In March 2016, at the age of 35, I was diagnosed with Stage IV stomach cancer. Only 3% of patients live 5 years or longer after receiving this diagnosis. Most die within the first year. I have a beautiful wife and two young children. This blog chronicles my experiences with cancer and the lessons I learn along the way.


Radiation review; Melissa's new business

Lots has happened since my last blog update! We had a wonderful and relaxing Christmas break with family and friends. My parents visited from Washington for about 8 days over Christmas, and we had some friends visit us shortly after Christmas for a few days as well. It was relaxing and enjoyable to reconnect with family and friends, and to have several weeks to spend time with my family and to just enjoy being together.

The radiation machine I received my treatments in

On December 30, I had the first of 8 rounds of radiation, and completed the 8th round on January 11th. For the most part, I was spared the unpleasant side-effects that often come with radiation, save for an unbelievable amount of fatigue. After the first few radiation treatments, I was often so tired during the day that I simply moved from bed to couch and back again most days. Mentally and physically, it felt as though someone opened a spigot on my body and simply drained out all of my energy. Today, although I'm still feeling some of the lingering effects of the radiation related to fatigue, I'm certainly on the road to recovery and regaining a more normal energy level.

We are also incredibly thankful that my radiation oncologist was able to carefully target the radiation so that my kidney was largely spared from unintended effects of stray radiation. Initially, he was concerned that I might lose as much as 50% of my right kidney function due to the proximity of the kidney to the cancer tumors that needed to be radiated. Keeping my kidneys operating as well as possible is really important for me, as the kidneys are needed to process the toxic chemotherapy treatments that I'm also receiving for my cancer.

So far, the radiation seems to have worked remarkably well. The severe back pain I was experiencing due to the growing tumors in my back muscles and near my spine completely disappeared after only three rounds of radiation. I've been able to drastically reduce my use of narcotic pain killers since the radiation treatments have been completed, and I think I will soon be able to stop using them completely. This is a huge answer to prayer, and we are so thankful for the many of you who have been praying with us toward this result.

Today, I consulted with my medical oncologist at MD Anderson who recommended slight changes in my chemotherapy regimen based on the tumors that were non-responsive to chemotherapy in my last scans. Her recommendation is to drop the 5FU from my regimen and add a drug called Paclitaxel to the Irinotecan that I am currently taking. Hopefully, these drugs will work well together to continue to shrink the tumors in my lymph nodes and stomach. Sometime this week or next, I'll have a CT scan to provide a new baseline of where my tumors are, and then next Wednesday (January 25th) I will start receiving chemotherapy treatments again with the updated regimen.

Ever since my diagnosis, one of my greatest fears has been leaving my family in a poor financial situation when I die. Although I have a life-insurance policy, it isn't one that will provide for my family's needs long-term. (Honestly, who thinks to get a million-dollar+ life insurance policy before they turn 40?) Side note: If you are the main breadwinner for your family, and you don't have a life-insurance policy that will care for your family's needs long-term if something should happen to you, stop reading this and go get some life insurance right now. You never know what your future holds - please learn from my mistake.

Over the past several months, Melissa and I have been working together to start a small business that may be able to provide some income for her and the kids on an ongoing basis. After several months of research, planning, product testing, and negotiation with various product manufacturers, we have launched our first product for our small business, Sharktooth Brands.

For many years, I've used single-earbud headphones to listen to music and podcasts in bed as I'm falling asleep. I like a single earbud for this purpose because I can keep one ear on my pillow, and one ear with a bud in it without having a second earbud flopping around. For quite some time, I would simply buy cheap earbuds and cut one off, but I found that solution to be sub-optimal, as produced audio often has different audio coming through the left and right channels. 

I discovered several models of single earbuds on Amazon, some of which do the stereo-to-mono conversion necessary to ensure that all of the audio is heard as intended, even when listening through a single earbud. Over the years, I've purchased several of these single earbuds, but never found one that I really liked. As such, when Melissa and I were looking for our first product for our new business, we decided to try designing and manufacturing a single earbud that would overcome the deficiencies I experienced in the existing versions available online.

We were able to find a contract manufacturer in Hong Kong that would custom-design a product for us, and about three months ago, we began selling our version of a stereo-to-mono single earbud on Amazon.com. Sales of our product have been going well, and we're just a few months away from making a second order of units from our supplier in Hong Kong.

Interested in helping our new business?

