Its been a while since I have posted some photos. Some friends and I have a new photography project in the works which will start in the new year. It will mean a bit more regular motivation to get out and take some interesting snaps, and more frequent photo posts from me.
I recently upgraded my canon 500D to a 7D, which is a really really nice camera. Theoretically it should take better photos that my previous one, but I guess it depends on who’s holding the camera :-). I have sold my current camera to my sister, so she is starting to pick up the hobby.
The rain in Auckland has been miserable lately, so I haven’t had a good chance to get out and take some photos, apart from a rainy day flower, and experimenting with light and kiwifruit.
Shutter 1/60, f/4, ISO400, 55mm
Shutter 1/250, f/10, ISO100, 116mm.
For the astute amongst you, you may have noticed that the 42nd round of chemotherapy has come and gone without so much as a blip. This is largely due to the fact that I did not embark on it as per my routine schedule. The reason for which…. there are murmurings underfoot.
I had a CT scan about 4 weeks ago which I have not reported back about, but it basically showed no change, except for the possibility of 1mm of growth in the largest node, but well within the margin of error. This scan has got people talking.
My oncologist, 3 weeks ago made a few comments. Basically, my cancer is not behaving as cancer should. Statistically, I have less than 20% chance of being alive in a years time, but that same statistic was true for me a year ago, and probably true for me a year before that. This cancer does not behave as conventional wisdom predicts it would. The conclusion, after 2 years of very little and very slow growth, in the context of no family history and my unusual presentation, has made oncologists begin to believe that they are dealing with a very different beast than they are used to dealing with. Cancer is a term that encompasses a very broad selection of illnesses, and whilst it follows trends, accumulates similar mutations and characteristics, each cancer is generally genetically unique to that person, and unique to the body habitus it finds itself in. Mine is clearly declaring itself to be on the more unusual end of the spectrum of illness. Forty one rounds of chemo and its tolerance, age, and my unusual response/progression, without organ metastasis (that we know of), are all testament to this.
Given this conclusion, people started to think that if this is an atypical presentation of adenocarcinoma, then perhaps it requires an atypical response. Conversations behind the scenes began to happen across multiple teams of multiple specialities. Then, two weeks ago, I was given an offer, which began to set things in motion.
The offer involves surgery. Retro-peritoneal lymph node dissection to be precise. The conversations were had with the urologists who are experts at this kind of surgery, since it is where testicular cancer spreads, and they perform it routinely for germ cell tumors. They were interested. The surgery is technically difficult. I have nodes behind my left renal vein (there is a possibility i could lose a kidney, but unlikely), one sandwiched between my aorta and inferior vena cava (IVC), and another one that is retro-crural, that is, behind the diaphragm where the aorta crosses. This surgery will require input from the urologists and the colorectal surgeons for their respective skills, as well as input from one of the countries leading experts in liver surgery, in order to access the retro-crural node behind the liver/diaphragm. There will also be input from the vascular surgeons as the removal of the node between the aorta and the IVC may in fact require removal of the IVC and the aorta themselves with replacement grafts sewn in.
In short, it is MAJOR surgery, with a number of potential complications that include the usual suspects of bleeding and infection, but with the addition of possible lymph fluid leak (which will delay recovery somewhat) and spinal cord infarction (this means paralysis). The latter of which is fairly rare, but present (1 in 10,000). Recovery is generally in the order of 2-3 months.
This surgery offers me three potential outcomes. The first being that the cancer relapses fast and aggressively (which is what it typically does and why surgery has not been offered up to this point). This means I die from cancer, but sooner than I might have, so in my mind, this is no different to the current situation I find my self in, just a quicker version of it. The second possible outcome is we achieve medium term remission of no cancer progression for 5-10 years, the cancer then returns, and the same ultimate outcome happens but at a much delayed time frame. Finally, the third possible outcome is long term remission, where the cancer does not return and I live for 50 years, only to die from being hit by a bus, or from a new cancer from the ridiculous number of CT scans I have had over the past 3 years. It is impossible to know what the likelihood of each outcome is, but it is reasonable to aim for medium term remission, hope for long term remission, and plan for fast relapse. To think of this surgery as cure would be inaccurate, and probably foolish, but its nice to have an option on the table that is different from my current one.
So, the next step is to get a CT PET scan, which will happen in early January, and will determine more accurately the degree of spread of the cancer in my body. If it turns out there are microscopic metastasis throughout the body, then the surgery will be a no go, if not, then I will be offered it. If the surgery goes ahead, then it’s likely to happen end of January, or beginning of February.
In the mean time, so that there are no false negatives on the CT PET scan, I have no chemo until January. Perhaps the record has been set at 41 rounds, and I shall not be extending it further, only time will tell.
Until next time….
My posting has been a little slack of late. This is largely due to the business of the time of year, which for me has also involved changing runs from older peoples health to respiratory medicine, a cluster of family birthdays, and rougher than your average round of chemo.
This recent round saw me over the toilet bowl vomiting as soon as my 5-fluoro-uracil push was given at the hospital. Not so flash. It was amazing the relief I had from nausea though after the vomit. There were a couple of further episodes over the weekend, and an extra day off work on Wednesday as I hadn’t quite recovered to full function as usual.
Now that it has all left my system, I am back to my usual in-between-rounds self, with round 42 next on the agenda, and a break for Christmas.
Until next time…