Journal: News & Comment

Avast! (Or Avastin!) A toast to bevacizumab!

Back when I was first diagnosed with cancer, I bought a small bottle of good scotch whisky. It took a few weeks to go through, by which time we'd figured out that things were worse than they first appeared. This week I bought some more, and a small bit of it (a dram, I guess) is my regular evening treat these days:

Cheers. Later on I might even get some better stuff, though the Glenlivet is rather guid, regardless.

Incidentally, Genentech, the company that makes Avastin—the trade name for bevacizumab, which is the anti-cancer drug treatment currently coursing through my system—is #3 on the Wired 40 list this year. The blurb mentions Avastin by name, actually. So I now interact daily with all of the top three companies in the list.

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Google Earth lets you spy closer on Vancouver

Via Beyond Robson, we find out that Google Earth now has high-resolution imagery of downtown Vancouver. Those detailed photos haven't yet made it over to Google Maps, it seems.

Go download Google Earth regardless—it's still a great way to find out about swimming pools you never knew existed.

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Daffodils and IVs

The logo of the Canadian Cancer Society is a daffodil, so it's no surprise to see daffodils growing in big bunches outside the B.C. Cancer Agency building, where I went today for my first dose of bevacizumab. Like the insulin I take for my diabetes, bevacizumab is genetically engineered, but instead of being a hormone it is an artificial antibody that interferes with the growth of new blood vessels feeding my rectal tumour.

The treatment was unspectacular. After walking around nervously in the spring sunshine for the better part of an hour, I entered the building and took the elevator to the sixth floor, checking in slightly early for my 2:45 p.m. appointment. Blood pressure taken, I sat in a chair while Leeanne the nurse inserted an intravenous needle in the back of my left hand and set up the pump for the drug to go into my bloodstream.

Then I sat for an hour and a half while the bevacizumab dripped slowly through the pump and into my arm. I listened to my iPod, chatted with Leeanne and a couple of other patients who came in after me, and then said hi to my wife when she came down to meet me. By 4:30 it was all done and she drove me home.

I'm tired now, but feel no other effects, and may not. Meanwhile, my CT scan last Friday showed that my cancer has grown since January, so that it is now pushing against one of my ureters, although I feel nothing from that. There is also a bit of concern that there may (or may not) be something in my lung. Shit.

But this drug and the others I'll start taking on April 12 should hammer any and all of those rather well. The radiation will do more against my rectal tumour. Then comes the surgery. Whack whack whack. So far so good.

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Top 10 worst inventions

"Have you ever heard a car alarm sounding and thought, 'Wow! Someone is trying to steal that car!'?"

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This is awesome. I think.

CBC Radio is adding a bunch of new podcasts next week. That's great—except now I'll have even more podcasts in my backlog.

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Last day before chemo

The doctors and nurses tell me I'm rather unlikely to lose my hair, and the real stuff (with radiation and full-on chemo drugs) doesn't start for a couple of weeks, but for posterity, here's what I look like 56 days into my cancer treatment, and one day before I start chemotherapy:

Several people have told me that, if I do lose my hair, it might come back different. KA (who ought to know) says Terry Fox's hair wasn't curly before chemo, and David at Navarik says a relative of his had grey hair beforehand, and black hair after.

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Thanks to the late Stephen Jay Gould

Here's a helpful old post of mine about cancer, which I just stumbled across. It links to a great article about statistics, which I'd forgotten about. I knew I had this blog for a reason.

My cancer is nothing as drastic as Stephen Jay Gould's was at age 40, but last Friday's CT scan shows that it has grown since January. As cancer does. Good thing we're going to start hitting at it this week.

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Busy days

Today I got another look at my cancer. That's because, after some blood tests, a urine test, an electrocardiogram, and a talk with Barb the radiotherapy nurse, I walked two blocks over from the Cancer Agency to Vancouver General Hospital to see Dr. Tai, who used a flexible sigmoidoscope to take eight (!) small biopsy samples from the body of my tumour, as I watched on the video screen.

