It Might Get Messy

Let’s take stock of what we, as a society, learned this year. The Higgs Boson still doesn’t exist, although deflections in the readouts make their nonexistence highly improbable. The oldest “animals” in Chinese fossils nearly 600 million years old turn out to be some kind of fungus (admittedly, it’s OLD fungus). Antioxidants don’t prevent prostate cancer. College graduates get better cancer treatment than those less well educated. And rats not only learn to liberate other trapped rats, they give them gratuitous chocolate treats.


Personally? What a year. The stuff “used to treat vaginal yeast infections” worked. The chronic pain on the deep left of my tongue is almost gone. I’m not generating nearly the volume of disgusting ropey throat mucous in the evening. My tongue rehab is making my voice at least marginally more understandable. And I can drink a 500 calorie breakfast product shake (made with whole milk, of course) in lieu of two of my cans of international emergency rations. 


So, physically, I suppose I’m climbing out of the hole. Although I’m still unable to swallow anything more challenging than cream-thick liquid. I’m also still pretty nervous about the future. Which is a good segue for this New Year’s edition. We need some predictions about next year!


Prediction 1: aliens will not contact earth. Earth will not contact aliens. Despite Discovery Channel’s best efforts, Bigfoot will not actually be encountered. See http: //www.bfro.net/


Prediction 2: none of the present Republican candidates for President will be elected. Can you frickin’ imagine? See http://nymag.com/daily/intel/2011/06/god_caught_backing_multiple_go.html


Prediction 3: anomalous weather will not be blamed on sunspots. The sun is in a period of low activity, and those annoying spots are nearly gone. Don’t worry. They’ll be back. We’re climbing out of the sunspot cycle minimum, see http://solarscience.msfc.nasa.gov/SunspotCycle.shtml


Prediction 4: the price of high-quality flash-frozen Bluefin tuna will continue to rise on the Tsukiji wholesale market, making those Australian tuna cowboys (see http://scubachronicles.wordpress.com/2008/06/20/tuna-cowboys-playing-with-14ft-makos/ ) wealthy beyond reason.


Prediction 5: the world will not end on 21 December 2012, despite the close-out of the Mayan Long Count Calender (ending the 144,000 day cycle and wrapping up the entire Mayan 5,200 year creation story). For sensible debunking from NASA, see http://www.space.com/14078-apocalypse-2012-doomsday-predictions-debunked-nasa.html . For a rather more fun comprehensive compilation of web-based sources of hysteria, see http://www.december212012.com/ .


So there you have it. Fun as it would be to check in to The Restaurant at the End of the Universe next December, we’re all gonna wake up on 22 December one day older and just those few hours wiser. I’m working on staying optimistic for the coming year, despite my trepidation. I’m running low on Xanax, though, so we’ll have to see how that goes. One thing I do know—you all are motivation for working hard toward recovery. Special shouts this week to Linda for the great photo from “the good old days”, the update from Margaret and her family, and the note from Mary. Thanks all—talk to you next week!

It Might Get Messy

Last February, I presented myself at my GP’s office with the swollen throat and tongue and impaired speech. He took one look and ran—actually ran—upstairs to the nearest throat specialist willing to look at me. Which the guy did. That guy subsequently panicked and called Greater Baltimore Medical Center and the Johns Hopkins Throat Cancer specialists to try to get me in that night. On my way out of his office, the throat guy said “just in case you want some hope that it’s an infection and not a malignancy, here’s a prescription”. I filled the prescription, started the course the next morning. A few hours later it was confirmed that it was cancer and I dropped the med. The stuff he gave me was an antibiotic called Fluconazole. I was reminded of this when my oncologist diagnosed my painful tongue as due to childhood favorite “thrush”. Which, it turns out, is a fungal—actually yeast—infection. Thus the new scrip my oncologist wrote this week for a higher dose tablet says “This medicine is used to treat vaginal yeast infections”. That’s pretty much it. 


But it seems to be working. After two doses, my pain is less and the ropey throat mucous isn’t as bad. Dr. H is just smegging awesome!


Last night I had a dream that I ate a whole pizza. After I was done, I wondered how I managed it by mouth instead of feeding tube. Then I woke up to the reality that it was an Instant Breakfast shake and more UN emergency rations by tube. Sigh.


Also last night, I finished the Gospel of Luke. Now I’m into the Gospel of John. It’s a long one, and takes some slugging to get through. Ah, but there’s the big reward waiting—my annual foray into the Revelation of John. Psychedelia like the Grateful Dead could only wish for.


Tomorrow night (I’m writing this on Friday evening), after the crowd leaves from the crab balls, shrimp, ravioli and ham dinner, I hope to have everything wrapped and under the tree so I can settle in to watch the Midnight Mass from the Vatican. It’s fabulous. They have a creepy little porcelain Jesus that is apparently by some famous post-medieval porcelain house. It’s frightening.


Finally, I hope all of you have a wonderful, wonderful holiday with whatever family and friends you’ve got around. I know I’m just glad to be here for this one, having come through disease and treatment, either of which could have, with a slight miscalculation on anyone’s part, especially me, have seen me not here to send my love to you this holiday. But I’m alive. And I’m damned grateful for it, and for all of you out there, giving me strength to fight through the darkness. Thanks all. I love you. Talk to you around New Year’s!

It Might Get Messy


Friday morning at the hospital, fine-tuning my rehabilitation with Therapist Bethany. Friday afternoon with Dr. K, my GP, gentlemen who saved my life by recognizing my Stage 4 tumors last February. After the exam, he said “May I ask a question? What was the worst part of the whole experience?”


I had to think about it. I thought hard about the emotional strain, the panic over my professional life, the night I was certain I was not going to survive.


The latter was the key. I had gone through the whole seven weeks of two-a-day radiation and weekly chemotherapy treatment, and while it grew increasingly painful on my throat and jaws, it didn’t disable me. I was chirpy and optimistic on the last day of treatment, a Friday when I got the last two doses of radiation. It was that Saturday night that the shit hit the fan. That was the night I dehydrated in nonstop vomiting and had to be shuttled to the ER next morning, where I was admitted, packed into a room, hooked up to an IV and an automatic vacuum throat drain, and given two units of blood for anemia. It was the physical exhaustion and pain of those first few nights after treatment ended that were by far the worst of the worst. As a scientist and at least amateur practitioner of Zen acceptance, I knew going in that cancer is like auto accidents, lightning strikes, and jet engines falling from the sky onto beds. It can happen to anyone. There’s no sense being personally affronted by it when it shows up. You’re gonna spend enough of your physical and emotional strength fighting the battle for recovery. Don’t want to dilute that focus by worrying about what you’ve done to insult the gods.


Dr. K is only a few years younger than I am (his daughter played double-reed instruments in her youth, as did Molly). He said he’s had cancer patients who didn’t have the strength to fight their way through the physiological wasteland of radiation and chemotherapy. 


While it did cross my mind that Saturday night that I might not survive the experience, that just kind of pissed me off. Weak as I was then, and horrified as I was at having to go to the emergency room (4th time in my life, once as a kid for a cut on the head, twice for my stone-packed gall bladder), it made me mad that I’d been forced to it and steeled myself for getting through it. I was, in short, enraged (along with being pretty much prostrate). 


So there you have it. Turns out I lied to Dr. K, and misled you a few paragraphs up. I DID end up emotionally vested in the process, angry, frustrated and out for vengeance. Which latter, with some hard work on this physical therapy, may come to pass. I may yet beat this and come out scarred but whole.


Speech therapist Bethany ran a scope through my sinuses to check out my throat yesterday. Turns out my epiglottis actually still exists. It’s twisted, misshapen, and dysfunctional. But it’s there. Hopefully I’ll have a picture for you next week. 


