Reflection

“Arriving at my hotel room in Princeton a short while later, I wept and wept for what I saw that day and all the people who had died, a final tally I didn’t yet know. All that I wanted was to be home and hug my family. The next morning, with air travel still grounded, I decided to get in my rental car and drive more than 13 hours straight home to be with my family.” — Michael D. Becker, A Walk with Purpose

Many Americans recall precisely what they were doing the morning of September 11, 2001. Still living in Chicago at the time, a business trip brought me to New York that fateful day.

We were in the process of buying a home in rural, beautiful Bucks County, Pennsylvania in connection with my new job. The home we just purchased was a quick 20-minute drive to the company’s headquarters in Princeton, New Jersey.

We didn’t appreciate that Bucks County was also a popular commuter town for New York City workers, which came in handy when I started working in NYC later in my career. People live in Bucks County because they prefer the aesthetics and/or the economics of living in the country, despite the hassles of commuting back-and-forth to NYC.

Nearly 3,000 people were killed in New York City, Washington, DC and outside of Shanksville, Pennsylvania during the Sept. 11 terror attacks. Our local community was hit hard, with the loss of 18 souls from Bucks County.

As a result, The Garden of Reflection 9-11 Memorial was created to remember and honor all of the victims from September 11, 2001. After years of fundraising and construction, the Memorial opened with a dedication ceremony in 2006.

The Garden of Reflection is a short distance from our house, so it is a favorite destination when I take our pup Humphrey for a walk. During most visits, it is merely a peaceful place for self-reflection that I enjoy immensely. As Confucius said, “By three methods may we learn wisdom: first, by reflection, which is the noblest; second, by imitation, which is the easiest; and third, by experience, which is the most bitter”.

“Twin Towers in Water” photograph © 2012 Michael D. Becker (www.michaeldbecker.com). Click image to enlarge.

On the anniversary of 9-11, however, the Memorial is a sacred place where people come together to honor, remember and celebrate the lives of all we lost. The grounds include all of the victims’ names etched in glass railings and twin lighted fountains reminiscent of the landmark Twin Towers that were destroyed in the attacks.

With a budding interest in photography, I attempted to capture the 9-11 Memorial at sunset in July 2012. It was a beautiful day, and I came fully prepared with a tripod, lens filters, and additional camera equipment.

I was pleasantly surprised after returning home and viewing the resulting photos on my computer screen. The setting sun was centered between the twin fountains and cast long, dark shadows that resembled the World Trade Center towers. The sun also nicely backlit the 18 local victims’ names etched in glass panels along the inner railing.

I’m not sure that I’ll ever fully grasp how the Sept. 11 terror attacks forever changed me. The sights, smells, and sounds of that day are permanently etched into my memory. One thing is certain—just like cancer, the events of 9-11 helped me to look at life in new ways and focused a spotlight on what really matters most.

Never forget.

First Vacation

The cover photo of my book, A Walk with Purpose, is an image of me hiking on the Iceline Trail located near Field, British Columbia in Yoho National Park. Linda Becker took it during our first family trip to the area back in September 1998.

Photo of my parents, Linda and Ted Becker, with baby Rosie taken during our 1998 family trip to Lake Louise.

When I decided to take a break from chemotherapy treatment in March 2018, my parents generously offered to include us in a trip they already had planned. Unfortunately, Lorie and our daughters weren’t able to go due to a variety of logistical issues.

It’s been nearly 20-years since that initial visit, but last Saturday I returned to Lake Louise, a hamlet in Banff National Park in the Canadian Rockies. I knew a week-long vacation with my parents, grandmother, and aunt would be therapeutic—and I wasn’t disappointed.

The trip was my first vacation since being diagnosed with Stage IV cancer in late 2015. Moreover, for the first time, the word “cancer” didn’t enter my thoughts with its usual frequency. Instead, I was able to relax and finally appreciate what people mean when they say “live in the moment.”

With the deleterious effects of chemotherapy fading, my appetite and stamina improved enough to feel confident in making the journey far from home. My hair has also returned, although I don’t recall it being quite so thin or silver. My eyebrows have grown back, and my eyelashes are slowly recovering as well. So, I no longer look like a fetus when I remove my glasses—which makes me happy.

Lake Louise looked very different from our prior visit during the autumn season, but still quite beautiful. The Rocky Mountain Fir, White Spruce, Tamarack Larch, and other native trees had green foliage instead of the yellow hues I recall. The mountain tops were blanketed in more snow. Most of the lakes were still frozen, and many trails were closed due to avalanche risk (including the Iceline Trail).

Fortunately, we were blessed with sunny skies and daily high temperatures above 70 degrees Fahrenheit (21 Celsius). A short-sleeve shirt was comfortable during most of the trip, although it seemed out of place given the wintry backdrop.

Aside from nature’s splendors and the fresh, crisp air, it was nice to spend quality time with my family. Nowadays, we mostly see each other around holidays, birthdays, and other events. However, the trip provided ample opportunity to converse without the hustle and bustle of food preparation, cleanup, etc.

It was one of the most prolonged periods of time away from Lorie and our girls, so I’m happy to be back home now. Next month, I will have my first CT scan since stopping chemotherapy, and it will be interesting to see how cancer has behaved (or not) during my respite. Regardless, I’m glad that I took some time to simply enjoy life and thankful that my parents made it possible.

PS – I placed a selection of photographs from the trip in a separate gallery that can be viewed by clicking here.

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Second Edition

In January 2017, I first started writing A Walk with Purpose. It was quite an undertaking. To make the endeavor more challenging, I was gravely concerned at the time that my health would deteriorate, and the manuscript wouldn’t get finished. With great urgency, I completed and published the first edition by the end of April 2017.

In October 2017, I released a slightly updated version. Since then, however, a lot has changed. Quite a lot, actually. Aside from my cancer journey, I’ve grown both as a writer and as an individual.

So, I recently dusted off my keyboard and began writing the second edition. My pup Humphrey was not amused that I spent many, many days locked in my home office writing again. But, I’m pleased to report that the “new” paperback and Amazon Kindle versions are available as of today (click here). Coincidentally, published almost precisely a year after the original release.

The second edition of A Walk with Purpose is mostly a rewrite. The ending reflects my situation as of the current day. Some text was removed to make room for newer information. Spelling and grammar checked (and rechecked). And much more.

I’m very proud of the second edition. It’s finally the story that I wanted to tell.

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Metaphors of Spring

Humphrey car surfing on the way to the park

One thing cancer has taught me is to seize even small moments to enjoy being alive. Today’s beautiful spring weather made it irresistible to take our Golden Retriever, Humphrey, for a walk at nearby Tyler State Park. I had plenty of other things to do, but surely they could wait. Cooler temperatures and rain were forecast for the coming days.

I witnessed so many metaphors for life, death, rebirth, and hope during the walk. And while I’ve been to the park numerous times, it was refreshing to view the landscape through a very different lens.

