Euro Trip 2014: Belgium

The last time we went to France was for the 24 hours of Le Mans. After the race we went to Brittany followed by the D day beaches of Normandy. This time we decided to try something different. We decided to check out the Northern Belgium cities of Bruges and Ghent, followed by a stop in the Norman cities of Rouen and Honfluer (to break up the drive to Le Mans), and finally our final destination Le Mans for the historic 24 hours. I know what you're asking yourself, "do you have to go to a race to go on vacation?" Well the answer is why not? The races we choose are not like going to you're local NASCAR or Indycar race. They're events. A quarter million people don't go to central France every year to just see cars go in circles. Anyways. Back to Belgium.

My dad and I got up early to take two trains needed to get to Garre de Lyon where we picked up our rental car. When traveling with four adults and a kid we've found renting a car is the way to go. Dragging luggage around airport and train stations, while corralling a toddler sounds like a nightmare (maybe not quite colon cancer level nightmare, but I'd imagine a close second). So Dad and I successfully got our car, a VW half wagon half van with an automatic (first automatic I've driven in Europe, they tend to like manuals) and made our way to the apartment to pick up the rest of the crew. We successfully navigated back to the apartment through Paris rush hour, packed the car and set of towards Belgium.

I love road trips and road tripping in Europe is no different. Around lunch time we stopped at a French road stop. French interstate system is a bit different than the US one (at least out West). First, they cost money to drive on and second, exits off of them are far and few between. So, every so often there is a road stop consisting of gas stations, a convenience store, and a restaurant or two (actually alot like the road stops in New York state, but with bettter food). After a tasty little lunch and some caffine we got back on the road. I will say that I wish American drivers would take some lessons from their European counterparts. Why? Because nothing gets under my skin quicker than 5 lanes of traffic on 880 all going 63 mph. The Europeans use the left lanes as they suppose to be used, as passing lanes.

We finally reached Bruges, checked into the hotel, got settled in our rooms, and then headed downtown for some exploring and dinner. It's strange walking through a touristy  downtown area in europe around dinner time because everything is closed. With the later European dinners (7pm-ish) and most shops closing around 5pm it's strange for us Americans who are use to stuff being open all night long. First order of business in Bruges some moules et frites (mussels and french fries) and Belgian beer. After a tasty dinner we made our way back to the hotel room for a little sleep.

Oliver waving to the canal tour boat on the way to dinner

Checking out some of the shop windows

Sushi chef nutcracker...how cool

My drink and Oliver's

Bruges Bell Tower

Lindsey, Oliver and me with the Bruges canals and bell tower in the background

After breakfast we made our way to the Church of Our Lady to check out the Madonna. Supposedly the Madonna in Bruges is the only statue by Michelangelo that left Italy in his lifetime. During WWII the Germans stole the statue and brought it back to Germany in hopes of putting it in the Fuerher Museum, but the war ended the Russians and the Americans were both looking for the stolen antiquities. The Russians were bringing the ones they found back to Moscow and the Americans were bringing them back to their owners. Luckily the Americans found the Madonna statue first in a salt mine in Austria and returned it to the rightful owner the Church of Our Lady in Bruges. We made our way back to the main square for lunch. I had more moules et frites and of course Belgian beer, I'm not sure a day went by in Belgium that I didn't have moules et frites.

Lindsey and Oliver checking out Michelangelo's Madonna

The Madonna

Oliver lighting prayer candles

Lunch time, Moules et Frites down the hatch

When the moules and beer were gone, we set off for the De Halve Maan brewery to drink more beer. The De Halve Maan brewery is one of the oldest in all of Belgium. We took the tour which was pretty cool (highly recommended for anyone visiting Bruges). They bring you to the roof of their building which gives you a great overview of Bruges. After a dinner not worth discussing we hit the sack.

Screwing around on the way to the Brewery

Hey there's a moon

Time to drink beer!!

Don't worry just apple juice

The next day we got back in the car to visit another Belgian medieval town called Ghent. I was impressed by the parking lot. illuminated signs telling you how many spot were available down each row. Then red and green LEDs above each spot. Red meaning occupied and green meaning open. As you pulled into the spot the LED would turn red. Awesome, if it eliminates the jack ass that goes 2 mph down each row not wanting to miss a spot. Ghent wasn't crowded that day so we didn't witness if it really worked, but a solid idea none the less. Anyways, we did go to Ghent to see something other than a parking lot.

