Like a knife through hot butter

So I saw my surgeon this morning who advised me that 18th March is the big day for surgery. “That’s all very well and good”, I hear you say, “but what are they actually going to do to you?”. Well, read on and find out. I apologise in advance as there will be some measure of detail, some diagrams, and maybe even a picture of a rectum or two just for shits and giggles.

The official name of my operation is a Total Mesorectal Excision (TME) performed by Low Anterior Resection (LAR). Sounds fancy eh. For some time now it has been the gold standard of curative surgical intervention for advanced (read lymph nodes involved, not metastatic) rectal cancer, and when combined with neoadjuvant chemoradiation, reduces the incidence of local recurrence (i.e. the cancer coming back in my ass) to <5%. That’s a good thing, because my pelvis is already irradiated to buggery and as much fun as I had with Zeus, I’d like to never see him again.

Unfortunately, because my tumour is ‘bulky’, and notwithstanding that it has shrunk and will likely continue to shrink, my surgery will be a combination of ‘open’ and ‘laparoscopic’. The diagram below shows the difference in terms of the incisions and ultimate scars. At best it’ll look like a snake going down to my man bits, and at worst it’ll look like I have an ass crack on my stomach. Anyways, better to have two asses than be dead. On a positive, I’ll be sure to shave the pubes:

Wounds

A quick anatomy lesson

The image below shows the large intestine, or colon. You can see that it is made up of various parts, with the rectum being the poo warehouse before dispatch, and the anus being the turd-cutter.

The colon’s principle job is to remove water from waste, and to move the turd along until it’s time to drop the kids off at the pool. The large intestine is pretty big, measuring about 5ft long, but is dwarfed by the small intestine, which measures on average, 20ft long.

The dark shaded part is what is removed in a LAR, although, as is the case in every instance, the actual bits removed will vary:

LAR.png

My tumour is more towards the top of my rectum and so they may not remove as much of my poo warehouse. The trade-off is that the surgeon will probably take a little bit more of my sigmoid/descending colon just to be on the safe side.

Because it looks like some lymph nodes have been compromised, they will also take out a large portion of surrounding tissue (read: fat) called the mesorectum. The image below shows the approximate plane of tissue that will be removed:

TME

The final part of the operation is to take a medieval looking torture implement and staple the healthy part of my colon, to the healthy part of my rectum, a procedure called ‘anastomosis’. The device itself looks like some sort of demonic dildo that has double rows of staples within it which creates a double seal, reducing the risk of a leak. They then flood my abdomen with water and pump CO2 up my ass like a reverse fart, to test for leaks, just as you would when repairing a bike inner tube.

Below is the ass stapler:

Ass-Stapler

Hopefully, my surgeon can read Japanese(?) and he knows that the bit on the left goes up the date and not the handle. The cap on the far left is stitched into the healthy part of my colon and the rod part from it marries up with a bracket in the long bendy part. Once they are paired up, the handle is pulled and a double row of staples are fired, creating a perfect (hopefully) seal.

Unfortunately, the fact that I will have an open wound in my sewer canal means that I will have to have a stoma while the anastomosis heals. Fortunately, it will only be temporary, and will be reversed after I finish my post-surgery chemotherapy. After that I’ll be able to poo again, albeit a little bit differently.

What is a stoma

A stoma is basically an opening of an internal organ to the outside world. The most common, and relevant ones in terms of this type of surgery, are colostomy’s and ileostomy’s. A colostomy comes from the colon itself and is more often than not permanent. The waste it removes is more like the turds you are used to seeing when you check to see whether you did a phantom or a floater.

I will be having what is called a ‘loop ileostomy’ which is where they remove the final part of my small intestine, the ‘ileum’ out through my stomach and sew it to my stomach creating an opening through which liquid waste can be expelled into my ‘bag’. I will have to have it for at least 3 months but in light of the fact that my chemo will go for at least 4 months, and my surgeon isn’t keen on digging around in my insides while there is poison in there…I know, what a pussy right, I will have my bag for c 6 months.

Below are two images. The first is roughly what a stoma looks like and the second shows what I will look like with my bag:

Stoma1

Stoma3

I am trying to think of a name for my stoma/ileostomy bag. At this stage I am leaning towards naming it after a defence solicitor who, given he is full of shit, lends his name quite well. I will refrain from naming him here but those who know and work with me will have a pretty good idea who I’m talking about.

Will I ever be able to poo normally again?

The short answer is ‘sort of’, the long answer is ‘probably not really’. As explained, the large intestine’s main job is remove water from the stool, making it more solid. It then travels through to the rectum where it is stacked and stored until it is time to ship out.

The result of losing a portion of both my colon and rectum is that there will be less water removed and less storage space. That combination means that I will need to have a pretty good idea where the nearest bathroom is, and at least at first, there may/will be times when I may not make it. In the meantime, I will be investing investing in double strength undies and mission brown slacks.

How am I feeling about it all?

With all puns intended, I’m shitting myself. The surgery will take 3-4hours and I’ll be in hospital for over a week. I’ll have 4-6 weeks recovery time before returning to work, but it is more than likely that I’ll be back having chemo within a couple of weeks of going under the knife.

Visitors will be most welcome, but in small doses, and preferably only if you have boring stories because apparently it hurts to laugh.

It’s also while I’m in hospital and for at least a couple of weeks afterwards that Lyndell and I will need the most help, and in that regard I’m (read: we’re) so grateful for everything that you wonderful people have done for us so far. It is a huge thing for me to ask for help but in light of the fact that I’ll be a cripple with two asses but who can’t fart, I need to suck up my pride and ask for a little assistance.

So now we’re all up to date. I’ve finished my treatment and will now be focusing on giving the body a rest from the rigours of treatment, and getting strong and fit so that surgery is smooth and my recovery is smoother.