I came across a pair of mallards wait patiently for eggs to hatch. I looked at barren trees wondering if they were dead or alive in the absence of greenery. Bright yellow and purple colors appeared out of nowhere among a sea of dead grass and branches. I saw the pure happiness of our pup, who was excited just to be outside and experience the scents of the season.

While it’s been a long, cold winter, the arrival of spring signals relief. Flowers bloom, leaves grow, and nature comes alive again. Similarly, after much cold and suffering, my body and mind are starting to come back to life during a recent reprieve from toxic treatment.

And although the flowers start to bloom again, there are still chilly mornings and evenings that serve as a stark reminder that winter only recently passed. Summer is yet to come, but we’re not there yet. Today was just a glimpse.

Cancer survivors often worry about things to come. Nature, however, appears immune to this concern. The budding leaves and flowers don’t seem worried they won’t make it to blossom. The pair of ducks didn’t look panicked that they will find ample food and successfully raise their young. Nature didn’t appear to have a “plan B” if things didn’t work out this time. Nor do I.

Yes, today I appreciated spring’s arrival, and it brought me great happiness. More importantly, it made me anticipate the days ahead. The chance to explore new ideas and opportunities. An opportunity to start over and reinvent once again.

Just A Walk

Finally. The type of day that begs you to go outdoors. Sunny and warm, with just the hint of a breeze. Time to go outside and shake the winter blues. Just a walk; no purpose this time.

Usually, I would have traveled to NYC today for chemotherapy treatment at Memorial Sloan-Kettering Cancer Center (MSKCC). However, my recent hospital stay due to low white blood cell counts led my oncologist to postpone treatment for an extra week just to be safe.

Humphrey

I didn’t need to ask our three dogs if they were interested. As soon as I grabbed a leash, they all swarmed me like I was holding leftover steak. I used to be able to manage two at a time for a walk, but not anymore. Three guesses as to which one got to go first.

I’m not sure who is in worse shape – me or Humphrey. Before we embarked, I set my expectations low. If I could manage only a few blocks, then so be it.

As soon as we got out the door, the warm air and sun on my skin felt amazing. I wore a sweat jacket over a t-shirt but took it off after only a block or two. Before I knew it, Humphrey and I had made it to my stretch goal – the Garden of Reflection 9-11 Memorial. Approximately a 2-mile roundtrip walk from our house.

Humphrey

When we arrived back home, I was sweating and Humphrey didn’t stop panting for 30-minutes. Clearly, we need to do this more often.

They’re an increasingly rare event, but days like today when I’m both motivated and have energy are a blessing. Hopefully, tomorrow will be the same  and I can walk the other two pups!

My Valentine

Valentine card symbol – birds in love

Valentine’s Day is widely recognized as a day for celebrating romance, with people buying flowers, candy, jewelry and other gifts as a sign of love and devotion for their beloveds. While no one has pinpointed the exact origin of the holiday, its romantic association is apparently related to the time of year when birds choose their mates.

Regardless of its origin, Hallmark Cards began mass producing valentines in 1913 and February 14th hasn’t been quite the same since. But “Valentine” comes from the Latin word valentia, which means “strength” or “capacity,” and it’s those attributes that serve as the inspiration for this blog post.

It’s strange how certain moments can really stick in one’s mind. For me, one such memory is from the beginning of Deadpool, a 2016 American superhero film based on the Marvel Comics character of the same name. A comedy seemed appropriate, as I was undergoing initial cancer treatment at the time and needed a good laugh.

Watching the movie alone from the comfort of my home on cable television, there were many moments when I chuckled. However, one scene caught me off-guard. You see, after learning that he has advanced cancer, lead character Wade Wilson (Deadpool/Ryan Reynolds) breaks up with his fiancé Vanessa rather than subject her to life with a terminally ill man.

“Listen, we both know that cancer is a shit-show. Like a Yakov Smirnoff opening for the Spin Doctors at the Iowa State Fair shit-show. And under no circumstances will I take you to that show. I want you to remember me, not the ghost of Christmas me.”

“The worst part about cancer isn’t what it does to you… but what it does to the people you love.”

– Wade Wilson (Ryan Reynolds) in Deadpool

Sure, it was only a movie. But the dark cancer message “what it does to the people you love” haunted me for days. Would my wife and children actually be better off not being subjected to my forthcoming shit-show? It wasn’t just a Hollywood moment, but rather a genuine concern.

Studies have shown that wives who encountered the unexpected and uncontrollable situation of having a husband with diagnosed cancer experienced a multitude of coping difficulties. In addition, wives underwent psychological disorganization, disequilibrium, and emotional imbalance. Not surprisingly, they also reported that their children had coping difficulties. Partners of patients who are experiencing a recurrence of their illness or who are in the metastatic stage of the disease are more vulnerable to increased distress and problems of adjustment.

Yup, running away. Disappearing. Going off-the-grid so that no one could find me. Deteriorating, suffering, and ultimately dying alone. No record or witness for what I went through. Those who knew me would simply remember me for who I was, not what I had become – a terminally ill cancer patient. I foolishly gave it all serious consideration in the name of protecting my family. Acquiring superhero powers just didn’t seem as viable.

Fast-forward to today and clearly, I did the exact opposite of simply disappearing into obscurity. I started this blog, published my memoir, and became a vocal patient advocate. Through radio, television, and numerous articles and interviews, I helped increase awareness for the human papillomavirus (HPV), its link to cancer, and the importance of HPV vaccination. Knowing that I couldn’t shield my family from the shit-show, helping others avoid my plight seemed like the only logical alternative to extract some good from a bad situation.

I suspect many people on the outside will have strong opinions as to whether or not I made the right decision. Entering my third year of treatment, I can say that I’m still not completely sure. There is a long, long list of sights, sounds, and sadness during this period that I would gladly erase from my family’s memory. But there are also many good times that I truly treasure.

Fortunately, I had complete faith in my wife, Lorie. I knew her resolution, inner power and confidence, which I found attractive qualities from day one, would help get her through the shit-show. She possessed the requisite strength and capacity.

It has been anything but easy, yet I believe our relationship is even stronger now as a result of cancer. Or, perhaps Lorie is just experiencing the Florence Nightingale Effect, as she has become quite a skilled cancer caregiver.

As we approach Valentine’s Day (also her birthday!), a special “thank you” to Lorie for simultaneously juggling work, caregiving, housekeeping, raising our daughters, being a strong role model for them, managing our small petting zoo, and much, much more. Happy Birthday and Happy Valentine’s Day, Lorie! You didn’t deserve a front row seat at the shit-show and I’m very lucky to have you by my side.

Blogging for the Terminally Ill

The days preceding my periodic CT imaging sessions to determine if my cancer is regressing (good), progressing (bad), or unchanged are often very difficult for many other cancer patients and me. Stressing about the results won’t change the outcome, but that doesn’t stop me from mentally exploring all of the various scenarios. There’s even a term for it – scanxiety – coined by fellow cancer survivors.

