Thursday, April 28, 2011

CT Scan Reports

As many of you will know, I have come out of the other end of a relatively short cancer episode.

But as many of you won’t know, there were other issues picked up in the CT scans I’ve had which were used to both confirm the cancer’s existence (Oct10) and disappearance (Apr11).

Whether you have medical experience or not, or you have been through the same thing as I have, or similar, you might be able to see what is happening.

While I have been declared cancer-free by the bowel surgeon, he has asked that my GP refer me to an endocrine physician to monitor developments. I will be seeing my GP today to discuss these and other issues.

So here are my two CT reports, abridged (without ellipses) to eliminate unnecessary details –

2 September 2010
History: Preoperative assessment for sigmoid cancer.

Findings: There is an apparent annular constricting lesion at the rectosigmoid junction. This measures approximately 15mm in length.

The liver, spleen, pancreas, right adrenal gland, and kidneys have normal appearance. There is an ovoid low density lesion measuring 26×21mm rising from the left adrenal gland. Note is made of tiny calculus measuring 4mm in the neck of the gall bladder. Lymph nodes composed largely of fat are noted along the external iliac vessels and is within both inguinal regions but these are not pathological. Fatty lymph nodes also noted in the para-aortic region. No significant abdominal or pelvic lymph adenopathy.

No discrete pulmonary nodules in the visualised lung bases.

No destructive bony lesion.

COMMENT:
Annular constricting lesion at the rectosigmoid junction presumably represents the known primary. Non-specific lesion on the left adrenal, and a metastatic deposit cannot be completely excluded. Incidental calculus in the gall bladder neck.


16 April 2011
History: Progress T3 NO MO sigmoid cancer following adjuvant chemotherapy. Progress left adrenal nodule.

Findings: The sigmoid colon cancer has been resected and there is no abnormality at the anastomosis or any other bowel pathology.
No thoracic, abdominal or skeletal metastases are present. Left adrenal nodule is unchanged in size measuring 20 × 26mm in size. The adrenal enhancement/washout study is indeterminate but it is likely to be a benign adenoma.

THORAX: There is no thoracic lymphadenopathy, pulmonary nodules or pleural effusion.

ABDOMEN & PELVIS: No liver metastases are present. A well-defined sclerotic bone lesion in the body of T8 is unchanged from the previous study and is considered to be a bone island.

COMMENT:
- No evidence of tumour recurrence or metastases
- Stable left adrenal nodule has an indeterminate appearance on a contrast/washout study but is likely to be a benign adenoma.

So there you have it. The oncologist sees me on 18May. As for the adenoma and bone-island, I will have to see my GP again about referrals (for some reason I wasn't able to get the pictures to the man last week). But in the meantime, date-cam is added to the list of things I have to go through with diabetes management checks. 

Tuesday, April 19, 2011

Why am I pissed off, or Warum bin ich aufgepisst?(1)

To answer that question, it’s the Monday after pay-day and we have no money. I took something like $50 in change and small notes to buy my tickets this morning, and now have $1.80 until Thursday week, which includes the super-extended Easter/Anzac-Day weekend.
  • We have child-care to pay for ($714 for a whole fortnight, despite their taking him for only six days of that fortnight [wages have to be paid over holidays too]).
  • We have to pay $180 to the surgeon tomorrow simply for him to look at the CT-scan I had on Saturday. (We might be able to get some of this back from Medicare but that’s not the point)
  • jr_g goes to the Easter Show on Thursday, and while it won’t cost anything for us to get in (BIL and SIL are members of the RAS, who run the show every year), Mrs _g still wants spending money (as you do).

We worked that out last night. Today started off as any normal Monday. Alarm goes off 04:50, check into Foursquare, go about feeding myself and preparing for the day.

I walk the 2km to the bus-stop. The reason I do that, instead of to the railway station, is that
  • Buses are more frequent (every 5-10min instead of half-hourly except between 7-8)
  • The fare is only $2 as opposed to $3.30 from the bottom of our street, but there’s no bus in either direction between 05:15 and 06:15
  • It’s 1600m to the station, so what’s 400m between friends [turns out it’s only 5-6min!]
  • The dietician wants me to move more, so there’s 400m extra daily

