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!

Looking Over Your Shoulder

CancerAs I approach the five-month mark since completing chemoradiation, I can FINALLY start to see light at the end of the tunnel. Just this month, I’ve started to notice significant improvement in both energy and ambition. A few weekends ago, I actually went out to see a movie, ran errands, did a photoshoot, and even jump-started a car. It seemed like a miracle! Prior to that, my weekend activities consisted solely of laying on the couch napping or watching television after managing to get through the exhausting work week routine.

I’m not sure if the increased energy was related to my body finally starting to heal or the fact that a few weeks ago I started taking a special type of ginseng supplement that has been shown to help with cancer treatment-related fatigue. For more information, you can read about it here. Either way, the difference is dramatic compared to a month ago.

Unfortunately, my appetite isn’t quite back to normal and my weight is now down 46 pounds from the start of therapy. Don’t get me wrong, I’m very happy to have shed those unwanted pounds – but I don’t think the chemoradiation diet fad will catch on anytime soon. Aside from not being hungry, my saliva output is still greatly diminished and that impacts on food selection and taste.

However, with the recent favorable PET scan, energy returning, and being back to what I consider my ideal weight – you’d think the word “cancer” would slowly start to fade from everyday thoughts and discussion. Not so.

Case in point: this past weekend. A series of minor gastrointestinal issues was easy to dismiss until escalating Friday evening. After vomiting for the fifth time during the evening, I briefly passed out while making my way to the bathroom and my wife had to call 911. While I couldn’t imagine any possible connection between head/neck cancer and the new gastrointestinal symptoms, it didn’t stop me from going to that “dark place” while laying face down on the bathroom floor and during the short ambulance ride to the hospital (PS – my first ambulance ride; not as exciting as it seems on television). Fortunately, this was one of the few non-cancer related trips to the emergency room and I was simply diagnosed with the norovirus, also known as the winter vomiting bug (lucky me to catch such a bug during the middle of summer…). After receiving two bags of intravenous solution to replenish my electrolytes, along with anti-nausea medication, I was released and felt much better by Monday.

What I hear from other cancer survivors is true – every little ache or anything out of the ordinary immediately causes anxiety that the disease has somehow returned. You are always looking over your shoulder.

Week #7 – Done and Done

Friday marked the last day of my seven week chemoradiation therapy journey. Aside from some routine follow-up appointments and recovering from lingering toxicities, I will now wait several months for the repeat PET scan that will provide some insight as to whether or not the treatment was a success. Of course, I’m trying to stay optimistic that the combination of radiation and chemotherapy treatments that I endured over the past seven weeks successfully eliminated all of the cancer – but there is always that nagging thought that it did not and that leaves a pit in my stomach.

Michael Becker's Radiation Mask

Michael Becker’s Radiation Mask

Fortunately, on Friday I was able to take home with me the dreaded radiation mask (see enclosed image). No longer will I need to wear this mask for daily radiation therapy, which makes me VERY happy. The nuclear technicians offered humorous insight as to what other patients do with their masks after radiation treatment is done.  Some make decorative items, such as flower pots. Others simply burn them in a sadistic revenge ceremony, which I must admit holds a certain type of appeal. Although it somehow conjures up thoughts of Darth Vader’s helmet, last seen burning in a funeral pyre in ‘The Return of the Jedi,’ winding up in the hands of Kylo Ren in the ‘Star Wars: The Force Awakens’ movie…

Regardless of what I do with my mask, I am enjoying a certain freedom knowing that I’m no longer beholden to a daily treatment schedule and that I have received the very best treatment possible for my disease by the entire team at Memorial Sloan-Kettering Cancer Center (MSKCC). It is amazing how quickly the seven week treatment cycle passed and it all seems like a blur right now. While I did not look forward to the daily radiation treatment, the appointments were at least a reminder that I was doing something to treat the disease. Now I have that same empty feeling that plagued me when I was first diagnosed and searching for the best treatment – the feeling that I should be doing something but cannot.

