September 7th - Port on the Starboard

Ever wanted an IV directly to the Jugular?

Of course you have.

In trying to provide as comprehensive of a history on this whole saga as possible I somehow forgot to include the story of my "Port" install. I guess you could the say the reason I forgot is that I now take the port for granted, using it every time I have a chemo session or need a blood draw for lab workups. It's easy to forget about but it is a major convenience and everyday part of treatment. 

So what is the Port? Well, according to the company that created it, the PowerPort® Implantable Port Device is: 

• Lightweight for Patient Comfort (Can confirm)

• Easily Identifiable (More on that in a moment)

• Power Injectable! (It's called a power port for a reason. Strap yourself in!)

• Titanium Port Body (okay, so their web designer isn't an English Major)

So what does all this mean? When you're facing the prospect of being injected with an IV drip daily for a week or more, efficiency and limiting needle punctures becomes medically advisable. Also, you don't want to look like a heroin addict, so the options are do the port install, have a semi-permanent PICC catheter installed in your arm or, just start a new IV every day which will give you the arms of early year 2000s Courtney Love. As I understand it, medically speaking, it's really only option one or two here because heroin chic went away with the 90s [citation needed]. 

So let's compare the two options before we get into the nitty gritty of the Port.

PICC Catheter Install

This gets "installed" in your arm. Read more about it here.

Real world example of the PICC

Looks like fun having that hang out of your arm right?

PowerPort Diagram

This is surgically implanted in your chest and leads up to a major vein. Learn by clicking through here.

PowerPort in the wild

You can see how it's surgically implanted under the skin here.

The PICC Catheter:

• Semi-permanent install into the arm vein

• Dangles out from your arm

• Must cover with plastic during showers like a savage

The PowerPort:

• Surgically installed under skin

• Turns you into a cyborg

• Can shower like a normal human

It might not be obvious given these vague images and descriptions but there is a huge downside to the PICC Catheter option: the ends of it are exposed and require constant attention. For example, with the PICC, you have to wrap it in plastic (i.e. Glad Press and Seal) if you plan on taking a shower ever. You also potentially need to tape it down so its not flopping all over the place. Let's take a break for a second to ask ourselves a question: Does cancer sound fun yet?

Honestly, for my part, the answer isn't as obvious as you might think. Does it suck I have to go through this? Yeah, but it's happening. Soo... on the plus side the medical technology at play here is really quite incredible and totally fascinating for the dweeb in me (Editor's note: my Dweeb-cell tumor is also being treated by the chemotherapy). 

PowerPort: Don't you wish your boyfriend was hawt like me?

The "PowerPort" or "Port" for short seems to be a vastly superior option here as far as temporary implantable devices go. It has made everything easier for this process from blood draws to actual administration of the chemo drugs. But how does it work?!? You might be thinking like the selfish, voyeuristic blog reader you are. Don't worry, baby birds, I'll feed you. 

The Port is a pretty neat combination of plastics, titanium, silicone and -- I think -- fairy wings. Pictured above and here, it's a relatively small little device with a couple grooves over a silicone membrane. 

Finding the Power Port: Don't you wish your boyfriend was a freak like me? Dontcha?

When getting an injection or drawing blood, the technician can feel for the three grooves beneath the skin to target the needle entry easily in between them. The device is flushed with a saline solution and then anti-clotting agent before treatment is administered. Because of the devices makeup, it is safe for most imaging scans (i.e. MRI and CT) which will be needed for follow up coming out of treatment. All told, it saves time, energy and cuts down on infection potential. 

The install of the port itself was a fairly straight forward, outpatient procedure. It was a little strange though since the numbing agent they use is local (i.e. on the skin) and the anesthesia is a minor "waking" anesthesia. Over the course of the 40 minute long procedure, I think I fell asleep once or twice but was awake for most of it. Generally speaking, it felt like being poked and pulled and pushed by a nonspecific manipulating digit. Let your mind run with that one. The port is generally installed for the duration of treatment and short time after depending on need.

Once treatment is over and you don't need to get stabbed with a needle every 24 hours, the device will be removed via a quick outpatient procedure. We should talk about two recommendations I have, though: 1) Keep the port until after you go on a celebratory bender when treatment is over, it will make administering IV Fluids easy to prevent hangovers; 2) Keep the port in a trophy case, you have earned it.

Next we start with the Chemo. It’ll be fun, I promise?

-- Post Script -- 

I'd like to take a second to thank you for reading. Most of these posts are emotionally draining to write so I don't take the time to edit them because I'm not in english class anymore, Dallas!  They are ultimately enjoyable and cathartic to write, however. It's like taking you on this journey with me and the resulting outpouring of love and support has been very uplifting. 

To that end, I've setup easier ways to follow the blog than just checking to see if I have the energy to write. You can now subscribe for e-mail updates every time there's a post or follow my twitter account which will post all new blog posts. You can use the buttons below. I might add them to the footer going forward to make it easier. 

Thanks again, people!

September 8th - Schrödinger's CAT Scan

Previously on "Out of Puns".. 

So I've mentioned previously that the initial, pre-op CT Scan showed two "suspicious nodules" in my left lung. To determine what those two nodules are, as well as check for additional metastatic spread of the original testicular tumor, my new Oncologist ordered a follow-up MRI (a wut?) for my noggin and a PET Scan (and that is?) for my torso, pelvis, and lungs.

