My Experience with Osteosarcoma

Symptoms

Family Trip

On June 30th 2021 I came back from a 3-day family trip about 1 hour away from where I live. I had fun, except one weird thing. I had trouble walking during the trip.

It was very apparent when we walked through a shopping mall, where I had to sit a couple times.

My left leg was limping, but I figured it would fix itself, despite noticing myself that the limping was actually getting worst…

Oops I Fell…

One July 10th 2021 (A Saturday), I had this convo with my mom on FB:

ER Visit

I wanted to wait for my dad who was on vacation.

Because he works in healthcare, I figured things would’ve been handled faster at the hospital with him around.

I guess after seeing me limp, she did NOT want to negociate with me on waiting for Monday.

I ended up meeting a doctor at 3 or 4 AM on Sunday.

I went there and sat in an ER wheelchair. I described to the doctor that I fell, my knee twisted and heard a crack noise. That I sat on the floor hurting for about 20 minutes until I composed myself. Said I couldn’t walk since the fall because the muscle above my knee on the topside of the my leg hurt.

She ordered a knee X-Ray which I did immediately and after checking it, she prescribed anti-inflammatory and some patience.

It’s important that I state: I strongly believe that if you take any 50 doctors and put them in that spot, with me at that moment… the events would’ve been the same. That doctor did nothing wrong.

Tests

About 5 weeks passed during which I walked around using crutches, sometimes attempting to walk.

Around August 10th I did an MRI. As I got out of the machine (40 mins test), I saw the poker face the Nurse was holding and I immediately understood there was a big problem.

An X-Ray followed right after but since only doctors disclose info to patients, all I got was weird vibes and an appointement.

I shared that info with Donpireso. This is the spook message I sent him to meet on voice chat:

I’m saying ‘spook’ because that message is in French. Despite both of us knowing French, we discuss business in English so it’s easier to include everyone on the team.

These are MRI pics of my left femur back then:

Somewhen mid-August I had a leg biopsy. They stick a big needle in your leg to grab a piece of the tumor. A radiologist does the procedure and it doesn’t hurt too much, except when I learned there are nerve endings on the inside of bones.

Diagnosis & Treatment

Big Business Meeting

On August 27th I drove up to a different, university hospital.

Deep down I knew it was cancer on the drive before even meeting the doctor there.

I was already lucky then as there was no shock or surprise when the doctor explained it was either Osteosarcoma or some other possible cancer.

A multi-disciplinary team of specialists had already checked out my case and figured out a course of action. Keep in mind that every cancer case is different, but I was offered a very confident outlook on diagnosis.

From here the timeline gets a bit blurry cause things moved fast. I had three goals from there:

1. Keep Family, Friends and Hypixel in the loop on information.
2. Follow doctor indications, tests and appointments.
3. Try and keep working in-between.

Another snippet of status with Donpireso, right before I announce him the diagnosis on voice:

The Plan

The treatment plan that the kind team of healthcare pros had for me was:

• Do 2 chemo cycles of 5 weeks each
• Surgery
• Enjoy 4 more chemo cycles
• Then check status often enough

There are many ways that doctors treat cancer. There is tons of information and knowledge out there about treatments. I learned a lot from the internet, from talking with other patients and from talking with nurses/doctors, but I can only write with certitude on my own experiences.

Osteosarcoma

Cancer = cells grow out of control.

Your body loses control of the growth of some cells somewhere and they’re forming a tumor.

Wikipedia’s Card:

If you squint your eyes and pretend you’re a doctor, you can see in the top-right that the cells are of varying sizes. They grew, out of control.

Chemotherapy

Chemo is one way to treat cancer.

Basically, some poison was injected in my veins.

It’s poison because it stops cell reproduction, therefore killing cells.

It doesn’t target cancer per-say, but it’s most effective at stopping cells which reproduce often.

Cancerous cells reproduce very often. Here are some other cells which reproduce often:

• Hairs, I lost all hairs except eyebrows and eyelashes (but I saw patients without them).
• Bone Marrow, which produces white blood cells fighting infections. Dodged COVID, dodged Leukemia too btw.
• Gastrointestinal Tract, I felt nausius and vomitted (whole dinners) about 8 times.
• Mouth, I had a couple times where I had troubles eating because it hurt but mouthwash worked quite well.
• Some skin, nothing ugly just a bit dry and some rashes.

