At sea 9/17

Nice lazy day at sea today. Breakfast in our cabin. AM trivia - we lost ;-( PM trivia - we won ;-) apparently we crushed all other teams and there was a comment "that team knows too much" - well, yeah. We know lots of answers and you don't


Obviously, we had lunch, dinner & snacks. Jill played slots and still running hot. Up another $150+ for the day. I've been focussing on watching entertainment - Ric Steele has been great - string trio is interesting, accapella quartet is solid.

Staff for our cabin is great. Butler delivers our breakfast everyday and brings afternoon tea/snacks to our cabin. He takes our laundry and would probably do whatever we want - if it's legal. State room and asst state room attendants are very efficient. Not sure which ensures that I have grapes and other fruits each day.

With so many people wanting to care for your needs, it is easy to relax.

I expect tomorrow to be busier. We don't have an excursion; but, will just go into Quebec City to see sites and maybe look for gifts. Will be a lot of walking. At least we'll have 2 days before departing.

Halifax 9/16

We shipped everything; so, we didn't have to pay sales taxes. That saved almost $50. They also had a location in the market at the dock; but, we took a cab to the store for $10 each way and most of the items Jill bought were $30-40 cheaper. We feel like very frugal shoppers today - forget about what we actually spent!!


Back onboard, we resumed normal afternoon activities - eating and trivia. We won 4 of the last 5 trivias. We've often teamed with another frequent cruising couple. In fact, we have cruised with them in the past and recognized each other on the first day.

We continue to enjoy the afternoon tea served each day by our butler. Many choices of pastries, mini desserts, mini sandwiches and a selection of teas.

The weather is quite a bit cooler here - more like we had expected. 57 F now. Probably around 50 F when we went off ship this morning.

The population in Halifax is 360,000. That is 40% of the total population of the province of Nova Scotia.

For Jill's friends, she won a little bit on the slots last night. She is up a little - around $220 for the cruise so far.

Bar Harbor 9/15

Very foggy most of the morning. It's a little cooler today. Had a big breakfast and were ready to go when we rec'd the notice that the whale watching tour was cancelled due to the weather. Only a short while earlier Jill had commented that we wouldn't be able to see anything.


So...we played trivia twice so far today. Won one & lost one. One more to go before dinner.

Last night Jill broke even at the slots. We were out late again enjoying Rick Steele. The ship moved him to a larger venue and the dance floor was packed. We even danced a couple songs.

It has been a relaxing day. We cruise to Halifax, Nova Scotia, tonight. No planned excursion tomorrow. We will find a shuttle or cab to the shopping area since Jill wants to look for Irish wool sweaters.

Portland Maine

Almost done with our day in Portland, ME. Breakfast in our cabin has been our habit. Only the day after departing NY was nice enough to have breakfast on the verandah. But, we have a nice dining table in the suite.




A city tour and lighthouses for an excursion today. Saw Bug Light, Spring Point Head Light and Portland Head Light-this is the lighthouse picture framed in my office from a previous visit.



It has been much warmer than expected throughout the trip so far. We definitely did not bring the right clothes; but, we have managed to get by.



Filling in from earlier when I didn't have service, we had a great meal at Bice in NY - an Italian restr at 54th & Madison. The Waldorf was impeccable. Cafe Metro was great for chocolate chip cookies & milk. Smith & Wilensky was great. The show, Jersey Boys, was wonderful and very entertaining.



NY traffic was outrageous due to 9/11 events. But, our driver got us to the port faster than we had expected.



Our suite on the ship is very nice. Two separate rooms plus a dining area. Quite comfortable. Our butler, Keith, has been taking good care of us.


The entertainment onboard has been excellent. It is nice to be back with live singers, a live band, an a capella quartet and a singer/guitarist named Rick Steele - we have been up late (for us) the past two nights as he has continued singing beyond his scheduled time. Hard to believe we were out until midnight last night!

