Food Tube Consultation

Daily Quote: "As much as I would have liked to have kept my cancer private, I now realise that I have a certain responsibility to those who are fighting their own fights and may be able to benefit from learning about mine." — Farrah Fawcett on her cancer / May 14, 2009

This morning I visited Dr Snehal Rohitdesal, M.D. of Digestive Associates for a consultation on feeding tubes.  He stated that having a feeding tube installed in my stomach is a precautionary measure due to the possibility of not being able to chew and swallow food because of the damaging effects radiation has on the mouth and throat, such as bleeding gums, open sores, raw throat, etc.  I may or may not need to use the feeding tube, but best to have it as I'll need nutrition to help fight the disease.

I'll need to visit Valley Hospital 1 to 2 days prior to procedure and have nothing to eat or drink six hours prior to exam.  (Mostly paper work, release forms, and of course co-payment beforehand)

The nurses at Valley Hospital will show me how to clean the skin and feeding tubes, the cleaning process should be done three times a day as the feeding tube is a foreign object to the stomach.

Therefore, I'm now scheduled to have a feeding tube installed at Valley Hospital on Thursday, May 5th at 1:00 p.m.  I'll need to have my wife, Suzie, pick me up after the operation as I'll be under a mild anesthetic.

This whole feeding tube situation does sound horrible to me, totally unnatural, but realize I may need to use it.

Later in the morning I visited my Radiologist and had radiation done on my throat and neck.  Took only 15 minutes, pretty easy today.  Had a small grilled chicken for lunch. I'm no longer nauseous, but still very tired, will be taking an afternoon nap soon.

Tomorrow morning my radiation will be at 7:45 a.m. and will begin working the four day weekend, 12-hour work days, it's going to be tough as I won't be able to take any medications that would affect my driving, therefore no nauseous medications.

Update On Cancer Treatments

Daily Quote: “It gave me a chance to re-evaluate my life and my career. Cancer certainly gives things a new perspective. I would not have won the Tour de France if I had not had cancer. It gave me new strength and focus.”  --Lance Armstrong


I've been lax on my blog updates on my cancer battles, I've been too busy and have been placing most of my emphasis on facebook and forum sites, plus squeezing in all the medical exams, cat scans, treatments, etc makes Bruce a very busy boy.  Here's a recap since my last cancer post:
 
April 11th:  Dr. Treadwell's office for a cat scan on upper chest and right lung. 
 
April 13th:  Biopsy of my right lung at Steinberg Diagnostic.
 
April 17th:  Won bid for a new work schedule that's more compatible to my treatments, but I no longer have Saturdays and Sundays off...I now have Tuesday, Wednesday, and Thursdays off.  I still work from 12:00 p.m. to 12:00 a.m.
 
April 18th:  Dr. Saltz, my dentist, checked the health of my root canals and replaced five fillings as to prepare myself for radiation.  Bad root canals could lead to infections and the removal of my jaw and bad fillings could lose my teeth from the radiation.  I now must use special extra-flouride toothpaste after anytime I eat or drink anything.
 
April 19th:  Dr. Parks tells me the results of right lung biopsy, I also have lung cancer as well as the neck and tongue cancer.
 
April 26th:  First chemotherapy appointment at 10:00 a.m., three hours and 20 minutes of chemo treatment.  I also had my first radiation treatment at 3:00 p.m., only 20 minutes of radiation.
 
April 27th: Second radiation treatment at Dr. Treadwell's office.  Doctor Treadwell consultation tells me of new strategy, the The doctors have determined to separate my radiation & chemo treatments...my first six weeks of chemo & radiation therapy for my tongue and neck cancer, the next six weeks the therapy will be concentrated on my right lung and upper chest...the doctors believe that I would become too sick if they tried to treat everything in eight weeks. Unfortunately, my therapy is now stretched to twelve weeks.
 
Tomorrow I'll be visiting Digestive Associates at 8:00 a.m. for a consultation visit on the need of a feeding tube.  My radiation treatment will be at 11:00 a.m.
 
