Sherry and I met with Dr. Frager this morning to review the treatment on the two BRAF-negative melanoma metastases in my brain (R parietal, R frontal). There is some exacting measurements to be done in preparation, then a single radiosurgery session to zap the two nodules which I hope will be done around December 15. Dr Frager reports that there is less than 10% chance of symptomatic impact (fatigue or seizure) which they will mitigate even further with prophylactic medication.

The picture is from the MRI they did a couple of weeks ago. It shows the larger nodule on the back right side of my brain (the picture is a mirror image with eyes at the top). It is just under 1 centimeter or about half an inch in diameter.

The smaller nodule is less than .3 centimeters or about 1/10 of an inch. It is so small that they considered doing nothing with it and waiting to see what the immunotherpy might accomplish. But Dr. Frager said the immunotherapy which is quite effective in the rest of the body hardly penetrates into the brain. So I affirmed doing the radiosurgery to both spots. Dr. Frager consulted with Dr. Mashru and it will be a “two-fer” in a single radiosurgery session.

If you want to see a larger version of the pictures click here.

The immunotherapy infusion will be Friday afternoon, beginning at 1:00. Dr Frager confirmed that most patients tolerate it well and the treatments are quite effective. Of course results vary by person and I would add by prayers of the saints on our behalf – and there are many for which we are extremely grateful.

I am in Boise where I co-teach my Leadership Cohort class (with Steve Walker) all day Tuesday. I would normally hang with Bethany (our non-legal daughter), Jesse and the three of their five who are not in school before I fly home. Unfortunately Jesse and Bethany are are not feeling well so I went directly to the airport with only a brief and distanced check in on Monday. I did get to tour the addition to their house which will finally give room for their family

I got a call from Kaiser as I was riding in an Uber to the Dallas Fort Worth airport informing me of the schedule of my immunotherapy infusions: Friday, December 3, Thursday, December 23, and Friday, January 14. All will begin at 1:00 and take the rest of the afternoon. Many times immunotherapy has little or no side effects because it stimulates the immune system. This is quite different than chemotherapy which poisons the cancer cells even more than it poisons the whole body. So my prayer is that I will be in the majority who have little negative effects.

The radiation oncologist and have a meeting Monday morning to discuss the radiation treatment for the larger melanoma spot in my brain.

In the meantime, Sherry and I are having a great time with Donn and Susan and Elizabeth and MIchael here in Kansas City. Donn and I went to the Chiefs game after church yesterday. Here is a taste of what we saw. You will hear Donn loudly in the background!

Last week’s surgery, MRI, and oncologist consult left me with the understanding that I have two types of cancer: Bladder (which has been removed) and metastatic Melanoma with nodules in every lobe of my lungs, two places in my brain and apparently in my liver near my gall bladder. Most of the nodules are quite small. The doctors keep telling me how rare it is to have two types of cancer at the same time.

I continue to marvel that the blood in my urine led to a CT scan which providentially revealed the nodules in my lungs. Otherwise there is no telling how much they would have grown to produce symptoms. Early discovery means small nodules make for much more effective treatment.

Dr. Frager is the radiation oncologist who will be supervising the radiation treatment on the larger nodule in my brain. We will meet on Monday, Nov. 29 to set up that process.

The strike against the Kaiser system was averted so I am expecting a call today or tomorrow from the oncology folk to set up the immunology infusions (opdivo and yervoy for all y’all curious folk). Each treatment will take about 4 hours and be done every three weeks. After four treatments there will be a scan to check the effectiveness.

My big question is what will be the side effects of the two treatment modalities. Since they vary widely from person to person those life impacting questions are unanswerable for now.

A challenging thing is explaining to people that I have no cancer symptoms at all. I sleep well, feel normally strong, and am enjoying a full and fulfilling fife of family and ministry.

The great anticipation is removing my catheter in Wednesday’s follow up visit with Dr. Burt to check on the success of the bladder cancer removal. There will be great rejoicing when I am once again living a bag free existence! UPDATE: The catheter is extricated and I am now free. Dr. Burt confirmed that the bladder cancer was lowgrade so he does not see any need for any chemotherapy or other stuff – just have a look every 6 months in case it recurs.

UPDATE: I am headed to Ft. Worth for Evnagelical Theological Society where I will lead the “Evangelicals and Women” session. It will be outstanding. But three of the five presenters cannot be present because of international travel restrictions, so I am taking portable equipment to bring them in by Zoom. Then to Kansas City to meet Sherry and hang with Donn, my son and and his family for Thanksgiving. While we are there, we will go to Topeka to visit Sherry’s uncle and also to visit Quentin Heights Elementary School where I did 5th and 6th grades back in the mid fifties!

Sunday: Drive up to get outdoor nurses station for the COVID test required for my surgert with the nurses working in the rain. The nose swabbing briefly interrupted me doing deep spiritual work with a friend who has been hurt in a life event.

Monday: I will get a call somewhere in a day full of appointments letting me know what time to report on Tuesday. UPDATE: We check in at 9:45. For sake of my stomach this is not a good time. With an 8 hour no food order it will be a long time for breakfast.

Tuesday: My gall bladder extraction surgery will compete with teaching (by Zoom) my Boise Leadership Cohort and leading (by Zoom) an evening Q&R with the Leadership Development team at Reach Church, Kirkland. I am hoping the team can get a picture of my cancerous bush for me before they remove it. The surgery will be under full anesthesia out patient with no incision. Dr. Burt thinks it is early so the surgery and the chemo injection at the wound site will be the end of this cancer. UPDATE: The surgery is done and I am home, 5 1/2 hours after we left. Dr. Burt had to go deeper into the bladder wall to get all the cancer out so I had to come home what a catherter which is VERY annoying. Other than that I am doing well. Starting my day with 2 hours with the Boise Cohort before the surgery was a joy. I really shocked them when I joined after the surgery, but no longer as teacher.The is food and sleep in my near future! BTW, I did ask about the picture. I don’t yet know if he remembered to take it. Hope so. I will get the biopsy analysis when I meet with him next week.

Wednesday: A day full of faculty meetings and such. We’ll see how much I am up to doing. David (our son) and Zach will be with us for supper and bunking before their final Converge class.

Thursday: Normal activities will be spaced around a noon time MRI of my brain to see if the melanoma has metastasized there. The PET scan from a couple of weeks ago showed three metabolic hot spots (bladder, gall bladder and lungs) but it can’t differentiate cancer hot spots from thinking hot spots. So the MRI will answer Sherry’s burning question: “Does Gerry have a brain in his head??”. UPDATE: I have scientific proof – there is a brain in my head. Sherry’s follow up question came post MRI: “Is it functioning?”

Sherry will join me at 3:30 for an oncology consult with Dr. Mashru. He will give us a full layout of the melanoma in my lungs, immunology treatment with schedule and possible side effects. This will be a big relief to my “plan my life” personality! UPDATE: The MRI showed that there are two melanoma spots on my brain. This is not surprising since when melanoma moves brain, lungs and liver are common spots. They will do radiation on one of them. Immunotherapy for all the nodules, brain, lungs and the spot by the gall bladder. Schedule for treatment will be determined soon. I will do a full post after I digest the ream of information I have now. Sherry is “on pause” and I am still living God’s word to me: “this is not the end. Keep on with what you are doing.”

Friday: I will teach my all day Leaderhship Cohort theology class followed up with supper with Tim Dalrymple and Tucker Fleishman, third year cohorters flying in from Chicago and Las Vegas for their class.

Saturday: All day elder “attack” at Grace. It is really a bi-annual major strategic planning session.