancer it is 15%. The incidence of cancer for lung and breast cancer per 100k population in the US is about the same: 64/100k for lung and 69/100k for breast cancer. If you do the math, and assume a US population approaching 300 million, that would mean there are about 192,000 cases of lung cancer and 207,000 cases of breast cancer that will be diagnosed this year. Of the breast cancer cases, 12% or 24,000 cases a year will succumb to the disease within 5 years. For lung cancer, the number of deaths within 5 years will be 163,000. Good God Why don't we put more money into fighting lung cancer, which is going to affect and KILL more people? If you want to see where I got these numbers, vit this web site: http://seer.cancer.gov/csr/1975_2004/results_merged/topic_survival.pdf

It is well documented that lung cancer is not getting the research dollars needed. Should we stop or reduce the funding for breast cancer or prostate cancer research? No. Should we spend LOTS more on lung cancer? You betcha. With these kinds of numbers, you would think that the government would get serious.

Now, you want to hear the kicker that adds insult to injury? The Federal government collects nearly $8 billion a year ($39 cents a pack) on cigarette sales...hmmm. Seems like my tax dollars have gone to something other than helping me quit smoking or cancer research. I think smokers and former smokers need to demand that the sin tax be used to help find a cure for lung cancer. What do you think? I would spend most of those dollars first to find ways of safely detecting lung cancer early -- perhaps finding a genetic marker or blood marker (like the PSA for prostate)? The statistics for 5 year survival would surely improve dramatically.

I read something really interesting. Because cancer grows geometrically, you can think of it like an algae that doubles in size. Eventually the cancer takes over the organ it has invaded, so the earlier you catch it the better off you are. The article was saying that if the algae was on a lake, and the algae grew to cover the lake in 30 days, how long before the lake was covered would you want to detect the cancer? Half way? That is on day 29. One quarter of the lake is covered? That would be day 28. Most people only find the cancer (allegorically) 3 or 4 days before the lake is covered.

One million cancer cells are smaller than the head of a pin. One billion cancer cells are the size of a pea and weigh about the same as a paper clip. To illustrate: 1 ...= The inception of cancer - one malignant cell growing ........uncontrollably. One to the 1st power is 1 X 10 =10; 10 to the second power is 10 X 10 = 100; 10 to the third power is 10 X 10 X 10 = 1000; 10 to the 4th power is 1o X 10 X 10 X 10 = 10,000 etc. 10 to the 9th power is the size that cancer can normally be detected by X-ray, scan, mammogram or feel. 10 to the 13th power is the stage at which the patient is generally dead. That is why early detection and prompt treatment are at the heart of treating the disease successfully. Early detection is what mainly accounts for the differences in survival rates between the various cancers out there.

What is OBVIOUSLY needed is a better way of detecting lung cancer. X-Ray is simply too crude and NOT good enough. I had an X-ray 2 years ago and nothing was detected. Had I had another X-ray in 2006 we might have found the tumor earlier. I was given an order to get an X-Ray in 2006, but I got busy and never did it! Maybe I would have caught the tumor a year ago...or maybe not given how quickly they grow. Yoko's mother had lung cancer but she survived 15 years because she had a surgery where they removed a section of her lung. They caught the cancer at an early stage and she lived until she was 77 years old. Stanford University is working on a project that would be very useful. The image on this blog was taken from that research at: http://biomath.stanford.edu/lung_adeno_ca2.html Check it out. This is not a hopeless problem.

Anyway, sitting there in the chemo treatment room, filled to the brim with cancer patients, I started thinking about what we need to do. We need some national leadership on this. Write to your congressman and senator and presidential candidate. Send them this blog.

Then what we should do is get Peter Jennings as a national spokesman for lung cancer...but, oh damn, he's not available....

My brother Frank wants to send my blog to the oncologists he knows in Boston; be my guest. Dr Ben Li, my cousin's husband who is an oncologist can share this with people if he thinks it would be worthwhile. I don't really care who sees this or I would have made it a members only. I want people (especially family and friends) to benefit and learn from my experience. We need to increase lung cancer awareness.

And now for the blood count: I am still looking good and this is a positive result because I am expecting my blood count to normalize once I am off chemo (starting from today). My weight today was 147...but I did not wear any sweatshirts (as I should have), which accounts for at least one pound...maybe two. I probably lost a little weight because of the slight difficulty I am having eating. I definitely did not eat as much this week.

Have a good evening. Yoko is calling me to bed!

PS... I ran the blogger spell check program for phlegm (flem)... and the only suggestion was that it should be CAPITALIZED. Now there's a hint!

Result Value (Previous) Normal Range

• WBC 4.1 (3.9) 4.2 - 10.0
• ANC 3.4 (3.1) 1.4 - 6.5
• Gran% 82.7 high 39 - 78
• HCT 36.3 (36.5) Low 41 - 51
• Hgb 12.1 (12.1) Low 14 -18
• Lymph # 0.5 (0.5) Low 1.2 - 3.4
• Lymph% 12.6 (14.4) Low 15 - 40
• MCH 28.2 (28.4) 27 - 34
• MCV 84.7 (84.8) 80 - 94
• MCHC 33.3 (33.3) 32 - 36
• Mono# 0.2 (0.2) 0.0 - 0.6
• Mono% 4.7 (5.4) 0.0- 10
• Plat 259 (241) (407) 140- 440
• RBC 4.29 (4.3) Low 4.5 - 6.4
• RDW 17.2 (16.9) High 11.5 - 15.0

Curb Your Enthusiasm!

In my world these days, no news is good news. Nothing exciting has happened in the last few days and there is nothing to report. I got a call from Scott Lunin, who read a prior blog and called because he wanted to know what color my flem is...(clear). The conversation went like this: "Hey Tom, its Scott again. What color is your flem?"

I'm telling you...this doctor is on top of things! I will see Scott tomorrow for our final chemo treatment. He is completely ignoring me on the Rotary invitation thing...but I'll keep after him.

Radiation goes on as usual. I am counting down the days to the end of these treatments because it is starting to get uncomfortable. I had my normal breakfast this morning and a late lunch at Amimoto, where Yoko works. I did not have much of an appetite this evening. Yoko made clam chowder. I had that and watermelon for dinner. By the end of the day I am very tired and just want to go home and rest. Last night I was in bed at 9:30 PM and slept until 8 AM. I felt better this morning but I still have a low level of energy. I worked until 5:30PM and came home.

I am starting to feel guilty about being as well as I am right now. I've got all you readers of this blog upset and praying for me...and I appreciate your prayers, but you may want to save some for if and when I REALLY need them.

I was saying to Yoko tonight that I kinda feel like Larry David, who stars in the HBO sitcom "Curb Your Enthusiam. " In one episode he "discovers" that telling people "my mother died" is the perfect excuse to get out of anything he doesn't want to do. Someone calls up and invites him to a party; he doen't want to go so he says, "I can't...my mother died." No one blames him for staying home. In the episode Larry uses "my mother died" to get anything he wants or to get out of doing anything he does not want to do.

Along the same lines, "I have been diagnosed with inoperable lung cancer" should be a great get out of jail free card. The best part of this is I am not in declining health at this stage, so now would be the time to play the cancer card. I will have to think about ways to use it!

Aunt Sue called to say hello to Yoko. Yoko was very happy to get the call and just chat. She also got a call from Linda Oppe (who did not want to talk with me) and from my sister Peggy(who also did not want to talk with me). Its good you are calling Yoko. She is not well represented on this blog and she can use the support. Yoko and my girls are the ones that is going to need help and support. Not me. I feel terrible for them that they have to go through this.

Yoko wants me to keep this blog honest and not to write for an audience. I am worried about having my heart out on my selve for the world to see. I don't want to embarass my mother, so I have avoided swear words and profanity. To be honest, I would have chosen different language for my "Don't Screw with Me" tee shirt....

I must say it is very nice to get comments and notes from my sisters and my children; at this stage, it appears, I can say or do no wrong. Did you notice? No one disagrees with anything I have to say. hmmm....

