Memory Talk

This weekend I gave a talk on memory at the National Oral History Conference, put on by the Oral History Association of Australia. This is the first talk I've done since I've been sick, and it was great to get back into the swing of professional activities...

Weekend Drive

This weekend we drove out to Maleny, a small town north of Brisbane, to go exploring. We found some great used bookstores there and picked up a few things. I was really tired after a week of catching up with friends who were in town for a local conference, so was nice to just sit in the car and see the great scenery.

The first picture above is of the Glass House Mountains; the second of Lake Somerset.

NO MORE CHEMOTHERAPY!

Today I had the final CT scan which would show if the tumor was stable - which in fact it did! The tumor has shrunk almost 80% in size since the start of treatment, but hasn't shrunk significantly in the past few months, demonstrating that there are no more active cancer cells. My hematologist, Dr. Kirk Morris (above) was very pleased with these results! I no go for follow-up visits with Kirk every 3 months for 2 years, then every 6 months for another 3 years, then every year once I reach 5 years post-treatment. Cancer, if it reoccurs, is most likely to reoccur in the first 12 months. I will have periodic CT scans just to check that the tumor remains inactive.

I was VERY excited to then finally get my PICC line removed. As promised, they just pulled it out - felt weird but hardly hurt at all! It was pretty long - almost a yard long. Tim dutifully photographed the proceedings....

PET scan results

Today I had a PET scan to check that the affected lymph nodes are still showing no signs of cancerous activity, and that indeed was the case! Yippee!

Too funny!

Maybe we should think about consolidating...

Nancy Gets a Tattoo!

Today I had my radiation planning meeting, where they take a CT scan of the area to be irradiated, then meld that with a prior PET scan of the tumor when it was at its largest, to plan how they will irradiate the entire area the tumor occupied, with minimal exposure of vital organs.

Part of this involves making reference marks on the patients body. I had understood that this would be with a semi-permanent dye, but instead, when the nurse started pricking me with a needle, I quickly figured out that it was a permanent tattoo! So now I have two brown spots, the size of a small freckle, on either side of my chest! And I'll get one more dot in the center of my chest the day I go for my first actual radiation treatment (now scheduled for October 4th....)

A Great Film

Tonight our friend Annette stopped by with spaghetti bolognaise for dinner (she is a great cook!). We then watched an excellent film, called My Neighbor Totoro, by Hayao Miyazaki. The movie won the Animage Anime Grand Prix prize in 1988. My favorite part of the movie is the catbus. If you want to see a charming film with a great storyline, rent My Neighbor Totoro.

Everyone Feeling Better!

Well, everyone is feeling much better today - Zamboni has lots of energy (although you can't tell from the posted photo!) and my thrust is also much less painful...(again, the photo above, of an Australian Bassian thrush, is not as accurate, but much prettier, than actual photos of medical thrush...)

Lung Function Tests

Today I had what turned out to be my final set of lung function tests...

Spirometry (from the Greco-Latin term meaning "to measure breathing") measures how well the lungs exhale, and the machine used to test this is called a spirometer (see photo above). Spirometry reveals any degree of narrowing or obstruction of the airways - my results on this test have pretty much always been in the normal range.Lung volume measurement records the maximum amount of air the body can hold and helps determine the elasticity of the lungs and rib cage. The most accurate way to obtain this measure is using a body plethysmograph, a sealed, transparent box (see above) that looks like a phone booth and determines the volume of gas in the lungs. An abnormally low reading indicates a stiffness that is common in restrictive lung disorders, such as scarring of the lung tissue (which can be a side effect of chemotherapy) where a person cannot inhale a normal volume of air. My results on this test have been slightly above average, which a common in those people like me with mild asthma.

Testing the diffusion capacity of the lungs permits an estimate of how efficiently the lungs are able to transfer oxygen from the air into the bloodstream. This is measured by testing the volume of carbon monoxide a person breathes out after a known volume of the gas has been inhaled. This is the test that for me has been way below average, right from before the chemotherapy. However, today the results continued to show improvement, and my diffusion capacity is finally within the low average range. The pulmonary doc said these numbers should continue to improve over the next six months. He also cleared me for flying without having to take extra oxygen (a real pain!) so that means I can fly starting in November with a short trip to Melbourne then a longer trip to San Fransisco to see my Mom and my sister Joann!

Unfortunately, my mouth had been in increasing pain over the last day or so, and I went and had the day oncology people look at it. They diagnosed oral thrush (a fungal infection of the lining of the mouth), a cumulative side effect of the chemotherapy. Fortunately it is easily treated with medication, but not as humorous as the drawing below...

Work on Water Pipe Continuing

Work on the water pipe just outside our backyard continues... I think they will finally be done with the construction after I am completely better.... Sigh... but it will be nice not to have construction noises, especially on Saturdays!

Zamboni Feeling Poorly

Zamboni seemed to be feeling poorly yesterday, so today we took him to the vet. We suspect that a slight chenge to his food caused some stomach upset, but the vet thinks he'll be fine after eating beef for a few days...

Twelfth and Last Chemo Treatment Today!

