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Wednesday, April 1, 2009

Dearest Friends,
    With a heavy heart filled with incomprehensible grief I must tell you that my beloved Carroll passed on Sunday morning. He fought a courageous battle against pancreatic cancer that I never dreamed would defeat us. Although I knew the illness presented odds that were tough to beat, I find myself completely unprepared to accept his loss. Gwynna, Spencer and I were with him when he passed peacefully on Sunday morning. As horribly difficult as it was to let go, we feel privileged to have been with him during his transition.
    A memorial service will be held in the celebration of his life on Friday, April 24th at 10 am at Harry P. Leu Gardens in the Native Wetland Garden. A reception will follow at 11:15 am in the Camellia Room and guests are then invited to enjoy the gardens and reflect. For those that are able to attend directions may be found at www.leugardens.org Please allow time for parking and walking to the garden.
    Carroll can best be remembered as a loving father, husband and passionate gardener. The setting at Leu Gardens is absolutely beautiful and fitting for the amazing person that Carroll was. The memorial service will be conducted by our wonderful minister, Reverend Scott Alexander of River Road Unitarian Universalist Congregation of Bethesda, Maryland. For those traveling from out of state Marriott Courtyard Orlando Downtown is providing a bereavement rate.   
    Thank you all ever so much for the constant support and love you have extended to our family. Going through a painful experience such as this has truly shown us the meaning of friendship.
With love to you all,
Patty


Monday, March 2, 2009
Hi, this is Gwynna. Dad had a deadline to write in the journal this week, but got side-tracked dealing with some major nausea issues. Dave Teffeteller, my dad’s good friend and the lovely fellow that uploads Dad’s journals online, is going to Patagonia for a couple weeks on a fly-fishing trip. Thus, Dad will not be able to update his journal till the end of March. While you are waiting on more Carroll action, you can also check out Dave’s blog Just Another Day in Ellijay.
    Dad has gone back to full chemotherapy treatment at the Florida Hospital. This is the first time that he has been dealing with some major nausea issues and has been hospitalized for a few days. Dad is a real trooper though and said to me yesterday, “These are the bumps in the road you have to deal with along your course.”
    Dad is supposed to return to Johns Hopkins on March 23rd for another ERCP, which is the bile duct stint replacement. After that we are looking forward to chillin’ with Pops over Spring Break, which probably means watching Keith Olbermann and discussing how cute Penny is. Here is a really random picture of Dad, Spencer, and me taken very recently…

Sunday, February 8, 2009  
Updating my personal journal usually waits for eventful information that I want to share that deems itself relevant. I have waited for this special event since undergoing the multiple therapies that I have received since my initial diagnosis with pancreatic cancer. On January 27, 2009, I attended the full day session, as a patient, at the “Pancreas Multidisciplinary Cancer Clinic” conducted by the Sidney Kimmel Comprehensive Cancer Center at the Johns Hopkins Medical Center in Baltimore, Maryland. A total of six pancreatic patients (the maximum allowed) attended this special evaluative clinic.
   First, let me extol the staff at the Johns Hopkins Medical Center and especially those of the Sidney Kimmel Comprehensive Cancer Center. I speak of the physicians, nurses, clinicians and support staff. I am absolutely ecstatic with the level of professionalism, knowledge, patient care and good ole customer service they each provide. If you, your family, or a friend is in need of medical attention, I highly recommend that you consider the specialty areas that Johns Hopkins Medical Center offers.
   
    In an effort to be succinct, I am only sharing the evaluation outcomes and recommendations.

  •  I continue to remain a non-candidate for surgery (Whipple procedure). The constituted problem is that the pancreatic tumor encases a portion of the Hepatic Artery and the Portal Vein.  It is too dangerous to perform surgery in this vital vascular area.
     

  • The pancreatic specialists in surgery, medical oncology and radiation all recommend that the treatment procedure “not rock the boat and maintain the current steady course.” Plans are to continue the regiment of chemotherapy with Gemzar and Tarceva over the next 12 to 24 weeks.
     

  • My tumor marker scores for the past 5 months have been excellent. The scores are low in the normal range. This means the overall tumor has been in an inactive state neither growing nor shrinking. My cell biology and the actual tumor have responded well to the therapies. All of the physicians that I personally met with, including medical oncology, surgery and radiation oncology stated that I was in a 10% category of national pancreatic patients. This meant I could not have surgery at this time, but did respond to the given therapies. Statistically, I am somewhat of an anomaly.
     

