***Merry Christmas to Jim****

Ready for some good news?  We have been waiting for it!  First, Jim found out his last biopsy was NOT cancer!!!  YES!!! That is so awesome!  Then, today's scheduled surgery turned into slightly aggressive freezing and a deep biopsy.  The spot that was scheduled for surgery was on the middle knuckle of Jim's right hand.  It hadn't grown since his biopsy and didn't feel deep.  The doctor felt confident freezing and monitoring it was  a safe option.  There were three other spots the doctor froze, as well.  In addition, there was a spot on Jim's right pointer finger that has been frozen before and is still troubling.  They biopsied that and we will wait and see.  Perhaps we can get lucky again!  We really feel like Jim dodged a bullet both with the last biopsy and the downgrading of today's procedure.  It was about time Jim had an easy one.

Jim's hands before freezing.  12/7/15
Last biopsy is on his right pointer.
Last surgery is on his left middle knuckle.
Skin graft is healing between pinky and ring fingers of left hand.

Celebratory beverage!!

Jim's right hand.  12/7/15
Frozen spots - base of ring finger,
middle knuckle, base of thumb.
Old biopsy (closer to palm) and new biopsy are bandaged.

Jim's left hand.  12/7/15
Frozen spot on middle finger.
Last surgery spot on middle knuckle.
Graft healing between pinky and ring fingers.

Blown Away

Wow, I don’t even know where to start with this update, but here it goes!  On Veterans Day, our veteran got some disappointing news.  Last surgery, the doctor took a spot off of Jim's left middle knuckle.  I said it was a surgery in the previous blog post, but it really was more of a deep biopsy.  When the staff analyzed it in the office that day, it appeared to have clean margins, but barely.  The doctor sent it to the lab, just to be sure, which turned out to be a smart decision.  As Jim's luck would have it, the margins were not clean and another surgery in that location was imminent.  Dang it.  Surgery was scheduled for Wednesday, November 18th, fifteen days after his previous procedure.  

The night before Jim's surgery, Spokane was hit with a massive windstorm.  Like most of our community, we lost power and also lost part of a tree that night.  We woke up in the dark on Wednesday, wondering what to do.  Jim tried to call the doctor's office and was unable to connect.  Since school was canceled, we packed up the kids and headed out.  The dermatologist did not have phone service or internet, but they did have power and were able to do the surgery.  It took two layers to get clean margins on Jim's knuckle, leaving a deep spot.  At first, the doctor was ready to do a graft and then decided it wasn't necessary.  That was a huge present!  Jim's stitches are tight and he has to really baby that hand, but avoiding another graft is a blessing.  The graft he had a few weeks ago is healing well, thank goodness.  Also, there was a spot on the pointer finger of his right hand that required a fairly aggressive biopsy.  We are waiting for results now.

Jim's left hand.  11/22/15.  Healing graft on pinky finger from 11/3/15.  Latest surgery on middle knuckle.

Jim's left hand.  11/22/15.  Healing graft on pinky finger from 11/3/15.  Latest surgery on middle knuckle.

After surgery, the boys and I took Jim out to our standard, post surgery lunch.  Due to the fact that most of the city was without power, the restaurants were overflowing with hungry guests.  We did get a table downtown and maybe overate a little in preparation for a simple meal at our powerless home that night.  Then, we returned to our cold house and built a fire.  

Post surgery beverage!

After the last surgery a few weeks ago, Jim had an uncomfortable, but minor reaction to his pain medication.  He woke up several times feeling quite itchy.  The doctor changed his medication, which was definitely better, but still left him feeling uncomfortable.  Due to his reactions, the doctor prescribed another new med.  Once we had Jim tucked in by the fire, we set off to get his prescription.  The first drug store we tried was completely dark.  So, we headed up the road to the next store, only to find the same scenario.  We decided to go a little further and see what we could find.  It took us a long time to go a few blocks as the stop lights were all out and traffic was heavy.  After quite a while in the car, traveling a very short distance, I thought it was best to check in on Jim.  Unfortunately, we were unable to get the medication that first night.  Jim spent a rather cold night at home with the medication that made him only kind of itchy.  UGH.  The following day, he headed to work and I packed up some things.  It didn't seem like 52 degrees was a great temperature for any of us, but we were all hoping for as much comfort as possible for Jim.  Luckily, my parents had power and were ready to take us in for a few days.  Recovery was much easier with a warm bed, a real meal, and finally medication that helped with pain and didn't cause any discomfort.

We are home now, feeling a little guilty having power while so many are still in the dark, but so glad to be back.  Jim's next surgery is two weeks away on December 7th.  The plan for that day is to address the spots on Jim's right hand.  Hopefully his left hand will be functional enough by then.  I'll keep you posted!