I hope everyone is having a good runup to the holidays. I sure as hell am thankful this Christmas. Just glad to be here!

It Might Get Messy

In case you haven’t thought about it lately, your epiglottis is an important piece of plumbing. As the (reviewed and referenced, despite missing the “a” in the first sentence) University of Maryland Medical Encyclopedia online puts it: 


The epiglottis is flap of cartilage located in the throat behind the tongue and in front of the larynx. The epiglottis is usually upright at rest allowing air to pass into the larynx and lungs. When a person swallows the epiglottis folds backward to cover the entrance of the larynx so food and liquid do not enter the windpipe and lungs. After swallowing the epiglottis returns to its original upright position.


In other words, your epiglottis sorts solids and liquids from gasses and makes sure each gets down the correct pipe. A major problem with people whose epiglottis fails to do this sorting correctly is pneumonia due to crud (i.e. solids and liquids) running into the air passageways. 


My General Practitioner, Dr. K (who saved my life last year by recognizing that I not only had throat cancer, I had acute Stage 4 throat cancer that needed immediate attention) last week prescribed a new medication for me. It’s a pretty big pill that has to be taken in the morning. I figured I’d just dissolve it like I do with the rest of my meds and pump it into my feeding tube. No go. Not only did that pill not dissolve in a glass of warm water, when I dumped it into the sink it got stuck and took an entire week (in a heavily-used bathroom) to dissolve. 


Nor could the pill be crushed. It has a sort of semi-moist texture that makes it squash but not fragment.


Well, I thought to myself, this’ll be an adventure. I cracked open a (full calorie) A&W root beer, sat on the bed, and took a mouthful of soda. Then I tilted my head back. I used to take pills by dropping same into the liquid in my mouth, then releasing the whole mess via my epiglottis into my gastrointestinal tract. In this case, I was surprised to find that the soda did not stay in my mouth—it drained all by itself into my GIT. None entered my airway (thankfully). Turns out, I can take the pill by being quick about getting it into my mouth during the head-tilt routine. Score one for experimentation.


I spent much of Friday at the hospital having further diagnoses and getting equipment and specifications for physical therapy for my crippled tongue and throat. The therapist set it up so I would start in radiology, where a doc would do real-time radiobarium imaging of my swallowing. I started with a small sip of the icky white liquid and swallowed as directed. “OK, let’s look at this” she says. “See, here’s where your epiglottis used to be. It’s not there any more—the radiation destroyed it.” 


Nobody (except me) seemed the least bit disturbed at the fact that I am now without such a critical item of gastrointestinal plumbing. 


We went on from there. I got a new set of tongue exercises, which we ran through at the therapy session. Between sticking my tongue out, over, and around, and doing isometrics (anybody remember those Royal Canadian Air Force isometrics booklets? My parents were big fans, albeit doing isometrics between cigarettes and glasses of beer) against a tongue depressor, the (now weak and badly scarred) back of my tongue was cramping.


And that’s a good thing. The only way I’m going to be able to eat “normal” food is by making my tongue strong enough to take over some of the function of my now-missing epiglottis. I assume such exercise will also help my voice recover. So now I’m deeply vested in squishy physical therapy with my tongue several times a day. I go back next Friday to check progress.


I’ll let you know. Thanks for stopping by. Y’all are a big chunk of why I’m still here, so thank you again!

It Might Get Messy

In 1897, Winston Churchill [1] wrote “Of all the talents bestowed upon men, none is so precious as the gift of oratory. He who enjoys it wields a power more durable than that of a great king. He is an independent force on the world. Abandoned by his party, betrayed by his friends, stripped of his offices, whoever can command this power is still formidable.”


I shuddered when I read this. It has only just occurred to me that I have made my living and my life based on public speaking. From teaching remedial summer school in Wayne, New Jersey in 1976, through graduate school, academia, government, and consulting, my ability to speak effectively has had my back. Which is a good thing—I’m not swimming in talent, and skillful oratory has been my one true core competency.


I shuddered because the aftermath of my cancer treatment is that my speaking voice is badly impaired. I no longer have the gift of oratory. This scares the crap out of me. There is nothing else I’m really able to do except talk on my feet. It seems to me it’s now a race—my professional life against the recovery of my voice. It’s certainly not a gimme. For one thing, my voice will always be different from its pre-malignancy self. Will it be as persuasive, as sharp, as effective? Beyond that, will I even have a job when it does finally recover? 


At my series of checkups at the hospital last week, it was made clear that it will take on the order of a year, maybe two years, for my voice to recover. It’s not at all clear to me that I can survive professionally that long. Of course, I’m not sure what the alternatives are… . 


On the positive side, the nutritionist gave me some very useful eating advice. I told her that just a bite or two of food by mouth makes me feel full, which is part of why it’s taking so long for me to get off the feeding tube (although recurrent surgery through a few weeks ago also played a role). She says that’s to be expected biochemically. What I have to do is eat a little bit by mouth before I eat via tube. This will prep my system for the big change-over.


And you know what? It seems to be working. I’m still pouring my 8 cans of emergency rations a day, but eating some real food first (well, except for first thing in the morning. I’m barely able to get the two breakfast cans down in the a.m., much less try to prepare and ingest some sort of gruel first). And the past couple of days, I’ve been eating more and more by mouth. I may get through this yet. At least physiologically.


Oh well. Today I put up holiday lights in the cul-de-sac and some in the front yard. Busy work week coming up. Tonight, I’m going back to read a little more of this history of World War Two. And also the gospels and Revelation. Every year between Thanksgiving and my birthday, I read all four gospels. And then, as a reward for the slogging that requires (the lists of “begats” alone is intimidating), I read Revelation. As psychedelic as anything Philip K. Dick, or even the Hindu holy books, can offer. This year, I have a brand new Oxford revised standard edition to replace the rather stodgy King James paperback I’ve used for decades. This is much more readable!


Thanks for checking in, my friends. My love to you all, and I hope you’re having a nice start to the holidays!


Notes


[1] My source is an excellent and very readable recent history of World War Two, The Storm of War, by Andrew Roberts, Harper Collins 2011. The quote is on page 46.

It Might Get Messy

I’ve always measured my years from the autumn. I think it comes from school, of course, which was until way past conventional “school” age (and remains to this day) a huge part of my life. The awkwardness and excitement of September has kept up with me, although more recently the holidays, kicking off with preparations for Thanksgiving, have taken a lead position.


Anyway, if change is gonna come to my life, autumn is when I’m primed to deal with it. My cancer, which was diagnosed at the close of the holidays last year, bridged autumn and winter, and I managed to keep up with it. But it’s autumn now, and time for things to sort themselves out.


My swallowing still sucks, and every evening thick ropes of mucous form in my throat. But over Thanksgiving I got hooked on the turkey gravy. Managed to chug quite a bit of it over a couple of days. Well, a couple of half cups, at least. More oral “food” than I’ve managed over the past weeks.


And this seems to have triggered something inside. I actually woke up hungry the other day. Pounded down a big glass of Instant Breakfast (made with whole milk to maximize calories, of course). I’ve been hungry at some point every day since. Can’t do much more than thick liquid (tonight I had some egg drop soup from the Chinese take out place), but on the other hand, at least I’m doing thick liquid!


Also, my chest drain pulled out last night. Two photos following show it. The white plate with the holes in it was inside my chest. To travel to Boston a couple weeks ago, I had to cut off the balloon collector from the end of the train and tie off the drain (traveling was hard enough without having to empty a balloon full of liquid every few hours). Apparently, the drain was superfluous, and let itself be yanked out as I tossed in my sleep last night. We’ll find out on Wednesday when I see Dr. H (for a drain removal!).

