Out of the chemo room -- for good?

I'm out of the chemo room and unless I can beat my docs' first and only prediction of personal life expectancy for me, may never be going back.

More than a week ago (which now seems like an extraordinary length of time), and after another scan of my lungs showed the cancer still growing and new tumors forming from the previous month's pictures, the docs said the coughing and shortness of breath I was experiencing, and the increasing exhaustion that accompanied every step I took, or every exertion I made, would only grow worse.

Putting me on a  new round of chemo, with all their horrible side effects, would only add to the burden my body is fighting against, and so they recommended no treatment at all other than the medicines and practices that might lighten the load and make my life a little more comfortable.

"How much time do I have?" I asked, knowing full well that's not a question an oncologist likes to answer.

In five years of treatments, neither of the two oncologists who have treated me, Dr. Tom Kenney out of Porter Hospital, and Wells Messersmith, from the Anschutz Cancer Center, has ever offered a personal life expectancy. I think both of them are surprised to see me still walking around, no matter how slowly. "Look at you!" Messersmith said as I pressed him for an estimate for my survival.

Then he turned to his assistant and asked: "What do we tell people as a standard?

"Three to six months," said the young woman doctor.

"So that's it?" I asked, always wanting to confirm what I've heard from a source, which is an old reporter's trick.

"I don't know," Messersmith said, but probably.

Over the period of three scans, I realized, my plant-based diet seemed to be having no effect on the disease and its progress as well. So this time driving home from the appointment I knew I was going to go back to eating meat and fish, ice cream and using butter in what I cook. Funny thing is that first week after the diagnosis, I didn't seem to have any appetite at all. And kept losing weight by virtue of not eating much.

I have not been able to have a beer or a drink either, and that, too, seems to find it's way to the bottomline on the scale.Call it a benefit. I know the alcohol will make me feel bad so it turns off my desire for even a sip.

Yet, still, on Monday, I went back to Centennial to play croquet with my friends and share the news. That was actually a mistake. The sun and not much hydration combined with every heavy-footed step up and down the court and the increasing shortness of breath that accompanies such "work" wiped me out for three days after I got home that afternoon.

But 'Look at me!' I am still walking around and getting some things done, and I expect to beat my "standard" life expectancy by more than an additional three to six months after this first ticket expires. If some new drug is approved by the FDA in the meantime, who knows (God knows) I may still wrack up that miracle survival from this stuff.

And walk back into the chemo room for another round of living, albeit with side effects.

Also in the meantime, there is hospice and funeral planning to take care of. My writing here will probably turn more frequently to the small business coverage I have been posting, and since every day of life seems to cost at least about $75, if not $300 or $1,000, if you have any interest in sponsoring my journalism, I'm still alive and kicking, and barely living off my Social Security.

Give me a call. I will try to accommodate almost any request.

Owners rank Colorado, Denver and Colorado Springs 'small-biz friendly'

Colorado Springs got an "A"; Denver and the state as a whole each got a "B+"; and Colorado came out 13th among 45 states ranked for "overall small business friendliness" in a recent national survey of 6,000 small business owners.

Thumbtack.com, a San Francisco-based nationwide referral service of local small businesses, said Idaho and Texas ranked first and second respectively atop their list, with Oklahoma, Utah and Louisiana following in order of the top five. Rhode Island (45), Vermont (44), Hawaii (43), California (42) and New York (41) were ranked the five least "friendly" states for small business. Five states were not ranked by Thumbtack because too few business owners in those states responded to the survey to make a ranking viable.

The states and 40 cities in them were ranked in 15 categories corresponding to questions posed to business owners regarding, among other things: "ease of starting," "cost of hiring a new employee," "overall regulatory friendliness," "friendliness of tax code," "current economic health of small business" and "change in revenue over past 12 months."

The study was conducted in partnership with the Kauffman Foundation,  the Kansas City, Mo.-based advocate of small business.

"Asking entrepreneurs to rank state friendliness to their businesses is a powerful resource for helping policymakers understand the needs of business owners and for helping aspiring founders understand the full dimensions of their business environment,: said Dane Stangler, director of research at Kauffman.

For the full results of the survey, click here.

Colorado bankers answer call for small-business access to capital

Bankers have been called nasty names for years by small-business owners who have been denied credit, but the Colorado Bankers Association has launched an effort that could change that.

Through a website, SmallBizLending.org, Colorado bankers are beginning to refer customers who don't qualify for their loans to other organizations around the state that might find a way for the cash-strapped owner to find capital he or she needs to grow.

I've been covering small business in Colorado for more than 20 years, and this effort is the first I've seen between agencies of government and large commercial banks to solve the "access to capital" problem that is a perennial complaint of small-business owners who don't qualify for bank loans.

