Neupogen

Today, I was scheduled to receive the chemotherapy that was originally scheduled for last Friday, but my white blood cell count proved to be too low.  Instead, I received an injection of Neupogen and am scheduled to receive another tomorrow, with the goal of increasing my white blood cell count enough for me to receive chemotherapy Thursday.  

BioVex

Today, privately held BioVex, Inc., announced that it raised $40,000,000 in a first close of a Series F round of financing.  BioVex will use the proceeds of this financing to fund a phase III study in metastatic melanoma with its lead cancer product, OncoVEXGM-CSF.

One of the previous investors in BioVex that participated in this financing was Harris & Harris Group, Inc., the firm that I was associated with from 1984 through the end of 2008.  I always felt privileged to get to spend the final years of my career making the sorts of investments that Harris & Harris Group makes.  As an early-stage, venture-capital firm, Harris & Harris Group helps to develop, and puts capital behind, worthy ideas, intellectual property, and people.

Because I lack both proclivity for, and training in, science and technology, I never thought that I was qualified to be a venture capitalist.  (I made sure to surround myself with people who were fully qualified.)  Nevertheless, I thought that I had  a useful role to play, because I seemed to be willing to take chances occasionally on people and projects that were not deemed fundable at the time by my peers.

There are a number of companies in Harris & Harris Group's current portfolio of approximately 30 privately held, risky companies that could, if they reach their potential, make a difference in the lives of people (as well as make a lot of money for Harris & Harris Group and its shareholders).  Harris & Harris Group has actually played a much more central role in many of these companies than it has in BioVex, and BioVex is not its only portfolio company developing cancer therapeutics.  But imagine if just BioVex, among Harris & Harris Group's portfolio of companies, reaches its potential and brings to market a cancer vaccine?  Thinking of the lives that may be saved, and the suffering that may be averted, it seems to me that my entire career was more than well spent if only for having been in the position to aid in this one effort.

A Short Walk

I had a little more strength today and went for a short walk with my son -- 0.68 miles, according to the pedometer that a friend recently sent me. We also watched Tiger Woods win the Bay Hill golf tourament. I was a little ambivalent about rooting for Woods after he threw golf clubs three times. But when one invests the time to watch a golf tournament on television, it is hard to complain about such a payoff -- getting to see another dramatic victory by what must be the greatest clutch performer in the history of sports.

A Quiet Saturday

Aside from a brief scheduled trip to the hospital for some follow-up care, we spent a quiet day at home. I was tired from yesterday, so I just read a bit, and handicapped and watched some races on television with my son (we might have seen two really good contenders for the Kentucky Derby in today's first two finishers in the Florida Derby, Quality Road and Dunkirk).

A Twelve-Hour Day

We left home at 8:15 a.m. to go to the hospital to have the infection caused by the implantation of the Mediport checked. At 1:30 p.m., we went back to the hospital when the infection appeared to worsen. At 8:20 p.m., we arrived back home.  In the interim, the Mediport was removed, implantation of a PICC through my right arm was attempted unsuccessfully because of thrombosis caused by implantation on March 12 and removal on March 15 of a PICC through the same arm, and a PICC was subsequently implanted through my left arm, where it now resides. A PICC, like a Mediport, enables infusion of chemotherapy. 

I opted to undergo these procedures under local anesthesia on the understanding that, if I did so, I would have to stay in the recovery room for only an hour. But bureaucracy prevailed, the computerized instructions to the recovery room were botched, and the nurse wouldn't let me go home for the better part of three hours.

An Infinitesimal Chance

Yesterday, before consenting to having the Mediport installed, I was told by the interventional radiologist who would perform the procedure that there was "an infinitesimal chance" of infection. I got infected. I was given intravenous antibiotics today for the infection and will not be given chemotherapy tomorrow as previously scheduled.

Mediport

Much of my day was spent undergoing a scheduled, minor surgical procedure to install a Mediport.  A Mediport is an implanted device that enables better infusion of chemotherapy.

