Tests and another meeting with the doctor

Monday was a full-on day. It started with a 9am appointment at the Nuclear Medicine dept at Wellington Hospital. The first test was the kidney function test. This involves having a radioactive isotope injected into a line in my right arm and then having a series of scans performed.

The isotope is processed by my kidneys in the normal way and a series of blood samples are taken every hour for five hours. The samples are then analysed to make sure that the isotope levels in my blood are dropping. If my kidneys are functioning correctly the levels will decay at a predictable rate.

Next up was the Gated Heart Study. This also involved a radioactive isotope that was injected into my arm, this time my left one. I also had an injection containing Tin before hand. The isotope binds to the tin and then that in turns binds to the red cells in my blood. (Well at least that's my understanding of the process).
I'm then put on a scanning bed, a lot like a CT scanner, and pictures of my heart are taken over a period of around thirty five minutes. From these pictures it is then possible to calculate the hearts efficiency. The amount of blood drawn in against how much is pumped out. Any damage to my heart valves would become apparent, possibly ruling out further chemotherapy. I'm told my heart is still in good shape.

The next test was Lung Function. This involves sitting inside a small sealed glass cabinet and breathing into a tube. Well.. kind of.. There are various tests that you are asked to perform. Breathing all the way in until you think your lungs will burst and then pushing it out until you almost feel like your chest will implode is one of them. Another involves panting into the tube and then pushing against a restriction that suddenly occurs. A computer graphs everything as it happens and then compares it against my previous figures from when we did the 'baseline' tests back in 2005.

No further lung damage has occurred in the last year. I lost about 15% efficiency after my first hit of chemo but none since.
My lung capacity is down slightly on last time but that's to be expected from the radiation damage to my bronchial tubes. I think if I'd done the test a month ago when I could hardly breath the results would have been a lot worse. So I kind of passed the lung test too. They aren't what they used to be, but with exercise I can increase the capacity, however the efficiency may never return to what it was.

This morning I had another meeting with Dr D'Souza. I was late due to traffic and he had to be called back from a meeting. He's been seeing me outside of his usual weekly clinics. It's good to know he's very keen to keep the ball rolling on this. In contrast to previous experience I've had within the public hospital system.

There's still no clear plan yet but he has confirmed that I will be having high dose chemo with stem cell support. The timing is unknown and is based around how quickly I can get my stem cells back from Germany. I've had a devil of a time getting any sort of response out of them. Finally yesterday morning they emailed me and said that they would complete the required paperwork and forward it to me and Wgtn hospital in the next day or so.

The last time I saw Dr D'Souza I suggested that having a couple of cycles of salvage chemo would be something I'd very much agree to.
I thought that it would help reduce the involvement of the cancer until the high dose could be started and also give us an opportunity to do another stem cell harvest off the back of the last chemo cycle. This is based on the phenomena whereby there is a rebound effect on the stem cells after chemo and a greater harvest of cells can be gathered than would be the case without chemo. Also reducing the cancer load means we have less work for the high dose to do and can reduce the burden on my system at a time when I would have a severely compromised immune system.

Today Dr D'Souza suggested that another round of salvage chemo was an option and that he could harvest off the back of the last cycle. I wonder if he realises this is exactly what I talked about at our last meeting. Fingers crossed we go down that path.
The other option is straight into high dose chemo and the stem cell transplant at the first opportunity. Personally I don't think this is the best option. He has indicated that there may be an opening for treatment this side of Christmas. I'll be subtly pushing for the salvage option when we next meet.

I'm racing this weekend at Shelly Bay. I expect that it will be the last event I enter for some time as there is only one event early next year, which I'll probably miss due to treatment and after that there's one event in April then nothing until August.
I've made some tweaks to my car, Launch control and minor suspension improvement in an attempt to do better than the 1:13's of the previous two years I've entered the annual Shelly Bay sprint.
I'd like to do an 1:11 second run, smashing the record of 1:12.85 set by Joe McAndrew in 1996... we shall see :)

Motorsport News...

I got this little piece of motorsport news in my email on the weekend..
***Click here*** (Read the "News" paragraph)

Not a bad result! Especially when you consider two of the events were entered when I was under-going treatment. At the Mount Victoria Hillclimb in April I had just completed radiation treatment, Had lost 15kg in weight and barely enough strength to drive the car.

Fitness level

Sarah and I went for a two hour bush walk on Sunday afternoon. We hiked up to the Korokoro dam from Cornish st in Petone. At no point did I feel tired or breathless.
I commented to Sarah that I was feeling the best I've felt in years. No aches or pains, no discomfort at all. When I think back to how sick I was when I first went to my GP four years ago complaining of joint pain, fatigue and the feeling I'd been hit by a bus when I awoke every morning.
It's incredible that with my Hodgkins spread so far from the days when it was just a lump on my neck, that I'm feeling in such good shape!

Last night I was so fired up that I jumped on the treadmill and ran for 3km's.
It was my breathing that gave out first, leaving me gasping for air but physically feeling like I could have gone a lot further. I'm hoping my lungs will improve the more I exercise.

As I was typing this I received a call on my mobile. It was a guy from the Nuclear medicine dept at Wgtn hospital. He asked that I come in on Monday for kidney function and gated heart study tests. Apparently it involves me being fitted with two IV lines, being injected with radioactive isotopes and about six hours of my time. Sounds like a fun day!

Cough Improving..

Isn't it weird.. This darned annoying dry hacking cough is getting better by the day!
It's still there, I'm coughing now as I type.. but over-all it's much improved over what it was a month ago. At that time I was having violent coughing fits that often got so bad that I vomited. Yuk!

Now it's just when I talk or if I breath in water etc when I'm drinking.. something that I seem to do far more often than I'd like, no matter how careful I am. I've been taking Seravent and I think that's made the biggest difference. I always thought that a lot of the coughing was asthma related. The cough when I talk is a result of the radiation treatment causing damage to my bronchial tubes. My biggest fear was that the cough was because of lung involvement, but if that were the case it would not be improving like it is.

I've been getting out and exercising as often as I can. I went for a bush walk last week that would normally have had me stopping every 10 minutes or so for a rest, but this time I did it without stopping, even on the steep uphill sections.

So my over-all fitness is improving in leaps and bounds. I want to start running again in the coming weeks. The idea is to be as physically fit as I can possibly be going into the next stage of treatment.

What next ?

I just got back from my consultation with Dr D'Souza. There is no clear plan of attack at this stage. Basically he checked me over and we discussed treatment so far and I gave him the details of the treatment I had received in Germany.
He was very pleased to see that I was in such good shape, as he said that his greatest concern was that I would be too unhealthy to withstand further treatment.
I agreed with him and said that was why I have been pushing so hard for treatment now while I am still relatively fit.

He has scheduled another appointment in two weeks time. This gives him an opportunity to formulate a treatment plan with his colleagues and some idea of time frame. In the mean time I'm to have a raft of tests to ascertain my state of health. Blood tests, gated heart study and lung function.

There are a couple of possible treatment options, One is the high dose chemo and stem cell transplant. The other is more salvage chemo. Or possibly a mix of both. Having some form of chemo can be beneficial to stem cell harvesting in that there is a slight "rebound" effect in the bone marrow that can provide more stem cells in the harvest. Of course I may not need to re-harvest, the cells I have in Germany may be enough. Like I said it's pretty much all up in the air at this point in time.

I had one night sweat on the weekend but other than that I'm feeling really good and oddly my cough seems to be improving.