[Cue the tuba]...bum bum bum...ba da da da...bah da bah dahhh

Countdown to the End...of Chemoradiation

On Thursday I will have my last session of chemo for a while. I get six weeks off and then we re stage to see what progress we have made, if any. I have 10 sessions of radiation yet to go, or another two weeks. At this point I am more bothered by the radiation than the chemo. It has definitely gotten harder to eat in the past week. I am glad the treatment is two-thirds completed. Tonight I had leftovers from Thanksgiving and the food was delicious, but I did not feel full after eating because it feels like the food is stuck in the middle of my chest. I am still hungry as I write this, but I am afraid to eat any more.

I have been surprised at how fast this first treatment regiment has gone by. When you are looking at seven weeks in front of you, it seems like a long time. Now that we have completed six weeks of treatment, it does not seem like it was very long at all. At this point in my life, I hope time will slow down a little!

Yoko has a slight cold; I think she is more run-down than I am. In my current vulnerable state she is staying away from me so as to not infect me. I went to bed early last night; Yoko slept in the guest room. I did not sleep well at all. I kept awakening every hour or two and I had some pretty weird dreams. (I am always dreaming about traveling. ) Last night I dreamt that I was leading a group traveling to Japan. Everyone in the group had cancer, but it wasn't bothering them too much!

Ever since the diagnosis, I have not slept deeply. I always wake up with a story about a dream. When I awake I am not tired or sleepy, but I don't feel rested either. I can function perfectly well, but I don't have a high level of energy. I am sure this has to do with my growing depletion of red blood cells. Of course, I am worried that everything from here goes well and that the course of this disease can be well managed and not too big of a burden on my family.

I noticed that I have developed a cough that is not a dry cough but contains some flem. This is new and I mention it as I know Dr Lunin will be asking. I have become much more sensitive to any little change in my body. I am now always wondering if something I notice could be a symptom for more ominous things. Flem in my cough... could this be the start of pleural effusion? I keep waiting for the other shoe to drop. Anyway, I will ask my doctor.

The other thing I have noticed is how my attitude toward people has become a bit more intolerant and less sympathetic. People make a big deal out of nothing. (Of course, not much compares with a life-threatening inoperable cancerous tumor.) For example, I got an e-mail from a client today who was furious that Morgan Stanley may force him to periodically change his password to access his accounts online. He was threatening to move to another firm if we make him change his password. He calmed down after I spoke with him but I really wanted to say, "I have lung cancer ....don't you have a serious complaint?" I should have a tee shirt made that says..."I Have Lung Cancer ....Don't Screw with Me." Instead of a smiley face, we could have the opposite frowny face. I really don't have much sympathy for people with these kinds of "problems" these days.

More Research Yields Not Much Results

Over the weekend I have been trying to get myself a little better educated on what is out there and what I may be facing in the coming months. I found an excellent website created by the American Society of Clinical Oncology (ASCO) that has details and video presentations about the various "second line" treatment regiments currently being tested for Locally Advanced Non-Small Cell Lung Cancer. It would appear from what I have seen so far that there are no great second-line treatments and those that are being tried have only minimal effect in extending survival (by months...not years) with increased risk of complication. If you are interested in seeing these presentations (there are many technical presentations designed for researchers and medical professionals) you can go to www.asco.org. I understand enough to understand that there is no magic bullet when it comes to lung cancer. Actually the prognosis for anyone diagnosed with Stage IIIA lung cancer is pretty discouraging, so don't visit this website if you are looking for good news. You won't find any.

There were some comments on this blog site about not knowing or understanding the blood count information I am providing each week. At the bottom of this blog is just a reference you can use to better understand the blood count I am providing. It comes from http://www.medicinenet.com/.

I spent the morning golfing...if you can call it that. I was up until almost 3 AM looking at the ASCO site trying to find something encouraging. I got up for golf at 6:30 AM and left the house at 7 AM for my 7:45 tee time. I played badly 47 on the front and the same on the back. I STILL won money from Chris Maher, however, so that made me feel better. The bad score was from staying up too late -- not the chemoradiation!

I came home after golf to watch football. Tampa beat Washington by pure luck. I drifted in and out of a nap all afternoon while watching the boob tube. I was finally awoken by a call from Jessie. She went back to Tallahassee this morning and apparently had a small fender bender in the parking lot. She backed her car into someone parked behind her at the dorm. No one was injured. There was slight damage to her bumper and the door of the vehicle she hit. My insurance will pay the damage to the person she hit with no-deductible; I will probably have to pay the $500 deductible to fix the bumper of Jessie's car. Oh well, at least she made it back to Tallahassee safely! If this the worst accident she ever has, I will be grateful!

Yoko worked on putting up Christmas decorations most of the day. She is trying to go about things normally, but I am worried about her because she is worried about me! I think she is more tired than I am from all the uncertainty. To add pain to injury, we are starting to get the bills for all the tests and treatments. Man this stuff is expensive! Thankfully, again, insurance is going pay for most of it.

I got to say that I speak with people all the time who tell me that "they don't believe in insurance." Between homeowners, car, medical and life insurance, I am probably the insurance industry's worst nightmare. You would have to be an idiot not to carry good insurance.

I spoke with my mother yesterday and she has decided to come here for Christmas. Jessie will be home again around December 15th. I am looking forward to the holidays and the coming Christmas season. I will have to begin working on my annual Christmas letter soon....hmmm. I wonder what I will have to say that I have not already posted on this blog! Stay tuned.

Thanksgiving is over. Now, back to work!

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What is the Complete Blood Count?

The complete blood count is the calculation of the cellular (formed elements) of blood. These calculations are generally determined by specially designed machines that analyze the different components of blood in less than a minute.

A major portion of the complete blood count is the measure of the concentration of white blood cells, red blood cells, and platelets in the blood. The complete blood count (also called CBC) is generated by testing a simple blood sample.

What are values for a complete blood count? The values generally included are the following:

White blood cell count (WBC). The number of white blood cells in a volume of blood. Normal range varies slightly between laboratories but is generally between 4,300 and 10,800 cells per cubic millimeter (cmm). This can also be referred to as the leukocyte count and can be expressed in international units as 4.3 - 10.8 x 109 cells per liter.

Automated white cell differential. A machine generated percentage of the different types of white blood cells, usually split into granulocytes, lymphocytes, monocytes, eosinophils, and basophils.

Red cell count (RBC). The number of red blood cells in a volume of blood. Normal range varies slightly between laboratories but is generally between 4.2 - 5.9 million cells/cmm. This can also be referred to as the erythrocyte count and can be expressed in international units as 4.2 - 5.9 x 1012 cells per liter.

• Hemoglobin (Hb). The amount of hemoglobin in a volume of blood. Hemoglobin is the protein molecule within red blood cells that carries oxygen and gives blood its red color. Normal range for hemoglobin is different between the sexes and is approximately 13 - 18 grams per deciliter for men and 12 - 16 for women (international units 8.1 - 11.2 millimoles/liter for men, 7.4 - 9.9 for women).
• Hematocrit (Hct). The ratio of the volume of red cells to the volume of whole blood. Normal range for hematocrit is different between the sexes and is approximately 45 - 52% for men and 37 - 48% for women.
• Mean cell volume (MCV). The average volume of a red cell. This is a calculated value derived from the hematocrit and red cell count. Normal range is 86 - 98 femtoliters.
  Mean cell hemoglobin (MCH). The average amount of hemoglobin in the average red cell. This is a calculated value derived from the measurement of hemoglobin and the red cell count. Normal range is 27 - 32 picograms.
• Mean cell hemoglobin concentration (MCHC). The average concentration of hemoglobin in a given volume of red cells. This is a calculated volume derived from the hemoglobin measurement and the hematocrit. Normal range is 32 - 36%.
• Red cell distribution width (RDW). A measurement of the variability of red cell size. Higher numbers indicate greater variation in size. Normal range is 11 - 15.
• Platelet count. The number of platelets in a volume blood. Platelets are not complete cells, but actually fragments of cytoplasm from a cell found in the bone marrow called a megakaryocyte. Platelets play a vital role in blood clotting. Normal range varies slightly between laboratories but is in the range of 150,000 - 400,000/ cmm (150 - 400 x 109/liter).

