Cancer: February 2008 Archives

One of the most obvious criticisms of the Canadian health care system (and Quebec system, and it pains me that I have to separate the two) is that it can take months to get important appointments such as checkups, scans and surgeries. But since being diagnosed with cancer, I haven't had to wait at all for anything, really. For example, I spoke to Suj last April and got an appointment with a GI on May 3. It took about two weeks. On May 4, I spoke to my surgeon. On around May 14, I had a diagnostic laparoscopy. On June 7, I started chemotherapy. When I got an infected blood clot, I was almost immediately sent to a room in the hospital. My surgery was scheduled only three weeks in advance. Post-operative care has been within three weeks whenever I needed it, and often much sooner than that. This latest round, my appointment with the oncologist was within two weeks, and my chemo (which is tomorrow) was scheduled within a week of that. Easy.

People say that those who get treatment as good or better than mine are considered or assumed to be privileged, as in rich; they get what they need when they need it. Everyone else can go to hell, it seems. First of all, who is everyone else? Am I privileged because I am close to a major Canadian health centre? Is that it? I think that's partially the reason, certainly. Someone in Kuujjuaq probably wouldn't have the same care as someone here, certainly. But what else sets me apart? Am I privileged even for those within a short driving distance of a major Canadian health centre? Are there people in Scarborough or Pointe St-Charles that have to wait and wait for weeks and months for care, while I have to just call or walk into the hospital and get what I want, sometimes even before I want it? Maybe the staff just likes me, I don't know. I think I get along pretty well with nurses, actually.

Can anyone comment on these phenomena? Who is not getting served properly in Montreal, Toronto, Vancouver, etc.? I know that I had an advantage at the very beginning getting into the system, and perhaps that made ALL the difference. I was able to get referred into the system, possibly because I knew someone. I can't say for sure if that's true or not, but it may be true. I was examined by this specialist. But I don't think that that explains the treatment I have received since then.

Spoke with the oncologist today. They have decided to give me the FOLFIRI protocol, which is MUCH less brutal than the TCF protocol that I had before. Instead of spending the day in the hospital, I will spend 2 hours hooked up. Instead of a large fanny pack with 500 mL of 5FU over 5 days, I will have much less of it in a smaller non-mechanical delivery system (it's quite ingenious) over less than 2 days. I expect to be at work the whole time. One funny side effect is that men often lose their head hair, but not their facial hair. Maybe I sport a Shaft look. Or maybe I should not exacerbate the Mandingo stereotype, which is pretty much what Shaft does in my opinion.

I told the doctor and the nurse that since I am in much better mental and emotional condition that I could likely withstand a stronger protocol this time around. They decided to give me something moderate rather than extreme because I reacted so poorly last time around. I hope that they are not making a mistake by giving me something that is weak because I was such a baby last time. (Well, it WAS pretty fucking brutal. It was.) I don't see why we should prolong this any longer than it needs to be prolonged.

There is another patient about my age with the exact same situation. Same cancer, same surgery, same surgeon, same protocol. His mental space was apparently worse than mine. He is also saying that he doesn't think that he can continue with the chemotherapy. He's exactly where I was at the beginning of December, but there is a difference. He's had a very negative attitude throughout the whole ordeal. He also had some complications from surgery, but by and large, our experiences have been identical. I am told, though, that the difference between him and me is that my attitude has been, over all, much better than his, but specifically it's because he's never really lived on his own, nor was he raised to do this.

I find this interesting. Does this mean that those that left home earlier are generally better able to deal with adversity of pretty much any kind? I left home to go to university when I was 17 and have only lived at home during the summers between school years. Further, I instilled in myself the expectation that I would go to university and take care of my own affairs. Maybe I would be in the other guy's position now if things had been different. He's apparently more depressed and scared than I am. He's frightened, actually. I wish I could help him. There has been lots of talk about how coddled young people are. Maybe it's true. I mean, I suppose since everyone is going to university, they are living at home longer and longer, but what effect is this having?

On another, scarier front, it seems that my superpowers are quickly evaporating. Ugh...

Sometimes I make an entry and then forget about my blog completely. Rose and I spent the day together, and I wasn't near a computer at all. Now it's nearly 1 am Monday morning and I am just checking my comments section.

I am overwhelmed.

I didn't expect this kind of outpouring. I won't go into the things that I was thinking about ten minutes ago, lying awake in bed, but I will say this: your thoughts and emotions have reinforced my resolve tenfold. I feel stronger than I have in weeks, even months. I feel as though I can do anything now. Even beat cancer once and for all. Or not. If it comes back again and again, I feel as though I could deal with that, too, as long as you are all behind me.

I've heard that bloggers are selfish and pompous exhibitionists, full of themselves. I've always known differently, but I've never felt it this much. If it weren't for blogging, and Yulblog in particular, I might be feeling very different right now. I won't forget all the things you've already done for me these past months.

And Rose, you're the most important non-blogging blogger there is. Don't think that I don't know that. I definitely do.

So I will continue, bravely and defiantly. This won't break me. It will not. There are times when spite is your best friend.

Thanks, everyone.

CT scan obtained for attenuation correction and localization purposes. images generated from the base of the skull to the proximal thighs.

The patient is S/P gastric pull-up surgery for esophageal carcinoma.

There is an intensely hypermetabolic 1.7 cm focus with an SUV of 11.7 nestled between the pancreas and the clips anterior to the abdominal aorta, inferior to the origin of the celiac axis, indicating a new metastatic lesion. There is also a more poorly defined focus superior to the origin of the celiac axis at the surgical clips at frame 110 with a maximal SUV of 4.4. It is uncertain whether this latter focus represents neoplastic disease or possibly only inflammatory changes.

Within the mediastinum however, there is also a new 1.6 cm intense lesion with a maximal SUV of 9.7. This node, in the right prevascular space anterior to the SVC at frame 73, would also represent distal neoplastic spread.

Elsewhere, there are no other FDG avid lesions to indicate additional potential sites of hypermetabolic neoplasm. Specifically, the lungs, liver and bones are free of FDG avid lesions.

IMPRESSION:

Mediastinal hypermetabolic metastasis. Additional metastatic lesion inferior to the origin of the celiac axis. Inflammatory or neoplastic changes more superiorly as detailed above.