In high school science, we learn the landscape of the Battle of Evolution. On one side, the trenches of Lamarck, backed by the artillery of mainstream thought. The armies of Lamarck defend the old school—organisms pass their individual experience to their offspring. Thus that illustration in the margin of high school and college biology texts of giraffe-like creatures reaching higher into the canopy for leaves, stretching their necks. And passing longer, stretched necks on to the next generation.
Across no-man’s land, the rebellious fortresses of Darwin and his guerilla army. Only random, inherent variations in the anatomy or physiology of organisms (they didn’t know about genetics or DNA at the time) are passed along to offspring. No man’s land is a bright line—the dumbshit Lamarckian losers facing the brilliant rising tide of Darwinian genius.
I believed in this simple, either/or, right-or-wrong universe when I was a kid. Then, over the summer before my junior year at Rutgers, I read The Origin of Species. And was immediately stricken with panic. Darwin was NOT the white-hat yang to Lamarck’s black hat yin. Darwin believed in the inheritance of individual experience. Darwin was a Lamarckian!
Over my long academic career, I took many classes in evolution. None of them spent any time on Darwin’s belief in inherited experience. Kind of made me wonder if the profs hadn’t slogged through The Origin. Or that maybe they just didn’t want to deal with the complications. Far be it for me (now THAT’S a strange idiom. Try translating that into, say, Serbian, or maybe Cantonese) to be cynical. But it sure seemed that something so obvious in the Origin warranted a slot in the curriculum.
Anyway. It’s not difficult to find Lamarck in the Origin. In the first edition (the Origin of Species changed enormously over its life of some 20 editions), Chapter 5 is titled “Laws of Variation”. Under subhead “Effects of Use and Disuse” Darwin says:
…I think there can be little doubt that use in our domestic animals strengthens and enlarges certain parts, and disuse diminishes them; and that such modifications are inherited.
Bang. There you have it, sports fans. Darwin believed that those stretchy-necked giraffe things passed their stretchy necks on to their offspring.
I don’t really know what, if anything, this means in the big picture. And I’m pretty sure that many of you out there are wondering what, if anything, this has to do with cancer and its aftermath.
Well, what it has to do with is my newest health contretemps. It’s an artifact of Darwinian disuse.
See, my thoracic and cephalic anatomy was broken down and then rebuilt as a necessary aspect of treatment. The bottom line is that my mouth is no longer a functional component of my anatomy. It’s been decoupled from both the gastrointestinal and respiratory systems. I can no longer use my mouth for speaking, eating, or breathing. It’s just sort of there, with its plumbing capped off.
It turns out, if you don’t use your mouth for anything, it starts to close up as the muscles formerly so useful for eating, drinking, breathing, and speaking find themselves no longer exercised. So, for most of the past year, my mouth gape has been shrinking. I’ve been kind of casually fighting this by using the special mouth exercise machine the speech pathologists gave me back when we thought I might be able to actually use my mouth when the treatments were finished. But it’s a struggle. My jaw muscles are partially frozen in place, and day-by-day they shrink a little more.
Which wouldn’t, on its face, seem to matter. I don’t need my mouth for anything, why not let it retire in peace?
Ah. Because oral hygiene is still important! You’ll recall that a few years ago, medical science established that microbial inflammation originating in the mouth plays hell with heart and lung health. A clean, well-managed oral cavity is crucial for long-term quality of physiological life.
But, if your mouth is shrinking shut, it gets harder and harder to reach in there to keep it clean. In fact, it gets rather painful. So, a few weeks ago, I found myself letting my oral hygiene slip. And was swiftly and violently punished for the lapse. I started to cough up lots of fresh blood. I was running weird cycles of fever and chills, sweating profusely for no reason. And generally feeling crummy.
This week I finally made the connection between my deteriorating health and my deteriorating oral infrastructure. So I did what needed to be done. Started forcing, however painfully, my mouth open enough to swab it down several times a day with clean water and baking soda.
The effort paid off. I’m back to feeling good again. My mouth is nice and clean. But I can see that this is going to be a long-term difficulty. It seems inevitable that my gape is going to shrink, despite my best efforts. And it’s going to get progressively more difficult to maintain effective standards of oral hygiene.
