Wednesday, January 18, 2017

Radiation therapy preparation

I think today's CT scan and marking, or radiation preparation, went well. I don't remember exactly what happened during my previous radiation prep treatments so I can't really say whether or not this one went better or worse than those ones.

When I got to the cancer center I hadn't realized that I didn't have to check in at the main desk so I wasted a little bit of time waiting in line there. Fortunately I wasn't late and my nurse was so it all worked out just fine.

The nurse started off by explaining what would happen: that they were positioning me to receive the radiation treatments with the help of a CT scanner and that I would have to lie very still. To help me lie still, they would be setting up a mold around me and they would be adding compression to my abdomen so that I didn't move much when I breathed. At this point we don't know how many treatments I will be receiving as the oncologist wanted to see the CT scan to see what was going on around my sternum. It will take an unknown amount of time to make all the calculations. I'll receive a call for the first appointment sometime and when I come to that appointment I'll get the the treatment schedule.

It sounds kind of loosey-goosey, doesn't it? Normally when people go in for radiation, they're told how many treatments they'll get. Then again, most people are receiving a standard radiation therapy treatment for their cancer, and in those cases everything is pretty much known. My treatment is customized for me and must take into account the amount of radiation I've received to that area already along with the arrangement of my organs and bones. Customizing something always takes longer than giving the standard thing.

After she talked to me she took a photo of my face for my file (apparently I've changed a little in the last decade), a second nurse came in, and we got started.

I laid on a narrow, hard CT scanning bed with laser lines projecting down onto me. One of them kept going into my eye so I ended up just keeping my eyes closed throughout. Some of my alignment marking tattoos from the first radiation treatments are still there and they used those to align me. It's an odd sensation, lying there still and heavy while they pushed and pulled me into position. Once I was fixed in place, they pushed what would become my individual mold close to me so that I couldn't move. Apparently this mold is like a giant beanbag with little styrofoam balls in it; to make the mold, they suck all the air out and presto-magico, instant mold! When I'm done with it they force air into it and it relaxes again, ready to be used again.

Once I was fixed into position, the oncologist came in and added the abdominal compression. She kept tightening it until my breathing was balanced between comfortable and uncomfortable. It's difficult to describe the feeling of trying to breathe when my abdomen was prevented from expanding. I could only take shallow breaths - taking deep breaths was really hard what with the big weight thingy on my abdomen - which led me to feel like I wasn't getting enough oxygen. Then I would start to feel like I couldn't breathe and that I was starting to suffocate and I'd have to remind myself that I was getting enough oxygen and to relax. Keeping my eyes closed helped me stay calm, I think. So did all that meditation training - for a while I was doing that "breathe in through one nostril and out through the other" thing.

After all that, the CT scan started. This was just like other CT scans except that I didn't have to hold my breath and I didn't have to have any contrast injected into me. When the CT scan was done, the nurses came back, removed the abdominal compression, and made little x's where they wanted to place alignment tattoos. They gave me the little dot tattoos and let me go. The whole thing took about an hour.

I'm a little nervous about the treatment, I think. I was very chatty this morning (I get chatty when I'm nervous) and the nurse made it kind of clear that she just wanted me to be quiet and let them do their jobs. Closing my eyes helped me do that, too. I'm also having episodes where I'm feeling a bit depressed. I think I'm feeling this way because things are changing for me and I'm entering a new metastatic chapter. Add to that all the unknowns associated with this change and it's not surprising that I'm feeling a bit nervous and down. I'm not feeling so sad that it's a problem; it's just something I need to be aware of and I need to make sure I take care of myself.

After all this, the actual radiation sessions should be pretty quick and straightforward.

Tuesday, January 17, 2017

Getting started

The cancer center called today asking if I could come in tomorrow morning at 8:15am for the CT scan and to get the markings. Of course I can! Let's get this stereotactic radiation therapy party started!

I've been waiting for this call - I had kind of expected that I'd hear from them before now but I guess my treatment isn't exactly urgent, given that my cancer has been stable for so long.

The appointment is supposed to take about an hour and fifteen minutes. I don't know when the actual treatments will start but I expect it'll be a matter of days rather than weeks.

Friday, December 30, 2016

A proper subscription box!

I've (finally) added a subscription box over at the side there so that you can be notified when I've written a new post instead of having to check back all the time. I don't see myself posting every day so I don't think you'll be overwhelmed with posts. Thank you for your support!

Thursday, December 29, 2016

Consultation for a new treatment

Well, it's been a while, hasn't it? I meant to post more but then it got away from me. So much of this blog, in the early days, was to keep my family updated about my life but now I mostly keep in touch with family via social media. The other main purpose of this blog was to chronicle my life with cancer and there really hasn't been anything new on that front.

Until now. But it's a good new thing! Sort of. 

What's happened is that the metastatic cancer spot on my sternum showed additional takeup on my annual bone scan in August over the August, 2015 scan (the one from the previous year). The way the scan works is they inject me with a radioactive tracer which settles in my bones. Areas where there's more tracer have additional takeup, and this means that some kind of activity is going on there. We redid the scan in November and it showed the same amount of additional takeup over the scan from August, 2015.

