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25 May 2012 / stageivhope

Ablated, Charbroiled, and On Break

It’s been many weeks since my last health-related update (as opposed to fundraising update), and there’s much news to share. And most of it is very good news.

Let’s begin all the way back in March: I had one of the intermittent scans I’ve been getting throughout treatment. Unlike the previous scans, which were PET-CT scans, this one was an MRI. The earlier scans had not been especially helpful in showing some of the micro-tumors in my soft tissue and the hope was that the MRI would be able to better identify the remaining growths I had, as well as anything new to be worried about. Thanks to a computer malfunction, which left me stuck in the machine and unable to move for some 30 minutes, the MRI took a bit longer than expected.  But aside from that, it went off without a hitch — and it was nice to avoid drinking the pretty awful-tasting barium milkshake the PET-CT requires. Of course, it’s not descriptions of being in an MRI machine that interested in, so on to more important things…

We soon received the results, and learned that I had a very small lesion (4 mm in diameter) on the right lobe of my liver. The radiation oncologists at the cancer center who interpreted the imagery were fairly convinced it was malignant, though my oncologist was less certain of that — mainly due to the fact that there was no visible growth boundary around the lesion. In any case, the consensus among the team of doctors consulting on my case was to deal with the growth immediately. Due to its small size, doing a biopsy on the growth wasn’t really an option (because it was quite possible that the probe would miss the precise spot of the growth, thereby sampling non-lesion cells), so I was soon scheduled for a radio frequency ablation — essentially a minimally invasive procedure in which a probe is inserted into the abdomen and directed to the site of the suspicious growth via CT, and then blasted with heat, thereby destroying it and a small area around the site; the NIH has a useful short video explaining the procedure here: http://www.cc.nih.gov/drd/rfa/video.html.

(If you watched the video above, you may have noted what is possibly the worst and most disconcerting medical term ever: charbroiling. Ah yes, since the ablation works by applying heat to the site of suspicious growth, there’s a chance that the heat could end up burning some other nearby tissue, as well — i.e., cook the tumor and you might cook some additional flesh. And for some reason, medical professionals decided to call this collateral damage, of sorts, “charbroiling.” As it turns out, since I have little fat and the growth in my liver was near the surface, there was a good chance I could end up being a bit charbroiled.)

I was scheduled to be ablated in mid-April. We were joined by my parents, who came out from Columbus. The procedure itself went quite smoothly and I was quickly discharged after spending a night in the hospital for observation. Though, as it turns out, the capsule surrounding my liver did get a bit charbroiled. (Which means I can now say that I’ve been “filleted, disemboweled and then bathed in hot poison” and charbroiled. Lucky me!) Yet, despite the charbroiling, I held up quite well. In fact, in a somewhat strange occurrence, I experienced virtually no pain and had no nausea. I was given a prescription for some opiates, but I never even bothered filling it. (One of my nurses actually commented to me during my short stay: “You’re not in pain and you look great; you don’t need to be here.”)

Despite the scare that accompanied an unknown and quite possibly malignant growth on my liver, things went about as well as they could possibly go. I’d be lying if I said I wasn’t a bit scared going into the procedure — I’ve read far too much about the standard progression of disease and know that things often turn dire once the cancer spreads to organs like the liver and lungs. But this story ends on a much more cheerful note than that: when we went back down to Tucson for follow-up appointments with the radiologist and then my oncologist, we got confirmation that the doctors were able to ablate the entire growth, and with no additional suspicious growths or tumors visible in the latest imagery, my oncologist proposed that I get a six-week chemo break. And, my friends, I said yes. (I never really formally proposed to Heather, and now I know what she missed out on — being on the receiving end of a proposal and saying yes sure is pretty swell.)

So, for about three weeks now, I’ve been on a chemo break. Recovery from the ablation was very quick, so for most of this time I’ve really been able to enjoy things. Meanwhile, side effects of chemo I haven’t been missing include: nausea, vomiting, hand and foot pain, sensitivity to cold, blistering and peeling skin, painful acne, and being immunocompromised. After 20 or so rounds of chemo between the XELOX + Avastin treatment I was on last spring and summer and the FOLFIRI + Avastin treatment I’ve been on since last fall, I’d gotten pretty used to being on chemo and dealing with the side effects. But no matter how well I generally tolerated treatment, not having to deal with any of that at all is wonderful.

Even some three-plus weeks later, I’m still not sure I’ve fully absorbed the good news. Perhaps it’s because every health-related surprise I’ve received over the past year-and-a-half hasn’t been good up until now, so I’m not quite sure how to deal with good news. And I’m sure part of it is that things can always be so unpredictable and change so quickly with cancer that I’m always hedging my bets to some extent. But see, here’s the thing: this is really good news. Last February, I learned that the lining of my abdomen was almost completely covered in small tumors. When I had the HIPEC procedure done last August, the doctor assessed my peritoneal carcinomatosis index (a measure of how far cancer has spread within the abdomen) as pretty much the highest it could be while still allowing for surgery. And despite spending some ten hours slowly stripping away most of my abdominal lining (and chopping out my gallbladder for good measure), the surgeon figured he was only able to remove about two-thirds of the tumors he saw. So, less than a year later, for there to be virtually no sign of any disease is as big a surprise as there could possibly be. It’s absolutely astounding. For most people, things simply don’t go this well; after all, most patients diagnosed with late-stage colorectal cancer don’t even make it a year. But I’m tough. I’m a fighter. I’m lucky. And despite the odds, I’m forever an optimist, hopeful that the good surprises keep on coming.

What happens next is a bit up in the air. It’s possible my chemo break could be extended, but it’ll all depend on what we see on my next MRI. I’m scheduled to go back down to Tucson in mid-June for another stint in the MRI chamber and will meet with my oncologist once the scan has been interpreted and presented to the various doctors consulting on my case in the weekly conference that the team has. If there’s anything suspicious-looking, I’ll be back on chemo, but if not I could have an even longer chemo vacation. Fingers crossed.

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6 Comments

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  1. lj / May 25 2012 6:36 AM

    I am so happy to read this, Ari.

  2. Adam / May 25 2012 11:05 AM

    Hooray for unexpected and happy surprises. You deserve a break, Guha and I’m happy to hear you’re well enough to actually appreciate it! Now go enjoy the hell out of these next three weeks and we’ll all think optimistic thoughts. (about your health, not necessarily the state of the world and such!)

  3. alinamo / May 25 2012 1:35 PM

    So awesome, and such good news!! Enjoy your time away from chemo and have some fun!

  4. Gargi, Ari's cuz / May 25 2012 9:15 PM

    happy you don’t have to deal with chemo but sorry you’re being BBQd instead ;-( You’re so skinny to begin with..are you eating?

  5. Alvin / May 26 2012 1:27 AM

    Happy for your really good news!

  6. The Big C / Jun 10 2012 10:30 AM

    I am so happy for you! I was diagnosed in 2009 with stage 4 colon cancer, after going to the emergency room for stomach pain. My blog is http://www.stagefourcancer.wordpress.com I sent your appeal to my facebook page, may-be you will get more people donating with more exposure. Keep on fighting the BEAST! I am. And keep on blogging, it helps to know that other people with stage four colon cancer are out there and blogging!

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