A celebration of life will be held on Saturday, May 5, 2012, 1:00 p.m

Gabriel "Mark" Pace III, 49, passed away peacefully on Good Friday, April 6, 2012, as a result of post surgical complications after a 6 year fight with stage 4 brain cancer (Glioblastoma Multiforme). His family helped walk him home to be with the Lord along with many special new and old friends.

Mark was born September 25, 1962 in Washington D.C. He grew up in Connecticut, graduated from Northwest Catholic High School and received a B.A. in Economics from the University of Connecticut. After graduation, he moved to California to pursue several sales ventures and made many friends. In 1993 he married Andrea Lackey and settled in Huntington Beach where they became parents of a son, Brock, in 1996.

Mark was a symbol of strength in many ways. Physically, he loved sports and made many friends through cycling, surfing, hockey, softball, frisbee, golf and tennis. He even had the highlight opportunity to be a professional tennis umpire at the US Open, Wimbeldon, the 1996 Olympics and more. Being healthy was a trait that he encouraged and shared with family, friends and even as the personal fitness merit badge counselor for the Boy Scouts of America. When he was diagnosed with brain cancer in 2005, Team Pace was formed with the motto “Viva Forte!” and he set out to not only fight physically, but he also mentally became a rock of hope and support for others facing new cancer diagnosis. Mark supported the Livestrong Foundation by riding in several 100 mile rides to raise money to fight cancer. He was granted the Messenger Award and was recognized as an Outstanding Fundraiser for the charity, getting to ride along side Lance Armstrong in the Ride for the Roses. Supporting a cause even closer to our hearts, Mark joined with several other GBM warriors and their families to annually raise money for UCLA Brain Cancer Research, which is a foundation that he fully credited for his long term survival with the disease. As summed up by Mark’s favorite biblical quote by James, "Consider it all joy when you encounter various trials, knowing the testing of your faith produces endurance."

Mark was determined to grow as close to the Lord as possible and be an example for others. He was extremely steadfast in his faith in God and was devoted to his church families. He has previously served as deacon, eagerly volunteered on the technical worship teams and even taught and participated in many bible study classes. He was currently striving to achieve a Masters from Talbot School of Theology at Biola University, where he became a friend and inspiration to many new students and teachers. Before his recent surgery, Mark had the opportunity to visit the Holy Land on a 3 week school trip to Israel. There he got to walk in the footsteps of Jesus, which was one of the big lifetime goals in his life.

Mark’s humor and kind spirit were loved by all and will be greatly missed here on earth, but as he rejoices in heaven, we can look forward to seeing him again. 2 Timothy 4:7-8, He fought the good Fight; he finished his Course and kept the Faith. He is survived by his wife, Andrea and son, Brock; parents, Gabriel Pace (Susan) and Rosamond Lawson (Al); sisters, Deborah Pace Sitzmann (Matt) and Sharon Pace Ward (Trevor); step siblings, Mandy and Robert Lawson; and several aunts, uncles, cousins, nieces and nephews.

A celebration of life will be held on Saturday, May 5, 2012, 1:00 p.m. at First Christian Church of Huntington Beach, 1207 Main Street Huntington Beach, CA

There will be a reception immediately following at the Pace family home in Huntington Beach.

For more information on the service or reception, please email: andrea@pace-family.com

In lieu of flowers, the family is requesting that donations be made to:

UCLA Neuro-Oncology Brain Cancer Research

Check Tribute Gift and please list Mark Pace in the box:

https://giving.ucla.edu/braincancerresearch

Checks can also be sent payable to UCLA Foundation and sent to: Team Pace, 18352 Oxboro Lane, Huntington Beach, CA 92648

Livestrong Foundation

A family friend is riding in Mark’s honor:

http://laf.livestrong.org/site/TR?px=1035632&pg=personal&fr_id=1182&et=WD1LeRf_iVY3bCDOeQum-w&s_tafId=1507

He is also creating biking jerseys and workout shirts that commemorate Mark’s fight, contact Dave Aronson through Facebook for more details

Mark your calendars!

Memorial services for Mark will be held on May 5th. Reception to follow at our home in Huntington Beach. Details on specific times and locations to be posted soon as well as donation information for those interested in helping our causes ;)

Mark is welcomed into the Kingdom of Heaven

Mark went home to be with the Lord the evening of Good Friday, which is a day that Mark believed would be a glorious day to leave this earth (as Christ did and also Mark's fellow GBM warrior Hank). Many friends and family were with him over the last few weeks to help walk him home and it was truly a blessing and gift to be able to share all of the wonderful Mark stories with everyone and see how much of an impact he made in this world and so many peoples lives. People that Mark didn't even know were changed by his strength, attitude, caring, smile and unwavering love for God. May he rest in peace & enjoy the Kingdom of Heaven for eternity and we will someday be getting to again hear his goofy jokes when we're all together again.

Hospice continues

Mark continues to be in hospice. We are sharing many moments with him day by day, have enjoyed hearing stories from close friends and realizing just how many people Mark touched in this world.

heart breaking times

The family is incredibly saddened and we are trying to come to grips with the latest news that hits way too hard....
Mark was diagnosed to have severe brain damage from the pulmonary embolism that triggered two cardiac arrests resulting in global ischemia and uncontrollable status epileptics from sustained lack of oxygen to the brain as well as residual effects from his crainiotomy to remove his most recent recurrent stage 4 brain cancer tumor (GBM) . Based on 2 weeks of continual ICU observation, clinical tests, EEGs and many many other medical results, over 6 doctors determined that he will not have any chance of meaningful recovery. Mark has just today been moved to a hospice care facility that is close to our home in Huntington Beach where we have spent our last 23 years together, he is comfortable and many close family members are here with him loving him up.

latest

Unfortunately, we're now on day 12 and Mark continues to remain unconscious in the ICU.

