One down, twenty four to go

Hello, Facebook group for Billybobs wildride! This is Billybob, the worlds wackiest liver reporting the latest on the bone tumor aka Lester Diamond.
Yesterday was Notbillybob's  first radiation treatment at the CU cancer center. 

25 in total have been planned, one down,twenty four to go.Once a day, every day through Christmas.

                                         Marked and ready

         This years'  Christmas present from Sharon, a 1965 vintage Soviet NBC warfare watch

                         Molinja 3602, made in USSR

If you were on vacation back on July 23rd this year, or in a coma, Bobby aka "Notbillybob" had a chicken leg sized tumor
removed from his ribcage. It started out as a broken rib on December 8th, 2007.  He simply rolled over in bed on his left side, and SNAP!  They eventually named it Lester. It turned out that Lester was a Plasmacytoma, which is a rather bizarre tumor made from malignant plasma cells. It is  incurable, but can be treated and a good outcome is common these days. Not so just a few years back. Even a recently as 10 years ago, this was a pretty nasty disease as diseases go, at least according to several of his doctors. Modern medicine has found ways to fight this cancer, and the latest clinical trials are yielding pretty good results. In the case of Lester Diamond, though, things are a bit complicated. There are some strange signs that suggest that the cancer might be far more wide spread than previously thought. 6 months from now, we will know a hell of a lot more. First, an MRI of an additional tumor in the pelvis, then possibly a biopsy. Then several soft tissue tumors have to come out and go to the pathologist.
This cancer  "hides like no other" according to the head bone marrow oncologist at the "U". Then there is a possibility that Notbillybob is a "non secretor" or worse, a "non producer". That would mean in the case of a non secreter that the abnormal cells only live for 6 hours or less , making it very very hard to detect in blood or urine samples. A non producer simply makes no abnormal cells that science can currently detect, but only show up as an after thought as actual symptoms, such as elevated calcium, leading to kidney failure, lytic lesions (destructive lesions) in the skeleton, which hurt really bad and can cause central spinal collapse. Ouch.
You know how the construction crews are always tearing big giant
holes in the street? Well, imagine what would happen if they never came back to patch them up? In the case of plasma cell cancer, the process of removing old bone and filling the holes up with new growth cells  gets disrupted. The holes are made, but never filled back in. It's called "uncoupling".
A type of bone resorption cells called "osteoclasts" reabsorbs bone , and their counterparts called "osteoblasts" are supposed to create new bone. But in the case of plasmacytomas the osteoblasts go on strike.
That's what happened to Notbillybob's rib... over TWELVE YEARS AGO.

This is a 3d CT scan of his ribcage taken on 6-8-2007.

 To date, no radiologist has seen this 3D view. The regular view, called the "axial" view shows some tiny itty bitty pin holes. The radiologst who read it initially totally dropped the ball. No, he fumbled it...it was returned for a touchdown.
Then of course as always, Notbillybob has a complicated case anyway. Nothing is ever simple. Initial test results are either mild, or negative. Then the other shoe drops.
 

This one still has the doctors scratching their heads.They use words like 'very rare', or 'bizarre', and in some cases they just drop their pens when told that the first symptoms were on an Elk hunting trip in Oak Creek Colorado, September, 2002.  Then the first hospitalization was Februrary 13, 2003 for chest pain while at work... his first ambulance ride. I mean, it's a long long time ago! It also explains a lot of bizarre health related things.
All the kings horses and all the kings men include:
A neuro oncologist, orthopedic oncologist, 2 radiation oncologists, and a bone marrow transplant oncologist , two thoracic surgeons. a nutritionist, and a chaplain.


 
So, we will update as it goes for those interested. Happy holidays and Merry Christmas!!!! And may your osteoclasts and osteoblasts be ever united!!!!

The PET scan results are in... and the winner is...

 There is good news and there is not so good news.

First the good news. Myeloma cells throughout the body were NOT found. It would have been a gi-normous surprise if they were, given the negative bone marrow biopsy report, blood tests, and urine electrophoresis.
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We 

let
 
that

sink

in

just

for

a 

moment.