Yes I'm a nerd I took pictures of the parking signs

Green = Empty, Red = Full pretty cool

Ghent is famous for the altarpiece in St. Bavo's Catherdral. It was very detailed for the time period and another of the antiquities that the Germans stole that was returned by the Americans. After checking out the altarpiece, visiting another cathedral, and lighting a prayer candle (Oliver was a fan of lighting the candles), we found a place for lunch. When our stomachs were full we visited  Gravensteen a castle. Oliver was really excited to see where the knights lived. While we found a mannequin being drawn and quartered (not exactly something we wanted to explain to our three year old) all we could find were swords and suits of armor. No knights to be found. Oliver was definitely a fan of the Castle. After we saw the castle we found some proper waffles. In my opinion the waffles billed as Beligian waffles here in the states kind of suck. They are bland unless you heap on gobs whipped cream and strawberries. We found Liege (a town in Eastern Belgium) waffles. They are awesome. A yeast based dough with sugar pearls mixed in and the sugar pearls on the surface that touch the waffle iron caramelize. Fabulous. Also got some Ghent noses, jelly bean like candies that you can't export out of Belgium due to their short shelf life, that are pretty tasty as well. When we were all done in Ghent we made it back to Bruges and had some more moules et frites.

Oliver and Me in one of Ghent's cathedrals

Sante

Another cathedral another prayer candle

Lindsey and Me with Castle Gravensteen in the background

Liege waffles and Ghent noses on the far right

Oliver can't wait to take a bite

View from the top of Gravensteen Castle

Knight's sword

King of the castle...king of the castle

Castle Gravensteen

Oliver looking over the parapets

Climbing in Castles is tiring

More moules

The next day we decided to check out the Chocolate and Frite museums as well as go for a canal boat ride in Bruges. We started at the chocolate museum which took you through the history of chocolate and history of Belgian chocolate. The tour ended with a little chocolate making demo and of course some sampling of chocolate. Then we had a little lunch and made our way to a canal boat ride. The canal boat ride was a good way to get a little history lesson on Bruges and it's unique architecture. Then we found the frite museum which Oliver loved. He's has much more of a savory pallet than a sweet one. One top of that they had a fun little paly area that he was sad to leave when it was time. After sampling some more frite we headed back to the hotel to get ready for dinner.

Lindsey and Oliver at the Chocolate Museum

Testing the chocolate

Bruges tower from the canal boat

Oliver trying to touch the tunnels on the canal boat ride

All of us on canal boat

Oliver cooking some frites

Waiting for our chef to cook our frites

Dinner was at a little grill right on one of the canals. It was a beautiful evening and what do you have on a beautiful evening in Belgium? Yes that's right frog legs. They were prepared really nicely and sort of taste like chicken. Even our adventurous little eater took part and had no problem devourering a pair of legs himself. After dinner we took a little sunset walk along the canal and made our way back to the hotel to pack up as the next day we were heading back to France.

Frog legs

Lindsey eating frog legs

Oliver eating frog legs

Last night in Bruges

Pain in Nick's A**: Colorectal Cancer Screening

I think it's time to get on my soap box. Well maybe not a soap box...how about empty colonoscopy prep bottles.

About a month ago the FDA a approved the Cologuard a non-invasive colorectal cancer screening test. Sweet right? No more scopes where the sun doesn't shine. I mean let's check out what the media had to say about the Cologuard test.

"Instead of a colonoscopy, which often scares people due to the prep work and the invasive procedure, a stool sample would be checked for the presence of red blood cells and DNA mutations."

http://www.kare11.com/story/news/health/2014/08/11/fda-approves-alternative-to-colonoscopy/13932001/

I'm scared no colonoscopy for me...woohooo!!

"A new alternative for one of the most dreaded medical procedures is about to hit the market. Cologuard is the first ever non-invasive colorectal cancer test that can be taken under the privacy of your own home."

http://www.wkow.com/story/26261424/2014/08/12/fda-approves-local-companys-non-invasive-test-for-colon-cancer

An alternative I can do at home...sign me up.