Until next time folks, be kind to your colon’s, and each other…

 

 

A day in the life of – Chemoradiation (CRTx)

As I near the end of my chemoradiation, I thought that I would do a day in the life of, with a bit of info about the radiation aspect of it in particular, because it’s interesting as hell.

Most of my recent treatments have been in the morning, which is good on the one hand because you get it out of the way early and then have the day to yourself but on the other, it’s fucking brutal having to fill your bladder so early in the morning and hold it. It also means that I piss like a racehorse for the rest of the day. Adding insult to injury is that despite the best intentions of Zeus in attempting to spare my bladder, it still cops some of the radiation, which means that each piss is accompanied by a not-so gentle reminder I’m unwell, in the form of a hot poker to the bladder.

Chemo

As per a previous post, the chemo aspect of this side of treatment is pretty easy. I take three of these puppies in the morning and again at night, within half an hour of eating. Sounds simple right? It is, except for “chemo brain”, which is an actual thing I’ve found, which sometimes makes me cut it pretty fine in terms of sneaking into that 30 minute window.

Below is a pic of the tablets:

Xeloda

As discussed, this is a pretty fucking smart drug. It is almost completely inert until such time as my liver converts it to Fluorouracil or 5-FU, which then travels directly to the tumour itself, where it basically tricks the tumour into giving it a hug and then it kicks it in the balls and steals it’s lunch money. OK, so it doesn’t commit robbery, but it does interfere with the DNA/RNA of the cancer cells which prevent it from reproducing. If it can’t reproduce, then the tumour can’t grow. It also works by starving the cancer cells of nutrients they need to just continue being cancer cells. That also leads to cell death and as the DNA is fucked, they can’t replicate and so the tumour shrinks.

Where it really comes into it’s own though is the combined effect it has with radiation. Tumour cells don’t like being irradiated at the best of times, and they like it even less when they’re struggling for life. Kind of like almost drowning, and just when you get to the edge of the pool, some bastard kicks you in the face and holds your head under water until your name is changed to ‘Bob’.

Fortunately, of all the side effects that Xeloda can cause, the only unwelcome visitor I have had to endure is fatigue. The fact that I am coming to the end of the treatment and have escaped the more sinister symptoms is a huge relief, kind of like doing a a really big poo for the first time in months, which also happened recently, but thats another story.

Full to the Brim

An hour or so before treatment, I start to drink as if I’m in a bar and they’ve just called last drinks, or pretty much a Tuesday afternoon.

It takes between 30 and 45 minutes for water to reach the bladder according to various websites. I thought during the first round of CRTx that I had shortened it to around 15 minutes but eventually realised that wasn’t the case, and that it was rather a ‘trickle down’ effect.

Prior to starting treatment, I had a ‘planning CT’ scan. Unfortunately for me, I took their advice to have a ‘full bladder’ to the extreme and turned up resembling the Hoover Dam. I now have a new found respect for my wife, having to endure multiple ultrasounds when pregnant with our spawn. Unlike my wife however, I have become the master of the ‘strategic wee’ and am able to let out little bits at a time so that my bladder is still full enough for treatment, but not so full that the therapists have to wear wellingtons while cleaning up the flood that was my bladder.

Radiation

Anyways, they take that CT image, and fuse it with the staging MRI I had following the diagnosis to make a incredibly detailed, 3D image of my pelvis. Going throughout that image are a number of different coloured lines showing the directions of beams that Zeus will administer from, and different coloured ‘clouds’ which show the principle radiation zone, as well as the areas that they administer lower doses to, such as areas where my lymph nodes are, to make sure that nothing is left behind. The end result is that my pelvis will resemble Hiroshima at the end of treatment…barely inhabitable and forever stained with the blood of Miguel (I don’t know whether any of the victims of Hiroshima were named Miguel – I suspect not).

Treatment itself is a walk in the park, most days.

I try to avoid eye contact with the other patients in the waiting room except for Terry. He’s a good bloke who has rectal cancer as well. I gave him my paper once after I had finished with it and now I am his best friend. I think he has a ‘radiation shirt’ in much the same vein as I have my ‘chemo’ shirt because he’s always wearing the same thing.

Anyways, it’s somewhat surreal sitting in the waiting room of a radiation oncology clinic. But for two other people, each of whom I saw once and never again, I am by far the youngest person in the room, and by a long stretch as well. People are shocked when I tell them the type of cancer I have because, as you might have noticed, I’m not a 65 year old man.

Then, often as they are about to enter the final round of a game show I’ve been annoying the other patients by answering the questions aloud, before the question is even finished, my name is called and it’s show time.

I lie on a gantry, on my back, place my legs in a custom mould and pull my pants down so that the elastic of my underwear is just covering the top of my shaft. The therapists are kind enough to hold a towel over me so I can retain what little dignity I have left as they shunt me and twist me into the optimum position, and so that the three tattoos they gave me during the planning stage (one on each hip and one on the front of my pelvis, right above my shaft) are lined up with the lasers that bounce around the room.

The lights are off at this stage and it’s kind of like being at a rave, except that I’m not drunk and I need to wee. Once, one of the therapists touched my penis. I’m sure it was ‘deliberately accidental’ but since she is helping a brother out and helping to make me better, I didn’t make a big deal out of it. The lights come on and the therapists flee the bunker like rats from a sinking ship.

On a good day, they only take a couple of quick x-ray images of my insides before the radiation treatment begins. On a bad day, they do a full 360* ‘cone-beam CT scan’ which itself only takes less than a minute, but ends up adding between 3 and 5 minutes to the total time because the therapists then need to check everything.

