The Christmas Whoosh

Tuesday morning we (Angie, Heather and me in one vehicle, Michael and Brooke in another) got off to a late start. We hit some weather along the way and didn't get into town until evening. My sister Karen, younger nephew James, and Karen's friend Jay had a far worse ordeal as Seattle had all but shut down for a couple days to deal with the snow. Instead of leaving Sunday, they couldn't get out of Seattle until Tuesday. But their connecting flight from Denver left before they could meet it, so they didn't make it in until shortly after noon on Christmas Eve. She wasn't happy.

Angie, Brooke, Heather, Michael, and I started the Christmas Eve festivities in Mandan at Darcy and Harley's with some contraband snacking before dinner at Angie's folks' house. After dinner we opened gifts.



Brooke went to her dad's for her continued Christmas Eve gift openings, and we returned to my parents' house. Karen had been busy wrapping the presents she had shipped to Mom's and fully intended to wrap days earlier. And we all but turned right around and unwrapped them.



Santa brought Heather more goodies Christmas morning, but Daddy (yours truly) was sleeping in and didn't catch any pictures. Angie and I went to visit her brother Marv and his girl Jill for an hour or two in the afternoon. And then we tried to get the Sinkula Christmas dinner going. The turkey wasn't cooperating very well, but eventually it all came together. And Daddy got stuffed.

Later that night, after playing a bit of Blockus, Angie found two dogs playing in the snowdrift. They didn't appear to belong to any house in the near vicinity, so I called the number on the tags. It turns out they belonged to my old buddy Troy, who had just shipped overseas in early December. I emailed him, saying, "Small world, huh? Two dogs from Tennessee bump into two Twin Cities residents in Bismarck."

On Friday, I also got a nice surprise in a phone call from my friend Mark's wife Lisa. We chatted briefly, as Angie, Heather, and I were off to meet up with Angie's friend Tanya, her husband, and her four boys at Kroll's. Later I returned to my attempt at being Mom's PC tech support. Eventually I had success getting her B&W copier/printer working again -- but not before spilling toner on the white carpet. I did call Mark later and did a quick catchup of what now turns out to be over a year since we had last met up in Fargo.

Meanwhile, Michael volunteered to join Angie to visit her friend Nicki in Flasher, ND. Meanwhile I continued trying to figure on Mom's printer issues; hours later I threw in the towel and talked with Karen and Mom for a bit. I managed to figure out "the other secret" to Mom's "secret" chocolate (and butterscotch) chip cookie recipe.

The snow picked up Friday evening, but I was dead tired. Angie called to note that they were leaving Flasher about 11. I made it maybe a half hour, but zonked out shortly thereafter. The phone rang a little after midnight, and caller ID showed it was from Angie's cell phone, but she left no message. I tried to wake up enough to call back, but I got no answer. Shaking off some cobwebs I went outside to grab a smoke and watch the falling snow accumulate. I called again about 20 minutes later and still got no answer. So I called some Highway Patrol number and checked the weather radar online. After a couple back-and-forths with the HP guy, Angie called and said that they were just leaving Buck's, where Michael wanted to make a quick stop. I called the HP back with the news, and returned to grogginess.

Saturday we were having family pictures at 10 am, so we had to get everybody up and dressed "early". We managed to get everybody there on time and the sitting went well, but of course it took longer than expected for Mom, Karen, and me to make all our selections. Finishing up just after noon, we stopped at home to grab a quick bite to eat and then get ready to head out to the Elk's.

From 2-4 we were celebrating Mom and Dad's 50th wedding anniversary. I really enjoyed visiting with many of our old neighbors and meeting some of the people Mom has worked with. We thought things turned out very well.



After cleaning up, "us kids" and our kids wandered off to Midway Lanes. We invited friends Dan and Sandy to join us, and we all had a really good time. And then it was time to pack for home.

Thank you, everyone, for a great Christmas. I wouldn't want it any other way.

Beginning of the Christmas Whoosh

Michael, my older nephew, flew in from Seattle in Saturday's cold, snowy weather. He is palling around town, and enjoying the midwest winter, first with some Army buddies in the area. They went to the Vikings-Falcons game yesterday, and he dropped by our house to visit tonight.

We opened the "stays-here" Christmas gifts tonight.


Click for full-size slide show.

Tomorrow we are heading west into the wind and snow that seems to accompany about every other Christmas venture home.

Optimism for Christmas

That last post of mine was rather negative. I suppose that was because I needed to ask a question of Dr. Amatruda and take in the answer. Today I followed up with Dr. Sielaff, and had to ask a few more questions and again take in the answers. The former brought me down, the latter actually perked me up. So I hope that this post makes up for the last and lifts Christmas spirits.

With the below-zero temperatures, and my general lack of circulation, I answered Dr. Sielaff's "how are you doing?" with "cold". The post-op wound management stuff for the liver surgery went pretty quick because everything looks dandy. I had to razz him a bit about the strange (to me) new appearance of my navel -- which isn't really noticeable to anyone but me. And then we broke into a pretty quick back-and-forth about things going forward.

I asked about the two spots that were resected, and Dr. Sielaff sketched wider ovals (I was envisioning a reduced-scale version of the wide excision) representing the removal of a larger area than the smallish spots themselves. I verified that I indeed still had a gall bladder. He inquired about the Hoag study -- whether or not I had heard anything from them yet. I shared that I had not, but that Dr. Amatruda had emailed them and cc'd me and we are awaiting an update.

And then my question of the days was about the "seeds". Perhaps it was my natural-born pessimism, or the fact that I like to buck up for worst-case first, but I had begun so envision my liver as a slice of watermelon -- as it pertains to both the size and number of the possible tumors. Dr. Sielaff explained that they were more like sesame seeds. That was good to hear, but I was now imagining a Whopper bun covered with them, so I asked about their number. He said perhaps 4 or more were seen during the laproscopic procedure. Relief and optimism returned and my spirits were lifted.

I did my best to relate the main points of my visit with Dr. Amatruda, mentioning the alphabet-soup experimental chemo stuff, the upcoming CT scan, and the scheduled start for chemotherapy. I asked if this was likely in response to the seeds, to try to kill them off, and I believe that is so. I think the Hoag vaccine, if all goes well, could be down the road a few months or so. And adjuvant therapy may also be on the horizon somewhere if the existing tumors -- too small for a needle biopsy -- are killed off.

All went well today, and I wished the folks at Abbott Northwestern a Merry Christmas. And may everyone reading this have a Merry Christmas as well!

The Big Question

Today's visit with Dr. Amatruda was another of the warm and good-spirited talks much like we've had in the past. Our topic may have been less than ordinary, but we have good banter.

