Round three

Everyone has a spirit animal, a creature that each one of us identifies with for whatever reason. Mine happens to be the hyena. I realize that seems a little odd but, as with most of us, there are quite different sides to my tastes. I can really get into its reputation as a laughing, scavenging beast. I identify with its unglamorous determination, its ability to survive despite having to rely living on what other larger animals leave behind. They’re frequently underestimated and reviled based on their looks and behavior,  and that suits me fine. They get things done one way or another, laughing all the way.

If I had to translate this raw, dirty, disturbing anarchistic energy to a musical choice, I submit Die Antwoord as the embodiment of such energy. The South African-based rap group has been around for several years, and as with most of my current musical tastes, my brother-in-law Kevin got me hooked on them. (so he’s to blame LOL) I can’t explain what I find irresistible about them, their energy and choice of imagery speaks to the inner hyena in me and fires me up, makes me ready to tackle my third block of chemotherapy sessions that commence early tomorrow morning.

I understand if you cannot watch the video below, it’s disturbing and profane. But that’s where my mind is at the moment, and I have to express this side of me, as it’s as important as the more pleasant, public-facing side. For better or worse, I’m back on the poison protocol, out for widespread destruction; with a bloody grin from ear to ear, waiting for the unwanted side effects to creep in, to try to sap my boundless energy, and laughing like a damned hyena all the way — raging… raging…

“C’MON, GODDAMMIT!
JUMP MOTHERF—ER,
JUMP MOTHERF—ER,
JUMP!”

PET Scan notes

OK, a bit of an update: I had a consult with another liver surgeon at another hospital (UNC in Chapel Hill) and a PET scan was recommended, preferably before my chemo started. Evidently there was a chance that some of the lesions found might not actually be living or active, and a PET scan would help determine the extent of my disease by showing the active tumors.

So I went in 2 days ago for the scan and below are the notes from the findings. As with most of you I don’t speak doctor, but I’ve bolded a few phrases below that lift my spirits and confirm why I’ve been feeling as good as I have. I do find it interesting that in referring to where these lesions are being found, the caudate is mentioned but the right lobe of my liver isn’t. Does this mean there’s no living tumors in the right side of my liver?

I’ll post next week to relay what this all means, as I want to discuss these results with my oncologist before I get my hopes too far up. My third round of chemo officially starts this coming Monday, and suddenly I’m ready for it now.

Have an awesome weekend, and thank you for your continued energy…. glancing at these results, I believe it appears to be working.

Narrative
Procedure: F-18 FDG PET/CT scan from the skull base to the mid thighs.

Indication: Male, 46 years old. C20 Malignant neoplasm of rectum (HCC), C78.7 Secondary malignant neoplasm of liver and intrahepatic bile duct (HCC), Restaging CT- rectal cancer Subsequent treatment strategy.

Radiopharmaceutical: 13.41 mCi of F-18 FDG, intravenously.
Blood Glucose level prior to FDG injection: 77 mg/dL.
Time from injection to imaging: 58 minutes.

Technique: PET/CT imaging was performed from the skull base to the mid thighs using routine PET acquisition following evaluation of serum glucose level and intravenous administration of F-18 FDG, per standard protocol. A CT scan was performed for localization and attenuation correction purposes only and is not intended for diagnosis separate from the PET scan.

Complications: None.

Prior Imaging studies: CT CAP 1/3/2017

Findings:

Head/Neck: Physiologic FDG activity is identified in the pharyngeal musculature, tonsils, and salivary glands. Small cervical lymph nodes are noted without abnormal FDG accumulation. No abnormal FDG activity within the neck. No metabolically active cervical masses.

Chest: No metabolically active mediastinal, hilar, or axillary lymphadenopathy. No metabolically active pulmonary masses or nodules. No abnormal FDG activity within the chest. Tiny right lower lobe nodule (image 156).

Abdomen / Pelvis: There are multiple abnormal foci of FDG activity in the caudate and left liver, as described on recent CT. SUV max of the caudate lesion is 8.4. SUV max of the subcapsular left lateral hepatic lobe (image 176) is 7.7. Multiple calcified lesions do not demonstrate abnormal metabolic activity. There is a small focus of increased activity near the gallbladder fossa (image 195). Borderline enlarged gastrohepatic lymph nodes have mildly increased activity, SUV max 3.7 in image 183. Focal uptake in the sigmoid colon (image 303) has SUV max 28.8.

