Wash, Rinse, Repeat.

Note: This blog has sat unfinished for over 6 months. I have had an overwhelming case of writer’s block. I still do. But, I decided tonight I would finally finish it. As always, these are just my thoughts, although very delayed. Your experiences with NET cancer, treatments, and treatment centers may be different.

If you watch any Science Fiction/Fantasy series long enough they will eventually have a Time Loop type episode. Think about it. Almost every Sci Fi shows in the past 30 years have had one. Stargate SG-1 did one of the best time loop episodes I’ve seen (https://en.wikipedia.org/wiki/Window_of_Opportunity_%28Stargate_SG-1%29 ). I just love watching O’Neil teeing off in front of the open Stargate. Classic TV! What’s your favorite time loop episode or movie?

Why do we love time loops? I think it’s a desire to work out a problem until we get it right without the constraints of time. The concept that we can keep trying until we get it right and then pick right back up where we left off originally.

Every 28 days I feel like I’m in my own time loop episode.

It begins like every other day. I get up and go to work. Then at 4:30 I walk across the street to the hospital for my 5PM appointment to have a Sandostatin LAR injection. Sandostatin is a drug that helps control the hormaone production of the NETs that have metastasized to my liver. Without the injection, I experience frequent flushing and other symptoms. Supposedly, Sandostatin can also slow the growth of the tumors. I can’t argue with that. Since I started Sandostatin in 2015, all the tumors continue to register as stable. That is time loop part 2.

Did you catch the part where I get the injection across the street from my office? My NET specialists are in a cancer center 45 miles away. So, I asked if I could have my injections done closer to home. The closest location happens to also be right next to my job. Cool huh? Well, mostly. I’m sure, until they met me, they had never administered a Sandostatin LAR injection. I continue to be the only NET patient they see.

At 4:30 PM I walk across the street to the hospital and sign in. Since I’m there every 28 days, I rarely come twice in the same month. Which means I’m a new patient. Thus, I must register each time and each time it is the same process. Are you Jeremy…? Do you live at…? Are you married to…? What are you here for? What’s that? You have what? Who’s your doctor? Then there’s the discussion about how to code it. Then they try to convince me to pay up front and save 30%. To which I explain that I already met my deducible. I sign a form and waive the option to pay now.

I understand this happening in January on my first visit of the year. But, it happens every time. Which is ridiculous. I’m on a High Deductible insurance plan which pays everything with no co-pays after the initial $2500 out of pocket. Given that the first shot of the year is about $12,000, there no point in trying to get me to pay it and save 30%. It would still be more than my deductible! Just bill me and let’s move on.

OK, now it’s 5PM and, if I’m fortunate, I’m on my way to get my injection. The area that they do this is in a Surgery Recovery area. So, I’m in an area with other people who are just getting out of surgery, or having other treatments. I always feel a little silly coming here to get a shot. However, the nurses there are very nice and they assign me a room or chair area. Before I go further, I will say that over the past 2-3 months it has gotten better. But, for the first year, it honestly was as if I had walked in there for the first time every time. What are you here for? What’s that? Is it an IV? You have what? Plus, there’s the wait for the injection kit to arrive. Oh my! Sometimes after 45 minutes or more they would tell me that they had to get one from another hospital and I need to wait for it to be delivered. This has gotten better too. Now they order it as soon as I register.

After about 45 minutes and a blood pressure, blood oxygen, and temperature check, I get my injection. It’s kind of like a box of chocolates. I’m never sure what I’m going to get. Did it get mixed right? Did it get warmed up enough? I have no idea. There have been a few times I’m sure it was done wrong. I would suffer all month with symptoms or get a painful lump in my hip. That’s usually when my wife tries to convince me to go to the cancer center instead. Is the 2 hours of driving worth it? Not for me,…yet. I like my walk across the street. Gradually, I’m giving the nurses enough practice that they are starting to get it right each time. Also, I’ve learned to speak up. I’m now much more vocal about my concerns with the mixture, temperature, and time needed to allow the mixture to absorb. We are more of a team now. At least, I think so.

With the Band-Aid secured, I’m cleared to pull my pants up and given my appointment for 28 days later. In 28 days, it will all repeat again. But, that’s not all, folks.

If you have NETs then you are very familiar with the second phase of the time loop.  NETs are funny little things. They usually grow very slowly or with the right reaction to some treatments they may shrink, until eventually they don’t. Thus, we need to be closely monitored to address any changes and adjustments needed in treatment options. The routine I’m on now is every 6 months I see my NET specialist. Along with this visit, I have a MRI and sometimes a CT scan. The day goes like this….

Wake up extra early. Since my first appointment is to have a MRI, I have to remain hungry and thirsty (and without COFFEE!) as I drive 45 miles to the hospital.