Given what I had learned in my grogginess following the partial hepatectomy and thereafter, I tried to cut to the quick a bit. So I asked the question, probably the real question that many folks would like to hear an answer to, and one that I have perhaps danced around a bit in the past: "I'm pretty well hosed, right?" Essentially the answer was to the affirmative. And with that biggie out of the way, we continued on discussing my current situation and the latest treatment plan.

Previously, the treatment planned was moreso toward adjuvant therapy, I believe. That is, things along the interferon and interleukin line. But since more "little seeds" of cancerous tumors were found on the liver, Dr. Amatruda has now suggested the chemotherapy route.

After some of the verbiage you will encounter further down, I tried to dumb things down a bit from the big words. I asked if the version I had been telling was a valid attempt:

The chemo is like roto-rooter, going through the system and killing stuff; the interferon is like a vitamin overdose, trying to get my body to kill the stuff but also having similar side effects.

He preferred to reword it something like this:

Let's say you've got moles ruining your yard. You choose one of two options poison (the chemo) or ferrets (the other). The poison may kill the moles, but it also may kill some of the grass; and after they're gone they may return again. The ferrets might also beat up the lawn a bit, but the may get rid of the moles too -- and potentially keep them gone longer.

But as it pertained to the big question earlier, either treatment is essentially to buy time. Stage IV is apparently not a happy place. Some of the treatments discussed were as follows.

1. High-dose interleukin-2. This is apparently quite toxic and given in an ICU, but it effects may last longer.
2. "Standard" chemotherapy with temozolomide. Or other chemotherapy types that may be better tolerated.
3. Experimental chemotherapy with Taxol and STA-4783. This was the way Dr. Amatruda currently recommended.

But before hopping into #3, I first need to visit with Gretchen^* to determine whatever we need to determine. And so we started setting up appointments, but it was a wonderful snowy day and my appointment was already scheduled for late in the day, so I'll need to get those things sorted out later.

But it will probably go something like this:

• Get a new scan. This time a CT, not a PET/CT, of my abdomen and what-not. Shoot for the week between Christmas and NewYear's.
• Consult with Gretchen in early January.
• Consult with Dr. Amatruda about 2 days after Gretchen.
• Start chemotherapy in mid-January.
• In the meantime, try to keep up on top of the tissue samples that went to the Hoag study.

And also start seeing a shrink to talk about stuff. Maybe not so much me talking about me, but to also include how to talk to the girls. And family. And friends. So you don't end up hearing about his on some stupid blog or something. D'oh!

Anyways, I'm still pretty much the same as always at this point, a tribute to boring consistency like no other. And frankly, I'll be doing my best to maintain this -- oh, I'm planning on doing so for quite a while.


^*I'll have to try to get more information later on.

Life Goes On Around Me

After the surgery on Wednesday, I had been feeling able to walk by myself already by about 4:30 -- just a couple hours afterwards. In fact, when they took me to the parking ramp in the wheelchair, they'd wanted Angie to swing the car around to end up right in front of me. But since it would have meant navigating the up-a-level/down-the-exit-side wanderings, I just got out of the chair and walked past the 20-ish cars to catch up with her and make exiting the facility easier. This was the start of me perhaps not taking it as easy as I should have been doing.

Having made it to an upright position for sitting, it was a bit uncomfortable trying to return to a prone position. And since sitting in front of the computer clicking and reading and tapping at the keyboard does not feel like any kind of exertion, I think I'd begun being a upright perhaps more than I should have been for the past couple of days. Come bedtime, finding a comfortable position lying down was a bit difficult. And since I usually sleep on my side, but mostly on my stomach, sleeping only on my back was making my back quite sore. So it was even easier to resume a sitting position.

But as the Vicodins dwindled through yesterday, I tried harder to get comfortable lying down. And this morning I had to have Angie do a morning routine with Heather while I slept in. The result is that the area on my right side that has intermittent twangs of brief, sharp pain has receded a bit. (Or maybe I'm feeling the sore back competing for attention a bit more?)

Anyway, I may be a stubborn old cuss, but when all else fails I'll do what I believe I'm supposed to be doing. Or at least I'm more inclined to lie down a bit more than I have been doing in the past few days.

My Distractions

Angie probably wouldn't care for me discussing her health concerns here, but I'll try to summarize: for a couple of months she has been stressed and her cycle has been way out of whack. The other night she finally sought medical attention and was prescribed the pill to try to set her cycle straight. This seems to be working in its initial start.

It snowed the other day, and at least I knew enough to ask Brooke to shovel the driveway while Angie and her friend were gone to the hospital -- she would have really been after me if I'd done it even though the first round was a fairly light dusting. When Angie finally returned home from the long medical visit, the first thing I heard was, "Who shoveled!?"

I knew better in part because I'd already sneaked out and driven to the drug store to fill her prescription for her. I was still taking the Vicodin, but that dose was wearing off and I'd gotten familiar with the effects in the previous days. And besides -- I needed to get out because once again my fake beer supply was gone.

In the meantime I've been spending a lot of time maintaining some of my online haunts. On Facebook more folks I know have been appearing, and I'm doing what I can to maintain on online presence there. But it's been as my alter ego, High Plains Blogger, where I've been doing many of my wanderings and updates. In particular, I've been rather engaged with Twitter as HPB. I really try to keep these two sides of me a bit separate, but since that's what's been keeping me busy lately, I'll make this brief mention.

Heather picked up a bit of a cold the other day, and we've given her some children's ibuprofen to nip in the bud some minor fevers and orneriness. That appears to be working as well. Brooke went to a movie with her boyfriend last night, and today they and some friends went to Cheap Skate for an afternoon of rollerskating. I've been instructed to ignore the fresh snow and let Brooke shovel again once she returns from skating.

A view from the garage.

Cripes, this post was been filled with a lot of random thoughts. 'Tis the season to be scatterbrained, I guess.

Before I forget, I'd better say an early "Happy Birthday!" to Dad, who will be 79 tomorrow. I hope I had gotten the cards out in the mail earlier this week.

Partial Hepatectomy

Today I had my surgery; I just got home a little while ago. I'm a little fuzzy yet, but my story goes something like this.

Everything seemed to go well as far as the planned procedures and what-not. Dr. Sielaff performed the surgical resections of the two locations he had earlier expressed interest in. These tissue samples were then used with the tissue kit for the Hoag study.

Being a laporoscopic procedure, Dr. Sielaff was able to further investigate tissues surrounding the ares of initial interest. Apparently there are more tumors on my liver -- "like little seeds" I believe Dr. Sielaff said. Their size and number meant that these were not treatable today.

