Varia

A little note to let you know that things are going well.
The trip preparations are going well. MJ is taking care of everything.

The Pet scan is done and the other scan as well. I also received a letter telling me that Dr Y as ask to put me on the surgery waiting list. This does not confirm that he will operate but it gives me real hope that he will. Why would he go through the trouble if he did think lean towards a yes. If he really did not want to do it he would not bother filling out the paperwork. I stay grounded though, he can always say no but the script I have in mind is more on the positive side.

Wednesday I had my bottle unplugged and at the same time they took out the Piccline. I was told to keep the bandage for 2 days but I kept it for 3. I was a bit scared to see the hole not completely healed. By the way, the tube they took out was 45 cm long (about 14 inches).

I will post some pictures from Dubai as soon as I can.

PET scan

Positron Emission Tomography – Computed Tomography (PET/CT)

What is Positron Emission Tomography – Computed Tomography (PET/CT) Scanning?

Sample image obtained using a combination of PET and CT imaging technology.
Positron emission tomography, also called PET imaging or a PET scan, is a type of nuclear medicine imaging.
Nuclear medicine is a branch of medical imaging that uses small amounts of radioactive material to diagnose or treat a variety of diseases, including many types of cancers, heart disease and certain other abnormalities within the body.
Nuclear medicine or radionuclide imaging procedures are noninvasive and usually painless medical tests that help physicians diagnose medical conditions. These imaging scans use radioactive materials called radiopharmaceuticals or radiotracers.
Depending on the type of nuclear medicine exam you are undergoing, the radiotracer is either injected into a vein, swallowed or inhaled as a gas and eventually accumulates in the organ or area of your body being examined, where it gives off energy in the form of gamma rays. This energy is detected by a device called a gamma camera, a (positron emission tomography) PET scanner and/or probe. These devices work together with a computer to measure the amount of radiotracer absorbed by your body and to produce special pictures offering details on both the structure and function of organs and tissues.
A PET scan measures important body functions, such as blood flow, oxygen use, and sugar (glucose) metabolism, to help doctors evaluate how well organs and tissues are functioning.

What are some common uses of the procedure?
PET and PET/CT scans are performed to:

• detect cancer
  
• determine whether a cancer has spread in the body
  
• assess the effectiveness of a treatment plan, such as cancer therapy
  
• determine if a cancer has returned after treatment
  
• determine blood flow to the heart muscle
  
• determine the effects of a heart attack, or myocardial infarction, on areas of the heart
  
• identify areas of the heart muscle that would benefit from a procedure such as angioplasty or coronary artery bypass surgery (in combination with a myocardial perfusion scan).
  
• evaluate brain abnormalities, such as tumors, memory disorders and seizures and other central nervous system disorders
  
• to map normal human brain and heart function

How should I prepare for a PET and PET/CT scan?
You may be asked to wear a gown during the exam or you may be allowed to wear your own clothing.
You should inform your physician and the technologist performing your exam of any medications you are taking, including vitamins and herbal supplements. You should also inform them if you have any allergies and about recent illnesses or other medical conditions.
You will receive specific instructions based on the type of PET scan you are undergoing. Diabetic patients will receive special instructions to prepare for this exam.

Metal objects including jewelry, eyeglasses, dentures and hairpins may affect the CT images and should be left at home or removed prior to your exam. You may also be asked to remove hearing aids and removable dental work.
Generally, you will be asked not to eat or drink anything for several hours before a whole body PET/CT scan since eating may alter the distribution of the PET tracer in your body and can lead to a suboptimal scan. This could require the scan to be repeated on another day, so following instructions regarding eating are very important. You should inform your physician of any medications you are taking and if you have any allergies, especially to contrast materials, iodine, or seafood.
You will be asked and checked for any conditions that you may have that may increase the risk of using intravenous contrast material.

How is the procedure performed?
Nuclear medicine imaging is usually performed on an outpatient basis, but is often performed on hospitalized patients as well.
You will be positioned on an examination table. If necessary, a nurse or technologist will insert an intravenous (IV) line into a vein in your hand or arm.
Depending on the type of nuclear medicine exam you are undergoing, the dose of radiotracer is then injected intravenously, swallowed or inhaled as a gas.
It will take approximately 90 minutes for the radiotracer to travel through your body and to be absorbed by the organ or tissue being studied. You will be asked to rest quietly, avoiding movement and talking.
You may be asked to drink some contrast material that will localize in the intestines and help the radiologist interpreting the study.
You will then be moved into the PET scanner and the imaging will begin. You will need to remain still during imaging. The PET scan takes 45 minutes.