While still without coffee I need to fill out paperwork. The same paperwork I fill out every 6 months. Why, oh, why can’t they electronically store these things and just ask me if there have been any changes. I’m taken back and put on my paper clothes. Inside the MRI machine I’m restrained and listen to what may or may not be the station I requested as the MRI does its thing for 40 minutes. I’ve actually started remembering the sequence of the MRI. I can just about sing it.

Then I wait around until I go to my doctor. At the doctor’s office, we go through the same routine every time. It doesn’t matter what answers I give, it’s all the same results. What if I did fall in the past 6 months? What would they do now? How’s my pain level? Well, maybe I’m a 1 today, but last week I was a 7. Doesn’t matter now.

Now they send me off to sit in a little room. Before they do, though, they weigh me just to make sure I know I’m getting fatter. My nurse comes in. She knows me now and we get along great. She asks me all the questions that she is supposed to ask every time and then I wait for my doctor to come.

For the past 3 years it’s been the same. I’m stable. The MRI report looks almost like a carbon copy of the last one. All the little tumors in my liver are content being the size they are. They haven’t multiplied or spread to other areas of the body. I’m reassured that I’m in good shape. Then I’m scheduled for the next MRI in 6 months when this cycle repeats again.

I’ve been thinking about skipping a turn. What if I waited a year or more before the next scan? But, then I think, “Why do that?”. I like knowing what’s going on. It’s repetitive, that is true. But, right now my insurance covers it. So, while I can, I want to know even if the answer is the same each time.

NET cancer is not currently curable. Thus, it won’t always be the same each time. Eventually, the MRIs will change between visits. At some point, the treatments will need to change. I suppose there will be a time in the future when I will wish for the time loopy, repetitive cycle I’m in now.

In a Time Loop episode, the main character often discovers more than the solution to the problem, but also a deeper understanding of himself and the world around him. After spending countless repetitions of the same day, they come out a better person. So, hopefully that’s the way I will manage this cycle of my life as I sit back and let it repeat as often as it likes.

NOTE: If you are finding this blog while searching for information on Neuroendocrine Cancer, I hope you find my experiences useful and/or entertaining. But, my goal is to give a personal story and not any medical direction. Please go to http://www.carcinoid.org for a lot of excellent information and resources for new patients, caregivers and doctors.

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Not Everything Is Cancer, Everything Is Cancer

One of my favorite movies is Joe Versus the Volcano. It didn’t do incredibly well at the theater, but I think it’s a cute movie and just makes me happy. :D

I seem to identify with Joe, a fact that my wife recently reminded me of. It’s not that I work in a cave-like office with an obnoxious boss. Nor do I have a desire to jump into a volcano. But, like Joe, I have a tendency to feel sick, sore, depressed or generally cruddy quite often.

During one of Joe’s doctor’s visits, he was told he had a “brain cloud” and was going to die. Bad news, off course, but now Joe had something to identify as the root of all his ailments. With that concern out of the way, he could now focus on his life or what was left of it.

Well, the revelation that I had NET cancer was not quite what I expected.

“You have some time left, Mr. Banks. You have some life left. My advice to you is: live it well.” – Dr. Ellison.

First, I imagined if I were diagnosed with cancer, I’d be taken to a doctor’s private office, like Joe and practically every other patient that gets cancer on TV and Movies. There, sitting behind a mahogany desk, he would break the news to me and my wife, show me the x-rays and scans, point to the problem, outline treatment plans and try to boost my morale as I absorb the shock. Wow, what an imagination!

It wasn’t like the movies at all. Instead, it was a rapid series of small rooms, exam tables, scans, tubes, needles, probes and paperwork. It happened so quick and was so…so normal. I did have a doctor draw me a picture of what they were going to do. So, I give him a gold star for creativity.

I had a neuroendocrine tumor in the terminal ileum that had metastasized to several lymph nodes and the liver. That is “technically” Stage 4 cancer. Unfortunately, for many, Stage 4 is when cancer is so advanced that there is very little time for successful treatment. If I were in the movies, I would be whisked off to chemo and aggressive treatment and I would go on a quest to fulfill my “bucket list” and inspire people along the way.

Well, Stage 4 cancer with NETs can be quite different. The doctors didn’t say I was terminal. Instead, they said they wouldn’t be able to cure me and would focus on quality of life. The pathology reports showed that the NET cancer I had was slow growing. All the hustle and bustle that I experienced before my surgery now slowed way down. I was told I had plenty of time. In fact, the word “decades” was uttered. Maybe that was supposed to be a morale boost. For me though, it still put a time limit in my mind. So very Joe of me.

“So I’m not sick? Except for this terminal disease?” – Joe Banks.