It’s then a waiting game, and this is by far the worst part. You lie there, perfectly still, looking at the illuminated ‘Caution – Radiation imminent’ sign near the door and hope that it remains illuminated. If my bladder isn’t full enough or I haven’t dropped the kids off at the pool and my ass resembles a Tarago then the light goes off, the door opens and I know that I’m in for a long day.

On good days, and fortunately I’ve only had a handful of bad ones, you feel the gantry being moved remotely and it locks into place. Then the fun stuff starts.

Most of you reading the blog will have seen the video I posted of my mate Zeus and I spending some quality time together. In total, he does a full rotation, stopping 7 times to hit me with his rhythm stick. When the radiation is being administered, it sounds like a swarm of robotic bees. Interspersed with that mechanical drone is a grinding noise as the less in the collimator move, shaping the radiation beam so that it hits the tumour, and doesn’t completely napalm the rest of my pelvis.

Zeus is a linear accelerator, or LINAC for short. He is, quite simply, a fucking marvellous bit of gear. He’s huge, think the size of a truck, but also nimble as Jarryd Hayne as he revolves around me. Basically, he makes x-ray beams, in the form of photons, and high-velocity ones at that. The photons are accelerated from the body of the machine, into the arm which holds the head, before being directed through a series of buffers and into my ass.

Inside Zeus’ head is what called a ‘multi leaf collimator’, sounds fucking impressive, right? Below is a picture of what I’m talking about, because it makes it easier for you to grasp if you can see what I’m talking about:

Collimator.jpg

The ‘leaves’ are those metal stick looking things and they move. As you can see from the image above, that machine is probably irradiating an apple. In all seriousness, those leaves move while the radiation is being administered, to shape the beam to make sure it goes where it’s supposed to, and doesn’t go where it’s not.

Each pass Zeus makes lasts between 25 and 33 seconds. After he does that for the seventh time, the warning light goes off, the door opens, I pull my pants up, jump off the gantry, exchange pleasantries and sprint to the toilet, or, if I have done a strategic wee before hand and don’t feel like I’m about to do the reverse Moses, I ask mundane questions which allow me to provide the information contained herein.

Anyways guys, this was a longer post, and if you’ve made it to the end, you should be applauded.

Until next time, be kind to your colon, and each other…

The China Syndrome…

is a fictional 1979 movie starring Jane Fonda, Michael Douglas, and Jack Lemmon. It’s premise is a news reporter and her cameraman (Fonda and Douglas) film a simulated emergency shutdown of a nuclear reactor. In typical Hollywood fashion, something goes awry.

For those not in the know, nuclear power is generated by radioactive elements, generally uraniam, which is ‘reacted’ to create heat, which in turn creates steam, which turns a turbine and you guessed it, creates electricity.

The premise of the China Syndrome, and hence it’s name, is that if a nuclear reactor were to explode etc, then it would melt through the earth to China, similar to the colloquial, ever efficient digger.

The reason I raise it is that my pelvis presently resembles a malfunctioning nuclear reactor. You know those wheat packs that you put in the microwave and then put on a sore muscle etc??? It’s like I have one of those permanently implanted in my pelvis. It doesn’t so much hurt, more, a constant reminder that I’m having some serious treatment.

Another side effect stems from the fact that my bladder is hit by the radiation, notwithstanding the best effort of my RT’s in shaping the radiation beams around the important bits. I’ve never had the clap, but I imagine that this is what it feels like. Not quite pissing razor blades, more like liquid lava with bits of jagged, semi cooled chunks in it.

Another less-PG side effect is diarrhoea. It. Fucking. Sucks. In one session today I did three courtesy flushes and still the sludge flowed like i was delivering concrete. Even worse is that it itself burns. Your stomach churns like an old witch tending to her cauldron and then next minute, my asshole resembles Mt Vesuvius.

The main side effect is fatigue. As discussed in an earlier post, prior to experiencing it I didn’t think it existed. It’s fast and silent in it’s approach, much like a gagged ninja. I spent Monday of this week on the couch, which in itself wasn’t a bad thing, I watched some US college football and generally convalesced like a lad of leisure. When it hits though it’s profound. I’m talking about not being able to physically get up off the lounge, bed, floor. I’m talking about falling asleep all over the shop like a narcoleptic taking stillnox and a valium just for shits and giggles.

And so completes my first block of chemoradiation. Other than the radiation side effects and some very mild effects from the chemo tablets I take, I’ve again escaped pretty much unscathed. Touch wood that continues.

Until next time, channelling Jerry Springer, “be kind to your colons, and each other”.

By the Beard of Zeus

I don’t believe in God. I never have. Religion is a wonderful thing when it provides hope to people who need it, but it can also be a veil behind which hypocrisy, hate and evil can hide, misinterpreted, either accidentally or deliberately, for peoples own selfish gains.

At school, and indeed at home, because my mother was an Ancient History teacher, I learnt about a different type of God(s). Namely, the Gods of the ancient world. Now, in light of the previous paragraph, I’m not so foolish to think that people many moons ago didn’t do some fucked up shit in the name of Thor and Anubis. I mean, sacrificing virgins to curry favour with some imaginary, all powerful homies is the epitome of insanity.

Anyways, today I started my chemoradiation block.

Chemo

In terms of the chemo, it’s pretty easy. I take 3 tablets of Capecitabine (Xeloda) morning and night. Capecitabine is a pretty fucking smart drug. When it is first consumed, it’s pretty much inert. It is then processed by my liver and travels directly to the tumour itself, where it is then converted to Flourouracil (or 5FU), which you may remember is the shit they pump me full of when I bring Optimus home in my crocheted bag. Here is the kicker, the tumour itself actually converts the drug to 5FU. It basically converts it into a drug that will end up killing it. It’s like suicide for tumours.

