Paul's Heart

Life As A Dad, And A Survivor

14 Feb 2026

Just Call Me Damacles


(photo is AI generated with ChatGPT)

“Heavy is the head that wears the crown.” This is a line that you may have come across in your life at some point, whether reading Shakespeare, or even listening to the radio, this reference is often made. It references all the things that come with being a King, and not all things are good such as anxiety and pressure. A clearer explanation would be to tell the Greek legend of Damacles, a tale of one man’s admiration for his king and power. The king tries to convince Damacles of the dangers of being king, by allowing Damacles to sit on his throne. The catch is, directly above the throne is a sword, hanging by a single horse tail hair, and that horsehair could give way any moment, without any warning, demonstrating the perils of being king. While this tale can often be told making reference to today’s world and news, it can also relate to the life of a cancer survivor.

When diagnosed with any cancer, almost everyone gets told the same thing, “at 5 years of remission, we consider you ‘cured’, or not likely to have the cancer come back.” Sounds great, right? That’s all a cancer patient wants to hear and do, get to that 5-year mark and beyond. But what happens after that? This is where it gets perilous, just as the sword of Damacles dangling over his head. Sure, great things lie ahead as we are on our “throne.” But there are anxieties and potential perils also. And just as if the sword were to suddenly fall, so too for the cancer survivor.

Before I go any further, I need to give credit to this comparison of cancer survivors to Damacles, to whom it belongs, my doctor. He was the first I ever heard give us patients an explanation what it feels like to be a cancer survivor.

During the first five years of survivorship, the anxieties are real. I still remember everything clearly. Symptoms pop up, similarly to when I was diagnosed. The worry every time a follow up appointment came up or worse, a dreaded scan, hence where the term “scanxiety” comes from, the worry that the scan will show that IT is back. If only it were that easy to remember, that some of the symptoms that we feel, we had long before cancer, and they were just something that happened, which doesn’t mean necessarily the cancer came back. And as for the scans, there is no reason to believe otherwise, not to believe we are still in remission, unless we are told otherwise. But that is what cancer does. It takes away our control, to be able to control and ease our thoughts. Once taken, it is hard to gain back. But I have good news, that control does come back. It will come back. This is where the comparison to Damacles fits. That sword, the fear of relapsing, hanging over our heads, by a single strand of hope, the sword of relapse does not come crashing down on us.

I promise you, this fear of relapse does get better as time gets on. In those first five years, your follow up appointments will get further apart, bolstering your confidence that your remission is getting stronger. Soon, less follow up scans are ordered, and appointments are sceduled even further apart, as far as just annual. It gets to a point soon enough, you no longer concern yourself with that sword hanging over your heads.

Then around that five-year mark, you have a crucial decision to make, and it is entirely up to you.

(photo courtesy of Live Science)

I am sure you have heard the expression, “bury your head in the sand” before. What happens when an ostrich does that? It cannot see, it ignores intentionally, it avoids, anything that is unpleasant or dangerous. And so, as a five-year cancer survivor, you can “bury your head,” and intenionally move on, force yourself to forget you had cancer (in all honesty, that part won’t ever happen), and never set foot in another doctor’s office, or…

You can take it from someone who was once in those shoes, that is not a wise option. It is not necessarily bad, I am just saying, continue to read. I want to stress, I am not a doctor. But I was that ostrich. And for years, as I tried to pull myself away from the world of cancer, it was a fellow survivor who kept trying to pull me back in, and I could not understand why. I was healthy, not like her, apparently dealing with health issues related to her treatments a long time before. This was not my situation. I was not like her. If I was the ostrich, she was the dolphin or meerkat, always looking out or on guard.

(photo courtesy of BBC Earth)

And then one day, that meerkat yanked the head of the ostrich out of the sand. It could no longer avoid the danger. Eighteen years from my last chemo treatment (and radiation), I was diagnosed with what is nicknamed a “widow maker” for obvious reasons, a fatal blockage that normally results in a fatal heart attack without immediate medical intervention. This ostrich, though not feeling great, but with its head in the sand, had developed a condition related to his treatments two decades earlier. And the problem was, no one was watching for it. And for the most part, no one knew to be watching for it, not even doctors. It is not an understatement, that as cancer survivors we are not expected to live beyond five years. Why do I say that? Where do you see any research on long term cancer survivors beyond five years, or maybe ten years now? You don’t. So back when I was treated, in 1988, and the decades before that, late developing side effects were not studied, because we were not expected to live long enough to develop any. But the truth is, we are living longer, and not just from Hodgkin’s Lymphoma, but many cancers. Which means many of us, not necessarily all of us, my develop issues related to our treatments. Science is slowly catching up. The Childrens Oncology Group has published and updates its “survivorship guidelines,” ( survivorshipguidelines.org ), which though its title is a bit misleading, information provided inside can actually apply to ALL cancer survivors as far as follow up recommendations and pertaining to which treatments. Most importantly, it is easy to follow.

