One Little Number

One aspect of Stage IV Colorectal cancer (CRC) life that remains largely unknown to the rest of the world is how much your life can be dictated by one little number – that usually arrives by email once a month. A brightly wrapped e-present in your in-box which may determine minor little things (ha)… like if your treatment is working; if it is failing; if you remain in remission (NED – No evidence of disease); if your cancer is back in a recurrence.  It is the CEA biomarker.

CEA stands for “Carcinoembryonic antigen” which are glycoproteins expressed in GI-tissues (and to a lesser extent a few other tissues) during fetal development.  They normally stop being expressed in high levels after birth.  There is a simple blood test to monitor for it if you have CRC.

Some patients’ tumors shed huge amounts of CEA.  I have many friends who have had levels approaching 1,000 µg/L.  That is just in my friends circle, I am sure clinically, values >1,000 µg/L are seen.  Then there are patients whose values never exceed “normal levels” (for non-smokers approximately 2.5-3.8 µg/L depending on the testing site), no matter how extensive their disease is.  Finally there are a group a patients who are in-between these two extremes.

Some patients’ CEA levels are exquisitely well correlated to their disease (they know exactly how their disease is regressing or progressing based upon how their CEA number fluctuates).  In other patients, there is a much less (or sometimes even zero) clear correlation.

Where do I personally fall on those spectrums?  In some ways I think I fall in the worst group of people (I know, I know the grass is always greener…). My CEA levels rise a little as my disease advances. Although their direction tends to correlate with disease state – due to the small numbers involved, these patterns are smack dab overlaid with the “error-bars” inherent in the assay. So… I get data that tends to indicate how my disease is doing but with big error bars.  In science there is a phrase commonly used “Junk data is worse than no data”.  I’m living that adage. Except my data isn’t always junk data – just sometimes. And the data potentially has huge impacts on my life.

Best of all worlds huh? 🙂 By the way, did you know that the sentiment that “The grass is always greener on the other side of the fence” was written as long ago as the Roman poet Ovid when he mused “The harvest is always more fruitful in another man’s fields”.  That is why I love history.  Details change but human nature is constant.

aol-youve-got-mail-alert

One little number: 6.7

An email arrived in my in-box last night.  I could see from the subject line that it was my CEA results.  I opened it optimistically.  Before I started my recent, relatively harsh, FOLFIRI chemotherapy my value had been 8.2 µg/L (its historical highpoint – why I started FOLFIRI!).  After only two infusions (and a long Christmas break) it lowered 25% to 5.9 µg/L! Woo-hoo! “The FOLFIRI was working – all the side effects were worth it!” went through my mind when that email arrived in January. So, I was optimistic to quickly open last night’s email. If my CEA dropped so much after only two infusions, I expected it to continue to plummet after more.  The CEA result: 6.7 µg/L.  Wait… 6.7? That’s the wrong direction!

Instantly my heart sunk.

The scientist side of my brain made some very quick points to the patient side of my brain.

  • Fluctuations of 0.8 µg/L are fully within the error-bars of the experiment
  • I had a continuous cough for 12 months prior to starting FOLFIRI. Doctors attributed it to a long-term infection/related inflammation.  As a person with lung tumors – let’s just say I had my doubts on that diagnosis……. The cough magically disappeared within days of me starting FOLFIRI (YES!!) as a very suspicious potential clinical sign of chemo success.  It remains gone.
  • Aside from chemo side effects I feel GREAT, with high appetite & just yesterday I hit my highest weight ever as a cancer patient – all clinical signs of a successful treatment!

But that is the psychological power of one little number… I may be a scientist but I’m not looking at a graph of results coming from a cellular assay. I am looking at a number indicating whether my current chemo is working or not. And there aren’t that many remaining available FDA-approved chemo choices left, if it isn’t…

Scientifically I have no reason to worry.  The number generated in last night’s test was “statistically insignificant”.  Personally, it plowed into my terminal optimism like a ton of bricks as I prepared to go to bed.

I woke up with my terminal optimism mostly back in force.  The data will become more clear when I get a CT-scan next week.  Ironically, a CT-scan intentionally scheduled to continue to work towards “my greatest research project ever: me!” (which although I am very excited about, I still am not ready to update you on – sorry, I never discuss half-done still-fluid projects – too many moving parts 🙂 )

I’ll get those scan results in about a week. Probably they will show my FOLFIRI chemo working.  But until then, I will have a nagging voice of worry in the back of my ear. This is something that CRC patients deal with on a constant basis. Is their (often harsh) treatment working? What treatment will they need to try next if it isn’t?  Is there an approved treatment to try next?