  • If the tumor begins to “act up” during or after the current chemotherapies, Dr. Joseph M. Herman,  Assistant Professor Radiation Oncology and Director of the Pancreatic Multidisciplinary Cancer Clinic recommends future potential treatment with Stereotactic Radiosurgery. Dr. Herman, a pancreatic cancer radiology specialist, is conducting research and protocols, in conjunction with Stanford Medical School  and M. D. Anderson Cancer Center for using this method on both lung and pancreatic tumors. Previously, this very finite form of therapy has been used on small brain tumors. He stated, "Stereotactical Radiation or Radiosurgery could be considered, but with caution.”  Oh, I quietly said to myself, it might blow up a few other vital organs, which would not go over very well with the body.  It could spring a gas leak!

    Until my next update, thank you again for the tremendous support that I continue to receive from family and friends. Enjoy the cold winter that everyone seems to be having  - and that includes Florida. Between the side affects of the chemotherapy and the weather, I have never been so cold!


Sunday, January 4, 2009  
Since my last journal update, I have been asking myself what is there to update. My life has been directed by chemotherapy and more chemotherapy. However, there have been lots of positive activities with the family. Our daughter, Gwynna, has been rigorously applying to colleges and taking the standardized tests. Patty traveled with Gwynna and Spencer to visit and tour two campuses in New York. Our son, Spencer, embarked on some new directions with drum lessons. They both continue to collaborate with much interest on video production. Yes, our family does have a strong drive for the arts. It has been an active household busily moving forward. In all honesty, I love to experience and enjoy this level of activity. The kids are really on the move.
    My big plans to travel to Johns Hopkins Medical Center in late January 2009 came sooner than later. On Tuesday December 22nd, I received my regular chemotherapy treatment and as usual, the impact hits two days later. Well, the first item that I experienced on Christmas Day was the impact of chemotherapy. The chemo really kicked my butt! Fortunately, I was able to get up for part of the afternoon to spend some quality time with the family and open Christmas gifts.  Afterwards, I went to bed and spent the next four days dealing with side effects and sleeping. I cannot ever recall spending so much time in bed sleeping. It was a time that you appreciate some drugs. Also, during this period I noticed some additional symptoms that were occurring...
    On Monday afternoon, I was diagnosed with a blocked bile duct and early stages of jaundice. I immediately contacted the Johns Hopkins Medical Center and they scheduled me for another ERCP replacing the bile duct stent on early Wednesday morning December 31st. Thank God that this institution can respond with expediency. Over a three day period, I received care and direction from six different physicians. The procedure was successful and I returned to Orlando very late in the evening on New Year’s Day.
    It has been a tough ten days, but I am recovering very well. I plan to return to my work schedule tomorrow.  Maintaining a work schedule tends to keep me focused and out of trouble. My theme is to constantly keep my eye on the big health picture, but effectively manage the daily and weekly bumps in the road. It’s an ongoing challenge and I have to strive for daily solutions with the help of family, friends, and medical professionals. I especially want to express my sincere gratitude to my bother-in-law Rick Forgham and to my special friends Steve and Brenda Putnam. They provided me invaluable assistance with my scheduling at Johns Hopkins Medical Center and during my stay at the hospital.


