It Might Get Messy

North Africa, early 1940s. The first extended engagements of World War Two were a technology testing ground (the German decimation of Europe in a matter of weeks the previous years really only proved that a well-funded and updated war machine trumped outdated armaments and desultory and inadequate commitment of men and materiel [nifty word, “materiel”]). The 1930s had barely seen the transition from multi-winged World War One aircraft to modern single wing designs. Tanks and other armored vehicles remained light-weight, under-armored, under-gunned machines intended to support infantry under the war doctrines of the day. In the Spanish Civil War, remarkably, only the Germans and Soviets took the opportunity to test weapons, tactics, and strategy. Other players plodded along by the numbers, investing as little capital, financial, technological or intellectual, as possible.

So North Africa, where an odd pastiche of French (both collaborationist and free), Italian, German, British and indigenous forces danced over a mosaic landscape worthy of a “Risk” game board, became the first major technology assessment laboratory for the tools of war. 

Of course, local quirks of the harsh environment dictated peculiarly specific fixes to problems that were less-than-general. Air filtration, for example. When I was in Jordan, one day we had driven deep into the eastern desert to visit an endangered species recovery facility. We got caught in a relatively minor sand storm that lasted about 45 minutes and required us to sit tight while it blew through, visibility dropping to zero. We buttoned the car up tight. But, with all windows and vents fully closed, a substantive quantity of super-fine sand accumulated inside anyway. It was so fine and thick it threatened computers, cameras, and cell phones. In the 1940s, such grit played hell with high-performance aircraft and vehicle engines designed primarily for the moist, clean air of northern Europe.

First victim was an Italian heavy fighter plane, the Breda “Lynx”. Its twin engines required a retrofit of air filters. As soon as the filters were in place, the plane’s performance fell to the point where it became a joke [1]. A short-term joke, as the entire stock of Lynxes was shot to hell in one fell swoop early in the conflict.

Even with filters in place, tank engines had to be changed out after 3500 kilometers of driving. In northern Europe, engines lasted 7500 kilometers [2]. Dust also had inordinate effects on radio hardware. It was difficult to maintain group cohesion with radios weakened, damaged, and destroyed throughout the active formations.

And just what the hell, I hear you inquiring, does this discussion of atmospheric dust have to do with cancer? 

Turns out that it has considerable relevance. For a long time, after I got out of the hospital, I was in the habit of using odd little barrel-shaped air filters on the sticky-outy end of my tracheostomy hardware at night. For some reason, over the past few months, I got out of the habit. I didn’t make any connection between this hardware hiatus and the increased levels of discomfort I’ve been feeling lately. 

In preparation for two weeks on the Outer Banks (which I, unable as I am to safely swim or even wade very deep in surf, intend to spend in intensive pursuit of reptiles, nature photography, and preparing dynamite dinners for our multi-family household), we ordered up a box of air filters (because having blowing sand blast directly into my bronchi seems like a guaranteed recipe for post-vacation inflammatory pneumonia). I started using them again at night. And it turns out, I feel a hell of a lot better during the day when I do so. The filters keep my oral cavity and throat moist, which results in thinner, less sticky and frustrating, mucous production. The filters also reduce the volume of mucous. I am uncertain why they have this property. I suspect it is because the warmer, moister throat environment feels more “natural” to the mucous membranes lining its surfaces. Absent the dryness and irritation, my salivary and mucous glands don’t feel the imperative to pump out goo to cover the inflamed areas. Leaving me much, much more comfortable.

Most nights for the past month or so, I’ve been awakened at least half a dozen times per in a claustrophobic panic, short of breath, having to rip out the removable inner tube of the trach system, take it to the sink, and flush out the accumulated sticky mess with hot water. This takes some time, and requires me to turn on the light in the bathroom. Which means that I’m not getting much rest overnight, having to deal every hour or hour-and-a-half with hardware maintenance. Last night, for the first time in a long time, I got through the entire night being awakened only twice. Felt really good. 

So I’m back on the air filters, big time. This, coupled with an increased calorie intake, has me feeling a bit better than I have been. Not great, mind you. But definitely better. 

It’s not much, but it’s something. I’ll certainly take it. I am really getting psyched for the upcoming beach trip. For one thing, there will be the warmth that comes from spending time with 50 or so old friends, including a couple of ex pats from the Antipodes in a rare appearance. But, as pointed out above, there will also be the opportunity to spend long hours pursuing reptiles, including some, like the Outer Banks king snake and the speedy legless lizards, that I haven’t seen in decades. And more hours every day devising ever-tastier dinners appropriate for the seasonal abundance of delicious food products in the coastal South. 