Taking Care of Business

This morning, Susan and I sat with lawyers while they witnessed my signing of my will, my living will, and a power of attorney. My next order of business will be to start identifying investment-advisory firms and/or trust companies.

At lunch, a friend treated me to Southern fried chicken, mashed potatoes, biscuits, and gravy at the University Club. Although I'm supposed to pack away all the calories I can, that lunch may have tested the limits of the theory!

A Fairly Busy Day

This morning, I had more energy than I can recall having in the last few weeks. As a result, I may have gotten a bit too ambitious: I wound up having lunch with one friend; a visit with another in mid-afternoon; and dinner with another. (I must confess, I let myself get talked out of the check at both lunch and dinner!) Other than getting a migraine at 4 pm, I felt pretty good all day.

Horses

At lunch today with some friends from Boston, we discussed, among other things, horses. Susan and I currently have five thoroughbred racehorses in training. Four of them are currently in Florida, and one is in France. They are young horses, with their racing careers ahead of them. They include a four-year-old gelding, W. C. Jones; a three-year-old gelding, Hot Money; a three-year-old colt, Mustang Island; a two-year-old colt, Backslider; and a three-year-old filly, Sacred Music.

W. C. Jones has made three starts, finishing a fast-closing second in his most recent race at Belmont Park at a mile and an eighth on the turf on June 22, 2008. Since then, he has been recovering from an injury, first in Kentucky and currently at a training center in Florida. When he is ready to run, he will go to trainer Christophe Clement in New York. I named W. C. Jones for my late uncle, who bred and raced thoroughbreds and got me interested in them in 1961. During the summer of 1963, between my junior and senior years at Princeton, I worked for his trainer at Saratoga racetrack. I bought my first thoroughbred racehorse in 1974, and Susan and I have owned and bred varying numbers of thoroughbreds-- sometimes in partnership with others-- ever since.

Hot Money has made one start, at Aqueduct racetrack on Long Island. We started him in a race on the dirt main track, just to give him experience. We think that he may prefer to run on the turf. We'll find out! He may be ready to run again in about a month, in New York.

Mustang Island was also given one race at Aqueduct before being put away for the winter. He may be ready to run again in six weeks or so, also in New York.

Backslider is at the stage of training in which owners and trainers find out whether or not a young horse has speed. A big part of managing racehorses is figuring out what they do best -- sprint, compete at longer distances, take the lead early, come from behind, run on the dirt or turf, etc. But if a horse is going to be top class doing anything, it has to have speed.

Sacred Music is in training in Chantilly, France, with trainer Nicholas Clement. All of our horses in the United States are trained by his brother, Christophe Clement. Sacred Music is being pointed for her first race at one of the Parisian tracks in mid April. She appears to be best suited to running long distances on the turf, which is the surface over which the French races are contested. Although there are many good turf races in the United States, most racing here is conducted over dirt or artificial surfaces.

Susan and I bred Hot Money, and I bought the other four horses at yearling auctions in Saratoga. Although, as you would expect, I recently gave some consideration to selling our horses, Susan and I have decided to keep them. Like all owners with young, largely untested horses at the beginnings of their careers, we are keenly following their progress as they are being prepared for this season's racing!

Excerpts from an E-mail

 Many, probably most, of you know from your personal experience much more about the realities of mortal illness than I do. I have the good fortune of still having my parents with me.  My father's 99th birthday is April 4 and my mother's 95th is not far away-- we recently celebrated their 70th wedding anniversary. 

I would like to share excerpts from an e-mail from a friend who wrote me today upon learning of my condition. "Having been through my mom's fatal illness last year, I can tell you that I deeply feel for you, your family and ... your friends.... Everyone may be different, but one thing I've learned is that most people with serious illnesses hunger for companionship and connection. They want to know and feel that they really matter to others."  