The mechanism of Capecitabine/5FU on the tumour is two-fold. Firstly, it prevents the cancer cells from reproducing (which is what they do best) by starving them of the nutrients they need to do so, and also destroys their DNA and ability to replicate themselves, causing cell death. The cells that don’t die, are substantially weakened, and that’s where Zeus come into the equation.

Radiation Therapy

Radiation Therapy, or RT in the buziness, is exactly what the name entails. A huge, kicks machine creates radiation, which is then directed through specifically created beams, to the the area for treatment.

The machine that does all this magic is called a linear accelerator, and it’s huge. Think about the size of a prime mover and you’re in the ball park, although it looks more like something out of a Transformers movie.

It’s a difficult thing to describe. It has a huge body and then protruding from it is the central arm which has a large disc on the top of it. That’s the part that houses the ray gun. on either side are two arms which operate an x-ray which can take scans during the treatment in real time, to make sure that the beam is going where it’s supposed to.

Anyways, the name of my linear accelerator is ‘Zeus’. I couldn’t think of a better, more apt name to give such a beast of a machine, and although my mum won’t be able to express her excitement due to her medical condition, I know that on the inside she’ll be just as chuffed as I am 🙂

Actually having RT is a piece of piss, almost literally (I can say that after having a whole single treatment LOL). Because I am having radiation administered to my pelvis, I have to have a full bladder. Today, eager to impress on my first day, decided to go all out, to the extent that when the time came to jump on the thin plank-like gurney, it almost came all out.

Fortunately, my RT’s were an awesome bunch of young fellows who were kind enough to let me keep my undies on (although pulled down to above the schlong – but covered with a sheet for my modesty and their safety) and didn’t try and touch my dick. Maybe tomorrow it will be a female therapist and I’ll get lucky, you never know.

Anyways, they put you on a gurney and whack my legs into a custom made cast so that I’m always in the same position, push and pull me to make sure the laser beams line up with the tattoos they gave me previously (see below) and then tell me they’ll see me in a little while. They then run to a bunker, and I’m not making that up. It’s literally called the bunker.

At the planning stage of the process, they placed 3 pinhead sized tattoos on me that they use as reference points for each treatment. Now you won’t see any of the techs on ‘Tattoo Nightmares’, but you’re sure as shit not going to see them on ‘Ink Master’ either. They’re fucking tiny, and a total disappointment. The only cool thing about them is that I hope to have them converted into a ‘connect the dots’ style tattoo when this whole sorry saga is behind me. Maybe i’ll get some sweet constellation, or perhaps the face of Zeus, that would totally be fitting.

Back to the radiation itself. It’s completely painless other than the feeling of my bladder stretching to the point that it resembles the Hoover Dam (that’s a big ass fucking dam in the USA if you didn’t know – it’s even been in movies and shit). The x-ray arms extend first and take some scans. It kind of looks like Zeus is reaching out to try and hug you, only to take photo’s of you with your pants down like a dirty perv. They then retract like I’ve got cancer and it’s contagious and Zeus himself gets to work. The head starts on my lefty side, below my hip and the buzzing noise of a thousand robotic bees tell me that I’m being irradiated. That continues for about 30 seconds or so and then the head moves around a short distance, before stopping and delivering another dose of gamma goodness. It continues to revolve around me until it reaches the equivalent of it’s starting position on the other side, and then we’re done. The warning light goes off, I see people come in and I’m allowed to pull my pants up like a sullied maiden.

Seems pretty easy, right. It is. I just have to repeat it another 24 times and I’m done.

In terms of side effects, it can cause nausea, diarrhoea, fatigue, hairloss and skin sensitivity to the irradiated part of the body (saves me waxing the crack), painful pissing like I’ve got the clap, and the general feeling that my insides have been microwaved, which they have. Apparently, they’re cumulative, which, for all my simpleton friends, means they get worse the longer the treatment goes on. That’s why I only have it weekdays (again, cancer doesn’t work on weekends guys) and have a break between the two treatment block. I should add that the ‘break’ consists of a week of chemo immediately afterwards, and then a proper recovery week before we start the fun all over again.

I’ll close by reporting on a really positive meeting with Sofia Vergara (my South American oncologist Giovanna something) after my RT. She confirmed that my blood test results were good and she was happy to hear that I hadn’t really suffered any side effects, other than fatigue, from the first cycle of chemo. She confirmed that the first cycle was generally the worst, and that the fact I had escaped relatively unscathed put me in good stead to survive the remaining cycles in a similar vein. I also reported that the physical symptoms of the cancer itself had disappeared and she reported that that was also a really good sign, as it means that my tumour is one of the ‘good’ ones, which is receptive to treatment.

Armed with that good news and with only a few happy tears having conquered Day 1 of RT, I had 2 toasted ham, cheese and tomato sammy’s for lunch, fired rice for dinner, and a large ice-cream from ‘Cold Rock’ for dessert.

Until next time, be kind to your colons 🙂

I’m a SHAMcer patient/The calm before the Storm

So I bitched and moaned about how tired I was at the end of my first cycle of chemo and then tried to turn the tables by saying how fortunate I was in the grand scheme of things. What a piece of shit thing to do, trying to scam sympathy like that…

On a positive, the last post broke records for reading both in terms of numbers and countries reached. The fact that my blog was read in Kazakhstan on the one hand filled me with joy, knowing that my good mate was there for work, and on the other hand crushed any hope that a Kazakhstani child had built a potassium (it’s their largest export) powered modem/router and was viewing my blog.

Anyways, this week has been good. Fuck it, it’s been GREAT. All of the shitty stuff Miguel did to me  in terms of symptoms, has gone. Not better. Not more manageable. Fucking. Gone!