Saturday Golf Tournament Report

Today we had our annual Rotary Club Golf Tournament -- Bogies and Stogies -- chaired by my good friend and golf buddy, Chris Mahr (pictured here). Kirby Rowe, John Wieber, Arron Olsen and I were his committee members.

We had about 104 players and 58 hole sponsors. In total I think we raised about $8,000 net for the club, which we will hand out as scholarships to high school seniors next year.

My team was composed of Brian Brunderman, who rebuilt my house after Hurricane Charley; Dr Kevin Van Nostern, a young chiropracter and all round fun guy (currently dating someone named Tyffiany who was in Paula's hig school class); and Phil Britian, who sells memberships for a national small business lobby and has a very interesting prior life. Unfortunately for me, other than Kevin, neither Phil nor Brian were of much help to the team. (Sorry guys.) The format was a four-man scramble, where you each hit and then play the best of 4 shots. We purhased 20 mulligans and used them all and still could only manage a 68 -- or 3 under par for the round. The third place group (Chris Mahr's) shot 57 -- to show you how far off the pace we were!

We had a good time anyway and I think the field had fun as well. Most of this was organized in the last month or so, with Chris doing the heavy lifting. Thankfully, this is the last golf tournament of the year. I participate in MANY as I am known to be golfer and charitably inclined. If I wanted to, I think I could play in a charity golf tournament every weekend around here.

Despite having chemo yesterday, I felt fine. I went to bed eary (10:30 PM) as I had to get up at 5:20 AM to help prepare for the golf tournament. I slept rather fitfully (the steroids) so I had no trouble getting up early. I arrived at 6 AM and spent most of the time putting up the hole signs. We had a shot gun start at 8 AM followed by lunch. We were done at 2 PM and Chris and Kirby wanted to play a bit more, so we went out and played nine more holes (compliments of the golf club). I just got home and I am feeling just fine. I had a hard time eating lunch (chicken sandwich) and oddly enough saw Dave Rice (my radiologist) at the tournament. Dave is a scratch player. I tried to get him on my team when I saw him Tuesday, but he had already agreed to play for Fawcett Hospital. Damn.

I played golf on Wednesday, again today, and tomorrow I play in my league. For someone who is sick and being treated for cancer, I'd say I'm doing pretty good Wouldn't you? Just hope I can keep going for a while. I am sooo tempted to tell Chris and Kirby they have been playing against a guy with lung cancer, undergoing chemo and radiation -- and I am STILL taking their money. When I can no longer play with them, I plan to steer them to this website.

When I got home I saw that Paula had purchased a ring for herself, June and Jessie. Let me read you the card she sent Jessie: " I bought this ring so that each of us has a way of keeping Dad in our thoughts daily. All three of us now own the same ring. Its a friendship, family, sisterhood & congratulory ring. I hope you like it. PS Good luck with your new job June! Love Paula".

THANK YOU PAULA! It would be nice to think that this thing I have will bring all of us closer together, even though we are physically far apart. I think of you all contantly and miss you. Speaking of which....

I have to run to watch FSU and UF play. June went to UF; Paula went to FSU and that is where Jessie is currently going to school. I am going to have to go with UF...only cause I think FSU does not have a chance, Mom is cheering for the underdog FSU and we NEVER agree on who we want to win. Anyway, June is further away from home than anyone else at the moment. So...Go Gators!

November 23rd Blood Count/ Chemo Treatment Number 6

Chemo treatment is becoming old hat. I had radiation as normal at 8:50 this morning and then went in for my chemo treatment at 9:15. I did not have to see Dr. Lunin...just a blood test and straight to chemo. I finished early today... 2 PM, almost an hour faster than usual. Between the drugs and yesterday's turkey, I had no trouble sleeping while getting my 9 bags of drip. I must have slept two or three hours.

Since Thanksgiving was yesterday and the cancer center was closed, today was a make-up day for all the patients that usually get treatment on Thursday. There must be 40 chairs in the treatment room and nearly every one was occupied when I arrived. However, because my chemo goes on so long, I was among the last to leave.

Last weekend Yoko and I went shopping and I purchased a Duke sweatshirt and hat to wear to chemo in honor of Dr Lunin, a Duke alumni. I was hoping to see him and then when he asked me to take off my shirt, I would display a garnet FSU tee shirt. (Last weekend when I wore all FSU stuff, Lunin claimed I was violating the cancer center dress code.)

Today I wore all my Duke stuff but did not have a chance to see Lunin; Apparently saw me sleeping in the Duke outfit, so he had the chemo nurse deliver to me a book entitled "Blue Blood" about the Duke/ Carolina rivalry. He came by to say hello before I left....

I thought the title of the book very apropos. Look at what chemo is doing to my normally RED (garnet?) BLOOD. Below are my latest results. White blood cell count continues on the downward path...but otherwise these are apparently still good numbers -- good enough to let my chemo continue.

Result Value (Previous) Normal Range

WBC 3.9 (4.4) 4.2 - 10.0
ANC 3.1 (3.6) 1.4 - 6.5
Gran% 80.2 (81.6) high 39 - 78
HCT 36.5 (37.6) Low 41 - 51
Hgb 12.1 (12.4) Low 14 -18
Lymph # 0.6 (0.6) Low 1.2 - 3.4
Lymph% 14.4 (13.5) Low 15 - 40
MCH 28.4 (27.9) 27 - 34
MCV 84.8 (84.6) 80 - 94
MCHC 33.4 (33.0) 32 - 36
Mono# 0.2 (0.2) 0.0 - 0.6
Mono% 5.4 (4.9) 0.0- 10
Plat 241 (288) (407) 140- 440
RBC 4.3 (4.45) Low 4.5 - 6.4
RDW 16.9 (17.0) High 11.5 - 15.0

Prayers of Thanks

Whenever I think of Thanksgiving I think of family and the time we have spent with one another and the little incidents that seemed to happen every year.

My fondest Thanksgiving memories are eating Thanksgiving Dinner at Grandma Donovan's home on Farmington Ave in Connecticut. I remember the whole Donovan clan being in attendance. There must have been 20 or more people. My grandparents would cook a gigantic 25 lb turkey all day in the basement oven and the aroma would drift up through the whole house and make us wild with hunger. One year I was able to secure a seat at the main table in the dining room (where all the adults were seated). I don't remember but apparently that Thanksgiving I said something out of school, so my mother kicked me under the table. My response was to ask her "what are you kicking me for Ma?" That story has been repeated a thousand time since.

(I was notorious for these kinds of one-line bloopers as a kid. When my cousin Henry got married, my parents made all us kids go up to the bride and groom during the reception to "say something." (I was probably 8 or 9 at the time) I had no idea about what to say to the newly married couple, so, instead of "congratulations" or something like that I said to Henry, "So (pause) ...what's new?" As soon as I said it, I was mortified. I don't remember what Henry answered, but every time I tell this story, my sister Jane roars!)

I remember the Thanksgiving we had the Sato's for dinner and Yashiko came dressed in a kimono. (Talk about going "full circle" tomorrow we are having Ryan Rupert and his fiance, Megumi and Ryan's parents to dinner. ) For some reason that Thanksgiving with the Sato's stands out in my memory. It was the first time Yashiko and Max ever had turkey, by the way. She was quite taken aback that the whole bird was served in a recognizable form...kind of how I feel about the lamb's head my Italian grandmother use to make!

Then there was a Thanksgiving when my parents had Joe and Sarah and their small kids over for dinner. Joe decided to give his infant son a sip of wine out of a fragile wine glass and the baby promptly bit on the glass and started chewing! Blood was coming out of the baby's mouth and the adults in the room were having conniptions. I remember Sarah yelling at her husband, "Why on earth would you give a baby wine!" (Good question! What was he thinking??)