“But Paul, you say you have no idea how many cancer survivors don’t have these issues, but everyone you know does have these issues.” Good point to which I reply, “people only seek out help when they need it.” It took eighteen years for my first late effect to become present, and it almost killed me. Whereas, had I kept seeing a doctor, in particular, my primary care doctor, equipped with the knowledge that these late side effects were a possibility, this condition could have been caught years before it was a threat to my life. And that is the difference. I am advocating for you, as a cancer survivor, to not bury your head in the sand, be the meerkat. No one knows if they will develop any late side effect or not, and only a doctor who knows what to watch for, will be able to diagnose it, in time, if it happens.

Anyhow, back to the sword of Damacles.

(picture is AI generated with ChatGPT)

Soon after my recovery from my emergency open heart surgery double bypass, I was encouraged to visit what is called a “survivorship clinic,” a program that specializes in recognizing, treating, and managing late side effects from cancer treatments. Now, if you noticed, there is a second picture, very similar to the top photo of the sword of Damacles. Only this second photo has multiple swords. Yep, you guessed it. In my case, I am dealing with multiple swords of Damacles, each suspended with that one strand of horse hair, perilously hanging over me. Which one(s) will drop first?

I can remember back in the day before everything going digital, my entire medical record being no more than a 1/3 of an inch thick. Even with my Hodgkin’s Lymphoma, my file was not that expansive. But following the first diagnosed late side effect being diagnosed, my medical file would not only expand inches in thickness, a second file would also need to be started to continue on.

I want to list these “swords” for you. I won’t go into the details of each as this post is long enough. But each diagnosis is related to my chemo, radition, or surgery for my Hodgkin’s history. The diagnosis is either in treatment, observation, or watch for further development. Some can be fixed (a temporary thing), some cannot. I will do them by “area”.

Head

  • eyes = macular edema, retinopathy, macular telangiectasis (chemo effects – watching progression)
  • teeth = enamel loss, osteonecrosis risk (bone loss of jaw) (radiation effects – treated as occurs)

Neck

  • thyroid = hypothyroidism, nodules (watching for cancer) (radiation effects – treated with prescriptions currently)
  • carotid artery disease = left artery blocked and stented (radiation effects – being followed)
  • “dropped head” syndrome = muscle loss in the neck causes head to fall forward (radiation effects – observed)
  • muscle loss resulting in “pencil neck” appearance (radiation effects – observed)

Shoulders/Upper Body

  • muscle loss, shoulders look like chicken wings, increased injury risk (radiation effects – observed)
  • radiation fibrosis syndrome (radiation effects – observed)

Heart

  • cardiac disease (chemo and radiation effects – being followed)
  • coronary artery disease (radiation effects – bypass and stent – being followed)
  • aortic valve disease (chemo and radiation effects – valve replacement – being followed)
  • mitral valve (chemo and radiation effects – being followed)
  • congestive heart failure (chemo and radiation effects – being followed)
  • myocardial ischemia (chemo and radiation effects – being followed)

Lungs

  • restrictive lung disease (radiation and chemo effects – being followed)
  • pulmonary nodules (radiation effects – being followed)
  • nodule suspected as indolent adenocarcinoma (lung cancer) (radiation effects – closely followed)
  • have had pneumonia twice, once septic

Gastro (Digestive)

  • Barrett’s Esophagus (pre cancer of esophagus) (radiation effects – being followed)
  • Zenker’s Diverticulum (radiation effects – observed)
  • Hiatal hernia (radiation effects – observed)
  • Extreme reflux (radiation effects – being followed)
  • polyps in esophagus and colon (chemo and radiation effects – being followed)

