2013 : Cancer Strikes Back!

Hospitalizes againWell I finally got the answer to the question I posed in my blog entry last October. It was not quite what I was hoping for. While statistical models predict a 4 year survival horizon in 80% of cases with cancers like mine, the envents of the past two months have me suspecting that I am perhaps a statistical outlier. — An exception to the rule. Time will tell.

Following what seemed to be a good response to the 8 course of  the CHOP protocole last summer, it appears after my 8th and final chemotherapy infusion, the cancer did not waste time to come back. Indeed, it came back with a vengance. In mid-november  (2012), I started feeling more lethargic and experienced a gradual loos of appetite. In hindsigh,  it was a rather subtle transtion that lurked “under the radar” and went largely unnoticed. In fact it all came to a head in mid december when my oncologist noticed that I was not well; I was  one “very sick puppy” and had me promptly hospitalized. I actually lost track of time and space for a few days while the hospital staff tried to find me a room. I was not eating and the attending doctors and wife Suzanne confirmed the worst: I was close to having a private audience with St-Peter. Really ? I was blindsided and did not see this coming at all! I was looking for the more obvious symptoms like fever, cold sweats etc.  Sleepeness and loss of appetite were not specifically listed in the oncology patient’s handbook.

I was placed to an isolated room in mid-december since I was in a state of neutropenia (i.e. very low white blood cells), which critically expose me to the risk of infection. Another course of chemotherary (ESHAP*) was started immediately and I was attended by at least 5 different speccialists (two oncolocogists, a microbiologist, an onco-hematologist, a dietician, and  physiotherapist). I also consulted a psychiatrist to sort out and attenuatate some phycotic effects of the medication which prevented me from getting more than 2 hours of sleep a day. Currently, things are getting back to normal after some adjustments to the chemotherapy dosage and a mild anti-psychotic medication.

The last PET scan results indicate that the cancer has spread. Indeed, the scan shows mainly the following :

1) A net progression of the of lymphatic impact since the last PET scan done in late september;

2) there is extensive impact to the liver;

3 Lymph nodes on both sides of the diaphram, the pleurae,  the lung(s), the liver, the spleen, and the bone marrow in the area of the right solder bone, the fouth lumbar vertebrae (L4) and the left ishium bone (stable).

Wow! The concer is manifestly an aggressive one. In response the this resurgence, my oncocologist opted for an equally aggressive protocol,  ESHAP. This is done in out-clinic and consists of 4 courses of infusion during 5 consecutive days spaced two weeks apart.

In addition, he has also enlisteted me for a autologus bone marrow transplant at another hospital as soon as the course of ESHAP is completed. That is it there are apparently no other option after the bone marrow tranasplant. I am hopeful that these two later treatment protocols will do the job of keeping ridding me of my cancer.

In the meantime, I am in very good spirits and remain optimistic that all the outcome of all this will be a positive one. I am also very grateful to my wife Suzanne, my brother and sisters, relatives and friends that continue to support me thourgh this life adventure and challenge.

Donald Fac bloated

Cheers,

Donald

* ESHAP is an acronym that designates the chemotherapy drugs used to prevent the multiplication of abnormal (cancer) cells and to destroy them.

Posted in Living with Cancer | 1 Comment

Chemo Hair

Now that my 8 rounds of “CHOP (*) therapy” are behind me, I am close to the two-month milestone of  a chemo-free life and being almost medication-free. I would like to think that I am also “cancer free” but that will be my oncologist’s call. I am not holding my breath yet.

Donald Chemo hair pencil drawing 2012

(*) Note: CHOP is an acronym for a cocktail of chemotherapy drugs made up of Cyclophosphamide, Doxorubicin (or Adriamycin), Vincristine (Oncovin) and Prednisolone.

In the meantime, I am starting to see some new hair growth. I must say that, out of the starting block, I pre-empted the transition to the messy process of gradual hair loss by submitting my dome to a radical deforestation. Indeed, while it may seem pretentious, I kind of fancy the Yul Brynner, Patrick Stuart or Bruce Willis look. Don’t women find them sexy? A few good things about going bald are not having “bad hair days”, that “bed hair” look, “tuque hair” in the winter, and saving a bundle on the cost of haircuts, shampoo and conditioner, not to mention styling gel. Unfortunately, all this comes at the cost of my head being more sensitive to drafts, cooler temperatures and, of course, pesky mosquitoes in the summer.

