Unremarkable

Adjective. "Not worthy of note or attention; found in the ordinary course of events; not exceptional in any way especially in quality or ability or size or degree."

This may be my new favorite word. Way back in 2007, I was very happy to hear "no evidence of disease (NED, for short)"... but now my watchword is unremarkable. This is what the professional readers-of-CT-scans (aka radiologists) write down when they do not see anything worth talking about relative to the many organs that a CT scan makes "visible." So, the bottom line is that nothing was noticed (by folks who are trained to notice things) in the CT imagery that we gathered on Tuesday. My oncologist was happy - and that is another reason for me to be happy. Stuff in the square brackets below is color commentary from [Yours Truly].

To wit:
PROCEDURE:
Following the administration of both oral and IV contrast, volumetric CT imaging was performed from the lower neck to the upper thighs, with reconstruction of planar images [requires an hour of drinking barium contrast, a pressurized IV contrast delivery through my port, and a certain level of no-clothing-ness - just thought you would like to know...].

FINDINGS: The lungs remain clear, and no developing nodular mass is seen in either lung. ... No areas of airspace consolidation are seen in either lung. No pleural effusion [buildup of fluid between the layers of tissue that line the lungs and chest cavity] is present bilaterally. No developing adenopathy [swelling or abnormal enlargement of the lymph nodes] is seen throughout the chest. Heart size is normal. [WHEW!] A central venous port is implanted in the upper left chest wall, with its catheter entering the subclavian vein. [Yup... I have a PowerPort there for easy blood draws, chemotherapy transfusions, and CT scan contrast infusions.]

When compared with prior exams [4/7/2011 and 5/22/2011], laparotomy [a surgical procedure involving a large incision through the abdominal wall to gain access into the abdominal cavity] has been performed with resection of two metastatic lesions of the liver. A portion of the left lobe has been resected, and additionally [a little redundancy there, eh?], a portion of the right lobe has been resected. Several small cysts are seen within the remaining liver [perfectly normal, I am told], stable in appearance when compared with prior exams. No new lesion is seen within the remaining liver parenchyma [tissue that is characteristic of an organ]. Pancreas, spleen, adrenal glands, and kidneys all appear UNREMARKABLE. Collecting systems are not dilated.

There are postsurgical changes also identified related to distal colon resection [the surgical procedure I had in 2007]. A suture anastomosis line is seen at the rectosigmoid junction. GI tract appears UNREMARKABLE without areas of wall thickening or dilatation [same as dilation]. No developing adenopathy is seen throughout the abdomen and pelvis. No ascites [excess fluid in the space between the tissues lining the abdomen and abdominal organs] is present. Bladder appears UNREMARKABLE.

IMPRESSION:
(1) When compared with prior imaging studies, there are new postsurgical changes related to resection of two metastatic lesions previously seen within the left and right lobes of the liver. No new lesions are identified within the remaining liver parenchyma. Several hepatic [related to the liver] cysts appear stable.
(2) Postsurgical changes related to distal colonic resection.
(3) At this time, there are no findings of metastatic disease within the chest, abdomen, and pelvis.

Sooooo..... can we have a collective woot-woot and a huge sigh of relief? Thank you, thank you very much. My weight is recovering (now at a nice 172 lbs...) and my energy is returning as well. I worked full-time for the past two weeks, and did not even once feel too fatigued during the day to remain at my desk. November is going to FLY by, with trips planned to New Hampshire, Seattle, Manzanita (OR), and Portland, and a huge gathering for Thanksgiving.

Thank you all for your attention - you will now be returned to your regularly scheduled program.

Namaste.

Stepping forward (and back)

The 2011 treatment regimen is officially complete. May we (please) have seen the last chemical infusion pump...

This second lost year is harder to reflect on than 2007. Then, it seemed like I could just put the whole cancer business behind me, and go on living. I upped my exercise (some might say manically, especially in the cycling department). I remained moderate in drinking alcohol, and backed off on the consumption of red meats (though that too was not high to begin with). I threw myself into work and projects. And we all grew older together. Regular checkups were positive and unremarkable. Unremarkable became a favorite word.

But 2011 feels qualitatively different. The pre-surgery biochemical therapy, the major liver surgery, the post-surgical chemo... all were harder than last time, and there has been a significant jolt to my thinking about life, the universe, and everything. Two steps forward, one step back? Or is it two steps back? I guess I would like to think that some progress has been made, but I am already loathing the CT scan that I have in two weeks. "We are establishing a new baseline" sounds so practical and ominous... but metastases are now no longer hypothetical for me. I fear another crushing blow to my spirit.

But I am working to remember that chemo is done, for now. I am slowly restoring my internal organic activities to some semblance of normal. I still have a few side effects to deal with, but each day is getting better in terms of appetite and energy. We have a lot of fun planned for the next couple of months, and are making firm plans to find someplace warm for a vacation during the cold and rainy period that we call the "holiday season" up here in the Pacific Northwet. Being done with the bi-weekly chemotherapy is a great physical burden lifted from my shoulders. This is a very good thing, and something that I am glad of.

Namasté, my friends!

Weirdest ride thus far...

So, yesterday was not easy. For those of you playing along at home, my chemo treatments for the past three months have looked something like this - treatment day 1: 2.5 hours of chemical infusions followed by aches and bed rest, but not much sleep due to steroids; treatment day 2: slightly better than day 1, but still receiving 5-FU via portable pump that goes whirrrr-click every couple of minutes and sleep is still evasive; day 3: pump is removed but I receive an injection to stimulate white cell production (which adds to fatigue for the subsequent two days). But by day 5 things are feeling almost normalish.