Doing a normal shit has never been so liberating.

The fact that I rebounded so quickly and consistently from such a low (I say that acknowledging that at present I’ve barely joined the VIP queue to get into hell, let alone experiencing any of its layers) and have maintained that level of awesomeness has made me feel bad.

‘Bad’, I hear you say. ‘What a fucktard’ is another thing I imagine is being bandied about, if not by the readers of this blog, then certainly by those fellow unfortunates who are presently walking the same (same same but different) path to me, and who glare at me with green eyes due to my portacath as opposed to the web of tubes encompassing their arms.

I feel terrible that when I go to have Optimus removed and the nurses ask me how I am, I reply ‘Great’. And not just because I’m getting rid of an figurative anchor, but because that’s how I actually felt.

Sure, the end of that week was shitty: I struggled to get off the ground; I sat in the shower for a good 20 minutes trying to stand up; and I don’t really remember Saturday.

But this week has been good. Really. Fucking. Good. So good I feel like a fucking sham!

The week culminated in work drinks, like most weeks do. Nothing unusual other than the fact that I felt normal, whatever the fuck that is, compared to a deflated clowns balloon the week before.

It was great. One of my colleagues commented that I didn’t look unwell, which is something that I am fortunate to still have in my arsenal. I will unlikely be so fortunate in the future.

And so I had a beer. And then another. And more still.

And I might feel it tomorrow, or the day after. But if if I do, I suspect it pales into insignificance when compared to the next month of treatment that kicks off on Monday.

I’ll sign off with a quote by Helen Keller, kindly passed on by my wife’s cousin:

Character cannot be developed in ease and quiet. Only through experience of trial and suffering can the soul be strengthened, ambition inspired, and success achieved.

I’m a ranga and thus have no soul. This blog debunks any myth that I’m anything resembling quiet. But at the end of this caper, maybe I’ll have some character, as opposed to being one.

Bring on the storm…

Folfox, 5FU & Fatigue

I should preface this post by saying it’s lengthy, and a bit technical. It is also a bit blue towards the end. If you want something less onerous and with a little more bounce, then go back and read about the awesome wank I had, otherwise, press on. Having read through it before publishing, it also loses it’s pizzazz about halfway through. I’m blaming the time of day and fatigue…and hey, cancer 😉

I’ve just finished (officially) my first week of chemotherapy. I say officially because the week is actually over and a fresh week starts tomorrow. In actuality, although I stopped having my chemo on Wednesday, chemo finished me yesterday (and Friday).

A previous post gave an overview of the treatment program that my oncologist/radiation oncologists have prescribed. Having now completed my first chemo cycle, I thought I’d give you an insight into what that week was like.

My week started on Monday, and it was reassuring to know that cancer kept normal business hours. I attended the day treatment centre at at Calvary Mater Hospital and assumed my seat on the blue pleather throne that are synonymous with chemotherapy.

First they removed the dressing from my portacath, admiring the handiwork of the surgeon who installed my hardware, with phrases such as “look how clean the incision is”, and “I can’t believe this is four days old”. Apparently, the preferred course is for patients having portacaths to have them installed some weeks before starting treatment, if for no other reason, it substantially lessens the chance of infection. Infection is bad at any time, when you’re being routinely poisoned, it can be fatal.

Anyways, having generally been given the impression that I have some form of superhuman healing powers, the nurse begins unpacking multiple bags which are sealed more tightly than Duty Free booze at the airport. The trolley is scrubbed, twice, and everything is laid out in a specific order, as though we are about to sacrifice a virgin on the altar of Olympus. If on;y we were sacrificing Miguel there and then.

The nurses discuss what size needle to use to access my port. They disagree because while there is some localised swelling and bruising, they don’t think they’ve seen a port settle quite as nicely as mine. It’s quite flattering being complimented on something that you have no control over whatsoever. They decide on 3/4″. If that sounds big, it fucking is.

The needles used to access the port looks like a record player needle. with a block housing from which a needled drops vertically, and which is tapered at the end. I can assure you that when they access the port with the needle, there is some music, as the wind is sucked from my lungs past my vocal chords like a cross between a banshee and a banjo. And then, nothing.

No pain, no discomfort. Nothing. Other than an a slight pulling feeling from the dressing which is put over the needle to secure it in place, nothing.

They start the infusion process with two non-chemo agents. Don’t kid yourself though, these fuckers are just as important as the hard stuff. One is a hardcore, slow release anti-emetic (anti-nausea) and the other is a steroid agent, which boosts the efficacy of the former.

Palonosetron is a highly effective anti-emetic drug. It basically works in two ways. Firstly, anti-emetics work by keeping your digestive system moving quickly so that food doesn’t sit in your stomach for very long but principally, it blocks certain receptors in your brain from thinking that anything untoward is happening: “Move along, nothing to see” type thing.

Dexamethasone is a steroid which works in tandem with the Palonosetron in their ruse against the body. It blocks the release of substances which cause inflammation, again tricking the brain into thinking that there is absolutely nothing wrong, despite the fact that a garage of toxins are about to mainlined into one of the largest veins in the body.

Those take only a matter of minutes, and then the fun stuff begins…

FOLFOX stands for Folinic Acid, Oxaliplatin, and Flourouracil (5FU). It is the gold standard for advanced colorectal cancer. If you decide to do some research on FOLFOX having read this post, please don’t be alarmed when you read that it is almost exclusively used for metastatic cancer. There is no evidence to suggest mine has spread yet, and in fact the brutal regiment they have me on is to ensure that it doesn’t. The internet is a great place, but it’s also a mine for anxiety etc.