Getting the news of NET cancer can be just as confusing as having a “brain cloud”. So, the thoughts that I had come and go are sort of like this……. Ok, I have cancer. People can die of cancer. That’s bad! But, this cancer is so slow growing that I may die of old age before the cancer would kill me. That’s good! But, wait I still have cancer. That’s bad. Cancer, cancer, that word just doesn’t go away. It affects everything. Not everything is cancer but everything is cancer. Errrr!

Here’s how silly it gets. When I go on a run/walk my nose runs. Always has. But now, honestly, every time I wipe my nose during a run I check to see if there’s blood. Why? Well, probably because on TV or Movies, if a person has cancer, they tend to randomly bleed from most any orifice. So, of course, since I have cancer I’m destined to eventually start bleeding from my nose, eyes, or ears. I told you it’s silly. Thanks a lot Marshal Stacker Pentecost.

Well, guess what? A person with cancer still gets sick from stuff that is not cancer. But, in the back of my mind there’s always that question. Is this feeling normal?  With NETs there are several common symptoms. But, for the most part, everyone seems to be different. So, how do you know if a new ailment is related to NETs, getting older, babysitting or the burrito you found in the fridge?

“Brain cloud! I knew it. Well, I di- I didn’t know it, but – I knew it.” – Joe Banks.

In addition, finding out I had NET cancer hasn’t validated any of my previous ailments. NET cancer was not the cause of years of depression and anxiety. When I found out that NETs can produce serotonin, I tried to pin the recent increase in anxiety attacks to NETs. But, my doctor will not agree that they are related. This appears to be a case where not everything is cancer.

Also, NET cancer did not cause me to have a bad back and neck. When I had x-rays of my neck, I expected there to be little NET growths on the bone. There would be the reason  for my chronic neck pain. But, Nope! Once again, not everything is cancer.

“You mean you were diagnosed with something called a brain cloud and didn’t ask for a second opinion?” – Patricia Graynamore

Over the past 6 months, according to my MRIs, I have developed fatty liver disease. The doctor is thinking it is NASH. Now, I realize, not everything is cancer. But, this may be different.

What baffles me is that my previous 3 MRIs say nothing of a fatty liver. However, since I started Sandostatin in 2015 the last 2 MRIs have shown first development and then progression of fatty liver disease. Is this related to Sandostatin treatment? Doctor says no. Pharmacist says no. However, I think the facts may speak differently. Have you had a similar experience? Please let me know.

“Do you think I feel good? Nobody feels good. After childhood, it’s a fact of life. I feel rotten. So what? I don’t let it bother me. I don’t let it interfere with my job.” – Frank Waturi.

I’ve had to adjust to knowing that just because I have NET cancer, not everything is cancer. However, having cancer has affected my life even though it has not advanced to the point of being life threatening at this time. At times I’ve tried to put it to the side and continue with life as if I had no medical issues. That is impossible, though. Every 4 weeks I get a nice little stab of reality in the behind. Every 6 months I’m poked and scanned because I have NET cancer. So, there is no time to forget or ignore it.

So, like I’m sure many of those suffering from NET cancer, I will just deal with it and try to live as normal as possible for as long as possible. Through it all, discovering that not everything is cancer, but yet…everything is cancer.

NOTE: If you are finding this blog while searching for information on Neuroendocrine Cancer, I hope you find my experiences useful and/or entertaining. But, my goal is to give a personal story and not any medical direction. Please go to http://www.carcinoid.org for a lot of excellent information and resources for new patients, caregivers and doctors.

Life of Circles

So the question is often asked, “Which came first, the chicken or the egg?” It seems like a valid question that points to one of the great circles in life. Chickens come from eggs but it takes a chicken to make an egg but chickens come from eggs. Yeah, but it also takes a rooster to mate with the hen if there’s any change of a chick coming from an egg. So there are some holes in that debate.

But to me it illustrates that our lives are full of circular events, and the issue often is, “Which came first?”

Some are easy. For example, over the past several months I’ve commented several times that I’ve had overwhelming fatigue and tiredness and just generally feeling cruddy. Plus, gaining about 40lbs and the almost impossible ability to maintain any exercise routine for the past year. Now it’s easy to blame gaining weight on lack of exercise. In addition, the lack of exercise and the weight gain can naturally cause fatigue. Then the fatigue makes it hard to start up an exercise routine again. And around and around it goes.

For months I’ve tried to explain this to my doctors. My oncologist has not offered much help to resolve this issue. In fact, I’m starting to wonder if he really even cares about anything except for tumor growth and well-known carcinoid syndrome symptoms. My family doctor has been a little hesitant to diagnose anything due to the carcinoid cancer possibly having so many different effects on my body. Both suggest getting more exercise to help. Well, sorry, but…..duh!