Unfortunately, after 2 months of being chemo-free, I only have a few sparse patches of black and white baby peach fuzz to show. The funny thing though, is that my beard is coming back with a vengeance; the only difference is that now it is snow white. A wise guy I know suggested that I let it grow out to a full beard and take on a part time job as Santa Claus with an authentic beard. I do not intend to quit my day job yet.

Well to have fun with this life of chemo-induced baldness and to avoid any UV exposure to my scalp, I started a collection of assorted “cranium covers”.  This year, collecting various styles of headdress has become one of my new passions. Because I was rather bored with the classic baseball cap, I sought out diverse forms of head gear. These ranged from a straw hat, a black spandex biker-style bandana, a white tennis-style bandana with the required Nike logo, a 60s style blue bandana, a newage head wrap with a batik paisley motif and an assortment of Middle-East Kufi skull caps. My fall and winter collection includes a classic Basque French beret directly from Paris and a Mountie style fur hat custom made from my aunt’s old muskrat coat. I can just imagine her rolling over in her grave. Of course for bedtime, a traditional Quebecois tuque does the job. I am not quite ready to don a turban of fez yet; that would be too eccentric no? While I recognize that being diagnosed with cancer is life-changing event, I am not quite ready to go that far!

Reactions to my diverse head adornments have ranged from indifference, mild amusement, curious looks, and compliments from the staff at the chemo infusion center. On one occasio, I was completely ignored when I , wearing a kufi skull cap, addressed someone, to pay them a compliment them on their pair of road bikes. (I love bikes).

I am now toying with the idea of adopting the “el duomo” look. Apart from the practical aspects, it is also a reminder for me of my journey to “Cancerland”; lest I forget  my voyage to “the undiscover’d country, from who’s boune no traveller returns”. In the end, it is my way of having fun and coping with all this. “Qui rit se guérit” — He who laugh heals himself.

Posted in Cancer, Chemotherapy, DLBCL, Living with Cancer, Lymphoma, Oncology, Survivor | 2 Comments

Are we there yet?

Temperate rainforest Vancouver Island 2004

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In the wee hours of the morning before the day of my medical appointment, I was awakened by a massive tremor and a tremendous « sonic boom »; a sound that evoked images in my mind of some kind of explosion in the distance. With barely six hours of sleep, it was a challenge getting up the next morning. That was the backdrop of the day when I was scheduled to meet with my oncologist to go over my latest test results. That morning the sky was overcast and a cold wind came in from the north to remind us all that winter was approaching.  While driving to the hospital, it seemed like all the talk on the radio was about the earthquake last night and the latest testimony of the Charbonneau Commission’s inquiry into corruption in the construction industry. There was little on the air waves to lift my spirits on such an important day; the day I meet my oncologist to get the latest news.

After the required blood sample before to meeting the doctor, I took some quiet time to enjoy a small breakfast and went over my notes and questions one more time before my consultation. Then it was up to the waiting room for a fifteen minute wait and finally I get the call over the intercom to go to room no 5… for the moment of truth.

Overall the post chemo scans and blood test results were positive. But that is where it ends, compared my previous round of scans, the latest imaging tests show the following:

  • Residual lymphomas in the bone marrow of the shoulder blade, the third left rib, the 4th lumbar vertebrae and the left hip bone (ilium);
  • A small (6 mm) residual lymphoma in the left recessus of the pleural cavity;
  • The internal lesion of the spleen  had somewhat diminished compared to the      previous scan in done in July;
  • An X-ray of the lung indicated some kind of  anomaly possibly related to an infection in the left pulmonary lobe. This      is being investigated with a follow up X-Ray next week.
  • There is no evidence of residual lymphomas in the liver or spleen.
  • The relevant blood parameters were normal.

My oncologist wants to do another PET scan in November to confirm the current diagnosis. Based on these results, the follow up may include biopsies of certain hotspots to verify if they are malignant or not.  This is necessary to better prepare any future course of treatment, if needed.

Another point to monitor is the gradual appearance about two week ago of a dull pain on the left side of my back. This may be correlated to the anomaly that showed up on my X-Ray. I am closely monitoring my vital signs (fever, coughing, weight etc.) including any changes in the level of back pain. So far so good! Further investigations are scheduled the coming week.

I have come a long way since April 2012 when the initial CT and PET scans revealed more than 35 hotspots of either cancer activity or related issues. Despite the uncertainties, I am somewhat comforted in the knowledge that the latest results show only 5 potential sites of residual cancer activity. Not bad at all! But I still have a way to go before I am out of the woods. What is left appears to be mostly in the bone mass. A curious turn of events.