Humphrey suffering from writer’s block

I find that writing helps keep my mind occupied during periods of scanxiety. Even when I am writing about cancer, the process of organizing my thoughts or researching a topic online is a welcome distraction that helps me pass the time.

So, this morning, I decided to Google “terminal cancer blogs” to research the writings of other cancer patients. I was looking for common themes among the multitude of cancers, not just my particular diagnosis. I was also generally curious how many “other” bloggers there are like me.

The exercise started innocently enough. Within 0.54 seconds, Google informed me of the approximate 580,000 search results. I clicked on the title of the first one that caught my eye – “Terminally Fabulous.” With a positive name like that, I hoped to find an inspirational blog.

Suddenly, I was engrossed in the life of Lisa Magill, a Brisbane, Australia woman who started her Terminally Fabulous blog in February 2016, three years after being diagnosed with an incurable rare form of stomach cancer at the age of 30. Ominously, the first thing I noticed upon visiting her blog was that the most recent post was from nearly a year ago (February 24, 2017). Only by following the link to the Terminally Fabulous page on Facebook did I learn that Lisa succumbed to her disease in early March 2017 at the age of 34.

Reading previous entries on Terminally Fabulous, I appreciated Lisa’s writing – full of humor, brutal honesty, and courage. In one entry, she referenced Emma Betts, a friend, cancer survivor and inspirational fellow blogger. Through her Dear Melanoma blog, Emma (like Lisa) shared her cancer journey to help educate others about the importance of cancer awareness and protection methods needed to help prevent melanoma. My heart sunk a little more profoundly after reading the opening text of the Dear Melanoma blog: “Hi, I’m Leon, Emma’s dad. By now I’m sure you’ve heard that Emma passed away in April 2017.” She was 25.

After visiting several more terminal cancer blogs from my Google search results, including The Death ProjectDarn Good Lemonade, Anna Swabey: Inside My Head, Tina’s Journey, Cancer in Context by Debra Sherman and others, the grim common theme became clear: Terminal cancer indicates a disease that will progress until death with near absolute certainty.

Yes – of course, there are always exceptions (and I still “hope” to be one…). Take blogger Sophie Sabbage, diagnosed on October 13, 2014, at the age of 48 with Stage 4 terminal cancer – multiple tumors in her lungs, lymph nodes, bones, and brain. According to a recent blog post from December 22, 2017, her brain scan showed EVERY tumor had gone except for an 8mm spot. She even states that her cautious oncologist called this “fantastic.” Twice.

What I learned is that more and more terminal cancer patients are placing their most private, personal journeys in this public and impersonal domain we call the Internet. Take some time to read these brave stories and embrace their author’s vulnerability. They serve to remind ALL of us that our time on this planet is limited and some even provide inspiration to lead happy and more meaningful lives as a result.

I hope to provide an update on my CT scan results early next week, so stay tuned…

Good Luck Charm?

It was July 18, 2017 when I started my third line of treatment (carboplatin/paclitaxel) for Stage IV squamous cell carcinoma of the head and neck. Things weren’t exactly going great at the time and I remember thinking that I wouldn’t make it until my 49th birthday in November.

For example, I had two chest tubes to manage a pleural effusion (buildup of fluid in the pleural lining of the lung). My tumors were slowly growing with each CT scan. Additionally, I had an IVC filter put in to manage clots since blood thinners had caused bleeding issues. I was a mess and in-and-out of the hospital constantly.

Earlier today, however, I received my third consecutive CT scan report since starting chemo again that showed further decreases in my lung, spleen, and pleural metastases (where the cancer had spread). It looks as though the cancer continues to respond to the treatment, which is great news.

It just goes to show the perils of trying to answer the question every cancer patient wants to know: How much more time do I have left? It doesn’t stop us from asking physicians, but as a dear friend consistently points out to me – you just have to live in the moment and enjoy every day. Much easier said than done, but sage advice nonetheless.

Our pup Humphrey

I can’t help but wonder if our 8-month old golden retriever puppy, Humphrey, is perhaps some kind of good luck charm? We got him about a month before I started treatment and things have been going relatively well since then. Not that we need another reason to love him! He’s such a clown, always making us laugh and smile. We love all of our other pets too, but there’s just something about Humphrey that makes him special. At the very least, he’s a great therapy dog for me.

In any event, today is a very good day. It will be nice to bask in the warmth of some good news as the colder weather of the season approaches.

Two Years Gone

You’ll know from the opening pages of my memoir A Walk with Purpose that it was the day before Thanksgiving in 2015 when I first discovered a large lump on the right side of my neck. The discovery catapulted me on a journey that I never could have imagined, full of twists and turns and changing the very fiber of my being—physically, emotionally and spiritually.

A lot has changed in the past two years—some good, some bad, some perhaps downright ugly. But Thanksgiving has always been one of my favorite holidays—a time of reflection and giving thanks for the goodness of the season past instead of complaining about what we don’t have.

Throughout the process of writing my memoir, I was constantly amazed to see how all the gifts and experiences of this world came together like tiny puzzle pieces to reveal the bigger purpose of my life. In particular, how an unlikely career path to the biotechnology industry would help forge key relationships, open new doors, and help me navigate a cancer diagnosis and treatment through the knowledge gained over decades of service and leadership. Most importantly, how I could use all of the aforementioned to help others facing head and neck cancer caused by the human papillomavirus (HPV).

In some ways, my revelation was reminiscent of the first time I saw the movie Signs written and directed by M. Night Shyamalan. In the movie, a father and former priest lives with his asthmatic son, his daughter who constantly leaves glasses of water sitting out around the house, and his younger brother, a failed minor league baseball player, on an isolated farm in Bucks County, Pennsylvania (coincidentally where we have lived for more than 15-years…). The father lost his faith and gave up his priesthood after his wife died in a local traffic accident. Towards the end of the movie, a crucial scene reveals the unlikely connection between asthma, glasses of water, and the mother’s final words to her husband instructing his brother to “swing away.” At the end of the movie, the father is shown returning to his priestly duties, apparently having regained his faith.

During 2017, I was fortunate to write and publish (then rewrite and republish…) my memoir. Since my diagnosis, I’ve also published a total of 70 posts (gulp!) on my patient blog. Supporting these efforts, I’ve worked with a publicist and conducted numerous interviews and penned guest editorials for various media outlets. All of these actions designed to: 1) help increase awareness of HPV and its link to six cancers in men and women; 2) underscore the need for additional prevention efforts for HPV-associated cancers, including efforts to increase vaccination coverage; 3) correct the misperception that HPV is mainly a disease affecting women; and, 4) highlight how HPV can be spread in the fluids of the mucosal membranes, which line the mouth, throat and genital tracts. Looking back at my efforts, I hope you’ll agree it has been a productive year.

