Picture this

Highly sensitive imaging can be performed to identify myeloma lurking inside and outside bone marrow.


As I wrote in my last column, I recently learned that I am MRD negative.  There are a few different test methods to detect minimal residual disease and the prognostic value of the tests varies with the testing method employed.

In my case, after doctors withdrew a sample of bone marrow from my hip it was assessed using next-generation sequencing (NGS). As I understand the process, an older marrow sample is used to identify the DNA of my original myeloma cells. The assay then looks for that DNA sequence against millions of cells in the newly extracted marrow, in my case 2,922,325 cells.  If no cells with matching DNA are detected there is no minimal residual disease and the patient is said to be MRD negative.  

It is possible, however, that sequencing of the cells from a marrow sample may not detect all residual disease because myeloma can appear outside the marrow.

A PET/CT (Positron Emission Tomography)/(computerized tomography) scan is an imaging technology that allows doctors to “see” areas in the body where multiple myeloma has caused tumors in soft tissue and/or congregated in the marrow.  While sensitive analysis of the bone marrow can detect MRD inside the marrow, a PET/CT can detect minimal residual disease inside and outside the marrow. This is called “imaging” MRD testing.

To perform a PET scan a radioactive sugar is injected by IV. The sugar travels in the body normally and creates a “tracer”. When the patient is scanned about an hour after injection, images of the distribution of the sugar are obtained. Because cancer cells use sugar at a higher rate than normal cells they appear as “hot spots” in the images. The PET scans are merged with the CT tomographic x-rays, cross-sectional images of anatomical structures, to show doctors with great specificity the existence and location of cancer cells.

It is well accepted that patients that achieve a deeper response to treatment are more likely to enjoy longer progression-free and overall survival. So it follows, achieving MRD negativity, the deepest response that can currently be measured, is a good prognostic predictor. While it seems logical, research last fall concluded that patients that are both MRD negative in a bone marrow assay and imaging analysis have statistically improved progression-free and overall survival.

The PET/CT is an interesting test, but generally not too uncomfortable unless you are claustrophobic or have trouble being still for long periods.

To start, I began fasting six hours before the test and couldn’t exercise in any way. Exercise “fires” up the muscles and changes the way the muscles metabolize sugars, and that would throw off the scans. Presumably eating causes a similar issue. The fasting was a challenge, but I didn’t have much trouble sitting idle all morning and watching television.

When my appointment began I was injected by IV with a radioactive glucose solution.  I didn’t feel anything, but I was suspicious when the nurse pushed herself away from me as we continued our small talk. When the injection was complete I was told to relax and not move around for forty-five minutes to let the tracer fluid distribute through my body. I heard “take a nap” and I always follow directions.

I was called back to the scanning room and directed to go empty my bladder as best as possible. “Be careful not to get urine on your hands, it’s radioactive. Wash up well when you are done.” Encouraging instructions, I’m sure this is all safe.

 Lying flat on my back, my head in a U-shaped pillow, the bundling process began. A large rubber strap was placed around both arms at my biceps, the weight of my arms against the strap holding them in place at the sides of my chest. My toes were similarly bound to keep my feet and my legs from rotating outward. Having my arms and legs thoroughly secured, I was swaddled head-to-toe in warm blankets. This was welcome as the room was frigid.

Now resembling a mummy, the slab I was on moved back and forth, foot to head, through the large round scanning machine. It’s a bit like being passed through the hole of a giant donut.

Before the scan started the technician explained the procedure and emphasized that if I moved we would need to start over.  The scanning process was easy. I tried to relax as best I could, listened to the music in the room, and tried to ignore the desire to move around. Of course, as we started I experienced an uncontrollable urge to cough. Thankfully, about 30 minutes after we started the scans I was informed they were complete and “useable.”

I was sent home to await the results. Unlike the cellular assay, when I expected the tests to detect at least some minimal residual disease, I hoped the PET/CT would confirm the earlier MRD negative findings. The PET/CT found “No abnormal osseous or extraosseous radiotracer uptake to suggest viable myelomatous involvement.” 

In other words, the doctors were unable to identify any minimal residual disease in either the assay or imaging. Time to take a breath and savor another victory in this long journey.

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Photo Credit: © 2010 Mark W Pouley

“Morning Calm” was 0ne of the first photos I captured when I recognized something special and needed to share it with others. The photo was taken very early in the morning on North Twin Lake. “Mirror” images are a common tool for photographers, showing the real and the reflected. By capturing a moment in time we get to see what the eye sees naturally as well as a fleeting hidden image seen only when the waters are calm.

