The Six Month Lupron Shot Blues

In my younger days, I would have written a song by that title this week. Now I write blog posts instead of songs. If this post was a song, maybe the chorus would go like this:

I got the six month Lupron shot blues,
I got the six month Lupron shot blues
I'm having hot flashes, crying spells, and what's my excuse?
It's just the six month Lupron shot blues (cue the guitar solo)

For whatever reason, when it was time for my Lupron shot about two weeks ago, they had ordered the six month version of the shot instead of the four month version, which I had been given previously. As I consulted with my oncologist prior to treatment that day, my favorite nurse, Melanie, opened the door to ask him if the six month shot was the right one. He wasn't sure why that version of the shot had been ordered, but thought it would be fine to go ahead with it. Less shots for me. The idea suited me fine at the time. But since the shot, I've had a bit of a rough go.

For those who may be unfamiliar, Lupron is a testosterone blocker. Prostate cancer feeds on testosterone, so the idea is to starve the cancer of its food by suppressing it. That's what medications like Lupron and the Xtandi pills I'm taking in addition to it are supposed to do. But there are side effects. Boy, are there.

There was much more soreness and stiffness from this shot than the four month version. While I never felt the shot itself thanks to the expert touch of Melanie The Super Nurse, there's no avoiding the after effects as the stuff slowly spreads into your system. I was sore and walked with a limp for at least four days. It was hard to sleep on my right side - the side I usually sleep on - and painful to turn over in bed. But that went away after a few days.

What stayed are the emotional effects and numbness. I've experienced what feels like real depression this past week for the first time in my life. Not all the time, just two days out of the last seven. But those two days were hellish. I felt like I was under a black cloud all the time. I struggled with the desire to live. It was hard to take my pills in the morning. Hard to simply put one foot in front of the other. I felt a sense of impending doom.

The good news is, I've felt good the rest of the time. I've had things to look forward to each of my "good days" this past week; Coaching the kids, visiting friends, therapy, and a long-awaited concert. But the two days I had nothing much planned, the black cloud asserted itself.

I don't attribute the times of depression to the shot alone. Circumstances play a large role as well. But Lupron doesn't help. It magnifies everything. Or should I say, it magnifies my emotional reaction to everything.

This is where the supplement I've talked about so much, 5-HTP, should come in, right? Yes and no. 5-HTP does a good job of helping me let go of what's bothering me, but it also makes me numb to my emotions. So if I'm doing something where I want to feel my emotions, like go to church, visit with friends, go to therapy, or write this blog, I don't take it. Most days this past week, that was a good decision. I had a good day without it because of the plans we had. But it turned out to be a mistake last Sunday. I had a horrible day that day, and church seemed to only make it worse. The black cloud was like a black marble ceiling. The desire to live was hard to come by.

But I have kept taking my pills. I haven't missed a day yet. Never fear. I'm starting to feel like my usual, optimistic nature is beginning to reassert itself. But I still feel like the black cloud could come back at any moment, and at the slightest provocation. It's a very strange feeling for me. And it's one reason I'll tell my team I only want the four month version of the shot from now on. I don't like feeling this way.

The other reason is numbness, especially in my abdominal area. I don't have much of an appetite since the shot, so I'm losing weight again. I'm sure my emotional state plays into my appetite, but I don't feel much like eating even on days when I feel good emotionally. I literally don't feel hungry until I notice my stomach growling. So my normal weight, which fluctuated between 130 and 132 pounds at the end of last year, is now down to 126. Actually, I've lost a pound a day for the last three days. Tuesday I weighed 128. Yesterday I weighed 127. Today it was 126. At this rate, I'll be down to zero by June 1st. I couldn't help but use that joke again, Deanna.

I went through this once before, and saw a nutritionist to help me with it. So I know what to do to gain the weight back. But it's hard for me to eat when I don't feel hungry. If I lose any more weight, however, I'll have no choice but to go back to protein shake lunches and regular snacks between meals. This is the other reason I don't want the six month version of the shot again.

