Get a Physical

Tuesday, May 24, 2016.  I remember taking this picture.  It was February 3rd (I only remember this date without looking it up in my calendar because my iPhone is so smart).

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I was on a plane from San Francisco (where I had been on business) to Colorado for the annual Zolfo Cooper ski trip in Beaver Creek.   It is a great trip with my partners and friends that gets better every year and I always look forward to it (in fact, I can hardly wait for the 2017 edition).  But I remember taking this picture, and the plane ride more generally, because I really did not feel well.  I had a lingering cold, which turned out to be a sinus infection.  And as I think back and try to remember just when it all started, it had to have been at some point in mid January.  Because I remember feeling like garbage the week before at our private equity client ski trip to Jackson Hole.  I chalked everything up to being busy, traveling and never getting enough sleep —- I still pull all nighters before court hearings for fear of not being prepared.  So when I get a little run down, it is because of my lifestyle not my health.  [This is a long post by the way — and it is one that I have been thinking about and writing in my brain for weeks.  I want to remember every detail forever.  Plus it is my last night on steroids and I am hopeful sleep starts setting in as soon as tomorrow!]

But on the morning of Super Bowl Sunday (February 7, 2016), after taking the red eye back from Colorado (via Los Angeles!) Friday night/Saturday morning to get to Jake’s basketball tournament that afternoon, I went to the Scarsdale medical center.  My primary doctor, who Jen uses too, is affiliated with the Scarsdale Medical Group.  I should have called her and made an appointment to get a physical.  Instead, I went to the place that is open on the weekends — where a doctor from the group is always on call — because it was most convenient for my schedule.  I was leaving town that week and simply went to the doctor for quick peace of mind.  [By the way, I am not writing any of this to complain about the care I received or criticize any of the doctors that I saw over the next 3 months before I was diagnosed with cancer in late April.  I have no ill will, hold no grudge nor think that anyone did anything wrong.  Instead, the point is that we know our bodies and when something is not right we — not necessarily a doctor — need to ring the alarm bell and make sure we keep knocking on the door until there is an answer.   Too often we let everything else get in the way.  But there is nothing more important than our health.]

On that Sunday the doctor on call told me I had a lingering sinus and upper respiratory infection.  He gave me a Z-Pak to help clear it up (I am allergic to several antibiotics), and also told me to use Flonase daily.  As for travel, he explained that I should take Sudafed and use Affirin before flights to help ease any pressure from the sinus infection.   And for those of you that traveled with me in February, March and April, you were witness to my plane ritual: Sudafed 2 hours before the flight and within an hour of landing; shots of Affrin immediately before take off (witnessed by flight attendants and passengers with great intrigue); and the use of EarPlanes (ear plugs) for the entirety of every flight.  I am a pretty intense person generally; by April I had this routine down to a science and there is no doubt people were watching and thinking I was a total freak show.

The week after the Super Bowl I was in Houston, San Francisco and then Houston again (and not back home until that Friday).  And while I didn’t feel great, I was working really hard, out late with clients nearly every night and not getting enough sleep.  So my sense was a little sleep on the weekend would set me straight.  Interestingly, it was around mid February that I recall having trouble sleeping through the night.  Although not a great sleeper regularly, I remember the tossing and turning and the sense of frustration that accompanies a lack of sleep when you know you need rest (which lasted for 2 plus months).  But the status quo continued until February 29th.   That is when I flew to Houston (on a Monday night) for a status conference in one my cases on Tuesday.  Notwithstanding my Sudafed/Affrin/EarPlugs ritual, the pain in my ears on the way down was so intense that I thought I popped my ear drums.  I was so frustrated when my ears would not pop that night or in the morning (and this lasted for about a week).  But I still stayed up most all the night Monday getting ready for that hearing on Tuesday, and I remember being in court and having to turn slightly to the right when standing at the podium because my right ear was working better than my left.

The pain was worse both during and after the flight back on Tuesday.  So on Wednesday morning (March 2nd) I called my ENT and drove over to his office for his first appointment of the day.  I really like my ENT.  I had gone to him last year after I was told I had wax build up in my ears during a physical.  At my doctor’s suggestion, I bought over the counter ear wax drops and had Jen insert the drops as instructed.  I am still not sure if she used too much!  The drops ended up coating my ear drums.  After two days of feeling like I was under water (and several attempts with friends to unclog my ears in between), I had to have the ENT literally drain and clean my ears to get full hearing back!  I assumed we would do the same thing that morning.  I was wrong.  This time the fluid was inside my ear drums and, as a result, the only way to clear the ears was by puncturing a hole — something he did not want to do.  This caused my hearing to be severely impaired.  The doctor prescribed a steroid (Prednisone), which happens to be the same steroid I have been taking for the last four weeks.  He also suggested that I avoid air travel, especially if it was personal as opposed to business.  So instead of flying that Thursday, I changed my flight to 5 am Friday morning.  The pain was awful on the way down to Houston and during the course of the day, but when I landed back in NY on Friday night my ears actually unclogged a bit.  And on Saturday they got even better.

