Imagine What's Possible, published by the American Cancer Society this year, is a child's-eye view of visualization - the technique of using imagery to lessen anxiety and even pain - as a tool in coping with cancer.
While the book is still far from a best seller, Jarrod already has his first speaking engagement next spring at Gilda's Club South Jersey, a cancer support group in Linwood. And last week the Skoles' book was named a finalist for Children's Picture Books by USABookNews.com, which could bump up sales by 10 to 15 percent.
The run-up to that book, and to Jarrod's diagnosis, care, and current cancer-free status, are now chapters of the Skole family history.
It was after an afternoon lacrosse game, Jarrod's spring passion, that the Skole family went out for dinner in April 2006.
Jarrod was exultant; he'd played well. But when he went to the men's room, he was unable to urinate. The next day, Jarrod told his mother, Terry: "I peed blood."
Because he joked a lot, she thought maybe her son was kidding. He wasn't.
Next hope: Since Jarrod had had minor sports injuries, some kidney trauma might account for the bleeding. "You grab on to whatever hope you can," Terry recalls.
After an initial consultation and early tests with a urologist, Gary and Terry got the grim news. "This does not look good," the urologist said.
At Children's Hospital of Philadelphia, that was confirmed. Jarrod's diagnosis, rhabdomyosarcoma, is a rare form of bladder cancer.
"These cancers can appear in various parts of the body," says Nicholas F. Evageliou, one of Jarrod's treating oncologists at Children's starting in 2006. Evageliou, then a resident in oncology and hematology, worked closely with Richard Womer, an expert in sarcomas, cancers of the bone and muscle.
Because biopsies showed no sign of the cancer beyond the bladder and a tiny part of the prostate, the care was intense chemotherapy for a year, with vigilant follow-up.
Says Evageliou, "Because there was no more obvious tumor to remove, there was no additional surgery, but the chemo is not the most pleasant thing for a young person."
Jarrod would learn that quickly. He remembers Mother's Day 2006, when he was enduring the enormous assault of chemo. Jarrod was in terrible pain and discomfort, but didn't want to disrupt the day for his mother. He needed to get to the hospital, but initially he wouldn't go.
"Finally, my mom said that the best gift I could give her would be to go and get help. And I did," he says. "But it definitely wasn't a good Mother's Day for our family."
What happens to the family when a child has cancer is often unpredictable. Jarrod had been told by his parents, who are partners in a company that provides assisted living for seniors in their homes, that he would lick the cancer, but that fighting it would be hard.
"We wanted him to know both of those things from the start," says Gary Skole.
Jarrod's sister, Lauren, 16, still gets teary when she recalls those early days. "I hated the idea that he would be so sick and lose his hair. And I guess I felt more protective. I just wanted to be there for him," says Lauren, "even though he was sometimes pretty nasty."
"One of the common things in a family dealing with a child's cancer is to totally indulge the child, and give him enormous power," says Joan Rolsky, a social worker at Children's Voorhees Specialty Care Center, which treats young cancer patients.
Jarrod was a regular chemotherapy outpatient there.
"Some parents are terrified all the time, and forget that even kids with cancer may need some limits," Rolsky says.
The Skoles found that their delightful son could swing from Jekyll to Hyde in a flash. "We definitely had our moments," recalls Terry Skole. "But it's really impossible to be angry at a child in a wheelchair who's lost his hair and is throwing up constantly. I knew how awful Jarrod felt when he even rejected our dog and banned him from his bedroom."
Jarrod sums it up: "I felt like crap, I was puking all the time, and I wasn't always very nice to be around."
But the worst came and went over that year of care. It turned out to be Jarrod's discovery of visualization techniques that he had been offered before, and had rejected, that helped him through the worst of times.
The idea had come from Jarrod's paternal grandmother, Ruth Skole of Margate, who had dealt with breast cancer in 1988, and had turned to visualization in a serious way.
Influenced by Bernie Siegel's popular book Love, Medicine and Miracles, Ruth Skole had learned as much as she could about mind-body connections, relaxation techniques, and imagery.