Welcome to the Myeloma Roller Coaster

Living with multiple myeloma is full of ups and downs, twists and turns and surprises. For me an unexpected twist has led to a very happy place.

Welcome ladies and gentlemen to one of the scariest rides of our generation. It will bring you to the highest point only to drop you down at unimaginable speeds. You will enter turns you never see coming and remain breathless to the very end. Welcome to the multiple myeloma roller coaster.

When last we spoke, I was celebrating three years post-ASCT and preparing to pare back my aggressive 3-drug maintenance regimen to something more manageable. I looked forward to a return of precious time to me and my family.  Since that column, the plan shifted to more testing and continuation of the same treatment regimen.

The good news is that my general health remains outstanding with no apparent changes in my myeloma. Regular blood tests continue to register no measurable monoclonal proteins, my free-light chains are normal, and my other blood counts and kidney functions are good for a person taking regular chemotherapy medication.

My physical health is strong, in fact, we ended the summer with a fabulous family vacation to New York and I wrapped up the year attending two-week-long conferences in Minnesota and Tulsa with several hundred colleagues. 

Shortly after writing my last column I met with my doctor, but the conversation didn’t go as I expected. Instead of suggesting a reduction in treatment, he said he wanted to continue the three-drug regimen indefinitely. The reasoning was understandable, given my high-risk cytogenetics, but it was still a big disappointment.

Approaching this meeting I felt I’d achieved an unexpected turning point in my myeloma journey. The treatments had gone so well that I was considering an even greater return to my pre-diagnosis life. While that was always my hope, I didn’t know if it would happen and reaching that point was cause for celebration. While not intended, the conversation with my doctor tempered the celebration.  Wrongly or not  I felt a level of defeat.

More realistically, it all comes down to the risk of relapse. All myeloma patients have the same goals; find the best method to forestall a relapse as long as possible, and be prepared for a relapse of myeloma that is more difficult to fight than the prior incarnation. For high-risk patients like myself, the goals are the same, but the chances of a harsh relapse are greater.

My current treatment has achieved complete response for a substantial time and there are no current signs that is about to change. I’ve tolerated this level of treatment extremely well. The theory, as I’ve been told, is “if what you are doing is working keep doing it, otherwise do something else.” Because the disease could return more aggressively and may not respond as well to the next treatment there is great value to preserve the progress I’m enjoying today for as long as possible.

My doctors and I both recognized we needed more information to make this decision. On my doctor’s advice I underwent another bone marrow biopsy in November 2019, but this time we would test for minimal residual disease (MRD). With a regular blood test, doctors can identify one cancer cell in up to one-hundred thousand blood cells. By contrast, MRD testing can identify one cancer cell in one million blood cells. Because it requires a bone marrow biopsy and it is more costly than blood testing, MRD testing is not regularly prescribed. Myeloma professionals also still debate the value of MRD testing as it relates to treatment decisions for individual patients.

Because the testing requires such precise measurements I waited sixty days for the results. I was not expecting that length of uncertainty, but I tried to temper my expectations. Given the current science, being MRD negative, finding no minimal residual disease, is still fairly rare and a bit of a milestone. During my wait, I assumed I was MRD positive (there must be a monoclonal cell hiding somewhere). I felt it was better to expect the “worst” and be surprised by the best.

I finally received my MRD test results on January 15, 2020 (a whole decade after the procedure). I was shocked and ecstatic to learn I am MRD Negative.

My first reaction was surprise. Perhaps because I’ve conditioned myself to be hopeful, but not overly optimistic I didn’t expect this result. My second response was to feel validated. At least that’s the word that comes to mind. I’ve felt healthy and “normal” for a long time, but knowing I had multiple myeloma and all that goes with it I figured it was a bit illusional. While I know MRD Negative doesn’t reflect any sort of “cure”, and I remain vulnerable to relapse and all the attendant risks of myeloma, at least for this moment there is no myeloma. I’m feeling healthy because there is no cancer. I’m not fooling myself, I deserve to feel good.

I have a new appointment to have a new conversation with my doctor. We may decide that some level of treatment will continue, but I won’t be disappointed this time. I have proof that all the work and effort is paying off. I have cause for celebration, but I’m not letting down my guard. 

