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!