I'm currently feeling very nauseous and extremely tired, I can't seem to get enough sleep.  I need to be ready for work on Friday.  Back to bed!

Team Bruce

Daily Quote: "Cultivating and maintaining a strong social network is vital to your emotional and your physical health.  Scientists believe this may be partially due to oxytocin, the bonding hormone people release in social situations, that has been shown to relieve stress and anxiety." --Linda Childers, "Living with Cancer Magazine," Article, "Taking Control Over Cancer!"  pg 31.

I have a fantastic running family at about.com's running/jogging forum site, they have been extremely supportive and caring since I had started coughing up blood in January.  I'm so very blessed to have these friends in my corner, indeed they have helped relieve my stress and anxiety  and are praying on my behalf.

Yesterday, I discovered that Winnston organized my running family as an organized "Team Bruce," where they'll be wearing t-shirts stating they are "Team Bruce" runners, he said,

"We are going to show some solidarity with you. How? We are going to show the world we care the best way we know how. We are going to get out and run, and some of us are gonna do it in "BRUCE" shirts for all the world to see. And when they ask us who this Bruce guy is, we are going to let them know. In the messages below should be a growing group of photos of us in our TEAM BRUCE shirts, and also some new profile pics.
Your say your doc says no running for 8 weeks? I can't imagine how tough that is going to be for you. But we have a bit of a solution. We are going to run those miles for you. We hope in this thread to log "Virtual miles" for you from many different locales. Not sure who is going to be doing the compiling, but it will all be right here.
See what I mean when I say that my running team is fantastic?  I'm so flabbergasted, I just don't know what to say.  Not often am I speechless, all I can say is WOW!!

Here are some of my Team Bruce photos, running athletes all:

Meet My Oncologist

Daily Quote: "During chemo, you're more tired than you've ever been. It's like a cloud passing over the sun, and suddenly you're out. You don't know how you'll answer the door when your groceries are delivered. But you also find that you're stronger than you've ever been. You're clear. Your mortality is at optimal distance, not up so close that it obscures everything else, but close enough to give you depth perception. Previously, it has taken you weeks, months, or years to discover the meaning of an experience. Now it's instantaneous." --Melissa Bank

I'll eventually need a new profile photo as I'll be a bald wonder.

Today is my first day I visited my oncologist, Dr. Hyo-Jong Park, M.D., at Cancer and Blood Specialist of Nevada.  It's an amazing coincidence (providence) that he was my friend's, Brenda Boswell, doctor in the past, he helped her have total remission from cancer!  The following is from his bio page on the Cancer & Blood Specialist web site:

Medical School: Seoul National University, School of Medicine
Internships: Seoul National University Hospital, Internal Medicine Department, St. Francis General Hospital
Residency: Pathology Resident, Shadyside Hospital, Pittsburg PA.
Fellowships: Oncology/Hematology University of Maryland Cancer Center
Dr. Park is board certified in Internal Medicine, Hematology, and Medical Oncology. He is a member of the American Society of Hematology, American Society of Clinical Oncology, the Nevada Oncology Society and the Clark County Medical Society. He has hospital privileges across the Las Vegas Valley. Dr. Park is licensed in Nevada and Arizona, and holds inactive licenses in Maryland and Pennsylvania. Dr. Park has practiced with Cancer and Blood Specialists since 1997.


Dr. Park will be giving me chemo once a week (three hours long) during my cancer fight.  We tentatively plan on starting chemotherapy on April 19th!!  The cancer fight begins soon.

During the visit he sat me down and asked me my history in regards to my discovering cancer and what I've done already.  I told him about my coughing blood in January, the route of discover with my new primary care doctor, Dr. Norris.  The route of examining my chest with a cat scan, the discovery of a small nodule in my right young.  The route of visiting the ears/nose/throat specialist, Dr. O'Donnel and his taking a biopsy of the lump on the back of my tongue.  The biopsy of my tongue being cancer.  The route of having a cat scan of my neck. The visit with my radiologist, Dr. Treadwell, and the projects I had to take with him (pet scan, dentist visit, eventual food tube from Digestive Associates.)