If you're interested in helping our new business grow and improving our sales, one thing you can do is buy our earbud and write a review on Amazon.com. One of the primary drivers of sales on Amazon.com is the number and quality of reviews that an item has. If you think our single earbud is something  you might use, you can help us tremendously by purchasing one and writing a review. Here's how to do it to provide us with the maximum benefit in Amazon's search indexing algorithm:

1. Visit amazon.com and use one of the following search terms to look for our product:

single earphone

single ear headphone

single earbud

single headphone

With some of these terms, you may need to search through to the second or third page of results to find our product. In the search list, it will look like this:

Amazon listing for our single earbud

2. Once you find our listing, click on the product, and purchase it. Every time someone uses one of our top search terms and then clicks on our listing and makes a purchase, Amazon uses that information to associate our product with those search terms, and eventually, our product moves higher in the search results for these keywords and related search terms. Obviously, the higher we can move in the organic search results, the more likely people will be to find and buy our product.

Note: For those of you with Amazon Prime, you can purchase our earbud with free Prime shipping. If you aren't an Amazon Prime customer, you can still get free shipping: Instead of using the "Add to Cart" button, click on the link that says: "New (2) from $19.95 & FREE shipping " under the "Other Sellers on Amazon" link, and you'll find the option to purchase with free shipping for non-Prime users.

 3. A few days after your receive your single earbud, you'll get an email from Melissa inviting you to write a review of our product on Amazon. This is the most important step if you want to help our business grow. One of the biggest drivers of Amazon purchases is the number of positive reviews a product receives, so we're working hard to increase our reviews. Unfortunately, only about 2% of Amazon buyers actually write reviews, so even when you sell a large number of items, it takes a long time to collect reviews. When you get that email from Melissa, please click on the link and write us a review! Tell us what you actually think about the product, and if you can include pictures and video in your review, even better! Amazon buyers use these reviews to make informed purchase decisions, so the more detailed your review, the better!

NOTE: Please DON'T write a review for us if you don't actually buy the product and try it out. This is against Amazon's terms of service and could lead to our account being suspended, effectively shutting down our business. Further, Amazon's new algorithms basically remove non-verified reviews from the calculations used to determine a product's popularity and rank, so if you review our product without actually purchasing it, it won't really count for us, anyway. Also, please don't search for our product and view the listing unless you actually intend to buy it. This lowers our "conversion rate" (i.e., the percentage of people who purchase our product after viewing our Amazon page), and Amazon will move our product lower in the search results as a consequence.

We are excited about the possibilities for this new business, and we are actively looking for the next products we will offer in our Amazon store. Thanks in advance to any of you who decide to try out our product and write a review for us - we really appreciate it!

We also continue to be SO SO thankful for the many of you who continually pray for us. Please remember the following requests in the coming weeks:

  • That the radiation treatments will prove to be effective at eliminating the tumors near my spinal cord and kidney.
  • That the new chemotherapy regimen will shrink the tumors in my lymph nodes and elsewhere in my abdominal cavity.
  • For strength and endurance as I return to full-time teaching this week.
  • For strength for Melissa as she continues to bear a majority of the burdens related to running our household and caring for our children.


MRI results; radiation treatment plan

Based on the results from my most recent CT scan at MD Anderson which showed a new mass near my spinal cord that doesn't seem to be responding to my current chemotherapy regimen, I had an MRI last week to get a better view of the area.

Yesterday, I meet with a radiation oncologist at UT Southwestern Medical Center here in Dallas to get his opinion of the MRI and to determine whether or not radiation treatment is needed in my case. I am opting for treatment here in Dallas because the radiation treatment will likely require 10 or more consecutive days of treatment, and travel to Houston for that duration of time would be expensive and impractical. My radiation oncologist at UT Southwestern is one of the very best in the country, so I am certain that the care I receive will be on par with, if not better than, the treatment I could receive at MD Anderson.

The MRI showed that the tumor is growing dangerously close to my spinal cord, and appears to be moving toward one of the areas where nerves leave the spinal cord for destinations further out in the body. Left untreated, the cancer could move into my spinal cord, ultimately leading to paralysis from the waist down. Further, there is another group of tumors that encircles the artery that supplies blood to my left kidney. Left untreated, it could cut off the blood supply completely, leading to the loss of my kidney. The radiation oncologist was optimistic that targeted radiation therapy could kill these most concerning tumors that don't appear to be responding to chemotherapy. 