So the main goals from today's adventure have been accomplished -- the larger tumor sites have been removed, and the tissue samples are off to Newport Beach for some warmer weather. My surgery was about noon; I seem to remember being awake about 3pm; and I was able to navigate Angie home from Abbott Northwestern's south-of-downtown-Minneapolis location back home. And I seem to be feeling fairly spry at the moment.

California Cancer Study

Hmmm. What to do, what to do? I've been looking into this lately, although not as well as I ought to have been.

VACCINE THERAPY

Vaccine Therapy.

The vaccine, consisting of either irradiated autologous tumor cells injected with 500 mcg GM-CSF, or dendritic cells that have been incubated with irradiated autologous tumor cells with 500 mcg GM-CSF, is given subcutaneously once a week for 3 weeks, then once a month for up to 5 months (total of 6 months of treatment). Patients will receive a maximum of 8 vaccination doses. All vaccine therapy will be given in the outpatient clinic at the Hoag Cancer Center, Newport Beach, California.


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Evaluations.

Radiographic evaluation with MRI, PET scan and/or CT scans will take place at baseline and then every 6 months for 4 years, then once at 5 years and 6 years from entry.

Vaccine Therapy Overview (abbreviated)



INFORMATION FOR POTENTIAL PATIENTS

Vaccine therapy is provided to patients free of charge, however all other study related costs are the responsibility of the patient, including approximately $275 for the tumor accession kit, and $1800 for the Cell Biology Laboratory for tumor tissue cryopreservation. Additional costs may be incurred for physician consultation and study related visits, monthly laboratory tests (which MUST be done at Hoag), radiology scans performed before, during and after vaccine therapy, as well as any additional testing or medical care needed during the course of vaccine therapy.

I had a visit with Dr. Amatruda again today and we discussed this a bit. I have also been trying to mull over the insurance and logistics. And apparently I should also try to give a call to Dr. Sielaff.

Given this upcoming busy weekend, I'd best "take it with me".

• Tumor Acquisition Info
• MAC VAC Protocol Synopsis
• Powerpoint Presentation Mac-Vac
• DC Melanoma Vaccine Interim Analysis 2004

Beer Trek

This may sound a little strange, but Busch N/A is not terribly easy to find. I have cleaned out the nearby Rainbow Foods. The local Cub Foods didn't seem to have any. The Star Liquors doesn't care it either. I've cleaned the MGM Liquor out twice, but I did ask the manager to increase supply.

My "weekend supply" dried up early with the Vikings-Packers game. So I went off in search of placebo beer.


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My first attempt was a neighborhood grocery store (B), but it was a longshot and an employee said they didn't carry that item. I pushed on into Blaine to check the SuperTarget (C). They had beer, they had N/A beer, but they didn't have Busch N/A. I needed to get some Dora soup for Heather, so I grabbed a couple cans and decided to take an O'Doul's as backup.

Not to be deterred, I pushed on. I went to the Rainbow in Blaine (D), thinking that the grocery chain might have it in stock at a different location. Well, there was a shelf spot, but it was empty. Nearly defeated, I decided to try the Cub Foods (E) not far away. Lo and behold, I found some!

All right. Go ahead and snicker.

Latest Summary

I had my consultation with Dr. Sielaff, the liver and pancreas specialist, on Monday. I meant to post an update sooner, but I was a bit occupied with the election and the other blog.

We went over my history thus far, and then he added his analysis and recommendations. He showed me some of the scans (the PET/CT and the liver MRI) and pointed me towards the areas in question. Instead of just the one spot, he said that there were two likely spots (see diagram).

Procedure-wise, he would prefer the RF ablation. This would be done laproscopically, going in through the navel like when Angie had her gall bladder removed. They will have the two areas of interest, but they would inspect and treat everything they find in one go. Because of the location of the one spot hear the gall bladder, that might have to come out as well. And if the need to resect anything instead of the ablation, they would do that.

So I've got my pre-op physical next week on Tuesday, and the surgery is scheduled for Wednesday, December 3. (At this point, I'm to assume that I will be able to be in Bismarck for both Thanksgiving and Christmas.) Approximately 6 weeks after this surgery, then, is when I believe we might begin the immune-enhancing therapies.

I received a copy of a letter from Dr. Amatruda to Dr. Sielaff yesterday, and I'll excerpt some of it here.

Dear Dr. Sielaff:

Mr. Sinkula is a 38-year-old man who has malignant melanoma. He has a single liver metastasis of melanoma. I would like you to give consideration to surgical resection or other local therapy directed at this liver nodule.

[...]He had some dizziness around June 2008. When he was seen in the ER, he was advised to seek attention for a mole on his back. This is a mole that was blistered, raised, flattened out, and began to raise up again. It was biopsied by Dr. Kortuem and was a melanoma, 5.2 mm in depth, down to Clark level IV. He had surgical resection of this and sentinel lymph node biopsy. The sentinel lymph node biopsy was negative. He had a PET scan which showed no other nodes in this area. However, he had a small abnormality in the liver seen on PET scan. An MRI of the liver showed a single lesion of 14 mm, with early enhancement and prompt washout. It did not have the characteristics of an adenoma nor of hemangioma. It was visible on ultrasound and was biopsied. Unfortunately, the biopsy showed melanoma.

I met with Mr. Sinkula on October 14, 2008. He was somewhat queasy after his biopsy. I met with him, his wife, and one of his young-children. I noted the following:

1. This is a single focus of metastasis. Unfortunately, this has defined him as having stage IV disease.


2. I think he should have local therapy of this single lesion. Two possibilities present themselves. There is a Mayo Clinic clinical trial which involves cryoablation of liver lesions, followed by immune-enhancing therapy with Leukine GM-CSF. He is not eligible for this clinical trial because his HLA blood type would not allow him to have the immune monitoring necessary to measure the benefit of the Mayo Clinic therapy. However, Dr. Markovic at Mayo Clinic would treat him off trial with cryoablation, followed by GM-CSF.


3. A second option would be to resect the lesion and then to pursue GM-CSF. I would like you to give consideration to either of these possibilities. I would prefer resection, if this is technically possible. [...]


4. Another issue is the location of this lesion. It is in the lower right liver and actually, it should be fairly accessible. If he does have resection of this, I would then treat him with Leukine GM-CSF for three years and then assess what further immune therapy we could pursue after that point.


5. [...]


6. I would like to arrange to have his tumor banked with the group in California for possible use as a source of tissue for autologous vaccine. You have done this previously with other patients. I will get the process going with E-mail.

There's a bit of jargon, but what I take from it is this.

• The cancer I've got is now staged as Stage IV. Let me substitute "a nasty one" instead of the clinical terms.


