Thursday, November 30, 2006

An Unwanted Journey: Day 0372 - My "Surveillance" Colonoscopy

Now there's a day I hope never to experience again. Almost 24 hours ago, I took my first phospho-soda as part of the bowel preparation requirements for the colonoscopy I had this morning. Then again, around 3:30 am, I had the other bottle. From midnight until just a few moments before my procedure, I was stationed nearby the washroom, feeling worse and weaker as time progressed. By the time of the procedure, I could barely walk. I don't know how much of the negative sensations I had were owing to having gone through surgery, but the overall preparation experience was definitely one I hope fades from memory quickly.

The experience of the procedure itself was different from last time as well - different hospital, different specialist (the surgeon for my low anterior resection), different sedative, and different results. The only thing that was the same is the sense of disappointment as my surgeon told me that there was something near the anastomosis that required him taking a biopsy. I won't have results of the biopsy for another week when we meet for a consultation in my surgeon's office.

Even though the sedative did make me groggy, I felt and saw almost everything this time, including a painful digital rectal examination following the colonoscopy itself. I spoke with the surgeon before, during, and after the procedure; we seem to get along reasonably well, but he obviously is concerned about what he found. Funny, though, the sedation left me feeling similar to last time - the news was disconcerting, but I was numb. Next week is when I suspect I'll be more nervous about the results of the biopsy.

The good news was that the colon itself was clear with no evidence of any polyps at all.

Still, this coming few days will be ones of "what if" scenarios playing out in my mind and in my conversations with my wife and sons. It could be bad. It the biopsy shows recurrent cancer, I will undoubtedly be subject to more treatment. The prospect of more surgery, radiation, or chemotherapy leaves me feeling cold. But, of course, I'll do whatever is necessary.

Tuesday, November 28, 2006

An Unwanted Journey: Day 0370 - Embarrassment

Even now, 2 months after the end of chemotherapy, things happen in my body that I have been unable to predict. Last night, for instance, I was up every half hour visiting the washroom from 2:00 am to the time I had to leave for work. While at work, I was very uncomfortable, not to mention tired. But the worst of it was that the urgency to visit the washroom was totally unpredictable. I was in the middle of a long meeting when the feelings struck without warning. Still, trying to escape as quickly as possible, I couldn't hide the expulsion of gas. Truly, truly embarrassing.

Thursday is the day of my annual follow up colonoscopy. Maybe it's some kind of psychosomatic function of worry. Maybe it's nothing but the new normal for a man with almost no rectum. If so, I guess I'll learn to live with it, embarrassment and all. But I don't really have anyone to ask about experiences like today now that I'm recovering. It's personal guesswork.

One of the books I've read in the past year talks about the dangers of universaling life's problems. I understand that some people do so. Occasionally I may do that as well. But these days, my bones, muscles, tendons are all complaining loudly. I'm moving like I'm 80 years old and have never exercised in my life. Is that universalizing? If so, I'm embarrassed to admit it.

Thursday afternoon, after a successful colonoscopy, I'll be thinking more clearly and particularizing my bodily complaints!

Sunday, November 26, 2006

An Unwanted Journey: Day 0368 - A New Hope

12.6 men die daily of colorectal cancer in Canada. It is the second leading cause of cancer death in Canada.

But today, there is reason to hope. The Canadian government has just announced a $260-million plan to equalize treatment across Canada where geography often means that state-of-the-art cancer treatment protocols are unevenly distributed to those most in need. Friday at the Montreal General Hospital, Prime Minister Stephen Harper announced a new agency called the Canadian Partnership Against Cancer would implement a new, 5-year strategy.

From a cancer survivor's perspective, the effort is truly admirable since it was conceived and developed by 700 cancer survivors and experts. The objective of the strategy and agency is to prevent, detect and treat cancer faster. The hope is that the new plan will prevent 1.2 million new cases of cancer and prevent 400,000 deaths from cancer over the next 30 years.

Current trends are staggering. Over 44% of men and 38% of women in Canada will develop cancer during their lifetimes. Over 24% of women and 29% of men will die of cancer. In the next 20 years, 3.6 million Canadians will get cancer and 1.7 million will die of the disease.

In my particular case, I have been extremely fortunate to have had the geographic advantage of living in the Region of Waterloo. The recently constructed Grand River Regional Cancer Centre was the location of all of my treatment, with the exception of surgery in the adjacent Grand River Hospital. Not all cancer patients in Canada have such advantages. But perhaps the new agency and the new national plan will make equal access to cancer treatment a more realistic goal in Canada.

