Lists

A good barometer for my overall level of well-being is my attitude towards post-it notes. As I have written here before, I went off to-do lists and post-its and spreadsheets and planning soon after being diagnosed with bot bot cancer.

This was quite a surprise (to me especially) because I love lists. Lists are so structured and clear and organised. I learnt to use them because I don't have a particularly good memory for general stuff (but I can however tell you the Latin name given to the common wombat).

Post-it notes are back. I don't remember when it happened, but all of a sudden I found myself writing things down that I needed to remember to do and that weren't related to cancer. Buy soy milk. Email Kim. Water parsley. Call Nancy back.

People with cancer know that things drop off general to-do lists when in the throes of trying to stay alive. Staying alive is, after all, the biggest to-do. I haven't wanted to put anything else on my list since January.

But now I am nearing the end of treatment and have started to appreciate small things again: things that I would have previously thought were a waste of my precious time, things that 'didn't matter'.

Having post-it notes back in my life is nice. Those little coloured squares are a sign that I am, once again, thinking of a world with me in it.

Fame

The run is over, the money is banked.

Thanks again to everyone that supported me financially and otherwise in the lead up to the race and on the day.

Your support of The Warwick Foundation meant the total raised was $5500, the 7th highest amount for an individual (12000 people participated).

The Warwick Foundation is a small organisation with a big mandate and each dollar donated to them goes a long way.

I also achieved my two minutes of fame when ran a piece on me, the run and the Foundation.

My turn

Cassie dropped her pants for me in Brisbane. Brock ran a personal best over 10 km for me in Ottawa. Susan abstained from alcohol for a month for me in Beijing. Kim cycled 55 km for me in Sydney.

I think it's my turn

The City2Sea is a 14 km run in Melbourne and takes place mid-November.

I'm going to be raising money for The Warwick Foundation - the first and largest Australian organisation supporting 18 to 40 year olds with cancer.

The race will take place after three days of Cycle 5 of my chemotherapy. This is good because it means I will be high on hormones, but bad because I will probably be tired as hell.

I'll be running with my PICC line and bum bag (of the medical apparatus kind) and so won't be going for a PB; it's the thought and effort that counts after all.

You can sponsor me here.

No pressure

I only have Stage 3 cancer AND will be running 14 km for CHARITY in the middle of CHEMOTHERAPY, 14 weeks AFTER surgery that removed 15% of my body weight and sent my resting heart rate UP 30 beats per minute.

Roid rage

Cancer has given me tattoos and a scar that looks like I lost an encounter with a Samurai, or maybe a shark, or maybe a samurai-wielding shark. Macho factors for sure.

But the only way to really become an Ultimate Macho Man is to work at it from the inside, and that means 'roids.

By NinjaMouf (devianart.com)

Even the name of the steroid I take sounds tough.

Dex: 100% MAN made

Dexamethasone is a synthetic steroid designed to mimic a steroid our bodies make called cortisol. Cortisol is a steroid released by the adrenal glands perched on top of the kidneys. Cortisol is helpful during stressful situations (like a battle with a samurai-wielding shark) because it contributes to our 'flight or fight' response.

Cortisol and Dex are glucocorticoids, which means they basically affect the way glucose is used by the cells in your body. During times of immediate stress (shark with sword) your body needs quick access to plenty of energy and cortisol makes this happen. Cortisol also minimises our perception of pain, boosts the immune system and acts as an anti-inflammatory agent.

Cortisol x 80 = Dex

Chemists didn't muck around when they made Dex because it is up to 80 times more powerful than cortisol. Dex also sticks around in the body longer than cortisol: its half life (the amount of time it takes to lose half of its ability to affect the body) is up to 54 hours (it's 8 hours for cortisol).

Dex is commonly used in cancer treatments to control nausea, but no one is really sure how it works. One of the fun things about having cancer is coming across treatments that work but no one knows why (there are several examples of this).

Unlike other anti-nausea drugs that directly block serotonin receptors and the main road leading to the Vomit Centre, Dex works another way; they're just not sure how, or why, or where.

Some things are known though: side effects

The list is long, but here are the most interesting ones:

• Increased appetite and weight gain (note: not muscle gain)
• Convulsions
• Insomnia
• Anxiety
• Personality changes, depression
• Irritability, euphoria, mania

I now put on up to 1 kg a week of body mass, I'm writing this article at 3:40 am, I got anxious today about something small, I breakout in a sprint when cycling for no reason except that I can, and when my thoughts start racing, they're matched only by my racing heartbeat.

But I haven't vomited once.

Chemo = Vom

Looking at or smelling chemotherapy drugs don't make you feel sick; they have to be inside the body to cause nausea and vomiting. And this doesn't involve the stomach (well, not at first, the vomiting bit is all stomach), it involves the small intestine.

Because cells lining the small intestine are particularly sensitive to chemotherapy drugs.

When these cells are damaged by chemotherapy drugs, they release the neurotransmitter serotonin. The name serotonin is loaded with meanings related to happiness in people and bullying in male animals, but around 90% of serotonin in the human body is found in cells lining the gut, where it has the mundane job of regulating how fast the digestive system pushes food along.

Three roads lead to vomit town.

The main road

Serotonin released by intestinal cells damaged by chemotherapy drugs is detected by vagal nerves hanging out near these cells. Vagal nerves send information (WARNING: Gut has been poisoned) to the medulla oblogata, the region of the brain where the Vomiting Centre is located. Then you feel sick and vomit.

The small side road

Serotonin released by upset intestinal cells enters the blood stream, chemoreceptor trigger zones detect it and alert the Vomiting Centre that something isn't right (WARNING: High levels of serotonin in blood stream mean gut is poisoned). Then you feel sick and vomit.

The smaller side road

The chemo itself is directly detected by the chemoreceptor trigger zones that alert the Vomiting Centre (WARNING: Poison in blood stream). Then you feel sick and vomit.

Controlling the flow

Oxaliplatin is a non-targeted chemotherapy drug and a part of my treatment. It is especially emetic, meaning it causes nausea and vomiting (emesis) in nearly everyone that has it. It even causes nausea and vomiting when given to patients in combination with super duper drugs that stop nausea and vomiting.

Drugs that try and stop nausea and vomiting act as road blocks along the streets that lead to vomit town. I'm a particular fan of one of these drugs, a steroid, because I now put on one kilogram of weight a week, have bouts of anxiety, and suffer from insomnia.

I refer to these side effects collectively as Roid Rage.