The liver biopsy was somewhere between major surgery and outpatient procedure. I guess due to the risk of a major accident, they check you into a short stay hospital room to make you wait afterwards and ensure there’s no issues. Luckily you could have a guest and my wonderful wife accompanied me for the day.

I decided against taking either of the drugs prescribed - I don’t need any addictions or withdrawal, so I decided to trust whoever was doing it that I’d be ok.

Luckily that morning I had just started a book on meditation - while I wasn’t even halfway through the book, even the early guidance helped me maintain a calm while being wheeled through the hospital to the procedure room (my nurse even commented about my perfect blood pressure).

Now that serene was a little interrupted when the biopsy doctors gave me an overview: “So we’re gonna numb you by sticking some needles deeper and deeper, then stick a large needle in, then remove that needle and suck up some cells. Now the liver is very filled with blood so in the event you start to bleed out, the first thing we’ll do is inject a clotting foam in you, and if that still doesn’t work and you’re still bleeding…” at this point I stopped paying attention, man I don’t need to know how the sausage is made, just stop the bleeding if it happens!

You are fully awake and get no anesthesia, so you get to hear the doctors prepping you. They then do a bunch of ultrasounds and say really comforting things like “hmm i don’t like the position of that” and “oh geez, that one looks really close to his bowel are you sure?”, “Think you can get around that fat?”. After poking and prodding me for twenty minutes (they said “hey sorry we’re window shopping!”) and they started the procedure.

In the end, I’m glad I didn’t take the drugs, like most procedures people make a big deal out of, I found this was really a nothingburger (or possibly the doctors were awesome). They inject you with lydocane deeper and deeper, then eventually shove a big needle in you guided by ultrasound. They were very good about explaining what I might feel each time, and every time what I felt was way less than what they say I might feel.

For whatever reason my lesions were hard to get to (I take this as a good sign, would rather not have a giant tumor that’s easy to access!), so I had a lot of “breath in just slightly, now hold it…” type exercises. In the end I think they ended up stabbing me around 8-9 times, making sure they got enough samples that I didn’t have to do it again.

In the end none of the worst case scenarios happened and i have a tiny bandaid that looks like its covering a few mosquito bites. It felt a little like I’d be punched in the chest and I learned a lot about where my liver is located… The nurse kept trying to tell me “you won’t get the results today, but soon!” as I imagine most people getting this test are getting a binary (it is cancer or not), in my case we know it’s cancer we’re just trying to figure out the flavor. Its estimated to take 3-4 weeks for molecular testing, so now we wait…

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Well, while in an ideal would I would quit today and spend every minute having fun times with my children there are a few key realities:

1. No one has given me days/weeks to live at this point, I could be around 3 days or 30 years - if it’s the latter, life has to go on. The kids have school, there’s only so much you can do each day etc…

2. It’s a great distraction - I took one day off coincidentally after I found out to do some work on our cabin, and most of the day I just had anxiety being alone with my thoughts. Work is a great distraction.

3. While Amazon is very flexible about letting me take the time I need, in the end health insurance in the USA is critical, and losing this exposes my family to too much financial risk.

4. Additionally, if I do end up dying, I want to make sure my family is as set as possible - between the pay and the extra life insurance through work, there’s just too much upside to not do this.

5. Luckily I did coincidentally take a sabbatical this past summer, and it was an amazing experience spending entire weeks with family when my kids were out of school, including a whole week at Boy Scout camp.

6. Should it become clear I can no longer work or the end is imminent, I do plan to take leave. For now, I’m assuming it won’t be necessary.

If you’re reading this blog, I’d request you don’t just passively follow but reach out and grab a coffee with me (I’ve cut out beer sadly). Check in with my family who needs the most support, and most importantly take care of yourself. Look into anti-cancer diets, and get all of your screenings! I may come up with more concrete requests in the future but right now the best thing most people can do is stay positive, and keep our family in your thoughts.

Send me motivating examples of people surviving worse. Send me your favorite podcast, give me some great book recommendations. Don’t be afraid to “bother me”. If you know my wife, she’ll need the most help - her current ask is anti-inflammatory recipes.

