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
The human skeletal system is a multitasking monster. Think about it. It fights gravity for you as a passively functional infrastructure. It anchors your muscles so you can breathe, play chess, and when you were younger, hammer a dynamite topspin backhand with that tightly strung T3000. It also massively vascularized—packed with blood vessels. So much so that if it is impossible for some reason to get an intravenous drip into your peripheral circulatory system, next option is intraosseous, pumping whatever you need into the circulatory system via your bones. Your skeletal marrow manufactures the red blood cells on which your entire aerobic physiology depends, does the quality analysis on the older cells, and swaps them out as needed.
The latter function means your marrow is intensely metabolically active. Which, as we discussed last year when I being hammered by the twice daily radiation makes it especially vulnerable.
To get the particle beams focused on my tumor, one vector was through my left lower jaw. That’s why they pulled so many teeth before starting my treatment—weak teeth die in place and rot away when they’re radiation poisoned. It turns out a very similar process of osteonecrosis (bone death) can occur in the jawbone itself.
And that’s where I found myself this week. That persistent pain “under my tongue” isn’t really in my tongue at all. It’s at the base of my mandible. A wide swath of the jaw in that vicinity was severely damaged by the radiation. That damage accrued to both the covering soft tissue and the metabolically active bone itself—the blood vessels and marrow. What that damage means is that there’s no good way for my immune system to protect that area—no way to get white blood cells, antimicrobial proteins, and inflammatory responses in place without a functional circulatory component. So now I have a nasty, nasty infection in my jawbone.
Last week, the dentist looked at the exposed bone, diagnosed the infection, and put me on both a systemic and a topical antibiotic. A couple days later, a piece of my jaw bone broke free from its decomposing moorings and rolled around in my mouth. I retrieved it and stuck it in a jar. Photo below.
After the hunk of bone broke off, I noticed increased pain in that quadrant. I started calling the oncology dentist, who is at the moment between offices. Got no call back on Post-Bone Chunk Day 1. By mid-day Day 2, I REALLY hurt and decided it was more than a dental question in any case. I called poor Dr. H, oncology surgeon, and he set up to see me late in the afternoon on a day’s he’s not scheduled at the hospital. I felt bad about dragging him in on a day off, but wasn’t sure what else to do.
He poked around and said the infection was pretty bad and that it was likely I would accidently break the bone and at that point it would have to be removed. He chuckled at the Actinomycin the dentist had me on, and put me on something much stronger. As he pointed out, it would kill everything that moves that isn’t part of me, and likely some moving parts—like my liver—that ARE me. And he said he wants me on it for the foreseeable future. If I managed to not break the bone, Dr. H thought we would try some hyperbaric oxygen therapy. They stick me in a pressurized chamber with a high-oxygen atmosphere and hope the banging on the circulatory system leaks a little oxygen and immune function into the infected bone. But he said he wanted to talk to the dentist.
The dentist had finally returned my call, and I had an appointment with him the next morning. When he saw me, he said it was a good thing the chunk of bone broke off—it was the most infected piece and needed to go. Wish he’d told me that earlier. He also said it looked like I was actively healing and might not need hyperbaric oxygen. Well damn! That was certainly a crack of daylight in the darkness!
So now I’m taking this enormous 300 milligram antibiotic tablet every 6 hours, rinsing my mouth with a harsh medicinal topical antibiotic, and regressed to tube feeding for a while so the swelling can go down and the infection can be controlled.
For all that, I’m not bad. It’s a painful and fussy setback. But the jaw’s not broken yet. With a little luck, I’ll be able to keep it. We’ll see! Thanks for checkin’ in everybody. I love you all. You’re keeping me on the road to recovery. And I sure as hell need the help staying on that track!
And sometimes it gets very messy. So messy it compresses your spirit, collapses your perspective, convinces your intellect that it’s as dark as it seems and there’s no sliver of daylight for a wedge of humor or irony. Basically leaving you whining and bereft of resources. And just about the time you reach that muddy bottom of the stinking anoxic soup that your life has become, you realize someone else is even worse off. And at that point, a spark burns deep inside, because you know the world—or at least said unfortunate individual stuck deeper in the dark goo than you are—NEEDS humor and irony. You rally. Do your job as a human being. And at the same moment discover that you’re not nearly as bad off as you seemed moments ago.
What triggered this Sunday evening harangue? The mother of one of Molly’s high school friends was diagnosed with tongue cancer, much like mine although it hadn’t made it full blown to adjacent glandular tissues—call it Stage 3. She is being treated at Greater Baltimore Medical Center, by the same head and neck cancer specialists who diagnosed and treated me. To save her, they had to surgically remove her entire tongue. They rebuilt it with a chunk of thigh muscle. This woman will have no taste for the rest of her life, and she’ll have to learn to talk by teaching a slab of leg meat to speak English.
And I thought I was having trouble getting my voice back. Jeez.
Anyway. I had an appointment with my oncology dentist (when I say that, doesn’t it sound like I have a whole staff at my command? “Wendy, please ask Charles to come to the Great Hall when he’s finished starching my wardrobe. The Sterling needs polishing…”). Which I figured was a good thing—as my mouth has gotten stronger, my tongue strength and gape improving, I’ve noticed a dull ache in my left rear jaw when I press my molars with my increasingly functional tongue. And last Monday night, as Tim and I finished our three hour class at the university, I noticed my mouth was filled with blood.