• The liver surgery with Dr. Sielaff is to remove any and all tumors on my liver. This I'll paraphrase as "they'll get rid of the bad stuff that they know about".


• Then I'll be following up with some alphabet soup of stuff that will help me keep any more tumors popping up from the nastiness.

And then we go from there.

Good News Today

I just realized that I hadn't mentioned that the day after I talked to Dr. Amatruda, I had a brain MRI done to check whether or not it had spread there as well. Oops. Sorry. It was on the Calendar in the sidebar.

Angie had been asking me whether or not I'd heard any results on the brain MRI I took last week. "When are you going to find out?" She was far more impatient than I was. I figured they'd tell me something when they had something to tell me, and that there wasn't really anything that being in a rush to find out would buy me.

So she called me up this afternoon and called to tell me that they had called the house and said that it turned out okay. Obligatory jokes ensued:

"What took them so long?" "They had to find it first, I guess."
"Maybe it was too small."

I was happy with the good results as soon as she said they'd called. I knew that if they weren't going to talk to me directly that it would be good news. And with her impatience, I think it was best that she took the call anyways.

So now it's onward to take care of the liver. I've pretty much switched over to Busch N/A these days. I do allow myself two non-consecutive Busch Lights a night. Angie tells me that has done wonders to curtail my obnoxious snoring. But the strangest side effect has been having an appetite. Oh, well. I'm sure I'll have more oddities to get used to in the near future. :p

Mayonnaise Jar and 2 Beers

When things in your life seem almost too much to handle, when 24 hours in a day are not enough, remember the mayonnaise jar and the 2 Beers.

A professor stood before his philosophy class and had some items in front of him. When the class began, he wordlessly picked up a very large and empty mayonnaise jar and proceeded to fill it with golf balls. He then asked the students if the jar was full. They agreed that it was.

The professor then picked up a box of pebbles and poured them into the jar He shook the jar lightly. The pebbles rolled into the open areas between the golf balls. He then asked the students again if the jar was full. They agreed it was.

The professor next picked up a box of sand and poured it into the jar. Of course, the sand filled up everything else. He asked once more if the jar was full. The students responded with a unanimous 'yes.'

The professor then produced two Beers from under the table and poured the entire contents into the jar effectively filling the empty space between the sand. The students laughed.

'Now,' said the professor as the laughter subsided, 'I want you to recognize that this jar represents your life. The golf balls are the important things---your family, your children, your health, your friends and your favorite passions---and if everything else was lost and only they remained, your life would still be full.

The pebbles are the other things that matter like your job, your house and your car.

The sand is everything else---the small stuff.

'If you put the sand into the jar first,' he continued, 'there is no room for the pebbles or the golf balls. The same goes for life. If you spend all your time and energy on the small stuff you will never have room for the things that are important to you.

'Pay attention to the things that are critical to your happiness. Spend time with your children. Spend time with your parents. Visit with grandparents. Take time to get medical checkups. Take your spouse out to dinner. Play another 18. There will always be time to clean the house and fix the disposal. Take care of the golf ball first---the things that really matter. Set your priorities. The rest is just sand.'

One of the students raised her hand and inquired what the Beer represented. The professor smiled and said, 'I'm glad you asked.' The Beer just shows you that no matter how full your life may seem, there's always room for a couple of Beers with a friend.'

I've heard this before, but it's worth sharing. Thanks, Andy.

Next Steps

I had another consultation with Dr. Amatruda today. We first went over bits and pieces and how I've been doing since the liver biopsy. And then we got into a next step being an MRI of the brain, to figure out if it may have spread there yet. And in a segue from what to do it it and spread, we then discussed some of the treatment options. I caught enough of what he said to surf for more information, which I found here.

Determining treatment options

The staging system for virtually every primary cancer is unique, identifying the progress of disease for that particular cancer. The stage of the cancer determines the treatment choices. For cancer confined to a specific area, local treatment may be used. Examples of local treatment include excision (surgical removal), or ablation, which means destroying the tumor with radiofrequency (high frequency energy), cryosurgery (freezing), or percutaneous alcohol (alcohol injection), or by blocking the blood supply to the tumor.

For this he referred me to Dr. Sielaff. I have a consultation set up, and I'm sure in the meantime he'll be reviewing my case. Following that consultation I will be undergoing one of the treatments to get rid of the liver cancer.

Following whatever that is going to be, Dr. Amatruda would like to get me to do one month of interferon, which sound less than fun. And after that, I believe he mentioned Leukine.

That may or may not work; so he also mentioned "Plan B", which amounts to trying other things, some experimental. There was some possibility of sending the tumor to California where some place might be able to create some sort of anti melanoma vaccine. If so, this one would be compatible, unlike my incompatibility with the Mayo one (mentioned here and here) he had presented earlier -- before my HLA test showed I wasn't the right type.

Music Break

Heather and I were jammin' to Dire Straits - Sultans of Swing (lyrics) last night and today.



Update: I've been having trouble with embedding the video.

Diagnosis

Recap

I got a copy of a letter from Dr. Amatruda to Dr. Korteum the other day. I thought Dr. Amatruda did a dandy job of clearly and concisely encapsulating the issues. With a few edits, here is what it said:

Today I had the opportunity to meet your patient Mr. David Sinkula. Thank you for referring this 38-year-old man. He was seen for medical oncology consultation regarding management of malignant melanoma which was just resected from his left shoulder.

Mr. Sinkula is a generally healthy man of 38. He works as a software engineer. He also has an avocation as a blogger. He does not have active medical problems. He acknowledges problems with anxiety and depression. He is currently on Zoloft 100 mg daily. He also notes [...] alcohol intake of probably ["more than two" --Dave] beers per night. He has been advised to cut this down because his liver tests have been off a bit in the past. He smokes about one pack per day.

About a year ago he had a scaling lesion taken off of his scalp. This was a seborrheic keratosis. He had an episode of atrial fibriliation about five years ago. This has not recurred. However, he had an episode of lightheadedness around June. He came to the emergency room and had no overall problems related to dizziness. However. they advised him to seek attention for a mole on his back. He described this as a lesion that blistered, got raised, then flattened out. and then began to raise up again. It had a pigmented area as part of it. You saw him and biopsied this. It was a melanoma 5.2 mm in depth down to Clark level IV. There were 4 mitoses per 10 high powered field. It was ulcerated. It was a T4b lesion. We recommended removal with sentinel node biopsy. Prior to this time he had a PET scan. The PET scan showed no abnormalities in the region of the melanoma. There were no supraclavicular, cervical. or axillary nodes. There was a small area in the dome of the liver of a nonspecific nature. There are no abnormalities in the chest.

