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Round 2. FIGHT! (An Update)
Loved ones, I believe this is working.

I’m writing to share an update on my treatment and recovery — and to celebrate some major improvements and share some major gratitude — after my first round of treatment.

I just started my second round yesterday. I sent out my first dispatch from the frontline of cancer treatment a week ago (two weeks into Round 1), and I have been touched and humbled by the outpouring of support, both in the form of those who have contacted me with words of connection and kinship, and those who have contributed to my healing fundraiser. 

I’ll expound more on the gratitude with which I’m bursting shortly. But first, the experience (and results) of the initial round.
Last week, I shared that I was diagnosed with a recurrence of testicular cancer after some intense and persistent back and abdominal pain drew me to the emergency room on a Wednesday in early June. I met with a highly regarded oncologist and we worked out a treatment plan that included three rounds of chemotherapy. Each round would last three weeks and consist of a full week of daily five-hour infusions, followed by two weeks of recovery, with additional infusions every Monday.
This photo shows me on my final day of my first week of treatment, 6/25. That thing on my arm is a patch that I had to wear for 24 hours, which eventually administered a dose of a medicine intended to help stimulate the production of healthy white blood cells after chemotherapy.

Incidentally, that day would have also been the 70th birthday of my late father, Ralf Irving Palsson, who died of cancer in 2008. The book I’m writing opens in Harlem, where I was living a year after college when I learned of my father’s leukemia diagnosis and resolved to move back to California to be by his side. But we’ll get into that chapter more in future installments.

While there have been some real low moments since treatment began, including some unpleasant side-effects of the medication (which we’ll also get into later), I’ll lead with perhaps the most exciting result of the treatment so far: the cancer and my body appear to be responding optimally.

By the end of my second day of chemo, that extreme pain I had in my back and abdomen had reduced significantly — so much so that I’ve no longer needed pain medication on a daily basis. Prior to treatment, my pain was so excruciating that a palliative care doctor prescribed me methadone (essentially, morphine) to help keep it at bay for 8 hours at a time. Before then, since being re-diagnosed that day in the ER, I was popping hydrocodone every few hours — not my preference, but really helpful when I was in such agony. 

That has all changed. Of the last 21 days, 19 have been pain-med-free. My oncologist suggests this is a major positive sign, indicating the cancer is responding appropriately to the chemotherapy. Less pain signifies a reduction in mass size, which is exactly what we’re going for. 

Continued reduction in cancer cells, until there is nothing left but a healthily functioning body... Anyone out there down to visualize that with me?
Additionally, my most recent lab work shows an improvement in the blood markers that we’re tracking. Prior to treatment, my LDH (lactate dehydrogenase), which indicates tumor growth — which is normally 140-280 units per liter in healthy adult blood — had risen from 344 in early June to a maximum of 570 just before starting chemo.

One week into treatment, my LDH had dropped to 429, and in my most recent labs at the end of round one, has fallen even further, to 181, well within normal range!

So far, my body seems to be doing pretty well with treatment — at least relative to what I know is possible. I’ve felt weaker and more easily fatigued than I am used to, as the chemo drugs have been targeting all rapidly dividing cells in my body (not only cancer cells, but also some of the healthy ones like blood cells and hair follicles, which are some of the most quickly dividing cells in the body). 
As I continue to shed my stubble and even body hairs, the message sinks in further still: I have a ways to go on this healing journey.
Two weeks into treatment, when I sent out that initial email, I had a full head of hair. Over the next couple of days, though, I began to notice some locks falling out when I ran my fingers through. With the type of chemo regimen I’m on — known as BEP (bleomycin, etoposide, and platinum) — hair loss is common. So I decided to lean into the process and shave my head. This photo is from a previous head-shaving back in February, on Lunar New Year, right after my surgery, with Satya as my barber. She was there for most recent trim as well. 

And yes, you read that right: I literally have platinum flowing through my veins. Can you say "bling bling"?

I’ve been pretty blessed, at least so far, with very little nausea (I’ve reached for the anti-nausea medication they prescribed me only a couple of times) and a pretty strong appetite. My weight is about the same as it was when treatment began, and I haven’t needed to vomit yet, which is encouraging. At the recommendation of some local friends, I signed up with Ceres Community Project, a local nonprofit that delivers healthy, locally grown, organic meals to people dealing with serious illness. I’ve also enjoyed some meal deliveries from Thistle thanks to a gift from several of my coworkers, along with some dank home-cooked meals prepared by my mom and friends, as well as some choice local burritos, Thai food, and one trip to Ike’s Love and Sandwiches.

According to members of my medical team, the fatigue is likely to increase through subsequent rounds of chemo. The toxicity of the medicine is likely to accumulate, take its toll, and require some time to recover from. But I also understand it is likely that the gastrointestinal effects of chemo will be consistent from one round to the next. I hope that's true.

Whatever the cost, what I really desire is full recovery. Above all, I desire, and choose, to live. I can survive side-effects and I will bounce back from this. I am — WE ARE — resilient!

Diet and nutrition have been on my mind a lot lately, and I’ve sought the advice of a couple of integrative nutritionists (and begun to sort through the oft-conflicting messages out there regarding what is healthy to eat and what isn't). As I’ve gradually awoken to my new reality, I’ve noticed a strong desire to support my body and its healing as much as possible. I was already enjoying a mostly plant-based diet, but I’m increasingly choosing sugar-free and vegan fare, featuring as much raw aliveness (and fresh green juice!) as possible.