I can attest that I am no exception. One of my first instincts  upon learning of my condition was to fear loneliness and isolation and to seek the comfort of family and friends with a special intensity-- an intensity that I suppose is borne in part of the realization that I don't know how much time is left not only, in my friend's words, to feel that I really matter to others, but also to let them know that they really matter to me. Whatever the source of the intensity may be, one thing I am sure of is that I want to fight as hard as I can fight against the fearful loneliness of dying.

Two Emails

Among e-mails I received today from friends, I have selected two to share with you.

One e-mail, from a friend who is coming to see me on Monday: 

[In response to last night's post in which I referred to a "dear old friend"]: "Charlie, when you blog Monday evening, could you please refer to me as a 'dear' friend and 86 the 'old' ?"

Lesson learned! Henceforth, I'll try to refrain from characterizing friends in my blog!

A second e-mail:

"Charlie, a quote I read tonight:

 'Everything can be taken away from man but one thing:  the last of human freedoms-- to choose one's attitude in any given set of circumstances, to choose one's own way.'

 - Victor Frankl"

I replied by e-mail:

"_____, that is very insightful of you. When I found out I had cancer, I thought almost immediately of Frankl's Man's Search for Meaning, which I have reread periodically since I discovered it some 10 or 15 years ago, maybe even longer ago. I realized that I had to find meaning in light of my new circumstances. When I got home, I got a copy from my bookshelves and reread several parts, including the passage you quote. I do not by any means think I have things figured out yet, and I do not know if I will be able to do so, but Frankl is definitely helping me to frame the questions in my mind."

Side Effects, Day Six

My temperature was normal today. I had a visit from a dear old friend.

Side Effects, Day Five

Today, I briefly developed a mild fever and a couple of other symptoms that might be attributable to reactions to chemotherapy. Earlier in the day, I had had a pleasant lunch with old colleagues from Harris & Harris Group.

Side Effects, Day Four

I hadn't planned to try to get together with any friends until Thursday. But I woke up feeling better today than yesterday. So I called a friend, and we walked to a simple, neighborhood, Italian restaurant for lunch. My seat faced the window, and I had the treat of watching the revelers in their St. Patrick's Day green delighting in the cool, sparkling sunshine.

Side Effects, Day Three

Today's predominant side effect was persistent, moderate nausea. As I have been instructed to try to eat, Susan suggested that spicy Indian food might pique my appetite. So we went out to dinner at a favorite local restaurant, and she was proven correct. I even had a glass of gewurztraminer with dinner!

Side Effects, Day Two

This morning, I felt energetic.  Later in the day, I began to have migraine attacks, a total of three altogether.  I hope that the chemotherapy is not going to trigger such attacks routinely.  In any event, whether as a consequence of the chemotherapy per se or the migraines, I lost much of my appetite.

If all goes according to form, tomorrow and Tuesday should be the nadir of this chemotherapy cycle.  I am planning on seeing people starting on Thursday, so please do not hesitate to get in touch if you would like to get together.  I would love to see you!

Side Effects, Day One

It has been explained to me that the side effects of chemotherapy generally grow worse over time, although a given session's side effects may be less severe than the previous one's. So I can't read too much into my side effects during the day and a half since the end of my first infusions. Nevertheless, I am pleased to report that the initial side effects have been quite tolerable. Until sometime tomorrow, I will continue to be hooked to a portable bottle of Fluorourasil. I am told this drug can change taste buds, but we opened a bottle of rose champagne tonight, and it still tastes delightful! I've been told to exercise as much as possible, so I did not rest today and walked to the Central Park Zoo and back on a pleasant family outing that lasted almost two hours.

First Day of Chemotherapy

Several of you have been kind enough to email or telephone to ask how my first day of chemotherapy went. I was particularly concerned about my tolerance of toxic drugs, because I have historically had poor and atypical reactions to drugs in general and therefore avoid them if at all possible. For example, one of the glaucoma medications I use, as a side effect, causes dilation of the pupils. In my case, this drug causes my pupils to contract, a reaction apparently not found in the literature until a research scientist documented my reaction.

