Radioactive Man!

Is it a bird?  Is it a plane?  NO…its Radioactive Man!

After a successful recon mission 10 days ago, at 0800 this morning the mission to destroy the liver tumor was launched. My Interventional Radiologist placed beads of radioactive isotopes, only a third the width of a human hair, into the blood vessels feeding that nasty tumor previously residing in my liver. She sealed all the exits out of the area to protect healthy tissue and organs and poof…bye, bye tumor! This is a very targeted and amazing technology, more like drone warfare when compared to the carpet bombing indsciminate destructive effects of chemo. Compared to other cancer treatments, this is much less invasive with fewer side effects. No procedure is 100% guaranteed, but the IR doc gave the tumor a double dose of isotopes and is highly confident of success. It will take a couple of days for the destruction of the tumor to be complete and confirmation of a kill will be several weeks away.

Just outside the “nuke chamber”

Of course there is always drama. A side effect of Lonsurf, the chemo I currently take, is a rapid reduction in neutrophils (the white blood cell that fights infections). My pattern is that the fall off occurs about 20 to 23 days after my cycle begins.  The Y-90 assault on my liver tumor will also suppress my white cells and neutrophil production. We have been watching my counts closely with twice a week blood draws.  Fortunately my bone marrow is highly responsive to the drug Zarxio which almost instaneously counteracts the drop. Well, my neutrophil drop is right on schedule as they dropped slightly below normal yesterday and my white cell count was only 2,300 (normal range is  4,500 -11,00) this morning at the hospital.  Unfortunately the doctors office didn’t contact my insurance in time for a shot of Zarxio yesterday, so we dropped by Dr. P’s office on the way home this afternoon for a shot. With another shot tomorrow my white cell count should be back to normal.

As I mentioned the side effects are not bad, although one is a bit unusual. I must abide by the 3 by 3 rule: for three days everyone should stay three feet from moi. Try explaining that to a cat, good luck! When they waved the Gieger counter over me after procedure the meter read .001, pretty cool. I had to ride in the passenger side of the rear seat on the way home and must sleep in the guest room, not so cool. I had some back and heart burn like pain after the procedure and that will be around for a few days along with fatigue and flu-like symptoms that may last a week or two…or not. I’m planning on feeling fine. I’m hoping I’ll be able to join Lee in our booth selling fabulous paintings this weekend the Quail Creek Fall Festival Arts & Crafts Fair and I have a presentation of my book on Monday afternoon.  

The great news is that I am home! Hooray!!  I get to sleep in my own bed…er scratch that, I get to sleep in the guest room bed!!! More good news, Little Lee and I were surprised by and treated to a lovely dinner from Giannasi Catering delivered by the cutest little Italian boy, Moe Giannasi.  The love and support we get from all of you just blows me away.  Thank you

Yummy, yummy, yummy. Feels good in my tummy.

The Y-90 technology has been around for about a dozen years, but there is only one doctor in southern Arizona who is currently practicing this procedure. Naturally she was not in my HMO.  As you know, I had to fight with the insurance company for about six weeks to get approval. It is an approved Medicare procedure, the doctor accepts Medicare rates, and it was a medically necessary procedure to extend my life. The insurance company knew they would have to approve it eventually. That was assuming I was still alive and well enough for the procedure. I wonder how many patients who don’t have the energy or will for the fight with the insurance company and don’t have an advocate to fight for them would have accepted the “Not in Network” denial resulting in an early departure from the living?

But enough of my rants The middle of October I had many old friends pay me a visit to celebrate my birthday with Lee and I, such a wonderful time we had. Last week it was back to normal and I found these four new friends at the end of my paint brush. 

Map For A Tumor-Free Liver

Yesterday I visited the Tucson Medical Center for an all day out patient “mapping” procedure. Eighteen months ago the massive tumor in my colon and one small liver tumor were surgically removed at this hospital. In ten days I am hopeful that I will return to TMC for the procedure that will obliterate the remaining large gnarly liver tumor. 

However, the evening prior to the mapping procedure my leg brace broke. Could this be a bad omen?  The following morning at TMC admitting we encountered more ominous signs.

