It Might Get Messy

Been a while since we visited the Tasmanian devils to get an update on the virulent nose cancer that is threatening the species with extinction. The New York Times has a nice up-to-date piece at http://www.nytimes.com/2013/01/22/science/saving-tasmanian-devils-from-extinction.html?pagewanted=1&_r=0 . Turns out the cancer has become even more ubiquitous and deadly since we last checked it out. It has mutated into an infectious disease, which is extremely rare for cancer (the only known comparable is a non-lethal canine cancer of some sort). The death rate is very high. In desperation, conservationists are populating a non-devil-inhabited island with “clean” specimens. The assumption is that if and when the mainland population goes extinct, the cancer will disappear as well, since it will have no host. At that point, the mainland could be repopulated from the island batch. 

This of course ignores the potential for some environmental cause of the cancer, which may or may not have arisen de novo in the genome of the devils. But I guess there’s only one way to find out… . 

But that’s not why we’re here. We’re here because irony is my favorite thing in the universe. I love irony. You might say I live for irony. And now, it turns out, I might very well die of irony. Here’s the deal.

I saw Dr. H today. His read on my health is that recovery is so far advanced that it is time to think about treating the remaining tumor in my throat. A week ago, he wanted to wait 2 months. Now he says it’ll probably end up being close to that even if we start to plan now. So I have an appointment with the radiologist, Dr. N, to talk over radiological possibilities. H thinks the viable choice might be a source insertion, sticking a small but radiologically hot particle into the tumor mass itself. This technique would avoid disrupting the ongoing healing in my face, neck and shoulders, and also contribute less to my already hefty lifetime radiation dose. 

A week ago, Dr. H was all about chemotherapy. I’m not sure what happened meantime, except that the patient care committee meets on Wednesdays, and maybe radiology won a round this morning. I’m a little skeptical myself, since I’m not even sure what the diagnosis of this residual tumor is based on. It seems to be in the memories of the surgeons who saw it live and in person while they were rooting around in my oral cavity for hours and hours over 3 weeks in the hospital. I’d like a little more diagnostics myself, but we’ll see how it goes.

Because here’s the irony. At the moment, my blood clotting is all screwed up. They suspect the embolism remains, they’ve tripled my dose of rat poison, put me back on the injectable blood thinner, and entered me into a special clinic where my clotting can be measured regularly with the objective of keeping my blood from coagulating into a circulatory-system-shaped slab of caulking compound. I would consider it damn near the ultimate irony to have fought my way through treatment for two rounds of Stage 4 tumors, and be starting Rocky Balboa-like preparation for a third round, only to drop dead of a stroke having nothing to do with any malignancies. 

At this point, it seems a toss-up. Sudden out-of-the-blue death by stroke vs. lingering, fighting death from residual tumors and/or tumor treatments. At the moment, I’d put my money on the tumors, and give myself at least a year or two. But much remains to be seen. What I DO know is that I love you all, and you are all helping to keep me alive. Keep up the good work! Oh, and if you get a pool going, give me $5 on 15 September 2014. Hell, if we run it $5 a day from now until sometime in 2017, there’ll be a fortune to be made!

It Might Get Messy

It Might Get Messy

Gibb’s rule on NCIS is “never apologize, it looks weak”. While NCIS is a well written and acted show, I’m afraid this “rule” must be there simply to generate controversy. I strongly believe that a person should apologize if and when it is right to do so. 

But there’s a big gray zone. On Thursday, I met with the reconstructive surgeon for the first time since the operations. He apologized directly for “putting you through so much hell in the hospital”. I told him his apology was accepted but unnecessary (a concept a good friend taught me a while ago). I’m a scientist. I know things can and will crash and burn under the most inopportune circumstances. He insisted—he feels bad because I’m now stuck for a lifetime with no tongue (or grafted-in tongue equivalent) and with no way to breathe except via little plastic tube. 

But Dr. B is right about one thing. It’s time to start thinking about the future. And my future, at least, could hardly be cloudier at the moment.

From one perspective, things are pretty optimistic. And I’m surprised about that. For the first week in the hospital, when I realized my tongue was gone, I had to breathe through a tube running with blood and saliva, and my gastrointestinal tract was permanently decoupled from my airway, I was intensely upset. Depressed to the point of being suicidal. As I recovered, I came to grips with the permanent debilitations. Believed I could find ways to function in the real world. If I was cancer-free, I might have considered the tradeoff worthwhile. 

