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 If it had, I would be withdrawn from the clinical trial: "You wouldn't want to keep taking it [and feeling the side effects] if the drug wasn't doing you any good, would you?"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.

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?

In the Chemo Room: Out with a tumor

I'm sitting at my computer on the day after a thoracic surgeon, John D. Mitchell, took out a relatively large colorectal tumor from my trachea, and I've been left wondering if all the muscle soreness in my body (as if at age 64 and totally out of shape I had just played in a two-hour pick-up, touch football game) is the result of not taking the heavy pain killers they usually give you after a major surgery?

Is that the pain they are trying to kill? Is it pain that results from full-body anesthesia? No matter where the surgery?

Because that's most of the pain I am feeling today on the day after. A mild sore throat, and little chest pain, but they pulled the tumor (literally) from the wall of the trachea and kept me overnight at the University of Colorado Cancer Center to make sure they didn't also pull out a hole in the trachea wall, which would have caused me further problems.

They did the work with a bronchoscope and had they accidentally pulled open a hole in the wall of the tube from my throat to my lungs, they would have had to split open my chest to go in and repair it. That's why I am home today; they did not open a hole, and I was released this morning as my over-all-aching increased by the minute.

But this has been the latest chapter in my fight from the Chemo Room against this four-and-a-half- year-old case of colorectal cancer.

The tumor grew in my throat while I was enrolled in a clinical trial testing a drug that had mild-to- moderate side effects and held most of the rest of the many tumors in my lungs and chest in check during the test. But then I started coughing badly, they ran a CT scan and looked closely, and ordered up the bronchoscopy.

So now I've been dropped from the trial because it was clear the drug I was receiving and have written about here before wasn't doing as good a job as we were thinking it was doing. But the trachea is a strange place for colorectal cancer to matastisize, so you can probably blame my individual cancer for the unexpected response to the drug.

The good thing is they found the tumor before it stopped my breathing altogether; they learned a little something about the drug; I'm breathing better now and no longer coughing as much. The bad thing is the tumor could grow back from the place where it was taken from, and the rest of the cancer mets (metastases) remain in my lungs and chest cavity (lymph nodes) and must be dealt with.

So you could call this chapter of In the Chemo Room, 'In, Out and Back Into the Chemo Room' because that's where I'm destined to return. As soon as all these aches and pains go away and my body heals from the surgery.

Dr. Wells Messersmith, my oncologist now, said he'd find a new way to treat me, which probably will involve a new clinical trial. But that's what the Cancer Center has come to be known for nationally in a very short time.

And that's why Mitchell, one of the nation's best thoracic surgeons I am told, is working there on patients like me. You can't say I'm not getting the best of care. And so are hundreds and hundreds of others who are passing through the center's gates.

In the Chemo Room: Integrative medicine

I'm in a clinical trial of a drug alphanumerically designated by its maker Genentech Inc. as MEHD7945A, as if it were a star or a galaxy.

The drug  has shown some benefit to me so far. It has reduced my lung tumors slightly, and kept other tumors stable. That, besides some moderate side effects, is the drug's benefit.

But my enrollment in the trial is a result of past chemotherapy treatments losing their effectiveness. Standard treatments no longer control the growth of tumors in my lungs and lymph nodes in my chest cavity; the new drug seems to be doing that.

But even as I take the drug and monitor myself for its effects, I have always been interested in what are called alternative or complimentary treatments for my cancer. They include diet, physical exercise, reduction of stress, spiritual and psychological exercise, dietary supplements and just about anything else someone might suggest to a cancer patient.

The suggestions can be overwhelming and an oncologist often will poo poo them as unscientific and not worth your bother.

But I listened to a 90-minute Colon Cancer Alliance webinar called Integrative Medicine: Wellness Throughout Treatment and Surviorship earlier this month and heard something I have wanted to hear ever since I began my own scattershot research of alternatives to chemotherapy.

Mary Hardy, a doctor and medical director of the Simms/Mann UCLA Center for Integrative Oncology, finally put an end to across-the-board dismissals of alternatives:

"I like to choose interventions from this arena that have scientific evidence where it is available," Hardy cautioned from her own scientific background.

She added, "The evidence base for what kind of diet, for what kind of supplements, for what kind of effects, is much smaller than it is for the chemotherapy medications that you'll be offered. But there is a body of evidence and it is growing, and when people are making recommendations for you in this area, they should be aware of this evidence, aware of these studies, and use them appropriately."

Hardy went on to share what she knew of the most-talked-about alternatives, first saying: "The best wellness plan is one that is tailored to you."

She suggested finding a knowledgeable coach to help you craft your own response to your disease, and she said to inform your oncologist of what you are doing so he or she can respond as well. Some chemotherapy drugs can be rendered less effective by certain dietary supplements.

Her basic components of a plan were simple:

• Optimize your diet.
• Exercise regularly.
• Maintain a healthy weight.
• Practice regular stress management.

Hardy's presentation -- you can listen to the whole show by clicking on the link above and then clicking on "Launch Presentation" -- was actually the second part of the webinar.

Anne Coscarelli, a clinical professor in the Department of Psychology at UCLA, opened the session speaking of the mental and emotional toll a cancer diagnosis takes on a patient, their family and their caregivers, and offering "mindful" techniques for patients to dispel fear and anxiety.

"Colon cancer, like other cancers, comes with a measure of uncertainty," Coscarelli said. "It really can change a person's life both physically, mentally and spiritually." It also can disrupt a patient's physical function, their social network, their sexual and reproductive health, their financial and work status and their spiritual and psychological outlook.

"Stress and anxiety become imprinted on us,' Coscarelli said. "They become imprinted on our brain."

She added that fears of the spread or recurrence of the disease can be spiked by news coverage of the latest medical or research developments, by surfing the Internet for more and more information about your disease, and even by anniversary dates: of surgeries or disease-free scans, or other markers in a patient's fight for life.

