Recognizing the time crunch that comes with the winter holidays, I am going to give you and me a break and not post this week. However, much is churning in our little pocket of reality. Interesting and important changes are going down across the scales of being, from my physiology and health, through the holiday foods and festivities, to the parallel social and ecological systems that determine the sustainability of the biosphere and our collective lives and endeavors.
So check in next Sunday, 5 January 2014. We will share perspectives on my third full year of intense cancer management, and consider sundry issues pertaining to the holidays (including recipes and photos) and the trajectory of life on earth as we plow one more year into the 21st century.
I hope you are all having rollicking good times with friends, family, foods, and drinks as we wriggle out of the thoroughly worn and torn skin of 2013 and squidge our way into the shiny and pristine corpus of the new year. Rock on, everybody. We aren't getting any younger, and that means that every day we live and breathe is another slap in the face of the cold, dark, inevitable, entropy-driven universe. Let's rock!!!
Saturday, December 28, 2013
Saturday, December 21, 2013
It Might Get Messy
Yikes. What a week it’s been for health care here in the USA. We finally get our shit together as a society, manage to find a way to get everybody access to health care, and the White House mangles the great concept via bungled process. Icky. But that’s not the worst of it. The conservative fringe (which is a hell of a “fringe”—something close to 50% of the country self-identifies as “conservative”) has spent months loading weapons, pointing them at their own feet, and blowing them into bloody political froth. If the Democrats could manage to walk and chew gum at the same time, the Republicans could be so discredited that we could sell the whole damned middle of the country back to the French and leave ourselves with the rational and fun loving coasts plus a hefty cash balance to constrain health care costs to treat the sun tan related skin cancers and alcohol-damaged livers from all the beach butt-parking.
But that’s not why we’re here. We’re here to consider my own health care contretemps. And in that department, it’s been a busy week.
Monday I had the diagnostic tests. The technician shot me full of radioactive glucose first thing in the morning, and after an hour parked me on the stretcher to run through the detector. The radio-imaging takes 24 minutes, during which I lay flat on my back with my head tilted back and cradled in a basket. So here’s the problem. A few weeks ago, you may recall, I noticed that the saliva glands in my mouth that had been shut down since the radiation treatments started last spring had struggled back to life. They’ve been pumping out great volumes of thin salivary mucous ever since. This has some potential to be an issue. Since my epiglottis is permanently disabled, liquids originating in my mouth and throat can slide down my airway as readily as they slip down into my gut. Conveniently for me (and unusual, my doctors are surprised to learn that I do not need to constantly use the mechanical vacuum apparatus I have to drain my throat of liquids), the large volumes of saliva mostly find their way into my gastrointestinal tract and not my lungs.
Unless I’m on my back with my head cradled and tilted back. Under those conditions, all the thin salivary mucous (along with the lesser volume, but more difficult to manage, thick mucous originating deeper in my throat) can’t flow into my gut because “downhill” with my head tilted back is toward my cranium. So, for 24 minutes (during which I cannot move without screwing up the imaging) I had to lie there and feel liquids relentlessly filling my sinus cavities. In fact, by the time the imaging was done, the liquids were deep enough to be running out my nose. And when I finally sat up… . Woosh! Something like a liter-and-a-half of mucosal secretions started pouring out my nose, mouth, and tracheostomy tubing.
I have a good relationship with the imaging technician. We’ve spent a lot of time together the past few years. She is a youngish woman (maybe mid-30s), possibly spent time in the military. She’s got a sexy little tramp stamp, a very artistic abstract tat on her shoulder, and a diamond stud in her nose. She is mostly gruff and businesslike. But not with me. I crack her up, for some reason. So while I’m sitting in her office waiting for her to cut me a disk of the imaging files and leaking fluids like a sunken ferry hull lifted from the water by industrial cranes, she chuckles and kicks a waste basket across the floor to me so I can dispose of the enormous mass of paper towels accumulating in my lap as I mopped up the waterfall of goo.
On Wednesday, I had appointments with surgeon Dr. H and hematologist/oncologist Dr. T. Neither of them had read the radiology report before I got there. But they’re both excellent at what they do. Pulling up the file and scanning through it, they gave me the results. Which are without a doubt amazing. There is not a sign of malignancy anywhere in my head or neck. The surgery, radiation and chemotherapy last spring, given an 80% likelihood of failure by the same doctors, totally succeeded. There are a number of small spots in my lungs and in a couple of lymph nodes in my chest (all the lymph nodes from my shoulders north having been surgically removed) that took up the radio-labeled sugar. But the doctors don’t see any of them as a problem. None of them seems particularly tumor-like. There is some long-term potential danger from the lymph nodes—apparently if those are actually malignant there is no effective treatment. But basically, Drs. H and T agreed that I am, somewhat to their surprise, cancer-free. They said any 60 year old male, lassoed randomly from the streets and without a history of cancer, would generate images precisely like mine.
On Friday, I saw my radiation oncologist. Dr. N poked and prodded. He and a nurse teamed up to get an endoscope into my throat (irritating it in the process so that I coughed up blood for several hours afterward), and there is no sign of any diseased or even suspect tissue. I’m clean.
I do have a new pain (I think I reported it here a couple weeks back) at the base of my right mandible, running along the Eustachian tube. But this is not tumorous. It seems to be an artifact of the surgery. As the scars have settled in and the surrounding musculature recovered, they are apparently stretching or inflaming that area. But a half dose of dilaudid twice a day deals with that nagging pain just fine.
All three doctors seem surprised at their own handiwork. They all expected to see signs of resurgent or emergent malignancy. But there are none. They did one HELL of a good job.
My only real problem at the moment is nutrition. The emergency-ration food liquid is dense. I can pour in six 250 ml cartons a day. But that is not enough to maintain my weight, even though such a volume of “food” gives me chronic nausea and a tendency to acid reflux. I am very weak, and really need to stabilize my weight and gain five or six pounds to be back to a strength that will allow me to exercise. It takes a daily ration of seven or eight cartons of “food” to balance my metabolism.
So I checked in with my dietician. She gave me a high-calorie additive (rather like those “gasoline additives” they used to advertise to be poured on top of a tank of fuel in your car) to try. Turns out the additive plays hell with my bowels and is also expensive (health insurance is not covering my medical “food” this round. Which is annoying because a) they covered it last round of treatment, and b) while I do have to eat (which is their argument for not paying for the emergency rations), I would eat nowhere near enough food to equal the cost of this stuff). Dietician K says I can’t just go a General Nutrition Center store and get an off-the-shelf weight gain product. Apparently the powders are impossible to hydrate uniformly, and even small bits of undissolved powder will clog my feeding tube, necessitating a full surgical intervention for repair.
So I have my work cut out for me. I have to find a way to get more liquid stuffed into my gut. One thing we’ll try after the holidays is substituting a higher-calorie version of the liquids I’m presently using for a couple of the cartons per day. This may be enough to stem the withering of my corpus. But the “2 cal” version of the “1.5 cal” food I’m taking now is slow-moving syrupy goop. It may screw up my digestive tract as much as the additive version.
We’ll find out after Dietician K gets back from her winter holiday. But radiation oncologist Dr. N came up with a treatment he thinks will stimulate my appetite, suppress my chronic nausea, and kill the pain in my mandible as effectively as the dilaudid.
He gave me a fat prescription for THC. So it’s going to be very literally a HAPPY holiday season. Oh, and you thought LAST year was the “Best Thanksgiving Ever”! It’s looking like quite the fiesta for next year!
And that’s where things stand at the moment. Not only am I not dead or dying, I am actually recovering and finding a very acceptable quality-of-life. Modern medicine is a truly awesome arsenal of physiological weapons. Now if we could find a way to get such health care to all our citizens, the future would indeed be bright.
And in my little corner of the universe, it is already very bright. I am weak and badly wounded, but I am alive and functioning. I am having a SLAMMING holiday season, cooking, writing, playing guitar, and watching our grown-up kids find their way in the world. I am so grateful to be here that there are no words to convey my joy.
Rock on, everybody. And if you come here to rock on, why, I have a big-ass bottle of THC. “Merry Christmas” indeed!!!
But that’s not why we’re here. We’re here to consider my own health care contretemps. And in that department, it’s been a busy week.
Monday I had the diagnostic tests. The technician shot me full of radioactive glucose first thing in the morning, and after an hour parked me on the stretcher to run through the detector. The radio-imaging takes 24 minutes, during which I lay flat on my back with my head tilted back and cradled in a basket. So here’s the problem. A few weeks ago, you may recall, I noticed that the saliva glands in my mouth that had been shut down since the radiation treatments started last spring had struggled back to life. They’ve been pumping out great volumes of thin salivary mucous ever since. This has some potential to be an issue. Since my epiglottis is permanently disabled, liquids originating in my mouth and throat can slide down my airway as readily as they slip down into my gut. Conveniently for me (and unusual, my doctors are surprised to learn that I do not need to constantly use the mechanical vacuum apparatus I have to drain my throat of liquids), the large volumes of saliva mostly find their way into my gastrointestinal tract and not my lungs.
Unless I’m on my back with my head cradled and tilted back. Under those conditions, all the thin salivary mucous (along with the lesser volume, but more difficult to manage, thick mucous originating deeper in my throat) can’t flow into my gut because “downhill” with my head tilted back is toward my cranium. So, for 24 minutes (during which I cannot move without screwing up the imaging) I had to lie there and feel liquids relentlessly filling my sinus cavities. In fact, by the time the imaging was done, the liquids were deep enough to be running out my nose. And when I finally sat up… . Woosh! Something like a liter-and-a-half of mucosal secretions started pouring out my nose, mouth, and tracheostomy tubing.
I have a good relationship with the imaging technician. We’ve spent a lot of time together the past few years. She is a youngish woman (maybe mid-30s), possibly spent time in the military. She’s got a sexy little tramp stamp, a very artistic abstract tat on her shoulder, and a diamond stud in her nose. She is mostly gruff and businesslike. But not with me. I crack her up, for some reason. So while I’m sitting in her office waiting for her to cut me a disk of the imaging files and leaking fluids like a sunken ferry hull lifted from the water by industrial cranes, she chuckles and kicks a waste basket across the floor to me so I can dispose of the enormous mass of paper towels accumulating in my lap as I mopped up the waterfall of goo.
On Wednesday, I had appointments with surgeon Dr. H and hematologist/oncologist Dr. T. Neither of them had read the radiology report before I got there. But they’re both excellent at what they do. Pulling up the file and scanning through it, they gave me the results. Which are without a doubt amazing. There is not a sign of malignancy anywhere in my head or neck. The surgery, radiation and chemotherapy last spring, given an 80% likelihood of failure by the same doctors, totally succeeded. There are a number of small spots in my lungs and in a couple of lymph nodes in my chest (all the lymph nodes from my shoulders north having been surgically removed) that took up the radio-labeled sugar. But the doctors don’t see any of them as a problem. None of them seems particularly tumor-like. There is some long-term potential danger from the lymph nodes—apparently if those are actually malignant there is no effective treatment. But basically, Drs. H and T agreed that I am, somewhat to their surprise, cancer-free. They said any 60 year old male, lassoed randomly from the streets and without a history of cancer, would generate images precisely like mine.
On Friday, I saw my radiation oncologist. Dr. N poked and prodded. He and a nurse teamed up to get an endoscope into my throat (irritating it in the process so that I coughed up blood for several hours afterward), and there is no sign of any diseased or even suspect tissue. I’m clean.
I do have a new pain (I think I reported it here a couple weeks back) at the base of my right mandible, running along the Eustachian tube. But this is not tumorous. It seems to be an artifact of the surgery. As the scars have settled in and the surrounding musculature recovered, they are apparently stretching or inflaming that area. But a half dose of dilaudid twice a day deals with that nagging pain just fine.
All three doctors seem surprised at their own handiwork. They all expected to see signs of resurgent or emergent malignancy. But there are none. They did one HELL of a good job.
My only real problem at the moment is nutrition. The emergency-ration food liquid is dense. I can pour in six 250 ml cartons a day. But that is not enough to maintain my weight, even though such a volume of “food” gives me chronic nausea and a tendency to acid reflux. I am very weak, and really need to stabilize my weight and gain five or six pounds to be back to a strength that will allow me to exercise. It takes a daily ration of seven or eight cartons of “food” to balance my metabolism.
