Commencement & Cancer Update

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I had an in office appointment with Dr. Mashru, my medical oncologist today. That’s the first time we have been in the same room in many months. My blood work has been fine for all those months which is wonderful. My recent scans showed one new small melanoma nodule in my lung. That new nodule prompted him to change from pausing immunotherapy after Wednesday’s session to continuing them through the end of June. Then there will be another scan and another consultation.

I am still trying to assess my reaction to this new nodule. It doesn’t really concern me, but any new growth must get serious attention, which Dr. Mashru is giving it.

At Sherry’s request I had Dr. Mashru take a look at a rough spot on my back. He looked carefully, gave a initial suggestion that the skin lesion was a skin cancer of some kind (not melanoma), took a picture and sent it to my Dermatologist. She soon messaged me saying it looks like a “seborrheic keratosis” which is a scary phrase. But she also noted that Dermatologists refer to these benign growths as “barnacles” 😊 So I laughed, thanked her, telling her I am looking forward to my July appointment where she will give me a complet skin check.

I have to admit my bigger emotion is toward Joy Love’s Saturday wedding in Stanfield with Donn and Elizabeth coming from Kansas City and Cyndee coming from Cannon Beach.

My 42nd Western Seminary commencement on Friday and Saturday was a wonderful event. As MABL program founding director, I get to hood all the graduates in the program. There are so many stories in this group of men and women, including two babies born to students this semester. Very productive time.

Anniversary Infusion

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We celebrated our anniversary in a different way: I got out of town early so we never talked face to face! We did talk by phone as I headed off to participate in the Exiles in Babylon Conference in Boise, part of the pre-conference conversation on Women in Church Leadership. You can hear my view on Preston Sprinkle’s Theology in the Raw podcast: here. I have a lot of material on this website in the “Exiles in Babylon” and “Women in Leadership” buttons.

We headed to Salty’s on the Columbia for our anniversary dinner as soon as I arrived at the airport on Saturday. It was marvelous as usual, though the rainy day meant no beautiful sunset for our dining pleasure.

We headed to the coast Sunday morning, to the Ester Lee Motel (of course!!). It’s been our spot for many anniversaries. This time they had all the paper work including our car and license plate number already filled out when we arrived! It has a wonderful cliffside view of the rocky coastline and the ocean. The problem is that the ocean is eroding the cliff and I have to wonder how long it will survive (!!)

We did a lot of relaxing as well as looking. I was able to go down to the Yaquina Head Lighthouse tide pools at a very low tide and see the ocean critters – including a bunch of seals who have moved into the neighborhood.

One of the very fun things is to see our name in lights!! Well, not exactly in lights, but out on the main highway so everyone can rejoice with us

We had our special coast dinner at Gracie’s Sea Hag on a sunny Tuesday evening over looking Depoe Bay. It was marvelous. The celebration ended with breakfast at Otis Cafe

Infusion and Cancer Prospects

We drove back to Portland and I went to my afternoon immunotherapy infusion. All my blood numbers were great and the infusion went quickly and without any problems of any kind.

I have an in office appointment with Dr. Mashru on Monday, April 24 and final infusion scheduled on Wednesday, April 26. He used the word “done” in our last conversation. There will be follow up blood work, scans, and appointments. Hopefully they will confirm that I am in the 30% of patients for whom the Nivolumab immunotherapy eradicates the melanoma. In the meantime, I have full energy and strength and love what I do!

Sabbath Presentation

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Looking at an invitation to present a paper at the Northwest Evangelical Theological Society meetings last Saturday, I plumbed my pile of “Ponders” and pulled out the topic of Sabbath. It’s the first practice in the Practicing the Way, a ministry I strongly support. But there are different understandings of Sabbath and its role in the Christian’s life. Some argue a 24 hour seventh day Sabbath is “baked into creation” while others see the practices as another form of legalistic works righteousness. There are many views between these poles.