The webinar, jointly hosted by the UCLA Center for Integrative Oncology and the Colon Cancer Alliance, is one of a series of "Conversations about Colon Cancer" held on the CCA's website. Check it out for more information about living with the disease.

In the Chemo Room: 4 years and still crawling, LOL

I’ve been dying of Stage IV, metastasized colorectal cancer for more than four years now.

That thought occurs to me standing in the sun outside my house in the backyard where a bunch of croquet buddies gather once a week to play a game turned on its competitive head by a former Denver Bronco, Max Leetzow, who likes to sit on a plywood-cushioned bar stool and sing “Grown men playing croquet” as he waits his turn to beat us again, playing with only one hand.

The song, one Max made up, is meant to disarm his fellow players, making light of the play and any serious pursuit of victory. Every word said on the croquet course is meant to distract or dissuade a fellow player from playing to his own advantage. That’s how Max has changed the rules of the game for this bunch over the past twenty years, and everyone plays along.

It’s very competitive; Max Leetzow, is the most competitive human being I have ever met.

We began playing in my backyard before I was diagnosed. So my croquet buddies, in an odd way, have served as one of my first support groups, although many others have joined the fight with me through the years: my three sisters, my two daughters, a retired Chicago cop, two women friends, a formal, on-line support group called Colontown, my doctors and the nurses at Porter Hospital, and now a new cadre of doctors and nurses at University of Colorado Hospital Anschutz Cancer Center in Aurora.

On July 8, I joined a clinical trial for a drug known only by its non-name: MEHD7945A, made by Genentech, a big-pharma company out of San Francisco that wants to find out whether the drug helps, hurts or kills me.

So far, it seems to have helped a bit, but that’s not really the point of the clinical trial I’m enrolled in. It wants to know how bad it hurts at the dose I’m receiving now every two weeks.

The hurt, so far, has been surprisingly, if not pleasantly, mild. And the bit of improvement that I have felt from the symptoms of my cancer suggest I might survive through this fifth year and maybe even long enough to finish my novel.

I’m smiling as I write that.

I think it’s funny; or at least, as my daughters would say, it’s been fun. I have always taught them it’s a dangerous world outside your door, but if you’re careful and not afraid, you should always make sure you’re having fun. After four years of fighting cancer, I still believe that, and they keep asking me if I'm having fun!

Yes, my "fun" principle has been challenged, but as I write my the novel, and deal with the side effects of this new study drug, I cannot deny I’m still having fun. Croquet and Wild Turkey, of course, play their roles in that, too.

But to the clinical trial: I told my study doctor, Wells Messersmith, last week, as we looked over my preliminary scans since starting on the experimental drug, that within thirty minutes of my first infusion, I felt relief from a breathy kind of cough and shallow shortness of breath that my Porter oncologist, Tom Kenney, said would signal the continued growth of tumors in my lungs.

Kenney said eventually, within two years or maybe less, I would probably need to wheel one of those little green oxygen tanks around behind me, and that, generally I would “dwindle” to my death.

I told my sister-in-law as I started the clinical-trial appointments in July that I had no intention of “dwindling” to anything.  Was I being gruff and bombastic? Yes, perhaps an old lion’s roar, as I used to call the barking of old men against the fading worlds of their own times.

But I also am determined. More and more people are surviving cancer for longer and longer periods of their lives. I expect to get something accomplished during the last years of mine.

In fact, I’ve been monetizing this blog, and starting a separate business, www.PioneerHQ.com, with two partners since the New Year, and I fully intend to request my sponsors here to renew when the  calendar turns a full year on their support. But back to the clinical trial.

As I made my report of feeling better and looked at my initial scans, Messersmith smiled, a little too indulgently, and said, “We like patients to tell us when things improve for them,” he said. “We include it in our reports when we discuss efficacy.” You could almost hear “dwindle” repeated in his tone.

But efficacy is not the point of Messersmith's study. My scans backed me up; there was some initial, minimal shrinkage of the tumors lit up in the scans by radiation and a contrast they make you drink that always causes a dose of diarrhea.

The study is more concerned with side effects, and Genentech’s drug is no “spindly-armed,” weak hitter, as Max would call a poor shooter on the croquet court, despite the “mild or moderate” side effects described in the consent documents you sign to join the clinical trial.

After that first treatment, when I could breathe easier, I came home to a long night of fever, chills, crawl-into-bed chemo misery, and after a poor night’s sleep a bit of chemo-exhaustion and even a belated, three-day-later bout of chemo-diarrhea, which is when I’m told all the dead cancer cells get carried out of your body.

Later the next week, my fingers and hands started showing some tiny “splits,” a nasty side effect of Erbitux which has been one of my other chemical little buddies along the way.

The MEHD7945A splits, separations of the skin like thick paper cuts, were hardly as big, wide and painful as the Erbitux splits, so the drug lived up to it pre-consent reviews on that front, although those reviews did not mention splits at all. But again, the drug is being given to me to find out how my body reacts to it.

Also the nasal drip that came with all the other chemical cancer killers pumped into my blood stream over the four years returned within about a week of receiving MEHD7945 as well.

Overall, though, like I said, it's been fun. After a few days post-treatment, you actually do laugh about these minor discomforts, especially if your hope is still alive that the drug with no name might actually cure you.

And I have found that hope, if not LOL funny, still happens to be a lot of fun.

Chemo 101: a web success story

Kristin Gustafson started marketing Chemo101 even before she launched the website that keeps chemotherapy patients, nurses, doctors and caregivers abreast of the latest information available about life in the Chemo Room.

Gustafson says her Denver-based site has grown like a blogger's dream over the last year, landing a $25,000 ad schedule from Whole Foods because of the marketing buzz she created within its target audience by competing for startup funding in the Pepsi Refresh Project.

That's a fund-raising program run by Pepsi which gives away grant money to make innovative ideas -- anyone's idea, really -- into reality by winning the funds to make it happen through a contest.