Final Day of Chemotherapy

Today was my last chemotherapy appointment. It was bittersweet watching the final drops of cisplatin fall from the bag, stream down the winding tubes, and finally enter the intravenous line into my vein.

On the positive side, I was able to complete all of the three cycles of chemotherapy that are associated with the encouraging survival rates published by the physicians at MSKCC. Some patients don’t make it through all three cycles due to side effects, and I was nervous earlier this week when I started running a fever that they may skip the last cycle.

On the negative side, the week following chemotherapy has been difficult for me in terms of nausea and a general sense of feeling crappy. On top of that, the doctors keep reminding me that the coming few weeks will be the toughest. This is due to the cumulative effects of both radiation and chemotherapy, as the two therapies continue to exert their toxic effects even after they are discontinued.

Michael Becker and Daughter Megan in the Chemotherapy Suite at MSKCC

Michael Becker and Daughter Megan in the Chemotherapy Suite at MSKCC

Fortunately, I was joined not only by Lorie but also my youngest daughter Megan. Megan was able to come to NYC thanks to Lorie’s best friend since 3rd grade of elementary school – Debby Novack. She came into town to help out after Lorie’s sister went back to Illinois after her three week tour of duty. Not an overly exciting day for Megan sitting around the chemotherapy suite and shuffling between various appointments, but it was great having her there.

The following two days (Thursday and Friday) are also my final days of radiation therapy. It will be so nice to have at least part of my life back next week – not having to be a slave to the daily treatments and the three chemotherapy cycles. Any remaining doctor appointments will simply be routine checkups leading up to a PET scan in approximately 3-4 months to determine in part whether or not the treatment was successful or if further intervention is needed.

Most important, my lower back pain has greatly subsided and I can get up and down much better than even a few days ago. Either the muscle spasm went away on its own or the myriad of pain medicines and muscle relaxers finally started working. Regardless, I’m happy and better positioned to deal with the coming weeks with one less ailment to worry about.

Snake Eyes

It seems as though each time I make an optimistic blog post, something goes wrong. Since my last post was titled “Lucky Seven,” it seemed appropriate to keep with the gambling theme and title this one “Snake Eyes.” For those unfamiliar with the term, a throw of two ones with a pair of dice results in the lowest possible score, and by extension the term is also used to reference bad luck¹.

image

Snake Eyes

Today was supposed to be the start of my final round of chemotherapy, with the second and final day on Tuesday. Sunday night, however, I started running a temperature of 102 degrees Fahrenheit that prompted my second trip to the urgent care center at MSKCC over the weekend. The obvious concerns being influenza, bacterial infection, etc. that would delay receiving chemotherapy.

After a variety of tests, influenza and infection were ruled out. While it is possible to run a low grade temperature from daily radiation, a high temperature such as mine is unexpected. This left all of us wondering what was causing my fever and why it was so high. Since there was no immediate cause for concern, they decided not to admit me overnight and said that I could use Tylenol for the fever. They acknowledged that it was unlikely I’d be receiving chemotherapy on Monday.

The next day (Monday) I saw Nicole – the nurse practitioner. I could tell she was on the fence proceeding with chemotherapy that day given that my temperature was again above 100 degree Fahrenheit. She conferred with Dr. David Pfister my medical oncologist and they opted to be cautious and postpone chemotherapy by one day. The only good news is that this shouldn’t change my final day of chemoradiation therapy which is this Friday.

Around the time of my daily radiation treatment, my temperature had dropped to low grade and I’m hopeful that we can continue with chemotherapy tomorrow morning. Separate from having cancer or receiving treatment, my lower back pain continues to be a problem so they switched me to some stronger opioid medications. I’m not talking minor pain or discomfort – but rather debilitating pain making it tough to get out of bed or getting up from a sitting position. I’ve experienced lower back pain issues in the past, but they usually only last a day or two and aren’t this severe.

It’s the final stretch and I “should” be done with therapy this Friday, so I’m trying not to complain. Hopefully these are just minor speed bumps on the road to Friday and then recovery. Until then, keep those thoughts, prayers, and good vibes coming!

