CT scan pix

I had to have my second CT scan on Friday.  I get CT scans every 3 months, and MRIs of my brain every 6 months.  I have do the CT scan “with contrast” which means I have to drink this nasty glue-like “smoothie” that tastes awful, and feels pretty bad.  Totally blows out my G.I. system.

Cat Scan Smoothie

The tech who does the CT scans has given me two of the best IVs.  The first time, I didn’t even feel it.  This time, I barely felt it.  He cuts off the finger of his glove so he can feel the vein better.  The first time he did it in a really dramatic/showy way, putting the glove in his mouth, and biting down on it, stretching it out, and snipping it. This time, he does it a little bit more practically, but still fun and cool.  I feel like I wrote about this before…



Finger on pulse for IV

I feel the sleepy undertow again

It is kind of amazing to feel the side effects of the Interferon coming on again.  Whereas before they were confusing, surprising, chaotic and alarming, now they are like the return of an old friend.

This morning I had my first “I don’t feel like eating anything in the whole world” feeling.

This evening I felt the sleepy undertow.  I lied down around 6pm, and felt like I could just go to sleep.  I felt like it was going to be so hard just to get myself up.  I had a friend coming for a walk at 630, so I forced myself to get up.

So all my old friends are back.  Fevers, Loss of Appetite, and Exhaustion.  Side effects make constant companions.

I will fight them, though.  I will fight them with water, food, exercise and meditation.

I sound rediculous, right?  I’m just reminding myself.  I guess I don’t really care what I sound like b/c I know it will work.

Feeling better this morning

i hope i’m not speaking too soon, but this morning i just feel like i am a little bit hungover.  like three glasses of wine hungover.  i slept through the night.  i shot up around 1am.  its 11am now.  i slept 9 hours.  if i had chills and fever i was able to sleep through them.

It was relatively cold outside (74 or so) so S proposed not using the AC last night, and just having lots of fans.  So it was in the high 70’s.  Maybe that helped.

Tired, achy, and sick feeling, but this round was a whole order of magnitude better than the first round.

Playing the Cancer Card, OR Saying “I might die”

I have tried really hard not to play the Cancer Card.  When I was riding the subway post surgery I would ask people to give me their seat.  It was really awkward.  I felt bad.  They didn’t quite get it.  I ended up standing more often than asking people for their seat.  Interestingly, not everyone I asked gave up their seat, confounding Stanley Milgram’s old research.  People didn’t believe me.  I even offered to show them my scar.  They usually made the talk-to-the-hand gesture. I guess tImes have changed in NYC.  It is a more selfish city.

When I was at the airport, I brought a letter from my doctor, and they got me a wheelchair, and whisked me through security. The gate was so far into the concourse, I probably would have had trouble walking all the way there.  They have an infrastructure for playing the Cancer Card, so I feel okay doing it.

At the Food Co-op they have an infrastructure as well: Medical Leave.  There is some paperwork, but it is painless and non-confrontational.  I was at the Co-op today, and I dropped a glass bottle of iced tea on the floor.  It just slipped through my hand.  I was having that kind of a day.  It exploded all over my hands, and my pants.  I got a little cut on one of my hands.  There is no infrastructure for telling one of the shift members that you can’t clean up the mess you made because you are in a post-injection side-effects daze.  So I kind of wanderd up to the squad leader, and said something about a broken bottle in the end of the express aisle.  Someone told someone, and it was taken care of.  But even that was hard for me.  My brother told me later that I should have just said to the shift worker on that aisle “I just started a new round of chemotherapy, can you help me and take care of this.”  I probably should have.  I guess it is easier to say “I am taking this drug that you know means I have cancer, and also has really bad side effects” than “i have cancer, so take pity on me.”

I had to play the Cancer Card pretty hard core yesterday.  I have a medical bill from 2 years ago for $12,000, that I was promised I would only be responsible for my $1700 deductible.  Billing staff changed.  I’ve been writing letters for nearly two years, trying to get them to understand what the old staff promised me.  I called up the billing coordinator and layed it all out.  explaining the whole history of the diagnosis, surgeries, trip to portland (hence I didn’t get any of their mailed bills for the last two months), return, and start of new Interferon treatment.  I still wasn’t really getting through, and so I pulled out the full weight of the Cancer Card.  I didn’t have to fake the almost-in-tears warble in my voice. I said “Stage III Melanoma has a 40 to 60 percent mortality rate.  I’m 30, and I’m fighting for my life.  I have 50/50 odds.”  At that point her tone changed, and she said “okay, send a letter saying all of this, and I’ll discuss it with the doctor. I got of the phone and started sobbing.

Now I exagerrated a tiny little bit.  It is true that Stage III melanoma as an average does have a 40 to 60 percent mortality rate, but I am so far to the good side of the bell curve, that my numbers are better.  I don’t have 50/50 odds.  Its more like 25/75.  or 20/80.  or 30/70.  The doctor won’t give me a hard and fast number, but he will say “the literature suggests that you have a 15 to 30 percent chance of recurrance.”  Recurrance means it shows up in one of the other organs or lymph nodes.  I still have a roughly 22.5% chance of recurrance, which means bad things.  It doesn’t exactly mean death, but it often means death.