I’m currently going through my third treatment regimen (chemotherapy) with the simple hope of buying more time. My body is weary from repeated assault with toxic chemicals aimed to keep the cancer at bay—hoping to see the day when a better treatment option becomes available. Fortunately, my current quality of life allows me to continue my walk with purpose. In fact, today I am doing a couple of media interviews and meeting with a head and neck cancer patient support group in Princeton, New Jersey.

My next CT scan has been scheduled for the last week of November. The results of which will inform whether or not my cancer continues to shrink, stays stable, or is progressing. Regardless of the outcome, I strive to simply live in the moment and take advantage of the Thanksgiving period to consider how we can spread more happiness around, to look back at all the great memories and good people who came into our lives.

May the good things of life be yours in abundance not only during November but throughout the coming year. Thank you to everyone with an interest in my story for your continued support and for keeping in touch!

The Role of Social Media in Cancer Care

Possibly due to my early days of computer programming and/or work creating one of the first brokerage firm websites, I recognized very early on the power of the Internet to connect people. When I first started my cancer patient blog in December 2015, it was mainly an efficient tool for me to keep family and friends updated on my health. However, I quickly realized that social media (e.g., Twitter, Facebook, Instagram, blogging) also afforded me the opportunity to provide unprecedented access to my personal experience as a terminal cancer patient. In doing so, I felt that my insight could be beneficial to others dealing with a head/neck cancer diagnosis and the effects of treatment. Importantly, I hoped that sharing my story could also help create awareness for the cause of my cancer (human papillomavirus, or HPV) and how today’s vaccines can prevent it.

Writing about my cancer experience is cathartic and that alone made all of the blog posts, Tweets, Instagram images, and Facebook entries seem worthwhile. What I didn’t expect was how my social media activities actually helped me deal with my own cancer diagnosis. Accordingly, the purpose of this blog post is to highlight some of these interactions with the hope that other cancer survivors find similar ways to derive benefits from social media.

For example, some people have a talent for making new friends. Unfortunately, not everyone is born with the gift—including me (yes, it’s true). Some side-effects associated with cancer and its treatment make this situation even more difficult. Being fatigued and depressed can lead to a lot of time being secluded in one’s own home—not working and feeling isolated and alone. The ability to meet new people and establish relationships can be enhanced through social media and other Internet activities.

In this regard, I’ve been fortunate to have met several Twitter acquaintances during their visits to the East Coast from as far as Buenos Aires, Argentina (@BursatilBiotech), the Pacific Northwest (@SheffStation), and Lenexa, Kansas (@bradloncar). Meeting individuals in person was an unexpected yet pleasant surprise in view of today’s digital communication era. Of course, it doesn’t hurt that our family’s latest animal addition, a golden retriever puppy named Humphrey, has attracted his own cult following on social media.

Lorie and Michael Becker – click to enlarge (photograph by Paul Reitano)

In late September 2017, I received an unsolicited email from fellow head/neck cancer survivor Paul Reitano. His surgical oncologist had posted a story about me on Facebook that led him to both my book and blog. Beyond our shared cancer background, we both enjoy photography and Paul wanted to include me in his personal project regarding portraits of cancer survivors. We set a date for early October when he was in town and spent the better part of a beautiful autumn day talking about common interests as he clicked the shutter on his camera. By late afternoon, we were like old friends even though we had just met. Among many excellent captures, Paul took a beautiful photo of me and my wife, Lorie, that we treasure. Aside from an array of gorgeous photos, Paul and I keep in touch and it has been great to have another head/neck cancer survivor in my life.

More recently, I had the pleasure of connecting with another head/neck cancer survivor, Jason Mendelsohn, through social media. Jason was recently the subject of a NBC news segment reporting on the silent epidemic of HPV-related cancers among men. Like me, Jason is determined to help others by sharing his story and experience through his blog.

Another unexpected benefit from social media is the support from reporters and related contacts I’ve developed throughout my career or who have recently covered my cancer story. One of the more memorable experiences was when @adamfeuerstein dedicated his 2017 Pan-Mass Challenge (PMC) ride to me as a token of his support over the summer. PMC raises money for life-saving cancer research and treatment at Dana-Farber Cancer Institute through an annual bike-a-thon that crosses the Commonwealth of Massachusetts. Through social media, I’ve also been fortunate to make several new media connections, such as @BiotechSusan, editor of BioCentury, and @JohnCendpts, co-founder of Endpoints News, among many others.

Social media can also be a means for health education and public messaging. Through Tweets and sharing articles, I’ve enjoyed being able to help correct the popular misconception that HPV vaccination is only for girls and cervical cancer. Creating awareness about HPV’s link to six different cancers and the proven safety/benefits of HPV vaccination for both boys and girls is one of my personal goals, which has been enhanced through my participation in social media.

The role for social media in cancer care is embryonic and evolving, but my experience thus far suggests that there are many potential benefits. There are, of course, certain challenges, not the least of which includes the potential for sharing inaccurate medical information and the lack of privacy and confidentiality when discussing deeply personal situations.

As an example of both, one need look no further than Michael Douglas’ revelation in 2013 that his cancer may have been caused by performing oral sex has and the resulting embarrassment caused to his wife, Catherine Zeta-Jones. In fact, only a few studies have looked at how people get oral HPV, and some show conflicting results. Some studies suggest that oral HPV may be passed on during oral sex (from mouth-to-genital or mouth-to-anus contact) or open-mouthed kissing; others do not. The likelihood of getting HPV from kissing or having oral sex with someone who has HPV is not known. According to the Centers for Disease Control and Prevention (CDC), more research is needed to understand exactly how people get and give oral HPV infections.

Perhaps the world just wasn’t ready to hear about the links between oral sex, HPV and head/neck cancer at the time, but fast forward to today and Michael Douglas’ story may have helped create greater awareness and a sense of urgency to better treat and prevent what is becoming the one type of oral cancer whose numbers are climbing, especially among men in the prime of their lives. The world could use more support from celebrities affected by HPV and cancer to further increase awareness and/or raise research funds for new treatments and diagnostics.

In view of growing use, researching and defining the role for social media in cancer care represents an important area of unmet need. Certainly, this is a subject that merits further investigation and could be an interesting workshop at an upcoming major medical conference, such as the American Society of Clinical Oncology (ASCO) annual meeting. In the meantime, thank you to ALL of my social media connections who help make the world seem a bit smaller and a whole lot brighter!

Meeting a Fan

A couple of weeks ago, I received an unsolicited message on LinkedIn from a young woman we’ll call “Mary” for the sake of anonymity. Like me, Mary is extremely passionate about the biotechnology industry and she works as a scientist in the lab at a local company.

In her message, Mary stated that she recently read my memoir and found the story to be moving. She offered to meet for coffee and expressed an interest in hearing more about my career path. Knowing that I’m going through chemotherapy, she completely understood if I wasn’t up for meeting, but stated that she “couldn’t pass up the opportunity to ask, as she was so inspired by my work.”

How do you say “no” to that? It isn’t every day that a fan reaches out to me requesting to meet (in fact, this was a first), so I was quite flattered. We settled on a date and time to meet for coffee in downtown Yardley, PA that worked for our respective schedules.