I titled my presentation “To Sabbath or Not to Sabbath: A Covenantal Question”, {footnoting Shakespeare of course). I spent time in the Old Testament looking at Sabbath. The first reason given is that YHWH ceased His work of creating (the verb in Genesis 2:2 has this primary meaning, not rest as is often translataed). Exodus 20:11 says YHWH rested (different verb that Gen. 2:2). Exodus 23:12 has the full command with all three verbs: “For six days you are to do your work, but on the seventh day you shall cease from labor so that your ox and your donkey may rest, and the son of your female slave, as well as the stranger residing with you, may refresh themselves.” [NASB2020]. When the Ten Commandments are repeated in Deuteronomy 5, the reason for Sabbath cnanges to “remember that you were a slave in the land of Egypt, and the LORD your God brought you out of there by a mighty hand and an outstretched arm; therefore the LORD your God commanded you to celebrate the Sabbath day (5:15). Exodus 31:13-17 clarifies the Sabbath as a sign for the relation between YHWH and His people, so it is part of the Mosaic Covenant with blessing for keeping it and death penatly for those who profane it.

In the presentation, I led everyone in wrestling with the account of Jesus’ disciples breaking the Sabbath by harvesting (sure seems this is what happened – they are harvesting), leading to Him to declare the Son of Man as Lord of the Sabbath (Mark 2:23-27) – the discussion in the room got quite animated!

We concluded with Galatians 4:10; Colossians 2:16-17 and Romans 14:1-9 where both food laws (Kosher) and Sabbath are taken out of the category of “must follow” and put in the category of personal valuation. That is quite a difference from the Mosaic Covenant status of death penalty offense!

My conclusion went to Galatians 3:17-26 which teaches the limited scope of the Mosaic Covenant: it is for the people of God, i.e., Israel, from Sinai to Pentecost. Believers in Jesus, the post-Pentecost People of God, are no longer under the authority of the Mosaic Covenant but are under Abrahamic Righteousness, the moral command Jesus summed up in “love the Lord; love your neighbor”.

Thus I think the work/rest pattern may be properly praticed in many different rhythms ranging from a 24 hour period once a week to a daily/weekly/monthly/annual personally defined pattern.

Two helpful books on the subject are Paul Jewett, The Lord’s Day and the volume edited by D.A. Carson From Sabbath to Lord’s Day

Video and audio recordings of the session are here. I’d love to get your responses via comments on this post.

Remembering and Anticipating

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This was me a year ago with my eyelids taped, neck brace to keep my head up and using a walker to prop myself up when I walked. I was in the 55% who have major side effects from Opdivo/Yervoy immunotherpary combination. Extremely high liver distress numbers were the invisible and much more serious problem. Thankfully all that receded by mid March and I started Opdivo (only) which has been effective treatment with no side effects. I had an infusion on Wednesday and am scheduled for three more infusions at the beginning and end of March and the final one on April 26. Then Dr. Mashru thinks I will be done with treatment.

In the meantime I work at full strength teaching Western classes, serving on the elder and preaching teams at Grace, doing a good bit of teaching/preaching in other churches (Cove Church in Anahiem last week and Capitol Church in Boise this Sunday and Alderwood Church, Saturday Feb. 11) along with pastoring pastors and checking in with grand children.

Sherry and I celebrated birthdays at Salty’s on the Columbia, our favorite celebration spot by far. After enjoying the marvelous dinner and sharing their complimentary white chocolate mousse cake, the server asked if we had a few minutes – another patron wanted to treat us to Mocktails. I had never heard of such a thing, but we found them delightful.

It is a great joy to be alive, strong and able to serve many in the years ahead.

Year-end update and prognosis

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Three doctor report

Dr. Frager, my radio-oncologist, released me from care since the melanoma in my brain is gone.  I remember the Green Mask and the multi-member team controlling the CyberKnife that did the ultra-precise zap on the two nodules.

Dr. Burt, my urologist, removed the bladder cancer with “ordinary surgery” a year ago. He just took another look and showed me the inside of my bladder: no sign of cancer visually. The urine cytology lab test confirmed: “Negative for High Grade Urothelial Carcinoma”

Dr. Mashru, my medical oncologist, after reviewing my last CT scan and blood tests explained that the infusions of Nivolumab every four weeks for treating the melanoma that metastasized into my lungs. The good news is that he expects to end those treatments in April, which is a year after they began.