If I lose too much ground with my weight, it will take me some time to gain it back with my high metabolism. But I have to gain it back. We have 40th wedding anniversary pictures to take this June, so I can't allow myself to weigh zero on June 1st. I will not look like Gaunt Cancer Guy for those pictures.

After the first month or so, I know from past experience that the emotional effects will subside some. I know I serve a God who can part the black cloud. And I know I can gain the weight I need if I eat the right way. I've done it before. But till then, I'll be singing The Six Month Lupron Shot Blues. Everybody sing along! #waroncancer

My Team

Until recently, if you'd asked me who my team is, I'd have said the Denver Broncos. I even found a graphic for this post in their team colors! They're still my favorite sports team, but I have a much more important team now. My medical team. My oncologist and his wonderful staff. I couldn't ask for a better team. I just hope I get to keep them.

After my last visit to the oncologist's office, when I got such stellar PSA numbers (.16, my lowest result ever, down from 1.3, my previous all-time low) and great care, which I talked about in detail in my last post, I received an email from Centura Health, where I get all of my treatment. Cypress Hemotology and Oncology at Porter Hospital here in Denver, Colorado is the actual oncology office I visit most often. They are part of Centura Health. In the email, Centura wanted me to fill out an online survey about the care I received.

I almost never fill out online surveys about anything, but this time, I made an exception. Each page of the survey asked a series of questions about my visit, from the reception staff to the doctors, nurses, and assistants. Each question asked for a rating, from Poor to Excellent. There was a box for comments at the bottom of each page.

As you can probably guess, I gave them an Excellent rating on almost everything. I think I gave them a Very Good on one thing, but I don't remember what. And I typed glowing reviews in the comments box on most of the pages.

On the reception page, I talked about how most of the receptionists seem to know me by name now, and how nice that is. On the page dedicated to the nurses and physician's assistants, I asked if I could give Melanie, my cancer care nurse and Nikki, who is the PA who does most of my blood draws, a ten. The ratings only went up to five. I love these ladies. And on the oncologist page, I raved about how my doctor is just the kind of doctor I want. A no-nonsense science guy who gives it to me straight, and always respects my treatment choices.

As I filled out that survey, the feeling that began after I posted Melanie And Me grew very strong. These people are my team. I honestly hadn't thought of them that way until recently. But the incredible, unprecedented response to Melanie And Me had brought that idea home to me. So many responded about their own cancer care team, or the team a loved one has or had. I realized that I love my team too.

After that visit, I felt so good about the way my treatment is going, I said in this blog that, since what we're doing seems to be working, we're gonna keep doing it. That is certainly my hope and intention. But it all depends on my ability to continue this treatment, and my ability to keep seeing my team.

Because, in spite of my good PSA numbers, I still have aggressive, Stage 4 prostate cancer. My prognosis has not changed. We're very hopeful that the good numbers will continue for a good long while, but that can only happen if I can keep getting treatment as planned.

There's a reason I'm writing this and posting it on Inauguration Day. I've talked about it before in this blog. I'm concerned that I'll lose my coverage. If I do, I'll have to stop seeing my team, and these good numbers won't last long.

I'm not here to blame anyone. I know that people who love me, and care about me deeply voted for this result. It's hard for me to reconcile in my head how that could be, but I have to accept it. And of course, I know it's not all about me. Everyone votes based on the issues that are important to them. I can't honestly say that I had the fate of my health care in mind when I voted. I can't expect you to be thinking about me when you vote.

I know that everything government does takes time, and even if they repeal my coverage tomorrow, there will be a period of some months, at least, before it expires. So I should have some time to keep going with my treatment. I should be able to keep seeing my team for a little while longer, at least. Maybe I'll even be able to get my next Lupron shot six months from now. But I fear that won't be the case. There are too many in Washington, D.C. who subscribe to the "makers and takers" view of society. There has never seemed to be a great desire on the part of those who share this philosophy to help those who are viewed as takers. I've been a maker for my whole adult life until I was diagnosed, but now I definitely fall into the taker category. I need help. A lot of it. Much more than can be raised in a GoFundMe campaign.

