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Posts Tagged ‘nodules’


The elephant in the room.

May 17, 2015

Let me just address the elephant in the room.  The result of my scan was not good.  My current clinical trial, from the looks of it, is not working according to my doctor.  He called as we were on our way home from the hospital.  The results came fast since I was the first patient scheduled for CT scan that Friday morning, so the radiologist got to it right away.

“Hi,Mr. Alvarez, Dr. S. here” said the familiar voice.  Dr. S and I are getting to know each other well.  He normally talks fast and is always smiling, but inspite of the friendly greeting his tone this time betrays him.

I stopped the car, parked, and put my cellphone on speaker so my wife could hear.

“The scan results showed some growth in your lung nodules…”  I stopped listening and just looked ahead.  It was not the news I wanted to hear.  Another bad news given.  I thought I was ready for this but no matter how many times  I get them, it still gets to me: Shock and disappointment.

My thoughts came back because there will be changes again, that is if I want to.  It always boils down to what I want.  The funny thing is you think you are in control but in reality you are not.  I want no more chemo but I still have to go for treatment (only if I want to).  Duh?

Dr. S gave me more details and told me about my options.  Options? What options?  It is more like pre-destined—and forced—options because they were not what I want.  Do they have something more pleasing like a Chinese buffet menu?  I digress, but today’s menu is:

  • stay on for more treatment with the current clinical trial to see if I respond or
  • move to another clinical trial.

You like, no like?  (In Chinese tone).

But this is serious real-life (and death) decision.  This is not even worthy of a FB post needing like/unlike response because there is nothing to like in the choices in front of me.  This is serious sh*t.

So now I am back to square one again.  Stay on and hope I respond, or move on and hope the next one works.  Two options both based on hope which, of late, is a very precious commodity.  Hope is the one element that has been fueling me all these years and lately I am running on fumes.  It is a wish, a thought, or a plead for something better.  Is that too much to ask?

Perhaps I should just ask for something simpler or maybe not ask at all.  Just do the gerbil run-to-no-where and enjoy the ride.

Cheers.

P.S.  On Wednesday I meet with my doctor to discuss other clinical trials and decide.

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2015: Resolutions and absolutions.
January 16, 2015
So far 2015 is starting out good.  There is always great expectations for new beginnings.  It normally begins with resolutions and absolutions for me.

For starters, I absolve or renounce the habit of counting how chemo treatments I have received (one to start 2015 last January 7th…sorry!)  I think this is a force of habit from my work.  I deal with data (lots of data), risks, likelihood, and impact.  That decisions should be based on data to minimize bias.  But sometimes you just have to throw away these things because it restricts your ability to…live.

I just had my CT scan today.  I normally get anxious for the results of my scan: good or bad.  There was a time I would hold my breathe when I see the caller id is from the office of my oncologist or radiologist.  Now, I get it by email that reads:
     “Scan looks stable.  One nodule increased and one decreased.  Dr. S said he would keep you on.”
That summarizes my world.  I am like a gerbil running on a wheel going nowhere.  I just keep on running until I am told to get off and move to another wheel (trial).  So why bother counting how many treatments I have received: it does not matter.  What matter is you are running on the wheel.  In fact, I would continue on any wheel they give me: big or small.

My wife notices my frustration of being stuck.
“Your nodules are stable and you are here with us.”  she admonishes.
Yes.  I am surrounded by people who love me.  There should not be any “if’s” and “but’s” about this.  That is why I am running on a wheel-to-nowhere.  Is there anything beyond love?  Thus, for 2015 I resolve to live beyond the numbers that define my cancer.  I resolve to fully embrace my new normal lifestyle and fully enjoy the experience of running round-and-round “the wheel.”I would still continue to keep fit, practice mindfulness, pray, help others, set goals, run, and have fun.  Does it matter how many chemo treatments I have?  Does it matter how many miles I have run?  There will be more treatments as much there are paths to run.  Just go and enjoy.

Cheers.

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You got mail …ding!

August 13, 2014

Imiss Dr. B, radiologist from my hospital.  He use to call me at home to give me news about my PET or CT scan (see previous post PET scan results dated April 30, 2013).  Now I get notified via email.  How impersonal medicine has become.

There is some comfort to be appreciated when you hear a familiar voice telling you the good news or there is bad news.  My doctor is there with me: good or bad.

The email reads, new test results are now available at the UofC’s MyChart web portal.  From the web portal, patients can access their medical records, schedule appointment, send secure email to doctors, and view test results.  MD Anderson has something similar and they call it MyMDAnderson, plus they even have a mobile app for IOS and Android.

Inspite of the coolness of all these technologies, I still could not shake off the feeling that I am about to see the results of my PET scan in a self-help web application.  I suppose doctors are just getting too busy now a days.

