Back On Chemo

Last Tuesday afternoon we visited the oncologist, the meeting started well, then went down hill.

First up, my latest CEA result is 1.3, 0.1 lower than my previous test.  This is very good news, a flat or falling CEA almost certainly means no secondary colon cancer is growing.  For some reason I was expecting the result to be a rising CEA.

Then on to next treatment.  As would be fairly clear from my previous post, I was fairly sure no chemo would be best for me, subject to validation from the oncologist and, I thought, with his agreement.  However it became clear that the clinical team behind my case had reached a decision that I should return to a further course of aggressive folfox .  After many words, some with a great deal of passion behind them, we agreed that I would go on a course of Xeloda.  This is a relatively recent treatment that has potentially more manageable side affects than the folfox treatment.  It is high cost (about $NZ600 for each two weeks cycle) but is fully subsidised for those eligible.  I have two weeks of treatment, then one week off, followed by blood tests to make sure I am coping OK, then another round.  This will continue for at least 8 cycles.

I started the new treatment last Friday and up until yesterday (Saturday) I was not aware of any side affects.  Today (Sunday) I feel a bit ill, mild nausea, a headache at times, and my joints are a bit tender.  So far a milder version of some of the side affects of my earlier treatment.

Last week I was at work for close to a full week, but by midday on Friday I was very tired, I am sure it was just the result of a near full week of work.  This week I am due in Wellington on Friday at least, I have booked Wednesday to Friday to catch up with people there, but I am not sure if I will be up to the full 3 days.  I will make a decision on Tuesday afternoon.

Back at Work, Partly

The past week I have been at work every morning and a couple of afternoons.  I have also been doing some work from home.  All went well until Friday when I felt as if I had a virus or something.  I must admit that I had been going downhill slightly from Wednesday.  Over the weekend I slowly recovered, this morning (Monday) I was back to feeling fine.

Sunday I did my normal weekly weigh-in and found I had put on no weight for the week.  I got quite concerned at the lack of weight gain, plus the way I was not feeling great, until I looked back at my first week back at work after my first liver surgery, I lost 0.5Kg that week and struggled with fatigue as well.  So clearly my progress is quite consistent, and no worse than my earlier recovery.  However I am finding this slow rate of recovery very frustrating.  In my respects I feel quite good, I just want to get on with life and work.

I am quite proud at one big step to normality I made last week.  My oncology appointment, due tomorrow to look at progress and next steps, conflicted with an important meeting at work.  So I have deferred the oncology appointment by one week.  This is the first time in over 18 months that I have given my medical treatment a lower priority in favour of a normal working life.

This week I will continue with every morning at work, and just see how the rest of the day evolves.

Real Progress - And What Is Next?

Last Wednesday I went into work for one hour, just to get my laptop on line and make sure all was OK with my environment there.  Next day I went in for 3 hours in the morning, but was really stuffed by midday, I expected that, but my time at work was good.  It felt really good to be getting back to normal.

On Friday ( a public holiday here) we went to Glentunnel and spend the weekend in the caravan.  It went OK, but weather on Saturday was cold and wet and it got to me a bit, we did have lots of rest though.  Today we brought the caravan back, we will tidy it up and get a bit of maintenance done on it and then sell it.  Realistically the very large caravan plus heavy duty utility in front is a bit much for us to handle now and we want to be prepared for a worse case scenario where I may go downhill again quite soon (very unlikely).

I must say that I have got a bit uneasy over the past couple of months at the number of well known (to me) people who have been diagnosed with colo-rectal cancer, or who have died from cancer (mostly colon cancer).  Going back to work only added to this unease as the building we work in has a new front tenant, Vodafone has moved out and The Cancer Society of New Zealand is moving in.  While I can ignore these "signals", it is a concern that New Zealand has the highest rate on colon cancer in the world, and the Canterbury region has the highest rate of colon cancer of any province in New Zealand (Christchurch is Canterbury's home city)

In terms of the decision in 10 days, about next stage treatment and/or monitoring, from a logical perspective chemotherapy would statistically not contribute to my desire of as many good quality days in life - it would almost certainly only extend life or non-recurrence  by a few months, while potentially causing more damage to me.

From a non-logical perspective, most days now I have a period of time, gradually increasing and now a bit more than an hour a day, when I feel really good and fit, in a way that I have not had for near than 2
years, before I had my first liver resection.  That suggests my body and mind is telling me that they are making me better and I should just continue as I am at the moment, with no more intervention.  The
only problem with a decision based on such an apparently illogical approach is that it may be a cop out, my gut feeling is that I don't want any more chemo or surgery and just want to focus on my Life.

Getting Better, Slowly

Yesterday I visited the cardio-thoracic and oncology outpatients clinics.  Prior to the clinics I had a chest X-Ray.

My lung is recovering OK, there is still some fluid remaining from my pleural effusion, but it is reducing.  Lungs are clear and as far as cardio-thoracic is concerned, I am finished with them.

We had expected to be considering next treatment options with the oncologist today, but that did not happen for two reasons; I am not yet fit enough to be considered for any chemotherapy at this time, and I am not ready to even think about the options and their implications.  The oncologist made it clear that this would be my decision as to which path I take now.  We will meet again in 3 weeks, ideally any chemo should start as soon as possible after surgery but I am not ready for it, and I am really unsure that I want to suffer any more this year.

I am slowly recovering my energy, and am mostly up and about for 12 hours a day.  However any exertion puts me back.  For example, last Sunday we went out and bought a new BBQ, this meant traipsing through two stores.  Then my brother and his wife visited for a couple of hours, it was not really a social visit with some serious  discussion about our parents and how we can help them.  Then I put the BBQ together and cooked with it.  Monday I felt quite ill, because of the exertion of the day before.  And when I got back from the hospital, with a lot of walking there, my lips were blue because I have not been breathing deeply enough. This morning, once again, I felt ill because of the hospital trips yesterday, but not as bad as I have been and this afternoon I am feeling OK.

The oncologist recommended that I not return to work until I don't need a day to recover after exertion, this should be some time next week at current progress.

Status Update

So where are things at the moment - overall, pretty good, progress is happening but it is very slow.  For the last few days I have gone out for shopping and lunch, today I over did it a bit and feel very tired now.