So just as I realized what a great team I have, I'm faced with the prospect of losing them. I know that the current system forced many to change their coverage and doctors, and if that happened to you, I don't minimize your experience at all. But it didn't take away your ability to get coverage. It may have made it more expensive and less convenient, but you probably still have it. And it provided a way for self-employed people like me to get coverage. Many of us, for the first time in our lives.

If I have to buy insurance on the individual market with no help, insurance companies will be able to charge me whatever they want. I have a $9,000 prescription every month! What will my premium and deductible be? If that's my only choice, I'll have to go without insurance, and without care. Nightmare scenarios involving paralysis, forced hospitalization or institutionalization with no insurance, followed by a seizing of all of our assets to pay the bills, leaving my wife with nothing but debt race through my head.

You may try to reassure me, but this possibility seems all too real to me. It happened to many people before the Affordable Care Act was passed.

I'm sorry if this post went off the rails for you. If it did, you probably haven't read this far. And I realize that my team extends far beyond my medical team. Everyone who prays for me, supports me, and loves me is part of my team. My extended team comes in all political stripes. I love each and every one of you, regardless of how you voted. But I still really hope I get to keep seeing my medical team for as long as I need to. #waroncancer

Melanie And Me

Today's visit at my oncologist's office was very good. My consultation with the doctor was first, followed by treatment. As usual, I "checked in" on Facebook when I arrived, and was overwhelmed with the amount of support once again, just from that simple post. You people are amazing.

I loved knowing my PSA number before my doctor had a chance to tell me. The "drum roll please..." aspect of waiting for him to tell me my PSA level has been a little unnerving in the past. I like their new system better. As promised, I made a list of questions and suggestions from some of you and asked him each one. Here are his answers.

First of all, I told him how, three months after my first Lupron shot, when my PSA had dropped from 15.8 to 4.00, I had asked my old urologist what those numbers meant. My urologist at the time said that it meant my cancer was only growing at four percent, rather than 15.8 percent. I've been using that as a measuring stick for future PSA numbers. My oncologist agreed with that first assessment, but said that now, it's more about the trend than the actual numbers.

Different types of prostate cancer produce different amounts of PSA. So while my score of 4.77 a few months ago didn't seem that high when taken by itself, the fact that it had risen so fast from the previous score of 1.97 was a cause of real concern. But others can have much higher scores, and their number may mean something completely different than my score.

In fact, he said that my contention in my last post that a score of .16 means my cancer is growing at a negligible rate is wrong. It's better than that. The fact that the number is trending down means the cancer is actually shrinking. So there's that.

I asked him about Zometa and Prolia, both of which are bone-strengthening drugs that were suggested to me in comments to my post, My Next Big Decision. He didn't think either of those would be as effective for me as Xgeva. I asked him about waiting until I have symptoms to start on Xgeva, and he replied that the point of starting it now is to try to postpone the day when symptoms begin. I'm all for that.

I asked about getting a bone density scan, which one of you suggested. He agreed that would be a good idea, to get a baseline of how much bone density I may have lost from Lupron over the past year or so. They will schedule that for me, and let me know. He says it's easier than a bone scan or MRI. Nothing awful to drink, and no IV. It's basically just an x-ray.

I asked him about the statement from a friend's physician husband that with Xgeva, I have a 2% chance of having jawbone problems, but I'd have a 100% chance of cancer wreaking havok on my spine without it. Wreaking havok is a direct quote. He agreed with that, but added that since I've had a dental exam and x-ray and been cleared for Xgeva, my chances of getting ONJ from it are less than 1%. So that pretty much clinches it.

