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.
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!!!!!!!!!
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
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.
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.
