Comparing *Old* CT Scans

First, Roberto is doing great.  He's awake the whole day and joking around like his old self.  He's even lamenting about prematurely buzzing his hair since it hasn't started falling out yet.  

Second, I worked my computer skillz and made .avi files of the CT scans.  These are scans from June 13 and July 19.  Roberto has NOT had a CT scan since his chemotherapy treatment started.  I thought the movies would be a good way for everyone to visually see what happened inside Roberto in one month's time.

Let's set the scene.  It's early June and Roberto has a small-but-chronic cough.  He complains about feeling liquid inside his right lung but still managed to run 18+ miles with Pedro and Chris for a Western States 100 training run the previous weekend without incident.  I finally convince Roberto to see a doctor who orders a CT scan.  The scan shows there is a large mass in the space between his right lung and his heart.  The large black spaces are the lungs.  The right side of the body is on the left of the image (trust me).  

In the following weeks, Roberto sees a thoracic surgeon, gets a needle biospy, and finally consults with an oncologist who recommends chemotherapy immediately.  At this point, Roberto is having difficulty speaking without coughing up a storm.  Roberto gets a CT scan on July 19th, right before chemotherapy starts on July 22nd. The CT scan shows us that his heart and bronchial tube have shifted to the left and there doesn't seem to be much remaining of his right lung.

Here's another view (at the end is the same scan but with less contrast):

What does the tumor look like now that Roberto has completed one cycle of chemotherapy drugs?  We don't know.  The next CT scan will be some time between the second and third cycles.  The doctors were right about Roberto improving quickly; I do notice that Roberto has stopped coughing as frequently, he can talk now without coughing and has an easier time walking up stairs.

We've come a long way after a single week of chemotherapy drugs.  Let's stay Robostrong and finish this!

ROBOSTRONG!

Cycle 1 - Day 8

Roberto is practically back to normal.  We did some gardening (we moved pots around, it was not labor intensive) and he did some handy things around the house like fixing a chair.  He also played a bunch of video games in the afternoon.  That's the more typical Roberto behavior.  :P   Amanda stopped by for a short visit today.  She's been hanging out randomly during the past week when she can which is awesome! 

Roberto also got a nice care package in the mail from Tasia!  Take a look at the goods:

Now I don't have to look for hard candy because Tasia found some Queasy Drops.  No more scary Ginger People for us.  And yes, that is a T-Rex.  It's a known fact that T-Rexes are the best dinosaurs for fighting cancer.  We are definitely going to have to play some of those Mad Libs in the future. 

Eric made up a great word that I love:  Robostrong!  Reading and saying the word brings a smile to my face.  Roberto likes it too.  We're going to stay Robostrong for the rest of the year!
 

Home Improvement

Cycle 1 - Day 7

Roberto's energy was up today!  No naps for that guy.  He went for a walk (down the block again), ate various solid foods including plums and lasagna, and even folded the clean clothes!  I've run around the house doing various chores and for some reason I have this huge mental block against folding the clean clothes.  I'll happily wash dishes all day while ignoring the two week's worth of clean clothes pile.  

Jim stopped by again to hang out for a bit sans his virus-carrying baby (she had live-virus vaccinations last week).  Roberto has to be careful of catching any viruses because chemotherapy compromises his immune system.  It was nice that Roberto was more awake to enjoy Jim's company.  Adam is here again for the week to help out and I have a new partner for playing Borderlands 2.  :)

Roberto seems to be recovering quickly from the chemotherapy drugs which is encouraging.  Roberto is planning on enjoying the next two weeks before the start of the second cycle.  He hit such a low during the week when he was sick.  It was hard trying to get through Thursday and Friday.  I'm going to try to find some good ginger candy before the next round; it'll have to be hard candy since he did not like the chewy candy the nurses gave him.  The brand of the candy is "Ginger People" with this scary looking ginger person on the package.  There must be some other candy out there with ginger.  

Here's to a good rest of the week!

More Than Soup

Cycle 1 - Day 6

Success!  Roberto did much better today.  He ate real food *and* didn't throw up!  Roberto felt good enough to go for a walk down the block and back.  Then he promptly took a nap when we got home.  Later, we went back to the Infusion Center so Roberto could get a shot of Neulasta.  Neulasta stimulates the bone marrow to produce red and white blood cells, so this is good for Roberto since ALL the chemo drugs kill his blood cells.

He also got to get rid of this little buddy:

Roberto has been carrying around this fanny pack for the last 6 days.  It was partially a fashion choice.  In fact, he insisted I don't take a picture of him wearing it because it was just too awesome.  The other reason for the man purse is that it contained a mobile medicine pump.

The chemo drug isofamide destroys the lining of the bladder.  The drug mesna protects the bladder from that onslaught but it must be administered for a full 24 hours after each infusion of isofamide.  Now Roberto is free!  It makes it a lot easier for him to get around when he doesn't have to worry about the medicine tubes getting caught on things. 