Ronny Allen made a suggestion a while back that I get my Vitamin D tested. That was a good suggestion, and I assumed among the plethora of blood tests they do every time I’m at the cancer center that Vitamin D would have been one of them. I guess not. So, last week I request a Vitamin D test from my family doctor. He says that it’s hard to authorize a vitamin D test unless the patient has had or suffers from blah, blah and blah. I said, “How about the fact that I’m missing the right side of my colon, ileocecal valve, and 3 foot of small intestine? Wouldn’t that merit testing malabsorption of vitamins?” He agreed and ordered the test among several others.

So, the range for vitamin D for me should be somewhere in the 30-100mg/mL range. Mine is 13.7. Finally, at least one thing that helps identify what may be causing some of my health problems.

Vitamin D deficiency can cause symptoms such as:

  • Fatigue
  • General muscle pain and weakness
  • Muscle cramps
  • Joint pain
  • Chronic pain

I have all these symptoms and for over a year I’ve been asking my doctors to help me.

So, now that we’ve identified one clear area that needs treatment, I’m on a 4000 iu per day dosage of D to help raise it up. I’ve read from other sources it may take 10000 iu per day temporarily to get a low D count higher. But, I’ll start with the doctor’s recommendation and go from there.

Ok, guess what, there’s more! Now the following may be a sensitive topic for men. But, hey! This is a blog where I tell all my health stuff that would make a HIPPA examiner cringe.

In amongst the tests ordered was one for my testosterone levels. Now, except for the obvious possible symptoms of lowered testosterone, of which I had thought was caused by Prozac not low testosterone, there are some very interesting additional ones, such as:

  • Fatigue or loss of energy
  • “The couch is calling”
  • Irritability or low mood
  • Loss of muscle or increase in body fat

Sound familiar? I think so! Thus, I was not surprised when I saw my level was very low. My chart says normal levels are between 348 and 1197. Kind of an odd range, don’t you think? Some sources put it at 300-800. Some say levels in the 300’s is enough to merit further examination. Mine is 137.

The doctor had me do a second test to verify the results. I haven’t found out the second set of results yet. I’ll update when I find out.

Now here’s the circle in all this, low testosterone can cause fatigue, loss of muscle (actually hindering the ability to gain muscle mass), and increased body fat. But, low testosterone can be caused by lack of exercise, weight gain, stress and other factors normal in life. However, low testosterone can then be treated by increase in exercise, especially weights (but wait, doesn’t low testosterone hinder the effectiveness of weight training?) losing weight, reducing stress, eating the right foods and other natural activities. So, which came first? I was active and healthy, then I wasn’t. Then I really wasn’t. Had my T levels dropped and the subsequent problems began occurring or did the low T come about because I couldn’t exercise like I should and basically haven’t felt like doing so for several months now. It’s quite a chain reaction, with no clear definition on what started it. It just keeps going around and around.

Hopefully, after I find out if the second test verifies the first, we can work on a treatment plan and maybe get me back up to a better energy level.

I have been living with neuroendocrine cancer for 2 years and it causes all sorts of havoc on my body. But, as has been pointed out to me many times, not everything is caused by the cancer. I’m also glad that the tests showed I’m not just being hypersensitive, which I had worried about. I really do have conditions that need to be and can be treated to help me get back to where I want to be.

I feel like this week may be the break in the circles, I ve been waiting for. I feel we have a clear path and have an opportunity to make some forward strides. I’m ready! Let’s go!

Sometimes you can hear the trains.

The town we live in has train tracks that goes right through the center of town. The town is very small so there’s not really a part of town where you can’t hear the trains go by. We live about 1/4 mile from the tracks. The trains go through town about every 30-45 minutes. As they go through each of the crossings they blast their horns in a particular pattern as defined by transportation laws. So, not only is the sound of the train heard throughout town but also the multiple blasts of the horns. This happens all day, all night, every day, every night. Thus, you may think it’s quite a nightmare living here. No, not really. It’s amazing, after a brief time the trains are not a nuisance. Unless they blast the horns in an odd rhythm, I do not notice them. Maybe only hear 2 or 3, if any, during the day. The brain just begins to tune them out, and the passing trains just become “normal”.

Awhile back I wrote about finding a new normal while living with neuroendocrine cancer. When I wrote about a new normal I don’t think I really knew what that would involve. Maybe mentally I’ve made some adjustments that would constitute finding a normal. When I was first diagnosed I was online all the time reading about this disease. Thinking about symptoms, side effects, progression free survival, overall survival, and just what to do and what all the tests mean. That’s all been quite normalized now.

It’s been almost 2 years since diagnosis, I’ve had all the tests. Yeah, I’m a regular pin cushion. I started Sandostatin LAR in April and after about 2 treatments the symptoms subsided quite a bit. My MRI and CAT scan in October shows no significant growth and no new metastases. Blood tests are looking good, too. Some high and low values but very minute variations.  By all accounts I’m stable.

