All systems go for chemo.

I met with Dr Buie (colon dude) and Dr Lupichuck (chemo chick) yesterday. We discussed options surrounding the drain with Buie and ended up deciding to leave the drain in for this course of chemo. If I got infected, which could happen while I'm immunosuppressed on chemo, they would just have to put it back in again which is one of the most painful things I've ever had done. So I suggested we just leave it in.

Dr Lupichuck was a little apprehensive about starting chemo on me with the drain in. She was worried about the increased possibility of infection. We ended up agreeing to have weekly blood tests to closely monitor my WBC count and lymphocytes, factors which, if deviated significantly from normal could provide an early indication of infection. After the plans were made I got the go ahead to start my folfox chemo today.

Penny and I went in and spent about three hours in the Tom Baker cancer today getting me hooked up to my chemo. I got the drip for 2.5 hours and then got to take a bottle home for 2 days. I have to go back to get disconnected on Thursday but eventually Penny will be able to do that for me. So far things are going well. I'm sensitive to cold and hot on my hands and in my throat, I have a terrible taste in my mouth and am tired already. The cycle I'm on will last two weeks and I have 6 cycles to do now before more imaging is done. My project in the coming weeks will be to line up doctor appointments and scan dates for after this three month period. My goal is to lose as little time as possible between the end of this 3 month period of chemo and whatever comes next (either chemo or surgery?).

What I Learned on my First Trip to Vegas

1) There is a lot more to do in Vegas than just gambling.

2) At any given store or bar, a bottle of water and a bottle of beer generally cost about the same. Sometimes the beer is less expensive than water.

3) You can drink just about anywhere in Vegas. This is particularly handy when your wife takes you (read 'drags you') shopping.

4) Drinking and shopping stops being fun when there are so many bags to carry you can't hold your beer.

5) Never underestimate the impact the words 'outlet mall' can have on your wife's usually sane disposition.

6) A Coach bag is a purse. Not a bag for carrying hockey equipment to practice.

7) Everything in Vegas is bigger than in 'real life' from hotels to drinks to shows to restaurant bills. They are currently building a new hotel in Vegas called the City Centre Hotel. It will have about 3600 hotel rooms in multiple high rise style buildings situated on a 60+ acre property in heart of the strip. That's huge.

8) If you go to Vegas bring comfy footwear. Things there appear closer than they actually are.

9) Anything goes in Vegas. At any given time of day you will see people dressed in bathing suits and ball gowns and everything in between.

PET results

We're just finishing packing for Vegas and getting ready to head to the hospital for my glue treatment this afternoon but I wanted to make a quick post about the PET scan results and meeting my thoracic surgeon.

The PET results showed three (possibly four) lesions in my lung. It also showed that there was no cancer anywhere else (good news!). Dr Gelfand (sounds a bit like a character form Lord of the Rings doesn't it?), my thoracic guy spent an hour with us yesterday reviewing the scans and talking about options. Although he wasn't able to cast a 'destroyouscancerous' spell, he did say that I am a candidate for surgery and he should be able to remove the lesions (surgically, not magically) without taking very much lung along with them. The lesions range in size from 2mm to 7mm. The surgery would involve making an incision under my right arm and part way across my back, spreading the ribs and removing the lesions by feel (no scopes or remote surgery or whatever its called - he wants to get his hands right in there so he can feel the evil stuff). He said it was my choice as to what order we do things (chemo first or surgery first) but after he conferred with Dr Lupichuck he said it might be more beneficial to do the chemo first. Penny and I both felt very good about the meeting and the options that are on the table.

So, I have more glue today, see Lupichuck Monday, maybe start chemo Tuesday and see Buie Wednesday. I may be able to delay my chemo until Wednesday after I have talked with Dr Buie and had his input on the drain situation. Until then its off to Vegas for a few nights of fun in the (hot) sun.

We're off to...

Vegas baby! Penny and I have never been so we thought a trip might be in order before I start my chemo again next week. We're headed to Lost Wages for 3 days and 3 nights at Caesar's Palace. We're planning to take in a show or two, spend some time at the pool, do a little gambling and (according to Penny) a lot of shopping. In fact she's online now printing coupons and mall maps and things like that to make her assault on the Vegas retail world as efficient as possible. Honestly I'm a little scared of the shopping bit but I think the trip will be great.

