How Do You Fight Stage III Cancer? John Fiala

Stage III cancer, how do you fight it? You fight it until the wheels come off. One year ago, I was diagnosed with Stage III rectal cancer. Stage III was a cancerous mass that had grown in my rectum and penetrated the rectal lining including the surrounding lymph nodes. I have finally come to a point in my recovery that I want to share my journey over the last year. Every cancer journey is completely unique just as every person is. This is my personal story, my approach, and my victory.

I was feeling strong physically in February 2022. I was in the second-best shape of my life per the analytics of my Peloton FTP test. I love statistics, game plans and goals. I did have some bleeding in my stool, but I lift weights, move heavy things, and ride the Peloton bike hard. There were no red flags in my recent bloodwork. Knowing that I was 48 years old and thought 50 was the time to start getting a colonoscopy. Did you know that it is 45 now?

John Fiala Head High School Football Coach, Cedarcrest

Get this, the NFLPA had just come out with a new program for retired players for preventive care. One of those benefits was that you could get a colonoscopy. I was putting it off to get one before because of being self-employed as a Realtor and the high deductible. Looking for any excuse really. Thank God for the postcard that had been sitting on my desk as a reminder.

Pre-colonoscopy

Heading into the colonoscopy appointment I was feeling good and without a worry. I honestly believed it was a hemorrhoid inside that was causing the bleeding. It still feels like a dream, coming out of procedure and having Meg sitting next to me and the doctor telling me I have cancer. No let’s see what the biopsy says in two weeks, but you have cancer, and you need to take action right away. They did still do a biopsy.

I spent the next four days trying to get two different hospitals and two different health insurance plans to release and transfer my medical records. I spent hours on the phone getting bounced from one department to the other. There is a process, but it seemed like it took forever.

Finally, I was able to get an MRI scheduled a week later, this was for the staging of cancer. I was so naïve that I was thinking the staging was to see how things were laid out so they could just go in a remove the mass. I quickly learned that was not the purpose, as I received an email that new information had been uploaded to my online chart. I had not met with any doctors yet about the results or even the next steps. My first doctor’s appointment was three and half days away, that was with my surgeon.

I will never forget the moment I read the results. I was sitting on my ride-on mower after finishing the lawn and read the results. I had Stage III cancer. It had grown through the rectal lining and the surrounding lymph nodes were affected. I did know that the lymph nodes were essentially the highway in the body. I was paralyzed by the results. I literally could not get my body to move off the tractor. Then every scenario ran through my head. I am 48 years old with three children. I had a 150-foot walk to the house to have the hardest conversation that I have ever had with anyone. To tell my wife that our future life plans might be altered in a way that was unimaginable.

Three and a half days seemed like an eternity waiting for my first doctor’s appointment. I met with my surgeon, who was amazing. This was also a time during Covid that I could not have anyone come with me to any appointments until the surgeries. He spoke about getting a chest port, chemotherapy, radiation and two major surgeries. The news was overwhelming but for me I needed a plan, hear statistics, and have structure. I needed a task list so I could start managing and setting goals.

The MRI for staging also revealed some areas of concern on my liver, lung, and hip bones. The doctors were worried about this because the cancer was in my lymph nodes and might have spread to other parts of my body. I had a week of more MRI’s and a full body bone scan. Thank goodness all the results that popped up in my chart were not cancerous.

Round 1

I then met with my oncologist. Probably one of the most positive and energetic people that I had ever met. He let me know of the exact game plan. You can tell I like game plans as a former player and football coach. I would need surgery to put a chest port in for chemotherapy. I would have eight rounds of chemotherapy over four months. It would be every two weeks. Then followed by five intense days of radiation (it was originally planned for five and half weeks of lower-level radiation, 5 days a week), a two month break to recover, surgery to remove the mass and lymph nodes. During that surgery I would have an ileostomy bag installed for at least six weeks to allow the rectum and colon to heal from the surgery. The final surgery would be to remove the ileostomy bag.

Chest Port

One week later I had a chest port install for chemotherapy. I learned about how important attitude was during this appointment. When Meg and I were leaving the procedure, the nurses were yelling down the hall, “you got this”, and “kick cancer’s butt.” It all came back to me. I remember all the doctors and nurses in the surgery room prior to the surgery stating their names and what they were responsible for before the surgery. I remember saying with conviction as I was drifting off, “My name is John Fiala and I am going to kick the crap out of cancer.” I heard cheers as I drifted off to sleep. Even in my subconscious I had my attitude in line.

Work Video Intro

I would be starting chemotherapy one month from when I was diagnosed with cancer. It had been an intense and emotional month. My real estate coach told me that cancer is an incredible journey, and you will be ready to share with people your news when you are ready. Incredible journey? I would soon find out. I waited to share my cancer diagnosis with my three children until I had a clear path of procedures and could answer as many questions as possible that they had. At that time, they were an 8^th grader to a senior in high school. Talk about a hard conversation telling your children that you have cancer. They all took it different ways based on their unique personalities and ages. From positive support with questions, just more bad news for our family (my dad passed away a month prior) or that dad was Superman, and everything would be just fine. I had only shared the news with my family, mom, and couple of my closest friends. That was all I was ready for at that time.

