“Everyone has a plan until they get punched in the face.” – Mike Tyson

I was asking the oncologist at Fred Hutch about any trials they are running. He leaned forward and asked me if I had heard this famous Mike Tyson quote. He tilted his head and said, “Everyone has a plan until they get punched in the face.” Then he hesitated for a moment and repeated it in Tyson’s voice, with a lisp. We both started to laugh uncontrollably. It wasn’t the reaction I expected. Tyson’s quote is deeper than I originally thought when the doctor originally said it to me. He punches hard, and when he punches you in the head, your brain stops working properly, and you’re not in a position to implement any plan you might have had. It’s disorienting, and you can’t think. What Tyson said is similar to the old saying, “No plan survives first contact with the enemy.” Of course, my enemy is terminal Stage 4 pancreatic cancer.

What's been happening with me?

- It’s been 145 days since my treatments started for terminal Stage 4 pancreatic cancer.

- I’ve had 11 treatments of chemo totaling 440 hours. They give me FOLFIRINOX for 40 hours every other week.

- My CA 19-9 tumor markers have gone from 67,000 to 5,351. That’s a total reduction of 92%. If your CA 19-9 is less than 37 U/mL, you may not have cancer.

- The Boebert tumor (Aortocaval Junction) has shrunk 86%.

- The Putin tumor (Pancreatic Tail) has shrunk 68%. - The Pancreatic Neck tumor has shrunk 38%.

- The Trump tumor (Bilobar Hepatic) has shrunk approximately 80% (not an exact reading), but is really dwindling.

- My liver tumor has shrunk so much it is not measurable on the CT scan. Through this process, I’ve gotten so used to taking scans that when I flew to London for the War Tails screening, as I went through security at the airport, I laid down with the my bag.

The doctors are pleased, and I am in the top percentile of chemo doing its job. My energy is very good, and I seem to tolerate chemo pretty well, though it can make your eyeballs spin and ears ring. I also happen to be in luck because I was blessed with ‘dumb’ cancer. Cancer cells mutate quickly, which helps them adapt and survive. Mine are still a bit clueless.

When the doctor and I stopped laughing, he got a bit more serious and explained that the cancer cells I have occur in the lining of the ducts in the pancreas. He reminded me that a giant asteroid hit the Earth some 66 million years ago, resulting in the extinction of dinosaurs. But, cockroaches survived. My type of cancer is like cockroaches. Even if you kill all the tumors or surgically remove them, they’ll eventually come back.

Once my brain started to work again from being hit like that in the head, I told him that I was there to put together a plan. I had been looking into their clinical trials. The team at BC Cancer, who have been really amazing, had mapped my entire genome. All 19,900 of them. They identified that I have a mutation of the KRAS G12D gene. By the way, you can upload your genome to www.sequencing.com and analyze it. The KRAS protein normally acts like an on–off switch. In response to certain signals, it becomes activated and tells the cell to grow and divide. However, some mutant forms, such as KRAS G12D, remain active even in the absence of growth signals, leading to uncontrolled cell growth. As you know, cancer sucks at first. But it grows on you over time. LOL.

Fred Hutch has an early trial that has only been used in mice targeting this gene. The doctor told me that trials for pancreatic cancer are like ear candy. Nothing has worked so far, but it gives people hope. He was blunt with me and gave me all the reasons not to count on it, but we can at least go through the process of getting qualified for a trial, which can take up to eight months. On to the plan: continue with the chemo I'm on until it stops working. If you do it long enough, it will eventually cause neuropathy. You lose feeling in your hands and feet. When that starts to happen, they have a lesser toxic chemo they can try to see if that can keep the tumors from growing back. After that, we try a trial if you meet all the conditions of the pharmaceutical company sponsoring it.

What I'm I Doing Now? One of my co-founders at Bot, Inc. was Admiral Archie Clemins, a retired 4-star who ran the Pacific Fleet. Archie passed away in 2020 from cancer. He used to tell me, "Dan, if you aren't living on the edge, you are taking up too much room." The plan is to keep living on the edge, doing what I can do and pursuing this journey to make every day a diamond. As a bonus, it turns out I look forward to Tuesday chemo lab day and making new friends, joking with the nurses and killing some cancer cells…an average of 444 per day, according to my calculations. The one challenge I’m having is that I feel like I am the only person on chemo who gains weight. The steroids they are giving me aren’t helping and I'm quickly growing out of my pants. WTF? How is that possible?

What do I worry about? Not about dying. I am worried about not living enough in the time that I have left. Time started to get really important for me and very relative at the beginning of this year. Einstein explained the theory of relativity to make it easier to understand. He said, “When you sit with a nice girl for two hours you think it’s only a minute, but when you sit on a hot stove for a minute you think it’s two hours. That’s relativity.” Doing chemo and the days recovering are my hot stove and seem like eternity. The time I get to spend with my incredible wife, daughters, new grandson, and friends seems like a minute. I’ve been trying to adjust my schedule, so I have as many hours as I can in those scenarios even if it seems like short minutes when they are done.

People ask me what keeps me positive. It’s as simple as gratitude. I am grateful for the life I’ve had. I am grateful for my kind friends and neighbors. People’s kindness really comes out when you are facing a challenge and it has really restored my faith in humanity. I am grateful for my amazing, supportive, and beautiful wife. Even though I know it’s difficult, Kim is managing this situation with grace and the same positive attitude. She is caring for me in every possible way. During chemo, my brain slows way down, and she manages my schedule making sure I eat right and taking care of all the details. Most of all, her love shines through while she keeps me laughing and smiling each day.

And if you are reading this, you either care or are damned bored. Thank you. Your thoughts truly help. You are important to me and are having a positive impact. Why wouldn’t I keep smiling every day with this kind of support and friendship? Well, to be totally honest, the thoughts and prayers are great, but all the steroids and narcotics aren’t bad either. Also, to my wonderful neighbors bringing me meals. They work even better than my stool softeners. Seriously, I do appreciate all the food.

Remember, you can’t always control the path, but you can control how you approach the journey. You may as well enjoy the ride.