If you try it, it might actually work.

When you go to the website, you see a cup of coffee beside a napkin with a hand-drawn diagram describing a business owner's route to successful financing. Below the napkin, three links are shown to get you started:

1. Before you Seek Funding
2. Steps to Securing Funding
3. Advice and Resources.

Click on "Advice and Resources" and you'll find a list of organizations that joined with the bankers to create the guide, all conveniently linked so you can go directly to them for more information. The list starts with ACCION, a small-business lender that operates in Colorado, New Mexico and Arizona, whose reputation for actually lending money to businesses has grown large over the last three years.

The list continues with: the Colorado Association of Commerce and Industry, a statewide chamber of commerce; the Colorado Enterprise Fund, a nonprofit lending source that can loan a business up to $250,000; the Colorado Office of Economic Development and International Trade, a state agency; the Colorado Housing and Finance Authority, another active lender to small business; the Denver Office of Economic Development and 10 more resources available to small businesses looking for financing they cannot get from banks.

But the member banks of the CBA are all supporting the effort to find money for firms and companies they cannot make their own customers. That is the unusual and unprecedented nature of this most recent effort to solve the "access to capital" problem.

"All of the CBA members were involved in the project," said Christie Drumm, vice president of communications for Wells Fargo & Co. in Colorado.

She said Wells Fargo, which was the nation's and Colorado's number one lender of SBA guaranteed loans in 2011, is instructing its small-business loan officers throughout the state to spread the word about the bankers' association website in order to educate business owners looking for credit that "there are other options" if traditional bank lending is not available to them.

Caroline Joy, who was the project director for launching SmallBizLending.org for the bankers' association, said the effort grew out of Gov. John Hickenlooper's Colorado Blueprint, a statewide plan for economic development.

The blueprint "saw a need to demystify the lending process," Joy said, and the bankers' association interepreted that citizen demand as a cry for "pulling down the walls of the silos" that separated lenders and other institutions who were ready to help small businesses grow and create new jobs.

"If a bank can't help you," Joy said, "we want to help you find another place that can."

In the Chemo Room: A lesson in clinical trials

I was treated to a little of the cancer-fighting establishment's scientific bias against alternative treatments last week, but the experience left me unconvinced that a plant-based diet is not helping me keep my cancer in check.

"There's no evidence for that," my doc, Wells Messersmith said when I asked if the diet could  have had any influence on results of a scan taken March 2 and compared with an earlier scan from Jan. 19.

Messersmith methodically measured the 10 largest tumors (the biggest being about one inch long) still growing in my lungs, chest cavity and abdominal region March 9 to show me how progress or the lack of it against the cancer is determined by the folks who conduct clinical trials of new drugs.

An independent report written by a reviewer Messersmith said could be in Japan, India or anywhere else in the United States, suggested the numbers of tumors and the size of existing tumors had increased in me while I was taking the study drug Estybon (rigsertib) for six weeks this year.

But my doc was skeptical and liked to take his own measurements even though he did expect the latest scan to show my cancer had gotten worse. If it had, I would be withdrawn from the clinical trial: "You wouldn't want to keep taking it [and feeling the side effects] if the drug wasn't doing you any good, would you?" he asked me.

So he measured up my tumors and found that overall the cancer in me had grown by 13 percent over the six weeks. He questioned whether one shaded area of the scan actually represented more tumors, as the first reviewer seemed to be suggesting, and he noted that "worse," as described by most clinical trials, usually was a 20 percent overall growth of the cancer.

My CEA (a tumor marker in the blood) also had risen from 40.3 on Feb. 15 to 41.1 on March 9, another indicator things were not necessarily getting better inside me.

Still, Messersmith wanted to keep me on the drug for another month and scan me again at the end of March or mid April, right around tax time. He said he expected the cancer would continue to get worse and then I would be pulled from the study and enrolled in another trial to try to keep me alive.

He actually mentioned that a "cost/benefit" analysis is what determines whether a patient remains in the trial or not. The maker of the drug, Onconova Therapeutics Inc., Newtown, Pa., provides me the drug for free and picks up all the extra costs of my treatment related to using the drug. But like any business, the company doesn't want to keep paying for all that expensive stuff -- costs of the drugs and scans can easily run into five figures, sometimes six -- if the trial shows the drug is not doing the patient any good.

That's the most significant lesson I have learned in participating in two clinical trials. The drug manufacturers, while hoping for the best for the patients testing their experimental drugs, are businesses that don't want to waste money where the drug isn't working the way it should, even if it is keeping rapid deterioration of the patient's condition at bay.