Sharing the news was hard for me in the beginning. I was worried that people would treat me different, it would affect my work, and I wanted to get a handle on how I would respond to chemotherapy. I had heard my 11-month cancer treatment game plan one day prior to speaking to my football team at a parents and players meeting.

John Fiala CHS Football

Not knowing how my body would respond during all of this and what I would be capable of doing and possibly even having surgery during the season. Coaching is a big deal in my life and thankfully, I have an assistant coaching staff that is amazing to handle anything that came up. I did not share with the team yet what was happening. The theme for the season was, “I am Here with Purpose.” This was reminder that everything we do has weight and don’t just settle for complacency, have purpose with everything you do. This is where I learned that I had to take one day at a time and make everything count. I would not have the time nor energy to have wasted days. Everything I did had meaning. You can’t worry about yesterday or tomorrow, only right now.

I never asked, “why me at this age” getting cancer, I still have not. I did do genetic testing for the informational purpose for my children. There were no outstanding genetic traits that were a concern. The issue that I dealt with is that I felt like my body had failed me. Something that I had no control over. I have pushed my body to it’s limits with everything that I do including physical projects, weightlifting, playing collegiate football and professional football. Everything my body has been through were conscious decisions. Cancer was not my plan, something I had no control over. I thrive off grit and pushing myself hard mentally and physically. Little did I know what was really coming.

Round 3

Final round, #8

Chemotherapy was specifically designed for my type of cancer. A mixture for rectal cancer. I would head in every two weeks. My treatments were very routine, and you could anticipate how you would feel on which days. It helped keeping a journal on how I was feeling. I would meet with my oncologist prior to chemo starting to review my bloodwork numbers and see how the side effects were being tolerated or progressing. My oncologist gave me the analogy of a heavy weight boxer in an eight-round fight. You start out fresh and recover fast. The cumulative effect of each round wears you out and you don’t recover as fast. This was spot on. I would start treatment on every other Wednesday and treatment would last for about four hours. Before I would leave, I would get attached to bladder pump system in a fanny pack and would then get the rest of my chemo dosage for the next 46 hours. I would finish on Fridays around 10:00am.

Coach Fiala with his line

Chemotherapy is no joke. The side effects did get progressively worse, and it took longer to recover. When I started, I would be mostly recovered by Monday afternoon. The weekends were the hardest since I had the full dosage in my system. My last few sessions, I would start feeling average a week and a half later with just a few days before the next round. Side effects depend on which chemotherapy cocktail you have, and some side effects are rarer. I did have nausea, loss of appetite, night sweats, dry mouth and sores in my mouth,

Cedarcrest Jr. Football Camp

fatigue, brain fog (this was crazy), extreme constipation from the anti-nausea medicine. My hair thinned but did not fall out. There was one of the drugs that made me very sensitive (stinging needles) to anything cold in my hands, feet, and throat. Some days I would be wearing snow gloves in June. Anything I had to drink needed to be room temperature. During chemotherapy, I was working full time, coaching Spring high school football, going to football camp at CWU and putting on a Jr. Football camp for 50 K-7^th graders. It was an exhausting four months, but I needed to do that as a distraction for how I was feeling. I needed to keep moving, even if it was slow.

After completing my treatment one of the side effects that you hoped not to get was neuropathy. I am still dealing with numbness in my feet and hands. My hands are getting better and my feet slowly. This can last up to a year or be permanent. I have been going to an amazing acupuncturist who has helped me so much. To sum up neuropathy, it is the worst, and I wish it on no one.

Taking it old school and gloves in the summer

Perspective is important and powerful. I could look at chemotherapy as a poison to my body that I had to take, or I could choose to see it as an opportunity to have a cancer killer destroy every bad cell in my body. There is always two ways to see a situation. One way is more powerful. Before each chemo session I would sit in my car in the parking lot and blast Metallica and Guns N’ Roses to get fired up for the day. The same songs I used to listen to before I played football games. I treated my treatment sessions as it was game day. They were big days. My blood pressure was always a little high when meeting with the oncologist.

Two weeks later after finishing chemotherapy, I was approved for a five-day intense radiation therapy compared to a five and a half week, five days a week schedule. I went in for alignment so I would be perfectly positioned every time. I was marked with three small tattoos dots on my hips and tailbone area. No one will ever notice them, but I do. A small physical reminder. Getting radiation was not bad during the five days of treatment. Each session was about seven minutes and most of that was getting me aligned. I did feel tired towards the end of the five days. I had also just started double days for football. I would coach a 6:30 am practice, drive to radiation treatment, and make it back for the evening practice. The real side effect would be coming in about 10 days. The radiation caused havoc on my digestive system. I had to plan my days and locations precisely to have quick access to a bathroom. Those symptoms lasted for about 14 days, and I was happy when those subsided.

