More radiation please!

The hospital called me up today; they can squeeze me in for my full-body CT scan on the 30th.

This is a fairly easy process when compared to the colonoscopy. I get to stay on all my medication, and can even have a light breakfast on the day of the appointment. I go for the appointment at 11am, after which I get to drink a litre of “gloop” (barium meal), get hooked up to another cannula (intravenous contrast agent) and then get fed through a CT scanner. A walk in the park!

I also got my follow-up appointment with my consultant (for the 14th February) when he’ll no doubt have the combined results from the biopsies he took during my colonoscopy and from the CT scan. Fingers crossed that all will be well, as amazingly it will be getting close to my 2 year anniversary – after which point the odds of a re-occurrence start to drop significantly.

I must remember to ask him for his opinion on the recent news in the press over aspirin being a good prophylactic for cancers. After all, what’s one more little tablet a day, if it keeps the cancer away?!

First checkup (reprise)

Todays CT scan went pretty much to plan. The basic format was identical to the last time, in that I needed to drink a Barium contrast agent to highlight my upper GI tract, and have an IV contrast agent to highlight my vascular system.

However, this time, knowing what was in store for me, I knew not to eat or drink anything in advance of the scan, which made drinking the Barium contrast agent much easier, if not any more pleasant. The IV contrast agent required that I have a cannular fitted, which was even less fun than normal. In the end it took two nurses, and both arms to get a working connection. Not exactly ideal, given how much I dislike needles.

Still, the CT scanner was absolutely state of the art, and did the actual scans at least an order of magnitude more quickly than the older one that I used last time. The scans couldn’t have taken more than a few seconds each. Very impressive.

Update: I forgot to mention that the IV contrast agent acted very differently this time. The first time I had this done I could very clearly feel the agent being pumped into me, and a hot sensation as it ran around my body. This time I could hardly feel it; there was the barest sensation of warmth, which as before finally settled into my buttocks. However, it was nothing like as peculiar or unpleasant as the first time I had this done. I wonder why not? Different chemical, slower infusion, more tolerance? Who knows. Interesting though.

Sadly, the Barium contrast agent seems to have very badly upset my digestion, so I’ve not had a terribly pleasant time through the late afternoon and early evening. Still, it will all be a small price to pay if the doctors come back with the all-clear. That will probably be a week or two away yet though.

First checkup

Tomorrow I start the transition from the treatment to the monitoring phase of my cancer treatment; I have the first of my (annual?) check-ups to determine if I am still cancer-free. Or not.

I understand that normally this will be done with a combination of a colonoscopy and a full-body CT scan, but in this case I’ve already had a recent colonoscopy as part of my ileostomy reversal, which showed that my colon was completely clear of any polyps. So this time I just get the full-body CT scan, which is looking for any signs of the cancer having spread to other parts of my body.

I’ve had one of these before when I was initially diagnosed and I’m not really looking forward to the procedure, mostly because of the contrast agents that I know they’re going to want to use. I’ll need to drink a litre of gloop (which is horrible) to highlight my upper GI tract, and have a very large cannula inserted in my arm (which I hate) to highlight my vascular system. So my wife is going to come along and support me, hold my hand, and make sure I don’t try to run away!

I keep reminding myself that it will all be worth it, provided the results come back negative. Speaking of which, I suspect I’ll have a week or two waiting on tenterhooks for the results to come back, which will be fun.

Marie Curie would have loved this

So, on Tuesday I was scanned.

There were two procedures, a CT scan and an MRI scan. From a purely geeky perspective, the whole process was quite interesting. I’d read up on the technologies in advance, so I knew roughly what the kit would look like, how it worked, and thought I knew what was going to happen. Of course, they still managed to spring a few surprises.

They did the CT scan first. This is basically a series of x-rays, but rather than producing a traditional xray image, they take many slices through you, saving the data into a computer so they can reconstruct various 3D images later. In my case, they were using it to image me from the neck to the thighs, basically looking for secondary cancers. The most likely locations for those would be bladder, liver and kidneys, though it can also show up in the lungs, bones, etc. Anything showing up in any of those would probably be fairly bad news.

