My Tribute to Three Important People

This is the post that is long overdue.

This is the post where I pay tribute to three people who had a profound impact on my current state of affairs. Without these three people, some aspect of where I am, and how I am feeling, right now, would be different.

Of course, many more people deserve to be mentioned. The nurses and my family and my friends have all been instrumental in this surgery and recovery. But there are three who deserve their own personal shout out.


HOLLY

I've written about the story before, both on this blog and on Facebook, but a special shout out goes to my friend Holly Holycross Chandler. Holly is the reason I came to Omaha to have this procedure done at Nebraska Medicine.

The short version is that Holly and I went to high school together (in the 80s) and are Facebook friends. When I received my cancer diagnosis in May and started this blog, Holly wrote to me to tell me that she works on these surgery cases, and she encouraged me to come see Dr. Jason Foster about my case.

At the time, I had already started the process with Dr. Evan Ong at Swedish Medical Center in Seattle. I was happy with my appointments with Dr. Ong, so I just thanked her and moved on.

But she didn't stop...

She kept writing. The next email was a little bit stronger, and talked about all of Dr. Foster's outcome numbers; percent of re-occurrence after five and ten years, percent of complications from surgery, etc... By this time I was living and training in Colorado with Rose, so while I was still happy with my decision to move forward with everything in Seattle, I was less connected to Seattle at the time. In fact, Rose and I had already been weighing the other options regarding having the surgery in Omaha versus Seattle. (Specifically, that I am from Omaha, and my family still lives there, so I have a huge support system available there, AND, my father has been having some medical issues as well, so it would be a lot easier on my family if I had the surgery in Omaha.)

Holly's next email included Dr. Foster's cell phone number. She had spoken to him about my case and he agreed to give her his cell phone number to give to me so that I could call him. She insisted that I at least see him for a second opinion.

As it turned out, I had already been thinking that I really needed to seek out a second opinion on such an aggressive surgery, and suddenly, Dr. Foster stood before me as the perfect option.

It took a few weeks to make the connection, but we finally made it work. I had a great talk with him on the phone, and made an appointment to see him after Rose's championship races were over.

As they say, the rest is history.

Throughout this whole experience, Holly has called me "inspirational" and "a hero." I can't speak to that, although if my words have found their place in to someone's life in some positive way, that is terrific. The truth is, it was Holly's adamant persistence that made all of this possible.

So I send a special shout out to Holly, for both her kindness and her insistence. I am very grateful to her for her part in all of this.

[A local news station did a story on us, you can find it here. They didn't get everything right (the pain, the chemo, etc), but you get the idea. :)]


AMBER

In every story there is usually an unsung hero. A person who is doing a lot of work in the background but not getting a lot of credit.

Amber Burke is that person in this story. Amber is Dr. Foster's nurse. I know what she has done for me, so I can only imagine how involved she is with all of his patients.

Five days (five days!) before my scheduled surgery, there was a discrepancy between what Nebraska Medicine was saying about my insurance coverage and what my insurance company was saying about my insurance coverage. Nebraska Medicine said that Dr. Foster would be considered "in network." LifeWise told me, repeatedly, that Dr. Foster was "out of network." There was no way I could afford to have the surgery in Omaha if he was considered out of network.

Four days before my surgery, and the day before I was scheduled to fly out of Seattle for Omaha, Amber stepped in and started making the calls to LifeWise herself; updating me any time she came up with new information.

The day before my surgery, when I was already admitted in to the hospital, Amber continued to jump through all of the hoops to make it all happen. I don't know how much extra time she spent on it, but I imagine it was quite a bit.

And somehow, almost as if by magic, she pulled it all together.

Holly got me to Omaha, Amber got me to the operating room.

So I send a special shout out to Amber for all of her extra hard work to make the surgery happen. She is also pretty good at removing stitches, for your information.


DR. JASON FOSTER

Perhaps the real hero of the story, and not just my story, but many people's story, is Dr. Foster.

Dr. Foster gave Holly his cell phone number for me to call, and he made the time to speak to me on the phone for 20 minutes. I have worked with many doctors in my life, and Dr. Foster has a unique combination of skills. In addition to his surgical expertise, he is very personable, funny, knowledgeable, confident, and just has a great overall "bedside manner."

It was Dr. Foster's confidence and his communication style that really won me over. That his outcomes seem to be awesome did not hurt the decision. :)

So I send a special shout out to Dr. Foster for being the surgeon and the person that he is.

