As much as my cancer has taken away, it has also given.

Those diagnosed with cancer, whether they survive or not, they are never the same. Life really is the penultimate gift, a gift that we all too often take for granted. The shock of potentially losing one's life, or the realization that you will lose your life, that truly puts things in perspective. What once seemed critically important, now seems trivial and what was once trivial now seems exceedingly important. Spending time with my friends and letting them know how much I value their friendship has taken presidence. Not that work and everything else has taken a back seat, it is just that my priorities have changed.

For those of you who are healthy, I suggest you hug your loved ones, tell them and show them each and every day just how important they are. Those afflicited with cancer, whether terminal or not, do the same. It will give you, and them, a huge sense of peace. For you, there will be no unfinished business. For them, there will be the knowledge that the months, weeks or days with you were positive and reaffirming. You will be a better person for it.

I have not only the chance, but an overwhelming desire, to right all the wrongs that I have done in my life. Not that I am worried about meeting my maker.  I am, for better or worse, an athiest.  Lack of belief in God does not mean that I do not believe that there are certain "tenants" that we should all live by whether Christian, Muslim or Hindu or Druid.  Violations of those tenants diminishes those we hurt, but, even more, it diminishes us as human beings. Thou shall not steal, thou shall not murder, thou shall not bear false witness, etc. are not the sole property of the Christian religion.  If you need to go to church to learn these lessons, you have far greater problems than you know or are willing to recognize.

Not that I am looking to find the girl in my 3rd grade class whose pig tails I used to pull- I am not. I am sure by now she has not given me a thought in nearly 50 years, but there are greater wrongs.....

It saddens me that it took a life altering, life afflicting illness to come to this realization but it is better to come to the realization later in life than to go to one's grave oblivious.

I look at new relationships, both business and personal, as an opportunity  to right those past wrongs.  Perhaps people will say "well he finally got it". I am, in the end, a better human being. However, being a better human being is not easy.  It requires work and effort- perhaps one of the reasons I was not as good as I should have been. Looking for, finding, and taking the short-cuts in life is rarely the wisest of choices.  In the end, the only person you short change is yourself. In the past,  I have always believed the mantra " it is better to ask for forgiveness than permission", and in business I still do, but never in my personal life.

Those who know me best have seen a change in me, albeit a subtle one. I am different.  I believe that not only I, but all those with whom I come in contact, are richer for it.

During the past two years, since my diagnosis, I have meet some amazingly warm, kind and generous people.  Health care workers and those afflicted with cancer whom I never would have met had I not gotten cancer. Would I rather not have the disease and have not met them?  Without a doubt, but I am still richer for knowing them. I am eternally grateful for their friendship, kindness, support and understanding

Cancer and Anger:

It is virtually impossible to be affiliated with cancer and not have some sort of anger issues. I am not angry with the cancer.  I don't say why me and I don't say I don't deserve to have cancer.

Those who know me best, myself being first, know that I have an incredibly short and hair trigger temper. I always have and most likely always will.  However, the older I get, the less noticeable it is - just slightly.

I could use the cancer as an excuse.  "Well I have cancer I'm supposed to be angry" or it is acceptable to be somewhat angry. That is an excuse that I refuse to embrace. The fact that I have cancer forces me to take a greater responsibility for myself and others around me to keep my anger in check.  It is my problem, not theirs. Why should my illness adversely affect others?  Additionally, I am trying to grow my circle of friends,  not dwindle it. Several counselors suggested deep breathing exercises or yoga. Those who know me best would find me doing yoga or deep breathing exercises laughable. It was not until a very dear friend of mine suggested deep breathing exercises, that I actually took the idea seriously.  Surprisingly enough, it works and quite well too.

During a cancer support group session, one of the participants in the group turned to me and said, "Chris you seem very angry".  The counselor of the group, whose job it is to keep things on track and civil, sat there stone faced and silent.  Not that I blame her, I don't, but it was a cold reminder that I really did have anger issues. Unfortunately, I never got the chance to thank the woman for making the comment and the counselor for having the good sense to keep quiet.  It was a life altering moments.  It made me face the fact that I did have anger issues. Her comment was not really a surprise, for one cannot be angry and unaware, but it did make me face and address the issue.