Tomorrow, I will go back to UT Southwestern for a planning session where they take additional scans and plan for how they will specifically target the radiation to eradicate these tumor groups in my body while attempting to avoid damage to my other organs. Based on his plan, my doctor disclosed that I will likely lose some of my kidney function (it simply isn't possible to hit the tumors where they are without damaging the kidney), but he is hopeful that it will be minimally damaging. I will also likely have some unpleasant side-effects due to the radiation affecting parts of my stomach, bowel, and intestines, but these should be fairly short-lived.

As of now, the plan is for me to continue with my normal chemotherapy regimen next week, and then begin radiation treatments shortly after Christmas. This is certainly not the way I planned to spend my Christmas break, but the timing works out well, and I should be recovered enough to teach classes as planned in the coming Spring semester.

The past few weeks have not been without fun for our family. Last night, Texas Oncology gave our family the opportunity to present the game ball at the Dallas Mavericks game, so we enjoyed great seats and the first half (small children can't stay awake for a whole basketball game) of the Mavericks-Pistons game.

Rob, Melissa, and Raegann at the Mavericks basketball game

We also had the opportunity last week to go visit ASCO equipment and drive some of the construction equipment that they offer for rent and for sale. Someone from ASCO heard my interview on the Kidd Kraddick morning show several weeks ago, and after hearing that Matthew and Raegann both love big trucks and construction equipment, offered to let us come out to one of their locations to drive some of the trucks. Matthew, Raegann, Melissa, and I had a great time driving a wheel loader, a backhoe, and an excavator, as well as moving around some dirt and digging some holes.

Our family with the construction vehicles we got to drive

As a family, we are looking forward to the Christmas break and the opportunity to spend more time together. My parents will be coming to visit for about 10 days over the holiday, so we are looking forward to spending time with them as well.

We are continually grateful for those of you who continue to pray for us. Please keep the following requests in mind:

  • That the radiation treatment will be effective at killing the tumor groups that aren't responding to chemotherapy.
  • That the side-effects of the radiation treatment will be minimal and short-lived.
  • Strength for Melissa as we move into the busy holiday season and as my energy levels don't allow me to contribute to the household duties as much as I would like.
  • For joy and peace during this Christmas season. We have so much to be thankful for!

Follow-up at MD Anderson; Good news and terrible news

Yesterday, I returned to MD Anderson Cancer Center in Houston for labs and CT scans, and this afternoon, I met with my oncologist to hear the results.

All dressed up for the CT scan

First, the good news: My second-line chemo treatment with Irinotecan and 5FU has dramatically reduced the size of my cancerous lymph nodes. Even my untrained eye was able to see a pretty significant difference between the scans from 8 weeks ago and the scans from yesterday. This is a great result, and a huge answer to prayer.

The terrible news: the cancer has spread into the muscles in my back, wrapping around my spinal cord. Per my oncologist, this is a pretty serious and urgent development that requires immediate attention. My team at MD Anderson is scrambling to secure referrals to a radiation oncologist and a neurosurgeon to try and evaluate the best course of action for treating this new localized cancer. Basically, those physicians will need to decide whether it would be best to try and zap the cancer near the spinal cord with targeted radiation, or whether it would be best to surgically remove it. Right now, my oncologist suspects that radiation will likely be the best course of action in my case.

Immediately after leaving MD Anderson, I made calls to one of my second-opinion doctors at UT Southwestern Medical Center in Dallas to get a referral for an MRI and to a radiation oncologist and neurosurgeon. Ideally, I’d like to be able to have whatever treatment is needed in Dallas, especially if it will require overnight hospital stays (surgery) or multi-day treatment (radiation will likely be a 10-day sequence).

Obviously, it was hard to hear the news of the cancer spread and the seriousness of its location near my spinal cord, but we rejoice in the effectiveness of the chemo at shrinking the other lymph node sites throughout my abdomen. We continue to trust in the goodness of God, and know that He is sovereign over all, no matter our circumstances.

Thank you to all of you who continue to pray for us so diligently. Please remember the following requests in the coming weeks:

  • That the necessary appointments will be able to happen quickly to schedule the necessary radiation or surgery to treat the cancer near my spinal cord.
  • That the Irinotecan and 5FU will continue its effectiveness at shrinking the cancerous lymph nodes and other tumors in my abdomen.
  • For Melissa, as she cares for our children and deals with the effects of cancer both in her husband and in her mom.