So I checked in with my dietician. She gave me a high-calorie additive (rather like those “gasoline additives” they used to advertise to be poured on top of a tank of fuel in your car) to try. Turns out the additive plays hell with my bowels and is also expensive (health insurance is not covering my medical “food” this round. Which is annoying because a) they covered it last round of treatment, and b) while I do have to eat (which is their argument for not paying for the emergency rations), I would eat nowhere near enough food to equal the cost of this stuff). Dietician K says I can’t just go a General Nutrition Center store and get an off-the-shelf weight gain product. Apparently the powders are impossible to hydrate uniformly, and even small bits of undissolved powder will clog my feeding tube, necessitating a full surgical intervention for repair.
So I have my work cut out for me. I have to find a way to get more liquid stuffed into my gut. One thing we’ll try after the holidays is substituting a higher-calorie version of the liquids I’m presently using for a couple of the cartons per day. This may be enough to stem the withering of my corpus. But the “2 cal” version of the “1.5 cal” food I’m taking now is slow-moving syrupy goop. It may screw up my digestive tract as much as the additive version.
We’ll find out after Dietician K gets back from her winter holiday. But radiation oncologist Dr. N came up with a treatment he thinks will stimulate my appetite, suppress my chronic nausea, and kill the pain in my mandible as effectively as the dilaudid.
He gave me a fat prescription for THC. So it’s going to be very literally a HAPPY holiday season. Oh, and you thought LAST year was the “Best Thanksgiving Ever”! It’s looking like quite the fiesta for next year!
And that’s where things stand at the moment. Not only am I not dead or dying, I am actually recovering and finding a very acceptable quality-of-life. Modern medicine is a truly awesome arsenal of physiological weapons. Now if we could find a way to get such health care to all our citizens, the future would indeed be bright.
And in my little corner of the universe, it is already very bright. I am weak and badly wounded, but I am alive and functioning. I am having a SLAMMING holiday season, cooking, writing, playing guitar, and watching our grown-up kids find their way in the world. I am so grateful to be here that there are no words to convey my joy.
Rock on, everybody. And if you come here to rock on, why, I have a big-ass bottle of THC. “Merry Christmas” indeed!!!
Sunday, December 15, 2013
It Might Get Messy
To reduce everybody's time burden this busy season, I'm not going to post this week. Tomorrow I have the HUGE diagnostic tests--PET scan (with radio tracer sugar) and CT scan (3D X-ray imaging) that will determine my short-term fate. If the tests are clean, I'll be nominally cancer-free (again) and can continue to enjoy life and the sweet winter holidays. If I have recurrent or emergent malignancy, it will be back into the trenches for more dramatic, life-or-death defensive warfare.
Stay tuned to see which path we walk together in 2014. I hope you all are having a wonderful winter. Things around here are just fabulous. All 3 kids back in the house, Christmas decorations up, the ancestral Panettone style bread ready to bake. I doesn't get better than this. Love you all. Happy holidays. Check this spot next week (pre-Christmas weekend) and the week after (pre-New Year's weekend) for all the cliffhanging drama you've come to expect from this real-life soap opera weblog!!!
Stay tuned to see which path we walk together in 2014. I hope you all are having a wonderful winter. Things around here are just fabulous. All 3 kids back in the house, Christmas decorations up, the ancestral Panettone style bread ready to bake. I doesn't get better than this. Love you all. Happy holidays. Check this spot next week (pre-Christmas weekend) and the week after (pre-New Year's weekend) for all the cliffhanging drama you've come to expect from this real-life soap opera weblog!!!
Saturday, December 7, 2013
It Might Get Messy
The thing about cancer is, it’s forever. This is, of course, literally true. It’s a simple matter of probability that a genetic error will coincide with other physiological conditions to cascade down the road of runaway cellular misconduct. This can happen any time, anywhere, at any age.
But it’s also true in a more immediate and frightening sense. Once you’ve had cancer, you have the nagging discomfiting feeling that it’s coming back. Or starting anew. Or both. There is a constant chipping at the edge of your consciousness, loose shards of paint and plaster around cracks where the tumor of your nightmares gains entry and proliferates.
I went to see my new “palliative care” specialist this week. Dr. S has been assigned the complicated task of keeping track of, adjusting, juggling, and prescribing my medications. He is being very sensitive regarding possible intrusions on my other doctor’s turf. I assured him that the medical team is not generally turf-conscious, and also that they are more-than-happy to be relieved of responsibility for the volume and diversity of my meds.
Dr. S is streamlining the anti-depressant and anti-anxiety components of my pharmaceutical program. We’re cutting back to one of each, and experimenting with doses to find the best balance between blissful sailing on the gentle waters of life and being passed out face down in muddy bilge scum under the storm-slammed decks of a trawler off Tierra del Fuego.
But I still had that “holy shit, we’re goin’ down, all hands to the boats, women and children first, get the band playing “Nearer My God to Thee” and signal the Carpathia” feeling when I started getting a new ache at the base of right mandible. It started as a single point of pain, about where the cheek meets the jaw. Over a few days, it grew and stretched along a line from up under my earlobe to down near my throat. Now it’s a constant dull ache, running along my Eustachian tube, feeling rather like a childhood post-swimming earache.
Anyway. First thing that popped into my mind, of course, was that there was a new malignancy sprouted and blooming in my throat behind my jaw. I emailed the doctors to appraise them of the pain and inquire about what to do. But, that was the first of the week of Thanksgiving, and perhaps unsurprisingly, the docs didn’t respond. Admittedly this is unusual. They’re ordinarily quick to reply. But I’m thinking they were just busy running between work and family, like most Americans at the holiday kickoff. When the pain stabilized, I figured it wasn’t some new issue. It feels more like an artifact of the surgical reconstruction of my face. There are a number of sliced, diced canals and suture lines in my neck. I think one of them is stretched, or maybe inflamed.
In any case, this pain is easily controlled with a half-dose of dilaudid twice a day. So I gave up trying to kick pain killers and resigned myself to one in the morning and one in the evening. Dr. S is onboard. He re-upped the scrip. Now I’ll be happy, not to say calm and relaxed, for the foreseeable future.
As to the potential for new tumors, that is, of course, reality. And for a number of reasons—baseline sensitivity, heavy doses of radiation therapy, massive application of diagnostic X-rays—I am more liable to sprout new malignancies than your average joker on the street here in the Year of Our Lord 2013, assuming your “Lord” goes by the consensus calendar we’ve all been using for the past few hundred years. We’ll be doing big threshold diagnostic tests the week before Christmas. I’ll have a PET (the one with the radiolabeled sugar uptake) and a CT (3-dimensional computer registered imaging) scan later in December. The results will be in my hands that day, in my doctor’s hands that evening. Since I am only able to read the imagery if there’s a massive crystal-clear tumor slurping up radiotag, it’s unlikely I’ll be able to tell anything at first glance. I’ll be seeing my covey of doctors the week or two after Christmas. That’s when we’ll really know if I’m cancer-clean, or if there is more painful marching to be done in 2014.
Until then I’ll be chirpily optimistic. Or maybe hazily optimistic, depending on how much pain medication I need to soothe my aching jaw. But in either case, I intend to have a slammin’ holiday season. 10 months ago, it was pretty clear to all concerned that I wasn’t going to be alive to celebrate these holidays. But here I am, candying orange peel, baking the family pan duce Christmas bread, watching football on TV, and reading Genesis, the 4 Gospels, and the Revelation of John in preparation for one more Christmas and New Year and birthday season.
I hope you are all having a great run-up to the holidays. Keep your stick on the ice and your aquavit in the freezer. With a little luck—and pending those upcoming diagnostics—I’ll be around to celebrate many more with you. Rock on, everybody!
But it’s also true in a more immediate and frightening sense. Once you’ve had cancer, you have the nagging discomfiting feeling that it’s coming back. Or starting anew. Or both. There is a constant chipping at the edge of your consciousness, loose shards of paint and plaster around cracks where the tumor of your nightmares gains entry and proliferates.
I went to see my new “palliative care” specialist this week. Dr. S has been assigned the complicated task of keeping track of, adjusting, juggling, and prescribing my medications. He is being very sensitive regarding possible intrusions on my other doctor’s turf. I assured him that the medical team is not generally turf-conscious, and also that they are more-than-happy to be relieved of responsibility for the volume and diversity of my meds.
Dr. S is streamlining the anti-depressant and anti-anxiety components of my pharmaceutical program. We’re cutting back to one of each, and experimenting with doses to find the best balance between blissful sailing on the gentle waters of life and being passed out face down in muddy bilge scum under the storm-slammed decks of a trawler off Tierra del Fuego.
But I still had that “holy shit, we’re goin’ down, all hands to the boats, women and children first, get the band playing “Nearer My God to Thee” and signal the Carpathia” feeling when I started getting a new ache at the base of right mandible. It started as a single point of pain, about where the cheek meets the jaw. Over a few days, it grew and stretched along a line from up under my earlobe to down near my throat. Now it’s a constant dull ache, running along my Eustachian tube, feeling rather like a childhood post-swimming earache.
Anyway. First thing that popped into my mind, of course, was that there was a new malignancy sprouted and blooming in my throat behind my jaw. I emailed the doctors to appraise them of the pain and inquire about what to do. But, that was the first of the week of Thanksgiving, and perhaps unsurprisingly, the docs didn’t respond. Admittedly this is unusual. They’re ordinarily quick to reply. But I’m thinking they were just busy running between work and family, like most Americans at the holiday kickoff. When the pain stabilized, I figured it wasn’t some new issue. It feels more like an artifact of the surgical reconstruction of my face. There are a number of sliced, diced canals and suture lines in my neck. I think one of them is stretched, or maybe inflamed.
In any case, this pain is easily controlled with a half-dose of dilaudid twice a day. So I gave up trying to kick pain killers and resigned myself to one in the morning and one in the evening. Dr. S is onboard. He re-upped the scrip. Now I’ll be happy, not to say calm and relaxed, for the foreseeable future.
As to the potential for new tumors, that is, of course, reality. And for a number of reasons—baseline sensitivity, heavy doses of radiation therapy, massive application of diagnostic X-rays—I am more liable to sprout new malignancies than your average joker on the street here in the Year of Our Lord 2013, assuming your “Lord” goes by the consensus calendar we’ve all been using for the past few hundred years. We’ll be doing big threshold diagnostic tests the week before Christmas. I’ll have a PET (the one with the radiolabeled sugar uptake) and a CT (3-dimensional computer registered imaging) scan later in December. The results will be in my hands that day, in my doctor’s hands that evening. Since I am only able to read the imagery if there’s a massive crystal-clear tumor slurping up radiotag, it’s unlikely I’ll be able to tell anything at first glance. I’ll be seeing my covey of doctors the week or two after Christmas. That’s when we’ll really know if I’m cancer-clean, or if there is more painful marching to be done in 2014.
Until then I’ll be chirpily optimistic. Or maybe hazily optimistic, depending on how much pain medication I need to soothe my aching jaw. But in either case, I intend to have a slammin’ holiday season. 10 months ago, it was pretty clear to all concerned that I wasn’t going to be alive to celebrate these holidays. But here I am, candying orange peel, baking the family pan duce Christmas bread, watching football on TV, and reading Genesis, the 4 Gospels, and the Revelation of John in preparation for one more Christmas and New Year and birthday season.
I hope you are all having a great run-up to the holidays. Keep your stick on the ice and your aquavit in the freezer. With a little luck—and pending those upcoming diagnostics—I’ll be around to celebrate many more with you. Rock on, everybody!
Saturday, November 30, 2013
It Might Get Messy
Long, long ago, in a galaxy far, far, away, I graduated high school. My beloved Aunt Deet, who was working at the time, I believe, doing accounting for a regional Jersey City record label (something like “CBS Records”, but not THAT CBS. A small, self-contained label that pressed its own vinyl and distributed the stuff locally by truck), gifted me with a brand-spanking new, state-of-the-art, first-of-its-kind, historically innovative Texas Instruments SR-10 Scientific calculator. I’m sure it cost well north of a hundred bucks at the time. It had hard function keys for squares, square roots, scientific notation, no storage registers, and a quirky red LED readout screen. For someone with a chronic math block (me), it was a godsend.
My college career, spent in the hinterlands of Piscataway, New Jersey, had its ups and downs. In fact, while helping Cathy clean the house for Thanksgiving, I ran into a copy of my undergraduate transcript. At the end of first semester sophomore year I had a solid C minus average (including three outright F grades), and was facing the hard reality that I might not make it through college. But intellectual savvy (or maybe it was panicked fear of being scooped up by the military and shipped off to die in a steamy, remote, paddy landscape in the Mekong River delta) was starting to click. I ended sophomore year with a presentable second semester, a high B average which included a couple of difficult advanced courses. After that, I found my key. I ended up graduating one semester late, but with sufficient credits for a Bachelor of Science degree (required 30-something more credits than a Bachelor of Arts) presented Cum Laude. My transcript is a wacky trace of my transition from shy and sniveling adolescent to socially and intellectually functional adult. My junior year and three semester senior year were basically straight up A grades, including some exceedingly challenging graduate-level courses.