Well, I'm very excited to be having my last chemotherapy treatment today! Can't wait to actually start feeling better again after the worst of the side effects are over, knowing that I don't have to feel so bad again in another two weeks, but that I can continue to feel better! Am looking forward to getting my sense of taste back (now almost completely shot), being able to eat dinner again (I've had to stop eating food after 4pm, as it makes it impossible to sleep), and to growing out my hair (although I've sort of gotten used to the "minimalist" look I sport above). It will be nice not to have to take the bone marrow shots (although I still have to do one more week of those, to get ready for the radiation therapy). I may start getting my periods back again (for the past 4 months I've been menopausal). I can finally get my teeth cleaned (the risk of infection is too great on chemo to do that). Lots and lots to look forward too... :)

Anniversary Brunch

Today we celebrated our 14th wedding anniversary with a lovely brunch at our newest find - a tapas restaurant making an excellent breakfast, lunch and dinner. I had the eggs benedict, Tim had the "Canadian-style" pancakes....

Roadworks

They are making the road between our house and the inner suburbs of Brisbane two lanes in each direction, which creates traffic mayhem in the morning, especially when we are trying to get to the hospital early in the mornings... Luckily most days we can leave a bit later and miss the worst of it. But it should be much better once they finish...

Sometimes it helps to pass the time to have the camera in the car, as you can get shots like the one above...

Research and Girl Talk

Chris Stephens was joined by her colleague Fiona Alpass (also from Massey) to have research talks with the investigators of our Australian Longitudinal Study of Women's Health here at UQ. Chris and Fiona recently received large grants from the New Zealand government to fund their own longitudinal aging study to look at positive aging, and to compare their results with similar studies in Australia, UK, the USA and Europe. Their findings will be used to inform public policy and practice. Although they look like serious scientists in the photo, we actually had two days of nice meals (including lunch at our house) and some very funny story-swapping...

Dinner with the Podd's

Tonight we had John and Anne Podd, friends from New Zealand, over for dinner. (Anne is on the town council in Palmerston North; John is on the faculty at Massey University.) John and Ann were kind enough to often look after the cats while we were in New Zealand. They really liked Denali, who was her usual exuberant self. All the cats came out to say hi, including Zamboni, who actually has a map of New Zealand on his head....

The Full Scoop on Impending Radiation Treatment

Today I saw the radiation oncologist to get the full scoop on my impending course of radiation treatment. I've explained why I need the radiation, as well as what will be used and potential side effects, below.I was initially diagnosed with the most common subtype of Hodgkins Lymphoma, namely Nodular sclerotic, which accounts for 50-70% of cases. I was diagnosed at stage II (see "Ann Arbor" Staging Classification system above - click on the graph to make it bigger). Stage II is often characterised by a mediastinal mass (which is when a tumor forms in the area that separates the lungs).

Treatment for lymphomas at stage I usually involves radiation; for stage II and above, a combination of chemotherapy and radiation is used. Radiation therapy, with x rays or other high-energy rays, also is used when the disease involves a bulky mass, where chemotherapy drugs cannot reach all of the cancer.

I will be receiving the most advanced form of radiation treatment, available only since the late 1990's, called Intensity-Modulated Radiation Therapy (IMRT). Computer-controlled x-ray accelerators distribute precise radiation doses to malignant tumors or specific areas within the tumor. The pattern of radiation delivery is determined using highly-tailored computing applications to perform optimization (mathematics) and treatment simulation (treatment planning). The radiation dose is consistent with the 3-D shape of the tumor by controlling, or modulating, the radiation beam’s intensity. IMRT also improves the ability to conform the treatment volume to concave tumor shapes, for example when the tumor is wrapped around a vulnerable structure such as the spinal cord or a major organ. The radiation dose intensity is elevated near the gross tumor volume while radiation among the neighboring normal tissue is decreased or avoided completely. Because of this, IMRT allows for higher radiation doses to be delivered to the tumor while sparing healthy tissue as compared with conventional radiation therapy techniques. This in turn results in better tumor targeting, less side effects, and improved treatment outcomes.

The main reason for giving radiation treatment after chemotherapy is that even though the chemotherapy has caused tumor shrinkage, microscopic tumor cells can be left behind as the tumor shrinks, which could potentially grown into new tumors.

There are short term (during treatment) and long term (persisting after treatment) side effects from radiation treatment. For the radiation treatment I will be receiving, in the necessary areas (meaning the area of the size of the ORIGINAL TUMOR, plus a small additional area around this) the short term effects are:

• fatigue
• loss of appetite
• skin redness where the beams hit (front and back of chest)
• dry, sore throat and difficulty swallowing and eating

The long term effects which will almost certainly happen include:

• loss of lung tissue that is unavoidably hit by radiation (approximately 8% total volume, which in most people results in very little noticeable changes in functioning)
• risk of development of secondary cancers (while radiation is a potential cause of cancer, secondary malignancies are seen in a very small minority of patients; in the vast majority of cases, this risk is greatly outweighed by the reduction in risk conferred by treating the primary cancer).
  

In my case, given where the beams will be targeted, there is an increased risk of my later developing breast cancer or thyroid cancer; however, the risk is relatively small and these types of cancer develop 10-15 years after treatment. There is also about a 1 in 300 chance of my developing radiation pneumonitis, an uncommon type of lung inflammation, about 6 months after radiation treatment; again, it is a relatively small risk.

My last chemo treatment is 10th September. The treatment planning session for the radiation treatment is 17th September, with radiation scheduled to begin on 1st October. I'll have 20 treatments all up, in other words, 5 days a week for 4 weeks. Each radiation treatment lasts approximately 2-3 minutes.

Nice Hike to Natural Bridge National Park

Today we drove to Mount Tamborine to grab some excellent fresh brie and bread from our favorite cheese shop, Witches Chase. Next we took in some antique shops and bought the really cool leather traveling case (below). Then we drove to Natural Bridge National Park on the Gold Coast to do a short hike with our friend Chris Stephens. It was a beautiful day!