Indeed, this week it will. Some of what follows is a little…gritty. May be hard to take if you’re inclined to be squeamish. I suggest those of you with weaker stomachs skip to the last third of the piece, where a nice, positive payoff awaits.
North Africa was in something of an uproar the first couple centuries A.D. Carthage was facing war with Rome, along with business competition from other seafaring city-states and a shifting climate that all combined to make things uncomfortable. Country-boy young Androclus ran into a Roman patrol while retrieving his sheep one afternoon, and was unceremoniously added to the slave staff serving the nominal Roman administrator. In the course of his duties, an opportunity to escape presented itself. Slipping away from the work squad detail, he found a convenient cave and ducked inside.
Only to find the cave already occupied by an adult male lion, but one sick from a thorn-infected paw. Androclus patched the lion up and it recovered swiftly. In gratitude, the lion hunted for and fed the two of them for years.
Eventually Androclus, feeling a need to rejoin the human world, emigrated to Rome, where he was immediately arrested and sentenced to be “thrown to the lions”. On Coliseum day, they heaved Androclus into the pit with the lions in front of a standing-room-only crowd. One of the lions took a good hard sniff, hugged Androclus, and backed up to protect him from the rest of the animals. It was, of course, his buddy from the cave, captured in the interim and consigned to the Coliseum himself.
From Androclus to Lieutenant Ripley, saved from certain death when the Alien sniffs out the embryo inside her, scent has been an important factor in ecology and evolution.
Possibly less so in humans than in other organisms, and certainly than in many other vertebrates. For example, humans have 350 genes coding for odor receptors, mice 1,100. However, it has been hypothesized that, while humans have jettisoned smell as a basic tool for environmental exploration, it may yet have enormous importance in interpersonal and intrafamily relationships, and be a dominant factor in breeding behavior (who among us can deny that the heady aroma of extra-large pizza and pitchers of cheap beer is a sexual stimulant from our post-adolescent days?). Humans seem to make up for the depauperate infrastructural hardware via expanded commitment of cerebral resources to sorting out inter- and intra-family activity and relationships based on odors.
Here’s the thing. I can smell my tumors. And they are absolutely disgusting. Something like a combination of agave syrup, Vietnamese fish sauce, Chinese oyster sauce, cheap grappa, and the carcass of a several-days-ago road-killed squirrel all simmered together. Nightmarish. I try to alleviate the odor by keeping windows open and fans on in the rooms I hang out in (and given the fatigue levels, I spend a fair amount of time hanging out) to minimize the intensity of disgust Cathy and Molly have to tolerate.
Actually, they say they can’t smell them. I’d say they’re just being polite, but believe me, this is not an odor you can be “polite” about (cross-reference Ms. Jennifer’s first shot of the Chinese shit: “How bad could it be?”). There is a growing scientific interest in odors associated with cancers, from perspectives of diagnosis and treatment (dogs have been found to be able to sense some tumors before other non-invasive diagnostic techniques can); evolutionary selection processes (elaborate and physiologically difficult mechanisms generate and maintain tumor odors, it is a nontrivial metabolic investment); and physiological responses (it has been found that the immune system of healthy mice activates and mobilizes in response to the scent alone of tumor-bearing mice).
From the evolutionary perspective, there is a single gene of particular importance. The p53 gene of vertebrates codes for proteins that help determine whether cells under intense stress should initiate DNA repair responses, or, if things are sufficiently bad, shut down and die. Embryos riddled with cancers and pre-cancers may be spontaneously aborted by mechanisms involving p53. If p53 is mutated in the clones comprising tumor cell masses, it is a bad prognostic sign. Radiation and chemotherapy are relatively ineffective in the context of mutated p53, because unmutated p53 is needed to stabilize the tissues being hammered by the radiation and drugs. No normal p53, no stability—continued cancers.
My oncologist sent me home with a sample vial to get her some bronchial phlegm. During my first exam this week, she said she can not only smell my tumors, she thinks she smells an infection. I was inclined to dismiss the latter, except here, 2 days later, I find myself coughing and congested. Under the circumstances, and pending getting the culture results back, I wouldn’t bet against Dr. Z’s nose on this one.
And why would organisms make the physiological and metabolic investment in generating intense and specific odors for certain tumors? Well, cancer-susceptibility is partially inherited (although only a few specific cancers are directly transferred genetically). Mating with partners with active tumors may just be too much of an evolutionary risk. I’m thinkin’ that tumors might smell to make potential mates aware. Getting your particular slice of the genome to survive with the fittest is difficult enough without adding increased probabilities of malignancies to the mix. Stinky tumors, perhaps, help minimize the momentum of tumorous genomes in the population as a whole.