Bravely, or perhaps foolishly, I ignored these omens and proceeded with my medical adventure. They rolled me into a room reminiscent of the futuristic operating room where Leeloo found herself in the movie The Fifth Element. Music was blaring in the room as machines and masked beings busily assembled their devices. I was strapped down, my hands were cuffed as they politely asked me if I was comfortable. They tightened the straps. Then the maestro appeared, known as Dr. Z.  They gave me some “happy” juice, but just enough to take the edge off, eupuhismically called conscious sedation. I wouldn’t want to miss the excitement, now would I?  I had to stay awake to stop breathing upon command as moble scanning devices were taking their images. They inserted a catheter into the femoral artery in my groin area and worked its way to my liver to have a look see (angiogram).  While there Dr.Z sealed all exits from the tumor area (embolization) to prevent radiation leak out which would result collateral damage to healthy tissue in other organs. Dr. Z  then inserted a small dollop of radioactive “test” beads into the tumor area.  I was then whisked away for a nuclear scan to test for leakage.  What a fun morning!

Jimmy gives his liver tumor the “bye” sign as he waits.

Dr. Z gave Lee the good news that my liver looked great (the power of fine red wine?) with the exception of the targeted tumor.  The isolated location of the tumor and the condition of the rest of the liver is such that she plans on delivering a DOUBLE DOSE of radioactive isotopes to make certain the tumor goes bye bye.  A final decision will be made after nuclear scan results.

On Wednesday I gave my third talk over a five day period. This talk was to the  Living With Hope cancer support group. I was honored to have one of my oncology nurses introduce me.

The Sermon & Birthday Celebration Week 2

The last of the Oregon contingent left today, Lee tells me that signifies the end of my birthday celebration. Poo!!  It was a fun filled few days, celebrating not only my birthday, but also that of Dennis and John. Three, three, three birthday celebrations!  Great food, great wine and great times! 

Heather and Kathie join the birthday boys for lunch on a sunny afternoon.

Our four Oregon friends joined Lee and I for a Sunday morning adventure, my very first sermon. Lee would disagree, as she claims I often preach to her. But this was different, it was in a church.It was a very interesting and fulfilling experience for me. I participated in several aspects of the service, delivering the Meditations and Living Gratitude, in addition to guest speaker. Many thanks to Ernie Lopez for offering me this opportunity and for putting together a great service. Not only was I able to deliver my message to over 100 people, but I had many heart felt one-on-one discussions after the service ended.
From behind the podium I share my gratitude for the special people who changed my life.
The cape appears as my sermon, my C.A.P.E. philosophy, begins.
Jimmy works the crowd, er…I mean interacts with the congregation. 😄

Below I would like to share with you two gifts from artisan friends, one Oregon friend and one Arizona friend, that I felt deeply.  

My friend from Oregon, and former vineyard partner, made this beautiful quilt.  On the inside of the quilt is a special message of support.  For those non enophiles, “Brix” is a wine term indicating the ripeness of the grape. Thank you Linda.

A friend from my time here in Arizona, made this pendant. It was inspired by Lee’s and my recent adventure in the slot canyons, along with our love for wine and each other. Sorry for the fuzzy photos. Thank you Piepster.

Oven the past 10 days I have felt so loved. I know, and my friends and family know, this could be my last birthday. I hope to see many more birthdays, but if not, at least I went out smothered with love and friendship. But now there are things to do.  I have a book presentation tomorrow for the Living With Hope cancer support group. Friday I will have the reconnaissance of my liver in preparation of the nuke of the big tumor on November 1. Thank you one and all for your support in my battle. 

Now, all together..1….2….3…FUCK CANCER!!!!!

Birthday Celebration Week 1

Whew!! What a week. And just think, I have Birthday Celebration Week 2 starting in a few hours. I best get a little down time tonight with just los gatos, Lee and I. I anticipate a lot of purring from the poor neglected felines, poor kitties. 

Last weekend six old friends from Oregon flew down to help me celebrate. We had a great time touring the Kartchner Caverns, the top rated caverns by USA Today, and the Pima Air & Space Museum, the second largest display of aircraft in the country. Four of my friends left for soggy Oregon and we then explored Mac’s Indian Jewelry, Bisbee (an old mining town) and Tombstone with our remaining Oregon friends.

At the Pima Air & Space Museum my buddies and I held up the earth

We took time from our touring to laugh, reminisce, eat and drink. No ordinary wine crossed our lips. Two of my friends were former customers when I had a wine shop and they brought many legendary liquid treasures for us to share.  Unfortunately we couldn’t consume them all and they had to leave two bottles (a 1985 Vosne Romanee and a 2010 Big Table Farms Pinot).😆  Of all the gems we consumed the 1981 Ch Margaux and the 1977 Stag’s Leap Lot 23 Cabernet stood out to me. The Stag’s Leap bottle is famous because it beat top Bordeauxs at a blind tasting in France with French judges, a coming out party for American wine. It is also a sentimental favorite wine, it was the wine I selected to take the restaurant when I asked Little Lee to marry me.❤️

On my actual birthday we were joined by many friends for the cutting of the cake and other festivities. Many thanks to  Linda, Carlyn, Harmony and Marj for all their help in making the evening special.