But of course I’m not cancer-free. While my lungs are clear, I still have a tumor on my palate, near the entrance to my sinuses. The doctors expect this spot to be as aggressive as the original tumors and the next round that we just excised. This bodes ill for my long term survival. 

But cancer survival is a complicated thing, both individually and in the population-at-large. 

One study of throat cancer survival rates clearly demonstrates that survivorship has not changed at all, or in some diagnoses, gotten substantially worse since the 1970s. However, the authors presume the cancers in their study are tobacco-related [1], which is not true in my case. Whether or not that matters remains to be seen. Apparently this cancer is so rare in non-tobacco users that very little is known in that context. 

More generally, according to the American Cancer Society, overall survival rates have increased for all cancers in recent decades. In the 1970s, 1 in 2 victims survived 5 years, now it’s more like 2 of 3 [2]. Statistics summarized by the National Cancer Institute Surveillance Epidemiology and End Results (SEER) [3] paint this picture of survivorship with time for all cancers combined for all population characteristics combined in the U.S. (remember you can double click to enlarge, at least in my browser):

This shows survivorship increasing with time over the past 50 years. 

Ok. In general, things are getting better in the world of cancer survival. In throat cancers, not so much. Given that my doctors and I have to figure out some way to treat my third round of tumors, I’m guessing my long-term prognosis isn’t good. In fact, the docs are already worrying about treatment options. Because I’ve had such high quantities of radiation in treatments past, that may not be an available avenue. For the moment, here’s the medical team’s best guess. We’ll wait a couple of months while my present devastated infrastructure heals. After that, when the residual throat tumor becomes symptomatic, we’ll start chemotherapy.

That’s it. That’s as far as the planning goes at the moment. Personally, I’m hoping for an outcome like the movie “The Guitar”. On being diagnosed with terminal throat cancer, the protagonist retires from the world, teaches herself to play rock guitar, and the cancer disappears. 

THERE’S an outcome I could live with!

Notes

[1] http://www.ncbi.nlm.nih.gov/pubmed/18427002

[2] http://www.cancer.org/cancer/cancerbasics/thehistoryofcancer/the-history-of-cancer-cancer-survivorship

[3] http://seer.cancer.gov/faststats/selections.php?#Output

It Might Get Messy

One of the critical points I hammer into the brains of my undergraduate students is this: money is the most important driver of human relations with the biosphere. Money is how and why we change the environment, and limitations on money constrain our abilities to direct such changes sustainably. Oddly, economics (from the Greek “oikos”, homestead, and “nomos”, to manage) trumps ecology (oikos again, + “logos”, to study) in the practical world. Which means, to understand and manage ecology, we need to understand money.

But think about that for a moment. As I challenge my classes: what the hell IS “money”? Bits of paper or metal bear no quantitative relationship to their impact on the environment. A few hundred grams of paper money can strip a pretty large area of forest, a process involving the shift of many tons of carbon, loss of much life, transformation of multiple habitats. 

On the Pacific archipelago of Yap, traditional “money” consists of large rings or donuts of stone:

The stone from which the money is carved is not local to Yap. It occurs only on islands hundreds of miles to the west. Perhaps you’re starting to see the picture here. People in dugout canoes took off across the ocean, balanced enormously heavy and unwieldy hunks of rock in them, and tried to paddle them home. I can’t imagine how many canoes full of people and rocks litter the ocean floor as a consequence of this Quixotic currency development. 

Oh yeah. The money stones are placed in traditional locations. They don’t move. Transactions are traditionally conducted by communal knowledge of who belongs to which piece of which rock. In other words, you might own a quarter of one stone. When it’s time to buy a couple pigs, you transfer your ownership of that quarter to the pig-seller. He can use it to buy more pigs from the breeder. All these transactions, and the stones just sit there and brood.

I bring this up because money proves to be a critical parameter in health care as well as the environment. And not small money. I have the three page bill for my hospital stay here. Let’s see…room and board in ICU, post-surgery, and regular room, total $23K. Operating rooms, around another $20K. Leeches, not broken out specifically. But the total hospital bill so far is around $88K. Note that this does not include individual doctor’s bills (for the regular physicians, it’ll run about 10% of that total each), anesthesia and anesthesiologists, the cardiac SWAT team, and other dribs and drabs. 