And my SR-10 made enormous contributions to my success. Anyway, following graduation in January of 1976, I embarked on itinerant pursuit of a career in biology. I taught high school as a substitute, and a full summer semester remedial course in biology. That spring, I got a three month job living in a log cabin in a remote woodland along the Potomac River, catching and breeding fish and subjecting them to methodical thermosensitivity experiments. After summer school ended, I drove off to southern Virginia for a lengthy master’s program in marine sciences. Then I weaseled my way into the Institute of Ecology at the University of Georgia. Followed by a stint running a lab and teaching an advanced invertebrate zoology course at the University of Maryland Eastern Shore in Princess Ann. Then into a series of consulting jobs, with a stop at New Jersey’s Department of Environmental Protection. We lived in Georgia, Virginia, Maryland, New Jersey, and back to Maryland. Somewhere along the way, I lost track of that SR-10 calculator. Of course, this was a time of frenetic development in computing hardware, and the SR-10 had long been superseded by more sophisticated calculators, mainframe computers, and then desktop and laptop machines.
Anyway, as we worked the kitchen for the Wednesday Night Seafood Supper on Thanksgiving Eve, Dr. B, an old friend who had himself moved from Virginia, to Canada, to Florida, to New Hampshire came in with a gift for me. It was my original SR-10, my name and dorm room scratched into the plastic, fully functional and fired up with new batteries that Dr. B kindly provided!
Can you imagine? My 1972 calculator found its way back to me, rather like the Master Ring in Lord of the Rings, or the kitchen flatware in Tom Robbins’ Skinny Legs and All. Another amazing circle of my life closing up neat and tidy.
The years I’ve been battling cancer have led to an astonishing number of such circles. I’ve re-established friendships with people who were intensely important to me decades ago and are now comfortably back in touch. I have achieved a worthy percentage of things on my life list of things-to-do-before-I-die, some of them added to the list when I was a child. I have been privileged to have a deeply satisfying life.
I suppose all of us hope to live such a life that there is no hole in anybody’s heart when we die. If we have been good friends, good parents, good spouses, and have managed to help people learn some things, experience some things, develop cynical and humorous approaches to the contretemps of life, there will be no real sadness in our death. We leave big chunks of ourselves in the care of those we love. For myself, if I have been able to introduce people to music they might not otherwise experience, I would consider my time on earth a success. I would die satisfied and serene. Secure in the knowledge that part of me lives on, and my smiling and laughing spirit is invoked every time somebody listens to a song I helped them discover. Part of me then lives on in you, and I am immortal. My body will be cycled back to the universal pool of molecules as building blocks for the physical future. But my spirit is alive because you've got some piece of me to keep with you on your own life journey. I am there with you, even though my body has cut and run.
I realized this as we celebrated Thanksgiving together. The holiday this year was magical. A house full of laughing friends pulled me away from my cancer-stricken body and put me on the path to forever.
I am deeply in your debt. You have given me life even as death was raising its weapons to finish me off.
I thank you. I love you.
Cathy and I talked it over, and next year we are going to rent an RV to park in the driveway for Thanksgiving week. They come with quite the berry bucket of amenities, ranging from big screen TVs and sound systems to supremely comfortable beds. Next year, nobody will have to scramble for uncomfortable sleeping space on couches and floors, or feel compelled to leave early for lack of sleeping space. We will be together for another sweet celebration of friendship and love, as many of us as can find their way to our home. We will collectively spit in the face of inevitable entropy on our way to another Best Thanksgiving Ever (trademark, copyright).
ROCK ON, everybody. We’re not dead yet!!!!!
A few Thanksgiving snapshots below.
My college career, spent in the hinterlands of Piscataway, New Jersey, had its ups and downs. In fact, while helping Cathy clean the house for Thanksgiving, I ran into a copy of my undergraduate transcript. At the end of first semester sophomore year I had a solid C minus average (including three outright F grades), and was facing the hard reality that I might not make it through college. But intellectual savvy (or maybe it was panicked fear of being scooped up by the military and shipped off to die in a steamy, remote, paddy landscape in the Mekong River delta) was starting to click. I ended sophomore year with a presentable second semester, a high B average which included a couple of difficult advanced courses. After that, I found my key. I ended up graduating one semester late, but with sufficient credits for a Bachelor of Science degree (required 30-something more credits than a Bachelor of Arts) presented Cum Laude. My transcript is a wacky trace of my transition from shy and sniveling adolescent to socially and intellectually functional adult. My junior year and three semester senior year were basically straight up A grades, including some exceedingly challenging graduate-level courses.
And my SR-10 made enormous contributions to my success. Anyway, following graduation in January of 1976, I embarked on itinerant pursuit of a career in biology. I taught high school as a substitute, and a full summer semester remedial course in biology. That spring, I got a three month job living in a log cabin in a remote woodland along the Potomac River, catching and breeding fish and subjecting them to methodical thermosensitivity experiments. After summer school ended, I drove off to southern Virginia for a lengthy master’s program in marine sciences. Then I weaseled my way into the Institute of Ecology at the University of Georgia. Followed by a stint running a lab and teaching an advanced invertebrate zoology course at the University of Maryland Eastern Shore in Princess Ann. Then into a series of consulting jobs, with a stop at New Jersey’s Department of Environmental Protection. We lived in Georgia, Virginia, Maryland, New Jersey, and back to Maryland. Somewhere along the way, I lost track of that SR-10 calculator. Of course, this was a time of frenetic development in computing hardware, and the SR-10 had long been superseded by more sophisticated calculators, mainframe computers, and then desktop and laptop machines.
Anyway, as we worked the kitchen for the Wednesday Night Seafood Supper on Thanksgiving Eve, Dr. B, an old friend who had himself moved from Virginia, to Canada, to Florida, to New Hampshire came in with a gift for me. It was my original SR-10, my name and dorm room scratched into the plastic, fully functional and fired up with new batteries that Dr. B kindly provided!
Can you imagine? My 1972 calculator found its way back to me, rather like the Master Ring in Lord of the Rings, or the kitchen flatware in Tom Robbins’ Skinny Legs and All. Another amazing circle of my life closing up neat and tidy.
The years I’ve been battling cancer have led to an astonishing number of such circles. I’ve re-established friendships with people who were intensely important to me decades ago and are now comfortably back in touch. I have achieved a worthy percentage of things on my life list of things-to-do-before-I-die, some of them added to the list when I was a child. I have been privileged to have a deeply satisfying life.
I suppose all of us hope to live such a life that there is no hole in anybody’s heart when we die. If we have been good friends, good parents, good spouses, and have managed to help people learn some things, experience some things, develop cynical and humorous approaches to the contretemps of life, there will be no real sadness in our death. We leave big chunks of ourselves in the care of those we love. For myself, if I have been able to introduce people to music they might not otherwise experience, I would consider my time on earth a success. I would die satisfied and serene. Secure in the knowledge that part of me lives on, and my smiling and laughing spirit is invoked every time somebody listens to a song I helped them discover. Part of me then lives on in you, and I am immortal. My body will be cycled back to the universal pool of molecules as building blocks for the physical future. But my spirit is alive because you've got some piece of me to keep with you on your own life journey. I am there with you, even though my body has cut and run.
I realized this as we celebrated Thanksgiving together. The holiday this year was magical. A house full of laughing friends pulled me away from my cancer-stricken body and put me on the path to forever.
I am deeply in your debt. You have given me life even as death was raising its weapons to finish me off.
I thank you. I love you.
Cathy and I talked it over, and next year we are going to rent an RV to park in the driveway for Thanksgiving week. They come with quite the berry bucket of amenities, ranging from big screen TVs and sound systems to supremely comfortable beds. Next year, nobody will have to scramble for uncomfortable sleeping space on couches and floors, or feel compelled to leave early for lack of sleeping space. We will be together for another sweet celebration of friendship and love, as many of us as can find their way to our home. We will collectively spit in the face of inevitable entropy on our way to another Best Thanksgiving Ever (trademark, copyright).
ROCK ON, everybody. We’re not dead yet!!!!!
A few Thanksgiving snapshots below.
Saturday, November 23, 2013
It Might Get Messy
No technobabble this week. As the holiday season kicks into full swing—did I mention that I love the period from Halloween to my January birthday and celebrate with rituals I’ve accumulated over long years?—I find myself riding an intricate and engrossing wave of emotions. Kind of like Joe Cocker balanced on a heavily waxed Hobie Noserider keeping the sound tsunami of the Mad Dogs and Englishmen Band churning beneath his feet as he powers “She Came In Through the Bathroom Window” all the way to the crystalline sand beach behind Leon Russell’s Malibu cottage on the western side of the Pacific Coast Highway. And you all know my body surfing and boogey boarding skills are pitiable.
Anyway. About a year ago I started rebuilding my life as the impacts of the savage surgery, chemotherapy, and radiation waned. I was back at work daily. Though my speech was impaired, I was working through it and students in the ecological risk assessment course at University of Maryland assured me that I was understandable and listening to me lecture was no hardship. It seemed that I would be able to step back into the stream of life, wounded but functional with the promise that things would get better as I worked on speech and physical recovery. I had traveled to Germany and the Philippines the year before, and managed to work around my damaged oral cavity to ingest sufficient calories to maintain weight and power ongoing recovery. The medical team breathed a deep sigh of relief, optimistic that the cancer was gone and only monitoring would be needed as I packed myself back into the crowded subway car of normal life.
But. Monitoring proved its worth. I went back and looked at the endoftheworldpartdeux blog [that’s this one] from 27 January 2013. That entry reported the findings of a PET/CT scan that my doctors and I hoped would demonstrate continued absence of tumors as my recovery from surgery, chemotherapy, and radiation treatments neared completion.
It did not. In fact, it revealed a particularly aggressive recurrent malignancy of my tongue, large and dangerous. Treatment cranked up almost immediately. First there was surgery which would further damage my tongue and make speech even more difficult, followed by intense radiation (Dr. N said he gave me more radiation exposure than most doctors would, because he thought I could take it) and hard core chemotherapy infusion.
This time, the surgery was devastating. The doctors were forced to remove my entire tongue, as the locus of the recurrent tumor. Attempted to build a new quasi-tongue with a slab of meat cut from my left thigh. And, while they rooted around in my oral cavity for the 12 hours of surgery, found that my palate was diseased such that surgical treatment was impossible. The thigh/tongue graft failed despite the application of medical leeches several times a day to harvest dead tissue and make room for the living muscle to function. During that long operation, the surgeons saw to their horror that a chunk of malignant material slid into and disappeared down a lymphatic vessel. So on the Friday after the long surgery Monday, they went back in to hack out the failed tongue graft. They peeled the skin off my upper body and removed as much of the lymph system as they could find. Recovery was slow and traumatic. I was deeply depressed, in a lot of pain, and wishing that I had refused the surgery and opted to enter hospice care and die. I built my life on teaching and public speaking, and now I was voiceless. I really didn’t want to live.
Further surgery was necessary to stem a tide of lymphatic fluid that poured into my chest cavity. I was in one hell of a mess. Hospice care and quietly managed death seemed like my path forward. I didn’t want to live with the blood, the pain, the reconstructed oral cavity, the lost tongue necessitating a lifetime of feeding via a tube in my gut and a diet of nutritious liquid in lieu of actual food. I seriously considered purchasing a couple of big jars of acetaminophen, crushing them, taking them via feeding tube, and walking into the forest on the Catoctin Ridge, away from my car with a sleeping bag and water, to die a painful death as the drug destroyed my kidneys and liver.
But I didn’t. Gradually, the pain subsided. The rebuilt mouth and throat infrastructure proved manageable. The discomfort of intensely damaged glandular systems abated (this is still ongoing, 5 or more months out from treatment). I learned to have almost as much fun communicating nonverbally as I used to have talking. The food thing is annoying, physiologically and logistically difficult, but not a real hardship.
My brain works just fine (well, as fine as it ever worked). I am comfortable functioning with my “new normal” physiology, wracked as it is. I’m happy that I did not pour the acetaminophen powder into my gut (I got as far as crushing two big bottles into a large heap of powder and having the Gatorade on hand that I would use as a vehicle) and hike into the mountain to die.
