Happy New Year!

We celebrated Christmas with Marjo's family and one of my sisters and her husband who visited for some days. We had a traditional Finnish Christmas dinner including a huge ham on Christmas Eve. We usually have a Norwegian dinner during Christmas as well and this year my sister and brother-in-law cooked Norwegian-style ribs ("ribbe") for us on Christmas Day. It was all very nice but I was a little unfortunate and suffered from lack of appetite. It has been a problem for a while and seems to go on. I'm down to 75 kg now and need to focus more on eating.

The Santa Claus (Joulupukki in Finnish) visited on Christmas Eve as well. The kids asked many questions ("Is one of your reindeers called Rudolf?"), sang to him, and got a lot of presents, mostly Lego which they both love. I got a lot of presents myself from friends and family (thank you!). The most special one was a blanket knitted by some friends. The colors were red, white, and blue which suite Norwegians very well! I should be able to cope with chills and cold temperatures very well now.

I've recovered from the side effects of the first virus treatment quite well but I'm not in as good shape as I would wish for. Some days are pretty good and I'm able to go for short walks in the woods. Other days I feel just uncomfortable, tired, not able to sleep well at nights, need rest frequently during the days, and like I said no appetite. I've got a fixed doctor at the local hospital in the palliative ward now and she follows me up often and very well. On her recommendation I'm taking pain-killers regularly so I am at least in no pain. My back has been ok recently anyway but I have had some stomach pains. The next virus treatment is next week in the private hospital in Helsinki. The follow up on if the treatment is working is supposed to be after the third treatment, I am not sure if they even take the cancer marker test before that. Before that we won't know if the treatment is working on me. Let's hope the second treatment will be a bit easier than the first one.

Wishing you all a Happy New Year!

Collection for family

Hey, this is not Jan Arne nor the wife writing, but a friend.

A lot of friends are looking for ways to support the family and, since not everyone is able to help in concrete things, many have expressed a desire to offer monetary help. This could also help ensure that Jan Arne get the virus treatments he's started at Docrates, the private hospital specialising in cancer treatments.

A group of us got together to put things in place to make a channel for doing that. We now have permits and an account in place to have a joint friends' collection.

The proceeds of this collection will be given to the family to use for treatments and other expenses at their discretion.

If you want to contribute, send a mail to:
ja_team(at)yahoo.com

and we can send you more details.

In the meantime, one day to Winter Solstice!
Celebrate!

A day at the hospital

I called the hospital in the morning and after some time got a call back and they had managed to fit Jan Arne to see a doc in the afternoon.

Blood tests were all ok, and the doc did not consider the ascites bad even though there was some fluid in the stomach, or whatever the whole cavity area would be called in English. So no need to drain the fluid, she said most of the uncomfort is caused by the constipation (caused by the nausea pills). The plan is for Jan Arne now to take some medicine to ease the constipation, and quit the nausea medication. The stomach wasn't actually that bad during the day today as it was yesterday evening, but good to check everything of course, like that there's no blockage in the bowel. All the personnel in the palliative ward is really nice, we even got offered some juice and Xmas cake. And to top this one of the doctors there is an old dear friend of mine from school I haven't met in years!

They also took some x-rays to check if there's anything worrying anywhere but luckily there was no fluid in the lungs and also none of the metastases in the bones and vertebrae had caused anything "destructive", meaning risk of the bone or vertebrae breaking because of the metastases "eating up" the bone. The doc translated us the results of the Docrates PET-CT and actually the vertebrae mets are quite high up (one somewhere close to the neck, the other in chest area), not in the lower back as we thought. If they start causing pain or risk breaking the bone they will radiate the mets. I'd still feel a lot better if there weren't any mets in the bones and especially in vertebrae :(

Jan Arne also got some new sleeping pills so hopefully he'll be able to sleep better tonight.

Not this as well

There were some better-er days there, Jan Arne even went for a walk the other day. He's also been playing a lot with the kids (no visitors here please as it is impossible to walk because of all the Lego all over the place) and has had some energy to watch TV and other such every day things.

But on the negative side he's had some fever and chills, still no appetite to speak of but at least no nausea as he upped the dose of nausea pills. The most annoying and uncomfortable and worrying thing is that his stomach has been slowly getting bloated. It is probably (and this diagnosis from me, and I am not a doc) the typical symptom of cancer I guess, google "ascites" if you wish. He was supposed to have a doctor's appointment at our local hospital on Monday but this evening the stomach started to be so bloated I think he will have to go there first thing in the morning. I hope they can identify the cause and do something about it. He is feeling quite uncomfortable and it is also difficult for him to sleep.

Again hoping for better days.

Saturday

I wish I could say it is going better, and it is, but I wish it was going... better-er. Today Jan Arne was up most of the day, watching sports on TV (how else) but did not go out because a) lack of energy b) it's pretty cold outside. So the day was a bit better, no fever and chills either, but he still has not appetite, and in the evening he started feeling quite sick again.

I went downtown with the kids today as the younger one had a Christmas party for his music playschool. On the way there he was quite adamant he was NOT going to wear the nice shirt and he was NOT going to go on stage, but when we got there he actually did and didn't even pick his nose too much while singing Xmas songs in front of some 200 people. After the show we went for hamburgers and fries (something we don't eat too often) and stopped by in a pharmacy to get some energy & protein drinks for Jan Arne. They had some that was even described as being meant for cancer patients. Nothing with hamburger and fries flavour though.

I am so worried Jan Arne is not getting enough of energy and proteins. He has not been eating much for the past couple of weeks so of course he is feeling quite weak because of that as well. Good luck the back pain has not been too bad the last couple of days. He said he did have an ok appetite the night before the virus treatment when he was staying over night at a friend's place, hey Juha can you tell me what you cooked for him? :)

On Monday he has to leave the house to get a blood test and to maybe try to discuss with a doctor at the hospital about palliative care and what to do with the metastasis in the hip bone.

Again, hoping for a better (and even better-er) tomorrow...

Day after

The day after the treatment Jan Arne has been mainly feeling like crap.

I went to the hospital in the morning and he had been awake most of the night, some fever, some nausea, just uncomfortable (well, hospital bed too of course). He considered for a while that there's no way he can travel all the way back to Tampere, and maybe he should stay at the patient hotel which is situated in the same building. But he started to feel a bit better after taking a shower so we left for Tampere by train.