That was the good news and it is indeed very very good. 
But Life is not always cherries. (Cherry season is over in Colorado.)    :-(

Sometimes it's also the pits. Now for the bad news.

The bad news is that another lesion was discovered.
The pet scan found another lesion hidden away in the very bottom of the pelvis. A bad place. Close to where the two sides of the pelvis meet at the pubic bone...s.?

"A lesion in the right inferior pubic ramus with a sclerotic rim, and mild FDG uptake-SUV max 3.1" it reads.

FDG is what they call the radioactive sugar. There was only  mild uptake. No bright orange to indicate life threatening emergency. But-the lesion has a sclerotic margin... that means it has a shell. Like an egg. A hollow bubble in the bone. A little egg from HELL. With Lester's ugly face on it. 

 Damn these lytic lesions.

Only we might have to find a new name for this one. The lesion on the rib was always thought to be 'benign' because it didn't HAVE a sclerotic rim. 

The oncologist said that this type of cancer "hides like no other." Now we get to see exactly what he meant. 
The area where the rib tumor was also lit up, and additional tumor couldn't be ruled out. 
 
There are cancer cells where they weren't expected to be. They knew that the surgical "bed" would light up, but outside the chest cavity and near the incision there are areas of concern. 

A special radiation doctor is going to address this next week. No waiting.

Next: Radiation treatments and monthly blood draws. 
Another PET scan around Thanksgiving. Oh, and not too forget...a visit to the liver transplant clinic. We don't want the hepatology folks to get to missing us too much! Heh.
Later, Billybob

A quick note from Notbillybob, aka Bobby-
thank you for visiting, reading, and your thoughts and prayers for Dad and the family in this difficult time. I started this blog in the spring of 2006 after being diagnosed with end stage liver disease, portal hypertension, hepatopulmonary syndrome, and hepatic encephalopathy. I did it to avoid having to repeat over and over which doctor said what and so on and so on. When I first developed upper right quad pain in summer 2006, Sharon sugested we give it a name. Billybob got his identity. Later it was determined that the liver capsule is bulging out in front and causing the pain, making it a fitting name. 

 In 2007, Billybob's wildride was name by the Fox news health network as one of ten blogs to watch in 2008.  After Sharon had three surgeries in three consecutive years, and Lester came to stay, I let the blog just sit for way too long. A special thank you to all those at the Liver cirrhosis support group at Yahoo for all of you support over the years. I hope that this blog is informative without putting you to sleep or making you feel like slitting your wrists or jumping off of tall buildings. On a serious note, with birthday number 8 looming just days away, I want to thank my AA sponsor , and that program for doing what I never thought possible, re-inventing me.
 Most of all, thank you, Sharon for taking care of me, and showing what Judge Simons meant when he said "in sickness and in health and , for richer for poorer...".
 Love, John Robert Aragon, 8-28-2014

Today, a PET scan at UCHSC,aka the "U"

Today our Notbillybob as I call him is on his way with Sharon to the "U" for a PET scan, or Positron emission tomography. They will inject radioactive SUGAR. This sugar is supposed to stick to any cancer cells. This will make GLOWWWWWW. 

If there are more Lester Diamond the plasmacytoma from HELL copies, they will be found. We think.

This is supposed to find clumps.

And lumps.

                                   As usual, click the images!

More on this later.

Fee Fi Fo Fum, I'll Grind yer Bones...

 To obtain the necessary diagnostic information...

           AS ALLWAYS, PLEASE CLICK ON IMAGES FOR FULL SIZE AND EFFECT

                     PLEASE CLICK ON IMAGES FOR FULL SIZE AND EFFECT

Notbillybob was at the "U" for the dreaded bone marrow biopsy yesterday.