The next week was intense, with a big hearing in Houston and a new case filing at the same time in Delaware (with a first day hearing on Friday).  While my ears were unclogged, I was still feeling like garbage and the lack of sleep was certainly not helping.  After a day trip to Dallas on March 16th, followed by a night and day in San Francisco (March 17th), I was back at the ENT on the afternoon of March 18th post a quick trip to Delaware earlier that morning.  It was when I landed around midnight on March 17th that the pain had started behind my ear (and ultimately in my neck and collarbone).  My doctor was unavailable so I had to see someone else in the practice since I knew this could not wait for Monday.  I was prescribed a 10-day dose of heavy antibiotics that would hopefully clear up this sinus infection once and for all.  Jen was appropriately all over me, making sure I was hydrated and did not drink alcohol so the antibiotics could run their course.   The pain, however, persisted and I was back at the ENT on March 22 (after a day trip to St. Louis on March 21st) because something was just not right.  My ENT was not sure what was wrong at this point and did not think it had anything to do with my ears.  So he sent me for an MRI to see what else could be going on (and special thanks to Margret (my fantastic legal assistant for many many years) who pushed to get me in for the MRI on Wednesday since I was leaving town Thursday on business and then flying to meet Jen and the kids in Philadelphia for the tail end of their spring break).

I hated every second of that MRI.  And I can still hear that clicking noise.  Margret and I called the doctor dozens of times that Thursday looking for the results.  I just had an awful feeling in my stomach that something was wrong.  I still remember walking out of the mediation session late that afternoon to talk to my doctor, who reported that the test showed a little stress on the nerves behind by ears and a cyst on my throat, but nothing out of the ordinary.  He had no issues or concerns.  The problem was the MRI only imaged the neck up.  The tumor — which has shrunken over the last four weeks of treatment — is in the middle of my chest.  But I had a huge sense of relief after the call from the doctor and enjoyed being out in Houston that night after the mediation session.

With the MRI showing nothing out of the ordinary, my primary doctors (Jen and my father in law) concluded that the pain in my neck and behind my ear was gym-related.  So when I landed in Philly, there was no working out that weekend and it was my job to rest.  I remember fading in and out while I watched Syracuse win late that Friday night with Justin, only to get in bed after the game and be unable to sleep (Justy — I am still sorry I didn’t help you clean up that mess as I was definitely awake!).  At this point I was trying anything to sleep.  Tylenol PM, Advil PM, Aleve PM, Melatonin.  Nothing worked.  This went on for weeks.  But I was busy that last week of March, leading up to a big trial on April 1st in St. Louis (and knowing that a vacation was around the corner on April 5th).   We worked really hard to get ready for that trial and as much fun as it was, I did not feel well sitting in that courtroom all day.  [I also missed a party for my brother’s 35th birthday that night (with my entire family in town), which I still badly about.]

I also felt like garbage on Saturday April 2nd, when I took Jake and Ryan to see Syracuse play in the Final Four in Houston.  But as uncomfortable as I was, those are 24 hours that I will never forget and I enjoyed every second of that day with my boys.

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We left for St. Lucia with our most of our closest friends on April 5th.  This is a trip with Jen and friends that I look forward to as soon as the previous trip ends.  And having been really busy leading up to the trip, it was really important to get away with Jen.  [We are so lucky to have parents that are willing to drop everything to watch our kids and let us get some much needed time away.]  I remember going through my standard pre-flight ritual and complaining to the flight attendant that the WIFI was not working (I cannot stand being in the air for multiple hours and then getting inundated with emails when I land — it gives me agida).  I also vividly remember my chest bothering me the moment we landed.  And of course Jen and all my friends knew this because I am not one to hold anything back and can admit that I am kvetch (i.e., someone who is not shy to complain).  My chest bothered me that entire week.  As much fun as I had on that trip, I just wasn’t myself (even though I got some much needed time to relax).  I usually fall asleep anywhere, but on this trip it was particularly embarrassing because at times I was falling asleep at the dinner table mid-conversation.  And although I slept most all of that week for the first time in ages, there were so many signs that something was wrong.  It was on this trip that I figured out I could not run at a normal pace.  Going up a very steep hill with my buddy Evan, I remember him turning to the side and being stunned that I was effectively where we started, unable to run.  I was so pissed off.  I made myself walk up this steep hill to the gym every morning.  The shortness of breath that accompanied my walk was aggravating.  And since I couldn’t jog, I made myself sprint (which probably was not helpful).  I also did not realize I was making noise when I worked out, likely as a result of the lung that was literally collapsing as a result of the tumor.  My buddy Ian was in the gym with me and I think genuinely concerned because the noises I was making were not normal.  This was also about the time that I developed a cough, and I never get a cough.  I was so concerned and worried about the pain in my chest that I wondered if I was going to stop breathing one night when we got into bed (and I am so sorry Jen that I never told you this; I hinted about it to Jeff and Pete one morning but never really came clean).