Family trip to the hospital

Today I had my 6th Glue treatment at the foothills. The last one didn't work at all so I'm hoping that one of these last two attempts will work. Carly and Andrew and Penny all came today to see what actually happens when I go. We got to show the kids the bed and equipment that they use for the procedure as well as meeting some of the nurses that work there. They were very interested in all the goings on. Carly was very good and stood still and asked some questions but Andrew just wanted to run around and push all the buttons. After a few minutes Penny snapped a picture and got the kids out of there so we could actually get started on the procedure. Before I went to the radiology department I stopped off in medical day care to get the one of the chemo nurse to access my port-a-cath (that's the implanted central line I have in my chest to administer drugs/chemo). It's a handy thing to have as it helps the nurses get drugs into me without starting a line which can be difficult after 12 hours without eating or drinking. Unfortunately not all the nurses are qualified to use it so I have to stop off at medical day care to have them do it since they're qualified.

I still haven't heard anything about the PET scan I had last Thursday but I do have an appointment to see the thoracic surgeon, Dr Gelfand tomorrow. Hopefully he will have access to the scan and results and will be able to go over all of it with me. I'm looking forward to meeting another doctor. I hope he's as good as all the others I've met in during this journey. I seem to have been blessed in that department and it would be a shame to mess up my run of good luck.

I got a chance to read the paper this morning and came across a couple of articles of interest. The first one (in today's Calgary Herald page A11) was a study done at the Institute of Human Genetics at Newcastle University in Britain. The findings suggested that taking a daily low dose aspirin may cut the risk of cancer in patients that are genetically predisposed to getting certain types of cancer. Here is an excerpt:

"'We believe that Aspirin may have an effect on the survival of aberrant (faulty) stem cells in the colon' Dr John Burn said, presenting his findings at the ECCO-ESMO European cancer congress in Berlin. Burn and colleagues tested 1071 people with Lynch Syndrome - an inherited condition that predisposes a person to a range of cancers, particularly of the colon - by giving some of them Aspirin and some a placebo. Followup tests after ten years showed that although there was no difference in cancer rates after 29 months, a significant difference was detected after four years, with fewer people in the Aspirin group developing cancer. 'To date there have been only six colon cancers in the Aspirin group as opposed to 16 in the group that took the placebo' Burn said"

It's a little late for me to be trying low dose aspirin now that I have cancer but it may be something to consider if you have either been diagnosed with Lynch syndrome or have a family history of cancer, particularly colon cancer. Taking a daily low dose aspirin can also reduce the risk of heart attack and stroke, two of the other major killers in Canada. It seems like its a good thing to do but talk to your doctor first.

The other article can be found in its entirety online here. It suggests that treating tumors with heat in addition to chemotherapy can mean that patients remain in remission longer and live longer than patients that are treated with just chemotherapy on its own.

"Targeted heat therapy has already shown promise in recurrent breast and locally advanced cervical cancer in combination with radiation, and studies combining it with chemotherapy in other localized tumours such as those in the pancreas and rectum are ongoing. Heat therapy for cancer involves a technique known as regional hyperthermia, which uses focused electromagnetic energy to warm the tissue in and around the tumour to between 40 and 43 degrees Celsius (104 to 109.4 degrees Fahrenheit). The heat not only kills cancer cells, but also seems to make chemotherapy work better by making cancer cells more sensitive. It also improves blood flow, allowing chemotherapy to be more effective."

It seems like this heat therapy treatment may be something that could help me although now that my only remaining tumors are in my lungs (fingers crossed!) I'm not sure if this type of heat treatment could be used (they didn't mention lung application in the article). I have a feeling that with the concrete findings of this study we will see more widespread use of heat treatment for tumor in the soft tissue. Hopefully this technology will find its way to Calgary sooner rather than later!

On clean ipods and another attempted glueing

Penny was intermittently doing laundry the other night while we were sitting on the couch watching tv. After she put some laundry into the dryer we heard a clunk clunk clunk like someone had thrown a set of pliers in there as well. When she went to see what it was, she laughed first then said "Dan, it looks like you may have got your wish". She walked back into the room holding my ipod complete with headphones still attached. You see, for a few weeks before that I had been complaining that my ipod (an 8GB nano) was full and could it please break soon (its 3 1/2 years old) so I could get a new one. Apparently after going for a walk the day before, I left my ipod in my pocket and forgot to remove it. So at first glance it appeared that my wish had come true. However because we are a household that doesn't give up easily (you hear that cancer?) Penny wouldn't take no for an answer. She got on the computer and googled "washed my ipod" which turned up a startling number of results (apparently I'm not the first one to pull that maneuver). One of the suggestions said don't press any buttons and immediately place the laundered ipod in question in a sealed container covered with rice. As skeptical as we were we gave it a shot. A couple of days later we dubiously opened the container to find a seemingly dead ipod. But after a short session of button pushing the screen lit up displaying the 'plug me into your computer" symbol. After plugging it in, I reformatted and charged it and since then it's worked really well. There are a few minor issues (the backlight doesn't always work and the buttons require more force than usual to work) but for the most part it's just like new. Bottom line? Don't wash your ipod. But if you do, make yourself some ipod sushi and you might just find yourself lucky (or is that unlucky?) like me.

