Category Archives: Cancer

The life of Kenneth B. Foreman and his journey after being diagnosed with Stage 4 Mantle Cell Lymphoma (MCL), a form of Non-Hodgkin’s Lymphoma (NHL).

Ken’s chemotherapy, immunotherapy, radiation therapy, and bone marrow transplant have been through Kaiser-Permanente (Tysons Corner, VA), Johns Hopkins (Baltimore, MD), National Institutes of Health (Bethesda, MD), and the Seattle Cancer Care Alliance in coordination with Fred Hutchins (Seattle, WA).

Where You Fall on the Spectrum

Dead Like Me is an American comedy-drama television series starring Ellen Muth and Mandy Patinkin as grim reapers who reside and work in Seattle, Washington. Filmed in Vancouver, British Columbia, the show was created by Bryan Fuller for the Showtime cable network, where it ran for two seasons (2003–04)

Back when I was in high school, my favorite teacher introduced me to the Apple Macintosh SE and taught me HyperCard.

Jason “Jay” Fogleman used HyperCard extensively for everything from lesson plans and notes to scrapbooking interesting articles from the internet.

Over the years, I’ve tried to use OneNote, EverNote, Instareader, and Pocket for bookmarking and scrapbooking articles I’d like to revisit, re-read, and use as references. Given the ephemeral nature of the internet and software, trying to find and use a single solution over the decades (1991-2021) has been exhausting and futile.

Anyhoo, long story short, a friend of mine lost her father this week. She was literally talking to him on the phone as he was in the hospital for COVID-19. Ten minutes later, her father was dead. No warning, no one saw it coming, he simply “gave up” and expired. My friend is ten years younger than me, her father was roughly ten years older than me. Late 50’s is NOT old, and far too young to be dying from a pandemic.

So her conversation with me about “I never saw it coming, we never knew, I didn’t know today would be the day I lose my Dad” stuck with me. I read several articles on Kaiser-Permanente and Johns Hopkins about the misconceptions and social memes that people (particularly Americans) have about death.

One persistent misconception is that people believe Death is a switch. A person is either Alive-and-Healthy or Dead. A strong number of studies indicate that Death is not a binary state of health, but a long continuous spectrum from vibrance to doorpost. Our health, persistence, and endurance are as likely in our heads as in our health. Some people bleeding out from shock trauma die rather quickly, some endure and overcome despite losing multiple limbs. It’s not a switch. It’s not a binary state.

I don’t have an answer for my friend. I still don’t know why her father, who appeared to be in relatively good health despite being hospitalized for coronavirus, decided to expire not ten minutes after talking with his daughter.

But I do wonder about that spectrum, where he fell on it, and the why of it all…

Doing My Best To Persist

“You never know how strong you are until being strong is the only choice you have.”
— Cayla Mills

On Tuesday, November 24th (the week of Thanksgiving 2020), I started running a sustained neutropenic fever of 100.6°F.  I was admitted to the emergency room at Reston Hospital Center and then transferred to the Progressive Care Unit (PCU, a “step-down unit from Intensive Care”) for the next three days.  They gave me IV fluids and heavy antibiotics for all three days, did a chest x-ray followed by a CT scan.  I was diagnosed with “walking pneumonia” and neutropenic fever.

I begged the hospital to discharge me into the care of my wife (a licensed and registered critical care nurse) so that I could spend the holidays at home.  I explained to them that this is now my THIRD THANKSGIVING SPENT IN THE HOSPITAL.  I was diagnosed with Stage 4 Mantle Cell Lymphoma in January of 2018.  Thanksgiving and Christmas of 2018, 2019, and now 2020 were all spent in the hospital… and I desperately wanted to go home and spend the holidays with my family instead.  Dr. Rao of Reston Hospital agreed, so I was able to go home, but remain on 10 days of Augmentin and Levaquin.