KG, as Gustafson calls herself, entered Pepsi Refresh last September at the $250,000 level, but lost out to a much larger organization, the animal protector ASPCA, which was able to marshal many more voters to its cause than Chemo 101.

But soliciting votes for her project from all the people who might use it essentially put Chemo 101 in the minds of its audience even before it was available. The site launched in December, and besides her Whole Foods advertising program, KG is now averaging 30,000 unique visitors to the site per month. Like I said: a blogger or website developer's dream.

And that's as much a reason for writing about her here as the nature of her cancer-related website. Gustafson has started a small business on the Internet in the booming health-care industry which never seems to shrink even as the nation's economy falters.

So KG's business lesson is valuable to many of the readers of this blog whether they come from the blogging world, the cancer world, the small-business world, or even the politics and policy world. Chemo 101 is an example of a successful, small-business startup in a booming industry fueled by the Internet.

And Gustafson has gone about starting that business in an instinctively entrepreneurial way.

Her professional background is in human resources, having worked with health-care, and specifically oncology-related, companies in Minnesota, before moving to Colorado to work briefly with a medical-device manufacturer. She found herself drawn back to oncology and the fight against cancer, however, and so decided to start Chemo 101 as an outgrowth of what started as an HR consultant's practice.

She didn't win the Pepsi contest, so her funding came from her own savings and investments, and she was helped by a friend who volunteered his expertise not only in programming but also in sales and marketing because he had been touched by the fight against cancer in his own life and wanted to "give back" while waiting a few months to take a new professional position.

Chemo 101 was borne of KG's experience with her target audience: patients, nurses, doctors and caregivers from mostly community-based cancer clinics. "Our site is really augmenting what they do in the clinic every day," she said.  "A lot of times from the day that someone is told there's cancer, they're just rushed through the process. And the oncology nurse has fifteen people that she's trying to get set up." So a lot of patients go home from a first treatment with dozens of unanswered questions.

KG's website has the answers to many of those questions. "My idea," KG says, "was build a website for cancer patients to understand their drugs and dollars, ... a resource to understand your chemotherapy drugs, understand the different food and drug interactions, and how co-pays work, and what type of insurance you're on; what questions to ask."

But while cancer consumers were the target audience, Gustafson knew her target market for monetizing the site was big pharma, the huge pharmaceutical companies that test, make and sell drugs that help millions of people fight cancer across the globe.

"My business models started with the thought of I'm going after the big pharmaceutical companies; they are the ones that have drugs in the data base that I have built. They have branded, marketed products that we see ... advertised on TV."

Those companies' oncology products, the chemotherapy drugs pumped into patients all over the world, are the mystery meat of the cancer-treatment industry. Millions of patients, nurses  and caregivers are constantly seeking the ever-changing, latest information about drugs and their side effects in order to ease the patient's struggle to stay alive.
 
And Gustafson, through the website, keeps the information up to date. She uses what are called Food and Drug Administration-approved "package inserts" to describe the chemicals patients receive during chemotherapy. The inserts are the printed material included with any medicine sold to consumers.

But she also has a "resources" section of the site she says will be used to offer information about alternative treatments ranging from use of medical marijuana for nausea to nutrition and diet information geared to the cancer patient. That portion of the site is not yet very developed, but like any site on the Internet, Chemo 101 is a work in progress.

Nurses' desire for more nutrition information, however, is what drove Gustafson to seek out advertising from Whole Foods Market. Surveys she collected at a national meeting of oncology nurses in Boston earlier this year showed nurses ranked a desire for more information on nutrition as high as their desire for information about clinical trials.

"Wow, nutrition is really something I never thought of, and here we've got 40 percent of the nurses saying they would want nutritional information for themselves and their patients," she said. So she contacted a Whole Foods sponsorship program in Boulder and quickly signed up for the first $25,000 of revenue Chemo 101 has generated for itself.

At a later annual  meeting of the American Society of Clinical Oncology in Chicago -- "Kind of the Big Dance in oncology," Gufstason said -- "we met with just about any pharmaceutical company that sells an oncology product that you can think of" and were "walking on air a little bit" with the Whole Foods ads already up on the site.

When you are talking with pharma "Goliaths" like Pfizer or Merck, Gufstason said, "David at Chemo 101 didn't seem so small when you had a partner like Whole Foods."

KG is still working to land other advertising and sponsorship deals that carry Chemo 101 into the future of the fight against all kinds of cancers.

But her one-year fight to start the company: the pre-launch marketing campaign through the national Pepsi Refresh program; her visits to national meetings to build traffic and credibility among professionals "critical" to the care of cancer patients, her primary audience; her widening of her advertising market beyond big pharma to businesses on the periphery of the cancer-care industry; all make for text-book examples of how to build an online small business.

So, even if you don't have cancer, Chemo 101 is a website to watch.

In the Chemo Room: A guinea pig

Never did I imagine I would be walking through the Phil Anschutz-funded doors of the Anschutz Medical Campus in Aurora volunteering to be a guinea pig for cancer research.

But that's what I did on Monday, Tuesday and Wednesday when I went for my first screening and scan appointments to enter a clinical trial for a drug called MEHD7945A, sponsored by Genentech Inc. out of San Francisco, which I suppose wants to manufacture and sell the drug once it is cleared by the FDA.

The consent forms are pretty clear: "You are being asked to take part in this research study of an investigational drug called MEHD7945A. The study drug is being looked at to see if it could be a treatment for advanced cancer. "Investigational" means that the study drug has not been approved by the U.S. Food and  Drug Administration (FDA). The FDA is the U.S. government agency that reviews the results of research and decides if a drug can be sold in the U.S.

"You are being asked to be in this study because your tumor has grown or spread during or following chemotherapy or other treatment, or there is no standard therapy for your type of cancer.... The purpose of this research study is to determine the safety of the study drug and to determine the highest tolerated dose ... that can be given to subjects safely.... This is a Phase 1 study. This is the first time that MEHD7945A will be given to humans and is in a very early stage of development.... Please carefully read the sections on risk and benefits below."