Finally, following is a photo of the wonderful linocut print Janice M. made to honor her  brother’s conquering his throat cancer, this is the proof she sent me. It’s the apparatus needed to get him his meds when his throat closed up shop from the radiation. Looks a lot like the apparatus I used for the same purpose! I hope she doesn’t mind my posting it here (Janice, just let me know, I can pull the photo if you want). 

Anyway, Thanksgiving was fabulous as usual, albeit exhausting. Thanksgiving photos and a bit of text up at http://docviper.livejournal.com/ so be sure to check in!

It Might Get Messy

I had to travel last week. For the whole week. Those of you whose first thought was “dude still has in and out drains, can’t eat or drink, can’t talk, and is too weak to carry a briefcase, much less a suitcase, this must’ve looked like a bad Marx Brothers movie” are spot-on. Between the big toxicology meetings in Boston, and a client meeting tied to same, it was rather professionally required that I attend. Thanks to the tolerance of the research sponsors and the foresight of the project manager, I didn’t have to muddle through a formal presentation at the conference. But I am coauthor on much of the work and responsible for a bunch of it. Had to be there. Slapstick or not!


Among the key comedy-script themes is the Butt Problem. I used to weigh 276 pounds. I now weigh right around 190. My hip bones spent the first 57 years of their life amply padded. Now, they stick painfully right at whatever I am sitting on. 


Oh, did I mention I took the train to Boston? I couldn’t see facing airports in general, much less trying to get my peg, port, and extra drain through security. Besides, the train ride is relaxing and pretty, running from the upper Chesapeake, along Long Island Sound, and past Back Bay. Only thing is, even on the Acela it’s more than 6 hours of sitting. And even with the nice, comfortable Acela seats, my butt hurt after an hour, and was pretty well bruised after the full trip.


Then there’s the Food Problem. I’m supposed to be on a routine of pouring a couple of cans of UN emergency rations into my feeding peg several times a day. This engenders several contretemps. First, there’s not really opportunity to peg-feed on a crowded train. I suspect the discomfort level is not unlike a woman breast-feeding a child, with perhaps the addition of a little general public disgust for the fact that the tube sticks straight out of my abdomen. So, first, I gotta carry enough cans of food in my luggage to eat as soon as I arrive somewhere private. Under no circumstances am I able to swallow actual food in meaningful quantities. Which means I also need food for the entire week. So I fedX’d a case of ration cans to the hotel. Which worked ok, except for a) the conference venue being 600 or 700 meters from the hotel, meaning a lengthy hike to get my several-times-a-day rations, and b) I had to switch hotels mid-week, meaning I had to carry even more cans of food across town with me. Feeding also requires that I have with me 60 ml syringes (which serve as the funnel to the peg), and plenty of water to flush the feeding apparatus with so it’s not stuck full of milky canned rations. Oy. I’m guessing I lost a little weight over the course of the week!


There’s also the Temperature Problem. Since the radiation really started to whack my physiology, say around April, my thermal response mechanisms have been out of kilter. Basically, I’ve been freezing since then. I spend almost all my working time at home in front of a blasting space heater, at the office right underneath a main heating vent. First night at the first hotel, the heater was not working. Called for maintenance. Took the guy not-too-long to arrive, but by the time he got there I was in the middle of feeding—had a syringe full of goop, cans on the coffee table, bottle of water at the ready. Had to answer the door to let him in. While he was futzing with the heating unit, I had an accidental  decoupling of the syringe from the tube and associated spill of liquid rations. Fortunately I had a towel ready for just such an emergency. Unfortunately, the towel didn’t catch the first half pint or so, which poured onto my sweat shirt and sweat pants. And while I’m fighting with my hydraulics, the maintenance engineer finishes up and is ready to leave. So now I have to a) cover the goop running down my front, b) hide as best I can the syringe (now back attached to the tube), c) find cash for a tip, and d) get the guy out of the room. Did I mention the word “slapstick” in conjunction with this trip? In any case, when I finally had things under control, I set the heater on “deep fat fry” and spent a cozy night!


Anyway, I survived the trip. Saw many old and good friends missed others who I know were around. Thanks much to the former, apologies to the latter but maybe this blog entry will help explain why I wasn’t hanging around the booth much—I was probably hiking back to get some “food”! Thanks also to all of you reading this. Special thanks this week to Janice M. for the wonderful, wonderful gift and uplifting letter.


I love you all—have a great Thanksgiving, everybody. I just finished making a huge pan of tomato sauce with meatballs and sausages for the baked ziti. I can just about smell that turkey and the seven-rib rack of beef cooking!

It Might Get Messy

Parasites and parasitic life styles seem sort of simple-minded and brute-force on their face. For many parasites, a simple balance between taking what they need from their hosts while making sure not to take so much that the host population is affected (after all, not only do you gotta eat, but all those generations of little parasites to come gotta eat as well!) defines things. 


But of course that’s just one end of a spectrum of evolution that gets incredibly complex. The creepiest parasites, and there is a surprisingly large number of them, take over not only the host’s physiology, but its psychology and behavior as well. There are fungi, for example, whose spores land on insects, and the mycelia—the “roots” of the fungus—burrow into the insects’s body (often these are ants or roaches of various kinds). While the insect is in the prime of its life, the fungus is careful to avoid the ant’s vital organs and feed only in nonlethal parts of the body. As the ant ages, though, the fungus takes over part of its brain. The fungus adjusts the chemical messages in the brain so that the ant crawls to the very top of a stalk of grass or weed, and then clamps its jaws tight on the plant. At that point, the fungus completes its job, consuming the brain and vital organs of the insect. Then the fungus produces spores, which are now nice and high in the wind and can spread good distances to find more hosts [1]. 


There are many other examples [2]. Toxoplasma acts like a sedative to rats, not only keeping them from panicking when they smell cat urine, but making them seek cat-favored places to hang out. Certain kinds of worms with partial aquatic life cycles get back to the water by triggering suicidal psychosis in grasshoppers, causing them to drown themselves and allowing the parasites the swim away.


Cancer isn’t usually viewed as a “parasite”, nor are its neurological effects generally considered major aspects of its pathology. But I can tell you this—one of the most devastating outcomes of cancer and its treatment is the fact that you, the victim, are not in control of your life. Or death. Or pretty much anything except how stoically you can take the pounding from both sides.


I realized this a few weeks ago after my first round of surgery. Doctor H scraped out all the lymph structure in the area likely to have acquired stray malignancies. This was done really as a precaution—there was no evidence at that point that my lymphatics were affected. But the cancer was large and advanced, and the odds were good that it had reached out and touched tissues beyond the obviously impacted right parotid gland. 


That surgery was supposed to be a landmark on the road to recovery. At that point, the cancer was gone from my body, and the future should have been under my control.


But it wasn’t. The failure of the surgery to stem the flow of lymph into my chest cavity meant I couldn’t get enough nutrition—particularly of the goopy gut-tube liquid—to get stronger. And I could feel it. Moving out of bed took serious effort, taking a short walk required Spartan commitment. Like one of those grasshoppers headed for the nearest farm pond, I was helpless in my own body.


So I went back in for another try. That was the surgery a couple weeks ago on a Tuesday. I knew by the time the anesthetic wore off that evening that we had failed again. I could feel that I was still fighting to keep myself from going for that swim.