In the event, it seems to me that the infusions went pretty well. They had to be stopped only once, to give me Atropine when I started having an adverse reaction to one of the chemotherapies, Irinotecan.

The pleasant surprise is that I got an almost immediate increase in energy and decrease in pain from the session, which I am guessing is the result of an infusion of iron and some steroid tablets that they gave me prior to the chemotherapy. Dr. Saltz had expressed that it was his sense that I was on the brink of "sliding off the table," and I do not feel in that imminent danger as I write this tonight. In fact, I was able to take advantage of the pleasant winter's day by walking outdoors cumulatively for a good hour, with energy to spare!

Meeting with Medical Oncologist

As scheduled, Susan and I met today for the first time with Dr. Leonard Saltz, the medical oncologist who will be directing my care at MSK. He confirmed that there are extensive metastases in my liver. It also appears that there is lymph node involvement. Dr. Saltz told us that my cancer is not curable. We accept his opinion.

Dr. Saltz recommends treatment, however. If successful, such treatment would extend my life by some indeterminable length of time, with periods in which I would be stronger than I am today and would be able to engage in an active life. Because my condition seems to be declining rapidly, he recommends that I begin chemotherapy tomorrow. He does not think that blood transfusions are called for at this time.

Dr. Saltz’s plan includes my beginning with six to seven months of chemotherapy. He is starting with chemo, rather than surgery on the colon, because during the recovery time from surgery, I would not be strong enough to receive the chemo I need for the liver. Accordingly, I will begin chemo as an outpatient tomorrow. The plan is for me to receive a “cocktail” of Irinotecan, Leucovorin, and Fluorouracil (known by the acronym “FOLFIRI”) over a period of two days, have twelve days off, and then repeat the treatment.

Physical Symptoms

A few of you have asked if I am in any pain.  When I move in certain ways, I have some internal pain in the location of the tumor.  The area over the tumor is very sensitive to even very light pressure.  But none of the pain is bad enough to require pain killers, and I can usually get into a pain-free position when I want to sleep.  

I am now anemic, I am told that I am pale, and I do seem to be losing strength on a daily basis.  My only current exercise is when my son and I go for short daily walks.  My weight has stabilized over the last few days as I have made a concerted effort to eat a lot of high-calorie food.

Overall, in terms of discomfort and loss of stamina, it feels as if I had hernia surgery a few days ago.  In fact, before I got my diagnosis, I thought that I must have torn an old hernia repair.  

Colonoscopies

Several of you have asked me about colonoscopies. There is an informative article about colonoscopies at the link below.
http://www.nytimes.com/2008/12/16/health/16cancer.html?scp=2&sq=colonoscopy&st=cse

Events to Date

I first heard the word "cancer" from a doctor last Monday, March 2.

On Thursday, March 5, I spent seven hours at Memorial Sloan Kettering having various tests, including a CT scan.

On Monday, March 9, I underwent a colonoscopy that confirmed that I have a tumor in the right colon that has metastasized to both lobes of the liver. As a result of the illness, I am anemic.

On Thursday, March 12, Susan and I will have a first meeting and consultation with Dr. Leonard Saltz, the medical oncologist at MSK who will be directing my care.

I am deeply touched by and grateful for the many messages I have received from friends and family. It has been suggested to me that a good way to enable people to follow my news without having to go through the awkwardness of asking is for Susan and me to post such news on this blog. Thus I can communicate with all of you in normal, interactive fashion by e-mail, telephone, and in person about other things. Although this blog is not set up for you to post replies, please keep your communications coming through other channels! I find that e-mails are especially good, as I can read and respond to them at any time or place; even sitting, waiting for another test, at MSK. You are all very much in my thoughts.

Thank you,

Charlie