It doesn't look like much—a slightly puffier chunk of my intestinal wall, with some blood on it. The exam wasn't comfortable, but the sigmoidoscope is actually less obnoxious than some of the other exams I've had, and I couldn't feel the biopsy pinches at all, which is a relief.

Dr. Tai will compare those to biopsies she will take of tissue removed during my surgery in three months or so, to see if all the bevacizumab, oxaliplatin, 5-FU, and radiation have an effect on the cancer at the cellular level in the interim.

I sure hope they do. And I told Dr. Tai that I didn't mind all the samples she took. The more of that tissue that gets out of my body, the better, as far as I'm concerned. I see Dr. Kennecke the chemotherapy specialist again tomorrow, then talk to the nutritionist and presumably get my schedule for starting the bevacizumab on Thursday.

Maybe I'll get a break Wednesday. Maybe!

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Canada's government may not care about network discrimination

Okay, Will, I hear you. Michael Geist has a good analysis of the Canadian government's current thinking (as elucidated in recent reports) about net neutrality—or, more accurately, data discrimination.

In Geist's words, the Canadian government seems to say that "we [the government] think blocking or prioritizing content may be acceptable, we recognize it is inconsistent with the recommendations of the Telecommunications Policy Review Panel, and we don't care because we plan to the leave the issue to the dominant telecommunications providers."

Those telecom providers have already shown that, given the chance, they won't play nice in maintaining the interoperability of the Internet that has made it a worldwide, massive success over the past decade and a half. One role of government in a free society is to protect its citizens, not just from physical threats, but also from those who might encroach on our freedom, physical or intellectual. And that's what we're talking about here.

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Accelerated treatment is a good thing

Remember two days ago when I said that if I were accepted into the clinical trial for enhanced drug therapy plus radiation that it would delay things by a couple of weeks? Nope.

I will be in the clinical trial (the study is known by the acronym "A-CORRECT"), but by some magic the trial nurse managed to slot me in to get started this upcoming Thursday, March 29, rather than a week or two later as we expected. So tomorrow, Monday, I'll have some blood tests, an ECG, and a simple flex-sig biopsy, just like the one that initially detected this whole mess back in December.

Three days later I will start intravenous treatments of the nearly unpronounceable bevacizumab (a.k.a. Avastin™ from our pals at Genentech). Around the middle of the month I will begin radiation treatment, along with the additional chemotherapy drugs oxaliplatin and oral 5-FU.

That should finish up in mid-May, meaning my surgery should happen in late June, in time for my birthday, and followup chemotherapy will then begin in late July. Because of the accelerated schedule, there probably won't be time for me to get the PET/CT scans, but that's okay by me.

Off we go!

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Feeding the addiction

Okay, okay. It makes no sense from any logical perspective, it cost too much money, and there is no rational reason for me to have bought yet another electric guitar. But it is beautiful and I love it:

Now I declare for my own future reference and benefit (and I can detect my wife raising an eyebrow already) that I will not be buying guitars once a year anymore—I'll find some other outlet for my lust for musical gear. I'm running out of room for these things.

Better than an impulsive buy of a new convertible as a midlife/cancer treatment crisis thing though, right?

Right?

Anybody?

I'm going to go play some guitar now.

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New Flickr content filtering is cool

I like the new content filtering features at the Flickr photo sharing site. They seem to be a well thought out response to the "NIPSA" controversy that flared up last year, and led to the popularily of Snapzilla for users of Second Life.

You can both specify what types and how "safe" your uploads are, and what kinds of things you want to search for by default. A good balance between choice and ease, I think.

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All guns blazing

After meeting with the radiation technicians and my medical oncologist today, here is our basic approach to my cancer treatment over the next number of months:

I was a little optimistic in thinking I would get started with radiation next week, because today and tomorrow are the last sets of diagnostic and planning tests, and the team (which grows all the time) needs a couple of weeks to plan it all out. But we will be even more aggressive than I expected, which is good. Let's go over the essentials.