I had my fifth glue treatment today. I'm on a first name basis with most of the doctors and nurses there so things go pretty smoothly now. They know what needs to be done and the quantity of drugs to administer. I just show up and hang out and get probed. Of course the glue didn't completely work again this time but they had more trouble forcing it through the fistula which could mean it's closing up. They are going to try again on Tuesday and then again on Thursday with the hope that having the treatments closer together might help. We'll see how that goes.

In other news, today was my last day of the chemo pills. I feel pretty good all things considered. My main side effects are fatigue, hot hands and feet (it feels like the palms of my hands and soles of my feet are sunburned) and a constant mild nausea. Overall its been quite manageable. Obviously I'm not looking forward to starting the serious chemo in 10 days.

That's all for now...

PET scan

Today was the day for my PET scan. I've never had one before so it was all a new experience for me. Basically the PET scan is used to create a 3 dimensional image of the body highlighting areas based on their glucose uptake. An analog of glucose (Fludeoxyglucose - a radioactive positron emitting glucose molecule) is injected into the body about an hour before the scan. Sited in the body which use glucose take up the sneaky little radioactive glucose molecules so that when the scan is done, areas of high glucose uptake are highlighted. Because cancer cells use glucose at a higher rate normal cells in the body, they show up well on a PET scan.

When you go for a scan you have to go an hour early. They test your blood glucose levels and then send you to a lead encased room (no wonder why my blackberry wouldn't work!) where you get injected with a small amount of the fludeoxyglucose. Then you have to sit still for an hour while the glucose makes its way into the body. You're not allowed to move at all and reading and listening to music are even banned. I fell asleep (what else was there to do) and when they came to get me for my scan I was truly relaxed. The scan consists of an initial CT scan to calibrate the machine and to get a 3D picture on which to drop the positron emission data, followed by a half hour slow scan to get that positron emission data. It is completely painless and I nearly fell asleep again during the scan.

When I came out from my scan they were preparing the next patient. He was a little boy about Carly's age without a single hair on his head. He was excited about being weighed and measured but the parents (mum was pregnant!) looked a little nervous. The nurses had to start an IV which no 4 or 5 year old likes I'm sure. The nurses had to hold him down while they did it and the whole time he was screaming "Help me mommy! Help me daddy!". It was heartbreaking to watch. Eventually they got the fludeoxyglucose into him and then they sedated him (what 4 year old do you know would sit perfectly still for an hour then lie perfectly still for half and hour for the scan?). I left after that but I felt so bad for the boy and his parents. It made me thankful that it wasn't my child going through that. As hard as this journey has been, it would be infinitely harder to watch your own young one go through the same process.

I expect to have the results from my scan early next week if things go well. Of course I will post the results here when I get them.

PET scan: Tomorrow is the day!

I got some good news on Monday. I got a call first thing in the morning from Rose the PET scan booking clerk. She told me that they had a cancellation for this Thursday and that if I wanted the spot it was mine for the taking. I was originally scheduled to have another glue treatment that morning so I had to make a call to the angio booking office and see if they could move it to Friday instead. By some miracle of the medical booking gods, they had a spot at 8am Friday morning. So, I will have my PET scan tomorrow and my glue treatment on Friday.

I'm not entirely sure but I think a friend of Penny's brother Rod had a little something to do with getting my scan moved up. He's an interventional radiologist who works in the Foothills hospital department where I have my glue treatments. I saw him last week when I was in and he introduced himself and said he would "talk to the booking clerks about moving my scan up". I'm not sure what he did if anything but my thanks go out to him none-the-less.