I have had no pain medication for 4-5 days and mostly have no pain at all, unless I am tired, but even then today there is no pain

Right now I have 3 issues:

• I cannot get through the day without at least 2-3 hours rest in the afternoon, even after actually getting up at 10:00 AM in the morning.  I am going to work on this, this week.
• Tingling and numbness in my fingers and toes, mainly toes.  This is most likely neuropathy or nerve damage caused by one of the components of my chemo treatment.  This is quite common, it may be permanent or may resolve over time.  At this stage it is not a big deal. 
• Not sleeping well, if at all, during the night.  This is normal following major surgery and I have experienced it before.  It will resolve shortly so I am not too fussed about it.

This week I will be doing some work from home and as soon as I am able to get through most of the day without a rest I will visit my GP to confirm I am ready to go to work.

Next big day is 1st November.  In the morning I have a chest X-ray followed by a visit to cardio-thoracic outpatients for a checkup.  Then in the afternoon I meet with the oncologist to start to think about further treatment (if any) and the ongoing monitoring strategy.

Anniversary, and Recovery

Last Thursday 13th October was the 5th anniversary of my original colon cancer surgery.  So I have made it as a 5 year survivor.   When I had the original surgery, 5 year survival was a significant milestone, these days 5 years of non-recurrence or NED (No evidence of disease) is much more significant.  Today I am one month NED!

Also last Thursday, I met with my liver consultant, he effectively discharged me but did say that I knew how to get in touch if I ever need to, however in the event of further mets in the liver further surgery would not be expected.  I am comfortable with that, the last 6 months have been hell and I really need to focus on quality of life.  An X-Ray I had prior to the meeting still shows some fluid buildup around my right lung, but this will hopefully clear normally.

Last Wednesday my boss called in for a social visit, that was good and he left a card with mostly helpful and supportive comments from my work mates.  He also gave me a copy of James Patterson's Private London.  I am about 1/3 the way though the book and  it is looking good, but I would have thought that this would be more relevant.

Friday after the two trips to the hospital (X-Ray plus consultant appointment) the day before, I felt quite ill, it would have been the outings plus quite a bit of walking on the day before.

Today (Sunday) I am feeling quite good, we went out to a hardware warehouse and I wandered around a bit, but had to have a wee lie down when I got home, mostly because I want to see the All Blacks vs. Wallabies Rugby World Cup semi-final match tonight.  But most importantly, I have gained weight over the last 3 days - only 0.2 Kg but that is a major change from losing 0.3Kg - 1 Kg a day as I have been since the liver surgery.

I had planned to visit my GP next week to assess my readiness for work, I looked back at my progress last time and found this post which is about the same date relevant to my first liver surgery surgery as now, and it fairly well represents where I am now at, at best.  It was a bit sobering, and realistically my expectation of spending some time at work this week is just plain wrong.

A Long Outpatients Visit

Last Friday afternoon we visited the surgical outpatients clinic for a checkup with the liver surgeon.  I was still not feeling great, and really struggled to walk to the clinic.  As usual we were early and as usual the surgeon saw us early, he seems to mostly work ahead of the clock.

The X-ray from the previous visit to the oncologist showed fluid build up around my right lung.  The X-ray result, plus my general condition was of real concern so I was promptly admitted to the Surgical Assessment and Review Area (SARA), a 12 bed unit attached to one of the surgical wards.  I must admit that I was expecting this and both Teresa and I were quite relieved that things were happening.

Very shortly after being admitted I had a chest and abdomen CT scan.  The scan showed the liver was recovering well but confirmed pleural effusion, a build up of fluid around the lungs, in my case it was a substantial build up around my right lung.  The indicated treatment was to insert a drain and let the fluid out.  Sounds easy so I agreed to the procedure.  This was done on my bed in SARA by a resident doctor assisted by nurses and watched by about 6 other people, including Teresa.  The drain would go in on my back, at the rear of the lung cavity.

I was told that I would get a local anesthetic, which would be the most painful part of the procedure, followed by a numb feeling and much pushing and pulling.  I don't know how many times I have been told that the stinging injection of local would be the most painful part of the procedure, and it was very wrong.  The initial puncture through to the pleural space was OK, but then the "hole" had to be stretched out to allow the drain tube to be inserted.  This proved to be very painful, I think the whole procedure took about 20 minutes.

About 2.5 litres of pinkish fluid was taken out and I was left with a drain attached.  I found my breathing was getting easier as the fluid came out, but there was some pain at the drain site and where my lung was touching the drain tube.  The time would now be about 6:00 PM, it had been an interesting few hours since I came in to the hospital.  Later that night I was moved to a general surgical ward

Over the next couple of days I started to feel much better and on Sunday afternoon I was released from hospital.  The most significant change in my condition was that I now have a real appetite, for the first time since my liver surgery, however my weight has still not stabilised.

Tomorrow morning I have a chest X-ray scheduled, then another follow up meeting with my liver surgeon, hopefully that will be a short out-patients meeting.

I am feeling much better now, but still low on energy.

Yet Another Visit To The Oncologist

First up, how am I feeling?  Not great actually.  Any activity is a bit of a struggle and I have been getting quite frustrated at the inability of my brain and my body to perform.  But I am actually making about the same progress as last time, particularly when it is is considered that I went into this surgery only a few weeks after the lung surgery, and still affected by the chemotherapy.  There is also another reson, that I found out about today......

Getting to the appointment was a bit of a struggle, I had to get up and shower at the ungodly hour of 8:45 AM.  We took a taxi due to the cold wet weather and the parking problems that continue to exist around the hospital post earthquake.

I had expected the meeting to discuss future treatment options, most likely based on chemo, but Dean (the oncologist) would have none of that.  He said he wanted to think of that in at least a month, once I was in a better stage of recovery.  I was very happy to hear that, I was dreading trying to work out the options and come up with the best result, but he seems really focused on my personal well being, rather than wanting to get his chemistry set out ASAP.

He also gave me a checkup and found that I have significant fluid build up in my right lung.  While is is a fairly normal consequence of my lung surgery, it will be setting my recovery back.  He scheduled a chest X-Ray once I had left him; no doubt the results will be discussed when I meet my liver surgeon for his checkup on Friday.

The oncologist also requested a battery of blood tests, but no CEA.  I asked for a CEA, he added it, but he was not particularly happy about requesting it.  He said that the outcome of the CEA test is irrelevant at this stage and there is no point thinking about, I said I wanted it as I had one about the same time after my other liver surgey and want to compare the results.

On the way out I had the chest X-Ray and blood tests, then got home at 11:45 AM, I was absolutely buggered and had quite a long sleep after lunch.  Feeling OK now after a good sized dinner, but looking forward to sleep tonight.