We have two nice couples as tablemates. A diverse group and we have enjoyed good conversations. On the first night, we rec'd a complimentary dinner at the Normandie specialty restaurant. I had the best rack of lamb. Jill's steak was delicious.

The ship has had 5 (yes, five) trivia games every day. We love it. Haven't been able to get to them all; but, we go to every one we can.

That's all for now. Gotta get ready for dinner.

Update 9/13

No service for a couple days until we got to Boston. Went out to shop at Quincy Market. Have mostly been playing trivia and watching the entertainment.


Celebrity gets an A+ for the actual live performances and a live band vs a lot of lip-synced recorded stuff on Holland. Jill has won at the slots - of course.

I'll try to write a more complete update later if my Blackberry works. Couldn't even use it to write for a couple days.
We are fine. All is well.

NY 9/10

Well...the 2 1/2 tour yesterday took 5 hours with all the added security stops and truck inspections. Happy they are being so diligent looking for screw balls. It was a nice tour - but very long for us. Last night the Jersey Boys show was fabulous.


Don't know what we'll do today. We had a nice breakfast and are pondering options. I picked up a banana, cookies, choc milk and Gatorade-tyoe drink. Not sure if we want to deal with the heavier than normal traffic since it might be even more intense today and 9/11 celebrations are tomorrow. And, Jill is a bit tired. We'll just wait to see what the day brings. Maybe we will just relax and go out somewhere for lunch.

We've had access to a restricted lounge for a nice continental breakfast and afternoon snacks. We've used it for both breakfasts and for snacks the day we arrived. Couldn't get to it yesterday afternoon because our tour ran so long.

Travel & NY 9/8-9

Our morning travel yesterday was pretty uneventful. Left Indy on time-small commuter plane-arrived on time-minor glitch with car was quickly resolved-drive to hotel was OK. When we checked onto the Waldorf Towers (attached to the Waldorf Astoria) we were treated very well. Our suite is quite grand. Jill says it is as big as our small house in Iowa.


For late lunch, we walk a few blocks and ended up at Smith & Wilensky Grill (next to S&W Steak & Chops). Picked up choc chip cookies and choc milk for later.

Friday late AM we boarded a double-decker tour bus for the downtown tour. He was a hop-off-hop-on tour. We just stayed on. Quite a bit of extra time to go through frequent police security stops initiated within the couple days. Every small truck was pulled over and police inspected the cargo compartment. While inconvenient, we were happy to see them aggressively doing security checks.
The nature of the tour was that we saw the sights and passengers could hop off at various stops to explore and hop on a later bus. We didn't do that - we just went for the ride. We spotted the usual sights of lower Manhattan - Rockefeller Center, Empire State Bldg, Chrysler Bldg, Chinatown, Wall St, World Trade Center site, the under-construction Memorial Tower, Battery Park, South Street Seaport, Brooklyn Bridge, Flat Iron Bldg, Greenwich Vlg, Soho, Madison Sq Garden, United Nations, Times Sq, 2 million sq ft NY Macy's, Central Park, and many Broadway Marquees. I'm sure I have missed something; but, we probably drove past it.
We were out for about 5 hours - very long for us. We went straight to Metro Cafe, ate lunch, bought choc chip cookies and chocolate milk for later and headed to our room to prepare for Jersey Boys tonight.

Travel & Cruise

I am going to give a shot at posting the travel updates for our cruise.  For those who already got these updates as we traveled, sorry.  You can obviously ignore this repeated info.

Lung cancer checkup

New lung and abdomen CT this morning. Saw Dr E. The fluid in the abdomen is pretty much gone and the lung cancer mass continues to reduce a little more each new CT. No need to change treatment - will continue on the crizotinib (now called Xalkori after FDA approval).

Also heard today from the RN for the Gamma Knife radiosurgery. Just checking in. No bleeding. No headaches. Can remove all band aids. Can return to normal activities. Will be going into the office tomorrow.

so far so good

Jill helped me to remove the turban and band aids last night. She put neosporin on each sore and put band aids on three. No pain. No headache. No nausea. No diarrhea. All is good. This morning Jill will drive me down to the IUSCC for an MRI and appointment afterward with Dr Einhorn. He will provide me with news about my lung cancer and continued use of crizotinib (now Xalkori after approval by the FDA).