Endocrine

  • Type 2 diabetes (chemo and radiation effects – being followed)
  • Insulin resistance (chemo and radiation effects – being followed)
  • fatigue (chemo and radiation effects – observed)

Skeletal

  • Osteopenia (chemo effects – observed)
  • Facet joint arthritis L1-L5 vertebrae (chemo effects – observed)

Immunological

  • asplenic (no spleen), more susceptible to contagions (surgical effects – observed)

So now you get the idea of why I picture myself with so many swords over my head. My heart and my lungs are of concern, always, while everything else is on the backburner. It seems like a lot, and it is. But as I stress, not everyone gets these late effects, some only one or two, some have had to deal with more than I have. The problem, like I said many times before, there are so many survivors out there, likely dealing with health issues that just don’t make sense for their demographic, and it is late side effects that are the cause.

As overwhelming as all these seems, I actually manage everything quite easily, calmly, and rationally. I advocate for myself, armed with the knowledge necessary to take on insurance companies when they erroneously feel they are qualified to overrule my doctors. And finally, I know that I have not just great doctors taking care of me, but doctors who are knowledgeable in the care of long term cancer survivors and their late side effects. No, it does not make it any less scary to face these issues, but I know my doctors will do all that they can, and I am at peace with that.

Posted in Cancer, Education, Family and Friends, Inspired By..., Side Effects, The Heart | Leave a comment
13 Feb 2026

The Importance Of A Colonoscopy


(photo courtesy of the Guardian)

The entertainment world and fans around were devastated to hear that actor James Van Der Beek, most known for his role in the television show, “Dawson’s Creek,” had passed away, complications of colon cancer, at the age of just 48 years old.

Van Der Beek is just one of many celebrities who have lost their lives to what is actually considered a cancer that has a really decent “cure” rate, especially for how prevalant it is compared to other cancers. Chadwick Boseman of the super hero franchise, “Black Panther” passed away a few years ago, also of colon cancer at the age of 43. For those of us older, Kirstie Alley of the television show “Cheers” died of colon cancer. And of more modern times, Randy Gonzolez of TikTok’s “Enky Boys,” died of colon cancer at the very young age of 35 years old. Cancer does not discriminate when it comes to age.

Those that have reached remission or cure, include Sharon Osbourne, widow of the great rock legend Ozzy Osbourne, a living survivor and advocate of colon cancer.

In my world of long term cancer survivors, especially when it comes to Hodgkin’s Lymphoma survivors of twenty, thirty, or forty years, some have found themselves facing colon cancer due to late side effects caused by their extremely toxic radiation and chemotherapy treatments. Though myself, I have not been diagnosed with colon cancer, as a long term Hodgkin’s survivor, I am watched and screened for colon cancer as part of my survivorship care. More on that later.

I am not going to get overly scientific or lost in the weeds with colon cancer, because I want to make sure everyone understands not just how treatable colon cancer is, but how easy it is to help your own cause. Colon cancer is highly treatable, well over 90% when caught and treated early enough. Success in treating colon cancer is also attributed, because it is a cancer that can be prevented or at the least, the risks reduced. Of course a good diet helps to lower the risk of developing colon cancer, but also does cessation of smoking (quitting), and limited alcohol consumption. But of course, if these lifestyle choices are too difficult, there is one option that actually is very effective in preventing this cancer, a colonoscopy. I know, your rear end likely puckered up just at the mention of that, so, I am going to put that off to the side for a moment.

Colon cancer are tumors that begin usually as polyps, that undergo DNA changes that make the cells grow uncontrollably, eventually into cancer. However, if the polyps can be removed before this growth occurs, the development of the cancer is prevented. A simple formula, a polyp removed = a cancer prevented. How does a polyp get removed? Via a colonscopy. But again, I know that word is scary. I will get back to that shortly.

So what are symptoms that can occur that might be of concern to seek out a doctor’s care, possibly for colon cancer? First, bowel changes. We all have our routines, mine are quite complicated, but in my case, reliable. Any change I would easily recognize. Another noticable concern, would be blood in the stool/toilet, from streaks of blood, to a lot. Abdominal discomfort is another sign that should be looked into, as is not emptying everything during a bowel movement completely. As odd as it may seem, unexplained weight loss is also something that should be looked into by a doctor.