A lesson learned from my myeloma journey is to not allow myself to get too high or too low. Since my diagnosis I’ve been up and down the roller coaster enough times to prepare for the next big turn or drop. For now my arms are raised high, I have a big smile on my face and I’m ready for whatever comes next. 

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Photo Credit: (c) 2019 Mark Pouley.

My family closed out 2019 making a trip to New York. For a week I set aside being a myeloma patient as we went all-in as tourists enjoying all the sights, sounds, and tastes of the “Big Apple.”

Anniversary and decision point

Celebrating the three-year anniversary of my stem cell transplant brings new choices about treatments and the possible improvement in my quality of life.


Today, how­ever, I’m still enjoying a com­plete response and rel­a­tive­ly good health with remarkably few side effects. My perspective on the future also is much brighter, and three more years of good health doesn’t seem like a stretch anymore.

Much of my current success is due, I believe, to the aggressive main­te­nance treat­ment I have been receiving. This third anniversary is not only cause for celebration of 36 months of pro­gres­sion-free survival, but it also raises a de­ci­sion about how to proceed.

A quick review of my history lays the groundwork for the de­ci­sion I face this fall. I was diag­nosed in 2015 with “high-risk” multiple myeloma due to the presence of the del(17p) chromosomal ab­nor­mal­i­ty. I was initially treated with Velcade (bor­tez­o­mib), Revlimid (lena­lido­mide), and dexa­meth­a­sone, which proved ineffective. I moved on to Kyprolis (car­filz­o­mib), Pomalyst (poma­lido­mide), and dex (KPD), followed by an au­tol­o­gous stem cell trans­plant. At 60 days post-transplant, I had achieved a nearly com­plete response and had to decide whether and what main­te­nance ther­apy to undergo.

July 22 marked the third anniversary of my au­tol­o­gous (own) stem cell trans­plant. Honestly, although the treat­ment went well, when I was sent home, three-years in the future seemed like a very long time away. I wouldn’t have been surprised if a relapse had arrived before this day.

If I’ve learned one thing about multiple myeloma, it’s that it can be uniquely personal in the way it develops and affects a patient, but more so, how it will react to treat­ments. Maintenance ther­apy, it seems to me, can be even more of a gamble then initial treat­ments. If a patient responds well to initial treat­ment and a trans­plant, is there a reason to con­tinue treat­ment to main­tain that progress? This can be a tricky question, especially for standard-risk patients who did well after initial treat­ment. In a nutshell, all treat­ments come with risks. To undergo main­te­nance ther­apy, a patient must decide that the chance of achieving extended pro­gres­sion-free and possibly over­all survival outweighs those risks.

There is data suggesting that main­te­nance ther­apy for “high-risk” patients like me can extend time without relapse, so fol­low­ing my trans­plant, my doctors rec­om­mended an aggressive main­te­nance ther­apy of a half-dose of the pre­vi­ous KPD treat­ment. This de­ci­sion was based on research out of Baylor University that sup­ported a triplet of medications for three years for high-risk patients.

During the first ten months after my trans­plant, my lab results showed a barely measurable amount of M-protein. After that, over two years now, there has been no measurable amount of cancer detected in my blood tests. By all standards, this is a great result and con­sis­tent with the best out­comes reported in the Baylor study. While there is no way to know if my current con­di­tion is because of the main­te­nance treat­ment, given all that has occurred in the last three years, I believe the de­ci­sion to proceed with the aggressive main­te­nance ther­apy was correct.

Now that I’m ap­proach­ing that three-year mark, I must decide what’s next. It’s easy to think that if the dis­ease is being kept at bay and I’m not suffering many side effects, I shouldn’t change any­thing. Though my current results are all we could have hoped for, as I under­stand the research, there is little in­for­ma­tion about what benefits, if any, I might achieve by continuing this treat­ment beyond three years. There is, how­ever, an ever-growing risk that the toxicity of the treat­ments will eventually be more than my body can handle, and that may open the door for more serious side effects or sec­ond­ary cancers.

Since there is a lack of clear data about the clin­i­cal benefits of continuing this aggressive course of main­te­nance, I will decide based primarily on how the treat­ments impact my quality of life.

