Marty Crouch 1947 – 2017

Marty Crouch was an electrical engineer, a manager, a life coach, an entrepreneur, a husband, a father, a friend, and a life-long learner. He lived with metastatic melanoma for the last four years of his life. He died in his home on September 11, 2017 at age 70.

Marty was born July 1st, 1947, the first child to Harold and Grace Crouch who uprooted themselves from the Great Plains of Western Kansas to settle in Douglas County, Oregon.

Marty grew up on a 350-acre farm along Calapooya Creek between Umpqua and Sutherlin. During his childhood, he was known to most as “Martin”, later adopting “Marty” while attending college at Oregon State University to pursue a degree in electrical engineering.

The oldest of four Crouch children, Marty recalled of his childhood on the farm, “We roamed the fields, hills, trees and the creek-side.” His love of the outdoors proved to be an overarching theme in his life. He developed an ear for music, graduating from accordion to trumpet, to electric guitar in his youth, only to return to accordion late in life. He retained an extraordinary sense of pitch, correctly identifying, by ear, the notes of wind chimes and other sounds in his last days.

Marty met his first wife Linda during his junior year at OSU. They were married in 1968 and had their first child, Corina, in 1969. After graduation Marty took a job as an electrical engineer with the Bonneville Power Administration and the young family moved to Beaverton, where they worked with a contractor to build their first home—Marty doing the electrical work and assisting with other trades—near Beaverton Christian Church, where they attended. Their second child, Chad, was born in 1973.

The family soon moved to Bull Mountain, on the fringe of Tigard, Oregon in 1977. This afforded the rural-raised couple a semi-pastoral setting with access to the well-regarded suburban school district. Marty designed and drafted the house based on the Saltbox Colonial architecture the couple grew fond of during a vacation to Cape Cod in the early seventies, again plying his skills and labor toward completing construction.

Marty was mechanically inclined and independent, performing most automotive repairs, and home & garden improvements himself. Marty’s personal interests included photography, computers, backpacking, cross-country skiing, kayaking, and running. In the late seventies and early eighties, a promotion within BPA to a management position coincided with an increased interest in running.  Marty could often be found jogging long distances along the narrow roads where housing developments cropped up between working farms.

Following a separation that ended in divorce in 1987, Marty began a multi-year period of seeking personal growth. He completed a Masters Degree in Counseling Psychology from Lewis & Clark College, participated in various self-enrichment organizations and programs, and in his words, “As years passed, I found a deeper interest in the Unitarians and the Buddhists.” In this timeframe he also took up mountain climbing and downhill skiing.   He summited many peaks in the Pacific Northwest Cascades, and remained a member of the Mazamas Mountaineering Organization for the remainder of his life.

Marty moved from Vancouver to the Hollywood District of NE Portland in 1995. He met his second wife Eddy while attending the Living Enrichment Center. Together, they taught relationship classes at the center, and in the autumn of 1996 they were married.

After taking an early retirement from BPA, Marty jump-started a new career as a business and life coach. He soon pivoted to a more technically minded role of providing teleconferencing and Internet services for professionals in the coaching field, eventually expanding his business, WebValence, to include his wife and seven independent contractors to serve a broadening client base.

Marty and Eddy found a lasting home at Multnomah Friends Meeting, a Quaker spiritual community, and formally became members of the Religious Society of Friends. Marty served on the Property Committee and clerked the sub-committee for the Friends’ remodel of the meeting house at 4312 SE Stark St. He also served on the Peace and Social Concerns Committee.

Marty always wanted to leave his corner of the world better than he found it. Never was this more literally true than when, upon receiving notice from the City of Portland to repair cracks in the sidewalk, he chose to, at considerable cost, completely remove and replace the original concrete to provide almost 200 linear feet of safe, handsomely crafted sidewalk for future generations outside Marty and Eddy’s home on the corner of NE 44th and Thompson, and at their rental home on the corner of NE 42nd and Thompson. Marty cherished the Hollywood District for its walkability.