8/30 Gamma Knife Radiosurgery

All went well yesterday; but, it was an incredibly long day. Registered at the outpatient desk at 7:45AM and left the hospital at 8:30PM. Am doing fine. Not quite as handsome as Capt Jean-Luc Picard as BORG on Star - The Next Generation; but that is quite a frame. It was attached using four sharp pins after I got four shots to numb the areas. Each brace in the picture is held at the top by a pin that attaches to my skin but doesn't attach to the skull. The pins are a bit tight. The numbing shots even numbed my lower left lip. These numbing shots are, apparently, the most painful step for many; but, they weren't really too bad for me.

After installing the frame, I was taken for an MRI. They also temporarily attached a large hard plastic bubble with labeled holes and stuck measuring pins to determine "air space" - I assume between the Gamma Knife and my scalp. Two doctors repeated the measurements for accuracy. The MRI and air space measurements would be used to target the lesion locations and compute the Gamma Knife settings. Four doctors (radiation oncology, neurology, neurosurgeon and a physicist) spent around 2 1/2 hours with the MRI data planning the procedure. The best news was that they had decided that they could treat all 13 lesions this time and I will not need to have a second treatment in 3 - 4 weeks.

When they finally finished, I was moved into the Gamma Knife room. The table was similar to an MRI table; but, it had a frame on which my head frame was attached. It felt like two pins on my frame that slid into two slots on the machine frame. All four doctors remained present for the entire treatment. The process of approximately 25 procedures started. The doctors measured the various angles for adjustments. Two doctors set and double-checked each setting - one would use a tool to set the X axis, one would check that setting and both would say it for an RN to confirm what was on the computer list for each procedure.  This was repeated for the Y and Z axis.

The table was then moved into the Gamma Knife. It is similar to going into an MRI tube. It was very quiet until the 2nd or 3rd procedure when the RN had music set up for me to listen to. I could move my feet, hands and I could talk. So...I proceeded to engage in music trivia with the RN. Those who know me know that I was pretty good - particularly on the 70's mix and the James Taylor. This was helpful throughout the process until the last three or four procedures. It had become pretty grueling by that time.

After each procedure, the table was moved back out and the doctors went through the reset process for each new procedure-X, Y, Z, check, double-check. For some, I had to have my chin almost touching my chest. For others, my head was about as far back as possible.  Others were various head positions. My head was moved since the multi-ton machine with 201 beams from cobalt-60 sources doesn't move. The circle of 201 beams are aimed at a very specific target - a lesion or tumor as identified on the MRI. The 201 beams converge to a very small point. Each beam is very low radiation; but, the radiation is stronger treatment level at the targeted location due to all converging at that point.

Some of the procedures were only a few minutes.  Others were 15+ minutes. In total, I received about 3 1/2 hours of this process. Jill went with me and toughed out the entire 13+ hours. It was required that someone drive me home and she drew the short straw. We had left home at 6:45AM and got home a little after 9:30PM. I had one fall at home before I went to bed but didn't hit my head - just landed on my butt! 

Today and tomorrow I have a classy white gauze turban covering four band-aids. I can remove the turban and three of the band-aids tonight. The 4th spot (left front) will heal last because that pin actually penetrated muscle. I will probably need to wear that band-aid for a few extra days.

Can return to minimal activity at home today-depending upon side effects. Thurs Jill will me drive for a CT and to see Dr Einhorn since I must wait 48 hrs before returning to some normal activities. Driving depends if I need to take pain meds.

I return to see Dr Henderson in three months. He will schedule an MRI and determine the status of the lesions. Hopefully, all will be gone or static at that time.

