Good to Great

After a two-week hiatus, I returned to Houston on Super Bowl Sunday, missed a lackluster game, and headed back into MD Anderson Monday morning. I no longer feel like an out of towner, not in the Rice Village/Texas Medical Center anyway. I've got a routine down, know how to get here and there without Google Maps, and Devin the Dude pops up routinely on my Apple Music "Sean's Station". The algorithms know that I know what's up in H-Town. I'm also strengthening my feeling toward the Rockets (positive - going to the game tonight) and the Astros (negative - glanced at their howe schedule in March/April and I just can't imagine wishing them well).

Go Rockets

Anyway, let's start with the cancer battle though as I have good news there. I had a blood test this morning, followed by a Dr. Chien appointment - I hadn't seen her since the day before treatment started, and when my cancer was at its peak. We chatted about running and marathons and whatnot, which is typical for us. She informed me she's running the NYC half marathon next month for Blood Cancer United, and that this move was inspired by me and the Marshall Michigan Ramblers. I informed her that I'll be joining her at the Houston Marathon in January 2027. At some point, I asked "should we chat about CLL?"

"Oh yeah!" She said, as if we almost forgot to visit this topic. "Your blood test results are excellent," she started. Dr. Chien proceeded to explain to me that, one month into a 13 month trial, I'm sitting on a best-case scenario. The cancer burden has been dramatically reduced, my body is clearly tolerating the drugs well (pirtobrutinib and obinutuzumab, that is), and my outlook is very optimistic. She told me that, while she can't predict the future with certainty, she believes that I'll be at uMRD6 by the end of this trial. "uMRD" meaning "under minimal residual disease", and the 6 meaning no CLL cells detected out of a test of one million blood cells - the most sensitive test available nowadays. 

I start a new drug today - venetoclax - which I'll take as soon as I'm done typing this blog post. In keeping with my 2004 Detroit Pistons analogy, if pirto and obin represent the Pistons team at the start of the season (winners), then venetoclax is Rasheed Wallace - a midseason acquisition that turns a good team into champions. Where pirtobrutinib blocks survival/reproduction signaling and flushes CLL out of its hiding niches, and obinutuzumab recruits the immune system to destroy CLL in the bloodstream, venetoclax gets into the bone marrow and other hard-to-reach areas, pushing CLL cells into apoptosis (programmed cell death).

While each of the three drugs (P, V and O) have been studied individually, the clinical trial I'm a part of here at MD Anderson is determining how well they work together. CLL has gone from "incurable" to "manageable" over the course of the past 10-15 years, now the question is "if we combine therapies and drive the disease to uMRD levels, how long can remissions last? 5 years? 10 years? Indefinite?" We shall see if this PVO combo is a championship team, and the early results indicate that it is.

Ok, I'm gonna take this venetoclax, then head to MD Anderson for an obin infusion. From there, I have another blood test, then grab something to eat before I head downtown to the Rockets game. 80 degrees and sunny down here!

Life, Plato, and a Four Hour Drip

Tuesday morning and I’m writing this at Houston’s Hobby Airport. Switched it up from the typical HW Bush Airport and things are…the same. It’s all airports, man.

Yesterday proceeded flawlessly. Got that workout in, setting a treadmill distance PR in the process (3.1 miles, normally I struggle to get to 2), then a brisk two mile walk to MD Anderson where I had a blood test (WBC down to 19…closing in on the normal range!) and an uneventful obinutuzumab infusion. Uneventful meaning no side effects, no surprises, just 4 hours of slow drip into my vein, followed by an hour of monitoring me. 

My New Years resolution was/is to read the original Athenian philosophers - Socrates, Plato, and Aristotle. Socrates never wrote anything down, so that one’s done, and I’m into Plato now. Great stuff, but I only recommend it if you’re stuck somewhere for 5 hours with nothing else to do. Quick Plato nugget for you, as I’ve been pondering this one for a while now, and it still holds up some 2,500 years later:

I see you Plato

Plato believed there were/are three fundamental types of desires that motivate us humans and drive our pursuit of happiness:

1. Appetitive Desires - food, drink, pleasure, money to acquire these pleasures

2. Spirited Desires - Honor, victory, impressing others

3. Rational Desires - Truth, knowledge, understanding of the world

Plato’s theory is that we’re all born into appetitive desires, and that the fundamental goal of education is not simply to pour information into people’s souls, but to change their desires from appetitive, to spirited, and ultimately to rational. This turns people from pursuit of what they falsely believe to be happiness, to the pursuit of true happiness. 