slightly less on the seizures

Seizure activity does show signs of lessening since he got his dose of the stronger med but still seeing some spikes. Vitals are still good and his temp was below 100 most of today and his arms and hands felt normal. Still waiting to see if there was any indication on cause of blood infection, results not definite yet. His skin was checked and looks good. Our UCLA and ICU team both agreed that they need to try to stop the seizures in order to see how Mark can respond without them. EEG does show baseline brain activity which is why they're trying so hard to control the seizures so he can respond. Today they also put in a central line which will be more comfortable for him rather than having to stick him for meds and blood draws. He will keep the EEG on all night so they can monitor throughout the evening. Mark still looks good, it seriously just looks like he is sleeping (with lots of tubes). He looks totally relaxed and his coloring looks great. He's definitely the most handsome patient in the ICU! Still waiting for him to wake up and start cracking jokes :)

continued seizure activity

Vital signs still good, still has low grade temp. Tests have not yet concluded the source of the blood infection. They did restart the feeding, but slowly. Unfortunately, today's EEG was showing consistent seizure activity, even with the 3 meds he is on to control it. They are not visible seizures, but are happening in pretty consistent intervals in his brain. There is still brain activity, so they are adding a 4th strong medication to help his brain stop seizing. CT scan did not show blood or extra fluid in the brain, but is consistent showing the damage from lack of oxygen that we'd seen before from the codes. The posturing we are seeing is related to his brain activity and not excess fluid. Dr Chen did consult with Dr Cloughesy and they agreed that the added med was the next step needed to get more aggressive at controlling the seizures. Dr. Chen assured me he is not feeling any pain right now and with all the seizure medications he is currently not aware of what is happening and is comfortable. We'll be monitoring him for the next couple days, but he will definitely be sedated while on the strong med.

new week, hopefully no new challenges

At the time of the last post, the blood cultures weren't showing any growth, but by the next morning it does appear that there is an infection in the blood. The doctors thought they'd be able to stop antibiotics, but with the new findings they now know which one can target the infection that he has. Test are still out to see if they can determine the cause of the infection, but it is known to be in the blood. Pneumonia and urinary infections have been ruled out for now. He still isn't showing response to the pain tests where they put pressure on his nail bed to get a reaction. Normally when they do this test, a signal is sent to the brain and it triggers the reflex to pull away. They have stopped the feeding a bit for now, because he body doesn't seem to be processing it all yet and it can pile up in his belly. They are also trying to help him make it pass (nicest way I can say it). A lot of times when the body is in trauma, it focuses on the vital organs and the stomach isn't one of them and it can decline to pass things through without a little help. I did feel a couple of thumb squeezes yesterday, but the nurse advised the grip is a normal body reflex and it may not necessarily be triggered by command or response to me. :/ We don't have to believe her though. Also, over the weekend while I was there he demonstrated what is called posturing. This is where both arms stiffen and the shoulders roll in a bit. This is typically an indication that the brain is hypersensitive and sick. :( The nurse recommended no visitors except me and immediate family for now since he is extra sensitive to stimulus. Today Mark had a bite blocker in his mouth because he was trying to bite down on the breathing tube. The neurologist will be again conducting an EEG and a CT scan on the brain and I'll hopefully have some results this evening. Depending on the results he may try to ween down the seizure meds again that could may help him wake up a bit more. His lungs seem clear, his coloring is good and vitals are good. He still has a low grade fever but tylenol seems to help a bit.

hoping for a restful uber healing weekend

Saw the neurologist again before leaving last night. He again mentioned that his brain activity logs were pretty consistent He said there were a couple spikes earlier on that may have been slight seizure activity so he had increased seizure meds a bit to help control. He had mentioned this before, however, this time he also added that the increased dosage can have a sedation effect. This probably explains why he seemed less responsive yesterday. They said they were going to stay at that dosage to help control and seizure activity to allow the body to heal for the next 48 hours. Today things remain pretty much unchanged. His temp is again around 100 and dropped to 99.7 while I was there. After the blood cultures came back, Dr Singh determined there was no presence of infection causing the low grade fever, so antibiotics were stopped...thank goodness, Mark doesn't really need any more things to fight at this point! His vitals are good. He had a slight twitch in his left thigh the neurologist watched throughout the day, but it was suspected to be seizure effects and the meds were upped slightly to help...which they did. He continues to show active salivary glands which results in alot of suction. Pretty sure we saw some slight arm and finger motion yesterday and when Brock and I visited this evening, we think we got a few slight finger squeezes from his left hand. His eyes were slightly open this morning for me, but he definitely looked like he wanted to keep them relaxed this evening.

road to recovery is slow going

Spoke to the neurologist this morning about yesterday's tests. Results of the SSE show that there is some connections in his arms, but it didn't show too much in his legs, at least for now; however, he said that Mark's legs are really tight right now that can explain the readings. The MRI does show that there is some damage to the right side of his brain; however, it does not show a major damage that is not healable like what you would see from a stroke. Because his brain now has damage on the right as a result of his code AND his brain has damage on the left that is trying to heal from surgery, his body is really trying to repair itself which is why he is not jumping right up to tell us jokes! Add on top of that his body is ALSO dealing with the pulmonary embolism in his lungs...his body has to fight exponentially hard! We are continuing the heprin drip to control the clot in the lungs while Mark's body buckles down to heal his head. The doctor's goal is to have him continue to rest and repair, remain stable over the weekend and the next milestone is to see how he is doing in days 7-10...in his words, "we're ONLY at day 5." He also exclaimed that from what he sees in the brain scan, the damage he sees there he would not label as terminal. We'll continue to see what more we can learn today

Here's an unexpected surprise. My brother-in-law did a search on Mark's name and we found this video piece that was recorded a few months ago. Funny thing is, none of us have ever seen it...including Mark!
http://www.youtube.com/watch?v=F94s8Tmxpm4

Also, here's an article we dug up as well:
http://articles.hbindependent.com/2008-05-07/features/hbi-pace050808_1_brain-cancer-life-expectancy-team-pace

the eyes have it

Last night as we were leaving, it seemed that he opened his eyes the biggest we've seen yet....almost got to see part of his iris. When Brock was saying good-bye, we think Mark was trying to give him a thumbs up. :) Today I spoke with the neurologist. He said that the eeg log looks pretty good and today he'll be ordering up an mri. He'll also be getting a sensory test (SSE) that will measure how the brain and spine are communicating with other parts of his body as well as another eeg. They say that all his reflexes seem hyper sensitive and there is a lot more "coughing"...translates to Mark has super active salivary glands so we're having to suction quite a bit. The nurse even showed me how to do it! This morning I was reading him all of the facebook posts and he really was trying hard to open his eyes. I saw alot more of his iris and now we're trying to see if he can work to focus his eyes purposefully. It seems like it is alot of effort for him to pull those lids up. Haven't felt much squeezing in his hand today, but today seems like he's really working to bat those eyes at us ;)

still waiting

Today's brain scan still confirmed that there is no new bleeding in the brain. His fever is still going between 100-101. We're still waiting for him to show movement and wake up. He is showing some more signs though and has been coughing (but not what you think)...coughing for some one on a ventilator looks like a terrible experience and pretty tough to watch, but is still a reflex motion that is hopeful to see. Today I saw more movement in his eyes and it looked like he would blink when I would touch over his brow. At one point I swear he was struggling to open his eyes, but it looked like it was quite difficult. Like every day though...there seems to be some surprise. Today the cuff of his ventilator was exhibiting signs of a leak which is not good and could prevent his lungs from getting all the oxygen they needed. They said it is kinda rare to have this kind of problem with the equipment, but it did seem to happen. They called in the anesthesiologist and replaced the tube asap. It was a pretty quick procedures, but I doubt Mark enjoyed it. We've been telling him stories and jokes all day. Tomorrow I will print out all the facebook wishes and read those to him. Still asking for extreme praying!

