Hello out there!
I had my latest long-awaited scan on Tuesday afternoon, and I had the report in my inbox within an hour. It has taken me a few days to process the info and craft this brief update for you. I hope this note finds you in good spirits!
According to the most recent imaging, the “periaortal” lymph node we’ve been paying attention to — the one that hosted a cancer metastasis the size of an orange last summer, and which housed a cherry-sized bundle of dead cells and scar-tissue in September after my chemo concluded — has reduced in size yet again, from 1.5 x 1.6 cm in December cm to 1.0 x 1.3 cm in March. (That’s a shift in volume from 16.1 cubic cm to 7.1 cubic cm over the latest scan interval. The goal volume is 4.2 cubic cm or less.)
What is the meaning of this?
While this was not (yet!) the “no evidence of disease” scan I’ve been hoping for and working toward, things are continuing in the right direction.
So, while it’s not (yet!) time for NEDfest, the latest results are quite encouraging!
Last week, I reflected that life, healing and the universe are non-linear. This new graph (curated by my awesomely helpful math and science teacher friend, Mike) shows all of my post-chemo scan results — which are now tracking on an increasingly natural-feeling curve, one that’s more exponential and less linear in appearance.
The latest scan was so close to clear that even the UCSF surgeon I’ve been consulting with — the one who has previously advocated a standard and pretty gruesome surgery to remove a dozen or more lymph nodes if the node in question is anything larger than 1 cm by 1 cm — sent me a note through the hospital’s patient portal acknowledging that “the lymph node is smaller” — which felt like a big deal, since all his previous communications had described the node as “stable” (even despite its gradual and significant reduction in size since September).
The kindly doctor invited me to continue on my healing path and book another follow-up scan in a couple of months — which, incidentally, is around the same time the updated data set indicates the likelihood of a clean scan.
When I told Satya about my imaging results the other day, I loved her response. She smiled and said, “that’s great!” — and then she asked if the node had ever gotten larger in size since treatment. When I replied that it had not, that it has been getting smaller all along, she added, “that’s excellent. That means you haven’t taken a single wrong turn. You’ve been on the right path the whole time.”
Making Sense of the Numbers... and the Unsung Power of Volume
This healing journey has brought me a keener-than-ever awareness of the power of three-dimensional volume — and how even slight changes in the outer dimensions of an object can make a big difference in its actual size.
As you can see, since September, the long-axis diameter of the node has gone from 2.5 to 2.2 to 1.6 to 1.3 cm, which might seem like pretty minuscule changes. But if you look at the “volume of oblate spheroid” column, you can also see those seeming small changes in diameter correspond to a volume reduction from 55 to 42.6 to 16.1 to a mere 7.1 cubic cm. Our goal is 4.2.
In the last 3 scans, that has also meant that the node has decreased from 100% of original size to 77%, then to 29%, and then, most recently, to 13% of the size it was back in September. The goal (which doesn’t show here) is a node that is no more than 7.6% of original size. We are well on our way there!
Something that caught my attention even more powerfully in this latest data set generated by my mathematician friend was the new column he added labeled “number of times larger than target volume.” It shows that in September, while the node’s diameter was only 2.5 cm as compared with a goal size of 1 cm or smaller, the actual volume in September was 13.1 times greater than the target volume. In October, it was still 10 times greater that the target volume. In December, it was 3.8 times greater. And the most recent measurements showed the node as being only 1.7 times greater than the target volume.
All this is to say, while the latest scan may not (yet!) have been the “all clear” I’ve been looking forward to, it still feels like a big win.
According to the data, the new target date for realizing a “normal size” lymph node and a clear scan is now May 20.
I still have yet to communicate realtime with my doctors since these results came in, but it looks like my next scan will be around that time as well — perhaps in early June, around the time we’ll be celebrating one year since the cancer recurrence that brought me into the underworld of chemo last summer.
It’s looking like the route forward is to keep on my healing path. And that feels just fine.
Also, over the coming weeks, I’ll be integrating "healing life" even more thoroughly with my "normal life" and moving into greater overall balance by gradually increasing my hours at work (more on that next week) — all while continuing with the diet, exercise, complementary therapies, supplements, and other practices I’ve developed over the last few months, and all while keeping up on my monthly blood draws and planning for my next scan after my students’ graduation in June.
On Will and Surrender
While these latest results have been encouraging (and by all means worth celebrating!), they have also been humbling. They’ve been a reminder that when you say insh’Allah, you’d better mean it.
Most cancer dancers out there (and sufferers from any other curable illness) — and especially the survivors among us — can relate to this feeling of just wanting the ordeal to be over with. We long to put the uncertainty behind us and move forward.
I appreciate that, after going through a cancer experience like this, it is unlikely that all fears and concerns will ever completely go away — but I also feel such a deep desire to have my total remission documented, such an ardent hope of having my inherent wellness and full recovery recognized by the ambassadors of mainstream medicine that are my doctors, that it has been difficult for me not to attempt to bend the Universe to my will outright.
I aspire to surrender ever more deeply, to trust the path, to let go of future concerns and to live with the joy and wellness that my heart knows is my birthright and destiny.
And at the very same time, my deeply flawed human self also desires recognition and validation and assurance and control.
Prior to this springtime CT scan, the hope I espoused for it to be my NED scan were prefaced by the spirit of insh’Allah — godwilling — and they were accompanied by some rambling rhapsodies on this spiritual philosophy I’ve grown over years of life and travels around the world.
But I am very much in process, and I'm learning to balance the opposing forces in this eternal dichotomy of vision and acceptance, intention and trust, will and surrender.
My continued hope is that my actions will continue to show the Universe that I have been sufficiently transformed by my healing journey this year — that I have learned so much from it and been changed so deeply by it that I no longer need to be reminded in the form of any clinical abnormalities.
I wrote this summer of the “tap tap, knock knock, bang bang” phenomenon — how spirit tries to get our attention and encourages us to change first with gentle invitations (tap tap), then with more forceful signals (knock knock), and ultimately with irresistible and life-shattering insistence (bang bang).
I am sorry that I evidently needed a big “bang” to wake me up — but I am up and I am here, wiping the crust out of my drowsy eyes and ready to move forward as instructed by Great Spirit.
I have some lingering pains and scars to remind me of what I’ve learned, I have timeless memories of this brush with mortality, and I have returned from this journey into the abyss with priceless treasures to share. I remember that initial pain of the mass that took shape in my body, I remember the feeling of sickness, my hair falling out, my days in ye olde chemo chaire — and I don’t ever need to go back there.
I complete the need for this cancer teacher and visitor.
I get the message, I honor it, and I move forward with an expanded consciousness that includes the fruits of my latest lessons. I am transformed, and I continue to be transformed, by this process. I am integrating the lessons, and no further dis-ease is required to remind me of these messages I’ve been given.
I authentically share my voice. I freely embody my truth. Creativity flows through me, and I serve from the heart in a way that is balanced and sustainable. I lovingly care for myself, and I do my part to care for our planet and people and serve the flowering of truth, love and justice in our world. And I am a fierce guardian of my joy.
I’ll be going into ceremony over the coming week, and I’ll check back in soon with more inspiration and clearer thoughts on what comes next.
For now, please accept my sentiments of enduring gratitude and kinship.
I stand encouraged and trusting in our shared victory, in eternal love and light, and in awe of the glory that is life.
Yours faithfully,
Nils
