Four Hours Til Surgery.

Here’s how this whole thing is going down:

1. There are three surgeons conducting the operation: Dr. Pelzer, Dr. Fine, and Dr. Chandler. Dr. Chandler is the neurosurgeon, he will be cutting my skull open. Dr. Pelzer will remove all of the soft tissue from my eye socket, to include my eye and all cancerous tissue. Dr. Fine is the plastic surgeon, he will be doing a microvascular transplant to install tissue in the space where my eye used to be. Dr. Fine will also be closing all incisions in order to minimize scarring.

2. The surgery will take from 12-16 hours in total. Due to the length of time under anesthesia, I may not be lucid for several days after surgery.

3. I will be in Intesive Care following surgery, so I will be unable to use my cell phone. I am not sure yet if I will have internet access.

4. Hopefully, I’ll be lucid for the Super Bowl. GO BEARS!

January 31, 2007 | Eddy's Journal | Comments (3)

Treatment Plan, Round 2/Continued Command + Marine Corps Support

Well, the good news is that I won’t ever need to wonder if we treated this cancer aggressively enough. I had a long meeting with Dr. Pelzer the other day, and we have come to the conclusion that a radical resection is going to be necessary in order to increase my survivability long term. This means I will have to have my eye and all other soft tissue in my eye socket removed. The surgery will be January 31st.

1. Dr. Pelzer feels that the size of the tumor that was unable to be removed via the “front door” is a very serious threat to my life. If I try to treat it with radiation or gamma knife alone, the chances of recurrence are between 70% to 80%. With this surgery, the chance of recurrence is below 20%.

2. If cancer does recur, it will start growing where it stopped last time. This means that it will begin from a position very close to my brain. A brain tumor would be Ghostbusters “bad”.

3. Lacrimal AdenoCarcinoma is locally aggressive but does not often metastisize. This means that while it doesnt grow very fast, it is resistant to radiation as well. It is slow moving and tenacious. Surgery is the only option to remove my remaining tumor.

4. The surgeons will take out a section of my skull and go in “through the roof” to remove all soft tissue in my eye socket, including all the remaining tumor and my eye.

5. Because my eye socket will be empty, there will be no tissue to support a fake eye. My eye socket will be sewn shut for the rest of my life. I’m not too thrilled about this, but we’ll have to make some lemonade somehow.

6. I talked to Captain Komnick immediately after my meeting with Dr. Pelzer. He has reiterated the ROTC command’s support of my situation, and had even begun the inquiry into my ability to get my commission. So far, it seems probable that if I do my part to get healthy after my surgery, I can still realize my dream of being commissioned and continue my career.

I spent my first two or three years in the Fleet Marine Forces serving under the idea that I owed the Marine Corps a great debt. I worked hard and served at my highest ability in order to attempt to repay the Corps for all of the intangible things it had given me. When I had achieved a level of performance I felt was to the highest standard, I declared my personal debt to the Corps paid in full. We were even. It seems now that I will start my career as a Marine Officer in the hole once again. I pay my debts. I’ll never forget the Corps standing by me when I need it. I will earn every day I am privileged to bear the title “Marine”.
January 22, 2007 | Eddy's Journal | Comments (4)

Pathology Report/NROTC support/Dr Symanski nickname contest

1. I met with Dr Mittal yesterday, and he gave me some bad news about the pathology analysis. There is a small amount of cancer that the surgeons were not able to remove during surgery (positive margin). The cancer is proving to be a tenacious opponent. It is located all the way in the back of the eye socket, where the optic nerve leaves the eye socket. It was too far back for the surgeons to be able to remove it. It is very small, but we don’t know how small it is. Dr Pelzer thinks it is in the area of 1-2 millimeters. I will have to have a CT Scan and an MRI this week to determine the size and location of the malignant tissue. It is possible that it is too small to show up on the scans. This would be a good result. Here are my options (so far):

A. Craniotomy: The surgeons can’t reach the cancer from the front door, so they go in through the roof. They would remove a section of my skull and remove the cancer. They would not be operating on my brain, but would be in front of it. Recovery from this operation would be measured in months (4-6?).

B. Gamma knife: The coolest sounding option. A massive dose of radiation is targeted on a very small area (the cancer) and nukes it out of my head.

C. Radiation therapy: If the doctors and I think the cancer is small enough, we may just go ahead with radiation therapy to destroy it. Radiation therapy is designed to eradicate any trace amounts of cancer left, so it will work if the cancer tissue is small enough.

2. Options 1 and 2 will be followed with radiation therapy. All options will utilize Intensive Modulated Radiation Therapy, which is a new type of therapy. IMRT is a recent development, and Dr. Mittal is published expert on IMRT.

3. This is a setback in the war on cancer. Our focus now is on the long term. Options A-C are listed in order of invasiveness v. containment. I could walk away from the hospital right now and claim to be cancer free (foolish), since the imaging probably won’t be able to detect anything. These therapies all present an opportunity to reduce the chance of cancer (in a significant way) returning, and each has a physical cost and risk associated with it. The goal is to keep me healthy long term in exchange for short term misery. We are basically starting the process over with a much smaller tumor.