The total bill for the acute portion of my care—minus the longer recovery, nursing, therapy, office visits, drugs, etc., is going to be well north of $100K. And Republicans can’t figure out why the “private sector” health care system leaves hundreds of thousands of less wealthy individuals behind. Can you imagine a treatment program like this without insurance? Man, we’d have to compile every money stone on every Yap out-island and paddle them to the insurance headquarters. And we’d still be behind. 

Hang in there, everybody. STAY INSURED. In today’s America, the difference between insured and un- is incredible. 

Love you all!!!

It Might Get Messy

I’m pretty sure we discussed CT Scan technology in prior entries. But I can’t recall, so we’ll give it a brief refresher here. Fundamentally, Computer Aided Tomography is a hardware and software package that greatly increases the technological reach of the basic X-ray. In its least complex formulation, multiple X-ray beams are combined to yield a series of “slices” of the body, illuminated via the different densities of the internal structures. A more intense version called “spiral” CT, yields three-dimensional representations. Adding an iodine stain to provide contrast between softer and harder materials makes the CT a powerful diagnostic tool. 

I had one this morning. Objective was to ascertain the status of the nodules in my lungs. If they’re bigger, there’s a good chance they’re malignant. Lung cancer at this point would obviate pretty much all other concerns. And given that I’m down to minimalist lifetime safe dose of radiation, possibly not effectively treatable. 

Here is a sampling of the different views of my lungs generated by the CT process. In all of them, you can orient to the…uh…orientation by observing the sharp, bright angles of the trach tube, which appears, like Waldo, in each image. Note in my browser you can double click the image and get a nifty enlargement. 

Note also what you do NOT see. You do not see lung “nodules”. The spots on my lung did not grow, they shrank. Making it preliminarily at least very unlikely that I have lung cancer! 

Yes, sports fans, I seem to be free of lung cancer!!! But of course life is tradeoffs. When Dr. H called (probably within minutes of receiving the CT output) he had to couple the good news with some bad. I have a pulmonary embolism. This means there’s blood clots in lung arteries, interfering with my breathing, causing me to generate bloody sputum when I cough, and risking quick death if the clots shift to critical places. Like my heart or even larger arteries.

Usually, pulmonary embolism is an emergency room issue. In this case, Dr. H phoned a blood thinner scrip to the pharmacy. It’s a self-injection system, plus I take a daily dose of rat poison (Warfarin’s primary use) orally. 

Medical technology. You got your massively high-tech 3-D diagnostic imaging sorting out my health problems. Then you got your treatment via leeches and rat poison. I’m feeling very 19th century at this point. 

But I am alive and I DO NOT HAVE LUNG CANCER. This opens up worlds of possibilities I have been dismissing. It may be that I can be stabilized, treated, and live more productive years than I’ve been anticipating. Now all depends on my palate tumor and the “lost” piece of material that shuffled off down my lymph vessels. 

Not sure what the next diagnostic steps are. But I gotta see Dr. H on Wednesday so he can drain the enormous pool of blood from my thigh (possible source of that clot in my lungs?). He’s also insisted I see Dr. T, my oncologist. It’ll be her job to sort out the embolism. Thursday I see Dr. K, hoping he can re-up key prescriptions like the morphine derivatives that help me so much. Although now that the embolism has been identified, I wonder if that’s not part of my pain/breathing syndrome. We’ll see. 

In any case, I’m just a few doses of rat poison away from another step to health. Or, as I like to think of it given my condition, “health”. 

Stay tuned, everyone. We have longer paths to walk to see how this story ends. My love, friendship, good wishes, and happiness to you all!

It Might Get Messy

“Port”. There’s a word replete with meanings. The best one, from my perspective, is the rich, fortified wine from Portugal. Grown in warm valleys upriver of the estuarine town of Porto, and blended on the left bank of the river in a section of wine houses almost as large as the rest of the town, it is in all its forms from white to ancient vintage absolutely delicious. As we convinced ourselves by spending an entire day walking around and sampling the ports in each of the houses. 

Porto was, I assume, an actual port at some point. Presently it is wine village and tourist town, quiet, attractive and delicious. One day Molly and I walked from the mouth of the river at the ocean beach upstream to the city. Fabulous hike. Made better by a soup-and-bread lunch in a taberna overlooking the tide wall.