I remain terminally optimistic. But I’m human.  The power of one little number.

43 Comments on “One Little Number

  1. While I am not a huge Tom Petty fan, he does have a point that: ‘The waiting is the hardest part’! I hate waiting and letting things claw at my brain. Stay strong and I am always thinking of you!!!

    Liked by 2 people

    • Looking forward to your visit next month CK!! Be prepared for a Petty boxset welcoming gift since I now know your a HUGE fan! 🙂

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  2. I have an appointment with my doctor in 30 minutes where I will get my latest CEA number. I raised slightly last month, as a liver tumor increased slightly. Both increases were within the margin or error, but it is unsettling nonetheless. Although I have had successful treatment to date, I know that can turn on a dime.

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  3. You hit the nail on the head! I hate how that little number affects me. I am a stage IV CRC survivor! Diagnosed November 2013. Completed 12 rounds of chemo and colon/liver resection. All successful ! Had my port removed last Monday, which impacted my emotional well being more than I would like to admit. Yippie, it doesn’t stare at me in the mirror any more, but I feel my security blanket was taken away. My port worked beautifully, delivering chemo to my body attacking my tumors! I am so blessed and thankful that my treatment worked. I try to stay positive and optimistic (on most days). The question that lurks in the shadows of my optimism is “How long?” As the end of February draws closer, so does that little blood test, and the email that lets me know my results are ready to be viewed. The terror that fills my sole, as I click the “open” button, can bring me to my knees . My numbers have also run on the low side. My highest reading was 8.8 at diagnosis. I consider myself a strong person. I hate how vulnerable opening that email makes me feel. Thank you for sharing you story.

    Liked by 1 person

    • Congrats on being deported!!!! Although a bit far-fetched, it is a dream of mine for “Daddy;s bump” to be deported myself one of these days,,, I was originally Stage IIIc NED after the initial chemotherapy so I remember well the feeling of terror & vulnerability of opening those CEA results each month…. much worse than I am currently feeling than as a Stage IV. You may find this hard to believe, but I found stage IIIc much rougher mentally/emotionally than Stage IV. Stage IIIC I was in purgatory – unsure if the Stage IV hammer would fall or cured for lift – a HUGE remaining life impact of where that even unfolded. Once Stage IV hit – now – I had data to guide me and I could start to formulate a fighting plan. A long shot plan I know but… a fighting plan none-the-less. Which for me is mentally better than to sit around waiting for test results… Anyways – try to enjoy your NED as much as possible – and best of luck! -Tom

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  4. Wow. I didn’t know people with Stage IV cancer had CEA results that low. And I say “low” because I’ve never had a CEA anywhere near your number. When I was diagnosed in January 2015 with Stage IV colon cancer, my CEA level was in the mid 700s. It’s gone down and up, down and up over the last 12 months. Having exhausted all other protocols, I’m now on Lonsurf. The ironic thing? My CEA last week was the lowest it’s ever been: 207. I think we can both feel good about our markers, even though they are vastly different. I celebrate 207 because I didn’t think I would live to see January 2016, and I feel better now than I have at any other time since the diagnosis. I don’t know how long the Lonsurf will continue to work, but I’m so grateful for how it’s helping me right now. It looks like I’ll be able to see my oldest child graduate from high school in May.

    I hope your scan shows Very Good Things next week! Thank you for continuing to share your feelings and progress, and for explaining things in such an easy to understand way. It’s always encouraging to discover a new post on your blog.

    Liked by 3 people

    • Hi Sarah, Congrats on all signs pointing to a successful Longsurf for you! I hope it works a long time (there are some long term responders to it!). The biggest congrats is making it to your child’s graduation in May – what an incredible life milestone to participate in that reading between the lines, it sounds like was far from uncertain in the past,,, Think past Longsurf – if you are on Facebook, friend me & then send me a PM – there is a CRC clinical trials group on there that I think could benefit you. Good luck and enjoy that graduation! -Tom

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  5. I have never expressed an incredibly large CEA value. I had my first recurrence after completing eight months of Folfox, and I am currently on Folfiri. I am on maintenance chemo, no end date in sight. But my chemo regimen has been altered, giving me more time to recover in between treatments. My CEA level dropped and has remained steady. However, it bumped up a bit last month, it is still within the margin of error, but none the less, this bump makes my mind race and my heart jump. It takes my oncologist and husband to provide calm and reassurance for me to hold off on repeating my CEA immediately. Ah, the power of this number is daunting. Sending strength and peace to all the fellow warriors.