While my fever has subsided, the lymph nodes became more swollen as the week went on.  For the past two days, I’ve been in pain and had difficulty swallowing.  I can feel multiple lymph nodes in my neck, chest, and abdomen now.  They are all swollen, tender to the touch, and make me want to vomit if pressed.  I woke up in pain last night and emailed my internist and oncologist:

Dr. Dogra,

cc: Dr. Nguyen,

I’ve been ignoring pain in my neck this week suspecting that it was just my lymph nodes being sensitive after my recent bout with pneumonia and/or neutropenic fever in the hospital, but the pain is becoming pronounced enough that I can no longer ignore it. I am having difficulty swallowing, and it is tender enough to the touch that pressing upon my left side causes a wave of pain and an immediate desire to vomit.

I can now feel painful lumps in my neck and middle abdomen on the left side underneath my rib cage. Touching any of them causes me pain and nausea, pressing upon them creates an immediate desire to vomit. Swallowing liquids or food is causing me pain.

Please advise. I am currently taking Oxycodone to control the pain with Zofran as needed. This is scaring me. It’s behaving and feeling much like it did in February 2018 when I was first diagnosed with Stage 4 Mantle Cell Lymphoma.

Sincerely,
Ken Foreman

Swollen lymph nodes, swollen spleen, fatigue, nausea, pain.

So it could be:
1) Cytomegalovirus (CMV) respiratory infection
2) Recurrence of Mononucleosis

3) Mantle Cell Lymphoma (MCL)

As many know, my wife is a critical care nurse. She had me stick out my tongue and go “ahh” and saw that my throat is swollen with white bumps, making her wonder whether this is an infection (CMV or Mono) rather than Lymphoma.

We’re waiting to see what Dr. H.A. Nguyen (my internist) and Dr. Shalini Dogra (my oncologist) recommend next.

And so, we keep hoping, praying, and trying to stay strong together as a little family.

Trying to stay safe despite infections…

Ken, at Kaiser-Permanente (Reston, VA)

So yesterday was a comedy-of-errors. I was scheduled for an upper-body CT scan (chest, abdomen, pelvis) but the scanner failed to boot up and calibrate. Kaiser sent me home and rescheduled for next Friday (day after Thanksgiving) at 8 AM.

My bloodwork was the lowest it’s been in months. I was diagnosed with Cytomegalovirus (CMV) during my colonoscopy a few weeks ago, so they put me on heavy antibiotics and weekly blood tests to follow. Between the infection and the antibiotics, my numbers all fell so that I now run the risk of “walking pneumonia” if I spend time outdoors.

So yesterday I was asked to “refrain from walking the pups until [my] numbers improve.” So Victoria will be outdoors with Kiyomi and Toshirō while we wait for the Zarxio injections to do their job and help my blood product to recover. Until then, I’m also in considerable fatigue and bone pain from the dwindling numbers and stimulated bone marrow.

Better Days, Better News

Traveling to Washington, DC for my latest full-body PET/CT scan

Results of my latest PET/CT scan

So my Ulcerative Colitis, Splenomegaly, and Severe Neutropenia (immunocompromised) are persistent, but my Stage 4 Mantle Cell Lymphoma appears to be controlled/in-remission since this February.

Given their findings, I’m hoping to meet with Johns Hopkins and Kaiser-Permanente on October 2nd to be medically cleared to return to work full-time (shifting my maintenance chemo from Fridays to Saturdays) and getting a written statement that I remain with colitis, lymphedema (swollen left leg), splenomegaly, and an immunocompromised state.

None of these conditions prevent me from working full-time, but the severe neutropenia would limit/prevent my working in a shared/open-workspace office.

Another Friday, Another Chemo Session

Blood Draw during IV Chemo

For the past 26 months, I’ve been getting IV chemo either weekly or every few weeks. Since on my third remission, I am on fast-rate, high-dose IV chemo every 56 days (not quite every 2 months).

I can tolerate the IV chemo, but it causes my blood pressure to plummet and stay at 80/55, to get a sore throat and post-nasal drip, and to generally feel like “sh!t warmed over” for a day or two.

Ping-Chan Tsui (my Oncology nurse) is getting comfortable with me doing my own blood draws when necessary, and got a little concerned about my blood pressure and appearance yesterday… I was fine, just fatigued going on utterly exhausted.

I slept all day yesterday afternoon and last night, finally feeling semi-human again at 5:30 this morning.

IV Fluids and Antibiotics while Hospitalized

I have a private room each time I go to Kaiser or Hopkins now. My neutrophil and white blood cell counts are never getting any better, so I am ALWAYS neutropenic and lymphopenic.