I informed my family about the upcoming meeting with Mary and they reacted as one would expect. Who is this person? Why does she want to meet? She could be a homicidal maniac, etc. Obviously, they were just being protective and looking out for my best interests. After all, I’ll admit that my mind wandered ever so briefly to Stephen King’s 1987 novel Misery about a psychotic fan who holds an author captive and forces him to write her stories.

I arrived at the coffee shop first and attempted the daunting task of identifying Mary solely on the basis of her LinkedIn profile picture. Instead, she instantly recognized me (not too difficult given my recent “bald head and bold eyeglass” look) and came over to say hello. I admit to a certain sense of relief that she looked nothing like Kathy Bates who played the psychopathic Annie Wilkes in the film version of Misery.

We ordered drinks and sat at a quiet table in the back of the shop. What ensued was a lovely conversation about my background and our mutual interest in the exciting biotechnology industry. It was clear that we were both bitten by the biotechnology bug and it was nice to exchange thoughts and perspectives about the field.

When asked, Mary shared that she was introduced to my memoir by a college professor at a prestigious university where she is participating in an online degree program. Apparently, the professor suggested the book to his class and others were reading it as well.

My ego sufficiently bloated, I asked Mary to provide me with the professor’s contact information so that I could at least thank him for recommending my book, which she did. I sent out the note without even making the connection that the professor and I had several prior exchanges on social media and that he was also a research scientist at the National Institutes of Health (NIH). He promptly responded and reminded me of the connection. What a small world after all…

The meeting with Mary at the coffeehouse lasted an hour and a half, but it went by quickly and felt much shorter. However, the high from interacting with a “fan” lasted a lot longer and inspired me to get out more often and meet with others who have an interest in my story. This could be via book signings, meeting with book groups, speaking at events, etc.

When I wrote A Walk with Purpose: Memoir of a Bioentrepreneur, it was with a historical perspective of my life’s journey. But I’m continually amazed to see that my walk and purpose are not yet complete. For example, at first I was humbled every time I learned that my book inspired a parent to reconsider vaccinating their child against human papillomavirus (HPV). Now, through my brief exchange with Mary, I have also witnessed how the book can ignite and/or reinforce one’s interest in the exciting field of biotechnology.

So, thank you Mary…and all of the others who have taken the time to share how my book has positively influenced them. Each of you inspire me to continue my walk with purpose!

The Space Between

The purpose of my blog and entries is multifaceted. Some are designed to entertain, while others focus on education and enlightenment for those suffering from cancer and the people who surround them. Others are simply updates on my disease for family and friends.

I don’t consider myself an optimist or pessimist, but rather a realist. Accordingly, I prefer to let the facts in my blog speak for themselves and let you, the reader, decide if the glass is half full or half empty.

For me, life is usually viewed in absolutes. Things are either black or white; rarely, if ever, shades of gray. And I like it this way…nice and neat. This is probably why uncertainty, which falls into the shades of gray zone, doesn’t sit well with me. Unfortunately, living with a terminal cancer diagnosis introduces a fair amount of uncertainty – almost from day one.

It starts with waiting for the initial diagnosis. Is it cancer or not? Usually this is a black or white analysis. The diagnosis of cancer then leads to a myriad of uncertainties. The patient wants to know details about the treatment options, their side effects and quality of life, and whether the potential for cure exists. Lots of gray zone issues suddenly appear.

Although clearly outside of my comfort zone, I’ve been able to successfully navigate the sea of uncertainties for the past two years with one notable exception: how much time do I have remaining? Or at the very least, how much time remaining where my quality of life allows me to function as a productive member of society?

Right now, life isn’t horrible. Sure, I suffer side effects from weekly chemotherapy treatment, such as loss of appetite and fatigue. And I lost my hair but save a ton of money on haircuts and shampoo. Nevertheless, I’m able to enjoy time with family and friends and keep busy with my mission to help raise awareness of the human papillomavirus (HPV), six cancers that are directly linked to HPV, and the available vaccines that could prevent such cancers for others in the future.

Enduring weekly chemotherapy is made easier given the fact that my tumors decreased in size according to my last imaging procedure. Exactly what the tumor regression means in terms of extending my life is unknown. Reality check – published scientific literature still favors that celebrating the New Year isn’t a likely event for me.

However, every patient is different – and there is one absolute truth in life: no one knows exactly when or how they will die. While perhaps the exception versus the norm, we’ve all heard dramatic stories about people living longer than originally expected. My realist nature makes me reject such anecdotes, but it does allow me to consider the fact that progress in treating cancer is advancing at a rapid pace and perhaps my existing treatments will buy me just enough time to receive some new exciting approach that keeps my disease in check.

In the interim, my greatest challenge is what to do with the “space between.” I’m talking about the period between now and when I eventually die, which could be measured in as little as one, two, or three months or as many as several years. No one knows for sure.

For example, I could start to write a new book. Although having recently gone through that process, it is a tremendous investment of time and focus away from spending quality time with family and friends. While it could be a worthwhile sacrifice, I just couldn’t bear the thought of embarking down that road again without knowing that I had sufficient time to finish it.

My other passion, photography, is made challenging since I really don’t know how much energy or how I’m going to be feeling on any given day. This makes scheduling photo sessions weeks in advance to allow adequate preparation time a risky proposition at best. For example, I never could have predicted ending up in the hospital on three separate occasions in July/August (including a trip to the intensive care unit). While life has been quite calm as of late (thank goodness…) there is always the chance that something else is lurking around the corner.

Besides, I was already able to complete two significant bucket-list items this year with the publication of both my memoir A Walk with Purpose and large format, high-quality, coffee table photography book, Strength, Confidence, & Beauty. In the near future, could I really top what I’ve already accomplished in each area?

Equally important to projects that produce legacy materials of a life well-lived, there is that pesky task of providing income to help support my family. I haven’t quite found an appropriate place on my resume for “terminal cancer patient” and I suspect few employers would find that an attractive attribute. On the flip side, freelance work or part-time positions might be workable solutions.

Don’t get me wrong, I’m not laying on the couch every day pondering the “space between” and wallowing in depression. I’ve been keeping plenty busy promoting my books and taking advantage of the plethora of amazing media outlets that express an interest in helping me with my HPV awareness mission. Perhaps that is simply how I’m meant to fill the space between?

At first, I thought if I could simply touch one person’s life through my efforts then I made a difference. But I’ve been inundated with messages from family, friends, and complete strangers who share personal stories about having their children vaccinated for HPV as a direct result of my efforts. Is there anything else I could do that would be as gratifying?

If you or a loved one is affected by cancer, I’d love to hear how you deal with the space between. Rather than messaging me directly, please feel free to comment on this post so that others can benefit from your shared experience.

Thankful for Cancer?

