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Archive for December, 2009


‘Twas the night before Christmas

December 24, 2009

….when all through the house not a creature was stirring, not even a mouse.

It was also seven days after the December 17 ‘massacre’ when lots of cancer cells died from Dr. B’s chemoembolization raid on my liver.  Fellow cancer cells mourn for the loss of their fighting comrades.

“Tsk…tsk.” But there was no bugle tap for the dead cancer cells for they were  not welcomed.  True to their habits, they did not go down without a fight.  They called in their ‘demon’ allies, who stalked me night and day.  I called them my demons, and for Christmas they called their special ally—The Grinch.

The Grinch has been bothering me since the massacre.  First, he induced me to vomit at the hospital.  He almost derailed my homecoming plans with vomit spells but I put a stop to that with Zofran.  Haha…  Then comes the chills, low-grade fever, sleepless nights, and constant stabbing pain in my abdomen.  He even threw in a couple of hiccup spells all intended to lower my résistance and be a pest.

Dr. B’s scientific explanation is that my liver is releasing toxins, therefore all the side-effects of chemo are coming out.  It is a clear indication that the cancer cells are dying.  He adds:

“I gave you a heavy dose of chemo. I knew your body could take it.” I just have this effect on people who express too much love for me 😮

“You will be in pain and feel lousy for a couple of days but we are sending you home with codeine for pain, zofran for nausea, and other medications.  If you have high fever call us or me personally.”

It has been a while since I experienced the nasty side-effects of chemo, and when it came it I was weakened.  I did not deal with abdominal pain before but the chills, vomits, and hiccups brought me back to reality and sleepless nights.  With the incessant pain, I try to strike a balance on when I should take codeine.  Too much of that stuff makes you constipated, so you counter it with stool softner and fiber.

At the hospital, I did not feel the pain because they know how to manage it.  I was even hooked up to my favorite gadget, personal control analgesic (PCA).  I just press a button and it discharges, Delodid (more potent than morphine), a drug addict’s delight.  It resets after a couple of minutes and I can press the button again.  Ah, heaven.  Then, in between I can request for Toradol, another pain killer.  They also gave me Decadrol, steroids to help my immunity.

But at home, I have to find the right balance with codeine, stool softner, ant-nausea pills, and Metamucil.  This puts a dirty smile on the Grinch.

“I wouldn’t smile, Grinch.  Lots of your friends are dead or are dying from the punishment given by Sheriff B.  And soon you will be gone as well.  Pain is temporary.” Besides, Santa is almost here.  The cavalry is arriving led by Rudolph.

It is Christmas eve.  Yes, the house is quite.  The promise of white Christmas is here.  The outside air is even calm.  Maggie, the beagle, is snoring in her bed.  My wife is asleep besides me radiating with all the warmth and care I needed to get me through the night.  Perfect.

Just you and me, Grinch.  You are not going to steal my Christmas.  I am here breathing and in child-like anticipation of receiving the blessings of life.  I am awake not because of you but for the simple pleasure of greeting everybody out there, Merry Christmas.

Come on, my demon-friend, let’s go get some Ensure and cookies.  Ho…Ho…Ho!

Cheers.

Woohoo...white christmas!

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At the starting line with Dr. B

December 22, 2009

I did not recognized him when he walked in that Thursday morning, December 17.  Dr. B, my radiologist, was in a surgical outfit.  It was different when I first met him last November 23 in his professional white smock.  (See related post, The long road ahead, November 28)

“Are you ready?” He greeted me.  I was going to be awake through the chemoembolizaiton procedure and I was already all prepped up by his staff, and was cold.  Have you notice how cold these operating facilities are?  They say it is because of the machines they have to keep cool but how about me?

I hear in the background the nurse reading my name, my birthday, telling the doctor why I am in there, and my vital signs.  I look at the clock and it was almost 9:30 am.  My day started at 5:00 am with my normal morning rituals, except for breakfast or any liquids, so I was hungry.

“Yes, I am ready” I replied.  He signals the nurse, who has been steadily infusing me with antibiotics and fluids for an hour now.

