Monday, November 17, 2008

Its GameTime!

The preparations are nearing completion. We have scouted the enemy and it is strong, wily and resilient. We have had a couple of practice runs, exhausted the experts, and the tryouts for the skill positions are complete. These few words summarize both the events of the past year and the events of the coming months.
In many ways this is a fitting time frame. It is a year to the day from the first surgery. The crisp fall air has given way to way to the first icy gusts of winter. For those enjoying collegiate football: Its OSU v Michigan, or the SEC or ACC championship, or perhaps USC v UCLA. Whatever your favorite gaming analogy; we see things from David’s viewpoint as he looked up at Goliath. It doesn’t look good from the outside, but we now feel an inner peace. The team is in place and the plan is coming together. In our corner we have guts, skill and compassion coupled with a fiercely resilient champion. In the opponents corner is a locally aggressive recurring mass with a unique array of genetic markers and histochemical signs with a sole apparent desire to take the champions life.
It was almost a year ago that the first entry to this journal found their way to the web. At that time we knew this war was akin to a marathon; now that we’re well into to run, we feel the aches and pains, the constant jarring rhythm of the road, and the cruel attacks on the psyche’s will to finish the race.
Helmuth von Moltke, the Prussian Field Marshal who became the German Chief of Staff in the 1850’s is credited with the quote, “No battle plan survives contact with the enemy” Those of us with a more modern Judeo-Christian outlook modify this to, “If you want to hear God laugh, share with Him your 5 year plan.” While this is no laughing matter, and keeping von Moltke’s adage close at hand we will share Evan’s treatment plan as we understand it.
It all starts next Saturday with an MRI. This will be the last best chance to find an identifiable tracking mechanism for the tumor. It will also serve to see if there have been any metastases of disease to other areas. As we understand the process, the MRI will determine a tumor resonance number, and that number will then be used as a benchmark on later scans to screen for recurrence.
At a time to be determined by Evan’s UNC treatment team (Dr. Julie Blatt – Pediatric Oncology; Dr. David Olilla – Melanoma-Surgeon; and Dr. John Van Aalst – Pediatric Plastic) he will begin a course of chemo-therapy to attempt to shrink the tumor. After this treatment, Evan will undergo an operation which will target not only the tumor, but any tissues associated with the tumor. The terms used for this sort of surgery are ‘aggressive’ or even ‘radical’. The goal is not to experience a bout of the woulda-coulda-shoulda’s at some later date.
Once this resection surgery is complete, there will be a reconstruction of the resected area. This will likely involve the unrolling of muscles surrounding the area like unrolling a Swiss cake roll. This flap reconstruction is aimed at returning full function to any affected muscle groups. In an almost cruel ironic twist of medical reality, this reconstruction will likely hide any recurrence of disease from visual identification. Ironic because it is only through seeing the mass grow back that we have been able to identify a recurrence.
Following surgery, there is likely to be a follow up course of adjuvant chemo therapy to target any remaining cells left behind after surgery. This plan as presented will take 9 months.
Yeah, Yeah, Yeah, but How’s Evan doing?
Evan continues to put up a brave front, but some of the façade on the walls is beginning to crack a little. One of his most endearing traits from a parents standpoint is his amazing tolerance for taking in negatives without responding; however, just like his Uncle David in Canton, when he blows you need to take cover. As we have kept him informed as to processes, meetings and appointments he is up to date on all aspects of his situation. We refuse to lie to him which can be extremely challenging when he asks incisive hypothetical questions about treatments and outcomes.
Evan has made new friends with others who are battling cancer. And those contacts are both reassuring to him and encouraging to others to see his smile and hear his infectious laugh while marveling at his insights, wisdom and resilience. These ongoing interactions with other soldiers in this life and death battle are seen in stark contrast with the relationships with teachers and classmates.
There exists a frustration of failed understanding that interferes with attempts at normalcy. Two main avenues of peer expression occur: Pity without purpose or understanding (Well intentioned sympathies expressed in painful ways) or a complete lack of compassion due to ignorance or choice.
How would you interact with an obnoxious unintelligent bully who does not have the interest in showing any compassion even if such a capacity existed? And before the testosterone rises to the suggestion of giving the miscreant bully a good thump in the nose; Evan has learned to modify his behavior not to resort to violence in conflict. (It should be noted that as cracks have appeared in his façade the rationalizations of events involving violence has rivaled current, former and future US Presidents for inventiveness) Let’s just say that a 9 year old boy should not be hindered with the basic understanding of stress – Where the human mind overrides the body’s basic desire to thump someone who richly deserves it.
Other than the people Evan has been enjoying school, relishing in his country report on Wales, reading lots of books (Start Wars, Technical how to manuals, fiction) and is gearing up for his Science Fair project. Components are being acquired; furniture is scheduled to be modified; and practice is occurring. The latest joy of course involved Microsoft. Evan modified his micro form PC and switched out the CD-RW drive for a DVD superdrive. Because Windows recognized a major component change, it demanded to be reactivated. You should try explaining the intricacies of intellectual property rights and their piracy and the resulting attempts at controlled commerce in the digital world. It was thankfully reactivated with the steps associated with a new computer build – one component added at a time starting with the keyboard.
Cub Scouts has been a wonderful distraction for the past year, and Evan is on track to earn the Arrow of Light based on his accomplishments to date. With the schedule of events for the coming year we are hopeful that he will continue to push forward in his pursuit of this honor.
As a family we face an uncertain future. If we all look closely at this statement it is redundant. The future is unknown to us because we have yet to experience it; so by definition it is uncertain. And yet in the midst of this current crisis we have found comfort and to varying degrees peace. At times of crisis and stress we all face the internal battle between fear and faith. That battle interacts synergistically with the conflict between hope and despair. It has been said, that faith ain’t faith till it’s all you have left to hang onto. But Faith without the knowledge of what to fear is not tried nor strengthened from the trial it is but a flimsy aphorism upon which we state our beliefs. Show us the person who has weathered the storms, been purified in the crucible, and let us feel and behold the faith of that person. In that person we may find a ‘childlike’ faith, in that person cynicism and sarcasm die deaths on the altar of faith and hope born not of idle imaginings, but of the fiery & frosted furnace of real life and real adversity. That person for us is Evan. We are just telling the story.
If you desire to help beyond your thoughts and prayers, please contact Heather Wray hwray@nc.rr.com for details about Evan’s Fund or the Melanoma-Giant Nevus Foundation.