To be continued.

DonD

Posted in Cancer, Chemotherapy, CT Scan, DLBCL, Living with Cancer, Lymphoma, Oncology, PET Scan | 4 Comments

The Big Meeting

As my scheduled meeting with the oncologist draws near, I have taken advantage of this quiet Thanksgiving Monday afternoon to review my notes, my health journal and to go through my list of questions for my upcoming meeting.

Now that I had my the last scheduled chemotherapy treatment a little more than 6 weeks ago, I am in good spirits (as usual) and feeling fine overall. The signs of chemotherapy-induced neuropathy like numbness in the toes and fingers persist. After sitting around for a while in front of a computer screen and getting out of bed in the morning, my muscles do not respond as I would like. Perhaps that has more to do with aging. In any event, physical activity like household chores, walking and biking is still on my daily list of things to do.

My only concern is the appearance a dull pain in my abdomen, just under the ribcage, which I suspect has something to do with my enlarged spleen. The fancy medical term used for this condition is splenomegaly. I understand that this condition does not necessarily mean that cancer has invaded the spleen. It may also be enlarged because it has been working extra hard during the course of chemotherapy I received. More about this later.

To avoid any complications with regard to my spleen,  as a precaution, I have suspended my Saturday morning yoga classes until I find out more about what is going on and what future course of treatment may be in store for me, if any.

Finally, it was a fine weekend to celebrate Thanksgiving with my immediate family and to take the time to recognize all the positive aspects I call my “tiny grattidudes” that I have experienced since this journey with cancer began more than ten months ago.

My niece and nephew

Next week end is the Light the Night walk for raise funds for cancer research and support for cancer patients organized by the Leukemia and Lymphoma Society of Canada. My campaign to sollicit funds for this foundation and for the hospital where I was treated has been encouraging for a first-timer. However, this experience has been quite revealing regarding true friends, social media.  I intend to write up a blog about this when all the results are in.

If you have not done so yet, please consider donating to either of the foundations listed below:

Light the Night Walk

Fondation Hôpital Charles-Lemoyne

DonD

Posted in Living with Cancer | 2 Comments

The Next Step: Glowing in the Dark!

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Next week (September 24 & 28), I will undergo a CT (Computed Tomography)  and a PET (Positron Emission Tomography) scan to assess how my lymphoma has progressed after 8 cycles of chemotherapy that started in March 2012.

The CT scan is essentially a series of X-rays images of the body that radiolgists use to look inside of the body. A contrasting agent (a salt of iodine) is injected duing the scan to help enchance the certain features of the anatomy. The scan consists of a series virtiual X-Ray slices through the body. The different organs, arteries, veins, lymph nodes and tumors have a distinct appearance that a radiologist uses to assess how the cancer has progressed compared to a previous scan.

In addition to this scan, a PET scan is done to map out the areas where active cancer cells are located. This is accomplished by injecting a solution of glucose (sugar) that is tagged with a radioactive isotope. In this case it is Fluorine-18, a radioactive isotope that emits protons,which are detected by a special sensor that circles the body duing the scan. The images show light areas in different area of the body where the cancer cells are located. By comparing the PET scan images with those of the CT scan the radiologist can accurately determine if there are any tumors and which organs or areas are affected by the cancer.

The image posted above is my actual PET scan taken before the chemotherapy was started. Based on my reading of the radiology reports, I have identified with red dots the sites where cancerous activity occurs.

After 6 cycles of chemotherapy, my CT scan confirmed that most of my enlarged lymph nodes (adenopathy) had significantly decreased in size, thereby indicating that I was responding well to the treatments. Some areas however did remained showed little change from the previous scan. I look forward to seeing the results of these latest scans.

I will get the complete results of the latest scans when I meet with my oncologist in early October.

To be continued…

Don D

Posted in Cancer, Chemotherapy, DLBCL, Living with Cancer, Lymphoma, Survivor | 2 Comments

The Next Leg of the Journey

Almond Blossom by Victor was shown at “Van Gogh Up Close” exhibit at The National Art Gallery, Ottawa

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Now that my initial course of chemotherapy is behind me, I find myself pondering what is in store for me in the next leg of this journey and reflecting on what I learned so far.