The forms went on to describe known side effects, which so far have been mild in most subjects, but the forms don't rule out death or some lesser cataclysmic personal reaction to the drug and they schedule your first infusion (mine is on Wednesday) as a 10-hour day to make sure you don't have one.

The scans taken this week are done to establish a baseline for growth or reduction of the colorectal cancer growing in my lungs. The best results the researches will tell you about, however, is a possible stabilization of the growth and spread of the tumors. That's one reason entering the trial is considered one way a cancer patient who has gone through "standard" treatment and not defeated the disease can prolong his or her life beyond the time it would take for it to kill you if left unabated.

Dr. Wells Messersmith, the "study doctor" in charge of my treatment, told me July 8 that I don't look like someone who has cancer -- I've been gaining weight lately -- and my hope is that I keep up those appearances (and energy) while this new drug stabilizes my disease.

But none of all that is what amazed me most as I walked through the doors of the Anschutz cancer pavilion this week. What amazed me was the beehive of economic activity represented by the center during what has been the third of probably the three toughest economic years in the state's history.

Patients and employees alike hurried in and out of the pavilion; cars fueled by $3 gas, big buses and small carts ferried people in and out of jammed parking lots; hospital shops and cafeteria, information desks and check-in outposts were hustling with an assured, customer-service oriented dispatch.

I never thought I would have to be grateful to Phil Anschutz, but the marvel that has been created by The Anschutz Foundation -- which has contributed more than $100 million to building the center -- the University of Colorado, the city of Aurora, the state of Colorado and the federal government calls forth a deep sense of relief over having available to me the very best opportunities to beat my disease.

I don't mind feeling like a guinea pig.

Maybe my participation in this clinical trial, like all the work being done at the medical campus, will save a few lives down the road. 

Back to the Chemo Room

Results of the PET scan came in yesterday, and the cancer is still with me, growing, unfortunately, but ensuring my membership in the Chemo Room.

What can you do? You have to keep fighting! A lot of people are dying in the world today: tornadoes, suicide bombs, soldiers, tsunamis. An associate in the media industry, Chris Power Bain, the former director of communications for the Denver Metro Chamber of Commerce, died Monday. She was 57 and had been battling lung cancer, according to today's Denver Post.

Chris was at the chamber for a time while I was at the Post and we developed a professional relationship that now is a pleasant memory. But you don't expect to read about such professionals dying at such a young age. And yet the Chemo Room teaches you it is all too true.

That's why you don't have much choice but to fight your cancer. If you don't, it takes you away.

My oncologist, Dr. Thomas Kenney, working out of Porter Hospital, is going to touch base with friends at the University of Colorado Cancer Center to determine if any clinical trials conducted there might be appropriate for my further treatment.

Otherwise I'll probably be going back on a mix of chemo called FolFox, which I really don't like. It tears you down over the long haul -- it was part of my first six-month round of chemo -- and caused neuropathy in my feet and lower legs that still bothers me today when I'm cutting the lawn or playing croquet.

I'm 64. About to enter my fifth year of fighting colorectal cancer, which means I'm so far about average at besting the odds of survival since diagnosis. About half of us make it this far, and half don't. If I make it through the fifth year, I'll be doing better than most.

And I plan to make it. One thing you find out about yourself when you are recruited into a battle for your life is that while death may be around the corner, living feels pretty good. The time you spend fighting is the time you have still to accomplish something in this world, and you keep in mind what I once wrote at ColoradoBiz: dying puts a period at the end of the sentence that is your life, so you better try your best to make what you do a good story.

That's this writer's take on it. There are millions of good stories out there to tell, and I want mine to be one of them. In the meantime, I'll try to keep telling some of the others.

One of the last things Chris Power Bain worked with me on was a chamber white paper that suggested health care for the poor, usually dispensed in hospital emergency rooms, raised the cost of health insurance because hospitals charged insured patients enough to make up for the free care they were giving away to the uninsured.

A lot of snow melt has gone under the bridges of Colorado since Chris and my discussion about such issues, and yet this country still faces the same problem, and opponents of what is called Obamacare still are trying to dismantle the only attempt this country has ever mounted to solve it.

They say chemotherapy clouds the mind, but I think mine is still sharp enough to ask: What's up with that?

It's amazing how well you can feel when cancer is growing inside you and the doctors are still trying to keep it from taking over your body. The side effects of the medicine (poisons) they give you are what put the struggle in the battle when you fight cancer.

But whiskey makes you frisky, and I'm feeling just fine.

Living, writing stories, and solving problems has been what my life in America has always been about. Lord willing, and the creeks don't rise enough to wash us away, I'll be doing that still for some time to come.

And then you can put that period at the end of this sentence.

End the wars, cure cancer, create jobs

Is the nation war weary? Would the $700 billion this nation is spending on wars be better spent creating jobs for Americans at home?

There is a double-edged sword in the conundrum offered by those two questions.

I've had an epiphany! The Republicans are right! We don't need more public-sector spending to create jobs. We need the private sector to invest money in more businesses to create jobs.

Public-sector jobs are real jobs and help the economy because money in the pockets of public employees is spent just like the money in the pockets of private-sector employees.There's no discriminating between dollars spent in a free market. We are all consumers, and the American consumer has always led the nation's economy toward growth and confidence.

U.S. Rep. Barney Frank, on Charlie Rose last night, mentioned he would like to see the $700 billion we're spending on warfare nowadays returned to the domestic economy in order to keep from "savaging" government programs here at home.

That's fine. But Republicans are essentially right when they say government spending does not create jobs. Private businesses create jobs that public-sector jobs are intended to serve. The need to hire hundreds of lawyers to staff the Security and Exchange Commission arises from the thousands of jobs created in the financial sector by private businesses taking financial risks to boost the nation's prosperity.

Teachers are hired to serve the children of parents working in both the public and private sectors who want to provide a better life for their kids.