I also told him of my recent pain on my upper right chest and under my right arm.  Dr. Park then proceeded to probing my chest and underarm, which he discovered a small soft mass.  He is scheduling me an underarm biopsy of the mass at Steinberg Medical
for April 13th.  I'll need a blood test at least two days before the biopsy.  Needless to say, I hope my cancer isn't starting to spread below my neck.

The consultation ended.  I proceeded to the receptionist desk where she gave me papers for my blood test as well as scheduling the appointment for the chemotherapy on April 19th.  The only time available for my chemo is 9:45 a.m.  Unfortunately, the chemo takes three hours and will not be able to make it to work on time after the treatment.  I must try and figure something out with my employer concerning my work schedule.

I still have a dentist appointment on April 12th to fill five fillings that were questionable.

April 13th is my underam biopsy.

April 22 is my consultation with Digestive Associates in regards to a feeding tube.

I'll be checking the Checker Cab bid board this week as to see whether their are any drivers who retired, quit, or fired who had work schedules that would be more friendly with my treatments.  I currently have Saturdays and Sundays off, but my cancer treatments are Monday through Friday...ideally, I need a work schedule that has at least Tuesday off for chemo, and the rest of weekdays be scheduled later in the day for the radiation treatments.  Fortunately, my seniority number is 28, we have about 700 Checker Cab drivers, and should be able get any shift that's posted on the bid board...just one of the advantages to being a Checker Cab driver for over twenty years.

I have so much on my plate, I can't describe how difficult it is to exercise, fulfill my medical appointments and then work a 12 hour shift.

PET Scan

Daily Quote: "CT scans and MR scans can give us excellent photographs of different parts of the body, and identify enlarged nodes or tumor masses. However, sometimes it is difficult to tell whether a lump or mass in the body actually has tumor cells in it only by measuring its size and shape. Small lumps or nodes may contain cancer cells, while larger ones may just be something harmless. That is when you need to measure the activity of the mass. And a PET scan is the answer."   --Indranil Mallick, M.D., former About.com Guide, Lymphoma site.

My appointment for my first PET Scan was held at Steinberg Diagnositcs at 7:30 a.m.  The PET scan was very similar to my previous CT Scan for my chest and the CT Scan for my throat. I had to eat 4-6 hours before the scan time, and not do any strenuous physical activity before the scan, since my appointment was so early in the morning had no problem fasting nor running.

I checked in at exactly on schedule, but still had to do about 20 minutes of paperwork, my co-pay was huge, $750.00, to be paid before the PET Scan!!  I'm concerned that I will be flat broke after 18 weeks of therapy, which consists of 40 treatments.  I'm worried that the financial burden may be to much stress for my wife.

Finally I was led to a small room with a large leather recliner. A small amount of radioactive material  (small enough to be essentially harmless), was injected an hour before the scan was done. I was told to recline in the chair and not move around. I immediately fell asleep in the chair as I waited...I'm not a morning person.

I was then taken to the bathroom and was told to change into a gown.  Went to another room, which had this huge scanner, laid down and was told the scanner will photo most of my body, but will stop at my ankles. The PET scan itself lasted about 45 minutes, which I fell asleep again.  Once the scan was over I dressed and left the clinic in about 10 minutes.

Decided to do my run before work rather than waiting until after work.  Bought a large bottle of Gatorade as I plan on flushing the radioactive material from my bloodstream during the gym workout. I ran on my gym's treadmill for 60 minutes at 6.0 mph (10 minute miles) on a 1% grade.  I did feel lightheaded on the treadmill, but was happy to complete the run now rather than 12 hours later.  I believe I accomplished the goal of flushing my bloodstream.