This also means if you so much as cough on me or sneeze on me, I will spend the next week hospitalized getting IV antibiotics.

Why A Unicorn?

Plush “The Last Unicorn” (Peter S. Beagle)

Hiring managers, recruiters, and “possible co-workers” have all been asking about the unicorn on my desk.

The unicorn kept me company at Johns Hopkins and Seattle during my cancer treatment and bone marrow transplant, so it’s sticking with me. 💕 It’s “The Last Unicorn” from Peter S. Beagle’s novel and film. 😆🦄

Adjusting to New Realities (and Working from Home)

My new view as I’m working from home…

Since being diagnosed with cancer in January 2018, my reality has been “Wear an N95 mask when outside-the-house, and work-from-home whenever possible.”

It took some time to get used to this new reality. When Sophos laid off ~3% of their workforce, my reality got thrown for another loop. Using our savings and severance, I’ve been cleaning up, re-arranging, and turning part of our master bedroom into an organized home office.

Now two weeks into serious job hunting, daily technical interviews, and initial discussions with a couple of possible employers, I’m back into a routine and feeling more comfortable again. Having a routine and a sense of security certainly cuts down significantly on my anxiety.

With the bleat of continuous bad news about the pandemic, the economy, unemployment, social unrest, social change, and world events… it’s nice to find some comfort and respite.

Ken Foreman (Working from Home)

Life Begins Anew (Again)

Ken, Kiyomi, and Toshiro

As of today, I am legally and technically unemployed. I’m under NDA to my previous employer, and I’m receiving Disability until my next employer.

It’s kinda overwhelming. These past few years have been the wildest roller coaster of my life. I am truly going to miss the friends and co-workers I’ve made these past few years. I wish we could have done more together; I would have liked to see our project go further (with the plans we had for improving it).

Over the past few years, Victoria and I neglected our house while we focused on my health and our travels to support it. Now we need to literally “clean house” as we address each room and make everything useable once again.

With my health and job search, I need a separate office space from the one Vicky has. She has an office in our Guest Room while I have a wall of our Master Bedroom. Both were neglected and collected books, papers, dust, and cruft. Now I need to make mine clean, presentable, and professional again.

Since hiring managers, co-workers, and engineering teams assess your background as much as you, I need to clean up my office so that my background is as clean and professional as my desk and workspace is.

So these next few days, and likely next full week, will be very busy as I pick myself up, dust myself off, and try to get my life back in order again.

#cancer #career #coronavirus

Cycled the 90mi Length of Hadrian’s Wall

Cycled the 90-mile length of Hadrian’s Wall

Many thanks to My Virtual Mission & The Conqueror Event Series for both the Inca and now the Hadrian’s Wall virtual challenges.

I was diagnosed with Stage 4 Mantle Cell Lymphoma (a Non-Hodgkins Lymphoma) in January 2018. Over the past two years, I’ve undergone 4 different chemo protocols, radiation therapy, and a bone marrow transplant.

Using the Peloton Cycle for my daily rides and My Virtual Mission and The Conqueror to motivate me, I’ve ridden over 94 miles in the past couple months. Hadrian’s Wall was excellent motivation as I try to rebuild my strength, endurance, and stamina!

Reference:
https://www.myvirtualmission.com/missions/18817/hadrian%27s-wall-virtual-challenge

Cycled the 90-mile length of Hadrian’s Wall

Fourth Month of Remission

For the Love of Family… Together.
Kaiser Permanante called to say that my latest PET/CT scan showed no active lymphomas. I am now in my fourth month of remission since my February 2020 PET/CT scan.
 
I do have an enlarged and impaired spleen due to my bone marrow transplant. They will continue to monitor me every two weeks, with my next abdominal ultrasound in two months and my next PET/CT scan in three months.
 
It means I may go for months, years, or the rest of my life with a depressed platelet count. I was unaware that the spleen was responsible for platelet counts. Kaiser Permanante and Johns Hopkins will be discussing this further with us.
 
We are very thankful to God and to all our family & friends for their love and support these past two years. 💕🙏🏻✌🏻
 

I am still immunocompromised (neutropenic, lymphopenic) due to my chemotherapy. I will still undergo “maintenance chemotherapy” for the next 3 years to keep my cancer at bay. What this means is I may have a fighting chance of beating this cancer.