    Liked by 1 person

    • You are a perfect example of the power of that one little number… I am glad your oncologist & husband are working to calm you down. A very rational response = but rationality aside, both you & I know the emotional power of that one little number. I hope in your case, rationality wins out and that little bump is just a statistical quirk and it goes back down again. My CEA value has certainly gone back down again after a quirky bump up – it didn’t reduce the emotional impact – but it has happened before, so don’t lose Hope!

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  6. Oh Tom. Sometimes I think we are connected through some kind of universal Karma. Here is the perspective of one who has lived on this roller coaster 10+ years. My CEA has always been like yours, pretty much related to my disease, with small incremental changes, always 11 or below. Until last year, when I started on Lonsurf. It began to rise steadily over the past year and is now at an all time high of 102. My scans, however, continue to show no growth. Of course I ask “Does the clinical trial data show rises from Tas 102 among those treated”? Ahh, the best scientific answer yet. “We never measured CEA on this trial. It’s too inconsistent”.
    CEA is terrorism. Is it lung inflammation? Is it because I have a UTI? Is it because chemo is working? Not working? Is it because I wore green socks today? Or is there cancer raging throughout my body? All relevant questions. Of course I know you know your slight rise may be a good thing. Increased cellular death and all that. The fact remains this number can make one despair or elate and it is just a number. I feel your pain. It’s hard to liberate yourself from the tyranny that is CEA, but I had a small victory last month when I decided to take a three week break and I refused to have it taken. Me-1, CEA -0.
    CEA schmEA. When the fear takes hold, do what I do, have your “other self” talk you out of it. “DO you really need to think about this right now Sue?” The answer is always the same. No, you need to be living your life. Easier said than done I know.

    Liked by 1 person

    • Great reply Sue! It accurately described the tyranny of that little number to the point that we (as patients) should ideally ignore it and just continue to live life. (At least from my persona’s perspective, unfortunately easier said than done… but I agree with the goal!)

      My oncologist once admonished me to never look at one number in isolation, to look at “trends” like he does. As he said “Don’t be worried until I get worried. I’ll tell you when I’m worried. Until then ignore”.

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  7. I am like Kimberly stage IV CRC survivor! Diagnosed May 2010. Completed 12 rounds of chemo and colon/liver resection and liver ablation. Had my port removed and months of the Chemo pill. MY CEA number has never been a good indication at all, really doesn’t move. That is scary for me and also and excuse for my health insurance company not to approve of CT or PET scans. Even with that being said I still hold my breath to see what they latest CEA number is.

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    • Keep on keepin’ on James! You are living the aftermath of attempted Stage IV cure – an exciting situation but also a very scary/nervous one as you wait for CEA numbers and CT scan data to periodically appear. I don’t normally advise looking at statistical curves but in this case, I think they help to reinforce Hope… if you look at the curves, you see that each month of clean data you increase your chances of hitting that cure jackpot! So each month when you receive good news – think of that and throw yourself a little party 🙂 Take care -Tom

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    • James, that is such amazing news and you have no idea of the impact stories like yours have when people are fighting their disease, being told what negative survival chances they ‘statistically’ have. You’re one of the people that bring those statistics up, so thank you for that and that you for sharing your story and providing a bit of hope.

      My dad was diagnosed with IVCRC feb 2015. Mets on liver and peritoneal wall (which is thought to be a terminal situation). And we were told it was, but thanks to an amazing team of doctors in Belgium, my dad got cytoreductive surgery +HIPEC sept. ’15. followed by 4 rounds of folfox. He has been NED with CEA’s consistent with state of disease throughout. Today we had got the results of the 2nd follow up CT after 6 month. No visible signs of disease on the scan, but CEA went from 2 to 11 in 3 months time. So after a little over a year thats seen as a def sign of recurrence. We’ve been told to wait 3 months and then get a PET. It feels so counterintuitive when the first signs are there and we just do nothing and wait how it grows in maybe unresectable proportions by then. My plan is to start the most intense natural anti-cancer regime that we can think of.