PET scan - Alberta Health Care Comes Through

Today I spent a good deal of time harassing Timely Medical in Vancouver for a Pet Scan date and location. I was originally hoping to have one this week and since it's Wednesday I thought they might want to let me know what was going on before the week is done. While I was waiting for them to return my call I got a call from the PET scan booking office at the Foothills hospital here in Calgary saying they had a date for me. October 1st was their initial offering but I pleaded for an earlier date and got one: September 24th at 12:15, two weeks from tomorrow. While it would be nice to have one sooner, having one in two weeks shouldn't really affect the timing of my care given that that week I'll be starting my FolFox chemo. I don't yet have a date with the thoracic surgeon so as long as I see him after the 24th he will be able to look over my scan and decide on the timing and type of surgical option that will fit for my care. Pretty good news all things considered.

So far the chemo I'm on is not so bad. My worst side effects are fatigue and a weird taste in my mouth. Not nearly as bad as when I had the 5Fu but its no fun. I have a constant craving for sweet things like fruit and fruit juice and gummy bears. Tomorrow is day 6 which means I have about 8 more days to go and then I get a week off. I'm looking forward to that!

I have my next glue treatment tomorrow. Things feel pretty good down there right now so I'm hoping that they can do a sineogram tomorrow and tell me the fistula is all healed up. It would be nice to put this drain thing to bed once and for all.

Carly had her first dance class today. She had fun but was disappointed they didn't do ballet on their first day. Maybe a few basics first honey before you tackle Swan Lake?

Who thinks this up?

200 or so people with a little too much time on their hands...

4 out of 4 doctors agree...

This morning I got an email from a friend who has a thoracic surgeon for a brother. She was kind enough to refer him to my blog and ask him his opinion on my course of treatment (chemo first then surgery as opposed to surgery first then chemo). He concurred with my other 3 doctors that really the key at this point is to attempt to control the microscopic disease. Without having that in control there is little point in going forward with surgery. Here's what he had to say in his own words:

"Wow, this guy should write novels. I managed to get what I could from the blog, which seems to skip over some details. As I see it, he has stage 4 colon cancer, and has had chemo followed by surgery. He then has an abcess and resulting fistula, but underwent removal of 2 liver mets. It seems he is just now starting his post-op chemo, and now he has at least 3 lung mets.The issue here is cancer behaviour. His tumour has clearly demonstrated an aggressive ability to spread. What we see is the tip of the old iceberg. His hope for control and potential cure rests with control of the microscopic disease, not what is visible. I think surgery now is ill-advised. Go for the chemo. If it allows further tumour growth, then clearly surgery is and would have been futile. If no further tumours appear, then consider removal of the lung lesions, assuming that complete re-staging shows nothing else.Believe it or not, cancer is no longer considered a surgical disease. Chemo used to be adjuvant treatment after surgery. Now surgery is adjuvant treatment to chemo, since microscopic disease is the real action.Best of luck to him. He sounds like a hell of a fighter, and attitude is hugely helpful in my opinion."

It seems that slowly we're accumulating a consensus among the doctors and that fact in itself is tremendously comforting. With each piece of information the path becomes a little more clear. I still plan to pursue getting a PET scan ASAP (still no word on that today!) as I see that being a helpful diagnostic tool going forward.

Happy Tuesday all.

Six Years

Sunday was our 6th anniversary. We celebrated by going out for supper at The Mackay Place in Millarville, followed by a stop at DQ for a couple of blizzards (I recommend the oreo cookie jar blizzard with oreo cookie, cookie dough, and fudge. yum yum.). Penny's mom looked after the kids and put them down for the night while we were out. It was an enjoyable and relaxing night.

3 out of 3 doctors agree. It's chemo time for me.

The past few days have been a little stressful around here. It feels like my treatment has come to a crossroad where a decision has to be made about which direction to go. With the discovery of some suspicious nodules in my right lung it's clear that my battle against this terrible disease is far from over. The decision we're facing now is do we do surgery or chemotherapy first? Our first thought, as with the tumor in my colon and the tumors in my liver was to get them out ASAP. My medical oncologist, Dr Lupichuck, is of the opinion that we need to address the possibility of further spread now and start chemotherapy. She says that chemotherapy will act on the existing tumors in the lung while at the same time working to kill off any microscopic disease elsewhere in the body. The risk of doing surgery now is that I could go through all the pain and suffering of another surgery just to have more tumors sprout up in my good lung. I can see her point but I sure don't like the idea of walking around with tumors in my lung for the next 3-4 months.