In recent blog posts, I discussed my interest in trying new things, such as transcendental meditation, acupuncture, sound therapy, etc. I connected with other terminal cancer patients and found that some of them were pursuing similar avenues.

Through these interactions, I was introduced and started reading The Tibetan Book of Living and Dying by Sogyal Rinpoche, Patrick D. Gaffney, and Andrew Harvey (thank you @StacieChevrier). I haven’t read much of the book yet, but so far it is chock full of valuable insights and memorable quotes. For example:

“Tibetan Buddhists believe that illnesses like cancer can be a warning, to remind us that we have been neglecting deep aspects of our being, such as our spiritual needs. If we take this warning seriously and change fundamentally the direction of our lives, there is a very real hope for healing not only our body, but our whole being.”

The quote implies that cancer could actually be a good thing. Similarly, in the past I’ve come across posts from other cancer survivors talking about the various ways they were actually “thankful” for getting cancer. I must admit, at the time I found such notions absolutely ludicrous. I certainly wasn’t thankful for having cancer. F@ck cancer!

However, I am starting to perhaps better understand and appreciate the nature of such remarks. For example, as stated in the quote above “…cancer can be a warning, to remind us that we have been neglecting deep aspects of our being.”

In the past, I was very skeptical of meditation, acupuncture, and other spiritual needs. Cancer opened my eyes to at least try new techniques, and now I am a believer and realize the void that they can fill.

By writing and publishing my memoir A Walk with Purpose along with my photography book Strength, Confidence & Beauty: A Collection of Female Portraits, I learned a lot about myself and my life’s journey. Tackling these activities were always in the back of my mind, but somehow there was never enough time to focus on them. Cancer provided both the motivation and a sense of urgency.

Left to right: Michael, Sheff, Brad (and, of course, Humphrey). Click to enlarge.

Through my cancer diagnosis, I also started connecting with amazing individuals and received overwhelming support from mere acquaintances to complete strangers. Just yesterday, a few of my Twitter buddies (@bradloncar and @SheffStation) made the long trip to rural Pennsylvania just to spend some quality time together. To be fair, it’s completely possible they just came to see our new adorable puppy Humphrey – but, hey, I’ll still take it. (In all seriousness, many thanks to Brad, Sheff, and others that have visited in recent weeks and months!)

I learned to “live in the moment,” appreciate the little things, and slow my life down a bit. Of course, some of this didn’t come by choice, but rather the diminished energy and fatigue of battling cancer.

Before cancer, I was wandering aimlessly with no real goal in life other than a desire for material wealth. Now, I am on a mission – to raise awareness of the human papillomavirus (HPV) and its link to six different cancers with the hope of getting more children vaccinated so they don’t suffer my same fate. I am someone with a deep motivation, a purpose in life, a definite direction, and an overpowering conviction that there will be a reward at the end of it all.

And so, I asked myself: “Am I thankful for getting cancer?” At this point, the fears and future uncertainties prevent me from answering with a resounding “yes.” But, I am warming up to the idea that cancer has changed me for the better, and for that – it is hard not to be thankful.

Puppy Power

I am often asked how I stay upbeat and positive in the face of a terminal cancer diagnosis. Keeping busy/distracted and trying new things are definitely key pieces of advice I would offer fellow survivors.

Recently, I started acupuncture and sound therapy with Sharon Czebotar. I was skeptical about acupuncture until being offered the service while inpatient at the NIH. I found the therapy helped with appetite, neuropathy, and more, which convinced me to search out a local expert. Sharon has been simply amazing and she also recommended a separate class on transcendental meditation, which I start next weekend.

Of course, writing has also been cathartic for me. With my memoir now published (phew!), I can focus again on updating this blog more frequently.

Michael Becker holding a 7-week old golden retriever puppy

Whenever my wife Lorie or I start getting a little depressed or down, she redirects the conversation to “happier topics” – and quickly rattles off puppies, kittens, rainbows, and unicorns. Of the four options, I found puppies the easiest to embrace and acquire. So, next weekend we pickup an 8-week old golden retriever puppy to add to our small zoo.

Other than getting one of the 4 males out of the litter of 11 puppies, we don’t know which one will get his forever home with us as of yet. However, we’ve visited the litter on three separate occasions and to be honest – they all seem great.

Let’s face it…you would have to try REALLY hard not to smile with a puppy licking your ear.

On a Happier Note

The last few posts have been downers, so I wanted to share one of my happier, recent moments.

While I am far from an avid hiker, I do enjoy the activity and some of my fondest memories are from a several day journey up a nearby section of the Appalachian Trail/A.T. (starting in the Delaware Water Gap). Another favorite hike was in Yolo National Park, British Columbia, during a family trip.

My youngest daughter, Meg, sensing my zeal to hike once again, prodded me to take her hiking this weekend. I told her that she’d need the proper shoes/boots and that it would be cold, so she’d have to dress warm. We went shopping to pickup a pair of hiking boots and made plans to leave early Saturday morning. I was so excited!

We left mid-morning and it was a truly magical time. When we arrived at the Delaware Water Gap (much closer to us than British Columbia…), the forest was so quiet – you could not hear a sound. There was no breeze, so the 30 degree fahrenheit temperature didn’t feel “too” bad. Fortunately my thoughtful wife planned ahead and bought me a hat to bring, which I did. I never wear hats in the winter. I was glad I did today!

I pointed out the white “blazes,” or rectangles of white paint 2 inches wide x 6 inches high, to Meg as we walked along the trail for a few miles. The A.T. is marked for daylight travel in both directions using this system of blazes that are found on trees, posts, and rocks. One thing we did not expect to find was a small rock garden with carefully balanced stones. It was remarkable and in the middle of nowhere. With greater respect than when entering a church in the middle of a service, we carefully navigated to the center of the rock garden – careful not to bump any stones lest we incur the wrath of the Blair Witch Project.

Towards the end of our journey, it began to snow. The perfect ending to a perfect time. Rather than writing words to describe the day more, here is a small photo collection:

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Thankful

It’s that time of year again; where we get together with family and friends to celebrate the Thanksgiving holiday. It is also a time for reflection and appreciation, which has even greater meaning for me this year.

It was the day before the Thanksgiving holiday in 2015 when I first discovered a suspicious lump protruding from the right side of my neck. The formal diagnosis of Stage IV oropharyngeal cancer would occur several weeks later, but I knew at the time that the palpable growth just below my jaw line was anything but benign.

As a senior executive working in the field of biotechnology, and in particular the area of oncology, being diagnosed with cancer was difficult – but hearing “Stage 4” was especially disheartening. While staging systems are specific for each type of cancer, in general the cancer stage refers to the size and extent of the disease and is assigned a number from 1 to 4. If my cancer was confined to the right tonsil (where it started…) and hadn’t spread elsewhere, I would have been diagnosed with Stage 1 disease. Localized spreading would have been Stage 2 and depending on the extent of involvement of nearby lymph nodes – progress to Stage 3. When cancer has metastasized, or spread to other organs or throughout the body, it can be classified as Stage 4 and may also be called advanced or metastatic cancer. Stage 4 usually carries a grim prognosis compared to earlier stages of the disease.