                      PLEASE CLICK ON IMAGES FOR FULL SIZE AND EFFECT


He didn't publish this post then because of an exquisite little inconvenience known as... STINKFOOT !!! SCRATCH THAT, SCRATCH THAT!. Sorry, there's that Frank Zappa song again. I think it's from the album "Apostrophe". You really should check out Frank Zappa on this one. Seriously. Here's a link for you.
The real reason he wasn't around all day yesterday is a pill known as Flexerill. Or it.s generic term, Cyclobenzaprine,a mild muscle relaxer. This pre-medication was to used to relax the patient for the procedure. Whoa daddy! Relax is not really an accurate term. Howz about KNOCK OUT? Kids, don't try this at home. And by the way, what do they consider a strong muscle relaxer?? Oh, yeah, I remember detox. Valium's big brother, Librium could be called a strong muscle relaxer, but it would have anesthetized our guy before lunchtime, and left him unconscious.

 As a result, the whole thing (day) is a blur, except for the part when the nurse practitioner took the bone sample. Here is an illustration which describes the event. A picture is worth a thousand words as they say...

 But it's all done. Wow. There are brave people whom have had many of these! I cannot even imagine.
Let.s say that it is not something one ever wants to do again... EVER.

                          PLEASE CLICK ON IMAGES FOR FULL SIZE AND EFFECT
 The upside in all this is that even though the procedure was done in a sterile fashion, Sharon was STILL allowed to sit next to and hold Notbillybob's hand. She scratched his goatee and talked about the cats and distracted him. Kudos, Sharon. You're the hero of the day.
And the NP and CNA They were excellent as all the staff here have been.

                                                THANK YOU, SHARON!!

                                           

Anyone curious who wants to see the procedure on video, here is a link to a youtube video (not ours)
but do not watch if you don't want to, by all means. VIEWER DISCRETION IS ADVISED











P.S.
for thos who are interested iin CG, here is the red wax basemesh of himself that Notbillybob did with Zbrush...

PLEASE CLICK ON IMAGES FOR FULL SIZE AND EFFECT

                                                 exploded view of skeleton

Acceptance is the key

                         PLEASE CLICK PICTURE TO ENLARGE

                      COLLAGE in main hall at the C.U. Cancer Center Anshutz outpattient pavillion


And acceptance is the answer to all my problems today. When I am disturbed, it is because I find some person, place, thing or situation -- some fact of my life -- unacceptable to me, and I can find no serenity until I accept that person, place, thing or situation as being exactly the way it is supposed to be at this moment.
Nothing, absolutely nothing happens in God's world by mistake.  Unless I accept life completely on life's terms, I cannot be happy. I need to concentrate not so much on what needs to be changed in the world as on what needs to be changed in me and in my attitudes. 

                   April 2006 Ardis on the liver transplant ward @ UCHSC

 For me, serenity began when I learned to distinguish between those things that I could change and those I could not. When I admitted that there were people, places, things, and situations over which I was totally powerless, those things began to lose their power over me. I learned that everyone has the right to make their own mistakes, and learn from them, without my interference, judgement, or assistance!

The key to my serenity is acceptance. But "acceptance" does not mean that I have to like it, condone it, or even ignore it. What it does mean is I am powerless to do anything about it... and I have to accept that fact.

Nor does it mean that I have to accept "unacceptable behavior." Today I have choices. I no longer have to accept abuse in any form. I can choose to walk away, even if it means stepping out into the unknown. I no longer have to fear "change" or the unknown. I can merely accept it as part of the journey.
I spent years trying to change things in my life over which I was powerless, but did not know it. I threatened, scolded, manipulated, coerced, pleaded, begged, pouted, bribed and generally tried everything I could to make the situation better -- only watch as things always got progressively worse.
I spent so much time trying to change the things I could not change, it never once occurred to me to simply accept them as they were.
Now when things in my life are not going the way I planned them, or downright bad things happen, I can remind myself that whatever is going on is not happening by accident. There's a reason for it and it is not always meant for me to know what that reason is.
That change in attitude has been the key to happiness for me. I know I am not the only who has found that serenity.

-Page 449 (first 3 editions, pg. 417 in the 4th edition) of Alcoholics Anonymous or The Big Book as it is widely known-