Friday, November 24, 2006

An Unwanted Journey: Day 0366 - Anniversary

Friday was the anniversary of my initial diagnosis of rectal cancer by the gastroenterogist who performed my first ever colonoscopy. From the previous evening to late Friday evening, it seemed as though events were conspiring to remind me of how precarious life truly is, yet at the same time acknowledging how precious is the time we have.

On Thursday evening, my wife and I watched Grey's Anatomy, one of the best medical dramas on television these days. But you can't watch shows like that without thinking about life and death and being reminded of time spent in a hospital. I also called a family member during the day to arrange a weekend dinner of our families. During that conversation I was told of a possible sarcoma on the kidney of her spouse, in addition to the many other medical troubles he has experienced over the past ten years or so.

Friday morning, one of my colleagues wanted to talk about putting down his dog because of cancer. Later that day, another colleague came in to work for a short period of time, stealing a few moments away from his significant other who is battling breast cancer and who had just undergone day surgery earlier in the week to remove one of her breasts and some lymph nodes (which turned out to be malignant) under her arm. Two more reminders.

Then, Friday evening, I attended the First Annual HIV/AIDS Requiem held at our parish church. It was an interfaith remembrance service dedicated to the many who are struggling with AIDS and the many who have already succumbed to the disease. Buddhists, Muslims, Jews and Christians of a variety of denominations were all represented. The Primate of the Anglican Church of Canada, Archbishop Andrew Hutchison, and the bishop of the Huron diocese, Robert Bennett, were also there. And the choir of St. George's Anglican Church sang selections from Faure's Requiem throughout the service. Again, reminders of death, disease, and the value of community were all present in that experience.

Before and after the service, there were many hugs and kisses as parishioners and friends made a point of talking to me and asking how I was doing. So, no matter how much emotional intensity I had felt over the past 24 hours or so, the healing of interpersonal contact was there too.

It's been a long year, a tough year, one that I hope I never have to experience again. But, when I stop to think about how I've changed and what is important to me now, I think this year was also one of great personal growth and illumination. I have never felt closer to my family and more loved than I do now. Whatever the level of infirmity I have undergone and continue to experience, those blessings more than make up for the troubles of 2006.

Thursday, November 23, 2006

An Unwanted Journey: Day 0365 - A Year of Cancer

Today is a major event for two of my nieces. They are twins and turn 31 today. That is monumental and truly worth celebrating. But...I find myself thinking - selfishlessly, no doubt - less about their moment in the sun than about my own anniversary tomorrow of my diagnosis of rectal cancer by my gastroenterologist.

A year ago today, I had my first ever colonoscopy. As I awoke from the effects of the sedative, I was told that the results indicated a fairly large tumour that was very likely to be cancerous. I began research immediately and thought that I was doing well in my response to the news I received in my groggy state. But the next day, after deciding to go to the gastroenterologist's office on my own, I heard the words, "I think you have cancer." Despite thinking that I was ready to hear the bad news, I wasn't ready at all.

The gastroenterologist showed me the photographs taken during the procedure of the tumour. He described what he found. Then he said something like, "I'm sorry. It's unusual for a man your age to have a tumour like this. But I think it is cancer." I was numb. I thanked him for his work, found my way to my car and then collapsed emotionally. After calling my wife and then my parents, I struggled back to work and then left for the day.

Even now, as I recall those events, I find the tears welling up inside. That evening, I was faced with talking to my sons about the diagnosis and what was ahead for all of us. Those were some of the most difficult conversations I've ever had. My wife and sons were devastated, as I was, but we began the process of preparing for next steps as soon as we could.

This past year has been incredibly difficult both physically and emotionally. My family has rallied around me and provided more loving support and care than I could ever have anticipated. I needed it, especially during the various treatment stages, beginning with combined chemoradiotherapy in January and February of 2006, surgery in late March, post-surgical complications throughout the month of April, gradual recovery in May and June and then chemotherapy from June to the end of September. I am recovering well now, but there are times when I feel so much older and more frail than when this process began.

My health is returning slowly. I feel pretty good these days, but it will only be one more week until I have another colonoscopy, this time with my surgeon, followed by medical appointments in December for a full physical, a CT scan of my chest, pelvis, and abdomen, a consultation with an allergist and a urologist - in other words, until close to Christmas, cancer and recurrence will again be on my mind almost constantly. My wife and sons will also be facing their own fears and uncertainties in the next few weeks, wondering what each appointment will mean. Will there be good news or bad news? Am I truly recovering or just putting in time until something else surfaces?