On September 16 he had wide excision and sentinel node biopsy. The sentinel node in the left supraclavicular region was negative. The test was technically difficult because the injection from the signal blocked some of the nodal groups. Therefore, it is reassuring that he did have his PET scan which showed no abnormal uptake in nodal groups prior to surgery. He also had some esophageal inflammation. No mass or density was seen. I suspect this is related to [...] alcohol use and maybe to tobacco to some extent.

He is recovering nicely from his surgery which was only a week ago. The wound is coming together well. I see him now to advise on follow-up and therapy options. His family history is negative for early-onset cancers to the extent that he knows it. He does not really know his father's family history that well because his father was the youngest of a large family and the patient himself is the youngest of a large family [correction: family of four: Mom, Dad, my sister, and me]. He has one sister. There is no cancer on his mother's side of the family. His maternal grandmother had COPD. His father had COPD. One paternal aunt had some form of liver disease. He has two children; one biologic and one stepchild.

On examination he is a slender man in good spirits. He is noted to be pretty chipper. This relates to his nice recovery from surgery and also. I think, a relatively good period of time at work. There is really not too much that is notable on exam. He has no scar or abnormality on his scalp. The lesion on his left shoulder is excised with a scar that is coming together over the top of his left shoulder. There is no posterior cervical. supraclavicular. or axillary adenopathy. His back shows no masses or density. His liver and spleen are not enlarged. The cardiac exam is regular and rapid. He has a brownish-red mole on his left chest which he has been watching. He does not believe that it has recently changed.

My impression:

1. Malignant melanoma. He has a stage IIC melanoma with a T4b primary tumor. Therefore, he has a significant risk of recurrence. I would estimate about a 50% recurrence risk in ten years' time and about a 35% recurrence risk at five years' time.
2. He needs to have some additional staging before we firmly define what therapy he should take. Specifically he needs an MRI scan looking at the liver to evaluate the small area of abnormality in the liver seen on PET scan.
3. I recommended that he consider adjuvant therapy with interferon. I recommended one month of interferon given intravenously. I note that that this therapy reduces the risk of recurrence. In his case it reduced the risk of recurrence by about 5 to 10%. The cost of interferon is a significant increase in fatigue. It sometimes causes severe headaches. It sometimes causes nausea. It can cause aches in the muscles. The overwhelming symptom is that of fatigue. It may cause depression. I do not think it would necessarily make his depression worse since he is already taking effective antidepressant agents for it. Interferon is designed to cause autoimmune toxicities. These may include patchy depigmentation of the skin, autoimmune hypothyroidism, autoimmune elevation of rheumatoid factor antinuclear antibody. If these occur it is a good sign. It predicts that someone will not likely have recurrence of melanoma, at least in the first five to ten years. We discussed how melanoma might come back. I noted that recurrence refers to melanoma coming back in a site aside from the primary site in the skin. It may involve spread to lymph nodes and to other areas more distant in the skin or possibly to lungs or liver. If melanoma does come back, as you know, it tends to keep coming back. Therefore, it is very difficult to cure in that setting. I think that interferon given for one month intravenously is his best option. He also could take interferon for one month followed by 11 months of subcutaneous shots. Right now I would probably avoid the 11 months. He does not have any nodal disease. I think 11 months of lower dose therapy might be a significant drain on his energy and might set him up for worsening depression. He could take part in a clinical trial which is a comparison of a month of interferon with observation. At this point I do not think he is inclined to take part in a trial. He also could take part in a trial at Mayo Clinic which is evaluating the effects of an antimelanoma vaccine. The vaccine is given as injections into the skin; usually a total of seven or eight injections over two to three months. The toxicity of this is much less than interferon. However, there is no clear evidence that vaccine does help to keep melanoma from recurring.

I think he understood things pretty well. He took notes. I asked him to review the copy of this letter.

Plan:

1. MRI scan of the liver.
2. Liver function tests. CSC. and HLA typing. The HLA typing is done to define his ability to take melanoma vaccine.
3. Cut back on alcohol. He needs to be on a lower level of alcohol intake to safely get the interferon since the interferon by itself causes liver function abnormalities. If he already starts off with abnormal liver function enzymes, he won't be able to get much interferon before he has to stop the dose to allow recovery of the liver. I think he understands this and is in agreement.
   

I have asked him to return to my clinic in three months. At that time we will review his thinking regarding interferon versus the Mayo Clinic clinical trial and also further define the schedule and location of follow-up.

Thank you for the opportunity to participate in David Sinkula's care. Please call if you have any questions or concerns.

Sincerely,

THOMAS AMATRUDA, M.D.

The Latest

In addition, Dr. Amatruda called me this afternoon. As before, the good/bad comes in either of two starts: "Do you want to hear the results?" or "I'd like to set up a for you to come in and..." I drew the latter.

I'm nowhere near as gifted as Dr. Amatruda in summing up the situation, so I'll have to wing it a bit. The result of the liver biopsy was melanoma on the liver. I believe this means
metastatic melanoma on the liver. Wikipedia doesn't paint a pretty picture of it:

When there is distant metastasis, the cancer is generally considered incurable. The five year survival rate is less than 10%. The median survival is 6 to 12 months. Treatment is palliative, focusing on life-extension and quality of life. In some cases, patients may live many months or even years with metastatic melanoma (depending on the aggressiveness of the treatment). Metastases to skin and lungs have a better prognosis. Metastases to brain, bone and liver are associated with a worse prognosis.

Well, I'm always one to examine the worst case first and then see that things can only get better -- so I guess that's the tale of the tape that shows me running behind the odds.

Now to the bright side. One of the things that Dr. Amatruda mentioned in our discussion this afternoon was that he thought it was odd that the liver biopsy result came back the way it did. I took that as meaning, to one degree or another, I was possibly an outlier in the statistics of medical outcomes. That is, in my words, I was likely in the group of one of the small tails.

I take that as being positive, insomuch as with a few of the things that Dr. Amatruda mentioned, because being so is possibly making more treatment options available to me. There sounded like there is quite a variety: from surgery to in-situ heat-something, to the immune boosting, to combinations of these and others.

Anyways, that's my story and I'm sticking to it. (Until I hear otherwise.)

Liver Biopsy

This morning I had my liver biopsy. If I'd try to describe it, I might do it much less technically than this:

After Arriving

A radiology nurse will:

• Ask you a few questions regarding your medical history
• Do a brief clinical assessment (pulse, blood pressure, etc.)
• Place a special plastic needle in your vein (intravenous line) before your exam

You will be asked to change into a hospital gown for your procedure.

The diagnostic medical sonographer and imaging physician will explain the procedure to you and answer any questions you may have.