So What Happened?

As a reader of this blog would realise, this surgery and initial recovery did not go as per my earlier liver resection on 26th May last year.

From my own faulty recollection and Teresa's input, the surgery completed as scheduled a little after 6:00 PM, it started shortly after 2:00 PM.  I went into recovery until about 10:20 PM then was transferred to the Special Care Unit.  My first memory is of a nurse phoning Teresa so that I would talk to her about 10:30 PM.  At this stage all was as expected.

The next morning, Saturday, I had little pain but felt very ill.  The main issues were very low blood pressure, vomiting and Postoperative Confusion (POCD) .

In order to resolve the low blood pressure I was literally pumped full of intravenous saline solution.  I suspect I may have had some drugs to help as well.  I am not sure yet, but I think the low blood pressure was as a result of some drug administered during surgery to reduce bleeding from the liver.  I gradually recovered normal blood pressure and by Monday morning was around my normal levels, but I was like a balloon.

The vomiting may have been complicated by the excess fluids, I don't normally have this problem after surgery.  In order to assist to resolve it a Nasal Gastric tube was inserted.  While the insertion process was not too bad, I would not recommend it as a required life experience.  With the tube in place my stomach contents were sucked out.   Nothing bad was found, but lots of fluid.  I continued to suffer from nausea until Tuesday, but medication pretty much controlled it.

The POCD was "interesting".  I was warned about the potential for it before surgery.  Apparently it's probability increases as I get older and the more time I spend under general anesthetic.  For me, it meant that I was quite confused at times, even paranoid.  At one stage I believed that there was some conspiracy to kill me!  Looking back it seems stupid but it was very real and disturbing at the time.  That has resolved during this week, but I do feel for some of the abuse the nursing staff got from me.

Overall these problems seem no big deal, but I was very concerned about my state of health at the time.  Only after I got home Teresa told me that  one of the Registrars had said that I borderline on recovery, I assume without having to go into the Intensive Care Unit for a while.

On Monday I went into a general surgical ward (the normal stay in the Special Care Unit is usually only about one day) and gradually recovered until release on Wednesday.

Recovery at home has been a struggle, I have suffered from nausea at times (with no vomiting) and also some diarrhea.  For the past 2 days I have got more lazy and not pushed myself as much.  I am sleeping 14 hours a day but have my full appetite back and I am feeling quite good with little pain.

Looking back at progress from my last liver surgery, I am now in the about the same point as last time.  I am losing 1Kg of weight a day (same as last time) but this should stabilise over the next few days.

Writing this post has been a real struggle, my brain still has a way to go to recover.

Back again

Jut a quick update.

• The surgery went as planned
• I came home Wednesday afternoon
• This has been a very tough time, but I am OK and getting a little better each day.

More in a few days.

All Clear For 4th Surgery

Last week I had an MRI of the liver area, to try to identify the smaller lesions.  This was not particularly successful, the MRI is only showing the main lesion.  The plan is to remove the right side of the liver and scan the rest with ultra-sound during surgery.  If the ultra-sound does pick up any anomalies they will be taken out, if possible.  I am cleared to have up to 70% of my liver removed.

While at the MRI clinic I got my CEA results from shortly after the lung resection. My  CEA was 2.4, which is just within the normal range of 0-2.5.  Before chemo my CEA was 7.3.  Clearly the chemo has done a great job of reducing the cancer, but my normal is around 1.0 and with no further action now the CEA value would start climbing soon.

This morning I attended the pre-admission clinic ahead of my liver surgery on Friday afternoon.  It was quite a drawn out process, but very thorough.  During my time at the clinic I had:

• A very thorough evaluation by a nurse
• Much blood taken
• An electrocardiogram
• Another evaluation and discussion about the surgery with a surgical registrar
• Yet another evaluation, discussion and consent signing by an anaesthetist
• A chest X-ray, to make sure my lung has recovered OK from the lung resection

I left the clinic with 2 sets of nutritional drinks to be taken over the next 3 days.  This should prepare my body for surgery and help recovery.

I check into the hospital at 11:00AM on Friday, apparently surgery will start about 1:00PM.  Assuming all goes well, there should be another update here next Monday or Tuesday, once I am out of hospital.

Liver Surgery #2 Scheduled

Today we met with the liver surgeon, as expected the next step is surgery to remove the lesions in my liver.  Despite many scans there is still some uncertainty as to what is possibly cancer metastatic tumours and what may be fatty deposits.  In order to get an up to date picture I will have another MRI scan next week.

At this stage it looks like about 60% of my liver will be removed, but surprisingly I was told that in general my recovery time is not affected by the amount of liver removed, as long as at least 30% remains.

The surgery is scheduled for 16th September, before then I will have another session with the liver surgeon next Friday 9th September to confirm the likely approach, based on the MRI results and a review with the multi-disciplinary committee, due next Thursday.  I will also need to attend a pre-admission clinic some time in the next 2 weeks.

It is good that it is all happening quickly, but the speed does surprise me a bit.

Colonoscopy #4 Over

The prep went a little better this time, according to the nurse that looked after me at hospital the prep treatment being used is more gentle than the fleet that they used to use.

While waiting for the nurses to "muck around" - the colo-rectal surgeon's words, I asked the surgeon if he could see the pathology results from my lung resection.  He looked them up and said that they had got the lesion, it was secondary colon cancer and had clear separation around it - so a good result.

The colonoscopy was normal, no polyps or other abnormalities.  The instrument went right to the end of the colon, which is also good.

I am feeling good now, I did sleep most of the afternoon.  Back to work and to normal tomorrow.

Status Update

Recovery has been going well, I am pretty much pain free now.  But yesterday afternoon through to this morning I have been feeling a bit ill, almost like I have a cold or flu, but no hard symptoms.  Last night I felt like a temperature was building but it was not.  I have the idea that I have some congestion stuck in my lungs, but it might be scar tissue, I guess.  I am also still affected by the chemo, no doubt this is slowing me down as well.

I have started feeling somewhat better this morning now that I am up and moving around, the weather forecast is good so I hope to go for a reasonable walk.  I did have the idea that all going well I would be doing some work from home today and perhaps getting into work tomorrow, I don't think that will happen, perhaps it will be a day later.