In speaking with a good friend and former co-worker from Sophos, I’m told the spleen is the organ that removes platelets from the bloodstream, so if it is overactive, it will remove them too soon (causing a reduced platelet count and lowering your ability to clot in response to injuries or cuts).  In his case, they discussed removing his spleen.

Kaiser Permanante tells me they will be monitoring my blood weekly, doing abdominal ultrasounds every 2 months to monitor my spleen, and full-body PET/CT scans every 3 months to monitor my cancer (and hopefully my continued remission).  We have to ask if that is what they suspect with my spleen and platelets, it wasn’t well explained by my Kaiser oncologist, but I’m hoping Hopkins will be thorough in discussing it with us.

Continuing to Fight and Beat the Odds

Preparing and Staying Protected

“ONE OF THESE DAYS, AN INFECTION IS GOING TO KILL YOU, KEN.”
— Francisco Javier Bolanos Meade, M.D., Johns Hopkins

It’s been over two years since I was diagnosed with Stage 4 Mantle Cell Lymphoma. This June will be the first anniversary of my Bone Marrow Transplant at Johns Hopkins Baltimore.

While I’ve beaten the odds that the National Institutes of Health (NIH) gave me last December, my immune system remains severely suppressed. Just in the past few months, I’ve been hospitalized twice for pneumonia and sepsis. It is thanks to Victoria that I am still here today… between my cancer and two recent bouts of septic shock, I doubt I would have been so fortunate or alive if left to my own devices.

So it’s becoming apparent that bone marrow graft is still straining to produce blood products, especially when getting knocked down with each infection or medical event I battle.

After discussing my situation with Victoria, Dr. Dogra (Kaiser), Dr. Nguyen (Kaiser), and Dr. Meade (Hopkins), I am going to need to wear my medical ID bracelet at all times and carry a medical precautions bag with a cloth N99 mask, two disposable N99 masks, Purell, SPF50 shirts and head coverings, and to be FAR MORE MINDFUL of the people and situations around me.

This is becoming my new reality… I need to be mindful, to be vigilant, to stay protected, and to know that my immune system is so weak that my next infection is deadly dangerous to me.

#cancer

Preparing and Staying Protected
Preparing and Staying Protected

Finished my First Virtual Marathon (26.2 miles)

After fighting Stage 4 Cancer (Mantle Cell Lymphoma) for the past two years, it feels good to have completed my virtual marathon.  I’ve completed my first 26.2-mile virtual marathon as I finished the Inca Trail Challenge. I’m now well on my way to my first 90-mile virtual marathon as part of the Hadrian’s Wall Challenge.

All of my miles have been outdoor walks with VictoriaKiyomi, and Toshirō, and indoor rides on the Peloton Cycle at home. This is all part of my cancer recovery, rebuilding my stamina, strength, and endurance.  I’m hoping to cycle actual 35-50 mile rides later this year on the Washington & Old Dominion (W&OD) trail later this year.

My first virtual marathon (26.2 miles of walking and cycling)

Week in the Hospital due to Pneumonia and Sepsis

A week in the hospital with Pneumonia and Sepsis
Thankful to be going home from Hospital

Last Tuesday (May 5th, 2020), I started running a high fever (103°F) and severe vomiting.  I was first admitted to Kaiser-Permanente in Tysons Corner, VA, then took an ambulance to Reston Hospital Center when they couldn’t get my blood pressure elevated higher than 70/38.  Virginia Hospital Center denied my admittance due to a high number of COVID-9 (Coronavirus) patients, and they couldn’t ensure my safety.

For the past week, I was pumped heavily full of IV antibiotics, antifungals, magnesium, potassium, and fluids.  I quickly gained 20 lbs of fluid retention and my lymphedema worsened in my legs and arms.  When I was discharged yesterday, I was shocked to see the scale.  I’ll need to walk more, ride the Peloton cycle more, and stretch more over the coming weeks and months to expel, reduce, or reabsorb this fluid weight.