Accordingly, when one is diagnosed with Stage 4 cancer, the immediate concern is whether or not the individual will be able to survive the disease. For me, however, the bigger concern was surviving the treatments and their side effects. In particular, my experience licensing and launching a product to treat oral mucositis made me very familiar with this debilitating side effect from both radiation and chemotherapy.

When reviewing treatment options with Dr. David Pfister, my medical oncologist at Memorial Sloan-Kettering Cancer Center (MSKCC), I was really hoping that I would be a candidate for recent advances, such as biologic agents and immunotherapies. This was due to my familiarity with their targeted and less toxic profiles, especially when compared with chemotherapy and radiation. In fact, back in early April 2010 I published a 150-page industry report titled “Cancer Vaccine Therapies: Failures and Future Opportunities” and later that year held the inaugural “Cancer Immunotherapy: A Long-Awaited Reality” conference that took place at the New York Academy of Medicine in New York. For more information and background on immunotherapy, read “Insight: Training immune system to fight cancer comes of age” by Bill Berkrot of Reuters.

Unfortunately, approved targeted agents like Erbitux® (cetuximab) still require combination with radiation therapy and its associated side effects. Immunotherapies, such as Opdivo® (nivolumab) and Keytruda® (pembrolizumab) were only recently approved by the FDA to treat head and neck cancer, but their initial indications are limited to patients with disease progression during or after chemotherapy. I remain hopeful that use of these and other new agents will expand to newly-diagnosed patients going forward and that ultimately we no longer rely upon chemotherapy or radiation to treat this disease.

Nonetheless, it is encouraging to see two new drugs approved to treat head and neck cancer this year and know that there are options for me in the unfortunate event that my disease returns. In this regard, I was glad to help ring the Nasdaq Stock Market Opening Bell last month to celebrate cancer immunotherapy advances and the one-year listing anniversary of the Loncar Cancer Immunotherapy ETF (Ticker: CNCR). I first met Brad Loncar (@bradloncar on Twitter), Chief Executive Officer of Loncar Investments, at my inaugural cancer immunotherapy conference and he was kind enough to extend me an invitation to the Nasdaq event.

Photograph by Christopher Galluzzo / @NASDAQ
Jill O’Donnell-Tormey, Ph.D., CEO and Director of Scientific Affairs of the Cancer Research Institute, Brad Loncar, Chief Executive Officer of Loncar Investments, and Michael Becker. Photograph by Christopher Galluzzo / NASDAQ

Ultimately, I went through seven weeks of daily radiation and three cycles of chemotherapy at the start of this year, which as actor Michael Douglas was quoted “somehow seemed very accurately mapped to the seven circles of hell.” In 2010, Michael Douglas was also diagnosed with Stage 4 oropharyngeal cancer and went through the same treatment regimen at MSKCC in New York.

So, while this year started off rough (understatement), I am extremely lucky and thankful to have no evidence of cancer following treatment and to finally be free of “most” of the debilitating side effects from therapy. For example, in recent months I have noticed a dramatic improvement in both energy level and saliva output and have started to reverse a 40-pound decline in weight I experienced during and after treatment.

Aside from eternal gratitude for my wife and daughters’ love and support throughout the process, I would like to extend a special thanks to all of the healthcare providers at MSKCC for their superb care. From my “dream team” consisting of medical oncologist Dr. David Pfister, radiation oncologist Dr. Nancy Lee, and surgeon Dr. Benjamin Roman to amazing nurse practitioner Nicole Leonhart and all of the others who cared for me. I wouldn’t be here today without you!

Photo of Michael Becker and Dr. Nancy Lee
Photograph of Michael Becker with radiation oncologist Dr. Nancy Lee of Memorial Sloan-Kettering Cancer Center (MSKCC) taken November 18, 2016

For my family, friends, and colleagues – too numerous to name – thank you again to EVERYONE that helped in some way…the thoughts, emails, prayer chains, food deliveries, financial support, hospital visits, etc. were all greatly appreciated.

My next PET scan is scheduled for early February 2017 and I hope to report that all remains clear around that time.

PS – as a native of Chicago and loyal fan, I am also thankful to have witnessed the Cubs baseball team winning the World Series for the first time in 108 years in 2016! Go Cubs Go!

Visit Home Cut Short

A repeat of my bloodwork confirmed that the elevated serum creatinine levels were a concern regarding my kidney function, so the physicians ordered more intravenous hydration with saline and potassium to flush them out. As mentioned in my prior post, this is a common issue with chemotherapy (cisplatin).

They originally wanted to do the hydration Friday late afternoon. Unfortunately, that would have interfered with my getting back to Pennsylvania in time to see Megan before her Freshman formal dance. After explaining the situation, they came up with the solution of hydrating Saturday instead. While this would allow me to see Meg, it made for a short trip to Pennsylvania before heading back to NYC.

Michael And Megan Becker photographed by Saron Mastrosimone
Michael And Megan Becker photographed by Sharon Mastrosimone

It was definitely worth the short trip. Our friend and fellow photographer Sharon Mastrosimone was kind enough to come over and take pictures before the dance. The image in this blog post is one of my favorites and alone made the night worthwhile. Many thanks Sharon!

So, here I sit at MSKCC with Lorie getting hydration on a Saturday afternoon instead of being back home in Pennsylvania. But I’m doing it with a smile on my face looking at pictures from last night. Megan looked beautiful and I’m so glad I was able to be there.

Reunited

When I first licensed the North American marketing rights to Caphosol® in October 2006 (see press release), I had no idea that nearly a decade later I would be a customer. The product is intended to treat some of the common side effects from cancer chemotherapy and radiation – both oral mucositis (inflammation of the mucous membranes in the mouth with symptoms ranging from redness to severe ulcerations) and xerostomia (dry mouth). While these side effects can occur as a result of various treatments, they are particularly prevalent in head and neck cancer patients undergoing chemoradiation like me.

Michael Becker and the oral mucositis and xerostomia treatment Caphosol
Michael Becker reunited with the oral mucositis and xerostomia treatment Caphosol (click to enlarge)

It was disheartening that so many years after its commercial introduction, no physician I spoke with had heard of Caphosol. After a fair amount of nagging and discussion, I was finally able to secure a prescription this week and locate a pharmacy that carried the product in advance of starting treatment this Monday (special shout out to my wife, former colleague June, and her colleague Ken for their assistance in this regard!). This is important, as one the key clinical studies supporting Caphosol’s efficacy incorporated the product at the start of therapy.  In other words, Caphosol was used before the incidence of oral mucositis or xerostomia – as a preventative therapy. The trial demonstrated that Caphosol was able to reduce the severity of oral mucositis, decrease pain and associated use of opioid analgesics, and reduce the days of neutropenia (abnormally low concentration of white blood cells in the blood) – see journal abstract from the study.