Wednesday, November 5, 2008

Friends, Neighbors, Baked Goods and Video

Thank you to Heather for getting this to happen (Link to video story below). And thank you to Heather and Amy for their work on the bake sale. The monies generated will go toward seed money for the MGN Foundation. There are many answer for other people wrapped in the mysteries surrounding Evan.

Today Evan sees Dr. Julie Blatt at UNC this morning and we humbly ask for your continued prayers for healing and discovery.

http://wake.mync.com/site/Wake/news/story/12499/community-rallies-around-boy-with-rare-condition/

Monday, October 27, 2008

Where to go from here?


Information continues to come in. A little here and a little there. Our latest information is encouraging, but the advice was discouraging. The information was that the tissue samples which have been genetically analyzed are neither melanoma nor sarcoma; however, the microscopic cell presentation indicates a sarcoma like growth pattern.
The advice we sought was requested without a definitive diagnosis; we asked for a gut instinct. What we got was a kick in the gut. The gist: seek a skilled cancer surgeon familiar with both GCN and sarcoma resection; and a skilled reconstruction/plastic surgeon. Together they would perform a wide margin excision of all potentially affected tissue and reconstruct the body around the hole that would be created.
We could rant, cry, or scream; We’ve done that all before, and We’ll likely do it again, at an appropriate time; however, that time is not now. Now is once again a time for action. Our plan is simple: Pray - for guidance, wisdom, and intersession. Do the research, consider a team, have different tests ordered and completed, and pray some more. Not necessarily in that order. We did not hear the news we wanted to hear on Friday; but we got sound advice - no matter what the mass is, we must come up with a reasonable plan for approaching its existence.
In summary. Evan has a tumor/lesion/growth; no doctor knows what it is; many know what it is not - including normal, melanoma, sarcoma, proliferate nodule; Our quest takes two paths simultaneously: What is IT? What to do about IT? In pursuit of the answers we return to North Carolina, and UNC Chapel Hill.
In the latest episode of medically inspired geo-adventures of our hero; Evan ventured into the Big Apple. One more time, thank you to all who have so generously given that we can find time to distract him from 400 lb gorilla in the room. We would list the sites, but sometimes its just fun to see the pictures and put the sites in your own words.





































































Your continued thoughts and prayers are a blessing and constant source of comfort to us all. We shall continue to keep you informed of personal and medical news as it arises.





