Looking back on this experience that started late in 2011, I have to recognize that I am lucky in my misfortune even though my cancer is advanced and is considered to be an aggressive form of Non Hodgkin Lymphoma (NHL). So far, I have been able to cope very well with the treatments without any serious side effects, infections or complications.  My body has responded well to the chemotherapy, but my oncologists tell me that some sites affected by the cancer remain present. The next step is to allow the last cycle of chemotherapy to take effect, and then assess the overall results by undergoing a CT and PET scan later in September.  From what I understand from the medical experts and my readings here and there, I might have to go through more chemotherapy or perhaps some a bone marrow transplant to complete the treatment. I will know more in October.

While I am satisfied that my medical is adequately managing the medical aspects of my disease, I realize that it is only one part of the equation. As for the rest,  I have face the human and emotional side of my illness, its impact on me and the people close to me. Thanks to the supportive people around me and other cancer survivors who were kind enough to have shared their experiences, I have learned many things that have helped make this journey easier to bear. The following are a few things I have come to learn during on the first leg of this journey:

  • Life is short and precious. Isn’t it really about our passions, the people we meet and  the things we create and share with them?
  • To look at this illness as an opportunity to learn and readjust my focus on Life;
  • To focus on the present and seize the moment (Carpe Diem);
  • Embrace Life in all its aspects,  the good with the bad (Frederich Neitzche);
  • Life is simple;
  • To keep active, both physically and intellectually;
  • Try new things;
  • Recognize and acknowledge the good things and people around me, for which I should be grateful;

So to celebrate the start of this second leg of my journey and put some of these principles into action, this weekend I took the opportunity to go and see the Victor Van Gogh exhibit “Van Gogh Up Close” at the National Gallery of Canada in Ottawa with my sister. It was not only a once in a lifetime chance to see more than 40 of  his works from all over the world, it also gave me the opportunity to get closer to my sister and to celebrate a memorable evening with my close cousins and their families.

I was particularly touched by another cancer patient named Paz, who sought me out in the crowd in the museum to share her experience, recognizing that I too was a cancer patient going through chemotherapy. Offering her my wishes of healing and wellness, I left her with a heartfelt hug and words of encouragement.

To my Family and friends who have inspired and encouraged me  and to Paz who made my day, I dedicate this blog page.

Donald D

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Hang Tough!

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I saw it coming when the radiologist was doing an ultrasound of my neck to see if there were any signs of blood clots or cholesterol on the walls of my jugular veins that could explain the temporary ischemic incident I had experienced a few weeks before. She happened to look a bit below my left jugular and found and what looked like enlarged lymph node. A golf ball sized one at that! I knew something was awry when she called-in her colleague for a second opinion. The report to my family doctor said that is was likely a lymphoma or a metastatic ganglion. WOW, what a surprise! Then it was back to see my family doctor but the cause of the temporary aphasia became a secondary concern. The burning question was to determine if the “golf ball” lymph node growing in my neck was malignant or not. In addition to all this turmoil, during this time my mother became ill with a malignant abdominal tumor. She was hospitalized and a short time later regrettably passed away.

Following this initial episode, it was a seemingly long and tedious process to get an appointment to see an eye nose and throat (ENT) specialist to investigate this suspected lymphoma. Finally, after a “quick and dirty” biopsy in the doctor’s office, the results came back two weeks later as inconclusive. Great! Just my luck. The quick and dirty approach did not cut it. So it was back again the in the queue for a full body CT scan and “day surgery” to collect a proper sample for a biopsy.

Guess what? The medical team decided to hospitalize me immediately following the biopsy, to carry out more scans, tests and prepare me for a proper course of chemotherapy. All this while the pathologists were figuring out the type of chemotherapy for “golf ball’. The enlarged lymph node turned out to be a Non-Hodgkin Lymphoma (NHL), more specifically, Stage IV (Diffuse large B Cell Lymphoma). The course of treatment was established as the CHOP protocol over 6 to 8 cycles lasting 21 days each. I should have suspected something was wrong a few months earlier, because I lost a significant amount weight over that time for no apparent reason.

To complicate matters further, I developed an accumulation of fluid in the pleural cavity of my left lung. This almost completely collapsed my left lung. Not surprising since close to 9 liters of fluid were drained from the pleural cavity. I am now breathing easier!

I am taking the chemotherapy well, without being burdened by too many side effects. After 6 cycles of CHOP, my oncologist considers that I am responding well to the treatments. But there is still a way to go yet before reaching the end. The fluid in the pleural cavity has not returned either in any substantial quantity. So far so good! Hang tough!

Donald D

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