It Might Get Messy

In fact, all the guesstimates I can put together from the doctors, therapists, and nurses suggest that eating is going to be unequivocally messy for the rest of my life. Between the tumor tissue now gone, the throat tissue roasted by the radiation, and the dysfunctional epiglottis, my oral apparatus is no longer engineered for effective food consumption. Which may be just as well. I’ve been hungry lately. Lacking the kicked-up metabolic residue of the radiation, and being barely able to exercise without hurting myself, I’m pretty sure I could bloat up in no time. If I could eat. Given how fussy and uncomfortable swallowing is, I have at least a chance to get back into some kind of reasonable physical condition before I get too massively overweight.

Dr. H is sympathetic to my gustatory discomfort. But realistic. He points out that certain post-treatment conditions represent “the new normal”. But that while I can expect to be uncomfortable and inept when eating, I need to keep on the solid food. And that I should NOT have to deal with substantive throat pain going forward.

Which, of course, is why he was peering around in my throat with a scope earlier this week. That pain I reported weeks ago, coupled with the white-hot positive PET scan and radiologist’s positive read of the follow-up MRI got me back in the operating room as we discussed a few weeks ago. The negative findings of the laboratory analyses of the biopsied tissue were, by that time, unexpected by pretty much all concerned, including Dr. H.

Still, he figured we should keep an eye on things. So he shoves the scope in via my sinuses and says “Hmm….hmmm….things look good. Good. Except there’s a big crater in your tongue where I grabbed the biopsy tissue. Hang on, I’ll show you the film.”

And he did. And indeed, there is a big crater in the back of my tongue. A bit of a scabby spot on the adjacent throat, apparently where the remote scalpels had to swing to get the proper angle to hack out the chunks of tongue needed for the biopsy. And the biopsy itself, it turns out, was pretty violent. 

Those of you with weak stomachs may want to turn away at this point. Following is a series of photos Dr. H took while doing the biopsy. First up is my throat as it was.

See that sort of red, inflamed looking area filling the right side of the triangle (apex up, whole thing is actually the back of my tongue)? That’s the place the PET scan and MRI indicated there could be new tumor tissue forming. In fact, that red inflamed scabby looking surface is precisely what a tumor looks like. Thus selling Dr. H on the concept of tumor recurrence in my throat.

Next is the trough in my tongue where Dr. H took the first slab of biopsy tissue. 

That’s that nice, neat little trench through the blood. 

Then there’s the much larger pit from which several biopsy samples have been removed.

Finally, there’s the tongueburger left in place after all the tissue was dissected out and sent to the lab. 

And that tongueburger is where there’s now a crater. Dunno if it’s permanent. Doesn’t seem to have affected my speech much, although my tongue gets exhausted after a couple hours of lecturing (as I found out working Dr. K’s class at UMass last Monday). 

But it hasn’t made swallowing any easier. Keeping my overall weight and fitness in mind, hopefully it’s made it a little more difficult. It’s uncomfortable. But it’s keepin’ me thin!

Thanks for stopping by, everyone. I got some great photos in the woods this weekend, I’ll work to get a docviper posted during the week. And to get my pro weblog back on track after most of the summer off. That’s the one problem with being healthy again—out of excuses for sloth! 

It Might Get Messy

My surgeon Dr. H has the fervor of a convert. He never did believe the PET scan output that raised the specter of new tumor activity in my throat. He thought the radiologist’s report from the subsequent MRI was over-cautious and that the MRI looked negative. But after he carved his way in to get biopsy tissue, and saw the visible light photographs of the tumor-looking spot, he figured we were back in the trenches.

The negative biopsy findings befuddled him. Although he had a good deal of faith in the fact that the free-floating pain on the right side of my throat had subsided. Still, that thing that he sliced up for the biopsy looked tumorish to him. He did not mention that it smelled tumorish, which Dr. Z the radiation oncologist had reported regarding the big-ass carcinomas in my throat on the first go-round. So maybe that was a clue. 

Anyway, I go in to see Dr. H middle of the week. I presume he’ll poke around, ask about pain, and scope me in the appropriate locations. Having seen the suspect blobs up close and personal during the surgery, he wants to keep a monthly eye on things. 

Which I, it goes without saying, am big-time in favor of. But I got other problems. Fitness, for one. On Friday, I did a short, slow, and painful “run” around Annapolis. After maybe a couple thousand meters, my hips were sore for the rest of the afternoon. Yesterday I hiked into the (topographically flat) Patuxent Reserve for maybe a mile each way and was tired. Did the same thing today. 

Along with fitness, I’m back to having to watch nutrition. The metabolic bump from the radiation is over. My weight is running between 215 and 220 pounds, despite eating being such a chore (resulting from my dysfunctional epiglottis and generally icky throat condition) that I have to force myself to do it. The lure of those endless massive milk drinks thick with cocoa powder and sweet with sugar is strong. So I spent the weekend converting to iced decaf coffees (maybe with just a scoop or two of cocoa) and real food. Well, about as close to the latter as I got was coldcuts on rye with mayo, but I’m working my way back to steel-cut oatmeal with Greek yoghurt and blueberries. 

