Highlights
- My SIRT treatment is complete and seems successful, subject to follow-up scans
- We’ve booked a (minor) surgery to restore my voice.
- I’m feeling pretty good and mostly getting on with life (between medical appointments).
The SIRT story
This is a bit detailed so please feel free to skim/skip through this section if it’s too much. To deal with the persistent tumours in my liver, Nick, my oncologist, recommended a procedure called Selective Internal Radiation Therapy (SIRT). They inject millions of tiny plastic spheres (SIR-Spheres --approximately 1/3 diameter of a human hair) covered with a radioactive isotope yttrium--90 (Y-90) into the small arteries of the liver near the tumours. The isotope delivers localised high dose radiation to kill the cancer cells.
October 10: Because I’ve had liver inflammation recently they first needed to assess whether my liver could handle the SIRT procedure. (Radioactivity is a bit of a stress on the liver.) First I had a liver CT scan. The scan showed minor growth in the tumours in my bones but nothing of real concern. The liver tumours, on the other hand, needed to be dealt with. Nick’s team agreed we should go ahead with the SIRT treatment.
October 29: To really see if my liver was up to the stresses of the treatment, Dianne drove me to Royal North Shore Hospital for a mebrofenin test. Technetium (99mTc) mebrofenin is a radioactive compound that is taken up quickly by a healthy liver and then excreted within minutes. The machine they use is called a SPECT-CT scanner (Single Photon Emission Computed Tomography-CT) that combines two types of scans: a 3D scan of the gamma rays being emitted from the mebrofenin followed by a couple of CT scans. Over the course of 15 minutes or so, this test showed how much of the mebrofenin the liver was taking up and how fast it got rid of it, both earmarks of how well the liver is working. I passed the mebrofenin test! The SIRT treatment was booked for November 12 and 18.
November 1: The SIRT surgeon wanted a new PET scan so we drove back to the hospital. I was scanned with a new type of equipment – one of only two of the $20 million units in the country – that does the scan in 5 minutes instead of the usual 15. Plus it uses less radioactive tracer and produces a more detailed image. Lucky me.
Ready for SIRT
November 12: We drove to the hospital for my SIRT
procedure “work-up”, the test and planning stage of my treatment. The surgeon
(really an Interventional Radiologist) is Dr Richard Maher. “Call me ‘Richie’”.
Guided by x-ray images, he ran a catheter, from a large artery in my groin into
the main liver artery and from there into the tiny arteries within the liver. He
injected a small amount of radioactive tracer into the arteries, studied the
pattern of arteries in the liver – we’re all different, it turns out – took a
number of Xray images (angiograms) and created a plan for the treatment session.
He gave me a local anesthetic for the groin puncture but otherwise I was wide
awake and following the proceedings. I was wheeled out of surgery and into a
nuclear medicine scan to check the test dose had been delivered properly.
If they couldn’t create a workable plan they would have pulled the plug at this stage but at the end of the session Richie told me we were good to go. After I lay flat for two hours to let the groin puncture seal up, we drove home that afternoon, fairly encouraged.
November 18: Back to the hospital for the SIRT
treatment proper. Again I was on my back in surgery with a hole in my groin
artery. This time there was a bit of light sedation while Richie injected the
SIR-Spheres into three liver arteries. Next I was wheeled up to a private lead-lined
room in the oncology ward for an overnight stay. They needed to monitor me for
side effects like pain, nausea and the unlikelihood that the SIR-Spheres had
found their way into somewhere outside the liver, like my stomach, lungs or
gall bladder. The nursing staff were
great and I had no complications. A bit of pain that evening was rapidly dealt
with by a painkiller. I had a great night’s sleep.
Radioactive Man
Now I’m back home, the Radioactive Man.[1] For a couple of days I felt great. Occasional dull ache in my midsection – those little beads are killing something in my liver, hopefully the right cells – was quickly smothered by the painkiller. I had lots of energy and a good appetite. (Thanks, steroids!) Later in the week, as the steroids wore off, that feeling of well-being was replaced by heavy fatigue. Lots of naps now and I’m just hanging in for it to improve. In January I’ll have another scan to see if the SIRT has worked.
My voice
Six months ago I had a filler gel injected into my paralysed right vocal cord to restore my voice from a whisper to a lispy rasp. The filler has now dissipated so I’m back to whispering again. It’s time to pump up the cord again. This time I’ve elected to have a permanent solution. On December 5th, under local anesthetic and light sedation, the surgeon will insert a pad of Goretex (yep, it’s somebody’s rain jacket!) into that vocal cord, a procedure called medialisation thyroplasty. (Good name for a rock band.) I’ll spend a night in hospital under observation and with any luck I should have a permanently understandable voice.
Life goes on
Row your boat
I’ve been continuing to get out and about through
all this. I walk to the local beach most days. I have been doing my weekly 5-hour shift Sunday evenings as a Marine
Rescue Radio Operator, though that’s on hold now until I get my voice restored.
And I’m back to the gym after four months away. A gentle start but it’s a step in the right direction.
It’s a time to try new things. Dianne & I made Barb’s lasagna recipe. Delicious – worth the effort!
Once again, my deepest thanks to Dianne who has driven me where I need to go, fattened me up when I am thin, made calls for me when I couldn’t speak so well, managed our calendar, provided constant love and support… The list is endless!
Thanks to all of you who have reached out with questions, encouragement, love and support. Keep them coming! If you’ve made it so far in this post, you are a friend indeed!
See you all next time.
[1] The half-life of the isotope Y-90 is 2.7 days, so the radioactivity in my body will decay over the following weeks to the isotope zirconium-90 which is not radioactive. Got it?