I told him I'd started the cannabis oil suppository program in December that he and I had talked about previously. I said I thought my low score could be partially due to that. He said it's possible, but he would expect to see a number that low just from this much time on Xtandi too. So who knows what's really working? Something is, so we're gonna keep doing what we're doing. He says he's all for it, though he winced when I told him the suppositories are frozen.

Finally, I asked him about getting the shots every three months instead of every month, which was also suggested to me. Some patients only get the shots that often, and some studies have shown it's just as effective that way. My oncologist is not opposed to that in the future, but would like me to get the shot every month to start with. Maybe we can back it down to every three months later, after we see how things go. But I'm happy to go in once a month for a while, because it gives me a chance to see my favorite nurse, the famous Melanie.

If you read my last post, you know that Melanie doesn't normally work on Fridays. She came in special today, just for me. When the doctor left the room and Melanie came in, I teased her that she only came in today so she could get another look at my butt. That's where you get Lupron shots. She joked right back, that yes, my butt is pretty cute, and I should be proud that I have my own personal nurse who will make a special trip just to get a peek at it.

This joking was in reference to the last time I saw her. A dear friend who shall remain nameless had just posted a picture of her husband's butt getting a Lupron shot on Facebook. An image that's still seared in my brain. I'll never be able to unsee it. Thanks for that, guys. I told Melanie about that when she gave me my previous shot, and we had a good laugh about it. She said I have a really nice butt, and I should put it on Facebook! But I will spare you that. You're welcome.

As expected, the shots were easy. I barely felt either of them. For whatever reason, they went with the six month version of the Lupron shot this time, which amounts to more of it in my system. So I'm starting to feel it in my hip now, and walk with a bit of a limp, but that will go away in the next day or two. All the while, Melanie and I joked and laughed and enjoyed each other's company.

When we were finished, I showed her my cross pendant, and told her about them. Then I pulled one out of my jacket pocket in a nice jewelry box and gave it to her. I repeated to her what I said in my last post, that since she treats cancer patients all day every day, and she had come in especially for me today, I thought she should have one. My wife makes them in just about every color, and she picked out a green one to give to Melanie. When Melanie opened it, she was delighted, and said it was her favorite color. In the selfie above, you can't see her cross, but we're both wearing our pendants.

As I was waiting at reception to schedule my next monthly visit for an Xgeva shot, she made sure that the date would fall on a day when she's working. It seems I really do have my own personal nurse. Then she gave me a big hug. The kind where you think it's over, but the other person doesn't. I tried to let go a couple of times, but she wouldn't. She said that this is the reason she comes to work; days like this.

I think this has to go down as the best visit to my oncologist that I've had so far. I hope you never need a Lupron or Xgeva shot, but if you ever do, ask for Melanie by name. She may even say you have a cute butt. #waroncancer

Almost Zero

I was going to wait to post again until after my appointment with the oncologist tomorrow, but I got the results of my last PSA test, and I couldn't wait to share it. It's .16! That's as close to zero as I ever expect my number to get, since I still have my prostate. It's a very good day today. We might have to break open the half bottle of champagne that we didn't use on New Year's Eve.

I'm sure my oncologist will give the credit to Xtandi, now that I've been on it for three months, especially after my number dropped from 4.77 to 1.3 in only two weeks after I started taking it. But I think the Rick Simpson Oil suppositories have a lot to do with it too. See my post Tiny Popsicles if you don't know what those are.

My head told me I might get a number below one for the first time in, like, ever, but my heart didn't believe it. For some reason, I was really nervous about this result. So this is a huge weight off of my shoulders.

What does this number mean, in layman's terms? It means my cancer is growing at a negligible rate. Less than two tenths of a percent. After 4.77 percent, I'll take that! It means my cancer is under control, more so than at any time since I was diagnosed. It's very good news.

My PSA will never be zero, because I still have my prostate gland. In spite of the fact that it's riddled with cancer, it continues to produce PSA. Only those who've had surgery to remove their prostate, or had radiation treatment to kill it, can hope to have a PSA score of zero. But .16 is pretty darn close.