The imaging physician will explain the risks and benefits of the exam prior to having you sign a consent form.

During Your Exam

You will be requested to lie on the examination table on your back.

Ultrasound images of your abdomen will be obtained to locate the precise area of biopsy.

A warm gel will be applied to your abdomen, this gel is very similar to hair styling gel. The gel allows the sound waves to travel from the machine into your abdomen more easily.

A transducer, a small, microphone-like device, will be placed over the area being examined. There is no pain; however, you may feel mild pressure from the transducer.

Once the location is identified, the imaging physician will clean your abdomen and place sterile drapes over the work area.

The imaging physician will numb the biopsy site; however, you may experience a slight stinging sensation as the medication is injected.

As the medication takes affect, the imaging physician will explain how you should breathe during the actual biopsy and will ask you to practice that technique until you are comfortable with the instructions.

During the biopsy, a special needle device is used to remove the sample of your liver. You will hear a "staple gun-like" noise as the sample is taken.

That probably plays a lot better than my version. Chatting with an online friend in the IRC above, I'd described it as follows:

• They used an ultrasound to find what they were looking for.
• Then they had some funky needle thing that they inserted a few cm.
• It had some spring-loaded thingamajig that scooped up a sample of the lesion in question.
• They took four samples and cleaned up me.

Dr. Close, I believe, did the work today (with several others), and I had asked him about the MRI and other results. He mentioned which series it was that the lesion in question was best seen on, but I took a peek when I got home and still didn't find what I thought he had told me. I may find it yet, though -- he said it's the size of a regular grape.

Since I had the camera out, I had Angie snap a few shots of how the big incision is coming along. So there should now be plenty of good information heading to Dr. Amatruda for my next visit next week.

At the moment I feel pretty much fine; the same. One of the first things I did when I got home was to try to follow up with some work stuff that's been spilling over a couple days. We've owed a European-voiced panel to them, and I was struggling with pieces of getting multiple-voice support. I believed I had finally made it ready last night, but I wanted to check in and make sure we were able to get a verified build of the main code. I believe I was able to verify another's build, so that should hopefully be ready to go.

More Test Results

I had the MRI done on Thursday. The machine did indeed look like the one at the right. Of course, the lighting was far less ominous. It went quicker than the PET/CT scan, and I didn't need the radioactive injection.

Even though Suburban Imaging gave me a CD loaded with pictures and 3D viewing software, I didn't really know what I was looking for. Neat pictures, though.

Dr. Amatruda's office left a message for me on Friday, but I didn't get it until after work. And today we played a little phone tag. In part because...

Today I went in for my followup with Dr. Economou, who had done the wide excision and such the other day. For our "wound management" visit, he was happy with the way that the skin is healing. (I should take pictures again one of these days.)

In addition to discussing the results of his work, we talked a little bit more about what news I had in regard to Dr. Economou. But at that moment I didn't know all that much more. He is really easy to talk to about such things, and I enjoyed the visit.

When I returned to work, the phone tag continued, but I finally got through to Michelle (I believe) with Dr. Amatruda's office. She told me that the MRI showed a lesion on the liver and that they would want to do a biopsy. From my understanding of what she described, it sounded like some sort of poking thing going in and being guided by ultrasound to get wherever they're going: the good thing being that it's not a surgery type of thing.

Anyways, with regard to what they're looking for, I don't really know. I'm sure they've got some idea, but it is likely standard procedure to simply do the test and present the results rather than offer any speculation initially. Michelle summarized it as [paraphrasing], "We don't know if it's good or bad; we need to take a look."

The Verdict

It seems I built a little bit of suspense for today. My apologies for this post coming a little bit later than I'd intended, but I took notes while I was with Dr. Amatruda, and gapped a few things after I went back to work -- so now I'm trying to regather my thoughts and double-check my interpretation of what I believe I heard.

As an aside, I believe I have invited Dr. Korteum, Dr. Economou, and Dr. Amatruda to visit this blog.
Perhaps they can offer comments or corrections for any of my wild-eyed assertions.

So now I'll attempt to answer the question that many have had, and which I had as well. Unfortunately, now it's my turn to pretend to be the doctor and present it from the beginning.

Good or Bad or In-Between? In-between.

I've been very pleased to be receiving test results to this point that point towards the better outcomes (oh, there I go already with doctor-speak). But further tests will yield more definite prognoses. And so I'm scheduled for another couple tests, first pursuing the 'whatever' that Dr. Korteum mentioned regarding my liver.

I am scheduled for an MRI regarding the 'whatever' that made them curious. They also did another blood draw today to accompany these results. I will revisit with Dr. Amatruda after these tests have been performed.

In The Meantime...

This is my current best paraphrasing of the conversation I had with Dr. Amatruda this afternoon.

As to further evaluation, I mentioned that already. As to surgery, there is nothing to cut off at this point (but I'm still going to try to milk the "what a pain in the neck" and "ain't no skin off my back" quips).

The Breslow's depth seems to be much more significant than my earlier "location, location, location" comment. While I believe we are currently still in the process of staging, I think the current understanding is that I'm about at "Stage II, T4b: High Risk Melanoma, 4.00 mm or greater primary w/ Ulceration" -- which, if Wikipedia can be trusted (and you know I don't fully trust them), means 40-85% survival.

Let's just say that what I retain from my discussion with Dr. Amatruda is that the basic numbers are this: 50% survival after 5-10 years. (It all seems to become a numbers game once you've started playing: that there are no definite answers, merely percentages and time frames.)

Treatment

Dr. Amatruda presented his assessment and recommended to me interferon to treat it. There were actually a couple of further options to consider. But the basics I took from it, as I took notes during our discussion, is that the interferon would start with one month of receiving daily (5 days a week) injections. And then the remaining 11 months in the cycle ... well, that's where the options came in.

The options I somewhat gapped, but were regarding being a guinea pig, err, test participant, in one of two unproven medical studies underway. One was with the Mayo Clinic and the other is local, if I remember correctly. There were various specifics for each, but I failed to note them. Essentially, the blood work from today will help determine which I may be better suited for, and I kinda left it at that.

I believe I noted that the interferon treatment improves the outlook by 5-10% over the duration. I'm sure I'll be getting to know the details better over the upcoming days. As will the doctors as the tests roll in.

But For Now...

I'm feeling fine. I had an appetite return recently. I need to tone down to a near standstill with the beer I love because the interferon will require it. But I have found that Busch N/A may be a reasonable substitute for the taste of real beer. Such issues are not a big deal to me, though.

So that's about what I know. Melanoma apparently tends to return, and when it does it may not be on the skin. And when it does return, it tends to be fatal. So the outcome is generally mentioned, at least from what I have been privy to, hedged in percentages quantifying 'tends' over some specified duration.