“Mr. Alvarez, I am going to give you benedryl to make you feel sleepy and relax.” Said Eunja, one of my nurses.  Whoosh!  I felt a rush go through my head and body.

“Wow.” Eunja heard me and asked “Did you feel that?”

She did not intend to give me give me any discomfort.

“I tried slowing the push but high volume of your IV to your port-a-cath seems to have carried the medicine fast.”

Oh well, I thought.  I could not blame her she means well…all of them.  The port-a-cath I have is inserted into the jugular vein which then goes to the heart, so you feel the medicine surge faster instead of infusions from the arm or peripherals.  The implant device is convenient for cancer patients to avoid being poked regularly during chemo session.  (Note:  Veins deliver the inward flow of blood to the heart versus arteries which deliver outward flow of blood from the heart.)

I felt a pinch in my right groin.  It was the local anesthetic Dr. B administered.  He feels for the femoral artery and marks it.  He makes the incision then slowly threads a wire going to my liver.  No pain there.  He stops and tells me he needs to map his way to the liver.

Map?  Don’t tell me you lost your way?  I should have brought my GPS.

But he has something better.  He puts a catheter over the wire and says:

“I am going to inject a dye contrast to map your artery.  You are going to feel radiating heat.” I felt the warmth radiating in my stomach.  He takes an image and there is our map.  Whew!  Smile liver.

He repeats the process inserting different types of wires, catheters, etc, moving ever so closely to the tumors.  With him in the room was Dr. F, another radiologist, and they discuss the careful approach to my liver.  They need to find the right artery to deliver the chemo then embolize or shutdown the artery to lock the medicine in.  One of the tumor was located at the edge so it took them time to position the wires.  He repeats the procedure until he is close to all three tumors.  Satisfied, he locks in the catherter and ask the pharmacy to mix the special chemo concentrate for me.  Houston, we are locked and loaded.

Dr. B tells me it is this time when his patience is tested because of the wait for the chemo concentrate from the pharmacy.  I guess you got have them fresh, right?  Nothing beats fresh chemo in the morning.  I love the aroma of fresh chemo.

When it arrives, Dr. B and his staff were in a flurry of activity.  He delivers the first chemo concentrate with embolized particles.  Panic breaks out among my cancer cells.  What the f#$%k!  Incoming….. boom!  Another concentrate, another, another, and another. I lost count but Dr. B came out firing on all cylinders.  Die, sucker!  Rat-tat-tat.  Shots fired.  Shotgun, machine gun, AK, cruise missile, kitchen sink… Welcome to Chicago.  Do you feel lucky, punk?  There’s a new sheriff in town.  Get out of town by sundown and don’t let the door hit you on your way out.  Ka-boom!

Cloud settles and I all feel is blouted pain in my abdomen.  As if somebody hit me in the stomach several times.  Raw.  But it is over.  Well done, Dr. B, with your help my journey has begun…again.

Cheers.

My wife, me, and Dr. B "The New Sheriff"

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I am home


I am home.
December 19, 2009

Just a quick note to say I am doing fine.  In pain , but very glad to go home today and in time to celebrate bday tomorrow, December 20.  Another milestone for me.  Small victories are greatest gifts.

Will write again.

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Tapering off for surgery

December 13, 2009

It is not exactly fun in the sun when I was in Miami.  They had record high of 86F in Miami while Chicago was in the freeze at -2F.  But why am I complaining?  I was running a fever while I was there and was getting weak.  During the day I was fine, probably propped up by Advil and liquids, but at night I could not sleep and was feverish.  The thought of being too weak for my coming surgery and being away from home disturbed me that I decided to go home a day early.  I have been away from home on long business trips but this time it was different, I have a surgery date on December 17.

I have learned to respect this cancer.  It came back with a vengeance for one.  It is now in my liver, which is a major organ, unlike before it was in my colon.  Also, although most people who see me tells me I look good, I feel weak and without energy.  I watch my weight for any sign of weight-loss and I try to eat…a lot.  I think knowing that this cancer is eating me inside is causing me stress, as well.