New chemo regimen review; So many blessings

Last Wednesday, I received my third infusion of my new chemo regimen with Irinotecan and 5FU. My body's response to the new drugs has been interesting. For the most part, the side effects of this new regimen are not nearly as severe as those I experienced with the Oxaliplatin and 5FU, but they are longer lasting. In other words, with the Oxaliplatin regimen, I could expect five days of misery following an infusion, followed by 6 to 8 days of feeling nearly normal. Now, with the Irinotecan treatment, I don't have the extreme battles with nausea, pain, and general discomfort that I experienced previously, but instead have less-severe side-effects that seem to last all the way until my next infusion.

Like most chemotherapy regimens, the Irinotecan causes some nausea, but in my case that has been well-controlled with anti-nausea medications that I can take orally during and after my infusions. It also causes some pretty extreme intestinal discomfort, but with a time delay of about 5 days after infusion. This lasts for a few days, and is manageable. I am experiencing fatigue with the new chemo, and find that I'm taking naps more frequently and going to bed by 8:30 most nights. The biggest side-effect that I'm dealing with has been a complete loss of appetite. This is a fairly common side-effect of the Irinotecan, but it's an especially bitter pill for me, a lifelong lover of food in all its forms. It's hard to have to force myself to eat at virtually every meal because I just don't ever feel like eating. My weight, which was fairly stable all through the Oxaliplatin treatments, has started to decline due to my lack of appetite and difficulty eating.

My sciatic nerve injury has slowly been healing. I visited a specialist to make sure nothing more serious was causing the pain, and he confirmed that it was just a reinjury of the sciatic that would take time to heal. He prescribed me with another steroid dose-pack which has certainly made the healing progress more quickly. I am sleeping better at night, and experiencing a lot less pain.

Decemer 1-2, I will again travel to Houston for CT scans and follow-up at MD Anderson. We are hopeful that this new regimen will prove effective at shrinking or stabilizing the cancer growth in my body. This new regimen is unique in that it does not have any additive side-effects, so I can stay on this chemo for as long as it is effective without any problems. For this reason, we really hope that it is effective and stays effective for a long time. Every switch to a new treatment protocol comes with it the possibility of reduced effectiveness, until eventually you run out of effective treatments altogether.

The semester is nearing its conclusion here at University of Dallas, so my mornings are usually consumed with either teaching, meeting with students, or grading. I tell people all the time that I teach the best students in the world, and I become more convinced of this with every interaction I have with the wonderful people I get to serve in the classroom each week.

For example, several weeks ago, I noticed students walking around campus with beautiful embroidered fabric bracelets that read "Pray for Dr. Yale." Upon investigation, I disocvered that one of my amazing former students, Stephanie Lobo, designed these bracelets and had 1000 of them produced to remind people to pray for me and my family. I am so blessed to have such a supportive student community behind me through this fight. It is encouraging and humbling at the same time.

"Pray for Dr. Yale" bracelets designed by a student

The past few weeks have also included a number of events that have been true blessings to me personally and to my family. Two weeks ago, I received notification from the Provost's office that I was nominated by a colleague and selected by a committee to be the University of Dallas nominee for the Minnie Stevens Piper Foundation's Piper Professor Award. Each university in Texas can nominate one faculty member each year, and the Foundation annually honors ten college teachers in the State of Texas for their superior teaching. Knowing the quality of the faculty here at University of Dallas, including those who have been nominated or named Piper Professors in the past, I consider it a huge honor to be thought of as even in the same ballpark in terms of teaching effectiveness as many of my esteemed colleagues.

In another unexpected blessing, last week, I received a call one morning from the Kidd Kraddick Morning Show. One of my classmates from an MBA class that I took two years ago nominated our family to receive a Christmas Wish. You can hear the radio interview here. In any case, I was completely surprised and honored to be nominated to receive gift cards for Toys 'R Us and some cash to make Christmas extra-special for the kids this year.

Melissa continues to amaze me with her ability to keep our household running smoothly when I'm mostly unable to share in the household duties as I normally would. She is so strong and capable, and I am so blessed to be able to share my life with her. 

Several months ago, we started a business together with the hope of it being able to provide Melissa and the kids with some income once I'm gone. Our first product is now on the market, and we are hopeful that sales will continue to grow as we begin marketing more aggressively. I'll write more about the business in a future post for those of you who are interested.

We continue to be blessed by wonderful neighbors who bring us meals, by friends, family, acquaintances, and strangers who encourage us, and by a growing community of folks who pray for us regularly. I am doing my best to make the most of every day that I have, and never taking any second that I get to spend with my family for granted.

For those of you who continue to pray for us, please remember these specific requests:

  • That the Irinotecan and 5FU will be effective at shrinking my cancer
  • For Melissa as she bears the burden of being a single-parent much of the time
  • For improved appetite and slowing of my weight loss
  • For peace and patience as we wait.