Health-insurance companies create jobs to serve private employers who want to provide affordable health insurance to workers whose health or illness creates jobs in the private health industry: nurses, doctors, lab technicians, record keepers and computer techs to create data bases to hold paper medical histories converted to digits. And the health-care industry needs public-sector regulators hired to oversee it.

But no one gets to create jobs if private investors don't have enough confidence in the American economy to invest in it. No one gets to return modernized, outsourced jobs to American shores unless private American money is pumped with confidence into successful, well-managed American firms.

War weary is right. We are all weary of the wars that keep claiming the lives of men and women who could contribute to a peace-time economy at home.

Contribute, for example, to the war against cancer that also keeps claiming life after life after life in this country and around the world. A drug war that seems eminently more winnable than any of the foreign wars we're waging because it actually has produced recent advances that have saved lives.

That's where the $700 billion could be put to better use for all Americans. End the wars, cure cancer and create jobs, too.

In the Chemo Room: 17 minutes to appeal $176,365 bill

I go back to the chemo room later today, but this morning I sat in on a medical panel that heard my appeal of Anthem Blue Cross Blue Shield's denial of $176,365 of radiation "benefits" I received last summer.

To make that clear: Anthem has initially refused to pay my doctors and my hospital $176,000 for treatments I received through May and June 2010 based on the company's medical protocols that don't consider the type of radiation therapy I received a standard treatment for metastasized colorectal cancer. 

Both my doctors, Thomas Kenney, oncologist, and Seth Reiner, radiation, were on the 17-minute teleconferenced call as the appeal hearing was conducted, and both explained why they prescribed the treatments I was given. The panel seemed to agree, but a majority vote is to decide the issue and I am to be informed in 24 hours how the vote went down.

It was all very professional, and my doctors both said they have participated in such review/appeals in the past. It is part of the "system" of health care we've got going for us here in America, and the new "affordable" health care act passed by Democrats last year probably won't change this part of the system.

The law preserved the role of private-sector health-insurance companies in the health-care industry, so health insurers, in order to preserve profit margins, will challenge doctors on protocols in order to keep from paying as much as possible on insurance policies that are racking up huge costs for care. If the company is successful, the bills fall to the patient, no matter their ability to pay, and the insurance company dodges, in my case, this one $176,000 bullet.

Anthem Blue Cross has already paid much more for my care during my near four-year battle against the disease, so I don't blame them for this attempt to save themselves some money. It's good business.

And its good business on my part and my doctors' parts to appeal initial decisions and make the insurance company pay. That's all part of the initial transaction I made with the insurer, and why I keep paying my ever-increasing premiums. The appeal process adds costs to the "system," but that's a policy the wise heads of industry and government have adopted. 

Of course, a public option to private health insurance might suggest a cure to this national chronic economic illness. But that's another story.

In the Chemo Room: Financing alternative care

"It is quite emotional when you're fighting for your life and you are out of money."

Those are the words of Sue Memhard, recent founder of The Emerald Heart Cancer Foundation, a new Colorado nonprofit that is raising money to help women fight cancer through alternative and complementary methods.

My last two reports from the chemo room opened a discussion between readers about the high cost of conventional cancer treatments and the lack of financial resources (meaning health-insurance coverage) available to cancer patients who choose alternative care.

"The foundation was started last year," Memhard explained, "as a result of my own personal experience of trying to find financial help for myself while I was doing alternative treatments for breast cancer. I'm a three-time survivor and I found that there were no organizations that could offer financial help unless an individual was doing chemo.

"I had developed very significant chemical sensitivities from prior chemo that I had taken a number of years ago," she continued, "... [but] everything that is not under the umbrella of the conventional care system is pretty much not covered by insurance. So even if you have insurance, it really doesn't matter.

"It's all out of pocket, and it's quite expensive."

So Memhard and her husband moved to Colorado from Massachusetts to get her under the care of a local alternative-care practitioner, putting the family under significant financial stress. When her husband, who is still looking for a job, asked what Memhard wanted to do here to help the couple survive financially, she said she wanted to start the nonprofit, no small expense itself. Part of the money she is trying to raise will go toward her own salary (which effectively means her medical bills).

And that's how creative you have to get when battling cancer from a pocketbook. My last post described some of my own bills; besides Memhard, the blog inspired Dr. Robert Zieve of Prescott, Az., to contact me about a conference in Phoenix next month that will gather experts on alternative and complementary treatments that are far less expensive than conventional chemo and radiation.

But that doesn't mean alternative treatments don't also cost patients their accumulated fortunes. Memhard called the three $500 grants her foundation has already awarded three women from Connecticut, New Jersey and California "a drop in the bucket" toward the total cost of their care.

That's also why she is actively looking for donors and other sources of financing to get her foundation up and running at a scale that might approach the great need traditional health insurers continue to ignore.

One of the things I've found that is a little debilitating about fighting cancer as hard as you might wish to fight it is the realization of your own uncertain future. Conventional cancer doctors estimate your survival times at various lengths: usually from three to five years. If you are found cancer free after five years of being cancer free, the docs will tell you it looks like you're cured, but not to count on the disease not coming back.

So the shadow cast by survival remains hauntingly over your shoulder, a little dark cloud no matter how well you might be feeling.

"It's quite emotional when you are fighting for your life and you are out of money," Sue Memhard told me.

A professional counselor with 30 years experience, Memhard also uses the foundation as a conduit for providing free telephone counseling to women who are facing the emotional anchors that threaten to pull you under while you are fighting the disease. She could use a little help along her way.

Give her a call at 303-993-8843 or go to her website at http://www.emeraldheart.org/. Whether you need help or can offer some, she'll welcome your call.

In the Chemo Room: Bills

The "Level 2" appeal of a $79,000 bill for radiation treatments I took last summer went into the mail yesterday, and I have before me two more invoices from chem labs for more than $1,000 for services done late in 2010 and as long ago as the summer of 2009 that have not been paid by my insurer.

And that's just the unpaid tip of the huge mountain of dollars that has already been paid by Anthem Blue Cross Blue Shield and myself during my four-year-plus battle against colorectal cancer. 

