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Help Dave fight the Cancer Monster

  • The long and winding road

      26 June 2018
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    Hi all

    We have just got back from our 5th trip to Melbourne. This time not for treatment, but for post treatment scans and consultation.

    The news is largely good. My tumours have continued to grow but the specialists explain this as “pseudo progression”. In other words it looks like growth but is explained by a general swelling of the cancer as a consequence of the radiation. The tumours have a large core of necrotic (dead) tissue surrounded by active cancer. The volume of active cancer has reduced and they have lifted my status from “progressive”, meaning getting worse, to “stable”. The future plan is ongoing monitoring, to be able to act when the beast shows life again.

    Its not quite the miracle cure we had hoped for, but then it is totally within expectations. To date there is no cure for this type of cancer so any treatment is aimed at reducing symptoms, delaying growth and extending life. Hopefully this will give me a few more years.

    Once again thanks for all your help with this. The total cost of treatment to date is around NZ$56000, of which your generous donations have contributed 50%. If we had not had your support we would have been stretched to cover this cost, and certainly not in a position to consider ongoing treatment. For those who wonder why I didn’t have insurance, the answer is that I did have, but on close reading of the fine print, this treatment was specifically excluded.

    Overall I am in reasonable health and still able to work a couple of days a week. The cancer has regressed somewhat from when I started the treatment programme so long may this continue.

    Thanks again folks. I am humbled and grateful for your help.

    Dave

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  • Cancer is a Game of Chess

      9 March 2018
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    From Dave

    Cancer is like a long drawn out game of chess. The Queen represents “Hope”. All the other pieces rush around looking at new treatments, new skirmishes, but the Queen must always be protected at all costs. Without the Queen, the game is over. Hope provides the incentive to get out of bed and enjoy life.

    We have just got back from the 4th (and final ?) round of PRRT in Melbourne. Fortunately no major side effects from the weedkiller, but I did manage to pick up an airline induced cold which has had me dribbling and spluttering for a few days.

    This time I went with some apprehension – this is the gold standard as far as treatments for NET cancer goes. If the treatment is not working, the Queen will take a massive hit.

    In a pre-treatment consultation I mentioned that in a previous meeting I had been advised of an anticipated mean of 4 years “progression free survival” following this treatment. The oncologist this trip was a new guy who I believe had been involved in a charisma transplant operation – with him as the donor. Very dry. Very negative outlook. He gave me a lecture that I should not be sucked in by population statistics and that any individual case could be above or below the mean. I argued that this was being pessimistic. My Queen lives on the right hand side of the curve and will stay there until there is clear evidence to the contrary.

    So far I’ve had a comparatively smooth ride with few side effects. I have met other NET patients who are experiencing rough times – cancer in the spine causing extreme pain and needing morphine, cancer in the bones which means that every PRRT round wipes out the white blood cells which makes them weak and vulnerable for weeks, cancer in major blood vessels threatening to shut down vital organs. In my case the biggest symptom is fatigue. On a normal day I can cope, but it becomes noticeable if I do anything physical, like mowing lawns, biking, surfing, heavy gardening etc. Now that the PRRT has run its course my next mission will be to try to build up my fitness to try to build some resilience against the effects of the rust in my liver.

    So where to from here? I had a set of scans and a second consultation before leaving Melbourne. The good news is that in a full body scan there is no evidence of the cancer beyond the liver. My new charisma-deficient oncologist tells me that it is early days yet (despite previous news that there was visible progress) and it will take some time before the full effects of the treatment are visible. I am scheduled for more scans in NZ in 3 months’ time, after which we will have a videoconference to work out the next steps. Once again I am leaning on the Queen in this period of uncertainty.

    As always - thanks for your support through this process. I’ll continue to update as I learn more.

    Photo - breakfast ! image001.jpg

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  • Round 4 PRRT - Hopefully it has worked!

      3 March 2018
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    We head off to Melbourne tomorrow for the 4th and final round of PRRT Treatment. It has been a long road, and while we have enjoyed Melbourne it has been no holiday. We have managed to look at a few exhibitions and take in some of the City sights. But mostly we have been at the Peter Mac center every day for some part of the treatment. Day one is the appointment, Day two the treatment, Day 3 the scan and final appointment to see if its doing some good.

    So Wednesday will be an important day, when we study the scans and try and see if somehow what we are looking at has changed again, we hope to see smaller tumors, so far that has not happened, or at least not shrunk but changed in density and shape.