      Since you have a unique story I would love to hear if there are any changes in lifestyle that you adapted to achieve such amazing results.

      Thank you for sharing and you will have a healthy and long life ahead!! no doubt.

      all the best,
      Romana

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  8. Boy do I totally understand the significance of that “one little number.” My husband has been going through the same course as you have been for approximately 6 months longer than you. I’m the one that gets more upset than he does over these numbers changing – especially if the change is in the Up direction. His CEA numbers have never been really high but this one little number in his body truly reflects what the cancer is doing inside. I must admit though that he has much the same attitude as you do and it is living as positively as is possible. He’s worked through his entire treatments even if he felt like total crap. His one big problem is if there is something that isn’t right, he won’t say a word at all. For instance, he developed a blood clot at his port. His right arm swelled to more than double the size of his left arm. It hurt like hell and he didn’t say a word until we received the last CT Scan a month ago that showed the clot. I wanted to kick his tiny butt for not saying a word! Luckily, his body is responding to the Warfarin treatments and he is able to continue his Xeloda/Irinotecan regimen. Being his wife and caregiver, I’m the one that takes things too much to heart!

    I truly enjoy reading your posts as it helps me cope with what Jim is going through. I get a better understanding because you talk about it. Jim won’t say a word. He just lives. I envy that part of him a bit as I try to adopt that attribute along this journey. I’m not succeeding as much as I’d like but I am learning to go-with-the-flow better these days. Thank you for sharing your adventures! You are touching and making a difference in more lives than you know.

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    • Hi Becky – I am glad you found my blog, since it sounds like you get a lot out of reading it! I admire Jim’s attitude (well except for the swollen arm part!) of simply living life and letting chips fall where they will. I admire it but it is completely outside of my personality for that to happen – and that sounds similar to you too. I try to roll with the waves quite a bit but never completely losing the mindset of thinking about the latest data and making plan A/plan B/plan C in my mind’s background. For better or worse, I’m too much of a project leader & planner 🙂 Here’s to both of us rolling with the waves thrown at us… take care,-Tom

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    • Hi Becky,
      I am new to blogging and need some type of support. My husband was diagnosed with stage IV colon/liver cancer last June. It was quit a blow to us, he’s only 53. He’s a lot like your husband when it comes to having that positive outlook and not saying a word of complaint. Where do you find your strength? He had surgery last October to remove the tumor in his colon (as well as an ileostomy), and then removed 4 lesions from his liver, since then he has had 2 ablations, the last being 3 weeks ago. His CEA number at that time was 12.7. Last week it was 21.7. He is scheduled for a re-draw as our oncologist thinks that this might be a false positive due to the recent ablation, today he received a call and stated that is was still at 21.7. When I looked into our patient portal, it was actually 23.7. I know he is trying to protect me, but I work in the medical field and realize what could be reality. To make a long story short, our son was involved in a MVA (passenger) of a fatal car crash that killed the driver (best friend) in April of this year. He was in the hospital for 18 days, received a level 3 splenic injury requiring stenting due to a severe TBI. He is 25 years old and living with us. With faith, he is progressing well and on his way to making a full recovery. I realize that there is so many wonderful people out there that are going through worse times, but when do you just sit and reflect on the “Why’s”. I would really use some inspirational advice.
      I want to better understand that this is just a journey that we have no control over.

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      • Hi Brenda, I wish I could say something “magical” to help us all believe that there will be a cure soon or that things are going to be totally fine. However, I can say that even though it is a very rough road we are traversing, we’re not alone and there is always someone that is in worse shape than our husbands. I won’t lie and tell you that I’m a super bubbly, optimistic person as I’ve been in tears so many times throughout the past 3 years. There are ups and downs and I fall with the downs and then pick myself back up and work toward getting back to the upside of things.

        We are on a “setback” right now so this was a total blow to our upside we were experiencing for the past year, Jim’s numbers have been climbing and we learned it’s because his spots have doubled and tripled in size and now he has multiple new spots.

        Tomorrow he starts back on the FOLFOX treatments and it’s not going to be fun. This time around though we have an arsenal of ways to tackle the numerous side effects this chemo cocktail with throw at us. I say “us” because I feel we are in this together.