I'm sure this means I won't have to get another test until April or May, when my next Lupron shot is due. That will probably remain true until my number starts to rise again. Which, hopefully, won't be for a while.

After much consideration, and a lot of support and feedback from many of you, I've decided to go ahead with the Xgeva shots to strengthen my bones. In all of my inquiries, I wasn't able to find one person who had dental x-rays and was cleared by a dentist, but still suffered from osteonecrosis of the jaw, a.k.a. ONJ, a.k.a. jawbone death from it. As you probably know, I had a dental x-ray done, and was cleared for Xgeva. That's one factor.

The comment that more or less clinched it for me was from a friend whose husband is a physician. He said the chances of my experiencing jaw problems from Xgeva are two percent, but my chances of having spinal problems if I don't are one hundred percent. If that's true, it pretty much makes this decision a no brainer.

I'll still collect all of the suggestions I got from many of you, write them down, and ask my oncologist about each of them. One suggested I ask if I can get the shot every three months instead of every month. Xgeva stays in your system for a long time, so that may be an option for me. Another wondered if, since I have no symptoms now, can I wait until I start having symptoms? Others suggested different drugs I might try instead. I will ask him about all of it.

I can't express how grateful I am for your response to my last post, My Next Big Decision. Over 200 responses of support, love, prayers, and valuable input on Facebook and in the comments of this blog have been very helpful. I'll never be able to thank you enough. You helped me gain some clarity in this very difficult decision. I feel very loved.

One last story before I close this post. When I was at the oncologist's office the morning of my blood draw, I stopped at the front desk to make sure my favorite shot giver, Melanie, would be there to give me my shots on Friday. I found out she doesn't work on Fridays. I stood there while one of the receptionists talked with Melanie on the phone, hearing one side of the conversation. She tried to reschedule my consultation with my oncologist to a day when Melanie was in. As I listened, it became clear that both of these women knew exactly who I was, in spite of the fact that they treat hundreds of patients, and I only see Melanie every four months.

After a couple of minutes, Melanie said she'd come in on Friday morning just for me. Just so I'll feel better about getting my shots. I think I need to take her something to thank her. This is a lady who treats cancer patients all day, every day. I think she might need a cross pendant.

I'll post again tomorrow about my appointment, and let you know how all of that went. I rarely post on back-to-back days anymore, but I thought this news called for it. Thanks again to each of you for all your support, and to the God from whom all good things come. #waroncancer

My Next Big Decision

I have a major decision to make with regard to my treatment in the next few days. It's a very difficult decision to make, at least for me. My next PSA test is next week. I expect the number to remain low, since I've only been on Xtandi for three months. But I'll find that out on Friday. I'm also scheduled to get two shots on Friday: My next four-month Lupron shot, and my first monthly shot of Xgeva to strengthen my bones. But Xgeva can have a scary side effect. That's why I'm still on the fence about starting with it.

I've talked about Xgeva before in this blog. In past posts, I've been pretty well decided against getting the shots because of stories I've heard about this particular side effect. It's called osteonecrosis of the jaw, or ONJ for short. In plain English, it's jawbone death. Some who are on Xgeva experience this side effect. You get exposed areas of bone in your jaw, and your jawbone starts to fall apart. Doesn't that sound lovely?

In case you're not up to speed on my condition, I am Stage 4 with metastasis to spine and ribs. Cancer on your bones can compromise their strength. This is especially concerning when you have cancer on your spinal cord, like I do. I have a friend whose husband's diagnosis is very similar to mine. He didn't go on Xgeva, and he had a vertebrae collapse from a tumor. He lives with paralysis from that to this day. I wouldn't want that, so that's an argument in favor of going on the Xgeva shots.