I’m convinced that Kyprolis is a myeloma-killing champion for me. Other than my trans­plant, it also has had the most sig­nif­i­cant impact on my quality of life. Kyprolis is admin­istered by in­fusion. As an initial treat­ment, it required trips to the clinic on two consecutive days three weeks on, one week off. As main­te­nance treat­ment, the trips are cut to one day a week, but still three on, one off. For me, that means a two-hour roundtrip drive and any­where from two to five hours at the clinic. Since starting Kyprolis in Jan­u­ary­ 2016, that has been a lot of time on the road and in the clinic. Since my appoint­ments are generally Friday or Saturday, it also means I can’t plan to travel or par­tic­i­pate in an activity on many weekends because I have treat­ment.

My wife and I cope with this schedule because we under­stand it is nec­es­sary and because my getting better has be­come one of our jobs. We are used to the inconvenience in our schedules and our lives, but it would mean everything to retake this time from the dis­ease.

Time, I have discovered, is more precious to me than any­thing else. Time with my family. Time with my grand­chil­dren. Time to take pictures and enjoy the world I live in. Time to work on the projects that are priorities to me at work. Time is finite with our without myeloma, and making use of the time doing what I want to do, instead of sitting in traffic or in a clinic bed, is the ultimate im­prove­ment to my quality of life.

Based on the ever-increasing risk of toxicity, the lack of compelling evi­dence I would im­prove my chances of long-term survival, and the thought of even a short-term return to a more nor­mal life, I have decided to drop the Kyprolis from my on-going treat­ment plan. On my doctor’s advice, I will con­tinue the oral medications of Pomalyst and the dreaded dexa­meth­a­sone. We will closely monitor my health and meet regularly with my specialist, ready to change course at the first sign of a relapse.

When I was first diag­nosed, I looked at treat­ment as a way to avoid dying. On this anniversary, I celebrate the past success and look at main­te­nance ther­apy as a way to keep living my life.

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 Photo Credit: (c) 2019 Mark Pouley

I celebrated my anniversary this year, as in the past, vaca­tioning at our eastern Washington lake retreat. As always, it was splendid. When we’re at the lake, I spend early mornings on my boat looking for scenery and wild­life to photograph. This year a bald eagle let me get unusually close, and it stayed and posed for many great photos.

Memories are Made of This

The unexpected passing of my cousin has me thinking about life and death and the memories we leave behind when we’re no longer here.


Just before Thanksgiving, I received word that my cousin John passed away. His memorial was held the Saturday fol­low­ing the holiday. There isn’t anything that makes me think about life and death more than the passing of a friend or relative (except perhaps my cancer diag­nosis). The fact it hap­pened during a time when I was with nearly all of my family made it that much more sig­nif­i­cant.

I hadn’t seen John in about six years, and we spent no time together as adults. Still, the news of his death hit me hard. In part, it was the sudden and unexpected nature of his passing from a heart attack, but more so that our shared childhood adventures are so much of my past, and now he is gone.

It’s not a stretch to say that I grew up at John’s house. When my parents left town on occasion, I would stay with John and his sisters. When I wanted to have a fun weekend, I would ask my parents to let me go to John’s. My aunt and uncle were great substitute parents, and John had all the cool toys my parents wouldn’t let me have: motorcycles and BB guns. He lived on acreage in a rural setting, and we spent many hours exploring and playing on the open land and in the irrigation canals.

Thinking about John’s passing, I realize that John and those adventures are all part of my most memorable childhood stories, the kind you tell your own kids decades later when you want to share what Dad was like as a kid.

A couple of the stories I’ve shared many times with family and friends stand out.

Once when I was young, my parents took me to John’s to spend the weekend. They were never fans of motorcycles, but when they dropped me off, I was expressly instructed to stay off the devil machines. Of course, John and I rode his dirt bike that weekend. It wasn’t enough, though, to ride the motorcycles. John was going to teach me how to jump the bike out of the dry irrigation canals.

The idea is simple enough: drive down one side of the ditch and up the next, “catching air” as you escape the ditch. John did it like a pro.  His riding skills surpassed mine by a lot. On my first attempt, I rolled down into the ditch and throttled the bike up the other side. Unfortunately, I failed to maneuver the short distance between the canal and the barbed-wire fence running along the canal. My failure is chronicled to this day by the scar on my right cheek where 36 stitches closed the gash torn in my skin by the fence.

In one of the outbuildings at John’s, there were several animal traps hanging on the wall. John told me that they were his and that he used them to trap muskrats in the canals. From that moment, I wanted to trap muskrats. One winter weekend, we finally got the chance to set John’s traps along the canal. When we checked them later, we found a muskrat trapped by the leg, but still alive. John handed me the bat he’d been carrying, offering me the honor of the kill. The muskrat looked at me with sad muskrat eyes and I couldn’t do it. It’s really a wonder I’m not a vegetarian today, but I will never forget that moment.

