Wednesday, December 30, 2009

Sometimes it has to be tough to be married to me.

Good morning! Vacation churns on. Unfortunately, for me, I am back at work - still trying to catch up on a schedule that is overflowing. Lynley is still off, the kids are still home, and Mama Marge and the Kipster are still in tow. It is rather unfortunate for me but, I must be honest, I don't so much mind not being dragged ( I mean invited) to all of the post Christmas sales. I reserve that punishment (I mean fun) for the kiddos. It works out well. I get some important work done. Kip gets some important ESPN and ESPN2 watching done. The girls, well, I don't know what they technically get done. All I really know for sure is that for a few short hours I don't get told what to do. In that sense, it really is still like a vacation.

Don't tell Lynley I said that. I am quite sure that statement would relegate me to another chore - probably under the house. It does seem like she told me to run another cable line to the TV out in the playroom. Too bad, I wish I wasn't so darn busy.

Yes, work leaves me relegated to my spot in the den. My spot is technically the red chaise lounge in the living room. It is complete with a snuggy and my new lap computer table that my adorable blushing bride got me for Christmas. It is important to note that I also have a special pillow that goes under my knees. This office system even comes complete with a cup holder. Now, I really have no reason to get up.

From this key position I can control the world. There is no medical research library out of my grasp. The only problem seems to be the refill process on my coffee cup. It still requires a trip to the kitchen. Given my new comfy office situation I am not yet at liberty to ask Lynley for a refill without some significant repercussions. She thinks my new "office" is a bit too comfortable and that I can get off my $*&%# and get my own &#%*^@ coffee. She also thinks it is a little too convenient for me to be so busy on her ^&#*@#$ Christmas break. Furthermore, letting the kiddos play Nintendo Wii next to me while I type on my &^#%$ computer does not constitute watching the kiddos.

See, this is why I know better than to ask for a refill on my coffee.

Plus, I have discovered that if I coordinate it just right and I get a large enough coffee cup I can swing by the kitchen on my bathroom break and still not break rhythm.

You know, of course, that I am going to get in big trouble for writing this. This is going to cost me a few hours of dirty scowls. She might even move the remote to the other side of the sectional or, worse yet, hide it.

But, she would be missing the point. I love my new spot. She created it for me. The chaise was her choice. My new pillow is the very one she purchased. As I already mentioned, my new lap computer table (complete with cup holder) was even her gift to me. Heck even my snuggy that keeps me warm has her idea.

She created this monster.

I am just a consequence of her purpose.

Tuesday, December 29, 2009

The Dam of Twerpful Debasement

The children have been great throughout the holiday. Sure, there have been moments of misbehavior and questionable attitude but, by and large, they have been really good. With a week to go before they return to school, I know that there is a capacity (and high likelihood) for change. In fact, I expect it to. Let's be real here.

Given that expected reality both Lynley and I have been working on the dynamics amongst the twerplets. One of our primary goals is to help Graham achieve some status amongst his meany sisters. It is true. He is abused by them. They are horrible to him and yet, in an effort to be included, he has put up with their ritual malevolence. He sucks up to them in an effort at inclusion which just further lowers his credibility amongst them. Just like with us, those girls look for chinks in the armor and then exploit them. Thankfully, we have almost 40 years of wisdom and history to aid us in foiling their evil plots. Graham, though, has little experience and even fewer successes.

To level the playing field Lynley and I thought it necessary to elevate his status artificially to protect him in the short term and then begin working with him to develop long term skills in protection from the dark arts.

It is simple really, we began with elevating his status. The trick was in doing so without making the temporary favoritism obvious. That would cause a backlash of resentment from the girls. We began by focusing on activities that encouraged participation with Graham both on our behalf and the girls. We did things that gave everyone an equal chance but that we knew Graham would either excel at or that the girls would choose not to participate in but later regret. Sure enough, Graham began helping me with manly chores. I made them as fun as possible. It is amazing how exciting crawling under the house can be for a five year old boy and even more surprising how quickly a 4 and an 8 year old girl can become jealous of the adventure and beg for inclusion. At this point, I gave the reigns to Graham and let him lead the girls. This had the ultimate effect of raising his status amongst the girls - without them knowing and without the resentment that would normally follow.

Sneaky, eh?

We tried several different activities like this. Some have worked flawlessly and others have been less effective. The problem is that Graham is still seeking their approval when it does not involve one of these little planned activities. That is ultimately our only problem with the system. Regardless, he is climbing in social status. Their are fewer times when he seeks their approval and the games that they play are more often fairly balanced. It isn't perfect and I know it never well be but we, the boys, are getting closer to a day not dominated by meany girls. (Well, he is anyway.)

I credit much of our overall behavior success during the holidays to these little activities. We will see if it continues to hold back the dam of twerpful debasement.

Purpose requires constant fiddling.

Monday, December 28, 2009

Merry Christmas and to all a Mama Marge

Well, well, well... Long time no type. Yes, I am feeling a bit guilty. But, I must admit that I have had so much fun over the last few days that I had totally forgotten about my need to write in my diary. For those of you that have followed along for a while, you already know that there can only be one reason for such week long bliss.

Yes Marjorie, my dear sainted mother-in-law, has arrived to sprinkle happiness and joy upon us.

However, even in all of her maternal glory, I must tell you that I have just had a really good time with the family.

It all started Christmas Eve Day with a trip to the movies with the kiddos. Fun enough, it was a couple of mindless hours spent listening to a bunch of guilty pleasures sung by some high pitched squirrels - er - chipmunks. None the less, the kids enjoyed it and it was cute enough. I was just happy to be out and about spending time with the family. It was more than that though. With the snow coming down it was almost magical and every one of the Dungan five was in a stellar mood. No fighting, no bickering. Just happy times. Good stuff.

Christmas Eve dinner was over at my mother's house - just 4 blocks away. Unfortunately, it was missing both Papa Kip and Mama Marge who had been diverted 400 more miles east in attempt to make it to Texas by Christmas. Their late arrival worked out well though. I was still able to enjoy my Christamas Eve dinner and without having to wash dishes - a rarity around the Dungan household. I took it as an early Christmas present.

What I received in trade was a trip along icing roads to the airport. A 45 minute commute on a normal day, the trip was complicated by icy overpasses on Christmas Eve night. Thankfully they were not too bad to me. However, there were several cars not so neatly parked into the guardrails every 1/4 mile or so. I clipped along cautiously at about 30 miles per hour without issue and made the trek in a little less than an hour and a half

I made it to the airport in time to find Lynley's parents getting off the plane. It had been a long flight. They arrived 6 hours later that originally scheduled. It was further complicated by the removal of one of the passengers for "weirdness" and a medical emergency. That would only be an appetizer for what they would experience on the ride home. In the time that we had collected their luggage, the temperature had hit that mark that froze all of the roads. Our trip home would be made between 5 and 10 miles per hour on an interstate littered with sliding cars. We crept along behind a mass of traffic and with the exception of a few occasions where we lost momentum going up some slippery hills we made it home with a minimum of sliding, no dents, and no injuries. The perfect ending to what was a very long day for the Fowler's. I was happy to make it home as well. Thankfully, I had Mama Marge sitting shotgun and gifting me with direction on what I needed to do to get us home safely. Lucky, lucky me. There is something about making it back home for Christmas with my family that was important to me. Not to mention the fact that there was still much for me to do that night, if you get my drift. In the end, Mama Marge talked us back to the house and cabana 1 without incident.

