Treasured teammates,
A happy autumn to all!
I write with what will for some be a long-awaited update.Since completing chemotherapy in late August, I’ve had a CT scan, continued blood draws, and a number of check-ins with a series of physicians at UCSF, and it has taken me some time to process the latest twists and turns on this path. Thanks for your patience.
Last weekend, just having marked six years since the fire that displaced me from my home and heralded a new era of wildfires here in the America West, I shared my Valley Fire story. If you didn’t get a chance to read it or watch the attached documentary, it is now up on my blog.
Otherwise, what follows is a major and pretty thorough health update. Thanks for all the continued messages of care and support, and the inquiries into how it’s been going. I appreciate the love, and the feeling is mutual.
For those in a hurry, I won’t bury the lead: my CT scan came back with some good (but nuanced) results.
Back in June, prior to treatment, my scan had shown an 8.3 cm (or orange-size) mass in my retroperitoneal lymph nodes, near my aorta, located in the rear of the abdomen.
After a difficult summer of healing that included three rounds of chemo, my September scan showed only one slightly enlarged lymph node remaining, clocking in at 2.1 cm, (or the size of a small cherry).
The scan report, which I received via email the next day, noted that this node was now “non-pathologic by CT size criteria.”
This felt like something worth celebrating — and, forsooth, it is! — but as I’ll describe further in this post, I’m continuing to work through some important subtleties here.
Before I get too deep into this reportage, though, I’d like to share the good news that, together, we are now 2/3 of the way toward reaching the goal of the healing fundraiser that was started to help my family through this ordeal. Thanks to everyone who has continued to keep this thing going with contributions of all sizes! Every little bit helps, and I continue to welcome your support.
“I believe deeply that the reason the node appeared slightly enlarged in the September scan has everything to do with timing, and my body’s natural process of recovering from the cancer and chemotherapy.”
So let’s get into it.
A few weeks ago, prior to the scan, I was referred to a new doctor because for some reason, after chemo had ended, my blood tumor markers remained slightly outside normal range.
The physician I met with is an expert in the field of genitourinary cancers, and when we met he took his time unpacking the unique aspects of my particular case. The guy is a department chair at UCSF, a world-renowned teaching hospital, and as we spoke over Zoom I typed out copious notes like a good student.
He made some comforting and even jolly remarks — including, “I’ve got good news for you, Mr. Palsson: your cancer is thoroughly unimpressive,” — but as I mentioned in a prior dispatch, he also suggested that further chemotherapy and even a massive lymph node removal surgery remained on the table. It would all depend on whether my blood tumor markers went down, and (even more tellingly) the results of my CT scan.
The day after Labor Day, I went down to Marin for the scan, feeling like I was riding a tremendous wave of prayers and healing energy, the lead horseman backed by a massive cavalry of ancestors and helping spirits. The whole thing took less than fifteen minutes, and the next afternoon I was looking at the report detailing the “non-pathologic,” 2-cm node.
A day later, I was back on zoom with my doctor and my mom, in what proved to be an emotionally complex conversation.
First, there was the apparent good news that whatever mass had been in my body had reduced dramatically in size.
On top of this, my tumor markers had finally settled down into normal range. I was apparently done with chemotherapy. There was much to be grateful for and much to celebrate.
Then, there was the twist.
Even in such happy cases as this — with an apparently “non-pathologic” CT scan and increasingly normal blood markers — as long as there was any node measuring over the pea-size mark of 1 cm, the by-the-book “standard of care” would be to recommend a surgery known as Retroperitoneal Lymph Node Dissection, or RPLND.
(Ahem…Can I please buy a vowel?)
The good professor shared that it is only through removal of the nodes that they can be accurately analyzed to determine the histology, or microscopic nature, of the tissue. A needle biopsy, he explained, was as useless as attempting to predict the contents of an entire beach by sifting through a single fistful of sand.
Writ large, analyses of enlarged lymph nodes following RPLND surgeries out there show that in 50% of patients, the excess tissue is nothing more than scar tissue and dead cells. Another 40% of the time, there is the presence of “teratoma,” or a benign, non-cancerous mass (which can either grow and become an issue, do nothing, or disappear entirely). The remaining 10% of the time, statistically speaking, there are live cancer cells — which is the main reason the standard of care is surgical resection, or removal.
I was invited to schedule a meeting the following week with the would-be surgeon, another highly regarded expert at UCSF, to learn more about the proposed procedure, and go from there.
Already having endured one major surgery this year, and with an intuitive sense that I have my lymph nodes for a reason, I explained my reluctance to sign up for a procedure like this.
Of course, I’ll fundamentally do whatever is necessary to achieve a long life of thriving and living my purpose as a father and writer and instrument of peace — but I’ve also had a very strong sense that I am already cancer-free, that my body can take it from here, that whatever remained within me at the time of the scan (that fleeting snapshot of a moment in time) is already on its way out.
My belief and hope is that this surgery ultimately won’t be necessary.
As my body and soul have rebounded from the debilitating process of chemotherapy, I’ve had a clearer vision of the outcome that I desire and stronger practices for reaching my goal of vibrant health and freedom from all dis-ease.