Tuesday, October 21, 2008

And now. . . a taste of the Big Apple!

As the many entries to this blog attest, the writer is not often at a loss for words; but the circumstances of the past few weeks have rendered such a sense of overwhelming love that any response will not do justice to the originators of: prayers, resources and assistance. With that patchwork excuse as a backdrop, a best attempt at storytelling and gratitude will now be attempted.
Let us start at the beginning. First and most importantly thank you God. For those who are new to our story, we have a deep and profound faith in God and a strong belief in our understanding of His interactions in this world. At this point it would not be too strong a point to say that we believe in miracles of divine origin; and that many of the doctors and scientists who we have dealt with, do not. None of this story, or our role in it would be possible without divine intervention. It began almost a year ago, and now has Evan scheduled to see Dr. Marghoob at MSKCC in New York City on Friday. It also has us waiting for a Christmastime arrival of news on a second round of genetic testing being done.
For those who offered prayers that we would be able to schedule an appointment in NY, thank you. It was not easy to get done, and without your encouragement and persistence, it might have been impossible. For those who have been following the ‘new’ science of genetics and its impact on Evan’s diagnosis/prognosis, thank you. The biopsy from 9 and a half years ago was identified, and had not been destroyed, and has been sent to UCSF for Dr. Bastian’s next experiment which will help identify if the cells from 9.5 years ago have the same lineage as those taken last November. We have yet to hear in the results from the comparison of November ‘07 to June ’08, but that bridge can be crossed at the same time as this next round of testing.
It seemed that scheduling was the easy part after it was done, and we faced the realities of dwindling resources and a trip to one of the most expensive destinations in the world, New York City. On the day we began to make arrangements to go to New York, we were hit with an unexpected personal economic challenge; the author was laid off by his employer. A good friend told us that this was a ‘panic’ situation, but we knew what we had to do for Evan, and nothing was going to get in our way. We made plans and got on our knees and were at peace with what would happen next. This was not the first time on our knees, nor will it be the last.
Those named next in this story would likely not wish for the credit, rather they just wanted to do what they could to help Evan. When we had to go to Texas in July; thanks is extended to Nana and Poppa, Granddad, Beth and Bart. Each of you and your offerings were an answer to our prayers. To each of the doctors we have encountered who treat Evan as a person, not just a ‘cool’ science experiment, thank you. Each of you is an answer to prayer. When we asked for monies to help defray medical and travel expenses; Val, Roger & Rex your help has funded the genetic testing to this point; Joe, Kelli, Dustin and the whole crew at Cape Fear Marble and Tile you helped us retire high tech testing co-pays; James, Denise & Blake and the WakeMed Health Park family your generosity has only been exceeded by your prayers. Each of you is a member of our family or such close friends that you might as well be family. And this would be a great end to this story, but . . . God has not just filled our cup to overflowing, He has taken our cup and dropped it in the barrel. We have not been blessed with just a spill; we can swim in the sea of blessings that have been poured out upon us in the last week.
We understand that the two most important commandments are: To love your God with all your heart, soul and mind; And, to love your neighbor as yourself. Many ‘smart’ legalists have thought, and at least one said, “But, Who is my neighbor?” The answer to the question is shared with us in the parable of the Good Samaritan.
Now, let me tell you of our neighbors; near and far, real and figurative. I will start with our neighbors in our subdivision who under the guidance and inspiration of Heather, a mother of 3, is in the process of raising awareness of Evan, the hope he represents, and in raising funds for medical, expenses, travel and research. Let me also tell you of our school ‘neighbors’ Tim & Debbie, Sheryl & Todd, Sharon, the Elementary MIT group, and the many teachers; all who pray for Evan, our safe travels and constant encouragement. They also help transport; provide housing and guide Morgan while we have/will travel.
But what do you say about the neighbor you have never met? Till last Saturday. What is to be said when that neighbor offers to fund a medical consultation visit in its entirety on the word of a fellow believer? 10 days ago, sight unseen, because he sensed God calling him to respond. How do you react to that person inviting his closest friends (Law partners, University Trustees, Rev. Al Sharpton, and fellow alumni of his university) to pray for Evan? His name is Willie Gary, and Evan is proud not just to call him neighbor, but friend. We see him as a symbol of God’s all powerful color-blind grace and mercy, a walking example of blessings being shared beyond those being received.