Christmas mornings are fun around the Dungan household. With 3 little believers it is truly a magical time. It isn't something I can put my finger on or describe adequately with words. There is just something incredibly special about being around little kiddos during Christmas. We all get to relive that fantasy through their eyes and that is an amazing gift for an old big kid like myself. Christmas morning brought more shoveling of ice off of the front walk and another trip along icy roads to pick up my mother and Grammy but that was relatively uneventful.

We made it together. Lynley, the twerplets, Papa Kip, Dee Dee, Grammie, myself and, of course, my very own Christmas gift, Mama Marge.

All is good in the Dungan household.

Purpose now is in spending time together.

Tuesday, December 22, 2009

Purple Cow TODAY!!

Please come out and join us today at The Purple Cow in the Chapel Hill Shopping Center in Fort Worth, between 11:00 am and 9:00 pm to help support Sydney and Graham's Tae Kwon Do team - Team GSX.

Bring your family. Bring your friends. Bring your coworkers.

Today the Purple Cow in Fort Worth will donate 15% of your check to Team GSX to help raise the funds necessary for the team to go to the 2010 Junior Olympics.

The Purple Cow
Chapel Hill Shopping Center
4601 W. Freeway
Fort Worth, TX 76107
(817) 737-7177

So how do you show your support for Sydney and Graham's team?
Simply come by The Purple Cow (one time or many times) between 11:00 am and 9:00 pm today. Enjoy some mighty fine food and company, and let your wait staff know that you are there to support Team GSX.

That shout out will mean that 15% of your check will be donated to Team GSX. That donation will go a long way in helping Team GSX Tae Kwon Do make it to the 2010 USA Taekwondo Junior Olympics.

Make sure to tell them you are there to support Team GSX!

We look forward to seeing everyone. As always, we can't wait to see you to thank you so much for your support. We genuinely appreciate it.

Today purpose is in the form of ice cream.

Monday, December 21, 2009

We are officially surrounded for the holidays

Good morning! Christmas is officially here. We successfully navigated all of the end of school parties and the kiddos are officially home for the holidays. Friday marked the grand finale for school. Of course, according to tradition, their classes were let go at just after 11:00 AM. I know I get little support for my vent about holidays before a holiday but I once again find myself at a loss to understand why the kiddos need a half day off before and after a school holiday.

Don't get me wrong. I love my kiddos. In fact, on Friday afternoon, I took off from work to entertain not only my usual gaggle of twerplets but I even recruited another to up my kid care skill level. Yes, on Friday, Jillian 2, came with us for lunch and an afternoon of play. At the very least, this also preempted some phone calls. You see, Jillian 2 is the other half of Sydney's little phone obsession duo. It turned out to be a great afternoon and evening. It was nice top see Sydney at home talking to something other than the phone.

There really is another person on the other end.

I do, however, also have an important announcement to make. As you know, Sydney and Graham are now on the Team GSX Tae Kwon Do team. Their team is raising money to make it to the USA Taekwondo Junior Olympics in Orlando. This is a big deal. We are talking the Junior Olympics here. On Tuesday (tomorrow) the Purple Cow in Fort Worth will be donating 15% of their sales to Team GSX Tae Kwon Do. Please ask your friends and coworkers to come by and have lunch, dinner, or both at the Purple Cow to help support Sydney and Graham's Team. Also, make sure they tell their waiter or waitress that they are there to support Team GSX. Please consider eating in or, if you can't, consider ordering out for your office. Either way we would sincerely appreciate your support. This is a simple, non invasive way for their team to cover some extremely significant costs for their team.

Please come out and support the team tomorrow

Lynley made this flier to hand out and post:
Team GSX / Purple Cow Flier

We look forward to seeing you tomorrow.

Today I will be buried in a pile of purpii.

Thursday, December 17, 2009

Ammo for my purpose gun

Thank you for all of your email. Yes, even from one who wrote:
"Oh my! If this is the response to a call from a girl I can't wait to ride along on the journey to sleepover planning, texting and *gasp* calls from boys! (at least we know where the drama comes from in the Dungan children's genes)"
As if we (Graham and I) don't already receive enough abuse from the gaggle of feminine supremacists who already dominate our fragile Dungan man world.

For the record, at this point I am relatively unworried about the advances of boys into Sydney's world. She is her mother's daughter after all. If I am being honest, given their history, one honestly has to worry a bit for the boys. Plus, even if that theory fails, I have a single shot rifle and I am a pretty good aim.

On the other hand, Ainsley is her mother's daughter as well. However, for her I must admit I do see fear on the horizon. Not from one boy though. With her habit of multiple boyfriends it seems my rifle may not be enough. For her, I fear I will need something fully automatic. I will also need multiple locks on all of our windows and doors. It probably would not be a bad idea to get her a permanent female chaperone either.

Finally, Lynley and I met over lunch and have come up with the following plan. Sydney can talk on the phone for up to 30 minutes per night. Homework and chores must be completed beforehand. No calls during dinner and friends are not allowed to call after 8:00 PM.

It is actually pretty exciting as we now have a punishment tool as well. The threat of taking minutes away from her calling time is as effective as anything we have used thus far. Boy was she nice to be around yesterday afternoon.

We will see how long it lasts.

For not though, I have more ammo in my purpose gun.

Wednesday, December 16, 2009

Has it really begun?

Last night after we got home the phone rang. I looked at the caller ID on the home phone to decide whether or not to answer it. Just so you know, we don't answer 95% of the calls that come in on our land line. Yes, I admit it. When it comes to our home phone, we are militant call screeners. The fact of the matter is, for us, almost all of the calls that we get on our home phone are completely unsolicited sales calls, etc. If you don't have a number we know, you aren't calling from Cook Children's, or your name isn't flashing across the caller id screen you can pretty much forget it. There is no hope of us answering the phone. This is just an FYI. People that know us know not to call us on our home phone. They call us on our cell phones. We don't screen those calls. After all, those could be from another family with neuroblastoma.

Regardless, this particular call had a familiar name scrolling across the caller ID. It was one of the family's from Sydney's class. I answered the phone to hear a very tiny voice echo back. "This is Jillian. Can I speak to Sydney please?" Easy enough, I called Sydney in and handed her the phone. To say she was excited to receive a phone call is a gross understatement.

For the next hour or so Sydney would be on and off the phone. Being her first experience spending anytime on the phone their were many hiccups. There were several accidental hang ups as she tried to switch the phone to speaker. With all of the excitement there were also several phone drops which eventually led to hang ups. Surprisingly, on one occasion, the battery even ran out on the phone.

Though, even with all of these little issues, Sydney found great joy in talking to Jillian. There were lots of giggles. From what I heard, the conversations were silly in nature but, none the less, apparently very important to the girls. Getting Sydney to hang up the phone before dinner was next to impossible. Oh, and of course, the rest of the night she begged to get back on the phone. We put our foot down and said enough was enough. Regardless, she is already planning for their next phone call and the one after that.

To be honest, Lynley and I are out of our elements here.

At what age is it appropriate for little girls to be talking on the phone?
How long is it acceptable for them to be talking on the phone every night?
Is this a habit we want to allow?
How will this habit impact our family?
What rules do we establish to create a fair balance for her and the family?

As you can see, I really don't have any answers. So I am asking for help.

What do we do? What are the pitfalls? Feel free to email me at (But you probably don't want to bother calling us at home;) I look forward to some educated feedback.

Just because you have purpose does not mean you have the answers.

Tuesday, December 15, 2009

Trials and Tribulations of Curbing a Thief

Last weekend was chock full of Christmas shopping for the Dungan five. On Saturday we would hit no less than 11 stores. I can also tell you that the twerplets were no less than excellent. All in all, we really had a pretty good time with the exception of one incident.

