Paul's Heart

Life As A Dad, And A Survivor

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Sixty And I Know It


(photo courtesy of IMDB)

Sorry, but it was the only photo I could find (of LMFAO), and play on the fact that today, I reached my 60th birthday. I’m sixty and I know it.

If anyone had ever told my mother what a complicated life I was going to have when I was born, she would have told them, he will be able to handle it. My mother only recently has begun to tell me of my earliest moments and difficulties. It appears I either learned survivorship instincts that early, or I might must have been born with them. But here I am, turning 60 years old today, a day I never thought I would see. At the age of 22, I was diagnosed with cancer, Hodgkin’s Lymphoma. I never thought I would make 30 years old. Why would I? All I knew of cancer was people died from it. My doctor did not help that either, when all he talked about was a 5-year survival rate. Nothing about ten, twenty, or even my current 38 years of survival. I had no reason to think I would be here today.

Four years after this photo was taken, at the age of 22, I was diagnosed with cancer, Hodgkin’s Lymphoma. Considered a rare form of blood cancer, it was also difficult to diagnose. As a society, we do not celebrate those who survive cancer. What I wild ride it has been, like a roller coaster with so many ups and downs, twists and turns, and seemingly G-force speed.

I recently watched a video of one of my favorite actors, Dick Van Dyke, talking about his longevity as he celebrated his 100th birthday. The interviewer asked him what his secret to living this long was, and he said that he did not know. While I do not expect to make another forty years, the fact that I made it this far, I do not know how either. Over the last thirty-eight years, my body has gone through so much trauma, not just from the cancer itself, to all the late side effects from my treatments, and the many sources of so much stress of which only in recent years, with the practice of Buddhism I have learned to keep stress in its place.

Over the years, I have kept a balance between living life after cancer, and not forgetting what cancer had given me, while not letting it define me. I am definitely not where I thought I was going to be when I was 22, but I am right where I am meant to be. Not the life I planned, but the life I have, and with all its twists and turns, I am okay with where I am right now.

If you are able to speak to a grandparent, as I once did, and ask them about their life and their experiences, you would likely hear tales of all the different eras from the great depression, hippies, and all other kinds of experiences over time. But someone diagnosed with cancer, would likely never have that chance to have all of those tales and memories. Right? Riiiiiiggggghhhhtttt?

I have so many things to share in just the 38 years since my diagnosis. And some of these things are huge, not just because of the number 38 years of cancer survivorship by itself is a really big deal. It is what has happened over those four decades that is truly exciting.

First, I will get the science stuff out of the way. The barbaric methods used to diagnose my cancer, are no longer done. I have witnessed this progress. The extreme amount of radiation used on me is no longer used, now reduced and focused on specific areas only. The toxic chemotherapy cocktail of MOPPABV, MOPP is no longer used, ABV along with D now considered the less toxic standard, still producing the great remission rates without the excessive toxicity. Even now controlling side effects from low blood cell counts to nausea, make it possible to continue treatments without interruption. Living long enough to see all this progress in treating Hodgkin’s has been exciting.

So what about life after cancer? What has it been like? I made a promise to myself that I wanted to give back to the cancer community for giving me another shot at life. And that began with becoming a cancer advocate for patients and survivors, wanting to be an ear to listen, and hopefully be an inspiration to those following similar paths behind me. I have been a patient/survivor advocate my entire survivorship, supporting efforts in fighting for health care, finding support, and educating survivors on late side effects from treatments.

I chose to work during my entire cancer journey, to this day I am still not sure it was the right thing to do, but the path it kept me on, would eventually take me to a career in medical research and actually handling one of the cancer drugs of my chemo cocktail. This would also be a game changer providing me the necessary health benefits to deal with the multitudes of late side effects from my radiation and chemotherapies.

I finally got the dog I always wanted, even before cancer. And for nearly 15 years, he was always by my side, especially his last five years as I was challenged with heart issues from my treatments, his presence made all the difference.