Chemo Cycles

Because of all these side effects, doctors split treatment into “cycles” to let people recover a bit in-between poison injections.

I saw this meme while browsing on my laptop during chemo injection: https://hypixel.net/threads/why-rick-astley-is-better-than-minikloon.4629522/

I told The Pit Conclave (it’s a private Discord server for Big Time players) to create a Google Doc, then produced this update after I recovered from a cycle.

The plan for a cycle for me was 5 weeks:

• Week 1: Injection of Doxorubicin+Cisplatin
• Week 2: Sick in bed
• Week 3: The Art of Peace
• Week 4: Hospitalized about 5 days to inject Methotrexate
• Week 5: Peace again? Repeat.

But here’s the rub. Plans fall off. When it comes to cancer, they fall off more often than not.

In my case, the plan didn’t derail too much. I broke down Movember 2021 (I literally couldn’t participate) to Donpireso:

The chemo you see on November 14th is Week 4 of my 1st cycle.

The hospital was nice. It was a special kind, meant for hospitalizing people with bone marrow transplants. I went to that special hospital because Methotrexate is such an effective poison at killing cells that it requires an antidote and close monitoring in case of kidney failure. It’s also the most secure healthcare environment possible against COVID.

My stay at the hospital was not nice. You can see that the green “hospital” span is more than 5 days. It’s 16 days. That’s because I vomitted an important pill at the wrong time. It was a nasty pill, as in try to chew on Tylenols and you’ll see what I mean.

Combine a nasty pill with constant queasiness and tada: I just feared the pill as a whole. Didn’t want to take it again because I figured I would just vomit again.

I had to stay in the hospital longer because my Methotrexate % in my blood was too high for safety without monitoring.

Because my stay was so unpleasant, and because it delayed Doxo, Methotrexate was cut from my cycles post-surgery. They became 3 weeks instead with only Doxo+Cisplat. I had personally read the studies about 5-year survival rate regarding Methotrexate in Osteosarcoma patients before the oncologist suggested this course of action to me.

Chemo Injections

The actual process of chemo administration was simple.

I showed up at about 9am at the hospital. Wait to get called, sit on a “chemo chair” in a room with other cancer patients. Wore a mask.

I took the above pic from Google. They hook you up on bags like these to inject.

Once in the chair, on the first day there would by hydration, meaning injection of saline water for 2 hours.

20 minutes injection of Doxorubicin.

Then 4 hours injection of Cisplatin.

Injection time has no relation to side effects. Doxo is the most effective poison.

Following that I would get hooked to a backpack containing 3-4L of saline and a pump which I would carry around. The pump would get angry and beep if the cable got twisted or if it felt like it. Only had minor beeping issues overall so that equipment seems reliable.

This mean I was hooked up to something injecting something for 24 hours, until I came back the next day around 10 AM and injected more chemo. During that time I stayed at a (very) closeby hotel-ish place hosted by the Canadian Cancer Society.

So: 6h20 chemo chair, 18h pump, 4h20 chemo chair, 16h pump, unhook and drive back to actual home. Some gaming/working for a day until I get sick and stuck in bed for 1 week.

During injection times I was able to browse on my laptop, philosophize on the Hypixel Slack, lose at poker, annoy nurses with jokes, pee in deep red from Doxo, talk with other patients… Basically vacation days!

There were also many many pills associated with chemo and treatment. One-time pills, per-cycle pills, daily pills, just… pills.

The hospital had no wifi so I had to setup a hotspot using LTE on my phone.

Surgery

Surgery was in the first few days of December. I was made aware of all the details a few weeks prior.

There was 1 orthopedic surgeon, 1 plastic surgeon, 1 anesthesiologist, each with a 0-2 apprentices and a handful of nurses.

The orthopedist sawed out the tumor while making sure cancer cells didn’t leak. Then replaced the missing femur part with a new femur part from a dead body and solidified everything with a metal structure. All these components were tailor-made by an engineering firm who worked off of the MRI/scans data.

The orthopedist also cut out a part of my fibula, the bone behind the tibia in the lower-end of the leg and pasted it on top of my femur.