Unlike the first time when I was diagnosed, I did not know I was even sick.  I was partying with my friends, after work, in the streets of Rio and ignoring the signs of tiredness and fatigue until one morning when I passed blood in my stool.  Lots of blood, as in crimson red and profusely. My first thought was something broke inside me as I tried explaining this to Dr. W, Marriott’s hotel doctor.  She sent me to Hospital Samaritano and that is where my journey to the finish line took a sudden detour.  There I met Dr. F, a bright colorectal surgeon who puts me at ease when I first met him.  With his direct ways and good command of English, he explained the results of my emergency colonoscopy;

“Your colonoscopy showed you have a tumor in the sigmoid area.  When you passed your stool it bruised which caused the bleeding.  We took a sample for biopsy and the result will be in a day or so.   Your only option is surgery.”

“Is it life threatening?” I asked not knowing it was cancerous or malignant.

“No.  Not at the moment since the bleeding stopped.”

“Will I be able to sustain a 14-hour flight back to Chicago?”

“Yes.  I believe so.” Our exchange went.

I was relieved.  I did not exactly relished the idea of a surgery in a foreign country, with my limited Portuguese, the hospital’s limited English, and a recovery in a hotel.  So I flew back to the US with a set of slides Dr. F gave me.  He did not tell me the results of the biopsy to avoid worrying me on my long flight home, alone.

“Show the slides to your doctors.  They will know what to do.”

“Muyto obrigado (Thank you)” I replied.  That was March 2008.

For this second time go around with cancer, I was not partying in Lapa, Baixo da Gavea or in some exotic place.  Instead, I just finished a marathon then found out my cancer is back.  Since then it has slowly taking over my routine.   It is slowing me down, consuming even my spirit.  My anxiety is high until I know I am able to stop its devastation on my liver and my confidence.  For now, I try to stay strong physically and mentally, and I pray.

Running discipline tells you to taper off, relax, and carbo load prior to a big race.  And that is what I am doing but instead of pasta, I eating anything I want because once my chemo race starts all bets are off.  Bring it on, baby!

Cheers.

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Message from the Messiah

December 7, 2009

St. Clement's Choir

Have you ever listened or watched Handel’s Messiah?  Over the weekend, my wife and I watched the oratorio as performed by the St. Clement’s choir.  My wife’s friend, Rose, recommended it and they have colleague who sings in the choir.  Of course, Handel’s most famous piece in the Messiah is the Hallelujah chorus.  You may have heard it played.  Tradition is you stand when this is sung and that we did.

It was a hair-raising  and uplifting performance for me.  The oratorio was performed in the church’s sanctuary surrounded by lighted candles.  Handel’s Messiah has a universal appeal because one can relate to its message of hope and redemption in the many verses that define each part of the libretto.  I claim the verse in part 1;

Chorus: ‘His yoke is easy, his burthen is light.’ – Matthew 11:30 (Part 1)

Yes.  He asks to carry my burden for his yoke is easy, his burden is light.  Many have come forwarded wanting to carry my burden but it will be with Him that I share my burden.  He and I will be ok as we journey together.  I am glad I went and heard the message of the Messiah.  This will be my companion during my chemo session.

Another message sent to me was from my radioligist, Dr B.

“Dr M (oncologist) and I discussed your treatment plan after we met (see November 28 posting, The long road ahead).  The original plan was to have the chemoembolization done in January.  Dr. M thought we should start your treatment as soon as possible.  If we postpone the chemoembolization to January, Dr. M would like to get you in to start your chemo infusion this December.  However, if your infusion cycle is started, there is a risk you might get weak for chemoemobolization so I would rather do your chemoembo first instead of  January.  With this change of schedule, we will just go with regular chemoembolization without the use of beads as previously discussed.  Also, I had consulted your case with a colleague at John Hopkins Hospital in Baltimore regarding not using beads and platinum based chemo for embolization, and they see no problem with this changed approach.”

