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.

Treading Water

Maintenance therapy for multiple myeloma can feel a bit like treading water. My disease is in check, but I’m just paddling about to keep my head above water. But sometimes treading water is a good thing.


As I enter my third year of main­te­nance ther­apy after experiencing very little change in my health the past couple years, I sometimes feel as though I’m just “treading water.”

While it’s often con­sidered derogatory to say that someone is treading water, being able to swim in that way is actually a very important safety skill. A swimmer isn’t going to make any forward progress treading water, but they’re going to keep their head above water (i.e., not drown) long enough to catch their breath so they can con­tinue a longer swim. Tread­ing water also allows a person who gets stranded too far from shore to survive on their own while waiting for help to arrive.

When I was diag­nosed with multiple myeloma, the purpose of initial treat­ment, and the measures of its success, were obvious. The same holds for the stem cell trans­plant that followed my induction ther­apy. In those instances, the energy and resources expended on treat­ment, and the toll the treat­ments took on my body, moved me forward by sig­nif­i­cantly reducing the number cancerous cells in my body.

The purpose and measures of success for main­te­nance ther­apy aren’t so obvious.

This is true not only for patients like me, who have no medical training. Maintenance also is a subject of discussion even among myeloma specialists. While main­te­nance is generally recommended by doctors in the United States, it remains unclear what its actual benefit is in terms of a patient’s over­all survival. This allows doctors and patients to question the value and necessity of recommending main­te­nance ther­apy for all myeloma patients.

Just as there are many types of initial treat­ment avail­able for multiple myeloma, there are a variety of options when tailoring main­te­nance ther­a­y to individual patient needs. It is truly remarkable that multiple myeloma patients have so many treat­ment choices avail­able. It does, however, make it more difficult to decide what course of action to take because it often seems whatever path we choose may foreclose other options.

Whether to proceed with main­te­nance, and what type of main­te­nance to pursue, are particularly difficult decisions because the benefits seem so hard to quantify, and there is a natural desire to be free of treat­ment, even for a short period. If I simply think of main­te­nance as holding the status quo, it can seem like a waste of energy. However, when I understand the true importance of “treading water,” the case for main­te­nance ther­apy seems to me to be more compelling.

The main argument in favor of main­te­nance ther­apy is that studies consistently find it extends the remission patients ex­peri­ence while they are undergoing main­te­nance. The treat­ment reduces any residual disease that exists in patients and delays the time until the residual disease begins to multiply, causing relapse.

The costs of the treat­ment, aside from the financial expense, are the side effects and other possible harm caused by the long-term toxicity of the treat­ment. For me, the price includes the hours of driving to and from the infusion clinic three weeks per month; taking a handful of pills daily; and suffering the constant fatigue and occasional cognitive lapses. There also are real health risks asso­ci­ated with long-term main­te­nance, such as secondary cancers or heart damage, which can decrease rather than increase over­all survival.

All this simply to stay in place.

I’m treading water with no movement forward. Or so it seems. If main­te­nance treat­ment doesn’t extend my over­all survival, is there enough reason to endure the possible toxicity of treat­ment?

The problem, both from the scientific perspective and the patient’s perspective, is that it is so difficult to know with any certainty if the treat­ment is extending an individual patient’s survival. While some studies sup­port this conclusion as a general proposition, as an individual it isn’t possible to know if the medications are effective or not.

If I don’t relapse, is it because I’m undergoing main­te­nance treat­ments? Might I also avoid relapse if I stop treat­ment? If I take a “drug holiday,” could I avoid relapse and the fatigue, neu­rop­athy, and other side effects of the medications?

There is no way to answer these questions, so I have to decide if it is worth the risk of relapse to stop treat­ments.

Given the relatively mild side effects I’m experiencing and the fact that my high-risk myeloma remains at bay, I’ve decided, with the sup­port of my myeloma specialist, that the benefits of main­te­nance outweigh the cost.

I am hopeful that a relapse is very far in the future. Realistically, though, I must prepare for the possibility that it is just around the next bend. I need to be fully prepared for that and the toll it will take on me to deal with it. Like the swimmer treading water, right now I’m just resting, keeping myself healthy enough to be ready for another tough swim in the future.

I’m convinced that my current main­te­nance treat­ment gives me my best chance at sustaining this pro­gres­sion-free period of my life. That is important for many obvious reasons, but given my relatively young age and my commitments to my career and family, I want to spend this time with my head above water.

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Photo Credit: (c) 2014 Mark Pouley

A duck calmly sits on a log at the crest of Niagara Falls as the roaring water rushes by. This photo reminds me how important it is to be content holding on in one place while everything around me moves by quickly.

