Ric Blake is disheartened but hopeful

By Marjory Sherman Eagle-Tribune Writer

A drawn and tired Ric Blake headed back to the National Institutes of Health feeling more exhausted than he'd ever expected.

No moment in all the months since The Eagle-Tribune began following Blake's journey with terminal thyroid cancer in January was more disheartening. In the four weeks since he finished chemotherapy and external beam radiation, he had become sicker, rather than stronger. This was far from the way he thought it would go.

"I'm feeling like I'm never going to get well. That's how I'm feeling,'' said Blake before he left. "It's a failure of faith, I think, because I can't even get a good night's sleep. I haven't had a day when I felt well in so long, I can't even remember what it's like. I'm tired. I'm sick of being sick.''

Just when he finally started to recover from the side effects of Taxol and radiation, Blake began to feel a different kind of sick: nauseous and exhausted. He dropped 22 pounds in three weeks, had frequent bouts of diarrhea, spiked a fever from 99 to 101 frequently. The weight loss and other symptoms were deeply disturbing.

"It's like the last straw,'' he said. "You should see my face. It's so sad. It's absolutely collapsing like a clay face. It's just falling apart.''

So it was with a sense of dispiritedness that Ric and Diane Blake left their home in Londonderry, N.H., a month ago to drive to the campus of the National Institutes of Health in Bethesda, Md, that houses the national government's arm of research medicine.

The Blakes had originally planned to fly to N.I.H., but in the wake of the Sept. 11 terrorist attacks, Reagan National Airport in Washington, D.C., was closed. So the Blakes drove to N.I.H., which was itself locked up tight, with intense security all around. When they pulled into the parking lot, security guards not only searched them, but also looked under the carriage of the car for weapons.

Once Blake was settled in a patient room on 8 West in the clinical unit at N.I.H., there were hints, small signs, of good news. Initial tests showed that his tumor marker, thyroglobulin, had dropped 19 points, from 86 in June to 67 this week.

On his third day there, a doctor removed the feeding tube that has been hanging from his belly for months, a tube that was an insult to his sense of self and that initially caused a painful infection. The tube served its purpose, however, allowing him for weeks to bypass his painfully swollen windpipe as needed with syringes full of nourishment and pain medication.

His biggest boost in the week before he headed to N.I.H. was that his voice returned, after weeks of being reduced to a whisper from swelling that comes along with radiation treatment. For weeks, his once-resonant voice, a beacon of hope and courage to many readers who are following his journey with advanced thyroid cancer, nearly disappeared. He could not talk on the telephone and felt so sick that he did not write e-mails, either. Now, in the days before heading to N.I.H., it had returned.

By Thursday morning, the Blakes were ready for "The'' meeting at 11 a.m. with Blake's physician Dr. Nicholas J. Sarlis.

The news was heartening, though not as positive as the Blakes might have hoped. The tumors on his trachea and larynx are still there, but the largest one has shrunk by 1 millimeter, the ultrasound and CT contrast studies show.

"Ric's disease has been stable. We cannot find any significant reduction in his disease despite the fact that he took this semi-experimental treatment with the Taxol and radiation,'' the doctor said.

Sarlis is carefully planning his next step in attacking the cancer. It could ultimately put the surgery option back on the table, meaning that, with radiation and chemotherapy, a cancer once called inoperable would be rendered operable.

The final analysis of whether the treatment worked will not be known until Blake returns to N.I.H. on Jan 7 for a Positron Emission Tomography (PET) scan in addition to the Magnetic Resonance Imaging (MRI) and Computed Tomography (CT) scans. PET scans are quite accurate, but are not reliable until months after radiation treatment, when all swelling has disappeared and the full effects of chemotherapy take hold.

Sarlis has two hopes for Blake, come January.

"What we're hoping to see, in the best-case scenario, is that his disease would have completely disappeared. More realistically, what I would hope to see is a significant reduction in the size and volume of his disease,'' he said.

Enough reduction in the disease in Blake's windpipe could prompt Sarlis to recommend surgery. Blake's case would mark only the second time in the doctor's experience where he attempted to make a once-inoperable thyroid cancer operable by killing off enough of it with chemotherapy and radiation. The same treatment works sometimes in non small cell lung cancers with good results, he said.

All of the talk of future surgery is jumping far ahead of the game for a pragmatist like Blake, a man who lives in the moment, both by nature and because of his illness.

Blake was surprised that early tests did not show significant improvement in his disease, but he is trying to maintain a positive outlook.

"I feel all right. It's about what I expected,'' he said. "Only 1 millimeter smaller is not very much smaller. I wanted them to be a lot smaller. But the thyroglobulin did not rise.''

Now back at home again, Blake is feeling a bit better, returning to his garden in short stints and once again playing "Risk" on his computer.

He knows that the longer the bulky tumors sit in his neck, the greater the chance they will mutate into an aggressive form of cancer cell that is undifferentiated, called "anaplastic.'' Once that happens, life expectancy is very short, maybe six months. He knows that the surgery would help avoid that, but he knows there are dangers involved too.

Meanwhile, the bigger mystery that followed him down to NIH has been solved. The exhaustion and illness that struck in the weeks after the treatment was due to colitis caused by a bacteria that strikes people who have taken a lot of antibiotics.

As his week at N.I.H. drew to a close, there was one final sobering moment. A woman at the Thyroid Cancer Survivors Conference he attended at the end of his week in Bethesda announced that her cancer is anaplastic, and she has six months to live. He spoke to her at length afterwards.

Even more difficult for Blake was returning to his advanced cancer support group at Lowell General Hospital last Tuesday to learn that fellow cancer survivor Elaine, a former nurse with whom he had shared much there, died Monday night. Elaine was the fifth of the six original members of the support group to die. The group has been in existence since December and now Blake is the only surviving member.

"The magic of the group is you get to know people in ways their family does not know them. When you have that level of intimacy with people, you have a very different relationship. And they're all gone. That's hard,'' he said.

Yet despite the loss of friends, despite his own exhaustion and weight loss, Blake continues to open his life to others so that the message of living well until the end rings out for people in the Merrimack Valley.