Though age is not discriminated, it is considered higher risk for colon cancer, once someone is over forty years of age. A family history or genetics can also play a role for developing colon cancer. Bowel issues such as inflammatory bowel disease (IBD) and other conditions can contribute to a diagnosis of colon cancer. Race, lifestyle, and diet are all factors of developing colon cancer. While I am older, I do not personally have any of the other risks, okay, maybe my diet is not the best, I do have one factor against me when it comes to colon cancer. The treatments I received for my Hodgkin’s Lymphoma, radiation therapy and in particular, the drug Procarbizine from my chemo cocktail, leave me at a higher risk for colon cancer, as has been the fate for many of my fellow Hodgkin’s survivors.

As I said, colon cancer has a very high rate of remission/cure, over 90% when caught early or localized. Now I am getting to the other “C” word, the one that is so important, it has the power to prevent the cancer from developing, the colonoscopy. There are some unpleasant stereotypes which I am not going to get into, because they are, well, just stupid, especially if they prevent you from doing something that might just save your life.

So what is a colonoscopy? It is a PAINLESS medical procedure, where a very thin tube with a camera at the end, travels up your butt, while you are anesthetized (via twilight sedation or general anesthesia). YOU HAVE NO IDEA THIS IS BEING DONE AS YOU ARE OUT COLD!!! While the doctor is looking around, if they see a polyp or polyps, the doctor removes them, and likely sends them to pathology for further study. Regardless, because that polyp(s) was removed, it will not progress to cancer. A polyp removed is a cancer prevented. When you awaken, YOU HAVE NO MEMORY OF WHAT HAPPENED!!! You will likely let out the post-colonoscopy fart, audio and visual now available as a montage on TikTok, have some crackers and a drink, get dressed, and go home. If pathology determines the polyps were something more, well, you cross that bridge if you get to it.

If you are fortunate to not have any polyps, then it will likely be recommended not to have another colonoscopy for ten years or more. But, if as in my case, I have polyps every scope, I have to get a colonoscopy every two to three years. In the last fifteen years, I have not only had five colonoscopies, but I have an added procedure called an endoscopy done, where they go down my throat, again, looking for polyps. I get both done at the same time since I will be out cold anyway. I call it my “pig on a spit” procedure (there is a visual for you). To keep my sense of humor, I always make sure to remind the doctor not to mix up the two tubes, so that I do not wake up with my breath smelling like shit.

So that is all there is to a colonoscopy for the most part. And it literally can save your life. And as I said, it is painless! So why all the fuss? There are some inappropriate stereotypes which I won’t address as they are just ridiculous, unfounded, and untrue. But there is one hurdle, that everyone seems to struggle with, “the prep.” What is the prep? It is a high powered laxative, necessary to clean your entire bowels out so that the camera can get its clearest pictures. Think of it as medicinally induced diarhea. While there are various forms of this “prep,” I am only sharing my routine, which, by itself is bad enough. But I have to do what is called a “super prep” as I have a complicated bowel system (which I am not going to get into). But I will explain it as just the normal “prep.”

You start likely about a week before, changing your diet to limited to easily digestable foods and avoiding “colored” foods especially with red dye. The day or two before, I am on clear liquid, like drinking chicken broth. Then, the night before, I pop a couple of stool softeners, wait a few hours. While this is happening, I mix the “prep” solution, incorrectly called “Go Litely”, often a flavored powder, mine is citrus, with any clear liquid. I choose Sprite. Then I put it in the freezer (it is an entire gallon, so it will not freeze in the two hours it chills), as the colder it is, the easer to get down. The instructions are clear, drink 8 ounces every fifteen minutes. You can either just swallow regularly, chug it as I do, or use a straw. At first, that it seems that it is no big deal, that first glass going down. Then as you finish the second glass, you can tell something is happening.

I want to stress, there is no pain! You are just about to experience something somewhat uncomfortable, really no different than any bout of diarhea you may have experienced, other than, for the next four to five hours, until you are emptied out completely, and you will empty out. Like I said, inappropriately called “Go Litely”, should be called “Go Quickly!” By the third glass, you find the need to coordinate between continuing to drink and run to the bathroom. As you finish the last glass, it is just a matter of another hour waiting for the urge to go to the bathroom to finish. Then it is off to bed, wake up the next morning, in some cases you may have to do a little more prep, and then it is off to the colonoscopy.