Perhaps as early as tomorrow, Dr. Kennecke, my chemo guy, will determine whether I'm eligible for not one, not two, but three separate clinical trials that may enhance the drug treatments I'll get. If that happens (which is a pretty good chance), in a couple of weeks I will begin IV treatments of a genetically engineered antibody designed to help prevent cancer cells from building new capillaries to feed themselves.

Then, two weeks after that, we begin the "normal" treatment. I will start radiation every weekday for five weeks—I already have two tiny tattoo dots on my hips and one in the small of my back, drawn on today, so that I am accurately lined up for that. Each day, a couple of hours before my radiation treatment, I will take a chemotherapy pill.

In conjunction with that stuff, I will take more of the antibody as well as another chemotherapy treatment. As part of one of the research projects, I may also receive two PET/CT scans and give a couple of extra biopsies. And that's all before surgery. As my wife said, "You always wanted to donate your body to science, now you can do it while you're still alive."

So, summary: antibody for a couple of weeks; chemo and radiation for five weeks, with additional chemo, PET/CT scans, and biopsies; a waiting period for five to seven weeks; surgery to remove most of my rectum; a month of recovery; and then four months more chemo. Whether I'm on the research trials or not, it'll be the end of the year before I'm all done.

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On the conveyor

I have to hand it to the fine folks at the B.C. Cancer Agency—now that I'm set up for treatment of my cancer there, they don't mess around with delays.

My wife and I agree that is both reassuring, because things are getting done, and scary, because it is so different from typical health treatments. Which means it's damn serious.

Some highlights for the next few days:

1. First thing tomorrow at 10:00 I have the "simulation" portion of my preparation for radiation therapy. That means I'll have marker tattoo dots placed on my body for precise positioning and have a few scans and tests done to figure out how my treatment will proceed, probably starting next week. I have to drink 750 mL of water half an hour beforehand.
2. I've learned a few interesting things about radiotherapy from the BCCA website, such as: "Some people do not have any side effects [or they] may not show up until after two weeks into treatment and can last two to four weeks after treatment" and "Your chances of sunburn on the area treated will be greater from now on" (I will likely have some irritated skin where the X-rays are passed through into where the tumours are internally) and "Most [radiation treatment] rooms are also equipped with music. Feel free to request your favourite type of music."
3. The machine I'll be under every weekday for the next month and half is actually an X-ray linear accelerator, like those groovy science experiments at Stanford and elsewhere, except a tad smaller.
4. At 2:30 in the afternoon I meet with Dr. Kennecke about my chemotherapy, which will be simultaneous with my radiation treatment. I should find out then what combination of intravenous (drip or push) and oral medications I will receive.
5. Other things I've learned about chemotherapy: "IV chemotherapy can take from 15 minutes to 12 hours or longer" and there are also pills, capsules, or liquid oral treatments, as well as topical creams.
6. On Friday, I have to drink another bunch of liquid in prep for another CT scan.

On the weekend, right after my CT scan is over, my wife and I will go to Victoria for a last pre-treatment getaway before everything gets started. The room has a jacuzzi soaker tub and a fireplace. Plus free Wi-Fi.

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How to unblock a Stratocaster tremolo

Back in 1990, I spent a couple of hundred bucks (quite a bit for me at the time) on a used Squier Stratocaster electric guitar, made in Korea. It's seen a lot of use in the intervening years, acting as the main guitar for both Sebastien and Alistair in our bands until they each got their own better instruments, and providing most of the guitar sounds on all the podsafe tunes I've recorded and released. (It's on my album cover too.)

While Alistair was using it, he had the vibrato mechanism (more commonly known, incorrectly in theory, as the tremolo system or whammy bar) blocked so that it acted like a guitar without one. He later did the same to the guitar that he bought to replace it—also a black Stratocaster, but a higher-end one. Blocked or "hard tail" guitars generally stay in tune better than those with tremolo arms, so I liked that blocked mechanism too, and I kept it that way over the past 15 years.