The p53 gene in my tumor biopsies is “positive”. It took me a couple rounds with the doc to establish that “positive”, in this case, means “good”. My p53 is normal and unmutated. Giving the chemo and radiation therapies a better shot.
The chemo and radiation are certainly giving me some shots this week. My entire oral and throat apparatus, from lips to shoulder tops, feels like tag teams of professional wrestlers have been pounding on it with two-by-fours 24/7. I am pretty much exhausted and very uncomfortable full time, and I feed myself liquid goop piped directly into my GIT. My speaking voice is totally degraded—nothing but a drooly and incomprehensible slur. Neither telephone nor in-person dialog is actually possible in any productive fashion. But there’s no sense whining. What needs to be done is being done. I leave you with photos of the radiation treatment machinery [thanks to gorgeous rock star radiation tech Traci for the great photography]:
the custom-sculpted plastic form that holds my tumors in proper position for radiation basting:
and me bolted to the table under the form, about to be dosed:
I really like the contrast of the post-space-age linear accelerator (debuted at GBMC in January 2010, just in time to work out the hardware and software kinks for me) that generates and applies the radiation with unprecedented precision and intensity, vs. the medieval torture look of the rivet-the-patient-in-place positioning form… .
BONUS THIS WEEK! New material up all around the horn. A couple of archival pieces at http://sustainablebiosperedotnet.blogspot.com/ and http://theresaturtleinmysoup.blogspot.com/, but they’re good ones and they had a limited run the first time years ago. All new spring ecology celebration at http://docviper.livejournal.com/ . Visit any and all that you have a spare moment to check it out. Thanks for all the good wishes. I love each and every one of you, and I’m glad you’re out there in the world. That seems to shift the balance between man and the universe just a smidge in my favor (see nominally related essay at this week’s sustainablebiopshere). I’m grateful and humbled.
Notes
Gene numbers and evolutionary importance of sense of smell, as well as interesting general review, is Sarafoleanu, C.M., M. Georgescu, and C. Perederco 2009. Importance of the olfactory sense in the human behavior and evolution. Journal of Medicine and Life Vol. 2 April – June 2009, pp 196 -198.
General aspects of cancer-as-evolution: Purushotham, A.D. and R. Sullivan 2010. Darwin, medicine and cancer. Annals of Oncology 21:199-203.
Mouse immune-system response to tumor smells: Alves, G.J., L. Vismari, R. Lazzarini, J.L. Merusse, and J. Palermo-Neto 2010. Odor cues from tumor-bearing mice induces autoimmune changes. Behavioral Brain Research 214:357-367, Epub edition June 2010.
It certainly did for Bob Marley. In the summer of 1977, he injured his toe playing soccer, the wound was slow to heal, and he reported that he’d had a chronic sore at that spot for years. Later in the year somebody took a biopsy and realized he was looking at a nasty malignancy.
He was advised that amputation of the toe at least and quite possibly the entire foot was proper response. He refused.
Why he refused isn’t entirely clear. Sources (see some citations below) talk about Rastafarian disbelief in western medicine and/or belief in mystical healing and/or simple deist fatalism. Others suggest he couldn’t imagine performing without the missing parts. I think he might just not have been convinced he had to go there to survive.
He did. Died in 1981 of lung and brain metastatic manifestations of his toe melanoma.
I think I can understand Marley’s dilemma. I might still have to face it. Apparently I presented late in the cancer-development process. My stage 4—already-metastasized—tumors should, I believe the doctors are telling me, have been apparent to any idiot long ago and been properly diagnosed. I actually went to my physician just about 3 weeks after I got the persistent symptoms of trouble talking and swallowing (ironically, after having dinner with an old and dear friend celebrating her own successful first-year’s battle with cancer who berated me into submission). Which seemed about right to me. For years I’ve had this chronic thing of swollen glands that I would deal with by attentive dental hygiene including application of washloads of alcohol-based mouthwash. Which latter is, of course, a risk factor for otopharyngeal cancers.
Hmmm… . Sounds sort of like Marley’s story, huh? Here’s the thing. A few years ago, I gather the recommended treatment for me would have been radical surgery, including removal of my larynx. The Greater Baltimore Medical Center docs and Hopkins faculty think the aggressive program of twice-a-day radiation and weekly chemotherapeutic infusion will be able to corral these cancers short of the massive excision.