Sunday, November 30, 2008  
Today we conclude our celebration of the Thanksgiving Holiday and also the last day of Hurricane Season. We gave our blessings for a most pleasant Thanksgiving that we enjoyed and also our special thanks that Orlando did not experience the wrath of any of this season’s hurricanes. Yea!
    On Monday November 10th, I completed my six weeks of radiation therapy which included 30 sessions. On Tuesday November 11th, I completed a total of eight weeks of Infusion Therapy with the chemo drug 5-FU (Fluorouracil).  I was warned that the radiation could cause some side effects with my stomach and true to form, it did. I had to learn to deal with a different level of nausea, along with some pain and the usual level of fatigue. Apparently, the work effect of radiation remains in your body for about thirty days after completing the treatment cycle.  So, I got two weeks off from any type of treatment (therapy vacation) and I now have started (November 25th) the regular chemotherapy with Gemzar once per week and the daily pill dosage of Tarceva. This latest chemo phase will last until I have my next major evaluation (January 2009).
    This extensive evaluation will be done at the Johns Hopkins Medical Center beginning Monday January 26, 2009 with a 3D CT scan. On Tuesday January 27th, I will be involved in a single day comprehensive evaluation of a patient process incorporating all the resources available for education, diagnosis, treatment, and research of pancreatic cancer as part of the Johns Hopkins Pancreas Multidisciplinary Clinic at the Sidney Kimmel Comprehensive Cancer Center. Also, I will be involved with the Johns Hopkins’ Sol Goldman Pancreatic Cancer Research Center. This evaluative team consists of six or seven clinical specialists and six or more pancreatic physician specialists. Wednesday January 28th and Thursday January 29th are days for additional follow up testing if necessary. Then, I will have an ERCP (endoscopy) to replace the bile duct stent on Friday January 30th. This lengthy patient process will determine the outcomes from the chemotherapies and radiation therapies. At the conclusion of the evaluative clinic, the team will present me with a recommended treatment plan.
    On future personal journal updates, I will share some of my thoughts on pancreatic cancer and especially, my use of both medical and non-medical therapies. I have consulted with a number of medical professionals and practitioners around the country that have assisted me with my therapeutic plans. One prevailing factor through this process is one’s personal determination, strength, attitude and a warm circle of energy.
     Over the years, I have always been a believer in Pet Therapy and one little member of our family has graciously provided me that special therapy. She is a terrier mix that we adopted from a local rescue group two years ago and her name is Penny. Our family has been totally enamored with Penny and how she shares her love and affection for everyone. About three weeks ago, I was having some discomfort around 3:15 AM, so I go out of bed, took some prescribed medicine and walked around the house for a while. Finally settling down and returning to bed about 4:00 AM, Penny sensed something was wrong and she jumped into our bed (she always sleeps in her bed). She gave me a nudge with her nose, a big lick on my arm and then curled up next to me until I went to sleep.  Penny shows her care and concern just as you all have extended to me over the past several months.


Fri
day, October 31, 2008
Yes, I have been procrastinating, perhaps I just went through a period of writer’s block, or maybe I just wasn’t motivated. Actually, it has been a bit of everything. Now for the truth! I am going through some very aggressive medical treatment, attempting to work full-time and keep up with a most wonderful and very active family. The daily schedule is full, even most weekends. Just last week, I remarked to my wife Patty, "remember when Sunday was a restful day?” Not any more with today’s lifestyles. In September and October I have had 41 medical appointments. Whew! Everyday I say my daily prayers and express a special thank you for the blessings that I receive.
    For the past 5 weeks, I have been under going radiation and chemotherapy in a joint treatment plan. Radiation is delivered daily Monday through Friday, while the chemotherapy is administered 7 days per week, 24 hours
per day through a pump that is permanently attached to my chest port. This method is call Infusion Therapy. This phase of treatment with radiation and chemotherapy is scheduled to end on November 10, 2008. The oncologist then plans to allow the radiation to work internally for another month. Then I go back to the original chemotherapy drug Gemzar for another 4 to 6 weeks.
    As you can surmise, although tough to endure, it is a very aggressive treatment plan. I am very pleased with this regiment that Dr. Edil at Johns Hopkins Medical Center and Dr. Dunn at Florida Hospital Cancer Institute have jointly planned. Upon completion of the treatment plan, I plan to return to John Hopkins Medical Center in January 2009 for an in-depth evaluation.
    On October 6, 2008, Patty and I traveled to Johns Hopkins Medical Center in Baltimore Maryland to have a quarterly scheduled procedure ERCP to replace my bile duct stent. The procedure was performed by Dr. Zhiping Li and was very successful. With pancreatic cancer, the tumor grows to narrow or pinch the bile duct which inhibits the fluid passage. Trust me, a blocked bile duct can cause problems.
   
Last Saturday, Spencer, Gwynna, Patty and I participated in a 5K run and walk sponsored by the Central Florida affiliate of the Pancreatic Cancer Action Network (a national organization). The event, part of a national program called Purple Stride, raises money for public awareness, education, and research for pancreatic cancer.
    November is National Pancreatic Awareness Month and the color purple represents pancreatic cancer. So take up this year’s theme Picture Your World Purple.