The way these rounds of chemo work (at least in my case), is that after a full week of daily infusions, I take two weeks off to recover, but go in every single Monday for additional, quicker treatments. On my second Monday, a couple of weeks ago, I had a really rough day. I woke up feeling pretty good, loaded Phoenix in the backseat, and went in for my shot. Afterwards, I was feeling plucky. I was a few days into being relatively pain-free. I was hungry for a good meal and I had a taste for adventure. 
I drove from sunny Greenbrae out to foggy Point Reyes, the western tip of the Marin coast, and took a lesser-known side trail out to the lighthouse. On the way, I met a herd of at least 16 wild Tule Elk. If you zoom in behind Phoenix, you may notice a few of them. After lunch on the road, we began the 90-minute drive home. And about halfway into that drive, I was feeling majorly sore in my back and hips. 

By the time I got home, I was aching deeply. I laid on the sofa, and when I took my temperature a bit later I found that I had a 101.3° fever. Instructed to phone the on-call physician with anything over 100.5°, I called up and was told to take some Tylenol and do my best to treat the fever at home over the next hour. If it didn't go down, I would need to head into the emergency room. I took that acetaminophen, hydrated majorly, applied some ice, and wrapped up Season 2 of All American on Netflix (for some reason, teen dramas have been my jam lately), and within an hour my temperature was down to 99°.

But the experience was a strong reminder that my body is going through something major here, and that I need to be taking care, slowing down, and paying closer attention. 
I spent 4th of July weekend in my hometown of Pacifica with Satya, visiting my mother and stepfather and enjoying some fireworks in a place with more ambient moisture than my current home in tinder-dry Sonoma County. I must have been feeling good, because we stayed up late lighting sparklers, dancing around “lightning flash” strobe lights, and chucking ground bloom flowers — and I jumped over my share of fountains. It was a welcome change of scenery. But I also spent a couple of nights there struggling to sleep, feeling a throbbing in my back I didn’t really want to acknowledge.

As much as every cancer patient (indeed, every afflicted creature) wishes for instant relief and whatever 'magic bullet' will bring about the quickest path to health and thriving, my body also continues to remind me that I am very much in a major fight. As I continue to shed my stubble and even body hairs, the message sinks in further still: I have a ways to go on this healing journey.

Sending out that first email last week was a major, symbolic step for me. Since then, I’ve been really lifted and deeply honored by the outpouring of support I’ve seen. I feel so much gratitude for the phone calls, emails, texts, and social media comments I’ve received since I began to share what I’m going through. From the bottom of my heart, I thank you for reaching out with your kind words of connection and care. I feel so firmly held by this community, and it really helps strengthen my hope and resolve and trust in this mystical process. I love y'all!

I’ve also been blown away by all the donations that you’ve made to the fundraiser that my friend started to help support me on this journey. Less than a week after sending that email, the fundraiser cracked $10,000, which will be a big help in not only defraying the medical bills I’ve already incurred, but helping with rent, transportation, and perhaps most importantly, making other complementary therapies more accessible.
According to my medical team, even with the best outcome of a complete remission (which is exactly where we’re headed, insh’Allah), there will be years of follow-up monitoring via bloodwork and costly imaging. I trust and believe it will be worth it.

With the gracious help of a caring hospital social worker, I’ve begun sorting through the complicated and confusing world of disability forms, as this rigorous healing journey is requiring me to be on medical leave from work for the time being. I am grateful to be employed in a professional community of amazing educators who have reflexively picked up the slack left in my absence and encouraged me to focus in on my healing. Even so, I anticipate my income to be substantially reduced in the coming months as I bounce back from this, and your donations are really going to make all the difference in helping me and my family through this difficult time.

So thank you!!! 
I had this dream last week (most of my nights lately have been replete with rather vivid dreams) that I need to tell you about.

In this dream, I was living in a Shasta-esque Old West logging town in Northern California. I had cancer in the dream, but I was also a young child, about Satya's age, in a poor family.

In the scene I recall, these scruffy, cowboy-looking men showed up in my home and were welcomed in by my parents. One of them handed me a small leather pouch full of old-fashioned gold coins. The man identified his posse as “the Cancer Bandits,” and he explained that they redistribute resources, taking from the rich and giving to those who are struggling.

“As long as some people are suffering and some have plenty, we’ll be there to make sure the good is shared and people like you have what you need,” he said.

I kid you not. My subconscious mind, or spirit, or whatever you want to call it, cooked this up. And in this dream (as in real life right now!) I felt deeply touched by the support and held in community. I felt safe, like someone was looking out for me. 

Thanks to all of you for being my Cancer Bandits.

In my next email, I’ll continue to update you on my journey and unpack some of the deeper aspects of healing that have been arising for me in this dance with cancer. I really feel like I’m just starting to get my bearings in this fight — either that, or I am somehow becoming more comfortable in this state of utter groundlessness. In any case, we are just beginning to peel back the layers of this onion. 

And I trust that there are plenty more tears to come.

Thank you for sharing them with me!

With immense love and gratitude — at least enough to outshine the immense fear and sadness that is also a part of this journey — I remain yours, 

In community and kinship,

Nils

Human in Solidarity. Savorer of Moments. Grateful To Walk the Path.
Previous post:
I just started chemo.
I wish I could be writing under happier circumstances — but even in our trials, there is cause for joy and gratitude. This January, I was diagnosed with testicular cancer. This is my story.

Inviting Contributions to My Healing Fund
I'm already several thousand dollars deep in medical expenses, with more to come. Please consider making a one-time donation to support me and my family through this unexpectedly difficult year.

It's all LOVE!