My PET Scan results are so very important to me, I hope that my cancer is limited to my neck and tongue and hasn't spread to my lower organs.  The actor, Michael Douglas, also had throat cancer recently and his cancer didn't spread to the lower body and he's now in total remission.  I would be thrilled with that outcome!

I won't know the results of my PET Scan until two business days.  My doctors should have the results by next Tuesday or Wednesday.  Next Tuesday I'll have my very first visit with my oncologist at the Cancer and Blood Specialists of Nevada.  I also have a consultation with my Dentist on Monday.  I hope to have a food tube connected to my stomach soon.  Next week will be a very traumatic and busy week!!

Meet My Radiologist

Daily Quote: "Dr. Sheehan was diagnosed with prostate cancer in 1986. By the time it was discovered it had spread to his bones. For seven years he lived with the cancer, and 'made every day count.' He was a runner to the core and he would not let the cancer change that. He ran until his legs could no longer carry him. Through it all, he remained true to himself, continuing to write about his experiences. This time it wasn't about running, it was about dying. Going the Distance was his last book. It was published shortly after his death."  --from GeorgeSheehan.com, http://www.georgesheehan.com/welcome/bio.html

I'll need to re-read the book "Going the Distance" during my own cancer fight as to keep me motivated to push myself forward.  Dr. Sheehan is a great role model for me!

Today is the first day I meet my Radiologist, Paul K. Treadwell;  I read his bio at the 21st Century Oncology website, which stated:

Paul K. Treadwell, MD, Board Certified in Radiation Oncology, received a Bachelor of Science with honors from the University of California. He graduated from medical school at the University of Nevada with a Cerficicate of Distinction in Surgery. He did his residency at the University of California, Irvine. During his residency Dr. Treadwell received the American Cancer Society Clinical Fellowship Award and served as Chief Resident for two years.
Before relocating to Las Vegas, Dr.Treadwell was the Associate Head of Radiation Oncology at St. Joseph Hospital and Children's Hospital of Orange County and was a Clinical Professor in Radiation Oncology at the UNiverisity of California, Irvine. Dr. Treadwell is a member of the American Medical Association. Dr. Treadwell's special interests include breast and gynecological cancers and Hodgkins lymphoma.
He is a member of the American College of Radiation Oncology (ACRO).

Hi bio gave me confidence he was competent enough to be one of my Knights in my struggle to beat cancer.  His photo was obviously taken when he was much younger, as the man has grown heavier and grayer. 

The following is a gist of my consultation with Dr. Treadwell at 21st Century Oncology at 8:00 a.m. on March 30th.  Completed several pages of paperwork.  Was taken to a very small room where the doctor's assistant took my blood pressure.  A few minutes later Dr. Treadwell entered and sat down across from me and was rather blunt about my throat cat scan, that I have squamous-cell carcinoma.  He proceeded to check out my lungs with his stethoscope.  After my quick checkup, I asked what will be my treatment? The chemo-radiation treatment will take about eight weeks and consist of 40 treatments.  Dr. Treadwell stated that the success rate of the chemo-radiation treatment is about 75-80% and much better than the alternative of cutting out my tongue, which I readily agreed!



He strongly suggested that I take a medical leave of absence from work as the treatments are very tough, the last three weeks of treatment are particularly difficult.  Unfortunately, I can't afford to take that much time off from work and told him I prefer to struggle through the process of working and taking treatments.  Trying to deter me he mentioned a previous patient who was a security guard in tremendous physical condition rippling with muscles who also wanted to work during the treatment weeks, but eventually had to quit his job as the treatments were just too tough for him.  He didn't realize that his little story sounded like a challenge to me, and had me repeating that I was not going to take a leave of absence from work.

I mentioned that I work from 12:00 p.m. to 12:00 a.m. and my treatments must be in the mornings.  He stated their are no guarantees when the treatments are scheduled.  Oh well, the treatments only take 15 minutes, not including the waiting room time, I could visit the radiologist when I'm working and treat it like a lunch break...I wish the doctor's office wasn't so far off the Strip.