In fact, with the holidays coming on, Thanksgiving getting wound up, my physical corpus becoming more and more comfortable, my stamina (slowly) reviving, and the pain retreating, I am damned happy to be here. Having walked right to the edge of the path into the long, dark abyss of death, contemplated its landscape, and stepped back into the land of the living, I am truly happy with the universe as it is. And I am deeply grateful to whatever suite of neurons gave me the strength to put the sleeping bag back in the closet and flush the acetaminophen powder into the wastewater infrastructure.
An enormous chunk of that strength came from you who are reading this. And the many others who built the ladder for my escape from the banks of the River Styx. I thank you all. I love you all. I am deeply in your debt.
And did I mention this: YYYYYYEEEEEEEEEEEHHHHHHHHAAAAAAAAAAAA!!!!!!!!!
Anyway. About a year ago I started rebuilding my life as the impacts of the savage surgery, chemotherapy, and radiation waned. I was back at work daily. Though my speech was impaired, I was working through it and students in the ecological risk assessment course at University of Maryland assured me that I was understandable and listening to me lecture was no hardship. It seemed that I would be able to step back into the stream of life, wounded but functional with the promise that things would get better as I worked on speech and physical recovery. I had traveled to Germany and the Philippines the year before, and managed to work around my damaged oral cavity to ingest sufficient calories to maintain weight and power ongoing recovery. The medical team breathed a deep sigh of relief, optimistic that the cancer was gone and only monitoring would be needed as I packed myself back into the crowded subway car of normal life.
But. Monitoring proved its worth. I went back and looked at the endoftheworldpartdeux blog [that’s this one] from 27 January 2013. That entry reported the findings of a PET/CT scan that my doctors and I hoped would demonstrate continued absence of tumors as my recovery from surgery, chemotherapy, and radiation treatments neared completion.
It did not. In fact, it revealed a particularly aggressive recurrent malignancy of my tongue, large and dangerous. Treatment cranked up almost immediately. First there was surgery which would further damage my tongue and make speech even more difficult, followed by intense radiation (Dr. N said he gave me more radiation exposure than most doctors would, because he thought I could take it) and hard core chemotherapy infusion.
This time, the surgery was devastating. The doctors were forced to remove my entire tongue, as the locus of the recurrent tumor. Attempted to build a new quasi-tongue with a slab of meat cut from my left thigh. And, while they rooted around in my oral cavity for the 12 hours of surgery, found that my palate was diseased such that surgical treatment was impossible. The thigh/tongue graft failed despite the application of medical leeches several times a day to harvest dead tissue and make room for the living muscle to function. During that long operation, the surgeons saw to their horror that a chunk of malignant material slid into and disappeared down a lymphatic vessel. So on the Friday after the long surgery Monday, they went back in to hack out the failed tongue graft. They peeled the skin off my upper body and removed as much of the lymph system as they could find. Recovery was slow and traumatic. I was deeply depressed, in a lot of pain, and wishing that I had refused the surgery and opted to enter hospice care and die. I built my life on teaching and public speaking, and now I was voiceless. I really didn’t want to live.
Further surgery was necessary to stem a tide of lymphatic fluid that poured into my chest cavity. I was in one hell of a mess. Hospice care and quietly managed death seemed like my path forward. I didn’t want to live with the blood, the pain, the reconstructed oral cavity, the lost tongue necessitating a lifetime of feeding via a tube in my gut and a diet of nutritious liquid in lieu of actual food. I seriously considered purchasing a couple of big jars of acetaminophen, crushing them, taking them via feeding tube, and walking into the forest on the Catoctin Ridge, away from my car with a sleeping bag and water, to die a painful death as the drug destroyed my kidneys and liver.
But I didn’t. Gradually, the pain subsided. The rebuilt mouth and throat infrastructure proved manageable. The discomfort of intensely damaged glandular systems abated (this is still ongoing, 5 or more months out from treatment). I learned to have almost as much fun communicating nonverbally as I used to have talking. The food thing is annoying, physiologically and logistically difficult, but not a real hardship.
My brain works just fine (well, as fine as it ever worked). I am comfortable functioning with my “new normal” physiology, wracked as it is. I’m happy that I did not pour the acetaminophen powder into my gut (I got as far as crushing two big bottles into a large heap of powder and having the Gatorade on hand that I would use as a vehicle) and hike into the mountain to die.
In fact, with the holidays coming on, Thanksgiving getting wound up, my physical corpus becoming more and more comfortable, my stamina (slowly) reviving, and the pain retreating, I am damned happy to be here. Having walked right to the edge of the path into the long, dark abyss of death, contemplated its landscape, and stepped back into the land of the living, I am truly happy with the universe as it is. And I am deeply grateful to whatever suite of neurons gave me the strength to put the sleeping bag back in the closet and flush the acetaminophen powder into the wastewater infrastructure.
An enormous chunk of that strength came from you who are reading this. And the many others who built the ladder for my escape from the banks of the River Styx. I thank you all. I love you all. I am deeply in your debt.
And did I mention this: YYYYYYEEEEEEEEEEEHHHHHHHHAAAAAAAAAAAA!!!!!!!!!
Saturday, November 16, 2013
It Might Get Messy
Prehistoric and archaeological cancers are difficult for science to get a handle on. The vast majority of cancers involve soft tissues that are badly preserved (in mummies and rare frozen cadavers) or not preserved at all (in fossils). As might be expected in the somewhat frazzled social systems that are the world of science, this hasn’t prevented people from attempting to draw conclusions. These range from ridiculously non-credible to rational, but still uncertain.
In the former category, there is an idiot woman on the Faculty of Life Sciences at the University of Manchester in the UK who says, regarding the few identifiable cancers in bodies dating to ancient Greco-Roman times: “In industrialised societies, cancer is second only to cardiovascular disease as a cause of death. But in ancient times, it was extremely rare. There is nothing in the natural environment that can cause cancer. So it has to be a man-made disease, down to pollution and changes to our diet and lifestyle.” [1]. This statement is so ridiculously and dangerously untrue that it merits severe debunking. That debunking was done by Bruce Ames (cross-reference last week’s entry in this weblog) and associates, who documented with devastating accuracy and highly credible research that the vast majority of human environmental cancers are triggered by natural, not man-made industrial, chemicals [2]. Although that figure DOES include tobacco and alcohol use, both of which are potent carcinogens, albeit derived from biological sources. It is worth quoting the blunt conclusions of the Ames group researches:
There is no convincing evidence that synthetic chemical pollutants are important as a cause of human cancer. Regulations targeted to eliminate low levels of synthetic chemicals are expensive. The Environmental Protection Agency has estimated that environmental regulations cost society $140 billion/year. Others have estimated that the median toxic control program costs 146 times more per hypothetical life-year saved than the median medical intervention. Attempting to re- duce tiny hypothetical risks has other costs as well: if reducing synthetic pesticides makes fruits and vegetables more expensive, thereby decreasing consumption, then the cancer rate will in- crease, especially for the poor. The prevention of cancer will come from knowledge obtained from biomedical research, education of the public, and lifestyle changes made by individuals. A re-examination of priorities in cancer prevention, both public and private, seems called for.
Did I mention that Ames scrupulously refuses to accept funding from the industrial private sector? He has no skin in the game beyond the search for truth and proper prioritizing of environmental management investments.
Anyway. Per the first paragraph of this piece above, evidence of past soft-tissue cancers per se in human beings is rare because soft tissues don’t preserve well. However, when soft-tissue cancers anastomose (spread from their origin), the do sometimes leave evidence in skeletons. Thus, it has been possible to estimate archaic cancer rates from skeletons. A Neanderthal rib tumor was recently documented, given the short life expectancy of members of the genus Homo at the time, this suggests that cancers were surprisingly prevalent [3]. One Anne Sumter, dead at 31 and interred in a cemetery near the Tower Bridge in London in 1794, had a metastesis suggesting acute lung cancer [4]. A collection of more than 3000 skeletons from Croatian ossuaries ranging from 5000 B.C. to the 19th century suggest that cancer rates were low, but that short life expectancies (i.e., people died of other diseases, accident, or conflict long before cancers would be expected to appear in their aging bodies), vs. actual cancer incidence, were the primary reason [5]. The New York Times ran an article that can probably serve as the definitive assessment of ancient cancers [6]. The conclusion? Cancers were probably somewhat less common in ancient times than they are today, because tobacco and alcohol use, longer life spans, and better diagnostics inevitably increase identified malignancies. But, as one of the researchers stated, “if we live long enough, we’ll all get cancer”. True whether you were around in the time of Christ or here in the 21st century.
And why am I subjecting you to this technical blather in what should be a quick and easy informal weblog read? Because I’m giving myself a treat this year. All the medical evidence compiled over the past 4 years suggested that I should be dead or dying by now. But I’m not. In fact, yesterday I had the oddest feeling. I realized I felt healthy, and normal, in ways I have not felt since this nightmare cancer war broke out years ago. I was comfortable, pain-free, and quite, well, feeling good. I seem to have passed some physiological threshold back to the land of the living from the no-man’s land of the doomed and the struggling. Weird. But, believe me, incredibly welcome.
So, for the upcoming holidays, I’m letting myself crack my bible to read Genesis, the four Gospels, and the Revelation of John early—like this evening. I read these pieces every year between Thanksgiving and my January birthday. If you’re an agnostic nonbeliever like me, that’s pretty much all the bible you need, or can likely tolerate. Still, it gives me a nice ritual to look forward to every year.
And this year, I’m going to revel in it, celebrate it. Simply because I’m here to do it, and not a carton of ashes and teeth on a shelf in the basement.
Crank up the holidays early and hearty, my friends. Every year we’re here for one more is a spit in the face of the cold universe of inevitable, entropy-driven decay.
Oh. One more thing. The last overseas trip I’ll probably manage in my remaining life was to the remote southern Philippines a year + ago. While Mindanao (where I was) missed the brunt of this most recent storm, it was clear from our work with the displaced from a prior typhoon that a storm surge of any meaningful magnitude would kill thousands and displace tens of thousands of impoverished people living in riverbottoms and along tidal waterways. Those of us in the hygienic, cozy, comfortable, wealthy west are very, very lucky. But the people of the rural Philippines were, as I’ve found throughout the world, incredibly resilient, cheerful, and gleefully ironic about their circumstances. Those qualities will stand the people devastated by Typhoon Haiyan in good stead as they grieve for their losses and recover their lives. Everyone reading this blog should go to Stephen Colbert’s web portal and text a donation to help out. I haven’t been proud of much about being an American over this past complicated year. But the fact that a U.S. Air Craft Carrier Battle Group could get in place in the remote Philippines in a matter of days and start producing 100,000 gallons of potable water per day for the impacted populace makes me very, very proud. Every bit of aid that makes it to the people is likely to save a life. And that’s just awesome.
I leave you with some of the best photographs I got on my life-changing trip to the Philippines in the interim of my cancer battle. Remember that in most browsers, if you click or double-click the photographs, you can view them in a larger format.
My love and gratitude to all of you and yours. High fives all around just for being here for one more smegging year on earth!
Notes
[1] http://phys.org/news/2010-10-scientists-cancer-purely-man-made.html
[2] Gold, L.S., B.N. Ames, and T.H. Slone 2002. Misconceptions about the causes of cancer. In Human and Environmental Risk Assessment, edited by D. Paustenbach, Wiley & Sons, NY.
[3] http://popular-archaeology.com/issue/june-2013/article/bone-tumor-found-in-neanderthal-rib
[4] http://www.aocarchaeology.com/key-projects/research-key-projects/cancer-in-the-18th-century-a-case-from-all-hallows-london
[5] http://news.nationalgeographic.com/news/2004/07/0713_040713_skeletoncancer.html
[6] http://www.nytimes.com/2010/12/28/health/28cancer.html?pagewanted=all&_r=0
Prehistoric and archaeological cancers are difficult for science to get a handle on. The vast majority of cancers involve soft tissues that are badly preserved (in mummies and rare frozen cadavers) or not preserved at all (in fossils). As might be expected in the somewhat frazzled social systems that are the world of science, this hasn’t prevented people from attempting to draw conclusions. These range from ridiculously non-credible to rational, but still uncertain.