I should get use to this change of plans.  This cancer is really putting a damper on my holiday plans or what’s left of it.  I also notice a sense of urgency by the changes in my treatment plan, but I trust all my doctors.  The chemoembolization is set for December 17 at 8:30 am.  D-day.

Chorus: ‘He trusted in God that he would deliver him: let him deliver him, if he delight in him’ – Psalm 22:8 (Part 2)

I should look at December 17 as the starting line of the race I am about to embark.  My personal marathon, wherein I was drafted to run.  I claim victory.

Recitative (Alto) ‘Then shall be brought to pass the saying that is written:  Death is swallowed up in victory’ – 1 Corinthians 15:54 (Part 3)

What else is there to say, except ‘amen’ in a glorifying crescendo of chorus, harpsichord, trumphet, oboe, cello, and violins.  Can you hear it?

Cheers.

PS:  If you are interested in listening to Handel’s Messiah, here is a link to National Public Radio broadcast of it.  I have written this post listening to it.  Enjoy.  On my way to Miami, FL for business and some sun.

Handel’s Messiah by NPR

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Yin yang and humpty dumpty

December 4, 2009

I could not help but think of the conversation I had with my manager, Carmela.  I updated her on my progress and other work related stuff, but she said something that stuck.  This is our second time around dealing with my cancer so we are pretty open with each other.

“When the door of opportunity closes on you, another one opens.” Bam!  It hit me.  I get it.  Like yin and yan, male/female, good/bad, right/wrong, etc.  The balance of the universe.  One cannot exist without the other.

She was telling me that cancer may have restricted my running or may have entenced me to a lifetime of chemotherapy, but it also opened new doors and I just have to look for it.  It is hard to see that door when the haze of denial and anger covers them.  I could not see them clearly.  But it has to be there somewhere.  It’s got to be there because it is part of the balance of the universe.  I may have passed through one of them already by tell you about it.  That’s right.

There was no sign that says…”welcome to the matrix, Neo,” but I passed through it.  I know I am there.  I know it because it is the place where I want to be…here…with you.  Thanks, boss.  By helping me you may have gone through a door of opportunity yourself.  All is good for both of us.

The door of opportunity also came when I saw Jamie, my PT, to start rehab on my left knee.  I refer to her as my savior or Mohammed (a private joke).

“Boy, Bo.  I didn’t think it was that bad when you first told me about but seeing you walk now I was wrong.  It looks bad.” She makes me feel so welcomed.

“I told you I am messed up.” I said.

“So tell me again, Einstein.  You did this because of an experiment (The New York Experiment)?  What’s up with that, Kenyan?” Eyes wide, admonishing, smiling, and taking notes.  Tsk…tsk, she mimicks.  Go ahead rub it in, I thought.  I sometimes think why do people go to PT rehab when all they give you is more pain, and in Jamie’s case humiliation.

After the bantering, we get to business.  I get on the rehab table and she start massaging my left knee.  She shows me that my left quadriceps have weakened as a result of my knee problem.  When I tighten my quads, it twitches like a fresh cut fugu fish (poisonous Japanese blow fish.), I commented.   The muscle has not been activated and has weakened compared to my right quad which was firm.

Will get you back, Bo.  You get special treatment today.”  Jamie said then calls Angela for the special gadget.  She was not kidding.  If you have not been to rehab, you see all these “torture” contraption they make you go through.  They have pulleys, tables, elastic bands, tapes, rubber balls, etc. similar to bondage…er not that I am intimate with them.

For the special treatment, my left quads got “electrocuted” (neuromuscular electrical stimulation or NMES), iced up using GameReady Vasoneumatic Compression, then taped.

Viola!

Whew!  I survived that one.  But it was all good.  Humpty dumpty is back together again.  Since I will be traveling next week, Jamie gave me take home exercise for my legs.  That’s it.  That was easy.

I was glad to see her.  She gave me confidence that I am on my way to getting back to running again.  Jamie opened the door for me.  Thanks, Jamie.  But wait, with my leg left taped up, I just realized something.  I can’t do yoga.  Darn, another door closed.  Oh well….just got to find that open door again.  Keymaster, where are you!

Cheers.

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