Marty’s desire to effect positive change in his community carried on after relocating to the Hillsdale neighborhood of SW Portland in 2007. Marty advocated for street improvements, modified his home’s landscaping to become an Audubon Certified Backyard Habitat, volunteered to nominate heritage trees, and, with Eddy, invited neighbors into their home for study groups on various topics close to their hearts.

One of Marty’s chief concerns for present and future generations was climate change. His response was thoughtful, proactive, and personal. Among his many commitments to personally making a difference was installing a solar array to provide all the electric energy used for both household needs and electric car charging. As a conscious consumer he was ever mindful voting happened with dollars as well as ballots.

Marty was diagnosed with stage one melanoma in the early 1980’s. The lesion and neighboring tissues were removed with a wide area excision. He was diagnosed, for the second time, over 30 years later in 2013 with stage four melanoma with metastases in his central lymph nodes and lungs. He qualified for treatment in an IL-2 immunotherapy clinical trial and had a favorable response, allowing for an additional three years of largely symptom-free survival. Finally in 2017 a seizure revealed new metastases in Marty’s brain. He was treated with brain surgery, another immunotherapy regimen, stereotactic brain radiation and lastly, a targeted drug therapy. Throughout his treatment Marty wanted his legacy to reflect his contribution to research efforts at finding a cure for others in the future.

Marty is survived by his wife Eddy Marie Crouch of Portland, OR, his daughter Corina Kaul of McGregor, TX, son Chad Crouch of Portland, OR, sister Kathleen Pedersen of Rice Hill, OR, brother Glen Crouch of Salem, OR, sister Annette Harper of Roseburg, OR, first wife Linda Pickett of Tigard, OR, and five grandchildren.

When a member of a Quaker meeting dies, the other members, family and friends gather for a Memorial Meeting for Worship. This memorial will take place on Sunday, November 5, 2017 at 4PM at The Multnomah Friends Meeting House, located at 4312 S.E. Stark Street in Portland, Oregon. The Memorial Meeting for Worship will be followed by a reception.  All are welcome.

In lieu of flowers, Marty requested that donations be made to Solar Oregon to support a clean energy future through the use of efficient technology and renewable energy.

 

 

Palliative Care

Calming Wheelchair

At Portland Providence Cancer Center, The Palliative Care Office is staffed to provide relief from the pain and stress that accompanies being cast in the part of a person with cancer.

Palliative Care, unlike Hospice Care, encourages continuing treatment of causes and symptoms, while attempting to offer reduced stress, comfort and relief from pain.

I was referred to Palliative Care by my oncologist  on June 10th, and encountered more Change Happening Too Fast.

Continue reading Palliative Care

New Treatment Decision

Marty seated in feckless wheelchair”Mark”, resting for the week ahead.

I am fortunate to qualify for targeted melanoma treatment with two compounds useable on mutations expressed in my particular melanoma genome, especially since my recent treatment with Pembro was complicated by immune-related adverse effects, motor impairment and loss of personal mobility. Clinical trials have produced better-than-usual response rates, and this response is often experienced quickly, within days or weeks.

Concerns are a litany of serious side effects. Care teams like mine are developing techniques to help moderate side effects and tweak the treatments, especially at research hospitals like Portland Providence Cancer Center. Continue reading New Treatment Decision

Immune Related Adverse Events

 

Marty and Eddy, savoring the disabled-accessibility of Salishan Resort Lodge

My last post on Pseudo Progression introduced “immune related adverse events”(IRAE’s). My brief experience with IRAE’s follows.

I was on a roll with nearly boundless energy– beginning with a slight left-foot drag, motor nerve impairments piled-on and within days my left leg was paralyzed, and left arm weakened so that I cannot raise nor use it normally.

In the interval of ten days I have changed from feeling healthy, energetic, and optimistic to wheel-chair-bound and dependent on a caregiver for most adult tasks of daily living.