The plastic surgeon took the blood vessels including an artery from the fibula area and hooked it all back up around the femur with the goal of having blood actually still pass there. Basically an overpaid plumber.

The anesthesiologist made sure I didn’t get bored during the 15 hours of the surgery.

The two left pics are MRI scans taken a few days post-surgery. The right-most pic is a CT Scan taken start of June.

Things Nobody Wants to Know

PICC Line

For the duration of chemo treatments (6+ months), I had a PICC Line setup. A radiologist does installation, but a nurse does uninstallation by just pulling on the cable.

If stuff went into my veins, it went through there. This includes chemo, constrast agents and whatever.

Source: https://www.aboutkidshealth.ca/article?contentid=1012&language=english

A nurse came to my home weekly for maintenance of the PICC Line. Visits of about 25 minutes. Sometimes I was sick from chemo during those visits.

It also hurt if I extended my arm and I had dangling cables. Look up “PICC Line” on Google Image to understand what I mean by dangling cables. They’re annoying but I got used to them.

PICC line can’t stay forever. Mine changed once because it was leaking a bit off the arm. Switched arm too so I have 2 marks on my skin right now, same place each side.

I also had clotting inside of my arm from the PICC Line so I had to take blood thinners. Also at one point the PICC Line cable came out a little so a radiologist had to re-insert it a bit further.

Blood Tests

Doctors are injecting poison into your veins. They wanna check if that poison is gone from your blood.

They also want to check a million other things from blood panels, very often.

While hospitalized, it’s blood tests every day.

Some people have their blood samples taken from their PICC Line, but in my case that was slow/unreliable.

A blood test means a nurse sticks a needle in your veins. Sometimes a couple of times, depending on the nurse’s experience and depending on your body. My PB is 6 attempts.

Weird Tests

There are some other necessary tests which were curious experiences:

X-Ray: An X-Ray is a blurry picture, it’s old tech but fast/cheap. Takes 5 minutes.

CT Scan: A scan is a ton of pictures. Enough 2D pictures to build a 3D picture. Takes 5 minutes aswell.

PET Scan: It’s a 3D picture of your body and it highlights cancer cells.

They checked whether the cancer had spread elsewhere than my Femur. The most likely spread location by far for Osteosarcoma is lungs, which is bad but solve-able. What this means is that my status checks for the future are leg and lung scans. My PET Scan result was clean.

A PET Scan is a special Scan where they make you drink a surprising quantity of weird goo first, then make you wait 1 hour under a hot blanket and then you go in some machine that looks just like a CT scan but it’s 20 minutes.

MRI with contrast: It’s a 3D picture too but it’s cooler. I wish I knew when to order a CT Scan vs an MRI, I would be a better doctor.

I had 2 MRIs. The first one for diagnosis, the second one with contrast. Injects stuff into your blood to show highlights on the picture. I heard vomitting is really rare, but that contrast costed me two Timatins that morning.

CT Scan with iodine: AFAIK it’s the equivalent of a constrast MRI but for CT Scans.

I had 2 of those. They’re about 10 minutes but I’m not a fan. The iodine constrat makes you feel like you peed yourself, makes you feel hot and has a weird taste in the mouth. No bueno combined with chemo.

Vagal Shocks

Science codeword is Vasovagal Syncope. I experienced 3 of those during treatment (once before in my life years ago).

1st was when I took a first look at the MRI pics I shared above.

2nd was during the first installation of the PICC Line.

3rd was the first time the nurse came to maintain said PICC Line. That one was ridiculous because I was sick from chemo and didn’t know the new allowable limits of energy I was afforded.

When these happen, you just basically collapse. What’s important as a patient is to realize what’s happening, understand you’re not dying yet and relax. Then just lie down, put your legs up if you believe in science, wait until it passes, drink some water and you’re k.

Sick & Stuck in Bed

The worst effect of chemotherapy for me was the weakness, the lack of energy.

It’s important to differentiate tiredness from weakness. I didn’t feel like sleeping. Sleeping wouldn’t help with this.

The problem I had was that if I stood up for 3-5 minutes or sat at my computer for 15-20 minutes, I would start seeing black at the edges of my vision, getting queasy, lost balance, lost blood pressure and would eventually collapse. While in the 2-5 days span of the depth of chemo reaction, this was an inevitabilty.