In high school we would go to the season-ending Thanksgiving football game (Hatboro-Horsham vs West Moreland) and then come home to dinner. There were a few years in Philadelphia when we went to see the Army-Navy game, courtesy of Uncle Tim, who was career Army. My father (a Navy man) and Tim had a bet going each year about who would win the game, and as I recall, the payoff was a bottle of booze. When Navy won my father would receive a bottle of Strega at Christmas. I loved the tradition and pageantry of the Army-Navy game; it was always fun.

In college I came home for Thanksgiving one year and we decided to go ice-skating before dinner. I fell on the ice and broke my right wrist, but I only discovered it was broken after I got home. We were eating Thanksgiving dinner and my wrist started to swell in the warm air and ache like the devil. I remember that Thanksgiving distinctly because I had to go back to college and take my final exams left handed. Ouch.

We celebrated Thanksgiving every year we lived in Japan, but it was hard to come by Turkey. (The Japanese don't eat turkey.) Yoko would invariably find a small turkey and make the traditional turkey dinner each year. We would invite her parents to dinner, but Thanksgiving in Japan was never like it was here in the US. I always got homesick at Thanksgiving.

Since returning to the States, we have had Thanksgiving dinner at our house every year. My mother and father would join us when they lived here in Punta Gorda, and for many years my Rotary club would purchase complete dinners to deliver to needy families. On a few occasions I took my girls with me so that they could begin to appreciate and give thanks for all their good fortune. I think delivering turkeys to the needy on Thanksgiving day was one of the best ways I have ever celebrated Thanksgiving.

What about this year? Well, June is in Hawaii and Paula is in California, so we won't be sharing Thanksgiving together. We'll be thinking of them and our extended family, however, and giving thanks for all the love and blessings God has bestowed on us. We love you and miss you all! Happy Thanksgiving!

Next Steps

I wanted to share with you more about the doctor who is treating me, Dr Scott Lunin. It appears that he reads this blog, so this is a good way for me to communicate with him (and you) and express my latest thinking and concern. (Nice pic Doc...I got it off your website.)

I have to say Scott has been extraordinary. I had a nose bleed yesterday, and he was immediately on top of it. I let him know I had a nose bleed by e-mail (Yoko insisted) and he immediately replied back to me on how I should take care of this and the possible cause. It may be from the chemo or it could just as well be from my "prying" fingers. (I am stuffy and it has been very dry around here lately.) Scott later called me just to check on me. It is obvious he is paying attention and cares about patients he is treating. It gives me confidence that I am getting the best care from a doctor who is truly concerned about my well being. I hope my clients feel about me the same way I feel about Scott. He's terrific.

I find it extraordinary that Scott is calling me at all hours of the day and night to check on me or to discuss my case. It would be one thing for him to call if were sick and looking for help; but I have really been quite fine -- if not improved -- throughout treatment so far. I have only two chemo treatments to go and 14 radiation treatments. I weighed in today at 151 lbs., so I GAINED weight this week. Scott has been very pro-active in treating me and thinking about what can or should be done.

One of the things I asked about and Scott is giving serious consideration to is what the "next steps" should be. Assuming surgery is out -- what is the next best course of action? To his credit, Scott is reaching out to colleagues he respects in the medical community to consult with on my case. It is very reassuring to know that he is using the resources at his disposal to get the best minds available weighing in on my case.

This morning he called me on my cell, because he was about to talk to a Dr Frank Fossell at MD Andersen Cancer Center in Houston. Dr Fossell is a leading thoracic surgeon who specializes in lung cancer only. I could not join the conversation because I was sitting with clients myself. I think Scott's thinking was it would be better if I heard this from the horses mouth...but oh well. In fact. Scott wanted me to hear the discussion so I would have a better appreciation of the complexity of the issues and biology involved. My nature is to simplify and estimate in order to find solutions to complex problems. (I learned this trick in college from Luther Liggett.) I'm not good with complexity.

At 8:30 tonight Scott called to relay the gist of the conversation with Dr. Fossell. We talked until about 9:15. I thought I would memorialize what Scott and I discussed here. That way, if I got it wrong or am misinterpreting or misstating what Scott said, he can straighten me out when I see him on Friday.

The real question I have is -- assuming this thing progresses as it "normally does" -- what would be the next step. The answer is that there is no "normal progression." Scott tried to explain how complex the biology is when it comes to cancer. That you can have two people -- subjected to identical treatments -- and end up with polar opposite results. In one case the cancer (tumor) melts away; in another case it does not or worse, it grows or metastasizes during treatment. These are opposite results and no one can say with any certainty which outcome I might have. No one knows why you get two polar opposite results -- because they don't fully understand the cell biology of cancer. What we are left with, therefore, is a trial by error approach -- to see what works. Try this -- try that...

The whole idea of re-staging is to measure the success or failure of a given treatment regiment. Until we remeasure, there is no saying what next steps should be.

I explained to Scott that I deal primarily with probability and outcome. I don't know what the stock market is going to do on any given day, but I DO know that I have a one in three chance of having a positive year, and that the odds of having positive returns improve with time. My concern about next step has as much to do with planning my life for the next three months as it does with anything.

I further explained to Scott that my thinking about this is that, even if we don't know what the outcome will be, we should know a range of outcomes from most likely to least likely. The question is should I liken the tumor "melting away" to winning the lottery? Sure it could happen, but I am not betting my financial future on having that lucky ticket. Now if he tells me that chemo radiation results in the tumors melting away 50% of the time, that would be encouraging, but I have gathered just from the survivor evidence (high morbidity) that that is certainly NOT the case. I think Scott conceded that the "melting away" outcome is possible but not a likely outcome.

Can we get enough shrinkage that surgery becomes an option? Again, I think the honest answer is "probably not." We are not ruling surgery out entirely and we are certainly going to ask again and re-confirm that surgery is definitely off the table. I think, at this point, that the likelihood of surgery happening is remote to none. The tumor is simply too "involved" with the central chest for this to be a realistic hope. But it does not hurt to ask one more time.

What does that leave us? Radiation can only go on so long before it does more harm than good. After receiving 70 grays, this tumor is cooked and I confirmed with Dave Rice that we would not look to any further radiation on the tumor beyond the definitive treatment we are currently doing. To do more risks harming good tissues in the lung, heart, etc.

If you eliminate radiation and surgery, all that is left is chemo. Scott and I agree that we will probably need to to look at some continuing chemo regiment. I think that even if the tumor "melted away" we would still be looking at further chemo.

Scott explained that the chemo I am currently getting is to treat the locally advanced tumor and is a "definitive" chemo radiation treatment, meaning that this is currently considered the the most effective treatment for trying to control this particular lung cancer. We have to understand that "most effective" does not necessarily mean "effective." That is to say, it may or may not work. I told Scott that I do not want his medical decisions to be influenced by my desire, for example, to continue working or not disclose my condition to clients. My first priority is to do what is best to treat the cancer; everything else is secondary. He assured me that his dosage or treatment regiment is not influenced by such factors. He is doing what is in his judgement the medically sound thing.

Once we complete the definitive treatment, which is really aimed at the lung tumor itself, we should probably look at a continuing treatment regiment that is optimized for systemic treatment of cancer. That is to say, to try and stop the cancer from spreading or growing elsewhere. Scott is considering a number of drugs and regiments. Dr Fossell thinks it would be reasonable to perhaps provide me with the same treatment that I might be provided post-operatively were I to have surgery. The problem Scott has with this is the "minimal" improvement in longevity -- perhaps 5% -- for the effort and risk of side effects. Whatever next steps we take will have to consider the risks to my general health. That is what will make this a hard decision.