        I think for “inspiration” I search for folks like Tom’s to follow because he is so upbeat. We need that as caregivers. He explains things from a man’s perspective going through this journey that our husbands are not sharing with us. Jim won’t tell me anything. I know it’s because he’s trying to protect me from the truth. I’m not sure he really believes that I can see the pain in his eyes and that I can sense he feels like total crap. I can and I get it to a point. I know I will never be able to totally understand how he feels because I’m not the one going through the chemo treatments or have the cancer attacking my body. I can be here though to be the “punching bag” for him.

        I guess that is one thing I have learned is that because I’m the closest one to him, he feels he can lash out at me and take out his frustrations even though he can’t “tell” me what he’s feeling. That’s another clue I’ve learned to accept which is when he’s feeling really bad, he can become quite nasty. It’s difficult to not take it personally but we have to learn to do this for our health.

        The one thing I can and have always done is research on the food and nutritional side of fighting cancer. I have Jim taking herbs and supplements. He won’t drink smoothies so I can’t get these things into one of those drinks. Tomorrow, Jim will totally lose his taste buds. He had them come back about 6 months ago so it has been fun to see him enjoy food again. That will be totally gone so I’ll resort back to adding loads of citrus zest or adding Grade B Maple Syrup, and using flavored sea salts to his meals to instantly change how things taste in his mouth. It took us 9 months to figure that one out the last time.

        The other thing I learned to do was make him lots of mini-muffin size goodies. This cocktail takes away his appetite so food will become an issue. Once I discovered that giving him things in bite-size portions, he was able to eat a lot more. He could just pop one of these things in his mouth throughout the day and finally get enough calories to regain strength and some weight.

        I think I just wrote you a small novel. If you wish, you can certainly e-mail me anytime with questions or concerns. I can’t say I’ll have all of the answers but I’ll do my best to share the things I have learned on our ride. I hope that you know you’re not alone. I think that is one of the most difficult things as a caregiver is feeling like we’re all alone and nobody understands. We’re not but there are days you certainly will feel that way and please know you aren’t!

        Thanks for reaching out to me. That’s a great first step in dealing with the overwhelming task of becoming your husband’s caregiver. Again, feel free anytime to write.

        Hang in there and do your best to Enjoy the ride!

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  9. Best wishes for good scan results. I have metastatic breast cancer and my oncologist switched to the CEA about a year ago. She reminds me to looks at trends, not numbers. She also reminds me to consider pain + CEA + scans so that one issue doesn’t scare me too much. And for me, the CEA is the least alarming. Thinking of you, Tom.

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    • Hi Kap – emotions aside, I agree completely with the good advice you are receiving from your good oncologist! I’m glad you found my blog from the Breast CA world – I hope (some CRC specifics aside), you have been able to get the broader points out of it that I try to convey. Take care, Tom

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      • What I gain from you, Tom, is the positive outlook and the scientific perspective! I told my son to read your blog because you best express how I’m approaching this.

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  10. The scary thing for me is they say mine doesnt work so I only know from my scans how its working,which is scary to because I have to wait 2 months before I know anything, I wonder what anyone knows about Hipec surgery for Colon cancer that is in the omentum ,any knowledge would be greatly appreciated,weighing heaviley on my mind. Thanks,Bridget

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    • I can totally relate Bridget. Because my levels don’t rise much, until disease burden gets high enough – for the first half of my Stage IV life, they didn’t even both measuring – so I was beholden to CT-scans every 2-3 months to know what was going on just like you! Having done both systems now, both are scary in their own way. Choose you poison…

      The advice I have for Hipec is to search out an expert in it – even though travel is required, I believe it is worth it for that complicated of a surgery. One expert I know of off the top of my head is Dr. Andrew Lowy at UC-San Diego. I know of multiple patients that has chosen to fly from all over the country for the opportunity for him to do the surgery. There are a few other experts – in general, Hipec is too important to cut any corners. Work hard to find the best one that you are able to get to. Good luck! -Tom

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  11. I wish I could take your worry away, but I really understand it. It’s all about managing the stress, right? Your optimism is the best stress management. Don’t give that up. Praying for you always. The world needs you.