Pretty cool concepts to think about while you’re receiving life-saving cancer treatment and pondering how you want to live life from this point forward.

Anyway, my flight is about to board and I should get a move on. Very pleased I was able to pull this off, beat the winter storm, and get home to my family. Flight seems to be on time. Grateful to my wife for coordinating all this, and to old man winter for closing schools yesterday and today - didn’t even have to take sick days for this trip.

The Incredible Journey to Houston

 It’s Monday morning and I’m back in Houston - somehow I made it despite the storms and such. You see, my wife Rebecca is highly skilled when it comes to flights, credit card points, hotel deals, flight changes, airport perks (due to credit card points), and all things logistics. Great for me because those elements of life stress me out. I’m much more of a “book a flight, show up to the gate really early, and wait it out” type of guy.

This is what I-94 looked like yesterday

So, I started my snowy, subzero journey along I-94 yesterday around 9:30am, trying to get to Detroit Metro Airport for a 1:30pm flight to St. Louis, where I would catch another flight to Houston later in the afternoon (Becky got a great deal on this flight, by the way). As I was putzing along, somewhere near Jackson, MI, Becky called me to inform me that the flight to St. Louis was delayed by like 6 hours, which would mean missing the Houston flight, which would throw everything off. So she got me on a 12:30pm flight to Chicago (who, according to Becky, “knows how to handle this sh*t”), and a subsequent late afternoon flight to Houston. I was surprised when the Chicago flight left on-time(ish). I got to “Club MDW” for a free meal (credit card perk I would have otherwise been oblivious to), and somehow got onto my on-time flight to Houston despite the Chicago blizzard.

Landed in Houston (Hobby Airport this time, not the usual HW Bush) on time, and it turned out the forecasted “Icepacalypse” was more bark than bite. Cruised to the hotel with an overly chatty Uber driver, caught the end of the Rams/Seahawks game, and here we are! Monday morning in Houston. All morning appointments were pushed back to the afternoon due to the storm that never happened, so I have a few hours before I head over to MD Anderson.

How to spend this time? Well, after I crank out this blog, I have some ideas. I have this unproven theory that getting my blood pumping will amplify the effects of the drugs that are, and will be, in my system today (and every day throughout 2026). Here’s my hypothesis:

1. I have already taken pirobrutinib today (about an hour ago). Its role is to block BTK signaling by the CLL cells - these signals tell the cells to multiply and to hide out in the lymph nodes and bone marrow. By blocking this signaling, pirtobrutinib prevents CLL proliferation and flushes the cells into the bloodstream, where they are sitting ducks for another drug to destroy them - that’ll be obinutuzumab today AND (starting next month) venetoclax.

2. Obinutuzumab’s role is to flag the CLL cells for destruction by my immune system. From what I understand, it’s tricky for the obinutuzumab to get into the lymph nodes and bone marrow, but it can go gang busters in the blood stream, particularly if my NK cells (part of the immune system) are fired up and ready to go.

3. According to my (unproven) theory, exercise will help pump pirtobrutinib through my body, lymph system, and through bone marrow by way of an increased heart rate (I have an especially strong marathon runner heart), blocking the BTK signaling of all those punks trying to hide out, and forcing them to drift out of their protective niches. 

Further, exercise signals to my NK cells to flood the blood stream and start looking for punks. There, they will team up with the obinutuzumab and blast cancer cells away.

Again, it’s an unproven theory and maybe the exercise does nothing more than improve my mental/physical health. But it seems like a low risk, potentially high reward strategy so I’m gonna get it going. I have a blood test early this afternoon, so stay tuned to what those #s show. Remember, the normal range for a white blood cell count (WBC) is between 4 and 11. I started treatment on January 12 with a WBC of 260(!), and my most recent blood test (January 19) showed a WBC of a mere 27. Anticipating some more good news today.