At Pier One, all of the Christmas decorations were out on display. One of my favorites were the tiny little presents that spilled out onto the top of the tables and adorned many of the other nick knacks throughout the store. They were small packages no bigger than a finger tip, wrapped in holiday colored foil, and secured with the tiniest of gold bows. They were adorable little decorations.

After we left the store, Lynley noticed Sydney was playing with something in the back seat. Sure enough, she had stolen one of these little decorations. Worse yet, she decided to lie about where she got the item. This was not going in her favor. After a few moments of thought though she finally confessed to her transgression.

Was I happy about the situation? Of course, not. Was I mad? Well, mostly for lying to her mother but also that she would take something, no matter how small, that did not belong to her. However, I do love these opportunities. This is an occasion to do some real valuable edumification.

You see, I have the belief that, in many ways, training little kiddos is very much like training dogs. To truly get something to sink in you have to catch them in the act. For some reason, with dogs and children, they do not make a true connection with hypothetical examples. However, the cold face of reality can make life long impressions almost instantaneously.

This was an opportunity to do some real learning, not only for Sydney but also with her junior gaggle of future thieves, Graham and Ainsley. In the large scheme of things the thievery of a table decoration was really not that big of a deal - no one was going to be arrested or sent to jail. However, this certainly had the chance to be a momentous occasion in their lives. This was a fork in the road. It is moments like this that gives you the opportunity to grow respectful and honest adults instead of people that think they have a right to what they do not own.

So, we took this opportunity to make this a life lesson. It would be a day before we could make our way back across town but indeed, we would make our way back to the store. The time actually did Sydney good. She did a lot of thinking and worrying about her transgression. I would even go as far to say that she lost some sleep worrying about what she would say to the store manager the next day when she returned the item to the store. Yes, this would be something she would never forget. It was a perfect learning experience. It was a big topic amongst the twerp brethren as well. It would dominate conversation for the better part of a day.

The next day, however, we made our way back to the store. Sydney did an excellent job talking with the store manager. She spoke clearly and apologetically. Her apology was among the best I have heard. It was heartfelt and meaningful. The manager thanked her for returning the item. There was no need to say much more. Sydney had covered anything that needed to be said and it was crystal clear that she had learned her lesson.

The saga was over and an almost meaningless item had been returned to the store. However, for Sydney and the rest of the twerplets this was a life lesson they would not soon forget.

As we walked out of the store we saw another little girl about Sydney's age at the table adorned with the little presents. As the little girl left the table she picked up one of the little presents and put it in her pocket.

Sydney's eyes became the size of half dollars.

The irony was thick.

But then Sydney turned to me and said, I don't want to be her.

She learned something.

It is amazing what can be gained from something that cost less that a nickel.

I wonder what the other child's parent will do? What will she learn from the experience?

Purpose can have amazing power.

Monday, December 14, 2009

Still carrying equal weight

Today's post will be short. You may remember on Friday that I stated that I had a huge deadline on Tuesday. Well, it is still looming over my head and I am fighting for every minute to complete it. Now, since, I took Friday off to spend with Ainsley at the tree farm I simply don't have another minute to spare. If you feel cheated (and I don't blame you) there is only one person to blame.


It is entirely her fault. If she wasn't so cute and adorable and wonderful, well, I would never have jeopardized this deadline to spend some time with her. None the less, she is and I did. Totally her fault.

The good news is that she and daddy had a wonderful time. However, it should come as no surprise that it wasn't just with Daddy. No, I was not the only guy her life. She spent equal time flirting with both "Zachawy Wogers" and Nash as well. In fact, I can't remember a moment that she was not clung to one of us. Sure, I could come up with all kinds of disturbing things to say about this scenario but I must admit that I was kind of pleased to still be in the mix. I carried equal weight with the other men in her life. I don't know how long that will last so I guess I am just appreciative of the time I still have.

Oh, and chalk one up for me. This is the first field trip I have driven to in a year in which I did not receive a speeding ticket. Kudos to me.

(Oooh, all of you from SCS who read my diary and who also have children in the kiddos class, don't be alarmed. This is technically also only the second time I have driven on a field trip this year. Oh, and, the dent on my right front fender was from a totally unrelated incident. That happened while taking the kiddos to school. Oops, probably shouldn't have mentioned that either.)

Regardless, now that I probably won't be allowed to drive on school trips any more I might have the time to finish this project.

Back to work.

Still, purpose hookie is fun.

Friday, December 11, 2009

One on One Freebie

On the heels of my dissertation on busyness - well - I am playing hooky today. Yes, your heard me. I am heading back out to the Mainstay Christmas Tree Farm with Ainsley's class for a field trip.


You see, don't tell anyone, but family is the most important priority in my life. Secretly, it is Lynley's as well. But, it is times like this that, for the moment, I have to forget about the fact that I have a huge deadline on Tuesday or that I am way behind on just about everything else. I get to go have fun with Ainsley and spend some time making some memories. It is about the most important thing that I can do.

Don't tell my boss. He is a jerk with no tolerance for family fun. For him, it is all about the bottom-line. If he finds out, I will probably be out of a job.

Nobody ever said that being self employed wasn't without politics or bad bosses.

Regardless, I am really, really looking forward to some quality one on one time with Ainsley. While our family is always together spending time with one another the one thing that we fail at miserably is spending one on one time with each other. It is always the entire gaggle of us. We go to the grocery store together. We go to Tae Kwon Do together. We eat dinner together. We do it all together. It is very rare that we get to do these "one-on-one" things and I absolutely love them.

As a parental unit this is one of the things that I get wrong. I know it would be great for their tender little psyches. It would also be great for us to see and appreciate their individuality - something we only get to see on special occasions. It is just difficult. How do you factor that in with 3 kids? On the surface, it seems easy enough. If Lynley and I spend one hour with each kiddo, each week that is only 6 hours. But, where do you fit that in with everything else? With laundry? With cleaning? With homework? With grocery shopping? With everything else?

I obviously don't have the answers since I have failed at this portion of my life so completely. I only wish I could figure a way to fit it end. Furthermore, I think I need to.

Well, I had best be off.

Today I get a purpose freebie.

Thursday, December 10, 2009

Just a little holiday activity

Good morning! Gee, I am so sorry for not writing in my diary yesterday morning. I am absolutely and utterly swamped. Work has me cramming for deadlines and with Lunch for a Cure in full swing there is a ton to do. Add on top of that a couple of new neuroblastoma diagnosises and a couple of parents working through relapse options and I am barely making it through my email, much less getting everything done that needs it.

On top of all of this, I still owe everyone an article on how the research funds from Lunch for a Cure will be distributed this spring, a review of the RALBP neuroblastoma research I witnessed last week, articles announcing that all of the 2009 ASCO neuroblastoma presentation videos are available for your perusal, another interesting new trial is out in the UK, what all the Accutane hubbub is all about, an announcement about several new live webinars on transplant and relapse therapies have been scheduled, and another nice emotional beg for some more research funding for Lunch for a Cure.

As if that all was not enough, my beautiful blushing bride decided that the already joyful hustling and bustling holiday season was not busy enough (it seems I just heard her complaining about that recently) and she has decided it would be a good time to reorganize and redecorate the house. Yes, that means that me, slave and boy toy du jour, must be up to all of the furniture moving tasks.

I love you dear.

All of this, and I am supposed to be enjoying the holiday season - damn it (foul language for dramatic effect)!

Ho, Ho, Ho - damn it (dramatic effect, again)!

The great news is that while we are horribly busy we seem to be having a pretty good time. The kiddos are nothing short of spectacular. They still haven't figured out that Santa could be watching them through the window at any giving moment, but their antics are still worth some pretty good laughs. Sydney's still a snot, Ainsley's still a twerp, and, well, Graham is still emotionally abused but very loved. I could not ask for more.