But over the past while I've bought two other guitars, both either "hard tail" or blocked too, and I've more recently been irrationally lusting after an expensive Strat with a working trem arm. So instead of spending money there, I thought I'd just bring my Strat's tremolo back into working shape.

The mechanism itself is cleverly simple, with springs on the underside of the instrument that pull the bridge of the guitar back into position after you pivot it on its bridge screws using a lever on the top side.

Normally, when a guitar technician blocks a tremolo, he or she will slide a piece of wood in that prevents the bridge block from moving, as well as tightening up the spring mechanism with extra springs. The guy who did it for Alistair tightened the springs, but instead of using a wood block, put two wood screws in instead. They worked fine, but to remove them I had to disassemble the whole bridge mechanism and pull it right out of the guitar. So I did:

Miraculously, once I reassembled everything, it worked great. That's less a testament to my guitar repair skills than to the always-brilliant simplicity of Leo Fender's guitar design, which was made to be easy to fix, as well as nice to play and look at.

Mine sure needs new frets, though.

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A piece of advice

Yesterday we made some "Sumptuous Split Pea Chowder," with a certified organic mix, plus shallots and garlic and carrots and herbs, which was extremely tasty. Very good. Yummy. So good I had three bowls.

My wife warned me that all that fibre could be problematic. But I've always had a cast-iron stomach, so I thought, "Nah, it's just too good. Three bowls. Yum."

Cast-iron stomach? Yup.

Post-surgical, colon cancerous, pre-radiotherapy and chemotherapy bowels? Not so much.

So, a piece of advice. If you're having intestinal issues and your spouse says, "take it easy with that" about some food, then pay attention, mmmkay?

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Our houseguest

I've never owned a dog. My roommates and I had a cat, Guildenstern, who died back in the early '90s. And I was a member of the Aquarium Club back in grade 8. So our houseguest Dizzy (a.k.a. Podcast Puppy) is something new for me.

He's adorable, even though he does poop and barf on the floor, or roust us out of bed for some outside time first thing in the morning. He sleeps at my wife's feet on our bed—she's clearly the Alpha in this household, and while she's allergic to most furry things, Dizzy is not among them (thankfully, neither am I). Dizzy is friendly with the kids, who think he's wonderful. And he is.

Still, while it's fun to dogsit for a few days, and I like Dizzmo a lot, I don't really want to own a dog, or a cat, or even a fish. I'll take my pets in small, returnable doses for now.

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Bring it the hell on

You're looking at a photo of a waveguide from a radiation therapy machine, like the one that will be aimed at me rather frequently in the next few weeks.

My wife and I visited the B.C. Cancer Agency in Vancouver today to talk to the radiation oncologists about the treatment they'll be giving me for my colorectal cancer, and for me to get a chest X-ray. The upcoming treatment will be delightfully aggressive. It will start soon. It will suck, and I will suffer. And through this spring and summer, we're going to kick that fucking cancer out of my fucking body.

Here's the plan right now:

1. Dr. Usmani, the radiation oncology fellow who saw me today along with Barry the third-year medical student, thinks that my cancer started in my sigmoid colon, and moved through my lymph system down (which is the opposite of the usual direction) into my rectum. So far there are no signs upward towards my liver or elsewhere in my digestive system, which is good.
2. Next Tuesday, March 20, a team of cancer specialists will discuss my case and confirm the planned course of treatment. On March 22, I'll see Dr. Kenneke, who will talk to me about chemotherapy. I'll have another CT scan the day after that.
3. The last week of March, or at the latest the following week, I will begin a course of five weeks of radiation therapy with Dr. Ma, five days a week, where I will lie face down on a table and get those waveguides aimed at me, firing ionizing high-frequency electromagnetic waves at my cancer for two minutes, paralyzing and shrinking it in preparation for later surgery.
4. In order to set up for the radiotherapy, I will have dot-like marker tattoos placed on my skin so that I can be exactly positioned using lasers before each treatment. (They will be permanent: my dad still has his, from when he had radiation treatment 35 years ago.)
5. At the same time I will also begin a course of chemotherapy which will treat my body systemically and further kick the shit out of any cancer cells hanging around.
6. I'll have side effects from both treatments, which will get progressively worse until a couple of weeks after the treatment stops in early May.
7. I'll then wait a few weeks to recover, go to the see The Police play in Vancouver, and prep for surgery.
8. In late June, Dr. Brown and other surgeons will remove part of my sigmoid colon and most of my rectum, and do their best to reconstruct things down there to try to avoid my having a permanent colostomy bag.
9. I'll have more chemotherapy post-surgery, to kill any straggling cancer cells and get rid of it once and for all, with any luck.
10. I'll spend a couple of months recovering, by which time it will be autumn.