"Alberto Gutierrez, Director of the Office of In Vitro Diagnostics and Radiological Health at FDA’s Center for Devices and Radiological Health, said, “Cologuard gives patients and physicians a better alternative to the painful session of colonoscopy in detecting colon cancer.”"

http://www.wallstreetotc.com/fda-approves-cologuard-test-giving-90-accurate-results-colon-cancer/27097/

Even the FDA guy says it's a better alternative.

"Those who would rather avoid having a colonoscopy now have the option of Cologuard, a noninvasive test that detects the presence of red blood cells and DNA mutations that may indicate the presence of certain kinds of abnormal growths."

http://www.cleveland.com/healthfit/index.ssf/2014/08/cwru_uh_researchers_discovery_behind_first_approved_stool_dna_colorectal_cancer_screening_test.html

I want to avoid cameras where the sun doesn't shine.

"In March, Mayo Clinic announced results of a large clinical trial showing Cologuard was about as effective as a colonoscopy in detecting problems."

http://www.twincities.com/localnews/ci_26317777/mayo-backed-colon-screening-test-gets-fda-approval

About as effective...that's all I need.

"Accurate colon cancer screening has usually involved a colonoscopy, an invasive and unpleasant procedure many chose to avoid. But on Monday, the Food and Drug Administration approved the first and only non-invasive stool DNA colorectal cancer screening test from Exact Sciences Corp. (NASDAQ: EXAS)."

http://247wallst.com/investing/2014/08/12/exact-sciences-colon-cancer-screen-fda-approval-a-total-game-changer/

It's accurate see they said so, why would I not want to avoid an unpleasant procedure?

Well let me be the first one to break it to you. If you do the cologuard test rather than a colonoscopy you ARE increasing the chance that you'll end up with colon cancer. Period! Now why did I not read that in any of the articles? Are you telling me the media of this nation didn't do their homework? Say it aint' so? I guess you really can't blame the media, I mean it is much easier re-printing press releases than being actual journalists.

Look there may be a place for the Cologuard in the colorectal cancer screening tool box. But, it doesn't replace the colonscopy in the tool box. I'm sorry everyone. It just doesn't.

So, you're probably asking yourself, "I wonder why?" First let's talk about how Cologuard works. Basically you poop in a jar and send it to a lab. That lab then looks through the poop for DNA and blood. The idea is that tumors and even some precancerous polyps slough off both blood and tissue (that contains DNA) into poop as it travels through the colon. The trick? The Cologuard guys have found a way to find it in quantities lower than ever before, so the test is more sensitive to the older fecal based tests.

So, since I'm a numbers guy, let get into that. This paper (http://www.nejm.org/doi/full/10.1056/NEJMoa1311194) was published in the New England Journal of Medicine and it has all of the goods. Let's get down to the bottom line. The Cologuard test has a 92% sensitivity in detecting stage I-IV colon cancers. Well that's pretty damn good, isn't it? I mean nothing is 100%. Yeah 92% is a solid number. So why do I make the comment, "If you do the cologuard test rather than a colonoscopy you ARE increasing the chance that you'll end up with colon cancer. Period!" Well it's pretty simple. While Cologuard is decent at finding cancer, it's mediocre at finding precancerous polyps. Cologuard only found 42% of precancerous lesions found by a colonoscopy. Let me tell you, if you have a choice finding colon cancer before it becomes cancer you should chose that. If they find something and it's cancer, if you're lucky it's just some cutting and sewing. If you're moderately lucky maybe some chemo and radiation. If you're luck is piss poor then it could be something you deal with for the rest of your life. As a guy that's had colon cancer and a polyp removed a few months ago, the treatment for the polyp is infinitely easier than the treatment for cancer.

I feel confident speaking for Colon cancer patients around the world in saying, "Suck it up and get your colonoscopy." Colon cancer is one of the few cancers that can be screened for and prevented given a timely colonoscopy. So, just go do it, they really aren't that bad.

P.S. Shame on the FDA guy for that quote. "Better alternative"? By what metric? Not at finding cancer or polyps, which is the point right?