Next steps:

• Nurse visit due today to review and clean the wound and dressing - now done, wound and general recovery is all very good.
• Next Sunday 28th, prepare for colonoscopy, I am really looking forward to that (NOT!).
• Monday 29th, Colonoscopy, I really don't have a problem with this procedure, I will be sedated.
• Tuesday 30th,  Nurse visit to remove stitches from my drain site.
• Thursday 1st September, meet with Liver Surgeon to schedule liver resection, should also have pathology results from the lung resection last week.

So next week will be a big one, at the end of the week I will know the status of the lump cut out of my lung, I will know whether I have any new polyps or cancer in my colon and most likely know the date for my liver resection.

At Home, With A Smaller Lung

Last Friday morning we arrived at the Day Of Surgery Admission (DOSA) office at Christchurch Public Hospital.  All went apparently well and at 8:30 AM I was in the CT scan waiting area for insertion of the wire marker.  Only problem was that the DOSA people had missed the requirement for a blood clotting test.  This took about 30 minutes to arrange so I was behind in the project shortly after start up.

Shortly after 9:00 AM the procedure to insert the wire started.  First up I was scanned and marks drawn on my chest to indicate the position and depth of the tumor.  This was followed with a local anesthetic injection into my chest wall, which was OK, just the normal sting.  Then a longer needle was used to inject local into my lung, that was a  very strange feeling. 

A small cut was made in my chest with s scalpel and then various needles and tubes were inserted.  After each insertion I was rescanned to make sure the main tube was lining up with the tumor.  Once this was confirmed a wire coil was pushed down into the lung along with some blue dye to help the surgeon find the tumor.  Finally one last CT scan and a chest X-Ray to make sure all was as it should be.

At about 10:00 AM I was wheeled into the prep room and then into the operating theater.  Most of my discussion at this point was to the anesthesia team.  I then got a wee injection and woke up about two hours later in recovery.  All had gone well and a wedge was removed from my lung with the wire coil attached.  The surgeons had not been able to actually locate the tumor, but were highly confident that it was in the center of the wedge removed - the problem was that the tumor was so small it could not even be found by palpating by hand.  After about a week the results of the pathology evaluation will be available, the surgeon will call me then.

As usual the hospital care was great, but I was not able to sleep well, there was far too much going on in the ward.  I have a wound under my breast area about 5 cm long, another smaller one down my right side, and a stitched hole where my wound drain had exited.  These will all be tidied up in about a week, but I can shower from now on.

While in the hospital I was strongly encouraged to walk and do deep breathing exercises, I need to keep those up for several weeks.  I feel OK now, very tender and at times painful from my right shoulder down.  This should come right in the next 3-4 days.  I am also very tired, this should also resolve within the next week.

Progress, Despite The Snow

We are in the middle of an unusual weather event, heavy snow, which has affected a large part of New Zealand.  We have had about 40 cm of snow over the past two days at our house, this is a one in 20 year event here.  Travel on the roads has been difficult, but I made it in to work this morning and to the hospital this afternoon.

This afternoon I attended my scheduled appointment at the respiratory clinic.  My lung functions were tested with a Body Plethysmography, this was quite a demanding process and took about 30 minutes, results are all normal.  In addition my blood was tested for dissolved gases, this proved to be a bit of a problem.  The clinician needed to take arterial blood from my wrist, in order to get the best results.  She had to have 3 attempts to get a good result from an artery, both wrists were punctured, in the finish we had to resort to local anesthetic as the pain was getting to both me and the clinician.

Following the lung function tests I went to the cardio-thoracic ward for preadmission tests and to give my formal consent to the lung resection.  This all took quite a bit of time, but we are now all go for the surgery.

I need to be at the hospital at 7:15 AM this coming Friday, 19th August.  First procedure, due at 8:30 AM is to insert a hook wire into my lung to identify the precise location of my tumour.  Then shortly after I will have the video assisted surgery to remove the tumour.  All going well I will be in hospital for one to two days, then home.

Lung Surgery Scheduled

Today we met with the Clinical Director of Cardiothoracic Surgery at Christchurch Public Hospital, Harsh Singh.  We talked about the surgery to remove the tumor on my lung.  The biggest challenge is that the tumor is now 12mm in size - it has shrunk from 29mm.  The problem is that a 12mm "lump" in my lung will be quite hard to find so the plan is to do some more 3D modelling to better define the location of the tumor.

What I had not expected is that he has scheduled the surgery for next Thursday 18th August, much sooner than I had expected.  I am very happy with that as the sooner the tumor is out, the less chance of further cancer spreading from it, but is was quite a surprise.

The expectation is that the surgery will be non-invasive laparoscopic surgery, but if there is difficulty finding the tumor, it may require invasive surgery via spread and/or removed ribs.  Assuming the non-invasive surgery does the trick, I should be out of hospital within 2-3 days and back at work in about a week.  My understanding is that invasive surgery will about double those times.

It looks like the liver tumor will be dealt with in about 4-6 weeks, after my liver has recovered from the chemo.  At the moment I am still very fatigued, most likely that is caused by my liver not functioning correctly, and it does feel similar to my recovery from my earlier liver resection.

I am feeling really good about the treatment I am receiving, it seems to be as good as any available anywhere, despite the fact that it is being delivered by the free public hospital system.  However I am struggling to keep positive, the surgery is daunting and realistically I only have about a 20% chance of 5 year survival, this is on my mind quite a lot.  It would be nice to take a break and get away and enjoy ourselves for a week or so, unfortunately the weather and hospital appointments are conspiring against this.  Work is also challenging, but I am well supported by my employer and so work is secondary to my treatment.

All Go For Surgery

As planned, we met with the liver surgeon today.  He confirmed that my main two tumors (one each in a lung and in my liver) had shrunk considerably following chemotherapy and that the 2 smaller liver ones were no longer visible on the CT scan.  Apart from improving the probability of surgery being viable, it also means my current variety of cancer is able to be managed by chemo, which offers opportunities in the future if surgery was not feasible.

We discussed the options, do nothing, further chemo or attempt to remove both tumors.   We agreed the best way forward is to attempt to remove the tumors, this is a radical and aggressive approach which only 18 months ago would not have been considered.  The surgery will be rough and the probability of a cure is likely about 30% but is the best opportunity to give me several years of good life.

The next step is a meeting with the cardio-thoracic team.  They will also schedule a colonoscopy, just to make sure that there is no more primary colon cancer developing.   Likely the surgery will happen mid to late September once I have recovered from the chemo and all the preparatory tests etc. have been done.  At this stage it is probable that the lung tumour will be removed first, followed a few weeks later by removal of the liver tumor, however it is possible both may be done at once.