That was why it was so important for Dr. H to come in that Friday with a fresh approach, an old hand, and a willingness to tackle the problem again right away. This time, by Saturday mid-day, I could feel a huge shift in my reality. Basically, I could feel that the flood of lymph had stopped, meaning that the last ongoing manifestation of the cancer and its treatment had been taken care of. Life—and recovery—were back under my control. The sense of panic—panic that there was nothing I could do to help repair myself—was gone. Oh, I still have the serious voice impairment, and the trouble swallowing, the inability to eat or drink by mouth, and the weakness that comes from 10 months without serious exercise. But those things are mine to fix now. Now it’s up to me to exercise, and straighten my voice out, and get myself eating real food. And maybe there are limits to how far that recovery goes, and for sure it’s going to take massive effort. But the worms no longer have my brain. I’m not hopping toward that pond, helplessly putting one leg in front of the other at somebody else’s bidding. I’m on my own and it’s up to me. 


Sure feels good!


Notes


[1] http://neurophilosophy.wordpress.com/2006/11/20/brainwashed-by-a-parasite/


[2] http://www.livescience.com/7019-mind-control-parasites.html

It Might Get Messy

So the docs came up with a slow-and-steady response plan to the failure of Tuesday’s surgery to stem the flow of body fluids from the lymph vessels to my chest at large. Concept was to stop using my gastrointestinal tract completely to let the physiology heal itself, in the meantime reestablishing my devastated nutrition via intravenous (vs. gut-tube) feeding. After a few days, the theory was, the exploded lymph system, decoupled from the forward pressure of the gut, might start to knit itself together enough to slow the tidal flushing.


For mostly logistics reasons, this plan went immediately awry. The scrip for the IV nutrition, apparently dangerous if not meticulously prepared, precipitated a kick around between the pharmacy and the docs. The potential for several days invested in mostly waiting with a fairly high potential for little therapeutic return seemed to be on everyone’s mind. The docs didn’t seem all that confident, but were reluctant to move immediately to more drastic and intrusive fixes.


That all went down over Wednesday and Thursday. Friday was now the day to begin to implement the attrition strategy. So it was something of a shock when Doctor H walked into my room at 9 o’clock Friday morning to say “Listen, I got an idea. How would you feel about going in for another round of cutting. Like, say, now. We can get an operating room on an emergency basis at 10:00. I think this will work and we should do it.”


This is one of those moments that patient advocates, patient advisors, and patients with any rational concept of risk management decision making would have a million detailed questions, starting with the basic “what do you want to do while you’re back inside there?” I’m sure we had time for at least a few inquiries and answers, a few moments for reasoned consideration and risk/benefit balancing.


I didn’t bother with any of that. I told Dr. H that if he thought there was something he could do by hacking his way back inside my chest within the hour, I was on board and ready to rock. He said he’d go scrub, I could sign the releases while they wheeled me downstairs, and he’d see me in the operating room in half an hour.


Next thing I knew, I hurt like hell again, Cathy and Molly had dropped everything and hotfooted it to the hospital, and nurses were injecting me with pain killers in the recovery room.


On his way home for the weekend Friday afternoon, Dr. H stopped by my room. He’d come to apologize, he said, for the way I got slapped into another round of surgery with zero notice and minimal technical justification. But he said he’d been waking up in the middle of the night all week worrying about the inability to stop my fluid losses and growing increasingly ticked off about a passive response strategy. He said he finally snapped, figured he knew which way I would prefer to go, and essentially over night lined up his department head, graybeard faculty guy who had more thoracic surgery experience than god, to participate in the operation. He said they dug into my chest until they found three cryptic lymph vessels leaking way in the back corners and tied them off. Then he glued me back together. 


I not only told him not to apologize, I thanked him for having the courage to take a hard-core aggressive path and to cover details like getting his department chair on board.


Status? I hurt like hell, especially my mouth, which has big-ass inflammation from, I think, the breathing tubes, and parts of my neck. But it looks like they cut the flux of lymph. Hell, if my mouth heals and this weird IV feeding bag stuff works, I could be a functional human being in no time.


You gotta love a surgeon not only willing to trust his own instincts but enterprising enough to make it work when he had to line up an emergency operating room and staff and engage a busy senior colleague and courageous enough to suggest to me that I trust his instincts as well. A professional masterpiece on Dr. H’s part that I can only admire and humbly learn from!

It Might Get Messy

10,000 years ago, when the Wisconsin glacial epoch was at its peak, what is now the southwestern U.S. was cooler (duh) and moister than it is now. Not like a swampy Siberian forest, mind you, more like a tall grass prairie—say, Iowa before corn and wheat. The big marshes and shallow lakes of what is now Los Angeles were attractive water sources for the flotsam and jetsam of ice age wildlife. But it turned out that the ponds were teed up on pits full of sticky petroleum goop—the La Brea Tar Pits. 


When a wooly mammoth stepped off the bank and got stuck in the goo, the more it struggled, the harder it got to escape. Since failure to escape was often accompanied by a back full of dire wolves and saber tooth cats (which contributed to the sinking of the entire biological ship), finessing your way out of the increasingly difficult trap, finding a way to spend less time glued to the cartoon-concept landscape, were important.


For me, hospital stays come with a large measure of time-in-the-tar pits analogy. It took me two separate sets of multi-night visits to get my gall bladder excised. After my chemo and radiation, my quick visit to stem the dehydration and anemia ran most of a week. And this week’s trip was scripted as an hour of surgery in the afternoon, overnight observation, out of here first thing in the morning. 


Now running into third night here, with more already added to the schedule, and about to start the odd procedure of being issued some sort of individually designed food mixture via intravenous drip. It is apparently customary to start such drips at bedtime. 


I’m guessing that’s not a good sign for the culinary quality of the stuff….


  

It Might Get Messy

Ray Davies wrote “gotta stand and face it…life is sooo complicated”… . Hard to argue with at the best of times. Ray wanted to “get away from…the complicated life son.” But you run afoul of a complex pathology like cancer in a structurally and functionally intricate area like your throat and, and the odds are good that things are gonna be complicated.


You also know from all those late nights watching syndicated re-runs of The A Team that “Plan B” is the funny one with, as Gimley the Dwarf points out toward the end of the Return of the King “near certainty of death, small chance of success? What are we waiting for?”


Here’s the deal, from day 2 in the hospital. Yesterday’s surgery was intended to plug fluids leaking into the spaces in my neck and chest where they cut out the lymphatics last  month on a more or less prophylactic basis. 


Once they got inside, they found what looked like the source of the leakage. But the tissue was too beaten up by the radiation to take sutures—they just kept ripping out. They improvised a fix with some sort of geotextile fabric stitched to the leaking vessel, but didn’t sound real confident in the post-op briefings.


Today it’s clear that things are still leaking. Thus the A-Team Plan B. In this one, they stop feeding me by tube into my gut and bring in some specialist team that hooks me up to get nutrition intravenously. Apparently the thinking is that if we can give my beat-to-shit GIT and lymph system a vacation, they will recover with less travail.


The whole thing sounds sort of wackily complicated to me. But I keep this in mind—in the A Team, Plan B ALWAYS worked. 


I’ll keep you updated. Thanks for being here for me, everyone. I’m not sure what the hell Plan C might be at this point, but it’s a sure bet it’ll be fun given the reality of Plan B. We’ll see!

It Might Get Messy

Sherman, set the Wayback Machine for one week ago today. Those of you too young to remember Rocky and Bullwinkle should immediately get ahold of all the seasons that have been released and watch them front to back in a weekend marathon. Otherwise, everybody go back to last Friday’s entry here at docviper and re-read it. Except for the one-week displacement (in which I did manage to accomplish some time-critical work, so meeting primary objective of the postponement), it pertains.