Upshot

I'm okay at the moment. It's likely I won't be that way forever. In the meantime I need to do what I can to improve my odds. But this here natural born pessimist has been saying, "some people have to make up that 18%" when I was preparing myself for the worst. My odds have only gotten better. I hope to keep it that way.

September Football Sunday

The weather here is absolutely gaw-juss.

Slide show.

Happy Birthday Mom!

Back to Work

Back to the grind. I went in to work as usual ... and worked.

But at least I was pleasantly reminded that today was the chili cook-off. I sampled 14 different and delicious chili recipes from folks in the office -- and voted on one that lost. But good chili is always in the taste buds of the beerholder, and alas we had no beer. The winning entry was quite good, by the way; I just prefer to add onions, cheese, sour cream, and jalepenos to mine, so I look for a "thinner" variety.

Towards the later part of the workday, my clothes were beginning to wear a bit on the bare naked wounds (as in, no bandages nor magic goo). I had left the house in haste today without bandages or the magic goo. I remedied that quickly after I got home.

So the day was much closer to "the normal" already: I gave Heather her bath (which took me a while to get all that hair back the way I try to keep it), but Angie didn't let me carry her to bed. Other than that, it's been pretty close to business as usual (with a notable exception about being wary of turning my head to the left when backing up a vehicle).

Until Tuesday I remain in a happy little holding pattern. "All is well."

Bandages Off

I took a break for a late lunch and picking away at the bandages. I got the neck one off first. While cleaning it up I thought it looked like I grew a gill.

The other one took a little while for me to get a good angle on. Angie had offered to take them off, but I chose to do it myself -- as well as their cleaning. I don't think she cares to touch them directly.

But I did make her put the magic goo on them, though.

Hm. Looking at the photo, it appears I have a little more cleanup to do on the big guy.

Update: Dr. Economou called just now (about 4:45) and asked if I wanted to hear the results of the pathology tests. Knowing now that 'over the phone' = 'happy results' I said "sure!" He told me that the node looked good and the surrounding skin that was excised did too.

So now all the information goes to Dr. Amatruda and on Tuesday he'll let me know where we go from here. My only remaining concern is that Dr. Kortuem had mentioned maybe something with the liver(?), and the pre-op for yesterday's work had indicated some "elevated" levels of 'liver stuff'. But at this point I'm hoping that the news will continue to come up positive.

I want to thank everybody for keeping me in their thoughts and prayers.

The Morning After

Today I'm working from home. My thoughts last night that I'd sent my co-workers (slightly edited):

Thoughts on work tomorrow:

• Things went fine: Todays Adventure.
• Afterwards I've been feeling okay, I just have the sore shoulder and back.
• I would probably come in if I knew how I'd be tomorrow, but I'm still playing it by ear.
• I haven't taken any pain meds yet, but if I need 'em one of them is vicodin.
• So I'm kinda leaning towards WFH, in that I can work on the [work specifics], as well as the usual audio trimming.
• Plus I can maybe call the IT folks and finally figure out the VPN.
• Then if I do need any pain meds, I don't have to worry about the drive home.
• Or if I need to lie down for a bit, it'd be easier to do here. (Heh.)

But basically I feel fine and would like to get some work done tomorrow, rather than lying around the house being bored.

I'm pleased to have finally gotten the VPN working (perhaps because I finally used Contivity instead of the other methods I'd confused myself into thinking were the ones to use). Some of the things I'm doing over the network are a bit pokey, but it gives me a moment or two to write this.

I'm still avoiding the pain meds; it's more 'discomfort' than 'pain'. It feels like I had skin that used to be two inches apart subcutaneously sewn together. But then again, I believe that's what happened.

So far, so good.

Today's Adventure

I'm returning from the hospital to report that things went okay.

The first thing they did was the search for the sentinel node. For this I got several injections of some slightly radioactive substance (not as radioactive as for the PET/CT scan) near the site of the original melanoma. After a short wait I was positioned on a machine that looked a bit like the PET/CT setup.

It took a while for them to get me adjusted to an angle that allowed them to see the sentinel node more clearly. I was on my back, on my side, at various angles in between; arm up, arm down. But they finally found a decent picture to take.

I forget which one they said it was -- I thought I'd heard suprascapular, but I think later perhaps lateral, which after looking it up sounds like it might have been a subscapular axillary node in the lateral group. But what do I know. They drew a spot on me between my neck and my shoulder.

After they finally got the good picture, the got me prepped for the surgery. I was having a bit of fun with all the questions they were asking:

Do you smoke?
Yup.
Do you drink?
More than I should.
Street drugs?
Uh, no thanks.

I got in a little earlier than my 3:30 time slot, I believe. And apparently all went well and it took about an hour. Angie said that Dr. Economou told her that all went well, that the node had a little crud in it but looked pretty good. The results of the excision should be coming in a couple days.

Right now the meds are wearing off a bit, so I'm starting to figure out where things are going to hurt. From the excision, the skin in that area seems tight, but doesn't really hurt. I believe they had to do some digging for the node, so that part is probably going to be the one that will hurt most. At least that's what it seems like right now.

A Good Time

Last night Angie got me out of the house!

We went over to a party at Noel's and had lots of good eats and drinks and laughs and fun. It was an 'eat lots of fatty foods' and drink beer and make a fire kind of thing.

We had deep fried venison, deep fried homemade onion rings, deep fried perogies, deep fried homemade corndogs, deep fried egg rolls; grilled jalepeno burgers, grilled sweet corn, grilled hot dogs, taco dip, deep fried homemade doughnuts. All kinds of yummy.

Dan and Sandy came to town to join in, and Al and Melissa were there too. Plus many of Noel's neighbors that join him far more often than I. It was a bit rainy most of the day, but it wasn't raining in the evening. Still, Noel got a bonfire going in the back, and we had many laughs (such as me cracking wise about being most afraid of hearing, "It rubs the lotion on it's skin" in reference to my upcoming excision).

Kathy* and I had some of our typical mock-fighting. Later in the day she happened to be wearing a flannel that looked quite a bit like mine. At one point she whipped it off because of something I said (like, "Where's my twin sister?" or something), and went to do something. I quietly replaced hers with mine. When she returned and put it back on she had a most quizzical look regarding the meds in the left pocket.

With all my other news being kind of a downer lately, I thought I'd share the good time I had last night to bring back some good cheer.


[*]Angie put 'Kathy' on the birthday card for her that we finally brought over (Cathy's birthday is in March).