a bit calmer, but the wait is overwhelming

Mark just got back from the procedure that inserts the filter into his large vein to prevent further clots from getting to his upper body. They have stopped the phenobarbital around 8am which is the drip that put him in the coma to stop the myoclopic? bursts that were happening every few seconds yesterday. Since they stopped the drip he hasn't shown signs of any seizures. He still has a bit of a fever and is getting antibiotics to help fight any infection. They have been reducing the medicine that was bringing up his blood pressure and he has received the blood transfusion that was helping to up his platelet counts. He is still getting the medium dose of the blood thinner to help prevent the clot in the lungs from getting bigger. In a normal situation, they would give him a much higher dose to break up the clot and get rid of it, but because of his recent surgery, there is a huge risk of brain bleeding that can occur if he gets too high a dose. Doctors in UCLA and OC are consulting on best treatments. It is too risky to transport him to UCLA, so we'll be continuing to treat him here at Western Medical. Now we are waiting to see if he shows any signs of movement. Unfortunately, it can take 24-72 hours for the phenobarbital to get out of the system that would allow us to see movement. The waiting is incredibly stressful to see how his brain functions will be after this ordeal. Keep the prayers going!

latest news

Mark definitely has a large pulmonary embolism which look like what caused the problems. His heart looks good, he lungs look good and currently no evidence of clots in his legs. Normally they would give high dose of anti-coagulant to thin the blood, but because of surgery this is most likely not advised. He currently has a low dose, but there are concerns that the dose isn't high enough to prevent any more clots from forming and going to the wrong place. We are trying to get consent to put in a filter in the groin that can help prevent any clots from getting higher than the legs as a precaution. His blood pressure was a bit low so he's on medication to help get it up and he is currently running a fever which may be caused by urinary infection that they are looking into. We are also working to get Mark up to UCLA. Looks like he might get to go by helicopter..which is what we are hoping!

so far today

Dr Chen the neurologist is there this morning. Follow up cat scan shows no evidence of blood in the brain! Seizures have died down a bit with the treatment last night. Pupilar response, coronary response, nose hair response all good. They are backing away from some meds to see. Will have a followup eeg, to see if there is still further seizure activity. Dr. Liau does want him back at UCLA. We are waiting for stability test results and clearance before he can safely be transported.

major setback, prayers needed!

Today started out good, I talked to Mark this morning around 9am and he said he had a good breakfast, got to shower and shave and finally got rid of that goatee that was catching all the crumbs. He had some speech therapy and then on to physical therapy. They taught him how to get around in his wheel chair with his left foot and even got him to stand with a cane. After that he said, that he was a bit tired and asked to sit down. Once he sat, he collapsed and went into cardiac arrest. The emergency team went into action and got the paramedics and started CPR. His heart did stop while at the rehab hospital and again right when he reached the ER. He's currently on a ventilator and is sedated with all the tubes, bells and whistles. They are trying to figure out what happened and doing all sorts of tests to try and figure out what happened. He is having myopic? bursts (similar to seizures) that are happening every few seconds that they are trying to control. He's had echo cardiagrams, ekgs, blood tests and all sorts of things. So far vitals are good, lungs are clear. We're waiting to see if there is heart damage, possible clot or other brain function issues. We're currently at Western Medical Center waiting for results. He will keep the breathing tube in for tonight for sure. There may be an MRI tonight or tomorrow as well. We're in a wait and see situation right now. Quite a big change from playing dominos last night!! Prayers please!

still moving forward

Mark has now started a pretty consistent regimen of therapy each day. He has a minimum of 3 hours spread throughout the day which includes physical, occupational and speech therapy. His speech is definitely coming back from that last mini seizure and sounds pretty good...much like he did before surgery. His right hand is also showing some improvements and we even got him to play dominoes with us over the weekend. His said his therapy makes him feel like his is having fun in kindergarten again, because he gets to stack alot of blocks...we may have to challenge him to a game of Jenga! Still having some trouble with the right leg and in fact he accidentally slid out of the bed the other night when he was working his way to the edge to get ready for the bathroom. He said he was pretty gracefully but still ended up banging up his hand and looks like he also may have a slight sprain on his right ankle which makes it harder to try and get up an do walk training on it :( The rehab facility will be doing an evaluation on Tuesday to see where he's at and will recommend a length of stay at that point. Dr. Cloughesy and Dr. Liau will be having tumor board on Wednesday to review everything and will get back to us regarding recommendations for the next steps.

1st day of rehab

The first day in rehab didn't start out that great. Mark had a mild seizure in the morning which seemed to affect his speech. I happened to be on the phone with him while it was happening and called the nurses. He also had quite a bit of head pain, but Vicodin helped that out quite a bit. After some rest, things seemed to get a little better. He had his first stint of physical, speech and occupational therapy throughout the day. He was able to take a few steps assisted with therapists and a walker and even got to take a shower which he was extremely happy about. Later we played cards and watched the Laker game and today the dog gets to come for a visit! He could definitely use visitors during the week if anyone wants to check-in :) Email me at andrea@pace-family.com and I can give the details.

get to go!