At the end of the conversation, I think my takeaway was that continuing treatment by chemo starting in February is the most likely scenario. That we are likely to look at a different mix of drugs to focus more on the systemic treatment; that whatever the case, the treatments early next year will likely involve more side effects, lower blood counts, the need for shots to counteract the chemo, and other measures, and will not likely be as "kind" as this first round of chemo has turned out to be. I may be looking at weekly (or more frequent) treatments.

It was a helpful talk and I really appreciated Scott taking the time to call. I am going to have to plan for a more "severe" regiment to come this winter and spring. The only thing I want now is to be well for my daughter Paula's wedding on June 7th in California.

Bring it on Scott ....I'm ready.

Cat Scan of The Tumor -- See it Now

I have a disc from Moffitt that as the cat-scan results. I wanted to provide the medical people in my family a chance to see these. I finally figured out how to export the images from the disc I have to this blog. So here goes:

The first image is my chest. The tumor is on the left side (my upper right lung). You can see it as a shadow that is very large.

The next series are showing me as if you were looking at a cross-section of me from the bottom up. In other words, you are seeing me in slices going through my body. The black area is the lung. The area that is gray on the left side of the image (my right lung) is the tumor. These are actually a series of 78 images that are merged together on a continuous loop so you can see the entirety of the tumor. I selected two here to show you the tumor at it greatest point. In the second image you can see the tumor is surrounding the superior vena cava, which is giving the doctors some worry. You can also see that it is quite involved with my entire central chest.

Its a big mother. I have lot's more pictures, but you get the idea.

November 16th Blood Test Results

Remember I blogged about going to Ft Lauderdale and visiting an old college friend who lives in Miami Beach? Here is a picture from that evening that I found. From left to right it is me, Dennis Kainen, Dennis's Mom, his partner, and another college friend, Art Harris, a freelance journalist. Art was recently on ABC's Dateline; after nine years of investigating he claims to have figured out who killed John Walsh's (host of America's Most Wanted) son. According to Art, he has proof that it was likely the serial killer Jeffrey Dahlmer. (If you google Art Harris you can see the video story.) Or click here for a video report: http://www1.wsvn.com/features/articles/investigations/MI38867/

Speaking of reports, let me report this week's blood test results, which look pretty good and account for my strong performance thus far. Bold is out of normal range. What do you think Janie the nurse?

Result Value (Previous) Normal Range

WBC 4.4 (5.0) 4.2 - 10.0

ANC 3.6 (3.9) 1.4 - 6.5

Gran% 81.6 high 39 - 78

HCT 37.6 (37.6)Low 41 - 51

Hgb 12.4 (12.3) Low 14 -18

Lymph # 0.6 Low 1.2 - 3.4

Lymph% 13.5 Low 15 - 40

MCH 27.9 27 - 34

MCV 84.6 80 - 94

MCHC 33.0 32 - 36

Mono# 0.2 0.0 - 0.6

Mono% 4.9 0.0- 10

Plat 288 (407) 140- 440

RBC 4.45 Low 4.5 - 6.4

RDW 17.0 High 11.5 - 15.0

Weekend Summary

On Friday after chemo I came home, checked for messages and then took a nap so I would be well rested. Yoko and I went to a farewell party for the departing Rotary GSE Team at Mike Riley's house arriving about 8:30PM. We stayed for a few hours and said goodbye to Gwen. I had two cranberry and vodka's and finger food for dinner and we were home and in bed by 11 PM Friday night. I stayed up for a little while, but I was decidedly not as hyper this time from the steroids.

I was up at around 8 AM on Saturday morning. The plan was to drive up to Sarasota to check out "Instride" which is a camp for disabled children where they take them riding on horses for therapy. There was an article in the local paper saying that they need volunteers who know horses to help. I would love to get back in the saddle and am thinking about helping out. Unfortunately, we did not get instructions on how to ge to the camp in time to make it up and back in the morning. So instead I blogged until I left to play golf with my usual golfing buddies, Chris Mahr and Kirby Rowe, at 11:00 AM.

We played in Rotonda at Whitemarsh and the weather was absolutely perfect -- sunny blue skies and 79 degrees. I just played terrible... I think I shot 93 -- 43 on the front and 50 on the back. Kirby and Chris clobbered me -- Kirby shot 81 and Chris shot 89. I am usually more competitive so they must think I am loosing my touch. They don't know about the chemo and I definitely have lost strength in driving the ball, which is screwing up my game...

After golf we decided to take the wives out to dinner. We each went home to get cleaned up and joined up again for drinks at Kirby's house. Kirby was the designated driver and all six of us piled into his van for the drive to Carrabba's. After dinner we came back to our house for coffee and desert. I found a new Italian bakery near our house and we had fresh brewed coffee and Italian pastries. In fact, as I am writing this I am having the leftover sfogliatelle...yum!

After they left, I felt a little funny. Food is not getting to my stomach quickly It feels like it is stuck in the middle of my chest. This is a side effect from the radiation. So after eating a meal, I am still hungry. If I keep eating, I eventually loose some, which is what happened last night. After our guests left, I promptly went to the bathroom and gave up the desert and coffee.

This morning I was up at 6:45 AM to play golf again in my normal Sunday league. There are maybe 30 guys in our league and we play together every Sunday morning; the first tee time is normally around 7:30 AM and we are usually done by noon. Yoko, as always, made me a full breakfast before I left. My foursome on Sunday includes Chris, Kirby and usually Doug Bowers.

Maybe it was the coffee or the steriods, but I could not sleep after dinner Saturday night. I stayed up writing to various people until3 AM. I decided to widen the circle of people who know what is happening with us, so I e-mailed Linda Oppe, Eric Madsen, Tom Witt, and Luther Liggett. Until today, Yoko had not told any of her friends here; today she decided to tell her best friend, Kazue Andersen. That's good because Yoko really needs someone to talk to about this. This whole thing is going to be harder on Yoko than me because she is going to have to live with the aftermath. She needs to have some strong support and it is good that she has a local friend she can count on to do help her through this.

Despite only having about 3 or 4 hours of sleep, today I shot my normal 86 at Bobcat Trail. (This is the course where we are having our Rotary Club fundraiser next Saturday.) I shoot 86 nearly every Sunday and I am always saying to Kirby and Chris that I don't know why I even bother getting out of bed. They should just mark me down for an 86 and let me sleep in the morning. Kirby must have shot the wad yesterday because today he shot 95 and Chris shot 91. My good buddy Doug shot 104...ouch. I was the big winner and took back the money I lost to these guys yesterday.

I met Yoko at the mall after golf to do a little shopping. She then went shopping for food for Thanksgiving while I took my car to the car wash, so it is clean when I go to work on Monday. (This too is part of my normal routine -- cleaning the car on Sunday.) I got home by 3PM and promptly took a nap until dinner tonight at six. (It is Sunday night, so we had our normal macaroni and meatballs, salad and bread for dinner.) After dinner we will be watching Sunday night football.

Last night when I was talking with Mom, she reminded me that my cousin, Mary (Donovan) Li, is married to Ben Li, who is a very well known and respected surgical oncologist working at LSU. Mom got me Mary's number and I called her tonight to say hello and see what Ben might say about my treatment. Mary explained that Ben is not a thoracic surgeon, that he was out of town and that his parents had just flown in from Hawaii. (I don't think I caught them at the best time.) Whatever the case, I gave Mary this website address and I am hoping Ben may have some suggestions as to who else I could consult with about my condition. I am going to try to get the cat-scans of me on this website. I have a disk, but I don't know how to load the file to show.