So, I found myself distancing myself from this condition and not thinking about it as much. In fact, I began thinking that I may forego the Sando shots next year and save some money. It’s really hard coming up with the insurance deductible of $2500 every year. Especially if, like this year, both my wife and I had enough medical issues to meet both our deductibles. So any surplus we had in our HSA are long gone. Now we have to set up payment plans with the hospitals. I know we are not alone, it’s a fact of life for many with long term health issues.

So, you may think I’ve went into denial. I do not think so, it’s always been very real. I think it just started becoming normal.

Until it suddenly wasn’t normal anymore. November was a bad month. I’m not sure what happened. For the first time since I started the monthly injections, I had to take additional doses of octreotide to help reduce the severity of the flushing and overall yukiness I felt. Did the Sandostatin shot fail to work? Was it not prepared correctly? Are the tumors in my liver becoming more active? Am I getting worse?

The fact is, I’ve been gradually feeling worse. Over the past couple months I’ve been feeling more and more fatigued and having more joint issues especially in my neck. I’ve been going to physical therapy and it helps briefly, but the weakness and pain return. Thus, I’m still not exercising properly. And, as a result, I’ve been gaining a lot of weight even though I try to not eat too much and try to eat healthy. So, I’m a little down about all that and that seems to keep the cycle going. I’m working on a blog entry to discuss that a bit more.

So, what is “normal” with neuroendocrine cancer? I thought I found it. But, it turns out having NET cancer is like the trains that go by silent, only because my brain tunes them out. My symptoms are still there. Everything was normal when they were quieted by the treatments. But, when the treatments don’t work well or when the tumors start becoming more active, what is ”normal” changes yet again.

NOTE: If you are finding this blog while searching for information on Neuroendocrine Cancer, I hope you find my experiences useful and/or entertaining. But, my goal is to give a personal story and not any medical direction. Please go to http://www.carcinoid.org for a lot of excellent information and resources for new patients, caregivers and doctors.

Zebras and Neuroendocrine Cancer

If you live in Kentucky there’s a very important questions you will get frequently asked. A question that surpasses any economic, political and religious divides. A question that, depending on the region of Kentucky you live in, will define you as either friend or foe. Are you a Kentucky fan or a Louisville fan? Are you a Wildcat or Cardinal? (I know that’s 2 questions, but they are  essentially the same) In Central Kentucky it’s not uncommon to hear people say they “bleed blue” or are “true blue”. Some will paint their houses in UK Wildcat blue and white. It’s a whole culture. Kentucky fans are truly devoted to their teams.

I’m not really a sports fan. I watch them occasionally, but I never considered myself a Lakeside Elementary Viking, a Bryan Station High School Defender, or a Kentucky Wildcat. It’s interesting that when I was diagnosed with Neuroendocrine Cancer I would be faced with another choice. Would I now be a Zebra?

If you are not familiar with Neuroendocrine Cancer, then you may wonder what Zzebrapoleebras have to do with NETs. Well, it come from a saying that doctors supposedly use. That if you hear hoof beats think horses not zebras. NET cancer can give so many symptoms that lead physicians down the wrong path searching for horses that, when the patient finally gets the right diagnosis, they find out it was more like finding a zebra, not a horse.

Now, there are three species of zebras. There is the plains zebra, the Grévy’s zebra and the mountain zebra. Although I think I’ve found another type of zebra. I drive past it everyday as I go to and from work. I think it’s a pole-ish zebra. What a zebra has to do with a greenhouse I have no idea. I assume it is supposed to create a reason for people to at least take notice of the place.

Am I zebra? In the sense that my symptoms before proper diagnosis were treated as traditional ailments, (ie. heartburn, acid reflux, indigestion, stress) then yes, I fit the zebra analogy. But, I haven’t adopted the team mascot. I also do not refer to other NET patients as fellow zebras. However, I’m not offended by the use of zebras in the NET community. It’s all personal choice. It’s ok to me, although the notion that a disease needs to be identified by an animal is a little confusing. I wonder if the saying was, “If you hear flapping think chickens not ostriches”, that we would be calling NET patients ostriches.

zebrasuperNow, maybe if zebras weren’t portrayed as being so goofy, like the depiction in the movie Madagascar or the Zany zebrahulkZebra of the children’s books I read when I was young, I’d feel different. Maybe we could have super powered zebras like a Super-Saiyan-like Zebra that could Kamehameha the stuffing out of neuroendocrine cancer. Or a Zebra-Hulk that would SMASH! NET cancer’s butt. Of course, these ideas are just as silly, but hey they’d be kinda cool, huh? I wanted to draw a menacing looking mecha-zebra, too, but I just wasn’t patient enough to draw it. I wasn’t very patient drawing the others either, sorry for the poor quality.