A perfect salutation!
Get you hands off, this is MY slice of cake!!

Today we went to see radiation oncologist. You may recall from last week’s post that Dr. P thought that stereotactic  radiation might be an effective procedure to eliminate some of the larger tumors from my lungs. Unfortunately I am not a good candidate for this procedure. Even though this is very targeted radiation which protects the innocent tissue from collateral damage, there is scarring in the treated area. I have ten tumors of significant size in my lungs. To treat them all would result in too much scarring. To treat just the large ones does not make sense because there are still others that are growing. They normally only use this procedure after chemo has eliminated most tumors and they can fry 3 or 4 stubborn tumors 1 or 2 cm large. My larger tumors are twice that size, which is also problematic with regard to potential damage. In addition, the gnarly tumor is unfortunately positioned where they cannot use stereotactic treatment at all regardless of size, it would be too dangerous. Treatment would very likely severely impact my quality of life and might kill me. The doctor even said a new type of procedure called proton radiation which is more exact and controlled, wouldn’t work in my case. Below is a PET scan image the worst of my bunch of troublesome lung tumors.  Hint, bright red/orange indicate the level of activity.  Not good to see in tumors.

So, for now it’s continue on Lonsurf and hope it slows down the cancer, nuke the bad boy in my liver and continue to look for immunotherapy trials. Fortunately Marian, Lee’s mom,  gave me a prescription to deal with these issues which I am dutifully following right now.

Vino Rx with party flowers arranged by Harmony.

Birthday Celebration Week 2 is rapidly approaching. I have a public presentation based on my book to do tomorrow morning, sponsored by Arizona Oncology, and then we will meet four more friends flying down from Oregon in the evening. Rumor has it they are bringing some good Oregon Pinot Noir.🍷

Let’s Play Whack a Mole!

It seems the insurance company has a “3 strikes and you’re  out” policy with regard to PET scans. After you’ve had three in a year, they say NO MORE. That is unfortunate if you are trying to evaluate chemo treatment, as the PET scan shows not only the size of the tumor, but also its metabolic activity. In other words, is the tumor dormant or active? Is it a dead volcano or a volcano about to explode? Dr. P initially wanted me to take a two to three week chemo pause and do the SIRT  Y-90 “nuke my liver tumor” treatment. However due to some really stupid and needless insurance delays with my SIRT treatment authorization, I have now been off chemo for a month and the nuke procedure is not for another three weeks.   Dr. P felt the PET scan was necessary to evaluate me for the next step. 

The insurance company said NO several times to Dr. P’s request for a PET scan, then changed it to maybe, then finally yes thanks to Dr. P’s perseverance. The CT scan I had in August showed the size of my tumors were stable about the same size they were from my July PET scan.  The PET scan I just had showed some tumor growth with significant metabolic activity. Dr. P feels the Lonsurf chemo treatment was effective in slowing down the disease  progression, so he wants me to resume my oral chemo. Now we have to figure the timing and how to manage the side effects of the chemo and the SIRT procedure so they don’t happen at the same time. Ya Hoo…we’re having fun now!

The PET scan shows three tumors that are most problematic, one in each lung and one in the liver.  So as we are nearing the end of chemo effectivess, we are turning from a systemic approach to treatment to a “whack a mole” approach.  Assuming the dry run mapping on October 21st is successful, they will nuke the liver tumor on November first.  Dr. P is now referring me to another radiologist to see if I’m a good candidate for Stereotactic Body Radiation Therapy (SBRT) to take out the lung tumors.  In this procedure they use very high does of radiation, using several beams of different intensities at different angles to precisely target a tumor. This targeting approach prevents damage to healthy tissue while destroying the nasty stuff.  Of course we no doubt will have to do more battles with the insurance company, so who knows when or if I’ll get to enjoy the thrills of SBRT.

In the meantime, I have some celebrating to attend to!  It seems my birthday is rapidly approaching.  Joining us in the festivities are eight friends flying down from Oregon, four Ducks and four Beavers.  I know, it’s astounding that I have Beaver buddies.  Although I tried to wait for them to celebrate, I just couldn’t hold off.  The celebrations began last night with a fabulous Wala Walla cuvée, grilled lamb chops and a surprise gift from our friends John and Sandee.

Green Valley News – Today’s Column

The first Sunday of every month, the Green Valley News runs my column. Below is my second of, hopefully, many more. I was hoping to talk about the phenomenal Oregon Duck football team. But based on their last three games I thought an article on Hopice care was more appropriate.  Enjoy!