But. After the whole course of treatment, part of the follow-up up will be continued diagnostics, including a neck dissection. I assume if the findings of the latter are dismal, they might still want to yank my larynx.
I’d have to think about that. I can’t really imagine life without my voice. I gotta admit I’d be much less possessive of my toe and even my foot. But we all gotta face Jah in our way and our own time, Mon. With whatever body parts we still got attached.
Anyway. I’m feeling pretty crappy this week, having gone through the second week’s chemo. Cathy points out that this is a milestone, puts me a quarter way through the treatment (by one measure). Problem is, that’s not necessarily a good thing in cancer (as opposed to non-malignant illnesses) treatment. Because the bottom line of cancer treatment is to make the whole system just sick enough to kill the cancer without killing the entire corpus. Which means things get worse before they get better.
A lot like real life. There’s a marginally-Marley-complementary essay newly posted over at http://sustainablebiospheredotnet.blogspot.com/ that’s worth a read. I’ll try to get new posts up at http://docviper.livejournal.com/ and http://theresaturtleinmysoup.blogspot.com/ for you this weekend as well.
Have a good weekend, all. “Live it while you got it” is the message I’m taking from my cancer experience. And at the moment “living” consists primarily of trying to hang on to the toboggan down the radiation and chemotherapy mountains. That means you guys gotta pick up the slack for me!!!
Notes
Religious aspects of Marley’s cancer
http://worldmusic.about.com/od/genres/f/BobMarleyDeath.htm
http://thehypelifemag.com/2011/04/16/a-death-by-skin-cancer-the-bob-marley-story/ --importance of time and treatment. Diagnosed in 77, refused effective treatment (excision). Continued injury to toe earlier in life.
Conspiracy theory (of course there’s a conspiracy theory!!!):
http://www.abovetopsecret.com/forum/thread235511/pg1
To paraphrase…perhaps more accurately desecrate…John Lennon, I offer this aphorism: “Whatever gets you through the tumor…that’s good humor…that’s good…”. OK, wait, that’s not gonna work. How about “Whatever gets you through the disease…do it please…do it please…”. OK, that’s not gonna work either. Let’s skip this forced fake literary crap and get to the point.
Which is that I’m not really a “Chicken Soup for the Soul” kind of guy. Don’t get me wrong. I love chicken soup (although I must admit it’s something I’ve never been able to make credibly in my own repertoire), and I’m very, very glad that the self-help industry cranks out X, Y, and Z’s for the souls of those constituted to benefit from same. Personally, I’m more comfortable with something akin to “Binge Drinking for the Soul”. Which does, of course, carry the unsurprising irony that a lifetime’s consumption of beverage alcohol contributed causally to my present medical difficulties.
One of major problems with cancer in general is nutrition. After all, you’re eating for billions (of cells), and the tumorous subculture is disproportionately ravenous. Plus, you feel generally like hell, chemotherapeutic drugs cause intense nausea, and it’s one time of your life that such niceties as good meals and svelte figures tend to slip down the priorities list. Maintaining adequate nutrition and body weight are ongoing problems in cancer treatment and management. Possibly magnified in my case by the fact that the tumors themselves erected their (large and distinctly uncomfortable) edifice at the gateway to my gastrointestinal infrastructure.
Treatment practitioners are very practical about these things. My radiation oncologist and her staff, the neck surgeon and his intern, and our assigned team of counseling and psychiatric professionals all asked about my weight and fitness, congratulated me on fighting my weight down more than 40 pounds from its peak, and told me to forget anything and everything I had ever learned about healthy dieting and start eating anything and everything I could stomach. The oncologist said “40 pounds is good, but when I am done with you you are going to be missing another 40 pounds.”
The National Institutes of Health National Cancer Institute guide “Eating Hints Before, During, and after Cancer Treatment” says (of course) “For most people, a healthy diet includes: lots of fruits and vegetables and whole grain products and cereals, modest amounts of meat and milk products, small amounts of fat, sugar, alcohol and salt”. Then it says “When you have cancer, you may need extra protein and calories…extra milk, cheese, and eggs…add sauces and gravies…eat low fiber foods…eat plenty of calories…eat when you have the biggest appetite”.
A liberating moment in my adolescence came one summer day when I was wandering around town with a couple bucks in my pocket and I had the revelation that instead of going to the Pompton Queen diner or Pompton Spa lunch counter for a cone or dish, I could go to the Washington Delicatessen and purchase and eat an entire pint of Breyer’s Coffee Ice Cream.
