So pretty much the sum of Haymitch’s advice to Katniss Everdeen on her first trip into the Hunger Games arena is “find water”. And his first gift, in her second trip, is a spile to tap the trees for drinkable sap. This is because humans can generally survive quite a while on minimal calories, but essentially no time at all absent adequate hydration.
A long time ago, in a galaxy far, far away, two of us had a daily job of fighting our way several kilometers out onto an exposed and fairly remote tidal marsh in southern New Jersey to build cages that would exclude clapper rails (part of an experiment to determine how a relatively nontoxic mosquito larvicide was suppressing fiddler crab populations, see [1]). One particularly hot day, our return involved substantial slogging through really deep, warm, sticky anaerobic mud at low tide—several thousand meters of it. By the time we made it out of the mud and into floatable water, my compatriot was badly dehydrated. To the point of no sweat, serious headache, double vision, etc. Somewhere between heat prostration and heat stroke, with a dose of we-finished-our-jug-of-water-7-hours-ago-and-have-been-slogging-in-the-hot-sun-ever-since. And we were, at that point, still a good 45 minute boat trip away from our rented research cottage and at least a half hour from the nearest occupied spit of dry land. Not a good situation.
So we remembered all the survival advice we could piece together. Don’t drink salt water. Don’t drink urine. And that was pretty much the sum of our resources. We settled soon-to-be Doctor H into the shadiest side of the boat, and I slopped out and started opening the oysters that lined the banks of the tidal creek (remember Rule #1—never go anywhere without a knife!). They were pretty moist. Salty, but not nearly as salty as the sea water sloshing back into the bay. And for some reason they were cool. After slurping a dozen or so, STB Dr. H started to feel better. Another half dozen, and he thought he could survive the trip back. We hightailed it to the cottage, and I sped out for an X-large pizza with fresh garlic (specialty of the local shop), 12 pack of cold beer, and a couple gallons of store-bought lemonade. Next day, the only aftereffects was the distinct smell of garlic wafting out with STB Dr. H’s now re-started sweat.
I bring this up because somehow my ability to consume solid (ish) food seems to be returning. I’ve been to lymphedema therapy twice in the past week. Therapy consists mostly of massage, and I have a weird low-budget horror movie looking face mask thing to wear at night to help work the loose lymph from my swollen jaw and throat back into the shards of my functional lymphatics where the surgery scars stop under my ears. I’m not certain whether or if so how that therapy might be doing it. But the last couple days, I’ve eaten some ice cream filled with cakey stuff (chunks of Oreo cookies), and today nearly an entire one-egg egg salad. Now, of course, I’m too stuffed to move, since I also did a heavy hike today in the heat and needed to rehydrate. Which I did with thick chocolate milk (not fresh-in-the-field oysters).
But this is a big step. I can eat stuff without choking on it. It still balls up in my throat, but it seems to dissipate after a while, and it doesn’t hurt the way it did a few weeks ago. I haven’t been diligent with my oral exercises, having cut back on them since my jawbone got so fragile. But I have to get back to them. This may be a true step-in-the-right direction. I had lunch earlier in the week with a very dear and very long-time friend I’d long lost contact with. She had a salad, I had a latte.
Next time we’re out, I’m hoping I’m having a salad as well. Have a good week, everybody! Check out a few photos and other referentia over at http://docviper.livejournal.com/, don’t miss the first chapter of the urban ecosystems book at http://sustainablebiospheredotnet.blogspot.com/, and this week’s installment of PeopleSystems and Sustainability at https://www.aehsfoundation.org/ . Most of all, keep in mind that spring is pretty much here. We’ve walked away from one more winter, my friends. Not bad, under the circumstances. Not bad at all.
Notes
[1] Ward, D.V., B.L. Howes and D.F. Ludwig 1976. Interactive effects of predation pressure and insecticide (temefos) toxicity on populations of the marsh fiddler crab Uca pugnax. Marine Biology 35:119 – 126.
Every night in the tropics, right around midnight (local time around the world), little larval nematodes, comfortably curled inside tiny round membranes, appear in large numbers in the blood vessels near the skin of hundreds of millions (you read that right, 100s of millions, see references [1] and [2]) of people. Sleeping people, awake people, drinking people, dancing people, hunting people, fishing people, people just watching the moon and contemplating their own mortality. Mosquitos in the most common and abundant genera—Culex, Anopheles, and Aedes—insert their oddly specialized spike-supported sucking-straw mouthparts into the blood vessels of these people and exchange a bit of their saliva for a big slurp of the people’s blood.
