Penmachine

Today I had yet another CT scan, to see how my various cancer tumours are doing. It probably won't be evaluated by a radiologist for a few days, so it's unlikely to disrupt my next chemotherapy treatment on Monday. But I will communicate soon with my oncologist Dr. Kennecke to find out the results.

Am I nervous? Yes and no. I've been at this so long, having scans every couple of months for over three years now, that I don't find worrying about the results to be too productive. Still, last time the news was somewhat good. I'm a little nervous about that.

Labels: cancer, chemotherapy, ctscan

I had another CT scan today, to see whether my current chemotherapy is doing any good to slow or reverse or do something to the ever-expanding tumours in my chest. I'll find out the results, and what that means for my chemo regimen, next week.

In the meantime, following my most recent chemo treatment last weekend, the side effects continue. A relatively new one is that if I haven't eaten for an hour or two, the first thing I pop in my mouth causes the salivary glands on either side of the back of my tongue to ache as they kick in. I can almost feel them pumping. It's not really painful, just bizarre.

And there is the endless fun with my digestive system. Last night I was in the bathroom for nearly an hour, then, when I thought I was done and was brushing my teeth to prepare for bed, suddenly my GI tract decided things needed to clear out from the other end as well, and I puked into the sink.

Next, to top it off, the sink clogged. I stared at it in disbelief for a moment, then searched our closets for the plunger at 1:00 a.m.—and I'm sure glad it worked once I found it. Very pleasant, I must say, especially in my chemo-nauseated state.

I didn't sign up for this. But at least I'm alive to complain about it, and I have a wonderful sleepy wife and puppy to keep me warm once I do get into bed tonight. They should help me sleep very, very well.

Labels: cancer, chemotherapy, ctscan, family, pain

Derived from the same CT scan of my body taken a few weeks ago is this 3D movie, also made with the open-source OsiriX software:

You can clearly see my portacath, which showed up just as well as my ribs. Freaky.

Labels: cancer, chemotherapy, ctscan, geekery, photography, science, software, videogames

Here, take a look at this extremely cool and scientifically amazing picture:

That's me, via a few slices from my latest CT scan, taken at the end of September 2009. I opened the files provided to me by the B.C. Cancer Agency's Diagnostic Imaging department using the open-source program OsiriX, giving me my first chance to take a first-hand look at my cancer in almost a year. Before that, the I'd only seen my original colon tumour on the flexible sigmoidoscopy camera almost three years ago.

I've circled the biggest lung tumours metastasized from my original colon cancer (which was removed by surgery in mid-2007). You can see the one in my upper left lung and two (one right behind the other) in my lower left lung. There are six more tumours, all smaller, not easily visible in this view. I'm not a radiologist, so I couldn't readily distinguish the smallest ones from regular lung matter and other tissue. Nevertheless, now we can all see what I'm dealing with.

These blobs of cancer have all grown slightly since I started treatment with cediranib in November 2008. To my untrained eye, the view doesn't look that different from the last time I saw my scan in December of that year, which is fairly good as far as I'm concerned. Not as good as if they'd stabilized or shrunk, but better than many other possibilities.

Labels: cancer, chemotherapy, ctscan, geekery, photography, science, software, video

That makes two consecutive CT scans showing my tumours to be stable. This drug may keep me around for awhile yet.

But man, these side effects. Just got back to bed after another hour and a half in the bathroom. There's always a price to be paid to stay alive, I guess.

Labels: cancer, chemotherapy, ctscan

Sometimes, for a few days, it's easy to forget how sick I am. But I found out I have cancer two and a half years ago, and I've been under some sort of treatment—chemotherapy, radiation, surgery, or recovering from those things—the whole time. Tomorrow I'll hear the results of my latest CT scan, good or bad. That will help determine what comes next.