It took me more than 50 years to mature past that moment to where I can again control my body weight on my own volition. Never would have expected a reprieve from that level of necessary self-discipline, however temporary it might be. I leave you with this photograph of a typical food shopping trip from week 1 of my cancer treatment experience.
Hang in there, everyone. I love you all, friends old and new, acquaintances and colleagues, casual surfers, all of you, and I miss each and every one of you dearly. I’m still struggling to get my weblog empire under some kind of regular control, but new postings will soon be up at one or all of them, so check:
http://sustainablebiospheredotnet.blogspot.com/
http://docviper.livejournal.com/
http://theresaturtleinmysoup.blogspot.com/
if and when you can.
Before I sign off, a quick update from Treatment Week 1. To be honest, I’m a hurtin’ dude. “Weak” and “painful” are deeply inadequate descriptors of my daily condition. However. The oncologist is pleased with progress. A couple of the tumors have shrunk and softened, and there is at least the possibility that the big one will not kill as much of my tongue as she thought it might. Just like real life—ya got some bad, ya got some good.
Rock and roll, everyone!!!
But I’m just beginning to get a grip on WHY it’s so messy.
Let’s start here. I’ve never understood the psychology of pregnancy. I can assure you that the instant my conscious mind realized there was a separate, discrete (discreet? I’m never sure…), parasitic, wholly “other” individual growing inside me I would FREAK THE HELL OUT. Neither of us would be likely to survive the next 9 minutes, not to say 9 months.
Of course, evolution provides a nice soothing sequence of hormonal sedatives and love potions that suppress that “holy hell there’s a thing inside me” panic in (many) human females. [I’m reminded here of that scene in…I think maybe it’s the fourth Aliens movie, the one with Winona Ryder, where the guy who they know is carrying an alien starts to cough and they all train their weapons on his chest and he says “No, it’s ok. Really.”]
Anyway. Mammalian pregnancy also requires elaborate physiological mechanisms to prevent the elaborately evolved immune system from simply rejecting the entire operation every time. That physiological complexity is needed because, of course, the embryo is only halfway genetically equivalent to the mother.
The problem with cancer, and the reason that even the awesome forces of human immunology are generally ineffective in control, is that the cancer is way more than HALF “you”. It basically IS “you”. The cellular delta between tumor vs. non-tumor tissue isn’t enough for the immune system to get a grip on.
Check out this photo.
This is a diagnostic fluorescence photo of a single leukemia cell. Cytoplasm is stained red. See those 3 green spots in the (large non-stained black) nucleus area? Those are marked with a DNA probe that targets human chromosome number 8. Normal cell would have 2 copies of number 8, this one’s got 3. That’s the basic structural delta between normalcy and cancer.
So what the hell do you do you “treat” the cancer? Paste together some kind of chemical stew to specifically attack chromosome #8? Wait, that’s not gonna work, we need a couple of those per cell. It’s apparently not even really clear what the pathological meaning of the third copy of chrome 8 is. It may not have anything to do mechanistically with the physiological devastation of the disease.
So we’re slogging. Presently, treatments focus on the higher per-capita metabolism of cancer cells, finding ways to target cells with higher rates of function. That’s where the radiation comes in, BTW.
Which reminds me. Treatment starts tomorrow. I expect to have the rad sources strapped to my throat by late morning. I’ll try to remember to get some good photos to post for you.
Hang in there, everybody. Remember I love you all, and thanks for reading these posts. Pass ‘em along with my greetings to anyone you think might be interested. I’m a little slower on updating associated blogs, but visit:
http://docviper.livejournal.com/
http://sustainablebiospheredotnet.blogspot.com/
http://theresaturtleinmysoup.blogspot.com/
when you can. I’ll keep ‘em spinning as best I can.
Notes
Photo is from "Cancer: The Evolutionary Legacy” by Mel Greaves, 2000, Oxford University Press. Excellent and readable introduction to the history of cancer itself, along with cancer research and response.
But not necessarily in expected ways. Let’s look at a hypothetical here. Let’s say you’ve been diagnosed with a complicated, painful, life-threatening, illness. Something like, say, cancer. Let’s say the diagnosticians are the best—there is no uncertainty in their call. Let’s say they immediately begin investigations to localize said cancer and that now, 4 weeks later, they know precisely (by which I mean within fractions of millimeters) where tumor tissue resides. Which is in large areas deep in the throat and at the base of the tongue.