Dr Lupichuck talked with a thoracic surgeon, Dr Gelfand, and gave him the coles notes of my medical status and asked him what his approach would be for someone in my situation. Dr Gelfand said he thought he could remove the existing tumors in my lung with what he called a series of wedge resections. He thought there wasn't a need to remove the entire lung at this point. One of his main concerns was that while I was waiting for surgery and recovering from surgery the microscopic cancer cells that are floating around in my blood and/or lymph system could form more tumors. His suggestion was similar to that of Dr Lupichuck in that he suggested that I undergo an intensive 3 month period of chemotherapy (FolFox + Avastin) and have a PET scan to make sure that there are no other tumor sites, especially in the left lung.

As part of her multidisciplinary approach to finding the best possible course of treatment, Dr Lupichuck also spoke to my colorectal surgeon, Don Buie about what he thought was best and what the plan would be to deal with the drain that I've had for 4 months that has thus far prevented me from starting my chemotherapy. Don actually called me the following day to tell me what he had discussed with Dr Lupichuck, what the plan was with the drain, and most importantly what the best possible course of action would be for me. His advice was the same as the other two doctors. He suggested doing chemotherapy first would be the best approach at this point. He said that the drain won't be a real reason to slow anything down. He said I could have surgery and/or do chemotherapy with the drain in place. The risk of infection would be higher but that could be adequately controlled with antibiotics. The bigger risk of starting chemo now is the same as it's always been: chemotherapy affects the body's ability to repair itself so my fistula may take longer to heal on chemo or it may not heal at all. He said there are surgical options for dealing with the fistula and abscess later but not to give up on the glue just yet. As with the other doctors I talked with about the glue, he said that it sometimes takes many attempts to get it to work.

So after talking to three doctors the consensus was: do chemotherapy first and look at surgery later on down the line once a) chemo has had a chance to kick the microscopic disease in the butt and b) I've had a PET scan to make sure I'm clear for surgery. In a welcome departure from normal, I was able to pick up and start my chemotherapy drug the same day I decided I would do it. The plan at this point is to do a 3 week cycle of capecitabine (the pill form of 5Fu) a mild form of chemo, while we give my fistula and abscess a chance to heal with the glue. After that 3 week cycle, weather the fistula is healed or not, I will start a more intensive 3 month regimen of Folfox (fulonic acid, 5Fu, oxaliplatin) and Avastin. During that time I will have a PET scan (hopefully next week) and get in for a consultation with doctor Gelfand, the thoracic surgeon. My hope is that directly after I finish the FolFox+Avastin chemo I will be scheduled for surgery where he can get all the nasty bits out.

As part of our research and as an attempt to cut down on the amount of time we spend waiting around, Penny and I have been looking into getting some treatment privately either in Canada or the US. While this option is expensive it is well worth it IF you can locate a reliable surgeon/hospital and IF it will save you a bunch of wait time. There are also private imaging clinics that offer PET scans, MRIs and CT scans if you can't afford to wait for those either. Since the wait time for a PET scan is long, 6+ weeks here in Calgary, I'm looking at getting one next week in either Mississauga or Bellingham. Because my thoracic surgeon needs one of those in order to accurately image the nodules in my lungs, this will likely speed up the timing of my first meeting with him and could stand me in good stead for my surgery later on. I'm arranging this through a company in Vancouver called Timely Medical which specializes in matching up Canadians that are tired of waiting for treatment, with doctors/hospitals either in Canada or the US that can provide treatment. They are an interesting company and have been very helpful so far.

At this point I'm on day 1 of my first round of chemo. I'm not looking forward to the next few months but it's just something that needs to be done. I hope it all goes smoothly...

3rd time lucky?

On Thursday I had my 3rd glue treatment to try and seal off the fistula that connects the abscess to my colon. The first two treatments didn't work and the doctors say that it often takes 5 or 6 treatments before it works. They also say that it sometimes doesn't work at all. The whole point of this glue treatment is to prevent the need for more colon surgery which would remove the abscess but also likely result in me having to live with a bag permanently. Honestly at this point I couldn't care less if i have a bad permanently. I would be happy to live to 80 crapping in a bag the whole time. So, I'm booked in for two more glue treatments over the next few weeks. Hopefully one of them works so I can move on to the next phase of my treatment.

Today's fortune cookie

Today's fortune cookie, originally uploaded by DPC Tutt.

I think one needs equal doses of time and truth when dealing with cancer.

a year spent

a year spent, originally uploaded by DPC Tutt.

Its been a year since my diagnosis. What a year its been. Get yourself a colonoscopy so you don't have to go through the same thing.