To make the best possible image of my digestive tract, I had to drink a litre of what can only be described as “gloop”. Fine from a taste perspective (faint lemon flavour) but the consistency was such that each mouthful provoked a gag reflex. I had an hour to drink it all, and somehow managed it without being sick. Although they never mentioned it, I suspect that it would have been barium sulphate in some sort of suspension. In addition, they put a cannula into my arm to allow them to administer a contrast agent into my bloodstream (iodine solution?) while I was in the machine. This should help them to see any unusual concentrations of blood vessels, which would probably also indicate more tumours. For once I managed not to faint, despite the needle being amongst the biggest I’ve seen so far.

The scanning process itself was trivial: lie on a table, which then rises up, and pulls you through the circular (rotating) x-ray source and sensor array. The operator then controls your position within the scanner, allowing them to image to their hearts content. Oh yes, and they control the pump which flushes the iodine into your blood stream. According to the nurse I “might taste a slight metallic tang, and feel a little flushed” when they did that. In practice, I felt sharp heat at the point of injection, which then flowed through the arm into the heart and all over my body before finally settling (most disconcertingly) as a very hot feeling in my buttocks. All in all, extremely strange, and somewhat unpleasant.

At this point I was glad to have the cannula removed, and move on to the MRI scanner…

Which turns out to need no special preparation, and is another donut shaped device with a motorised bed arrangement. Except this time the tunnel is much longer, but smaller in diameter; there was only just room for me to fit into the tunnel of the scanner – my shoulders were touching both sides of the tunnel. It’s obvious why when you know that magnetic force diminishes according to the inverse square rule; smaller devices will need less power to generate the same field in the center of the tunnel, and presumably cost a lot less to buy and run. Still, I can imagine patients who are in there for a long time would find it very unpleasant. Fortunately since they only wanted to image my pelvis, my head was poking out the far end of the machine, so not as bad for me.

Since these things generate truly amazing levels of magnetic field (the one I was in can go as far as 3 Tesla!) you have to be very careful not to have anything ferrous on or in you – as otherwise it would be dragged around with huge speed and force – think “projectile injuries”. They machines are also very loud – 100+ dB apparently. The noise is from the coils of the electromagnet, which make a lot of noise as they change the polarities, so they give you a set of sound-deadening earphones, through which they can talk to you and play music to keep you amused while they get on with looking at your insides.

In my case, they made a big fuss of asking me what music I’d like to listen to, only for them to not actually have anything that I really fancied. Turns out not to matter much – we settled on some Phil Collins, only for me to discover that I couldn’t even hear it over the buzzing and clacking from the machine anyway!

One thing that I did wonder about during my 20 minutes in the machine was how you got a really big person into it. I’m definitely a bit of a fatty, but nowhere even near the size of some of the people we are starting to see in the UK, who must live on the most dreadful diets to achieve their dimensions. On subsequently asking about this, it turns out that apparently the “super-size me” patients are sent to the local vetinary college where there is an MRI scanner specifically designed for treating horses! If that didn’t provide the impetus to go on a diet I’m not sure what would…

Anyway, the results of the scans and the biopsies they took earlier should all be with the consultants now (they operate as a multidisciplinary team for diagnosis and initial treatment planning) so I expect to be called in after they all meet on Tuesday morning, at which point I’ll know the worst, and what they plan to do about it.

Frankly I’ve passed the point of worrying any more; I’ve had a couple of very bad nights imagining the worst. I’ve come to terms with the fact that beyond being positive there’s very little I can do to affect the outcome, so I just want them to get on with whatever they can do to help me.

Lightning strikes twice

Yesterday I was diagnosed with bowel cancer. No news on how bad it is yet; they’re growing cultures from the biopsies now, and I’m booked for a full body CT & a lower body MRI on Tuesday next week. That will tell us if its already out and spreading, and how bad the base tumor is respectively. Prognosis varies wildly depending on the current state of the tumor, but the only treatment is (fairly major) surgery along with optional supporting chemotherapy and radio therapy. Realistically I’ve a fortnight of waiting while they gather information and build my treatment plan, but at that point things should shift into overdrive. Its likely I’ll be in surgery within 30 days, and recovery from that will take 3 months or more.

We’re not even over my wifes brush with breast cancer yet. Sometimes life is a bitch. But the alternatives are not acceptable. We beat this thing once; we can and will beat it again.