Today, Mark got in trouble with the nurses! He decided he really wanted to take a leak and figured he'd try getting to the bathroom himself (even though we all told him NOT to do it the day before). Inevitably, he fell! Luckily he didn't get hurt, but his punishment was that he now had to have a catheter and he got labeled as a "falling star" patient on his door so nurses knew he was a risk for falls. I think he learned his lesson though and asked for help each time he wanted to get around after that! This morning, I went and did a tour of a few acute rehabilitation facilities where Mark could possible go next. I'm super glad I went to check them out, because the vibe between the two was night and day. We picked a place in Tustin where he'll get to spend his next weeks in inpatient rehab. It is a bright, sunny place and the dog can visit! We're waiting for his ambulance transport to get him down there...at least HE will get to drive in the carpool lane! ;) If you have his cell number, he may be up to phone calls Friday or later and possibly a visit as well. If you need information on how to connect, please email me at andrea@pace-family.com

getting out of here soon...sorta

Today Mark got his first taste of physical therapy and was able to walk assisted and do some exercises. His therapist's name is Andrea and she was encouraging and helping him get moving. He'll also be getting to see a speech therapist today as well. Mark also was able to get his "turbin" removed. Dr. Liau did a great job on the incision and it looks pretty clean. The doctor's think he's probably ready to go tomorrow, but not home like we thought! Instead he'll be referred to an acute in-patient rehabilitation facility for 2-3 weeks. There aren't that many facilities that do this type of care so we have a list of about 5 to choose from and some are closer to home...but not much...he already nixed the one that was located in "the hood" ;) So today, we'll be trying to get information and maybe visit to see where the next 5star hotel for Mark might be!

no longer in ICU

Today Mark got to move from the ICU to a private room which is pretty nice with its own bathroom and no other roommates. He's no longer connected to any tubes except an IV for fluids. His speech seems to be getting a bit better and he seems to be gaining alot more control of his right leg. His right arm is still according to Mark, "jacked up" but...there is definitely some improvement. Dr. Liau came to visit and again mentioned that we were waiting for final pathology and readings of the MRI he got to have at 3am!! Physical therapy is most likely going to start tomorrow and we're taking bets to see if he'll get out on either Thursday or Friday. The anesthesiologist from the surgery came to check up as well and had some funny stories of Mark during surgery...apparently he was cracking them up in the operating room when they had to wake him up to test his functions mid-surgery. Apparently he answered some of the questions in Spanish trying to be smart, but Dr. Liau wouldn't have it ;) He then told them all how much he loved them all and once surgery was done, as he was being wheeled to PCU he was exclaiming over and over, "You guys are rockstars!!!"

on the road to bouncing back

Today started off a bit less jovial than yesterday. When Mark woke he saw he had little control over his right side and speech, but didn't remember hearing the part about an expected deficit, so he was a bit confused, sad and angry. Once I was able to connect with him again I helped explain what all went on yesterday and he felt a bit better that he had an explanation of why the right side was quite weak. We've been told that rehab will help him regain some control and so it begins. He now has orders to be moved from the ICU to a regular room, so we're waiting for our private room in Hotel Ronald Reagan ;)

comedy in the ICU

In the ICU, Mark is cracking up the whole ward! He sounds like a drunk comedian and is making everyone laugh. He was just able to move his right leg for the first time and yelled so loud in joy and triumph, it made everyone turn around ;)

out of surgery

We had a call time of 4:45am at UCLA for a 7:30am surgery today. This time we got to be in the brand new Ronald Reagan hospital that has been newly built since the last time we were here. Everything during the checkin process seemed to flow along fine. We escorted Mark up to the preparation area and sat with him while he got debriefed by about 6 nurses and 3 anesthesiologists about what to expect during the operation and answered any questions we had. Mark seemed to have quite the international team, everyone was quite nice and we met players in the surgery from Iran, China, Greece and more! They whisked him off on time around 7:30am to the operating room and he was in good spirits joking all morning as usual. The waiting area was beautiful and seemed quite high tech. They set us up with a restaurant style pager and we parked ourselves by a monitor where you could watch the progress of where patients were in surgery…big improvement from last time where they never told us anything! About an hour in, there was a loud announcement over the speakers that said “Code BLUE, Code BLUE, radiology intervention needed on the 2^nd floor.” It was quite unnerving and sounded alarming and we were questioning what code blue was, but agreed it didn’t sound good. The next thing I knew, some one was asking I come to the phone because the doctor wanted to talk to me! My heart raced as I went to the phone, but was relieved to find out it was just a coincidence that the two announcements happened at the same time. The doc on the other end of the line said that incision happened about a half hour before and everything was going along fine. Whew! I later found out that code blue is related to some sort of cardiac emergency..but fortunately it had nothing to do with Mark!! The next update I got was from Dr. Liau herself. Surgery finished about 1pm and she said it went well. Initial pathology did conclude that it again was a GBM, the tumor was about walnut sized and again had all the characteristics of a stage 4 tumor. She said they did wake him up mid surgery to assess function and he was able to move all of his extremities and talk. She said this tumor was invading on the motor sensory areas and she did have to be a bit more aggressive than last time since tumor growth would affect his motor skills anyway and it was better to resect. She said that she got 90-100% of the visible tumor, but it is likely that he will have deficit on his right side; however physical therapy can help regain much of it. Next step is to wait for final pathology results in about a week. After that it is typically at least 4 weeks before any chemo or radiation plans are made so the situation can be assessed. He will be having a MRI later this evening and will most likely be in the hospital 2-3 nights. He will again be eligible for the vaccine trial since there is new tumor. She mentioned that he may not be able to drive for about 3 months, but depending on how he feels he may be able to go short distances…but no freeways for awhile! Once we see how things go, regular physical therapy arrangements can be made either in hospital or somewhere closer to our home. For now, Mark is in the recovery room and we’ll be able to visit in about 2 more hours.

deja vu

Mark had the functional mri and brain lab mri scans last Friday.  Today we met with Dr. Liau to review the results. The mapping scan shows that the new area is just in front of resection of the old spot.  In the test they mapped the language, motor and sensory areas.  The new tumor does go into sensory area of hand, and Dr. Liau was really surprised that Mark wasn't already showing any symptoms of numbness on  his right hand? She suspects that other parts of his brain may be compensating.  The mapping showed that the new tumor doesn't seem to be too close to the comprehension or language areas.  She said she can surgically remove the tumor, but there is risk of numbness in his hand and possibly weakness. Surgery is a good option because then we'll be able to get it out to help slow down growth, we'd know what it was (scar vs tumor) and would have tissue. There are recurrent trials that can use tissue if we take it out and there is also a gene therapy trial Mark could be eligible for.  Because it has been long enough, radiation can still happen after surgery if needed or instead of surgery.  Some swelling does show in the scans so it will be good to make a decision before it affects in other ways.  Most likely it is tumor instead of scar tissue because of the length of time it has been since the original surgery. A biopsy to find out would be just as risky, so it is better to go for surgery.  This time surgery would be done while Mark was awake. She could also go through the same incision and even smooth out the scar some!  Mark is opting for surgery.  We have a language eval scheduled  on 2/24 @ 11am and surgery will be  3/5.  We still need to schedule the primary doc for surgery clearance (ekg etc) and are getting a blood test today.  We had to sign a lot of papers, but looks like we'll be headed to surgery early next month!

researching the next steps

We again went to see Dr. Peter Chen - Mark's radio oncologist
He checked out Mark and said all his body functions looked good and his tumor wasr emarkably localized.  He said Mark is a great candidate for radiation again.  He said that there is less risk of a swelling reaction since his body has recovered from the previous radiation treatment for years.  He mentioned that they have had good results with recurrence. The radiation would be delivered in fractionation in high dose over 5 treatments (600Centigrade)

It takes about 1.5 weeks to plan, so Mark is in today to get mapped and fitted for the mask and start with preparations.