So, despite continued weakness, pain, and discomfort, I’m feeling pretty good about things at the moment. Just have to remember to count my pills carefully to make sure I’ll have enough to get me through the beach fortnight. 

Rock and roll, everybody. Summer’s here, and the time is right for enjoying life. Live ‘em while you got ‘em. My love and gratitude to all of you. Hope your summer is shaping up to be a good one.

Notes

[1] http://listverse.com/2011/04/04/top-10-worst-aircraft-of-world-war-2/

[2] http://usacac.army.mil/cac2/cgsc/carl/download/csipubs/toppe.pdf

It Might Get Messy

My mother had an incredible tolerance for pain, and was quite stoic in physical matters (conversely, she could get pretty wired up regarding emotional contretemps). I did not inherit her high pain threshold. I’m such a weenie that I start to squeal BEFORE the dentist touches my teeth with a scraper. And “Marathon Man” is the only movie I’ve never been able to watch again since my first viewing.

I DID inherit something of Mom’s calm, focused, stoic approach to crisis management. For example. The night before football tryouts in my freshman year of high school I slipped and gave myself a massive second degree burn, huge lymph-filled eruptions on my left hand and forearm, while ironing my workout jerseys which was a (quirky and, in retrospect, quite weird), coach’s requirement. It hurt like all screaming hell. I iced it down, finished getting my gear together, and sat up most of the night drifting in and out of sleep and replenishing the ice. When the intense pain subsided around 3 a.m. I got 3 straight hours of deep sleep. That day I bandaged the arm to hide the damage from the coaches, worked through all the tryouts, and survived the cut. My career as a mediocre offensive lineman was off and running. 

Oh. Then there was the time I was driving a state government vehicle full of cheap chicken hotdogs and illicit beer. In a parking lot, I hooked my bumper into the left front quarter panel of an elderly woman’s brand new Chrysler luxury cruiser and ripped a big sheet metal gash from headlight to front door. I took a moment to suppress my heart rate, clear my mind, and accept the reality of the accident as something that had to be properly dealt with. First, I peeled the “In Case of Accident, Call State Police” decal off the dashboard and crumpled it into the nearest trash can. I got my co-conspirator to haul the cases of beer behind the store in case the cops showed up, and talked things over with the little old lady. I apologized, told her it was my fault, gave her all my contact information and the appropriate state numbers I found in the “In Case of Accident” kit in the glove compartment. Then we drove a couple miles to another shopping plaza and I called the Administrator’s office back at the ranch. First thing the Administrator said was “whatever you do, don’t admit it was your fault”. I said “uhh, Trish, it WAS my fault. I stated as much it in writing in the stuff I gave the lady”. Trish swore at me. We swung back to pick up the abandoned beer and headed into the wilderness to take our overnight shift, hauling smallish sharks out of gill nets and packing them on ice for later measurements and conversion to graduate student rations.

The follow-up from the accident was almost as comical as the incident itself. The lady of course had trouble mobilizing the state bureaucracy despite my having given her a signed note acknowledging responsibility that should have been a hefty hammer for the most lackadaisical attorney. I was forced to pay a $2.50 fine and read a sheet of safe driving tips. I SWEAR. 

I am not recounting this by way of braggadocio. I’m setting the stage to tell you how important my inheritance has been in the transition from the real world to here in Cancer Land (copyright, trademark). Being able to calm myself and free my mind has served me well for everything from dropping harnessed leaches into my gore-filled mouth to helping the doctors shove a huge chunk of metal tubing down my throat and into my lungs in preparation for surgery. 

And being able to mobilize a little Zen dispassion on demand helps me with my current difficulty. Which is the continuing struggle with nutrition. I’m managing to find ways to get enough liquid emergency rations pumped in to allow my weight to creep up instead of down. But damn, once I pour in that last slurp of vaguely disgusting milky syrup, I have to put myself into a Zen trance, empty my mind of active thought, and sit upright, eyes closed, paper towels at the ready, barf bucket at hand, and let the waves of nausea pass over and through me. 

And this is WITH the continuing application of miracle anti-nausea drug Zofran. And I’m not always successful. A couple nights ago my gut simply turned in revolt and pumped up a mess. I spent a really uncomfortable night in recovery. My ickiness factor is, at the moment, close to maxed out. 

But. I have to say that it seems like there will be a real payoff in the long term. For the moment, I’m having trouble managing my day so that I can get in some activity. But with the uptake in my weight, I’m feeling stronger. I think if I can struggle over this hurdle and get my weight back up in the neighborhood of 190 pounds, I may kick in a feedback loop where a larger, stronger, more active body will let me “eat” sufficient “food” to keep healthy without so much travail. 