So I login to the site.  I get to the scan report and start reading it.  Time slows down for me when I am about to get the results of my scan.  I just don’t want to miss anything.  I get to the summary:

“IMPRESSION: Stable to minimally decreased in activity of multiple bilateral lung nodules.”

In English: my new treatment is working!  There are no new nodules and the existing ones have decreased, minimally.  Yes!  Let’s do the lab rat dance.

Go number 5!  Go number 5!  Go number 5!

This is where I miss Dr. B.  We would share a moment of happiness and I would be thanking him profusely, as if there is no tomorrow.  Nonetheless, reading the good news of my scan gave me a sense of relief.  After only two cycles of chemo treatments, I am responding to the new drug.

The minimal assessment is relative; fighting cancer is a game of inches and centimeters.  A 1.4 centimeter or 17% reduction in the size is still, at face value, a response in the right direction.  It gives new hope and is a blessing.  I know how this works, for having to live it in the past six years: You take what is given and be thankful.  Others may not be as lucky I am or would want to be in my place.  I know them.  I see them.  I pray for them.

What’s next is I continue with the trial.  My next treatment is next week so for now we celebrate.  We run and get ready.

Cheers.

P.S.  For the mid-week run, anything above 10 miles again.

 

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A beautiful day for a run.
March 9, 2014

TThe lake was still frozen.  The morning air was cold at 26F (-3C) but the sun was out.  The sky was blue so I just got to go out and run.  It is my first-time to run outside and I was excited.  I have been exercising (spinning and cross-training) indoor but when there is an opportunity to run outside I take advantage.  Life is beautiful.

As always my wife, training partner, and nurse was with me to make sure nothing happens to me.  Lucky huh?  It was wonderful to be out there.  Trails were clean.  There were a few runners, but mostly it was peaceful.  I run without music.  It is so soothing to hear the steady cadence of my foot as it hit the ground.  I got lost in the moment.  The air was brisk and very refreshing to my cancer-riddled lungs.

I wonder too how the 14 nodules in my lungs still enable me to run.  I’ll take what is given.  That’s three miles at 13 min-mile.  Done.  What a wonderful after glow feeling.  Intoxicating.  Only 23 more miles to go.

Frozen

Frozen

CT Scan Result and Cardinal George.
I had my CT scan last Thursday.  I did not expect much of it since my CEA tumor count was trending up.  Depending on your outlook; the good news is that the number of nodules is stable, still 14, or you can view at as three months of chemo which did not even kill one.  There was also a slight increase in size in a few of the nodules.  The bonus was there was no other metastasis to other organs.

I try not to read too much to news like this.  I can’t change it.  I just accept it and move on.  But there are certain news that stops me, like the cancer relapse of Cardinal Francis George  Archbishop of Chicago.  I can relate to his journey.  It is his third time also and he will have to undergo aggressive chemotherapy.  He is the leader of our church and helps many lost souls.  That is so wrong.

Cancer changes you, and for it to touch (again) a man of great conviction and belief is a humbling experience.  He has the courage to ask for prayers when I look up to him to pray for me.  Also, I wish I have the same ounce of courage he has.  His braveness and acceptance of his fate is reflected in his word that I dare not even whisper.

“While I am not experiencing symptoms of cancer at this time, this is a difficult form of the disease, and it will most probably eventually be the cause of my death.” —Cardinal George.

God bless out, Cardinal George.

Cheers.

P.S. I meet with University of Chicago doctors this week to discuss chemo trials.

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The results of my scan
November 10, 2013
Dallas, TX

The results of my CT scan came out Friday, November 8.  It is funny how you receive news now a days.  You can breakup on Facebook or email.  News of my results came by text from my oncologist.  He said:

 

“Ct scan showed stable if anything there is improvement of lung nodules.  Gd news.”

With that I showed it to my wife and mom, and we all hugged.  My mom was more emotional.  I can feel her mother’s love: she has witnessed, from near and far, all my ups and downs over the years.  It is from her I draw strength when I feel weak.  At her age, she does not have to take care of me or witness my struggles, and yet she is there.

My oncologist and I spoke on his next plan for me.  He and I know, he is running out of options.  For almost six years, he has given me all the chemo drugs available for my type of cancer.  Some put me almost to the edge of death, while others gave me allergies and complications.  They have infused me with it and I have taken it in pill form.

He also knows, I would like to seek another opinion at MD Anderson in Houston, TX.  I initially wanted Memorial Sloan Kettering in NYC, where they are using IBM’s Watson for cancer research, but they were not responsive.  Initial feedback from MD Anderson was I go on clinical trials because I have practically received all the applicable chemo drugs, and in large quantities. However, they cannot see me until I finish my current treatment and see the results of my scan.  

Weill it is out.  It showed persistent, possibly improving bilateral pulmonary metastatic nodules.  In english: it is still there, did not grow but improved, and still present in both lungs.