They start with the Oxaliplatin, and probably for good reason. As far as the chemo drugs they have me on, this one is a bitch. It’s the one that has a ‘side effects’ list longer than the Amazon, and none of them are nice. Fortunately, because the regimen they have me on is somewhat’tweaked’ from the norm, I only have to take it during chemo weeks, and not when I’m having radiation, and so I may not suffer as badly as many who have gone before me.

The Oxaliplatin looks meek enough. It’s just a clear liquid, hung on an IV post. The only evidence I have that I’m actually taking it is the reassuring beep that Baxter (my IV pump) makes and the fact that the bag gets smaller, minute by minute. The Oxaliplatin takes a fair amount of time to get into you, principally I suspect because they want to slow it down to a rate that won’t make you consider death as a viable option. In any event, the constant checks from the nursing staff and reassuring words are such that you have a long time to think about the possible onslaught that may be around the corner.

The main side effects of Oxaliplatin are nausea, vomiting, neuropathy (tingling in the hands and feet), hand and foot syndrome and extreme sensitivity to temperature, particularly cold.

Hand and foot syndrome is something I am really not looking forward to, but hopefully, as I said above, the way in which I am having it may go some way to minimise the effects I’ll face. Basically, my hands and feet become super sensitive and swell like a dead hippo in the savannah. Needless to say, cracks abound and life is generally unpleasant. So far so good, but ewe’ll cross that bridge when we come to it.

The temperature sensitivity is something that I experienced, and while it is uncomfortable, it’s short-lived and in a lot of ways, pretty funny. I can say that because I’m having chemo in summer, and not the depths of a North American winter, where I imagine the experience would be far less jovial.

Basically, for the week I’m having chemo, I have to touch test everything before I put it in my mouth. Hands and feet are faced with arctic strength pins and needles but my throat does not react quite as well. Put simply, my throat seizes up quicker than a stripper denied payment, and I feel as though I can’t breathe. They assure me I can, but that it is a pretty confronting experience. Thankfully, I managed to avoid any throat seizures and can now happily report that beer is back on the menu.

5FU is the abbreviated name, no doubt thought up by a patient who had to undergo chemo and became proficient in ‘fuck’. My first lot of chemo is dispensed at the hospital, via the IV. They give it to you at the same time as the Folinic Acid, which the nurses call ‘the bus’. I queried them as to the reason they call it that, and they assured me that it was due to the fact that the 5FU is a passenger and the Folinic Acid simply takes it where it needs to go and not because that’s what it feels like when it hits you. Good enough for me.

5FU is, as far as I can tell from my reading, far better tolerated than other chemotherapy drugs, and particularly the Oxaliplatin. That’s not to say that it’s a walk in the park, but I haven’t felt like necking myself quite yet.

The hospital dispensed infusion of 5FU is a short affair and before I know it, we’re hooking my chemo pump up and I’m getting a quick lesson on how it works and what to do when the alarm goes off.

Optimus is the name I gave my chemo pump. A friend from high school suggested it after I posted a photo and it had a ‘prime’ button on the front console. Having thought about it more it’s entirely appropriate. He is a workhorse, infusing nearly 300mL of 5FU into me over 46hrs without as much as a complaint. He is confronting looking, although perhaps, no more than an 80’s mobile phone, but most importantly, he’s a good guy.

Don’t get me wrong, he’s a pain in the ass. He’s bulky, he gets in the way, he routinely gets tangled, and most importantly, he’s a constant reminder that I’m sick. And of all of it, that’s the worst.

Sadly, but also hilariously, having Optimus installed wasn’t as easy as it should have been, mainly due to the fact that I hadn’t thought ahead and shaved my chest. 20 minutes and three rounds of clipping later, I’m hooked up, strapped in and on the way home.

The next 46odd hours were really nothing of any note, other than inconvenience. Maybe it was because it was the first run but I found it really restrictive in terms of what I could and couldn’t do, and that included being pretty much useless with any housework/chores. Hopefully that’s because it was all a bit raw still and the second time around I can get into a better routine as I know what to expect. Only time will tell. Anyways, before I knew it, Optimus’ alarm telling me it was almost time to disconnect went off and I was on the way to the hospital.

I can’t even think about having Optimus removed without tearing up, and hell, I cried in my colleagues office when his alarm went off telling me the end was nigh. Even now there are big fat tears streaming down my cheeks.  After I was disconnected, I ran upstairs and saw Lyndell and Annabelle waiting for me near the cafeteria and Annabelle smiled and put her arms out for a cuddle. Being able to pick her up and hug/carry her, and hug Lyndell without fear of pumping the needle/port was the greatest thing I think I’ll ever experience. Even better, was it meant that I had beaten the first week of treatment. Well so I thought.

Fatigue isn’t a real thing, right? That’s what I thought. That was until Friday morning when I fell asleep at work, in the middle of typing a report.  I don’t know how long I was asleep for but I know it wasn’t long, maybe a couple of minutes at the most. E-V-E-R-Y-T-H-I-N-G took so much longer to do. It was a struggle to type, I couldn’t concentrate and it took me a coffee and a can of Coke before my brain was operating at something that resembled normal (I know, great cancer diet eh). It didn’t help that Newcastle was 38* on Friday, and that I went out at lunch to get a haircut (it looks good thanks for asking) but by the time I got home, having had 1.5beers over 2.5hrs (my friends will tell you that means I was really sick) I was a wreck. It hurt to get off the lounge. Physically hurt. By the time I got to the bathroom I had to sit on the toilet to regather my strength to have a shower. When I made it back to the couch, I didn’t leave it.

The following day was somewhat better but not really. To say it was an unproductive day is being super polite, I was a lazy cunt!

Today is better, at least thus far. I’ve had my maxalon (more preventative than anything – you know, keep me on a steady course), and hopefully tomorrow is better again.