I asked for clarification, and he confirmed that since there has been no activity in the cancer over the last 15 months of treatment, he expects it is dead. Follow up CT scans will monitor to confirm

No cancer?? I will admit that it is hard to wrap my mind around that prognosis. But with prayers of thousands and cutting-edge treatment, that seems likely.

UPDATE: I had my pre-infusion blood tests (all good) and conversation with the Nurse Practitioner. She was pleased to hear how well I was doing which led me to do a bit of research on response to nivolumab treatment for Melanoma, If I read this article correctly, the overall survival rate is 42% and the disease progression-free survival rate is 36%. Mine was detected early and even more importnatly covered with prayers of many.  

New News

Nicole & Colton are engaged!

Colton formally proposed and slid the ring on Nicole’s finger. This means two upcoming weddings: Joy and Nathaniel in late April and Nicole and Colton on July 1.

We had a Thanksgiving celebration – at Red Robin, of course!

Christmas in Kansas City

We are spending a week with Donn, Susan, Elizabeth and Michael through Christmas Day. We got a blizzard to highlight our time! You can see Michael’s sled trip in sub-zero weather here. Michael also went high to top the Christmas tree decorations as you can see here

Our visit will include a Saturday Chiefs game. With temperature in the low teens, wind chill in low single digits, Donn purchased Mobile Warming Heated Wool Socks. I get to use Elizabeth’s pair!

The visit will culminate with Christmas Eve and Christmas morning services at their church. I am excited that Elizabeth will be doing readings on Christmas Eve, but a bit disappointed that their children’s Christmas program occurred last week.

Visit to Spring Branch Cemetary & Wheatland

Sherry and I traveled to Spring Branch Cemetary, outside the church I grew up in and where we will be gathered to our fathers, to introduce Michael to his ancestors, going back to grandparents, great-grandparents, and great-great-grandparents!

His great grandparents
It was cold!
His great-great-grandmother
His great-great-great-grandfather

Then we drove south to Wheatland and had a marvelous lunch at Gigi’s Cafe.

Infusions and Scans – November

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The results of my Wednesday CT scan are back and the news is very good: (1) No evidence of disease progression. (2) Stable to slightly smaller pulmonary nodules. There is a lot of detail but that’s the bottom line.

I will continue having Opdivo (Nivolumab) infusions every 4 weeks and scans every three months, the next in January and another in April. The only side effects is an itchy back so Sherry anoints it each evening. But next week I will be in Denver for Evangelical Theological Society National Meetings Monday-Friday and then at Grace Pointe Church in Las Vegas for the week end. I may ask Andrew, my roomie, to do some unusual duty

I have been at all the national meetings of the Evangelical Theological Society will be since 1977. This will be the first time since 1986 that I will be I will have no leadership role. It’s going to feel very strange! But I will enjoy meeting many old and new friends as well has hearing some fine papers.

The NEW news is that Joy sprouted an engagement ring thanks to Nathanael! He joined the Dojo where Samantha teaches. After a couple of sessions, Sam asked Joy to come “help” her. The rest to the story is summed up in “happily ever after”!

Scans and Infusions

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My seventh and eighth infusions were wonderfully unremarkable! The only drama was no results from my early morning blood draw showing up in my medical record. Those results are required before the infusion could begin. I called Trish, my oncology case manager. She put me on hold and called around, discovered that the blood chemistry machine that serves all the labs at Kaiser Interstate was non-functional. She also discovered that someone had driven my blood (and doubtless others) to the big central lab. Happily, the results came up as Kathy, the nurse of the day, was finishing the pre-infusion questions. So the eighth infusion proceeded in a wholly unremarkable way 😊

The MRI of my brain confirmed that the radio surgery had killed the melanoma cells in my brain. One of the two remaining pockets of dead cells is completely gone and the other much smaller. I like the idea my brain healing!

The final event of the day was CT scan of my torso, looking particularly at the melanoma nodules in my lungs. The conclusion is that the nivolumab (trade name “Opdivo”) has stopped the cancer. There are no new nodules which means the normal metastasis of the very aggressive melanoma is not happening. Neither are the nodules growing. Of course, I would like them to be smaller, something the two med treatment accomplished but with terrifically impacting side effects (see January-March posts).