As kind of a post-script shout out, I want to say that I think it was Dr. Tellman who did the open and close at my surgery. If so, fine work, young man. The incision looks great.


It has been said that no man is an island. And I tend to think that even those who claim to be "self made" might find, on closer inspection, that they had people along the way that gave them the means or the confidence to push onward. If I have written something inspirational, or acted in a way that someone found meaningful, it is a result of the teachers and the supporters I have had in my own life.

And when we look back at the tapestry of our lives, and identify how the strands were woven together in a particular way, the three people listed here will all be noted as some of the most influential people in this event of my life. Another thank you to all of them.

The OCR Community, Peritoneal Perspiration, and Counting Chickens

I have never been quiet about the fact that I have an amazing family and amazing friends.

This has been true for as long as I can remember. Even though I have traveled around and lived in different places, I have always been blessed with a really great group of friends and acquaintances.

But I want to give a well-deserved, and specific, shout out to the OCR/Spartan community. In addition to the GoFundMe account that Matty and Amelia set up, and that so many people contributed to, I heard about the support shown for me and Rose at the LA Spartan Race this weekend; from moustache wearers to people running with Rose and Tim hashtags written on their bodies. There has been so much support from the OCR community, many people whom I don't know or haven't met personally, that it has been a little overwhelming.

Being a healthy and fit person my whole life, I never imagined that my name would be after one of those hashtags. And yet, here I am, recovering from cancer surgery and intraperitoneal chemotherapy, drain tubes still coming out of my abdomen, listening to stories about all of the community support. It is really amazing.

Of course, I know that this benefit is primarily the result of being Rose's significant other. She is the "popular" one. I have been at a lot of races with Rose. I know that whether she finishes 1st or 5th, the same number of people come up to her afterwards, wanting to talk to her or to get a photo with her. By association, much of that love spills over on to me. :)

But that aside, it doesn't change the fact that the OCR community has rallied around us in a way that I have not experienced from such a large group before. It is really remarkable, and I want to thank each and everyone of you for it. You, collectively as individuals, are why the community is what it is.


Ok, so, the drain tubes. They are still in because, apparently, my peritoneal keeps "sweating." I have the ok to have them removed as soon as the output gets below a certain number. But nope, they keep draining.

Of course, first and foremost, I am all for the best long-term recovery outcome. If that means leaving them in for another week, so be it.

But...I confess that I am ready to not be plugged in anymore. I have to wear a binder on my abdomen right now, and it is suppose to be a little snug to provide "support," both to my healing incision and to my (still in shock) abdominal muscles. But the binder also presses down on and rubs against the drain tubes sites, which is a bit uncomfortable. Probably the most discomfort that I have at this point.

And then there is also the logistics of the tubes and bulbs; pinned to my flannel shirt, tucked in to the internal pockets of a fleece vest, in the way of showering and washing, etc...

There have been a couple of times when the output has drastically dropped, and I'm like "sweet!" And then, eight hours later, there will be 50-100ml in them again. Ugh.

It's a mystery. I don't know how to stop my peritoneal from perspiring. :)

My next appointment with Dr. Foster is on Friday, 12/11. It might be my last appointment with him, outside of a CT we will have done the following week to get a "baseline" for future reference. At that point, I imagine the remaining incision stitches and the drain tubes will come out.


When I first received my cancer diagnosis back in late May, and I decided to blog about the experience, I thought long and hard about what to call the blog. I decided not to piggyback it on to my old blog (http://mydharmadays.blogspot.com/), which I started back in 2005.

Instead, I chose the Race Sherpa theme, and went with Race Sherpa Rises for two reasons:

1) Back when I started using Race Sherpa on Facebook (in private, I used it long before Rose got involved in OCR), I began every race travel morning with the line "Race Sherpa rises." Simply meaning, rises from sleep and off to action.

2) I knew that after surgery, there would come a time when I would have to battle back and reclaim my previous health and fitness. In this case, "rising" from the "ashes" of post-surgery/chemo.

I am not one to count my chickens before they hatch. At this point, I am still in full-on recovery mode (even though I am now past the point where most of the complications can arise). BUT, my mind is starting to create the template that I will use to re-create myself.

In many ways, this is a great opportunity. As a personal trainer and strength coach for the last 12 years, I have a lot of resources to draw from, but as sometimes happens when you are self-employed and busy, I had let my own training fall back in to a rut.