Just one more thing to whine about here in Cancer Land (copyright, trademark). But with a little discipline, I expect I can keep this aspect of my health under control.
Let’s hope so. Because with spring here, summer is not far behind. And that means that the beach is coming into focus. So I gotta maintain my health so I can get to the barrier islands in shape to cook, catch cottonmouths, and park my butt on the beach. Which also brings us to this week’s musical interlude.
This Week’s Musical Interlude
As promised last week, I’m gonna append a brief bit of recommended listening to this regular web log. Life demands good music, dammit! Anyway, in keeping with the beach theme, Amazon offers a 4 disk download of awesome guitar instrumentals called Surf Age Nuggets. You can find it at
http://www.amazon.com/Surf-Age-Nuggets-Various-artists/dp/B00FKDYHU6/ref=sr_1_1_title_1_mus?s=music&ie=UTF8&qid=1398577700&sr=1-1&keywords=surf+age+nuggets
I highly recommend it. For $38 you get a massive set of awesome guitar tones and tunes. By the time you’re into the second disk, you’ll be lost to the conscious world, deep in daydreams of hot sun, crashing surf, and Negroni cocktails on the deck. No household should be without!
Oh. One more thing. Spring is here. Means I’m getting out and getting used to my new high velocity, industrial grade, NASA approved camera. A couple of photos are appended below to whet your appetite. And then, if you have a few moments to kill, surf on over to docviper.livejournal.com where I’ve posted a longer string of flowers and other early spring photos.
Enjoy! Thanks for being here. Rock on, everybody. Just because we damn well can!!!
We’ve talked some here at the End of the World weblog about tumor nutrition. Our interest has been largely diagnostic: because malignant cells have screaming rates of metabolism, they reveal themselves in their desperate thirst for radioactively tagged sugar. But there is a mechanistic aspect to this. Clumps of malignant tissue (that is, tumors) are not engineered like clumps of normal tissue (approximately, organs). Among the many groceries in the shopping cart of evolution is the three-dimensional functionality of vertebrate bodies. Every one of the billions of cells (if you google “number of cells in human body” you get a hilarious grab bag of hits, about a third of which point out that the number of microbes in the normally-functioning human gut outnumbers the number…uhh, outnumbers the number…yeah, that works…outnumbers the number of human cells in the whole body by orders-of-magnitude) in the body gets regular deliveries of the long list of stuff needed to function. And also has its waste products carted off to the wastewater treatment facilities and the landfill. But a tumor is a runaway, improvised, rapid-fire mock-up of real tissue. Ravenously dysfunctional cells glued together in a structurally impaired cartoon of a happily operating organ? How does everybody get fed? Where does the sewage go?
Normal (that is, noncancerous) cells can signal blood vessels to grow on an as-needed basis (for example, after an injury). When a clump of cancer cells reaches a certain size, the baby tumor hijacks cellular signals and gets blood vessels to proliferate in and around the tumor [3]. Now, the mutations that release cancer cells from normal constraints on cell growth have only open highway ahead. The tumor gets all the care and feeding and waste removal it needs from the circulatory system it has carjacked. Indeed, the tumor-induced blood vessels themselves contribute to the runaway nature of the enterprise [2]. At this point, the mutant DNA is riding shotgun, with a weapon pointed at the driver, a full tank of gas, and a lap full of truck stop burgers and fries.
The frantic, mutated metabolism of the tumor cells sometimes provides therapeutic leverage [1]. More frequently, it just sucks up increasing shares of the body’s nutrition, expanding its influence at the expense of the normally functioning tissues.
Nutrition continues to be my basic problem here in Cancer Land (copyright, trademark). We continued to work with the nutritionist, attempting to find ways to get sufficient calories into my system so I can function. Actually, her advice began to wander down unproductive pathways. Eventually she recommended a product called “Ensure Clear” which has zero fat, zero fiber, and 60 calories per 100 milliliters. Given that my primary problem has been inability to maintain weight, and knowing that I need somewhere approaching 3000 calories a day to do so, this didn’t seem like a productive way forward. I gave up on the consultations, and reverted to my standard U.N. emergency rations, which at least provide well north of 100 calories per 100 mls. So I’ve upped my intake of liquids and antinausea drugs and started forcing in five or six 250 ml containers per day. I may feel stuffed and have to struggle to keep everything down. But at least my weight is going back up and my energy level maintains.