What we need to consider here is a medical port. This is a catheter (“portable catheter” or “portacath”) that runs from the outside world directly to a major vein somewhere inside. I actually had a permanent one placed in my chest a couple years ago, but it wasn’t functioning properly. So, when my veins collapsed and could no longer be accessed as needed, a port was placed in my shoulder (apparently a relatively innovative position, see http://donnapeach.com/2010/07/07/portacath-placement-in-shoulder-instead-of-chest/). The catheter ran from the top of my shoulder joint into my pericardial sac, presumably ending somewhere in my superior vena cava, see:

(http://www.uwhealth.org/healthfacts/B_EXTRANET_HEALTH_INFORMATION-FlexMember-Show_Public_HFFY_1116944249855.html).

Now. This is close proximity to the heart. A situation with some inherent danger. One afternoon, the nurse changing the dressing (has to be done in a sterile field) felt the catheter move. She panicked. An X-ray was called for. Sure enough, the tip of the catheter had driven deeper into the heart, to the point where it threatened immediate infarction (interruption of blood flow). Mind you, at this point early in the first week in the hospital, I was in severe pain, deeply depressed, barely functional.

An emergency team, sort of a cardiac SWAT squad was called in. They laid me down, spread a sterile blanket over my face and torso, and went to work. I’m not completely certain what they did. I know it involved massive pain and discomfort. And two more X-rays. I managed to get someone to ask about the relative risk of the carcinogenic X-irradiation vs. the slipped catheter. They said no question, the catheter was a more drastic and immediate threat. 

When they were finished, I had a safe port again, which was used over the next 2 ½ weeks to draw blood, infuse blood, inject meds, etc. Last thing  before I left the hospital, a specialist came in and yanked the port. This time it didn’t hurt at all.

Everyone, I’m getting stronger every day. Love you all. I’m gradually crawling back enough to start getting into my email and other contacts. Keep those prayers, thoughts and good wishes comin’ in—I’m gonna need ‘em. We’ll find out how MUCH I need them next week, after the CT Scan of my lungs. I’ll let you know!

It Might Get Messy

I’m a little fuzzy on what went down my first week in the hospital. Wait, let me rephrase that. I have pretty much no idea what happened that week. I spent it cycling between screaming pain and narcotic bliss, with a constant overlay of abject terror as the claustrophobia that comes with having to breathe through an entirely new orifice carved in my throat hit my addled brain.

I do know the basic outline. First thing they did on Monday was slice my tongue loose from its malignant moorings and toss it into the “medical waste” bucket. Then they hacked off a chunk of thigh muscle, whittled it into a tongue shape, and grafted it into my throat. 

You would think a piece of thigh muscle intended to replace a tongue would be relatively small—say tongue-sized and shaped. But you would be wrong. The chunk of meat they cut from my left thigh ran from knee to waist. The stitches, now almost a month old, are impressive. The hollow groove leftover is massive. Here, see for yourself:

Awesome, no? But it doesn’t end there. Not by a long shot. 

Fastforward from Monday to that Friday. By now it is clear that the “tongue” graft is failing. And fast. The doctors caucus. They decide to scrap the whole concept. This entails assembling a surgical team on short notice. Surgery is scheduled for 7 pm. It ends sometime after 11. I’m a mess coming out the back end.

Consider the geometry of this endeavor. Things were pretty straightforward when it was just a tongue swap. The idea was that the graft would strengthen, take over basic tongue functions like preventing me from drowning in my own spit, and make the tracheotomy irrelevant. Now, however, we need some anatomical origami. They filleted the left side of my chest, cut a slit in my neck that opens in my throat, folded the chest flap up so that my mouth and nose are cut off completely from my airway, and closed everything up. 

I’m not crystal clear on this folded-paper model and how Tab A fits into Slot B. But I do seem to have residual evidence of the procedure. This is in the form of two enormous tunnel-like voids, one on each side of my neck. Here’s a couple photos:

Two more recovery weeks in the hospital got me home, and today I had my first post-treatment checkup with Dr. H. He’s comfortable with my overall condition (I’m still struggling to breathe, but that’s my problem at this point). He drained a bedpan full of blood from a large hematoma on my thigh, and removed the surgical drain which was failing to take all that fluid. 

Then he got to the point. We are running low on treatment options for residual malignancies. He opened the conversation by announcing that we are beyond long-term “cure” of my cancers. Now we’re dealing with management, and possibly simply with symptomatic management.

There are three presently known or suspected carcinomas in my body. There’s a tumorish surface on my sinuses above where the tongue malignancy was. There’s a small piece of tissue that the surgeons apparently observed slipping away into a lymph vessel. And there’s two spots on my left lung. These are presently of unknown standing. They seem to have increased in size (bad) but did not take up the radiolabeled sugar at my last PET scan (good). If the lung spots are actually cancerous, treatment for the other spots is obviated. If not, Dr. H has some alternatives including clinical trials of various therapies. My throat cancer is so rare in nonsmokers that it is of scientific interest.