The next steps will be to slow the infusion cycle from every two weeks to every four weeks with scans every three months. If all goes well, Dr. Mashru will pause the treatments after the April scans to see what is happening.

I deeply appreciate the prayers and encouragement of so many. I continue feeling fine with no effects from the cancer or side effects from the nivolumab. Now if I can just get my grades done . . .

Sherry, Cyndee and I spent a week at Clydehurst Christian Ranch in the mountains of South Central Montana. It is the place where Robert Redford filmed “A River Runs Through It.” I found my curiosity, which is always huge, kicked into an even higher gear with all the beauty and all the stories of people. As I was doing a pre-marital with Erik and Cynthia tonight, my eyes went once again to a cross stitched picture which a friend who sees my soul made for me many years ago.

Infusion #6

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The bi-weekly infusions continue to be uneventful, I am glad to say. The blood panels I do before each infusion show the liver distress numbers (AST and ALT). The graph shows before, during and after the two med infusions back in December/January that caused all the huge spike and the other nasty side effects. The numbers continue to run in normal range, actually declining a bit, during the one med infusions

Ann and Jack, my sister and brother in law, came for a short visit. We went to the coast to hang with Cyndee and then to the Columbia Gorge and on to The Dalles to see David, Samantha, Nicole and Joy. There are more pictures on my Facebook page.

Infusion #5

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The infusions are getting to be totally routine. Blood panel numbers are nominal, infusion nurses are friendly and wonderfully professional, the actual infusion takes 30 minutes and I walk out feeling fine in about an hour. The only change is what work I do while the infusion is going. Liz Ditty is one of my Leadership Cohort students who did a study on Elijah last term which is now contracted as an Intervarsity Book entitled “Prayers God Answers.” I get to go through it, appreciate the insights and make some suggestions for the final edits.

I have infusions scheduled every two weeks through the middle of September with an MRI and a CT scan scheduled for August 1. The scans will confirm no active melanoma in my brain and hopefully much reduced nodules in my lungs. I wouldn’t be too upset if they were absent all together. I don’t think I’d miss them since they have not made their presence known to me other than through the scans.

The other new event in my life is catching my first river salmon. Vinnie Sylvia loves to share fishing in his 14 foot boat. We have gone on the Columbia twice. This time we went on the Willamette near the St. John’s Bridge. After a wonderful morning on the river – fishless to be sure – Vinnie announced we’d head back in a half hour. Three minutes later my rod went crazy. It took a while to land the 14.5 pound salmon. It was VERY tasty.

Infusion #4 & Elizabeth’s Baptism

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Infusion #4 happened Thursday afternoon. As I was preparing to go to a lunch appointment, Jennie, who was my nurse again, called to ask about the blood panel labs. I stuttered out that Dr. Mashru said I didn’t need to do them every time. Turns out I had misunderstood his “we don’t need to talk everytime” and skipped the required labs. So I hustled to get them done so the infusion could progress. Happily the last three labs were almost identical so the infusion proceeded without incident. I have had no side effects or fatigue. The only change is that I am weaning off Pyridostigmine, my “stand up straight” steroid pills and that is going well. Boring report 😊🙏

Sherry, David and I went to Kansas City last weekend for Elizabeth’s baptism at Good Shepherd Community of Christ which has been their church home for several years. It was a marvelous family event with all four of her grandparents along with Uncle David, Aunt Nancy (behind her in the picture) and Uncle Brian present, and great grandmother joining by Zoom from the LA area. The whole service was dedicated to the two baptisms and the confirmation the two along with Donn’s confirmation.

Elizabeth’s baptism was done by her sponsor (video here). Her confirmation (video here) and Donn’s confirmation (video here) were wonderfully personal and deeply moving for us. We all went to Donn and Susan’s home for some food and celebration. Susan took her parents to the airport, and then the rest of us went to Jack’s Stack for their wonderful BBQ with the Hickory Pit Beans – without doubt, the best beans in the whole wide world!!

Sherry, Susan, Elizabeth, Donn, Michael, David, Gerry, Nancy, Brian