It takes a lot of energy for me to earn a day.  I am not like others who’s tomorrow is almost guaranteed.  It is a given for them to finish the race in quality time, while I struggle to run mile after mile.  And when I do reach the finish line, I find out they moved it again.  This time they moved it to Houston.

Cheers.

P.S. October 18, IBM Watson is now in MD Anderson to be used for leukemia studies.  I wish they had started with colon cancer.  Oh well.

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Gid ‘er dun.

October 30, 2011

That’s ‘get it done’ in English…hehe. They talk funny here in Atlanta, I guess I sound funny to them too, being from Chicago and the Philippines. But runners—especially slow runners—are the same all over: They have same anxiety when starting a race.  But beyond the Southern accent, they are nice out here.

This is my first time to run outside of my home city. I am glad I did it here and in a small race to fully experience Georgia’s southern hospitality. The Silver Comet race was named after the trail the half-marathon was run on. It is flat and is beautifully set in tree-lined pathways big enough for the 1500 participants. Being small the crowds were limited except at the end. Race rules says no iPods or earphones in-use but nobody would call you out.  That would not be nice.

They have their own version of timers too. At each major mile marker, they have volunteers standing and shouting out your time as you pass-by. “Seventy minutes. Ten seconds,” shouted a volunteer at mile 6, then he counts for the next runner. The water stations were adequate and they have bins to dispose of your cups. Runners would take time to throw it properly in designated trash bins or piles. I told you they are nice here.

Nice but still competitive. The male winner came in at 1:18:01, while the female winner 1:26:36. I came in at 2:37:48 which is a good improvement from my last half-marathon of 2:43:56 (bye-bye, Al Roker) in August.  I got it done.  Also, I am happy with my time and felt much stronger in the second half. Stronger but still vulnerable.

When you think about it, my predicament is unbelievable, unreal, and unfair. I have confirmed cancer nodules in the very lungs (both lungs) that keeps me running. I have improved my time by six minutes in the half, finished a marathon three weeks ago, and I am not wheezing or coughing. As if my cancer is not real and yet I have to give this all up for chemo in two weeks.

I am not bitter.  I know what this disease can do and I am not taking it for granted. I take what is given; like the opportunity to run here in the Atlanta area or be with friends. Besides, it is best to deal with my cancer when I am my strongest and the nodules are still relatively small and few.

Now for the finale, my wife and I are entered to run the Hot Chocolate 15/5K race on November 5. What a better way to close my running season than eating some decadent Ghirardelli chocolate at the end of race. Yes! My cancer cells will be so happy with first class chocolates to plump them up. It will be a sugar-loading feast for them until November 8. Ha…ha…ha! Happy Halloween.

Silver Comet race in Atlanta, GA

 

Cheers.

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I thought I escaped.

October 27, 2011

n my mind I thought I escaped by leaving for Atlanta, but in the end I think it was just taking a detour to the same destination: chemo treatment. The results of the CT scan still bothered me so I called up Dr. B, the radiologist who read my July 28 PET scan.

I had gotten to know Dr. B when he did my chemoembolization(or targetted chemo) December 2009 (see related post ‘At the starting line with Dr B‘).  He is a very warm and caring doctor who is thorough with his work. He said he was disappointed when he saw my July 28 PET scan showing the suspicious nodules in my lungs.  I told him the reason for my call.

Dr. B, can you tell me which of six nodules discovered last July 28 grew when compared to the October 20 CT scan?  The October 20 report just said ‘representative nodule’ measures 1 cm,” I asked nervously.

He ticked off the growth of each nodules with a professional tone:

6 mm to 7 mm

8 mm to 10 mm

9 mm to 11 mm

3 mm to 5 mm for the nodule on the right.

Each time he gave me the comparative results, it felt like a stab to my heart.  Breathe. I lost count.  It was like pounding nails sealing my faith, forcing me to accept reality: it is back.

It is conclusive, Bo.” He solemnly said. I thank him for his openness. Also, he does not think another PET scan will be helpful.  He just advised me to have a discussion with Dr. M on my treatment plan.

It is back to chemo for me. It is like, I am being told to go back to the back of the line because you have not learned. I maybe missing the point of this lesson this time or it maybe just hard to see it at the moment. Do you get it?

What my muscle memory tells me is just to stand up, move, and never give up until I finish this challenge.  But chemo treatments are not marathon races.  They are unique by itself. There are no endorphin highs or no medals to show.  There are even no winners or finishers, just survivors. In the end, there are just those who are with us or those who are not.

I will commit myself to this again.  What else is there to do.  I will be at the starting line again on November 8.  Please come with me again.

Cheers.

P.S. I entered a half-marathon race this Saturday, October 29, here in Atlanta.  It is called the Silver Comet.  Let’s see what they have here in Atlanta besides peaches.

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