The coming week should be interesting. Ryan has his fiance in town and will not be coming to work. (Can't say I blame him.) We have a short week. Just Monday and Tuesday for me. I am planning to take off on Wednesday, since the market is closed in the afternoon. Our sales month ends on Wednesday, so any business I am going to do has to be completed by Tuesday at 4 PM. Jessie is coming home from college for Thanksgiving on Tuesday and maybe we can play golf on Wednesday. Thursday we are having Ryan, Megumi (his fiance) and Ryan's parents (Terry and Debra) to our house for Thanksgiving Dinner. (Only Ryan knows about the cancer at this point. I am thinking about telling his parents, who are clients and about the same age as Yoko and I. It might be good to get their perspective. We'll see.) On Friday I have chemo; Friday evening I'll be helping stuffing "goodie bags" for the Bogies and Stogies Charity Golf Tournament being run by Chris Mahr. The golf tournament is a shot-gun start, four man scramble Saturday morning. Sunday will be my league golf again... and so life goes on. I'll be blogging in the meantime and will look forward to hearing from you all.

Uncle Sam's Letter

I got a letter from my Uncle Sam today. He was responding to the blog site, but he decided to send me a letter by snail mail. I am not sure why, but I am going to assume it is because he did either did not want to post something for public consumption or he did not know how to comment on this website. I wanted to let you know that he sent a letter of encouragement and prayer instead. I don't mind telling him publicly that I really appreciated his words and sentiment. I love you Uncle Sam. Thanks.

The letter contained a poem, I wanted to share, that was my Aunt Lu's favorite by Haydin Marshall which reads as follows:

The tide recedes but leaves behind

bright seashells in the sand

The sun goes down but gentle warmth

still lingers on the land

The music stops and yet it echos on

in sweet refrain

For every day that passes

something beautiful remains

I love all my Aunts,Uncles, and cousins, but I must say there is a special place in my heart for my Uncle Sam and Aunt Sue and their kids -- Joanie, Jimmy, Sammy and Suzie. (They will never be Joan, James Sam and Sue to me!)

First of all, Uncle Sam and Aunt Sue are my Godparents -- and you know what that means in the Italian tradition; Jimmy and Sammy my god-brothers and Joanie and Suzie are my god-sisters. Beyond that, Uncle Sam and my father were like best friends and they were a lot alike. They had a great relationship and really loved and respected one another. Sam looks, acts, talks and laughs just like my father. Now he is the surviving child of the Savino Cappiello clan. Like me, Uncle Sam married a woman from another country. ( Aunt Sue was originally from Holland. (I don't have a Dutch Uncle -- I have a Dutch Aunt!)) His son Sammy is following in the footsteps of his father and me; first by working in the brokerage business and now marrying a Japanese. (I hope Sammy will comment about what the first year of marriage has been like living with Mie! I'm sure the day to day has been a hoot.)

I remember as a kid visiting Aunt Sue and Uncle Sam in their apartment in downtown Stamford. Uncle Sam was working for a brokerage firm called Peabody, I think. That firm eventually merged into what is today Merrill Lynch. As a kid, I really didn't understand what exactly it was that Uncle Sam did for a living, but at the time we were living in a house and he was living in an apartment, so I wasn't much impressed. I DO remember going to the apartment for Sunday dinner one time. Aunt Sue was making pasta in a tiny kitchen and I remember it steaming up, so it might have been winter.

I remember we had to take an elevator to get to the apartment, which was on an upper floor. (I think it must have been the first time I had never ridden an elevator.) I recall the art work they had hanging. In the dining or living room they had a piece that looked like a Rembrant -- very dark with interesting lighting of a woman. I think there was fruit or a fruit bowl in the painting. All I remember is that they had that painting for a long time. In fact, they might still have it.

Around the time they had Joan and then Jimmy, they moved into a beautiful little white house in a Stamford residential neighborhood with a white picket fence. I remember the house as being small but very pretty and well decorated. I still really did not know what Uncle Sam did, but it was obvious he was doing better than before! In the hallway of that house they had a piece of modern art that looked like a Mondrian, like the one on this blog. I don't remember if they bought it or if Aunt Sue did it herself o what, but I really liked it and remember it to this day. So you see? My Aunt Sue and Uncle Sam's artwork was some of the first that sparked my interested in art. (Later on, in college, I took an Art History class, which, next to my Chinese history class and Chinese poetry course, was one of the best courses I ever too in college. We would frequently go to the Smithsonian Nation Art Museum or to the Hirshorn Museum of Modern Art. I especially liked the Hirshorn.)

I remember that Uncle Sam started moving up the corporate ladder and soon was managing Merrill Lynch's retail operation in New York City; I remember they had moved the family to in Long Island and had acquired a very large home. Uncle Sam sat on the board of Big-Mac (The Municipal Assistance Corporation), that was set up to help bail out New York City in the 1970s. At the time he was having back problems; I remember them talking about what a problem he had getting into the city each day and if I recall correctly, he was taking a private ambulance to work at times. I finally began to realize that Uncle Sam had made it in big-time business. He has always been, next to my own father, an inspiration and someone I have admired my whole life.

Unfortunately, I never made it into upper management. I never had the skills to be a good manager of people, like Uncle Sam, but in retrospect I am not less happy for it. I do joke that I could do the job of Chuck Prince (Citigroup's CEO) for half his what he makes ($25 million per year.) They finally got rid of Prince with a $95 million separation package. Why they had to pay this guy to leave with the stock price 30% below where it was when he started is beyond me. He would have done everyone a favor if he never came to the office in the last five years and I would still be with Citigroup. Oh well... if you have not figured it out yet, life's not fair.

I am sorry to see the turmoil at Merrill Lynch these past months. Maybe Uncle Sam needs to come ot of retirement and right the ship! You Merrill guys should be comforted to know former Morgan Stanley executives are going to help straighten things out!

Jimmy and Sammy, call me if you want to come to a smaller, more manageable shop! You can join "The Cappiello Group a Morgan Stanley." My partner, Ryan Rupert (27) is engaged to a Japanese, so three of the four of us would have Japanese wives! Plus it would be nice to have my book eventually inherited by family! You could stay in Buffalo and just "feed" the Florida operation with "snowbirds." I'll come to Buffalo in the dead of winter to pitch the Florida escape!

Anyway, this blog is to let Uncle Sam and his family know that I appreciate all your encouragement and prayers. You are great and I love you all. I wish you and your families the best always and will be thanking God for all your prayers and good wishes this Thanksgiving.

Chemo Treatment Number Five

I had radiation this morning and then went to chemo. I was late to radiation because of traffic (the bridge was closed again) and subsequently I arrived late to chemo as well. I was suppose to get a blood test and go straight to chemo treatment, but Scott Lunin saw me in the hallway with an FSU cap and sweatshirt. He began to tell me about the Florida Cancer Center dress code...but then asked to see me for a quick second. When I followed him into the exam room, he wanted to see the rash. Ah Ha! So he HAS been reading this blog on a regular basis. Good for you Scott. I am going to have to think of some way to honor you next time I see you.

We had a short talk and Scott addressed the issues I had raised in my last blog. First, the low dosage approach is designed to provide continuity. That is to say, the dosage should kill the cancer cells without giving me severe adverse reactions. It is better to not have reaction and continue the regiment for the seven weeks than to risk that the treatment be interupted because of complications. It use to be that practioners felt they the treatments were not effective if the patient was not experiencing severe adverse side effects. That has proven to be false. The lack of side effects should have no bearing on the effectiveness of the treatment.

I asked Scott what the expected outcome of this round of treatments will be. He is expecting shrinkage of the tumor, on the order of 50% or more, but it depends. We'll have to see. Some people have better outcomes than others. He plans to take the pictures and have Dr. Robinson examine them again. He does not expect Lary will come back and say that surgery is now possible, but it would not hurt to ask. He says that after this treatment, there is no accepted clincal practice. Scott considers my case challenging and unusal because of my age and general good health. I am not like most of the lung cancer patients he sees. I am decades younger and tolerating these treatments extremely well. For most of these people, a second round of chemo would be hard to take. So Scott is somewhat at a loss as to what to do after this round is completed. He was considering a Taxatere/Cisplatin regiment...but the studies to date don't reflect much observable improvement in survival rates by doing this kind of continued treatment.