I also couldn’t focus so much on either my laptop or cellphone. Just TV. For example I can tell you that Brooklyn 99 seasons 1-3 have a lot more jokes centered on disgust than later seasons. I just skipped those scenes, much like that one Office cold open about Phylis’s parfum.

Because I couldn’t afford to fall, this meant I peed in containers next to my bed and was just stuck there for 5-7 days. This span started a 1-4 days after injection.

As cycles continued the span shortened and all side-effects reduced (dosage stayed the same), but in regards to energy I developed anemia anyway which stuck around for about 5 weeks once the chemo ended.

Philosophy

Getting through Treatment

Two internal forces were at odds for me. I think they helped me get through treatment.

First, not walking is a big problem. Not walking is a breach of independence, which is something so important to me that it might aswell be in my dictionary definition.

Second is a personal philosophy best described with a pic:

As most things, that philosophy is usually easier to declare than to maintain.

If you scroll up and take a look at the MRI again, what you see is a brittle bone.

What this translated into for me pre-surgery (including chemo) was that I couldn’t ever put any weight on my leg and had to be extremely careful about it.

The reason was that if that brittle bone breaks, not only would it hurt a lot immediately, it means the cancerous cells break out of their bony cocoon and start spreading en masse, dramatically increasing the odds of metastasis.

Not Walking

So uh… don’t walk before diagnosis, but absolutely don’t walk after.

It also means don’t fall, don’t slip on ice from Canada’s cold winters.

Don’t take risks about it, going outside is risky not only from being immunosupressed from chemo during COVID, but someone might shove you by accident.

It means you shouldn’t go get your own groceries. You shouldn’t go get your own medicine.

If I needed to be somewhere, I had to make sure it was an absolute necessecity.

How can I yolo going to the toilet if I’m risking it all? Well, maybe it’s always been yolo.

I was lucky, because I had a loving family who took care of my supplies, transportation to the hospital and checking my status.

Hospitalization

I despise staying in any hospital. My life was dictated to me, all on a schedule. If a person is defined by their actions, then being stuck in a hospital bed means they are undefined.

Every day is a blurry repeat of the previous day, with attendants/nurses/doctors doing their job on a schedule. At some point I learned the beat and planned how to make the next person entering laugh so I could break the monotony.

I also broke the schedule by listening to music, playing some games on my phone, reading, but all of it was ephemeral.

The real breaks which helped pass the time were family/friends visits and I was lucky there.

If you’ve followed the story this far, I was hospitalized 1) for 1 chemo cycle 2) for surgery 3) for a chemo-related incident (low blood pressure ER visit). The strictest minimum I could handle.

On Technoblade

Techno truly achieved icon status. The best way I describe it to boomer friends is that I once setup a new smart TV at a cousin’s house and once we launched the YT app, Techno was the 2nd recommended little square.

But therein lies everything that needs to be understood about him. Jayavarmen knew him from his time in the Elite team on Hypixel (9+ years ago, on Skype). Jay explained to me that even back then, at 60 subs and 14 years old, Techno said he was going to hit a million subscribers. Remember that in 2013, hitting 30,000 subs was reserved for “pro” youtubers, before they were called generic “content creators”.

It’s a true example to follow, no matter who you are or when you were born. Crafting yourself a goal which everybody finds ridiculous, using your creativity to entertain millions, sticking to it no matter the ups and downs and always playing fair. Sometimes they’re called influencers but in this and age, the world objectively lost a good influence.

I was lucky to interact with Dave a few times. When playtesting SkyWars, when playtesting The Pit’s first version (before there were perks), when gathering feedback for the Dante event and when he shared his insights on Hypixel games throughout the years.

I was diagnosed nearly around the same time as Techno of the same disease. Mine in the leg, his in the arm. Same disease, same treatment. Once I had cleared the chemo cycles in March and we didn’t hear any news, I had a feeling that the saying “no news is good news” didn’t apply.

People often ask me what I do for a living and I struggle to explain. Karen? I say I work for Minecraft. But when I was in the hospital bed after surgery and felt like just creating games, I understood something about myself.

So in conclusion, when Techno’s dad said the message at the start of his final video was written in the last 8 hours of his own life, it hit a really strong note with me. Not just about how lucky I am, but how everyone has something to learn from the blood god.