Emergency Room Adventure!

This week has been... interesting.

Late last week, I started having pain in my back. Not pain related to my growing retroperitoneal lymph nodes, but nerve pain that felt like it was caused by an irritated sciatic nerve. I injured my back more than 10 years ago and had a long bout with sciatic nerve pain, so I'm familiar with the symptoms. Over the years, I've had a few relapses where the pain returned.

This time, it started out fairly mildly on Thursday or Friday evening. I used a heating pad to relax the muscles, and for the most part, other than some discomfort which shifting from sitting to standing or vice versa, I was able to function normally, despite the pain.

Over the weekend, the pain continued to get worse as the sciatic area became more and more irritated. This culminated early Tuesday morning when I woke up at 12:30am with my whole back entirely seized up. It was so tight and painful that I couldn't move much more than my toes. I was unable to roll over, sit up, or do anything that required the use of my completely frozen back muscles. 

I woke up Melissa and we tried to figure out what to do. We briefly considered calling an ambulance, since my pain level was around a 9 or a 10, and any sort of movement just made it even worse. Eventually, Melissa was able to roll me over enough to place a heating pad under my back, and after about 30 minutes, the muscles began to relax. I still wasn't able to move very easily, but as long as I stayed still, my pain was under control.

Thankfully, Melissa's college roommate and dear friend was in town, and Melissa was able to call her to come over and stay with our kids while we went to the ER. It was a slow and painful journey to the car, and I ended up riding in the cargo area of our Toyota RAV4, sitting on my knees with my torso draped over the back seat for the two-block drive to the local hospital.

When we arrived, I was checked in and evaluated. They put me flat on a bed, which seemed to be the best position for eliminating the pain.

Lying in the bed in the ERAfter taking my history, the ER doctor gave me some Valium as a muscle relaxer, assuming that the pain was muscular in nature. After a few hours, they gave me a CT scan to look for a cause of the back pain, but the scan didn't reveal any musculoskeletal cause.

I was prescribed more Valium to use as a muscle relaxer, and after walking around in a circle in the hall to demonstrate my mobility (albeit still with extreme pain standing and walking), I was released. In truth, I spent 6 hours in the emergency room, and was not doing any better upon discharge than I had been when I arrived.

I rode back home in the cargo area of the RAV4 and slowly, painfully, made it back to bed. I had grand visions of the back pain retreating enough for me to be able to teach my classes on Tuesday morning, but by 8am, the pain was so debilitating with movement that I couldn't even move well enough to get out of bed. (I'll spare you the details of the alternative use I discovered for empty plastic applesauce containers).

I rested in bed for most of the day on Tuesday, and was able to get an appointment to see my chiropractor at 2PM on Tuesday. At this point, the pain was so bad that I literally crawled on my hands and knees from my bed to the back of the RAV4. This time, we removed the car seats and put down the back seat so I could lay flat in the cargo area for the 15-minute drive to the chiropractor.

Selfie from the cargo hold of the RAV4 en-route to the chiropractor

When we arrived, Melissa went in to check-in for my appointment and explain my situation. Rather than having me come in, one of the doctors came out to evaluate me, and recommended that I stay in the car and go home rather than being adjusted. In my condition, he explained, an adjustment would just further aggravate the inflamed sciatic nerve and increase the length of time it would take to heal. He explained that emergency room physicians are usually not well trained in dealing with back pain, and so they end up prescribing muscles relaxers and pain killers, which do absolutely nothing for sciatic nerve inflammation.

He recommended I go home and give my back at least 72 hours of rest, icing my back for 30 minutes, waiting an hour, and starting over. He also recommended contacting my doctor and requesting a prescription for a steroidal anti-inflammatory drug that would help calm down the inflammation of the sciatic area.

Thankfully, my physician was more than willing to prescribe an anti-inflammatory, and so I spent the rest of the day Tuesday and all day Wednesday icing my back regularly and taking the prescribed medications.

By Thursday morning, although still not at 100%, I was able to get up and move around, take a shower, and get dressed to teach my classes. I wore a back brace for the morning to provide extra support, and I was able to teach both of my classes with minimal discomfort. By early afternoon, some of the pain was returning, so I went home early and have been resting my back and icing it again. I am hopeful that another day or so of rest will return things to normal once again.

Thanks again to all of you who are so faithfully praying for us and encouraging us in so many ways. We love you all.

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