I was very cautious and kept separated from all the Coronavirus patients at Reston Hospital Center, but it was made abundantly clear how very dangerous a respiratory infection and ventilator would be to my severely immunocompromised health.  The medical team made the implications of a DNR (Do Not Resuscitate) and what a respiratory infection would do to me while being so heavily compromised with neutropenia and lymphopenia.

So I need to be VERY careful when outside of the house and in social settings… now more than ever.  I’m thankful to be home again, but I need to be even more mindful and careful.

Returning to Working from Home (WFH) after Hospital Stay

Thankful to be Working from Home (WFH) again
Screen Shot 2020-05-14 at 9.11.55 AM

Thankful to be back home, and working from home again after a week in the hospital due to bacterial pneumonia and septic shock.

Yesterday was actually really productive both personally and professionally. I got a surprising amount done for my first day back from the hospital.

Today is already off to a busy start between Docker updates, Mac updates, and validating docker containers I scripted and deployed yesterday evening.

Odd Differences in Neutrophil Counts

Blood Testing in a Lab

NEUTROPHILS, ABSOLUTE, AUTOMATED COUNT (ANC)
saw 0.68 10*3/uL, expected 1.70 – 6.30 10*3/uL

NEUTROPHILS, MANUAL COUNT
saw 1.14 10*3/uL, expected 1.40 – 6.80 10*3/uL

LYMPHOCYTES, MANUAL COUNT
saw 0.79 10*3/uL, expected 1.10 – 3.50 10*3/uL

…normally the ANC (Absolute Neutrophil Count) and WBC Manual Differential are within 0.20 10*3/uL of each other as I get my blood drawn. This week we saw a 0.46 10*3/uL difference, which alarmed Victoria and me since 0.68 meant I was “heading south” again.

We called our oncology triage nurse to discuss my test results this evening and she said they’ve seen this from time to time.

The ANC comes from a blood centrifuge followed by an automated count where ANC = ((%neutrophils + %bands) x (WBC)) / (100).

The Neutrophils Manual Count is just that. The lab observed and recorded 1,140 neutrophils per microliter.

I’m told that Kaiser-Permanente recorded 1.14 10*3/uL as my Neutrophil count for this week, and that we should not be concerned. Vicky and I remained a bit puzzled about why there was such a difference between the two counts this week.

I’m hoping that one of our family/friends that understand blood chemistry and lab work better than we do can explain the difference, or why this would happen. 🤔🤷🏻‍♂️

REPLIES:

Rowena-Andres VerdanI’ve been in Chemistry for 20 years, but Andy’s been in Hematology for 30 years. So Andy says the instrument counts 10000 cells. Manual count is 100 cells only, hence the difference. Instrument reading is more accurate. No need to be alarmed.

Ken ForemanThanks, Tita Rowie💕 … Victoria: see Tita Rowie’s answer. That’s a far better answer than the Oncology Nurse gave us. Good to know!

26th Month Anniversary of Cancer Survival

February 4th, 2018 – First Round of IV Chemo for Stage 4 Mantle Cell Lymphoma

803 DAYS AGO
115 WEEKS AGO

26 MONTHS OF CHEMOTHERAPY AGO

Apparently, Kaiser-Permanente has been keeping track of my chemotherapy protocol, how many months it’s been since my first chemo, and told me today is the “26th Month Anniversary” since beginning chemo at Virginia Hospital Center on February 4th, 2018.

Today (17-Mar-2020) marks 26 months of chemotherapy since I was diagnosed with Stage 4 Mantle Cell Lymphoma. I’ve lost over 40 lbs and most of my body hair since this picture was taken, but I’m thankful to be with you here today.

IV Chemo at Kaiser-Permanente (Burke, VA)

Receiving the start of my 26th Month of IV Chemo while at Kaiser Permanente Burke Medical Center today.

The IV clinic felt surreal today, with every nurse gowned up and practicing extreme hygiene and distancing, all of the patients wearing N95/N99 masks at all times and practicing distancing. I wasn’t sure if it was a hospital or a scene from a Stanley Kubrick movie.

Another Day of Chemo at Kaiser-Permanente (Burke, VA)

I fall to my knees and thank God for Victoria being by my side and my constant companion these last two years. What an incredible journey this has been… and the journey continues!

