Wednesday, December 17, 2008

Planning comes first

I learned today in my all-day doctor’s appointments that:

  1. Doctors make you wait one heck of a long time to be seen by them, and
  2. Radiation treatment requires a lot of upfront planning

Due to the upcoming holidays, the detailed planning for my treatment will not begin until the end of this month (Tuesday, December 30 to be exact). Regular treatments will being sometime the following week and continue for the next 5 weeks.

Here’s a detailed breakdown of the entire process for those in my family who just “have to know”:

CT Simulation
The first phase in the planning process is CT Simulation (12/30/2008). During this time, I will lie on a table and the area to be treated will be reviewed through a CT scan device. The purpose of the scan is to pinpoint the exact location of the treatment area. Temporary marks are then placed on my leg at this time and will remain until plan verification simulation the following week. Using the data collected during CT simulation, the doctor is able to finalize and calculate the treatments.

Plan Verification Simulation
The next phase in the planning process is Plan Verification Simulation (01/05/2009). During this phase, the therapist will use the treatment plan and shift from the marks placed on the skin previously to the final centering points that have been determined by the treatment plan. X-rays will then be taken and reviewed by the physician for localization of the treatment fields. Finally, new marks will be painted on my skin and these will need to remain in place during the full course of my treatments (5 weeks). My first treatment appointment is expected to be this same week.

Dr. D’Amato Follow-Up
In my follow-up appointment with Dr. D’Amato today, I was told that I would need to get CT scans of my chest, abdomen, and pelvis (CAP) every 3 months and MRIs of my leg every 6 months, both for the next 2 years. Though this is not really a surprise, that’s one tough regime, especially given that these are the “with contrast” CT scans involving my favorite barium sulfate “smoothie” drinks. Oh well, it’s still better than chemo!

Tuesday, December 16, 2008

Picture Perfect

Well, I had a CT Scan of my chest and an MRI of my left thigh early this afternoon and I'm happy to report that both apparently look great. Dr. David Monson (my orthopedic oncologist) said that he could find no abnormalities in the chest scan and that the MRI showed continued shrinkage of the tumor. This is really great news as it shows that the chemo did its job. And did I mention today that I'm really glad to be done with chemo?!?

I also took the opportunity to ask Dr. Monson about my upcoming surgery (which should happen sometime mid-February, after radiation). He is very optimistic as to how that should go given that my tumor is near the surface, has shrunk considerably, and contains no major blood vessels. He also thinks I should have minimal muscle loss as a result of the surgery. Apparently my case is "easy" compared to many of his other patients. What a relief!

Tomorrow morning I have a follow-up with Dr. Gina D’Amato (my oncologist) as well as my first appointment with the radiation oncologist, Dr. Karen Godette. Apparently I have 5 weeks of radiation coming, but I'm just not sure when that's going to start given the holiday schedule.

I'll make another update tomorrow after I have more details on the treatment plan.

Thursday, December 11, 2008

Looks like I’m going to avoid the hospital this round . . .

Great news! I believe that my body is now producing new white blood cells and that I’m finally on the upswing for Round #6. And just in the nick of time too, as my white count was very low Wednesday morning.

So how do I know I’m producing new white blood cells? For me, the signal is night sweats. (Yes, I know we’ve had a bit of a warm spell here in Atlanta, but that’s not it I assure you.) I noticed several months ago that I experience night sweats about 1 week out from having chemo and it lasts for about a week. This is the exact timeframe when new white blood cells would be produced. In fact, after Round #4 when I was hospitalized with critically low white counts, I knew I was going to be OK when on my second night I experienced night sweats. That morning, blood tests confirmed that my white count had jumped significantly overnight.

The doctors too have validated my theory, stating that “everyone’s body signals them in a different way. For you it is night sweats; for someone else it could be something completely different.”

I mention this mainly for the benefit of other cancer patients: learn and know your body’s signals. For me, it’s really encouraging to know that I’m on the mend without having to wait for the doctor to tell me that.

Sunday, December 7, 2008

Doing great . . . so far

I feel great!
Perhaps it’s because Dr. Gina D’Amato went easier on me this time than last, but I’ve been doing great since I got home on Thursday. And, thanks to the Emend (the best anti-nausea drug I’ve tried), I’ve been eating at practically my normal pre-chemo intake rate (read as hungry man). It’s really nice to feel good for once. Holly thinks this is the best I’ve ever been coming out of a chemo cycle.

"Bad" week ahead
But before I get too excited, I need to remind myself that my hard week is approaching. My levels have been dropping since I got out of the hospital and will continue to drop. I expect to bottom-out sometime between Tuesday and Thursday of this week. It’s only a question as to how low that bottom is and whether or not it will send me back into the hospital. I certainly do not want to go and have already said my goodbyes to the nurses on the cancer floor. I just don’t think I could handle hearing anyone say “patient dining” at this point.

That's a lot of chemo!
To give you an idea of just how much chemo I get (and had gotten), Round #6 consisted of exactly half the amount I received during Rounds 1 – 4 (for both the Doxorubicin and the Ifosfamide). Even so, the good doctor tells me that I am still receiving “ample” amounts of chemo. She went on to say that this “half dose” is greater than the max doses many doctors give their cancer patients. Oh really?!? Well, than thanks for going “easy” on me doc! I’m just glad the chemo part is over (hopefully forever).

Wednesday, December 3, 2008

Getting out of here Thursday Morning

Well, my chemo didn’t get hooked up until after 10:00pm on Monday, so I won’t be finished here until after 10:00 Wednesday. Therefore, I’m just going to end up spending an extra night here and get picked up Thursday morning. No biggie.

Last night I was hooked up with what I hope will be my last bags of chemo. To commemorate the occasion, I took the following picture from my iPhone:

Final bags of "poison" loaded up and flowing (click to enlarge)

I really do hope that all goes well with my CT scan (scheduled for the 16th) and that I am truly done with the chemo. It’s pretty darn rough going through intensive chemotherapy and I will be happier than you can imagine having this behind me. What’s next then? Radiation, Surgery (all TBA), and supposedly hair re-growth. I just can't wait to have this all behind me so that I can move on with my life, my family, and my job.

Monday, December 1, 2008

Round #6 ("Final Round") Starts Now

Well, I'm back in Crawford Long waiting to be hooked up with my "final round" of chemo. For those visiting or calling, I'm in room 7123, which can be called direct at 404-686-7123.

When I saw Dr. Gina D’Amato earlier today, I begged her to go easier on me this time (given that I again had complications after Round #5). Much to my surprise, she complied and ended up taking off another day from this round. She said that I should count my many blessings and credited her goodwill to "the festive spirit of the Holidays".

In any case, I should be getting out of here either late Wednesday or early Thursday morning (all depending upon when the chemo starts flowing). I’m just happy to be cut some slack once again and that I can get home a bit earlier. I can only hope that this all translates to fewer problems the following week.

And now for the biggest challenge of each and every inpatient chemo round: surviving the hospital food. And I just heard the two scariest words spoken on this floor: “patient dining”. Time to call the nurse and get started on my anti-nausea drugs.