Anyway. The fact that I’m alive to bitch about stuff like this its own reward. That I’m sufficiently functional to recognize and act on fitness and nutrition deficits is icing on the cake of life. I spent some time this week at the viewing for a close friend’s wife who finally lost her long and painful battle with cancers. My take home message is to not take life for granted. Live it while you got it, my friends, it’s not forever!

Next week I’ll report on Dr. H’s updated findings. I didn’t spend enough time in the woods this weekend to get a whole docviper column together, so here’s a few first-day-of-autumn photos. One’s a daisy of some kind—oxeye, maybe? Some mushrooms, witch hazel flowers, a snail in the verge, and finally there’s a scruffy mid-molt Carolina wren. That wood pile she’s on is home to the largest black racer snake I’ve ever seen, BTW. Presume she’s keeping her eyes open!

It Might Get Messy

It Might Get Messy

Last week we celebrated the test results showing that the tumor-looking growth in my throat was not, in fact, cancerous, and discussed the interesting, if to-date-not-particularly-useful fact that naked mole rats possess a couple of genes coding for proteins that suppress tumor development and so are generally immune to cancers.

In a novel, Perdido Street Station, whose premise is so imaginatively bizarre as to question its author’s (China Mieville) educational, if not biological, background in the same world as the rest of us, the storyline hinges on the captive growth and feeding of a particular larval moth. Insects, like mole rats, it devolves, have important lessons to teach us about cancer. 

Some insects like moths, butterflies, beetles, and others undergo complete metamorphosis—that is, they hatch from an egg, begin life as a distinctly different larval form, totally remix and re-batch their bodily fluids inside a quiescent pupa, and finally emerge as a totally newly structured adult. This is physically bizarre. It is equivalent to taking a puppy, say, a few months old, popping it into an industrial-strength stainless steel blender set on “frappe”, whirling it into a froth, then pouring it into a Mason jar and letting it sit on the counter for a couple months until the contents reconfigure themselves into, say, a cuttlefish or maybe a squid, and slurping itself away into the nearest estuary. Like I say, bizarre. 

The gooey fluid in the insect pupa converts itself to the awesomely complicated structure of an adult via organizing structures called “imaginal disks”. These disks float free in the tissue goop, and when and as appropriate times come, they direct the conversion of proteins and other chemicals in the pupal slop from goo to adult insect. 

It turns out, even if the pupa is starved (this figures in an angular way in Mieville’s novel, BTW), the imaginal disks continue to direct growth—they keep on keeping on, transitioning the preinsectoid soup into insect. In this, they act much like tumors. One of the interesting properties of many cancers is their inherent ability to pirate materials for and prioritize their own growth (and growth of necessary ancillary tissues like directed blood supply) at the expense of other tissues that would otherwise step into proper position-of-priority as growth materials become available. 

Except for a hard-stop substance called juvenile hormone. When juvenile hormone shows up in the soup, the imaginal disks coordinate their development, behave themselves as proper physiological components, and properly and calmly perform their necessary functions. It turns out, even in starved pupae, juvenile hormone makes a rather heroic effort to show up in time to try to help transform the developing insect into a functional adult with whatever resources are available, rather than giving the imaginal disks free range to expropriate and expend whatever resources of matter and energy they can grab.

The lesson, my friends, is that information is important. Really, really important. Information—like that inherent in juvenile hormone—trumps brute-force physiological hijacking. A smart system is a healthy, persistent system. We might say, a non-cancerous system. This week I’ve added a new weapon to my personal arsenal of anti-cancer weaponry. A deep dislike for inherent stupidity. Oh, I’ve always had that particular personality quirk. Just never had a real use for it before. Now I got one. Cancer? It’s not just evil, painful, disgusting, and inhumane—it’s stupid. So there. Take that. 

Next up? Maybe I’ll just find a way to work an ancient Sicilian symbol indicating the recipient’s mother’s relationship to various hoofed animals into a pre-surgery ritual for application in nontraditional cancer treatment centers. That you cancer? Really? You sure? ‘cause I got your marones right here, awright? Awright!

It Might Get Messy

It Might Get Messy

Consider the naked mole rat, Heterocephalus glaber. You may not want to consider them too close to bed time, BTW. Unless you’re a pretty hardcore biologist they are, in a number of ways, kind of creepy. But in the coolest possible way. 

Naked mole rats live in dry sandy environments in east Africa, in colonies of up to several hundred individuals. They are odd looking—hairless tubes with big teeth, kind of like wrinkly bratwursts with fangs. Here’s one slurped off the web:

They are, as you might expect, burrowers. They share an odd assortment of evolutionary skills or abilities or outcomes. First, they are eusocial mammals, which means they live in colonies dominated by single queens who do most of the reproducing. Naked mole rats live for decades—incredibly long life span for a sub-mouse sized species. They have little or no sense of pain in their epidermis. You can fry ‘em or dip ‘em in acid, and they just laugh in your face. They use tools—they place carefully shaped wedges of wood or dried  plant stems behind their teeth so that they reduce the quantity of dry, physiologically problematic particulate matter run down their gullet. When one wedge wears out, they replace it as neede. Pretty slick, huh?