I'll take it.

Just bear with me. No more.

The purpose is burning inside.

Tuesday, December 8, 2009

Christmas Purpose in Pictures

In yesterday's rush to remember the "purpose" of Christmas I forgot to share some pretty important pictures. Now beware, this is a spoiler alert. For those of you hoping to see pictures of the Dungan five in your Christmas stocking, on our annual calendar, in a picture book or on a coffee mug you may not want to look any further. Santa Claus may be thinking about crafting a gift for you with one of these very pictures. For those of you with no desire to have anything permanent with our goofy little faces on it (I don't blame you) read on. You can see what a great time we had at the Mainstay Christmas Tree Farm.

Helping Daddy cut down this years Christmas tree. Yep, not so much. They were having fun though.

A Twerp maze - now this is entertainment.

The rope walk - just another indication of how unbalanced we are.

Just another ordinary average Twerplet picture.

Awesome purpose twerps, aren't they?

Monday, December 7, 2009

Holiday stress

You know, as I get older it becomes more and more obvious that I am just a guy. I guess I should probably say that I never doubted my masculinity. No, not this dude. What I mean to say is that I still don't get all of the stress around the holidays. Some would tell you it is because us guys don't do anything.

We don't send out the Christmas cards.
Of course, we generally take all of the pictures that end up on the Christmas cards and we do all the necessary formatting. We even format the addresses to be printed on them.

We don't help decorate the house and make it pretty.
Although we do go out and buy all of the lights that go out on the bushes and spend hours stringing them up. We do get out the inflatable snowman and run all the wire. We do run to no less than three stores to find big enough suction cups to hang all of the wreaths on the windows and then hang them. We do cut down the Christmas tree, tie it to the top of the car, and then drive it home. We do trim the tree, put it on the stand, and bring it in the house. Heck, I seem to remember that we also even put on all the lights and then gather the family to put on the ornaments.

We don't do all of the shopping.
Although we do go to 15 furniture stores with our wives to pick the perfect couch that they want for Christmas. We even religiously check the newspaper and the Internet for holiday furniture sales. We schedule delivery and even make arrangements to be home when they deliver the massive Christmas present. We visit all of the stores and scour the Internet to help make sure that Santa's elves find all of the presents that the kiddos are wanting. We even make sure that Santa is prepared with all of the things that he may want to put into the stockings. Heck, it even seems like we go to the grocery store several times per week just to make sure we have the items that we need to get through the rest of the week and the holidays. In fact, when your credit card number is stolen and thieves have emptied your bank account we are there to purchase the groceries.

We don't do all of the laundry on top of all of these other things we don't do.
Hold on, yes we do.

We don't cook during the holidays.
Although we do make breakfast every morning for the family. We do the grilling for dinners several times per week and cook inside when necessary. We don't do salads or vegetables but we are more than happy to bake a potato or french fries. We also pour the milks and set out the plates and utensils. We are always the first gather the twerplets for dinner.

We don't complain.
What is the point?

The fact of the matter is that Christmas is not going to be busy. Every year it is going to be 5 times the work of a normal month. It is going to be jam packed with wall-to-wall stuff to do. That is the way of Christmas. However, if you do not relax and enjoy the process, Christmas will become a nightmare.

The Holidays aren't about the perfect Christmas tree. It is about the family being together and cutting down their very own Charlie Brown Christmas tree. It is about the time they spent together on their journey to get the tree. It is about the memories and the fun. It is about being together.

It isn't about having the prettiest house on the block (not that we are at risk). It is about Graham being incredibly proud that he had all of the extra bulbs we needed to replace the burnt out ones on the strands of lights outside. After all, those are the bulbs that made the whole string of lights work.

It isn't about plugging in the inflatable snowman. To the girls it is more about the kitty that peed on the snowman as it blew up. For me, it was the memory of the girls being grossed out. Oddly enough, they now dare each other to touch the snowman. Gross, but funny.

Stop, breath, relax, and enjoy.

Remember what the purpose is.

If you aren't enjoying it, you are missing something very important.

That is a lesson in purpose for all of us.

Friday, December 4, 2009

A day of successes

Good morning! Wow, I have been inundated with email. Bear with me, I am working through it as fast as I can. I have all kinds of news to share but not the time or space to do it this morning. First, thank you for your support of Lunch for a Cure. I received news late last night of another $10,000 check on its way. I am absolutely blown away by the support we are receiving. Thank you so much. We will be funding some great research and I hope to have time to line everything out next week. Finally, some have had questions and I want to reiterate
100% of the dollars we receive will go to fund neuroblastoma research!
NO administrative costs, NO marketing costs, and NO foundation salaries - just research.
On another note, the scientific presentation went very well yesterday. It was exactly what a suspected. It was complicated and my brain is still digesting all of the metabolic pathways discussed. However, the news was very good. This research will impact neuroblastoma. Once I get a chance, I have fully digested all I learned and am capable of sharing it with others I will write about. At the moment, I barely understand it - much less passing on the knowledge to someone else.

I am still amazed that this whole project started because of a lunch between my wife, Dr. Awasthi and I and the idea to apply his research towards neuroblastoma. That lunch, somehow, turned into published research - incredibly. My wife and I are incredibly thankful for Dr. Awasthi's interest and passion. It is heart felt.

Well I had best be going. As I mentioned, there is a very large pile of email and the rugrats are beginning to stir. All is well in the Dungan clan.

Purpose pulses here.

Thursday, December 3, 2009

Chock full

Good morning! First off, thank you so much for your support of Lunch for a Cure. Sydney loves the fact that the ornaments on her tree continue to grow. It has put a big smile on her face. For me, well I am happy because I see the research that is going to be funded with those lunches. We already have a clear vision of some of the research that desperately needs funding and an indication of where these dollars are most needed. Perhaps tomorrow I will have the time to outline them.

Today is already full throttle. I am excited to be attending a seminar on targeting resistant neuroblastoma by bypassing P53. I know, I know. It probably does not seem very interesting to many but, to me, it is a talk I have been awaiting for a long time. I don't want to speculate too much but I believe that I will finally be hearing some results of some very promising preclinical research. It is a truly novel approach and, if it is as good as I believed it would be in the first place, this could be a significant step. I don't want to get everyone too excited but you can be sure that I will be reporting on this one.

Yes, I know. The neuroblastoma nerd in me is coming out again. What can I say. I just can't help myself when I see change. New research and novel approaches excite me.

Unfortunately, the rest of my day is swallowed up with meetings with the health department and other miscellany. I also have a pile of email from families wanting to discuss the various pros and cons on various phase 1 trials. Frankly, that is the thing I want to do most today, but unfortunately, it is also the thing that I will probably be able to do the least given today's hectic schedule. For those of you awaiting email, I am doing my best to get back to you.

As for everyone else's concerns - the kiddos. Well, the twerplets extraordinaire are doing spectacularly. It has been a busy week back to school and, of course, it has also been jam packed with Tae Kwon Do team practice. We already have 3 down and the kiddos can expect another one tonight and one on Saturday morning. In the midst of all of this we also had time to play around the house, share in the excitement of the first snowfall of the year, and play pyromaniacs as we lit the first fire place fire of the year with balls of newspaper. (Not to worry, although fun, this is a great opportunity to teach the kids about fire safety.) Oh yeah, and yesterday the ABS brakes went out on my car - a $2800 hickey. At what point have you officially driven your urban assault vehicle into the ground?

Life is feverish but I don't know that I want it any other way.

The family is great.

The purpose rocks on.

Wednesday, December 2, 2009

Giving Trees Alive and Well!

