I can’t dance that well. I shuffle my feet back and forth in a systematic flow of 4-6 moves, augmented with an occasional flail of my arms. It isn’t flashy or smooth and it certainly doesn’t attract the opposite sex. And I don’t care.

The dance with cancer is different. I can’t simply choose to elect a simplified dance and force my partner to tolerate it. Everything is so new. I don’t know the tempo. I don’t recognize the style of music. I can’t feel the intensity of the rhythm. Hell, I can barely hear the music. Right now, cancer has the lead in the dance.

PETs Allowed

As the doctors probe a little deeper, they use different scanning tools to see if cancer is showing anywhere else. I had a CT scan of my chest which showed nothing “remarkable” – a term I’ve grown to love. There were no signs of any lung cancer and given the smoking I’ve enjoyed too much over the years (even though I quit quite a while ago), that was good news.

The next level of testing is the PET scan. This is used to scan for active cancer masses over a large part of your body. For me, they scanned from my knees to the top of my head.

The PET scan appointment took nearly 3 hours. After the usual checking in, I was asked to slip into one of the hospital gowns. In the world of “one size fits all”, I am an outlier. The nurse then put an IV line in my arm to prep for the test. I was then asked to drink some room-temperature concoction of water and sawdust. Okay, it wasn’t actually sawdust, but it held the same appeal. After a few minutes, the nurse wheeled in some large cart. She connected a line from this contraption to the IV line in my arm. The device was used to inject some radioactive elements in my body for the scans to detect.

I was mildly radioactive. That explained the sign I saw in the bathroom advising people to sit for all bathroom activities – to minimize radioactive spray. Really? I turned off the light in the bathroom a couple of seconds before opening the door to see if there was even a slight glow in the bathroom… nothing.

I had to wait for a while to let the radioactive elements to settle into my system. I then had to drink a little more of the nasty drink and then go the scanning room.

The PET scan looked like a bigger version of a CT scan. A big donut with a bed that slides back and forth through the donut. It was nowhere near as tight as an MRI machine, which I was happy about. I was asked to lay down on the narrow bed that could have easily doubled as a balancing beam.

The machine scanned a (roughly) 4-5 inch section of my body for a few minutes. The bed would then slide down to allow the machine to scan the next section. No noise, no flashing lights. It took about 40 minutes, with the last 25 spent trying not to think of how badly I had to go to the bathroom

The Results

I met with my radiation oncologist 3 days later. As the appointment drew nearer I found that it took more effort to rid my mind of the nervous chatter – what’s he going to say? Is there anything else to deal with? What are the next steps? Fortunately, I had my work to help me keep my mind focused on the now.

The oncologist simply told me that the PET scan did not reveal any active cancer tumors. I was happy to hear that. Then he went on to summarize all the findings to date.

The cancer cells analyzed in my the lymph nodes removed from my neck were “poorly-differentiated”. He explained how cancer cells evolve in someone’s body. Each normal cell in our bodies have differentiated – a heart cell looks and acts differently than a nerve cell. In the early stages of a cell becoming cancerous, the features of the original cell are still identifiable – still differentiated. At these stages, cancer can be more benign.

As these cells transition into more a more cancerous form, they increasingly lose the features to identify where they came from. At the latter stages of this cellular evolution, the cell’s origin can no longer be determined. They are now poorly-differentiated.

From what the oncologist described, these cells are the dangerous ones. They are much freer to travel elsewhere in the body and trigger cancerous growths.  Because of the nature of the cells found, he strongly advised that they treat the cancer aggressively to minimize the likelihood of future challenges with cancer.

The Plan

The plan prescribed is a combination of radiation and chemotherapy. Radiation would occur daily (M-F) over 6 weeks. Chemo would occur on 3 days – the first day of treatment, and 2 other days later within the 6 weeks. That all seemed fairly straightforward, that is, from my purely academic, sweetly naive viewpoint. Already within a couple of weeks of that appointment, some things have happened to dent that naivety.

The Mask

I quickly came to appreciate how important it is to keep a patient’s head during the procedure. Nobody wants a patient to pop up and ask for a glass of water while radiation is being beamed in. In order to lock my head in place for radiation, I had to be fitted for a mask. It is basically a plastic meshing which is warmed up and formed over my face, with a frame on 3 sides which is used to hold me in place.

I was asked beforehand if I was claustrophobic. Generally, I am not, but I am not really a fan of tight spaces. This mask does impose a sense of being in a tight space, feeling constricted. The one thing that makes me feel more comfortable with this mask is knowing that each of the individual radiation treatments is quite short.