I may not be a Wildcat, I definitely would never paint my house blue, but I cheer for the team when they play. I’m not going to call myself a Zebra or start wearing zebra stripes, but I’m glad to be a part of an active community of NET patients, caregivers, and doctors who are working together to educate, advocate, and hopefully eventually help find a cure.

NOTE: If you are finding this blog while searching for information on Neuroendocrine Cancer, I hope you find my experiences useful and/or entertaining. But, my goal is to give a personal story and not any medical direction. Please go to http://www.carcinoid.org for a lot of excellent information and resources for new patients, caregivers and doctors.

Goodbye, my friend.

I wouldn’t consider myself an animal lover. I’m not really a dog person or a cat person. However, I do like animals and if they are not annoying I like to be around them.

Our relationship with animals amazes me. We let these creatures into our homes to become our friends. That is fine with domestic animals, cats and dogs. They seem to like the attention of people. Although I recently read an article on MSN that said your cat may be thinking of ways to kill you. So, just a heads up. But, still we like to take animals who are perfectly happy living outside and let them in our house or cage them up all because we want them to be our companions.

When my son was little we tried all kinds of pets. We did not want a dog, we could not have a cat due to allergies. So then there are the pets that we tried that, in my opinion, aren’t really pets, for example, guinea pigs. Cute as could be while they are small, stinky and boring when they are grown. I used to have a hamster, and during those few weeks before he died, I made a decision about having pets. Any animal whose sole goal is to get away from you, no matter how cuddly they are, are not pets. The guinea pigs did not want to socialize with us. They just wanted to run away, pee and poop on us and gnaw on our fingers. Soon they were confined to the basement because they were too stinky, we became allergic to them, and then finally we gave them away.

Then came fish. Fish are cool to watch, but they aren’t pets either. You can’t cuddle with a fish. They do not seem to really care whether you are there or not. To me, it also seems a bit cruel. Are they really happy being confined to a tank? I don’t know. I do know, fish die really easy. Our son, Kyle, did a really good job of taking care of the fish. But, they too, had to eventually go. We dumped them in a local stream. I hope they liked that better, but probably the local stream environment (temperature, bacteria, ect.) killed them. Did I mention, they die very easy.

Then we had a snake that Kyle caught. Had to let it go cause it wouldn’t eat. Kyle also had several lizards. One we accidentally left outside too long in it’s glass cage and the sun fried it. Oops! Honestly, we should be kept away from animals.

Kyle wanted to try having a parakeet. Now, I will say the parakeet, of all the non-pet pets, was probably the most social pet we had owned to that point. He actually wanted to be around people. He picked up on a few word my wife would say to him. But, given the chance that bird would fly away. It’s a bird, a creature of flight, and we kept it in a cage. Just seemed unfair. After Kyle left home, the bird had to go to a better home. He’s happy, we found him a home with another parakeet and they get along well.

In the middle of all these attempts at a non-dog pet for Kyle, when he was 6 we went to the pet store to look at ferrets. Supposedly certain breeds of ferrets are less likely to cause allergies than a cat. Kyle picked up a ferret and it grabbed his arm and bit him. Poor guy, he was definitely allergic to the ferret. Well, to calm everyone down, we went over to the puppies. Why not pet some puppies for a while and be happy?

Why? I will tell you. Because if you pet a puppy in a pet store you might just end up buying a puppy at a pet store. We bought a $400 puppy. Insane! Why? Don’t know. Weakness I guess. Maybe down deep I wanted a puppy more than my son. Now, for all our efforts to the contrary, we have a dog, Rusty.

Rusty was Kyle’s dog,  but he never quite adopted Kyle as his human. Instead he bonded to me. Thus, the reason for all the additional pets discussed earustyrlier. Kyle kept searching for that pet that was a friend. He even tried owning a rat. Poor guy. On the other hand, the rat was a surprising friendly little rodent.

15 years later, our puppy was now an increasingly feeble little dog. He had survived through many problems, including being hit by a car a few years ago. But, this week, he got so sick, we had to put him to sleep. We never intended to have a dog, but we had one of the best little dogs I could imagine in our lives. He was our friend for over 15 years and we will miss the little guy. Goodbye, my friend. :(

Exchange Server 2007 Move – Lessons Learned

NOTE: This is not intended as an instructional or technical article on moving Exchange 2007 to another server. It is long and a bit technical, but hopefully a bit entertaining too.

Maybe I’m wrong, but I don’t think there are any Systems Admins that get very happy about needing to recover, migrate or move an Exchange Server. It’s a challenge. It is especially so when the Exchange Server is one that was already established long before taking on a job role.