Between the scan results and the fact that I've been experiencing additional pain in my sternum over the last eight months or so, it's reasonable to conclude that my spot is starting to be active again. There are no other spots showing up in any other area: the only active area is this spot on my sternum.

So my oncologist suggested that we see if we can get rid of it with a type of focused radiation called stereotactic body radiotherapy (SBRT) (aka stereotactic ablation radiotherapy, or SABR). In this treatment, the tumour/lesion/spot is basically burned out and because the radiation is focused, there isn't as much damage to surrounding tissue. My cancer centre recently got the equipment to do this type of treatment so it could be done locally. She sent me for a consultation with a radiation oncologist, who I saw today.

I am a candidate for the SBRT because my sternum hasn't received the maximum lifetime dose of radiation. Apparently, although SBRT is in use throughout the body - including in the brain, liver, and lungs - and it's been extremely well-studied in all those places, it's less well-studied in bones. This doesn't mean that it won't work, just that the benefits and side effects aren't quite as well-understood. I didn't see this as a reason to not do it. 

Benefits of the treatment is that it'll take my spot out, which will reduce the amount of metastatic cancer in my body. Yay! The radiation oncologist also indicated that I should see reduced pain in the sternum after the initial spike. Yay again! Side effects of the treatment include fatigue, initial increased pain, and possible tissue damage. Side effects from that tissue damage depend on which tissue is damaged, but can include heartburn, lung damage, rib damage, etc. One other side effect is that my sternum will become very fragile so it could break more easily. 

The radiation oncologist has to check what doses I've received and where and make up a plan for me but she thinks that I'll get one or two treatments. I'll need a CT scan for positioning (applying radiation has to be a very thorough and detailed process to minimize tissue damage.

I'll be posting updates about the this treatment and side effects so watch this space for more details.

Wednesday, June 29, 2016

Gozer update

It's been a while again, hasn't it? Pretty much all of my time and energy has gone towards Gozer and her training. She was having a much easier time at night once we stopped making her sleep in her crate. She's been sleeping on a comforter on the floor that used to be on our bed so it smells like us (even to the untrained human nose).

I forgot to give her the Clomicalm late last week and we've had some problems with her being restless and demanding to sleep on the bed beside me since then. We've also set up an exercise pen (xpen) in the bedroom so that she can become desensitized to it. We're both going to be traveling in a few weeks and Gozer can't just sleep any old place on the floor while we're away, so we're hoping she'll sleep in the xpen. Before we can get her to sleep in there, she needs to see it as just another piece of furniture.

We've also been working on training Gozer and getting her used to me moving away from her while she's in an xpen in the great room. Training is a lot of a work! Fortunately, Gozer's doing well. One game she really loves is Find It, where we put kibbles under a 500mL yoghurt or cottage cheese container (or two) and she has to sniff them out and get to them. She is very good at turning these containers over. Of course this means that these containers aren't safe on the floor because she'll try and find kibble under them.

I hope that Gozer continues to improve. At least we have an awesome (and very patient) trainer helping us with Gozer. She's made this training easier than I thought it would be and she's got good tips and ideas.

Thursday, May 26, 2016

Bark bark bark bark

Have I mentioned that Gozer is barking at night? Sometimes she only barks a little at around 1am and then around 5am, and sometimes she barks a lot - the night before last she barked continuously from 11pm until 7am - but she barks at night. It's exhausting for all three of us.

I don't know exactly when the barking started - I'm too tired to remember much - but I do remember it was around the grooming before last, which was a couple of weeks after we got the new bed. The new bed is higher than the old one so it's possible that part of the problem is that she could no longer see us at night. It's also possible that something freaked her out at the groomer's (they put her in a crate for part of her visit there). It's possible that her cataract is bigger, which means she's not seeing as well at night. There are a lot of possible reasons for the barking. I think something - any one of those possibilities, or something I haven't thought of - triggered the night barking and now we're in this terrible cycle that we just need to break somehow.

It's not like we haven't tried to stop the barking. We've tried:
- moving her crate into a different spot in the bedroom
- moving her crate into the living room (where it was when we first got her)
- playing doggie sleepy music
- putting a thundershirt on her
- keeping a light on
- keeping the lights off (including closing the door on the pepper seedling lamp)
- tiring her out with a brisk walk before bedtime

Nothing really helps. She just keeps barking: barkbarkbark pantpantpant barkbarkbark pantpantpant barkbark in this frantic barking and panting cycle all night long. Ian's parents succeeded in shutting her up by playing late-night talk shows but that required them to also be awake and that's not a long-term solution.

I took her in to see the vet today because we're at our wit's end. All three of us are exhausted. The vet thinks thinks that there's a separation anxiety component to this and that we need to stop it as soon as possible. Therefore, we're going with a multi-pronged strategy involving pheromones, drugs, food, and training.

The pheromone is Dog Appeasing Pheromone (DAP), which is a synthetic version of the one mommy dogs send out to calm their pups and that has apparently been shown to calm some dogs. At this point, I figure it's worth trying because maybe it'll work with Gozer. I bought an Adaptil plug-in diffuser that we're putting near her crate, a spray that can be used on both her bedding and thundershirt, and a collar for when she gets to stay somewhere else.