Although this surgery was quite an adventure, we are so grateful to so many loved ones.  We are extremely thankful to our neighbor who spent Wednesday limbing the downed pieces of our spruce and hauling branches away to the dump.  That was the nicest surprise after surgery!  Thank you to the neighbors who have been raking our yard.  I know it has happened at least three times in the past weeks, but probably more.  Thank you to the neighbor with the gas hot water tank who made it possible for us to sneak off to surgery clean.  I was dreading showing up with my greasy, crazy hair.  OH, and thank you for the hot coffee!  I know the line at Starbucks was insane as no one had power that morning.  Thank you to my folks for taking us in, feeding us, letting us drink the good wine, and so much more.  This has been a tough road, but much easier with the love and caring of friends and family.  We are humbled and grateful.

Crazy #8

Today marked Jim's 8th skin cancer surgery.  As I scrolled through Facebook this morning, I read so many thankful posts from friends and family.  I reflected on that and briefly thought I wasn't thankful for a darned thing.  I even considered posting something snarky and sarcastic about being thankful for cancer.  Perhaps I was indulging in a bit of a pity party, but luckily I realized it could be so much worse.  We really do have so many reasons to give thanks.  Truthfully, I am extremely thankful for Jim's medical team.  His doctor is absolutely amazing.  He always listens to our concerns, takes the time to discuss options, and every single time makes decisions that best address Jim's medical needs while balancing his personal concerns.  Today, and so many other days, I am very thankful for our wonderful doctor and his skilled and compassionate staff.  Of course, we are both so thankful for our circle of support.  Our friends, family, neighbors and coworkers have been amazing.  Thank you to all of you for your kindness and caring.  

In today's procedure, they removed a spot of cancer that was nestled between Jim's pinky and ring fingers on his left hand.  This is a spot that doesn't naturally have a lot of excess tissue, but also was the site of his first surgery and was a little thick with scar tissue.  Those factors made us pretty nervous he would require a skin graft.  As we feared, he did need one to close the site.  UGH!  The donor skin was taken from Jim's upper left arm.  Additionally, they addressed a spot on the middle knuckle of Jim's left hand.  The doctor's suspicions of cancer were confirmed, but luckily it was not too deep.   A third spot on the outside of his palm was removed and will be biopsied.  The doc thought that was pretty small and that if it is positive he is very hopeful the margins will be clear, requiring no further surgery.  

Afterwards, Jim was ready for grub!  We enjoyed the magic time before the local anesthesia wore off with lunch out.  It always seems like a tiny bit of a reward to spend some time together and relax once the procedure is complete.

Jim celebrated surviving another procedure with a Stella...
or maybe two.

Of course, T3 was on the menu for me. 

So... time to relax with good pain meds.  Jim's next surgery will be on his right hand on December 7th.  Five weeks to heal before we go back for more!  

More Chapters

The other day, Quentin was telling us about a school writing task called a “small moment.”  As he was discussing his topic options he said, “I really wanted to write about Dad’s skin cancer stuff, but this is supposed to be a ‘small moment’ and that story is more of a chapter book.”  Well… that’s the damn truth!  I love his honest insight and believe Q hit the nail on the head with his analogy.  So, in the spirit of chapters… it is time to write the next few chapters in Jim’s book.

Last week, Jim had a planned follow up with his dermatologist.  At that appointment the doctor shared with us that he has been watching the research for squamous cell carcinoma (SCC), specifically with Jim in mind.  Unfortunately, there has been no new research for SCC, so our treatment options remain the same.  BUT, there is new research in the area of basal cell carcinoma, which leaves us hopeful that maybe SCC will be next.   After examining his hands, the doctor froze every questionable spot that was small enough to treat through freezing.  In all, Jim had 33 spots frozen on his hands, 2 on his arm, and 1 on his face.  Truthfully, it was horrible to witness.  I was blown away with how tough and resilient Jim was that day and has been throughout this entire journey.  I would have had tears flowing like a river, but Jim just took deep breaths and carried on as the liquid nitrogen can repeatedly assaulted him.  Next, the doctor zeroed in on two spots that required biopsies.  At this point, I got my buns out of there!  I figured the last thing Jim needed was me succumbing to the nausea that was creeping up.  Jim endured the two biopsies, one on each hand.  His strength, tenacity, humor, and determination are absolutely incredible.  

And then…. We waited.  I would say that is the worst part, but my eyes have been opened to more of the trials of Jim’s journey and can only imagine the pain of biopsies and the 7 surgeries he has had thus far.  Of course, healing from this many frozen spots was the pits, too.  Jim’s poor hands looked like they had lost a battle, with many spots blistering, swollen and painful.  Now, he is mostly scabby with a few blisters.

This week, Jim got the call from his doctor’s office that begins, “I’m so sorry.”  Well, both spots are positive for squamous cell carcinoma.  Since the spots are not on the same hand, it will require two separate surgeries.  Jim will head in for one hand on October 27^th and will return a second time (or technically a NINTH time) on December 7^th. 

Jim's right hand.  Current SCC spot is under the bandaid.
Dark spots are from the freezing.
October 2, 2015

Jim's left hand.
Current SCC spot is between the pinky and ring fingers,
in scar tissue from first surgery.
Dark spots are from freezing.
October 2, 2015

I have contemplated what else to say about our lives lately and figured it might be good to share and answer some frequently asked questions.  So….. here we go:

Do they know what is causing this?