    Cherryl has been making me a necklace of beads we are now on row 5, and suddenly the beads are bigger, well.... to represent the treatment.

    The costs have been $13,500 to $15,000 each trip depending on whether it is Lutetium or Ittrium, that they are giving me, one is more expensive. We have enjoyed our little apartment on Elizabeth Street, cheap and cheerful, no frills but feels like home each time we go. The wireless connection is dodgy and the Heat Pump is on the blink, but its clean and the only place to offer separate beds.

    Thankyou!!!!!!! to every one of you who have contributed, we really appreciate it. Its been good not to have to panic too much about where the money is coming from, the savings have certainly taken a hit.

    We will keep you posted how this last treatment goes and what the outcome is to be, time to rest and rebuild the body, or more trips?

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  • Dave has cockroach genes

      2 February 2018
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    Dave – the cockroach.

    My oncologist described NET cancer as “cancer in slow motion” – slow to develop and slow to respond, but it’s a killer and very debilitating during the journey.

    I have now received 3 of the 4 planned rounds of PRRT. Last week I had a session with my local (Auckland) specialist and it appears that everything is proceeding according to plan. I feel more energetic (less sleeping in front of the TV at night), and less pain. The scans show a reduction in the size of the cancer and what appears to be a breakup of the large cancer into smaller nodules. For the technically inclined, my cancer has a Ki 67 score of 8%. This means that at any time only 8% of the cancer cells are duplicating. The PRRT particularly attacks the reproducing cells, which explains why they schedule multiple treatments 8 weeks apart. The first treatment knocks out 8 %, the next another 8% of the 92% and 8% for each subsequent treatment. This is not a cure but is a long term palliative. In medical speak they claim a median of 48 months “progression free survival”. This means that they expect 48 months before the cancer starts to wake up and start growing again, and if it does I can come back for further treatments to put it back in its cage. As an optimist I expect to be on the right hand side of the bell curve and look forward to a greater PFS period. By the time it becomes a problem we hope that funding will be available for treatment in New Zealand.

    Tanya thinks I have cockroach genes which enable me to survive all the various surgeries, weedkiller rounds, radiation and now PRRT. All have been unpleasant. Some have been painful, some debilitating for long periods, lots of side effects, but I keep coming back.

    Once again thanks for your support – without your help this would not have been possible. Much of my treatment to date has been outside the bounds of the public health system (and also my insurance which turned out to be useless as it only provided the same services as the public health system), and our funds have become depleted. Without your help we probably would not have made the decision to undertake PRRT.

    One more treatment to go, in early March. This will be followed with an ongoing monitoring plan involving more scans which while available in NZ, are also not publicly funded.

    Dave

    PRRT

    What is peptide receptor radionuclide therapy (PRRT) and how does it work?

    Peptide receptor radionuclide therapy (PRRT) is a molecular therapy (also called radioisotope therapy) used to treat a specific type of cancer called neuroendocrine carcinoma or NETs (neuroendocrine tumors). PRRT is also currently being investigated as a treatment for prostate and pancreatic tumors.

    In PRRT, a cell-targeting protein (or peptide) called octreotide is combined with a small amount of radioactive material, or radionuclide, creating a special type of radiopharmaceutical called a radiopeptide. When injected into the patient’s bloodstream, this radiopeptide travels to and binds to neuroendocrine tumor cells, delivering a high dose of radiation to the cancer.

    The cells in most neuroendocrine tumors have an abundance (called an overexpression) of a specific type of surface receptor—a protein that extends from the cell’s surface—that binds to a hormone in the body called somatostatin. Octreotide is a laboratory-made version of this hormone that binds to somatostatin receptors on neuroendocrine tumors. In PRRT, octreotide is combined with a therapeutic dose of the radionuclides. Yttrium 90 (Y-90) and Lutetium 177 (Lu-177) are the most commonly used radionuclides.

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  • Round 3 PRRT

      17 January 2018
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    Cherryl and I spent last week in Melbourne for round 3 of PRRT. Tanya was able to join us, so while I was locked away behind lead screens having weedkiller pumped through me, the girls were able to explore some of the sights. We are now getting to know Melbourne well and transfer to/from the airport shuttle, to our apartment was easy using door to door free tram service. Melbourne must have one of the best public transport systems I have encountered, with much of the central city being free.