In yesterday's post I neglected to reiterate a very important point and was peppered with emails from around the world.
Yes, the Lunch for a Cure Giving Trees are alive and well.
In fact, the great news is that they are easier than ever. There are no longer any Giving Tree codes to confuse everyone. Simply donate in a child's name and your donation will be registered on that child's Giving Tree. For each $5 dollars donated an ornament will appear on that child's tree. Once the tree has been filled up, a gift will be sent to the child. Or, in the case of a giving tree of child who has lost his or her battle with neuroblastoma, a gift will be sent to another child fighting neuroblastoma in that child's memory. Either way, your donation will certainly put a smile on the face of a child who surely needs it.

The Giving Trees for all of the kids can be found here. And, most importantly to Sydney, her Giving Tree can be found here.

And, yes, she loves to see it fill up with ornaments.

So, in short, I am sorry I forgot to mention this ever important little fact in yesterdays post. Please, consider making a donation and putting an ornament on Sydney's tree. You can donate here:

Don't forget, 100% of your donation will go to fund neuroblastoma research. There are no administrative costs, no salaries, and no marketing costs. As it should be, all of your hard earned donated lunches will be used to do what we need them to do - help find a cure for neuroblastoma.

Please help!

This is purpose.

Tuesday, December 1, 2009

Lunch for a Cure - the rebirth of purpose

Each year since Sydney's diagnosis of neuroblastoma we have counted on our friends and family to help us put an end to this deadly disease. This year we have launched Lunch for a Cure to help make the difference. As of today, we have raised $948,000.00 and we are hoping to break the $1 million mark by the end of the year. With enough lunches we will get there. As I do every year, I make a plea to all of my friends and family to help us achieve our goal.

Here goes!

When Sydney was diagnosed with neuroblastoma we were thrust into a world of unknowns. She was just 2 years old and facing, unbeknownst to us at the time, over 4 years of intense therapy. In that time she would encounter so much chemotherapy that, for many of the drugs, she would receive a lifetime maximum. Sydney also endured multiple surgeries and she faced a stem cell transplant which, like most children, nearly took her life. That was followed by over 30 rounds of radiation and years of oral chemotherapy. She also tolerated almost 3 years full of painful immunotherapy treatments and, to this day, has probably received as much as anyone in the world. In all, she would be a part of 6 clinical trials and she would be treated in three different hospitals throughout the country.

All of this was with no guarantee of success.

All of this with a track record of less than a 25% chance at survival.

Even given all of that, Sydney is certainly considered one of the lucky ones. She is still here. Sure, she has hearing loss as a side effect from the chemotherapy. She also has thinning hair and a multitude of other treatment related late effects.

But, she is here. She is alive.

During this same period though, most of the others with her same diagnosis did not survive. They were little kiddos just like Sydney. Perfectly healthy and wonderfully pure, they were just like every other toddler you have ever looked at with a smile on your face. There is no rhyme or reason. It could have been your child, your grandchild, or even one of their friends.

I can tell you that as it was one of mine.

Childhood cancer isn't right and it isn't fair.

We can do better.

It was all of this realization that motivated me to want to create a change. It was out of this that Lunch for a Cure was born. The simple idea of giving up one lunch and donating the lunch money for research into a cure for neuroblastoma. If enough people would give up one day's lunch we could cure this cancer. We could reduce the side effects of the treatment and we could guarantee that more children could grow up to live happy lives.

Research funds are desperately needed. Neuroblastoma is the most common cancer found in infants and the most common extra cranial solid tumor cancer found in children. Furthermore, cancer remains the number one disease killer of children in the US.

Now, let me put it into perspective. Last year the National Institute of Health funded over $680 million dollars in research for breast cancer. They provided less than $10 million to fund neuroblastoma research. This disparity is huge and this is the reason that research funding is so desperately needed for children with neuroblastoma. This is where your lunch money comes in.

Please consider giving up one lunch and donating those dollars to Lunch for a Cure. If you can afford it, I challenge you to give up one lunch per month for a year and become a member of the Lunch a Month Club. Every single penny you donate will go directly towards neuroblastoma research. Your donations will not be used for administration costs or marketing costs. 100% of your donation will go to The Neuroblastoma Foundation to fund neuroblastoma research.

Please go to to donate your lunch and, please, ask all of your friends to do the same.

Your lunch will save lives.

Monday, November 30, 2009

Back to the present

Good morning! Wow, it feels like I have been away from my diary forever. Well, we are back in Fort Worth. We made our trek back in the Suburban on Saturday. I am just going to come out and flat out say it. My children are the world's best travelers. It is roughly a 13 or 14 hour drive between Huntsville, AL and Fort Worth, TX. Trust me, when you are driving with 1 wife, 3 kids, and 2 dogs that estimate can grow exponentially. Potty stops alone must account for 6 hours. Then, factor in stops at Cracker Barrel and Walmart, a few meals, and dog walks and you can see that another huge chunk of time can be added on to your journey. I am pretty sure that without all of that the drive can be completed in a little over 15 minutes.

All joking aside, my kiddos were truly phenomenal. Everyone was well behaved and we all had a great time. I know that may sound strange but it was indeed true. I honestly have no clue what we have done right as parents to make trips work out so well but I must admit that I feel a sense of pride. We really did have a good time. There was nothing really memorable. It was not exceptional. However, I could not leave the car without feeling good. I have a great family.

I woke up this morning and made a trip to the bathroom. I know, that is probably far more information that you probably needed. However, as I was leaving I looked down on the top of the white counter in the bathroom to find two perfectly brown Ainsley sized foot prints on the top. They are grubby and grimy. It is hard to believe that my sweet little demure(not!) princess could have such dirty feet. On top of that it should be interesting to note that there is nothing above the counter. There are no cabinets. The light switch is on the near wall but that is completely in reach by her from the floor. In short, there is no rational reason for these two brown little footprints to be on our bathroom counter - none at all.

They are two simply little, dirty, and yet somehow incredibly adorable foot prints. I wish I could frame them.

I will ask her this morning her reasoning for being up there but knowing her I am quite sure she will deny it completely. She will most certainly blame the foot prints on the dogs, a heffalump or, worse yet, me. None the less, this will be one of those things that will carry me through the day with a little smile on my face.

So, now I am ready for my shot back to reality. The kiddos will head back to school and Lynley and I back to the grindstone. I have enjoyed the rest and relaxation experienced over the last week but it is time to get back to work.

There is a mountain of purpose to climb.

Tuesday, November 24, 2009

A step towards womanhood - not mine!

Good morning! This morning you find me, once again, reporting from Huntsville, AL. I am sitting outside this morning. It would not be nearly so bad if it were not somewhere in the 40s but that is the price I am willing to pay for Internet access. You see, wireless Internet access is only available on the back porch. Don't ask. Just think of it like an outhouse for the new age and remember that I am in the ol' south and things are just a bit different here.

But, enough about Internet access. I actually have a pretty momentous occasion to report. This is somewhat of a serious subject so you may want to forget everything I have said above.

You see, one of the long term side effects that Sydney has experienced from all of her treatments has been hair growth. While her hair has come back it is extremely thin and somewhat sparse. With an inability to grow long hair this has been a subject of sadness for her. She struggles with feeling, well, "girly." She constantly complains of looking like a boy. While I think nothing could be further from the truth, it is ultimately meaningless how I feel. It is her perception that counts. I can tell her that she looks pretty 1 million times but if she does not believe it, it is wasted breath.