We are also working to  connect with Dr. Linda Liau for surgery consultation.  We are hoping to setup up a language eval, brain lab mri and functional mri so she can determine if surgery is a possibility.  We are still trying to schedule and hope these tests can be done soon so decisions can be made asap

more growth apparent

We went back for the first follow-up MRI after switching to the CCNU chemotherapy round. Unfortunately, the two hot spots got a little bit bigger, so it was determined that Mark's tumor does not respond to CCNU and a new plan of action needs to come in play.

From Dr. Cloughsey's perspective, he doesn't think surgery is an option because it looks like the tumor is in the motor and sensory areas and may cause problems with loss of function. He will be working with Dr. Linda Liau (neurosurgeon) for a final opinion on the feasibility of surgery.

Fortunately, the hot spot is in a pretty localized area and isn't lighting up in other parts of the brain. Because it is well localized, radiation (300 centigrade over 10 days) is an option paired with avastin (3omin intravenous every 2 weeks). This treatment combo has had good local control results and along with avastin's anti-tumor capabilities it also helps reduce swelling from radiation. Before we can do this, we'll need to set up a consultation with the radio-oncologist to see if he would be able to prepare the treatment based off the past 3 scans. I've already got all of the scans on a CD and have a call in to the radio-oncologist to set up an appointment.

Dr. C has already put in an order for the Avastin so we can get the ball rolling and make sure insurance issues are in order while we wait for word from both Dr. Liau and the radio-oncologist.

There is a phase 1 trial that Dr. C is also considering that involves delivering a certain virus to the tumor area through a biopsy. They have been getting good results, but the catch is that once the virus is inserted you have to watch it grow for 4 weeks while the virus gets activated to see if it is going to attack the tumor. At this point, Dr. C is favoring the radiation/avastin combination over Trials, since we can still do radiation while the tumor is still small.

So next step is we wait for Dr. Liau's recommendation and the radio-oncologist consultation

some change in the scans

Had another MRI yesterday, but this time it looked like there were two new "hot spots" near the area we've been watching this year. The doctor says that it is not definite that it is tumor but is about 70% sure. He said that we could do further tests like dopa scans or other tests to get us to a 90% assurance, but they could take a while to schedule/get results, so he suggested that we treat it like it is tumor and take the next aggressive step to halt it. The next step is a different chemo called CCNU. Fortunately, it can be taken orally as well and slightly less side effects (ie constipation) than the temodar. This medication has a 1 pill, 42 day cycle (Temodar was 5 pills, 28 days). Since Mark is still within the 28 day cycle of his last round of Temodar, he has one more blood test to take on Monday to make sure he is cleared to start the new chemo. Luckily, the timing of this chemo and next blood tests/doctor appointments do not conflict with Mark's big Israel trip he's taking next week! So, Mark will get blood done on 12/26, leaves for Israel 12/27, will take the single dose of CCNU on 12/29, be in Israel til 1/17 and then will be back to start getting the weekly blood tests to assess his counts and how his body is tolerating the new chemo. He will also be taking a bottle of decadron (steroid) on the plane with him, in case the altitude/pressure causes any swelling and leads to a dull headache that makes him uncomfortable. His next MRI and doc appt are 2/8. If this medication works well, he can continue it for 5 more cycles. We're also going to be looking at which trials are available that Mark qualifies for as well. Surgery is not a good option at this point, since the area is too close to the speech zone. Mark actually feels fine, no change really, a bit tired, but no seizures.

tst

steady

Had another MRI today and again the tumor was stable with maybe a slight reduction. Blood counts were pretty good this time. He did go into the appointment not feeling super great. We just returned from a family trip to Hawaii on Monday and since then he's had a fever and not feeling 100%. His muscles were quite fatigued from heavy lifting his nieces all week too ;) Scan looking good, he'll go on another two rounds of chemo and we'll be back for the next MRI in 8 weeks on 8/24

Staying Stable

Mark went into this appointment with a bit of a headache and sore throat (however, Brock and I seemed to have a similar bug).

The new scan was stable. It looked about the same as the last scan with maybe a slightly reduced area. Mark will continue to a 3rd round of Temodar.

His blood counts were good, but slightly lower in lymphocytes so as a precaution he'll also be taking Bactrim (antibiotic) to help his immune system.

The next MRI is scheduled for June 29

round 1: Temodar is winning!

Mark had his first MRI after round 1 of chemo after recurrence
His mri was better, looks like the temodar is working!
His tumor area shrunk significantly...
He is starting another round of chemo today
MRI in 4 weeks

we also asked about bradykinin which is something being used in a trial in Univ of Alabaman
Dr. C they did trials with this in '97 without good results. At this time, not recommended from UCLA

DOPA results & treatment options

Went back to UCLA to get the results of the DOPA PET scan. Unfortunately, the area on the dopa scan is positive which does indicate tumor. It verified that it is the same area of contrast we saw on the earlier MRIs. The new tumor is in a crescent shape around the resection area and has infiltrated into more sensitive areas of the brain.

options
surgery – at this point, the tumor is not causing any symptoms, the risk with surgery is that it can possibly take away tumor, but can cause symptoms that would be undesirable; unfortunately though, without tumor we can’t do dendritic cell vaccine

radiation – is an effective therapy, however, since it was given only 5yrs ago, it probably is not long enough to repeat and increases the likelihood of radiation damage (tissue breakdown) which again can cause undesirable symptoms

chemo – there's alot more data that exists today that when temodar was used successfully before and recurrence occurs greater than a yearafterwards..patients typically do really well on temodar again. This is Plan A that Mark is choosing for the first fight. Mark has already taken round 1 and we're waiting for the bloodwork on day21 and day28 before doing round2. We also asked about the risk of leukemia? Typically the risk is higher when you do a continual dosage which is why we stopped after 2 years. If a patient had a durable response while on Temodar the first round, it is a reasonable initial treatment choice for recurrence.