In the interim, though, I thought of something. I don’t know much about the lymphatic system. In fact, the only two “things” I sort of know are that a) when your “glands are swollen”, that is usually the flotsam and jetsam of microbial warfare clogging key points in the lymph system, and b) the lymph system is a major route by which cancers spread from primary tumors to the rest of the body. Given that lymphatics is why I am where I am now, heading back in for additional surgical slicing and dicing Tuesday, and also how my secondary tumor that took over my right parotid gland was produced, I figured I should learn something about it.

Evolutionarily, it goes like this. Fish circulatory systems, with gills, operate at a nice moderate pace and pressure. The oxygen-for-carbon dioxide exchange process runs a rate that also allows the nutrient fluids that bathe the tissues at the end of the arteries to release their good stuff and let the spent liquids back into the veins. It just matches up nicely.

Now, when you take away the gills and the direct blood vessel gas exchange, the pace and pressure in the system—arteries and veins—increases. In fact, it gets too high for the cellular bath to make its way back into the veins. Evolutionary solution? Devote a set of vessels to the fluid itself. Run it at low pressure, and the all that fluid can re-enter the circulatory system, run itself back through the heart and other acquisition points, and make another round. A nice, low-tech solution.

My problem now is that the hook-ups from the lymph vessels back to the veins aren’t sealing. Basically, my circulatory system is releasing goop out into the tissues and not picking it back up as needed. Doc H needs to re-seal things up.

I’m hoping this explains my last month of incredible weakness. My nutritional cycle is all screwed up. With a little luck, this might put me back onto some kind of directional path to better health.

You’ll know, because my communications abilities have been very limited lately. I start to feel better, you’ll be inundated with emails, weblogs, photos, random thoughts and way more words than you hoped you’d have to deal with. I’m looking forward to it. Hang in there, my friends. You all are keeping me alive. A little more time and effort and I can shoulder some of the effort from you. Thanks—and all the love and good thoughts I can send your way!

It Might Get Messy—More Supplemental BS

My risk balancing instincts may have gone awry this week. So far, for this most difficult year, I’ve been keeping good track of the trade-offs necessary for cancer treatment, follow up, testing, and normal life—getting actual technical work done at a quality and quantity that mean I can keep my job. So when I woke up Monday feeling particularly strong and functional, I figured maybe I should take the risk to use the week to catch up on some time critical work, especially as needed for the upcoming Society for Environmental Chemistry and Toxicology conference in Boston the week before Thanksgiving. 


This part is actually working pretty well. I’m still close to paralyzed from the perspective of movement and exercise, but when I get to the documents needing thinking, the thinking piece seems to be holding up nicely. Quite possibly I can get caught up on the last month’s being behind on work this week. That’ll be a bonus.


The issue is that my one strong day was just that—one strong day. So I still need Dr. H to do his surgical magic to paste the layers of my chest tissue back to my chest. Hopefully he can work me into his surgery schedule for next week and I’ll get it done. I’m still pouring bodily fluids into their little collection balloons, and that has to stop, so it may be time to cut. 


Because I want to be ready to make Thanksgiving-associated meals. Big ones. Good ones. Ones that take a lot of chopping and slicing and dicing. Basically, I am getting absolutely desperate to do some major cooking. I’m counting this as my TG1 baseline year. Absent the outstanding response by my GP, his nearest throat specialist, and a immediate and intense commitment from the Hopkins folks, there is a better-than-even chance that I wasn’t going to be here to greet all of you and cook you a holiday kickoff. I can’t wait. I really can’t wait. 


I’ll let you know how the medical shit goes. But I’ll document in good goddamned detail the food preparation. Cause I am in big time!

It Might Get Messy Supplemental Edition

It Might Get Messy—Supplemental Addition


After teeing up the whole return to the slicing and dicing process tomorrow, I pulled the plug this morning. Could end up as a temporary, quasi, pseudo, or otherwise short-term decision. But here’s thing.  I woke up this morning pain-free and with more energy than I’ve had in many months. I’ve barely been able to slog through the stuff I need to do to have a job at the backside of this total and ongoing medical mess. So, on the chance that I can get a modest uptick in my ability to function as a human being and keep my job, I postponed the surgery. 


Doc H says the main downside to postponement is nutritional. Basically, I’m pumping in liquid food, and it’s pumping itself right back out of my GIT and into the remnants of my lymphatics, where I collect it and dump it in little containers. I’m hoping a little patience pays of, and I’ll heal better with another week. Worst case, I think I’ll survive another week of borderline nutrition. But with a job!


I’ll keep you posted. For some reason I’m feeling that something momentous is on it ways into play. I’ll try to get you photos!

It Might Get Messy

Jargon being much of the essence of science, biologists call things that have right and left sides “bilaterally symmetrical”. This means that if you cut something longwise, the halves are roughly equivalent. This seems pretty basic. Almost all animal life is bilaterally symmetrical—everything from simple looking earthworms to the complicated shells of crabs and lobsters. Interestingly, human beings are not evolved from the complex bilateral invertebrates. For reasons having to do with embryology, our closest invertebrate relatives are starfish and sea urchins—roundish things that are distinctly not bilaterally symmetrical. This means that chordates (almost, but not all, of which are bilateral) evolved such symmetry independently at least a second time during the history of life on earth. 


I bring up this bit of zoological esoterica because my present medical difficulties have to do with a breakdown in my bilateral symmetry. When Dr. H sliced the lymph nodes out of my shoulders, neck and chest, he did it on both sides. He did note much more radiation damage on the left side in general, and in fact had to deal with it during surgery during some unexpected nontrivial bleeding. But he got everything excavated to the lymph-node-removal level, excised what needed to be excised, stuck a drain in each side to draw off surgical and physiological fluids while things healed up, and shipped me home. 


Now, a month later, the right side is pretty much healed. Drain is mostly empty. The tissue layers sealed up nicely. Left side, not so much. I’m still running liters of fluid per day through the surgical drain, and it ain’t getting’ no better. 


One of the many things I like about Dr. H is that he is young, smart and inquisitive, with no deep ego-driven preconceptions about the single “correct” thing to do. So he brought my case up at the regular Wednesday faculty discussion of patient issues and inquired about some potentially innovative solutions. He said the closest one he got was somebody who suggested drilling a series of holes in the tissue to the level where the healing has gone awry and injecting crazy glue to paste it all back together. I chuckled at that one he, agreed with me. 


So it’s gonna be a bad week. Tuesday, he’s going to re-open my left side, get to the layers that are refusing to match up, and sew ‘em back together. This means another night in the hospital, but I’m pretty sick of dumping disgusting bodily fluids from collection jars in every available pocket, so I’m on board. And maybe, if nothing goes wrong this time, he can get me a photo or two.


The processes of contracting and treating cancer have, oddly, enhanced both my hearing and sense of taste/small. This is odd because the usual outcome of this sort of tumor is the opposite—loss of sensitivity. My empathetic abilities seem to have increased as well. I feel more love and good thoughts from you all every week, and I feel them deep in my emotional well. I cannot thank you all enough, or make it clear how important and healing it is to feel that waves of love. Special thanks this week go to Ginger and MaryEllen for the physical and spiritual CARE packages. You guys are the best, and the best thing is that your message got through loud and clear. I stopped beating myself up so much after I got your stuff. Thanks!


Professionally, I am going to be impaired most of the week by the surgery. This means that the time-critical deep-south project work I’ve been hammering on is going to slow. I do, however, have a lengthy table of staff work (figures, tables, text, research, ideas) that needs to be done and this is the perfect opportunity to catch that up. So for GM and JL, I’ll discuss in detail with AF and we’ll come up with a plan. 