Sigh. It’s not easy. But it sure as hell beats the alternative! My love and thanks to all of you. As a reward for your patience, I append below a musical coda to this week’s column. With summer coming on, it is becoming appropriate to open the doors and windows and crank up the stereo to broaden the musical horizons of the neighbors. I’ll try to include at least a brief selection of musical recommendations on a weekly basis going forward. If spring is here, the beach can’t be far behind!
Music Update
In the four years or so I’ve been struggling with cancer, a number of remarkable circles in my life have closed. People who were important to me, and lost for decades (in some cases, almost all the decades) have come back around, and we are part of each other’s lives again. So it has been for books, poetry, and art, even some of my own work.
Anyway. For more than 30 years, I’ve been waiting for Athens Georgia jangle rock band Swimming Pool Q’s phenomenal album Blue Tomorrow to make it to CD. Well, a couple of weeks ago, it did. This album has been on my “10 Best Albums of All Time Bar None” list since the first time I played my vinyl copy in the early 80s. It was the Q’s third album, and their best. Also something of a swan song, although they soldiered on through various lineups, and reunited after Anne Richmond Boston got her kids raised. But Blue Tomorrow is absolutely incredible. I commend it to you, particularly in the “expanded” edition available from Amazon as “The A&M Years” (http://www.amazon.com/1984-1986-Years-3xCD-DVD/dp/B00CMYRS9I/ref=sr_1_1?s=music&ie=UTF8&qid=1397945078&sr=1-1 ). The Amazon set contains the Q’s second album (self titled), plus Blue Tomorrow, a disk of rarities and alternate versions, and a DVD of the band. To me, it is remarkable that anybody retained and curated all this material all these years. But, as I’ve discovered through my health travails, there is much that is remarkable in the world. Like Blue Tomorrow. Do yourself—and the world—a favor. Go to Amazon and purchase this. It is more than worth the $33 for the 3 CD, 1 DVD set. It is absolutely awesome. And, unless you’ve been subjected to my compilation sets over the decades, it is fresh and surprising music that you’ve never heard before. Absolutely recommended—No Household Should Be Without.
Notes
[1] Vander Heiden, M.G. 2013. http://www.jci.org/articles/view/72391
[2] http://weill.cornell.edu/news/news/2014/03/tumor-blood-vessel-signals-turn-cancer-into-a-lethal-disease-resistant-to-chemotherapy-shahin-rafii-bi-sen-ding.html
[3] http://www.cancerresearchuk.org/cancer-help/about-cancer/what-is-cancer/grow/how-a-cancer-gets-its-blood-supply
It’s been a tough week here in Cancer Land (trademark, copyright). My weight continues to fall. If I pour in anything like enough calories to maintain my weight, I get terrible stomach cramps and tend to vomit or simply have my gut contents spill out past that Lower Esophageal Sphincter Muscle (LESM) we talked about last week. All of which leaves me weak and shaky. Which reduces my ability to exercise—or even walk for more than a dozen paces. Which further reduces my ability to accept the U.N. Emergency Food Rations. Which further reduces my weight. Which further…well, you see the circular nature of the problem. And of course, there’s no magic solution. We talked to the dietician. Whose advice, of course, is to try to find some way to stuff more calories in to stem the weight loss. So I’ve switched from the U.N. Emergency Rations to over-the-counter Ensure Plus, a standard weight-gain diet formula.
Hasn’t helped.
Before we continue with my whining, let’s take a detour to explore the whimsical world of space science. According to
http://news.yahoo.com/cherry-tree-space-mystery-baffles-japan-085044593.html
if you fly cherry pits into space, they become sort of super-seeds. According to the Buddhist monks who (for some reason) sent the seeds up, a few months in space yield a number of benefits. First, seeds from an ancient (more than a thousand years old, according to the story) cherry tree that have never sprouted before finally did so. The monks are happy because their ancient tree can be replaced by its own progeny. Other seeds, from trees that do sprout regularly, yield trees that flower years before their non-space siblings. And, the flowers have mysteriously irregular numbers of petals.
