Friday, March 6, 2009

Canaries in a Cat Scan

I have already talked with all my kids, so here's the news, again in the form of a gently edited letter to protect the identity of the recipient.

Details, commentary, the  expert opinions, and the path ahead will follow soon

Dear Friend,

Well, I am not waiting for clarity or good news or even a sense of direction to write again.

My bone marrow biopsy was perfect. Not only am I cancer free down to the last drop, but back to normal. My blood tests are all boring (boring is good in my line of work).

Then the CT scan had to gunk up the works. One of the privileges of being a doc, is that I get to see the images as the radiologist (he like being call rad) studies the shadows made by my insides. Like the shamans reading chicken entrails, but hopefully with a better batting average

At first it looked OK, then there were two suspicious nodes in my gut, but not so definite that a second quick scan might add more info, which showed that it was actually only a knuckle of bowel and all is well, except that with a third look and a second pair of eyes they really are nodes after all. What a roller coaster ride in real time. The biggest node is only 2.2 cm x 1.7 cm. Barely pathological, but clearly growing. Just two 2 stupid nodes are bigger now than on the images from Dec 1 last year. The glands in the armpits, chest, pelvis, groin, and even all the other mesenteric nodes are stable or shrinking.

But the rain's gotta start at some corner. Those two mesenteric nodes are my canaries in a coal mine.

I have left the land of remission and entered the land of relapse. Or at least my toes are through the door. There is still a sliver of a chance that these aren't yellow canaries but actually are red herrings. Pray for me that I am already cured, but my will is being tested.

I am still coming to terms with this all means. Certainly more chapters in my book.

Hopefully the leukemia gurus will have answers, but I think I already know what they will say. Redo the transplant, with a bigger hammer. Bummer. I feel like a bad schoolboy: Brian, you will do this over and over again until you get it right.

Well, at least I have choices and the energy to pursue them.  And with a clean marrow, much time to weight my options.

Some good news:

My son Will was juried into the very competitive Laguna Festival of Arts. At 20 he may be the youngest artist ever accepted.

Our two ton sculpture finally made it into our front yard after years in storage. The house feels more grounded. Now yours isn’t the only house with a playful entrance.

Patty and I are tickled about scoring tickets to hear Leonard Cohen in San Diego. He sure delivers his songs on the NPR podcast from New York. Check out

Be well.


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Blogger Alison said...

Brian: will be thinking of you. Very best regards, (love Leonard Cohen, he was here in January, as you know).

March 7, 2009 at 5:18 AM  
Blogger Barry B. said...

Well, that's unfortunate. Perhaps it will not be linked to the CLL. It's hard to believe that there is no evidence in the marrow, yet just in (some) lymph nodes.

I think one of the hardest problems in treating CLL are the cells that hide away in the lymph nodes. They find a nice, warm, safe home, and they set up housekeeping, and start making lots and lots of babies.

Flushing them out would be an excellent thing to do, but difficult indeed.

I wonder if you've looked into trials of AMD 3100. That drug is being tested in CLL (certainly a coincidence, but I wrote the company asking for such a trial about six months before they set one up...).

It's designed to push stem cells out of the marrow, but there is some thinking it helps push CLL cells out of hiding as well.

March 7, 2009 at 11:45 AM  
Blogger Judy Cleri said...

Dear Dr. K,

Seems like it is always one step forward, two back. But the good news your bone marrow is cancer free and we will hang on to that.

God has not brought you this far to let the CLL come back and take you from us. We need you back. After all, everything that you have been through is only going to make you an even greater doctor.

Take care our friend. Be well and know that you are in our prayers.


March 7, 2009 at 12:58 PM  
Blogger Unknown said...


"When we reach the end of all the light we have,
and walk into the darkness of the unknown,
we must believe one of two things will happen.

We will be given something solid to stand on,
or we will be taught to fly..."
author unknown

March 7, 2009 at 5:56 PM  
Blogger Lezlei Ann Young said...

Well...I can't offer any medical opinion, but I will continue to pray to the "Great Physician".

March 13, 2009 at 9:17 AM  

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