I'm finally in the process of adding it all up, and hope to write more about it for your reading horror, but also to illustrate the cost of fighting and surviving cancer in Denver which is no small financial hill to climb.

Maybe some of you can share your financial experiences with me if someone in your family has been fighting a serious health issue.

Part of my problem in facing these costs over the years has been my lack of income. I went from a salary just under $80,000 a year to a spotty income of about $30,000 annually for 2007, 2008 and 2009, what with writing a book for pay, doing a few public-relations projects and cashing out my retirement and one life insurance policy.

This past year has been a lot worse, as it has been for many, many people, and I've been borrowing heavily to make ends meet. Strangely, even though I am still taking chemo therapy, I feel as if I have recovered 98 percent of my energy pre-diagnosis, and I'm working hard on writing projects, including this blog, but making no money.

I plan to change that this year. And one of the ways I hope to change it is by writing about how much it costs to survive cancer in Denver, Colorado. The problem with survival, as I've already indicated, is not only that you have to pay for a portion of its expense, but also that you have to pay all the rest of your "cost-of-living," like rent, groceries, car insurance, etc.

So filing an appeal of a medical bill that has been denied by an insurer becomes routine business for a cancer survivor.

And you do it with a kind of a hippie-inspired equanimity because you know your insurer already has spent hundreds of thousands of dollars to keep you alive. You can only be grateful for that, even when you realize you are simply collecting on health-insurance premiums you have paid all your adult life.

Those total premiums, after all, hardly match the cost of long-term cancer care at today's health-industry prices.

But you realize something else as well. What you do not pay for during the four-year struggle is all the support, prayers and love shown to you by friends, family and readers of your blog. You can only be grateful for that, too. So thank you.

In the Chemo Room: I'm back ... !

Yes, I'm back in the Chemo Room, just as my oncologist suspected I would be, and I had hoped I would not.

But the only way to keep cancer from killing you is to keep fighting it.

So I am back in the Chemo Room fighting my cancer with the same two chemicals that got a "profound"  response from my body during my last round of chemo: Erbitux, that expensive cell-starving biologic, and Ironotecan, a cell-killing juice you really don't want to try.

My latest treatment was last week on Thursday, and I spent most of Friday and part of Saturday and Sunday trying to get over the hump of it. Sunday's Broncos' thumping of Kansas City helped.

I feel better now, so I'm back at my computer to tell you again about where I've been in my fight against this disease.

Before the latest treatment, I was telling people I felt I had come back to nearly 100 percent of my work energy before ever being diagnosed. That was the result of a seven-month break from the chemicals: my hair grew back; the neuropathy in my hands, feet and legs continued to dissipate, making me feel like my nerves were growing back; I was writing and posting these blogs (about other subjects) more frequently, writing on http://www.examiner.com/ about Colorado poetry more often, finishing my book about Denver oil man Timothy Marquez, and even writing about other literary topics on my poetry website, http://www.robertschwabpoet.com/.

I also underwent six weeks of radiation therapy trying to kill the one cancer-cell production center -- a lymph gland in my chest -- spotted in the March 17, 2010 pet scan I received following the end of the first Erbitux round of chemo.

The side effects of that treatment were minimal except for the fact that Anthem Blue Cross Blue Shield initially denied paying for the treatment and sent me a statement indicating a debt of more than $70,000. I believe that claim is now being worked out. When you don't make much money, you have to treat such claims casually and just seek to have them resolved between your doctors, the hospital and your insurer.

Five-year survival rates for colo-rectal cancer starting with a tumor in the rectum are about 59 percent, according to a 2006 post on About.com.

My doctor, Thomas Kenney, believes my cancer had already metastasized to my lung before the September 2007 surgery to remove my tumor, so my odds of living with the disease for five years probably have been considerably lower, but my luck on the Erbitux and Irinotecan gives me a chance to boost my odds of survival even past the five-year mark.

I was taking flax-seed oil during the whole last round, and I believe (with no proof) it might have helped me, too, since long-ago research that was ignored by the medical community claimed flax oil acted as an anti-cancer agent. The latest anti-cancer agent to acquire blooming Internet demand is something called Lypo-Spheric Vicamin C, but you won't find many doctors swearing by it (again no proof).

My docs don't like me taking extra Vitamin C because they claim it interferes with the chemo. Kenney has told me to investigate my own alternative treatments to the cancer, and during the seven months I have been off his chemicals I have found that diet is probably the most logical alternative or supplemental treatment besides flax that I might undetake.

That's a difficult choice. You pretty much have to stop eating red meat, and if you don't eat vegetables raw, you should cook them from a raw state to have the most impact. The idea is the foods naturally boost your immune system, and your immune system is the best cancer-fighting agent there is. Chemo essentially destroys your immune system.

But with a new Whole Foods store and a Vitamin Cottage nearby, I might just give the food route a try. Many of you who know me well, know that I have never lost my appetite during this fight. Not for the fight, nor for a good dinner, cocktail and dessert on most evenings.    

In the chemo room, Chapter IV

A quick update, with more to come soon.

The PET scan I talked about in my last post (look down this series of posts to find March 10) revealed a "profound" response from my body to the Irinotecan and Erbitux mix of my last round of chemo.

The quote is my doctor's. Thomas Kenney, my oncologist, presented my case to the tumor committee of Porter Hospital today because he wanted the medical staff to take a look at what he saw and did not see in the scan.

What he did see was a single, still-active, cancer-producing lymph node in my chest that is considered a primary site for lymph-node production of metastasized colo-rectal cancer cells; what he did not see was any more production centers. Neither did he see any obvious reproduction of cells in my lungs, but he was going to double check that before presenting my case to the tumor committee. I presume he didn't see much when he took that second look.

That's all great news, of course, even if the single lymph node indicates I haven't yet stopped abnormal growth of cancer in the Schwab body.