Consultation With Dr. Economou

Today I met with Dr. Economou regarding my wide excision/sentinel node biopsy. I think he first explained some of the previous stuff that he'd gotten from Dr. Korteum, some of which was reassuring. The most salient tidbit was this: the depth of 5.2 mm is normally quite bad, but as with real estate, location is everything.

Since it was on my back, the skin is thicker there than, say, on the hand. This helped make the difference between being a class 5 something (through the skin) and a class 4 something (not through the skin). He was also happy to hear that the PET/CT scan was already done and was negative (which to me means positive/happy results).

He proceeded to describe the surgical procedure I will be undertaking next week on Tuesday. It starts out with by making a series of injections with some radioactive stuff in the area surrounding the initial spot that was removed. Then I go wait for a couple hours. When the waiting is done, there's another round of injections of some kind of dye, but I'll probably be under general anesthesia as the main bit begins.

The incision and such was something I was curious about, and he described it well enough for me to find a picture of how I imagine it. It would be about at a 45 degree angle on my back, starting on the lower left and angling toward the neck. But it's only taking the skin, not getting into the underlying tissue (I think because it was the class 4). So he's going to remove that football of skin and send it off to the lab and stitch me up.

Then he'll start poking around with a Geiger counter to find the sentinel node -- which I understand to be the lymph node most likely to which the melanoma drained to. Then they'll remove the sentinel node and send that off for biopsy. I may have the order wrong, but I trust he knows how to do it.

Upcoming Stuff

I'm starting to feel like Mom and Dad with the relative number of doctor's appointments I've been making lately.

Today at 2:30 is the surgical consult with Dr. Economu. Then what will be taking place on Tuesday the 16th is a sentinel lymph node biopsy.

I'm getting started with the oncology stuff with an initial consultation with Dr. Amatruda on Tuesday the 23rd. By then all of the test results should have been gathered and examined by him and then I'll know more about what future adventures I will be having.

Test Results

Dr. Kortuem called not long ago and told me the specifics which I vaguely recall at the moment, but the upshot is that the result of the PET/CT scan was the preferred outcome.

So now it's on to the next round of tests, which I believe include a lymph node biopsy and a wide local excision. I guess it will be Dr. Sam Economou who does this work.

Update: I've got an appointment at 2:30 tomorrow with Dr. Economou.

PET/CT Scan

Today's update isn't much of one. I had the PET/CT scan, and that's about it.

I tried calling my dermatologist, Kimberly Kortuem, M.D., and the oncologist she recommeneded me to, Thomas Amatruda, MD. But by the time my 'fancy pictures' were likely ready, it was late afternoon.

So, the waiting game continues. In the meantime, I've been amusing myself with the temporary title "Radioactive Man". Since I've still got leftovers in my system, I have to do crazy things like avoid children and double-flush for 24 hours.

I believe it is this that I've got in my system:

The only other obstacle to a wider dissemination of PET-CT is the difficulty and cost of producing and transporting the radiopharmaceuticals used for PET imaging, which are usually extremely short-lived (for instance, the half life of radioactive fluor18 used to trace glucose metabolism (using fluorodeoxyglucose -- FDG) is two hours only. Its production requires a very expensive synchrotron as well as a production line for the radiopharmaceuticals.

The tech told me the half-life was 110 minutes, and they called it a radioactive sugar solution.

I really enjoyed my Culver's Bacon ButterBurger Deluxe after not having much of an appetite this past weekend. And I can still have some beers (until they tell me otherwise) while I watch the Monday Night Football season opener of the Vikings at the Packers.

The girls are watching the game at a friend's while I hang out downstairs and putz around with the computer -- the only thing extraordinary in that is that the girls usually come down and join me during the evening. Tonight has been "too quiet".

That's about all I've got for now.

Unpleasant News

Back in May, I believe, I was feeling very lightheaded and dizzy at work, so I drove to the emergency room. I seemed to get a clean bill of health, but one of the folks examining me recommended that I get a mole on my back looked at. The dermatologist was booked for quite a while, but I finally got in and had it removed.

On Thursday I got the result of the biopsy: malignant melanoma. I believe that my Breslow's depth was 5.2 mm. On Monday I have a PET scan to determine more.

I'll try to keep everybody posted.

Update: For the curious, here is what the paperwork might look like.

Mommy's Flowers

The new flowerbeds in back are looking good. Unfortunately, the flowers in them are not. The ones in front look much better.

Heather's 4-Year-Old Portraits

We just got them today.


Slideshow

Father's Day at Como Zoo

Today we went to the Como Zoo for a couple hours. It was Brooke's first time in the zoo -- we had tried previously but gave up on trying to find a place to park. We almost did the same today, but found a spot a long walk away.

Slideshow

Heather's 4th Birthday

My oh my, how time does fly.

Slideshow

Tornado Reported in Coon Rapids [Updated]

Yesterday our neighbors were refinishing their deck. Heather decided to supervise.

"A little bit off."

I was trying to start a new flower bed.

And today much of the same manual labor continued for my neighbors and me. They tilled and added stairs to the deck. I borrowed their tiller to work on the garden.

It was very humid in the afternoon, and the conditions were ripe for severe weather to develop, and it did.

Slideshow

The above pictures were taken in these vicinities to the east of us.


Initial reports of touchdown were in this area to the west of the above location.


Update: Here are some related news items:
Damage surveys start in storm-ravaged Minn. town
Tornado Wipes Out Homes in Hugo, 20 People Missing
Tornado hits Coon Rapids as storms barrel through the metro
1 Confirmed Killed, 20 Missing In Minn. Tornado

The Devil went to Church

People were in their pews talking at church. Suddenly, Satan appeared at the front of the church. Everyone started screaming and running for the front entrance, trampling each other in a frantic effort to get away from evil incarnate.

Soon everyone had exited the church except for one elderly gentleman who sat calmly in his pew without moving, seeming oblivious to the fact that God's ultimate enemy was in his presence. So Satan walked up to the old man and said.

"Don't you know who I am?" The man replied, "Yep, sure do."

"Aren't you afraid of me?" Satan asked. "Nope, sure ain't" said the man.

"Don't you realize I can kill you with a word?" asked Satan. "Don't doubt it for a minute," returned the old man, in an even tone.

"Did you know that I could cause you profound horrifying, AGONY for all eternity?" persisted Satan.

"Yep," was the calm reply.

"And you're still not afraid?" asked Satan. "Nope," said the old man.

More than a little perturbed, Satan asked, Well, why aren't you afraid of me?"

The man calmly replied, "Been married to your sister for 48 years."

[Found in an email.]

Dave on a Plane

Playing Doctor

My wife comes downstairs and says, "All right, I'm ready to play doctor."

I said, "Is your insurance current? Is this address correct?"