In the former category, there is an idiot woman on the Faculty of Life Sciences at the University of Manchester in the UK who says, regarding the few identifiable cancers in bodies dating to ancient Greco-Roman times: “In industrialised societies, cancer is second only to cardiovascular disease as a cause of death. But in ancient times, it was extremely rare. There is nothing in the natural environment that can cause cancer. So it has to be a man-made disease, down to pollution and changes to our diet and lifestyle.” [1]. This statement is so ridiculously and dangerously untrue that it merits severe debunking. That debunking was done by Bruce Ames (cross-reference last week’s entry in this weblog) and associates, who documented with devastating accuracy and highly credible research that the vast majority of human environmental cancers are triggered by natural, not man-made industrial, chemicals [2]. Although that figure DOES include tobacco and alcohol use, both of which are potent carcinogens, albeit derived from biological sources. It is worth quoting the blunt conclusions of the Ames group researches:
There is no convincing evidence that synthetic chemical pollutants are important as a cause of human cancer. Regulations targeted to eliminate low levels of synthetic chemicals are expensive. The Environmental Protection Agency has estimated that environmental regulations cost society $140 billion/year. Others have estimated that the median toxic control program costs 146 times more per hypothetical life-year saved than the median medical intervention. Attempting to re- duce tiny hypothetical risks has other costs as well: if reducing synthetic pesticides makes fruits and vegetables more expensive, thereby decreasing consumption, then the cancer rate will in- crease, especially for the poor. The prevention of cancer will come from knowledge obtained from biomedical research, education of the public, and lifestyle changes made by individuals. A re-examination of priorities in cancer prevention, both public and private, seems called for.
Did I mention that Ames scrupulously refuses to accept funding from the industrial private sector? He has no skin in the game beyond the search for truth and proper prioritizing of environmental management investments.
Anyway. Per the first paragraph of this piece above, evidence of past soft-tissue cancers per se in human beings is rare because soft tissues don’t preserve well. However, when soft-tissue cancers anastomose (spread from their origin), the do sometimes leave evidence in skeletons. Thus, it has been possible to estimate archaic cancer rates from skeletons. A Neanderthal rib tumor was recently documented, given the short life expectancy of members of the genus Homo at the time, this suggests that cancers were surprisingly prevalent [3]. One Anne Sumter, dead at 31 and interred in a cemetery near the Tower Bridge in London in 1794, had a metastesis suggesting acute lung cancer [4]. A collection of more than 3000 skeletons from Croatian ossuaries ranging from 5000 B.C. to the 19th century suggest that cancer rates were low, but that short life expectancies (i.e., people died of other diseases, accident, or conflict long before cancers would be expected to appear in their aging bodies), vs. actual cancer incidence, were the primary reason [5]. The New York Times ran an article that can probably serve as the definitive assessment of ancient cancers [6]. The conclusion? Cancers were probably somewhat less common in ancient times than they are today, because tobacco and alcohol use, longer life spans, and better diagnostics inevitably increase identified malignancies. But, as one of the researchers stated, “if we live long enough, we’ll all get cancer”. True whether you were around in the time of Christ or here in the 21st century.
And why am I subjecting you to this technical blather in what should be a quick and easy informal weblog read? Because I’m giving myself a treat this year. All the medical evidence compiled over the past 4 years suggested that I should be dead or dying by now. But I’m not. In fact, yesterday I had the oddest feeling. I realized I felt healthy, and normal, in ways I have not felt since this nightmare cancer war broke out years ago. I was comfortable, pain-free, and quite, well, feeling good. I seem to have passed some physiological threshold back to the land of the living from the no-man’s land of the doomed and the struggling. Weird. But, believe me, incredibly welcome.
So, for the upcoming holidays, I’m letting myself crack my bible to read Genesis, the four Gospels, and the Revelation of John early—like this evening. I read these pieces every year between Thanksgiving and my January birthday. If you’re an agnostic nonbeliever like me, that’s pretty much all the bible you need, or can likely tolerate. Still, it gives me a nice ritual to look forward to every year.
And this year, I’m going to revel in it, celebrate it. Simply because I’m here to do it, and not a carton of ashes and teeth on a shelf in the basement.
Crank up the holidays early and hearty, my friends. Every year we’re here for one more is a spit in the face of the cold universe of inevitable, entropy-driven decay.
Oh. One more thing. The last overseas trip I’ll probably manage in my remaining life was to the remote southern Philippines a year + ago. While Mindanao (where I was) missed the brunt of this most recent storm, it was clear from our work with the displaced from a prior typhoon that a storm surge of any meaningful magnitude would kill thousands and displace tens of thousands of impoverished people living in riverbottoms and along tidal waterways. Those of us in the hygienic, cozy, comfortable, wealthy west are very, very lucky. But the people of the rural Philippines were, as I’ve found throughout the world, incredibly resilient, cheerful, and gleefully ironic about their circumstances. Those qualities will stand the people devastated by Typhoon Haiyan in good stead as they grieve for their losses and recover their lives. Everyone reading this blog should go to Stephen Colbert’s web portal and text a donation to help out. I haven’t been proud of much about being an American over this past complicated year. But the fact that a U.S. Air Craft Carrier Battle Group could get in place in the remote Philippines in a matter of days and start producing 100,000 gallons of potable water per day for the impacted populace makes me very, very proud. Every bit of aid that makes it to the people is likely to save a life. And that’s just awesome.
I leave you with some of the best photographs I got on my life-changing trip to the Philippines in the interim of my cancer battle. Remember that in most browsers, if you click or double-click the photographs, you can view them in a larger format.
My love and gratitude to all of you and yours. High fives all around just for being here for one more smegging year on earth!
Notes
[1] http://phys.org/news/2010-10-scientists-cancer-purely-man-made.html
[2] Gold, L.S., B.N. Ames, and T.H. Slone 2002. Misconceptions about the causes of cancer. In Human and Environmental Risk Assessment, edited by D. Paustenbach, Wiley & Sons, NY.
[3] http://popular-archaeology.com/issue/june-2013/article/bone-tumor-found-in-neanderthal-rib
[4] http://www.aocarchaeology.com/key-projects/research-key-projects/cancer-in-the-18th-century-a-case-from-all-hallows-london
[5] http://news.nationalgeographic.com/news/2004/07/0713_040713_skeletoncancer.html
[6] http://www.nytimes.com/2010/12/28/health/28cancer.html?pagewanted=all&_r=0
Saturday, November 9, 2013
It Might Get Messy
Bruce Ames is one of, if not the single most, principled human being in history. Early in his career, he developed the Ames Test, a rapid microbial screen for potential carcinogenic activity of chemical substances [1]. The Ames Test was instrumental in cleanup of hazardous waste sites and regulation of industrial chemicals in the closing third of the 20th century.
When Ames realized to his horror that slapdash science by environmental groups and regulators was twisting priorities for environmental management in dangerous and unproductive ways, he owned up. He documented and presented an irrefutable case that human exposure to natural carcinogens—primarily in plants, but also in animals—swamps the total carcinogenic activity of industrial products. He took a lot of flack for this, but he stuck to his guns and told the truth. Here in the 21st century, we can see that Superfund and other regulatory programs have done their job. The Clean Air Act, Clean Water Act, and their analogs in other countries, and the investment made in environmental cleanup have greatly reduced the carcinogenic potential of exposure to industrial chemicals. If we as a society had half a brain, we would be pivoting our environmental management investments of time, money and expertise to more important sustainability impairments, including provision of potable water, ecosystem habitat quality, suppression of contagious diseases, food quality and quantity, antibiotic resistance, and others. Instead, we (to Ames’ and my frustration) continue to spend exorbitant resources managing meaningless quantities of industrial chemicals in the environment.
There is a sideways or hidden-ball importance to Ames’ work in the past 30 years. While demonstrating the abundance of natural carcinogens, it devolved that there is a corresponding abundance of natural anti-carcinogens. In an earlier post on this blog we discussed the anti-cancer screening program that yielded key chemotherapy drug Taxol from extracts of evergreen tree bark. Recently, the marine environment has provided substantial evidence of cancer-fighting chemicals.
Surveys show that cancer-fighting chemicals are associated with sponges, tunicates, corals, jellyfish, mollusks, bacteria, and blue-green “algae”. In fact, bacteria and cyanobacteria (blue-green algae, as we used to know them) are little factories pumping out carcinogenic and anti-cancer chemicals, often via complex and delicate ecological association with eukaryotes—sponges, tunicates, corals, etc. [2]. In many cases, it may be ecological system itself (that is, the physical and biochemical relationship of the microbes and their eukaryote associates) that is the source of the anti-cancer molecules.
Identifying, isolating, and testing chemical products of marine organisms is a technically difficult and expensive process [3]. In general, the organisms produce very small quantities of potentially useful molecules. To obtain sufficient quantities for screening and more intensive tests, it is usually necessary to find ways to synthesize the molecules originating in the marine environment. This is challenging enough. Of course in many cases naturally-produced molecules have toxic activity along with anti-cancer potential, similar to the drugs now used on chemotherapy cocktails. This complicates the development of effective and safe drugs from raw marine biochemicals. But the diversity and potential value of such chemicals makes the effort to develop them worthwhile (even if researchers tend to include a degree of obvious funding-agency cheerleading in their publications, see [2] and [3]).
Anyway. I’ve been having trouble balancing my own medications, even with the addition to my medical team of “palliative care” specialist Dr. S whose sole job is keeping me appropriately medicated. I’ve basically come to a twice-a-day process. I take meds once when I wake up in the morning, and then again around 7 or 8 in the evening. I’ve been trying to cut back on the morning meds, mostly because I take a lot of pills and it just seems like I ought to be able to survive on less. However. As I reduced the morning dosage of Benadryl and other meds designed to slow the massive production of thick, icky mucous in my throat, I became less functional during the day. I ended up parking my butt in the recliner in front of the television, with books and guitar within reach, and not moving until I took the larger evening dose of meds, when I was able to be more functional.
Now, while I’m quite able to survive reading a novel a day (which is about my rate when I’m butt-parking for 9 or 10 hours), noodling a little guitar, and watching “Pawn Stars”, “American Pickers”, and “NCIS” marathons, it’s not really much of a life. So, in the interests of becoming a more actively functional human being, I’m experimenting with increased dosage of morning meds. Today I took a moderate upgrade in the total a.m. mass of medications, and was able to spend some time clearing the finished half of the basement in preparation for Thanksgiving and running to the grocery store to get stuff to make rigatoni with bacon and mushroom cream with a salad of kohlrabi and other chunky vegetables in a soy-based Japanese style dressing for dinner tomorrow when Molly stops by to visit.
So I seem to be getting on top of this issue. Over all, I believe I continue to improve. What remains of my oral salivary glands came back online a few weeks ago, having been again suppressed by the radiation last spring. This means my mouth fills with thin, watery saliva at the same time that my throat continues to produce a thick, ropey mucous. But this actually means I’m recovering. The radiation damage continues to recede. I can’t feel any obvious signs of recurrent malignancy, but the December PET/CT will be the arbiter of that question. I’m also getting more comfortable with being without a tongue and thus unable to eat, drink, and talk for the rest of my life. This is a threshold that only a couple years ago I would have thought I’d never get past. But here I am, alive, mute, and obtaining my dietary ration by pouring goopy liquid rations into a tube stuck through my abdomen. Sometimes I amaze myself, and this bit of life process is one of those times.
Meanwhile, as always, I owe much of my strength to you, my friends and blog readers out there in the real world. Thank you so much for being here for me. This being autumn, I’m getting my writing chops together and working much more diligently on producing usable material. So if you have a little more time and interest, you will find a music review over at www.theresaturtleinmysoup.blogspot.com , a reprint of my www.aehsfoundation.org weekly weblog at www.sustainablebiospheredotnet.blogspot.com , and the first chapter of our urban ecosystems book manuscript at www.docviper.livejournal.com . Regarding the latter, I know I’ve posted most of the manuscript in prior entries at that web portal. But I’m getting back into the rhythm of working on this book, and I’m going to post the existing material sequentially as preparation for posting new chapters starting in a few weeks. I expect to produce a chapter per week over the autumn and winter, which means we’ll have a draft ready to go to the publisher sometime in 2014. Yeeha!!! Thanks again, everybody. I love you all, more than you will ever know. I owe you my life, and that’s a debt I will never be able to repay. So bask in the knowledge that you are the primary reason I am alive and breathing vs. a box of ash and bone chips in the basement. Once more for posterity: Yeeha!!!
Notes
[1] http://reason.com/archives/1994/11/01/of-mice-and-men
[2] Simmons et al. 2005, Marine natural products as anticancer drugs. Mol. Cancer Ther. 2005:4:333-342, http://mct.aacrjournals.org/content/4/2/333
[3] Sima, P. and V. Vetvicka 2011. Bioactive substances with anti-neoplastic efficacy from marine invertebrates: Porifera and Coelenterata. World J. Clin. Oncol. 2011 November 10:2(11) 355-361.