We got back on Sunday April 10th.  I had another busy week.  But I wasn’t sleeping again and continued to feel like crap.  I should have made an appointment with my doctor to get a physical.  Instead, I waited until Saturday and went back to the Scarsdale medial center for pure convenience.  I explained the last couple of months to the doctor on call, who I really liked.  I remember him hearing me cough and saying there was definitely something going on.  He also knew my ENT well and we joked about getting together for dinner.  He prescribed me a Z-Pak and powerful nose spray.  The nose spray was not ready when I got to the pharmacy, so I did not start on that until Monday.  And things got worse.  My neck was in such pain (now we know from the tumor pressuring my nerves) that Jen was putting a heat pack on me before bed.  I went to the Yankees game with Joff and Nicole on Tuesday night and coughed the entire time (I also remember telling both of them that I felt like garbage and could not sleep.)  I drove to work that Wednesday morning with Paul and told him I thought I had sleep apnea.  I also stopped lifting weights that Wednesday.   And I still couldn’t run at a normal pace so I like an idiot I was doing the stair master with one lung.  I was in such bad shape that I cancelled a trip on Thursday that I normally would take without question.  On Friday, I worked from home and told Jen I would go back to the doctor during the day.  But I got stuck on the phone the entire day and I had promised the kids I would play basketball against them and their friends when they got home from school.  I still remember Jen reminding me that I needed to get off the phone to carry through on my basketball promise before we had to leave for Seder on the early side.  I was in no mood to play basketball, but I did.  It was Ryan, Noah and Daddy vs. Jake and Lev.  Tough match up.  I did not have my A game.  And Ryan was pissed.  He cried like crazy after we lost.

Sedar that night was at the Tauber’s and I remember being uncomfortable the entire night.  I took 4 Advil for the pain in my neck, which I now thought was related to the afternoon basketball session since I had not lifted weights in several days.  I had to stand at various points during dinner because I just could not sit still.  Yet I decided on the way home that I was going to run on my treadmill on Saturday morning and get to the gym to work out with weights in the afternoon because I had not gone in 3 days.  I was so frustrated on Saturday morning when I couldn’t run at 6.0 on the treadmill for more than 2 minutes.  I just could not figure what the hell was wrong with me.  Jen and I went to Greenwich for lunch to see one of my best friend’s from college, his wife and gorgeous 6-month old daughter.  It was so good to see them yet I sat there uncomfortable the entire time.  And I remember telling Michael that I had been feeling like shit and couldn’t work out.  That afternoon we looked a new house in town and had a Seder with my in-laws.  I just was not myself.

So it was decided that I would go back to the Scarsdale medical center on Sunday morning (April 23rd), at the direction yet again of my doctors (Jen and Lenny).  Lenny thought I needed to be nebulized.  Jen thought I had walking pneumonia.  Nobody thought it was cancer.  Yet after two failed breathing tests with a nebulizer treatment in between, the doctor on call suggested that we take an x-ray.  She was concerned with what she saw and decided to fax it over to the local hospital for someone there to take a look.  She asked me to wait in her office.  After checking my emails, I grabbed an US Weekly and was about to look at the first couple of pages of celeb photos.  But I never got a chance.  The doctor walked in, was a bit startled, and reported that she had bad news.  She told me that the x-ray showed a very large mass on my lung (at least that is what I think I heard her say), and that I needed to get myself to the hospital right away.  I grabbed my phone and my keys and walked out of the office quickly.  I think that I thanked the doctor on the way out.  I dialed Jen immediately in a complete state of panic, explained the situation and drove to the hospital.

I don’t tell this story or share these details because I am looking for sympathy.  If anything, I am incredibly fortunate because I am on top of this disease and already winning the battle as evidenced by the tests from yesterday.  It took a while to figure out what was wrong, but we figured it out and I have a team of incredible doctors that are going to make sure it goes away and does not come back.  Yet so many people in this world are walking around with ailments and diseases that they do not know about and may not find out about until it is too late.  I should have gotten a physical months ago (even thought it is unclear if it would have shown anything out of the ordinary).  The point, however, is we need to know our bodies and when we should be hitting the pause button.  Lack of time to get checked out is a terrible excuse.  If there is something bothering you, it is better to be safe than sorry.  And being safe means going back again and again until you get an answer that not only gives you mental comfort, but actually makes you feel better.