Before you get too comfortable that is a tale of exotic foreign lands, you should consider that Aedes includes the very, very common salt marsh mosquito of the east coast of the United States, and that Anopheles and Culex populations are dense throughout North America. And Eurasia. And pretty much everywhere else.
Anyway. The mosquito saliva slips tiny, young larvae of the nematode Wuchereria bancrofti into the people’s bloodstream, and picks up a simultaneous load of the older larvae comfortably encased in their cozy little containers. Inside people (the only known host except for an obscure Malaysian monkey species), the larvae mature, lay eggs, hatch, and turn into the infective little buggers the mosquitos pick up. In the mosquitos, the larvae molt a couple of times and become sausage-shaped infectives, hanging around the salivary glands just waiting for their opportunity.
Wuchereria, and a couple of related nematodes, cause elephantiasis. As you are no doubt aware, elephantiasis is a nasty condition in which massive swelling of human tissues occurs because larval nematodes block up the lymphatic system. The lymph seeps out into the tissues, but not back into the clogged and broken vessels. People are disfigured and disabled. In enormous numbers.
My own lymph system has been surgically impaired in ways that parallel, qualitatively if not quantitatively, elephantiasis. With much of the lymph system north of my chest removed, and all the lymph glands in my jaws, neck, and shoulders gone, my face is full of lymphatic fluid that has no place to go.
So it might get messy. But it might look prettier. I went to “lymphedema clinic” this week for an initial diagnosis. Lymphedema is treatable by massage and exercise. Basically, the therapist gives the lymph additional space to spread out in, and over time it can be resorbed into healthy tissue. This is not just cosmetic—although in my case the cosmetics are not trivial. It is a real epidemiological threat. Lymph, especially loose lymph flushing around tissues in general, is protein-rich and a ready-made growth medium for infectious microbes. So, several week’s worth of therapy and exercise is an investment well made. Count me in.
And of course, it won’t make me pretty. But it’ll help get me back to my normal state of cosmetically marginal visual condition. And maybe even help my voice.
Thanks for being here, everyone. Spring is here! Check out some nifty nature photos over at http://docviper.livejournal.com/; the start of a chapter-by-chapter exposition of an upcoming book on urban ecosystems at http://sustainablebiospheredotnet.blogspot.com/; , and the week’s update at http://aehsfoundation.org/ . Love to each and every one of you!
Notes
[1] http://www.who.int/mediacentre/factsheets/fs102/en/
[2] Smyth, J.D. 1976. Introduction to animal parasitology. Cambridge University Press.
Head and neck cancers are rarish. They account for about 3% of U.S. cancers, most common in white males over 50 [1], meaning about 52,000 diagnoses annually. So far—aging, white—I fit the profile. But tobacco use is highly positively correlated, I’m clean on that axis. Unfortunately so is alcohol use (and we’ve already discussed my lifelong love affair with beverage alcohol and chronic application of alcohol-based oral care products), so I’m back in the doctors-can-only-shake-their-head-when-they-hear-about-your-lifestyle in the diagnostic history category. But it turns out there’s something else interesting. The Human Papiloma Virus (HPV) turns out to be related, quite possibly causally, to some head and neck cancers.
So, despite the anti-vaccine wack jobs populating the internet and public meetings nationwide, and the even wackier jobs populating the religious-intense wastelands of North America who think that disease-preventive vaccination is somehow going to turn their children into sexual predators (or prey, or something), there’s ANOTHER reason for a universal HPV vaccine. Real reductions in head and neck cancer rates.
As for me, I learned this week that despite vast improvement in my overall health, my jaw is still painful, I still get a head full of sticky mucous at the end of the day, and I can easily push my under-exercised physiology too far. I’ve managed to work my daily activity up to something over 1000 meters of “running” (read: “slow, painful, shuffling”) alternating with shooting 30 to 45 bolts with my 175 lb draw crossbow on the range at College Park. Believe me, between hauling a crossbow-safe target several hundred meters down to the backstops (don’t even THINK about trying to retrieve your bolts from backstops made for longbows, recurves, and compounds) and cocking and shooting for an hour or more, I get plenty of exercise.