Thanks, all. Remember I love each and every one of you, and cannot wait to see you, live and in the flesh. Given the possible alternatives to that delightful outcome, I’m smilin’ right now!

It Might Get Messy

Bob Dylan asked “Senor…Senor…can you tell me where we’re headin’? Lincoln County…or Armageddon…?”. A couple weeks ago, still pumped on the surgical drugs, realizing that the war was won with the disappearance of malignant tissue, and that the remaining battle was to recover from the treatment and surgery, I figured I was on my way to Lincoln County. You know the place. Rolling hills in the countryside, green grain fields, wood lots, small towns with ice cream counters and ancient hardware stores (a lot like Ashtabula, Ohio, if you’ve ever been there). Comfortable. Painless. Quiet. Nice place to visit for a while.


But it was not to be. Absent an acute recurrence of the cancer or some less exotic contretemps (getting hit by a bus, say), I’m not gonna make Armageddon any time soon. But I sure as hell seem to be on the trail, and struggling with the trail at that. I’ve been incredibly sick the past couple of weeks. Partly, I suspect, because I just didn’t have any real understanding of the trauma associated with the surgery. The primary objective was to get rid of my lymphatic system in places it might have picked up stray cancerous cells. Turns out, this means Dr. H dug down to lymph-node depth, stripped  back the entire layer of tissue from my jaw through my shoulders and down past my neck, sliced out the lymphatics, and pasted it all back together. 


Oh. He apologized for not getting me photos of the surgery, but explained that he “ran into a little bleeding problem”. Which it turns out was that one of my radiation-stressed  jugular veins fell apart into shreds at the touch of the probe. Apparently it took him quite a while to figure out how to halt the blood flow and do something to replace the fragmented vein. 


Meanwhile, since he closed me back up, I’ve healed on the easy side (my right), but the difficult side, the left, continues to leak fluids into the unhealed space Dr. H opened up in my tissue layers. And it’s left me exhausted, in pain, and a bit dysfunctional. 


Hopefully I’ll start to recover a little quicker from here. I’m still losing weight, so that’s got to stop. This week I’m gonna try to kick my butt back into some functional gear. I’ll let you know how it goes. Thanks for stopping by—even if it’s just for some whining. I’ll get over it. I promise substantively non-whiny blog entries starting soon!!!

It Might Get Messy

But I never expected to get as messy as it did the past couple weeks. The surgery kicked my ass. Except for some reading and writing professional work to keep up with, I have been too sick to do much of anything. Can you imagine? Today is the first day I’ve felt like half a human being since they cut me.


It’s not that there’s anything particularly physically wrong (beyond the huge incisions, drains, etc.). I guess it’s just the beating it took to carve out the lymph nodes north of my shoulders. This procedure adds enormously to the remission and survival rates of the treatment, theory being that if there’s going to be a reappearance of the malignancy, that’s where it’ll be. But man, I gotta tell you, if I know how nasty I was going to feel, I would have dug a lot deeper into the risk ratios before I let them do that again.


Anyway, since I’ve been flat on my butt for two weeks, I have no material for you this week. I gotta get back into real society this week, back to the office, back to the actual world. Appreciate the patience, look for something with a little more heft later in the week. I’ll come up with something less whiny and more funny!

It Might Get Messy

Actually, it IS pretty messy. I’m a seriously hurtin’ dude. Still leaking lymph and what looks like surgical fluids, massive swelling, pain, blah blah blah.


Just so you’ll know I’m bona fide, see the following photos. 

Neck suture.

Suture plus surgical drain. 


I’ll be in and out of doctor’s offices much of the week. But, I got work to do. For those at work, I’ll start on email tomorrow and hook up with you asap. Everybody, keep my recovery in your thoughts. I get over the humps of this surgery, I should be good to go for a long time!

It Might Get Messy

You know that scene in Johnny Mnemonic when J-Bone introduces Jones-the-hacker-dolphin saying “the Navy got him wired up for hard encryption”? Well, Dr. H got me wired up for bodily fluids. I got two drains “out” and one drain “in”. Oh, and when I woke up from the anesthesia, I was catheterized. And I’m thinking, “what the hell?!”


But let’s not start there. Let’s start with the overnight technician. In the GBMC hospital, the nurses and technicians write their name and 4 digit cell number on a big white board over your bed with every shift change. My tech was Maria, a tough, take-no-prisoners Cuban woman, early 60s, I’m guessing. I’m also guessing she could have hammered rum with Hemingway all night then gone out at dawn to wrestle 700 pound marlin without batting a dramamine. She came on around 8 o’clock, came in to look me over and introduce herself, and immediately decided I was “Pops”. Officially. For the whole night. I’m 58, BTW.


Back to that catheter. Doctor H, anticipating that it was going to make me crazy, left instructions that we could remove it at midnight, but apparently there was some sort of urine volume threshold involved. The nurses insisted we couldn’t pull the catheter until they had 300 ml. I was too fuzzy brained to ask, but, given that the basic plumbing—kidneys, bladder—is the same whether the urine is passing via catheter or penis, why would there be a volume delta?


Anyway. Via some desperate slurping of ice water and ice chips, I made my vigorish. Technician Maria comes in and prepares to remove the catheter. I say “this is gonna hurt, isn’t it?” And she says “no, no. I pull, you say ‘ouch’, and it’s over.”


Trust me. It hurt. 


After the catheter contretemps, my head cleared. And when the nurse came in to give me a heparin shot, I asked why—given that I was bleeding at the time rather profusely through massive incisions. She said—“oh. That’s a good question. It’s to prevent blood clots in your legs. But you’re not going to get blood clots in your legs, are you?” We skipped the heparin. 


Also worth introducing is the phlebotomist who came in to get my morning labs. She was seriously harried by 0930 hrs. But still smiling. “Man, they got me rockin’ and rollin’ this mornin’, Sugar” she says (obviously hadn’t met Maria). “Don’t tell anybody, but I’m thinkin’ of going and sittin’ in the bathroom for a while. How about that?!” I told her that’s where I usually hide. She liked that. 


Anyway, here’s the big finish for today.


It might get messy. But it probably won’t get messier. All the biopsies came back clean. I am, at the moment, cancer-free!


Check back here on the weekend. I’ll put some photos of the suture lines up. Those of you with weak stomachs will have to turn away!

It Might Get Messy

Ok, fans, it’s crunch time. My long-awaited surgery is on for Tuesday morning. Arrive pre-op 0530 hrs, anesthetic around 0700, knives about 0730. 


To be blood honest, I am terrified of this procedure. Not at all sure why. I’ve had three surgeries in my life: vasectomy, back, and gall bladder. All were via small, polite incisions. Although the bruising pattern from the first suggested that the trained-in-the-Soviet Union doc from some Central Asian “country” was in there to his waist with his hands stretched over his head wielding a ballpeen hammer and a set of sheet metal shears. 


But still. I have every faith in young Doctor H. and his staff. I’m not afraid they’ll find more malignancy—I know that’s a real possibility and I’ll deal with it when the time comes. I think the main thing is the massive nature of the operation itself. If I understand correctly, he’s going to split me mid-lateral from chin to chest, rip the entire cylinder open, and poke around in there for a couple hours. 


He’ll biopsy the two areas of residual radiation uptake, but the oncologist was not concerned about those. He’ll also look for other suspicious tissue and I’m at least hoping clean up some of the dead stuff that is cosmetically problematic. 


No idea how this is gonna come out, except that by mid-day Tuesday I’m gonna be a veg. I’ll probably update this blog several times this week and let the others lie fallow, but I’ll keep you up to date when and where new material might be. Keep good wishes for me in your heads, my friends. And maybe an image of undergraduate anatomy lab of a throat with little pins with flags identifying organs and glands… . 