And there are probably more. Anyways, the bus pulls into the stop while I’m about 200m from it. After a while I say to myself, “Don’t make me run”, but he stays there. Turns out the guy at the stop had $20 for the $2 fare which, regular commuters will know, pisses off the driver; especially when he has to play mix-and-match with his own money.
I get to the ticket window at Blacktown Station and pay the $472 fare in $5 worth of 50c, $2 worth of 20c, and $40 notes. Turns out I only have $4.50 of 50c, and give her 60c of the additional 20s I had on me. I left the window without collecting the 10c change. That could make a difference come the end of the week. 
Oh, and speaking of loose change, we get out to the car yesterday morning, and I find the contents of the centre-console and ashtray-come-money box on the pax-seat. I ask mrs_g if she’d left it like that. No? Great – someone has been rifling through our car. Sometimes it locks itself, but obviously not this time. Good thing I’d not left my wallet and phone in it ... as sometimes happens. mrs_g reckons we’d left it open on Saturday when we’d got home because of the rain. Nothing else was taken (incl music discs and toll tag).
Back to the main whinge, and I manage to get a fast train (Parramatta / Redfern / Central), make the office by 07:30, and begin my day. I’m told at 09:00 that I will be in the call-centre this morning – Mondays are the busiest, so that’s not good news. I ask where one of my colleagues was (I did the call-centre last week, so it would be his turn this week, while I would do tomorrow) and am told he would be in later. Great – he did the same last week: and I said as much. The other colleague (the Aspergers man – I’m sure I’ve mentioned him but if I haven’t I will be happy to) isn’t in yet, but is rostered to be on phones from 09:00. When he rocks in at 9:15, I say nothing, but when he’s not taken any calls by 09:30, I look to see what he’s doing (that’s OK – he is APS2: the lowest of the lowly; I am APS3, still lowly, but “allowed”, nay, expected, to give him orders / work / directives, etc). Now this guy lives at Leichhardt on his own. We have people coming from Morisset and Wollongong who can make it in the office by 08:00, yet this guy can’t make it in from the next suburb by 09:00. So I tell him. His defence was (and he has an excuse for everything) that he was checking on a booking he said on Friday that he’d look into for a patient. I said that he should have come in earlier to do that, because his tardiness means that other people have to cover his arse. He had nothing, and didn’t say boo to me all day).
Then my phone rings .. and because I hadn’t taken the divert off, it went to the hunt-group. Fem-colleague picked it up, muttered something at the phone, then at me. I think I’ve mentioned this woman before (let’s call her Mrs Useless, because she is USELESS (as opposed to Useless, as per Mr Asbergers above). She can speak something like 5 languages, but I am almost positive that none of them is English. Then my phone rings again (I hadn’t taken the divert off yet, probably on purpose – if this call is something I don’t want to deal with, I won’t) – it’s her trying to put a call through (the first call) but it goes back to the hunt-group. This is why I hate working where I do. NO ONE knows how to use the phones properly. We have an Avaya system – those of you in offices with such machines will know that there is a button you can hit if a call isn’t answered – that button brings the call back to you. Granted, I only learned that secret a few years ago, but there are limits (i.e – I know how it works now, why doesn’t anyone else – and I’m not a team-leader or responsible for training so I won’t show you! I found a manual online and sent it to Mr Asbergers. He has yet to read it, yet every time he asks a question about how to use the phones [25 years in the service and he still doesn’t know how to use a computer] I ask if he’s read the book yet … [I should write entries on these people I work with]). SO she tells me I have a call – “Who is it?” I ask. “Ay Dah Nah”. Why would you transfer a call to someone without either knowing who it is or introducing the call/er (the DC3 sent an eMail out recently about cold and warm call-transfers which I’m sure no one read.] I told her to find out … turns out it was a call I wanted, but that’s not the point.
Doing some really boring work (checking data-base details for a national project, and ringing to confirm / obtain them), but would prefer to be doing that than call-centre phones. I see this project as a chance to build relationship with service providers, which is pretty pointless as I have been told that I will be going back to the call-centre full-time. Well, the eMail went along the lines of “we need to discuss your return to” the call centre. My response was, “that’s not a good idea”, to which mgt replied along the lines of staff-rotation / fairness / yadda yadda / platitudes / bullshit / etc. Those of you who deal with bureaucracies will be fully aware of the kind of response I got. I have been in a/c-payable for a year, half of which has been spent sick, or going to doctors / specialists due to either jr_g’s arrival or my own health issues. I excel at Excel and am the only person of the 17-member team anywhere near capable with that application. Plus other medical issues I have (anxiety / GAD, and GORD) make call-centre work inappropriate. Anyway I noted my concerns down, dated it, and will present that to mgt when the time comes. But preparations are well under way – the third colleague (whom I know I haven’t mentioned) is doing stuff that I know nothing about – stuff I haven’t been shown, stuff that makes his role less expendable. But also stuff that Mr Asbergers was doing before his move to the call-centre, and I’ve taken many components of his work  over and made them mine… spose I shouldn’t get too paranoid.
I leave work early, and have to take either Burwood-Strathfield-Lidcombe-All to Emu Plains or wait another 20min for the slightly-quicker train. The “Burwood Train” will get me to Blacktown by 16:00, as will the later, quicker one. So here I am. I texted mrs_g that I would meet her at Seven Hills either before or after she collects jr_g from child-care. Still no response. If she hasn’t replied by Parramatta I’ll ring her. That may mean waiting for a Quakers Hill or Marayong train, which could be anywhere up to half an hour, then walk the aforementioned 1600m (with the appropriate Foursquare check-ins for each street I’ll be using).