These are my stories. At John’s memorial, friends, family, and co-workers shared story after story about John. It was a really special tribute to a great guy.

John’s memorial reminded me that we are our memories and the memories held by others.

John left us suddenly and without warning. I haven’t spent sig­nif­i­cant time with him in almost 40 years. Even so, he lives after his passing in my vivid memories and the many, many stories shared by others at his memorial.

When I look back on my childhood, who I was, and the things that influenced me, I remember those stories and so many more that live on in me all these years later. Those adventures shape who I am today.

My wife often says it is our job as parents to make memories for our kids. Taking them to Disneyland, sharing family traditions, showing them the world we live in, is all about helping them make memories. I know we’ve done a good job of this with our children, and now I’m work­ing on making memories with our grandchildren. I hope when they are my age they will smile when they think about their crazy Papa.

As long as we’ve been married, my wife and I have hosted Thanksgiving in our home. When we were in school, we invited friends who couldn’t get home to their families. Today, our entire family and many sig­nif­i­cant others join us for a day of fun and food that often spills over through the weekend. It’s been so many years that the traditions and stories of past Thanksgivings are etched in the everlasting memories of everyone. It is a highlight of our year, and a highlight of my life. Each year the traditions are the same, but each year is dif­­fer­en­t, and we build on the memories of the past.

There is a 100 per­cent chance I will leave this existence, re­gard­less of multiple myeloma. It is also a certainty that family and friends will remain here and go on without me. If I’m lucky, and I believe I’m very blessed, I will con­tinue to live in their memories.

My family, my children, my grandchildren will celebrate Thanksgiving after I’m gone. It is possible the location will change over time. The people able to attend may also change. Still, many of the traditions will con­tinue. The stories of our past holidays will be told with joy and laughter.

Each day it is our responsibility to keep the memories of those who have gone before us alive. It is our responsibility to imbue memories of ourselves in those we contact. John’s memorial service reminded me that we get to choose the nature of those memories.

We are our memories and the memories held by others.

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 Photo Credit: (c) 2010 Mark Pouley

An aesthetically pleasing landscape photo is good, but a really good image should tell a story. In some rare cases, a photo can also stir deep emotional feelings, at least for some of the people viewing it. For me and my family, this is such an image. This is the very first view of the Twin Lakes we see as we drive down the mountain road into the Inchelium area. This familiar glimpse of the water means our long trip is nearly done, and we are about to enjoy the pleasures of the lake, the outdoors, and the people.

Lies, Damned Lies and Statistics

Every cancer patient is bombarded with statistics about survival rates, and “high risk” patients get the short end of those statistics. Instead of giving those numbers too much power, we need to remember what’s really behind them and how they apply to an individual patient.


I was recently reminded of an important lesson about statistics that applies to multiple myeloma. Interestingly enough, I was reminded of the lesson sitting in a stadium full of soccer fans, of all places. While a reg­u­la­tion soccer match is 90 minutes long, the official time is kept by the referee and he or she can add a few minutes to every match to compensate for the time play was stopped for injuries or other reasons. In the 93rd minute of the last game of the regular season, the Seattle Sounders scored a goal that shattered statistics.

The regular season of Major League Soccer (MLS) starts in early March and ends in late October. Like many American sports, the regular season is followed by a playoff to declare the final champion. The Sounders won the championship in 2016 and played in the championship match, but lost, in 2017. The Sounders have ad­vanced to the playoffs all 10 years they’ve been in the league, but in 2018 it appeared this streak would come to an end.

When the 2018 season began, the team’s star forward suffered a season-ending injury in the first match. Clint Dempsey, arguably the greatest American soccer player ever, retired mid-season after barely getting on the pitch in 2018. Losses piled up early. Some close games were given away, some matches weren’t even close. It seemed the season was lost before it really got going.

There are several organizations that compile sports statistics that track soccer teams’ successes, and failures, game-to-game. The numbers are used to project a team’s likely finishing position. In June, about mid-season, the Sounders had the worst record of 23 teams and were given only a 1.67 per­cent chance of making the playoffs in 2018. From my vantage point, that number seemed generous. The team looked terrible.