When Ames realized to his horror that slapdash science by environmental groups and regulators was twisting priorities for environmental management in dangerous and unproductive ways, he owned up. He documented and presented an irrefutable case that human exposure to natural carcinogens—primarily in plants, but also in animals—swamps the total carcinogenic activity of industrial products. He took a lot of flack for this, but he stuck to his guns and told the truth. Here in the 21st century, we can see that Superfund and other regulatory programs have done their job. The Clean Air Act, Clean Water Act, and their analogs in other countries, and the investment made in environmental cleanup have greatly reduced the carcinogenic potential of exposure to industrial chemicals. If we as a society had half a brain, we would be pivoting our environmental management investments of time, money and expertise to more important sustainability impairments, including provision of potable water, ecosystem habitat quality, suppression of contagious diseases, food quality and quantity, antibiotic resistance, and others. Instead, we (to Ames’ and my frustration) continue to spend exorbitant resources managing meaningless quantities of industrial chemicals in the environment.
There is a sideways or hidden-ball importance to Ames’ work in the past 30 years. While demonstrating the abundance of natural carcinogens, it devolved that there is a corresponding abundance of natural anti-carcinogens. In an earlier post on this blog we discussed the anti-cancer screening program that yielded key chemotherapy drug Taxol from extracts of evergreen tree bark. Recently, the marine environment has provided substantial evidence of cancer-fighting chemicals.
Surveys show that cancer-fighting chemicals are associated with sponges, tunicates, corals, jellyfish, mollusks, bacteria, and blue-green “algae”. In fact, bacteria and cyanobacteria (blue-green algae, as we used to know them) are little factories pumping out carcinogenic and anti-cancer chemicals, often via complex and delicate ecological association with eukaryotes—sponges, tunicates, corals, etc. [2]. In many cases, it may be ecological system itself (that is, the physical and biochemical relationship of the microbes and their eukaryote associates) that is the source of the anti-cancer molecules.
Identifying, isolating, and testing chemical products of marine organisms is a technically difficult and expensive process [3]. In general, the organisms produce very small quantities of potentially useful molecules. To obtain sufficient quantities for screening and more intensive tests, it is usually necessary to find ways to synthesize the molecules originating in the marine environment. This is challenging enough. Of course in many cases naturally-produced molecules have toxic activity along with anti-cancer potential, similar to the drugs now used on chemotherapy cocktails. This complicates the development of effective and safe drugs from raw marine biochemicals. But the diversity and potential value of such chemicals makes the effort to develop them worthwhile (even if researchers tend to include a degree of obvious funding-agency cheerleading in their publications, see [2] and [3]).
Anyway. I’ve been having trouble balancing my own medications, even with the addition to my medical team of “palliative care” specialist Dr. S whose sole job is keeping me appropriately medicated. I’ve basically come to a twice-a-day process. I take meds once when I wake up in the morning, and then again around 7 or 8 in the evening. I’ve been trying to cut back on the morning meds, mostly because I take a lot of pills and it just seems like I ought to be able to survive on less. However. As I reduced the morning dosage of Benadryl and other meds designed to slow the massive production of thick, icky mucous in my throat, I became less functional during the day. I ended up parking my butt in the recliner in front of the television, with books and guitar within reach, and not moving until I took the larger evening dose of meds, when I was able to be more functional.
Now, while I’m quite able to survive reading a novel a day (which is about my rate when I’m butt-parking for 9 or 10 hours), noodling a little guitar, and watching “Pawn Stars”, “American Pickers”, and “NCIS” marathons, it’s not really much of a life. So, in the interests of becoming a more actively functional human being, I’m experimenting with increased dosage of morning meds. Today I took a moderate upgrade in the total a.m. mass of medications, and was able to spend some time clearing the finished half of the basement in preparation for Thanksgiving and running to the grocery store to get stuff to make rigatoni with bacon and mushroom cream with a salad of kohlrabi and other chunky vegetables in a soy-based Japanese style dressing for dinner tomorrow when Molly stops by to visit.
So I seem to be getting on top of this issue. Over all, I believe I continue to improve. What remains of my oral salivary glands came back online a few weeks ago, having been again suppressed by the radiation last spring. This means my mouth fills with thin, watery saliva at the same time that my throat continues to produce a thick, ropey mucous. But this actually means I’m recovering. The radiation damage continues to recede. I can’t feel any obvious signs of recurrent malignancy, but the December PET/CT will be the arbiter of that question. I’m also getting more comfortable with being without a tongue and thus unable to eat, drink, and talk for the rest of my life. This is a threshold that only a couple years ago I would have thought I’d never get past. But here I am, alive, mute, and obtaining my dietary ration by pouring goopy liquid rations into a tube stuck through my abdomen. Sometimes I amaze myself, and this bit of life process is one of those times.
Meanwhile, as always, I owe much of my strength to you, my friends and blog readers out there in the real world. Thank you so much for being here for me. This being autumn, I’m getting my writing chops together and working much more diligently on producing usable material. So if you have a little more time and interest, you will find a music review over at www.theresaturtleinmysoup.blogspot.com , a reprint of my www.aehsfoundation.org weekly weblog at www.sustainablebiospheredotnet.blogspot.com , and the first chapter of our urban ecosystems book manuscript at www.docviper.livejournal.com . Regarding the latter, I know I’ve posted most of the manuscript in prior entries at that web portal. But I’m getting back into the rhythm of working on this book, and I’m going to post the existing material sequentially as preparation for posting new chapters starting in a few weeks. I expect to produce a chapter per week over the autumn and winter, which means we’ll have a draft ready to go to the publisher sometime in 2014. Yeeha!!! Thanks again, everybody. I love you all, more than you will ever know. I owe you my life, and that’s a debt I will never be able to repay. So bask in the knowledge that you are the primary reason I am alive and breathing vs. a box of ash and bone chips in the basement. Once more for posterity: Yeeha!!!
Notes
[1] http://reason.com/archives/1994/11/01/of-mice-and-men
[2] Simmons et al. 2005, Marine natural products as anticancer drugs. Mol. Cancer Ther. 2005:4:333-342, http://mct.aacrjournals.org/content/4/2/333
[3] Sima, P. and V. Vetvicka 2011. Bioactive substances with anti-neoplastic efficacy from marine invertebrates: Porifera and Coelenterata. World J. Clin. Oncol. 2011 November 10:2(11) 355-361.
Saturday, November 2, 2013
It Might Get Messy
We used to think (that’s a royal “we” as in “we scientists”…) that invertebrates didn’t get cancer. As the authors of a 1950 review paper [1] put it: “… until fairly recently, invertebrate tissues were often considered incapable of developing tumorous growths”. That was then. Nowadays we know better.
Sponges, corals, and nematodes are all theoretically subject to tumor development based on cellular biochemistry, and actual tumor-like growths have been observed or induced in corals and nematodes [2]. An enormous lobster developed a correspondingly enormous tumor that filled its carapace, pushed into its head, and killed it. Ants are known to develop brain tumors (I know, it’s hard to fathom how a tumor could form in the itty bitty blob of nerve cells serving as a “brain” in ants). A bumblebee was found to have a tumor on a pharyngeal gland. This gland is generally similar in function to human salivary glands. The cancer in my parotid gland thus has an antecedent in a little “throat” gland of a bee!
And why the hell would we be interested in invertebrate malignancy? Well, consider the effect of X rays on fruit flies. Outcome of X ray exposure has a threshold below which tumors are propagated. At higher doses, X rays apparently heal fruit fly tumors [2]. Such an effect has potential for understanding and administering radiation therapy in human beings.
There are a number of studies demonstrating that virus and bacteria infections cause tumors in invertebrates. This knowledge was gained in the 1940s, eerily forecasting our present understanding of microbial infections as direct causes of specific kinds of cancer in people.
Weirdly, tumors are induced in some insects after certain nerves are severed. This raises concerns regarding the potential for nerves damaged by injury or surgery to cause cancer in humans.
On the plus side, “A large body of data indicates that invertebrate marine organisms produce a multitude of active substances that, in humans, exhibit potent anti-tumor activity” [2].
So, it’s clear that studying tumors in invertebrates can provide important insights regarding the genesis and development of cancer. Even better, there are potential cancer treatments kicking around invertebrate physiology. Maybe someday chemicals extracted from fiddler crabs or oysters will provide breakthrough therapies for cancer.
But, given the infancy and rarity of scientific investigation of invertebrate malignancy, I’m not going to survive long enough to benefit. Sigh.
However. It seems, preliminarily, that I may be around for a lot longer than any of my doctors thought. I saw radiation oncologist Dr. N this week. He continues to be surprised and amazed that he doesn’t see tumor recurrence when he examines my throat with the endoscope. I also saw Dr. S, my new “palliative care” specialist. I think palliative care means treating symptoms vs. the actual disease. Basically, all my other doctors enlisted this guy to take charge of my medications.
Of which I continue to need a boatload. We’re working on cutting out some of the drugs treating depression, inflammation, and pain. I’m having a lot less of this trio of contretemps, so the diversity of pharmaceuticals now has some redundancy—I can suppress the triad triptych with precision guided weapons vs. intense carpet bombing. I still have periodic bad days when my throat gets sore, mucous production rises, the mucous itself turns thick, ropey, and brown, and I develop inflammation in my oral cavity. But those incidents are declining in frequency and intensity. I’m getting better.
So it seems that, assuming the cancer doesn’t recur, I may emerge from this long-running soap opera with a reasonable quality of life. Although the bar defining “reasonable” has certainly been lowered. In one of the early posts of this “how to have cancer” diary I was fairly certain that if my voice was destroyed I would halt the treatment and let myself pass more-or-less peacefully (depending primarily on how willing the docs are to issue pain killers, tranquilizers, anti-depressants, and mood enhancers) onto the ferry across the dark river to oblivion. Now I find it’s more of an inconvenience than a life or death threshold.
So if the December PET/CT scan is negative for lung and throat cancer, I’ll be back in business. I’ve already turned my attention back to cranking hard on the urban ecology book. Learned to write and play (primitive, but listenable) instrumentals on the guitar. Improved my photography skills. And upgraded my cut paper artworks. It’s autumn. My favorite time of year. The time of year when I am at my intellectual and artistic best. I didn’t think I’d be here to revel in this autumn. Turns out I’m not only having a great autumn this year, I might (pending that PET scan) have many more autumns to enjoy.
Hell frickin’ yeah! As always, I thank you all for being here. My strength through this odd and long-running challenge derives in large measure from your support. You have my love and gratitude. Hang in there, everybody. Talk to you next week!
[1] Tumors in the Invertebrates: A Review Berta Scharrer and Margaret Szabó Lochhead Cancer Res 1950;10:403-419.
[2] Robert, J. 2010. Comparative study of tumorigenesis and tumor immunity in invertebrates and nonmammalian vertebrates. Developmental and Comparative Immunology 34:915-925.
Sponges, corals, and nematodes are all theoretically subject to tumor development based on cellular biochemistry, and actual tumor-like growths have been observed or induced in corals and nematodes [2]. An enormous lobster developed a correspondingly enormous tumor that filled its carapace, pushed into its head, and killed it. Ants are known to develop brain tumors (I know, it’s hard to fathom how a tumor could form in the itty bitty blob of nerve cells serving as a “brain” in ants). A bumblebee was found to have a tumor on a pharyngeal gland. This gland is generally similar in function to human salivary glands. The cancer in my parotid gland thus has an antecedent in a little “throat” gland of a bee!
And why the hell would we be interested in invertebrate malignancy? Well, consider the effect of X rays on fruit flies. Outcome of X ray exposure has a threshold below which tumors are propagated. At higher doses, X rays apparently heal fruit fly tumors [2]. Such an effect has potential for understanding and administering radiation therapy in human beings.
There are a number of studies demonstrating that virus and bacteria infections cause tumors in invertebrates. This knowledge was gained in the 1940s, eerily forecasting our present understanding of microbial infections as direct causes of specific kinds of cancer in people.
Weirdly, tumors are induced in some insects after certain nerves are severed. This raises concerns regarding the potential for nerves damaged by injury or surgery to cause cancer in humans.
On the plus side, “A large body of data indicates that invertebrate marine organisms produce a multitude of active substances that, in humans, exhibit potent anti-tumor activity” [2].
So, it’s clear that studying tumors in invertebrates can provide important insights regarding the genesis and development of cancer. Even better, there are potential cancer treatments kicking around invertebrate physiology. Maybe someday chemicals extracted from fiddler crabs or oysters will provide breakthrough therapies for cancer.
But, given the infancy and rarity of scientific investigation of invertebrate malignancy, I’m not going to survive long enough to benefit. Sigh.