For whatever reason, those simply had to be scheduled on a Friday afternoon. I emphasize that because depending on the results of those tests, the currently prescribed round of chemotherapy could shorten or get longer. If, for example, the MRI showed it had spread to my brain -- which is not uncommon -- the chemotherapy could go 4 rounds (12-weeks) or more. So while my current prognosis remained excellent, there was a large asterisk next to it pending the follow-up scans. You know what's fun going into a weekend? Not knowing if you have brain lesions. 

The night before the scans, I was instructed to abstain from any carbohydrates and eat a high protein meal, followed by nothing except water the day of after 11 AM. So I arrived at the imaging place at 2 PM slightly hangry and anxious to get it over with. First up was the MRI, here's what that looks like:

This is a real book in the waiting room. A real, smutty book.

1. Have an IV put in your arm for the "contrast fluid";

2. Remove all metallic objects from your person;

3. Lie motionless in a large metal tube for roughly 30 minutes;

4. Read Harlequin novels in the waiting room and wait for the PET Scan

So basically, you lie on a table that they push into a huge tube. Because they were doing the MRI of my brain, my head was put in a sort of harness to keep it as immobile as possible. They also told me the MRI is very loud and offered a pair of large, over-ear headphones to listen to music while the imaging took place. Not quite Beats by Dre® more like a pair you get at the Public Library to watch educational content. They offered my choice of music and, since Insane Clown Posse wasn't one of those options, I chose "Classic Rock". 

They really aren't lying when they say the machine is very loud. After they push you inside the tube, they talk to you via the headphones. What followed was an endless process of,

"Alright Michael, are you okay? Okay, this scan will be 3 minutes. I need you to remain very still.",

"Okay Michael, are you doing okay? This scan will be 6 minutes." [Insert Rolling Stones 'Fade to Black' over the sound of a machine].

What does an MRI sound like? So glad you asked. Here's an MRI simulator for you.  Why does it sound like that? Because magnets are loud and medicine should occasionally terrify you. After about 15 minutes, the MRI tech came back out, injected the "contrast fluid" into my IV and the process repeated.

All told, the process is pretty painless, but you always end up with an itch you can't scratch while getting scanned. When you're not getting scanned, you're also not supposed to move in case it shifts your head, potentially creating a "shadow" on the MRI or blip that they mistake for something more sinister. So, you know, don't move so we can see if you have cancerous brain lesions and if you do move, we might think you have cancerous brain lesions when you don't. Fun, right?

So after the MRI, I went back into the waiting room to get better acquainted with exactly what a rancher does while undercover (I'll give you a hint: it's sexy) and wait for my PET Scan.

Mmmm feel the medicine.

The PET Scan is an interesting one because it involved radioactivity and a whole lot of waiting. So the process is very similar to the MRI with a couple important differences. First and foremost, the needle they inject the "contrast fluid" with is encased in lead. Why is it encased in lead? Well because it's radioactive, of course. After that injection, you get a cup of cloudy liquid to drink and then you wait for an hour and 15 minutes because -- I'm just guessing here -- the radioactivity really needs to sink in.  Before you go into the PET Scan room, the tech asked me if I would be "handling" children or the elderly after this appointment. Who... Knows how to respond to that question so I said, "Well.. I mean... Maybe?" Apparently you aren't supposed to come into contact with either party for at least 4 hours after because you might make them also radioactive. So that's fun. 

The PET Scan machine is very similar looking to the MRI machine, but it's mostly silent. Also unlike the MRI, you don't stay motionless in waves but instead you stay motionless the whole scan. 25 minutes with no music, no dialogue, just thinking. What do you think I was thinking about that whole time? 

Luckily, by the time I was coming out of the PET Scan, I received a voicemail from the Oncology Office: the results from the PET Scan wouldn't be in until after the weekend, but the MRI images were in. There was no evidence of tumor activity in the brain. Have you breathed an actual sigh of relief? I don't think I had really until that day. What it really meant was that the prognosis likely couldn't get worse, it could only get better with the results of the PET Scan. That was good to know going into the weekend since I would have to mentally prep myself for starting Chemotherapy on Monday, September 11th.

That's the subject I'll cover next time to get you all up to speed.

September 1st - Oncology

Want to try some new supplements?

Last time I lost my something important.. 

The Oncology center is in the same building as my dentist. I passed it every time I went to get my annual cleaning and always remember thinking, "Well, hey, at least I'm not going there for my appointment."

Well, on September 1 I did go there for my appointment. There wasn't a lot of new information, to be honest, so I expect this to be short. The thing I will say about it is that from the moment I walked in to the moment I walked out, the staff was impressive. They were surprisingly upbeat, caring and engaged. In sharp contrast to some of my previous experience with, for example, getting the ultrasound done, they were on point each phase of the process. Even their paperwork seemed less onerous than others.

The big takeaway from the appointment with my new Oncology doc was that I would be going in for follow up scanning - A PET Scan and an MRI - to nail down what the previous CAT Scan had shown in the lungs and whether there was any evidence of additional spread. Regardless, my new Doctor wanted to emphasize that the prognosis was still excellent. 

Next time we get into scans. Lots of scans.