The PICC line was also removed, this is great, I can now have a proper shower and a bath if I like, I miss my baths.  Likely I will get another PICC line during or after surgery as I would expect another short course of chemo after surgery.

I am still suffering from the effects of my last chemo, feeling tired most of the time and still have very mixed up taste buds, hopefully this will improve over the next few weeks.

No Chemo Tomorrow

Late this afternoon I got a call from the Chemo day ward, my chemo for tomorrow and subsequent chemo sessions have been cancelled.

Apparently this afternoon the chemo day ward reviewed my blood results and found one test slightly out of range for chemo, no big deal and normally my session would just be deferred for a day or so.  But they referred the result to the oncologist for his advice, he had the results back already from my CT scan this morning and due to the exceptional response I have had from chemo they have cancelled chemo and I am now being fast tracked for surgery.  No doubt I will have more detail after my visit to the surgical clinic on Thursday.

I have not really absorbed the news yet, I guess I should feel over the moon, the surgery, particularly the lung resection, is a bit daunting, but is my only real chance for a cure.

A rough week then a visit to the Emergency Dept

This has definitely been my hardest non-chemo week.  So far I have not recovered from the last round of chemo, I have felt quite ill most of the week (as if I have a cold or mild flu) but I am very sure the problem is just the progressive effect of the chemo on my body.

Making matters worse, I have had a painful left knee for most of the week, just moderate pain, but it has slowed me down and is quite debilitating.  I have had this sort of pain in my left knee before, since an ankle injury about 5 years ago, so I was not too concerned.  By Saturday morning the pain had resolved and my left knee feels fine now.

However late Friday a sharper pain appeared in my right knee, it was much worse than that in my left knee and made movement very painful.  On Saturday I found that panadol did provide some relief - panadol does generally work well for me.  Come Sunday morning and my knee was up like a balloon and I felt I needed to take some action.  My chemo "rules" require me to call the oncology unit if anything unexpected happened, so I called them at 8:00 AM this morning and explained the situation.  By 8:30 AM they called me back, after referring to an oncologist.  They strongly recommended that I report to the Emergency Department of Christchurch Hospital.  They suggested I turn up at 11:00 AM as by then the Registrars and Consultants would have finished ward rounds and should be available for me.

We arrived at about 11:00 AM and were taken straight in to the ED, due to my green chemo card which puts me high up on the triage process.  I did feel a bit sorry for the others still waiting.  I was taken to an isolation room, to keep me away from all the sick people there.  Much blood was taken, tests were done, and fluid taken from my knee.  In total 60ml was extracted from my knee, to relieve the swelling.  The fluid was a light straw colour, which was good, apparently.  After another hour the results of the tests on the extracted liquid was that I have gout. I was not impressed at all, but apparently it is not unknown for chemo to trigger it.

The recommendation from the ED Doctor was to reduce alcohol, particularly red wine, shell fish and tennis.  This will be very hard to do for me as I don't drink any alcohol since going on chemo, don't like shell fish and the last time I played tennis (badly) was about 40 years ago.  They prescribed prendisone  and Ibuprofen.  I am not happy about the side effects of prendisone and will wait and see if there is any improvement on just panadol and ibuprofen  before I try it.

This week is a biggie in terms of hospital visits;

• Tuesday - CT Scanning
• Wednesday - Chemo starts
• Thursday - Meet with Sugeon to look at results of CT scan and consider and maybe plan surgery to Lung and Liver
• Friday - Chemo pump removed.

I will post an update here after the Thursday meeting.

Visit To The Surgical Clinic

We met today with Saxon Connor, my liver surgeon.  He described various options, but the key next step is to see what the CT scan, scheduled for 2nd August, turns up.  If it shows no more mets and shrinkage in the known ones then I am a candidate for surgery.  My CEA has dropped again, to 4.0 now, which is consistent with the chemo doing its job.

If there is no reduction in tumour size, and most likely it would be growing, then I have about 15 months left to enjoy.  This is worst case and in view of the CEA result, is highly unlikely.

Assuming a reduction then I can continue with the full 12 rounds of chemo (just done my 5th round) and then look at surgery, but this will cause some damage to my liver.

The other option, which we favour, is to finish this cycle of chemo, one more round to go, then take a break for a few weeks and have the lung tumor removed.  Then about 4 weeks later have the liver tumour out, along with any other suspicious bits.  Following recovery from surgery I would then have another 12 rounds of chemo.

The surgeon has booked an appointment for 4th August, by then my CT scan results would have been reviewed and he will have discussed my case with the oncologist and the cardio-thoracic team.

According to Saxon, I have a 20-30% chance of cure after this surgery and chemo, median survival is about 40 months.

Oncologist Visit

Today we met with the oncologist for a scheduled review after 2 cycles (4 rounds) of chemotherapy.

Just before we left I got an appointment in the mail with my liver surgeon, Saxon Connor.  The appointment is for next Thursday 21st July and likely means that he is assessing me for surgery in the near term.

We had quite a good session with the oncologist, with some focus on my down state on the Thursday through to Sunday after chemo.  The plan is that I will stop taking one of my anti-nausea medications, Dexamethasone.   I will need to be more aware of potential nausea and take additional medication if needed, but it should resolve some issues causing me real grief, including hiccups, insomnia and potentially depression during the black 4 days.

We talked about the potential for surgery and how many more chemo cycles I could or should have before surgery.  We discussed this paper, it proposed that under normal conditions I should have any liver surgery before having more than 6 rounds of chemo, that is the plan as long as all the right conditions are met, which means no more that 2 more rounds of chemo before a break.  The oncologist is scheduling a CT scan shortly to see if a break for surgery before the 6th round is appropriate.  It is possible, but remote, that my chemo cycle next week will be my last.

We also talked about the object in my lung.  It is not 100% confirmed as cancer because it did not light up during the PET scan.  It likely is a cancer met, but may be too small yet to be confirmed.  We are going to park consideration of it for now and see what happens with future scans.

A Great Result

Started next round of chemo today, all went OK, and I now have my infusion pump attached.

While in the chemo out-patients ward I asked if they had my latest CEA results, taken 10 days ago.  I was quite apprehensive even asking for the results because there was little chance they would be good so soon into chemo and because chemo can push the CEA levels up.