I thank my Mom for giving me the strength to wrestle this mess to submission. And I thank you all for being here for me. You have my love and my gratitude. Summer is here, everybody. It’s time to rock and roll. Live ‘em while you got ‘em. See as many as possible of you at the beach!!!

It Might Get Messy

Indeed. I saw doctors this week. Palliative care specialist Dr. S re-upped all my meds and ascertained that I need to find some way, somehow, to pump in more calories. My weight is down rather drastically, approaching 175 pounds, a benchmark I probably last passed in maybe fifth grade. At this point, it is mostly up to me to deal with this contretemps. The docs have done their part, giving me THC for appetite and Zofran to suppress spew. All we need now is for me to find some way to get on top of things and dump in sufficient United Nations Emergency Rations to boost my biomass. 

However. Those of you who know me will recognize that personal discipline is not my strong suit. Of course, since we’re dealing with life and death at this point, the consequences of being 61 years old and needing adult supervision are stark. I gotta eat or I’m gonna die. Duh. 

The big picture stands in chirpy, sunny contrast. I remain cancer-free. Dr. H did the due diligence, examining my throat since I continue to hack up copious quantities of bright, red blood from both my trach tube and mouth. A quick check with the endoscope revealed that there is no obvious malignancy, certainly nothing approaching the scale of carcinoma that would precipitate overt bleeding. What there IS, apparently, is irritated, inflamed tissues, a direct outcome of the radiation treatments.

Which were more than a year ago. I gather that this irritated, inflamed, bleeding mess is permanent. Dammit. I was assuming…or hoping, at least…that “recovery” from the cancers and their treatments would engender happy and healthy mucous membranes throughout my otopharyngeal infrastructure. 

Bummer. In any case, we did a sort of sea-trial practice run for THE BEEAAACCHHH [copyright, trademark] this weekend, spending a few days in sunny southeastern Virginia. This fantastic visit with old friends provided the opportunity for me to reality-check the hardware, logistics, and processes I’m going to need to survive two weeks on the Outer Banks. 

The shakedown cruise revealed some weaknesses in the functional systems. For one thing, there’s the sheer damned bulk of materials needed to support operations. Two and a half days away from home requires half a dozen rolls of paper towels, a 12 pack of Coca Cola (caffeine free, of course), several bottles of Gatorade, ditto for water, plus a case of rations, 4 carefully counted bottles of meds (broken down into morning and evening flights), a couple bottles of cough syrup, large and small beakers for dealing with liquids, syringes, tape, and other small items necessary to wrestle meds, food and water into my recalcitrant physical being. Plus I’ve generated a garbage bag-and-a-half of trash. Scaling this up from 2 days to 2 weeks is a little frightening, probably something like the panic that gripped Eisenhower when he realized how much shit he had to get onto the blood-and-ordnance-strewn beaches of Normandy to allow his troops to function after they fought their way past the coastal strand. 

Ah, and then there’s the saga of the feeding tube infrastructure. Dr. H and I talked this over. There aren’t a lot of options for responding to full-on failure of apparatus that lets me pour liquids directly into my gastrointestinal tract. Replacing the sturdy system I have installed now requires anesthetic surgery. Read “complicated and expensive”. So we agreed to try to make the existing system last as long as possible. This is ok, I’ve already established that the big home improvement warehouse stores can provide parts needed to keep the external components operating. And if the internal parts fail? Well, that’s a little tricky. If it happens on like a Saturday, it means waiting at least until Monday, and possibly longer, as surgery must be scheduled. This would mean hospital admittance for IV fluids to keep me from shriveling into a 175 pound raisin. Dr. H has an emergency system we can use for the short term, should the primary system fail. This is a weird little balloon and tubing mechanism that requires I inject myself through muscle into stomach wall with the balloon that will then be inflated once it’s inside. I have a vision of a bad World War Two movie here, with our hero the hard-luck corporal trapped behind enemy lines with a gashed belly and protruding intestines repairing things with only a bottle of Cognac, a bayonet, and a couple feet of parachute cord for tools. 

Anyway. The overall picture is positive. I’m cancer-free, and though crippled, able to function. Regaining strength is clearly going to be a longer, slower slog than I would like, but the key is that I’m healthy enough to actually regain strength. 

So, I just gotta get to work. I’m on it. With two weeks at the beach pictured firmly in my mind as motivation, I’m ready to do what needs to be done. Because Live ‘Em While You Got ‘Em is more than a slogan, it’s a life imperative. My love and gratitude to you all. Have a slammin’ week everybody!!!