Sunday, September 21, 2008
Just a quick update for my friends and colleagues around the country. Thank you for wanting to know.  Last week, I completed what I am referring to as Phase I of the treatment plan. I finished 12 straight weeks of chemotherapy which included the drugs  Gemzar  and  Tarceva. These are the two most commonly used drugs for pancreatic tumors. The oncologist did confirm that overall the tumor did not shrink, but did remain localized. From all test indications, no other organs, blood vessel, or bones have been affected. The tumor blood marker scores were better (I really do not know what this means). Overall, I survived a tough regiment of drugs although it was a daily challenge. Chemotherapy affects so many parts of your body and you could almost say that no two days are a like. It is challenging both physically and psychologically.
   Now, I am moving into Phase II of the treatment plan. This past week I had my first meeting with Dr. Robert Sollaccio, radiation oncology, to start the planning and mapping of the radiation treatment. I also completed the CT scans and markers to complete radiation mapping. My initial impressions of Dr. Sollaccio were excellent and I am pleased that he will be working with me.
   Phase II treatment will utilize both radiation and chemotherapy at the same time. I will receive radiation Monday through Friday each week for a period of six weeks. At the same time I will receive another chemo drug called  Fluorouracil  or for short 5-FU. The drug 5-FU works in combination and enhances the radiation treatment. Next Tuesday, I will be fitted with a portable pump with a week’s supply of the drug and it will be connected to my power port embedded in my chest. The pump will have to be carried in a shoulder sling bag 7/24 and refilled each week. So, just think of the bag as a man purse. My daily shower that I have always cherished now becomes a daily trick! Just remember that cleanliness is next to Godliness


Friday, August 29, 2008
As both a student and an aficionado of business marketing over many, many years, I have always been intrigued and practiced within the concept of “Perception Creates Reality.” Now that I have completed ten (10) straight weeks of chemotherapy (without the usual break), I will attest that the general perception of this medical therapy holds truth. Yes, it is a most valuable medical therapy, but most enduring. I have no major complaints and feel fortunate that I have personally persevered with no major side affects. I am most thankful to only deal with the minor affects and let me add to your perception “there are lots of minor ones on a daily basis.” My individual treatment plan includes the drug “Gemzar” that I receive intravenously once per week at the Florida Hospital Cancer Center and the drug “Tarceva” taken orally at home every morning around 6:00 AM. Overall the schedule has not been burdening.
    Last Monday August 25, 2008, I had my first evaluation tests, which included CT scans and x-rays. Although I do not have the complete results as yet, I had a telephone conversation with my medical oncologist today. He said that we would proceed with the planned second phase of the therapy with external beam radiation. On Tuesday September 2, 2008, I will get the test reports and the radiation treatment plans. Good news to date is that the tumor remains in the original diagnosed area and has not affected any other organs, vessels, or bones.
    In early October 2008, I am scheduled to be at Johns Hopkins Medical Center in Baltimore for my quarterly scheduled endoscopy. At that time, I will have a bile duct stent replaced. Trust me, this procedure is well worth it and eliminates many complications. It keeps me from looking like the big yellow banana (jaundice).

People in My Life
Periodically, I would like to mention or recognize people in my life. First let me thank everyone for reaching out touching me and my very special family. The friendship, the spirit, and the prayers from so many people have been truly enormous. I have been personally uplifted and emotionally touched almost daily. The spirit of friendship and the spirit of life are meaningful. Just saying thank you does not fully convey the heartfelt appreciation.  
    Last weekend, our family was honored to have Terry A. Chervenak a close dear friend and professional colleague, visit with us at our home. Terry, known to our kids as Aunt Cherv, resides in Knoxville, Tennessee, where she is owner of Chervenak & Associates PC a public accounting company.
    I have had the pleasure of working with Terry (although there was a few of my business days that she probably did not find me a pleasure) for over twenty five  years. Terry has been a business confidante, mentor and advisor and a very special friend to me and our family. Thank you Terry for putting up with me for so many years!