On the other hand, I've heard stories of those who have experienced ONJ from Xgeva. For some, there is terrible pain. You start to lose pieces of your jawbone. But this side effect is supposed to be confined to those who need a tooth extraction or root canal. So you're supposed to go to the dentist and get an x-ray first to make sure you're a good candidate for Xgeva.

If you've been reading this blog, you know I did that last October. I have a lot of fillings, and a few caps, and I hadn't been to the dentist in years. So I was nervous about the quality of my teeth, and how susceptible I'd be to getting ONJ. But my x-ray showed no need for extractions or root canals, praise the Lord, although I did have some cavities that needed to be filled. My bite still isn't right from that, which makes me nervous. I still have discomfort chewing on my left side, which I've only had since I went to the dentist.

So I hesitate. On paper, I should be fine to go on Xgeva. I asked about it in a support group today, and haven't heard from anyone who was cleared by a dentist, and still ended up with ONJ. But I keep hearing it's a very common side effect.

I don't know how common paralysis is in those with mets to spine who don't go on a bone-strengthening drug like Xgeva. I should research that. But frankly, I'm tired. Tired of the life-or-death choices I have to make. Tired of weighing which horrible side effect would be worse.

Which do you think is worse? Having your jawbone fall apart, or paralysis? Having to drink all your food through a straw, or not being able to get out of bed? I suppose paralysis would be worse, but I wouldn't want to live with either. Quality of life over quantity. That's my motto.

So one of my biggest questions for my oncologist when I see him on Friday is, what are the risks of both? If I go ahead with Xgeva, what are the percentages? Likewise if I don't. What an awful choice to have to make.

I know that for many, any treatment that the doctor says will help is a no brainer. But not for me. I want to know the odds. I want to know what is the worst that could happen. A low percentage is not necessarily comforting to me. And while I still have no symptoms, it's easier for me to believe I'll experience problems from treatment than from my cancer itself. That's all I've experienced so far.

I don't have a spiritual point to drive home in this post. I'm just letting you all in on my dilemna. Do I go ahead and take my chances, or hold off and take my chances? It's a gamble either way.

That's the life of a cancer patient, especially one with an aggressive, Stage 4, incurable cancer. So many life-or-death decisions, and many times, there are no good choices. Please pray for me over the next few days that I'll make the right choice. #waroncancer

Hopes And Expectations

In a conversation with a friend last night, my friend expressed the belief that this year will be better than last year was. I replied that I hoped so, but I don't get that feeling. My friend's reply was that it will be a good year because we will make it one. I understand what was meant by that, and I agree up to a point, but when I look at my accounting of what happened in 2016, much of what made it a good or bad year was totally outside my control.

That conversation got me thinking. I decided that a good follow up to my retrospective post about 2016 might be one that looks ahead to this new year. I have hopes, and I also have expectations. Sometimes my hopes line up with my expectations, but not always. It's a little like making football picks. The team you want to win isn't necessarily the team you expect to win.

So what do I hope for in 2017, and what do I expect? First of all, I both hope and expect that when I get my PSA tested on January 10th, and see my oncologist on the 13th, I'll get the news that my PSA has not risen at all. If anything, I expect it to drop further. If my PSA has started rising again so soon after starting on Xtandi, this train will go off the rails fast. But I don't expect that. I got a good ten months out of Lupron before my number started going up. Surely I'll get more than three months out of Xtandi. Won't I?

In fact, as I told friends at dinner Saturday night, I expect the combination of what I'm doing now to give me a year of good numbers. But that's assuming I'll be able to continue doing what I'm doing now. There's no guarantee of that. That's where my hopes and my expectations diverge.

I hope that the coverage I have for my health care will remain in place. Until last November, I had no doubt that it would. But the results of the last election have cast that in serious doubt. So while I hope to keep my coverage for as long as I need it, I do expect to lose it sometime this year. If that happens, I will have no way to pay for Lupron or Xtandi. Then I'll be in serious trouble.

