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.

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?

Neuropathy, continued

OK. We are what, nearly two years out from the last chemotherapeutic encounter with FOLFOX. And the idea was that after a certain period of time the tingling feet and the extreme sensitivity to cold in my fingers and throat would go away. And while I am certainly less tingly and sensitive, I am still aware of the peripheral neuropathy every day. Just yesterday, on my way to work, I had a strange itching sensation right above where my PowerPort used to be... and then today the itch was back again. I even thought that is was on the wrong side, but sure enough (I checked) it was the scar site.

So, what are we talking about here? I don't know. Except that the original purpose of this blog was to tell my story, and the story continues. My hands and feet are still susceptible to cold, though the tingling in my feet is confined to a very small area near the balls of both feet. I do not feel pain when picking up cold objects immediately, but I cannot comfortably hold cold objects for long periods of time in my bare hands. Swallowing cold drinks is not a problem at all. I have not "forgotten" how to swallow food/drink since the chemo ended.

That's the news for today.

Time to reinvigorate the blog...

2.5 years ago, I entered CancerWorld by way of a hyper-active glandular cell in my lower colon that forgot to stop growing. It has been excised, my immune system has been whacked and regenerated, and I have ridden thousands of miles on a bicycle. Time has passed, and I have completed two LiveStrong Challenge rides (40- and 100-miles in 2008 and 2009, respectively). I am very excited to Ride for the Roses with Lance Armstrong in just over two weeks - another 100 miles in the hills outside Austin, TX.

I stopped blogging for a while... but you already know that. I had tired of reflecting on the effect of a cancer diagnosis on my physical, mental, and spiritual health, and of the effort it took for me to write about those reflections. But I have found that being tired does not make problems go away. Be comforted that I am still "no evidence of disease" (NED), and that my exercise regimen seems to be a very good idea regarding recurrence. But cancer is patient and insidious, and I do not go a single day without thinking of possible futures involving more surgery, more chemicals, and the possibility of radiation. I am ready to take up the virtual pen again.

Two close friends recently detected recurrence of their cancers - one melanoma and one lymphoma... both are very nasty and agressive. And I am ready to maintain a blog of my thoughts on our journeys forward. I trust this meets with your approval. :)

Mamma Mia!

Just watched this on DVD with the daughterini - and I must say I hope I can be at her wedding. All the stresses and such that they go through in this silly musical ABBA-fest reminded me that nothing is assured in life, and that I would sure like to be available for the "giving away" part of the wedding ceremony.

Just sayin...

Where the heck have you been?

Excellent question. Be prepared for the lamest of answers, but I have found busy-ness to be a welcome (though overwhelming) change from cancer-dom. Cancer world is a place where you focus most of your energy inward - self-examination of mental and physical states takes one hell of a lot of energy. I now find that those inward-oriented "looks" are both simpler and not as important to my days (and nights). The sleeplessness of chemicals and worry have been replaced by the heavy sleep of exhaustion after a hard day's work and play.

I ride my bike a lot. I work hard (both at my paid job and at home tasks). Too many things are on my plate, but I rather enjoy a full-to-overflowing plate much more than the one that looks picked over with only bits of salad and potato left. I finally succumbed to Facebook (having been pushed into LinkedIn by a colleague and then goaded by my wife to "get with it"). I have enjoyed many a glass of beer or bottle of wine with my friends. I am enjoying the living of my life.

But the blog suffers. And even the most deicated blog readers slowly drift away as a result of my inattention. Cancer survivorship is a heavy responsibility - for family, for friends, for those whose journey is just beginning - but I have been giving myself room to distance myself from the 24/7 mental and physical work that chemotherapy is. Just ask anyone that has gone (or is going) through it.

I am well. No evidence of disease through the second round of post-chemo CT scans. Next "viewing" is in December, right before we head to SunRiver for a week of post-Christmas skiing and playing in central Oregon. It's nice to have stuff like that to look forward to...

Sad news - Leroy Sievers has died at age 53

A great light for me - now extinguished - and I am sad. In so many ways Leroy's blog was a vicarious living for me. And his valiant fight has ended. I discovered him just after my own diagnosis with colon cancer, as he had just described his own cancer journey on a television program Living with Cancer. His death is a reminder to me that nothing can be taken for granted, that our efforts daily must be wholesome, and that fighting does not always mean winning.

I am sad. This is hard to write about, because he was NED/NEMD for four years and then his world went to hell. And I must admit to my own fears and uncertainty.

You can find a nice description of his life at the NPR site (http://www.npr.org/templates/story/story.php?storyId=92028479) and a wonderful commentary about his impact on the blogging world at his blog (http://www.npr.org/blogs/mycancer/).

When the second shoe drops, it can be very loud.

Peace and love everyone - and live strong.