All the consent forms for these trials inform the patient they have been chosen for participation because standard treatments for their late-stage cancers have already proven ineffective; the cancer inside them might run riot if the trial drug doesn't help slow or stop its spread.

Those who advocate alternative treatments for cancer often criticize the scientific, medical and business communities that test new drug treatments for recruiting late-stage patients to a trial that also calls on those patients to forego alternative treatments while enrolled in the study.

That's why the cancer-fighting establishment is known -- and also criticized for -- testing drugs that provide a late-stage patient with only a month or two of life, and effectively write off the patient's life as collateral damage when the drugs don't work.

That old practice -- now cancer fighters are much more enlightened about the "potential" benefits of alternative treatments -- was also made clear to me by my experience with this new drug. A one-month commitment to the drug is not very long.

But Messersmith and his team at the University of Colorado Hospital and the Anschutz Cancer Center have allowed me to continue my "alternative" ways through this trial: a plant-based diet, some additional Vitamin C and flaxseed-oil supplements.

I admit that when Messersmith told me I was the only patient in the trial he knew who was experimenting with a plant-based diet, I rushed out to the grocery store to buy three half-gallons of "dairy" ice cream and looked forward to a nice juicy steak.

But then I re-thought about making that choice.

No evidence that a plant-based diet restores the natural immune system to a point where it can fight cancer by itself is not necessarily evidence that it does not.

And if I am the only patient on a plant-based diet involved in this trial and my cancer hasn't grown more significantly in a month on a lower dose of the drug than it did during the first six weeks on it, maybe I'll be manufacturing some evidence the drug companies should pay attention to. We'll see.

In the meantime, it's back to beans and nuts for me. I'll cheat a little with that ice cream still in my freezer, but not much. And if I last the month, there may still be plenty of time for that juicy, half-cooked steak. Scotch on the side.

"Feasting on junk info"

ronntorossian.com

There is one story in the Sunday Denver Post you should not miss, a piece in the Perspective section headlined: "We are feasting on junk info," by Clay Johnson, who originally wrote the piece for the Los Angeles Times.

"When you click on the computer, remember that clicks have consequences," Johnson wrote.

And he's more than right.

The information explosion brought on by the Internet, the engine powering this very blog, has caused a lot of wasted time, wasted reading, and a worldwide degradation of human comprehension, a true understanding of what we know and don't know about the world.

The reason for that last gargantuan opinion is that the Internet has changed our reading and writing habits. Even this blog is written short for a reason. I, the writer, am afraid I cannot hold your attention for longer than the time it takes you to read the words I put down here.

That's first a function of my writing skill, but secondly a realization that "writing short" is the style that has evolved for writing on the Internet.

If you read the daily emailed news report from The New York Times and only glance at the headlines and read the blurb rather than click through the link for the full story for fear you might have to pay for it -- "clicks have consequences" -- you now understand what I am writing about.

Johnson says it better:

"Our news is largely provided by conglomerates focused on the bottom line, and they have figured out that shrill opinions and celebrity hype draw more eyes than facts and substance. To the handul of billion-dollar corporations providing much of our news, journalistic integrity equals market inefficiency. Fear, opinion and gossip are less expensive to manufacture and draw bigger audiences than the truth."

If you haven't clicked on the link to the full Johnson column in the Post that I provided above, you should do it now so you can comprehend the fullness of his argument.

Johnson also is the author of "The Information Diet: a Case for Conscious Consumption," and he has written the column not only to further the argument of his book, but also to market the tome by seizing some space in the Los Angeles newspaper, and now the Denver newspaper as well.

That's how you market books and yourself nowadays. By adding to the information feast Johnson complains about; a surfeit that this blog, too, tries to become part of, a tasty appetizer included occasionally on my readers' information menu.

Hope you enjoy.

And by the way, I was serious about the Johnson piece being the one piece in all the Sunday Post that you wouldn't want to miss.

In the Chemo Room, again

Well, I was back in a Chemo Room all day on Friday, although I was only there to take two pills and have my blood tested nine times over 11 hours, and to collect every drop of urine I could pee.

I'm entering a new clinical trial for a drug that has been widely tested on others and that is now given orally and requires me to keep a diary of the times I take it twice a day at home. The pee collection continued at home, too, for the remainder of 24 hours. You have to refrigerate the pee until your next appointment when you bring it in and they finish checking out how quickly your body takes up and disposes of the chemical.

So after that first day, you go in once a week so they can retest your blood and urine. After a while, I'm sure they'll scan me to see if the drug -- this one is called Estybon (rigsertib) and designated ON 01910.Na for the study -- is working any magic on my tumors.

It's still a Phase 1 study, but the clinical trial has gone on so long that the docs have pretty much determined what the best dose is, especially regarding peoples' tolerance to its side effects.