I told Scott that, assuming surgery is out, and the tumor is only, say 50% reduced, doing nothing does not seem to be a good answer. Seems like a new "cocktail" of some sort would make sense. Whatever the case, a cisplatin (platinum based) treatment on a continuing basis now raises other toxicity concerns. Nuropathy, hearing loss, kidney failure etc. may become more likely if cisplatin based chemo is continued indefinitely.

I asked Scott how many lung cancer patients he has had. He said it was the MOST common cancer patient he sees. I said that my impression was that prostate and breast cancer were the most common. And then he said something that surprised me. He said these kinds of cancers have a more vocal lobby and bigger political voice because they, frankly, have much higher survivor rates. Lung Cancer, even though it is far more prevalent, have a weaker voice, one, because it is more fatal and so there are fewer survivors to raise a voice, and two, because people have less sympathy for lung cancer patients in general. They are viewed as having brought this on themselves by smoking or leading unhealthy lifestyles. Scott has sent a letter off to experts at the Cancer Centers at Moffit in Tampa and MD Anderson in Houston to see what suggestions they may have. I raised the issue of participating in trials, but Scott reiterated that I am not the profile and were are not there yet.

Scott mention that he would be interested to see how I resolve the "who do I tell" issue. As we walked out, he asked me to wait in the waiting room while he checked to see that they were ready to take me to treatment. When he came back, he called out "Bill, they are ready for you" to show that he was "on board with the privacy issue." I just hope they gave me the right drugs today!

Preparing for Week Five Chemo

Today I finished my 18th radiation treatment, so I am half way done with radiation on the tumor in my lung. I have not had much by way of ill effects from the radiation. I am really not feeling any ill effects from the chemo either. Tomorrow I will have my 19th radiation treatment and my 5th chemo treatment. I spent the entire week doing the things I always do. Tonight I had another investment seminar (with 28 people in attendance, by the way) and got home at 9 PM.

Last week Dr Lunin read my blog prior to our appointment and was able to tell me how I feel when I walked into the room. This blog is a test to see if he does it again. Scott, I feel fine. I have a rash on my skin you should check out that I think is from the radiation. Also Yoko has a rash on both her arms and wants to know if that could be caused by contamination from me. Other than that, I have no complaints. I think you'll find I weigh the same 149 pounds. My lungs are clear. No joint pain. No cough. You can feel my neck and shoulders but I don't think you will find anything. (What are you looking for anyway?) I'm betting that my blood work will remain within the normal range. I am less tired than I was in week one and two. I did not come home to take a nap or alter my normal schedule in any way. I don't think by looking at me you would have any idea I am being treated for cancer.

I DO have a few questions this week; if I am tolerating the treatment this well, why would we not increase the dosage of taxol and cisplatin? Wouldn't we be better off to be more aggressive now? Is the low dosage approach in consideration of keeping me working or my desire not to let people know? Does that kind of thing influence your thinking when you decide dosage?

My second question is what thoughts you have with regard to a continuing regiment once we do the re-staging. Last week you intimated that you would plan to continue treatments after re staging. What drugs do you have in mind? Would the next stage of chemo be similar to the current stage (i.e. once a week for six hours)?

I am very hyped up after chemo because of the steroids. (Eat your heart out Barry Bonds!) I fully expect to be going 100 mph by 5 PM tomorrow night. Is there anything that would counteract the steroids? Would drinking alcohol, for example, be OK? (Yoko and I are planning to attend a party tomorrow night.) I have generally avoided any drinking since starting chemo.

The thing I am still struggling most with is who to tell. My thinking was that it was better to tell no one except my immediate family. So I have not told any of my close friends. Right now the only people who know about this are family and a select few people at work. But the longer this goes on, the more I will have to lie to keep it secret. Inevitably, people are going to know and then they want to know why I did not tell them.

I received a call from a client this afternoon to make an appointment. My client expressed concern that I had been out of the office a lot when he called. He specifically asked if I was sick and whether I was OK...almost like he knew something was wrong but wasn't saying. (Maybe he found this blog site online!) I told the client I'm fine and made an appointment with him for 10 AM on November 29th; right after that that I got call from Dr. Lunin's office saying they want to change my November 30th treatment date to the 29th. Do I call the client back to change the appointment? The same thing is happening with my Rotarian friends, who noticed I had missed a lot of meetings in the past 6 weeks. Last night at the St Vincent de Paul board meeting, I was asked to attend a two-day Building Better Boards conference. I could not say yes because I do not yet know what my treatment regiment may be in January.

Bottom line is that I am beginning to think that trying to keep this thing a secret is going to ultimately fail and perhaps backfire. (i.e. People find out but don't say anything and then wonder why I am being deceitful about telling them.) So I need to come up with a better strategy. One thought I had would be to meet with each of my clients (during year end reviews for example) together with my partner Ryan and tell them in person what is going on and just assure them that, whatever happens, Ryan and I am going to make sure they are well looked after. Perhaps I should let a few of my closest friends know about my condition. Shouldn't I tell my friends who are not here in town?

If you are reading this blog, let me know your opinion. Should I continue as I am currently or should I let clients and friends know what is going on with me? If I disclose this to clients, should I also tell prospects who will also eventually find out? I am not looking for sympathy. I simply don't want to lie when I know that the truth will eventually come out. Your thoughts??

Have You Noticed? Cancer is Everywhere!

I had an appointment with a couple this morning who had been at my seminar last week. We talked for three hours. It took me an hour into the conversation to learn that the woman had been diagnosed with brain cancer in 2002. They removed most (not all) of the tumor and she is now on medication, but she has survived for more than five years with this diagnosis. The cancer did not metasticize and she appears to be doing well. Once she got cancer, she went on disability right away and will be collecting disability for the rest of her life. As a disabled person receiving disability from Social Security, she is able to receive Medicare as well.

No sooner did this first prospect leave than my next appointment called to cancel. She was in severe pain. She explained that she is being treated for breast cancer and that the disease had metasticized. She is now suffering from Stage IV breast cancer. The pain, she says, comes and goes. When the pain comes it is debilitating. I asked her where she is being treated. Turns out she is getting chemo at the same place I am going -- except she goes every Monday.

Not a day goes by that I don't talk with someone who has cancer, is a cancer "survivor", or has a friend or relative with cancer. As long as I can remember we have talked about cancer, but I don't ever remember a time where it has hit this close to home with so much frequency. Maybe it is just the place where I live (the oldest county by average age in the United States) or maybe its just me. It feels like an epidemic. Everywhere I turn there is another cancer victim.

Another Groundbreaking Day

This is a picture of me taken this weekend at my club,Verandah. I look fine, don't you agree?

We were all up early this morning to see Gwen off. Don Kennedy came by at 6:15 AM to pick Gwen up and take him to the Charlotte Harbor Rotary Breakfast Meeting. I was able to go back to bed until 7:45 and then I had to get up for radiation. I was a few minutes late getting to the 21st Century Oncology because of the continuing traffic trouble caused by the bridge going over I-75 being taken out by a tractor-trailer. My understanding is that it may take several more weeks of work before my normal route is restored. After radiation I saw Dave Rice, my radiation oncologist. I told him about the stiffness in my chest and he said that is exactly what he expected to happen at this stage. He showed me how he had designed the radiation treatment and the six angles he is using. The angle that is closest to my esophagus is the one I am feeling, but he thought I would finish treatment without this getting much worse. That's good.



After radiation I had an appointment with my primary care physician George Nackley. Nothing to report there. He basically wanted to see me so that he remained in the loop about what treatment I am getting and to answer other questions. I told him I thought Dr Lunin was was doing a very good job and that Dave Rice was also quite good. At this point I have no symptoms and I am tolerating the treatments extremely well. We talked about the progression of the disease. He agreed with my accessment that this is going to be a matter of taking one day at a time. I told Dr. Nackley that I am optomistic and also realistic. I have a tumor that is inoperable and the size of a baseball. They may take out 95% or even 99% of the cancerous tumor and that would still leave billions of cancer cells floating around in my system. In all likelihood, it is a matter of time before we see cancer somewhere else. I think we agreed this is the likely scenario. No one can say when that might be. Anyway, we discussed next steps and George explained how the chemo is not likely to stop with one treatment. Depending on what we find in restaging, we may go through a second or third round using different drugs. It just all depends and no one can say how things will likely progress. The cocktail of drugs will change depending on what they find. The tough thing about cancer is the variability of cancer cells. Not all cancer is alike and the method of treatment is going to be substantially different depending on what it is you have. The upshot is that I should expect some kind of continuing treatment. I'll have to ask about that at an upcoming appointment with Scott, to see what specific thoughts he has.