Thus, after a long life, the time has come to move our Exchange Server 2007 SP3 install from it’s aging Microsoft Server 2003 platform to a Microsoft Server 2008 R2 server. You may be wondering why go through all that trouble and use Windows Server 2012 R2 and Exchange 2013. Well, calm down, there’s a reason. That’s just the way it is. It will all be OK. :)

You know, one of the difficulties working in technology for a SMB (small to medium sized business), in my opinion, is that it’s very hard to become an expert at any particular aspect of technology. I think, even if a person comes into an SMB having a specific skill set, there’s no guarantee that they will use those skills or when those skills would be used. I’ve been at my current job for 8 years. Because I get pulled in so many different directions, I’ve gained, lost, regained, and lost again many different skill sets. Sometimes, it is discouraging, since it feels that I only have the skills, any any given time, that I had to learn or re-learn due to whatever the current project is requiring of me. But, on the other hand, I kind of like that about my job. It’s rarely dull and I love to learn new things or refresh old skills. I wear a lot of hats and they all fit a little different.

This is the first time in my career that I’ve needed to migrate an Exchange Server. I have a good feeling about what it will require and how to do it. But, I’m also cautious enough that I researched it to death before moving forward.

Which brings me to one of the lessons learned. When researching a big project, Save the Links! Now that I’m trying to write about it, it would sure be nice to remember all the places I went to gather information. I used 3 different browsers on several different computers. Thus, my history is so scattered that finding any reference to where I found a certain article is very difficult. Lesson learned!

Back to the subject. There’s really two methods of moving an Exchange installation. As a recovery or by moving mailboxes. In the recovery scenario, Exchange setup would be run with a switch (/m:RecoverServer) allowing it to be in recovery mode. Then all the databases would be moved and the old server shutdown and the new one put in place. However, when I started, I could not find convincing documentation that this method would work with moving an Exchange 2007 SP3 from 2003 to 2008 R2.

Then, I found one forum thread titled, “Restore Exchange 2007 SP3 to Windows 2008 R2 from Windows 2003”. Perfect, right? However, most comments said recovery was not supported in this scenario. Which translates to, “We’ve never tried it, but we read the manual. You should, too.” Then there was one guy that said he does it all the time and that the support docs are out of date as of SP3. (Link to the Exchange TechCenter Forum Thread) I’m still not getting the warm and fuzzies, though.

This is one the problems I have with forums, in general. Overall, they are not very helpful (or maybe instead of “not very helpful“, I should say “not very efficient”). This is not just the case for IT support. I’ve found, no matter the subject, they all tend to be very similar. One person poses a semi-vague question without all the information necessary for people to properly respond. Then comes the immediate respondents who point to an article that may or may not have any relevancy to the actual question. Even if it is accurate, often it is so vague that there is little gained by the post. After awhile a few others respond or the originator clarifies the question or begs for clarification of the respondent’s answer. Then, for some reason one of the respondents re-posts the same message again, as if that makes it more official than the first posting of non-helpful information. Then there are the few that hijack the conversation and steer it completely off topic and some who respond to the vague answer of the first respondent, “Yes, FORMAT C: solved all my problems, you are the best. Saved my butt!” Of course, there are those who just are annoyed by people who ask questions on a support forum, and say RT*M or some other unhelpful comment. I mean, really? The nerve of some who think a user forum is to get some sort of beneficial help for an issue. I do declare!

But, occasionally…. occasionally there’s some kind soul, a beacon of light in the darkness, who does manage be helpful, to guide the lost to the right article or point to a blog of somebody who had a similar issue and wrote his experience. Ahhh! that is where I find the gems.

So, I found via a forum somewhere, this blog article (Steps to move an Exchange 2007 deployment). It was pretty close to the scenario I felt most comfortable proceeding with and I used it pretty much as an outline for my Exchange move.

The recovery method I mentioned earlier was not the way I wanted to go. I wanted the opportunity to test the server first by moving a few accounts over and then gradually move all accounts over. My goal was for this to be a seamless as possible.

And, I failed!

I didn’t lose all the data or anything catastrophic like that. In fact, at first, everything looked great. Server was good, install went fine, firewall was configured and our email host was communicating to the new server. I had moved a couple mailboxes over and I could send and receive mail.

Problem was that the new server started picking up internal mail. Even worse, something was preventing it from leaving the mail queue. I did not think about that happening. My ignorance was thinking that this server would only service the mailboxes installed on the database residing on itself. Instead, it started acting as a secondary transport for any mail that the old server could not process immediately. Not what I wanted!

I ran through the Mail Flow Troubleshooter and the Event logs. I kept getting and seeing the same errors. For example:

421 4.2.1 Unable to connect Failover to alternate host did not succeed
Send connector Intra-Organization SMTP Send Connector has failed to authenticate

I researched and worked on the problem all night without success. Finally, I moved the mailboxes back and turned off the server to come back to it another day.