    Liked by 1 person

    • Thank you for the calming message Bridget 🙂 You’re right – my optimism and my related advocacy actions really are great at managing stress. I am far from giving up & still filled with major Hope. I may finally be able to shed some public light on some plans I have in motion in a couple weeks that I am very excited about 🙂 Those have also been a major buffer against CEA stress…

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    • I can totally picture you doing that AkaSleen. Akasleen the test result assassin. Just be careful doing this around Bethsda facilities, the government may be less understanding of stalkers 😉 haha

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  12. My CEA level is a 6.5. Been off chemo for 14 months. Has CAT scan everything looked good. Doctor said not going to worry unless CEA go over 10. What do you think of this?

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    • Hi Tammy, I can’t give medical advice or attempt accurate interpretations of your numbers since I am not a MD and I don’t know your full medical chart/history. A PET-CT scan may be the most informative diagnostic test – but it can be tough to get insurance to cover. Best of luck! -Tom

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  13. Can totally relate. Ironically, when my CEA was below 7, I watched it like a hawk for any induction of movement. When it hit 13, they could find no tumors on the scans but I was panicked and insisted on surgery (where they found a pea-sized tumor).
    Years later when it jumped higher, I watched for trends and had to remind myself to focus on how I felt, not what I was told by the doctor or the number. One time, it went from 80 to 160. I was crushed. But two weeks later, it was down to 70.
    All the best to you on this journey. As you note, it is one data point and not a super reliable one at that. Or even most relearn.

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    • Great points with real world examples Marie for how this little number can fluctuate all over the place, lead to questionable decisions etc. Ahhh, the fun crazy life of us Stage IV’s huh? 😉

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  14. I’m one of those who agonize over what my number will be. After a year NED, belly pain sent me in to visit my onc. She ordered a CT, but called as soon as my bloodwork came in to let me know it was “fine” at 4.8. It’s never been over 5, so big sigh of relief, right? Wrong. The CT 2 days later showed a new primary cancer in the sigmoid colon that was already into the belly wall. Here we go again…Surgery, chemo, and a new treat, probably radiation this time. It amazes me that there is NO test or marker that is absolute. We always need to remember that NED doesn’t mean no disease, it simply means no EVIDENCE. That nasty crud could be hiding, just waiting to jump out and smack you upside the head. Mama always said life isn’t fair – right before she died of breast cancer. Thanks Tom for being our voice.
    XXOXO, Delinda

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    • Hi Delinda, I’m sorry to hear of your recurrence and your Mother’s loss to Breast CA… Certainly I agree that “clinical signs” (how you are feeling, plan etc) are more important than a blood test number – as illustrated in your example. I currently feel fine with good appetite, weight etc – so I am hoping those (good) clinical signs will trump whatever little fluctuations are seen in my blood test. Please take care, -Tom

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  15. I know exactly how you feel. The anxiety is unbearable. I had my scan today bumped up three months after 3 elevated test. 1.6 Aug 14 -1.4 Nov 14 -1.7 May 15 -2.4 Nov 15 Then onc decided to retest in three months 2.9 Feb 16 Hence the scan today. She is not worried since still in normal range 0-4 here in Canada. If not worried then why the bump up? I was stage 2 with complete path response and did the mop up FOLFOX. I got my fingers crossed for you Tom. Chin up.

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    • My fingers are crossed for you too! I think your onc was looking at the “trend” more than the absolute numbers. The numbers are so small that it may have been conservative for her to do this – but very reasonable. I hope the scan worked out well and please take care. -Tom

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  16. I eventually decided to stop asking what my CEA is, because increases made me worried, and three times I had increasing CEA whilst CT scans showed that my peritoneal metastases were actually shrinking on FOLFIRI + aflibercept. Hopefully you’re experiencing a similar CEA rise that’s completed uncorrelated with what is actually going on…

    Thanks for writing this blog – as a fellow young stage IV colon cancer patient (I’m 34), I need all the hope I can find!

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    • Hi Caz – thanks for the hopeful comment & I’m glad you enjoy the blog! I think you hit the nail right on the head. I hope that in this case, my CEA value was just “assay noise” but regardless of that, those little numbers can still have major psychological impacts! It sounds like you made the right decision since your assay was giving you, as patient, information that was more detrimental than helpful… Wishing you all the best -Tom

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  17. Pingback: The (Positive) Power of One Little Number | AdventuresInLivingTerminallyOptimistic

  18. Pingback: A Currently Incurable Summer Vacation | AdventuresInLivingTerminallyOptimistic

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