Before we left the nurse brought in the blood test results from the morning and she was satisfied with them, changes compared to Tuesday morning as was to be expected: platelets down, crp (infection marker) up etc. He will have to go to a blood test in Tampere on Monday to check how the values are, Docrates then wants the values to be sent to them by fax.

The taxi drive to the train station in Helsinki was quite an ordeal as there was some heavy snow fall on Tuesday evening and the city was in a bit of a chaos still and roads were really bumpy. Not nice to a guy who is nauseous and generally feeling uncomfortable. :(

The rest of the day he has been sleeping or trying to sleep, no fever really but no appetite either. Let's hope tomorrow will be a better day.

First virus treatment

Jan Arne received his first virus treatment today. I took a train from Tampere and am just visiting him at Docrates (or actually this part of the hospital is a ward of a private hospital called Eira). Jan Arne has a private room with a 40 inch Sony Bravia so he'd be happy except no Canal+ = no ManU football match for him today.

First thing in the morning they had taken blood tests and the values keep on amazingly good levels. Then they injected some radioactive stuff in him to take a PET scan, after which they injected the genetically engineered adenoviruses into five spots of the lymph node and liver metastases. He is currently a biohazard and radioactive so I sit on the other end of the room (just kidding). They had seen in the PET scan a bone met in his hip which they had missed in the scans in Tampere, we will have to ask them if it should be radiated.

At night he may start feeling the effect of millions of viruses in his body and may run a high fever so I will escape to my cousin's residence and leave him to more capable hands (nurses). He should be ok enough to get home tomorrow morning when we'll take a train back to Tampere.

So things are looking ok at the moment, please spare some thumbs and prayers and positive thoughts that this treatment will have some effect! Thanks for all the support until now, we have so many friends it seems...

Helsinki

Today Marjo and I travelled to Helsinki to meet up with a doctor at Docrates, a private clinic specialising in cancer treatments. We took the train as neither one of us was very eager to drive and the temperature this morning was -20 degrees (Celsius). It was nice and relaxing and a good choice.

In Docrates we met Akseli Hemminki who's in charge of the experimental virus treatments at the clinic and also a professor at the Helsinki University. He had gone through my papers beforehand and seemed well up to speed on the situation with my cancer. He said it's logical to believe that the cancer is causing the back/hip pains I'm struggling with. I'm now taking stronger pain killers but it seems I either need to take more or get even stronger medicine as it's still difficult to fall asleep at nights.

He made a lot of detailed questions to understand what shape I am in physically. The cancer has an impact now and I am clearly in a worse shape than during summer. For example, I get quite tired even after a short 2 km walk around the woods here. He also wanted to know how much I need to sleep during the day time. That varies a little depending on how well I sleep during the night but typically I take a one-hour-long nap in the afternoon.

Then he introduced the virus treatments and emphasized they are experimental at the moment. At some point they will run clinical trials but they have not yet got to that point. As of August 206 patients have received the virus treatment and 50%-63% have had a positive response ("antitumor" as they put it) in one way or another. Not cured, but the cancer has stopped advancing for a while. We also discussed the risks and side-effects of which the most common are flu-like symptoms and fever that can last for days, as well as swelling in the tumours which may actually increase my back pain. He also pointed out that they may not have discovered all side-effects as they are in an experimental mode. They use various viruses but would choose one that they believe is most suited for my type of cancer. He also recommended to take a set of three treatments as this has shown best results.

There were three criteria I need to fulfil in order to be eligible for virus treatment. First of all, I have had to go through all standard chemo treatments (Eloxatin/Avastin, Camptosar/Erbitux and Xeloda in one or both of these combinations). I'm fine on this criteria. Then blood values and physical shape need to be quite good. They pay special attention to the liver values and he was a little concerned that my ALAT value had gone up to 72 which is slightly above the normal range. He said they would do a final check of the blood values on the treatment day.

He concluded the assessment saying I'm at the moment good for virus treatment but that we shouldn't spend too long time making a decision as the cancer seems to be progressing fast. I said let's go for it and Marjo agreed. He booked me in for Tuesday next week, then we went through the procedure and I signed the papers.

Doctor in chief

First of all thanks a lot for all the calls, blog comments, messages and mails after my previous blog post. I have not got around to answer to you all yet. Sorry about that!

Since summer I've had some pain in my left hip. It has been a bit on and off and I've managed fine up until a month or so ago when it started getting worse. In particular lying down has been painful and I had to start to take pain killers at night to be able to sleep. I told the doctors at the hospital and they immediately took an x-ray image of the area. There was nothing abnormal and they concluded there was no connection to the cancer. I visited the doctors at work and they suspected an infection. I got some cortisone injections, sports gel and painkillers, but nothing helped.

Two-three weeks ago the pain moved to my lower back and intensified. I brought it up with the doctor in the CT scan review. The scan did not show anything that could explain it either but the doctor set me up for a special gamma scan of the skeleton Monday this week just to double-check. I also started going to physiotherapy. The senior doctor said today the skeleton was clean. However, he suspected the pain could be a result of a tumour pressing on a nerve somewhere as there is quite a lot of cancer in the lymph nodes outside of lungs and liver and along the colon. I got a whole bunch of prescriptions for stronger pain killers.

And then about the discussion with the senior doctor today. In fact it was quite long mainly because of Marjo's many questions. Most of the discussions went over my head. Anyway, going back on the first drug (Oxaliplatin) I was on is not a good alternative. The doctor was pretty certain that it most probably would not have any impact on the cancer but only give me the side effects. We asked about the other older chemo they said could be tried but his opinion of that was the same, most probably no effect but it could be tried, actually together with gemcitabine I have been receiving this autumn. Then Marjo asked about clinical trials but there's nothing on or open I could enter.

We also discussed the Helsinki private hospital virus treatments. His opinion was that the positive news about the effect of the treatments has been exaggerated, that their scientific data is not actually bulletproof, and he does not know anyone of his patients that would have had any use of the treatment: a progressing cancer has continued to progress. He commented though that Docrates is not the only hospital in Finland giving the treatments. The hospital in Kuopio has given virus treatments successfully for patients with brain tumours using a certain virus (with virus treatments it is relevant which virus they are using).

To make sure all loose ends are tied Marjo even asked about fever/heat therapy, RFA, and radiation. He replied that the there's way too many tumours for any therapies really but if there's a tumour in a bad spot they can try to kill it with radiation of course, that's part of palliative treatment.