There is nothing and no one more important in my life as a cancer survivor, as those of my daughters. They are my world and have lived through over half of my survivorship, the most difficult of those years. My daughters are my driving force to get through each health issue I get diagnosed with, and there are a lot. But realizing that I have no control over my mortality, I go to bed each night, with plans for the next day, the next things I need to deal with my daughters, now as adults, there are things I need them to know and prepare for.

But wow, have I had fun watching these two grow. From helping with homework, to extra curricular activities, and then on to planning for college, I have had the chance to continue to teach them the importance of money, responsibilities, voting, self-care such as doctor and dental and eyes, and as they near the end of their college careers, they have some big choices ahead, and I hope to be one of their influences, jobs, relationships, a home. I have done what I can to be a good role model for them, to give and get respect, prioritize, manage their time, and to not get tangled up in bullshit that does not concern them. I could not be more proud of both of them.

I’ve gotten to travel, a lot in my earlier years of survivorship, not so much today anymore. I bought a house. And I have met so many people over these decades in so many different capacities, all I consider a blessing because they all gave me a variety of experiences.

Something I never thought I would do, I jumped into our local school board election as a candidate. While I had belonged to organizations before, and never shied away from leadership, this was a first for me. I met so many interesting people and friends, of whom I still consider friends to this day.

I can never forget those involved in helping to create my family and the many friends I met through adoption, again, still friends after all of these years, all of our children now adults, college graduates, married and with children of their own.

And then there are the most important and critical people in my survivorship, my fellow Hodgkin’s survivors who I consider not just friends, but family. From Linda, the first survivor who kept after me about my follow up care, to Tobi, Josh, and Jenny (Josh and Jenny have since passed) who were the first survivors I personally met and interacted with to the literal hundreds if not thousands of other survivors in our community, who we all support each other with each crisis we face, there is no doubt where I would be without each and every one of them. There are so many with longer years of survivors, and shhhhh… older in age too, my hopes for more time with my daughters exist because of them. And can I tell you, I am so inspired by the many younger survivors as they build their lives after cancer. Just ead the many stories I have shared here on Paul’s Heart like about Stephanie.

I have written books and other publications, even had one of my stories performed by Broadway actors. This was a fun night. I have given my share of survivor speeches, attended all kinds of conferences and events for Hodgkin’s.

(photo by Hodgkin’s International)

I wrote and published my first book, journaling my 35 years as a cancer survivor.

And finally, I would not be celebrating my 60th birthday without the best doctors and nurses in the world who recognized the need and specialty in taking care of cancer survivors who would live long enough to develop side effects from the treatments. I have been so blessed to be taken care of by who I have been. The pictures above are from survivorship, and the photo with my daughters in it, have my oncology nurse from 38 years ago, and my social worker who got me through my emotional struggles during those days. Though I know I have a picture of us somewhere, my primary care doctor of nearly 40 years, with me through it all, my biggest advocate of my survivorship, never doubting or giving up with all the challenges my body put me through. I literally would not be here today if it were not for Dr. J.

These last several years have been a bit more difficult with dealing with my late effects, but I have the best caregiver anyone could ever hope for. I am not an easy patient to deal with, stubborn is an understatement, but my best friend, my partner, my advocate, has been there each step of the way and I clearly would not be writing this if it were not for her. A cruel twist of fate, she accepted a role, unthinkable with her tragic and ironic past herself, to assist me in my survivorship.

So, now I am off to the airport for two very important passengers, arriving today, the ultimate birthday gift which was all that I wanted, and together we are going to celebrate this huge milestone, turning 60 years old as a 38 year cancer survivor.

When Diabetes Can Be A Choice


(photo courtesy of HealthyWomen)

November is Diabetes Awareness Month. This is another box I check when it comes to my health as I am a type 2 diabetic. I was not always this type of diabetic. It was something that developed over the last many years of my survivorship, in fact, I go as far as connecting it to my late side effect issues from my treatments for Hodgkin’s Lymphoma. Type 1 diabetes did run in my family, but not type 2. And it was not until about fifteen years ago, when type 2 diabetes appeared on the radar. I am always of the mindset, if it was not something I was born with, does not run in my family, and happened post-cancer, then it gets connected to that period in my life. Honestly, I am not really about the “why” stuff happens, I prefer to be “what do I need to do about it?”