What will I experience during and after the procedure?
Most nuclear medicine procedures are painless and are rarely associated with significant discomfort or side effects.
If the radiotracer is given intravenously, you will feel a slight pin prick when the needle is inserted into your vein for the intravenous line. When the radioactive material is injected into your arm, you may feel a cold sensation moving up your arm, but there are generally no other side effects.
It is important that you remain still while the images are being recorded. Though nuclear imaging itself causes no pain, there may be some discomfort from having to remain still or to stay in one particular position during imaging.

Upcoming schedule

This message is just to keep you informed of my schedule in the days to come.

March 18 (tomorrow): I will spend the morning at the Notre-Dame Hospital for pre-op tests: blood work, ECG, urine analysis.
here will be a scan of the thorax and abdomen but perhaps not tomorrow.
Dr Y, the surgeon, wanted to have these scans done by his hospital on top of those done at Sacred Coeur.

March 22 (Sunday) is the day of my PET scan (nuclear medecine imaging). This review is essential for my surgeon's decision-making: to operate or not.

March 23: Chimio # 15, the doses of all agents were reduced. It has been 5 weeks that I did not have chemo.

March 25: I get my bottle of chemotherapy unplugged and also my Piccline. This will allow me to swim whule in Dubai. Upon my return, according to the planning of the operation, I will have a port-o-cath installed, it's another distribution system for chemo that sits under the skin in the pectoral region, a bit like a peacemaker.

early April: departure for Dubai.

23 April: meeting with Dr. Y. Decision on the operation.

Medical appointment update

Well! We had a big day for appointments and information. I will summarize it.

Dr C. prescribed chemotherapy next week. It will be Wednesday. The doses of each chemotherapy agent have been reduced. For the PET scan that we wanted to have Monday, it's pretty hard. If the trend continues I will go in the private sector even if it costs an arm and a leg.

Dr. Y told us his vision. It seems that I have 2 strikes against me even before you begin: metastasis to the liver, the extent of the disease (he explained that even if we do not see cancer anymore several areas were still affected). He told me about the statistics and as you know they do not interest me. He had to do it because if he accepts to operate it is a very difficult procedure. My stay at the hospital will be about a month (including a week in intensive care) and recovery should be about three months. So he wanted me to take an informed decision. I also believe that he tested my determination.

He now has to talk to a colleague before making his final decision (operate or not). In the meantime he will have me go through the pre-op testing. A series of tests before the end of March for a possible late April early May surgery. If the doctor agrees to operate, and I am confident he will accept. The three months of recovery will be very hard but not as much on me as on my wife and children. It will be in this period that I count on you a lot to offer support and assistance to Marie-Josée. I will have a single focus, get back full health with the fewest complications.

Finally, there is good news, my markers are now 5.4, very near the normal range.

Good weekend!

Stabilization

I am writing today March 10 to announce that my condition seemed to stabilize more than two weeks after the beginning of my diarrhea. As I said earlier it was a difficult period, both physicaly and the psychologicaly. It is a vicious circle which I managed to get out of today thanks to my wife and my brother Omer. Marie-Josée found this period difficult but she was able to give me reason to hold on to and change my paradigm. Let me explain: My body was losing strength because of diarrhea and so was my mind. I could not explain why this was happening, even though deep down I knew that it was a side effect of my new chemo. Being aware of this fact did not really help me justify the severity of the effect. The first turning point was provided Marie-Josée. In her readings on the Internet, she shared an anecdote of a patient who received irinotecan, whom also had diarrhea. This patient sayd It was a strong dose of irinotecan that gave such a severe case of diarrhea but the outcome was that all her metastases had disappear after this treatment. This story gave me a positive spin out of my downward spiral. Now my position is that the diarrhea was caused by a high dose combined with the fact that I probably have no more cancer so the chemotherapy only had my gut to attack. Me, I buy this version. This can not be confirmed until a few weeks but now my mood is in better health. The cherry on the sunday was the call from my brother Omer today. He offered to have a coffee in my neighbourhood. Omer and I do this from time to time when his work brings him in my neck of the woods. It had been a while so today's invitation was welcomed. Even though my moral was better, I lacked a little something to be fully motivated. 30 minutes chatting with him pumped me up and completed my recovery.

Thank you to my wife and my brother. It's amazing what a good timing can do for someone.