The side effects during chemo will be that my saliva will be thicker, will need to eat through a feeding tube and I will not be able to taste for four months! 

I asked when do we start my treatments.  I had several projects before treatment:

(1) Need dentist approval as to not have any root canals exposure...the radiation could eat my jaw and teeth resulting in partial or total removal of my jaw.  The dentist also has to retrieve for me a flouride brace (I have no clue what it is) and will use the flouride for the rest of my life.

(2) Southwest Medical will need to provide me a feeding tube and will need instructions on how to use and clean it.

(3) I must have a PET Scan as to see if my cancer has spread or if cancer is still isolated above my neck.  I have a PET Scan already scheduled for April 1st at Steinberg Diagnosic.

(4) Approval from my HMO, which sometimes takes two weeks!  My insurance does like to drag things.

The consultation only took about 15 minutes and then I went immediately to the gym and ran six miles (at 6.0 mph, 1% grade) on the treadmill before work.  Called my dentist and made a consultation appointment for Monday, April 4th, 9:15 a.m.  It was an exhausting day, but feels great that I'm finally beginning to start my fight against cancer.

My next post will be about my PET Scan.  Bare with me, I'm a little behind due to time restraints.

Result of Neck Cat Scan

Daily Quote: "Ninety percent of cases of head and neck cancer (cancer of the mouth, nasal cavity, nasopharynx, throat and associated structures) are due to squamous-cell carcinoma. Symptoms may include a poorly healing mouth ulcer, a hoarse voice or other persistent problems in the area. Treatment is usually with surgery (which may be extensive) and radiotherapy. Risk factors include smoking and alcohol consumption." --Wikipedia

Finally received the results of my Neck Cat Scan that was at Southwest Radiology on March 23rd, which was taken before my biopsy result.  Friday, I'll have a full body Pet Scan, which will show if the cancer has spread to my lower lymph nodes and/or other organs.  The following is the result of my Neck Cat Scan:



CT NECK WITH CONTRAST
CLINICAL HISTORY: Benign neoplasm of tongue.
COMPARISON: None.


PROCEDURE: Following the uneventful administration of intravenous
contrast material, CT images are obtained from the skull base through
the aortic arch.


FINDINGS: Lung apices are grossly clear. Slight degenerative changes
are seen in the spine. Dental hardware is seen. There is mucosal
thickening along the inferior aspect of both maxillary sinuses.
Visualized mastoid air cells are clear. The parotid glands,
submandibular glands and the left thyroid lobe are unremarkable. There
is a partially calcified cystic and solid nodule involving the right
thyroid lobe on image #69, measuring 10 mm. There is uniform
enhancement of the great vessels of the neck. There is focal nodular
thickening along the base of the tongue towards the right side of the
vallecula on image #37, measuring 3.2 x 1.8 cm. Bilateral abnormal
lymph nodes are seen in the jugular chain region, zone II on the
right, measuring 2.3 x 1.5 cm and left side on image #34 measuring 1.7
x 1.4 cm.

IMPRESSION:


1. Focal soft tissue thickening and masslike area along the vallecula
centered towards the right side. In addition, there are multiple
abnormal jugular chain lymph nodes along the zone II bilaterally.
These are worrisome for malignant neoplasm, recommend further
evaluation.


2. Mucosal thickening is seen along the maxillary sinuses bilaterally.


3. A 1 cm partially calcified nodule along the right thyroid lobe.
Recommend dedicated evaluation when clinically appropriate or
comparison to a prior.

Ran after work on my gym's treadmill at 12:15 a.m.  Easy run, six miles on the treadmill with a 1% grade, which was done at 6.0 mph (10 minute miles.)  No heart rate monitor.  It's very tough to run after work as the stressful 12-hours driving a cab on the Strip takes alot out of me, but I do feel a sense of accomplishment afterwards, like I have at least some control over something!