So I was a little shocked to find that a quick business trip to Chicago, where I had to function for a day-and-a-half including a lengthy dinner with clients (great restaurant, wonderful service—Kinzie Chop House—the only thing I could deal with—the broth from the minestrone—was homemade beef stock. Incredible! And the lemoncello—made by the owner’s aged aunt—of course—awesome). Got to visit Beth and Maggie for a couple hours. Flew home, passed out, got up, drove to West Virginia where Dr. Y and family had rented an old-timey tourist cabin in a state park while attending a technical conference. Had a fabulous time, but was frickin’ exhausted by 10 pm last night, and am even more frickin’ exhausted now—just about precisely 10 pm—Sunday night.
So it’s still a struggle, my friends, but a struggle we’re winning, it seems. I go in for “lymphedema clinic” this week, where they’ll attempt to massage my lymph-swollen face back into some semblance of normalcy. I’m also getting much closer—very close—to getting all 4 weblogs in this little writing enterprise back up and going. For the moment, I’ll leave you with a few interesting photos.
A twig with the bark stripped by porcupines.
A soldier beetle guarding its territory.
A gorgeous little spring flower.
Thanks for being here, everyone. Spring is powering into the northern hemisphere, we’re just about back to bare feet and shorts. And parking butts on the beach. Yee Haa!!!
Notes
[1] http://www.medicalnewstoday.com/releases/243574.php
In an episode of BBC weekly human comedy “Doc Martin”, the doctor is requested to ascertain whether one of his patient’s parents is becoming senile. He asks her if she knows when World War Two started. Her answer (imagine sour, sarcastic face) is “28 June 1919, when the Germans were forced to accept the Treaty of Versailles which humiliated them and stripped them of all economic potential for their foreseeable future.” Or words to that effect. The Doc figures she’s not slipping into Alzheimer’s.
She is also, by consensus, correct. The last couple decades of the 1800s, what was finally a more-or-less united Germany rode a razor’s edge between progressive, liberal, egalitarian democracy and autocratic, centralized, reactionary oligarchy. And the delta? Which way Deutschland—and, by extension of circumstances as it turned out, the world—slipped off that edge might well have been due to the darkest case of throat cancer in human history.
Now, stay with me here just a few seconds. Queen Victoria and Prince (Consort) Albert of England were not British—they were German. They favored widespread public participation in government and liberalization of legal systems. And they figured the stuffy Prussian establishment would be the perfect place to start. So Prince Frederick and Princess Victoria married, and generated a series of great plans to reign in the power of the Kaiser, expand the German vote, and drive the united German government from the aristocracy to the people.
Frederick succeeded to throne of Emperor of Germany and King of Prussia in 1888. 99 days later, he died of throat cancer. From there, things went downhill with a vengeance. The Chancellor and the militarists took Germany into World War One, which led to the Weimar Republic, multiple recessions and depressions, the rise and fall of pre-war Communism, the rise of Nazism, World War Two, and the rise and fall of post-war Communism. Which largely got us where we are today.
Bummer about Frederick’s throat cancer, huh?
Personally, of course, the odds on my changing the world for good, ill, or as a matter of fact in any meaningful way are akin to the odds of the Millennium Falcon getting safely through the asteroid field (“Never tell me the odds!”). Which makes it sort of ironic that my throat cancer was curable and, while recovery is admittedly troublesome and uncomfortable, rehabable (is that a word?). My mouth still hurts. My jaw is still dead, but it is apparently recovering. There’s only one small piece of continuing-to-rot exposed bone, and the dentist will look at that next month. My speech/chewing therapist remains confident that I can be eating enough solid food to survive a week or two in Europe in May. I’m still on an all-liquid diet. I reported to Dr. H that I was feeling rather like a weenie because I hurt too much to chew solid food. He suggested I stay with the weenie factor for a while as the bone could still break which would be a very bad thing.
So I continue to rock and roll on the road to recovery. Wish my recovery could do something as helpful as preventing World Wars One and Two. But I’m afraid I’m gonna have to live with the knowledge that the best any of us is gonna get out of my surviving throat cancer is a few good meals, photographs of snakes and flowers, some decent jokes, and the occasional oddball work of art.
I’ll take it!!!!!!
One of the coolest things about being an ecologist is color. The differences in it, the significance of it. What looks like a brownish early winter landscape to many people is a mosaic of structural and functional diversity to a field ecologist. That yellow-brown over there through the bare trees? The grassy meadow whose winter caramels and tans will provide the seeds that get many of the songbirds through to spring. And spring! Man, we’re talking daily shifts in the greens and flower-whites that run like a real-time art movie.