The drug is Clomicalm (clomipramine), a tri-cyclic antidepressant, which will help to reduce anxiety in general. I don't love giving Gozer drugs but it's clear that she's distressed and unhappy and I want life to be good for her, too. We'll wean her off this drug as soon as possible after the situation is under control.

The food is Royal Canin Calm, a food that boosts serotonin production and that should help to reduce anxiety. It's the same manufacturer as her current food and is a urinary-reduction food like her current food.

The training is separation-anxiety reducing training, which means that I need to work on getting her less attached to me, getting her more independent and more confident by practicing more basic training (stay and come, for example), and to break the associations with bedtime. Normally with dogs that have separation anxiety if their owner leaves, the owner breaks the associations with leaving by doing parts of the leaving routine out of order or without leaving, and then leaving the dog for longer and longer. So we'll (or I'll) need to practice the bedtime routine all out of order and at weird times of the day. This is not going to be easy, because she barks when we leave, too. But let's get the night barking problem under control first.

The vet also suggested moving the crate back into the bedroom and to raise the crate so that she can see us at night to eliminate that part of the equation. We're trying that tonight.

Monday, May 16, 2016

Metal forming classes

I spent the last week in Albuquerque at Rio Grande, my favourite jewellery supplier, taking classes forming metal using miniature stakes. The classes used the super-awesome Fretz hammers and stakes and were taught by Bill Fretz himself! That probably doesn't mean anything to you but he's one of the "rock stars" of the business, and the hammers and stakes he's designed are the best. The opportunity to spend a week learning from him how to use the hammers and stakes he designed to form metal was just too good to pass up.

Albuquerque is located in a high-altitude desert and it was very hot and windy. The plants were quite different from what we have in Southern Ontario - I had no idea that yuccas grew so tall! - but they were beautiful in their own way. I spent my last morning there at the local botanical garden in the Southwest US section but those are pictures for another post.

Today I want to show off what I made during the week. We practiced on circular tubes of varying widths and diameters; most often, we sawed the finished forms open to make cuffs. We used brass for almost everything. Almost all of my pieces still need polishing - but these were metal forming classes, not metal polishing classes, and I wanted to make the best possible use of my time. I can polish things at the studio if I want to.

In the first class, Forming metal with miniature stakes, we learned how to control the hammers - not only to hit what you're aiming for, but how to hit with the right amount of force - then how to make concave forms, how to make convex forms, and how to add fluting (ridges).

Chantelle's projects made in Forming metal with miniature stakes class
Back row, L-R:
- learning hammer control by planinshing (hammering lightly using overlapping blows to smooth out the metal and harden it) on a cuff made from a 7/8" wide by 2" diameter blank
- a concave (also known as anticlastic) cuff made from the same blank
- a wider oncave cuff made from a 1 1/2" wide by 2 1/4" blank
Front row, L-R:
- a large convex (domed, also known as synclastic) unopened cuff made from a 7/8" wide by 2 1/4" diameter blank
- a small convex ring made from a 1/2" wide by 1" diameter blank
- a convex fluted (ridged) unopened cuff made from the 7/8" wide by 2" diameter blank
- a small concave ring thing whose sides have been completely folded over made from a 1/2" wide by 1 1/4" diameter blank
Not shown:
- a wiggly convex fluted form (I forgot to bring it home)
For reference, the background plaid has a repeat of about 5 1/8" in each direction.

Whew! We did a lot in those two days!

In the second class, Continuing metal forming, we focused mainly on fluting: adding it in different directions, to different shapes, and we used fine silver for a couple of pieces.

Chantelle's projects made in Continuing metal forming class
Back row, L-R:
- a concave fluted unopened cuff made from a 7/8" wide by 2 1/4" diameter blank
- a 2 1/2" diameter bracelet made by closing this wiggly 1 1/4" wide by 8 1/2" long blank into a ring, making it concave, and then folding the sides over to meet
- a wide flat unopened cuff with fluting running around the cuff whose sides were flared upwards, made from 1 1/2" wide by 2 1/4" diameter blank
Front row, L-R:
- a 2" diameter disk that is domed and then fluted
- a slightly convex fine silver cuff made from a 7/8" wide by 6 1/2" long blank that is closed, formed, and then cut open
- a wide convex fine silver form with fluting running around the piece and the sides flared upwards made from a 1 1/4" wide by 6 1/2" long blank that is closed, formed, and then cut open
For reference, the background plaid has a repeat of about 5 1/8" in each direction

We didn't do as many pieces over these three days because the fluting takes quite a bit more time to do than it does to make a convex (synclastic) or concave (anticlastic) cuff.

I loved these classes, although I found the week exhausting. Hammering and learning are both very tiring! I really, really, really love the process of forming these pieces and I will be purchasing the equipment to continue learning. I may end up practicing in copper instead of brass, just as I've been doing with the foldforming. I don't know exactly where these techniques will take me but I am bursting with ideas and I'm excited to get to work on realizing them.

(updated to include starting blank measurements and background repeat, as well as formatting).