I have no control over whether that happens or not. But if I do have to stop traditional treatment because I lost my coverage and can't afford private insurance, I'll be able to do what I've wanted to do from the beginning of this process; Just trust God. Ultimately, he will decide if I stay here, or he calls me home. And I'm OK either way.

I hope and expect to continue seeing my therapist for the rest of this year and beyond. Even if I lose my coverage, I hope to be able to continue, either as a pro bono patient, or with help from a friend. I hope and expect that one of those two will be available to me, if the need arises.

I hope that I will continue to be pain free. I'm thankful for every day that I don't have bone pain. But I don't expect that to last. Before the year ends, I expect to be dealing with pain. I am a total wimp when it comes to pain. I'm not sure how I'll handle that when the time comes.

I have travel plans twice in February. I hope and expect that I'll be fine for both of those trips. Maybe I'll need an extra nap after I arrive, or even a full recovery day from travel. I haven't gotten on a plane since my diagnosis. Flying has always wiped me out. Now it will only be worse. But my endurance will not get better with time, so better to travel now while I still can.

Those are things that I can't control; My energy level, my PSA, and my coverage. As much as I'd like to think I can control my cancer with lifestyle choices, I don't really believe I can. All of the links and articles you send me don't mean a thing to a Gleason 9 score with metastasis to spine and ribs. Ultimately, my cancer will do what it will do, and I'm not in control of that. God is.

But there are things I can control. Those things can make a huge difference in what kind of year 2017 turns out to be.

I hope and expect to have published my book by the end of this year. I hope and expect to get my ice cream on the market in 2017 as well. I hope and expect to produce my last CD project in the first quarter of this year. I hope and expect to still be working with the kids I'm helping to coach. Barring unforeseen complications, all of those things should come to pass, and they should all be major factors in how well this year goes for me.

Those things really lie beyond hopes or expectations. They are commitments. I will do these things, or die trying. And there are other commitments as well.

I'm committed to celebrating our 40th wedding anniversary in July. Come hell or high water, we will have our anniversary pictures taken to go on our wall, and I will not look like Cancer Man when we do. I will lead the band for the party. Nothing will stop me. I might have to recover for a week afterwards, but that will happen. Count on it.

I will continue to be proactive in making new friends this year. The friendships I made last year helped make the bad news not seem quite so bad. So I hope and expect to have made new connections. But that's a two-way street. As Bonnie Raitt once said, I can't make you love me if you don't. I hope you do, but I can't expect that.

Likewise, I will keep cultivating the friendships I have now. I tried to do that last year, and in most cases, it bore fruit. But a few fell by the wayside. There's a new standard of friendship that I've begun to apply to my life in the past several months, in light of my prognosis, in light of my limited remaining time on this planet: I only have time for the people who have time for me. It may seem harsh, but I feel like if you don't have time for me, we must not really be friends. To paraphrase Forrest Gump's mom, friendship is as friendship does.

So I hope and expect that all of my current friendships will have deepened and grown by the end of this year. But that's a two-way street too. I can only control my side of it. The rest is up to you.

I neither hope for nor expect a miracle cure or healing this year, or any year. You may have a hard time accepting my prognosis, but I don't. But I do expect God to keep revealing himself to me this year. And I commit to being open to whatever he wants to do in my life.

As the old saying goes, while we plan, God laughs. Things I haven't thought of will play a significant role in how good or bad 2017 is for me. That's true for all of us. That's why I place my trust in God alone. Circumstances are bound to change, and friends may fail me, but God never changes or fails.

I love my friend, but we don't get to determine what kind of year this is. God does. If I've learned one thing in this journey, it's that I'm not in control. Nor do I want to be. I'd rather be at peace. I have found that peace and joy come from relinquishing control. From realizing we can't fix everything. They come from accepting that fact and being fine with it. Not worrying about it. That's where I've tried to live my life ever since I was diagnosed. And I'm committed to staying there for as long as God wants to keep me around. #waroncancer