I Hear You

I was told that I needed to have a hearing test done prior to any of the procedures. I just thought that since the radiation would be occurring in the neck, that there was a chance that neighboring areas such as the ears could be affected by any radiation scatter. Maybe the hearing test was just a formality and that potential impact of radiation on hearing was very low.

I was wrong.

I did the hearing test on the morning that I was to see the chemo doctor. The hearing tests showed some minor hearing loss, nothing too abnormal for a person my age. But the audiologist also told me that the chemo could make my ears much more susceptible to hearing damage for over a year after the chemo treatments. No one had ever mentioned this side effect.

She gave me a lengthy listing of noises that could prove to be damaging over the next year. No surprise: rock concerts and jackhammers. Surprising: blenders, barking dogs and vacuums. She emphasized how important it is for me to wear hearing protection over the next year.

When I met the chemical oncologist, he said the drug being used to treat the cancer I have will definitely make my ears more prone to damage. He said that the chemical will get flushed out of my body within a couple of days – except in the ears. The chemical camps in the “hearing” part of the ear for over a year. 20-40% of patients can experience some hearing loss.

Since I want to be part of the 60-80%, some things will change. I won’t be going to any hockey or football games. I won’t be going to see Blue Rodeo in concert (which we do annually). I won’t be listening to music with my headphones on. This last one seems like no big deal, but it is a huge one. For 40 years, I have found great therapeutic value in putting on headphones and losing myself in a local concert of my choosing. Depending on where I am, I often decide to help the lead singer. From Meatloaf’s “Bat Out of Hell” to Harry Chapin’s “Cats in the Cradle”, I can cover it all. This will have to put on hold.

The Final Piece to the Plan

After finishing with the audiologist, I went to see the chemo doctor. Sue joined me for this visit. The first thing that hit me was the number of people in the waiting room waiting to see a specialist.

The chemo doctor was much younger than I expected, but I could tell quickly he knew his stuff. He had a quirky sense of humor, which I liked. It also gave me the green light to joke right back with him – yet still have this obviously serious conversation.

He told me about the chemical they were going to use. We discussed various dosing options – either smaller doses more frequently or larger doses less frequent. There wasn’t enough research to show which approach was better, so I chose less frequent visits, figuring I could spend less time cooped up in the hospital.

He also told me about the impact on my hearing. This one bothers me, but I have to trust it’s for the greater good. He also told me that I will need to have a nurse come into my home for each of 5 days after each chemo treatment to administer some fluids to ensure I remain properly hydrated. Another new piece to this cancer treatment regime.

He also said that I will likely only need 2 doses of chemo – one less than first thought. That I am okay with.

Some Final Prep Steps

After the oncologist left, a nurse came in a few minutes later with a detailed schedule for the next 6 weeks. The chemo/radiation combination is starting May 13th. The whole day is scheduled for the infusion followed by the radiation part of the day. Before the actual radiation, I will be fitted for a guard for my teeth. I think is to help protect my teeth from the radiation, but it is also meant to minimize radiation scattering that might bounce off any of my fillings.

The nurse took me on a tour of the chemo treatment wing. Again, the number of people being treated and waiting for treatments was heart-stopping. So many people having to deal with cancer, and this was just a small subset of the grand total of patients at the Juravinski Cancer Centre.

The last thing to do before leaving the hospital was to buy my 6-week parking pass. That was the easy part of the day.

Nothing Now But Waiting

So now I seem to be filling in time waiting for Monday morning. Happily, it is Mother’s Day weekend so there are some visiting and festivities to help pass the time.

I am waiting on Monday morning with an odd mix of intrigue and apprehension. I am intrigued to see all the equipment and processes – how things work, learning new things. I am a little intrigued as to the side-effects of this treatment – what will happen, when it will happen. This is also where the apprehension comes in. Some of the stories regarding side-effects (short-term and long-term) scare me. I keep telling myself that this is payment on an insurance plan for a healthier future.

Cancer Has the Lead – For Now

As the treatments get going, I will start to see how I am reacting. Currently, my mind is sharply focused on keeping the bumps on this journey to a minimum, but this is all new. I have no experiences to judge how my body will react to these intrusive procedures.

Because of these unknowns and uncertainties, cancer has the lead in our dance together. I cannot even pretend to lead when I can’t even hear the music or see what is on the upcoming playlist.

But I do know that with time, I will know how I am reacting to the treatments and what to expect. As that time slowly unfolds, I will begin to hear the music. Eventually, I will choose the songs. I will take over and lead this dance with cancer.

Until then, patience is my friend and ally.