However. It seems, preliminarily, that I may be around for a lot longer than any of my doctors thought. I saw radiation oncologist Dr. N this week. He continues to be surprised and amazed that he doesn’t see tumor recurrence when he examines my throat with the endoscope. I also saw Dr. S, my new “palliative care” specialist. I think palliative care means treating symptoms vs. the actual disease. Basically, all my other doctors enlisted this guy to take charge of my medications.
Of which I continue to need a boatload. We’re working on cutting out some of the drugs treating depression, inflammation, and pain. I’m having a lot less of this trio of contretemps, so the diversity of pharmaceuticals now has some redundancy—I can suppress the triad triptych with precision guided weapons vs. intense carpet bombing. I still have periodic bad days when my throat gets sore, mucous production rises, the mucous itself turns thick, ropey, and brown, and I develop inflammation in my oral cavity. But those incidents are declining in frequency and intensity. I’m getting better.
So it seems that, assuming the cancer doesn’t recur, I may emerge from this long-running soap opera with a reasonable quality of life. Although the bar defining “reasonable” has certainly been lowered. In one of the early posts of this “how to have cancer” diary I was fairly certain that if my voice was destroyed I would halt the treatment and let myself pass more-or-less peacefully (depending primarily on how willing the docs are to issue pain killers, tranquilizers, anti-depressants, and mood enhancers) onto the ferry across the dark river to oblivion. Now I find it’s more of an inconvenience than a life or death threshold.
So if the December PET/CT scan is negative for lung and throat cancer, I’ll be back in business. I’ve already turned my attention back to cranking hard on the urban ecology book. Learned to write and play (primitive, but listenable) instrumentals on the guitar. Improved my photography skills. And upgraded my cut paper artworks. It’s autumn. My favorite time of year. The time of year when I am at my intellectual and artistic best. I didn’t think I’d be here to revel in this autumn. Turns out I’m not only having a great autumn this year, I might (pending that PET scan) have many more autumns to enjoy.
Hell frickin’ yeah! As always, I thank you all for being here. My strength through this odd and long-running challenge derives in large measure from your support. You have my love and gratitude. Hang in there, everybody. Talk to you next week!
[1] Tumors in the Invertebrates: A Review Berta Scharrer and Margaret Szabó Lochhead Cancer Res 1950;10:403-419.
[2] Robert, J. 2010. Comparative study of tumorigenesis and tumor immunity in invertebrates and nonmammalian vertebrates. Developmental and Comparative Immunology 34:915-925.
Sunday, October 27, 2013
Big Fly Dropping
Lou Reed died this morning of liver disease. He had a transplant in May, obviously it wasn’t enough. At least Lou went out on a “Sunday Morning”.
Which was one of the best songs on the single best—and most shocking—rock album of all time—Velvet Underground and Nico. For some reason, I can’t remember why now, I had to wait weeks for it to show up at the Sam Goody shop in Willowbrook Mall. Some problem with the Andy Warhol cover, I’m guessing. Anyway. That record was so shocking I couldn’t stop listening to it. Plus, it was good for driving my father out of the living room late at night so I could have it myself.
To this day—and the album came out in 1967, when I was 14—I can list the way it changed my half-baked personality and shaky thought processes. Almost as much of an adolescent life sculptor as sex and drugs…maybe more.
PS—the regular “It Might Get Messy” entry for this week is immediately below. Suggest we all send Laurie Anderson our sympathies. And pull out all the Velvet Underground CDs we own.
Which was one of the best songs on the single best—and most shocking—rock album of all time—Velvet Underground and Nico. For some reason, I can’t remember why now, I had to wait weeks for it to show up at the Sam Goody shop in Willowbrook Mall. Some problem with the Andy Warhol cover, I’m guessing. Anyway. That record was so shocking I couldn’t stop listening to it. Plus, it was good for driving my father out of the living room late at night so I could have it myself.
To this day—and the album came out in 1967, when I was 14—I can list the way it changed my half-baked personality and shaky thought processes. Almost as much of an adolescent life sculptor as sex and drugs…maybe more.
PS—the regular “It Might Get Messy” entry for this week is immediately below. Suggest we all send Laurie Anderson our sympathies. And pull out all the Velvet Underground CDs we own.
Saturday, October 26, 2013
It Might Get Messy
About the worst thing that can happen to a human being is venomous snake bite. Whatever the venom’s primary mode of action, incredible tissue destruction always follows a venomous bite (only a half to two thirds of bites by poisonous snakes actually inject venom. The rest are “dry” bites that are not dangerous and have no symptoms other than a little bleeding).
Evolutionary drivers for the conversion of otherwise ordinary and harmless saliva glands to venom factories vary among different varieties of snake. In the mambas and boomslang, African arboreal species, the venom is evolved to act rapidly—probably an adaptation for eating birds, which need to be put down swiftly before they can fly away.
Black mamba in action
One of the first things that happens in a mamba bite is blood thinning. With the blood morphed so it slides through the vessels like a NASCAR machine on steroids, the venom quickly reaches heart, lungs and muscles where other modes-of-action—tissue degradation or respiratory suppression—drop the bird in place before its fight-or-flight hormones can carry it away.
Black mamba fangs on display
In contrast, venoms of viper snakes tend to cause rapid and massive destruction of circulatory system, muscles, and organs. In this is the clue to the evolutionary origins of venom. Of necessity—lacking limbs to hold prey and cutting or tearing teeth to rip it into bite-size pieces—snakes swallow their food whole. And often they swallow food items of enormous size relative to the size of the snake.
Viper eating food bigger than its head
This engenders some physiological problems in an ectothermic (“cold-blooded”) animal. Specifically, digesting a huge meal takes time. So much so that the food item can begin to rot before it is broken down into absorbable (is that a word? Spell checker seems to like it…) molecular fragments. Having a vat of rotting flesh in the gut is problematic. Decomposition microbes can pour out of the food, killing the snake by rotting its gastrointestinal tract. Indeed, in captivity, maintaining digestive health of snakes is a technical issue of importance.
Anyway. Evolutionarily, it seems that venom is primarily an adaptation for feeding, not self-defense. Injecting a fat dose of tissue-destroying toxin into a prey item begins digestion processes even before the food is ingested. Eating is safer and more efficient when venom is involved.
This also means that snake venom is chemically complex. A variety of physiologically active substances, almost all of them proteins, are present in snake venoms. The composition varies from species to species, and even among individuals of the same species. But in general, snake venom is a complicated soup of bioactive chemicals, many acting as enzymes. Some of them tear tissues apart and destroy cells, some control blood clotting and circulation, some affect respiration, muscle tension, and nerve functions.
Why a lecture on snake physiology here at this cancer-themed weblog? Because the chemical complexity of venom gives it enormous pharmacologic potential. That potential is being explored for medicinal purposes—including cancer treatment.
An excellent (although grammatically weak—could’ve used a good technical edit) review of snake venoms in cancer treatment is titled Therapeutic Potential of Snake Venom in Cancer Therapy: Current Perspectives [1]. Chemicals purified from venoms have been shown to bind specifically to tumor cells. Such chemicals may be applied to tag and identify tumors or to carry other, anti-tumor substances to the diseased tissue. Other venom chemicals can re-program cell death into tumor cells that refuse to die as they would normally. Some venom components inhibit tumor cell reproduction, destroy tumor cell membranes, or constrain cell metabolism. Tumor cell adhesion and migration can be inhibited by venom chemicals, preventing tumors from finding susceptible places to settle. In addition, venom compounds provide indirect but useful functions including pain inhibition, inflammation reduction, or enhancement of blood and lymph flow.
So snake venoms may prove to be a valuable pharmacy of cancer-fighting chemicals. Identifying, testing, and applying these chemicals of course takes time, money, and technical expertise. In other words, it’s going to be a long time before the therapeutic potential of venom is realized. Of course, it would be less time if the U.S. government could function without shutdowns interrupting research programs periodically.
In any case, I’m not going to be around long enough to benefit from snake venom pharmaceuticals. But I may be around for a longer time than it seemed just a few months ago. I still have issues with mucous production, throat inflammation, weakness and discomfort, and of course my diet is limited to weird milky medical foods dumped directly to my gut via polyvinyl tubing. But once that whining is out of the way, I’m getting better. This week we drove up to Amherst, Massachusetts where I was (oddly) a guest-of-honor at an awards dinner provided by the Association for Environmental Health and Sciences, the not-for-profit for whom I write a weekly column on environmental sustainability (www.aehsfoundation.org, go to the lower left of the home page to click through to the PeopleSystems column). I had a great time driving the 6 hours each way, listening to music and enjoying being functional. At the conference, I was pretty much exhausted, but had a wonderful evening at the dinner. Many old friends were there, some of whom had made long trips to get there to share the event.
To those friends and to all of you reading this, you have my eternal gratitude and love. I could not have fought me way through the past few years without you. Knowing you are pulling for me, and that only by surviving could I hope to see you again, are powerful motivators. Thank you. Talk to you next week!
Notes
[1] http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3627178/
Saturday, October 19, 2013
Hagfish are hilarious. I know you never thought of it that way. But National Geographic has a video from the New Zealand Natural History Museum, showing various predatory fish choking on the mouthfuls of slime generated when they grab a hagfish, and it's pretty funny, see
http://video.nationalgeographic.com/video/news/animals-news/new-zealand-hagfish-slime-vin/
When I was in school, we learned that hagfish and lamprey eels made a single class of related organisms, the Petromyzontiformes or jawless fishes. Indeed, hagfish have a bony, rasping, two-part tongue that functions like jaws, used to catch polychaete worms and to tear at deep-sea carrion. Turns out that they are primitively jawless. Until a single 300 million year old fossil was discovered, we thought hagfish had secondarily developed their jawless structure. No, turns out they come that way evolutionarily. They are the only organism known to have a cartilaginous skull and no vertebrae—they are actually invertebrate chordates, like the sea squirts and amphioxus [1]. Hagfish are about as long as your arm, and far more disgusting [2]:
First pic immediately above is of Gene Helfman, with whom I learned ichthyology at UGA, holding up a little hagfish slime. See, that’s the thing about hagfish. Their primary characteristic is the ability to produce bucketloads of proteinaceous slime. It’s possible that mucilage and other animal protein glues might be replaced, if some nutty “natural products” entrepreneur pipes up, by packaged hagfish slime. It would be green and sustainable—hagfish don’t need to eat for months at a time, and over that period can produce enormous amounts of mucous. Although, now that I think of it, such an entrepreneurial endeavor would presumably leave us with large quantities of horse, donkey, dog and cat carcasses to process where they now go into the retorts at Elmer’s glue factories.
Anyway. My primary residual problem at the moment (well, discounting not being able to eat, drink, or talk and having been surgically reconstructed in cosmetically unattractive fashion) is mucous production. The slab of chest muscle and arm epidermis that the surgeons used to separate the airway from the gastrointestinal tract in my oral cavity continues to irritate, and that generates boatloads of slime.
I gather that this problem is expected to go away at some point. I’m not sure what that point is, though. I’m now many months out from the last radiation and chemotherapy treatments. You’d think I’d be healthy by now. But I believe the key issue is the arm skin that they pulled inside to build the partition. Apparently, the hairs that were on my arm are still visible at the surgery site inside. Dr. H says that they couldn’t use muscle alone (without the skin) because the muscle tissue would get too flabby. The epidermis has cellular toughness that helps it hold up in its new role as throat component. Dr. H also says that eventually, the (former) arm skin will transform itself into a supple and effective barrier that will help keep me from chronic pneumonia associated with leakage of liquids down the airway into my bronchi and lungs. But for now, I have to put up with constant production of hagfish-like levels of excess mucous.
At least I can cough it out and into paper towels for disposal. Most people in my condition have to use a mechanical suction apparatus to slurp the stuff out of the bronchi on an ongoing basis. Indeed, last time I left the hospital, I was held up a day while the suction pump was being delivered from the medical supplier. Doctors weren’t comfortable sending me home without the means to suction sloppy gunk out of my airway as needed.
But, in fact, I have never used the suction gear. Coughing seems to work just fine for me. I do, when I travel, make sure I take the (rather heavy and cumbersome) suction kit with me just in case. But hopefully I will avoid the requirement for its use. It’s humiliating enough to be in my condition without the added discomfort of having to slide long rubber cannulae down my throat and into my bronchi and pumping up extracellular excretions.
As always, I thank you for being here for me. Next week I’m going to Amherst to receive the AEHS Lifetime Achievement Award, an honor which I’m more than proud to be awarded. After that, I start cooking for Thanksgiving. Given that I didn’t expect to be alive to see this Thanksgiving, it’s going to be The Best Thanksgiving Ever. Followed by the winter holidays. Which I’m glad to get another shot at as well. My love to you and yours. Talk to you next week!