In my mind I was still seeking and innovating, but I wasn't spending enough time translating those new ideas to my body. I noticed this at least 2-3 years ago, but I continued to let the daily life stressors keep me from implementing all of the new ideas. I usually just defaulted back to the old tried and true routine.

But now I have the opportunity to start over, and to build from a different base. I am 49 years old, and have been an athlete all of my life. I don't want to just recover my old strength and fitness, I want to re-engineer myself, and embody the broad spectrum of what I think it means to be an athlete.

This doesn't mean I won't eventually find my way back in to the gym to push iron, but that isn't where I am going to start. I am going to lay a different foundation, and I have a lot of resources to draw upon.

First, yoga. I used to be a "yoga freak." I was really fortunate to be immersed in the yoga scene when I was (1998-2005 or so), because so many top teachers used to travel around and give amazing workshops. I had the opportunity to study with some of the best instructors in the world (at least those who visited the US), and I loved how each teacher had their own unique interpretation and expression. Many of these teachers are the primary teachers of people who teach today (or perhaps, by now, we are on the second generation).

At any rate, I took a break from yoga, for reasons that are too numerous to go in to now, and I never really went back. Not in earnest, at any rate. This winter will be a great time to re-immerse myself. My goal is not to become an asana master. Long ago I lost the desire to pursue the perfection of as many asansas as I could. I have some specific goals in mind, and knowing the principles of yoga very well, I will carve out and pursue my own unique practice.

Second, there are so many people out their doing cool work; bodyweight, clubbell/kettlebell, gymnastic/ground based movements, parkour, etc... I already own a lot of material/resources from these people, and I've dabbled it in for years, but I haven't really committed to it. And while there is way too much material here to do everything, and while each and every "system" might be complete in and of itself, I have already started to compose my own personal integration of it all. Mostly because that is just what I do. I am an integrator. I look for themes and principles and try to find the best ways to express them. Find what works and what is useful, and let the rest go.

There is no way I could list all of the people who are doing cool work in these areas, but here are some of my own personal favorites:
Ryan Hurst (Gold Medal Bodies) https://gmb.io/
Chip Conrad (BodyTribe) http://www.bodytribe.com/
Ross Enamait (Ross Training) http://rosstraining.com/blog/
Coach Sommer (Gymnastic Bodies) https://www.gymnasticbodies.com/
Mike Fitch (Global Bodyweight Training) http://www.globalbodyweighttraining.com/
Scott Sonnon (TACFIT/CST) http://www.rmaxinternational.com/om/home.php
Pavel Tsatsouline (StrongFirst) http://www.strongfirst.com/
Erwan Le Corre (MovNat) https://www.movnat.com/
Too many parkour-based resources to list

Of course, there are a lot of people in the traditional strength and conditioning world that I love as well, but because I am going to hold off on that piece until the rest of the foundation is in place, I won't bother listing any of them right now.

Three, climbing. Truth be told, I haven't done much climbing, and I have never excelled at it. As a traditional strength/power athlete, it always seemed so counter-intuitive. And that, along with it's high level of "function," is precisely why I want to do it. Besides, most of the climbers I know are good at so many other things.

Four, OCR. I don't mean the actual races. It will be a while before I am anywhere close to that. But I have always been an advocate for the OCR training paradigm. In fact, I had been conceptualizing that kind of training for quite some time when I went to my first ever Spartan Race (Washougal, 2013). I remember walking in to the festival area, looking around, and thinking "Holy crap, they are already doing all of this stuff, in a race format." It was pretty cool to see.

Of course, much of the stuff that I would clump in to "OCR training paradigm" can be covered in the groups listed above, but there are still the uber functional movements, or primary human movements. The ones you could label "farm/rancher/contractor training," especially heavy and awkward lifts and carries.

Fifth, and finally, running. I have been running for quite a while, so this isn't actually new. But my breathing issue forced me to do all of my runs long instead of fast. I would like to see what times I could drop to with my breathing back and with the correct training. I'd also like to get even better at what I am already decent at; running up mountains.

So those are the resources upon which I am drawing (plus others not listed); the bedrock from which I hope to rebuild my foundation.


Again, baby steps first. Recover, get my drain tubes out, get my stitches out, and ease back in to normal, every day activity. After that, it is game on.

Race Sherpa rises.

Part Two: The NG Tube Blues, Awesome Nurses, the No Good Very Bad Day, and a Rose By Any Other Name

In the tackling of every major challenge, we typically have our share of ups and downs. Battles that we win that propel us forward, and battles that we lose that temporarily set us backward. You can usually sense the overall progress forward, even in the losses, but it is the small wins that build and sustain the fortitude to push onward.