So to sum it up, his opinion was that whether I get some treatment or only palliative care (mainly pain management) the end result and the time I have left are going to be the same. Still, interestingly when Marjo said something about there not being any hope, he replied "There's always hope". We don't know what he meant with that as my case is clearly "hopeless" by now, but maybe it is still a good thought.

The end of the road?

The feedback from the CT scan came faster than I thought. Actually, a nurse called me up on Wednesday afternoon a few hours after the scan and said the doctor wanted to see me first thing in the morning (Thursday). I knew it could not be good news and it wasn't. Cancer has clearly spread further in lower parts of lungs. There are now tens of tumours and the biggest was 11 mm in diameter. The old tumours in the liver seem to have died and don't change in size but there was one new tumour that was quite big already (2,9 cm x 2,5 cm). More lymph nodes around the liver had grown in size also.

The doctor said she had discussed my situation with the senior doctor who's pulling the threads behind the scene. The progress of the cancer means the current chemo I'm on does not work and will be discontinued. Unfortunately, there are no good treatment alternatives left and the doctor said moving on to palliative care could be the next step now. That means I would get treatment to relieve suffering and pain. In other words, it's the last stop on the road. I still have the meeting with the senior doctor on 25.11 so we'll discuss through the alternatives there. There is one very old drug left that could be tried and there is the issue of going back to the first chemo I was on. The doctors don't believe any of these two options will have any impact on the cancer but it will only give me all the side effects.

There are also many pros and cons to be considered. For example, is it worth trying something that probably won't work and make me sick while I could feel better and spend time with kids? It could also seem like my body is tired and does not take chemo as well as two years ago. That could be the reason why I've been reacting to Gemzar this autumn.

When I came home yesterday I called up Docrates, a private hospital in Helsinki offering cancer treatments. They are doing experiments using virus treatments to cure cancer. None of the doctors at the hospital where I am now recommend it as it's still very experimental and you have to pay for it yourself. However, we'd like to hear what they possibly could offer. I promised to copy my papers and send them over and a doctor would call me up sometime next week.

Many people ask how I'm doing. Well, pretty fine actually. Living with incurable cancer for 2,5 years has made me somewhat prepared for this situation also.

Food!

Previous week was of a challenging sort. I had nausea, no appetite and struggled to eat the whole week. The anti-nausea pills I would normally take didn't improve my condition very much either. My weight dropped to 78 kg and we started getting a little worried if the cancer had a role in this. Marjo forced me to see a doctor. I called my nurse on Thursday, cancelled the chemo treatment and got a doctor's appointment the following day at 1300.

The doctor couldn't find anything unusual but prescribed me cortisone pills to increase appetite. We have to wait for the CT pictures to find out how the cancer is really doing. I'll have the scan tomorrow but get to hear the results in two weeks when I'm scheduled with the senior doctor.

Well, the cortisone pills seem to work and the appetite improved during the weekend. Yesterday I was happy to have half a pizza for lunch at a Kotipizza restaurant. I took the rest with me home and had it in the evening.

Winter-time

Time flies! Clocks have already been turned back! I've been a little lazy updating the blog lately. I haven't been busy in any particular way either so guess this comes down to pure lazyness. Well, I tend to end up tired in the couch in the evenings with little motivation to do much else than watch TV.

The chemo I'm on (Gemzar in particular) gives me some trouble and the treatment schedule is so that nausea, tiredness and stomack issues hit during weekends. During weekdays I normally feel pretty fine. I'm taking various drugs as counter-measures to the unwanted side-effects and the situation isn't too bad. My appetite isn't what it used to be though, and I have to pay more attention to eating. I've gone under 80 kg whereas I was over 90 kg one year ago. I will try and have the chemo schedule changed after next CT scan (November 10th) so that I can enjoy weekends better.

I had a little break in the treatment in October as the platelets level was very low. We used the opportunity to visit friends outside of Turku and then we had visitors from Norway one long weekend. Both very nice.

Birthday

Yeah, I turned 40! We did not plan any big celebration as my condition is a bit unpredictable. The birthday didn't start very well either. I was sick in the morning with some stomach-flu like symptoms. Luckily it passed and by lunch time Marjo got a green light to bake a cake together with the kids. The youngest guy is especially eager to help with cooking nowadays as he gets to lick the spatial. He's very determined to help with anything and do stuff on his own at the moment.

We had a very small birthday party in the afternoon with in-laws and some relatives. The cake was great and there was a very heavy present waiting. I'm now the lucky owner of PlayStation Move! Now we just need to figure out what games to buy. I bet a football game will be high on the list.

On the outdoors front, we've lately done some geocaching with the kids. It's a fun way to get out into the woods. Well, fun as long as we find the cache. Once we even took the father-in-law with us. I've also managed to squeeze in a couple of rounds of golf. The end of the golf season is getting close as temperatures are dropping so I may have hit my last golf ball this year already.

I'm doing better battling Gemzar. I tried a better anti-nausea drug called Emend and last weekend was pretty good. I got Gemzar again today so hope Emend will do the trick again.

Here's one of my favourite Monthy Pyton sketches. Enjoy!

Gemzar

It seems I forgot to update the blog after the doctor's appointment last week. Well, there isn't that much of news really. The blood values were good and the doctor put me back on the Gemzar/Vectibix treatment. They also took the CEA which was 730,6. This is roughly the same level as in August when it was 733,6. It seems Gemzar unfortunately gives me some trouble. This time I had a chemo brain on Thursday and Friday (which isn't that bad really) but felt totally crap on Saturday and Sunday. Monday I was fine again. I managed to join the family for circus during the day on Saturday so I wasn't totally out of it either. I have to admit I've had some thoughts if it's worth getting Gemzar as I'm supposed to be getting it three weeks in a row and then there is only one week of break. Next CT scan is in November so I guess I have to try and manage until then.

Just a brief update

Jan Arne was in the hospital until Friday last week. They gave him IV antibiotics in case the throat infection was caused by bacteria, but they didn't manage to figure out with tests what bacteria it was. One doctor said it is a clear case of mononucleosis, but in the end it was not according to tests. His blood values were on the low side, platelets down to 50 (limit for normal 150 and limit for getting chemo 100), and also leucosytes and hemoglobin were quite a bit below normal limits.

They let him come home anyway for the weekend and he was very tired but well enough to even do some geocaching with the kids. We also went to pick up some apples from friends' garden on Sunday.

This morning Jan Arne went for a blood tests, still feeling very tired after a badly slept night. Interestingly enough, his blood values were back to the level they were before they gave him Gemzar a week and a half ago, other values normal, even platelets up to 127 which is good for him. He will have another blood test and a doctor's appointment on Thursday. The doctor will then decide if he will get some chemo and/or Vectibix on Thursday.