Last night I hardly slept. I was in the bathroom at least once an hour, sometimes several times, right through till 6:00 a.m., and luckily my wife Air was able to get up and make sure the kids got off to school, which is usually my job. Side effects of cediranib, my current medication, kept me up. They're hard to predict, so when I felt them coming on last night I had no idea whether they might clear out my intestines in an hour, or whether it would take all night. All night it was.

I will also note, without further comment, that the bag of popcorn I ate when I took the kids to the movies on Saturday was a very bad idea.

Now I'm awake, taking some Advil and hoping to recover enough to get out of the house sometime today. Before she went out to her appointments this morning, my wife put a second coat of varnish on our stairs. They look good, and there's a fan helping them to dry. We need milk and butter, the baby chickadees are growing in our birdhouse, I love my family. Life continues.

Labels: cancer, ctscan, family, pain, sleep

There are some pretty views from the Fairview neighbourhood of Vancouver, but it is now officially my least favourite part of the city. It's objectively far nicer than many other parts of this region, but that doesn't matter.

Part of my dislike comes from a job I had there back in the '90s. There was no backbreaking physical work or relentless tedium (I encountered those in earlier jobs, installing alarms and working night shift at a gas station, respectively), but it was still the worst position I've ever held, because the psychological environment of the place was positively poisonous. I would take the longest lunch hours I could, sometimes walking down to False Creek and sitting on a grassy knoll, just staring into the distance eating while trying to purge the stress from my system.

I quit after nine months, during which numerous coworkers had come and gone, some quitting after one day and others (including the person who hired me, who'd been with the company since it was founded) being summarily fired for often arbitrary reasons. I'm amazed I stayed so long.

But that's not the main reason. It's because Fairview is also home to the B.C. Cancer Agency, where I spend far too much time these days. Counterintuitively, the people there, from volunteers to doctors to nurses to technicians, are overwhelmingly wonderful, friendly, helpful, and understanding. The building is nicely decorated for a medical facility. It runs like clockwork—I've never had so many appointments with such complex interrelationships run so smoothly and on time, or been apologized to so profusely when things run late or get postponed.

And yet, it is the Cancer Agency, where I have gone for CT scans and radiation treatments and chemotherapy and emergency prescriptions of blood thinner injections. It's where my doctors told me that my cancer had spread to my lungs. True, Fairview is not where I spent the worst days of my life, late last July when I had lost 50 pounds, was hooked up to two IV poles in a ward at St. Paul's hospital, and could only lie in bed—not bathe, walk, eat, or even drink—for several days.

Yet somehow Vancouver's downtown West End, where those worst days did happen, still holds too many other happy memories, of fireworks and new love with my wife, and childhood walks in the park with my grandmother. Fairview is where I'm reminded, all the time, of how broken my body still is. Even driving through it on my way elsewhere, I feel queasy, my subconscious focusing on the nauseating chemical soup of chemo I get there every two weeks. Tomorrow is the next infusion.

Sorry, Fairview. I can't help it. You suck.

Labels: cancer, chemotherapy, ctscan, fatigue, linkbait, memories, radiation, surgery, vancouver

Of course I would prefer if the small metastatic tumours in my lungs were gone or shrinking significantly. But they are stable, so this is still an encouraging report from my oncologist today:

Looks great, the pulmonary embolus [blood clot in the lung] has resolved! The [cancerous] spots in the lung are the same size... all good, cheers!

"Looks great" and "all good" are nice words from a cancer doctor, and it's very pleasant to be rid of the blood clot.

Onward. Damn right.

Labels: cancer, chemotherapy, ctscan

I was supposed to have another CT scan today, but the scan machine was broken, and the technicians were on the phone with GE, who make it, to try to find a resolution. My scan will be rescheduled.

Now there's some tech support I wouldn't want to deal with.

More chemotherapy tomorrow. Only two more treatments after that. As far as I know for now, anyway.