My earlier results were 2.7, 6.6, and recently 7.3.  Today's result is 6.1, that can only happen because the chemo is shrinking the tumour.  This is a really good result for me, and it means that surgery is most likely to be possible and effective.

I feel really good about this, but the logical part of me is waiting to see what develops....

Oncologist Update

Friday afternoon we went to the caravan at Glentunnel, we could only stay one night due to baby sitting duties, but we really needed to check that all was OK with the caravan as it had been 6 weeks since we were there last.  No problems with the caravan as such, but we got a frost of -2 C and the 1Kw oil heater inside did not cope well.

On returning home I spent about one hour water blasting 1/3 of our drive, I now feel like I have done the Coast to Coast race. The chemo is clearly having an inpact on my energy level.

On getting home there was a note from the oncologist, recording our last meeting.  Here is the relevant content:

Diagnosis:
13.10.06 Anterior resection for sigmoid carcinoma — T2NO (0/16) Dukes A adenocarcinoma.

26.05.10 Hepatic wedge resection segment 5 for CEA secreting solitary liver metastasis
Consideration adjuvant therapy, declined. For watchful monitoring with 3-monthly CEA and imaging on CEA rise.

Apr2011 Rising CEA. CT documents new right pulmonary 1.1cm nodule plus further 2cm segment border liver metastasis.

May2011 PET-CT confirms right middle lobe pulmonary lesion and FDG avid segment 8 hepatic metastasis, along with several subcentimetre foci specific for additional hepatic metastases
MRI liver confirms segment 8 35mm metastasis, however no clear evidence of metastases at the two other FDG avid areas 

ECOG performance status: 0 

I saw Tony today in outpatient clinic. He had seen my registrar the week earlier, but had some questions regarding the longer term management. His MRI scan has not demonstrated two of the small liver lesions emphasised on the PET. The feeling of the imaging border is that this may represent a false positive PET as MRI liver tends to be a more gold standard investigation.

I discussed with Tony that I envision that we would continue to manage him relatively aggressively. I would plan for him to proceed on with 3 cycles of FOLFOX, of which he has completed one. At this time, we would perform imaging with a CT scan of the chest, abdomen and pelvis to identify any evidence of response in the lesions. I would be hopeful that we would see a response given the slow disease growth pattern and recurrence, and the fact that he is chemo naive. His CEA is also a good marker of disease and, he believes, it is down as he relates the CEA also with a pattern of itch, which he feels has resolved since commencing the chemotherapy.

I’ve recommended that we reimage him after 3 cycles and assess the lung lesion, along with the liver lesion. The liver lesion, I believe, is resectable and we will give further thought to the merits of whether or not to investigate the PET areas with intraoperative ultrasound or other possibilities. With regards to the pulmonary lesion, we will base our decision making on if it responds to chemotherapy or not. Thought could be given to RFA or a lobectomy were an aggressive surgical path to be taken, but this would require control of his systemic disease with response in the liver and other sites.  

First Quarter Over

The last round of chemo went OK, there was a wee glitch at the beginning, last Wednesday morning.  The first step in the oncology day ward is to flush out both PICC tubes and check that blood can be drawn back.  The blood would not come back, despite much sucking with syringes.  Apparently this is not unusual, it is due to small clots forming on the end of the tubes and acting like a one way valve, fluid can go in, but not come back out.

I helpfully suggested pushing a wire down the tubes, but our kiwi No 8 wire mentality was not considered appropriate.  Rather the plan was to inject some anti-coagulant (I was told that it was not drain cleaner) to dissolve the clots and return in 2 hours for another go.  That was successful so the chemo could start.

This round, I was to modify the medication I take at home to reduce the hiccuping problems and also reduce my Saturday downer.  The hiccup treatment did not work, Thursday afternoon and much of Friday was not good.  Teresa found this article which looks very relevant to me.  I take dexamethasone to suppress my immune system and give the anti-cancer medication a better go at the nasty cells.  That steroid could also lift my mood and as part of the changed regime I was to take an extra tablet on Saturday.  I did not take the extra medication and had no hiccups on Saturday.  My mood was down, but manageable as I was expecting it and felt in control.   I will discuss this with the oncologist when next I see him.

Fatigue and tiredness was definitely worse this time round, From later Thursday until Sunday afternoon I was unable to stay up for more than an hour or so, I was not even able to watch all of the Crusader's Super Rugby match, believe me, that was tough.  However I did give in and just go and lie down and try to relax rather than forcing myself to stay up and active, that helped, but I did struggle at times as I hate not doing anything.

So better on the "in control" side of things this time, worse on fatigue, but overall about the same as last time.  Today, Monday, I have my normal diarrhea in the morning, but I expect that to clear shortly, I will take a wee rest, then should be able to get into some work.  I am feeling positive about the treatment, and looking forward to an end of this phase later this year.

Oncologist Update

The meeting today went quite well, the oncologist was very upbeat.

While the MRI results were technically inconclusive (as reported by the Medical Registrar last week) it was the opinion of the radiologist that the other 2 "things" in my liver were not cancer, and were not likely to be of concern.  Dean, the oncologist, commented that the radiologist who reviewed the results was very experienced and that he would trust their judgement.

So the plan now is 2 more cycles of chemo (a cycle is 2 treatments) followed by a CT scan and provided there is shrinkage, particularly in the lung met, then surgery would follow.

The surgery would most likely be a liver resection, plus possibly a Lung Lobectomy.  Apparently there is a fair possibility that chemo alone could shrink the lung tumor to a state that no further action would be needed for a reasonable time.  There is also the possibility of radiofrequency ablation but that would have to be done in Australia.

In terms of prognosis, I have passed the worst case basis, assuming no spread beyond the two original mets, so average life expectancy now is 20 months.   If there is shrinkage then average expectancy increases beyond 30 months.  Dean felt that with my current state of health, my ability to tolerate the chemo so far, and that I have not had prior chemo indicate that I would have a better than average chance of extending beyond the normal time.

I guess the only down side to the meeting was that I am feeling very tired and somewhat ill at the moment, I have not recovered to the same extent as I did after my first chemo treatment.  The oncologist said that was to be expected and it was likely I would get progressively worse.

MRI Results

We went to the oncologist meeting today, as expected we met with a medical registrar as my oncologist is on leave.  Unfortunately the MRI results are not clear as to whether the other 3 small lesions in my liver are cancer mets or not.  Further, it is not clear at this stage as to whether it would be possible to resect (cut out) all the lesions, due to their dispersal in the liver, if they are all mets.