Notes
[1] http://www.ucmp.berkeley.edu/vertebrates/basalfish/myxini.html
[2] http://www.whaletimes.org/hagfish.htm
http://video.nationalgeographic.com/video/news/animals-news/new-zealand-hagfish-slime-vin/
When I was in school, we learned that hagfish and lamprey eels made a single class of related organisms, the Petromyzontiformes or jawless fishes. Indeed, hagfish have a bony, rasping, two-part tongue that functions like jaws, used to catch polychaete worms and to tear at deep-sea carrion. Turns out that they are primitively jawless. Until a single 300 million year old fossil was discovered, we thought hagfish had secondarily developed their jawless structure. No, turns out they come that way evolutionarily. They are the only organism known to have a cartilaginous skull and no vertebrae—they are actually invertebrate chordates, like the sea squirts and amphioxus [1]. Hagfish are about as long as your arm, and far more disgusting [2]:
First pic immediately above is of Gene Helfman, with whom I learned ichthyology at UGA, holding up a little hagfish slime. See, that’s the thing about hagfish. Their primary characteristic is the ability to produce bucketloads of proteinaceous slime. It’s possible that mucilage and other animal protein glues might be replaced, if some nutty “natural products” entrepreneur pipes up, by packaged hagfish slime. It would be green and sustainable—hagfish don’t need to eat for months at a time, and over that period can produce enormous amounts of mucous. Although, now that I think of it, such an entrepreneurial endeavor would presumably leave us with large quantities of horse, donkey, dog and cat carcasses to process where they now go into the retorts at Elmer’s glue factories.
Anyway. My primary residual problem at the moment (well, discounting not being able to eat, drink, or talk and having been surgically reconstructed in cosmetically unattractive fashion) is mucous production. The slab of chest muscle and arm epidermis that the surgeons used to separate the airway from the gastrointestinal tract in my oral cavity continues to irritate, and that generates boatloads of slime.
I gather that this problem is expected to go away at some point. I’m not sure what that point is, though. I’m now many months out from the last radiation and chemotherapy treatments. You’d think I’d be healthy by now. But I believe the key issue is the arm skin that they pulled inside to build the partition. Apparently, the hairs that were on my arm are still visible at the surgery site inside. Dr. H says that they couldn’t use muscle alone (without the skin) because the muscle tissue would get too flabby. The epidermis has cellular toughness that helps it hold up in its new role as throat component. Dr. H also says that eventually, the (former) arm skin will transform itself into a supple and effective barrier that will help keep me from chronic pneumonia associated with leakage of liquids down the airway into my bronchi and lungs. But for now, I have to put up with constant production of hagfish-like levels of excess mucous.
At least I can cough it out and into paper towels for disposal. Most people in my condition have to use a mechanical suction apparatus to slurp the stuff out of the bronchi on an ongoing basis. Indeed, last time I left the hospital, I was held up a day while the suction pump was being delivered from the medical supplier. Doctors weren’t comfortable sending me home without the means to suction sloppy gunk out of my airway as needed.
But, in fact, I have never used the suction gear. Coughing seems to work just fine for me. I do, when I travel, make sure I take the (rather heavy and cumbersome) suction kit with me just in case. But hopefully I will avoid the requirement for its use. It’s humiliating enough to be in my condition without the added discomfort of having to slide long rubber cannulae down my throat and into my bronchi and pumping up extracellular excretions.
As always, I thank you for being here for me. Next week I’m going to Amherst to receive the AEHS Lifetime Achievement Award, an honor which I’m more than proud to be awarded. After that, I start cooking for Thanksgiving. Given that I didn’t expect to be alive to see this Thanksgiving, it’s going to be The Best Thanksgiving Ever. Followed by the winter holidays. Which I’m glad to get another shot at as well. My love to you and yours. Talk to you next week!
Notes
[1] http://www.ucmp.berkeley.edu/vertebrates/basalfish/myxini.html
[2] http://www.whaletimes.org/hagfish.htm
Saturday, October 12, 2013
Marie Curie was born in Warsaw in 1867. She received multiple degrees from the Sorbonne. Impoverished, she apparently lived on buttered bread and tea during her academic years, and was symptomatically malnourished. She was 29 years old when Henri Becquerel discovered the radioactive nature of uranium salts (he inherited a vial of same from his chemist father).
Curie, her husband Paul, and Becquerel were awarded the Nobel Prize in physics in 1903. In 1911, Curie received a second Nobel, this time solo, in chemistry for her discovery of radium and polonium (the latter named in honor of Poland). As an aside, it is worth noting that Curie’s daughter won the 1935 Nobel for work on the synthesis of radioactive compounds.
Years of working with radioactive materials, and her cavalier attitude to same (she frequently carried a vial of radium in the pocket of her lab coat) did not serve Curie well. She was chronically weak and ill from radiation poisoning. She died at a French health spa of aplastic anemia, caused by a lifetime of radiation exposure.
Radiation exposure has long lasting and severe effects. Tissue damage at the exposure site is intense. The tradeoff in cancer treatment is the destruction of DNA in tumor cells vs. the same (and other impacts) in affected healthy tissues.
In my case, shockingly (at least to me), I am still not fully recovered from the radiation treatment last spring. On the PET scan a few weeks ago, my throat in general took up visible amounts of radiation tagged sugar, indicating the area has yet to return to baseline levels of metabolism. This is problematic because high metabolic rate is also indicative of tumors. We can’t rule out recurrent or residual throat cancer until my throat area is back to baseline metabolism.
I also continue to have an odd problem with my lips. The epidermis sloughs off in slabs, and the skin is chronically thick and rough. This issue is resolving, albeit slowly. For the first few months after treatment, my lips were continually cracked and bleeding. Now they’re more like severely chapped, although the radiation effects are different from standard chapping—the dead epidermis comes in larger and thicker chunks than simple dried skin.
Anyway. I met with my new “Palliative Care” doctor this week. He went over my medications, of which I continue to require a bucketload. Dr. S generally approves my mix of prescribed and over-the-counter medicines. He had some suggestions about balancing my OTCs, but overall is happy with how I’m proceeding.
As am I. I still sleep long hours, am weak enough so that a middling walk (with or without the dog) tires my leg muscles, spend most of my time in a reclining chair, and produce ridiculous quantities of thick, ropey mucous from my throat. The latter in particular is a social difficulty. It’s hard to interact with people if you’re hacking up mouths full of phlegm regularly.
But even that is getting better, I think. My throat still feels funky—I’m not certain how to separate ongoing irritation from the “new normal” of a system that has been surgically rearranged so a slab of muscle and epidermis from my chest and arm nominally partition my airway and gastrointestinal tract. So I don’t function as well as before the cancers and associated treatments. On the other hand, I’m still alive. Which, at this point, is somewhat remarkable and cause for celebration.
Thanks for being here, everyone. My love to you and yours. Talk to you next week!
References
These web portals are sources for the biographical and technical material in this week’s posting:
http://www.cancer.gov/cancertopics/factsheet/Therapy/radiation
http://www.nobelprize.org/nobel_prizes/physics/laureates/1903/marie-curie-bio.html
http://www.nobelprize.org/nobel_prizes/physics/laureates/1903/becquerel-bio.html
Saturday, October 5, 2013
It Might Get Messy
All diseases are matters of chance. At the level of fundamental epidemiology, chains of probabilities determine the behavior of diseases in a population. In simple terms, the chance that you’ll encounter the disease organism (or other cause, such as chemical exposure) and the chance that you’ll receive a critical dose (sufficient microbes or molecules to cause illness) define your likelihood of getting sick. Consider two basic examples. Bubonic plague is endemic in ground squirrel populations throughout southwestern U.S. When I walk through a patch of brush pockmarked with ground squirrel burrows, I have a certain chance of encountering plague bacillus (primarily by having a flea leave its squirrel and jump on to me and take a meal), and then a certain chance that the flea will inject enough bacteria cells to trigger the disease. For a second chemical exposure example, when I hike in woods of the Patuxent Preserve, there is a chance I will step near a copperhead snake, and then a chance that the snake will bite me and inject enough venom to make me sick (mostly by digesting the tissues of whatever limb the snake bites).
Similar probabilities pertain to cancer. With this addition: for many cancers, there is a nonzero chance of spontaneous appearance. Otherwise, there is a chance that some environmental exposure (like smoking) will trigger one or more cells to mutate into a tumor, and then a chance that your immune system will fail to deal with it, and then you’re off and running in cancer land.
My cancers—of the tongue, throat, palate, and parotid gland—are classic smoker’s cancers. Except I’ve never smoked. I have, however, abused my oral cavity. Heavy and longstanding consumption of alcoholic beverages, heavy use of alcohol-based mouthwash, and heavy use (from my teens to my 30s) of epinephrine inhalers for asthma could all have contributed to cellular malfunction leading to tumor formation.
Or, it could be that none of the above had a thing to do with it, and that my tumors began with spontaneous mutations of cells in place. According to the American Cancer Society (http://www.cancer.org/cancer/cancerbasics/lifetime-probability-of-developing-or-dying-from-cancer) men in the U.S. have about a 1 in 2 (or 50%) chance of developing serious cancer in their lifetime. Women are about 1 in 3 (33%).
Think of what this means statistically. For a specific environmental exposure to cause an increase in cancer, it occurs in the context of a 33% of developing cancer in any case. The probability is 0.33. For many kinds of risk assessment, USEPA applies a threshold of 1 additional cancer in 10,000 to 1,000,000 exposures as an “acceptable” risk limit. That pushes those additional cancers pretty far out on the probability scale. 1 in 10,000 means a 0.3301 chance, 1in a million is 0.33001. Not much of an increase in the context of overall cancer rates.
Think of this the next time you hear of some food additive, pesticide, or chemical “doubling” or “tripling” cancer rates. In most cases, this means the probabilities increase from 0.3301 to 0.3303, or 0.33001 to 0.33003. These are not big increases. In fact, in epidemiological studies (where actual cancer occurrence, rather than predicted cancer “risk”, is the measure) such “doubling” or “tripling” of cancer rates is likely to be undetectable because of normal statistical variance in the test populations. That is, the 0.33 cancer rate is an average, with statistical variation that might be 10%, 20%, even 100%, of the average. Under these circumstances, detecting increased cancers from use of a chemical like methylethyldeath (MED) in food or cosmetic products is not possible. The putative “doubling” of cancers due to MED is simply an arithmetical artifact of the risk model. It is not something that could be detected even if it occurs, because with a third of people getting serious cancers anyway, doubling or tripling the rate out in the fourth or fifth decimal place is a trivial increase.
Now, you are asking why I am subjecting you to this technical harangue. It is because there are important choices to be made regarding how we manage our environment. The resources of money, time, and technical expertise that can be applied to environmental management are finite. If we choose to spend resources reducing exposure to methylethyldeath, we must take resources away from other environmental management activities. Such as assuring sufficient potable water, air free of breathable particulate pollution, sustainable soil quality, and protection from infectious diseases. Environmental management is a “zero sum game”. There is a finite pot of money on the table, and if MED “wins” some of that money, other players (clean water, clean air, infectious disease) “lose” money.
As a society, human beings must make rational choices when investing in environmental management. Reducing smoking rates and eating a healthy diet both can reduce real-world cancer cases enormously. More than enough to be measurable in epidemiologic studies. And more, in most cases, than MED compounds like alar on apples (remember that?) or nitrates in lunch meat products.
To come back to my case, beverage alcohol is a powerful carcinogen. The probability of cancers additional to baseline are high enough to be easily measured in epidemiology studies. There is a good chance I gave myself cancer by choosing to drink heavily for decades. But there is also a chance I would have contracted these same cancers had I been a teetotaler without chronic mouth infections (the latter explain my heavy use of mouthwash) and without asthma. There is no way to tell—it’s a matter of chance.
Anyway, I am continuing to heal and strengthen. I get in a walk to the point of being tired nearly every day now. Assuming I remain cancer-free and continue to have time to devote to recovery, I may achieve something akin to a decent quality of life.
And, on my walks this week, I got a few decent photos. The first one up—the garter snake eating the enormous toad—entertained me for more than half an hour in the woods. That’s how long it took the snake to immobilize and ingest the toad. And all I could think of while I watched was that the toad was pissed off at himself for making a right instead of a left at the nearby hawthorn bush. Because that left would have reduced his chances of running into the garter snake!
Photos follow. I thank you all most deeply for being here. I can’t emphasize enough how important you have been for my war with cancers. Pat yourselves on the back and have a glass of good wine……
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