Self realization of a deficiency is always the first step to self improvement. Over the last year, I have concentrated on keeping my anger in check, questioning if a situation warrants getting angry.  Most often the answer is no.  Occasionally my anger still gets the better of me, just ask the man at the check out register at Duane Reade who tried to talk me into signing up for a Duane Reade's discount card. Suffice to say the dialog is unprintable.

Having a little anger and expressing it is a healthy thing.  Keeping it all bottled up lends itself to a whole host of different problems. Being able to express your anger allows people to understand your frustration and never have people misinterpret your desires, a problem I seldom have.

Needless to say, self improvement is an ongoing process.  One is never finished and realizing one has a problem is always the first step. My only regret that is that I did not realize this sooner.

Cancer- Depression & Anxiety

It is a given that those suffering with cancer also suffer from some form of anxiety and depression at some point. The depth and duration of the bouts of anxiety and depression can depend on a host of variables. Those suffering terminal cancer the effects can be even more debilitating.

Anyone who has ever suffered from either anxiety or depression knows that they often wash over you like a wave, enveloping you completely even to the point of suffocation. For some this can be chronic and very debilitating.

For any of you wondering , "is Chris suffering from anxiety or depression and is this his way of letting me know?". Rest assured I am fine, I am not depressed, although the anxiety never really leaves. Through modern chemistry, I am able to manage. I am also fortunate enough to have an extensive group of very good friends, many of which date back over 25 years, that not only support me, but are proactive in their support.

For me the anxiety and depression are a result from losing life as I once knew it, a career, a purpose in life, but most importantly a hope of a better future. To lose hope is to lose all. To know that one is biding one's time, waiting for the inevitable.... if depression was not an inadvertent side effect, I would worry. With the help of my therapist and anti anxiety drugs, I am able to manage. Anti depression drugs have a slew of side effects that make life even worse, if i was not depressed before taking them I surely would be after. Every time I become overly anxious or depressed I ask myself would I react in the same manner if I were not ill. Most often the answer is no, and I know it is me that is being irrational. It is my way of maintaining a check and balance in my life and making sure I never stray too far off.

Weather plays a major factor in my depression.  Last winter was especially rough and the depression was much worse. There were days I would not leave my house, sometimes for up to five days at a time, not even answering the phone or returning calls. This winter has been exceptionally mild which has made this year much better. Also I am now able to recognize the the first signs of anxiety and depression and proactively address them.

The more one has of anything, the less importance one places on any given item. The less one has, each remaining item becomes that much more important. If one has a career, a wife, a pet, a girlfriend and all the accouterments of life, losing one of them may seem meaningless, however to see them each slip away, each remaining article becomes vastly more important.  Hence the feeling of both anxiety and depression. Keeping busy, finding purpose in life, staying as active as possible are all essential in keeping the depression at bay.

I am happy to announce that my blog is being read and hopefully enjoyed on 6 of the 7 continents. The only continent missing is Antartica. Thank-you, one and all

Cancer & The 7 Stages of Grief:

A very dear and close friend recently asked me why I haven't exhibited any of the normal 7 stages of grief. For those unfamiliar with them they are, "Shock and Denial", Pain and Guilt", "Anger and Bargaining", "Depression,"Reflection and Lonliness", "The Upward Turn", " Reconstruction and Working Through", and "Acceptance and Hope".

Below is how I explained my beliefs to her, they are simple and intuitive.

Shock and Denial: I was in shock for some time. The initial shock wore off after about 48 hours, but it took about another 48 hours for it to sink in completely. Denial did not seem to make any sense. Not having gone to medical school, not having any idea of what was going on, and knowing my doctors had no reason to lie to me, I accepted what they said.  Denying what was obvious to my docotors seemed beyond foolish.

Pain and Guilt: There was no physical pain at that time, emotionally it is painful, but the human body, the human psyche is amazingly resilient.  I am not religious therefore I do not believe that it is God that does not gives us more than we are able to handle, but rathher, we as humans, have the ability to adapt to adversity.  Perhaps I am fortunate and have a greater ability to adapt and cope with adversity. For me there is no guilt, not that there are not things that I regret, but I have made peace with all those I have offended, or at least to all of those that matter to me.   I am at peace with my life.