All of which might be interesting scientific findings. If the findings did indeed have a scientific basis. As one of the project investigators pointed out, there were no “control” seeds, only the experimental (sent-to-space) version. So they’re not sure if the drastic effects of (presumably) cosmic rays are real, or simply peculiarities of the batch of seeds selected for the test.
Duh.
OK, let’s get back to my whining. I had pretty well established, using the U.N. emergency rations plus the five decaf cokes I use to take my meds, that I need 3000 calories per day to maintain my weight. Which required six U.N. emergency rations. Seven Ensures are necessary to reach the same threshold.
In my panic after checking my weight this morning (under 180 pounds, which is about what I weighed freshman year of high school), I pounded down six Ensures in two batches.
Now my tummy hurts.
OK, it’s hours later. I had a long nap, cooked supper (with a super-assist from Beth, who’s out here on the east coast so she can experience some actual weather), and took my evening meds. I feel pretty good. I have to dump in at least one more bottle of Ensure Plus tonight, but that won’t be a problem. There’s almost nothing that qualifies as a “problem” after you’ve had 16 milligrams of dilaudid.
Anyway. Spring is indeed, finally, here. Earlier in the week, I wandered over to the Patuxent Reserve, and quietly slid into the meadow where the big timber pile shelters that enormous black racer I posted photos of a couple years ago. She was indeed out sunning herself on a heap of cinder blocks. I managed to get within arm’s length of her. In fact, I had her tail in my hand as she woke up and slithered off. I was trying to be gentle, though. She was covered with the silver epidermis indicating that she was about to undertake her first skin shed of the year.
Snakes in this condition are delicate. If you grab them too tightly, or they thrash too hard when you have a hold of them, they can tear the new underskin waiting its turn to serve as the primary epidermis. Which is not good. So I didn’t try too hard to catch her. I’ll go out tomorrow and see if she’s finished her shed. I’d like to get a tape measure on her sometime. She is absolutely huge. The Peterson field guide lists record length for black racers as 73 inches, or 185.4 centimeters. I’m pretty sure this one is at least six feet long, possibly longer. So sometime this year I’ll make a serious attempt to catch her and get a measurement.
If I see her on my walk tomorrow, or anything else worthy of your natural history attention, I’ll post photos here next week. In the meantime, enjoy the warmth and the full daylength.
As always, I thank you for being here. My health seems to be slipping a bit, I suspect due to my inability to ingest sufficient nutrients to maintain my weight. I’ll keep you appraised as I wrestle with this new contretemps. I am learning a new lesson from the geography here in Cancer Land (copyright, trademark). Which is that cancer, even if it’s in remission or otherwise “cured”, is forever. Patience and stoic acceptance are the overriding skills needed to deal with cancer survivorship. Given the alternative, however painful the schooling necessary to acquire said skills, it’s a bargain!
My lower esophageal sphincter muscle (LESM) doesn’t work… .
Ooh. I heard about a third of you wallop your head onto your desk, a third of you choke back a good spew, and a third of you say “huh?” Personally, the last time I thought of my LESM was in a high school summer biology “enrichment” class. We dissected one out of a preserved shark. You can get a good picture of the esophageal sphincter situation at [1].
But that’s not why we’re here. Oh, wait. Yes, it is why we’re here. But before we deal with my LESM, let’s think a bit about hemorrhagic viruses. Because climate change has been getting a lot of press lately, and one of the potential downsides to climate change (remember that I have a quirky personal take on climate change. I think a warmer earth is a better earth considering net outcomes) is that a long list of illnesses traditionally thought of as “tropical diseases” by those of us in the smug north temperate zones are likely to spill across borders and hammer our pale, overfed, overwatered carcasses in an orgy of illness making the medieval “black death” look like a sniffle-nosed kindergarten class.
The viral pathogens causing “hemorrhagic fevers” are little globs of fat with a strand of RNA inside [5]. The diseases are your standard science-fiction plagues where people deconstruct in a matter of hours, collapsing from fit physical specimens into gelid goo as the small town sheriff’s deputy frantically dials the governor’s office, trying to mobilize the National Guard.