FDA approves crizotinib (now Xalkori)

This is the test drug I have been taking since November, 2010

Non-Small Cell Lung Cancer Drug Gets FDA Nod

By Emily P. Walker, Washington Correspondent, MedPage Today

Reviewed by

August 26, 2011

Review

WASHINGTON -- The FDA has approved crizotinib (Xalkori), a novel targeted therapy

for late-stage non-small cell lung cancer.

The Pfizer drug, an inhibitor of anaplastic lymphoma kinase, is a twice-daily pill

intended for a select group of patients who express the abnormal anaplastic

lymphoma kinase (ALK) gene, which causes cancer development and growth.

The FDA also approved a companion diagnostic called the Vysis ALK Break Apart

FISH Probe Kid, made by Abbott Molecular, to help determine if a patient has the

abnormal ALK gene.

"The approval of Xalkori with a specific test allows the selection of patients who are

more likely to respond to the drug," Richard Pazdur, MD, director of the Office of

Oncology Drug Products in the FDA's Center for Drug Evaluation and Research said

in a press release. "Targeted therapies such as Xalkori are important options for

treating patients with this disease and may ultimately result in fewer side effects."

Crizotinib's safety and effectiveness were established in two single-arm studies

enrolling a total of 255 patients with late-stage ALK-positive non-small cell lung

cancer. One of those studies, published in the New England Journal of Medicine last

year, found that crizotinib shrank or eliminated 57% of ALK-positive non-small cell

lung tumors.

The most common side effects reported in patients receiving crizotinib included vision

disorders, nausea, diarrhea, vomiting, edema, and constipation.

Crizotinib was approved under the FDA's priority review program, which provides for

an expedited six-month review of drugs that may offer major advances in treatment or

that provide a treatment when no adequate therapy exists.

Since publication of trial results last October, crizotinib has generated much

excitement among oncologists who said genetically-targeted treatments like crizotinib

have the potential to change how cancer is treated.

Although no more than 7% of non-small cell lung cancers are driven by the ALK

genes targeted by crizotinib, the drug would still benefit as many as 10,000 patients

with non-small cell lung cancer in the U.S. alone, Gregory Kalemkerian, MD,

co-director of thoracic oncology at the University of Michigan in Ann Arbor, told

Medpage Today last year.

Disclaimer

The information presented in this activity is that of the authors and does not

necessarily represent the views of the University of Pennsylvania School of Medicine,

MedPage Today, and the commercial supporter. Specific medicines discussed in this

activity may not yet be approved by the FDA for the use as indicated by the writer or

reviewer. Before prescribing any medication, we advise you to review the complete

prescribing information, including indications, contraindications, warnings,

precautions, and adverse effects. Specific patient care decisions are the responsibility

of the healthcare professional caring for the patient. Please review our Terms of Use.

© 2004-2011 MedPage Today, LLC. All Rights Reserved.

Gamma Knife radiation surgery

Met neurosurgeon yesterday. Looks like Gamma Knife radiation surgery very soon. Apparently, with the number of lesions and the scatter throughout my brain, he says I will need 2 surgeries. 2nd will be 3-4 weeks after the first. That means one before my trip and one after. They have agreed to try to schedule around my trip ;-)


He went through the risks involved - some of which could be significant - but, have a 3% to 5 % (or less) risk. He also went through the process for the day - a very long day. I should hear about the schedule in the next couple days. Next, I will view a CD about the procedure.

stress test / neurosurgeon

Spoke yesterday with the RN from the cardiologist's office.  She is waiting for the cardiologist to review the full data from the portable monitor, the stress echo and the ultrasound.  However, she didn't seem to think that there is anything significant.  Apparently, my pulse was low - at 39 when I slept wearing the monitor.  Since the Dr had just taken me off metoprolol, she suggested continuing to monitor BP and pulse.  Last night, BP was 144/67 and pulse was 58.  She said that the cardiologist would contact me if he wants to change anything.

Yesterday, I had a brain MRI.  Today, I see Dr H (radiation oncologist) and meet with Dr W (neurosurgeon) who would do the Gamma Knife radiation surgery if they decide to go that direction.