Lynley and I have debated what to do. We have discussed many things. Ultimately, it has finally come down to something as simple as earrings. The decision was not difficult for Lynley or I. Frankly, we could care less. If it makes her feel more feminine than we are for it. Especially considering her history. For others, it has been more stumbling point. In fact, for some it has been a source of much difficulty. Apparently there is a rule about how old you must be for it to be considered "acceptable" to have earrings. Apparently, if you get them too young, it is considered tacky. I wonder, in this case. Are they more worried about how Sydney feels or how they will?

Get over it.

This is a very easy way for Sydney to feel more feminine and she certainly deserves it.

And so, without further ado, I present a beautiful little lady..........

Purpose is about what you believe, not what others may think about what you believe.

Monday, November 23, 2009

Sweet Home Alabama

Good morning, well the Dungan 7 - Hold on, I said Dungan 7. Not 5. Was that a typo? Good lord, I wish. But no, after much cajoling (actually female dictatorship) Lynley convinced everyone to bring along the dogs on our trip to Alabama. Thankfully it was not all of them - just 2 - but, that really was enough, wasn't it? Ironically, the dogs were the best behaved. They were our absolute best travelers. They were followed by the kids and then, well, Lynley. I would love to tell you some great Griswold Dungan stories about our trip across the country (well, half of it) in the suburban assault vehicle but there is really very little to tell. For the first time in the history of Dungan travel there was no high pressure or stress getting here. For the most part, everyone had a pretty good time. All of the kiddos were well-behaved and even Lynley seemed to sneak by without any of her usual travel demerits. In fact, she only scored on the bottom of the Dungan travel ratings because she is under the weather and she was a little whiney about her sore throat. She claims it is not the flu but time will tell. She seems pretty perky this morning so she may already be on the mend. If not, I am sorry Alabama. The upcoming statewide H1N1 pandemic is probably my wife's fault.

On Saturday, the day before our trip, Sydney and Graham had a Tae Kwon Do tournament, the DFW International. Of all places, the tournament took place at a church. Yes, we are in the bible belt aren't we? It all began to make more sense as we drove up though. This was a Korean church - complete with a sizable gymnasium. The big bouts were between Team USA and Team Mexico but the most entertaining portion of the opening ceremony was a sword demonstration by a team traveling from Korea. I hope to post some video once I get back to Texas and the video camera.

The kiddos did the best I have ever seen them do as team Dungan. For the first time there were no bronze medals - just silver and gold. Graham received gold in forms and Sydney received silver. However, Sydney came in second to another team member from GSX. Quite frankly, he was incredible. I love my daughter but she was no where close to Jacob in her performance. He did an great job. However, Sydney was clearly better than the rest of the competition and did well earning her medal. Sydney and Graham both won silver in sparring. Although they both lost to kiddos that were at least a belt level above them they both preformed better than I have ever seen them. Their technique is improving and I was terribly proud to be their father. They get better and better every time. Their confidence is improving. The both lack a bit of aggressiveness which seems to be the difference between matches that the lose by a single point and total domination. They are getting close. Technique is good but they just aren't throwing enough offensive kicks.

Well, enough bragging. The girls are all up and it is time to entertain the Dungan chickees.

Good news, Alabama , with more time this morning for review Lynley appears to be greatly improved.

Off to a week of fun purpose.

Thursday, November 19, 2009

A Pre Vacation Vacation

Okay, so this is how the rest of the week will pan out for the Dungans. Today is a regular school day. That means the twerplets head off to school. Interestingly, this is also an out of uniform day for them. The reason for that is because this is the day of Southwest Christian School's Thanksgiving Feast. You may be wondering why they are having the celebration today and not tomorrow? Well, you see, tomorrow they do not have school.

Now, this may not bug you but it does me. Why don't we finish out the week? It makes sense for parents that have to work. It makes sense for the kiddos that have to learn. Why aren't they having school? I mean, isn't it enough that they will be missing all of next week? For some reason, and I am still completely baffled by it, SCS deems it necessary to have a holiday before the holiday and, generally, a holiday after the holiday. It is as if they don't want to shock the kiddos too much. Let's see, they will be out all next week. So, let's give them Friday off so they can get used to not being in school all next week. That way the huge vacation won't be such a shock to their system.

In most cases, we also see this on their return to school. The day they return from a long holiday is generally a half day - sometimes 2 in a row. In this case, they are wanting to ease them back into school. These leaves parents with a couple extra days of scrambling to care for the little out of school heathens. Of course, I say that with deep rooted love.

Wow, I guess I really have some pent up child care issues. Well, none the less, school today and none tomorrow. On Saturday we have the DFW International Tae Kwon Do Tournament in Dallas. (I will be more careful when eating a hamburger after this tournament) On Sunday, we will be happily placing our tushies in the car for a 12 hour drive to Huntsville, AL for a week long visit with Mama Marge - a treat like no other.

Hmmm. Now I am beginning to understand why the kiddos may need a vacation before and after their vacation.

It will, none the less, be purposeful fun.

Wednesday, November 18, 2009

The Difference in Medical Care

Sometimes my kiddo's reactions surprise me. Hold on, let me back up. Let me start before that. A few days ago I mentioned that we didn't have to worry about the scar on my thumb because I was not burdened with having to be the good looking one in Lynley and I's little couplet. I get that. But does that mean I am a second class citizen?

Lynley had no less that two incredibly gifted surgeons work on her forehead. These were no schleps. We are talking top of their class Harvard Medical School graduates here. She got to go to two of the fanciest doctor's offices I have ever seen. There were 42" LCD televisions everywhere and the waiting room furniture was plush. She was even offered an Evian while she waited. The procedure was much the same and the follow up was even better. They carefully removed her stitches in only the most sterile of conditions and then carefully counseled her on the proper use of Maderma to reduce scarring. She experienced the pinnacle of medical care and I would say that my blushing bride deserved no less.

My experience, however, was a little different. First, I was told to sit in the back seat of my dirty suburban with my thumb in a bloodied used Chili's napkin while we drove an hour to the hospital that was most convenient to home. The surgeon operating on my thumb was not chosen by skill but rather by which ER would be less busy. I am quite sure this correlates with being the ER with the highest standard of care, right? After some cleaning and discussion with a nurse practitioner and a few student doctors they stitched me up while my wife and the gaggle of medical types made fun of my inability to cut a hamburger in half.

That was just the beginning.

I was ushered out of my fast food hospital experience with a warning to have my stitches removed in 8 to 10 days and a warning to call if my thumb turned black or started oozing green stuff. The problem for me became, who removes my stitches. I could go back to the ER but that seemed almost nonsensical. I could go to my PCP but he dumped me because I was too healthy and not profitable enough (yes, really!). Nope, neither of those worked. That left me with my family and this gets me back to where I began today's story.

Sometimes my kiddos surprise me. Without a good alternative to remove my stitches I figured I was left with my last option. Begging one of my kids to do it with the small clippers from the nail kit. Yes, a far cry from the luxury my parental counterpart experienced but, hey, I am willing to take one for the team. I first asked Sydney. She seemed the most trustworthy with scissors and the most sanitary but she declined me based on "grossness" as she put it. Who would have thought, after everything she has been through, this would be the tipping point for her. I won't go into everything gross I did for her but when she is old and grey and she reads this she will finally see the irony.

Regardless, I was left with Grubby and Grimey. Graham jumped at the chance. Due to his enthusiasm, I had to flash back quickly in my mind to see if I had punished him lately and whether I was due any malpractice. Of course, this was Graham so I felt pretty safe. Ainsley was in for it, too. Of course, I kept her a safe distance.

Graham was an excellent nurse. Together we removed the three stitches on the counter next to the kitchen sink. There were a few dirty dishes but not many. They were both very proud as was I.

My scar isn't very pretty but I guess that is the difference between Harvard trained medical professionals and Dungan trained 4 and 5 year olds.