Within this obstacle of cancer and surgery, one of these early battles stands out above the rest...

The NG Tube.


The NG stands for "nasogastric." I also believe it stands for "not good."

Although, to be fair, it is only "not good" from an experiential standpoint. From a functional standpoint it is a very useful and helpful (albeit uncomfortable) medical tool.

Let's let Wiki step in here:

"Nasogastric aspiration (suction) is the process of draining the stomach's contents via the tube. Nasogastric aspiration is mainly used to remove gastric secretions and swallowed air in patients with gastrointestinal obstructions.

If the tube is to be used for continuous drainage, it is usually appended to a collector bag placed below the level of the patient's stomach; gravity empties the stomach's contents. It can also be appended to a suction system, however this method is often restricted to emergency situations, as the constant suction can easily damage the stomach's lining. In non-emergency situations, intermittent suction may be applied giving the benefits of suction without the untoward effects of damage to the stomach lining.

Suction drainage is used for patients who have undergone a pneumonectomy in order to prevent anesthesia-related vomiting and possible aspiration of any stomach contents. Such aspiration would represent a serious risk of complications to patients recovering from this surgery."

So as you can see, it serves a very important function. And, truthfully, not one person misrepresented my need for it, nor the "suckiness" of having it in place.

Way back in June, during my first appointment with Dr. Ong in Seattle, he told me I would need an NG tube and that it would suck. Every person who I talked to since then corroborated that sentiment, including Dr. Foster, when I met with him in October. Although, for the record, I do not believe he actually used the word "suck."

It's worth pointing out that to say that the NG tube "sucks" is true on at least two different levels; a coincidence that hadn't occurred to me prior to having that constant suction sound whirling away twelve inches away from my ear, all day and night.

While uncomfortable, I didn't really dwell too much on my NG tube the first few days after my surgery. It was late Friday night (my surgery was on Tuesday), that it all set in. The nurse that evening did a flush of the tube, and something changed. I don't know if the position changed, or just my sensitivity changed, but it suddenly became very uncomfortable.

I had a number of gag responses that night and the next day, and it hurt to swallow. I knew that it was pretty standard to have it in for four days post-op, and and I knew that I was on day four.

I was determined to try to have it removed that day, and the idea had worked deeply in to my brain. There was no shaking it. I even made a public offer of flowers, donuts, and coffee to the individual who could help me make it happen.

And after I passed all of the requisite tests, it did come off that afternoon. (And the flowers/donuts/coffee offer was paid in full.)

It's one of those things, you know? Those things you don't appreciate until it is taken away from you. Breathing and swallowing and being able to quench your dry mouth and throat. Having the NG tube out made me feel like my recovery had increased by 500%. For hours afterward I just lied there and appreciated the experience of it all.


Each day in the hospital was pretty similar to the others. The surgery team typically came in between 6am and 6:30am to do rounds, my vitals were taken and my meds were given every four hours (with miscellaneous IVs and other asundry things happening in the spaces in between). The pain team came in mid-morning. Dr. Foster made his way in some time during the day, depending on his schedule. And, of course, I had my daily walks, which began with a walker and progressed to just the IV pole.

A highlight of all of those days were the nurses. I can't say enough about the staff at UNMC. Everyone was so great and helpful. If you ever have to have this surgery, I highly recommend you at least consider Dr. Foster and the UNMC team.

And speaking of the UNMC team, Dr. Foster is the Man. His numbers (complication rates, days in hospital, re-occurrence rates of disease, etc) are excellent and his bedside manner is unparalleled. He is loved and admired by so many people and when you meet him, you will understand why.

Again, if you are confronted with having to have this surgery, I highly recommend you go visit Dr. Foster.


But back to me...

On Wednesday, eight days after the surgery, I was discharged. It felt so good to not be confined to a hospital room, but as soon as I got home I was presented with other challenges. Managing three drain tubes and a wound vac is pretty easy when you are lying around all day, but it adds another level of complexity as you try to navigate life at home.

Wednesday night went decently, and on Thursday I was just trying to focus on eating and pooping; both large steps in the recovery process.

On Thursday afternoon I was feeling a little "off," and as the afternoon went on, that "off" feeling turned in to a nauseous feeling.

There are numerous reasons why vomiting is a bad idea for someone in my situation. One, the bowels get sleepy after operations like this, and it is important that you get them to wake up and start moving things downward. So vomiting is kind of a step backwards. Two, when you have a new 8 inch incision in your abdomen, the abdominal muscle contraction of vomiting can be no bueno.