    The treatment appears to be on track. The latest scans show that the bulk of the cancer has broken up from being a single dark mass, to multiple smaller individual blobs. We were advised that this process can be expected to continue for the next 12 months, as cancer cells damaged by the radiation fail to reproduce. Back to Melbourne on 2nd March for the 4th and final round. Current statistics are that this should delay further development of the cancer for an average of 4 years “progression free survival”. Hopefully I’m on the right side of the bell curve and will get a greater period before further progression takes place. One of the advantages of this treatment is that if the cancer does re-emerge, further rounds of PRRT should be able to put it back in its cage. PRRT is not a cure, but is a palliative which hopefully can be repeated several times – subject to $$$$$.

    Once again thanks for your financial support. Many people have contributed anonymously which makes it hard to give personal thanks. Our thanks to all. You have raised almost half of the overall treatment cost, which has significantly reduced the financial burden. Overall this treatment is cheap in comparison to some cancer treatments – a relative of a friend is trying to raise $1.5 million for a treatment in the US!. There are moves afoot lobbying the government to pay for PRRT. If this happens then hopefully any future rounds will be covered. Last week the PeterMac Hospital treated 5 kiwis and I was able to catch up with a couple of patients in a similar situation.

    Photo – Cherryl, Tanya and me eating Italian spaghetti at Lygon Street.

    Image may contain: 4 people, people smiling, people sitting and indoor

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  • Treatment 2 of PRRT

      24 November 2017
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    We went to Melbourne last week for round 2. This time we had a better idea of what to expect and it all went to plan. This time the weedkiller was Yttrium rather than the Lutitium at the first round. The difference is the split between alpha and gamma radiation which have different penetration depths. From the scans taken the early advice is that the first round appears to have stopped progression of the cancer, and further treatments will hopefully trim it back and slow its re-occurrence. This second round was a lot less debilitating than the first. I felt a little tired on the Sunday but overall no nausea or other unpleasantness. We are now scheduled for the 3rd round (Lutitium) on 7th January.

    While we were in Melbourne it was 35 deg every day. We went to St Kilda beach but it was deserted – too hot to sit on the beach! No surf, flat as and boring. On the Tuesday we went to dinner at an Italian Restaurant in Lygon Street with some Christchurch friends from 20 years ago. Just what the Doctor ordered, good company, good food and a chance to put the elephant to one side and behave normally. We also went to the Science Museum, which was a bit of a disappointment – it seems to cater for school parties only, and as a casual visitor we found it a little underwhelming.

    Health and safety moment - when they had finished with the patient in the chair next to mine, the nurse spilled a drop of the radioactive agent on the floor. The next minute the room was in shutdown, the nurse got a Geiger counter and chalked an area on the floor. She then spread paper towels over the affected area and taped them down. This was to isolate, contain and remove the danger. Very slick and impressive to see a well rehearsed procedure. I noticed that all the staff wear film badges which are reviewed each week.

    Once again, thanks for your support – I am just overwhelmed with your generosity.

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  • Round 2 pf PRRT

      4 November 2017
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    We are now getting ready for round 2 of PRRT. This involved a barrage of tests to make sure that I can handle the next round. This was mainly liver and kidney functions. They test the liver to make sure that it hasn’t been too badly fried and is capable of more cooking without shutting down, and the kidney because that has the job of disposing of the weedkiller. Hopefully all is OK as we have already booked air tickets to take advantage of discounts, and I am not sure if cancellation of an appointment qualifies under travel insurance for a claim.

    The first round was relatively benign. I had a weekend of hot flushes and cold shivers and spent much of my time on the couch with the cat. (photo attached). Monday I went to work – not 100% but functional.

    The second round is on the week of 12 November. We were able to put this back a week as the previous week is Melbourne Cup week with all accommodation fully booked and expensive flights. After the treatment they do a scan and the uptake of the radioactive isotope will provide information on how successful the first treatment was. The isotope is only taken up by live cancer so if there is a reduction from the previous scan it indicates that the previous treatment has been effective. The first round used a Lutetium isotope. The second round will use Yttrium. These have different alpha and gamma particle emissions which affects the range of effectiveness. (Photo – lead pot containing the Lutetium dose of weedkiller – note the hi tech plumbing fitting used as a plug! The silver background is a 50mm thick lead screen that the technicians hide behind when administering the dose).