Metronomic doses of Temodar? – instead of 5 out of 28, it can be done week on week off or 21 days straight, it tends to affect white counts more (concern for Mark since he had issues with low counts last time around). The studies haven’t seen data that supports that it is any better than the normal dosage for tests done on recurrent tumors.

combining chemos – we could do this, but so far there isn’t a lot of good data with the agents they typically combine with (ccnu, acutane, etc) that warrant this choice as an initial treatment

avastin (now FDA approved!) can be more effective than temodar alone; however studies show that it works better when clear VEGF (vasculin growth factor) is present in the tumor area which can be noticed by evidence of swelling/adema. At recurrence you could go to avastin, but they believe that it is better to save til later on. Better to see if you get a response out of temodar. Avastin use can also exclude you from several trials. At this point Mark's tumor area isn't displaying these VEGF characteristics so Avastin isn't yet being suggested as part of plan A.

dendritic cell vaccine - there is no longer any of Mark's original tumor available to create a vaccine, surgery would be the only way to get another piece, but risks are high so it is not yet suggested. We asked about a synthetic version of the vaccine. Apparently there is a group at Baylor that trials one. It has a set number of antigens they combine with dendritic cell. It is often used with radiation but when combined they can’t see if there is a benefit from the vaccine or from the radiation. It is not typically used in recurrent setting. So far there don't seem to be any side effects if this is used. This could be an option Mark may consider.

Novacure headpiece - Electric field therapy to stop GBM cells from dividing
there is a phase 3 trial going on at USC, UCSD where they send an electric field over two grids. In a petrie dish it looks good, tumor cells don’t grow, however it is not yet proven if it goes through the skin/brain and produces the same results? They've had patients at UCLA try it out, but they complain about the burdensome nature of the treatment. You have to wear the device all the time, shave your head for good connection and carry around a 10-15 lb battery a minimum of 20hrs a day. Men seem to tolarate better because the battery is heavy. There don't seem to be any real side effects

Carl Berg/molecule?
Dr. C did look at some documentation on this molecule. At this point, there isn't documentation given didn’t show any evidence of success in glios. Dr. C said that he would talk to the doctors involved with this trial if we want him to.

what's next:
bloodwork to be done 4/8 and 4/15
next MRI 4/27

DOPA Pet scan

3/29/11
Mark was finally able to go in for the DOPA PET scan today. This procedure is supposed to give a really clear picture of what is going on and identify tumor or not.

It is actually an experimental procedure and is not widely performed. They need to create radioactive isotopes to inject and read through the scan. They are very unstable and difficult to make. Because it is so difficult, they only do this once a week for a small number of hours/patients (which is why it was so hard to get us in). Mark is radioactive for the day, so no kissing babies or pregnant women for 24 hrs ;)

There are only two places in the US that have the equipment to do a DOPA PST scan. UCLA actually invented the procedure and has the equipment. Anyone who wants to be trained in its use has to go through UCLA. There's another place in Florida that has the equipment as well.

We'll be talking to Dr. C tomorrow about the results and ask the other questions that we've been loading up.

latest info

Well we at last got a little more information, but it isn't necessarily the best news. Since we were unable to get a PET scan scheduled, we decided to go back in for an MRI to check things out. The new area of concern does seem to be a bit bigger than what we observed 4 weeks ago. We also observed another scan that showed blood flow and it does show an increase in blood traveling to the area in question. Dr C is again pushing for us to get the DOPA PET scan. This scan would help us determine for sure if it is tumor or not, or if it is a "cold" spot to keep watching. Once we see this result, Dr. C is already recommending Mark start back on chemo treatment. We're planning to start back on Temodar (chemo) as soon as the PET scan is done/read which we're hoping is Tuesday, 3/22. The new area to watch is outside the old tumor area somewhat and a bit more toward the center of the brain. The doctor said due to the areas where we're seeing this new change, surgery is most likely not an option because of the sensitive brain functions that could be affected there. Since Mark had alot of radiation 5 years ago, they are not recommending radiation at this time because of the intended damage this could cause. Not necessarily the best news to get...

still waiting to get the new scan

Well, we're still waiting to get the DOPA PET scan. We were scheduled for this past Tuesday, but it got rescheduled to Wednesday. On Wednesday, Mark did the big drive up to UCLA only to find out that the machine was broken! We then got rescheduled for Friday 3/11, but got a call today that the machine was still broken and it could be 2 weeks or more before it was fixed?! Needless to say, this is getting to be too long for us to wait :( We have an email in to Dr C to see if we can get the scan done at another facility or if there is another option? This waiting stuff is for the birds...

some change, could use some prayers

Mark had an MRI today, but this time it did show something a little different. There was a bit more fuzziness and light color around the cavity area than we normally see. Dr. Cloughsey said it doesn't normally look like what he sees when there is tumor growth and it could be an artifact of the scan, but it is a change so we're going to investigate more. We're looking to schedule a PET scan (hopefully on Tuesday) that will help detect if there is tumor growth or if it is just an anomaly in the scan. This test will inject dopa into his system that goes right to the brain. When reviewing this scan, they'll be looking for normal areas to be bright and look for any other unexpected areas that may light up that could indicate something else is going on. We're waiting for insurance to approve this test and it is only performed on Tuesdays. So if we get scheduled this Tuesday, it takes 24 hours to get results so we wouldn't have any information until Wednesday. Hopefully we'll get in next week and not have to wait longer. At this point, try not to worry but send prayers and positive thoughts!

still all clear

Last appointment was 08/18/10....all clear

All's still clear

Had another MRI this week and everything is still all clear! No change in the cavity and Mark easily passed all of the normal neurological tests. Next checkup in 9 weeks :)

still clear

We're on the 10 week MRI schedule these days, so it seems like it has been forever since we last had to head to UCLA. Things were all clear and no changes in the scans. Mark is still feeling and looking good!

4 years later

This month marks 4 years since we first found out about GBM. Another visit with great results! No changes in the scan...again :) The doctor even wanted to put us on a 12 week comeback schedule, but we felt a bit more comfortable sticking with 10. Next MRI is in February. Happy Holidays!

scans still remain unchanged

Our most recent checkup was on 9/30/09. The scans still remain unchanged!

ho hum...