Next: Why Are You Still Working?

The second step is identifying if the cancer in my liver/lungs is potentially a second, different cancer than my original one. I think that’s pretty low odds, but I guess it’s worth the risk - especially if its a cancer that can be treated better than the original one.

Here’s what my next few weeks look like:

• Oct-21: Liver Biopsy

• Oct-26: Pelvis MRI

• Oct-30: Brain MRI

• November-XX: Get results back from molecular testing of biopsy and determine best treatment plan. Also likely a second opinion of whatever plan that is.

Next: How Can I Help?

So for me at least, first I’ll talk about my original cancer. Around 2019 I started occasionally ejaculating blood, which was an obviously very concerning situation. I went to a urologist (Doctor 1) and I had no elevation in PSA levels (prostate cancer marker), and no swelling of prostate etc… He suggested i see if it persists and come back in 3-6 months. It did, and I did go back and he thought it might just be some sort of cyst or blood vessel thing but ordered an MRI just in case because he was still concerned (Doctor 1 was awesome). The MRI showed a tumor, and he referred me to an urologist oncologist (Doctor 2).

Doctor 2 got me a biopsy (prostate biopsy one of the worst possible things I’ve experienced, I’d describe it as getting sodomized with a knife) and it confirmed basal cell carcinoma of the prostate. If you’re semi-familiar with cancer you may hear basal cell and think “wait isn’t that skin cancer?” and you’re right! There’s a small amount of skin cells in the prostate and I guess that’s where mine started. Due to the rareness of this, the UPMC tumor board suggested a prostectamy which sounded fine to me - I wanted this stuff out of me ASAP before it spread. What I didn’t know at the time and have heard since is that sometimes when a large tumor is removed it removes the controls that tumor is keeping on check for other ones in the body (also if you are considering a prostectamy there are some pretty serious side effects I’m happy to review with you, I did end up questioning this decision in the intervening years).

Anyway after the surgery and recovery, I asked Doctor 2 how what’s next and he said “well you have no prostate and your margins are clean so there should be no more cancer. I’m a surgeon and you don’t need any more surgery so go see your original Urologist (Doctor 1) about the recovery from surgery and I’m out.

Now here I think there is a serious issue - I should have had periodic scans, and I asked for this but a) My urologist (Doctor 1) moved out of town and my PCPs (Doctors 3/4) are clueless about this type of stuff, so they just kept proscribing PSA tests (which were never elevated for me). I always meant to try to follow up more aggressively with Doctor 2 on getting scanned, but time moves on quickly… but in my opinion he really should have came up with a regular scan plan.

So this summer I turned 45 and my PCP suggested a colonoscopy. Given my previous cancer experience I said hell yeah - and I encourage you do to the same, WHY WOULDN’T YOU WANT A CHECK OF YOUR SYSTEMS? The colonoscopy showed no colon cancer but the excellent doctor (Doctor 5) noticed nodules in the prostate bed and wrote a letter to my original surgeon (Doctor 2) about his concern, and suggested I set a follow up appointment.

I tried to setup an appointment with Doctor 2, but the earliest i could get was 3 months out - no worries, he got the letter, if he thought it were more serious he’d move me up right? Well not only did he not move it up or acknowledge it, but a week before my appointment his secretary was like “actually he can’t do that day can you do a month from now?” and I was like “hell no, i scheduled this 3 months ago” so she fit me in with a PA in a week. The PA confirmed something didn’t feel right in my prostate area, sent me to an oncologist familiar with basal cell, and that oncologist sent me for a PET scan which showed the negative results where I am today.

Now in hindsight I actually had quite a few warnings which i did seek medical attention for but no one connects the dots - I had pain in my spine and ribs (which i went to the doctor for), I had weird vision changes (which i also went to the doctor for, she said i just didn’t know how to wear bi-focals…). If I were to do it again, I would probably pay for private PET scans (~$10-15k a pop) outside of insurance every 5-10 years for peace of mind (this is not medical advice - keep in mind CT scans which are used in PET scans also cause cancer… ). And obviously stay on top of all of your possible checkups - people have a somewhat justified fear of prostate and colon exams, but neither is really a big deal in my experience, and the brief amount of discomfort is worth the long-term peace of mind.