Dave and Dave in Comox

This past weekend two of my friends from university bought me a trip out to visit them in Comox BC. Needless to say it was a great time. We went out for a couple of nice suppers, cooked some killer ribs on the BBQ and spent a couple of days cruising about on a boat. A fair amount of alcohol was consumed (I'm not on any meds right now so I could actually partake!) which resulted in an obscene amount of singstar being played. None of us can sing so we were all equally terrible which made it quite fun. On our second night we got asked to tone it down a bit by one of Dave's neighbors. He asked what we were doing and when Dave replied that we were playing a karaoke game he said "That's why it sounds so bad!"

It was also great to catch up with Ashley (soon-to-be wife of Dave #1) and her 9 year old son Levi (a fellow cancer survivor). Levi and I compared war stories and scars. It was also great to see Katie (future wife of Dave #2) who just moved up to Comox from Nanaimo to live with Dave #2. I hope we all get to hang out again soon, perhaps here in Calgary?

Thanks again for a great weekend Dave+Dave

I hate cancer

Now its threatening to kill me and its really pissing me off. Why can't it just piss off already?

I met with my medical oncologist yesterday and found out all about what the results of my latest CT scan mean. It was a long, depressing meeting but at least there is some semblance of a plan now.

So far I've has about 12 CT scans over the past year but only 3 of those have been of my chest. I hand one when I was originally diagnosed in September 08, one before my colon surgery in January 09 and one a couple of weeks ago in August. When I was in the hospital last week or whenever it was, I had a CT scan that showed 2 "suspicious lesions" in my right lung. Well it turns out that there are actually 3 lesions in my right lung and one of them was actually there in the CT scan I had in January 09. The radiologist that looked at my scan in January didn't see or didn't make a note of the lesion that was in my lung at that point. But the radiologist that looked at my most recent scan saw the three lesions and looked back at my January scan and made a note that one of them was actually there in January and had grown in size from then to now. So to summarize there are 3 small (~5mm in size) lesions in my right lung.

One of my first questions about these lesions was are they actually cancerous? The lesions are too small to biopsy and without a biopsy we won't know for sure. However it is highly likely that they are metastases and going forward we will treat them as such.

I know from previous discussions with lots of my doctors that the only real possibility for a cure is the removal via surgery of all macroscopic cancer. Without surgery a cure is not possible, so obviously I was curious to know if I was a surgical candidate. My doctor said that she would talk to a thoracic surgeon, show him my file and try to get a quick first pass opinion as to if I could be a candidate. I heard back from her today that the thoracic surgeon thought I would probably be a surgical candidate. He thought he could probably do 3 wedge resections and remove the tumors without having to remove my entire right lung. Obviously that is great news and Penny and I were tremendously happy to hear that a cure is still not totally out of the question.

As with all of my cancer treatment to date, it's not just a simple case of make an appointment and cut out the nasty bits. There is still the drain in my butt to consider and the likeliness that there is still microscopic cancer floating around in me. My oncologist was keen to get on with chemotherapy in order to make sure that no more tumors form. BUT I can't go on chemo until my drain heals up since chemo affects the body's ability to heal. Also, before the thoracic surgeon will give me a definate yes on my surgical candidacy, I will need to have a PET scan. These are scanners are rare (there are only 3 or 4 in all of Alberta) and hence difficult to get an appointment on.

The ideal scenario according to my oncologist would be something like this: Thursday, get more glue in my drain and pull the drain, then wait for it to heal (maybe a week or two?), then have a PET scan, then start a 3 month cycle of intensive chemo, then have another PET scan and see the Thoracic surgeon, then have surgery. My problem with that scenario is that there are lots of moving parts and lots of potential wait times and one thing I've learned the hard way over the last year is that time is crucial. So Penny and I presented a different potential scenario that may work better, although it will be quite costly: Thursday get more glue and potentially get the drain removed, organize a PET scan immediately in Toronto or Bellingham, a week or two following the scan have my lung surgery somewhere in the US (then my drain and my lung can heal at the same time - don't forget I had my liver surgery with the drain in my butt), about 1 month following surgery when my lung and drain have healed, start chemo for 6 months. We've already looked at the US as a means of speeding things up and have leads on PET scans and hospitals. It takes about a week or 10 days to get either surgery or a PET scan using options in the US. The risk with the option that Penny and I presented is that the microscopic cancer doesn't get treated and more tumors form before I'm done healing from the surgery. I guess there are risks either way.

So, there is lots to digest and lots to think about. I suppose a lot depends on how things go with my drain on Thursday. If it goes well then I could be starting chemo soon but if not then maybe I will need to consider the US options.