No.  The doctors do NOT know why this keeps happening to Jim.  The popular theories involve his Crohn's medication (which he is no longer on, but took for a LONG time), radiation exposure in the military, and a job stint doing game studies near Hanford.  Any one of these could be the culprit or all combined could contribute to his situation.  Of course, being of Irish decent, fair skinned, blue eyed, and previously a little lax about sunscreen hasn’t helped.

Can’t they do anything else?

Our options are surgery and topical chemotherapy.  Traditional chemotherapy would not be effective in treating this kind of cancer.  Additionally, radiation is an option for some, but our doc feels it could make Jim's case worse.

What if you did nothing?

Well... that's not an option we are entertaining.  If we did nothing, the cancer could spread deeper and then eventual surgery would be more invasive.  Our doctors, whom we trust completely, have been very clear that complacency would be the worst option.  

Could the cancer be anywhere else?

At this point, my two biggest concerns would be anything affiliated with his Crohn's disease or lymphoma.  Jim is up to date on all of his Crohn's tests and he is in really, really great shape.  Concerns regarding lymphoma came up early because of the connection with the medication he had been taking.  He has NO symptoms of lymphoma.

So, how are you doing?

We are really, truly doing ok.  It stinks, it is so discouraging and frustrating, but we are ok.  We know he will live through this and maybe they really are building his clone bit by bit in the lab.  Of course the world needs two Jim's!  We did get to relax and enjoy Jim's time of being cancer free.  We handle each day with humor, a drink or 4, some profanity, a whole lot of love, and just keep swimming.

Finally....

Waiting for Jim's biopsy results always brings on a little anxiety, at least on my part.  If we had bet on the outcome, my money would have been on one positive and one negative.  Jim's birthday came and went on Wednesday and still no news.... did I mention my anxiety?  Of course, being the loving spouse I am, that prompted me to ask, "What if they saw your birthdate in your file and decided to wait a day to give you the results?  Why bum you out on your birthday?"  He laughed and told me he would let me know as soon as he heard something.  Well, as luck would have it, his best birthday present came a day late.  BOTH spots were negative!!!  Hooray!!!  What a huge relief.  It truly was his turn for some good news.  

Jim is doing well.  Healing and finding humor in his recovery.  I have decided his stitches 'stache is definitely more Charlie Chaplin and not Hitler-esque at all.  What a goofball.  The stitches will come out next week, hopefully giving him a much needed break.

Jim's stitches. 7/29/15

What? No Whiskey???

Today has been a pretty typical summer day - a walk with the dog, kids at science camp, a hair cut, and oh yeah, Jim had surgery....again. That's starting to be a little too routine for us!  And, even though he made a special request, the doc still did not have whiskey for him!!  What is up with that?  I'm pretty sure it should be part of the frequent flyer program.  They could have punch cards like the coffee stands - at the lucky 7th surgery, free whiskey.  Sounds good, right?  Unfortunately, the only shots he received were painful and involved a needle.  UGH.

As for the surgery details, things went well.  The entire spot was removed in one layer, getting all the cancer in that location, and a skin graft was not needed.  YES!!!  In the following picture, the surgical spot is marked with the circle on Jim's pointer finger.  The circle at the base of his thumb and the opposite side of his palm were frozen.  The last two circles, by his middle finger and up on his wrist, were biopsied.  We should have the results of those biopsies next week.  

Jim's left hand.  7/22/15

In addition to the spots on his hand, the doctor froze a few spots on Jim's face and is watching a concerning spot on his other hand.  Jim will return in a couple of weeks to monitor his progress and have the stitches removed.

Jim is now home and resting, headed for a nap after his exciting morning.  Thanks for all the positive thoughts and well wishes.  Jim is doing well.  He's in the good spot - full belly, tired, and glad it is over.  Hopefully, he will do well this evening and overnight.  That's typically when things get a little bumpier for him, but we are getting to be pros at keeping him comfy and staying on type of the ice and meds.  

Jim - post surgery.  7/22/15

  

Some Good News

Today, Jim was scheduled for surgery on the pointer finger of his left hand - the most recent positive biopsy.  BUT, over the past week and a half, Jim's middle knuckle on his other hand had swelled significantly with a dark spot in the middle.  This is the spot that was operated on in March.  

Cyst on knuckle of right hand middle finger.
 6/24/15

Cyst on knuckle of right hand middle finger.
6/24/15

Jim showed this spot to the dermatologist who felt like that had to be addressed before the spot on his left hand.  He did suggest possibly operating on both hands, but the daily limitations of having no functional hands would be tricky.  So, surgery was only on this swollen spot on his right hand.  It turns out the spot was not cancerous, but rather a cyst caused by the previous surgery.  The cyst was easily removed and closing the location did not require a skin graft.  Whew!!

We are so relieved that this spot was not cancerous and that it did not require a skin graft.  All good!  Unfortunately, surgery on the cancerous spot on his left hand had to be rescheduled.  We will go in again on July 22nd for surgery #7.