Wednesday, July 30, 2008
Yes, I admit that I have been a little lax with my time and schedule for the past couple of weeks. I realized I had not updated my personal journal for over two weeks. As I had recommended earlier for everyone to stop and smell the roses, I soon found myself falling asleep on top of the rose bush. The chemotherapy is going as well as to be expected, but I have become more tired daily and even more zapped on certain weekdays. This week I successfully completed my sixth straight week of chemotherapy. Both my white and red blood cell counts remain low, however I have been able to continue on without missing a week. Usually, when your blood counts are low you must skip a week to build the cell numbers again. My chemo nurses keep patting me on the head saying, “Good Boy!"
   This past weekend, I was unable to attend my high school reunion in Greenville, SC. I had planned to go, but was advised to stay home and wait for the reviews. One of my best buddies emailed and summed up some our classmates: old, gray hair or bald and overweight and you should have seen some of the guys too.  I salute my fellow classmates as we have all aged the same. I send my best wishes and I'm thrilled that everyone had a good time. I really missed seeing everyone. Remember that we won our division for the South Carolina State Football Championship as well as baseball, track, tennis and golf. The basketball team lost by either one or two points in the state finals. What a year for GHS sports! You have to remember that I was truly an ole jock. Jersey number 24.
   On a sad note, Dr. Randy Pausch, 47, Carnegie Mellon University professor and pancreatic cancer patient, passed away on Friday July 25, 2008. He was such an inspiration to me and so many people. He was highly recognized for his compelling book “The Last Lecture” based on his last Carnegie Mellon lecture “Really Achieving Your Childhood Dreams”. Click here to view this lecture on youtube. I send a special prayer for him and his family. May God Bless 
         


Friday, July 11, 2008
This week I completed my third week of chemotherapy in Orlando and all seems to be well. I am especially pleased with my medical oncologist, Dr. Phillip Dunn. He is a very bright and dedicated professional. Hopefully, I will continue to settle into a weekly routine and complete the projected six month cycle. I am pleased to announce that to date I have not experienced any serious side affects. Yes, there are numerous daily side affects to manage, however they are minor inconveniences in working toward our primary treatment objectives which is the big picture. I did have a bump in the road that was not related to the chemotherapy.  On Wednesday June 25, 2008, I experienced the sudden onset of a fever of 103 degrees. Dr. Dunn hospitalized me for five nights to manage the fever and an internal infection. Apparently, the infection was centered on some small blockage around the stent that was placed in my bile duct. The extensive antibiotic regiment and care that I was given was successful. I returned home on Monday June 30, 2008 and returned to work the next day.
Lesson learned!
Please heed this advice from Carroll. While hospitalized, I was scheduled to receive the intravenous antibiotic at 11:00 pm one night.  The nurse came to my room about 11:20 pm. In a light sleep, I awoke and asked if she would like to turn on the lights to set up the machine with the drugs. She declined, started the process and I went back to sleep. The next morning I randomly looked at the prescription bottle and bag still affixed to the IV pole. I discovered that I had been given another patients prescription medication. After consulting with my physician, I was given the okay and I did not have any negative results from the drug. The lesson learned is to always ask any medical personnel before you are given a prescription. Ask them “What are you giving me”? Make sure that they have looked at the label for the drug name and your name. You should also do the same. I have now heard other similar stories since then.
  I have always heard that you should “stop and smell the roses”.  With my lifestyle changing overnight, I now really believe that one should follow this advice. Last week, a friend and fellow master gardener Alice Mikkleson (we were in the same Master Gardener class) brought me a very special vase of roses she cut from her huge rose collection and garden.  They are absolutely beautiful.  Thank you Alice! I now stop and smell the roses everyday and recommend that everyone do the same. Everyday is a special day.


