The on-going, first-hand tale of a journey through medical oncology... and what happens after.

Monday, January 31, 2011

Looks good (not to be confused with "good looks")

So, that is the succinct summary of my bone scan report, as communicated to me by my surgeon when he called this morning to schedule my new PowerPort. He thought tomorrow (2/1/11) at 9am would work, and wondered if that would fit my schedule. :-) Nothing quite like moving quickly! So, I report to the OR tomorrow at 7:30am. The port will be installed in my left upper chest, and we will use that device to ease delivery of chemotherapy drugs and CT scan contrast agents to my heart for whole-body redistribution. These things are SO MUCH easier than the arm-poke method.

What happens after that? Well, I take a nap and have a sore chest. I schedule and attend a consultative meeting with the liver surgeon at OHSU, and then the first rounds of chemo begin. He will be closely monitoring the effect of the chemo on the tumors... we want them to shrink, but not too much. Then we resection those bad guys. Then we bathe my insides in more chemicals. I will talk in some detail about the chemicals once I know which ones we are using.

Last tidbit... We are going to Orlando next week, prior to the beginning of chemo. I want to see Harry Potter World with Julia and Karen before the chemo begins, and we are going to Cape Canaveral too. I expect to ride every roller coaster, and drink some butter beer, and be silly. I think my girls deserve some fun before we dive back into chemotherapy hell again. We will be figuring out routines, and will work our way through the next several months. As of today, my outlook looks good.


Sunday, January 30, 2011


I have been surrounded by books my whole life. From the moment I have distinct memories of places, we have always had books around our homes And since my Dad helped to manage university BOOKstores, they were always a backdrop for any conversation. This is all a good thing. I love books. They are such constant friends, ready to transport you into other minds and other perspectives.

I am a great fan of science fiction and fantasy, mostly because they begin in a reality and then move thoughtfully through that reality. All authors are skilled writers (duh!) but their gifts vary widely. Some are especially great at devising world systems, and then telling epic stories about those places. Others rely more on the human experiences of social development, but tell very interesting "alternates" to them, hinged perhaps on a subtle change to an outcome.

Of course, with an introduction like that, I could go in a dozen directions. But my intent was to talk about my little library. I have several hundred sci-fi/fantasy books. My wife has often referred to it as a part of my dowry. When we married, I sold off at least half of it, but have been building it back again. There are about 250 titles in the "already read" section, and another hundred or so in a "to be read" section. I keep that "to be read" section for the sole reason that I always want to have something that I know I will like at hand - it is a kind of reading security blanket for me. And I love me a good discussion about fantastic futures!

I expect that there will be plenty of time for reading in the next bit. I am always looking for good books to read, and participate in two book clubs already. Anyone with a good sci-fi/fantasy title to suggest? I am all ears. They help me focus on the future, and live outside the present...

Friday, January 28, 2011

Bone scan 101

New adventure in nuclear medicine today, and it was not too bad from a consumer's perspective. I walked over to the diagnostic radiology lab, conveniently located near our local hospital, to experience another tool in the toolkit of the oncology professional. As mentioned yesterday, my oncologist referred me here so that we can be somewhat sure that our treatment plan is oriented toward the right objective (which is hopefully those two tumor in my liver). The bone scan is meant to rule out additional mets that would not normally show up on a CT scan.

So, as I understand it, the idea is to inject the patient (aka, "Ed") with a radioactive element (Technetium-99m) that has a short half-life (6 hours) and emits a steady flow of gamma radiation that a gamma detector can detect. The technetium is carried by my bloodstream throughout my body, but it is especially attracted to the calcium in my bones. So everywhere there is blood contact with bone, a little of the technetium binds to the calcium there and emits gamma radiation until it has no energy left. More blood flowing to areas generates more technetium deposited, which then leads to more gamma radiation emitted. There is a ton of additional information on Wikipedia, should you really want to get into the science of that process. I was injected with the technetium at 10am and told to come back at 1pm for the scan. No special diets, no fluid restrictions... piece of cake.

Went back at 1pm and was asked to lie down on a gurney. The technician then gave me a cushion to support my knees (slightly bent) and two straps (one to hold my feet together and another to support my arms. He then wheeled me under the gamma detector and I took a nap (honest!) while the machine moved slowly over me. All of my bones slowly light up on the detector, and areas that have the highest concentration of technetium light up the most. The detector is very sensitive, so we will have a good picture of my skeletal health when all is said-and-done. The radiologist's report will be available on Monday.

Not too bad, really.

Thursday, January 27, 2011

dagnabit, muskie!

Alas, here we are again... four years out from the first roller coaster ride and I am back in line for another. It turns out that the elevated CEA levels from last week's blood test reflected two liver metastases from the colon tumor that we exorcised in early 2007. Too bad those rotten little cancer cells were resistant to the FOLFOX cocktail, eh?

So, tons of oncological fun on the near horizon. Tomorrow we have a full body bone scan to check for bone mets. For the uninitiated, "mets" is the lingo for metastases, or cancer that has spread from one organ to another place. It is possible that I have developed bone mets because, in the blood test that demonstrated an elevated CEA level, I got the bonus news that there was an elevated (barely within the upper band of normal) level of calcium in my blood. Calcium in one's blood can result from many things (including vitamins, though this is not the case for me), but we are checking to see if bone mets are the culprit for the elevated calcium. We are hoping beyond hope that this is not the case, since otherwise the metastatic colon cancer is going wild in my system and the liver tumors are the least of my problems.

If the bone scan is negative, then the next order of business is reducing the size of the liver mets. FOLFIRI is our new cocktail friend, possibly supplemented by cetuximab, a biological agent. FOLFIRI is fluorouracil (5-FU), Leucovorin (aka folic acid), and Irinotecan, and it is delivered intravenously. I will need to get another port-a-cath installed, so that they can deliver the FOLFIRI directly to my bloodstream near my heart. This cocktail will be administered every other week until the liver tumors shrink to a manageable size (as detected by CT scans). TOO MUCH FUN!

Surgical resection would happen next, followed by some more chemo to be sure there are no additional tumor-wannabes waiting around, probably with 5-FU, Leucovorin and Avastin. Maybe 2011 will end with an all-clear. Let's hope so.

In the meantime, everyone should relax, enjoy their lives, and hug their loved ones. Really, what else is there to do?