Cycle 12 Day 25. Wednesday, April 29th, 09:09 in the morning.
So, waking up to today, I realize that these coming two days are days of examinations.
The First Exam: Applied Tree Care
Tomorrow I have an examination in applied tree care.
The second part of that course that I’ve been having over the last four to five weeks.
And I will be examined on my knowledge of subjects including:
different solutions for planting trees and shrubs
assessing the soil and improving the soil around trees
supporting both young and old trees with tree supports or tree crown stabilizations
different tree pruning techniques
nature preservation
protection of trees when undergoing construction work
tree inventory
tree risk assessment
tree plans
tree care plans
Etc.
So that is for tomorrow.
And I haven’t had too much energy and time to study, but I accelerated my studies yesterday and I will keep preparing for the exam today.
The Second Exam: PET-CT Scan
However, that’s for Thursday.
For Wednesday, we have the big exam.
And the big exam is namely the PET-CT scan.
The examination of my whole body by first having me fasted so that my blood glucose levels are lowered a bit, and then injecting me intravenously with radioactive glucose.
So that’s the 18-FDG fluorodeoxyglucose.
And what happens is that when glucose is taken up by any tissue in my body, also radioactive glucose will be taken up.
And the PET-CT scan will detect the radioactivity that is emitted from those parts of my body where the radioactive glucose has been taken up.
According to the Warburg effect, most tumor cells are very prone to glucose metabolism. This means that, apart from a few other organs in the body such as the thyroid, the bladder, the heart, maybe some others, any tissue that shows a high differential uptake of this radioactive glucose might be a suspected tumor tissue.
And I’ve done quite a number of these scans already.
The first one was in July 2024, and then three months later, and then another three months later, and then another three months later, and then another three months later…
So that’s like one, two, three, four, five, six, seven.
Yeah, this is my eighth PET-CT scan.
And then apart from PET, you have the CT, which is computer tomography, where you’re also able to decipher somewhat the density of the tissue.
So you can see morphological changes to tissues through the CT scan as a layering.
So there are two layers to the scan:
one is tissue density
the other one is uptake of radioactive glucose
Strategy at Stake
And this exam is of course much more important than the one on Thursday.
And we’ll see.
It’s basically examining my performance, you could say, in terms of everything that my body is being exposed to:
my own protocols
the treatment
everything combined
So let’s hope I’ve done enough to tempt fate here, and that I can move the needle in the right direction.
If it turns out that the needle hasn’t really moved much, or that it’s moved in the wrong direction, I will really need to quickly reassess my strategy here.
Possible Adjustments
That might entail adjusting the chemo protocol in one or multiple ways.
One potential option, which I don’t think I would go down, is to intensify treatment frequency.
Another one is to increase dosage.
But if anything, in terms of changing the chemo protocol, I would probably first look at changing the chemo substances or the chemo cocktail.
From FOLFOX to FOLFIRI
The second-line recommendation would be to switch from what I currently have, which is FOLFOX:
Oxaliplatin (neurotoxic, affecting DNA repair mechanisms)
5-FU (a broken DNA/RNA base analog)
And switch that to FOLFIRI.
FOLFIRI still involves the two-day infusion of 5-FU, but replaces oxaliplatin with irinotecan.
Concerns About Switching
And my concern there, apart from the general concern that I have a proven track record with FOLFOX—so why change horses mid-race— well, maybe if my horse is losing, I would have to…
But the other concern is that irinotecan seems to have a higher toxicity to the gut lining.
And I really need my gut lining to stay strong and resilient enough to recover between each treatment round.
Because I’m fasting so aggressively, and then upon initiating my recovery arc, I need to refeed very aggressively.
So if my gut lining would be even more sensitive, it might impact my ability to refeed successfully.
And that could impact my overall recovery heavily.
And in the worst case, that could lead to a downward spiral where I’m not able to recover well enough to get iterative rounds of treatment over and over again.
Immunotherapy: A Double-Edged Sword
Another avenue to explore would be the immunotherapy realm.
Currently, I have been avoiding retreating myself with PD-1 inhibitor antibodies, such as:
Nivolumab
Pembrolizumab
These antibodies, if successful, would attach to tumor cells and dysfunctional immune cells and instruct my own immune system to eliminate malignant tissue more effectively.
But if unsuccessful, they could trigger autoimmune adverse effects.
And I am very much convinced that this is what happened to me over a year ago, when my adverse effects in terms of:
autoimmune dysregulation
autonomic nervous system dysregulation
held very strongly for over eight months.
And it impacted my quality of life even more heavily than going through aggressive systemic therapy.
So introducing this antibody again—I’m quite split on it.
But if push comes to shove, I might have to.
Because there is a track record of me succeeding in systemic therapy when these antibodies were part of the protocol.
Whereas this time around, they haven’t been included.
Adjusting My Lifestyle: Tree Work
Another thing I’ve been very actively doing is that I’ve abstained from operational tree care work.
Unfortunately.
During the winter, I had my first internship.
And the way you do tree care work is that it’s medium to high intensity physical exertion throughout the whole day.
And then you come home, rest a bit, sleep, wake up early, and repeat that for five days straight.
And then you have a weekend.
And it seems that that doesn’t necessarily help my body recover.
What I need is:
days of full recovery
short bursts of intense resistance training
...followed by day(s) of full recovery
That seems to be the most efficient way for me to rebuild and repair my systems.
So for now, I am not an operational tree care worker.
Instead, I’m focusing more on:
inspections
inventory work
Which I don’t mind.
But it would be nice to climb trees again, to be up in the canopy.
A Difficult Balance
This adjustment is also influenced by the fact that my winter internship coincided with a worsening PET scan result.
It’s just one data point, but I don’t want to take that risk again.
And intuitively, it feels like too much stress for my body right now.
Especially since back then I wasn’t even doing systemic therapy.
Now I am.
So this challenge—combining treatment with education—will intensify.
Especially going into the summer, where I’m expected to do a nine-week internship.
If I’m continuously undergoing treatment, I won’t be able to do full weeks consistently.
So I need to solve a puzzle:
syncing with different people
finding single days to join as internship days
adapting to my energy levels
Final Preparation
Most importantly now, I will use these last two hours before the scan to wind down.
There will also be time to rest at the hospital, because after receiving the radioactive glucose:
I need to rest
I receive a beta blocker to reduce brown fat uptake
So I’ll start winding down now to improve scan accuracy.
And then we’ll take it from there.
There’s no use getting ahead of ourselves.
Once the results come back—hopefully within a few days—I’ll reassess everything.
And we’ll just keep calm and carry on.
Closing
And oh yeah—tomorrow I might be celebrating finalizing these two exams by going to Tak on the rooftop of Gallerian by Brunkebergstorg in Stockholm.
So if any one of you wants to dance in celebration of the sun arriving in Stockholm, do join me there.
Write me a message.
I’ll be there with others who want to celebrate.
And if you don’t want to celebrate, or don’t have the time, you can still write me.
We can talk.
Be mindful of your life force, fam.
Namaste.