But vomit I did. Over and over and over. The No Good Very Bad Day.

We finally made the call to go back to the hospital. I sat in the back seat of my parent's Jeep and continued to vomit pretty much the entire way back.

At the hospital they tried a few things via IV but nothing was working the greatest to stop the nausea. I kept wondering how it was possible that I could vomit 20-30 times. It didn't seem possible that I had that much of anything inside of me.

Eventually, the resident came in and said that Dr. Foster had told him that if I continued to vomit, they were going to have to put an NG tube back in.

Excuse me?

My will became resolute. I was not going to vomit one more time. And thankfully, I think I had pretty much emptied myself by then. Finally, they administered Compazine, and that seemed to be the ticket. Relief. I think I fell asleep not long after that.

The next day Dr. Foster explained that this is a common occurrence. It can happen when the bowels are still a bit frozen, and everything just starts to back up. It can also be a side effect of the chemo treatment that was used during surgery.

At any rate, after a couple of bowel movements I was back on track and ready to go back home by Friday afternoon.


I've mentioned the drain tubs and the wound vac a few times. See the three photos below:

The first photo is the incision itself, with Steri-strips over top of it. You can also see two of the three drain tubes coming out of my torso.

In the second photo the wound vac is applied over the top the incision. The tube that is attached leads to a small portable vacuum type box that applies constant suction to the area. The medical adhesives that are used to apply the wound vac gave me the opportunity to experience an abdominal and upper pubic waxing two times every week. You might think that this free manscaping would be a nice little perk, but another wound vac is just applied over top, so one doesn't really gain the "aesthetic benefits" from having it done.

The third picture is just for reference. That was on my 48th birthday, in October of 2014. I was probably about 163 lbs in that photo. Right now I am in the 148-150 lbs range. This would seemingly put me in the Matt "Bear" Novakovich boxing weight class, but seeing as how I am not allowed to lift more than 10 lbs, I imagine punching, and getting punched, are out of the question.

As for the drains, they are called JP drains, and they are used to collect bodily fluids from surgical sites. The suction of the little grenade-shaped bulb at the other end is what helps pull the fluid out. Dr. Foster has, on a number of occasions, referred to this fluid as "peritoneal sweat," but frankly, I have no idea what that is. I will just trust him on that one.


I have been home now for ten days, and like in the hospital, those days are all very similar to one another. I watch sports, I read a little, I get on my laptop now and then, and I take lots of walks around the house. The weather in Omaha has been cold and off and on snowy, so outside hasn't been a really great option.

One of the (many) reasons I decided to have this surgery in Omaha was because my father has also been going through some medical issues, and it was going to be a lot easier on my family for me to have the surgery here. But a result of that is that there are numerous times throughout the day when both myself and my 74 year old father, dressed in sweat pants and long sleeve flannel shirts, are shuffling around the house with tubes coming out of our bodies. It paints a whole new perspective of the phrase "Oh god, I am becoming my father." :)

As of today, 12/1/15, I am down to two drain tubes. Yesterday, Dr. Foster decided that the incision was healing really well and took the wound vac off. It is great to not have to carry around that little satchel containing the vac system anymore, but for the first 12 hours I definitely felt more "vulnerable." As today goes on it feels better. It is likely that within a week both drain tubes will come out, and at that point I will be "tube free."

There has been one very important aspect of this whole experience that I haven't written about yet, and that is how Rose has risen up to the occasion. She is basically in a cold, flat, state, away from her friends and family, living at her in-laws house. I will give you a moment to let that sink in.

Rose stayed with me at the hospital every single night, and for a good part of the day. She read Facebook comments to me at 2:30am during "The Dark Night," and was basically there to volunteer to help out with anything that I needed. Since we've been home she has been just as helpful, while trying to fit in make-shift workouts whenever she can.

I am both grateful for her, and proud of her. She has been the champion that most of you already know her to be from Spartan Races. It has been a trying time, perhaps for her more than me, and she has held up extremely well.

Thank you, babe. You are awesome.


And a special P.S. shout out to Amelia Boone and Matty Gregg who took the time to set up a GoFundMe account to help me and Rose cover our medical expenses. https://www.gofundme.com/timandrose

Their kindness is of no surprise to those who know them. They are extremely special people, and we owe them, and all of you who have contributed, the largest thank you. We have the most amazing friends and supporters. We are truly blessed.