Time Marches On

“How did it get so late so soon? It’s night before it’s afternoon. December is here before it’s June. My goodness how the time has flewn. How did it get so late so soon?” – Dr. Seuss reminds us how time flies, and the second anniversary of my stem cell transplant gives me a chance to look at the time that has passed and the time ahead.


“How did it get so late so soon? It’s night before it’s afternoon. December is here before it’s June. My goodness how the time has flewn. How did it get so late so soon?” 

– Dr. Seuss

Two years. Where has the time gone?

I just celebrated the second anniversary of my au­tol­o­gous stem cell trans­plant. At times, it seems like only yesterday. At other times, I can hardly remember it and have to wonder if it happened at all.

It is human nature to mark the anniversary of events, big and small. It provides us an opportunity to reflect on where we are and where we’ve been. We get to take stock of our accomplishments over time.

Many times, as is the case of the anniversary of my trans­plant, we get to reflect on an event that shaped our lives and the highlights of the year that passed.

Naturally, the first thing I review when I take stock of the past year is my health and where I stand as a multiple myeloma patient.

Immediately fol­low­ing my trans­plant, my M-spike was a tiny fraction of where it started, and for the last 12 months, there has been no detectable mono­clonal protein in my blood samples. I remain in a full and com­plete response, and I’m generally very healthy. By all measures, I’m in better health today than I was a year ago.

As a “high-risk” myeloma patient, I feel great reaching 24 months post-transplant in such great con­di­tion. Each day, each month, that I remain healthy feels like a great accomplishment.

Of course, the real value in keeping my good health is having the opportunity to ex­peri­ence the joy of my family.

My wife and I celebrated our 36th wedding anniversary at our favorite fancy restaurant. The next day, we attended an explosive live Pearl Jam “Home Show” in Seattle with one of our sons and his girl­friend. We remain young at heart but enjoy our occasional senior-citizen discounts.

My eldest son welcomed his third child, my third grandchild, into the world this year. She is the sweetest, most adorable girl (since her elder sister, of course). I can’t imagine missing her smile and snuggles as I try to coax her to sleep.

Before my first grandchild arrived, which was also pre-diagnosis, I wasn’t sure I was ready (or old enough) to be a grand­parent. Today seeing them grow gives me my greatest joy.

My daughter com­pleted her masters’ studies and was awarded her degree in December. She is also a fantastic roommate. She’s gone through the trials, tribulations, and excitement of remodeling and improving our new shared home. She is raising goats, and she adopted a couple barn cats to keep the mice population in check. It’s been an amazingly fun year in our new home.

The city of Bellingham promoted son number three to a position rewarding his hard work. He has also committed his services to his fellow employees as a union steward during a tough negotiation year.

Salmon are a critical resource in the Pacific Northwest, especially for the native tribes of Puget Sound and the coastal waters. Son number two, a salmon biologist, led a local tribe’s efforts to preserve and enhance salmon runs in their traditional waters.

Obviously, I’m proud of my children and their accomplishments. I adore my three precious grand­children. I know I share this trait with all parents and grand­parents. For me, it highlights the great value of being given another year of successful treat­ments.

As children, we couldn’t wait for the next event. Be it a birthday, Christmas, or summer vacation, the next exciting event was always in the future.

The special events might change as we get older, or as our health changes, but we don’t ever shed our anticipation of future events.

When I was a child, the time before an anticipated event seemed to crawl. I thought Christmas, or my birthday, would never arrive.

As an adult, this is no longer true, and as a myeloma patient, I view this with a new perspective.

I’m certainly excited about reaching this second birthday active and healthy, but I’m shocked at how quickly it arrived. The cynical gremlin in the back of my head reminds me that not only do the happy future events come and go quickly, so will the less pleasant events. That is the double-edged sword of time I suppose.

Of course, this dilemma is true for all humans. We anxiously await the next big thing, ignoring how the passage of time is bringing us closer to a grand finale.

As cancer patients, we certainly may be more aware of this, but that could be a blessing too. If we’re lucky, we gain a greater appreciation of all the good in our lives. Knowing our time may be limited, we seek opportunities to enjoy that time.

I know in the past I might have said no to getting up and doing something that seemed less enjoyable than what I was doing but gave me a chance to share time with family or friends. While I still don’t always say yes, knowing the finite chances ahead to do these things gives me a new measure to make my decision.

I eagerly await my third birthday next July. I will, as I’ve done today, reflect on the many joys that take place in the next 12 months. It is now my responsibility to fill that time with as many happy memories as possible.

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Photo Credit: (c) 2017 Mark Pouley

I spent my second birthday back at the Twin Lakes and had a first-of-its-kind opportunity to watch five or six juvenile bald eagles share a feast of fish at lakeside. Here is a photo of one of the eagles leaving his perch in the tree to go down to the buffet.