But even in saying these things, they become real.  I really felt that possibility of dying in a way I hadn’t since my doctor told me the lymph node was positive.  At that time, I had found a way to accept it.  I think I am struggling to do the same now, while trying to understand really how likely that outcome is.  It is unknowable, of course.  And therefore vexing.  But having to pull the Cancer Card and say “I very well may die” made me think a lot about that possibility.

I was talking with my psychologist today about all of this.  I related her this story.  I wondered out loud if I was doing the right thing, trying to go on with my life, hoping that I would make it through this 11 month treatment intact, and that the Melanoma would never show up again.  She asked me an interesting question.  She said “Well, what if the doctors told you you had one to two years to live, what would you do differently?”  And I thought about it, and said “probably nothing. i probably would continue to go into the studio, I would finish the book I’m writing, I would try to ride my bicycle as much as possible.”  Truth be told, I might try some things I would never have done otherwise – I might do some drugs (something I never do), or I might learn how to ride a motorcycle really fast (something I was always prohibited from doing growing up).  When I was in amsterdam before the surgery I even thought for a second “Hell, I might die, when is the next chance to actually frequent the famous red light district.” But I didn’t act on it.  Partly because the whole scene was totally revolting to me, but also because deep down I harbored hope that this wasn’t my last shot.  That I wasn’t about to die.  That I would be back to Amsterdam repeatedly over my long and happy life.

So the lessons learned today:

First: If life were a RPG, playing the Cancer Card would open any door, and convince anyone to let you do anything, but by playing that card you would loose half of your hit points.

Second, I think I am doing what I should be doing: trying to live my life in some semblance of the way I have built it over the last few years, without compromising the priority of resting and healing.

N.B. this is the first time I have used the “death” tag

Self Injection Day 1: I learned how to shoot up!

The calm surrounding restarting the drugs evaporated about two hours before I had to head up there.  I started getting headachey and overheated.  I tried everything to make it go away (eating, drinking, pain killer.) it wouldn’t go away b/c it was psychosomatic.  This was happening a bit in PDX. My Dr there explained to me that it was a very well documented phenomenon that chemo/interferon patients get psychosomatic symptoms *before* they go to actually get the drug.  So chemo patients will start puking in the morning before they go to the hospital for chemo.  In my case, I got headaches, feverish and even more tired in the hour before I was going to leave for infusion.

My appointment was for 5pm.  I got there 15mins early.  But when I arrived at the office, it was like an episode from the twilight zone.  All the receptionists were different, they didn’t know the nurse practitioner I was there to see, they didn’t my Dr’s Physician’s Assistant, and they didn’t even know my doctors phone number. Apparently this office is used by different doctors each day.  Rather than have one set of receptionists and assistants, each doctor has their own set of receptionists and assistants.  I guess they just sit in a cubicle the rest of the time answering calls and scheduling appointments.

So I call up to the receptionist who is in her cubicle, and she says that she will page the nurse and send her down.  15 minutes later I call back, but it is 5:02 and the call goes straight to the message system.  The twilight zone receptionist leaves.  Doctors leave with their bags. You can see where this is going.  Knocking on doors I found someone who knew what I was talking about and who i was looking for.  He made some calls, and actually spoke to her: there was an emergency in the chemo clinic, but she would be down as soon as she could get there.  

About an hour passed.  I was starting to get more psychosomatically symptomatic.  Plus I was getting tired and hungry.  Right when I was really ready to walk out the door I decided to try the open-the-book-when-waiting-for-the-bus technique.  Right when you give up on the bus coming quickly, sit down and open up your book to read, the bus inevitably shows up before you finish the first page.  Its like Law of Nature.  So I announce that to S, who doesn’t quite get me, and I go turn on one of the computers in the waiting room.  They have two public computers to keep people from getting too bored.  And sure enough, right as the first little windows flag shows up in the boot cycle, the door opens and the nurse walks in.

After all that waiting, the injection was really easy.  I’m glad I got instruction, b/c I would have screwed some things up.  I would have pushed the needle in too far.  And not done it at the correct angle.  As is, I didn’t really do it at the right angle.

Pushing the needle in is painless.  As in, I couldn’t actually feel the needle enter my skin.  It was weird that way.  Injecting the IFN stung a bit.  I had to do it slowly.  I did the first half, then I did the rest.

After I did the injection I had this 5 minute spurt of energy, optimism, and other kinds of good feelings.  It was partly b/c it was over, and it was soooo much easier than I thought it would be.  But it was also probably partly chemical. I’m sure there were a lot of endorphins, or adrenaline or whatever that my brain pumped out when my brain groked that i *really* was about to stick a needle in me.  It was so weird to be looking down and think “I’m going to stick this needle into my stomach…”  and then to do exactly that.