Yesterday, day 3 of this last cycle, I was "awakened" by my pump beeping like crazy. I was barely asleep anyways, so that was not a big deal, but the pump indicated that there was an "upstream occlusion" and would not be whirrrr-clicking anytime soon. So I managed to silence the incessant beeps, and called the clinic. They said to bring myself in and they would manually pump the remaining chemo (9 mg in solution) into me and disconnect the pump. That is about half of the infusion that I receive at the very end of every day 1 prior to hooking up the pump, and it really knocked me back. To say that this led to a sub-normal day 3 is an understatement... and I did not even have the injection to stimulate my white cell production!

Exercise class ended with me sitting in a chair with my head down, trying to stay conscious. After ten minutes, I regained enough color that my instructor allowed mr to leave. I had a scrambled egg, slept for an hour, then went to a reiki appointment... which usually energizes me. Unfortunately, not this time. It was a busy day, and perhaps I should have slowed down. But with the sad announcement of Steve Jobs' death, I really wanted to seize my day. And every day.

This morning feels pretty good, relatively speaking. I may even try to catch up on some of my workload - which unfortunately does not seem to realize that I am not there! Best part of the morning so far is that I am hungry.

Namasté.

Energy expended, now what?

Number six is now coursing through my veins, with a little boost of 5-FU every few seconds for the next two days. Fatigue, but not sleepiness,idead and gut aches, warm flashes and dry mouth. No appetite to speak of, and way too much time to think. No googling info on side effects anymore - they are all too familiar.

Called some medical providers today - one to straighten out a toenail fungus cream (leftover from the ingrown toenail treatments in May, I think) and the other to straighten out billing for lab work done in January. Insurance companies are a bane and a boon. Given my extensive treatments over the years, I am happy to have their support. But sometimes things go awry. Alas.

Going to turn out the light now (it's almost 1am) to try sleeping. Wish me luck!

Where we get energy...

So, the blogger feels like he has once again let himself down on his commitment to post more frequently (and seems to have adopted an annoying habit - referring to his very own self in the third person). As I am sure I have said before, the idea of thinking and writing about my cancer journey has become less appealing as time marches on. Unfortunately, that leaves my loyal readers and supporters in the proverbial dark. And there have certainly been some dark days this year!

Right now, I am in Boise (pronounced "boy-see"), enjoying the marvelous early fall weather and the amazing energy of the National States Geographic Information Council - NSGIC (pronounced "niz-jick"). This is truly one of the most satisfying professional engagements that I have ever had, and this group has had big impacts on the way that geospatial data are created and used all across the nation. Most if not all of the background imagery that we see on GoogleMaps, Bing, Yahoo, etc. is provided by federal/state/local government collaborations, and NSGIC has led that effort for many years. And that is only one small example of the work that NSGIC does year-round. I get a lot of energy from the excellent NSGICers that work diligently year after year to promote the efficient and effective use of geospatial technologies in government, and consider many of these people among my close friends.

It was also wonderful to have a chance to ride 20+ miles with several NSGICers on Sunday morning. Riding along the Boise River in the sunshine was a great reminder of what my near-future will look like. Over the past few years, my return to regular cycling has energized my life and has created a means to re-engage my self in mindful (and healthy) exercise. Planning and accomplishing long rides are a healthy distraction from the difficult reality of next Monday - my final treatment of 2011. So expect to hear about long-ride options that I am considering in future posts!

Namaste.

New old news

So, here I sit again, staring out the window into grey cloudy skies that predict an early fall, attempting to drown out the whirrs, clicks, and alarms of the chemo infusion clinic with a healthy dose of Enya. My bloodwork was encouraging this morning, with my neutrophils 'recovered' to a nearly-normal 3000 per milliliter. The bone pain in my left femur was a predicted (and predictable) side effect of the Neulasta shot that I received two weeks ago, and I anticipate another one of those beastly injections on Wednesday to be sure we can finish Chemopalooza 2011 on time. All evidence points to finishing the fifth treatment this week, and then a final transfusion has been scheduled for October 3rd. Woo-hoo.

Karen and I went to the coast this last weekend with three other couples - dear friends that form a wonderful little book club / drinking association. I have been virtually a teetotaler for the past eight months, but let myself get a little wild by having a couple Bud Lite Limes. Lest anyone miss the irony of that, I have long been a fan of handcrafted and small lot beer batches. Local favorites include the Deschutes Obsidian Stout, the Ninkasi Tricerahops, and just about any Oregon-produced India Pale Ale. Drinking Bud Lime is like drinking a weak shandy. But I digress. We had a fun time laughing and playing games together, canoeing in the Siletz Bay, and traipsing around Robert's Book Shop in Lincoln City. It was a perfect relaxative prior to today, and we even got to watch the Packers win.

Namaste.

That giant sucking sound...

...is not jobs flooding into Mexico after NAFTA, despite Ross Perot's fiery speech. It is the sound of exasperation and fatigue from this particular cancer-boy. I am just past my 10th of twelve treatments (six before surgery, and six after), and it is not getting any easier. Between the chemo and the side-effect management drugs, I have been mostly horizontal for the past 72 hours. I am achy, sleepy, and generally tired. Last night, I was reminded of how I am not all that good with stuff beyond my control - which leads to me trying to control 'something' - and that is also a hard place for me to be. So both physically and mentally, I am not feeling good. Cancer still sucks.

So, only two more treatments! Suck it up. Easier to say than to do. I lament my inability to sleep, that I am cold during the hottest days of the year in Oregon, and that I am too weak to be of much use at home or at work. Two more of these weeks, and we will be on the upswing again. I sure hope so.

I am grateful for all the support I receive daily. My family and I are luckier than many. But today I am tired of feeling lousy, and that is that.