There you have it. I don't think I missed anything, and I'm still letting the plans soak in. They're good ones. Bring it the hell on.

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The return of Planet TV

Yay! Lucian's "Planet TV Show" is back! It's been months and months and months. Other than his paternity leave and revamping his studio, Lucian's reasons for being away are rather mysterious, but whatever. I missed the show.

Never mind that I wrote the theme music. It's a great video podcast.

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Beaten to death with croutons

Yay! I have my MacBook back! And all the problems (fan grinding, DVDs not writing, sudden battery death) seem, at this point and at last, to be resolved. Thanks to my wife for tolerating my regular use of her iBook in the interim.

And with that, I'll follow up yesterday's post with a nice quote about Twitter from technology curmudgeon Bruce Sterling: "It's like watching you get beaten to death with croutons." I don't quite understand that, but it made me laugh.

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Small joys

I've never been to the SXSW conference in Austin, though it's been on my "get there eventually" list since the early 1990s. There's a bit of glee, then, in reading Todd Levin's snarkolicious takedown of the whole event (via Kottke).

My favourite bit is this dissection of Twitter:

Twitter is a very simple concept to explain. Imagine there is a tiny invisible girlfriend sitting on your shoulder, constantly whispering in your ear, demanding to know what you're thinking at that precise moment. Now, imagine you decide to answer every instance of her question by sending a text message to her, and all of your friends. That's kind of what Twitter is like, and we're positive it's here to stay!

It's not only snarkolicious, it's accurate. I'm not sure whether Twitter is here to stay, but it's one of those online phenomena (like MySpace, Digg, Facebook, Second Life, Friendster, podcasting, Flickr, del.icio.us, Skype, and even blog comments and tags) that I've held back on to see if it was actually going anywhere. (After giving them a chance to prove their usefulness, I eventually joined the Digg, podcasting, Flickr, Skype, and comments bandwagons, and still avoid the rest.)

My wife tried and loved Twitter, and then burned out on it and has purged it from her online life. She may be a harbinger of what others will do, I don't know. I do know that I'm definitely on the rrroll up the rim to win bandwagon:

I also framed that lovely gift poster from the Northern Voice folks.

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Time to redesign

This website has accumulated a lot of cruft since 1997, when I first launched it. And I've made some code improvements and colour changes, but the basis of this site design is also still the same as it was almost seven years ago, when I last reworked it in any serious, non-incremental way. Looking back, the more minimalist versions of what I have here are better than now.

It's time for a ground-up rethink of this site's design. I don't intend to delete anything—I hate linkrot, so I just want a visual and usability redesign, while maintaining whatever makes this site, er, penmachiney. I'll start thinking about what to do. Suggestions (or full-on mockups) are welcome!

P.S. Like many, I admire John Gruber's approach, at least as a starting point.

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Walk evidence

Friday was the first day my daughters walked to school by themselves. Today, at their insistence, I brought out the camera and big zoom lens to document the walk:

You can see that I can watch them (and they me) almost the whole way—their school is just behind the blue house at the top of the hill, before the trees in behind that. They ask me to wear my bright orange Gore-Tex jacket so they can look back and see me easily. There's a crossing guard at the major street just before I lose sight of them. So they like it, and I like it. Big steps.

Those two have some pretty funky fashion looks going too. That's their mom's influence.