Train ride sucked, but not that bad.  I got the headaches for real right as we turned the corner to the apt.  I got some chills, but not that bad.  I should transition to a mild fever shortly.  But overall, not so bad.  Not as bad as restarting.  Which is interesting because I am at the same dose that I was at for the second two weeks of IV, I just take it 3 times per week, rather than 5 times.  I guess the body doesn’t absorb as much when the IFN isn’t mainlined into the vein.

Calmly, I start my self-injection tomorrow

I start my self injection tomorrow.  Strangely i’m not nervous.  The last two times I started the drugs I was in a real panic.  The initial start had me panicking 2 weeks out.  I panicked for two days before the restart after I had to take a week off on a drug holiday.  But this time I am barely giving it a thought.  Maybe that means its denial.

The drugs have to be kept refrigerated. I have the drugs, and I have to keep them them cold on my trip up to Columbia Presbyterian.  I was looking around the house to find something to keep them insulated.  I thought of slipping it inside one of the ice pockets on my ice vest, but I’m afraid that it will actually freeze the drugs, which I have been told ruins them.  Or maybe it just breaks the needle.  So I settled on putting it into a metal coffee travel mug.  I was inspired by stories that I have been told of the pro cyclists around 10 years ago who were all doping, and were toting around their needles inside of metal water bottles.  Apparently the needles would clink back and forth making noise.  And everyone was doing it.  So everyone had a clinking metal water bottle.  So off I go tomorrow with my clinking coffee mug.

Verdict: Ice Vest Rules!

The ice vest totally worked.  I feel better than I have felt since I returned to NYC, even though I had a full day.

I wore it for 3 hrs running errands in the morning and in in to the studio.  Refroze the ice packs (though I don’t think they fully froze b/c they were stacked on top of each other…). Then I wore it to meet BH for lemonade, ride the subway to chinatown, get a massage, and then eat dinner.  After about 4 hours, all the umph was gone from the packs, so I took it off for the last ride home.

Frankly, I think everyone who gets overheated should be wearing one of these during the summer here.

Yay!

My New Ice Vest: I’m kinda like an Olympic Athlete

The hardest part right now is the heat.  And the worst is walking to the subway, and waiting on the platform.  The commute wipes me out so bad.  At some point this week I had a flash of an idea: an Ice Vest.  P had told me about them being used by elite distance runners before the race, and I saw the riders in the Tour De France warming up with them on.  The athlete idea is that you warm your legs up, but keep your core temp down (extending endurance performance by 21%).  My idea is that I will not overheat, extending performance by huge physical and thus emotional leaps and bounds.

The vest is made by StaCool.  I wore it this morning for about three hours.  On the way to my psychologists, during the session, on my way back, around the house, and then on the commute to the studio.  It kept me cool the whole time.  By the end, between the melting of the ice packs and the pressure of my backpack on the vest, the back bottom of my shirt got pretty wet.  Maybe related to the pressure of the pack.  Maybe just what happens after 3 hours.  Anyway, it kept me cool.  It worked.  I love it.

Me on the subway this morning, with my new ice vest.

StaCool Ice Vest

A studio photograph of the same vest looking a bit cooler than mine:

David Millar warming up in an Ice Vest.

Nike’s new PreCool vest, to debut at the Beijing Olympics

Intron A / Interferon Unboxing!

So the geeks out there know about unboxing. When you get a new cool gadget, and you think you are the first to get it, you photograph or video your opening the box to show everyone how cool the gadget is (and therefore how cool you are.)  Someone actually called it “Geek Porn,” but I think that is best applied to other things.

I have uploaded the full size images, b/c there are no good images on the Internet of what this thing looks like.  Believe me, I tried looking.

So here is my Intron A Interferon unboxing.  These are the needles for Subcutaneous (Sub-Q) self-injection.

I picked it up at my local drug store.  It has to be kept refridgerated, so it was in a brown paper bag that said REFRIDGERATE UPON ARRIVAL.   In red.  Allcaps.  Pretty intense.

(Of note, that sticker was made in Redmond, OR, a town which I have not thought about in probably 15 years, and a town which is now probably just a suburb of Bend…)

Inside the bag were two boxes of Intron A.  The prescription was for 4 units, and the tag on the bag said 3 units, but I only got 2!  And this stuff is *not* cheap.  I have to go back and ask for my third box.

Inside the box is one preloaded needle, with 60 MIU of Interferon.  Supposedly it is a little overfilled, so there is actually 70 MIU in there. As you turn the handle it increases the dosage.  One full turn is 5 MIU, Two full turns is 10 MIU.  Each notch on the turn is one MIU. The pink part at the right functions as the plunger/button.

This is the end that the needle screws on to.  Looks like there is some kind of membrane that the needle goes through. Something resealable or something.

And it comes with a batch of screw on needles in their own little individual double walled containers.

Intron Interferon Self Injection Pen

On monday I go up to Columbia to learn how to use it.  I think I have a pretty good idea, and it comes with instructions, but it will be good to have a professional needle-person walk me through the first time.