Saturday, September 27, 2008

No news, Good news, and Bad news. . .

Another interesting day in the medical life of Evan Coleman. Friday, September 26, 2008 saw Evan in Detroit seeing Dr. Tor Shwayder (Pediatric Dermatologist) where photos were compared from 6 days of age to 6 years of age to current time. Conclusions. . . fascinating situation, no historical context, consider seeing Dr. Marghoob, consider CGH of 6 week sample from same area on Evan's back, and continue to wait, watch and see. At the same time in San Francisco, Dr. Bastian (Geneticist with interest in pigmented lesions) was getting his first draft of his report ready. Dr. Bastian was kind enough to give us a call with the preliminary results, medical conclusions and proposed plans of action.
We haver not received his final written report, and so the information shared here is paraphrased from a half hour conversation while the author was driving down a freeway during Detroit rush hour.
There are chromosomal abnormalities, but they are not consistent with melanoma. The histological presentation is sarcotamous (like a sarcoma – soft tissue malignancy). There is no record of any person having a sarcoma arising in a GCN. When given Evan's clinical history, Dr. Bastian expressed a profound curiosity and offered to study not only the current tissue, but could we get tissue from the original sample taken when Evan was 6 weeks old. This he offered to do of his own volition in his private lab. His gut instinct is an atypical proliferative nodule with sarcomatous presentation, something that has never been seen before.
In conclusion our fears shift from one type of cancer to another (melanoma to sarcoma), testing will continue, and we continue to be vigilant observation concentrating on lymph or glandular involvement, areas of breakdown, and generally protecting the area in question to avoid unnecessary contacts and traumas. Thank you for your continued prayers. We find ourselves continuing on the path of the unknown, and your thoughts and prayers offer constant light to our way.
Combining work with pleasure is a requirement for a young man on the go. So Evan engaged in some fun activities with friends and family while out of town. First he went with his friends Courtney, Lily and Ethan out buying property in Detroit. As you might have heard, property values in Detroit are not what they used to be. Here, Ethan is acquiring a couple of homes for $200. Following a late night out on the town with his friends, it was a relaxing tractor ride into the orchards of Michigan to pick bushels of apples with family. Later today Evan will be cutting up the dance floor at his cousin's wedding. No pictures at this time, and the videos may be classified, but we'll try to smuggle some into the blog for the next episode. Till next time . . .

Thursday, September 11, 2008

Please Stand By. . .

And the latest news from the lab is. . . please stand by, we are having technical difficulties. The coinciding of our need for genetic analysis fell at the time when technicians critical to the process had scheduled their vacations. As a result of these delays we have been told not to expect results before September 26.
In the meantime, we felt a brief musical interlude was in order, followed by a biographical snippet from Evan’s sister Morgan.