It Might Get Messy

Entropy. The cold, unstoppable Master Control of the physical universe. And one of the few high-level concepts of modern physics that is accessible and generally understandable. Basically, unless fed with matter and/or energy, things deteriorate. Sand castles don’t build themselves, and sand castles once built quickly revert to randomly blown grit unless they are coddled, protected, maintained, repaired, and replaced.

In more formal terms, a sand castle is a physical system. If the system is isolated from additional inputs of matter and energy for protection and maintenance, the Second Law of Thermodynamics demands that the nicely-placed grains of sand in a castle revert to the more disordered, higher-entropy condition of randomly tumbling along the beach [1]. 

Entropy is often invoked on Discovery Channel programs as the ultimate hammer of suicidal gods, an overriding property of the physical universe that dooms us to eventual thermodynamic equilibrium in unimaginable cold darkness as the energy of the “Big Bang” that birthed us dissipates over time. 

But this ominous vision of the (very) long haul requires simplifying assumptions that seem highly unlikely. The universe will only wind down to the great cold and dark of thermodynamic equilibrium if it is isolated from inputs of matter and energy that would work to maintain or even increase order. It seems to me that the Big Bang itself was an enormous input of ordering energy. And unique, one-time events don’t happen in nature, so it’s highly likely that whatever pumped us up 14 billion years ago will pump us up again as we toddle along time’s arrow. In addition, we are only able to see, feel, hear, smell and taste 4% of the total universe. The remaining 96% of the universe is “dark matter” and “dark energy” that we only know is there. We have no way to reach it to figure out what the hell it is and what the hell it is doing. Seems to me that our active 4% of things is only a side show in a much, much larger circus blaring behind a curtain we cannot peek through.

Anyway. Why, you ask, am I subjecting you to this harangue about the state of modern-day physics, when the nominal focus of this weblog is the biology and sociology of human cancer? And the answer is that the physical infrastructure of cancer treatment is subject to the universal laws of thermodynamics. If you were to have, say, a polyvinyl tube inserted through your stomach wall so you can pour in matter and energy to keep your body ordered via inputs of United Nations Emergency Liquid Food Rations, said polyvinyl tube would be expected to deteriorate with time absent ongoing cleaning, maintenance, repair and replacement.

Basically, this week my feeding tube exploded. In fact, this wasn’t the first time I’ve had to input some matter and energy to counter the corrosive properties of time and entropy. Some months ago, the “distal”, or outer, half of the tube sprouted a quite colorful garden of what I presume was yeast and/or fungus along its lumen, slowing the influx of liquid and making me suspicious about possible health effects. At the time, I sliced off the fuzzy tainted length of tube, fitted it with a little plastic plumbing coupler from Lowe’s, and added a short length of (better quality, by far) replacement tubing, also from the back shelves of my local home improvement store. So I’m down to about 12 centimeters of original surgical tube poking out of my gut wall, the other end of which is coupled to a sphere the size of a golf ball that Dr. H implanted last time I was in for surgery. (I know this because, if you will recall, in the brief period between my cancer diagnoses, Dr. H had to yank the tummy ball out through the little hole the day before I flew to Germany for the toxicology conference a couple years ago). 

And this residual hardware is itself showing signs of imminent catastrophic failure. I’ve been leaking gut fluids and liquid rations around the insertion point in my tummy. This is ominous. If the feeding tube abandons ship, I have no way to input the nutritious glop that serves as “food”, or the water so necessary for the physiological processes of life. Basically, I’d have to be admitted to hospital so I could be hooked up for intravenous inputs of the necessities of life. 

I surmise that the designers of the feeding tube hardware didn’t contemplate the need for long-term functionality. Certainly the material  itself isn’t sturdy enough to last for years. And I hope to be around for quite a number of years, now that my cancers have been wrangled into submission. 

I presume that repairing/replacing the failing feeding tube hardware will require full-on, lights out surgery. It was painful enough when Dr. H yanked out the original internal components while I was on my way to Germany. I don’t see any obvious means for pushing and pulling replacement parts into place, certainly the yank-out-the-old-gut-globe through the tiny aquarium tubing hole in my stomach muscles doesn’t have any obvious way to reverse the process to insert new infrastructure.

I see Dr. H on Wednesday this week. I’m actually looking forward to the visit. I anticipate a discussion worthy of a Monty Python sketch as he decides how the hell he’s going to construct a long-haul version of the stopgap structure presently in place. Cancer does indeed have substantial humor value along with its more obvious dark properties. Check back here next week after my visit with Dr. H. I’ll be sure to keep you fully informed, particularly with whatever slapstick outcomes might arise.