I'm happy that Roberto has more energy already.  Hopefully he'll slowly get back towards normal before the second cycle starts.

Chemo - C1 - Day 5 - Today's Post Is Brought To You By The Letter V

The day started off well with no major incidents.  Once we got to the Infusion Center, Roberto got settled in and he was awake enough to ask for the TV to be turned on.  We started by watching Phil Mickelson give table tennis advice to Matt Lauer.  That probably was a sign that the rest of the day wouldn't be quite right.  After some channel surfing, we settled on a cartoon based on the "How to Train Your Dragon" movie.  The lesson of the day was that you should not steal dragon eggs from dragons that can spit acid and are able to camouflage themselves.  Kid shows are so practical these days.  Also, I was half-paying attention to the episode.

The rest of this post is mostly about vomiting, so you probably want to skip it or read it when you're not eating.

I got some nice chicken soup for Roberto's lunch and he drank quite a bit which was nice.  About a half hour later, he threw up which is not great.  Roberto says he doesn't know how feeling nauseated actually feels so we never get a good warning for when he might vomit.  Roberto does keep complaining about the smell of medicine that is emanating from his mobile medicine pump (which I'll explain tomorrow) and also permeating through the bed sheets and his quarantined bathroom at home.  I'm going to try to clean everything tomorrow and see if masking the smell with some incense will help a bit.

After we got home and right before dinner, Roberto vomited again.  At least it was before dinner so there was no food for him to throw up.  I made him some chicken soup with lots of broth and that seemed to settle his stomach a bit.  He felt better and even stayed up long enough to watch TV.  I got to learn about the secret world of racoons, or angry cats as I like to call them. 

Today was another challenging day, but we made it!  No more chemo drugs until the start of Cycle 2!  The nurse said that he will start to feel better after about a week.  Tomorrows goal: eat more than soup. 

Chemo - Cycle 1 - Day 4 - Things Get a Little Worse

Day by day this week, the chemo drugs work their magic on Roberto's body, but the drugs do not make distinctions between "good" and "bad" cells.  Their target is all rapidly growing cells; they destroy the malicious cancer cells in his body but also his healthy blood cells.  The microscopic battle raging on inside him has absolutely drained Roberto of his energy.  He spent today mostly sleeping on the beat up, green La-Z-Boy in the corner of the living room covered by the quilt my mother made me. 

At the Infusion Center, Roberto threw up twice.  This is by no means a set back but rather an expected side effect from a few of the over half-dozen medications he is taking.  However, this does make each small meal that more precious and it felt like a small victory when Adam and I were able to cajole Roberto to rise from his resting spot and drink some soup.

Jim was able to visit Roberto at the Infusion Center today for a couple of hours, and, from what I heard, the visit energized Roberto a bit.  Visits like that and the little messages I keep receiving from Facebook, emails, and phone calls from you guys are wonderful.  I relay the messages to Roberto when he wakes up for a couple of minutes.

There's one more day of chemo drugs for this cycle!  It's another day of Roberto suffering the medication side effects but it's also another day of killing the cancer and letting Roberto reclaim his body. 

Chemo - Cycle 1 - Day 3 - (Not) Hungry Like the Wolf

Today we encountered some new side effects.  Roberto had a stomachache at the beginning of the day and also had a decreased appetite.  For the first time since I've known Roberto, I watched him take tiny bites of his Nugget sandwich instead of gigantic mouthfuls at a time. I'm so used to him eating two humongous meals for a day and now it's a slight struggle to get him to eat a few small meals.  We were expecting him to have a decreased appetite at some point but this seems too soon.  

He's also slept the entire day away like a hibernating bear.  I don't think he was awake today for more than ... an hour ... or half an hour ... at a time.  Another fun thing since his cancer treatment has started (or maybe when he starting taking cough medicine) is the little sighs he makes while sleeping.  He had a conversation last night with someone:  "Hhhhhuuuhhn.  Huuhhn huuun hhum.  Hhhnnn."  These conversations have done wonders for my sleep and also amuse Adam and me when we keep Roberto company at the Infusion Center.

I realized today that I might have glazed over some of the specifics of Roberto's chemotherapy.  Roberto will have 12 weeks of chemo.  This will consist of 4 cycles.  Each cycle is 5 days of chemo drugs and 16 days of rest (that's 21 days for those of you playing along).  So, just TWO MORE DAYS of chemo drugs for this cycle!

Keep those well wishes coming.  Roberto can't check his emails as often since his eyes seem more comfortable with the lids shut, but I'm more than happy to pass along your messages. 

Chemo - Cycle 1 - Day 2 - The Shaving

Second day!  Chemo was more straightforward today and Roberto was out of the Infusion Center by 3pm.  I guess the biggest problem today was the huge traffic jam at the convenient valet parking system.  Although, it was amusing watching the drivers run down the block to the parking garage.