It Might Get Messy

It has NOT been a good week here in cancer survivor land. I’ve been too sick to make it to the office, which is fine for my own projects which mostly involve writing and reference books I have here at home, but is bad for other people relying on me to help them with shit. I managed to make it in for like two hours on Tuesday to not-so-much help Tim by scribbling a page of gibberish. Then I had to drive home in two stages because I hurt so much.


I have no idea what’s going on. I’m still weak, but the pain is less, so I’ll have to get to the office to start cleaning up the messes (literally and figuratively) tomorrow. The big deal coming up is surgery. A week from Tuesday. Hospital at 0530, anesthesia by 0700, knives at 0730. Icky. He’s going to do a “bilateral neck dissection”. This means he’s gonna open me up like a specimen in an undergraduate anatomy class. I can see all those little pins…”thyroid gland”…”epiglottis”…”trachea”…etc. 


Anyway. I thought maybe my issues this week were dietary, but I’ve been good about getting more than maintenance calories every day and trying to eat something by mouth so my swallowing reflexes keep operating and my tongue exercises (!) don’t go to waste. To make sure, I even fired up my IV bag feeding pole apparatus. Takes frickin’ forever (well, a couple hours, anyway) to get 1000 mls in. But, you can read and write while you’re doing it. So it’s got its goods and bads. 

It is pretty cool. Here’s the bag, holding 750 mls of food and some water. The nurses like to put ice in there with the UN emergency rations, for reasons that are completely unclear. 

This is the primary control valve. It’s operation is, perhaps unsurprisingly, illogical, although simple enough to figure out.

Then there’s the coupler that links the IV bag to the tube inserted in my gut. 

Finally, the tube inserted in my gut. It’s been there for…1, 2, 3…7 months. Fresh as a daisy, near as I can tell. And I assume said figure of speech slash metaphor refers to a young, newly opened, daisy. As opposed to an old dried droopy one. 


Which latter is more how I feel. Many apologies for being such a whiner this week. In penitence, I have new material up around the horn, hit http://theresaturtleinmysoup.blogspot.com/ for some subbacultah (per The Pixies), http://sustainablebiospheredotnet.com/ for some bitchin’ lecturing on the environmental impacts of ancient Greek military engineering, and http://docviper.livejournal.com for some Bad Art By Dave. Thanks for stoppin’ by!


PS—on more health item. I purchased a cross bow this weekend. This is a serious weapon, 150 pound draw weight, battery-operated sighting scope, carbon fiber and titanium construction. It’s beautiful, I like to just pet it like Lucy the New Dog. But I also like to shoot it. It’s scoped within millimeters at the 10 yard range in my basement. Next up is the 20 yards at my carport. Eventually, this thing with a good broadhead and some insanely macho tactics, will drop a bison or a moose at 30 yards. Meantime, the main thing about crossbows (I laughed when my instructor reminded me of this) is to KEEP YOUR DAMNED LEFT HAND BELOW THE PLANE OF TRAVERSE OF THE BOW STRING. Laugh I may have. Stupid I am. See photo of my left ring finger below… .

It Might Get Messy

It’s not like there aren’t enough humiliations that come with cancer. Now I’ve got a big sheet of…get ready…tongue exercises. And not only that, I had to go in for an hour of tongue exercise coaching. A couple of otherwise cute speech therapists tortured me by making me practice the entire set of reps—6 exercises times 10 reps each = 60 reps @ 2 times per day—but by illustrating each of the exercises for me and doing them with me. Man, it doesn’t get any weirder than that. 


Plus, my tongue is now exhausted. Which can’t be a good thing, given that the one place there remains the possibility of malignant tissue is on my tongue. I’m thinking the poor thing really needs a nice long rest until the surgeon gets in there and can biopsy that tissue. The one thing this HAS done for me is convince me to call the surgeon’s shop and try to get an earlier slot. If that tissue IS malignant, I want to know sooner rather than later. I’ll try his scheduler this week and see if you’ll give anything that might open up between now and my surgery date, which is 27 September. 


Cancer brings out religious people like an open bag of flour brings beetles. Preacher’s secretaries call hospital rooms because the “padre would like to stop by and have a word with you.” Religious organizations send mailers looking for…well, opportunities to stop by to help you in your time of need, or offering to take your call when you are ready to talk. 


They called twice when I was in the hospital. Plus some odd in-house group of nonsectarian religious people that kept wanting to visit. Finally I told them that I didn’t need to talk. I needed somebody to run ice chips and fetch the nurse when the pain killer wore off. They said they’d go to the next person on the schedule.


Somewhere my Mom, whose last cogent “word” was a middle finger when she realized I was fending off a priest the day before she died—is smiling.


I’ve been sick all weekend. Not sure what the problem is. I’m as tired as I was months ago right after treatment. And all my muscles are sore. I’ve slept 45 hours out of the last 60. I even took today off from work. Which was a bad thing. Shit is hitting the fan on multiple fronts at the office. I’m gonna have to fight my way in tomorrow no matter what. Oh well. They re-upped my Xanax prescription. A couple of those early and maybe I’ll get enough sleep to drive in safely… .


New material up around the horn. I’ve been sick, I apologize for being a day late with this stuff. Check http://sustainablebiospheredotnet.blogspot.com/ for the cancer diary, http://docviper.livejournal.com/ for photos and a little ecology, http://theresaturtleinmysoup.blogspot.com/ for the best in pop culture. And thanks again for stoppin’ by—every time you guys read this stuff, I feel a little more life come back to my battered frame!

It Might Get Messy

When the universe peels apart, I can’t sleep. Last time this happened was in the hospital a couple months ago. Thirty hours after we stopped pounding my corpus with radiation and chemotherapeutics I ended up on the bathroom floor in a puddle of vomit and mucous, starting a week when I would be wide awake 24/7, much to the dismay of the nursing staff who like to have their patients slumbering for a third of every day. The cosmic split then was between the block of universes in which I actually dehydrated and died of treatment side effects including anemia over that weekend vs. this one where I made it to the ER and survived. It took a few days for the cosmos to sort itself out, and while it did, I was awake.


I’m awake now. Fourth night in a row. This time I think we’re losing the universes where I died of the tumors that were treated in that episode. It’s just about the time they would have finally closed up both my respiratory and gastrointestinal systems and shut me down absent drastic and effective treatment courtesy of Greater Baltimore Medical Center and their awesome throat cancer specialty shop. 


Good riddance. I’m happy to put up with a week’s lost sleep to have that whole slab of universes where I’m about to be mourned, or not, depending on the paths that got me to the point of death-by-throat-tumor, fall away into someone else’s existence. 


But that does leave us looking up at the enormous stack of universes that plod forward from here. 


Interesting things are stirring in the world of cancer therapy. This week, the University of Ottawa and a private biotech company published stunning research results. Patients with advanced liver cancer were given intravenous injections of a bioengineered virus derived from a now-archaic smallpox vaccine designed to trigger immune response. 87 percent of the recipients had viral replication in their tumors and none in their normal tissues. Six of eight patients in the highest dose group had their tumors stabilize or shrink. Side effects were minimal. Larger, more statistically valid trials, are planned.


Awesome. This is technology that bypasses the blunt trauma cascading from radiation and chemotherapy. Radiation and chemo work because there is a very, very slight tendency for tumorous tissue to be more susceptible to the destructive toxins than non-malignant tissues. The procedure is brutal, but often effective. If sufficient radiation and toxic chemotherapeutic drugs are administered to bring healthy tissue to the verge of collapse, then malignant tissue perishes slightly sooner and the patient can be saved at the last instant when that sensitivity delta has been exploited. Thus my trip to the hospital. The radiation and chemo slapped my otherwise healthy body to the edge of death by dehydration and anemia. Along the way, it burned down the mutated tumorous tissue.


