This series is about my journey following a diagnosis of lung cancer.
Whilst I will add updates on my treatment and the related progress, I want to also look into the dietary aspects of multiple complex diagnoses. With comorbidity of Emphysema, Hypertension, Heart Failure, Lung Cancer, and Type 2 Diabetes juggling the correct dietary requirements is going to be challenging. (I’m not talking about miracle superfood cures etc but what are the best ways of getting the proper nutrition your body needs given the medical constraints.)
To set the scene, back in March 2018, weighing in at 155kg, my GP dropped the Diabetes Type 2 bomb on me. My previous three HbA1c results were in the high 8 mmol/L . It was time to start treatment in the form of medication and serious lifestyle changes.
16 May 2018 – Somethings Not Right In The Lung
The first hint of a problem came following a routine CT scan at the Footscray Hospital respiratory clinic. The scan showed a couple of spots which could be scar tissue from my many bouts of bronchitis , or they could be more sinister. Another CT was ordered and a followup appointment to be arranged and a letter would be sent out with the date and time
Subsequent medical appointments were as follows:
- 9 July 2018 – Chest CT scan (Footscray Hospital)
- 13 August 2018 – Respiratory Lab for breathing tests. (Footscray Hospital)
- 15 October 2018 – I developed a nagging pain in my back that was probably a pulled muscle, however nothing I did would numb the pain. The GP asked if I’d had any falls or such-like that might have caused a broken rib. I hadn’t had any falls and there was no reason the have an X-ray as I could safely rule out a bone fracture. I settled on a script for Panadeine Forte as the pain was quite severe and showed no sign of relenting. (GP – Dr Aranda)
24 October 2018 – Things Are Getting A Bit Serious
My return visit to the Respiratory clinic took a while and the news is not good. Both of the “anomalies” had grown, with one in particular tripling in size. The respiratory specialist didn’t hold back any punches and said outright that with my age and smoking history, cancer was a very real probability and that we had to get a few more tests done to confirm the diagnosis. The tests to be done are a PET scan and a CT Guided Lung Biopsy, with a followup appointment at the Respiratory clinic in 3 weeks.
Things moved fast from here with a phone call in the afternoon from Western Private asking me to come in on the 26th for the PET/CT scan and the following morning Footscray Hospital Radiology rang with an appointment on 5th November for the CT Guided Biopsy.
26 October 2018 – PET/CT Scan
As I can’t take my diabetes medication on the morning of the scan and I have to fast for 6 hours prior to the scan I have been lucky enough to get the first appointment of the day. So I get settled into a chair that is sort of a fancy dentist chair and the first needle appears. A quick prick of the finger and my blood glucose comes in at 5.1 mmol/L which gives us the green light to go ahead with the scan.
Before going any further the nurse starts explaining the process and gets my consent to proceed. To be quite honest I was feeling pretty tired so most of it went in one ear and out the other. I do remember her saying multiple times that I need to remain still for the next hour so that the radioactive tracer can accumulate in the right areas.
Fine, just get the cannula in and have the scan already, I’m getting hungry. So the stuff is injected into me and the DVD player turned on so I can watch a movie to keep me occupied and still for the next 60 minutes. Next thing I know the nurse is tapping my shoulder and saying it’s time to hop in the scanner. Remember earlier I said I was pretty tired ? Well, sure enough, I fell asleep for the whole hour and never moved.
5 November 2018 – CT Guided Biopsy
The idea of lying on a CT flatbed, wide awake, while a doctor puts a needle down through my ribs and into my lung to take out a chunk of tissue doesn’t appeal to me.
In preparation a cannula goes into my hand in order to administer a mild sedative and a nasal oxygen mask is put into my nose. Now lets get cracking, first the local anaesthetic goes in (no worse than having a flu shot) and then the biopsy begins. I can tell that something is going on but, most importantly for me, there is no pain. Then I winced, a small niggle of pain but nothing too serious, so the doctor gives me a bit more sedative and carries on. Five minutes later he announces “that’s it”. I asked if that is the preparation all finished and his reply was that the biopsy has been completed successfully and I can get up and go. The have been no subsequent complications or pain, and the site healed up very quickly.
14 November 2018 – The Verdict Is In – Lung Cancer.
No beating around the bush, the biopsy confirmed Lung Cancer. The next step was to get me in to see an Oncologist at the Sunshine Hospital. A few phone calls and the next thing I know is I’m booked in for 10am the next day.
15 November 2018 – The First Oncologist Visit. Peter Mac Sunshine Campus
Visiting an oncologist has never been high on my bucket list, yet here I find myself at the Sunshine campus of Peter Mac, waiting my turn to be seen.
After asking how I feel we get down to business. The PET scan has revealed 3 hot spots of varying sizes, and for discussion sake I shall refer to them as baby bear, mama bear, and papa bear.
- Baby bear, although quite small, is in the upper lobe of my right lung, nestled up against my superior vena cava. This in itself would be an extremely dangerous situation, however the consensus of the Radiation Oncologists at the Centre is that this may not be a cancer growth but more than likely an active cell that is unrelated. The plan therefore is to exclude “baby bear” from my current round of treatment and take a watch carefully approach.