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Bleah

Okay, I know I live in Vancouver, and the stereotype is that it rains here all the time. But it doesn't—except this week. It has been raining and raining and raining and raining:

Yes, it's beautiful in a temperate rainforest sense, but in my current state, I'd like to be able to go out for a walk from time to time, and it's just too unpleasant. While I have my Vancouver rain suit, it's too much hassle to heap it all on as well. Bleah.

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Three things

You know, I said this wouldn't turn into an all-cancer, all-the-time blog, but you will have to put up with mostly-cancer, most-of-the-time, especially since back when I wrote that, I didn't think it was nearly as serious as it is. Here are three things that I didn't know before this weekend:

1. When I say my ass still hurts almost three weeks after my endoscopic rectal surgery, you might think, well, duh!, but healing from surgery takes longer than I expected. I was finding it distinctly uncomfortable. Rising from bed at least three times a night to refresh the hot pack, use the bathroom, and maybe take some more painkillers was getting old, and seemed perhaps to be getting worse. There was no fever or other signs of infection, but I was also turning into a grump around my family.
2. Sleepiness also lasts a long time, whether from my surgery, the cancer, the painkillers, or whatever. Sometimes, when I'm feeling good, I can take on something like a full day's activities. Get the kids to school, go downtown, eat out, that sort of thing. But no matter whether I go out or stay at home, at some point in the mid-afternoon I tend to crash, hard, and nap for as long as two hours. I'm learning to avoid feeling guilty about it.
3. While they often equivocate, doctors do know what they're talking about a lot of the time. I went to see my GP, Dr. Hassam, today (he was the first one to tell me about the cancer), told him my woes, and he prescribed a non-steroidal anti-inflammatory suppository—often used to treat rhumatoid arthritis—three times a day. Less than an hour after the first dose, I was already feeling better. I didn't even need that nap, though I was pretty sleepy in the bathtub before dinner.

My first appointment at the Cancer Agency is with Dr. Mah next Friday, March 16. It's supposed to last three hours, and may include another CT scan. One of my friends even told me where I might find free Wi-Fi there.

Oh, and don't forget to move your clocks ahead. Tomorrow morning it will be an hour later than you expect.

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The walk

Three and a half years ago I walked my older daughter to kindergarten for the first time in the warm September sun—that's the photo. This morning, for the first time, I stood on the sidewalk in front of our house while she and her younger sister walked the whole way to school by themselves in the drizzle of March.

The older one is in grade three, her sister in grade one. We've been working up to the trip all week, during which I walked them part way, then turned around and went home while they finished the remaining blocks. In these more paranoid times, that's a bigger step than it used to be (at their age, I think I'd been walking to the same school by myself for a couple of years).

The other advantage of having them walk themselves is that it rids us of the temptation to drive them there, which in our hurly-burly lives is far too easy to fall into.

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Dentist! Jugga jigga wugga!

Today I saw a new dentist, near my house, for the first time in over 25 years. My wife made the appointment, after waiting (and waiting and waiting) for me to set one up for more than a year. Recent distractions didn't make it more likely, so I'm glad she organized it. Good news all around. My teeth and gums are all fine, and I have still so far avoided a single cavity in my life.

My youngest daughter was remarkably patient, waiting by the chair for the entire hour. (The overhead TV, with headphones and remote control, sure helped.) The dentist told me that if my gums hurt a bit after the cleaning, I could take some Advil. I told her there was no need—I'm on something much stronger at the moment after my recent surgery, and in comparison to that, dental cleaning is like a walk in the park anyway.

Jugga jigga wugga!

UPDATE: Let's be clear. This is the first time I've changed dentists in over 25 years. The last time I went to the dentist was the fall of 2005, not so long ago. Sorry for the poor phrasing on my part, and to Tod and others in the comments for correcting me.