Next step is an MRI of my lungs to try to ascertain what, in fact, the visible spots are. Personally, I have some hope about those bad boys. Childhood allergies and asthma, years of norepinephrine dosing for same, periodic pneumonia, chronic bronchitis, etc. involved decades of physiological insults to my lungs. Hell, I’d be surprised if there was NOT some record of all that in my lungs. And not necessarily cancerous.

We’ll see, starting soon. Updates to come. Rest assured, as I find stuff out, I’ll pass it on to you. Love to you all!

It Might Get Messy

You can surmise you’re in trouble when you’re drifting in and out of a post-surgical stupor and you hear the nurse shouting on the phone to her supervisor. “THEY ASSIGNED ME THIS PATIENT AND HE’S KIND OF SLOPPY AND NOW HE’S SPRAYING BLOOD AND SALIVA AND I DON’T THINK I CAN TAKE IT.” And of course you want to help the poor kid, but between the blood loss, the narcotics, the pain, and the shock, you immediately pass out again.

When you come to, shifts have changed and it’s a new, more mature nurse. George had apparently seen plenty of “sloppy” patients and wasn’t intimated. Of course, he also had some new weapons in his arsenal.

Leeches. I know, you learned in Bio 101 that leeches used to be used to “bleed” patients in Medieval times. And that there was some kind of revival of interest in leech therapy in recent years. But you never thought you’d see it in action.

Or feel it. Or taste it. I’ve seen some big leeches in my time, mostly on the backs of turtles in stagnant water. They don’t look appetizing.

When the tongue-shaped chunk of thigh muscle grafted into my mouth started to fail, the recently micro-stitched veins were the first things to crack under the strain. Too much pressure, too much blood, too much general ickiness for the delicate vein structures to take. 

And how do you clean up excess blood, mass of loose fluid, snootfull of general ickiness? Leeches, of course! Why didn’t I think of that?

Apparently, you just order them like any pharmaceutical product. They come in a nice little harness, so they can be dropped into your mouth, taped to your cheek, and recovered after they have filled their blobby bodies with blood and other goop. They don’t chew blood vessels (saving those veins), and they can suck up huge quantities of material.

Here’s how they come from the pharmacy, freshly prescribed:

Here’s one in its little harness, ready to be dropped into the patient’s mouth:

Let’s explore the sort of patient who might benefit from the ancient-art-made-new of leech therapy.

THOSE OF YOU WITH DELICATE SENSIBILITIES SHOULD ABSOLUTELY TURN AWAY NOW. It’s about to get ugly.

First, such a patient from the outside. This joker has had his tongue excised and replaced with a piece of thigh muscle, a port run from his shoulder to his pericardium (more on that later), a tracheotomy tube inserted, and other major knife-driven insults. Don’t bother to count the staples. 

Here’s the mouth full of goop that has the little flock of leeches itching to get at it. Most of the contents here just continually bubbled up from my throat, hour after hour. Necessitating some way to clear things up (leeches) and some way to make up the loss (something like 14 units of blood over several days).

Note at first the leeches seemed tasteless. Somewhere on the second day, they started to have a flavor, somewhere between the smell of an algae-encrusted pond in late summer and a salt marsh at low tide on a hot summer day. In other words, vaguely disgusting. This, coupled with the tiny cross-shaped razor cuts of their rear anchor and forward mouth, made the whole experience really bizarre.

Here’s a leech, having filled its gut, attempting to escape.

Because after being used for therapy, the leeches were drowned in alcohol. Which I suppose may not be the worst way to go after a huge meal. 

Stay tuned to this weblog, everybody. Not sure where we’ll go next, but rest assured it’ll involve massive surgery and plenty of discomfort… . 

It Might Get Messy

SHEEEEEEEIIIIIIT! Or “shite”, as my granduncle Henry, late of Belfast via Brooklyn, would have put it. Over the past few weeks I have been gutted, stitched up, gutted again, stitched up again, partially gutted again, partially stitched up again, leeched (I SWEAR), drugged, and set on the path, such as it is, to the rest of my life. I quickly found myself unable, for various physical and psychological reasons, to deal with weblogs and emails. So I’ve been in radio silence since things kicked off. I may be back in business now, with this specimen as the test-case weblog. Let’s pick up the narrative thread where I left it the night I tried to write about recovery from surgery.