This week I got the formal report from the imaging center. My preliminary assessment per last week’s entry was pretty much on target. The report documents that they gave me 19.2 millicuries (I assume that’s what mCi means) of fludeoxyglucose 67 minutes before they imaged me. They compared the images from this round with the pre-treatment imaging from 8 March. The “impression” is “resolved tongue mass and resolved adenopathy in level II region and right tonsil”. That means the tumors, both primary and secondary, are gone. More ominously, “there are two persistent areas of increased uptake, one in the right anterior mid tongue and one at the right anterior tongue base which are of undetermined significance. These could represent areas of post irradiation change although recurrent or residual malignancy cannot be excluded...the scan is otherwise unremarkable…”. I believe that Doctor Z, the radiation oncologist, thinks the “persistent areas of increased uptake” are unhealed devastation from the radiation, not residual malignancy. But I think this is what the surgery is for. 


The docs didn’t call about the surgery last week. I’ll have to call them next week. Got a busy autumn coming up. Major technical report due, plus SETAC in November, then it’s Thanksgiving, then the winter holidays.


Damn, it’s great to be alive!


New stuff up around the weblog horn this week. Be sure, if you have a few minutes, to visit http://sustainablebiospheredotnet.blogspot.com/ for an essay on environmental consequences of armed conflict, http://docviper.livejournal.com/ for the natural world, and http://theresaturtleinmysoup.blogspot.com/ for the best in modern culture. Thanks for stopping by!

It Might Get Messy

It is an incredible, awesome, damned near unbelievable time to be alive. On Thursday, the imaging technician handed me a CD on my way out the door. Actually, he handed me two CDs. One was the audio track he had playing while I bounced back and forth in the scanner. On the way in he asked me what kind of music I wanted. I told him Scandinavian death metal. He said ok. Then he said he lost that tape but he had some good dinosaur rock if that would suit. Stevie Ray Vaughn and Kenny Wayne Shepherd together blasting some seriously slick electric blues. I have no idea why the guy was so insistent that I take a CD of the stuff he played as background music while he did his job. But what the hell. It’s good music.


But these are not the droids we’re looking for. The astonishing CD is the one that has 239 computer aided tomography images of my body on it. These are 239 transverse slices of me from roughly hips to skull. There are sagittal and coronal planar views as well, but these are for navigation. In fact, they generate a cool set of 3-D figures that let you click on any location you want to see the detailed information. The heart of the matter…the meat, so to speak…is in the transverse sections. There seems to be about a meter of me in total in the images. That makes the resolution of the transverse slices better than half a centimeter. I imagine there are possible tumors smaller than that. But half centimeter resolution via completely nonintrusive technology (except for the radiation that of necessity is at the base of the imaging) is pretty damned comforting to me. 


Before they passed me into the imaging machine, they did an intravenous injection of fludeoxyglucose. Which is a radiolabeled analog of glucose sugar. The radioactive moiety (now THERE’S a word you don’t see very often) allows a positron detector (PT scan) to pick up the places in my body that are most metabolically active—places that take up the sugar rapidly and massively. Simultaneously, they recorded x-ray computed images—CT scans. In roughly half an hour they sliced me into 239 conceptual segments and recorded two high resolution images of each slice, one PT, one CT.


Then they burned me a disk with the image data and the software necessary to process the images. Oh yeah. Plus the Kenny Wayne Shepherd disk.


Anyway. A few years ago, the hardware, software, ethical, liability, legal, and social contretemps associated with handing a patient a package of kick-ass diagnostic material on his own condition would have tied the system up in knots. At GBMC on Thursday, they just handed me the disk with a smile. At home, my computer recognized it, loaded up the data, accepted the software, and let me dissect myself 239 * 2 times as often as I want to. Is this a wonderful universe or what!?!?


In Manhattan, east and south of Madison Square Garden and Penn Station, around 30th to 33rd streets, there is a string of Korean hotels and restaurants. This is not a tourist neighborhood. There are no “little Korea” shops. This is a hard-core Korean language business neighborhood. There are few Anglos in the restaurants. The wait staffs don’t really like to serve white people. 


In the 90s, I braved the gruff and uncomfortable service to eat in those restaurants a few times. There are no menus in English, and the staff offer no help when they hand you the menu card in Korean. It has only a few items on it. I simply pointed at random at what seemed to be main dishes and awaited my fate. All the food seems to be variations on the same theme. You get a cup of soup, then a plate of kimchi and one of pickles. After a while, a bowl with bright and crisp whole lettuce leaves is set out, followed by a huge platter. The platter contains a veritable museum’s worth of laterally sliced organs. All kinds of organs. From all kinds of animals. I’m a Ph.D. biologist, for crap’s sake, and I couldn’t identify the phylum most of the organs came from, much less what the organs are. The idea is you roll up some of the organ slices in one of the lettuce leaves and eat it. The exercise is of more biological than culinary interest, I must admit. 


I’m reminded of those restaurants when I sort through the data on the PT/CT data CD. Let’s play “Name That Organ”!!!

Let’s start with slice number 126. Low down along my back, you see the paired kidney shapes of my…uh…kidneys. They’re hot with radiation. They are metabolically active, doing their kidney thing, separating the salvageable and useful from waste liquid and passing it on to the bladder. To the left and above the kidneys is the generally well-lit mass of my liver, sequestering or detoxifying potentially destructive molecules—including the radiolabeled sugar, I presume—at its plodding but effective rate. 

Wanna see my heart? Slice 155 here runs right through. Four chambers and some chemical glow—hard working heart muscle. 

Now, let’s go to the crux of the matter—the base of my tongue, where the primary tumor was and presumably where the potential for formation of new tumor tissue is high. This is slice 203. You can see the void of my windpipe, forward of that the mass of my tongue. I think what we’re looking for is small, single, hotspots—that is, unpaired. The paired spots mostly match up with anatomical knowns. I suppose it’s not impossible to get paired tumors, but I’m relying on the docs to know the wheat from the chaff in that context. I note that the software comes with a helpful zoom function in the icon of a magnifying glass, but I haven’t figured out how to capture the zoomed image in a jpeg. But in fact you can get the important stuff from this figure. No oddball unpaired hotspots. Thus, no visible tumors. 


That’s the punchline. The radiation oncologist called on Friday to say the PT scan output is “fabulous”. Quote. This is the big-personality Romanian woman, who takes no prisoners and offers no bullshit. Especially she doesn’t do premature or unjustified positives. So I’m taking her at her word—fabulous it is. I believe that means I have only to get through some pro forma surgery (the team meets on Wednesday to discuss active cases, I expect they’ll propose a scope and date for surgery then and call me afterwards) and the difficult discipline of getting over my incredible weakness and regaining my strength—pretty much on me, I’m afraid, and you know how “Mr. Discipline” I am—and I should be back to full health a year later and a shitload wiser. 


We’ll see. 


Those of you with a weak stomach or delicate constitutions should turn away for just a few seconds now. That heavy dark streak low in my torso in all those 3-D images? Fecal mass, awaiting excretion. Oh well. My only actual innate “skill” is taking a good dump, no reason detailed whole body imaging shouldn’t pick up on that theme!


Anyway. There’s a new short essay up at http://theresaturtleinmysoup.blogspot.com/,  the other sites— http://docviper.livejournal.com/ and http://sustainablebiospheredotnet.blogspot.com/ have yet to be updated. Thanks for stopping by!