Osseous: No aggressive lesions. No abnormal osseous FDG activity.

Impression:

1. Low-attenuation lesions in the left hepatic lobe and caudate have focally increased and abnormal metabolic activity. These are suggestive of hepatic metastases. Densely calcified hepatic lesions do not demonstrate significantly increased activity.

2. Mildly increased activity in borderline enlarged gastrohepatic lymph nodes are nonspecific, although concerning for metastatic involvement.

3. Focal uptake in a sigmoid colon mass, in keeping with known primary neoplasm.

4. Focal uptake in the region of the gallbladder fossa may represent misregistered FDG uptake in a gallbladder metastasis (as was described on recent contrast enhanced CT scan), though exact localization is difficult. This could also represent a small adjacent hepatic lesion. Attention on followup.

January ’17 Update

Greetings and Happy New Year! I hope this year brings us all many happy times! I know most people would rather not have to remember how awful last year was, but I thought I had a pretty good year personally. Being off chemo since March and letting myself heal made for a pleasant year, one where I could see myself announcing now that “last year I quietly made great progress on my illness on my own terms, without conventional treatment”…

Unfortunately I have no such announcements; the cancer has not shrunk, I’ve lost some progress gained from chemo. Old lesions have grown, and new ones have formed — I might have one on my gallbladder as well. The time spent off of chemo was nice  – and the radioembolization was fun – but these things didn’t help me as I wished it would. My body can’t kill the cancer on its own yet.

The silver lining in all of this is that I continue to be in good physical health, my spirits continue to stay up and the cancer is still contained in my liver (though they’ve taken up residence in the surrounding lymph nodes).

How do we feel? I took the news with cold stoicism (like a good Midwesterner) and I’m understandably frustrated with this development but refuse to let it depress me or alter what I’m doing – indeed, my liver surgeon’s only directive was to “keep doing what you’re doing.” Because I still look and feel fine, and this attitude I’ve taken on — knowing with all my heart my loved ones are in my corner and continue to share my own conviction that ERIC is STRONG — is what’s keeping me up and living my life normally. Even the doctors are starting to notice: how I look isn’t lining up with what the scans show. Evidently, when most patients get this far, they don’t look so hot. Me, I look better than when I first showed up. And it’s because I’m not worse than when we started, it’s not a total regression – more like “2 steps forward, one step back”.

So I shall have to turn back to chemo to knock down the new stuff and regain the stranglehold I had early last year. We grit our teeth and buckle down a little tighter because I go back on the attack. Chemotherapy starts on the 11th.

I’m a lucky, lucky man to have you here with me, and I will continue to do my very best in everything. My success depends on the support, love and energy coming from you.

I love you! Here’s to a better 2017 for all of us!

A Quote:

We have before us an ordeal of the most grievous kind. We have before us many, many long months of struggle and of suffering. You ask, what is our policy? I can say: It is to wage war, by sea, land and air, with all our might and with all the strength that God can give us; to wage war against a monstrous tyranny, never surpassed in the dark, lamentable catalogue of human crime. That is our policy. You ask, what is our aim? I can answer in one word: It is victory, victory at all costs, victory in spite of all terror, victory, however long and hard the road may be; for without victory, there is no survival. Let that be realised; no survival for the British Empire, no survival for all that the British Empire has stood for, no survival for the urge and impulse of the ages, that mankind will move forward towards its goal.

But I take up my task with buoyancy and hope. I feel sure that our cause will not be suffered to fail among men. At this time I feel entitled to claim the aid of all, and I say, “come then, let us go forward together with our united strength.”

Winston Churchill, 1940

And a Note: Doctor’s CT summary straight from my records, for those who can speak Doctor…

CT CAP on 01/03/2017-
1. Interval increase in size of eccentric wall thickening within the sigmoid colon concerning for increase in size of the patient’s primary tumor.
2. Multiple new low-attenuation lesions within the liver compared to prior MRI concerning for worsened metastatic disease. There is a likely metastasis to the gallbladder.
3. New gastrohepatic ligament lymphadenopathy concerning for metastatic disease.