Ivan rocking it since 2003

[Amanda]

Hi Ivan,
Your right you can make this manageable but it still isn't fun Staying as strong an as healthy as you are is the best way to go in after these dam things...
So if i am reading this right the growth other then the 9mm is maybe 2 mm in two years with the others?
How many can be ablated at one time?

[mikko]

Dr. Littrup ablated three (one 15mm, and two 10mm) mets from Jussi´s right lung in one session ( A Hat-trick as Dr. Littrup said) and a week later two smaller mets (5-7 mm) from the same lung in an other session. These ablations were done 10/2012. A control ct scan will be taken this month here in Finland.

[Olga]

Thanks, this is pretty much what I am thinking at the moment, if 2 of the right lung mets could be ablated in one session. The location of the mets might be different though. I am going to ask Dr.Liu and Dr.Littrup about it.
Decision making process:
Dr.Liu successfully treated 2 Ivan's mets of about the same size before (may be a little bigger like 12 mm) located centrally and it def. an attractive possibility to stay home and pay nothing for the treatment - versus Dr.Littrup's level of expertise.
On the other hand if Dr.Liu will not consider doing 2 at once (I do not know if he ever done 2 at once before) and Dr.Littrup would, it may be a valid reason for us to go to Detroit and pay. Not only it would mean getting rid of 2 bigger mets at once but also 2 general anesthesia session less as Dr.Littrup does most of the treatments under the deep conscious sedation and Dr.Liu always uses the general anesthesia - which is desirable to avoid if possible.

[Ivan]

Amanda, multiple nodules can be ablated together, as Mikko says. Dr. Littrup can do it, I am not sure whether they do it locally or not.

I want to speak with Dr. Liu, and then probably with Dr. Littrup.

Simple mets can be ablated for free in Vancouver, but more complex cases require the superior experience and equipment that Dr. Littrup possesses. We need to understand which category these few mets fall under.

[wangcns]

Glad to hear you're feeling better, Ivan and that the cryoablations were a success. Bummer about the Phillipines I know how you feel, 40k in Rolle fees + travel + other stuff = seed money to start our own company. Ah well, the funny cards life deals us sometimes. At least we had money saved up.

Here's to continued successful management of this disease. Happy 2013!

[Ivan]

So, Dr Littrup just ablated 3 nodules in my right lung (12mm, 9mm, 8mm) a few hours ago. Feeling great, back at the hotel and about to go out for some late lunch. Tomorrow, 1 more nodule (9mm) in the left lung. After that, I should hopefully have a nice long break from any treatment.

Before leaving, I reviewed my scans in excruciating detail for a few hours. There are 20 visible nodules in each lung. I compared April 2013 to November 2009. Other that the ones have been ablated in the past, and the ones that are currently being ablated here, not a single one has increased in size to within 1 mm (some did shrink by a few mm).

Many of them are 4-6mm in size, which leads me to believe that they are scars left over from bilateral laser resections that Dr. Rolle's performed. If the mets lasered were 2-4 mm, I expect the scars with margins to be 5-7mm.

One thing I've observed is that scars from laser surgery don't seem to resolve, while scars from cryoablations of even 1 cm nodules can go away completely within a year. Potentially, that's a big advantage for cryoablation. Even that huge one which was ablated 5 months ago has shrunk by over one half.

[Josh]

Good news, man! So it looks like those were the only suspect nodules you had, and they will all now be cleared out? I assume the 12mm one was the fast growing one that you noticed late last year/early this year?

Here's hoping for a good year with nothing new on the scans once you knock these sucker out.

[Ivan]

Josh

Yes, the 12mm one was invisible a year and a half ago. Lately, it started growing at roughly 1mm per month which is pretty fast for me. The other one took 4 years to grow from 5 mm to 9 mm, so it was inching along very slowly. The third was somewhat like the first, except growing slower. That's pretty unusual for me - 2 nodules coming out of nowhere. For all intents and purposes, it means they were 1 mm or smaller before they started growing.

The funny thing is that the one in my left lung (to be done tomorrow) took 3 years to grow from 2mm to 5mm and then went from 5mm to 9mm in just 3 months.

All "problem" mets I've had were on the periphery - close to the chest wall. Once they hit a certain size (5mm) they just take off in growth. Had one like that in 2009 which was removed in my last thoracotomy by Dr. Rolle, had another which was ablated by Dr. Littrup in 2010, then this one which was re-ablated by Dr. Littrup near my heart 5 months ago after a failed attempt in Vancouver. They are also harder to spot early. All of mine were spotted later than they would have been spotted had they not been hiding in the margins.