Anger and Bargaining: Those who know me best will admit, and so will I, that I have some "anger issues", but that is a topic for another post.  However, I am not angry at the disease. I have often heard people with cancer saying "why me". I have never fully understood those feelings. I am no better, nor worse, than anyone else.  My reply is "why not me?", not that I am happy that I have cancer, but if it was not me it would be someone else, perhaps someone with less ability than I to cope. Bargaining seems silly.  The last time I bargained,  I was 16. From the age of 7 to the age of 16, I attempted to "bargain" at least a dozen times, essentially every time I got myself in a major "jam". It never worked before, it seemed hardly likely that it would work now. I am reminded of the saying, "when I was a child I played with childish things, when I became an adult I put away childish things". For me bargaining is one of those childish things and it is an exercise in futility.

Depression, Reflection and Loneliness: The depression is something that never really goes away.  I do have time to reflect, often I have too much time to reflect.  I am reminded of the mistakes in my life and the fact that I have a limited amount of time to correct the errors of my ways. Because of my cancer, I am often alone but I seldom have feelings of loneliness. I am truly blessed, perhaps more blessed than I deserve.  In the end, it is the friendships we have made that carry us through the very end and I have some very, very good friends.

The Upward Turn: This refers to the point where one accepts ones fate and makes the most of ones life.  It is difficult for me to really think of this as a true upward turn, but I have accepted my fate and am trying to regain as much of my life as I am able.

Reconstruction and Working Through: This is an extension of the Upward Turn, it is a continuing and ongoing process, one that hopefully gets better and better. I am a true work in progress.

Acceptance and Hope: I have come to accept my fate, not happily, but not fighting it either. There is always a modicum of hope, however limited.

Anyone diagnosed with cancer and who has  undergone chemo, either oral or intravenous, knows that the cure can often be worse than the cancer. For those lucky enough to have a chance of going into remission, it is as small but painful price to pay. For those unlucky enough to be undergoing palliative chemo, it is a very different case. Palliative chemo is usually ongoing, one is on it from the time of diagnosis until the end.

The side affects of the chemo vary from drug to drug and patient to patient. Two people taking the same drug may have vastly different side affects. Some are able to weather the side affects better than others, but even those with minimal side affects have unpleasant results.  It is just a matter of degrees. In my case,  the Sutent has a host of side affects; being extremely tired, pain, nausea, vomiting, diarrhea, tenderness of the skin on the bottom of ones feet and palm of ones hands, loss of appetite, weight loss, shortness of breath, depression and anxiety, and hair loss- that being the least of my concerns. I suffer from seven side affects. On a very good day, there are no side affects.  A bad day has all seven.

Oral Sutent is administered for 28 days with a two week break and then the cycle repeats. The deeper into the chemo regime, the more pronounced the side affects become. Week one and two are manageable, week three and four are much less so. Week five, as the chemo exits the body, the effects lessen and week six is the best of all. Out of six weeks, there are three that are manageable.  Every day is an adventure, a surprise, waking up in the morning one never knows which of the side effects will manifest themselves that day. Will it be none, one, or all seven? There are days that I am physically unable to leave the house. It is on those days I wonder which is worse, the cancer or the chemo?

There are drugs to combat the side affects of the chemo, but those drugs also have side effects.  It is always a balancing act, take too little of the drugs and they are ineffective, take too much and it causes a new and different issue. Even after being on Sutent for a year, I have been unable to accurately determine the precise dosage of medicines to combat the side effects.

My Oncologist is very pleased, with not only my treatment,  but with my ability to cope with the side affects of the Sutent. Personally, I am less pleased with my ability to weather the side affects but I have no base line to measure them against. Over the last 18 months, I have been forced to modify my entire life to accommodate the disease.

The problem with Sutent is that, after a period of time, the drugs lose their effectiveness.  Essentially the body, the cancer cells figure out what the drugs are doing and figure out how work around them. At that point they are rendered inaffective and the tumors start to grow at their normal rate, in some cases at an accelerated rate. When that happens, one is forced to go to Plan B. For my type of cancer there are essentially four different type of drugs. Unfortunatley Plan B doesn't work as effectively as Plan A, Plan C not as well as Plan B and that assumes that one's body will not have an adverse reaction to any of the drugs, an anaphylactic reaction.  If they do,  then one may be forced to jump from Plan A to Plan C.