But it did change Kenney's thinking about what to do next. There are some clinical trials of new cancer radiation treatments being done at the Anschutz Medical Campus in Aurora, and since my cancer only was showing up in my chest, he thought I might be a good subject for localized radiation to kill all the cells in that area.

If there is no microscopic cancer-cell production still going on in parts of my lungs, the radiation of the chest nodes might indeed cure me. But if the lungs are still growing little tumors, like bulbs in a spring garden, the cancer eventually will grow large enough to be picked up by the scan again, perhaps in three to six months.

Kenney has to consider all those ramifications in deciding what treatment to recommend to me. After all his ruminations though, we'll talk about the next, best treatment options, and I'll decide what I want to do.

Of course, if I can afford it, I'll do whatever I can to kill off the stuff growing inside me. I figure it is going to take me another seven years to finish the novel I've started, and to make a success of the business I am just starting. No one can guess the percentages playing for or against me, but if this "profound" Schwab body is making a bet, I'd lay odds its going to get it all done.

I'll update you soon on my next treatment decision.

In the chemo room, III

I'm actually out of the chemo room as I write, but my coming out is one reason for a new chapter in this series.

A week ago, I had my last of 12 treatments in my second round of major chemotherapy, and I will soon be scheduled for another PET scan, an imaging procedure that involves injecting me with radioactive dye that lights up the areas of my organs where cancer cells are being produced at an abnormal rate.

In other words, the scan will show my oncologist, Dr. Thomas Kenney, what effect this second round of therapy has had on my cancer. Kenney and I will then discuss what further treatment I require to keep myself alive.

Kenney is now treating me as if my colorectal cancer is a chronic disease, not curable but treatable, probably a little like Elizabeth Edwards, whose breast cancer has been described the same way.

One PET scan has already shown that cancer producing cells in lymph nodes in my chest and in my lungs were being kept in check during the first three months of this round of treatments. Kenney, however, doesn't really know what to credit that development to. No oncologist can.

My doctor prescribed a combination of Irinotecan, a cancer-killing chemical, and Erbitux, a cell-starving biologic, for this round of treatment; but cancer doctors treat you according to their knowledge of the latest results of clinical testing of all the drugs available to them for specific cancer treatments, and the result is largely as individual and random as a toss of the die at a Central City roulette game.

The only thing predictable about the treatments are their side effects, and since my experience of the side effects of my two infusions followed past patterns for the drugs, the doctor and nurses who treat me guess the treatments are doing what they are supposed to do: reduce the spread and rate of reproduction of cancer cells in my body.

The new PET scan will confirm or deny that assumption.

Other than a sick day or two on the day of the treatment and the day after, I have been feeling pretty good most of the time. I haven't felt some bothersome pains in my chest, especially after hard labor like hauling downed tree limbs around my backyard, since the treatments began; but then I haven't had many tree limbs to haul since then either.

I feel like the treatments are doing some good, but the new PET scan will confirm or deny my self diagnosis.

So I asked my doctor about alternative treatments.

Clinical trials, for instance, if any are being conducted locally, that might lead to a cure of the cancer rather than mere abeyance; or perhaps nutritional therapy, which you frequently hear about saving lives.

"Most doctors won't take on this discussion," says one line in a book I'm reading called "Ultraprevention," by Drs. Mark Hyman and Mark Liponis, proponents of alternative treatments for a variety of ills.

And the authors were right about Kenney. He said he would leave any research of such "cures" up to me because he, himself, has seen no "data" -- and I know he updates himself on the latest data on everything as quickly as it is released -- that suggest proven beneficial effects.

Kenney plays percentages like the general manager of a professional baseball team, and he allows for only scientifically derived percentages of tested treatments to direct his care for patients.

That's more than okay with me, actually, since he made it clear to me at the beginning of my treatment that the cancer-fighting game is largely one of percentages. I figure Kenney's professional transparency is a lot more than you get from a banker nowadays.

So I'm reading this book called "Ultraprevention, The 6-Week Plan That Will Make You Healthy for Life." I have already watched a CD about dietary treatment of cancer, but the CD ranted on and on about why the "cancer industry" was all wrong in the way it treats cancer patients, while it offered little on the diet it suggested might cure you.

Both the book and CD were sent to me a while back by two friends in Chicago, but I largely ignored the advice until it became clear to me that Kenney was probably going to having me on Erbitux for the rest of my days.

The biologic, which attacks a sort of anchor that is characteristic to certain colorectal cancer cells, costs as much as $4,500 per month per treatment according to some of the latest news about it, and my health insurance company, Anthem Blue Cross Blue Shield of Colorado, so far has sported for the full costs of my chemotherapy minus copays.

I do pay $1,100 monthly premiums for the coverage, however.

I'll write another chapter of this series when I get the results of the PET scan to let you know how I'm doing. I'm also going to back track through my treatments to give you an idea of what it costs to treat colorectal cancer in Colorado, an idea originally conceived as: "What it costs to BEAT colorectal cancer in Colorado."

Developments have augured badly for a cure since that original thought occurred, and the energy robbed from you from cancer treatments also interfered with producing such a series of posts on an appropriately efficient schedule.

I do mean to finish the project. Stay tuned.

In the chemo room, Chapter II

Getting out of bed to start another day becomes one of the more difficult chores of the patient under chemotherapy.

I say that not to garner sympathy, but merely to report a fact. I’ve felt like that, in fact, at other times in my life when I have not been under the influence of chemo, and I’m sure others have, too. It's like waking up with a hangover, or just facing another day of monotony in your job or even among your family.

(Photo credit: Cancer cell, healthjockey.com)

So, I think I can safely say just about anybody can identify with the experience even if you don’t have cancer (and I pray you never will).

But the right thing to do -- always -- is to get up and get started. Get going. Make a move. Take a risk and make some money!

You have to think hustlers for survival have made that decision endless numbers of times on endless numbers of mornings throughout history.