EVAN
by Morgan Coleman 8/28/2008

We live in fear of a monster. Days go by where not a word passes our lips, but we know it’s lurking in the darkness, waiting to pounce on its prey, my brother. We anxiously await the tests, which currently reside in San Francisco. During this process, we wait, weep and pray. We know God is in all of this somewhere.
We all knew something was there ever since he was born. A giant congenital nevus. On the nevus a small bump which was biopsied after six weeks. But exactly a year ago August 28th, while running around in church, the bump got bumped. But not just bumped, more like brutally squashed. Overnight, it grew three times its original size. That night I felt so guilty because I was the one chasing him which caused him to rum into a chair. It was not a question, the bump was coming off. Not only because it was hazardous to his health, but it was one of the worst pains he had and would experience.
On November 15, 2007, he had the surgery to get the bump removed. They couldn’t remove the whole nevus because it covers from his neck to lower back and wraps around his flanks. The doctors estimated surgery time to be an hour and a half. It turned out to take 3 hours. I was in Mrs. Soto’s class when my mom called to tell me Evan’s surgery was over and they were still waiting for him to wake up.
On November 28, 2007, the diagnosis was back. Malignant Melanoma, the rarest of all cancers. Pediatric Malignant Melanoma occurs in 1 in 3 million people between the ages of 0-20. The giant congenital nevus occurs in 1 in half a million. So his condition specifically is 1 in 1,500,000,000,000 (1.5 trillion) and will probably not occur again in our lifetime. After this event, my parents initiated a prayer chain. We notified family, friends, pastors and employers. We began to research and gather medical input. Evan had a PET/CT scan of New Year’s Eve 07. The results came back negative, that very night. We were overwhelmed with relief and ready to start the year anew.
A little into the New Year, we were finding some interesting articles; but we were told they weren’t of much use after being and were rejected by the medical team. Instead Evan had what we were told was a Wide Margin Excision on February 1st, 2008, which required a skin graft. A week later, he went back under for a dressing change.
On May 15th, he had another PET/CT Scan. The results were still negative. But a new mass was visible to my parents. They were determined to keep and eye on this. On June 15th, the mass had grown. My parents sought out surgical consult the next day, and on June 17th they had a biopsy taken.
Unfortunately on June 22nd, the results were back, positive. It was here, it was real, and it was cancer. I remember, it was a Thursday afternoon after a long day of being in charge of the 1st grade class at my church’s VBS. My “co-worker” came with me to my guitar lesson later and we went shopping at Old Navy and got matching shirts. We came home and watched my favorite comedian on DVD, and that lasted about 2 hours. Then there was a phone call that my parents picked up and mysteriously a half hour later my friend was suddenly picked up for and unexplained reason. My parents told me to wait in the bonus room while they talked to Evan. I had the feeling in my gut what it was that they were about to tell me. My mom called me in. She had red, puffy eyes and so did my brother. They told me everything and I was speechless. I wasn’t the same person for about a week afterwards, and it wasn’t even me who was diagnosed. Oh, how he must have felt. But it brought everyone to tears when Evan piped up and said, “Its ok, Mommy. If I die, I know I’m going to heaven.” These results brought us shock, panic, fear, anger, guilt, commitment, grace and faith.
Ten days later, the medical team introduced an oncology surgeon. He suggested a wide margin excision (hadn’t we already had that?), which we were told, if done right, is life-threatening. The surgeon also recommended a second opinion, which we looked into.
That same day my dad got an invitation to present Evan’s case to the Nevus Science group on July 10th. The next morning the doctors also scheduled the wide margin excision, for July 10. But we declined.
From July 9th-11th was the Nevus outreach convention in Dallas, Texas. I thought it was kind of funny how people scheduled a conference for a bunch of people with a pre-cancerous skin condition in the middle of the summer, in one of the sunniest places in America, but whatever. Our family hope is restored because the literature we found previously was actually valid. We continue with caution.
We find a new medical team at Texas Children’s Cancer Center, which is the world’s leading children’s rare tumor specialist team. At this point a new plan is developed.
On July 16th, we started shipping pieces of Evan around the country. The tests will take four to six weeks.
On the first of August, the tests begin. The earliest we would get an answer is August 29th. This brings back one of my favorite lines from the movie Evan Almighty. “When people ask for courage, does He make them courageous or does He give them the opportunity to be courageous? When they ask for patience does He give them patience or the opportunity to be patient?”


THE END

Sunday, August 10, 2008

Summer of Fun vs. Anxiety of the Uncontrollable

A musically gifted frined from NY shares a lullably


It is difficult to watch a summer come slowly and unceasingly toward its end. This year perhaps more so as we savor every hour of every day not knowing what is yet to come. The feeling here is one of nervous anticipation, a calm before a potential storm, the hazy days of summer making way before the possibility of a hurricane.
Evan sitting on the Texas Children's Gecko