And it's.... a hospital trip for a change

It hasn't gone quite the way we thought it would go this week.

Jan Arne got the dose of Gemzar and Vectibix last Thursday. We thought the side effects of Gemzar weren't supposed to be bad but on Saturday he started to feel very sleepy and weak. He didn't have fever so I figured it was just fatigue which is a common side effect from Gemzar. The problem was that the fatigue was Just So Bad, and he had no appetite either. He slept most of Saturday. And Sunday. And yesterday. Except in the evening he took the older kid to football practise, and today to play a game (they won 2-0, yippee :) I felt bad that Jan Arne had to go but I had something else both evenings and he said he is tired but ok, except today he had a sore throat in the morning.

The problem with having a cancer patient and two young kids in the family is that the kids keep you busy until they go to bed (even with my parents helping), and only then you can really pay attention to the cancer patient. Good luck he paid attention to himself and took his temperature. It was 38.7 C so I took a look at his throat and it looked like it could be infected (no I have not started my medical studies yet but maybe I should). I phoned the cancer ward and they said he should get to the hospital. Unfortunately the doctor had just gone home 15 minutes earlier, otherwise he could have taken a look at Jan Arne. Instead he had to go to the first aid once again and it's not the nicest place as the service can sometimes be quite slow. He went there two hours ago and had just now had his blood test taken, and it's 23:30 (11.30 pm).

Sigh. Well at least he got some kind of a bed to lie in in there but hopefully they will take him to the cancer ward soon so he can get some proper rest (in a hospital bed?? Yea right). But better to be safe than sorry if it is a throat infection as we don't know how his blood values are after Gemzar and if he manages to battle the infection. But now we don't know if he's been tired because of the chemo or because of a flu.

To be continued.

In the woods

I had my first dose of Gemzar today and I am experiencing a slight chemobrain. I had almost forgotten how it feels like since last I had it was with Camptosar back in April. The wife and I celebrated the first dose by having some lunch downtown. When I came home I went straight to bed and slept for two hours. Another reason for feeling tired may be staying up late last night to watch Copenhagen - Rosenborg (football). Copenhagen won and was by far the better team (congratulations Denmark!).

I've recently been going to the woods with a map and a compass. There are these weekly orienteering events open for everyone that I've joined a couple of times (iltarastit in Finnish). I've had a two years break from orienteering and it feels fantastic to fly through the woods again. Well, flying was a bit of an overstatement. I walk part of the time as I'm not that fit anymore. I hope to go for the third time next week.

I also played a round of golf with a friend the other day. I haven't played much the recent years so my swing is pretty rusty. But actually it doesn't really matter anymore. It was great fun anyway!

Something to add

(wife writing this time) An interesting turn of events today. Jan Arne got a phone call from the doctor we met yesterday. She had discussed Jan Arne's case with another senior oncologist specialising on colorectal cancers and he had suggested that in the next treatment they will add a new chemo to his cocktail, Gemzar (gemcitabine) which is most commonly used for pancreatic and lung cancers. Let's hope it will have an impact on the metastases in the lungs! Have a good weekend you all! It'll be another warm one in Finland, the heat wave has lasted almost continuously since the beginning of July.

Good and bad news

The doctor had both bad and good news to share about the CT scan report. To take the good news first, the tumours in the liver had shrunk. The measure of the biggest tumor is now 2,7 x 3,8 cm while it was 3,6 x 6,1 cm in the April CT scan. Quite a big change actually. Also on the positive side was the fact that CEA had gone down to 733,6. It was 829,6 on 2nd of June. The bad news was that there is cancer growth outside of the liver. Many lymph nodes around the liver have grown in size and some small tumours (2-3 mm in diameter) can also be seen on both side of the lungs.

We don't know if the cancer started to grow before or after I started on Vectibix. Since the CEA value decreased since June, it is possible that the growth happened during the (unintended, because of bile duct trouble) chemo break in April/May and that Vectibix has had an effect and reduced the cancer. In any case, the doctor recommended I would continue on Vectibix, then they will check the CEA value again in a month, and take another CT scan in two months.

Funnily enough, I left the doctor's office with a positive feeling. I had expected worse news, but now I choose to belive Vectibix is working. Anyhow, times are uncertain.

First impression

Summer holidays are soon over. Schools start in Tampere tomorrow and our kids start kindergarten next week. We have had a fantastic summer and the warmest ever in Finland. Recently thunderstorms and even tornadoes have hit the country. Makes me wonder about global warming and where all this is going.

The two weeks of cooler weather in Norway was a nice break away from the heat. The trip was also otherwise nice and we were lucky to meet up with family and many friends. The kids speak much better Norwegian now and especially the younger guy improved his language skills a lot, now he speaks pretty consistently only Norwegian with me.

We have a nice beach nearby that we have visited frequently with the kids. The other day there was a huge, in terms of muscles, man standing next to us watching his own kid swim. He was bald and had lots of tattoos. I imagined he probably rides a Harley Davidson and is a member of the local motorcycle club. All of a sudden he spoke to me and I got slightly worried. He thought I spoke Swedish with the kids and he explained he had himself lived in Sweden for years. We spoke for a while and he turned out to be a really nice guy. It was one of those times you realise first impression is not always right.

Yesterday I had a CT scan and I'll get to hear the results on Thursday. We are again living exciting times. The blood values have been good throughout the summer but this time I'm worried about the results of the scan because of the cancer marker that was on the rise in June.

Norway

"If you have the energy" said the husband when I asked if I should update the blog. Well I guess I do.

No news is no news in this case, just business as usual. Jan Arne has received Vectibix now three (or four?) times and the blood values have been good every time. The liver values have normalised since all the hassle in April/May so the stent is finally working. Even one of the values (afos) we thought is probably related to the cancer being active again is almost within normal limit which it has not been since the diagnosis.

In July we had two anniversaries: two years from the diagnosis and 15 years since we started dating (and pretty much the same amount of time since we met Jack ;D). We celebrated the 15-year anniversary the day before by going to the new IKEA nearby to have shrimp sandwiches 3.90 euros each.

Now we are in Norway for two weeks, enjoying the cooler weather (in Finland the temperature has been around 30C for close to two weeks now) and meeting a lot of friends and relatives and eating a lot of cakes. Nice :)

Midsummer

Thank you wife for maintaining the blog in my (mental) absence!