The next step, hopefully next week, will be a clinical review by all the specialists as to the next step.  Quite possibly it will be to wait for another chemo cycle or so and repeat tests.

I asked about prognosis and possible quality of life and duration, but beyond confirming the worst state (6 months), the registrar said she did not have the expertise to comment and that I needed to talk to my oncologist.  Hopefully this will happen next week.

The good take out of the meeting is that my medication has been tuned a bit, hopefully my hiccup issues are resolved and I may not get as far down during the first 4 days of chemo.  But overall, the news was not what I had been prepared for, due to a lack of clarity about the diagnosis.

Writing this, the shaking continues.  There have been 3 or 4 aftershocks in the past 10 minutes.  We have come through the past 2 days with only light cosmetic damage to our property, unlike the majority of Christchurch houses.

A Wee Bit Better

Overall I am doing somewhat better than the first round of chemo, partly because I have a better idea of what is going on, plus the 5FU infusion pump emptied in time at around midday on Friday, so I am a day further along than last time.

So how did it go:

• Wednesday, morning at hospital getting the chemo, home about 1:00 PM, feeling fine, could have gone back to work at that stage, but started to feel ill later in the afternoon.  Head was OK, able to do some work
• Thursday, progressively felt more ill.  Later in the afternoon I really struggled to focus
• Friday, quite ill, brain really mush, found that emails I had sent Thursday afternoon were largely rubbish (more than usual).  Felt bloated and near nauseous through Friday night
• Saturday, pretty much bottomed out, started to move around and starting to think ahead by late afternoon.  Highlight of the day was Crusaders beating the Blues
• Sunday, really feeling better, constipation resolved (best not to go into that), started to get some stuff done at home, but quite weak and frequent rests.

Reading the paper, there is quite a bit of attention to colon cancer at the moment, one person going though the same performance commented "In the days following each session of chemotherapy, it feels as if life is draining out of here".  I can relate to that.  There are times when I wonder if I really have what it takes to get through 6 months of this, but within a day or two I will be back to a fairly positive frame of mind, it must be hard on Teresa though.

I tried to change my Tuesday appointment with the oncologist to another day, it really causes a clash with work.  However this was not practical, and I found that I will be seeing a registrar on Tuesday as my oncologist is away for the week.  That is a pity as I had hoped to go into some detail of the prognosis and next steps.

Round Two Starts Today

Today I start my second round of chemotherapy.  This means about four hours at hospital with a couple of two hour sessions on a drip, then an infusion pump is fitted for two days.

Overall I am feeling pretty good.  I have dry lips and mouth and I have sensitivity to cold, but nothing significant.  Yesterday I would have comfortably done a full day at work, except that I had to be at home at 4:00 PM to have my PICC line dressed by Nurse Maud.  The nurse also took blood for testing prior to my chemo today - to make sure my blood count is OK.

The trip to Glentunnel did not turn out as well as we had expected.  The weather was generally cold and wet and my sensitivity to cold meant that whenever I went out of the warm caravan I felt ill.  I recovered quite quickly but it was not pleasant so we came home Sunday morning.  We still got some good rest and sleep though.

The next big event should be next Tuesday when I meet with the oncologist again.  We are expecting a formal prognosis and the next stage of the treatment plan.

Message From Glentunnel

Thanks to all who have reminded me that I have not posted an update for a few days, it does make me feel a bit special and the effort of updating the blog more worthwhile.  However my main objective of writing this was to act as a journal that I can look back on, if it informs and helps others facing the same challenges then that is a bonus.

The past few days since Monday have been good, with every day better.  I have felt pretty damn good since Tuesday, way better than I had expected, but I do have problems with energy.   Yesterday I was able to be at work from about 8:30 until 4:30, from today I likely would be back to my normal work day, beginning at 7:30 AM.  However I took annual leave today to take an extended break in our caravan in Glentunnel, next Monday is a public holiday in New Zealand.

Getting back to work has proved to be a rather interesting experience, at least for me.  Because I know that I am going to be away from work, and I really don't know what the future holds, I have been very focused and have prioritised based on what I can do to really make a difference.  The results have been very good from my perspective, I seem to be working in much the same way as I used to several years ago and sailing over the top of delays and anything that disrupts.  Not sure if others around me feel as good about it though.

The MRI scan was interesting, not quite as I had expected.  The actual scanning process took longer than I had expected, I was "in the tube" for about 45 minutes in total for the main scanning.  The other thing I had not expected was the way the I was moved back and forward during the scan to centre the specific lesions under the scan, unlike the CT scan which is pretty much a one pass activity.  The scanning was in two stages, most of the time was taken with the back and forward process, and I had to hold my breath during many the actual MRI processes.  There were several of 20 seconds each, for me at least, 20 seconds is a long time to hold my breath.  Good practice for working and listening, I guess.

The next stage was to inject a tracer and do about a 5 minute rescan.  Then 2 hours later, repeat the process.  The objective was to determine if the small lesions that had shown up in the PET scan were cancer or not.  If not, the cells were likely to be a benign lesion of some sort, which would have compromised liver cells which would not process the tracer in the two hours so still show up after 2 hours.  If they were cancer mets the cells would be active and process the tracer and not show up in the same way.  I expect to get the results of this scan during my next chemo session next Wednesday.

So looking forward to a quiet weekend, among friends if we choose to socialise, or much reading and sleeping.

The Journey Continues

If all had gone to plan, I would have visited the oncology unit last Friday and got my infusion pump removed and then no more hospital visits until Wednesday 8th June when my next round of chemo starts.  But plans are made to be broken....

First up, last Friday morning Teresa took a call from radiology at the hospital, my oncologist has called for an urgent MRI scan, this to take place this afternoon (Monday).  Then when we came to remove the infusion pump we found that it was not yet empty, apparently one of the lines was slightly kinked, so back to the hospital on Saturday to remove it, fortunately it was well empty by then.

Overall, Friday and the weekend was not one of my better times, I felt quite ill, I suspect I have got a cold or similar virus, and I felt very tired, listless and depressed.  Yesterday I started to move around a bit more and today I am feeling a little better, except that I have very bad diarrhea - a normal consequence of chemo.  I have drugs to counter it and they appear to be mitigating the worst of it.  Other side effects of the chemo I currently have are dry mouth and throat, tingly lips and sensitivity to cold on my hands and mouth.  I continue to have real problems focussing my brain, reading is a pain, about 2 pages of a book is the most I can comprehend at once.  I understand this is commonly called chemo brain.

