It Might Get Messy

OK, sports fans, it’s time to ante up and put up the date and time for the shitrain to fall. In other words, I had chemotherapy yesterday. This was after a week off to get two units of blood and give my platelets time to recover on their own. Yesterday they did all they could proactively to try to keep me out of the ER following this round of chemo. Short term antinauseal. Long term antinauseal. Steroids, just because steroids help fix the symptoms of pretty much anything. Rebalanced my electrolytes. Then they dropped the green flag and stomped on the accelerator—in went the nasty chemicals synthesized after discovering that a number of molecules found in the bark of free-growing evergreen trees had anti-cancer activity. So it’s off to the races here at noonish on Saturday.

But before we go there let’s tackle a technical issue that’s been bothering a number of my astute and intelligent readers. 

I’ve been taking something of a pounding from several smart readers challenging my contention that alcohol “caused” my cancers. In general, these people are correct—with very few exceptions, it is impossible to attribute a specific cancer to a specific exposure.

Perhaps I should explain myself.

“Conventional” poisons are the kind of thing you get in television crime drama, or from World War One movies. Cyanide, chlorine gas, mercury, lead, botulinum toxin, etc. These compounds function on a rigorous “dose-response” basis. That is, the more of the poison you ingest (or are otherwise exposed) the sicker you get, until you reach a level that kills you—the latter being called “lethal dose”. Like all things in the physical world, the response of a body to a specified dose of poison varies. It differs among different species of organism, so understanding the toxicity profile of these poisons requires a separate dose-response curve for each species. Toxicity also varies with a variety of more-or-less random variables—a long list of things that can be discovered and evaluated scientifically (timing, age, simultaneous exposure to multiple compounds, etc.). It also varies on a random basis—the “lethal dose 50” (LD50) is technobabble for the concentration of chemical that kills 50% of the organisms exposed. There is some randomness in this number—it varies slightly experiment-by-experiment. But, in general, the random variability in effect of conventional poisons is low. If you give 100 mice an LD50, you have damn near a spot-on likelihood that 50 of them will die. A few less, perhaps, if their physiology is randomly on the “good” side, a few more if they show up on the “bad” side. But this variation is relatively low.

Now, certain “non-conventional” poisons operate differently. The mechanics of toxins whose primary response to dose is cancer are particularly distinctive. In these compounds, if you remember back a couple years of this blog, we discussed how complicated a chain of physical, physiological, biochemical, and immune processes yields (or allows) cancer. This complex of events multiplies uncertainties at every phase. In addition, many, many things have a finite chance of chambering the round that leads to the target that triggers cancer. Bruce Ames, a government scientist is California is a pioneer in this field. He has documented the overwhelming abundance of foods, drinks, and incidental items (soil and airborne chemicals, primarily) that cause cancer “naturally”. The bottom line is that about a third of human beings develop lethal cancer(s) during their lifetime. According to Ames (and many other scientists who manage to be technically objective in this most acrimoniously subjective field) cancer is a damn near inevitable public health phenomenon, primarily because of cancer-causing substances in the natural world. 

And relatively few cancer cases can be directly attributed to specific doses of specific chemical compounds. In other words, industrial chemicals in the environment are responsible for very few malignancies. Estimating the likelihood of contracting cancer in a manner analogous to that for “conventional” toxins is somewhat different. The dose-response curve is potentially more relevant to individuals from the exposed population (BTW, this runs counter to the convential heuristic shorthand that holds that conventional toxicity is an individual problem, and that cancer accrues only to populations. As you will see in the following paragraphs, I am taking a different approach to this, one that discerns individual impact of otherwise collectively measured intoxication). Thus a cancer that has an LF50 (likelihood of 50% contraction) for a population means that you, one of the potential victims, have about a 50% chance of affliction with whatever form of cancer can be caused by the methylethyldeath to which you have been exposured. That is why every new doctor I see spouts the first question: “how long were you a smoker”? They are consistently shocked to learn that I never smoked. This is because the dose-response curve for tongue and oral glands (parotid, in my case) is severe—if you smoke, you have a very high probability of getting these specific cancers. 

The doc’s second question, then, is “were you a drinker”? Again, beverage alcohol (ethyl alcohol) has steep dose-response profile. Every time you consume alcohol, you get closer to that 50% likelihood. I am scrupulously honest with the doctors. I explain that I drank for about 40 years, and over 20 of those years, I drank the alcohol equivalent of more than a liter or wine per day. This is a massive dose of a highly carcinogenic chemical. The odds are very high (although the effect remains a probability the probability is very high) that those years of extraordinarily massive drinking contributed massively to my cancer, swamping other sources of carcinogen exposure (see Ames’ recent public research demonstrating the carcinogenicity of such important foodstuffs as broccoli, peanut butter, potatoes, et al. Just punch Ames into any browser to see complete lists in various publications).

What this means (and my apologies for dragging you through all this technocrap), is that I cannot, with 100% certainty, attribute my cancer to alcohol. But there is a very high probability, based on the inherently intense carcinogenicity of ethanol and my other life style choices. Some of the latter are positive (carcinogenic): exposure to the second hand smoke of my parent’s heavy smoking (although it is worth recalling that the likelihood that second hand smoke is carcinogenic, it is only weakly so), consumption of fish, frogs and turtles from local contaminated waterways, use of and exposure to industrial solvents and preservatives in laboratories, etc. Others are negative—never smoked myself, worked in gloves as often as possible, ate very little peanut butter, again etc. In addition, I spent years self-medicating various infections around my wisdom teeth, using high-alcohol mouthwashes.

The net outcome of my lifelong exposure to beverage alcohol buries the anti-cancer lifestyle choices I made (an aspirin a day, periods of intense exercise, cautious use of pesticides, and more). 

I can state, with a high probability, that alcohol consumption contributed big-time to my present condition. It’s not the sole source, and it’s possible (although unlikely, given the other aspects of my life) that it’s not a “cause” at all. 

So my read (and that of most of my doctors) is that alcohol was one of, if not necessarily the only, finger squeezing the trigger on the chain of physiological events that has left me terminally ill.

Which circles us all the way back up to paragraph 1 above: my health and ongoing treatment. So far, now about 20 hours since they dripped in the therapeutic toxins, and I’m doing ok. No nausea, no vomiting, no internal bleeding. But that’s not unusual. Generally, the shitrain holds off until Sunday following a Friday round of chemotherapy. So tomorrow, by early afternoon, I should have a feel for just how bad it’s going to be. 

Either way, next week’s chapter in this serialized e book will give you the update. If it’s from the hospital, you’ll know that our defense collapsed, allowing the savage chemo drugs to once again hammer my body into a ¾ dead roadkill. If it’s from home, and all chirpy and optimistic, you’ll know that we finally got the balance of antinauseals in the chemo cocktail and continuing home administration of antinauseals, pain killers, and now i.v. infusion of hydration fluids to do their collective jobs. Under these circumstances, I may gain a few months of productive, fun, relaxed life until the inevitable end not much after that.

No way to tell at this point. I would request that all of you think about me for at least a few minutes to tomorrow. As you know, I’m personally not attuned to formal, join-up religion, so can’t pray myself. This doesn’t mean I don’t think, in a pagan/animist sense, that interpersonal action-at-distance has value. As does the collective love among friends and families. So I’ll be attuned to the waves of good wishes as they come in. And I’ll be thinking of all of you, the friends and family I’ll leave behind when the tumors chamber that last round and fire away. I love you all. And I admonish you to use, actively and positively, the time you have to your credit. Because you need to use ‘em while you got ‘em. They are NOT forever!