Times have been pretty good since the last stent insertion where they used the ERCP technique. The blood values on Monday were also good so this may be a sustainable solution. I'm getting Vectibix every second week and had my second shot on Monday. The side-effects aren't bad. The main issues are rash in the face and upper-body. In future I can expect nail bed infections and (natural) eyelash extensions.

I've been on sick leave from work since the bile ducts problem started in April. I'll stay off from work throughout the year since the situation with the cancer is uncertain. The next CT scan (August?) will probably tell more what's happening.

I've had the pleasure of spending a lot of time with the kids recently. A week ago we took a day trip to visit Hakkaraisen talo in Vammala (House of Mr. Clutterbuck) and the spa in Ikaalinen. I think this was the first spa visit with the kids ever and they had great fun. The water slide was in particular a popular place and it was difficult to pull them out from there when we decided to leave.

Last weekend we celebrated midsummer (Juhannus) on in-laws summer cottage. The oldest kid fell in love with the tent that we brought along for the fun of it and decided to sleep all three nights there. He had no trouble falling asleep while I stayed awake for most of the night. Luckily, Marjo stepped in for the following two nights so I got to sleep inside the cottage in a proper bed.

In and out and in and out of hospital...

The wife of a lazy husband here again. Well, he hasn't had the easiest of weeks so maybe he's entitled to just lie down on the couch and watch football...

ERCP went well! Hehe, that's the wife perspective I bet. The patient himself said the procedure was awful and it sounded like that was an understatement. If you want to imagine the gory (??) details read more about ERCP here. It also sounded like the doctor managed to scratch his pancreas slightly during the procedure, this did not luckily end up into pancreatitis (which can be hellish or even lethal I understand) but did cause a lot of pain and nausea. So Monday was not a good day for Jan Arne.

But lo and behold, the following day they let out this man, weak but anyway, although 10 hours earlier I had asked the nurse if he would live throughout the night. Well, I must admit that was a bit sarcastic question to a nurse that was not being very friendly to me.

On Wednesday we visited an oncologist, just a regular visit that we have not made in several weeks. The oncologist (a new one, they still have ones we haven't met during these two years!) said Jan Arne's blood values were ok for chemo treatments and they got him an appointment for today (Friday). So in he went today for his first ever dose of Vectibix.

I say chemo but Vectibix is actually an anti-body medicine. We agree with the doctors it makes sense to go with a moderate approach after the difficult six weeks Jan Arne has had, but it does not mean that if all goes well for a few weeks we would not go pestering them about trying with one or another chemo one more time.

Other than that, Jan Arne has been tired after the ERCP but we even ventured a short trip to the local amusement park with the kids yesterday. So all in all, after Monday, a pretty ok week. Jan Arne can give his own perspective when he has energy.

Out and in of hospital

Wife here for a change as the patient himself is so busy. Jan Arne got out of the hospital a bit more than a week ago and has been slowly getting better. He's been tired because of the infection and the antibiotics but now finally the blood values are more or less ok, except a couple of the liver values. He's been well enough to even look after the kids while I have been at work, just regular father-sons action, going out for hamburgers and new water guns (or water bazookas more like). Now they have been visiting the grandparents here in Finland for two days.

The oncologists (cancer doctors) had discussed Jan Arne's case in their meeting last week and the conclusion seems to be that first of all the bile duct stent & drain solution needs to be changed to an internal stent without drain so that the risk of infections would be smaller. When that is done and if all goes well (and no new infections) they will try another treatment with another antibody medicine called Vectibix. It's a similar medicine than Erbitux which Jan Arne has been receiving for a year now, but somehow slightly different and can be used alone without a chemo. The cancer seems to be getting active again so the doctors apparently want to change the medication because they think that the previous treatment no longer works. So not really the best of news this time but let's see how the ERCP (method of installing the stent) goes on Monday and then keep all the thumbs up and fingers crossed or whatever method you want to use for wishing that they can start with Vectibix and that it will work.

Ice cream

The family stopped by the hospital during the weekend and we had some ice cream Marjo picked up from the hospital kiosk. I asked the kids what their favourite ice cream were. The oldest kept a specific twister ice pop (saftis / mehujää) as his. The youngest had strawberry ice cream in a cone (kroneis / tuutti) as his favourite. By the way, it happened to be exactly the one he was eating. It's wonderful to watch your kids eat ice cream. You realize how much technique really is needed if you want to get it done without making a mess.

I've just been allowed to leave the hospital. The infection is on decline and the pipe solution has been working (up until now at least). I'm now waiting for some papers and after that I'm off into the free world. The doctor said there is a department meeting tomorrow afternoon where they'll discuss my case and how to continue treatments. She promised she would call me up on Thursday morning with more information.

Back in hospital

Things change fast in my situation. On the very same day as my previous blog post (Thursday a week ago) I had to check in at First Aid. The drain solution seemed not to work as it started leaking liquids in various colors, also some blood. After many investigations during the evening I was sent home again and asked to come back if it got worse. During the night it did really get worse and on Friday morning I had fever and felt lousy. I checked in at First Aid again and this time I was sent to the surgeon who changed the pipes. According to him it is not unusual that the drains get stuck and need to be changed.

I was allowed to leave First Aid around four in the afternoon. Summer waited outside with lovely sun and +25 degrees. I had a pretty good weekend and even managed to go out with a friend on Saturday. We played mini-golf and had something to eat in a restaurant.

Unfortunately, the good times didn't last long. On Wednesday morning the drain started leaking heavily again and wise from experience I went immediately to First Aid. The pipes were changed and this time they increased the dimensions of them. Hopefully bigger pipes will do the trick.

As if all this pipe hassle wasn't enough, I naturally came down with some fever Wednesday evening. When I measured my temperature in the morning (yesterday) the meter showed 40 degrees and there I was off to First Aid again! The doctors spent all day on investigations but didn't really come to any other conclusion than that there may be an internal infection related to the drain change. At eight in the evening they transferred me to the cancer department for monitoring and further treatment. So, I'm back at the same place as I was at the end of April. Room 8 this time.

Sunshine in between

The days since the hospital exit about two weeks ago have been pretty challenging. In general I can't remember I've been this sick since I got the diagnosis in 2008. Though I've had some good times in between, most of the time I've felt crap (nausea, bad appetite, insomnia, itching skin, tiredness). The 10 days long antibiotics treatment (pills) after the hospital was pretty hard and I think that caused some of this but possibly the condition of the liver also plays a role. The liver values in blood samples have been going up and down and we’re not sure if the tube and drain solution they put in works as it should. I'm scheduled for further investigations (ultra sound) on Monday morning, which also happens to be Norway's Independence Day. Maybe I should bring a Norwegian flag with me to the hospital? The doctors won't put me back on chemo either until the liver works properly again.