Here is the schedule for the coming days:
Thursday I meet with Dr. C, hematologist. She will probably prescribe chemo next week.
Then, Thursday at noon I meet the surgeon dr Y. I look forward to have his opinion and at the same time I fear will not hear what I want.
Since diarrhea delayed my treatment, Marie-Josée saw an opportunity to do the PET scan earlier. So we are waiting to see if next Monday, there would be a spot for me. We strongly hope.

Finally we continue to plan the trip to Dubai. The aircraft is booked and the hotel too. Children are keen to go skiing in the inside ski resort. There are plenty of other activities that we expect to do. We will be glad to share the first eight days there with grandpa Yvon and Loulou. We are fortunate to have our reception committee on site. I will let you know about my medical visits as soon as I can.

A week in Hell

Hello to you all.

The last week has been painful. In fact, it was the worst week since the beginning of my treatments. Normally after the chemo I sleep a few days and I feel like Sleeping Beauty who wakes up a little more each day. Except for last week when the day I usually feel normal, I began diarrhea. It was Friday 18:30. It lasted until Wednesday of the next week, or yesterday. Diarrhea as I've never had in my life. I followed the Imodium protocol I had received from the hospital pharmacist, but things did not change. This protocol requires taking 2 tablets of 2 mg at the onset of diarrhea followed by one tablet every 2 hours (2 tabs every 4 hours at night). I continue this until 12 hours has elapsed since the last diarrhea.

I did that Friday, Saturday and Sunday. Come Monday I called the hospital because the danger of this type of diarrhea is dehydration, and all of its consequences. I was therefore instructed to go to the hospital Monday to meet Dr L, to do a blood test and then receive a glucose solution intraveinously. I saw Dr. L. He looked at the results of my blood sample and I was not dehydrated so I didn't get the intraveinous solution. Still, I am really tired. My next chemo is scheduled for Wednesday but the doc believes that we should make the decision Wednesday morning.

In the meantime, he prescribed Sandostatin. A powerful drug, given by subcutaneous injection, to control peristalsis (bowel movement). It is imperative to calm the frenzy in my belly. As I have a generalized itching and I think it is the Imodium, he substituted it with Lomotil. For Sandostatin I receive the first dose at the hospital under observation in case of allergic reaction. Small administrative errors were made so I had to wait 3 hours before receiving my injection. That evening my wife stuck a needle in me once for Neupogen and 2 times for Sandostatin (the pharmacy had only vials of 100 mcg while I need 200 mcg). My stomach began to calm down. I could sleep a little better.

Sleep. It was not so easy with the Imodium protocol since I had to set my alarm clock for the night dose, at least Sandostatin provided a good night.
The next morning my upper lip looked like itwas injected with collagen. Josée thought I was having a stroke. I reassured her but my mouth really looked weird. I therefore decided not to receive the morning dose of Sandostatin should it be responsible for the swelling (or allergic reaction).

I turned to Lomotil, 2 tabs q4h (2 tablets every four hours). Wednesday morning, a day of planned chemotherapy and where I met Dr. L. at 8:30. Danielle (Josée's aunt) came to the house to babysit. Upon entering the office of the doc, he noticed that I did not look my best. I confirmed that it was slowly getting better but I am still very tired. We agree to postpone chemo to next Monday. I want to be in top shape a few days before falling down again with chemo. In discussing with Dr L., I admitted I was scared this week. He said "me too".

I was afraid of not being able to get out of this diarrhea or to have to eliminate Irinotecan from my arsenal too early (three doses). He reassured me. Several options are still available and the first is a reduction in the dose of irinotecan. He mentioned that as we have an aggressive attitude, so was the dose. For the next treatment everything will be adjusted. It will be adjusted not only according to the scale but also because I lost 7 pounds (about 3 kg) in the last week. I went from 170 to 163. When the hospital pharmacist called me to check my weight she had 175 pounds in her notes. I hope, I am sure that the difference will be noticeable when my next treatment comes.
Regarding the itching, we don't know the cause. Wednesday while returning from the hospital we purchased some Benadryl. As Danielle was at home she kindly agreed to stay a little longer so I could take Benadryl and sink into sleep. That's what happened from 10:00 to 14:00. A very deep sleep and rest. Today, Thursday, my bowel movements seem under control. The content of my stools are still very liquid, but it's a slow return to normal.

In any case my energy level now is quite reassuring. I have 2 more chemo before taking a break in preparation for the PET scan. I do not want to relive a week as the last.