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Tidbits from a sick day

Some tidbits from the past few weeks:

• My mom couldn't believe it when I started getting grey hairs several years ago, but it's undeniable now, and I'm pretty sure they've been going grey more quickly since the cancer diagnosis in January. I guess I'm really a grownup now.
• Now that I'm at the tail end of the recovery from my first surgery back on February 20, the best painkillers aren't the Tramadol pills I've been swallowing, but the hot baths I've been taking. I had two yesterday. I make them about as hot as I can stand, and as soon as I dip in, any pain (really, by this point I'd describe it more as annoying discomfort) in my butt becomes unnoticeable. I've almost fallen asleep in the tub a couple of times.
• The Magic Bag does a pretty good job too, and has been getting more work than anytime since my wife's pregnancies years ago.
• Every person in the medical system I've dealt with so far has been remarkably friendly, forthright, helpful, and sympathetic. No one has tried to couch things in oversimplified language, no one has treated me condescendingly, and everyone has apologized when there have been delays. Next Friday (March 16) I have my first appointment at the B.C. Cancer Agency, where I expect the trend to continue.
• While all this has been going on, my wife and her "wingwoman" (as Maryam Scoble put it) KA just celebrated the first anniversary of their Lip Gloss and Laptops podcast. They've put out 51 episodes since the beginning of March 2006, with only a couple of breaks. Wow!
• My podcast co-host Paul is now crisscrossing the U.S.A. leading a series of podcasting seminars for Apple. His first stop: chilly Minneapolis (although it's only –3°C there today).
• My MacBook is still in the shop.

Today I'm home with my youngest daughter, who has a cold. We're hanging out in the big bed watching TV as I type this.

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Yay! Some good news!

It's not my good news, but Robert and Maryam Scoble are having a baby, so Robert's son will have a half-sibling later this year.

They weren't ready to announce anything when I saw them here in Vancouver last week, so I'm sorry that I can't say felicitations to them in person. Great news!

It's been a real baby boom among people I know this year, with several pregnancies at work as well. For some people 2007 will be a good year!

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Let's reset that timeline again

I'm not sure I'm quite used to having the scenario change almost every time I see a doctor, but I'm beginning to understand what Mike Myers said in an interview: "You can't plan anything."

It turns out the nodule in my rectum that surgeons removed a couple of weeks ago was cancerous after all, as was at least one lymph node they removed with it. Dr. Brown, my main surgeon, said he found that "shocking," which is not something you hear a doctor say too often. So now I have two definitive centres of cancer in my rectum, one at the top, one at the bottom, and the lymph node means that my cancer is at Stage Three, not Stage Zero, One, or Two as I would prefer. (But at least, as far as I know, I'm not at Stage Four.)

Here's what that means. I won't be having surgery right away as anticipated to remove the cancer higher up. Instead, in the next week or two I will visit the B.C. Cancer Agency, where I will begin a course of radiation therapy (and perhaps chemotherapy too) to zap the cancer into submission. That will last something like five weeks. After that I will wait up to eight weeks while the radiation takes effect, then have the surgery, which will remove most of my rectum, and (hopefully) all the cancer with it.

They hope to be able to reconstruct my intestinal system afterwards so that things will function normally down there eventually. Right now I'm not too focused on that, though.

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One more day

Tomorrow afternoon I'll find out the biopsy results from my last surgery, and I should also determine with my surgeon what the plan is for the next one, as well as roughly when that will happen in the next week or two.

It's been almost two weeks since the previous procedure, and I'm still on the painkillers. That didn't involve an external incision. I'm starting to get permanent squint lines in my forehead from scrunching up my face, and I think the grey hairs are coming in much thicker now.

So who knows what it will be like once they take out a chunk of my intestine? Apparently during my week in the hospital I'll get a button that can dispense pain relief as often as every six minutes. I'm sure part of my gut pain right now is nervousness about that.

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Guitar addiction

Yesterday I felt great, so I took myself out of the house and hopped the SkyTrain downtown. My mission was to find some additional Wii Remote controllers (no luck), but I also ate a wonderful crêpe for lunch and—of course—visited some music stores.