After my appointment with Nackley, I was off to the Family Services Center, where we had a ground breaking for the new free clinc St Vincent De Paul Community Health Care is opening. I am the treasurer of this organization, which has captured the imagination of our little community.



We started out as a free pharmacy, providing drugs to the poor and uninsured. In the last 12 month we started an HIV Clinic and a Clinic for Hepatitis C patients who do not have the wherewithall to pay for the care they need. The new free clinc, designed to relieve the local hospitals from having uninsure show up on their doorstep, is the next step. Our free clinic will provide healthcare services for free to the poor and uninsured. Services will be provided by a group of volunteer (for the most part retired) doctors. Funding is coming from the three area hospitals and donated land and facilities. We are building the 4500 square foot temporary clinic with rented modulars on county land; a permanent facility, which would be about 8000 square feet, is already being planned. We have $2 million in funding coming from a potential gift plus matching funds. A developer has offered us the land we need. I have been on the board ofSt Vincent De Paul Community Healthcare for the past year and one half and I must say it is one of the best non-profit things I have done. I am very proud of the work we have done and to have played a small role. Our operating budget this year was $300,000. Next year the operating budget will be $750,000. If we build a permanent clinic next year, we will need a capital budget of over $2 million. Thankfully, there is a lot of support for what we are doing, so I expect we will be able to raise the money needed.



After the groundbreaking I had lunch Thai Cafe with the Executive Director, Paul Ringenberger, and my friends Brian Brunderman and Dr Mark Asperilla. Mark is a nationally reknowned specialist in infectious diseases and the driving force behind the St Vincent de Paul's efforts in providing healthcare services and medication to the poor. Of course, none know about my cancer. But as we ate lunch Mark remarked how good rice was for preventing cancer. Hmmm...I lived and worked in Japan for 15 years and eat rice nearly every day. Guess I'm just lucky! I just want to note this as it seems cancer comes up in many conversations and am much more aware than I use to be. I want to tell my story to the smokers I see every day... But for now I resist the temptation.



Between doctor appointments and St Vincent De Paul, I did not get into the office today until 2PM. When I arrived there was news that we did not get either the $4 million account we were working on nor the smaller $1 millon prospect. That was disappointing. We spend a lot of time and money cultivating these new relationships. Oh well, in the one case, the gentleman did not agree with our recommendations. He wants to be all equity all the time -- and we insisted that retired at age 70, a certain amount in fixed income made sense. In the smaller case, she is not ready to depart with the portfolio her dead husband left behind, even though it is tech heavy and not providing the income she needs. You can bring a horse to water but you can't make him or hir drink...oh well, we have plenty of other fish to fry.



I stayed in the office late as tonight was a parent's meeting for Project Graduation, starting at 7 PM and I am co-chairing this for my Rotary Club. I'll have more to say on Project Graduation, another great community project, later.



The meeting ended at 8:30 PM and I returned to the office to make one more phone call to a client who lives in Indiana. That turned out to be a productive call and I made a sale tonight that should help me make my budget for the month. I left the office at 10 PM and got home to a dinner of roasted lamb, potatoes, beans, watermelon and French butter cookies. Yum. Told you...I am spoiled. Yoko ALWAYS has dinner waiting for me, no matter what time I get home.



It was a very long but very good day. I continue to feel just fine...not even tired. I need to go to bed now, however, if I am going to get up for my 7 AM Rotary meeting. (If you have not noticed by now, when I am not working, I am either doing volunteer work or golfing. You have to admit, its a pretty nice life.)

Project Graduation and Rotary

As you can tell from this blog I spend a lot of time doing community service activities. I have been very involved with Rotary in particular. If you recall, I was a Rotary Exchange student in high school. That experience changed the course of my life and so Rotary is very special to me. Volunteering has been a great way for me to get out, meet people and make new friends, which is good for business. But it has also been very gratifying to contribute to making our little community and the world a better place.

When I was in high school, I knew a kid that as killed in a drunk driving accident. After graduation a bunch of kids had driven from Pennsylvania to New Jersey (where drinking was legal at 18) to celebrate. On the way back, the car he was in swerved as he was sticking his head out the window to get sick. His head hit a telephone pole...and that was it for him He died instantly. I always remembered this tragic incident and how devastating it was to his family and the community. As a parent, I was strict about enforcing a curfew (11 PM) during my kids high school years. I wanted to know where there were and what they were doing at all times because I wanted to keep them safe.

I did not become a Rotarian until 1999, when I was introduced to the Rotary Club that I now belong to -- The Harbor Heights Peace River Rotary. That was the year this Rotary club decided to sponsor a party for kids graduating from Charlotte High School as their major community service project. Paula was in the class of 2000 , so I decided, as the parent of a graduating senior, that I had an obligation to help. Besides, I had not done this kind of thing while we were living in Japan.

I went to the organizing meeting in the fall of 1999, where I met Dr Dennis Munholand and other Rotarians. These club members had taken it upon themselves to organize the event. At the initial meeting they explained that there were two nights in the year that see the most teenage fatalities from traffic accidents -- prom night and graduation night. These are the nights when teenagers are prone to drink and drive. Project Graduation, which started in Virginia, was to provide teens with a drug and alcohol free environment in which to celebrate. The object of Project Graduation is to keep kids safe.

The "party" is not a lock-in -- kids can leave whenever they would like. What we try to do is entice them to come and stay for the night. Each year we hold the event in the high school gym, which is decorated so elaborately that it is transformed into a place you would hardly recognize. Members of the graduating class can attend for free. They must arrive before the doors close at midnight. No girlfriends or other "outsiders" from other schools are allowed to attend. The celebration is strictly for the graduating class.

If they want to go home, they can, but the rule is that they can not return. Every hour we give away prizes randomly. These include such things as TV's, computers, i-pods, dvd players, etc. The best prizes are given away at the end of the night and you have to be there to collect. (In other words, we try and bribe the kids to stay to the end.)

During project graduation there are all kinds of things to do; we have a casino, where you can win tickets to obtain door prizes; we have huge inflatable games such as a bungee run, obstacle course, king of the mountain and the like. We have body painting, a photo area, caricature artists, massage tables, fortune tellers, video game and Foosball area, a cafe where you can have all you want to eat and drink for free, etc. At 2 AM we shut down the activities for an hour while a nationally re known hypnotist entertains the class.

It costs about $20,000 each year to put this party on for the graduating class, which typically has numbered about 400 students. This will be our 9th year and the graduating class is nearly 500 kids! Usually we have more than 90% of the graduating class in attendance. It is a challenge to keep that many kids engaged and entertained for 6 hours. So far, however, it has worked and at Charlotte High it has become a tradition. No one plans a graduation party that competes with Project Graduation.

We get a lot of support from the local hospitals, area businesses, and individuals each year. I have been involved in helping run Project Graduation for the past 8 years and I am proud to report that during this time we have not had a serious car accident involving a teenager on graduation night. Ironically my friend Dr. Dennis Munholand, who was the original organizer, was himself killed in a freak car accident this year. On behalf of our club, I have helped create an endowment in Dennis's memory and have stepped in to help the parent Co-chair run this year's event.

Project Graduation at Charlotte High will be held on May 19 2008. We have already held two organizational meetings. In addition I am helping the Arcadia Rotary organize a Project Graduation for DeSoto High.

I am hoping I can hold it together to fulfill these obligations in the coming year.