Here are the facts. We have chosen a plan that involves waiting for genetic results. That we wanted this testing done 8 months ago is spilled milk or water under the bridge. The results will be back sometime in the first 2 weeks in September. The offending cells have not gone away and a new mass is forming in the same location as the older removed lesions. Every physical symptom (feeling cold, feeling hot, aches, pains, a cough, etc.) is filled with anxiety and guilt ridden doubt. Evan does not have any swollen glands (a good thing) he continues to act, play, practice and act out just like every other 9 year old boy.
This portal for information is increasingly challenging to maintain. We have a plan, but the eager desire for information on our part is echoed, mirrored and amplified by the sincerest of question, “How’s Evan doing?” To maintain a degree of normalcy we throw ourselves in to the activities of the moment, leading hyper-active lives. Authoring a blog about the trials and tribulations facing a boy and his family as they face the black cloud of rare childhood cancer is not normal. So, we throw ourselves into work, play, study, preparations for the new school year, and for the moment we prize every moment in an effort to pry a little more life out of every minute. We have an understanding that to dwell on the unknown, the uncontrollable is to fall firmly into the old Chinese proverb, - Anticipation of death is worse than death itself. We must seize the day, Carpe Diem. After all the past was yesterday, tomorrow is the future, and God has given us this day, that is why it is the Present. This is the day that the Lord has made, and we shall be glad in it.


In the meantime, cousins come from foreign lands (Carew and family), other cousins get married (Matt & Melissa, Beth & Tim), another cousin came from another state to visit (Meg) and other cousins email (Gareth and family, Jeremy, Katie & Riley) And we are about the business and joy of lives being lived. For it is a more pleasant place to reside in the joy of today than to seek out the deep dark, morass of the ‘What If’s?”
To all who have emailed Evan at Evan@e-nevusnotes.com, thank you. To all who have and continue to pray for us, thank you. To all who have brought meals, or invited us to break bread in their homes, thank you. To those who have given us their hard won PDO and PTO, we say ‘Thank you’. And to all who have donated monies to “Evan’s Fund”, thank you.Food Glorious Food . Meeting friends in West Virginia


IN THE LATEST EPISODE OF OUR SERIAL, WE FIND OUR HERO . . .

Evan had the most awesome time getting a personal private tour of the CISCO international headquarters and lab. We’re not sure if our tour guide will get in trouble for sharing this news, but Evan couldn’t stop talking about it for the next two days. What an awesome friend, the masked man of CISCO shall remain our secret, but way cool. Lunch at the world headquarters and then half an acre of rack mounted servers and networking. Evan has his eyes set on a future employer.
The plans for the Science Fair continue. For a brief history, 2 years ago, Evan built a LEGO robot and programmed it as part of a demonstration, deemed too young to have done it by himself, he did not place. Last year after writing to businesses, accumulating all the parts, and building the experiment he demonstrated and scientifically broke down the energy and financial benefits of different types of lighting (Incandescent, CFL’s and LED’s) 2 years younger than the oldest competitors, Evan placed 4th in the State of North Carolina. This year he wants to build a new computer (he already built his first in 2005 and is still using it) Not only does he want to build it, he intends to video/photograph the steps, and present the project on a multi video display using presentation software detailing its construction, it’s features and it’s benefits. Here is Evan’s long awaited list of supplies to be acquired to begin building his computer.


Zalman Reservator 1 V2 fanless water cooling system (www.xoxide.com/zalman-reservator-1-v2.html)
Gigabit Desktop Network PCI Card
PCI Multichannel Sound Card
N1 wireless desktop card
Sunbeam UV LED UV Blue reactive clear case
ATX Full size motherboard
Quad core or similar CPU
Video PCI card capable of HDMI, XGA, DVI and S-video
4 GB ECC RAM
Tuner card
DVD Combo Drive
500 GB internal HD

From a parents stand point this is over the top, outrageous, and completely awesome. How or why would one discourage this sort of creative ambition in a child? So, if any of you, the readers would be interested in encouraging this behavior, please contact Evan by email (Evan@e-nevusnotes.com), I’m sure he would love to hear from you, and share the mad grandeur of his plans.
Thank you to Meg for giving the family a reason to go to the beach, here are some pictures of Evan in his Australian surfer/sun suit playing in the West side of the Atlantic Pond











Morgan, Cousin Meg, and Evan

Evan, just waiting on a wave