I've made money as a drummer for 18 years now, so I've been considering finally buying a set of electronic drums, so I can play and record my own drumming, instead of using loops and samples all the time in my podcast tunes, while also avoiding the tremendous racket my acoustic drums produce. (Right now it would be hard to record a drum track while everyone else is asleep, for instance, so I've never done it.)

Electronic drums have improved tremendously in the past few years; still, even virtual kits that cost $1000 or $1500 or $2000 aren't tremendously inspiring. They work, though the sounds are nothing to write home about, and would probably require some twiddling and some better sample sounds on a host computer (running something like the BFD plugin) to be truly effective.

And then I found myself drifting into the guitar department again. I'm not an especially skilled guitarist, but it was my first instrument back in 1978 (holy cow!). We already have five guitars in the house: my old classical, my daughter's mini-steel string acoustic, and the three electrics I've accumulated over the past few years. Yet different ones always appeal to me, and yesterday it was the Fender American Deluxe Stratocaster, with a maple neck and in one of two sunburst finishes, that did it most clearly.

As I've already written on several occasions, the Strat is the most versatile of guitars, but lusting after one seems silly for me. After all, I've owned and played a more proletarian Stratocaster made by Fender's low-cost Squier division for 17 years, and there's nothing wrong with it. Still, there in my hands, played through a Vox AC30 or Fender Twin or Dr. Z amplifier, that American Deluxe sounded and felt fantastic.

So does that cheapie Squier at home, run through my old Fender Princeton amp, by the way. It feels and sounds different, but it's also fantastic in its own way, and a much better bang for the buck. I bought the Squier Strat used in 1990 for about $225; the American Deluxe is close to $1500. And other than the colour, I doubt anyone who isn't a guitar geek could tell them apart.

Guitars can be an addiction, I think. A mild one, and like caffeine not necessarily harmful. But there's no reason any rational player would need more than a few to get any sound he or she needs. No one needs to be Nigel Tufnel of Spinal Tap, with a room full of guitars.

But needs have very little to do with it in the end, do they? I'm not one who checks out fancy cars, or drives around looking at expensive houses, or who wants a boat or a plane or a high-end mountain bike or pair of skis. Let me loose in a guitar department, however, and I could hang out all day. My name is Derek, and I'm a guitar addict.

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Pain management

I learned a good lesson in pain management yesterday, courtesy of my wife, which will be useful when I have my bigger surgery in a week or two to remove the cancerous tumour from my intesine. On Tuesday I felt pretty good, so when I ran out of the Tramadol painkillers my surgeon had prescribed for me, I figured I would simply switch to something non-prescription like Tylenol or Motrin. After all, it had been more than a week, and I had only needed a couple of pills over the whole day.

Wrong. The nurses at St. Paul's hospital had told me that the best way to heal was to reduce any pain as early as possible, because pain runs in a feedback cycle, and eventually your muscles tense up and your body releases stress hormones that can slow down the healing process. It makes sense, and that sure seems like what happened yesterday. I walked the kids to school, with an awkward, uncomfortable gait, and then slept most of the rest of the day away.

Each time I woke up, I had to heat up the Magic Bag. I contorted myself into all sorts of strange positions to try to be comfortable, and it didn't work. I was in the bathroom all the time, because while things seem to be healing well in my rectum, it was also a bit like the intersection of 12th Avenue and Cambie Streets in Vancouver right now: things were moving, but considerably slower and more painfully than normal because of all the construction. I didn't even want to play Wii Tennis, which is saying something.

In the evening, my wife returned from dropping off our oldest daughter at Brownies, saw me on my elbows and knees on our bed with a hot pack on my back, and said she thought we should visit the local medical clinic and get me more proper painkillers. I didn't argue.

An hour later I had taken a dose, and not too long after that I was sleeping again, much more comfortably. I took another about 3 a.m., and again when I woke. This morning I feel more like a normal human being, and will be walking the kids to school with a much better approximation of my regular step. Plus traffic is moving more smoothly again, if you know what I mean. So managing pain does help other things work better too.

Yay painkillers. Yay my wife. The only downside is that it will be even longer before I should drive a car again, but that's okay by me.

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