First-world problems

1 Not a real word, but the exchange student at uni with whom I first used it seemed to appreciate the context! Call it Ausdeutsch. But for purists, he correct term is probably geƤrgert.
2 This is the weekly fare from Marayong to the City. It is $57 if you want to use unlimited trains, buses, and ferries in the same area. For more info, see www.cityrail.nsw.gov.au.
3 In the APS, the Deputy Commissioner is the highest-ranked officer in the State. This person reports directly to the Commissioner, usually based in Canberra. There is a whole hierarchy but I won’t bore you with the details … Ministers, Secretaries, etc etc …

Friday, April 8, 2011

My cancer experience

In the twenty-first century more than half of the population will be touched by or personally experience cancer. In my 46th year on this planet, I was one of those more-than half. This is my version of what happened.

Every April, the Rotary Club of Terrigal puts out a self-test kit for a nominal fee which was recommended for all over-forties to buy and complete. Since I turned 40 in 2005, I thought it pertinent to take that advice, and in 2008 I did and passed my first test for bowel cancer.

In April 2010 I took the test again. Things were not as pleasant this time, with the test coming back positive for blood in my poo. I took the results to our GP who agreed with me – as bowel cancer takes a while to develop, and I was clear two years prior, it would be due to other issues. But we booked me in to see a gastroenterologist as soon as practicable.

Unfortunately it was July before I could see the doctor and, as my wife was pregnant with our first (and now only) child, the appointment date clashed with baby’s due-date. But due to some vagueness, I actually turned up a day before the appointment. Doctor was able to see me, and we booked my colonoscopy for 30/8/10 (the eve of my 45th birthday).

After the procedure, the doctor wanted to see me to give me the results. They were not good. I, indeed, had bowel cancer. Timing much? Our boy was not even six weeks old. And bowel cancer was not for someone of my age. But there it was.

And not only was there the boy to consider, but I had just started my very-last semester at university (This may be the subject of another post). Having started my journey through the higher-learning phase of edumacation in 2002, I had come through so much to have to throw it all away! Thankfully, however, my tutor told me of the provisions for withdrawal which allow for circumstances like these. While I had to get a letter from the surgeon stating exactly what was going on, it simply meant filling-in-one-of-these, attaching that letter, putting my own story forward, and hoping for the best: fortunately the university was more understanding than my workplace, as I will go into later.

The gastroenterologist then made some calls and referred me to a surgeon who said that the disease was so advanced that it had to be removed poste-haste. But it was going to cost us $5000, payable before the procedure (which, on Tuesday, was scheduled for the coming Friday). Bedside manner? I doubt it! And his receptionist was less feeling. So I got onto a woman at his main office who agreed to speak with him, and he accepted half-now and the rest in instalments. That was doable.

So in I went for major bowel surgery. I was in hospital for four days, on morphine for one, and in bed for almost all of it. But we know how impossible it is to sleep in hospitals. And my being diabetic didn’t help, with the pills (for pain and diabetes) and checks required every six hours. The worst thing was the lack of visitors. My wife and son came every day (you’ll see a photo from one of those visits on my foursquare account), her parents came on the Saturday, and my father came (I think it was) on Monday. I did request no-visitors for the weekend, as I expected to be non-compus for the first couple of days. But I was there until Wednesday and was quite put out by a seeming lack of caring.

And on the Wednesday, when I came home, there was a message from work. How did you want to take this leave? When I left work on the Wednesday after the consultation with the surgeon, it was agreed that I would sort this out on my return. Apparently HR would not accept this. Great – how is one supposed to recover from major bowel surgery while worrying about how to organise leave?! It turned out that I had hardly any personal / sick leave left, so I would have to take a great swathe of my recovery month unpaid. But someone somewhere along the line (I think it was this same HR person) told me of the ability to access the Department Secretary who has the power to extend personal leave in special circumstances. Is this special enough? Apparently not – because I had used a lot of my leave in the previous year, the Secretary deemed my illness as not falling within the realms of that specific part if the Act (or whatever it is). So along with physical and emotional pain, now we had to look forward to financial pain as well.

So we booked a follow-up appointment with the surgeon. He was pleased to announce that he had removed the main mass of the cancer, but not so pleased to announce that the growth had come to within 0.04mm of bursting into the peritoneal cavity and being inoperable. Again with the timing (and the bedside manner – this absolutely horrified the wife). But he wanted to refer me to an oncologist for a second opinion.