Live ‘em while you got ‘em, my friends. I love you all. 

Notes

[1] a nicely hyper-linked presentation of the concepts of entropy, in easy-to-follow format, is at http://hyperphysics.phy-astr.gsu.edu/hbase/thermo/seclaw.html#c4

It Might Get Messy

Every summer, cottonmouth snakes from Newport News City Park in Virginia to Trail of Tears State Forest in Illinois wander along creek banks and through marshes and swamps, restlessly seeking a comfortable place to set up shop (Ooh. Good idiom there, no?). They set out on their treks in all directions, looking mostly for wetlands with lots of three dimensional structure (i.e. cover), plenty of fish, frogs, and birds, and, importantly, not too many resident cottonmouths.

Of necessity, some of the snakes move north. A few individuals move far to the north. As winter closes in, these snakes find comfortable muddy burrows and settle in to hibernate. Unfortunately for our itinerant heroes, winters these days ain’t what they used to be. Warmish conditions during what are nominally the cold seasons make hibernation problematic. Metabolic processes don’t shut down completely, because the warmth favors ongoing chemical reactions. However, warmish weather isn’t sufficiently warm to allow the snakes to wake up, shake off the sleep, and get out of the burrows to go fishing, frogging, turtling, whatever.

Bottom line is, the northward pioneers starve while they sleep [1]. I suspect the irony of winters being too warm for survival is lost on the snakes themselves. Still, it’s an interesting story, and a nifty bit of science to boot (this last being an idiom with which I’m familiar, but which I neither understand nor know the origin of). 

Anyway. The dynamic at work in the population of northward-marching cottonmouths results from the natural tendency of organisms to push limits, just to see what happens. In practice, limit-pushing is a fundament of ecology and evolution. All the action is at the margins.

Limit-pushing is also, I’m learning, a fundament of post-cancer life. As spring arrived, I started to get active. Finally liberated from my recovery recliner, I’m anxious to do stuff. Last week, for example, we spent a wonderful afternoon having a picnic lunch and trail walking at the National Arboretum in D.C. This was more walking than I’ve done in 8 months. Took me 2 full days to recover. 

This week, I made it out the Patuxent Reserve to look for my mega black racer, other snakes, and early spring flowers. I only managed to walk in about a half mile before I had to stop, choke out big blobs of throat mucous, and drop to my hands and knees to catch my breath.

Took me a full day to recover from that minimalist expedition. For crap’s sake. But, I suppose that’s the not-unexpected cost of having been butt-parked for the better part of a year. 

Then yesterday, having rebuilt my “strength” from the earlier “hike”, I headed back out to Patuxent. Once again, I found myself unable to get all the way down the trail to the ancient river levee that I suspect harbors at least a small population of copperhead snakes. This is unfortunate. I want to document the presence of copperheads here, and try to get some idea of their population size. The Maryland Piedmont has, as a natural landscape, been transformed into a single, rolling residential development, complete with highways, shopping malls, and the other necessita of modern suburban life. The preservation of the big slab of habitat in the Patuxent Reserve is remarkable and unexpected. The value of the land for housing development was on the order of 10s of millions of dollars when the last owner died a few years ago. The farsighted coalition of public and private organizations that managed to snatch the property off the table just as the developers were reaching for it has my deepest gratitude. Now I’d like to do my part, by documenting some of the awesome biodiversity in this landscape that, in some parallel universe, is a honkin’ big slab of quarter-acre lots and endless mowed lawns.

And hopefully I’ll be able to get back out there this weekend. But I’ve been unexpectedly and depressingly sick all day today. Until further information is available, I’m chalking it up to recovery from yesterday’s walk, with maybe an assist from the abundant aerial pollen following the rains of the past week. 

We’ll see. If I do get out there, I expect to have a bucket of photos now that I’m becoming familiar with my new high-powered, rocket-charged, nitro-fueled, laser-guided camera. So check back here next week. Spring is here, and that means large numbers of cool pix. 

Rock on, all. Remember the key lesson of cancer: live ‘em while you got ‘em. Especially if they’re warm, breezy, and bright. But even if they’re damp and muggy. We only get one shot at this, and it is up to us to do something with it!

Notes

[1] I turned up this story in a dissertation some guy did in the 1970s at, I think, VCU. At the moment I cannot recall his name or the title of his thesis, so I can’t find a bibliographic reference for you. I do have a hard copy of it somewhere, but I suspect it remains buried in a box in the basement. I regret not being able to give this guy the citation he is due, but don’t have a lot of recourse. I offer a proactive apology to the intellectual ether, on the off chance that his spirit stumbles upon this weblog and recognizes the characterization of his work.