Wednesday, June 25, 2008
Hallelujah, my chemotherapy treatment started yesterday afternoon. It has been five weeks to the day since my official diagnosis. The wait appeared to be a process of never ending eternity, while living with such anxiety and uncertainty. I have remained positive to go forward each decisive step of the way. It reminded of the little train book that we have all read as young children with the special message of “I think I can, I think can” until we reached the hilltop. Chemotherapy has now become my first hilltop with many more to go. I remind myself constantly, “I think I can, I think I can”. So many family, friends, and colleagues have been right there behind me daily with so much support and encouragement.
   With good progress along the way, chemotherapy has been scheduled for six months here in Orlando. The primary drug induced is Gemzar (Gemcitabine). There has been success with many pancreatic tumor patients on Gemzar. One nice feature with this particular drug is that I will receive it only once per week. My medical oncologist is recommending another drug taken orally each week and possibly radiation. I am very pleased with this aggressive plan and I anxiously await the collaboration with my local oncologist and the surgeon at Johns Hopkins Medical Center.
   Now for the fun stuff! This is a recent photo of Gwynna, Spencer, and myself taken during our visit to Johns Hopkins. Patty was taking the photo, so she could not get in this one. This photo shows how the kids have grown. Spencer is now fourteen and will start high school next fall at Winter Park High School. Just a little over a week ago Gwynna celebrated her seventeenth birthday and will be going into her senior year at Winter Park High School. Yes, we have started the college tour project with her.
   Patty will be celebrating a very special birthday this fall. However, I cannot divulge which one or my chemotherapy might get interrupted very quickly.
 My family has just been a wonderful inspiration and I am so thankful.

Friday, June 13, 2008
Although I have been unable to respond to so many of you individually, I want you to know that I hear and feel your special thoughts and prayers daily. I have fully realized the profoundness of friendship. Everyday I am touched emotionally and motivated to accept this challenge and to positively go forward. Clearly, friends are one of life’s greatest gifts.
   With the help of my dear friend Dave Teffeteller, I am creating and sharing this personal journal. Dave’s creative genius and wisdom have been part of my professional life for over twenty five years. Although this format can be impersonal, it will allow me to share some updates with many of you periodically. These updates are read-only and do not have a response function. However, please feel free to e-mail or telephone me at your convenience and I will attempt to respond as my time permits.
   Gwynna, Spencer, Patty and I returned to our home in Orlando on Wednesday June 11th. I have to say that as a family, we are all completely in awe of Johns Hopkins Medical Center. Johns Hopkins is a remarkable institution with an unbelievable staff.
After additional diagnostic testing and consultation with my lead surgeon, the course of treatment has been changed. He has recommended not doing the surgery at this time, but instead pursuing a very aggressive chemotherapy plan in Orlando. A portion of the tumor is in a very vascular area that affects the liver’s hepatic artery and the portal vein, which makes for even more difficult surgery. To date, all surrounding organs, blood vessels and bone have not been affected. The goal is to reduce the size of the tumor over the next 9 or 10 months and then consider surgery at that time. The race is now on!
   This afternoon I will be meeting with our selected oncologist to review and determine the chemotherapy treatment. I am very fortunate to have Johns Hopkins to take the lead with my local team of oncologists and gastroenterologists. Over the past two weeks, I had a couple of other medical procedures at Johns Hopkins that were very successful and helpful, and I have plans to return there every 3 months for some procedural follow-ups.
   While in Maryland last Sunday, we as a family attended our church and rekindled a special love and spirit. Thank you Rev. Scott W. Alexander and the River Road Unitarian Universalist Congregation for reaching out and caring. You have always filled my heart and soul with such a divine spirit. I have been reminded by Rev. Alexander as to, “what is a friendship?” It is knowing that there is another human being you can trust completely.
   In closing, I want to express my warmest and sincere gratitude to my family. Everyone rallied together immediately to create a support network. They worked at multiple levels within a very short timeframe to assist in so many ways. Their love and compassion has been monumental in providing me daily inspiration. Thank you so much to Patty, Gwynna, Spencer and all my family and friends.

Friday, May 30, 2008
Last week, with no major symptoms, I was diagnosed with a pancreatic tumor. Immediately, I started my crusade to move through the morass of medical professionals and insurance roadblocks. I have been accepted by both the Mayo Clinic and Johns Hopkins Medical Center. As of this afternoon, I have confirmed plans for treatment at the Johns Hopkins Medical Center in Baltimore. On Tuesday June 3, 2008, I will have additional testing and surgical consultations at Johns Hopkins. The Johns Hopkins pancreatic surgical team is ranked as the world’s leading authority for this very intricate and difficult surgical procedure (The Whipple Procedure). I am very thankful to reach this level of expertise and care.
   Patty and I will be traveling on Monday to Baltimore with Gwynna and Spencer joining us on Wednesday - after the school year ends. Please feel free to communicate at any time, but I will be unable to respond to e-mails or telephone calls for several weeks.
Thank you for understanding, but more importantly thank you for your friendship.