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If you are still reading and not bored out of your mind, I had another great day.  The treatment yesterday had me tired until this afternoon (I even took a nap in the middle of the day, which probably explains why I am sitting here at 5:30 am as the sun comes out).  But this afternoon was awesome.  Had lunch and got to hang out with one of Jen’s closest friends from college who came to visit from the City.  I went for a walk and caught up on some phone calls.  I responded to dozens of notes from colleagues and friends who were alerted to my situation at the UJA luncheon.  I played board games with my boys in the basement for an hour (and I was completely captive).

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And I had a great dinner (thanks much Rumbold’s, with appetizers care of Tauber) and hung out with a bunch of good buddies from town, which was a good distraction and very relaxing.  I am going to try to sleep a little now, but already looking forward to today.

8 thoughts on “Get a Physical”

  1. Dr. Josh–another silver lining in this whole ordeal is that you are earning a MD…and while it won’t come with a sheepskin, it will definitely serve you and the family well in the years to come! Keep smiling Doctor Josh!

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  2. Thanks for sharing this detailed account of how you came to your diagnosis (I did read the entire post:-)). Such an important reminder that we all need to pay attention to what our bodies are trying to tell us. Hindsight is always 20/20. It’s so easy to chalk up ailments (especially the ones that seem normal to us at the time) to our lifestyle or other stuff going on because that makes more sense when we are otherwise perfectly healthy. I am so glad to hear that you are responding so well to your treatments! And your family is absolutely beautiful, Josh. Looking at your 3 boys is like looking at 3 mini-Josh’s, especially your oldest. Blessed, indeed.

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    1. Thx Missy. You said it well.

      As for the 3 boys, I think they lucked out and look more like their mother than me (which is obviously a good thing!). But looking at old pictures, it is kind of crazy when you see your son’s face in yours.

      We often quote that hindsight phrase in my business. It is just so true. And it goes for everything in life. Talk to you soon.

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  3. Hi Josh,
    I really enjoy reading your daily updates. I’m so impressed with your honesty, courage, sense of humor and positive attitude. Although we have been personally in and out of touch over the years know that I’m always rooting for you. sending you, Jen and your beautiful boys lots of love, hope you have a fantastic weekend at the shore!
    Xo,
    Lindsay

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    1. Thanks so much Lindsay. So glad you are enjoying! I feel the same way and we need to make sure we get our families together. Way too much history to not have our kids get to know each other better. Looking forward to it.

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  4. Hi Josh,
    A mutual friend, Jonathan Newman, alerted me to your blog. I have been intrigued and impressed by your journey, perhaps because it hits so close to home. Your positive outlook, humility in the face of such challenges, perseverance, and openness are commendable. Like you I am a father of young children with a demanding career in New York. For some time I had become accustomed to living life at a full pace hence becoming somewhat self absorbed by everything ahead and rather unconscious to many of the small details (i.e. “priceless” moments) that makes life worth living. Three years ago that bubble burst. I was diagnosed with a germ cell tumor (a.k.a. testicular cancer). I had been healthy and athletic my entire life. In fact I rarely got sick. How could my body fail me? That’s the stuff for old folks who smoke, drink too much, eat poorly and don’t exercise. The thing about cancer that you now know is that rogue cells are indiscriminant.

    My story is not relevant, but suffice to say that I am fortunately in pathological remission, which is what I wish upon you in the very near term. I was blessed with incredible support from my family and friends and excellent medical care, both of which contributed to a positive attitude and success in beating this disease. I am pleased to hear about the abundance of love and support in your life, the optimism in your voice and the balanced perspective you have so kindly shared with those who will listen. Thanks for sharing your trial and tribulations so openly.

    Josh, I hope you do not find my note intrusive since we have not yet met. I certainly do not pretend to preach or provide you with any advise. I am just immensely attuned to what you are going through and wish you the best in this journey. You got this!

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    1. Jorge, thank you for sending this. I do not find your note intrusive at all. Quite the opposite. It is refreshing and heartfelt. I thank you for sharing your story and experience.

      I am happy to hear that you are doing well and I suspect your outlook and perspective have shifted dramatically (like mine). While there are some things in life (and with cancer) that we cannot control, there is no doubt that our state of mind and attitude is something that we can always keep focused. And if nothing else, I have learned that this will be the key to getting to the other side. I have always worn my heart on my sleeve — now it is just more exaggerated!

      I really appreciate your perspective and well wishes. Looking forward to connecting with you and talking about how we beat the shit out of cancer and then helped lots of other people do the same thing.

      Like

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