The CRP (infection level) has come down to almost normal level so some progress in that area at least. The pain from the surgery is also on retreat.

I've felt pretty well after ending the antibiotics, in other words the last two days. After giving a blood sample at the hospital this morning I went downtown for an errand and stopped by in a café for a cup of cappuccino. I haven’t felt like drinking coffee for weeks, but today it tasted really good. Maybe the ice-hockey world championships have also had a positive impact on my recent well-being. Denmark and Norway have had some surprise wins and finally tonight Finland got their play together and beat USA. Tonight's match was a thriller to watch though.

We had otherwise a fantastic warm and sunny day today. The temperature hit 20 degrees (Celsius) and all of a sudden nature has come to live. Maybe an exceptionally long and cold winter will turn into an equally long and warm summer? In the afternoon father-in-law, the kids and I went downtown to buy ice cream at the harbor market place. Marjo is on a business trip all week and in-laws stay at our place to help out.

Checking out from room 12

The CRP (infection level) did come down this morning and was 76,3. The doctor said everything looks good and that I can check out tomorrow (Friday). They'd want to give me IV antibiotics for one more day to see the CRP further down before letting me go home and continue with pills. She also said they'd wait another week before starting chemo again.

That means room 12 is mine for one more night and mine only. Nurse said there will be no other patients unless someone would come in via emergency. I'd be happy to get some proper sleep as my roommate last night was a master snorer. Otherwise a very nice guy but what noice! After I got the last IV at mid-night the nurse gave me ear-plugs and a sleeping pill. In addition I put the headphones I use with my iPod on top. Eventually I fell asleep. In the morning the nurse said we both had been snoring loudly. Naturally I think she was joking.

Marjo and the kids dropped by yesterday which was nice. The kids were excited about the bed that could be adjusted with a remote control. I was thinking of letting them have a go with the control but there were too many nurses around. Next time maybe.

Room 12 - day 3

Another lovely and sunny day in Tampere and another day in room 12. I've got a new roommate today so already third since I arrived on Monday.

The infection level (CRP) had gone up since yesterday and was this morning 92,5. CRP should normally be between 0 and 10 so I'm now clearly out of range. Yesteday the doctor decided to change to better antibiotics and I've been given that three times a day as IV. I didn't ask what "better" in this context means. Is it stronger or better suited for my type of infection or what? I was a little surprised to see the CRP further up but the doctor didn't seem worried. She said it could take two days before the drugs kick in. I expect to see some good results tomorrow then.

The liver markers had improved further which were good news:
* ALAT 80 (10-70 is the normal range)
* AFOS 225 (35-105 is the normal range)
The doctor said it could take a couple of weeks for the liver to recover so these markers may come down slowly.

Alright, this all means I'm not checking out of room 12 today and most likely not tomorrow either. Marjo and the kids will visit this afternoon. I have prepared a little party and bought some fresh buns and juice from the hospital cafeteria.

An update from room 12

Thank you wife for maintaining the blog in my mental and physical absence! I'm now in hospital sharing room 12 with another patient. There isn't a lot happening in room 12 except swapping through the TV channels and some chitchatting with fellow roommate. Luckily, there is a common room with TV and a laptop connected to the internet.

I got an infection after the surgery and I'm getting intravenous antibiotics for it. The CRP (infection marker) was yesterday 49,9 and had gone up to 80,0 this morning. The doctor said there is typically a little delay between start of antibotics and the CRP coming down. The liver markers had come further down this morning so we are on the right track. ALAT was now 118 (283 on 21.4) and AFOS 259 (348 on 21.4). The doctors current belief is that the surgery was successfull and that the infection is the only problem right now. As soon as the infection is cleared they will continue the chemo treatment.

I feel otherwise quite fine but have a bit of stomach pains after the surgery. I get painkillers for it and can manage.

Seems I will have to stay here for at least one more night. Luckily a friend of mine just brought me some football magazines. I've got plenty of time to go through those thoroughly.

Not such an easy weekend

The next step was supposed to be blood test on Monday morning and that is now done, but at the same time I had to leave Jan Arne at the hospital. His stomach has been quite sore at times at the weekend, moving around and especially getting up from or lying down to chair or bed has been painful, and last night he had close to 39 C fever. The fever came down and his temperature was normal this morning at the hospital, but they are still suspecting there may be some infection somewhere or that the stent they installed (so heard at the hospital today that they did indeed put in a stent) may have dislocated itself and now causes pain. At least there seems to be an infection so they have hooked him up with some IV antibiotics now. Liver values have not come down much either so I wonder if it means the stent is not working ok or if they just come down that slowly.

So there he is again, turning into a hospital pro very fast, as in the morning he only took with him his toothbrush and a charger for his Nokia E71... Hospital provides medication, food, clothes, bed and linen, and a TV in the room, so I guess that's all you need. I'm anyway glad he's there as it's easier for them to keep an eye on him and take a look into his stomach if need be (looking for the sailing stent), and their storage of antibiotics is better than mine as well. Let's hope things are ok and he will get his next dose of chemo/antibody soon. Kids will be disappointed he is not here when they get home from daycare but good luck grandma came here to entertain them, and to cook (good luck for me).

Update about husband

A very brief update as I am in the middle of baking pizza and Jan Arne is unavailable = watching a ManU match on his laptop.

I went to get Jan Arne home from the hospital on Friday. The nurse wanted to show me how to flush the drain that is now attached to his bile duct/gall bladder (not sure where it is) but he has in fact done it himself. It didn't get clear to me what they had actually done as the doctor we saw had not done the operation. Nor do I know why the external drain instead of internal stent but a wild guess is that as they don't know the reason for the stricture maybe the drain is a safer solution? It is permanent, at least temporarily :) But the main thing is that the bilirubin levels had gone down already on Friday so the solution seems to be working.

Jan Arne is fine except the site they operated on is quite sore whenever he tries to do anything that requires stomach muscles. So walking or sitting down or getting up from bed or getting down to bed to lie down is not that easy, which is unfortunate as all that is quite a big part of life :) But he's doing ok. Enough to watch football anyway. (soon he will not allow me to write these blog entries).