Scans still unchanged...boring is good!

we've graduated to 10 weeks

Mark had another great appointment that showed no change in the cavity. The doctor laughed, because Mark basically went through all the neurological tests without even being asked! Guess that shows that his memory is still going strong :) We've been going every 8 weeks to get an MRI and check up on things. We have now graduated to going every 10 weeks. This is a great sign, since Mark's condition has been so consistently stable. Mark continues on his seizure medication and has reduced the amount of melatonin he takes from 20mg down to 5mg.

boring is still good!

We had another checkup and things are still unchanged, which is the way we like it :) Mark has had two mild seizures since we last saw the doctor, but they seemed to be related to days that he missed taking his anti-seizure medication. He complains that his vision seems to be getting fuzzier, but we're not sure if it is chemo after effects, or dare I say...age (we hate that answer ;) )? He passed all the typical neuro tests and the scan looked great. There is now a generic version of the medication he takes, so we'll keep an eye to see if there are any weird symptoms related to taking a new medication. He's pretty much got our guest bath down to studs and is building it back up to be awesome and he starts going back to school this month too! Things are great :)

boring is good!

Mark had another checkup this week. Nothing new to report, everything was exactly the same...boring...but boring is the best news! MRI was unchanged, nothing to be concerned about in the blood reports. All neuro tests were passed with flying colors, although Mark was defiant and not wanting to answer the math questions ;)

Things still looking good!

We met with Dr. Lai this time how reviewed Mark's scan and told us all there was no change (which is a good thing)! Mark has not been complaining of any headaches and no seizures. Mark had some blood drawn to send to the nutritionist for a checkup to make sure we're still on track on our supplements regimen. Mark's been enjoying being on disability and has decided to go back to school to study Apolgetics :)

clean scan and new backyard!!

We went in for another checkup this month and met with Dr. Cloughsey. There was no change in the MRI scan, which is all good. Mark has been complaining of being tired, but then again, he has been working hard on our backyard project. (Since the last checkup, Mark has gone on disability and has been enjoying focusing on the house. We now have a backyard that we can party in!!! Yay!!) He also complained of a dull headache at the base of his head, but the doctor said there was nothing in the scan that would indicate any trouble and it may also be related to his hard work and not drinking enough water. Since Mark is no longer on chemo, he hasn't taken a blood test in a while, so the doctor mentioned that he should still probably get a test every 6 months to make sure things were ok. He had a blood test yesterday and no reports of any concern. Mark also had questions about the long term affects of treatment. He was hoping that the "chemo brain" feeling would go away now that he is no longer taking the drug; however, he still feels the effects. The doctor said to give it a few more months of being off the treatment to see how he feels, but we're hoping some of that feeling will go away. Next scan 9/17

no more Temodar, clean scan, no work and a walk

Mark has now completed 24 rounds of Temodar and is currently no longer taking any chemotherapy!! There is a risk of developing Leukemia if you stay on the drug too long, so the standard treatment is 24 rounds then you come off and continue with scans indefinitely.

Mark had another MRI and doctor visit yesterday. He passed all the neurological tests with flying colors and entertained the student nurse by answering some of her questions in Spanish ;) He has practiced spelling "world" backwards so many times that he now has it memorized, so when she asked, "Spell world," he instinctively spit out "d-l-r-o-w" in lighting speed. You should have seen the look on her face, 'cause she asked him to spell it forwards!! We met with Dr. Cloughesey and all scans remained unchanged, so good news there. He also met with Dr. Liau last week for another dose of the dendritic cell vaccine.

Over the past few months, Mark has complained of more fatigue and does seem to get tired alot. His work recently went through some down sizing and Mark was now required to do more of the calculations and bidding. Since numbers and word recollection seem to be some of the areas that are affected by his tumor, he was feeling more and more pressure and frustratation on a daily basis. He has since sought council with the social worker at UCLA and will be going on state disability for the next year. The interesting thing about this program is that they also provide career counseling and training to help patients find areas of work that are more satisfying and require less emphasis on the areas that seem to cause him trouble. I think the backyard project will be good relaxation therapy for him too ;)

This weekend (May 10th), we will again be participating in the Tom Atkinson Memorial 5K to help raise funds for the UCLA Neuro-oncology program. This walk is being sponsored by brain tumor patients and families of those that have lost loved ones to this terrible cancer. Brain cancer research gets a tiny percentage of the medical research budget and since we have a vested interest in their outcomes, we’re hoping to help contribute in as many ways as possible. All donations go 100% to the cause and we're hoping to raise more money to help the doctors continue to find new ways to fight brain cancer.

If you’d like to help us through an online donation, please visit the following website:
https://giving.ucla.edu/braincancerresearch
Under Gift Options, please be sure to put “Team Pace” in the tribute gift section, so our team gets credit for your generosity :)

unchanged again

We had another MRI on 3/12/08. Everything looked the same and there were no changes. Mark passed all of the neurological tests. He is currently starting his 23rd round of Temodar. After this round, just one more to go and then he's through with Temodar but will continue with the dendritic cell vaccine as long as it is still available. We also had talks of tapering off the seizure medication, but for now will remain at the usual dosage.

another easy check up

we had an MRI and doc appt on 01/16/08
the scan was unchanged and looked exactly the same
Mark passed all of the neurological tests. This time they threw in a new one that stumped him at first (count from 100 backwards by 7s) but he did it with flying colors :)
We still have yet to have another dose of the dendritic cell vaccine, but we are in scheduling now that they're growing more tumor to make the vaccine.
Next appointment will be in March

all clear!