Then there’s the idiosyncratic colors that, for arcane personal reasons, piss you off. Every herpetologist has some kinds of snakes that he or she knows, deep inside whatever the source of their destiny is, they’re never going to find. Except sometimes they get lucky. The late Carl Kauffeld, esteemed Director of the Staten Island Zoo with its legendary rattlesnake collection, spent most of his career dead center in the range of the rather abundant black rat snake. He caught his first very late in his days. Me? I grew up knowing I’d never find a smooth earth snake, Virginia valeriae, an obscure, tiny, brown, secretive species inhabiting woodlands just about as far north as central New Jersey.
Except, today, in a wood lot across town on the other side of Columbia, I saw one. On the surface of the forest floor. I was so shocked, I forgot to reach down and grab it. It only took it 3 or 4 seconds to disappear forever under the leaf litter. I’m sure I’ll never see another one. Even the enormous black racer I found a few hundred meters further on (photo below) wasn’t enough to console me. I’m still bummed.
Color has another reason to piss me off these days. My mouth and throat are a polychrome battle zone. Brown and black flakes of bacterial film slug it out 24/7 with white, sticky fungal slime. Usually, the bacterial film owns the morning and the fungal slime the afternoon and evening. The medical arsenal being thrown at these clashing armies are state o’ the art. My oncology surgeon doesn’t like antifungals—he believes the trade-off in liver toxicity isn’t worth the return on investment. So he’s prescribed massive and massively toxic antibacterials. Conversely, my general oncologist and local GP both love antifungals. I have buckets of marginally-to-completely-in-effective antifungals and anti-yeast medicines. Meanwhile, I just watch my mouth change color and texture throughout the door. It would be entertaining if it wasn’t MY FRICKIN’ MOUTH.
Anyway, I see Dr. H, Oncology Surgeon, on Wednesday. Hopefully he’ll help me sort this out. If it’s sort-able out-able. I’ll let you know, my friends. Thanks for stopping by, letting me vent. Now that spring is here, I expect to get the 4 blog empire back into action, with additional nature photos, rough-draft chapters from our forthcoming book on urban ecosystems, etc. But not this week. This week, I’m just enjoying life’s colors…. .
Do, however, if you have the opportunity, check out my weekly professional PeopleSystems and Sustainability weblog at http://www.aehsfoundation.org/ . Labor of love, which means I really don’t bother to check my imagination at the door… .
Among my parent’s friends when I was growing up was Mr. W and his family. I believe Mr. W might well have been Doctor W, I think he had a PhD. He was a devoted and innovative teacher. His kids all grew into successful intelligent professionals. Mr. W had one odd weakness. In a crowd of (very heavy) drinkers, his tolerance for alcohol was nearly nonexistent. At parties, he’d drink a beer, maybe two. Then he’d fall asleep on the couch. For the remainder of the party.
Ulysses S. Grant (whose birth name was Hiram Ulysses Grant) was not, despite popular belief and media portrayal, an alcoholic. He wasn’t even a heavy drinker. He shared with Mr. W (or perhaps it was vice versa), nearly nonexistent tolerance for alcohol. As he learned early in his life (essentially all of which was spent in the military), it took a tiny dose to elicit a major-ass response. After his time as a Quartermaster in the war with Mexico, he seldom drank. And never when it was important [1].
He sure as hell smoked though. Cigars, and lots of ‘em. Pretty much constantly. I’m sure he got through the hell of the Civil War at least partially because of the nicotine haze he lived in.
And it cost him. He died of throat cancer, a few days after he delivered the manuscript of his memoirs to Mark Twain, his publisher. In 1885 there wasn’t much they could do for you if you had a tumor plumping up at the top of your trachea. But at least it pissed him off enough for him to keep himself alive long enough to finish his book.
I no longer have a tumor plumping up at my trachea. Or my tongue. I continue, however, to have a painful, rotting mandible. Actually, by keeping my mouth scrupulously clean, swishing things with my topical antibiotic, and not eating solid food (which tends to ball up in the injured area), the pain has been manageable.
But it’s still there. It’s achieving a sort of chronic status, the kind of pain you live with because you just have to.
I gotta get past it, though. My speech is improving, but my mouth has been too painful to do my tongue exercises and even my gape width calibrator. Plus, even though I’m getting all my calories (and keeping my weight up) by mouth and not by feeding tube, it’s all frickin’ liquid. Big-ass tumblers of Carnation Instant Breakfast with an extra scoop of Nestle Quick chocolate milk mix.
