Some of you already know the background behind Jim's current health status, but we want to be thorough in our communication as we begin this blog.
In March of 2011, we learned that Jim had a golf-ball size melanoma in his left supraclavicular area, the region between his trapezius and clavicle approximating the base of the neck. The melanoma was a derivative of a melanoma that had been removed from his left scapular area in the summer of 2007. This melanoma was thought to have developed from the years of open sun exposure to his back.
Jim was aware of the lump in his neck for sometime, but was told by his dermatologist who had removed the original melanoma that it was most likely a dermoid cyst. As time progressed, the lump grew bigger and eventually in early 2011 Jim decided he wanted the lump removed. He contacted his dermatologist to schedule an appointment, but learning of the growth of the lump, his dermatologist requested a needle biopsy to rule out a cancerous lesion. The result came back positive for melanoma. The dermatologist explained that the melanocytes had most likely traveled through the lymph channels in the left posterior cervical chain, arriving at what is referred to as the "sentinel lymph" node. The probability is high that the sentinel lymph node was already impacted in the summer of 2007 when Jim had the surface melanoma removed from his left scapular area. If this is in fact what happened, the lesion at the site of his sentinel lymph node had almost four years to grow before it was detected.
The news was a shock to the entire family. Here is someone who is a perfect specimen of health. Of all people, how could this happen to Jim? Again, the only reasonable explanation is that the massive sun exposure he experienced as a teenager and adult brought about the melanoma. The family came together and processed the news.
Next steps were to get a CT scan (computed tomography) of the head, neck, chest and abdomen. This would not only define the size of the cancerous lesion, but would also reveal whether the cancer had traveled elsewhere. When cancer has struck the lymph, particularly the sentinel lymph node, it is common for the cancer to travel to other sites in the body. Functionally, the lymph system is a powerful arm of the immune system, acting as a filtration and drainage site for the body. Thus, it is important to have imaging evidence regarding the distribution of the cancer before laying out and making a decision as to the treatment options.
The results of the CT came back during the latter part of March. According to the imaging studies, it was determined that the sentinel lymph node was the only visible cancerous site. Based on this evidence, the doctors felt that the body had effectively contained the cancer to the sentinel lymph node. They recommended a surgical removal of the lesion, which would entail extracting the anterior cervical chain of lymph nodes. Similar to the nervous system, the lymph system entails branches that reach throughout the entire body. Removing the anterior cervical chain is like removing a branch of a tree that has a series of branches on it.
Jim and family felt comfortable moving forward with the surgical option. He had surgery the last week of March. This was a rather invasive surgery, as major nerve and blood pathways also travel through the site of surgery. Following a week long period of rest, Jim learned that his shoulder anatomy would perhaps change permanently. In the weeks and months that followed his surgery, he struggled with issues of extensive shoulder and arm numbness and severely impaired shoulder elevation. This certainly impacted his normal mechanics when adjusting patients at Holladay Chiropractic, so he had to adapt his adjusting skills. Perhaps the most frustrating post-surgical reality were the challenges associated with sleeping. Jim was waking up regularly two to three times a night due to the pain and discomfort in his left shoulder. Most of his normal sleep positions involve placing pressure, direct or indirect, on the left shoulder.
Five months following the shoulder surgery (early September), one of the doctor's managing Jim's case recommended that he go in for a follow-up CT. He had a CT of his neck, chest and abdomen. They also did a general scan of the head. He received a call from a nurse on the evening of September 11th, who said it appeared that there was a brain tumor in his head, and possibly some associated brain bleeding. However, more specific studies were needed, so they scheduled an MRI of the head for the following day (Monday, September 12th). The results of this MRI revealed that there were three cancerous lesions in the brain; a larger lesion (perhaps an inch) in the right frontal lobe, a lesion in the right parietal lobe and a lesion in the left occipital lobe. An appointment was made with a neuroradiologist, a specialist in the removal of brain cancer with radiation methods, for the following day (Tuesday, September 13th). Jim, Ann, Jason and I attended this appointment. After an hour of review and consultation with the neuroradiologist, the family felt unanimous about pursuing a treatment option called stereotactic radiation.
Stereotactic radiation is a radiation method which facilitates targeted radiation of brain tissue, utilizing modern advancements and radiation devices. The University of Utah has the foremost technology - the Mercedes of stereotactic radiation technology - and has utilized it extensively for the management of brain cancer. The procedure involves first attaining an exact knowledge of the size and dimension of the lesion with highly specific MRI (1 mm slices). Then, the MRI is used to draw a three-dimensional image of the lesion(s). A second appointment is scheduled to create a sort of radiation mask, which of course is worn by the patient during the sterotactic radiation. The radiation targets are then drawn onto the mask. And finally, the procedure is performed within days of the MRI.
This all transpired within this week. Jim completed the MRI and the radiation mask components on Wednesday. Yesterday, he went in for the actual procedure, and everything went wonderfully. So, with all this background, the question is what is next?
Procedurally, Jim will go in for an MRI follow-up every two months. His next appointment is scheduled for November 22nd. Since there is a 50% probability of recurrence, it is imperative that frequent monitoring takes place. If further brain cancer lesions are detected, the same procedure may be used to treat the cancer.
Functionally, Jim may return to normal activities. However, there will be "flare-ups", which are symptomatic evidence that the radiation is working. It is important to note that the stereotactic radiation remains active for approximately a year. This prolonged activity of the radiation is crucial in systematically destroying the cancer. Some of the effects of this radiation may not be felt for weeks, perhaps even months. The flare-ups may include symptomatology including headaches, irritability, dizziness, loss of peripheral vision and loss of normal motor and coordinative function.
At times, these symptoms may require Jim to completely retreat from the clinic, and we are prepared for that. However, the neuroradiologist was very clear in encouraging Jim to remain involved in those activities that give him purpose and fulfillment. Psychologically, the importance of Jim being in the clinic at this time cannot be understated. He has made it very clear that he will remain active in the clinic, and does not wish to be persuaded or convinced otherwise by family and friends. Please respect both he and the family in this regard. Furthermore, know that we have already extensively discussed and agreed upon the modification of his work routine, which will include regular rest periods throughout the day.
As always, we feel the best support you can provide to our family is that of prayer. Amidst the challenges, we are certainly aware of the ways in which God has already answered prayer. We will continue to send our prayer requests, petitions and praises to the Lord as time moves along. Thank you once again for your undying support and love toward Jim and our family.
Much Love, Erik (on behalf of Jim, Ann, Jason & Roanne, Erik & Paige)
It is almost as if life is completely normal right now. Jim is on top of his routine, he is getting better sleep more consistently and the love and laughter that has characterized him is back in full session. If you've seen him in the office, you'll notice that he really seems like good 'ole Dr. Jim. And by the way, for the first time in 33 years, he wore a Halloween outfit. That's right, he was a hot-dog!
Mind you, victory is a rare thing for him, but you'd never know by the way he talks to me on the ping-pong table! One of our favorite moments was when I threw a slice serve over and he completely whiffed it. The ping-pong ball had so much English on it that it bounced on his side, he whiffed it, and then it bounced back on my side of the table. Believe it or not, I felt the draft from his whiff. We were rolling on the floor laughing. Great father-son moment!