I’ve been returning to more vigorous exercise and eating better than ever before. I’ve been continuing to receive energy work, massage and acupuncture, and without chemo's copious contraindications to contend with, I’ve also been benefitting from a range of excellent healing supplements and a powerful tonic of traditional herbs. I’ve been releasing decades of previously blocked-up emotions and finally getting into the practice of telling my story, writing my book, singing my song.
In short, I have been getting my radical remission on.
So… couldn’t we take the route suggested by my intuition (and shared by my naturopath), hold off on that surgery, and continue to monitor my healing progress through bloodwork and occasional scans?
While still encouraging me to speak with the surgeon, the oncologist replied that, yes, there is a chance that this node will return to normal size, and that it would indeed be medically appropriate to re-scan in a couple of months.
With a dawning sense of clarity about next steps and timeline, I began to set my sights on having another scan in November. By the end of the week, the surgeon's office had phoned me to scheduled a meeting for the following Wednesday (which was last week).
Then, with a major need to untangle all these strands of new information — plus a desire to relax and celebrate the apparent accomplishment of being done with chemo — my mom, Phoenix and I took a road trip last weekend to San Luis Obispo.
It was my first time ever visiting that beautiful place, and we enjoyed a few leisurely days of walking, swimming, reading and writing (including some deep journaling and a first draft of my Valley Fire story).
The warrior spirit of my mother (almost 75!) and my dog (probably around 105 in dog years!) was particularly evident on the big hike we took on our last day in SLO, up to “Bishop’s Peak,” the highest of nine small mountains (or “morros”) that envelop the central California conurbation.
I had no idea it would be such a burly hike, but at 3.5 miles with 1,000 ft. of elevation gain and minimal shade, it really put my two ol’ ladies to the test. We had to take it slow and stop to rest a few times, and I extended my hand regularly as a support to my companion — but by mid-afternoon, we had sumitted the ponderous crag and enjoyed a victorious view from the top.
The next day, we drove back to Pacifica on Highway 1, taking our time wending along the rugged coastline.
There is something powerful about taking the long way back, rather than always following the quickest route from one point to another. As the masters say, “happiness is not a destination; it is a way of life.”
Two days later, I was back in my own home, where we met at last (on Zoom) with the surgeon. He was very straightforward and polite, and clearly also an expert in his field. He described the process, which would include a pretty gruesome 6-inch midline incision and 3-4 hours under the knife, followed by several days in the hospital for observation and another couple of months to recover at home.
“The surgery is major,” he said, adding that they would not just “cherry-pick” the one enlarged node. The standard course of treatment would be to remove all lymph nodes in the retroperitoneal area, likely around 20 of them.
He reiterated that surgical resection of the mass is really the only way to know what it’s made of, which could be a strong indicator of long-term results: if it is scar tissue or teratoma, which is the case 90% of the time, risk of relapse is a mere 5%. If there is any live cancer present in post-surgical biopsy, risk of relapse is 30%.
While his recommendation was to do the surgery sooner rather than later, he consented to the “give it time” path that I had discussed with my oncologist and called it “reasonable” — with the slight amendment that he thought I should re-scan in one month, not two.
Later that day, my most recent lab work came through, and my blood showed even lower levels of the AFP tumor marker — down from 5.4 to 4.0, right smack dab in the middle of normal range — reinforcing my belief that I am indeed cancer-free and that my lymphatic system just needs a moment to catch up and process and eliminate the waste and byproducts of this traumatic summer.
Which brings me to this delicate moment, in which I am celebrating the end of chemotherapy, and also doing all in my power (and calling on all the help that is available) to support my body in processing and removing any remaining unwanted tissue from my lymph nodes prior to my next scan in mid-October.
I believe deeply that the reason the node appeared slightly enlarged in the September scan has everything to do with timing, and my body’s natural process of recovering from the cancer and chemotherapy.
The drugs I took and complementary healing work I did were successful in eliminating all cancer from my body, and it turned something as big as a baseball into something smaller than a gum ball. Of course there will be scar tissue and leftover proteins — and of course the body will need some time to heal.
My truth is that, even since that last scan, I’ve been continuing to mend and repair and shed what no longer serves me (more on that in our next installment) — and my continued belief is that this next scan will reinforce what I already know: we got this.
The next few weeks will be replete with healing activities, as I give an ongoing receipt to the universe to signify that I've gotten the message behind this tango with dis-ease. I'm availing myself of a new gym membership; I'm continuing with the sugar-free, low-carb diet rich in vegetables, protein, and whole foods; I have ongoing acupuncture and other forms of healing booked every week; and my intention is to continue reducing stress, to take inspired action to live my highest purpose, and to remain one-pointedly focused on the outcome I desire while also surrendering to what is.
I'll have Satya with me the next two weekends, in which we will first be visiting Pacifica to celebrate my mother's 75th, which is tomorrow (Happy Birthday, Mom!), and then joining some friends on the Sonoma Coast for continued fresh air and realignment.
I'll continue to keep you updated on my progress, and to share whatever interesting ideas and exciting co-creative opportunities emerge along the way. As always, I treasure being in community and communion with you, dear friend.
Much Love and Aloha,
Nils
PS. For anyone interested, Satya and I will also be participating in an Equinox Ceremony live on Zoom TONIGHT at 5pm Pacific (8pm Eastern) with Caroline Casey, the luminary host of my favorite radio program, The Visionary Activist Show. Please join us! The ceremony is by donation and more info is available on Coyote Network News.