4. FAQ: No you can’t borrow my eyepatch. Very few people can pull off the pirate thing. You are not one of those people.

I will uphold the pirate tradition of terrorizing the Navy, and giving young midshipmen nightmares.

5. The ROTC command has stepped up for the Team. Captain Komnick informed me today that he has requested a one year MECEP extension on my behalf. After approval, that will allow me an extra year to finish school or medically recover enroute to my commission. We can’t express strongly enough how much this means. I am still charging hard to graduate and commission on time, but it is a great relief to know that should my treatment not go as we would hope, we don’t need to struggle with professional obligations during that troubled time. Myself and my entire extended family send heartfelt gratitude to the Commanding Officer, the Executive Officer, and the Marine Officer Instructor for their support.

6. I would thank GySgt Wiss as well, but he’s a Seahawks fan and we just don’t do that.

7. It has come to my attention that Dr. Symanski is very upset that she did not receive a creative yet aggressive nickname. Since she is the lovely opthalmologist who initially discovered my extremely rare cancer (its quite possible she saved my life), I would like to put this task out to all members of Team Schrank. Whoever comes up with the best nickname for Dr. Stacy C. Symanski will get a free official Team Schrank T-shirt, and will have front of buffet line privileges right behind the Petersens (PeterSENS, PeterSENS…). Post your ideas in the comments section of this post.

8. Next update will be after the Diagnostic scans, probably end of next week.

January 12, 2007 | Eddy's Journal | Comments (13)

Margins Are Clear!/Every Team Needs A Uniform…

MOST IMPORTANTLY: The pathology analysis from the tumor removal has determined that my margins are clear…this means that there is a good chance they successfully removed all of the cancer. This is a pretty big deal.

1. GySgt Petersen held a suprise pep rally last night to unveil the Team Schrank uniforms. Sgt Petersen did most (all?) of the work, but GySgt Petersen upheld the tenets of his rank and took
the credit.
2. It meant so much to us to have so much support so visibly apparent. I really thank you guys and have decided we like the shirts so much that we’re going to order more of them for all the friends and family. We’ll add the team logo to the back and get them printed!
3. We are also going to make sure that the rest of the Schranks understand that we have been
spelling our name wrong all of these years. You can tell by the shirts that there is obviously no “c” in Shrank.
5. I had a phone consult with Dr. Agulnik today, after he had met with Dr. Pelzer. He set me up with Dr. Bharat Mittal, who will be in charge of my radiation therapy. Dr Mittal is a professor of clinical radiology at Northwestern’s Femberg School of Medicine, and has written a textbook that sells for $485 on amazon http://www.amazon.com/Advances-Radiation-Therapy-Bharat-Mittal/dp/0792399811/sr=8-1/qid=1167977631/ref=sr_1_1/102-4378001-3489701?ie=UTF8&s=books. Thats $1.59 a page, so he must be a genius.
Thanks so much for all the support. I’ve got about a month left before radiation therapy, so I’m looking forward to doing as much as possible.
Next update will be after the meeting with Dr. Mittal.
January 5, 2007 | Eddy's Journal | Comments (14)

Pop Smoke, Shift Fire

Just six days after declaring “major combat operations in my head have ended”, it appears not to be the case. Not for the first time, this phrase appears to have been premature. The fight against cancer has only begun. We will not fail. Some more information about how the surgery went down:

1. I have been running lately. Dr. Few informed me today that there is a space in my head where the tumor used to be (3 cm X 2 cm?). It is now a hole surrounded by exposed surfaces that have scabbed over. As my body starts to absorb the platelets, very delicate blood vessels will be exposed. If they rupture as a result of increased beart rate (cardio), they will bleed into my eye and I will go blind. No more running for a while.
2. Dr. Pelzer has informed me that the cancer was more extensive than they expected, and that I will definitely need radiation therapy. Dr. Agulnik’s guestimation will be approximately 6 weeks of daily radiation. To paraphrase, he told me the side effects will suck battleship because the radiation will be so close to my brain. I should expect extreme nauseau and fatigue. The radiation may damage or destroy my vision temporarily or permanently because of its proximity to my eye.

3. More discouragement: Dr. Few took out my stitches today. The effect was underwhelming. I still can’t see a damn thing, because now the swelling is keeping my eye shut. I thought my eye was going to pop open when he unstitched my eyelid. Not the case. He reminded my of the seriousness of my operation and that it would be at lease six weeks before my eye reopened. Awesome.

4. These are some setbacks, but my determination moves proportionate with adversity. I was focused on the surgery as the war on cancer, but it was just the prep fire bombardment. It’s time for fire team rushes…no one ever won a war through air power, somebody has to go claim real estate.
Next update will be tomorrow…Drs. Pelzer and Agulnik are meeting to hammer out the scope of my treatment plan with pathology data from the surgery.
January 3, 2007 | Eddy's Journal | Comments (2)