What is the difference between type 1 and type 2 diabetes? I am not going to get lost in the weeds explaining the technicalities, but with type 1, the body has a lack of insulin caused by the body’s own immune system destroying insulin-producing cells, causing that shortage. As a result, type 1 diabetics need to monitor their blood sugar and give themselves insulin shots. They also have strict diets as well as other behavior recommendations such as exercises and avoiding certain vices. A type 1 diabetic knows they are type 1 as their symptoms are better recognized, but also severe and quick.

Type 2 diabetes is a resistance to insulin, the body either does not make enough insulin, or it does not process the way it needs to. A type 2 diabetic does not need to do insulin shots necessarily, but should monitor their blood sugar. Side note, as I have written before, this is one thing I am unable to do, as I have written about previously and recently.

Both types of diabetes carry their own potential issues ranging from cardiac to circulatory, optical, and so on. Cardiac can lead to heart disease, circulatory can result in amputation due to “gangrene”, and a condition with the eyes called diabetic retinopathy, where blood vessels in the eye become damaged, causing issues from blurryness to floaters, and possibly loss of vision.

As I mentioned earlier, I attribute my type 2 diabetes to my late effects from treatments. It was about fifteen years ago when my doctor began to monitor my “A1C”, which measures the blood sugar levels over the last three months, so an average of what diabetics check daily. Now here is the thing about the A1C with me, I thought I was being smart. I learned early on, that I could impact my blood tests, when fasting was required, by avoiding things such as cholesterol and sugar, through the week before the blood test, and have great results. The A1C put a stop to that, because while I could have a great blood sugar reading, the A1C proves otherwise.

Initially, my number was around 5.5, which was considered normal, but close to pre-diabetic. Over the years, my A1C would creep higher capping off six years ago at 9.0, full type 2 diabetic. The pancreas is one of the few body organs in me that has not been studied for impacts from my treatments, though I do see an endocrinologist. The loss of my spleen from the staging process of my cancer as well as my thyroid being impacted from treatments, also caused issues with my metabolism which has likely contributed to this.

There are other factors that impact the A1C, such as activity level (exercise), weight, diet, and stress. Medication was also prescribed for me, some that I could afford, some that I could not. I currently take two pills which have lowered my A1C somewhat, while not a great impact, lower is better regardless. Exercise for me is limited to walking. I have lowered my weight to its lowest in thirty years, but I have plateaued as I often do when I get to this level. I do not eat a lot of sugar and the one vice I did have, Coca-Cola, I have all but given up. I do not drink alcohol, do not do drugs, and I don’t smoke. And in recent years, I have finally managed to reduce my stress by 95% and how I respond. My result last month showed my A1C now at 7.4, not great, but going in the right direction.

As for my eyes, I see an eye specialist as well. Nothing has been decided on the retinopathy, though treatment has been talked about in the future. I do have damage to my eyes from the high dose prednisone that I was on during my chemo. And most obvious, I can tell my vision is getting worse.

From the cardiac standpoint, I seem to be holding my own. All my “bionic” repairs to my heart are holding their ground, though new diagnosis have come, but with everything else I have done, I am going in the right direction. I do plan on getting my A1C back into normal range within the next two years.

If You Could Really See It


This is an actual picture of my current handicap placard. Looks in pretty bad shape, doesn’t it? I have had this one just a little over two and a half years, with a year and a half to go. I have my personal identifications blocked out, but the things that should stand out to you, are the number of cracks this placard has (there is actually another located above the white portion holding the card to my rear view mirror), and the amount of tape I have used to hold this thing together.

Being someone who loves music, I often try to to quote some sort of lyric to connect my posts, but all I can really come up with, is the nursery rhyme, Humpty Dumpty. Now that I think of it, this might actually work.

Humpty Dumpty sat on a wall.

I completed 8 cycles of chemotherapy and 30 treatments of radiation therapy for Hodgkin’s Lymphoma back in 1988-1990. Got to remission, and was living life.