Roberto is currently experiencing a metallic taste in his mouth and hiccups.  Not too bad on the list of possible side effects.  The doctor prescribed some pills for the hiccups so he doesn't stay up at night (and keep me up!).  

Adam and his clippers wreaked havoc on Roberto's hair!  In anticipation of losing his hair, Roberto wanted to buzz his hair down.  Here are a few pictures of the transformation.

Before the buzz!  Adam waits patiently in the back.

Buzz buzz buzz.

He should have stuck with the mo hawk! 

Feelin' the mo hawk!

Almost there!  *This* is where they should have stopped.

It is done! 

Chemo - Cycle 1 - Day 1 - Prologue

Chemotherapy takes forever!  It didn't help that there were first day snafus.  Time was spent waiting for the proper drugs and a pump from the pharmacy.  Also, I didn't realize that each drug requires one hour to be administered.  I guess I didn't think through the logistics; only so much liquid can be pushed into a vein at a time.  With three chemo drugs and five supportive drugs and hydration before and after, Roberto was at the hospital from 8am - 5:15pm.
:-\

Roberto is enjoying the little things.  He has an automated lay-z-boy-like chair that is controlled with a remote.  It also has a seat warming button with multiple levels of heat! As a patient, Roberto gets free food for lunch (although, the food leaves much to be desired) which includes a slice of cake to Roberto's delight! I do go out to Nugget to get Roberto a real sandwich.  Here are a few pictures from today.

This chemotherapy treatment is Roberto approved!

 Getting the drugs.

Chemotherapy specific drugs get their own scary, brown bag (they are light sensitive).

Watching the nurse ... ?  Neil took this picture, by the way.  :-P

 Totally in charge now ... and kinda sleeping.

Now we're at home hanging out with Adam and Eli.  I get to watch the Top Gear Bolivia special for the second time in two days.  Yay!  Hopefully, tomorrow will go smoother and we won't have to be at the hospital for as long as today.  Also, hopefully Roberto continues to feel (relatively) good.  :)

Chemo - Cycle 1 - Day 1

It begins!  Roberto is doing well. No allergic reactions yet and no drips drops in blood pressure. Neil is here to keep him company and out of trouble.  One of the drugs is making Roberto drowsy, but he's fighting the sleep so he can watch Game of Thrones with Neil.  I'll post pictures later tonight.

New CT scan and PICC dressing cleaning

Roberto's CT scan from yesterday shows that there is significant growth in the tumor.  So much that the on-call oncologist phoned Roberto to make sure he didn't need any emergency care.  The scan shows that most of Roberto's right lung has been squished by the tumor and his heart is pushed more to the left of his body. 

There should be two big, black lung-holes in the picture above.  So, we're pretty sure this is caused by the seminoma since it's a germ cell tumor and those types of tumors grow rapidly.  Seminomas respond well to chemotherapy and Roberto should show improvement soon after treatment begins next week. 

Today, Roberto PICC line dressing got replaced and now there is a bandage with a nice window on it so we can see the tubes poking out of his arm!  I might get of picture of that later.

Chemotherapy starts in two days.  In two days, Roberto starts reclaiming his body!

PICC Line

Roberto had a PICC line placed in his left arm.  The process required wire threading, a scalpel, plastic tubes, and a malfunctioning magnetic sensor.  The nurse was very experienced with placing PICC lines, so the unhappy sensor didn't slow her down at all.  There is now a long tube inside Roberto's arm that stretches from near his elbow to near his heart!  The PICC line will stay in Roberto through the duration of chemotherapy since all the medication will be administered through injections (intravenously).  The PICC line means Roberto won't have to be pricked over and over again.

Roberto also got a CT scan so we can see if the tumor has changed at all. 

Chemo Education

Roberto and I sat down with the nurse who is part of our cancer team.  We learned about all the drugs that will be pumped through Roberto's body and their glorious side effects. 

Chemo Drugs

1. Isofamide
2. Etoposide
3. Ciplatin

Supportive Drugs

1. Mesna
2. Decadron
3. Ativan
4. Aloxi
5. Neulasta

 One major part of Roberto's home care is him drinking 2-3 quarts of water every day!  He needs to make sure to flush all the drugs out of his body so they don't destroy the good parts of his body *too* much. 
 

The Oncologist

Today, Roberto and I met the oncologist that will help us treat the cancer.  He informed us that Roberto has a mixed tumor consisting of a seminoma and teratoma.

The seminoma is a type of germ cell tumor associated with testicular cancer.  While uncommon, such tumors can occur outside of the testicles.  Germ cell tumors respond very well to chemotherapy, so Roberto will go on a 12-week chemotherapy treatment.

The teratoma is not a germ cell tumor and does not respond as well to chemotherapy.  After the chemotherapy treatment, Roberto will require surgery to remove the rest of the tumor.  Decisions and information about the surgery will be given after the chemotherapy treatment is complete.

So, now we gear up for chemotherapy and the joys of side effects!