    We have booked the same accommodation in Melbourne as it is convenient and on the tram system. The treatment requires me to be at the hospital for 4-6 hours on each day so we will not have a huge amount of time for sightseeing, but will try to do a few things. The Melbourne Science Museum is on the list.

    Thanks for all your good wishes – I’ll give another update after round 2.

    dave

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  • First Treatment of PRRT

      17 September 2017
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    Cherryl and I got back from Melbourne on Friday night following my first PRRT session. . The treatment went according to plan – very much like chemo but easier.

    (Inside the Peter Mac Centre)

    Monday was a consultation, consenting, and a general talk through what is planned. They gave us plenty of time, and answered any questions thoroughly, Logan (our son who is an Anaesthatist & ICU specialist In Perth) helped with asking some tricky ones, and then explained to us some of the medical stuff that we were not sure of.

    Tuesday I sat in a large “lazyboy” style chair and they put a lure into your arm. They first flush through with amino acids to protect your kidneys. They then bring the radioactive isotope in a lead flask. The medicos work behind a heavy lead shield and reach over to inject the isotope into the drip system. It’s a very small quantity – only about 5ml but they feed it in very slowly over 30 minutes or so. Then they continue for another 2 hours with more amino acid. Its all very straightforward and no drama.

    Wednesday I had a scan. This is a combination of a CT scan and also a gamma ray scan. This is two plates like X-ray plates which step around your body over a 30 minute period picking up a 3D profile of where the radiation has found a home – hopefully in the target cancer. This is followed by another consultation to review the scans. Following the scan, there was a second consultation to review the effectiveness of the treatment.

    In my case the radiation is totally concentrated within the cancer and with no traces anywhere else in the body. This is an amazing targeted therapy and I am now waiting for the radiation fairies to do their stuff.

    Logan joined us in Melbourne and took us on a guided tour around the city centre. He is Mr superfit and I don’t think he realised that us old crocks were struggling to keep up. We did 16-18 km each day we were there. Melbourne is a beautiful city. I’ve been there many times on business but have only previously seen the airport, taxis, office and back to the airport again. Melbourne has some amazing architecture, both old and new. I got the impression that there must be town planning rules which means that a developer is not allowed to just put up a box, and every building is dramatic in colour and style. I was particularly impressed with the “old shot tower” at central station. This is a previous century building where they poured lead down a tower to make lead shot for munitions. The old tower has now been completely surrounded by a shopping plaza with a conical glass dome – a building within a building.

    The central city area is serviced by a tramway system which is free. This means that everyone uses the trams, and the streets are not congested with traffic.

    We stayed in the City Edge Apartments in Elizabeth Street, simple no frills, the price was right. It was in the central city, on the tram route so only 2 stops and a short walk to Peter Mac. It had a Metro food shop across the road, Wi-Fi and a little kitchen, we ate out for cheap for dinner and being so central was easy. When we arrived and left we used the Sky-Bus from the airport and they had a free shuttle bus to our accommodation, so very cheap to travel. We are trying to keep the costs down as much as we can.

    I started to feel tired by Thursday afternoon, and then on the way home had a stinging pain at the site of the cancer. So far largely free of any debilitating side effects. Saturday I had sweating, shivering and trembles, and feverish. Sunday morning slightly less, and by afternoon feeling much better, just a hungover feeling.

    Next trip in early November has been booked. We are a little concerned when they told us they expect to do 4 rounds and then perhaps a review in 6 months and another round. We have been fundraising, and I want to thanks all those people who have been so kind and donated. We really appreciate this help. Without the kindness and donations of all of you, we would not be able to take up this treatment.

    The kindness and help takes many acts, when we got home our cat had been collected from the cattery and fed and sorted at home, house warmed up and a soup for supper on the bench. We were dropped off and collected from the airport by another friend. Our house, mail etc was sorted while we were away, and a roast pork dinner was delivered on Saturday for us from another friend.

    Cherryl really appreciated this as she was on the go the whole time we were away, and has been wife, nurse, carer support person through the whole process. She is glad to be home to let her feet heal from all the walking!

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  • The Call-up for Treatment

      27 August 2017
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    Wow – we have now reached 25% of our target. Its hard to describe how much appreciated this is, and it’s a wake up call to realise that people do care. We have received donations from people who have crossed our paths many years ago, life long friends, friends of friends, recent friends, business associates, and some who have never met us. Many thanks to all and if we can help you in some way, we will.