Humpty Dumpty had a great fall.

I was only watched by my oncologist for a possible relapse for five years. At that point, I was considered “cured” or likely free of it coming back, and nothing to worry about. But unbeknownst to my doctors (I was not being followed up anymore), my body was developing late side effects related to both of my treatments. The first of many issues, was discovered in a big way, a “widow maker” heart blockage of one of the main arteries of my heart, appropriately called that, because normally, someone does not survive that condition. Imagine if you will, Humpty Dumpty not only scrambled from his fall, but cooked in the sun on the pavement below.

All the king’s horses and all the king’s men,

An emergency double bypass for that main artery to my heart, the left anterior descending artery, literally saved my life. Comparing my life to Humpty Dumpty’s life, that heart crisis was just one piece of broken “shell” that would be discovered over the years. I have had two additional heart surgeries, I have several other conditions with my heart, a pending lung cancer diagnosis, I have a pre-cancerous condition with my esophagus and my thyroid, my carotid artery has been repaired, and the list goes on and on and on, literally. Take another look at my handicap placard. Then look at my recent photo. Of course, the main difference, you can see the horrible condition of my placard, but not what I am dealing with in regard to my health.

My “shell” looks pretty good (as far as health goes), as good as when Humpty Dumpty when he was still sitting on the wall. So you can guess, when I have to use my handicap placard in certain parking situations, and it is really not often but not without reason, I get stares, glares, and often times some pretty rude comments. My reactions or responses depend on my mood, or physically, how I am feeling at that moment. And if I am not feeling well, I am likely to respond quite negatively. Though I realize my outer appearance, “my shell” does not show my handicaps and disabilities, those unable to mind their own business or those who feel or suffer vigilantitis will bear the full brunt of my frustrations. Sure, “how could they know?” Of course, but it is also none of their business.

I have nearly a dozen doctors involved with my survivorship care from the late effects of my treatments: cardiology, pulmonology, cardiovascular, endocrinology, gastroenterology, physiatry, and many more including a primary care and a coordinator of my late side effects. This “Humpty Dumpty” has quite a few King’s men. If I were to walk around with all of my health issues on the outside, where everyone could see them, I would resemble my handicap placard. And then, you would be able to accept what I deal with. But then you would have to accept the burden that only I carry, the feelings of “that sucks” or “I would hate to have to go through all that” or anything else that may interrupt the good life you may be able to enjoy. So, I give everyone a smile when they see me, if you will, the tape that holds my placard together, you just won’t see the cracks. That keeps you safe, untraumatized.

Couldn’t put Humpty together again.

My doctors cannot stop what is happening. They cannot reverse anything that is happening. But what my doctors are able to do, is deal with each issue as it is discovered and repair what they can. I am enjoying a lot longer than I expected I would when I was told I had Hodgkin’s Lymphoma, cancer, and definitely more time than Humpty got with his four line story.

“But Paul, why not just get a new placard since that one is in such bad shape?” you might be asking. And a reasonable question, a simple question. I wish it was that simple. But just as it is with my body, the best I can do is get a replacement, however it will still have the same expiration date, and inconvenient paperwork still needs to be filled out. I wish my health were as simple as just “replacing” things. Unfortunately, there are so many extra risks associated with any corrective actions than if they were done to normally healthy people. And sometimes those risks are too risky to take.

So yes, I try to take the compliments “you look great!” and such, but it is hard because inside, my body could not feel further from it. If we are spending time with each other, family or friend, I do all that I can to not show you, or let you know, I am not okay. It is not how I want to be remembered. But… next time you see someone taking a handicap parking spot, climbing down from a monster-truck, thinking “that person can’t possibly be handicapped,” first, you have no idea what is under that person’s shell and the most likely legitimate reason they are parking in that space, and second, it’s none of your business. I do not get any satisfaction out of letting anyone know that if and when I get confronted. But if you want to make it your business with me, I will unload everything on you that I carry so that you can know the mess that laid at the bottom of the wall where Humpty landed.

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