Next: What’s Next?

Also I realized your writing is one of the few things you can leave behind (so i may also post stuff in my backlog of topics to write on…). The last time I had cancer I kept it pretty private but this time I see nothing but upside from sharing - but please still reach out to me directly for social interaction, I’d love to chat!

Wait, what’s going on?

Doctors have found a recurrence of my cancer (I had prostate cancer in 2020) and it’s quite serious. There is a large tumor where my prostate used to be, and it appears to have spread to my bones, liver, lungs, lymph nodes and potentially brain (PET scans are unreliable with brain, so I have an MRI to follow up on this Oct-30). Now if I just read that paragraph I’d say “holy shit that guy is about to die”. But… I feel fine? I have almost no symptoms except some mild bone pain (I had even gotten a chest x-ray over the summer thinking I broke a rib - it said I was fine). At the point I’m writing this we don’t really know what’s next - the cancer I had in my prostate was so rare my doctor called it “theoretical” - there’s only been <100 cases of it worldwide ever. And that type of cancer spreading is also extremely rare! Gemini and I have calculated it to be roughly 1 in 80,000,000,000 that I’m in this situation - so maybe I should have been playing more Powerball…

Next steps, I’m getting a bunch more testing - MRI for brain and pelvis, biopsy for cells from liver etc… so the course of treatment can be determined. The bad news is if its my previous cancer and not a new second type of cancer there will be mostly guesswork (try chemo and see if it works, etc…), but the good news is cancer therapy has come a long way in recent years and people with this diagnosis can now survive many years. I take inspiration from folks like Lance Armstrong who had metastatic cancer with 90s technology and are still around 30 years later.

What’s Next?

I’ll be documenting where I am with my journey here, but one thing I’ve resolved myself on is I will not go down without a fight. I’m angry the system didn’t do a better job following up with me. I’m angry I didn’t eat healthier in the intervening years, and I’m angry that this type of thing can happen in general. After many days of crying (and I probably hadn’t cried in 5 years before that…) I’ve found my anxiety goes away when I take the fighter mentality. Even though it’s cliched, it really does work for me - cancer is an invasion and it must be fought off. I have literal scars from the first round and sure I’ll have even more this time.

I’m doing literally everything I possibly can to extend my life - not for me, I personally feel I’ve seen the world, have two amazing kids, a wonderful wife, a beautiful home, have accomplished everything I wanted, left it a better place through volunteering, mentoring and have no regrets. My family is reasonably set from my years working in tech, having life insurance and selling businesses.

But I want my kids to have more time with me, and so immediately I…

• Changed my diet - I don’t think I ate especially bad, but the Anti-Cancer research shows inflammatory foods are pro cancer (sugar, alcohol, white bread, corn fed red meat etc…), and I believe this based on the way a PET scan works - it’s looking for high consuming cells of sugar! So fuck those cancer cells, they are not getting more.

• I will take any and all blessings and prayers. I’ve been asked “is it ok if we pray for you?” YEAH MAN RAIN IT DOWN. If your religion says standing on my head ten minutes a day cures cancer, I’m giving it a try. Meditation? Sure i’ll give it a try.

• Perhaps the age of AI is perfect timing for this challenge. I’m hoping to get clinical trials from the top cancer hospitals and hope for a hail mary that the new abilities of AI will let these doctors find connections and solutions that may not have been possible in the past.

• I’m realistic, but also having a winning attitude about this - studies show cancer feeds on negativity and cortisol of stress. I’ve had my tears, and I’ll have more, but the way I look at it today is it’s a blessing I have this time to be aware of the preciousness of life. Some dads get hit my a truck and never get a chance to say goodbye. I have the time to ensure everything is set up well, write letters for my kids, and savor every moment. So now the fight begins.

Next: How Did You Find Out?