- Mama bear is larger (about 1.5cm) and located in the lower lobe of the right lung. A fairly straight forward target for radiation therapy.
- A finally there is Papa bear. At 4.5cm and located in the middle lobe of my right lung, this is a fairly large growth and is eroding one of my ribs as well. This growth is also a good target for the planned radiation therapy and the rib invasion will be assessed following treatment.
Next we discussed the particular treatment – it will only consist of radiation therapy using the saber technique. Shit, the visions are running around my head of a surgeon holding a radioactive saber piercing my tumours. Fortunately this is not the case, it is the SABR (stereotactic ablative radiation therapy) technique. Whilst I won’t go into depth about how it works, suffice to say SABR targets tumours in the body with high doses of radiation with extreme accuracy, destroying cancer cells with minimum damage to surrounding healthy tissue. And as a result of the high doses that are precision targeted, fewer treatments are necessary.
Moving on, I was taken into a CT room and, for the next 2 hours, not moving, and breathing at a regular pace, the radiology technicians had me going in and out of the machine in order to get the precise measurements for my treatment. They then tattooed me with a black “dot” in four places as reference points for next time and sent me on my way. Appointment over and it’s time to go home.
21 November 2018 – Second Oncologist Visit. Footscray Hospital
This appointment was purely to confirm the plan and dates of treatment, plus go over any concerns etc. I didn’t have any at this stage, however the oncologist (Dr Keelan Byrne) asked me if I was coughing blood or having any pain. I said that I had some back pain that has lingered for a while and was taking Panadeine Forte for the pain. Keelan said “and how’s that working out for you?”. My response was not the best. He had a chuckle and said to look at the computer screen. As he scrolled through the PET scan I could see this pretty blob of bright colours. He pointed at the screen and said this is the larger growth and if you see here it is your rib, and at this spot here the cancer has eroded over half of your rib thickness. You don’t have a strained muscle, you have a broken rib, probably after a sneeze or cough – it wouldn’t have taken much.
Using his best bedside manner he continued that it won’t even start to heal for a month or so following treatment and that the pain is likely to intensify over the next month during treatment. This is not an unusual situation and I will give you a script for better pain killers. Endone and Targin – just what I needed, oxycodone to fry my brain, but damn it does a good job of numbing the pain.
22 November 2018 – 4 December
The breakthrough pain at the rib fracture became increasingly noticeable so on the 3rd December 2018 my GP increased the medication Targin to 15/7.5 mg with the result of noticeably improved pain relief.
5 December 2018 – First Radiation Treatment. Peter Mac Sunshine Campus
For someone with a fair amount of strength and resilience, both in mind and body, waking up to the thought of having my lung zapped by an expensive microwave oven was playing heavy on my mind. Even my fasting BSL, at 8.9 mmol/L, told me I was a little anxious. Popping 10mg of Valium helped as I had until 1.30pm to wait for the appointment and feeling anxious won’t help much in getting through the day.
On arrival at the hospital I was greeted by a couple of lovely nurses, one of who gave me a couple of tablets “to help during the procedure”. I also mentioned to her that I was experiencing a little bit of shortage of breath. No problem, we’ll put you on oxygen and see how it improves your sats. Whilst we walked around to the pre-procedure room I asked what was the name of the tablet I just took again as I hadn’t heard properly. “Lorazepam” was her answer. Just what I need, another sedative on an already tired and medicated brain. Fig 1 shows me with the oxygen cannula in place and the sedation clearly working. The second tablet was dexamethasone, a corticosteroid, to help reduce swelling in the lung due to the irritation of the radiation therapy.
Time to go to the treatment room and prepare to be zapped. At this stage I might mention that getting ready on the slab isn’t like having an MRI or CT scan done. Remember, at my previous visit on the 15th November the setup measurements were all taken and now I was to be positioned on the slab in exactly the same location; This took around 15 minutes, and I am now ready. If you notice to the back-rear of my right elbow that there is largish box hanging off the machine. This box extends out along my torso to be adjacent to my lung, as too does one on the other side. A better picture of the radiation therapy machine can be found by clicking here
For the next 30 minutes I have these space satellites positioned above and to each side that begin humming and rotating around me. All I had to do was lie completely still and breath evenly. No problem, as fig 2 shows, the position is quite normal and comfortable – hahaha – okay, maybe not. It took every effort not to fall asleep with the cocktail of drugs flowing around in my blood.
6th – 24th December 2018 – Subsequent Radiation Treatment. Peter Mac Sunshine Campus
Over the next few weeks I had another 8 sessions of radiation therapy. Each session was set up quicker than the previous as I was getting better at positioning myself on the table. The Radiation Therapists would then jostle me into the exact position. When I say exact, I mean exact – they use rulers and the “dot” tattoos to be totally accurate. As I mentioned earlier, you don’t move, you stay like a statue until they have finished the zapping. My last day of radiation therapy was on the 24th December 2018 – and now I have to sit back and wait.