¹ http://wordsmith.org/words/snake_eyes.html

 

Steady As It Goes

The second round of chemotherapy and end of Week #4 was relatively uneventful – especially when compared with the first cycle when I came down with the flu. The biggest changes are increased taste alteration and fatigue.

Michael Becker Receiving IV Hydration

Michael Becker Receiving IV Hydration

My heart rate and blood pressure were elevated this week, so my physician ordered an extra 2-hour intravenous hydration session. Frankly, I was happy to do so – as I planned on coming home to Pennsylvania for the extended weekend.

I took the train home on Friday afternoon, but spent most of the day on Saturday sleeping which isn’t like me at all. I’m not normally one to take naps, but the fatigue from radiation and chemotherapy makes it hard to even keep my eyes open at times. I feel like I’m sleeping the entire weekend away!

Lorie’s sister Maureen is in town for a few weeks and has been a tremendous help around the house. She’s also a great cook and has been making some fabulous meals, although I just haven’t been up to eating them and have very little appetite. However, Lorie and the kids are enjoying them.

Sunday (today) is Lorie’s birthday in addition to being Valentine’s Day, which is another reason why I really wanted to make it home this weekend. I definitely owe her a proper celebration after we are past the cancer treatment, but in the meantime it will be nice to have a small celebration at home.

Monday starts Week #5 and it looks like March 4th will be my last radiation session. From what the doctors tell me, this is where things start to get rough with the treatment. Accordingly, I’m a bit nervous about what the coming days/weeks will bring…

Second Round of Chemotherapy

Today was the start of week #4 for my chemoradiation treatment. It was also the second time that I was scheduled to receive chemotherapy (cisplatin) in addition to my daily radiation treatment. I receive a total of three chemotherapy treatments – one at the beginning, one in the middle, and then one at the end of my therapy.

Fortunately, I felt well enough last Friday to come home to Pennsylvania for the weekend. It was great to see my wife and kids, pets, and sleep in my own bed for the second weekend in a row. I was really glad I could make it, since I missed being with Rosie for her 18th birthday during the week while I was in NYC. I can’t remember the last time I wasn’t with her to celebrate her birthday in person, although I was able to FaceTime and sing happy birthday.

This morning, my wife and I took the morning train from Bucks County, PA into NYC for my chemotherapy appointment. I was feeling a lot of pain this morning from the mouth sores and for the first time in my throat as well. I was miserable the entire train ride, but made it to New York and we headed to Memorial Sloan-Kettering Cancer Center (MSKCC) for treatment.

The day started with radiation therapy and then an appointment for blood work and then a meeting with Nicole – the nurse practitioner before starting chemotherapy. Last week when I met with her, she prescribed gabapentin and a lidocaine gel to help manage the pain. Today when I communicated my current pain level to her, she also prescribed Oxycodone. After about 30-minutes, the pain was improving and continued to do so throughout the next few hours with the Oxycodone. Nicole also mentioned that the steroids administered as part of the chemotherapy could also help with inflammation and might help alleviate the mouth and throat pain.

Chemotherapy (cisplatin) infusion pump

My chemotherapy was scheduled for 1pm, but the routine blood test came back with some bizarre readings in the metabolic panel. In fact, had the results been correct – the nurse said my heart would likely have stopped! Needless to say, they also couldn’t proceed with chemotherapy if the results were accurate. They needed to take another blood test to determine whether or not the readings were true. Not surprisingly, the first results were wrong and the second set was perfectly normal. As a result, the chemotherapy treatment proceeded – but not until around 2:30pm.

I finally finished chemotherapy at 7:45pm and Lorie and I went to a nearby restaurant for a late dinner before heading to the apartment. The second dose of Oxycodone left me feeling little pain and I actually had an appetite. It was the first time I felt comfortable going out to eat in more than three weeks. The French toast sounded like a good bet for some much needed calories and I ate the entire portion except for some of the crust. It was a fantastic end to a day that started off a little rough.

Tomorrow is the second day of chemotherapy and then I’m back to just daily radiation for the next few weeks. It will be interesting to see how I handle this round of chemotherapy as opposed to the first round when I came down with the flu.