I first started taking the Sutent, I was told that it would work for perhaps 6-9 cycles. The fact that I have done as well with Sutent is a blessing. Unfortunately during my last visit with my oncologist, he said the drug was becoming less effective that some of the smaller tumors were growing at a much more rapid rate. After my next full round of chemo, he is going to be forced to switch to Plan B, to switch me to a different chemo medicine. I currently have the balance of my current treatment, 10 days, then a 14 day break then another 28 days of chemo before I learn my fate. Although I don't feel any worse than I did last week, there is an obvious shift in my overall health in addition to a greater level of anxiety.....

More on this after my next visit with my oncologist

This will be my only post this week. Next week I will revert back to posting twice a week, on Tuesday and Thursday.

The scariest thing about having terminal cancer is never  knowing the exact path one's cancer might take. My oncologist, Dr. Darren Feldman, is a world class oncologist, working at a world class institution, Memorial Sloan Kettering Hospital.  He is completely trustworthy.  Dr. Feldman's knowledge is based on years and years of education, seeing hundreds if not thousands of patients, and a compilation of studies based on past cancer patients. Some patients are alive but many are dead, a fact that  is rather disquieting in itself. He is giving me his best estimate. I fully appreciate the limitations of my doctors and their inability to provide me with a medical certainty.  If we were talking about anything other than my life, I would smile and shrug it off. But we aren't, it is my life.  The fact that we are dealing with my very existence demands certainy, it insists on exact, precise, medical certainty.

Not that I want to know the exact date I am going to die, although if I did I could make sure my apartment was spotless, not a dish in the sink, etc.,  and I could say my proper good-byes and make sure that all of my affairs were in order.

The thought that my days are numbered always rattles around in my head, it is impossible to shake off completely. Sometimes it is deeper in the recesses of my mind, other times it slips in the forefront. Often I will be walking down Broadway in upper Manhattan and see a parent with an infant and it hits me- by the time that infant is in kindergarten, I will be dead. It is a thought that I can never completely evade.  The reminder is constant since Manhattan is filled with young families.

February 8th marks the 2nd anniversary of my diagnosis and my anxiety level is much higher.  The changes of the seasons use to be loved and welcomed, now they are but a reminder that another three months have slipped away.

I lost a friend last September to cancer, she too had stage 4 cancer and was deemed terminal.  The really scary thing is how quickly she went down hill. A year before she died, she was skiing in Vermont.  In the spring she was sailing in Bermuda and off the coast of Italy.  Six months later she was dead. To see her amazingly quick demise at times shakes me to the core and I often wonder when it will be my time to see a more serious decline in my health. I will be writing a separate detailed posting on Nyla, dedicating the posting to her within the next 60 days.

In my last post I mentioned that this post was going to be short .  Time has been spent adding to the "Resource Guide".  There are additional hospitals, a list of Clinical Trials, as well as links to The Cancer Center Resource Guide.  Additional links on both Nutrition and Alternative Medicine will follow in the coming weeks.  

 Shortly after writing my first two postings, I received phone calls from close friends commenting that my writing was dispassionate. One person mentioned that she felt it wasn't personal enough, she wanted to read more about me.  Having been diagnosed with this disease for almost two years, my approach to telling my story is very different than it was in the first few months. But more importantly, although it is my story, it is not solely my disease. The focus should not be on me or my personal daily battle, but rather people should  focus on the disease.  Consider me merely the means to deliver a story, one that afflicts millions of people world wide and touches millions more.  But not just a story,  I also want it to be a world class resource guide. For those afflicted with cancer and their families, the last thing they need to do is to sort through a myriad of cancer organizations.