So_much_change_so_fast…

Continue reading Immune Related Adverse Events

Pseudo Progression

Marty leaps for bridge over Sandy River Waters hoping to reach a safe shore  (ca 2014)

Pseudo Progression

Treatment of Melanoma Brain Metastases with immunotherapy has produced a new Magnetic Resonance Image (MRI) construct named “Pseudo Progression”. The hallmarks of pseudo progression are sudden, dramatic growth in size and number of brain tumors following one or more infusions of an immunotherapy such as Keytruda (aka pembro), Opdivo, and/or Yervoy.

My experience with pseudo progression started with an MRI of June 20, 2017 after my third infusion of pembro. In the preceding week, I had developed neurological symptoms including five local seizures, (tongue, mouth, left eye, and the left side of my face) and a loss of motor control over my left leg. Suddenly, I needed hiking poles to safely walk around the house or on city streets.

My oncologist agreed to my request of a new MRI, because these symptoms were very concerning and the next routine MRI wasn’t due until July 18th. The new MRI was more startling than the neurological symptoms, because it was dotted with numerous new tumors, some already more than a centimeter in diameter in addition to my resected tumor pocket, which doubled in size. At first glance, this MRI looked like dramatic disease progression.

Oncologists believe that pseudo progression appears in the MRI because Immunotherapy creates inflammation in the area surrounding tumors of all sizes. This inflammation is caused when Killer T-Cells attack and destroy melanoma tumor cells. On the MRI screen, inflammation lights up; microscopic tumors look like small white dots; visible tumors appear as larger white lights, larger than they actually are. It’s like shining a flashlight at the dark woods and suddenly seeing many dangerous wild creatures looking back at you.

Pseudo progression is difficult to distinguish from actual rapid cancer progression because MRIs are low resolution images that don’t distinguish and differentiate individual cells.

Pseudo progression is both a blessing and a curse. On the plus side pseudo progression suggests that my immune system, empowered by infusions, is mounting an attack on active melanoma metastases. But in the brain, resulting inflammation can cause dangerous immune-related-adverse-events (IRAEs), including malfunctioning nerves that can disable a patient. Oncologists must balance treating the cancer with avoiding and providing relief from the IRAEs. Fortunately steroids, are effective at reducing inflammation and side-effects, at a cost of slowing down the treatment effects, so it’s best to minimize the use of steroids.

My care team agreed to delay pembro infusion #4 by several days, while doubling my daily dosing with anti seizure compound (levetiracetam) together with adding a low dose of steroid (dexamethasone), a strategy to reduce seizures and reduce inflammation in hopes of relieving my left leg impairment. With these precautions in place the new plan is to administer pembro infusion #4  on Monday June 23.

After discussing this matter of pseudo progression, and in parting, my radiation oncologist said, “There is an International Gamma Knife Society Meeting in March of 2018. If you prove to be a positive case for my studies of pseudo progression, I will use your MRI for my talk. You will make me famous.”

I replied, “Count on me, I’ll do my best to help make you famous!”

Crush It

Marty, Granger, Lynne and Connie savoring a moment with Sushi, prepared by Granger

Niece Jessica says, “when you decide to become a doctor, you should not plan the whole journey, nor think about it too much, because you might give up before you begin. You should just start, take it a step at a time, and enjoy the challenge.  It’s amazing how fast time passes when you’re engaged in a worthwhile pursuit.

A slightly different step by step prescription applies to people with cancer. Many people, perhaps the majority of people with cancer are destined to die from their cancer. But worrying about, or even thinking about it that much has a way of undermining the very life we cherish.

My friend Granger from Mindfulness Based Stress Reduction left us with, “Crush It – Live every day like it’s your BEST day!”

That thought helped me today after three infusions of Keytruda. I’ve been developing neurological symptoms: seizures, numbing, and difficulty with my walking gait. I was shown yesterday’s Brain MRI, which lights up like a Christmas tree — so many active nodes! But my oncological team says that’s the way it often looks with brain mets on immunotherapy … They call it:  Psuedo Progression.

This evening Eddy took me to REI to acquire some Black Diamond Hiking poles to keep on trekkin’ with less risk of falling. A BEST day!