Even if it’s not, I haven’t really got that much to complain about. I’ve got an awesome wife/doctor who looks after me no end, I have incredible friends who have made meals, sent messages out of the blue to check in and who put up with me being a whiny bitch.

Stay tuned for the next instalment which could either be “I’ve slept for a whole week and it was awesome” or “So I’ve just been nuked in the ass and now my colon feels like a microwave dinner”.

 

 

Dropping the kids off

I’ve been called a wanker a heap of times. And let’s be honest, who doesn’t like rubbing one out. ‘There’s Something About Mary’ isn’t the first time any of us have gone out after cleaning the pipes, albeit without the same sticky consequences.

When you’re told that you have cancer and you will have to undergo various treatments, the last thing on your mind is that someone is going to suggest you have a medicinal wank.

Even more disconcerting is that EVERY doctor you meet, often within the first couple of minutes of meeting them, raises the topic.

My wife and I have a beautiful daughter Annabelle. She was born 7wks premature and spent her first 5wks in NICU. She was born via emergency caesarian which was shit. It was shit for my wife because she was sent home without her/our gorgeous daughter. It was shit that my wife, and to a large extent I, missed out on the normal birthing experience.

It was also shit because out obstetrician had told us if we had another child, the same risks existed. From a purely selfish standpoint I don’t think I could go through that again, and my wife agreed. Or so I thought.

And so I ended up at the IVF clinic wearing a trench coat and fedora. OK I didn’t but I may as well have given I was the only bloke in the waiting room.

The technician called my name and as I looked up I was happy and ashamed at the same time to see an absolute glamour. I’m talking Heidi Klum, mixed with Gisele Bundchen, and the a dash of girl next door. Her ‘come with me Geoff’ was met with a giggle that I’m sure she had shared with other wanker’s before me.

It was then she showed me to my room and said “you should find everything you need in here. When you’re done, come through the door and we’ll be waiting for you”. I was gutted to think that there were other people on the other side of any door, let alone the one I had to enter to make my deposit.

The room itself was nondescript, other than the pleather recliner, TV mounted to the wall, multitudes of reading material and various cleaning products. I settled in, not confident to sit on the chair, being unaware of how many asses had previously sat there while certifying their cheques, and perused the selection of titles.

Once I had made my selection, I tried valiantly to get to work. I’m not sure whether it was the radio playing ‘background’ music, or the utter shame of being led into a room by an absolute glamour, at a place where I knew someone who worked there, to have a wank, but it was the hardest wank I’ve ever had, and not hard in the sense that you could hammer nails in with my cock.

Needless to say, I got the job done, and was relieved to walk through the door and hand off my spawn to the technician, safe in the knowledge that she would judge them according to their number, motility, and concentration. What a way to start the day.

My elation at being almost done was overridden by the fact that I recognised one of the other technicians as being a girl I went to school with over the shoulder of Heidi. She glanced in my direction and I knew the game was up. While we had been civil to each other in our younger years, our relationship was about to step up a notch. I only hoped that she looked at my sample and didn’t touch.

And so I ran away. Quickly. My getaway was slowed only by the fucktard who parked less than half a foot from the drivers side door of my car, requiring me to access the vehicle via the passenger seat, allowing me to access the 8th layer of hell.

The highlight, other than the wank of course, was getting to work, just in time to greet one of my bosses, who I was yet to meet. Notwithstanding that I had washed and sanitised my hands a number of times since dropping the kids off, as I shook his hand, my immediate thought was “I just had a wank with that hand”.

Good times.

Any port in a storm

Because I am having chemotherapy for such a long period of time, it is preferable to have some sort of direct access to a major vein. As such, the options are a PICC line, or a portacath.

In essence, both are the same. They are both semi-permanent catheters which are put into a major vein above the heart, where chemo (and other drugs) can be pumped.

There are however, major differences, and having been made aware of same, my heart sunk when I was told I would likely be having a PICC line put in, due to the speed with which I was starting chemotherapy.

By way of a summary, a PICC line is a cannula thingo that enters a major vein above the heart, via the arm. Specifically, it is a generally a single line going into the vein above or below the elbow, and then weaves its way through the vein to above the heart. The tube (and sometimes numerous ones) are exposed where the tube leaves the vein/skin. The result is a web of tubes coming out from me which look like ideal playthings for Annabelle to grab whenever she sees them. The real bummer is that they are difficult to shower with, and cannot get wet.

Conversely, a portacatch is a device which is about the size of a 20c piece but dome shaped with a silicon bladder on the tope of it. A tube runs from that bladder, to my jugular vein at the bottom of my neck, and stops just above my heart. Once inserted, it means that anytime I have to have a needle, be it for chemo or blood test etc, instead of making me look like a junkie, they tap into the port and away we go. Where it shits all over the PICC is that with a port, I can shower normally, there are no external tubes, and I can go swimming.

As I indicated, I was supposed to have a PICC line put in, and I’m not ashamed to say that I got really down about it. It meant that on top of what was shaping up to be a Christmas/New Years break marred by nausea, vomiting, and all manner of other side effects, I wouldn’t be able to take Annabelle to the pool/beach. It means I can go to the pub without having wires hanging out from my arm and looking like a cancer patient, which, as much as I like to think I’m not vane, is a huge fucking deal.

I can remember getting the call and being told that I was getting a port instead of a PICC and bursting into tears. The woman on the phone said she’d never had a patient so excited to have a port inserted before. I tried to explain that she had given me a large portion of my self/life back but couldn’t really find the words.

I rocked up at John Hunter ready to become a cyborg. I met the surgeon who would be inserting the hardware and blindly signed the consent form. Partly because I had been fasting and wanted to eat something, anything, but mostly because I just didn’t give a fuck as long as I got to enjoy summer with my family.