Another Friday, Another Month of IV Chemo

Another Day of Chemo at Kaiser-Permanente (Burke, VA)
IV Chemo at Kaiser-Permanente (Burke, VA)

Another Friday, another month of IV Chemo…

This time we’re at Kaiser-Permanente in Burke, VA, since Tyson’s Corner, VA, has Coronavirus patients. 🤧😷🤒

All of the local Oncology and Infusion patients are going to Burke now, with fastidious protocols for staying protected and practicing social distancing. ✌🏻

Burning Down the House

Charles Papert, Burning Down the 100yo Farmhouse (Washington State Veterans Cemetery)
When we are frustrated with ourselves, or with each other…
When we are angry with ourselves, or with our neighbor…
We don’t go burning down the house, no matter how immediately gratifying it may be.
 
Thomas Neal Foreman would never be my first choice for a role model, although he continues to shape my decisions to this day. If stories like “The Shack” and “Five People You Meet in Heaven” are true, I am certain that my father and I will meet again to resolve our unreconciled differences.
 
Kenneth Balogh Foreman would never be my first choice for a role model for others. I was the oldest of three sons, made more than my share of mistakes, was the loner and black sheep of my family. I attended college for two years, joined the US Air Force, tried to do the best I could with my own resources over the decades since. I did wrong by others, I did wrong by myself, and tried in various ways to set things right or atone for my mistakes.
 
A little over two years ago, I broke. I shattered. I got shitty news. Pretty much the shittiest news a person could get. My internal medicine doctor called us at home on a Sunday afternoon to apologize for the news he was about to give, and then told my wife and I that I have cancer.
 
The last two years have been the craziest roller coaster you could ever ride. Imagine doing loop-de-loops and hairpin turns until your hair fell out, you puked out your guts, and you shit yourself… now ride it for another year or two. Cancer and chemotherapy are kinda like that.
 
But for all my brokenness, the world around me was sane and fixed. The world around me was steadfast. I could grab hold of my family, our friends, our medical team, and know that the world was in a fixed position and I was the one who was spinning out of control.
 
And now, we all are the ones who are broken. It is not just me spinning looking for my magnetic north and hoping to settle there, we are all looking to stop spinning.
 
And this is weird, and this is bizarre, and this is heart-wrenching and heart-breaking. Who do you turn to for help when the helpers need help?
 
I don’t have an answer for this.

Watching People Overstress and Snap

Our elderly, our sick, and our parts of society we neglect

Having Stage 4 Mantle Cell Lymphoma in the middle of a sane and functioning society makes me the broken one. My health is critical, and I wouldn’t make it if not for my dependence on others and the medical system.

Being immunocompromised in the middle of an irrational and dysfunctional society makes each of us broken. When I am in need, and someone snaps at me, is it because of my neediness or because of their frustration and anxiety at being in a terrible and abnormal situation.

I read in several comments and tweets yesterday that the economic and social stresses are too great, and perhaps the elderly and immunocompromised should die for the greater good of the society. I was appalled at each, but I understand where each is coming from. From their perspective, they are young, healthy, and do not fear the coronavirus. Death is something that happens to other people; people they don’t care about.

Our society and our infrastructure were designed only for a best-case scenario where all days are sunny, things would last forever, and no would need to care for or maintain anything. This pandemic is showing just how frail our systems and society really are. This is what happens when not all days are sunny, and what happens when you don’t take care or think about the capacity of your medical system.

And the saddest thing is, we probably won’t learn anything from it. Your health, my health, our health, should NOT be a profit-making endeavour. If it is not profit, then it is a non-profit. Non-profit agencies and corporations are dependent on society to make them work, which many people mistakenly call “socialism” without the foggiest clue of what that word means or the necessity of social contracts in order to make shared infrastructure work.

We are victims of our own hubris and desire to get the most we can for the cheapest while the few profit from our desire and scarcity of supply to our demand.

I don’t know what to say to this. I feel terrible and overwhelmed being a very broken person in the midst of a broken society where the young, the stupid, the uneducated, and the foolish want me dead so that they are not inconvenienced and their frail social ecosystem can continue rolling in entertainment, selfish/singular happiness, and financial well-being…. even if it comes at the cost of others’ lives.

#canceer #coronavirus