But it’s nothing compared to this—naked mole rates are not known ot get cancers of any sort. They share one generic anti-cancer gene with human beings—genetically coding for a tumor suppressing protein called  p27. But they also code for second powerful tumor-suppressive protein called p16. Between the two of them, they pretty much keep naked mole rats footloose…well, as footloose as a small, short-limbed burrowing rodent can ge…and cancer-free.

I am, as of last week’s biopsy of the suspiciously tumor-like growth in my throat, once again technically cancer-free. I think it’ll be touch and go with this for me. The appearance of blobby tumor-looking but not-malignant tissue is not a good thing. But maybe by the next time I have to go around for treatment…or certainly by the time our kids have to around for treatment—naked mole rat genetic engineering will advance our treatment technologies beyond the blunt-trauma hammers of radiation and chemotherapy. Weird-ass as they are they, that may be a very, very good thing.

Hang in there, my friends. And do a little research on naked mole rats. They’ll very cool in so many ways. Especially non-cancer ways!

Useful Reference 

http://io9.com/5889665/10-reasons-naked-mole-rats-will-inherit-the-earth

It Might Get Messy

Information. Obviously important. Like, critically, vitally, fundamentally important. As important as time, space, matter, and energy. Because if you have time, space, matter and energy without information, you got goop. And goop, in general, ain’t helpful.

But if you got goop, you got the goods. All you need is some information. With a little bit of organization that time, space, matter and energy smoothy you’re looking at becomes…well, a universe. Functional, alive, complicated, beautiful, horrific. In brief, OUR universe.

It was hard for the South to lose the battle of Gettysburg. Robert E. Lee had the right troops, at the right time, in just about the right place. There was some squishiness in that definition of “right place”. The Federals actually held most of the high ground, such as it was, in the rolling farmlands of southern Pennsylvania. But there were weren’t very many of them, and they weren’t very well led. If the armies were blue and gray goop, all Lee needed was a little information to organize HIS goop into the winning blob.

In the 1860s, military information was generated by cavalry. People on horses could ride out farther and faster than other people could walk, count the walking people and their weapons, and ride back with that information. The kind of information Lee needed to massage his goop into the winning blob was that the Federals on Little Round Top and Cemetery Ridge were, at that moment, loosely connected groups of men from multiple commands with little understanding of what needed doing and even less of their part in the doing. In short, with the basic information a simple cavalry engagement would generate.

Only he didn’t have such information. Via a series of what in retrospect can only seem like a far-less-than-improbable cascade of bad military dealings, Lee’s cavalry, including units led by both his son and nephew under the command of J.E.B. Stuart, were out in the hinterlands around Gettysburg (and if you’ve ever been to Gettysburg, you’ve pretty much seen for yourself that it’s all hinterlands) doing nothing particularly productive. And leaving Lee blind to the fact that the federals were, for the moment, militarily impaired.

You know the rest of that story. The Confederates went back south of the the Rappahannock and Potomac rivers, the Union clumsily if persistently hammered on them until they had to surrender at Appomattax.

So information is good. The more information you have, the better. The easier it is to make right decisions. The easier it is to avoid getting your ass kicked at a place like Gettysburg where you should have been the one kicking ass.

This information phenomenon applies to cancer as well. The past two weeks you’ve seen the graphics on which medical decisions are being made as was speak that will determine whether or not, and how well in the former case, I live. The initial information was not promising. The PET scan showed a white-hot spot in my throat where cellular metabolism was racing, converting sugar to ATP and busting it back to ADP in an almost frantic exposition of life. And the MRI, more subtle, with far better resolution, convinced the radiologist there was a visible structure correlated with that hot spot. Hell, I thought I saw it myself.

To his credit as a professional and for sticking to his guns, Dr. H never saw it. Never thought there was a tumor there. And the news this week? Well, on Friday last they put me under and cut me up. You saw the slashed-away spots on my throat. All that meat went off to the lab. And all of it…every single shred…came back negative. No cancer. I have a metabolically active rough spot in my throat, its coherence enhanced now by having been hacked away with scalpels and extractors. But that’ll heal. I can add chicken nuggets and ice cream to my milk shakes, and get back to swallowing as best I’ll be able to. We’ll have to track it closely, because it IS a suspect bit of physiology, sitting there cooking in otherwise benign throat tissue.

But for now, we know this. It’s not cancerous. I am tumor free. I am back in the real world, with all the real problems of earning a living, crafting a family, and growing into something I want to be. But what I am NOT is fighting a carcinoma.

Once again I thank you, my friends. For sticking with me all this way. I love you all. And, it seems, I’m gonna be around to keep on loving you for some time yet to come!!!