Literally, that is all there is to it. I am not sure how Van Der Beek or the others discovered their colon cancers. But they were all too young. Cancer does not care about age. Van Der Beek leaves a wife and six children behind. I have two adult daughters, and I know the increased risks I have for colon cancer and I want to make sure they do not have to mourn me for something that is preventable for the most part.

I am known among my fellow long term survivors for always pushing them to get colonoscopies because we have that extra risk. And we have several who do end up being diagnosed with colon cancer, and we have had some who have passed away.

But on this post, I want to encourage you reading this, if you were born at a time when music was the greatest, the mid ’80’s, you should really consider a colonoscopy. You are in your forties, young, the time when the concern increases, and prevention is key. Please consider getting a colonoscopy. James would be one of the first to encourage you to do so.

(photo courtesy of People.com)

Posted in Cancer, Education, Family and Friends, Inspired By..., Side Effects | Leave a comment
06 Feb 2026

If Sgt. Pepper Was A Seattle Seahawks Fan


(photo generated by ChatGPT)

It was 20 years ago today, the Seahawks had a game to play.

The team play with flashes bold, Alexander’s runs were gold.

Hasselback did the best he could, his receiver’s hands were made of wood.

The Hawks used all their might, the Steelers did prevail, Seahawks NFC champs we stand.

No Super Bowl trophy that year. But does it count if I did not get to see the game?

You see, it was also twenty years ago, this very date, that I was in an airplane, flying over the North Pole, on my way to Nanchang, China, to welcome my second daughter into my arms. In previous weeks, I had joked with my co-workers, to bet their houses on the Seahawks winning the NFC championship. But perennial losers, the Seahawks did not carry a lot of respect, more known for choking. My co-workers did not understand how strongly I felt about this bet. I had Murphy’s Law on my side. News of potential travel advised us that we could fly as soon as February 4th or around that date. It was then, I knew that I would not get to see the Super Bowl, and my team, the Seattle Seahawks would definitely be playing in their first ever Super Bowl.

And that is exactly how it played out. The Seahawks won their NFC championship to advance to the 2006 Super Bowl to play the Pittsburgh Steelers. The Steelers had many Super Bowl championships, this was the Seahawks first trip. Knowing that I could not see the game, as the plane was not going to carry the satelitte link to do so, I simply had to rely on my television DVR to record the game. On the plane, I was wearing a Seahawks jersey, and my older daughter who was travelling with me, was wearing a cute little Seahawks cheerleader outfit. We were the only ones wearing blue colors of Seattle, and were surrounded by many wearing black and yellow, Steeler colors. This was a typical scenario for me, living on the east coast, furthest away from the Emerald city of Seattle.

Somehow, as we landed, some of those same passengers were now approaching me, offering consolation. I was wondering, “how could they know?” And it was a lot of them. As I got to the hotel, I turned the television on, to see a very grainy picture of the last minute of the Super Bowl. The Seahawks had lost, 21-10. At that point, I thought it was just a good game. And then came the phone call to my Dad, to let him know I had landed in China. To prefact this, I need to explain, I am not even sure my Dad knew what shape a football was, but he wasted no time ridiculing dropped passes (even naming the receiver) and what appeared to be blown calls in favor of the Steelers. I would have to wait two weeks until I returned to the US and watch what I recorded.

Unfortunately, like the game itself, a technical issue resulted in me not being able to watch the game. So the first and only time up to that point, I never got to see the Seahawks in their first Super Bowl.

But as I said, I had much bigger plans that date in 2006. I was becoming a Dad for the second time. Having gone through the adoption previously, I was more comfortable with the process, enough so, that I was able to help other new parents on their first journey.

Time would pass, and each time this date comes around, I call her my Super Baby, and yes, I wasted no time in raising her to be a Seahawks fan (whether that holds today or not remains to be seen, but I tried).

So here we are, on the 20th anniversary of that Super Bowl I did not get to see my team, the Seahawks play, I also celebrate the 20th anniversary of the adoption of my youngest daughter. And 20 years later, the Seahawks are in the Super Bowl again, playing a familiar Super Bowl foe, and will hopefully reverse the tragic results of 2015, on a blown coaching call, not calling for the guaranteed touchdown run by Marshawn Lynch, opting for a pass play on the one yard line, intercepted by the Patriots to seal their win. Sunday, I am hoping the Seahawks correct that history, and leave no doubt.

Go Seahawks! And Happy Anniversary to my Super Bowl Baby!

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