Might Get Messy indeed. It would be damned hard to get much messier than it is right here and right now.  One shade or two more of “mess” and there won’t be much left to clean up, believe me. For the few moments I’ve been lucid this week, I’ve been terrified of writing this piece. This is because things are so much worse, and simultaneously so much better than when I posted a week ago, that I wasn’t at all sure what to report, and how and why. Still, I am strong enough now to begin getting this column out of arrears. 

For reasons that will clarify in the coming weeks, some aspect of the cyclical processes of being will be appropriate themes. On the other hand, so much happens on an hourly basis that it’s tough for me to do more than whine. But I owe more than that to the mystics who operate the Spiritual and Physical Realms. Hell, the observation I offered a couple years ago—that I can’t sleep when the universe bifurcates into 2 suites, one missing my corporeal self in error and one containing it in same—still pertains. Haven’t slept in more than a week, as the physics sorts itself out (and probably befuddles itself at my continued presence, given that I’ve now fought through 2 full follow-up procedures and at least one near-death experience with a pericardial catheter after my tongue and mouth surgery last Monday.

But let’s not start there. Let’s start with the best drink of water I’ve ever had. 

As an adolescent, I was an idiot. None of you are shocked to hear that, I understand. But I was more idiotic than you might suspect even of me. In particular, I was idiotic regarding winter sports. 

Back in the days when New Jersey had 4 seasons and public open space, we ice-skated and played ice-hockey with a barely subreligious fervor. The most intense risk levels associated with these behaviors were injuries from under-equipped amateurism and thin late-season outdoor ice on lakes and ponds. One year, it remained possible to play on Pompton Lake well into March (remembering that opening day of trout season was usually 1st or 2nd week April then). 

And play we did. One Sunday, we started in the morning and played deep into the afternoon. Nobody brought drinks or water. Our usual habit was to hit the convenience store at the downstream end of the lake by the dam. But, with the ice this thin, even stupid and oblivious teens could see that it wasn’t safe to make the run down the channel to get to the store. So we basically dehydrated over the course of the day.

About 4 o’clock, we all looked at each other. My parent’s house was relatively nearby, but the stock of teenager-friendly soft drinks was always spotty. Besides, we wanted to play one more period, for the unique experience of the late afternoon light.

So we did what any idiot adolescents would do. We hacked a hole in the ice and drank the cold, cold water directly from the lake. 

Well. I can still remember every detail of that drink. The water was clear, tasted clean, slightly algal, and on a parched throat was like morphine cutting into long-lasting pain. I drank liters and liters of lake water that afternoon. It was incredible, and that morphine analogy is hardly too strong for the quenching pleasure and physiological relief.

Mind you, we understood at least some of the risks we were subjecting ourselves to. The lake had long been closed to swimming due to sewage input and bacteria counts. The watershed even then was highly urbanized, street runoff and storm sewage was a high proportion of total flow. Hell, in summer when we’d violate the swimming ban, we’d come down with massive earaches and boils on legs and arms. And we were well aware of the industrial chemical inputs from the upstream manufacturing facility. 

But we went ahead and drank. Nobody was made directly ill from the incident, as far as I recall. But that can only go down to luck and youth, I suspect.

This is relevant because the tale of my hospitalization and the devastation wrought by my treatment (wait until you see some of the photos!) is a story of risk assessment and management in a complex situation under intense pressure. There are lessons here for all of us. And the teaching continues—despite the massive and radical therapies I’ve been subject to, and my present intensely weak and difficult condition, residual carcinomas or suspect carcinomas remain at several places in my body. These have to be factored into decision-making going forward, and soon. The cancers are aggressive, and prone to proliferate.

But we have a long way to go before we get to THAT discussion. Tune back in here every 2 or 3 days or so for the foreseeable future. Just recounting the adventures of my time in hospital is going to require multiple entries. Oh, plus I got photos of the leeches!

I am far behind on emails and thank-yous. I’ll get caught up asap. But for the moment, I’m going to concentrate on this record of my time in the belly of the medical system. Ever see the George C. Scott classic “Hospital”? I urge you to watch it as prequel to the coming entries in this blog. My love and thanks to you all for the good wishes, prayers, food for the family, the Power Point document, cards, emails, inquiries and calls. Once again I can’t tell you how important those were in getting me through weeks of darkness in the hospital. They gave me an edge of the pool to see and work towards even when I was sunk in the depths. Thank you all!!!