Another lesson learned. At some point: STOP, go home and rest, then pick it up later. I was so determined to solve this puzzle, I just couldn’t put it down. I didn’t even break for dinner (big mistake!), just kept going until about 11:30PM when finally some sort of common sense kicked in and told me to hang it up, this was ridiculous. Actually I accomplished very little for the amount of time spent. I should have backed out much earlier and came back with fresh eyes on it.

I can’t remember all the things I tried, but some of them were valid. For example, I did find a TLS issue. Windows 2003 was not set to read the same version of TLS as the Windows 2008 R2 server. So, I needed to install the hotfix on the 2003 server and add the proper registry settings to the 2008 R2 server.

It got to a point that I tried turning the new server back on. But, the same issue reared it’s ugly head. Messages kept going over to the wrong queue and would not release.

Jumping ahead a bit, I did finally figure out one of the major issues. I identified that all the messages getting stuck in the queue were to distribution groups not individuals. (I should have noticed that earlier, …oh well!) When I looked at the groups in the EMC (Exchange Management Console), I noticed some were set to allow ANY server to be the expansion server, and some were set only to our old server. The ones set to the old server were the ones getting stuck. Once I changed all the groups to ANY and restarted the transport service, all messages went out of the queue and mail flowed properly. However, I still had “Send connector Intra-Organization SMTP Send Connector has failed to authenticate” in my event log, but it wasn’t hindering mail delivery. I made the choice to just ignore it, for now.

I think the root cause of this error, was that I tried too hard to be neat and tidy. After installing my 3rd party SSL certificate on the new server and assigning it all the services it needed to bind to, I deleted the self-signed SSL certificate Exchange created during install. I think Exchange needed it to communicate to other Exchange servers properly. That’s my theory and I did see one comment in a forum pointing to a fix where Microsoft’s support reissued self-signed certificates and the problem was resolved. I’m very curious as to whether that would have fixed it, and my OCD really, really wants to know but, I also needed to prioritize, finish this project and did not have time to test it out.

OK, I decide I have to get this done. My wife is gone for the week. I decide I will take the weekend and do it all at once. It really doesn’t matter whether the two Exchange servers can relay mail to each other. The goal was to move not add a server. I warn everyone that email will be quirky during the weekend and if they would please delete their deleted items to help speed things up.

Next lesson, users do not delete anything. Why would someone have almost 60,000 items in their deleted items folder? Same reason they have 70,000 in the Inbox, right? Or 50,000 MSNBC RSS feed messages. Oh my! When I planned this, I thought I would be moving mailboxes for maybe 2-6 hours. Nope! Some mailboxes took 5 hours to move. When Exchange moves a mailbox it moves by folder and then each message. So, even if a mailbox is not large in data size, if it has lots of messages it can take just as long as a larger sized mailbox with fewer actual messages. It took most of 3 whole days/nights (oh, those sleepless nights monitoring mailbox moves) to move 170 mailboxes over.

FUN FACT: Did you know that if you use Outlook, Microsoft recommends no more than 2,500 – 5,000 items per folder in your mailbox? (https://support.microsoft.com/en-us/kb/905803) That was fun to know, wasn’t it?

One of the last things to do was uninstall Exchange on the old server. I followed the uninstall procedure and then the uninstall process just hangs. :(

Now, I’m pretty patient. I’ve been in IT long enough to know that just because it looks like it isn’t doing anything, doesn’t mean it’s not. Be patient and it will complete. However, after an hour, I’m wondering if all is going well.

No failures in the event log. Hmmmm? So, I turn to my best research friend and secondary brain, Google. Google says go read Chris Boessen’s blog, Exchange 2007 Uninstall hangs on Remove Exchange Files. Bingo! Uninstall finished. Whew!

Overall, the move went well. I did accidentally destroy the public folders. Public Folders are tricky, especially when they have previously been migrated from an older version of Exchange. So, I had to perform some destruction to the Public Folders to get the Exchange uninstall process to begin. Looking back, I think I know what I did wrong (Next time only run MoveAllReplicas.ps1 once). On the bright side, I have a full backup and can restore them. That’s right, I actually made a full backup of all my mail databases before trying any of this. :) Yeah, backups!

So, if you are planning an Exchange move, all I can say is prepare to spend a whole weekend, it’s going to take more time than you expect..Unless you are a professional Exchange Admin and migrate servers for clients everyday, you probably are like me and know just enough to get it done slowly with the right research and documentation.  Also, don’t rely on your users cleaning their mailboxes out. Document your research, you will want it for review later. Oh, and before you do anything, back it up.

For us, this was just stage one. Next year we are either going to stay internal and upgrade to the current Exchange Server or move it all to Office 365 services. Either way, this was a great opportunity to dig into some of the more granular aspects of an Exchange installation. I ready for the next one.

Now it’s time to get some sleep. The next project is right around the corner.