I'm still waiting for the CT scan report from Vancouver radiologists on my last scan. I'm going to LOL once again if they miss the met which is going to be ablated tomorrow. Saw it myself, pointed it out to Dr. Littrup, and he agreed.

[mikko]

Congratulations from Finland Ivan and good luck for today! Our regards to Dr. Littrup and Barb.

[Ivan]

Everything is done. 3 on right, 1 on left. I feel very tired and frankly bored, but what choice is there? I'd much rather be at home suntanning while working and listening to philosophy podcasts, training at the gym, etc I want healthy home food, not overpriced restaurant meals which probably aren't very healthy either. The fact that Detroit has no real grocery stores within a few km's of center is very disturbing to me.

A minor quantity of air escaped the third probe incision under my skin after the first ablation yesterday. It was discovered via an x-ray and subsequent examination this morning. You can actually feel it's there by palpating the flesh, which creates a slight crunching sound. The area feels slightly puffy and inflamed. There is no pain associated with the air, although there is pain due to the hole left by the probe.

Dr. Littrup said it's no biggie, and that it should resolve within the next few days so long as the leak had stopped. I believe it has, but we'll see in the next few days. He suggested that it should be fully gone before flying is considered safe, although there is no research indicating one way or the other on the subject.

Hopefully tomorrow I feel less like shit. I'm not in much physical pain - probably a maximum of 3/10 on deep breaths, but my body feels beat up, bloated, and exhausted. Of course, it's a great privilege to be able to receive this treatment - and to be able to afford it. Obviously I would be dead many times over under the government health insurance offered in Canada.

Today, I was forwarded the CT scan report from Vancouver by my oncologist. Here, let me quote some of the stuff the radiologist wrote for your entertainment -

"There are innumerable other pulmonary nodules..." Well, let me see now. The dictionary definition of the world innumerable in this context would be: too numerous to be counted. I guess if you have a secure government job with a bloated pension which in no way depends on your performance as a radiologist or the well being of your patient, 20 per side is absolutely considered innumerable.

"Some other nodules have slightly increased in size..." Oh yeah, don't worry about mentioning the nodule which almost doubled in size from 4-5mm to 9mm in a few months. You know, that nodule I just had ablated today for $10K of my own hard earned money. The nodule I found myself by staying up until 2AM, because I took the time to enumerate the so-called innumerable nodules and to compare them carefully with past scans which, I must admit, wasn't that difficult. The nodule which could have easily doubled in size in the next six month until the next scan and become dangerous and hard to get rid of just like what happened to the one near my heart or the one next to the chest wall back in 2009.

Oh, and did I mention that this report was more thorough than most of the previous ones I've seen? Therefore, let me re-iterate this again: READ YOUR OWN SCANS if you don't want to die or suffer needlessly later.

[MarietjievdMerwe]

Dear Ivan,
So glad to hear that you are ok. I absolutely adore your sense of humor. Hope you have a VERY speedy recovery. Be thankful that you are able to read, my Friend! Can you imagine.....
Wishing you well.
Kind regards.
Marietjie.

[Ivan]

Ha, I don't need to imagine. What happens is the following:

1) Initially the scan is read as stable with a maximum met size of 8mm.
2) Next few scans are read as stable stable.
3) Next scan is read as a slight interval increase, with the maximum met size of 15mm, and in location later found to be unsuitable for ablation (but would have been possible at a smaller size).

Yeah, this actually happened to me back in 2008-2009 here. I'm sure I am not alone.

[Ivan]

All the air that was in the flesh above the puncture site has now dissipated to the point where it cannot be felt at all anymore.

I feel good. My lung volume is 3750 ml on the breather, whereas normal is just over 4000 ml. Going to the gym later tonight, walked around for a few hours yesterday.

The pain, and the amount of blood being coughed up from these 4 nodules that have been ablated is much less than from the one big one last time.

[D.ap]

Ivan
Sooo glad for the news. Here's to onward and upward of your recovery

About the ablation cost. Canadian health care doesn't cover it?
Sincerely
Debbie

[Ivan]

No, Canadian healthcare doesn't cover any of this.

Went for two 1 hr walks outside, feel extremely tired right now. I guess quadruple ablation is just a much greater systemic toll somehow.