To be perfectly clear – I have absolutely no financial interest in Caphosol. However, I am a believer in the product and did extensive due diligence as part of the licensing process. As a result, I hope that this blog post can help other patients at risk for oral mucositis and/or xerostomia learn about Caphosol. While there are other agents used in the treatment of oral mucositis and xerostomia, Caphosol is unique in that the product’s efficacy was demonstrated in a randomized, placebo-controlled clinical study. Perhaps the most significant distinguishing feature of Caphosol is the high concentrations of calcium and phosphate ions. Why is this important? Calcium ions play a crucial role in several aspects of the inflammatory process, the blood clotting cascade, and tissue repair, and phosphate ions may be a valuable supplemental source of phosphates for damaged mucosal surfaces. No other product on the U.S. market is formulated this way or has the proven clinical benefit that Caphosol does.

As you can see in the accompanying image, Caphosol is supplied in a carton with 30 doses.  A dose is comprised of two ampules of aqueous solutions, one containing a phosphate solution and the other containing the calcium solution.  The two solutions are combined in a glass and patients are instructed to swish the resulting mixture in the mouth thoroughly and then expectorate (spit out).  This process can be repeated 2-10 times per day, although four doses per day is what was used in the clinical trial.

I will report on my experience with Caphosol (good, bad, or indifferent) throughout my chemoradiation treatment over the next 6-7 weeks.  My first round of chemotherapy and radiation therapy starts this Monday and Tuesday.  As the treatments occupy most the day, it may not be until later this week that I post any blog updates.

Pointillism

One of my wife’s favorite artists is Georges Seurat, a French post-Impressionist painter known for his role in devising the painting technique called “pointillism.” This technique uses small, distinct dots of color that are applied in patterns to form an image. Looking at such a painting from afar, our eyes and brains blend all of the dots of color into a fuller range of tones that then form an image.

Yesterday’s meeting with the radiation oncology team at Memorial Sloan-Kettering reminded me of pointillism. Prior to the visit, I saw the complete picture from afar – it would be 6-7 weeks of treatment and the associated side effects, but there was the prospect of being cured by the end.  After the meeting, however, I started seeing the hundreds or thousands of individual dots of color that represented my treatment.

IMRT mask
Example of the type of mask used during radiation therapy for head & neck cancer

For example, during the day they created the “mask” that will be used to keep my head and shoulders in the exact same place for my daily (Mon-Fri) radiation treatment. The mask is secured where you lay and prevents any movement of the head and shoulders (see example image). Unlike the older masks, there is a cutout for your eyes, nose, and mouth but coverage of the jaw largely prevents you from speaking. Frankly, it is terrifying! They did three imaging procedures in the afternoon (MRI, CT, and PET) and each one involved the mask being worn for about 30-minutes. Each time I was rolled into the imaging tube, I couldn’t help but think – what happens if I start coughing or choking? With my jaw immobilized I wouldn’t be able to do much. Trying to get past that fear, I quickly realized – wearing the mask would become a daily routine for the next 6-7 weeks.

The side effects of radiation therapy were another one of the individual dots of color that came into focus as I looked more closely at my treatment “image.” I’ve lost count of how many physicians and nurses have told me to “bulk up” now before starting therapy. Gain 10 pounds or more they say. This is due to the fact that in a few weeks it will be difficult to chew, swallow, etc. as a result of oral mucositis and dry mouth from the radiation therapy. As a result, weight loss and fatigue are to be expected.

During the day, I enrolled in two clinical trials – one for imaging and another for blood tests.  The imaging study looks at levels of oxygen deficiency (hypoxia) in the tumor tissue. Hypoxic tumor cells are resistant to radiation and to many anticancer drugs and therefore tumor hypoxia influences the outcome of treatment with radiotherapy, chemotherapy and even surgery.  The hope is that ruling out hypoxia in the area of the tumor could reduce the amount of radiation therapy needed to cure the disease – and thus reduce side effects. The blood test can be viewed as a type of “liquid biopsy” that detects circulating tumor cells and fragments of tumor DNA that are shed into the blood from the primary tumor and from metastatic sites. Changes in these markers may be able to predict the likelihood of disease recurrence after therapy.

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The doctor uses a flexible, lighted tube called an endoscope to examine areas of the head and neck that are less accessible. The tube is inserted through the nose after applying a topical anesthetic (lidocaine – applied directly to the nose and throat) to make the examination more comfortable.

It was a very long day with my first appointment starting at 9am and not finishing until around 6pm, but aside from the aforementioned and putting aside more poking and prodding (including my fourth endoscope procedure – see tiny camera getting stuck up my nose in the embedded image…), by the end of the day I felt somewhat better knowing the timeframe for starting radiation treatment, which looks like it will be Monday, January 18. In addition, I felt much better after meeting my radiation oncologist Dr. Nancy Lee (you can watch a video interview with her under the “Videos” menu tab at the top of my blog). She is fantastic! I have a follow-up appointment with my medical oncologist this Thursday, where I will learn more about the timing for starting chemotherapy.

Since I couldn’t eat all day due to potential interference with the imaging tests, the best part of the day was grabbing a quick dinner in NYC with my wife before taking the train back to Pennsylvania. It is so great having her by my side during this ordeal!

The Impatient Patient

One of the hardest aspects of having my particular type of cancer is the fact that it has spread to a cervical lymph node on my neck that is both visible and palpable.  I am reminded of the disease every time I look in the mirror or place my hand on the area. As a result, I am quite anxious to get started with treatment despite the associated side effects. I just want it gone – now!  Christmas day will be exactly one month since I first discovered the growth and I cannot help but feel that the cancer is being given too much time to grow and spread.

Michael_Becker_Cancer
click to enlarge

I mistakenly envisioned that following a “formal” cancer diagnoses (which itself takes some time waiting for biopsy and imaging results…), a SWAT team of physicians rushed in to promptly start therapy.  In reality, however, it can take weeks to schedule appointments with some doctors.  For some procedures, such as radiation therapy with IMRT, the process also involves complex treatment planning to deliver dose to the tumor and spare normal tissue and getting fitted for a special reinforced thermoplastic mask to hold the patient within a few millimeters for consistency each day of therapy.

Michael_Becker_Cancer_PET
click to enlarge

Upon starting daily radiation and chemotherapy, I plan on doing a series of self-portraits to document the associated changes in physical appearance over the 7-week treatment cycle.  In preparation, I took a self-portrait today so that you can see the difference in size between the right side of my neck (blue lighting; site of the cancerous lymph node) and the left side (red lighting; normal side).

To help put this in perspective, I also included a comparable image from my recent PET scan that shows the relevant lymph node as a highlighted/glowing mass in the same general area. In case you were wondering or alarmed – no, I don’t have brain cancer.  The brain also lights up on a PET scan in extremely intelligent individuals.  Just kidding – the brain always lights up as glucose is the predominant substrate for brain metabolism and PET imaging utilizes radiolabeled glucose.