It’s a life-generating decision. Just deciding to get busy again makes you part of the world you live in. The Broncos have won! The Rockies, too! The heat’s coming on in the house even on the last day of summer. It’s Monday. Another miserable Monday, and yet you are glad to face it, glad to be alive another day.

Actually glad to have bills to pay, and a dog to feed. A lawn to cut, and a book to finish. A batch of pals to play poker with, or croquet!

Glad for the challenge to figure out your finances for the next two years, and yes, even glad to still be facing your taxes! Life isn’t always filled with beautiful sunsets and close companions near at hand.

Sometimes it’s only you facing the morning and another day of work.

But that’s okay. The Broncos have won! The Rockies, too! Life is good and getting better.

In the chemo room

I smell like chemotherapy now, having finished my first session of my second major round of chemo yesterday (Sept. 17) with about eight to a dozen other patients at Cypress Hematology & Oncology who, like I, it seems, are going mano a mano with death.

It was a good group, and two women who are fighting breast cancer (one of whom has already done battle with lung cancer as well) had a frank discussion with me about our treatments so far and how we cope with the prospect of not surviving. A fourth patient listened pretty intently during the five hours I was there at the Porter Cancer Care Center in South Denver since I think it was his first ever session in the chemo room.

I entered the building a little leery of what the day would hold.

The major side effect of both the chemicals they pumped into my body yesterday, Irinotecan and Erbitux, is diarrhea, and since the same symptom proved a problem for me during my first major round of chemo, I walked through the automatic sliding doors of the center with a sense of foreboding bordering on doom. The foreboding was for the reaction to the drugs; the doom because the chances of surviving my metastatic colo-rectal cancer for up to or more than five years are pretty slim -- five percent.

But my oncologist, Dr. Thomas Kenney, said the treatments might give me two to three years, and I told the two women in the room with me I wanted the time to finish a book I'm writing about a Denver oilman, Tim Marquez, as well as my own novel, which is up to five completed chapters so far.

As for the rest of the day, it wasn't so bad. I had a 90-minute interview with Kenney's nurse practitioner who went over the treatment, the symptoms of the side effects, and what current medicines and supplements I'm taking that she said I should curtail or continue. She wasn't at all surprised -- except by the little information about the topic in the materials she was giving me -- when I asked her the effects of the chemicals on my sexuality.

I think women, who have grown up with menstrual issues and the prospect of pregnancy, have a better handle on the sexual reactions of the body and its parts acting sexually than do men. We men usually do not like to talk about it. Unless it is with a woman.

The materials the nurse gave me mentioned that sexual intercourse should be performed with a condom since chemo chemicals can be transferred in bodily fluids, which also rules out oral sex while one party is in chemotherapy.

What the materials didn't talk about was passionate kissing, nor a man's arousal to erection and ejaculation, nor a woman's arousal. My nurse told me the chemicals I'm receiving shouldn't have much effect along the latter lines, and I didn't ask about the kissing but assume that should be limited to closed-mouth as well.

My nurse did admit she and her fellow nurses are not often asked those questions. Sex is still a dirty word in America.

Then came the five-hour infusion session, meeting and talking with my two new women friends, and the relief of leaving the center knowing the first chemo session was done, and I didn't have to take another for two weeks. Of course, then the steroid they give you to boost the effects of the chemicals, kicked in and kept me awake past three o'clock this morning. And by six, the diarrhea.

That's why I'm not getting to this blog until now to write and post what I actually wrote in longhand in my bedside journal between 2 a.m. and 3 a.m. this morning.

I still smell like chemo, but at least I'm alive to write about it.

Cancer's back!

I've got cancer -- again.

The colorectal cancer I was diagnosed with on June 5, 2007, and that for the past year or so I thought I might have beaten, has shown up again in my latest PET scan Aug. 4.

And this time, like a good reporter, I figure I'll write about my renewed go-round with the disease, since it could well be my last.

In fact, it probably will be my last. I just looked up the survival stats for Stage 4 colorectal cancer, the last stage of the disease, and found only 5 percent of patients diagnosed at that stage in the United States survive the disease for more than five years.

Back in the summer of 2007 (the 40-year anniversary of the "Summer of Love, when I joined the throngs of baby boomers who trekked to San Francisco), Dr. Thomas Kenney, my oncologist, told me I had about a 50 percent chance of surviving the disease for that long, and about a 20 percent chance of being cured. But he also warned there was a high recurrence rate for colorectal cancer, and for that reason he would treat mine aggressively.

I underwent radiation, surgery (actually four surgeries within fourteen months), and six months of intense chemotherapy that deadened the nerves in my hands and feet (neuropathy, which continues today), and was cleared of cancer cells last summer or so. Probably.

They don't tell you much definitively when you are being treated for cancer, the argument being every individual is individual, and no one can predict beyond the average how your body will respond to treatment.

I wanted to write about my treatment this time around because I want the cancer to work for me instead of against me, as it has done so far. The last time around, I considered writing a longer, magazine-style journalistic piece about what it cost to be treated for cancer in Denver. But I never did it.

I admit my own laziness in putting off that attempt, but I also felt like my treatment never really ended while the neuropathy continued and the management of my own re-sectioned bowel continues to give me problems. It's also why I never seriously looked for a public-relations job following the initial diagnosis and surgery since I had left my job at ColoradoBiz magazine in February 2007.

Instead, I took the two years of treatment to decide I wanted to make a business of my own out of my writing: poems, short stories, a novel that has been started, a non-fiction book I'm writing for Denver oil man Tim Marquez, and perhaps some specialized small-business media consulting I would do if I could find the work. And this blog.

And now the cancer has come back, threatening to cut short those efforts -- but not really, at least for as long as I can continue them. So I'll continue to write about small businesses here. About politics, and anything else that comes to mind. I'll keep writing poems to post on my website, http://www.robertschwabpoet.com/, and I'll keep writing about literature at http://www.examiner.com/. Keep reading.

This story is "probably" going to be the best one I've ever written.

(Photo credit: Cancer Cell, HealthJockey.com)