Next step: blood tests on Monday and a dose of Erbitux on Tuesday if the blood tests allow.

Better news!

And the wife acts as the secretary again as the husband lies in the hospital...

This morning Jan Arne went to the hospital early in the morning for the CT scan. After 10 am I got a phone call, of course just when I was in the shower washing my hair (was not at work as my doctor put me on two days of sick leave as I am pretty much unable to work because of the stress caused by this situation).

Jan Arne had phoned me so I phoned back a while later and Jan Arne handed his phone directly to the doctor (the same one we saw on Tuesday) and she said right away "GOOD NEWS. The CT scan showed the metastases in the liver have actually gotten smaller, and the obstruction in the bile ducts is caused by a stricture". Say what?? For some reason the ultrasound didn't give a very good idea of the state of the liver this time. Haven't seen the scan report so don't know more about it now but we'll fill in the blanks in this blog later on. The CEA (cancer marker) value was up a bit from February but that can well be because of the condition with the bile ducts.

They put Jan Arne directly to a line up for the stenting operation, or so I thought. This is where it gets a bit unclear for me, I thought they'd put in an internal stent (i.e. placed inside the biliary duct as a support structure to keep it open) but Jan Arne phoned me in the evening and said he now has a PTC, a percutaneous biliary drainage (google for it if you wish to know more) which is a permanent or a temporary external drain to drain the bile out of the liver. I'll go to the hospital tomorrow to find out more why this solution. Whatever, if it works, and the husband will return to his usual pinkish colour, I'm happy.

Hopefully Jan Arne will get home tomorrow. He says it is painful to move and especially to walk but I hope it will get better soon. Life after operations, even the smaller ones, tends to be a bit painful unfortunately.

And last but not least, a huge thank you to all of you out there around the world for all the positive thoughts and prayers once again, keep doing what you are doing :)

Unfortunately

It's the wife reporting this time. Today in the afternoon Jan Arne had an appointment to have an ultrasound of the liver at the hospital, to figure out what was the cause of the elevated liver values. I left work in the middle of a meeting when Jan Arne sent me a message that the ultrasound was over and he was waiting for the doctor to give him the "verdict". The news was that something is blocking the bile ducts, and unfortunately considering his medical history and what the ultrasound was showing ("heterogeneous liver tissue") the most likely reason for this is that the metastases (tumours) have started to grow again and are maybe putting some pressure on the bile ducts and the bile can't get out of the liver. I hope I am getting this right, it was hard news to listen to and concentrate to listen to and translating this into English is not a piece of cake either right now.

The doc said the next step is to have the CT scan (Thursday, or is possible to squeeze it in , then tomorrow) and in the scan they will see more clearly the situation with the metastases. The scan is also needed by a doctor who will then hopefully later this week put in a stent to help the bile get out ("biliary stenting" it's called). The stent is needed as otherwise Jan Arne's condition will start to get worse little by little.

When we asked "and then" (if the stent works but the cancer is now growing) the doc said that the chemo route has been exhausted, so that's it, pretty much. They can try some radiation to make the tumours smaller. This sounded really bad as we thought there's some medication left they can try. Hopefully we get to talk to another doctor later this week and hear a "second opinion".

But let's just first wait for the CT scan results and the stenting operation.

We left the doctor's office to go pick up the kids from the daycare via pharmacy where Jan Arne got some medication to e.g. ease the itching caused by his condition.

So unfortunately not good news at all today, but I guess we have been still kind of ok. Or maybe we are in shock. Not quite sure how this works.

Break

The blood test on Monday was good and the platelets count had gone up. I got therefore the full package of chemo (Camptosar, Erbitux and start of Xeloda pills) on Tuesday as planned. However, there is something "unplanned" going on now.

I haven't felt very good for more than a week. I got nauseous, dizzy and tired even though I had not gotten chemo. After the IV on Tuesday I had a couple of rough days when I stayed in bed continuously. My urine also started getting unusually dark at which point Marjo forced me to contact the hospital. Well, she had asked me for a couple of days already when I called up the nurse on Thursday afternoon. I was first advised to drink a lot and monitor the situation. On Friday morning the nurse called me from the hospital and asked me to go in for another blood test right away. A couple of hours later the doctor called me and said my liver values (alat, afos and bilirubin) were higher than normal. She told me to quit Xeloda pills right away and next week's chemo is cancelled. I also have to go in for another blood test tomorrow (Monday) morning. I have a CT scheduled for Thursday and they have moved the doctor's appointment forward from Wednesday the 28th and set it up on Friday 23rd. I assume they'd have the CT analysis ready by then as well.

The weekend went pretty well still greatly helped by in-laws who stepped in to help with the kids. I managed to go for a couple of walks and even watch the Manchester City vs. Manchester United game on Saturday. Great result! However, I guess I can't help being a little worried about the medical situation at the moment but try not to speculate. It can be so many tings, e.g. liver is tired of chemo but can also be something non-cancer related.

Hmm

I had a long day at the hospital yesterday. I usually have a blood sample taken the day before chemo, but due to the Easter holidays I had to take it yesterday morning. The same applied to all the other patients that were in for chemo so it took me one hour just to get the blood sample done. Then I spent another hour waiting for the lab to deliver the results. The platelets count was surprisingly 75 and since the lowest limit is 100 for giving chemo the nurse had to consult the doctor. That took another hour as the doctor had to consult yet another doctor which I assume was the senior doctor. Finally at noon I was told they'd only give me Erbitux and that I'd have to wait one week with the other drugs (Camptosar and Xeloda). Only after this decision the nurse could order the drug and the delivery takes some time as well.

The platelets have stayed good-enough-for-chemo for a long time so I got a little worried because this is what happened last spring when the first chemo combination ran out of juice. The platelets count then stayed low for several weeks in a row and the doctors concluded in the end the cancer prevented it from raising. This together with the slight rise in the cancer marker (CEA) in February I can't help but wonder if the cancer is progressing again. I will find out only after next CT scan which is scheduled for 22.4 (April 22).

When I checked out of from the hospital I had spent a nice 6 hours there.

A trip to Stockholm

We did a cruise from Helsinki to Stockholm and back earlier this week. We had a cabin with a window towards the sea which was pretty much covered by ice all the way. I've never been on a ship paving its way trough ice before. While some passengers fancied shopping, the kids and I found it quite interesting just to watch the ice move by. I admit the noise of ice hitting the ship brought into my mind a couple of flash-backs from the movie Titanic. I didn't see any ice bergs though.