It’s not bad. But it’s not food. I see my surgeon on the 21st. No idea if he can do anything for me. But I made a massive pan of risotto Milanese tonight, and couldn’t eat any of it. I’m really starting to get ticked off about this.
Not that it’s gonna help. Didn’t do much for Grant.
Notes
[1] A number of excellent biographies of Grant are available, and his own memoirs have a good rep. An up-to-date biography that concentrates less on the Civil War and more on his post-war career is U.S. Grant: American Hero, American Myth by Joan Waugh, University of North Carolina Press, 2009.
Back in the good old days of experimental ecology, we had a brute-force technique that we liked a lot. We would seal known weights of plants in neatly constructed little screen-mesh envelopes and put them out in the woods. Using different mesh sizes, we could determine the importance of different size classes of forest-floor invertebrates (selectively screened out by the mesh) in the recycling of carbon and nutrients from tree leaves back into organic soil. But you know, we couldn’t shake the nagging feeling that those mesh bags themselves were affecting results.
To get past that, we tried using uniform size large mesh bags, and keeping the invertebrates away by spritzing the whole setup with moth repellent—dichlorobenzene. Before dichlorobenzene, mothballs were made of naphthalene. Either way, the strong chemical smell—a lot like the northern end of the New Jersey Turnpike used to smell, if you ever drove that way—was obvious and kept the invertebrates away. But the energy-rich organic chemicals added a new variable to the mix. Microbes loved it. Thrived on it. Chowed down on it. And not just bacteria. Lots of fungus, also. So even though we usually got a differential response between the treated and untreated bags, we were never completely certain what the delta was due to. Got to see some colorful fungal slimes and hyphae, though.
And now I am my own little ecosystem perturbation experiment. Since my left jawbone is exposed from the radiation burns, and the skeletal material itself is in the throes of “osteoradionecrosis” [1], I’m doing some sequential chemical alterations of my microbial flora. I’m on 300 milligrams of Clindamycin Hydrochloride every 6 hours, and Chlorhexidine Gluconate oral rinse 5 times a day. These are antibacterials. Of course, as soon as the bacterial community of my mouth shut down, yeasts moved in and now I’m back in the painful grasp of thrush. I’ve been taking the systemic antifungal Fluconazole for a couple days on the assumption that if the yeasts have triumphed in my mouth, they’ve probably taken over the lebensraum in my gastrointestinal tract as well. When I’ve done a few days of Fluconazole and my liver needs a break (apparently this stuff is HELL on the liver. Which, come to think of it, would make a good song title), I’ve got Clotrimazole in “troche” form, which means dissolve-in-the-mouth lozenge sort of things. That’s to strip the thrush off my tongue, cheeks, and gums.
The theory, apparently, is that my mouth tissues (both soft and hard) might not be completely dead. Although according to sources it can take over a year for the jaw bone to even begin to die from the radiation. Now how is THAT possible? Anyway. If it’s not dead, killing the infectious microbes might let enough blood and lymph flow back to heal things up. And if not, then we go to the hyberbaric oxygen therapy. You know, like they do for people who decompress from deep dives too quickly and end up with nitrogen bubbling around their circulatory system.
You know, the sequential cascade of physiological issues appearing, resolving, and appearing (primary tumor’s gone, secondary’s toast, salivary glands once were lost but now they’re found, beard truncated now regrown, fungus at the tumor spot on my tongue was healed, now my jawbone’s mostly dead, etc.) is getting to where it’s just smeggin’ humorous. I mean, what’s next? Teeth falling out? Ears falling off? Liver degrading into some kind of wurst? Kidneys shutting down and going on vacation?
Don’t answer that. I’ll handle it as it comes. Meantime, I’m fine. Really. Drinking enormous quantities of thick, nutritious instant breakfast shakes. Keeping my weight up. Not really doing much solid food, but maybe when the antifungals finally clear things out. Thanks for stoppin’ by! Have a good week, everyone. I’ll check with you next week!
PS—I’m not quite up to getting all 4 blogs in this empire back into circulation. But I’m close. Meanwhile, check out the “professional” weblog over at http://aehsfoundation.org/. Click on the “PeopleSystems” box on the right, you’ll be whisked right there!
Notes
[1] many sources available, nice compact one is from the UCLA med school program, at
http://www.uclahealth.org/workfiles/documents/clinicalupdates/HyperRadiation.pdf