Had an appointment on 11/21/07 for an MRI and meeting with Dr. Claughesey.
The MRI looked unchanged, nothing to be concerned about and Mark passed all of the normal neurological tests. He even spelled 'world' backwards! He started another Temodar round 11/24 and will be done before we head off to our family reunion cruise to the Carribean next week!

running out of vaccine

Mark has been doing great since the last post. He continues to take the monthly Temodar and has been tolerating it well. He does seem to get a bit more tired than before; however, he still gets out and works out hard on his bike and in the gym. There have been no signs of regrowth in the last MRI and we have our next one scheduled for Nov. 21st. He has been continuing with the vaccine; however, we got a call this week that the tumor cells they have in storage aren't reproducing quick enough for them to make another vaccine, so it could be a while before he gets another dose. Maybe it is a silver lining to know that his tumor cells are underachievers and don't want to grow fast?!

things back to normal

Had MRI and appointment on 07/25/07
met with Dr. Cloughesy
Since last month the docs thought they saw blood in the cavity, we scheduled a MRI for a month instead of waiting for two. Mark did have a significant seizure on 07/03/07 that worried us, but after looking at this MRI, everything seems pretty much unchanged. When looking at the MRI, we compared the last three months and there really weren't any differences between them. Last month's MRI was a bit brighter, but didn't really look like any significant changes and this months scan looked the same as May's. There is no signs of swelling and no evidence of any tumor growth. Mark has been feeling more tired lately, but it is most likely due to 15 rounds of chemo! Next scan will be in early September.

slight change in latest scan

MRI and appointment on 6/27/07
Mark took his last round of Temodar on 6/5-9/2007. He tolerated the treatment well, but has been feeling a bit more fatigue than usual, but has been very active lately. He hasn't had any seizures, headaches or other problems. In a church softball game last Sunday, he got hit smack in the head by a ball. When viewing the MRI this month there was change in the scan; however, due to the contrast that was observed, this change likely represents blood products rather than tumor and there is no increase in mass effect. We have seen blood in the cavity before and coincidentally, the last time we saw blood there he had also been hit in the head while playing ultimate frisbee. This time he got hit with a softball, so we think the head trauma may be related to the blood. The doctors indicated that they do see evidence of blood in the cavity from time to time in patients that are also on the dendritic cell vaccine. Since he does not have clinical symptoms related to the scan changes, we will continue to observe the change for now. They scheduled his next MRI for 2 months, but just for piece of mind, we'll be trying to schedule one in a month instead. He will be starting a new round of temodar next week and has another vaccine coming up later in the summer. Mark continues to ride his bike on the weekends too :)

another smooth check up

05/02/07
We met with Dr. Lai
last Temodar staredt 04/10/07
Mark had a small seizure on 04/11/07, but had forgotten seizure meds on that day and was up late
Mark is in tip top athletic shape and wows the docs with his resting heart rate of 44!
He passed all neurological tests and had practiced spelling world backwards, but they didn't ask him this time ;)
The scan looked unchanged.
They had a new process in the MRIs to add a new sequence to see surrounding change in tissue which looks stable in Mark's scan too.
Mark is taking a blood test today to see if he can start back up on Temodar this evening.
He'll start up another round of vaccine in 2 weeks as well.

This Saturday (May 12th) we'll all be participating in the Tom Atkinson Memorial 5K in Long Beach. Our team has already raised over $4,000 and as a whole fundraiser, I'll bet we at least make $20,000!!! Wish us luck. For more info see: www.jeanniescure.org

still rolling along

Had an MRI and appointment with Dr. Cloughsey yesterday and Mark's scans were again unchanged. The doctor said he didn't see anything that he was worried about. Mark had taken his Jan and Feb temodar on schedule without any side effects. He did report a small "euphoric like" seizure on 2/13 that lasted for a half an hour, but felt that there were other circumstances (eating late, not getting enough rest,etc) that may have contributed as well. Mark had his blood work done again and everything was up to par and he's cleared to start the next round of Temodar, starting Saturday night. Since the last post, Mark has also had another injection of the dendritic cell vaccine without incident. There are two more boosters that will be available to him during the trial over the upcoming months.

Plans are in the works for a Tom Atkinson memorial 5k that will be held mother's day weekend in Long Beach. We're all training to get ready for it and will starting to be raising funds as well. All of the money will go to jeanniescure.org which directly supports research for UCLA Neuro-oncology and is helping to fight brain cancer. Stay tuned for details.


Mark is headed up to Solvang this weekend to do another century bike ride with his bike club!

Happy New Year!

Just back from our big New Zealand vacation and Mark admittedly fell off of his strict diet...but hey, that's what vacations are for, right? Now back in the states, we had another MRI and meeting with Dr. Cloughsey on 01/10/07. Again, the scan looked pretty much unchanged and there were no significant new enhancements or areas of concern. He had a blood test and all was well, so back on Temodar starting 01/11/07 and for the next four days. Last month, we had a LIVING STRONG party to celebrate Mark's "1 year since diagnosis" anniversary and that he was doing so well! It was great to see all of the family and friends and have a chance to really celebrate the miracle that we're still living!

1 year later...

Since the last MRI, Mark got a boost of the dendritic cell vaccine (11/22/06) and started his 9th round of chemotherapy on Temodar (11/29/06). Everything was going well, but he did experience small euphoric seizures on 12/01/06 and 12/10/06. He hadn't had any seizure activity since May '06, so it was a bit concerning. As a precaution, we went in for another MRI and checkup (12/13/06) and everything was fine. The scan was unchanged since last month, no swelling, nothing unusual and from the scan, there wasn't any obvious reason for the seizures. The doctor mentioned that sometimes, changes in the weather pressure or holiday stress can trigger episodes as well. Since we do have an upcoming trip planned, the doctor did prescribe some steroids as a precaution in case the pressure in the airplane causes headaches; however, they really didn't think there was a concern. As a side note, 12/19/06 marks 1 year since our initial diagnosis and obviously, Mark is beating the statistics and still LIVING STRONG! To celebrate, we're having a party this weekend with family and friends to mark this inspirational milestone. Woo hoo!

Coming up:
01/10/07 MRI and checkup

Mark 's Cancer Fighting Smoothie

For those of you that come across this blog, we want to share this recipe with you. This is something that Mark takes everyday and really helps get down some of those essential cancer fighting ingredients.
Enjoy!

Mark 's Cancer Fighting Smoothie
Ingredients	Amounts	Possible Brands
Green Tea	8 Ounces
Organic Wheat Grass Powder	1 TBS	Amazing Grass
Kidz SuperFood	6 grams (1 Scoop)	Amazing Grass
Organic Cinnamon	teaspoon or to taste
Organic Ground Flax Seed	1 TBS
Organic Flax Oil Filtered	1 TBS	Spectrum
Organic Plain Whole Milk Yogurt	1/4 to 1/2 Cup	Straus European Style
Add organic blueberries	2/3 cup	Usually frozen
Add organic raspberries	1/3 cup	Usually frozen
If on Chemo, I put in Miralax Powder for constipation.
Blend until mix is smooth.
Lastly, turn off blender and add :
Whey Protein Powder	1 scoop is 20 grams	"Whey to go"
This is the best Whey I have found. It contains 16 grams of protein per 1 gram of sugar.
By the whey, cancer loves sugar. "No, whey". "Whey".
If you need a sweetener use Stevia or organic liquid blue agave nectar.