    The last month has been full of logistics in getting scan data to Australia for their patient workup. One of my scans was in Hamilton and not accessible from Australia. I asked for it to be sent to Mercy Hospital in Auckland which Peter Mac could access. It was instead sent to Auckland District Health Board and it took a while to understand why the Australians were having difficulty in getting access. Then we ran into difficulty between whether you could upload to a site or whether the other party should download from a site. All very frustrating and full of IT technobabble but finally achieved.

    My company took a group of us for a day’s skiing to Turoa ski field on Friday. I say skiing in a generic sense as the rest of the bunch were all knuckle draggers, totally lacking in grace and style. For a while I was able to outski the group, but I overestimated my abilities and while I was fine for the morning, in the afternoon I hit an energy wall, got cramps everywhere, and had to come down for a rest. The mind was willing and full of memories of being able to blitz down a hill but the body said “no way”. This was a combination of being unfit as well as poor energy reserves from the cancer. While wending (that’s what skiers do) my way down I had a call from Peter Mac hospital to request me to come for treatment on Sept 11-12.

    We now have some action. I am scheduled to have my first round of treatment at Peter Mac Hospital Melbourne on Sept 12th. We have booked to fly across on Sunday, consultation on Monday, the first treatment on Tuesday, scan on Wednesday and then fly back on Friday. I am not allowed to use public transport for a couple of days after treatment to avoid radiation exposure to other travellers. Cherryl and I need to sleep in separate beds for the first 2 nights. I am told that I will be given a card to present to airport officials, in case I trigger a radiation alarm ! It would be interesting to trigger a full on security emergency just by checking in.

    Current plans are to have 4 treatments some 6-8 weeks apart. The first is described as the main attack, and subsequent treatments will be using variants of protein/isotope to mop up what is left. I have heard of some people only needing the first shot so once again we live in hope. Side effects are described as being negligible, to some pain, through to considerable discomfort and loss of energy for a considerable period. It seems variable from patient to patient and unpredictable so only the experience will provide the answer.

    The next update will be the gory details of the procedure.

    Thanks everyone.

    Dave

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  • A message from Dave

      12 August 2017

    Hi all ,

    Thanks for your very generous donations. These are somewhat overwhelming and very much appreciated. I had hoped that people would be able to find a few coins in the fluff at the bottom of your pockets, but the size of some of the donations is amazing and beyond generous. I hate the concept of asking for donations, but this cancer seems to skirt the bounds of NZ Health funding or facilities and the only option is this treatment available in Australia. I was diagnosed some 8 years ago and was initially told I had 3 months to live. I then went through a series of procedures, most of which were self-funded as the public health service deemed that most treatments would not improve either my life expectancy or quality of life. My chemo (unsuccessful) was public funded, but subsequent treatments for “Selective Internal Radiation Treatment”, and for removal of the primary, we had to fund ourselves. These treatments must have been effective as I am still here!. Unfortunately there is no absolute cure and the cancer has recently started showing signs of being active again. These various treatments mean’t I couldn’t work for a period, after which my qualifications had lapsed as I no longer met the requirements for “continuous professional development”. This means that we have been on a reduced income for this period, and with the costs associated with treatment, our retirement funds have been diminished.

    In those 8 years, understanding of NET cancers has advanced, largely due to the activities of organisations like the Unicorn Foundation. NET was previously thought to be a rare cancer but was often confused with other cancer types and not recognised. It is now known to be more prevalent than cervical, brain, ovarian, pancreatic or stomach cancers. Diagnosis and treatment options for NET cancers have expanded and the proposed PRRT treatment appears to be the gold standard. Not available in NZ, not funded and expensive both for the treatment and for the associated costs of scans, travel and follow ups. I anticipate that I will need around 5 visits to the Peter MacCallum centre in Melbourne over the next 6 months. For those of a technical bent, the treatment is to dose me with a specific protein which attaches itself to the cancer. The protein thus tracks down the cancer wherever it is in the body. The protein is attached to a radioactive element and radiation kills the cancer. Very clever, targeted and early statistics show it works.

    I have now been referred to Peter Mac and it looks like my first visit will be in about a month’s time. They are gathering information about my previous treatments and scans so they can be fully informed for the first consultation. I have had CT scans in Whakatane, PET – Gatate scan in Auckland and a PET-FDG scan in Hamilton. I won’t bore you with the technicalities other than that they all involve being slowly passed through a rotating donut over a period of 30 minutes or so.

    I’ll let you know how I get on

    Dave

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