So off we went to see the prof, who prescribed a course of chemotherapy. What the…? How is this a second opinion?! The prof explained that, while the surgeon had removed the main mass, the chemo would make sure that there were no nasty microscopic bits left. That was to start on 01Nov10 – one week of treatment, three weeks off, a follow-up with the prof in week two or three to see how it was going (chemo is ½ science and ½ witchcraft he said: the science is knowing what drugs are best for what cancers; the witchcraft is used to determine just how much of the drug is needed, and how to adjust the dosage to make sure the treatment isn’t as bad as the disease).

Because of what I do with the agency by whom I am employed, I was slightly aware of how this was going to be for me – cancer treatment makes one quite ill, and I was in for six months of it. Unfortunately I didn’t have the time to be able to have treatment and take time off to recuperate: I had to do the treatment in my own time in accordance with how they booked me in. Fortunately for the way the system works, they book the long-termers in early, and the short-termers like me in late. My treatments eventually fell to 16:00, and there was a definite cycle to how it all worked. Mondays were manic: at one point because of how things worked out, I didn’t turn up until 16:15. They kept me waiting there for a half-hour. Then there was the rush-round to see where my drugs were, whether there was a “bed” for me, etc etc.

But don’t get me wrong – I wish I could name every one of the nurses in that centre, from the one who took me through the first course (in one of the consult-rooms so I could have the fam in with me), to the one who took a particular shine to me: offering me a drink or ice-block “because I’m special” when it was part of the treatment that no one else did; to the one who got me in and out in record time, to the ones who only looked after me the once. I won’t name any of them for fear of leaving any of them out. The work they do is fantastic – from dealing with the angry woman who had been sitting there for two hours and had yet to have the drugs go through, to dealing compassionately with the long-termers who were very obviously not going to make it, from joking with those of us who still had a sense of humour, and all doing it for the menial amount that nurses are paid. They do all the work, the doctors get all the kudos – that’s how I see it.

My ability to cope with the treatment ebbed and waned. Obviously these are hefty drugs – super-powerful, and accumulative. After a couple of cycles, my ability to back up at work declined, and my ability to carry on with every-day living over the weekend diminished as well. At one point I slept from 19:30 on Friday to 11:30 Saturday. But if this was the worst with which I would have to cope, then so be it. I always kept reminding myself that it was better than the alternative. Eventually, however, I succumbed to a chest-infection which meant that I would have to defer my very last cycle. Combined with the cumulative effects of the chemo, I was unable to attend work for the best part of two weeks.

With the second deferral came a request from one of the prof’s registrars that she see me with a chest X-ray. The first time, this registrar had prescribed me super-powerful anti-biotics to fight the chest infection, but they had not done that much. The X-ray, however, was clear of any pneumonia or other nasties. So she went around to the prof, and came back to say, “You’re done”. It turns out that the minimum number of cycles in cases such as mine was 4, and the maximum six. I had done five, and was waiting to start the last one once this infection had cleared. But the prof said that five was enough. Not exactly the finish I wanted, but the end is the end.

So to all those who supported me through this ordeal: the doctors, nurses, friends, family, and tweeps – thank you: it would not have come out quite the same way without any of you!

Wednesday, April 6, 2011

Pets, and how they make our lives more interesting

We’ve had two cats now. The first one took 18mo to figure out that he could get out of the garage we put him in overnight, and this last one has figured out how to get out of the garden shed we have to keep him in. This was after putting him in the laundry for a week or two.

The decision to put him where we do is because of the damage he’s caused to much of the stuff we have in boxes. Many of the boxes were actually shredded from his clawing / stretching / doing what cats do. The laundry here is a little small for him: only room enough for a poo-tray, water, food-bowl, and carry-box.

But after a while I realised that the garden shed, which is lockable, is bigger, despite having more stuff in it (mower, weed-whippers, empty rubbish bins, etc etc). But the shed, along with the rest of the place, hasn’t been kept really well, and the door has started to jam and the lock-hasp didn’t quite make it up to the staple. So I just put the house-brick in front of it and left it at that.

But at 0300 today came a knock at the door. It was the cat. He’d got out. The reason we didn’t let him sleep with us is, well, if you’re a cat-owner, you’d know about the ungodly-hour calls – he had learned that knocking on the wardrobe doors makes a noise which makes us get up and attend to him (even if it was to lock him in the laundry for the next couple of hours).

But this morning, after he came in, he just went to the sofa, and slept there until we got up. I think he knew he’d done the wrong thing. Strange creature.

Other things our strange creature does is refuse to use the cat door to leave the house, or when we’re at home or awake. He will use his door when we’re at home and asleep, and when we’re out and left him out of the house. We’re considering getting a step so the dog can use it as well. 

Pets - can't live with them; can't live without them.