I went into theatre and met the various persons who would share my adventure to becoming part machine. They were all lovely, and we really had a lot of laughs. I really only remember Emily, my radiographer (because she was stunning), Lyndall, one of the doctors, and AJ (the fellow who did the cutting).

My most vivid memory is being told by AJ that I would feel some burning as the local anaesthetic was injected into my chest. He lied. It felt like fire ants vomiting molten lava and farting chilli’s were being injected under my skin. My yelp of ‘FUCK’ clearly got his attention and after asking the nurses twice, he confirmed that I was yet to be sedated. Strike 1 to AJ.

The rest of the procedure went off without a hitch and to be honest, was bloody interesting. I was able to watch on real time x-rays as the port was inserted and watching the guide wire go into my vein. I think I also scored some brownie points by telling them that I had performed surgery on my ingrown toenail on a number of occasions without any form of numbing agent. I’m pretty certain that Emily was impressed.

My next memory was being in the recovery room and listening to a woman come out of a heavy sedation and demand Coca-Cola every 30 seconds on the dot. Seriously, you could set your clock to this hag. It got to the stage that she would request Coke and I would answer on behalf of the nursing staff and tell her “Not yet, we need you to wake up a bit more”. I got more than a few giggles from both the staff and the other patients.

All was well until the following morning when I woke up and felt like I’d been stomped on the chest by an elephant. Fuck me my chest hurt. I now know how women having breast augmentation must feel, except that instead of having DD’s, my implant resembles half a caramello koala.

Anyways – I’m now up to date, in so far as I start chemo tomorrow. I’m sure I’ve missed out parts, particularly the really fucking low days I’ve had since the diagnosis. It doesn’t matter though, as somehow, I suspect the hard times are still to come…

Asspocalypse Now – Lets Napalm/Nuke this bitch

This is a very short post. Its aim is to very briefly set out my treatment plan, at least as it presently stands.

Week 1 – Chemotherapy

3.5hrs in the hospital having a concoction known as FOLFOX6 intravenously (along with anti-nausea meds).

48hr continuous infusion via pump which I get to have at home from Monday – Wednesday.

Week 2 – Rest

I think by ‘rest’ they actually mean “not feeling like death warmed up” but we’ll see.

Weeks 3-5 – Chemoradiation

The double whammy. Chemo tablets in the morning and evening, and radiation at some stage during the day.

Week 6 – Chemo

Week 7 – Rest

Weeks 8-10 – Chemoradiation

Week 11 – Chemo

Week 13-17 – Surgery at some stage

Review and likely same chemo over again

What do you with a rectal tumour? (sung to the tune of ‘What do you do with a drunken sailor’)

I saw my surgeon first. Having beaten myself up in the days leading up to the consult, thinking I would have months of chemo/radiation therapy he gave me the glorious news that I was booked in for surgery, and that he thought I would have to have a short course of radiation therapy beforehand.

I’m not too ashamed to admit that I cried tears of pure joy, much like Michael Jackson would shed at the beginning of each new season of Sesame Street, if he was still alive.

I left his office armed with a referral to Professor Martin, who my spies had told me was the ‘go-to man’ for all things radioactive, a spring in my step, and a frozen coke which Lyndell and I shared overlooking the beach on the way home.

Sadly, that elation was turned on it’s head when I met with Professor Martin and realised that he had a completely different view on how best to get rid of Miguel.

On an aside, Miguel is the name of my tumour. I should have mentioned that earlier but I’m catching up on posts and so have likely left various parts out. He has his own Facebook page: “Miguel Fuentes – A real pain in the Ass”. I like to think that his page is hilarious. In reality I accept that at best, it has it’s moments, and at worst, it’s pure tripe.

Anyways, back to Professor Martin. He’s a tall, lanky Kiwi (that’s a New Zealander for those who don’t know) who has great taste in cufflinks but terrible taste in sayings. He repeatedly tells me that this treatment is so brutal (and it is – we’ll get to that) so that “we can get it off your in-tray for the rest of your life”. I don’t have the heart to tell him that the cancer is in my ‘out-tray’ and if we could get it from there that would be ace.

Professor Martin is brutally honest about my condition and the corresponding treatment, which is refreshing, albeit terribly confronting. He speaks of a 98% chance of remission which in his words is “as close to a guarantee that anyone will give you, particularly an oncologist”. Unfortunately, as the cancer has already spread to my lymph nodes in my pelvis, there is an increased risk of it metastasising elsewhere, if it hasn’t already and is just too small to pick up on scans.

Sadly, really fucking sadly, my anxiety only allows me to focus on the latter, and the fact that I’m looking at a long haul battle instead of a nice “zap and chop”. Instead, Prof Martin has me looking at weeks of chemo and radiation, surgery, and then more chemo.

He refers me to see a medical oncologist, Dr Van Der Westhuizen, who will go through my treatment plan in more detail.

Dr Van der Westhuizen is a lovely, softly spoken South African fellow. Our first interaction involves him apologising for a minute or so, and then confirming what his oncology registrar (a crazy South American woman – more on her in a moment) had previously told me, that is, they intended to poison me, well principally Miguel, to a level which wouldn’t kill me, but that would make death look like a decent alternative. He smiled apologetically and left.

I can’t remember the name of the oncology registrar at the moment, other than her first name was Giovanna. I am truly grateful, and somewhat perplexed by her presence, all at the same time. Every time she spoke, I imagined Sophia Vergara from ‘Modern Family’. It is hard to get upset when describing your anxiety levels to a woman whose questions are asked with such gusto. Nevertheless, I still managed some tears. I figured she deserved them after all her years of study…