"I needed to feel that I had some control over my life, and of course, when Jarrod was diagnosed, I tried to work with him," said his grandmother, who took training through Siegel and became certified in using guided imagery.
But her chosen images eluded Jarrod. "Mine just didn't work for him, and what we later realized was that what works for an adult may be meaningless" for a child.
But what no one knew was that Jarrod had not ignored the technique. He had, instead, made his own images, often alone in his bedroom.
"I can't explain exactly how it happened," he says. "I guess I just started imagining things that I daydreamed about, a kid's version that worked for me."
So he sometimes pictured blowing the stress and fear from his body in bubbles that were all the same size and floated the torment away.
When he had to face MRIs, which he hated, he'd become a captain/commander of a spaceship or time machine.
Distraction worked, too: Jarrod would defuse feared procedures by counting backward or making a mental list of items in a room at home.
But his all-time favorite was the drill sergeant visualization, which had him imagining his own body creating good blood cells, with a tough drill sergeant barking at the cells to multiply. "Work it! Work it!" the sergeant cried, and so the blood test of the moment wasn't so awful.
Did it work?
Jarrod Skole will tell you it did, but not always. His nausea and vomiting were intractable. But then once, when he badly wanted to go on a trip with the soccer team that he still played on even through chemotherapy, he spent a weekend intensely visualizing those multiplying good cells, and got a great count three days later. He went on that trip.
Christina DiNicola is an integrative pediatrician at the Jefferson-Myrna Brind Center of Integrative Medicine, where she works with ill children using both conventional and alternative therapies. And she is enthusiastic about guided imagery for them. "Pain and stress are innately tied to wearing down the immune system, so anything that helps reduce that has to be considered. And I think visualization has been highly overlooked, and has great potential to help kids going through difficult illnesses."
DiNicola, who tries to use mind-body modalities when she can, notes: "This is not yet taught in medical school, but I think Jarrod's experiences, and his book, will be particularly valuable because it's really straight from a kid's point of view. And frankly, Jarrod's book explains how to do it better than any doctor I've heard because he's been there."
Imagine What's Possible was a post-care joint effort of Gary Skole and his son when they both realized Jarrod might have something important to offer his peers.
With guidance from Children's Rolsky, father and son reduced the son's painful experience to words and images. They invited local college students to submit drawings for Jarrod's visualizations.
For one student, that would be life-changing.
Afton Metkowski, 21, now a senior at Temple University, illustrated warring armies, good cells and bad cells, doing battle in Jarrod's body, with the good guys winning.
She was so affected by working with the Skoles, she said, "that it actually clarified what I wanted to do in my life. I'm now applying to medical school."
A family friend, psychologist Herb Zaretsky, past president of the board of directors of the Eastern Division of the American Cancer Society, took an interest in the project. He helped the manuscript reach the society's Len Boswell, book publishing director at the home office in Atlanta.
"Jarrod's book is not the first and only book on visualization and guided imagery for children, but as far as we know, it's the first written by a child, and the first that focuses on the challenges faced by children with cancer," Boswell says. "The whole goal of our publishing program is to provide high-quality, evidence-based information . . . and visualization is considered one of the most useful therapies to help reduce some of the side effects of chemotherapy."
The cancer society notes in the book that while "imagery techniques are considered safe, especially under the guidance of a trained health professional . . . relying on an alternative therapy alone and avoiding conventional treatment could have serious consequences."
He's loving his freshman year, playing soccer, discovering he likes English as much as math, which used to be his clear favorite.
He is still under surveillance for his cancer, but for now, he's clear. He has moved on - gets no special treatment from his friends or teammates - and has this lingering thought:
"I wonder," he says, "whether I'd be a better soccer player if I hadn't had cancer."
"I probably would be," he adds, "but that's OK. I'm cool with where I am."
How to Buy the Book
Imagine What's Possible by Jarrod Skole and Gary Skole is available through Amazon in hardcover ($12.95), and through www.dreamofhope.org. The Skole family has started a foundation affiliated with United Charitable Programs, a 501(c)(3) nonprofit that facilitates charitable projects. The family, through sales and donations, hopes to provide books at no cost to the families of children with cancer.
Sally Friedman can be reached at email@example.com.