Dad and Reid Fiala

By this time, I was two weeks into the high school football season, real estate was very busy, and I was getting very tired. The neuropathy was increasing daily in my feet and hands. It was hard to stand for an entire practice. But for me, I had to keep moving. I had to keep putting one foot in front of the other to not stop and think about how terrible I felt. I kept showing up and moving forward with work, family, and coaching. Most importantly to show my children and 70 high school players that you can do hard things. You can do hard things and succeed.

I had a two month break from the end of my radiation to heal and recover before my surgery. Surgery was performed over a five-hour period and my recovery was about five hours (poor Meg). I was able to get discharged only after two days since I was recovering well. Surgery was done robotically. The doctor made six incisions in my abdomen varying in size. The goal was to remove the mass with margins and surrounding lymph nodes. My mass was in the top third of my rectum. To remove it, the surgeon took out a portion of my rectum and colon, about 10 to 12 inches. When reattaching the colon and rectum the risk of inflection is very high. To help with this risk, they put in an ileostomy. Our bodies are amazing. They basically take the top of your small intestine, cut it and have it stick out your abdominal wall and the digestive material can be secreted into a bag. Pretty amazing! This took some time to get use to, especially how to change it which was about every four days. The bag would be emptied about six times a day. I had this for two months and was ready to get the reversal. There are many people who have this for their entire lives. Once again, our bodies are incredible.

Five Minutes of Life. How to change a flat tire. CHS Football

The reversal surgery was short, about two hours. I was supposed to be in recovery for about a day or day but ended up staying in the hospital for five days. My digestive tract needed to wake up and start functioning again. Nothing had gone through my colon for two months. The recovery from this was much slower than I anticipated. I was worn down physically and mentally from the chemotherapy, radiation, and two surgeries. They were not able to close the outer section of the ileostomy hole. They were able to close all the inner lining and abdominal wall. The swelling was too much and staples or stitches would have just torn out. There was a 2×2 inch hole that was really deep. I had the joy of packing it everyday for two months and it was finally completely healed after two and a half months.

While talking with several people about their cancer treatment story, I never heard how they felt after everything was completed. In hindsight I should have rested more during all of this. A month after surgery I found myself completely burnt out. I had given this fight everything I had, until the wheels came off. I was mentally and physically exhausted while waiting two months for my first CT scan to make sure they got everything, and no cancer had returned. I didn’t realize how nervous I was before the test. The thoughts of potentially not getting everything and going through more treatment was daunting.

Five Minutes of Life. How to do a proper handshake. Cedarcrest Football.

I have daily reminders from my battle with cancer. I can see the chest port and surgery scars and my little tattoos from radiation. The mental challenge of cancer and the emotional feelings will surface still with an old picture, a thought, a smell, or a scene from a TV show. I have been stopped in my tracks with overwhelming tears of joy or a pain from just a little reminder. These will fade and soften over time, but I hope the life lessons I have learned will continue for the rest of my life. With the hope of sharing these lessons with others.

The results are in. I am officially in full remission from cancer. You are technically cancer free in five years. I am now recharged. I took some time off to rest every aspect of my life. I am grateful for my family, coaching and work. I am back working out, riding the Peloton bike and selling houses.

I wrote this for others who might have to go through this same process. I was searching for real stories from people before I started this. Maybe you will find this story and it can help prepare you for what lies ahead. The unknown was the scariest part. Everyone’s cancer journey is different. This was my story, how I navigated through it, and responded to a life threatening situation. Your story I am sure will be as unique as you are. This is also a reminder to me to cherish what I have learned from cancer and not let this life lesson be lost in the day-to-day activities of life.

Here is what I have learned from this incredible journey

Time is a nonrenewable precious resource.
Truly listen to other people. They might have a story they need to share.
Our bodies are the greatest instruments we will ever own.
You can own something, but it does not have to define you as a person.
My wife was my rock and so much stronger than I was.
Attitude and perspective can change the trajectory of a path that you are headed down.
You can’t worry about yesterday or tomorrow, only what is happening right now. If you worry about the other two, you will miss what is most important right in front of you.
Don’t sweat the small things, the real troubles in our life will come when you least expect it.
Don’t put up with people wasting your time. You only have so many precious moments.
There are people who want to help you unconditionally with no expectations in return. Find those friends and lean into them.
The people who work in cancer treatment have hearts of gold and can transform your journey.
Take some time to stop and enjoy the important moments of life, if not they will pass you by.
The power of prayer and people praying for you is more powerful than you could ever imagine.
Trust in God and Heaven securely

I wanted to give a huge thank you to my wife Meg, my kids, mom, all my treatment staff, friends, football staff, football players, Booster Club, clients, Windermere Central family, and colleagues. I could have not done this without you.

Cancer Survivor 2022,

John Fiala