Hemorrhagic viruses are endemic in animals of various kinds. They make the jump to humans when people intrude on their habitats or domesticate the mammal vectors (a couple hemorrhagic viruses were “discovered” by western science when they showed up in research populations of monkeys).
Recently, a particularly nasty hemorrhagic virus, ebola, has been emerging at the interface of modern, global society and African wilderness [2]. The big problem in today’s world is ecological linkage. That is, people now go from outback landscapes to major cities (and vice versa) in a matter of hours. Given the take-no-prisoners epidemiology (the viruses spread fast and easy once a population has been infected) of these bugs, this is a disturbing development. French doctors have taken to stationing themselves in the one international airport in Guinea, hoping to spot infected individuals before they transit to the clean world of the north temperate zones in Europe, Asia, and America [3].
Even more disturbing, if you’re inclined to conspiracy theories, is the emergence of hemorrhagic viruses in the 1950s, at the height of the Cold War when massive investments were made in biological weapons of war [4]. If you want to have some fun sometime when you’ve got time to invest in a quick read, Lab 257 by Michael Carroll is worth a look [you can find it on Amazon at 6]. Carroll builds a convincing (to me, anyway, his work has taken a beating in the comments on Amazon and in reviews) case that Lyme disease had its American origin at a government microbiology laboratory on Long Island in the 1950s. This conclusion is given some legs by what is probably a careless exposition of the history of hemorrhagic fevers on the CDC web portal [5].
Anyway. Back to my dysfunctional Lower Esophageal Sphincter Muscle. The esophagus has a sphincter (tightly wound loop of muscle that closes and opens the tube) at both ends. In my case, the Upper Esophageal Sphincter Muscle went the way of the rest of my mouth and throat hardware. That is, it was pretty much destroyed in place by the radiation therapy, and then hacked out and sent to the incinerator with the other body parts that were problematic when the surgeons deconstructed and then reconstructed my throat. This wreckage at the top end of my gastrointestinal tract was expected, closed and done.
But the lower sphincter, I sort of casually assumed, would be there for me when I recovered from the radiation and surgery. It turns out that the LESM is really critical to comfortable functioning in the modern world. Specifically, it would keep the intensely acidic digestive fluids in place in the gut, where they belong and where they can do their work in cheerful quiet, out of sight and out of mind.
However. For whatever reason, my LESM is missing in action. I’ve discovered this recently as my recovery has proceeded. Mucous production has been declining, allowing me to move around and do more stuff. Like cooking, for example. Where you have to periodically bend over to check items roasting and/or baking in the low oven of the stove. Turns out, if your LESM isn’t performing as designed, when you tip your digestive tract over so the top end is lower than the bottom, the screamingly acidic liquids spill out and over the sensitive (because of surgery and radiation) tissues of the esophagus itself. It’s a simple display of high school physics. And it is incredibly painful. And once the acid has been smeared over the plumbing, it takes quite a while for the effects to dissipate. Causing further irritation via coughing, which inflames things to the point where they bleed.
Oy. It’s never easy. But, of course, the fact that I’m here to actually feel the acidic burn in my throat is a major triumph. So I’ll stop whining now. And I’ll also try to remember to drop to my knees, rather than bending over, when I check to see if the chicken is achieving crisp roasted perfection.
Thank you all for being here. Spring still seems to be coming, although it’s taking its time getting here. Rock on, everyone. Live ‘em while you got ‘em!
Notes
[1] http://www.webmd.com/digestive-disorders/picture-of-the-esophagus
[2] http://www.nbcnews.com/news/world/medical-staff-scanning-ebola-guineas-airport-n72766
[3] http://www.nbcnews.com/news/world/medical-staff-scanning-ebola-guineas-airport-n72766
[4] http://onlinelibrary.wiley.com/doi/10.1002/jmv.23856/abstract
[5] http://www.cdc.gov/ncidod/dvrd/spb/mnpages/dispages/vhf.htm
[6] http://www.amazon.com/Lab-257-Disturbing-Governments-Laboratory/dp/006078184X/ref=sr_1_2?s=books&ie=UTF8&qid=1396770359&sr=1-2&keywords=laboratory+257