When I was first diagnosed, there were only three people, other than myself, that knew I was ill, the British girl (who exited my life more quickly then she entered), my older brother and my nephew.  My mother was unaware. At the time, my mother was out of the country. My brother and I both decided that this was news to be delivered in person, not via a trans Atlantic phone call. Not only did I worry about her health at hearing such news, but there was nothing she could do.  Not telling her was agonizing as I have a very close relationship with my mom and I hated to lie to her, even by omission. Mom was not due back for 12 weeks and  they were  long and difficult. The fact that she was out of the country was both a curse and a blessing. A curse because I was unable to tell her, a blessing because I needed to get over the shock and absorb the news myself. When mom finally returned in the spring,  it was a Friday.  Late Saturday morning I was on her doorstep. After giving and receiving a huge hug, the first question out of my mothers mouth was " so, how is your health"...... a very easy segue into explaining what was really happening. During the preceding weeks, I had been cautioned to break the news slowly, giving mom a bit of information, let her digest it and let her ask another question, rather than inundating her with all of the information at once.

Breaking the news to my close friends took time, over a period of weeks, as I felt more and more comfortable explaining my situation. I still remember vividly the first phone call, to one of my oldest friends. Although we are close, we didn't chat regularly.  She is one of those friends that whether we talk once a week or every six months, our friendship will remain the same, it never really skips a beat.  She is and will remain a friend for life. We had spoken a mere two months before and I remember her quizzical sound in her voice when she answered the phone.

Forming the words " I have cancer and its terminal" for the very first time was exceedingly difficult. I remember her asking  "so, what's new?"  I just hemmed and hawed, then hemmed and hawed some more, unable to even get out a single syllable. Even before I uttered a single word she knew, no matter what the news, it was not going to be good. What should have been a 15 minute conversation took 45 minutes. Finally,  I finished my story.  Her kindness,  understanding,  compassion, and empathy still touch me to this day. For the first 18 months she would e-mail me at least every two weeks and call at least once a month.  It is heart warming. We still stay in touch much more than we did before, that in itself is a huge blessing.  I know in the very end she will be with me, if not in person, then in spirit.  She is my "Rosebud".

Over the next weeks and months I started telling my closest friends.  Each telling of the story became a little easier. Most were amazingly sympathetic and supportive.   To those friends, I thank you from the bottom of my heart.  It is your friendship that gives me the strength to cope. Then there are some friends, whom I assumed were close, that heard through the grapevine that I was ill and never returned my calls.

I have come to realize that everyone grieves differently,  copes differently.  The fact that some friends have not responded the way I hoped is disappointing but I understand.  Many people are not comfortable with death,  and rather than get directly involved choose to stay on the sidelines. They are missed.  I wish they felt differently, but, in the end, it is their decision.  We are all worse off for their decision.

For all of those people who have tried to become a member and follow my blog and been unable, I apologize. If you still want to become a follower- member on the home page, on the banner line, there are options "follow", share etc. Click on the "follow" your name should automatically be added as a member and future postings should be sent to your in-box.  I emphasize "should" because, on occasion, the software does not work as expected.

To all of the people whom I don't know personally who read my blog, specifically those in Russia, Romania, Ireland, India, New Zealand, Canada, Germany and Australia, the U.K. and those in the United States I thank you. Knowing that you find my story interesting enough to read is heart warming. I encourage you to sign up as a follower and feel free to send me a message either here or to cpb12569@gmail.com

This Thursday's posting will be a shorter one due to the fact I am concentrating on adding additions to the resource guide on the right hand side of the page. Additions will include additional hospitals, a link to Cancer Clinical Trials, Nutrition, Alternative Medicine and hopefully the Cancer Patient Resource Guide.

The day I received my diagnosis of Stage 4, terminal kidney cancer my life changed irrevocably.

The company that I had worked for the previous 5 years had closed their doors, gone out of business six months before. I was unemployed and in the process of looking for a job. Now, my immediate concern was to stabilize my condition the best I could, that meant surgery, recovery, etc. I obviously had more pressing issues at hand.

Even if I wanted to work, and I did, at my age, 54, being in the worst recession in nearly 80 years and having cancer did not put me on anyone's " short list" of potential hirees. Even if I was fortunate enough to get hired, nobody would insure me for my now "pre-existing" condition. My yearly medical costs are in excess of $200,000 per year. Thank God for the existing insurance I already had. I would have to make $275,000 a year pre- tax just to cover those expenses, and in the middle of the worst recession that was not going to happen. I would need to make a minimum of $350,000 to cover my total expenses pre tax and that certainly wasn't going to happen.