In Stockholm we visited the Vasa museum and Junibacken. The first time I visited Vasa in 1995 I had a "wow" experience. The ship is still very impressive. Junibacken is a children's play house based on many familiar characters from Swedish children’s books. It looked like our kids had a similar "wow" experience there as I had in the Vasa museum. It was a great place to visit. Our kids haven't really listened to Swedish very much but our older kid obviously managed to pick up some as he refused to leave the Pippi Longstocking show before it ended.

There is nothing much exciting happening on the cancer side of life except that my eyelashes have grown wild again and need a cut. The doctors were kind enough to postpone my next infusion until after Easter which gives me a few more days with a clear brain.

Winter

We've had an absolutely fantastic winter in Tampere. Skiing and skating conditions have been perfect for months. Maybe slightly too cold for outdoor sports at times. The older kid is already pretty good on crosscountry skis and the younger one gets down the hills nicely in a crouching position. I haven't done a lot of skiing myself but a few weeks ago I felt great and did a couple of trips.

In this video clip I'm going down the steepest hills in the woods around here with my mobile phone in one hand and the poles in the other. One of my sisters is visiting at the moment from Norway. Today she went skiing while we were at work and tried out the same hill. When I asked her how skiing was, she said it's pretty flat around here. So much for that "steep" hill.


I came down with a flu last week and a sore throat this week. Hopefully I'm still able to start the full chemo round on Thursday.

Scan analysis

We had to wait for half an hour before we got to see the doctor this morning. Usually that's nerve-wrecking when there's a CT analysis on the agenda and I'm booked with the senior doctor. This morning the TV was on and I got to watch the third period of Sweden-Slovakia, Olympic ice-hockey quarter-finals, and I almost forgot about what was to come. Sweden surprisingly lost.

The CT scan showed that the direction is still good. No new tumors and the existing tumors are the same size or slightly smaller. CEA had gone up to 57,6 (from 30,3 in December). I was a bit worried about this but the doctor said the pictures are the most important and that other non-cancer factors can impact CEA. The tumor measurements were:
* 6,3 x 3,4 cm (previously 6,7 x 4,1 cm)
* 2,5 x 4,3 cm (previously 2,6 x 4,2 cm)
* 2,1 x 1,5 cm (previously 2,1 x 1,9 cm)
* 1,7 x 2,4 cm (previously 1,7 x 2,4 cm)

We decided to continue the weekly chemo though it's quite tiring. The doctor said I could also change to a bi-weekly treatment schedule, but the schedule I am on now is the most common and most studied one and it is probably also the most effective way of doing it. So I decided to stay on the weekly schedule for the time being, but it is nice to know there is a bi-weekly option as well.

Marjo brought up the issue of future treatment alternatives. We can at least forget the RFA radiation (radio-frequency ablation), which the Independent article in my previous blog post talked about. The doctor explained it would do more harm than good in my case because of the positioning of the tumors. They're sitting too close the border of the liver and thus the radiation might cause damage on other organs close to the liver. He did mention some other possible treatments but Marjo was in a hurry to get to work (as the doctor was half an hour late) so we didn't have much time to discuss that. Will have to ask more about those some other time.

Actually, the doctor didn't discuss the future alternatives much but he mentioned that a longer break from chemo to let the body recover may be possible/necessary at some point as I have been on chemo for almost two years soon. I could also continue with Erbitux and Xeloda only and leave the heaviest chemo Camptosar out for a while. I said a break would be great during summer time but we didn't make any detailed plans.

Scan time

I had another CT scan yesterday but have to wait for the result and analysis until Thursday next week. I've been scheduled to meet the senior doctor this time so I'll have to ask Marjo to think of difficult questions to ask.

Today I was in for a round of full treatment (Camptosar, Erbitux, Xeloda). The platelets count has been consistently good for a long time, but in yesterday's blood sample the count was below the treatment threshold. This was surprising as I've had one week off the heavy drugs (Camptosar and Xeloda). The doctors decided I'd still get the drugs but with reduced Camptosar dose.

My sister forwarded an interesting article in The Independent about a success story of a bowel cancer patient. He got very much the same diagnosis as I got and used the same chemo as I am on now (cetuximab is another name for Erbitux).

Our sons had birthdays earlier this month and they are now three and six. The younger one especially is at a very funny age. A quote from him from this morning while sitting on toilet: "Mom, I don't like dad, he is stupid, he sings stupid songs and gives us too many sandwiches".

Taxi driver

I actually made a New Years resolution this year. I'd try and update my blog a bit more often. Looking at the time stamp of the previous post, I can't say I'm off to a very good start. I have a feeling 2010 is going to be a good blog year though.

My weekly treatments were moved from Wednesdays to Thursdays. When I checked in at the cancer ward a couple of weeks ago the nurses asked if I wanted to share the room with another Norwegian. It turned out he had been there for a while as well but on different days up until now. Pretty cool to have a Norwegians-only room though only for a few hours. We'll try and meet up outside of the hospital as well.

I had to check in at First Aid on Tuesday evening. There has been a stomach bug going around in the family and I eventually got it too. I had a bit of fever and the doctors took it pretty seriously even though I told them it must be the same stuff as the rest of the family has had. I guess they wanted to ensure it was not the swine-flu. I even had to stay over night at the cancer ward. All the rooms were actually booked so they put me into a storage (or something) room. There was a lamp above the bed that looked like those they use when doing surgeries. I didn't sleep too well, but the following morning I felt fine and was sent home. Later on in the afternoon the stomach starting acting up but it lasted only until midnight.

I took a taxi home from the hospital and had a good conversation with the taxi driver. We touched upon important issues like the beautiful winter we have had so far and the status of her taxi business. The usual topics. Well, we also discussed problems around immigration (not sure why) and she was horrified when I gave her some bad examples from Oslo that I've picked up from Norwegian newspapers. Then I noticed she wore no seat belt. I think it's the first time I've ever seen someone drive without a seat belt. I was pretty close to ask her why but managed to keep my mouth shut. It was a pretty nice Mercedes with probably a lot of good air bags, but still I don't get that.

P.S. A note from the wife: what is it with the taxi drivers and immigration?? More than 50% of the time the topic comes up. Gitta Helin even mentioned it in her column in Aamulehti (newspaper) today, she said in Helsinki they have two kinds of taxi drivers: loud racists and those who don't know where Kalastajatorppa is. (Kalastajatorppa being a famous hotel which is not situated downtown Helsinki)