I see where I rank.

But this is why my purpii are so important. Without them, what do I have?

Tuesday, November 17, 2009

Pictures - finally!

Good morning! I hope everybody had a great day. Mine was full of meetings - some of which were in Dallas. I mean no offense to Dallas-ites but life is too short to drive to Dallas. The good news, for me is that today I will be able to finally get back behind the keyboard to get some work done. Enough about me.

I know, I know. You want to hear about the Hot Harry Potter. You know, this really started as a joke. Lynley went in to her surgery calling the doctor Dr. Voldemort. (Yes, we are nerds.) I thought it was actually pretty clever and it was my stimulus for calling her the Hot Harry Potter.

Well, I'll be darned if it didn't come true.

I saw her for the first time late yesterday afternoon at Tae Kwon Do. There she appeared, back lit from the windows behind the door - the Hot Harry Potter. It turns out that her scar is a bit bigger than we both expected. It is obviously still very fresh. It is not zig zaggety like the original Harry Potter's scar but it is good enough for me. Over the next few months we should see the redness disappear and the scar fade into oblivion.

None the less, she will always be my Hot Harry Potter.

Great news! I finally have some of the pictures from our last Tae Kwon Do tournament. What do you think?

Graham winning his medal.

Sydney sparring in her first match.

Watch out! Graham is serious.

Winning gold! (Yes, they are older than she.)

Yep, it is there. 4 pictures of purpose.

Monday, November 16, 2009

Life, Liberty, and the pursuit of Answers

Good morning! First off, thanks for the email responding to Friday's neuroblastoma post on MIBG false positives. I had several people write and ask - "Well, what was found on Sydney's MIBG scan?" I probably should have reminded everyone that her positive result was for brown fat. She has an area around the nape of her neck which has always shown. It is not prominent. In fact, I would say that most would miss it, but, it is indeed there. So, to make a long story short. Sydney is fine. The finding for her is considered a false positive. I guess this is one of the reasons that I wrote about it. I knew it was an issue but was completely blown away that there was such a large percentage of children that also had this finding. Rarely am I surprised by something in neuroblastoma and the prevalence was a new one for me.

So, where are we?

Well, the Hot Harry Potter is recovering nicely. She goes back to the cosmetic surgeon today for a check up. She should get her first look at the scar this morning. If she was a good girl and followed the doctors instructions we can hope to see a healthy scar that will hopefully disappear in a few months.

My thumb? Ah, it is groovy. I will probably take the stitches out today. It isn't going to turn out nearly as pretty as Lynley's forehead but, not to worry, I am not the one that carries the burden of beauty anyway.

The kiddos? Hmph! I am in such a quandary with the kiddos. One minute they are perfectly stellar examples of human behaviour, the next, they need to be traded in on newer models. I am totally blown away by their propensity to change behavior on a dime. They are truly miniature versions of Dr. Heckyl and Ms. Behave. In this case, I would be misrepresenting Graham if I said he was truly apart of this dual personality syndrome. In this case, he is the good one. Of course, he is generally the brunt of the girl's behaviour so his split personality comes in the form of being happy one moment and crying the next because the girls have done yet another mean thing to him.

To be honest, I have had it with the abuse. Yesterday after Sydney sprayed Graham down with a hose for no good reason I told him to go throw her in the pool. I quickly realized this was not a very good idea and corrected it before he had the chance. Of course, he is too nice and probably would not have done it either way. The point is the pattern is recurring and if Sydney is not trying to make Graham cry it is Ainsley. He is grossly outnumbered and no amount of Lynley and I scolding and punishing the girls is doing the trick. He is going to have to solve this one on his own. He has got to fight back or they will never give him the respect that he deserves. Of course, he is too nice to fight back and too conscious of the rules to do anything bad to his sisters.

I want to help him but I haven't quite figured out the answer.

I need to think more about my purpose.

Friday, November 13, 2009

False Positive MIBG

During Sydney's last set of scans we had several little surprises. Thankfully most were unrelated to neuroblastoma. One of the scans however, MIBG, did show some uptake. Uptake on MIBG scans is always the scariest for kids with neuroblastoma because it has such a high specificity. In other words, it has a pretty good track record of only lighting up what it is supposed to. It is very specific to neuroblastoma. It should also be noted that MIGB is also used to detect other conditions such as pheochromocytoma. The bottom-line, however, is that MIGB is a pretty good tool at finding neuroblastoma and when in lights up on a scan it is a pretty good indication in a child with neuroblastoma that it is indeed neuroblastoma. I have always considered it one of our best weapons of detecting neuroblastoma. I have always considered it an accurate tool. Is it foolproof though?

MIBG dose show false positives. As of this date, a search of pubmed on "MIBG false positive" will bring up 111 articles. It is important to note that the bulk of the literature discussing false positive MIBG scans deals with soft tissue. In fact, until recently, I had never seen a published article which addressed false positives in bone. In soft tissue, there are a myriad of things that will uptake MIBG. Most of these are of sympathetic origin but there are several examples which are not.

One of the most common examples of soft tissue with MIBG uptake is brown fat or brown adipose tissue (BAT). BAT is one of two types of fat found in mammals. It is especially abundant in newborns and its primary function is to generate body heat. It is commonly found in the nape of the neck and is often a source of false positivity in MIBG scans. In fact, there are published reports showing as many as 12% of children with neuroblastoma showing accumulation in the nape of the neck - in none of these cases was the accumulation identified as a tumor by other imaging modalities or follow-up studies. Interestingly, it is also most commonly seen in winter.

There are several other soft tissue examples of false positivity as well. It is well known that MIBG can be taken up by tumors such as pheochromocytomas but it can also be seen in some carcinomas, adenomas, and angiomyolipomas. There are reports of uptake in an excessory spleen, benign liver tumors, and pyelonephritis. Uptake can also be seen when there is an obstruction in the urinary tract or kidneys. It has been seen in arteries and veins with stenosis and capillaries with angiomas. While that probably seems like a rare occurrence, you should note with all of the surgical intervention and chemotherapy seen in children with neuroblastoma it is more common than you may think. We have even seen uptake in the adrenal glands unrelated to neuroblastoma when the children have been treated with chronic adrenocorticotropic hormone. Finally, as you can tell if you have ever seen an MIBG scan, there are many examples of uptake throughout the chest an abdomen as the MIBG radiotracer makes its way through the blood stream and out of the body.

Seeing all of the potential for false positive may make one more wary about the specificity of MIBG. The good news is that most radiologists are trained to be able to tell what is real and what is not. However, it does illustrate the strong potential for false positivity in soft tissue.

Bones are a different story and there are far fewer examples of false positivity for neuroblastoma. Frankly, until recently, I had never even seen one in print. However, in this months Journal of Clinical Oncology (Vol27, 2009) there is a correspondence which seems to indicate some examples of false bony uptake - one on the ribs and another along the vertebra. The authors quote a small cohort but site several examples in the lungs, liver and original tumor bed in which MIBG showed uptake that later became non avid without further therapy indicating that perhaps these historical telltale signs of neuroblastoma relapse may in fact not be real.

So, as a parent of a child with neuroblastoma, what should all of these mean to you? Well, MIBG is still a pretty specific test to find neuroblastoma. However it is not bullet proof. It does fail. It is important to confirm findings with other scans and tests. At times, when you are suspecting a relapse due to a finding in MIBG this post may bring you some hope. More importantly, if you are one of the lucky few to have false positivity it may also prevent unnecessary treatment. Proceed with caution. Look at the entire picture.

That is what purpose is all about.