Men are measured by what do you do for a living, what company you work for, your position within the company and how much money you make. It is what defines us, it is our identity. To lose that, and to know I would never recover it, was probably one the most difficult obstacles I had to overcome. My very good and long time friends understood and never made or make me feel uncomfortable about the fact that I am now technically disabled. It is very different with new friends, new relationships. Having to explain why one is not working is not easy. Being forced to explain the very most intimate details of ones personal life can be uncomfortable at best.

A month or so before my diagnosis I met a woman. She was charming, young, and British. I am a sucker for a beautiful woman with a British accent, but what man isn't? We had gone out on several dates prior to my first meeting with internist and had a wonderful time. She was bright, engaging, sweet, charming and sexy as hell.....possibilities abounded. During the period between my first meeting with my internist and my meeting with my oncologist and my prognosis, there were about 10 days. I intentionally laid low, only seeing her once during those 10 days and not wanting to lie to her, even by omission. Once I had scheduled my appointment with my oncologist, I called her and set up a date for that evening. It had been a week and I was very anxious to see her, never imagining my news from my oncologist would be as dire as it was. I was still in a state of shock when we met that night and it was obvious. I really had to " come clean", even if I was not emotionally prepared to do so. She was understanding that night but the following afternoon I got an email saying she needed to break it off.

Perhaps I am showing my age or my naïveté or a combination of the two, but it was my first Dear John letter via email. Ending a relationship can be difficult, but to end it via email, text, IM, or Twitter is cold and heartless. All of my readers under 30 take notice. To say I was hurt is an understatement, but I am at a point in my life where nothing really surprises me. She did explain that she lost her mother to cancer and was not prepared to go through the same emotional roller coaster ride less than a year later.

It was at that very moment that I realized I was damaged goods, rather, more damaged then I was before the diagnosis. There comes a point, an age in our lives, when our life experiences define who we are, it is called "baggage". After further reflection, I don't blame her. In her shoes I may have done the exact same thing, though not as cold heartedly, to be sure. I don't know who in their right mind wants to get involved with someone who is terminal- at least in a committed monogamous relationship .

Seven years ago I was forced to undergo a bi-femoral aortal by-pass surgery. For those unfamiliar with the operation- it is no picnic. They cut you from fore to aft to access the aortal artery and the same below to access both femoral arteries. It was, to this day, the most painful procedure I have ever undergone. There is no non lethal dose of morphine that can totally ease the pain. The only comfort comes from the knowledge that tomorrow will be a bit better than today and the following day a bit better than the previous. Some of my nurses would have made Dr. Mengle proud. Less than 24 hours after the surgery they wanted me to walk, small very short walks, to be sure but none the less- walks. It is nothing short of pure torture. I am told there are sound medical reasons for this, at the time I did not care. I just wanted to be left alone to suffer in relative peace.

At the time I had no physical "reference", nothing to compare the operation to. It had to be done. I knew it was not going to be enjoyable but I had no choice. The operation was a life saver. Not having it would have meant sure death. I remember at the time thinking " well this is going to be an adventure", an unpleasant one to be sure, but still an adventure. Five years later when I was told I needed to have my cancerous kidney removed I had a reference point.  I knew the torturous procedure that major surgery could be but I did not have a choice. Due to the incisions smaller size and location, it was marginally less painful.

I chose and still choose to look at my cancer treatment as an adventure, an adventure in the truest sense of the word. Never really knowing what tomorrow may bring. Never knowing the path of the illness will take. Not knowing the path of the treatment. In order to cope, I attempt to always focus on the positive rather than the negative.

Cancer really is an insidious disease. It robs you slowly and systematically. It rifles through the pockets of your life, first robing you of life as you knew it, then it slowly robs you of your dignity. It robs you by leaving you in constant pain, always anxious and often depressed. It leaves you unable to eat or hold food down or get good nights sleep. In the end, when there is nothing else to rob, after it has picked your pockets clean, it robs you of your life. But for all it has taken, it has given. My cancer has reunited me with old friends, allowed me to forge deeper and closer bonds with existing friends and introduced me to new ones as well as giving me a different perspective on life.