The goal of the study now is to determine how effective it can be at stabilizing the growth and spread of tumors in advanced-cancer patients. It's manufactured by Onconova Therapeutics, a small drug maker out of Newton, Pa., and Pennington, N.J.

I was told I was one of the few colorectal cancer patients being tested at least locally, but the company says this about its drug:
 

ESTYBON (rigosertib) is a novel multikinase inhibitor, with selective cytotoxic effects on tumor cells without impact on normal cells.... A significant effect of ESTYBON in cancer cells is the induction of multiple centrosomes during cell division, resulting in a multi-polar spindle and total disorganization of the mitotic apparatus, a phenomenon called chromosomal catastrophe….

Given the unique mechanism of action on tumor cell survival pathways, ESTYBON has the potential to be active against a wide variety of cancers.... Early clinical results from ESTYBON combination studies with either oxaliplatin or gemcitabine indicate rapid response in pancreatic, breast, colon, ovarian, and lymphoma patients, suggesting multiple indications for solid tumors.

That's typically dense language for cancer-drug descriptions, but it is what we patients find hopeful even if we don't understand all of it.

I'm still feeling out the side effects this drug will produce in me. The consent forms I signed list practically every side effect known to cancer patients as having been experienced by 2 percent of the people who have been enrolled in the trial. That means only that two out of 100 enrolled patents have experienced just one of the side effects in the long list.

If you give enough cancer patients any drug over a long period of time, you can bet that one will feel at least one side effect he or she has experienced on some other chemo drug and claim it is a repeat of that symptom under the new drug. That's the nature of clinical trials.

I reported more familiar symptoms under the first "study drug" I took than I think the docs wanted to count, but they were required to count them even though I'm sure they thought I was re-imagining old hurts and past responses.

The big side effects to look for under this drug are fatigue, nausea, diarrhea, decreased appetite, and painful urination. I'm happy to report none of them so far, although it seems I am dancing with diarrhea again. The condition encourages anticipation anxiety, so  you don't really know what you've got until it hits. One thing is sure: I have no decreased appetite to report.

And I was able to play croquet on Monday, and drink a beer while once again losing the game. Who can ask more of life than a pleasant game of croquet?

Vectra Bank's forecast counters local good vibe

I walked into Vectra Bank Colorado's economic forecast breakfast Wednesday and quickly ran into the always optimistic Tim Jackson. President/CEO of the Colorado Automobile Dealers Association, Jackson bubbled about a 13.7 percent sales increase for his industry in November, and said he hoped that Colorado dealers would finish the year posting a full 14 percent gain for 2011.

Jackson then introduced me to Andy Rogers, general manager of the Ritz-Carlton Denver, who said December was the best month of the year for the downtown luxury hotel, and he agreed with Jackson's ebullience over how Colorado's economy seemed to be picking up.

Then I sat down to listen to Vectra's speakers for the day:

• Patty Silverstein, who delivered the Denver Metro Chamber of Commerce's and Metro Denver Economic Development Corp.'s 2012 economic forecast;
• Mark Snead, vice president and economist at the Denver Branch of the Federal Reserve Bank of Kansas City; and,
• George Feiger, CEO of an investment firm in San Francisco, a past member of the Vectra Bank board of directors, and a frequent commentator on Bloomberg News, Fox Business News and in the Wall Street Journal.

Man, what a downer!

Silverstein told the crowd in the Seawall Ballroom at the Denver Center for Performing Arts that 2012 was a time for Colorado and metro Denver to "rebuild," but that the rebuilding will be "slow" because consumers are still being frugal; jobs will grow only about 1.1 percent both nationally and locally, leaving 123,000 people in metro Denver still looking desperately for work; "wages have been growing relatively slowly" in the region; and home prices may get boosted 3 percent at most during the year.

Snead, of the Denver office of the Fed, told the 400 business people: "It could be worse, it could be a lot worse. You could be in Greece."

And then he pointed out that Greece and the United States "have just about the same amount of debt."

The U.S., of course, is better equipped to handle that debt, Snead said. It is much bigger, and most of its population isn't drinking ouzo out on the beach. But still the comparison can be made; and, in general, Snead kept repeating, the U.S. and world economies during 2012 will mostly be "bottoming, not accelerating."

And then, with coffee in the room growing cold, Feiger took the lectern and told everybody the euro zone would definitely fail before it got better; China is actually in worse shape than its Communist leaders will ever let on; at least the U.S. is "the least bad place to be" in the world today; and nothing about what he was telling all the business leaders, who are generally paid to be optimistic about the outlooks for their firms, was funny.

"It's very far from funny," Feiger added.

No one was laughing as everybody headed for the doors.