Labels: cancer, chemotherapy, ctscan, hospital

Here's what I wrote, hurriedly, on Facebook and Twitter earlier today:

CT scan good: lung tumours either stable or "noticeably smaller." Alas, small blood clot in lungs, must take blood thinner needle daily now.

Let me explain that. This morning, I talked to a social worker in the patient counselling department at the B.C. Cancer Agency, as I do about once a month, just to get things off my chest. I was having a CT scan later in the day, which would be the first test in several months to see whether my current chemotherapy round is actually killing my cancer. I felt mixed about that, not knowing what path my life would take in the next few months, even more so as I prepared to give a speech at my friend Martin's memorial service on Sunday.

The scan itself was uneventful, and I didn't expect to hear any results until Tuesday, when I next see my oncologist Dr. Kennecke. So my wife and I drove back to Burnaby. The chemotherapy has started to thin my hair, which isn't falling out in clumps, but is shedding some in the shower, so I decided to get a short haircut again in case that gets any more pronounced. After that, my wife went to find some shoes and I had a snack at the food court.

While I sat at the table, my phone rang. I expected my wife, but it was Dr. Gill, another oncologist from the Cancer Agency.

"The CT scan found an incidental blood clot in your lung," she said.

Oh shit, I thought.

"Are you having any trouble breathing, or chest pain?"

I wasn't.

"That's good. We'd still like you to come back to the Agency this afternoon, so we can start you on some blood thinners. How soon can you be here?"

It was 3:45. I said around 4:30.

"I'll see you as soon as you arrive."

I called my wife. She freaked out a little. I called my dad, who was watching the kids. He sounded calm, but I knew he'd also be freaking out a little. Back into the car, through traffic, at the Cancer Agency by 4:30.

A nurse immediately took us aside. "Take this form up to the lab for some blood tests right now. You can also take this prescription to the pharmacy down the street and get it filled immediately. Then come back here to Station C and Dr. Gill will see you." In a flash we were back at the elevator, blinking and stunned, my wife to go the pharmacy and me for my blood tests. We were both back within 20 minutes, when Dr. Gill met us and explained what was going on.

Some of the chemotherapy agents I'm taking, particularly Avastin, can lead to bleeding and blood clotting. I've noticed that in places like my nose. Turns out it's happening in my right lung too.

So now we have a new drug in our cupboard, a series of syringes of anticoagulant (blood thinner), which I must inject subcutaneously, the same as I have done with insulin for the past 17 years. I'll do that once each day for the next six months or so. The drug will help prevent the clot I have from growing, and should help keep new ones from forming. I will also bleed and bruise more easily as a consequence.

The good news is that Dr. Gill also told us about the main result of the CT scan, which is that the metastatic tumours in my lungs have not grown. Indeed, some are stable, while others are "noticeably smaller." So the chemo is doing something, which is the whole damn point. While obscured by our alarm about the blood clot, that is the kind of news I've been waiting to get for a whole year.

The nurse who came to show me how to administer the blood thinner (it's so similar to insulin injections that I was very comfortable with the procedure right away) also listed off some of the possible side effects, but said, "These probably won't be a worry for you, because you're young and healthy."

I laughed. People like me with stage 4 metastatic colorectal cancer don't apply the word "healthy" to ourselves too often. But that was also good to hear.

Labels: cancer, chemotherapy, ctscan, hospital, therapy

I just had a CT scan at the Cancer Agency (I'm blogging this from one of their public computers).

My doctors will look at it to see how much my cancer has shrunk since we hit it with radiation and chemotherapy starting in April, and use the results to plan my surgery on July 26, as well as any followup chemo in the autumn. I'm supposed to get a copy of the data CD so I can look at the scan myself using some free software that can open DICOM files, but apparently that has to wait until my oncologist Dr. Kennecke looks at it next week.

That means I have to wait, which will be frustrating. So right now I'm going to the post office, and to buy some bagels.

Labels: cancer, chemotherapy, ctscan, geekery, radiation, surgery, vancouver