While at the hospital last Friday to attempt to remove the infusion pump we were told that we must not leave until the oncologist had caught up with us.  I assumed this was something to do with the urgent MRI scan.  When the oncologist arrived he was unusually positive, apparently the PET scan had confirmed the tumors in my liver and lung, and while there was a couple of other abnormalities seen in my liver, there was no additional indications of cancer in my body.  This is VERY positive, I had been prepared for additional small mets in lymph nodes or elsewhere.  The objective of the MRI scan is to quantify the other abnormalities in my liver and determine if they are likely to be mets or not.

Both Teresa and I got the opinion from the conversation that my liver surgeon is probably sharpening his scalpel at this time.

The MRI is a bit of a challenge.  The scan is scheduled to start at 2:00 PM and take up to 1.5 hours.  However I can have no food or drink 4 hours in advance and the main scan is to be followed by a second one 2 hours later.  It will be a long day.

Hopefully I will be spending some time at work this week, and really looking forward to a long weekend away in our caravan next weekend, however at this stage it is all about waiting to see what actually eventuates.

No Longer Chemotheraphy Naive

Chemotherapy Naive is a term used by oncologists to describe people who have not experienced chemo.  It is a good place to be in, unless you really need it.

Earlier this week I got a 3 page "summary" from the oncologist, detailing his diagnosis and the treatment plan.  It was a really good and informative note, but his assessment that my case constitutes "incurable disease", caused a double take.  Logically I was aware of it, but seeing it in print was hard.  My actual prognosis is not discussed, I would like to get a bit further down the track before thinking about that.

The PET scan was done yesterday, it was a long drawn out process.  In order to work effectively I needed a minimum of stress and activity in a quiet room to allow the radioactive tracer to find its way to high areas of glucose uptake.  Cancer normally uses a lot of glucose due to rapid cell multiplication so if we can avoid activity and stress, which is the normal user of glucose, the tracer will only go to the cancer areas.  The results of the PET scan should be available after 2 days or so, they then go to my oncologist, liver surgeon and my GP so I will be pestering each of them on Friday until I get an answer.

Today started out tough, we were both quite stressed in anticipation of the chemo.  However it all went fairly well.  Even the parking issues at the hospital, which has been a nightmare since the earthquake, did not turn out to be a big deal, more by good luck than good management.

The actual chemo regime (FOLFOX6) has quite a bewildering array of drugs, some by IV via my PICC line and some in tablet form.    Most of the drugs are to counter side affects and enhance the action of the core chemotherapy.  The tablets I take using a fairly complex schedule over 5 days.  There was a 2.5 hour session of IV drugs this morning and I am now on a 46 hour infusion delivered from a pump bag attached to a belt on my waist and feeding through the PICC line.

So far I am feeling OK, a bit spaced out and aware that I am feeling different.  I have had some tingling on my lips and throat after contact with cold air and fluid but nothing significant.  I did take a call about work a few minutes ago and had to do some thinking, it went OK but I did feel quite tired just after.

So what next - most likely I will feel progressively more tired and sick as the infusion goes in and for a further 2-3 days after.  But I may not get much worse and will easily cope, or may get VERY ill, hopefully more the former than the latter, but whatever.  As always, I feel very confident in the support I get from the hospital and they have made it very clear that we MUST call them at any time if I am uncomfortable about anything.

Not A Great Day

Yesterday Teresa got a call from Southern Cross Radiology, I am booked for a PET scan next Tuesday.   With chemo due to start tomorrow (Friday) this a is a bit of a problem as I should have a PET scan before chemo starts, as a base for comparison, and the scan won't work properly with fresh chemo in my system.

This sort of uncertainty upsets me, plus I had quite a difficult day at work yesterday that flowed into today.  So I started today with a curdled brain and feeling really stressed and anxious.  The logical side of my brain was OK, knowing that all would be sorted but I could not seem to get through to my "other" side.

Today started out with a phone call from the radiology clinic, asking lots of questions and giving me lots of prep and after care information - all good and fine.  But they also made it clear that I should not have chemo tomorrow, as planned.  At their recommendation I called the oncology unit to try to sort it out, I had planned to call anyway.  The nurse I spoke to agreed that it did not seem right to have the chemo first but needed to confirm the situation with the oncologist, who was out of town.  She would keep trying him and get back to me.

In  the meantime I went to the hospital to get the PICC line installed.  This all went OK, the only minor issue is that it is in my right arm instead of the left arm.  I had been told prior that it was likely to go into my left arm as I am right handed, however the nurse doing the job explained that it would really have no impact on the use of my arm and the route in was a bit shorter and easier via my right arm.  I am all for simplicity so right arm it is.

After leaving radiology for the PICC job we went to oncology.  We had to deliver documents from the PICC insertion to oncology and I was looking forward to trying to sort out my chemo start date, which we did.  They had been in touch with the oncologist, my new chemo start date is now Wednesday 25th May and I seem to be on a Wednesday cycle now.  This may well have an impact on working time, but I am not too fussed about that now.

Had a wee rest this afternoon and got some good sleep, I have not been sleeping well for 10 days or so.  I am feeling quite a lot better now.

Here We Go Again

My CEA results have been increasing since the beginning of the year.  Last check was 6 April and that was 6.8, up from 2.7 3 months before.

Our GP referred the CEA test results to the local hospital and shortly after I got a request for a CT scan and more blood tests.  Last Tuesday we met with my oncologist who gave us news I was not expecting, the scan shows a 2.9cm lesion in my liver, close by the previous resection, plus a 1.6cm lesion in a lung.  I had either expected no visible CT scan result with that CEA level, it had to get to 20 last time before a tumor was visible, or maybe a small tumor.

I certainly was not prepared for two organs to be affected.  The lesions are 99.9% probably cancer mets.  The big issue is that normal protocol is not to have immediate surgery when more than one organ is affected, but to use chemo to shrink the tumors, if possible, and see if any other tumors appear.

So last week I met with the oncologist, next day the colo-rectal clinic (I am primarily still in their care), then  attended a chemo training session, to help Teresa and I understand the side effects, how they are dealt with, what to watch out for, and how the process works.

Next thursday I get a Pic Line installed, then the following day I start 12 two weekly cycles of chemotherapy, using FOLFOX.

Felt really down last Tuesday, when I got the news, but feeling somewhat better now, thanks to amazing support from Teresa, Christchurch Hospital and my employer.