Treatment planning is initiated. Further diagnostics are conducted. Meetings take place. Faxes are exchanged (I know. FAXES?!?!? I couldn’t even remember how to send a fax from the office machine the day they needed one from me). And the first thing everybody says is “yeah, but we can’t do anything until we deal with those teeth”.
And your first thought is “what frickin’ teeth?!?! Remember those three-dimensional diagnostics? The throat thing? The tongue? I’m pretty sure if there was cancer in any teeth, somebody would have noticed by now.”
I’m still not sure what the hell is going on, BTW, or why these people are obsessed with teeth. But they sure as hell are. They sent in a couple of dentists like Omaha Beach triage nurses. They went through tooth-by-tooth: “This one stays. This one stays. This one goes. Stays. Goes. Goes. Stays.” Etc.
Then they injected me full of biologically active chemicals, climbed on my chest like a bad outtake from an old “Foghorn Leghorn” cartoon, and yanked out 6 of my teeth.
I spent the next day in complete and utter misery. Remind me to tell you about Jon “Josef Mengele” Sujian, the Butcher Dentist of Wayne New Jersey and my personal emotional problems with teeth. But some other time. For the moment, I leave you with this. It is the chewing surface of one of the teeth deemed superfluous last week. If I squint just right, this image looks to me like a frame from that film of “Bigfoot” walking along the that pine forest logging road. You know, the one where you can see it wave to the camera with a little heavy metal “devil horns” swing of its right glove…I mean hand.
Or does it look like something else, maybe? At least it doesn’t look like a frickin’ tooth… . PS. I had to negotiate with the dentist to get him to give me my teeth, which he did not want to do. Nor is negotiation easy to do with your mandible paralyzed by narcotic drugs. I take the fact that I now possess these teeth as a sign that my negotiation skills, at least, are still good and might survive the next few weeks of cancer treatment hell… .
PS--be sure to visit other nodes in this web
http://docviper.livejournal.com/
http://sustainablebiospheredotnet.blogspot.com/
http://theresaturtleinmysoup.blogspot.com/
http://endoftheworldpartdeux.blogspot.com/
Thanks!
Oh, it’s gonna get fucking messy, alright. But let’s start here. There’s good stuff along with the bad, and we got plenty of weblog entries to get through before we shut it down.
I love the scene in Constantine when Tilda Swinton leans over to whisper in Keanu Reeves’ ear and point to his cigarette saying “This is going to kill you. You’re going to hell for the life you took. You’re fucked.”
There are many layers of interest in this scene, starting with the easy one which is that Constantine’s apparently been condemned to hell for committing suicide but NOT for smoking despite having an acute case of lung cancer. And that’s always sort of the little-things level I figured I’d have to deal with my gods at. I’ve advised my kids to be as “ready to die at any moment” as you think you can be, because bad shit happens all the time. And the director is not going to tell you when the jet engine is going to fall through the roof of the house onto your bed, because she’ll want that genuinely surprised look on camera. So my religious rituals tend to be little things. Did I smooch Molly when she when to bed last night? Remember to tell Cathy to drive carefully when she left the house this morning? Send Beth an email just to check in? A surprising number of those things DO get done in their turn, and then I don’t feel like I have to get all melodramatic like Keanu and give Satan the finger while I drift over toward heaven (which, in that particular scene, looks remarkably like suburban Indianapolis). All I have to do is give myself a couple thumbs up as the jet engine wacks through the ceiling. Thumbs up and a smile, ‘cause I’m taking that smooch and that careful driving warning and that email with me and whoever the hell dropped the jet engine on me can’t have them. They’re mine. Which means I win, dammit.
And you know, that’s really all it takes. Although, on the off chance that you run into Tilda Swinton and she has an open date with a room overlooking the Park along 59th and access to a case of top quality rose champagne, would you let her know to give me a call? Thanks!
PS-- given where we are at the moment and where we have to go from here, I can ASSURE you it’s gonna get messy. Next entry up I’m going to have to review the timeline of this whole thing. You realize I’ve gone from healthy, happy, possibly annoyingly contended middle-aged guy to cancer patient in deep trouble in the course of less than a month, correct? Wait’ll I post the photos of the 6 entire frickin’ teeth they insisted on yanking this week for no reason that I can fathom. You’ll like that. Then I’ll show you the “nutrition injection port” they inserted surgically a couple weeks ago. Remember cartoon show the Jetsons? THAT is the level of technology we’re talking about here…