Pain in Nick's A**: Annual CT Scan

Two weeks ago I went to Redwood City to Stanford's Outpatient Medical Center for my (currently) annual scan. These scans are kind of a big deal. Us Colon Clubbers call it scanxiety, the anxiety caused by the upcoming scan/scan/waiting for the results. While I had a colonoscopy 2 months ago to look for local recurrences, local recurrences are not very likely ~10%. Recurrences in my kind of cancer are typically found by CT imaging. Colon cancer likes to travel to the liver (favorite place) and lungs (second favorite) and the best way to look at those sites is via the CT scan (with contrast).

I got there early (6:45am for a 7:30am appt. you never know about Bay Area traffic in the morning), because that's how I roll. Got signed in, changed into scrubs, and waited in the prep room. Since I was getting a IV with contrast they had to start an IV. So I'm not sure what I've done to whom, but the Stanford nurses are 0 for 2 in starting IVs in me in 2014. It's really not that big of a deal, just somewhat amusing. The nurses always feel really bad. I guess with the number of IVs I've had over the last 24 months it's inevitable to have a couple not work out.

So, once she got the IV set and tested it, I waited a couple minutes and the rad tech came and got me. Remember, early appointments mean things are typically on time. I laid down in the bed of the CT scanner, the tech tested the IV again and then plugged me into the automated contrast plunger. I told the tech to check the connection because I had one leak on me once upon a time, so he did. They do a scouting scan first, then pump the contrast in (which feels really weird, like you're peeing you pants), and then two more slower scans (abdomen/pelvis and chest). Five minutes later all done. I chatted with one of the techs who recognized me (from the clinical study I did when I was going through radiation therapy) and then I was off to work.

In the April my Oncologist decided to leave Stanford, which was a little sad because him and I got on so well. But, I'm not on active treatment,so it really isn't that big of a deal. With that said, after my last scan he called me the evening of and told me the results. This time around I don't theoretically have an Oncologist. My last followup was with his Nurse Practitioner, who is super nice, but seemed hesitant to want to call me with the results (maybe MDs have more latitude in the rules than NPs). So with that in mind I decided to schedule my scan on Wednesday the 24th followed by a follow-up with the NP on Thursday the 25th. I didn't want to be waiting forever for the results. My plan was foiled about two weeks ago when the NP's office called and said they were going to have to reschedule my follow-up. Damn. I actually will not be seeing the NP until Oct 7th due to a business trip to Europe. So, I sent her a message, begged and pleaded, and she said she'd have someone call.

So, now that I've had you read four whole paragraphs you're probably wondering what the results were. Wednesday afternoon I got a call from one of the nurses. He told me everything is stable and there was nothing new to report. Good right? Yup that's what I was hoping to hear. I asked him to release the report so I could read it, he said he would as soon as the radiologist signed it. I felt a little indifferent, I mean I should be ecstatic, but I really wanted to read it myself. Wednesday evening goes by, no report. I send the nurse a quick reminder Thursday morning. Thursday evening still no report. By Thursday evening my head is going to bad places. Maybe the radiologist didn't sign something because he reviewed it again and found something or he wanted a second opinion on something that wasn't good. I spent much of Thursday evening thinking about how to go about getting a copy of the report if the Nurse doesn't release it Friday morning. I'll call the office at 9am Friday morning. Then if that doesn't work I'll call the Rad Onc's nurse (who is freaking awesome) to see if she can get me the report at 10am. I had my story all ready to go and 15 minutes before I get on the phone, I get an e-mail saying the report is released and a note from the nurse apologizing because everyone was off site on Thursday. So I finally put eyes on the report.

Reading a CT scan report is a little underwhelming. It doesn't say anywhere on there, "Congratulations you don't have cancer," so don't look for that. No doctor is going out on that limb. You look more for what it doesn't say than what it does say. 'New lesions', 'new nodules', 'new focus', 'growth', 'enlarging', etc... all those would be examples of bad things in a report. 'No new_____', 'no enlarging', 'stable', 'normal', 'patent', etc... are all things you like to see. The report was full of the later. So I'm good to go for another year. The odds are now on my side that I probably won't have to deal with this cancer again anytime soon. Wow. That sounded positive didn't it? What can I say? I'm a head case. Part of me feels if I talk to strongly about not having cancer I'll jinx the whole thing. What can I say I just don't want to tempt fate.