Truly, I think the news will be good. It's what I am expecting. But, like I indicated, thinking about this past year, especially the first few days after my initial diagnosis, is hard for me.

Monday, November 20, 2006

An Unwanted Journey: Day 0362 - Stem Cell Hope

A Canadian research scientist, John Dick, from the University Health Network in Toronto, has recently demonstrated that a very small percentage of colon cancer cells are responsible for growing cancerous tumours. Previous research had shown that the cell marker CD133+ was expressed on cancer stem cells for brain and prostrate cancer. More recent studies have shown the same for colon cancer.

Evidently these stem cells represent about one in 50,000 tumour cells and one in 262 CD133+ cells. What this means is that current therapies for colon cancer are sometimes ineffective because they do not target directly the cells responsible for the spread of colon cancer. As most people know, colorectal cancer is the 2nd leading cause of cancer deaths in North America. Colorectal cancer recurrence is especially common. But if this research is indicative of new directions in therapy, the heirarchy of colorectal cancer cells in incredibly important in developing those therapies.

Colon cancer initiating cells (CC-IC) may well be found in only an incredibly small percentage of the tumour's overall mass of cells. Two to three percent of the total cell mass may well be responsible for making the cancer metastasize. These cells also demonstrate resistance to radiation and promote vascularization of the tumours.

Both Dick and researchers in Italy will be working on research to determine whether these cells mutate from normal colon cells or are part of a developmental regression of differentiated cells.

Sunday, November 19, 2006

An Unwanted Journey: Day 0361 - A Vaccine?

I've done quite a bit of research into colorectal cancer during the past year. At one point, I read about a promising line of research which promised to boost the body's own immune system to find cancer cells. This week, in Clinical Cancer Research, there was further evidence that research is progressing briskly.

The vaccine used in the clinical trials simulated a protein called TNF-alpha, according to a British immunologist Lindy Durrant. Durrant has been working on this research for over 10 years. That in itself shows tremendous perseverance and commitment. The promise of a vaccine must have sustained those efforts over the years.

The idea for the vaccine came from a colorectal cancer patient with metastatic lesions on the liver who, nonetheless, survived for another 7 years after the metastasis was discovered. Usually, patients die within a year of the spread of the primary tumour. The vaccine she developed stimulates the production of T-cells which then produce proteins called cytokines that destroy cancer cells.

About two-thirds of the patients treated with the vaccine in the clinical trial showed improvement but survival was not one of the effects studied. Durrant is hoping that a newer and longer clinical trial will be funded allowing her to directly measure the effect of the vaccine on survival results. Why there wasn't more attention paid to survival in the first clinical trials does seem more than a little odd.

Perhaps the best vaccine is a simple diet of fish. A recent meeting in Boston of the American Association for Cancer Research found that men who ate several servings of fish each week had lower risk of colon cancer. This may be owing to the higher amounts of omega-3 fatty acids. But it seems that you must eat fish at least 5 times a week! After 19.4 years of follow-up, men who ate 5 or more servings a week had a 40% reduced risk of colorectal cancer than those men who ate fish less than once per week.

So, I guess I'll be eating more tuna and salmon sandwiches at lunch these days while eagerly awaiting news on vaccine development.

Friday, November 17, 2006

An Unwanted Journey: Day 0359 - Shared Fate

One of the good things about being a cancer survivor is that other people who have received a cancer diagnosis or have a loved one just diagnosed feel comfortable talking to me about my experiences. I can honestly say this is a tremendous honour. I value being able to help another person as they begin their journey and I am humbled that somehow my experiences can be of value to them.

I think I am also more aware of how cancer affects the lives of others. We all go about our daily lives, most of the time blissfully unaware of the worry and uncertainty felt by so many around us whose lives have been turned completely upside down by cancer. But when people know that we have been touched by cancer, there is an opportunity for them and an opportunity for me. These bonds of friendship and commisseration may be short lived, but they are incredibly intense and honest. The shared intimacy of a shared fate binds us together in ways that are difficult to convey unless you have experienced it yourself.

