July 13th

I have been working and avoiding thinking about much off my situation in the last week. I think I am allowed this luxury!
I had a meeting with the oncologist yesterday. This was the real reality check!!
One of the plans of action with the Oncologist was to gain a better understanding of staging with a test called a PET scan.
This is really interesting stuff. PET stands for Positron Emmission Tomography or PET Imaging. Basically, I was going to be scheduled for this test to determine if there were any additional growths in any lymph nodes throughout my body. From a basic standpoint, this test works like a cat-scan, except that the machinery is a little different and priorr to insertion into the donut you are injected with radioactive glucose. Glucose of course is a major fuel source for metabolically active tissues, and will attach itself to things like your heart, lungs and any fast growing tissues int eh body (like tumors also). This cool thing is that tissues like lymph nodes do not usually attract glucose, so any indication of radioactive glucose in these tissues would be an instant indicator of neoplasm (new tissue) in these areas. This seems like a great tool in determining staging of the cancer and determining appropriate treatment . . . . For more on this test see: website
However, my insurance is Anthem Blue cross of Colorado. For whatever reason, they consider this procedure unnecessary/experimental, so it does not look like we will be doing this. I really find this to be a little illogical for the insurance company to not consider this procedure a good investment from a deterministic or financial perspective. First, proper understanding of the staging can determine that a patient (myself!) does not need follow-up chemotherapy or surgery in the case that lymph nodes are determined to be devoid of neoplasm. This could mean a significant financial benefit to the insurance company and patient in the case of good pathology in combination with good PET results. Second, It is really rediculous that I am using financial rationale to explain this since health benefits should not be determined by short term financial goals of insurance companies. This is seemingly unethical behavior by insurance companies since it can result in health issues for patients who are in precarious timing situations with treatment options. Doctors with specific expertise whould not be second-guessed on procedures that may have benefit to patients.--- Especially considering that this is a potential upside for the insurance company!!
OK-- so that is the end of my rant. I am going to go for the Chemo regardless of the test since it is a good safety net for me. I am a little upset at the insurance company, but that is a fact of life in the US with our current health care options. This is one case where I expect a HMO would beat a PPO option for treatment and testing options. FYI: I could possibly do this test on my own (and may do it eventually) but I will be out of pocket approx $5-10K. youch!
At this stage, I am silling to suffer through chem though and the insurance will pay 100% of this, so I am going for it!
Treatment for BEP looks like the following:

Week one: 5 weekdays of 5 hrs (approx)/day including two of the three drugs every day and Bleomycin on Tuesday.
Week Two: Bleomycin on Tuesday
Week Three: Bleomycin on Tuesday
Week Four: 5 weekdays of 5 hrs (approx)/day including two of the three drugs every day and Bleomyacin on Tuesday.
Week Five: Bleomycin on Tuesday
Week Six: Bleomycin on Tuesday

Side effects are pretty whacky-- nausea/vomiting are pretty common-- My blood counts and platelets will also drop pretty significantly sometime in week two and I will likely lose my hair.

In order to ease the stress of the needle pokes throughout the next six weeks, I am going to have a "Double loomen hickman Catheter inserted into my chest for use with all blood draws, treatments, etc. Putting this thing in is a short outpatient procedure and will happen on Friday. Surgery is my biggest dread these days, but I talked to a really nice lady at the surgeon's office who was raving about this catheter for use in her own chemo treatments. I trust her 100% on this since she was having treatments for a long time and had a stem cell transplant recently. I am not sure of her age, but whatever treatments she had, they worked great! she is in remission and looked great.