Thursday, November 12, 2009

The next level

Good morning! Well, after yet another deadline, I find myself with some time to catch up. First and foremost, everyone is well. My thumb has finally stopped throbbing and I think I am on my way to recovery. I can finally type without wincing in pain. Now, in fact, it is more like a tickle and I can't help but type a sentence without a little smile. Lynley too is on her road to recovery. She however, is not nearly as far along. In day 3 she is in a battle with swelling. Oddly the swelling is not really in her forehead. It has seemed to accumulate at the crown of her nose for some reason. She, of course, sees this as a massive disfiguration. I , on the other hand, still see her as the hot Harry Potter. What can I say? Other than that though, us two old twerps seem to be making a relatively swift recovery.

Now, onto the kiddos.

With all of the excitement over the last few days I really have not had an opportunity to cover the kids Tae Kwon Do tournament. It was meaningful for a few reasons. First, as I mentioned on Monday, they did well. However, this was also a proving ground for them. Did they have the right stuff? Were the ready to truly begin competing? Were they ready to take this to the next level?

Oh yes, this was much deeper than just a bunch of kids kicking the crap out of each other.

On Monday night, after Tae Kwon Do, we were called into Master Adrian's office. The discussion was about Graham and Sydney joining the team. This is a big step for a couple of reasons. This is a whole new level of Tae Kwon Do and it takes a commitment. No longer are we biding our time from one belt to another. The team is about the team and it is serious business. The team works a bit differently. First, we no longer go to our traditional Tae Kwon Do classes. We are now responsible for going to the team practices. There are 3 practices per week and one of them is essentially a double class. On top of that it is still preferred that we go to the sparring practice on Friday to further hone their skills. Fortunately, this is not too different that what we were doing anyway.

The classes, however, are very different.

They are full gear, pedal to the metal practices which focus on Tae Kwon Do in actual use. Team practice goes beyond simply teaching technique. Focus is not only on how to do something but how to do it effectively. The goal is true mastery. It is about the team and less focus is placed on personal belt development. It is no longer about learning the next set of skills as much as mastering the use of the ones you already know. It is for this reason that belt progress will also move much slower. Before, we could expect a new belt about every three months but it will now take considerably longer.

It is a sacrifice for the kiddos. It means more practice and it also means that their friends will likely progress in belt levels before them. It takes dedication and, for this reason, it is their decision. They are required to sign a commitment to the team.

Ultimately, we left the decision up to them.

Of course, with the sacrifice also comes rewards, as members of the team they will travel with the team. This means that they will also be vying for positions at the Junior Olympics and Nationals. Ultimately, they will be groomed with the intent for them to compete at very high levels. In this sense, it is quite an honor. However, once again, it sounds pretty nice but it ultimately comes down to them.

They agreed. They are on the team.

What do I think? Well, of course, I would be lying if I did not say I was proud. And frankly, the idea of have a teen age daughter who is also a competing black belt in Tae Kwon Do is somewhat appealing on the boy front. However, ultimately, for me. I think it is a character builder. I think the kids will learn a lot about themselves - about sacrifice and reward. They will learn that if they try hard enough they can accomplish great things. It will be a great personal journey for both of them. For me this is an incredible opportunity to teach them about life.

The trick will be in keeping it as fun for them as possible.

It is one small step for twerpkind but one huge leap for purpose.

Tuesday, November 10, 2009

The Hot Harry Potter

You can say that, can't you? I mean you are allowed to call your wife the "hot" version of Harry Potter and get away with it can't you. I sure hope so. Well, the point is that Lynley came through her ordeal just fine. We arrived at the dermatologist's office a few minutes late - go figure, Lynley late. Who would have thought? Regardless, it still was not very long before we were back in the operating suite. After about 20 minutes of prep she was ready to go. The entire procedure took about 5 minutes. Then, of course, we waited for pathology to test the tissue. The good news was that they were able to get all of the cancer out in one fell swoop. This had us leaving the building at roughly 11 to head to the surgery center to be closed by a plastic surgeon. At this point her "look" was questionable. She had a big protective dome on the crown of her forehead. The skin colored covering made her look like some sort of horned creature. However, that was far better than what lurked underneath - a grotesque open wound that looked like the scene from The Believers.

Thankfully, they were able to fit her in a bit earlier at the surgery center. This was good news as she was able to finish in time so that we could pick up the kiddos from school. The only snafu seemed to come in the form of a nurse that did not listen to her in recovery. She had already worked out what drugs she wanted in recovery - none - with the anesthesiologist. Unfortunately, the nurse did not get the message. Lynley asked what the nurse was about to give her. He said Versed. She said that she did not want it. He told her she was not in a place to make her decisions and pushed the drug in anyway. This, of course, sent Lynley off. Her perfect day of skin cancer removal was ruined. I am quite sure that she will now dedicate her life to ensuring that this male "know-it-all" nurse never has the opportunity to do that again. (Wow, do you think she might have some hidden pent up anger towards that type of person?) After our experience dealing with Sydney, we really have lost all filters. We simply don't take that type of thing lying down. Treat the patient - not your ego. It took her the better part of the evening to get over that little incident and, frankly, I am still staying out of swinging distance.

Well that completes most of my coverage of Lynley's big day. She now has a small bandage on her forehead and is recovery nicely. Today we should get our first good look at the incision on her forehead. We are both hoping for a lightning bolt.

Today our purpose should return to normal.

Monday, November 9, 2009

Let the MOHS begin

Good morning! Well it would just figure that today I would have a ton to talk about and a complete inability to do so. You see, after a wildly successful Tae Kwon Do tournament with the kiddos, I decided to cut halfway through my thumb at Chilis. You might think I was trying to do something sophisticated. Nope. I was trying to cut my hamburger in half.

I missed.

I don't really know how you miss cutting your hamburger in half and instead cut your thumb but I sure did it. It did, however, make for an exciting trip to the ER for a few stitches to put Humpty Duffus back together again. To be honest, I was never too concerned about the whole ordeal but the kiddos were all sure I could see the light.

At the end of my stitchery they came in to bandage my wound. I had a choice. I big band aid or a little one. I was hoping for a large complicated wound dressing and thumb board. How was this going to look? This was not going to go over well with the kiddos.

Sure enough, I got home and the kiddos laughed at my little boo boo. Even Ainsley said "That's it - a band aid?" At that point I had to take off the band aid to show them the stitches so that they would believe me. At least my Frankenstein stitched finger returned a little bit of my Daddy cred. Once I proved my toughness to the kiddos by displaying my massive injury I went to the cupboard to get out yet another band aid. Unfortunately, we only had Strawberry Shortcake or SpongeBob band aids. So much for by cred.

Well outside of some throbbing the weekend went smoothly. The kiddos did wonderfully at their Tae Kwon Do tournament. Sydney beat a boy at sparring that was an entire belt above her. I must admit, that made me pretty proud. In all, Graham came home with silver and bronze medals and Sydney came home with gold and silver medals. Their will be some great pictures coming in the next few days (thanks to Mike for being our official photographer).

Well, enough about all that fun stuff. This is the big day. Today Lynley has surgery to remove the skin cancer from her forehead. The fun begins at 9 this morning with the MOHS procedure and will finish up later this afternoon with the plastic surgeon at 2:00 PM. For those of you interesting in following her progress I will be tweeting the highlights from my iPhone. Lynley has been trying to get me to start using twitter so I am finally going to break down and do it. I signed up for a personal twitter account and you can follow me on twitter here. We will keep you updated and for those of you interested in following our day-to-day escapades, well, you can see those as well. We will see how this goes.

Well, I had best be off. There is a mountain to do to get everything ready for this morning. Their are kids to feed and get to school and a wife to get to the hospital.

It will be a long day of purpose.