This shared fate is something I have experienced at other times in my life too. In fact, shared fate is the name of a book which was instrumental and incredibly helpful to my wife and me when we decided to adopt children. The idea, in that context, of the title was that there is something which links the adoptive parent with the birth parent. For the birth parent, it is the untimely nature of fertility. For the adoptive parent, it is the tragedy of infertility. Somehow, these two seemingly disparate experiences have the potential in open adoptions of creating a deep bond between birth and adoptive parents, all embodied in the child, the one who signifies both the tragedy and the treasure of adoption.

Similarly, when we share our experiences of cancer diagnosis, our trials and tribulations, and possibly our triumphs, we adopt one another into a very close circle of intimacy that others simply cannot fully appreciate the way we do. For me personally, it is as if the intensity of my own diagnosis and concern surfaces again with all the attendant emotion and uncertainty. The vulnerability is there again, resurfacing simply as a response to the story being shared with me.

I hope I never lose this sensitivity to others. I trust my experience with cancer will enable me to serve others similarly diagnosed for many years to come.

Wednesday, November 15, 2006

An Unwanted Journey: Day 0357 - Feeling Secure

Security has been on my mind recently. The last breakout session of the business conference that I attended last week in Las Vegas was all about the security features of our ERP software where I work for a living. Then, the very next morning, as I connected remotely to our business network, I discovered a security breach, the upshot of which has been the focus of this week's work and discussions. Finally, with only two weeks left until I have my next colonoscopy, I'm reflecting on what security means to me in regards to my unwanted journey.

Security is partially a feeling of having a future, mainly one that is unclouded by doubt and despair. When one is diagnosed with cancer, the clouds appear on the horizon immediately. Often, those clouds become thunderheads, maybe even twisters, in the imagination. That, of course, means doubt, lots and lots of doubt, about the future.

In the real world, cancer patients and survivors often tie their feelings of security to medical test results, sometimes to bodily sensations. Although, in the latter case, I find it difficult to trust my bodily sensations since they didn't tell me anything about having cancer in the first place. Medical test results, on the other hand, seem to have some scientific merit and reflect a reality which bodily sensations cannot match. What are my blood counts? What do the MRI and CT images show? What is that spot in the X-ray? Were there any polyps you discovered during the colonoscopy? How does the anastomosis look? What does the scar tissue in the colon and rectum look like now eight months later?

As we close in on Christmas, I'll be thinking a lot about this time last year when I was undergoing a barrage of medical tests and imaging. Unlike the festive lights of the seasons, my future didn't look bright at all. This year, I suspect that I'll be much more optimistic about my future - in other words, more secure.

But security is truly an illusion. Last night, my wife and youngest son and I had a brief discussion about the inevitability of tragedy in our lives. We normally don't live with the fear of something tragic about to happen, but it does happen nonetheless, whether it be the death of a loved one, the loss of a friend or job, the onset of a life-threatening disease, an accident, or a host of other possibilities. Our security is really just a sense that the overall balance in life will be good...and that part of the feeling of security is true and accurate. Life is good. It is often beautiful. And it is a treasure we should all value, as consciously as possible.

Sunday, November 12, 2006

Taking it easy in Vegas

It's taken almost a year, but I think I'm finally ready to try an occasional personal blog that isn't about an unwanted journey. I will continue to write about cancer, colorectal cancer in particular, for quite a long time, but part of my recovery process means regaining a sense of normality. And that means that my blogging activity should also be moving in other directions. That has been happening recently on my corporate blog, Bringing Closure, but it will also happen here. The visual cue will be the title - today's entry, for example, says nothing about An Unwanted Journey.

Our business conference ended yesterday at lunch. I've been good about getting my much-needed rest. Yesterday, though, it was time to have some fun. So, my business colleagues and I went back to the Stratosphere to catch a complimentary viewing of Viva Las Vegas and then headed out to the other end of the strip to visit some hotels/casinos like the Luxor, the Excalibur, New York New York, and the Bellagio. We also took in a performance of Tournament of Kings at the Excalibur where we participated in a feast of game cornish hen, tomato soup, potatos, and broccoli. But the real centre of focus was the medieval joust and battles on the arena right in front of us (we were in the front row).

Today we went to the Venetian and the Wynn to get some souvenirs for our family and tonight we're off in the other direction. We still haven't done any gambling yet, but there may be a little time to do that afterwards.

While resting in my hotel room this afternoon, I watched a show about the history of entertainment and casinos on the strip. It reinforced a gradually growing fascination with the history of the Entertainment Capital of the World. What has been done here in the desert is absolutely phenomenal, despite the many obvious shortcomings of Sin City. To visit a hotel like the Wynn illustrates how incredible this development has been and continues to be.