Many loyal fans, even in my household, wrote off the season. All objective in­for­ma­tion before us suggested the team was going to finish the season outside of the playoffs. It wasn’t a matter of giving up hope; looking at all the facts, this seemed like the only reasonable conclusion.

In July, the Sounders started winning matches, and by the end of October, they turned in the best half-season of soccer in MLS history. They not only qualified for the playoffs, but with the goal scored in the dying minutes of the last game of the season, they finished with the fourth-best record in the league.

The Sounder’s playoff games begin on November 4 (likely before this column is published). The statisticians give the Sounders only a 9 per­cent chance of winning the championship. Given what I learned this year, I’ve decided to ignore the numbers and just enjoy the games.

As myeloma patients, we’ve become pretty familiar with statistics. There are numbers everywhere we look. Every treat­ment comes with a spread of numbers suggesting how many patients might respond to a given treat­ment, how likely the response will be com­plete and whether or not the treat­ment might, in comparison to other treat­ments, extend a patient’s pro­gres­sion-free and over­all survivals. Of course, we are all familiar with some of the grim statistics regarding the number of months or years a myeloma patient might ex­pec­t to live, re­gard­less of treat­ment. As I’ve discussed in other columns, I’m con­sidered a “high-risk” patient, and the statistics for the group of patients that share my chromosomal ab­nor­mal­ity are not very cheery.

Cancer patients are often warned against giving too much stock to statistics, and for good reason. The statistics we see are merely summaries of a collection of data from a set of patients within a given category. Even within the measured collection, some patients did better and some patients did worse than the final averages and medians. There are numerous factors that influence how relevant any given data might be to our own particular case. As a single example, when discussing the over­all survival of myeloma patients, one factor that can skew life ex­pec­tancy statistics is the vast number of treat­ments that have been introduced in the last 10 years.

I’m not questioning the accuracy or validity of statistics. Statistics are critically important to researchers and doctors that are making long-term decisions about caring for myeloma patients. Statistics are especially important to draw general conclusions about a set of data from a sample. The numbers we see today are encouraging for the future of today’s patients and those who follow us. There is a reason for hope for all patients, but that too is a generalization.

For individual patients, and for me in particular, how well a specific drug worked on average for a group of patients studied in a particular location during a window of time is far from a perfect prediction of how well I’ll respond to the drug. How long the average myeloma patient diag­nosed in 2010 survived does not tell me whether I’m likely to to watch the 2022 World Cup or not. How well I do in treat­ment, how long I will survive, is controlled by too many factors, knowable and not, to make any reliable predictions.

During the post-game press conference fol­low­ing the last match of the regular season, the Sounder’s coach was asked if, given where the team was in June, he honestly believed his team would make the 2018 playoffs. He gave a wry smile and quickly responded yes because he knew the team had it in them to turn the season around and beat the odds. The people forecasting the Sounder’s final position in the league weren’t wrong, they just didn’t account for the many individual factors that influenced the out­come of the season.

The survival numbers and treat­ment reviews aren’t wrong as they relate to the myeloma pop­u­la­tion over­all, but they are much less relevant to any single patient. There are just so many factors that skew the numbers one way or the other. In some areas, I’ve already surpassed the averages for “patients like me.” In other respects, I’ve still to reach some longer mile­stones.

From my perspective, the lesson of the Sounders’ 2018 season is that for each individual person, none of the numbers really matter. I will do everything in my control to stay as healthy as possible. My care team will apply all methods possible to keep me healthy. I will get exactly as much time as all the factors taken together will deliver to me. Each day I’m here, though, I will sit back and enjoy the game.

UPDATE (November 9, 2018) – Unfortunately, the Sounders were elim­i­nated from the playoffs on November 8 by their hated rivals, the Portland Timbers. Just as they had during the regular season, the Sounders played to the very end, including thirty minutes of overtime and penalty kicks to break a tie. Objective observers are calling it one of the greatest MLS playoff matches ever. The Sounders entered the match with long odds of ad­vanc­ing, and through multiple dramatic lead changes met the challenge and pushed the opportunity to ad­vance to its limit.

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 Photo Credit: (c) 2013 Mark Pouley

Centurylink Field, home to the Seattle Sounders FC (and the Seattle Seahawks) is one of the most beautiful pitches in the MLS. On many days, like this one in 2014, the view is magical. During the last 10 years I’ve found refuge from a busy life in the stands, but since my diag­nosis, attending games has taken on a very special meaning and given me great joy.