Our cab driver told us that over 45 million people visit Las Vegas each year. He also told us about new developments like the Trump Tower, the construction near the Bellagio, the new Wynn towers, and the end of the Stardust. Clearly, nothing is hindering the growth of the city and the strip in particular. My colleagues and I are taking it easy here, but many, many others - both visitors and those who make Vegas their home - are not taking it easy. They are building a dream, an unabashedly free-market, capitalist dream dependent only on the flow of capital.

Monday, November 06, 2006

An Unwanted Journey: Day 0348 - Gambling on Recurrence

This week I'm off on a business trip to Las Vegas. Yeah, that's right...a business trip! Will there be some gambling involved? Maybe. It depends on whether the Fun and Sun hotel/casino package's promise of $150 of casino dollars can be used for gambling. If so, then I will certainly be doing some evening slot machine analysis. I'm not much of a gambler, so it's bound to be experimental.

Gambling with cancer recurrence is something else again. Certainly if I were to decide that since my treatment was apparently successful, I can do whatever I like with nutrition and fitness, then that would constitute gambling with recurrence in my books. But beyond that fairly obvious observation, it becomes much harder to know whether one is gambling or simply living.

What would you say, for instance, about eating red meat or drinking wine? Does that constitute gambling? What about a failure to eat lots and lots of dietary fibre? Or greens? Or having a beer on the weekend? What about swearing at stupid drivers on the road? Is that needless stress in one's life? Should I become a dedicated yoga enthusiast? Should simply walking and doing some weight training constitute gambling?

I don't know the answer to most of these questions, nor do I even know if they are worth asking. All I know for certain is that the life given to me should be lived consciously and deliberately with abundant gratitude. While I'm in Las Vegas, I'm pretty sure that means at least 2 or 3 great meals with my business colleagues, perhaps tipping a glass or two, perhaps enjoying some typical Vegas entertainment, all the while being thankful that I don't have to live there!

Saturday, November 04, 2006

An Unwanted Journey: Day 0346 - The Cancer Code

I've been using mind mapping software for almost as long as I have used Microsoft Office software. If you aren't familiar with mind mapping, it's a technique for note taking in which graphics and the free flowing of ideas are paramount. Mind mapping has been around since the 1960s when Tony Buzan began popularizing using diagrams with an image in the centre of a page and ideas radiating from that centre. Buzan claims that he began taking notes using the "radiant" graphic approach in his university days out of frustration with the traditional note-taking approach. The idea was that key words, images, colours, and associations work far better than simple lists and pages of elaborate text.

Personally, I have used mind maps for note-taking, brainstorming, agendas, teaching, strategic planning, presentations, and hyperlinking of documents in various formats. But because most of my work involves computer use, I quickly sought and found software to do what was traditionally conceived as a manual, almost artistic, endeavour. MindJet's MindManager quickly became my desktop mind mapping software of choice.

The connection between mind mapping and cancer is not a personal one. Instead, it is about the originator of MindManager, Michael Jetter. In his book The Cancer Code: How a journey through leukemia led to software that changed the way people work, Mike and Bettina Jetter document how his personal battle with cancer coincided with a lifework project to create software enabling mind mapping on the desktop. Today, with over 500,000 customers world wide, MindJet's Chief Technology Officer is Mike Jetter. This is a book I recommend, especially if you have an interest in inspirational cancer survivor stories as well as an interest in productivity software.

Wednesday, November 01, 2006

An Unwanted Journey: Day 0343 - Risk of Recurrence

As we enter the month of November, I'm anticipating my first follow up procedure, a colonoscopy at the end of the month by the same surgeon who performed my low anterior resection in late March of this year. A recent press release in the UK claims that the most significant factor in a recurrence of a cancerous tumour in the rectum and for life-expectancy at 5 years after surgery is the quality of the surgery itself. But, in addition, it found that a pre-operative chemo-radiotherapy combined with the best quality surgery could result in less than 1% of patients experiencing cancer recurrence within 5 years of the surgery.

I have every reason to believe that the quality of the surgery performed on me was of high quality. I also believe that the treatment regime recommended to me of preoperative chemo-radiotherapy, surgery, and post-operative chemotherapy was the best, most up-to-date regime possible at the time. Not only that, but my confidence in the recovery recommendations and my followup team is very high.

Whether this means I should consider myself a likely candidate for the less than 1% recurrence rate group or not is obviously something that only time will tell. But it is something worth pinning my hopes to.