I was in for my first cleaning since my diagnosis a year ago, but I mentioned the pain to Dr. C. He took a quick look inside and said “Ooh. Let’s get an X-ray of that.” These are not good words to hear from ANY dentist, much less an oncology dentist.
It turns out I have a naked stretch of jawbone exposed in my mouth. Which is now coated with a nasty microbial film making a good living off the bone surface and microvascularization. The explanation for this contretemps, according to Dr. C, is that mouth tissue surrounding the six (!) teeth they pulled in preparation for my radiation treatment last year didn’t have time to heal before it was devastated by the radiation. When the soft tissue fried under the particle beams, it sloughed off. Leaving a length of my jaw exposed to the bacterial elements.
You know, I KNEW pulling those teeth wasn’t a good idea. But would anybody listen to me? Of course not. It is, apparently, a delicate balance. If your teeth are weak, the radiation kills ‘em and they rot in place. And in my case, if you yank the weak teeth, your mandible bone rots in place.
Sigh. Cancer. If it doesn’t get you coming, it gets you going. For all that, I’m actually doing rather well. My voice and gape are indeed improving apace. We spent the weekend in Atlanta feeding Colin at a high-end restaurant that cooks straight out of monumental encyclopedia Modernist Cuisine (they even put a spiced foam on Colin’s gorgeously crisped and perfectly cooked sea bass, served the rectangular chicken “nuggets” with spiced sauces in laboratory pipettes and a little blob of “encapsulated” blue cheese, and offered bleu cheese sorbet with the dessert assortment. The latter was not bad at all). I ate two whole slabs of chicken, half a crab hushpuppy, and a quarter-cup or so of incredibly rich cauliflower-cheese soup. I was still full this afternoon when we flew home after watching lacrosse Friday, Saturday, and Sunday.
So, in reality, I’m good. And grateful to you all for stopping by. Thanks so much!!!
PS--don't miss my new weekly weblog on Global Sustainability over at http://www.aehsfoundation.org/ . If you have a few moments to kill, I think it's worth a read. But then I would, wouldn't I?
In 1950, cancer in invertebrates was poorly understood. A review article [1] reported “spontaneous growths” in annelids (worms), arthropods (insects, spiders, and the like), molluscs (clams, snails), sipunculids (small rare blobby things), and ascidians (sea squirts, oddly closely related to true vertebrates and thus to people. “Oddly” because ascidians themselves are rather blobby, although not particularly small or rare), but pointed out that evidence of true neoplastic character was nearly completely lacking.
Since 1950, it has become clear that cancers are ancient genetic artifacts and that many invertebrates are subject to malignancies (for example, bivalves, [2]). Indeed, people are hopeful (as ever) that near-magic anticancer drugs will be extracted from the marine environment for applications in human treatment.
I’m skeptical myself. It seems to me that if we’re going to find magic cancer bullets, we’re more likely to find them in our own closely-evolved-in-concert-with-our-cancers physiologies than in the remote genomes of squishy or click-clackety invertebrates. But that’s probably why I’m not a cancer researcher.
I bring this entire arcane discussion up because I spent last week in Fort Lauderdale at a technical conference on managing contaminated sediments. Molly had a long weekend off, and she came down to vacation. On one of our jaunts to the Everglades, we managed to fulfill one of the top items remaining on my life list of things to do: find a uropygid in the wild. Uropygi are vaguely scorpion-like things that manufacture acetic acid which they spray defensively from a tube in their abdomen. They are popularly known as “vinegaroons”.
This little lady is only about ¾ of an inch long (in my browser, if you double click on the photo, it enlarges). When she grows up, apparently she will be the size of the palm of your hand.
Anyway. I ran out of time last Monday before I left for Florida, so I shipped a case of liquid medical food via FedX without strapping it with additional packing tape (which the office was out of, and I didn’t have time to stop at a FedX store to get the damned thing dealt with). It arrived at the hotel minus one can and wrapped thoroughly in packing tape. That’s pretty much what I figured would happen.
However. I pretty much managed to make it through the week without using my feeding tube at all. I stopped at grocery stores and bought as much Carnation liquid breakfast (and, when that was unavailable, Special K Dark Chocolate Protein Shake) as they had. Pounded down 4 to 8 bottles a day. Ate raw oysters, tuna sashimi, a few forkfuls of creamed spinach and wasabi mashed potatoes, and a bite of Molly’s incredible roast duck. Went offshore fishing on the last day of the conference, hiked for two weekend days with Molly, and only lost a couple pounds.
I must confess I fed myself two cans of food on the last night in Lauderdale. Thought I might dehydrate after all that walking in the Florida sun and wind. Still, I left 21 cans in the hotel room. We got back late last night. Haven’t used my tube today, either. My mouth is incredibly sore (I think the thrush is back. The morning after the night I ate a few spoonfuls of clam chowder, the back of my throat was still hiding blobs of chowder. THAT’S not hygienic, although I really can’t figure out how to completely clear things out). I seem to be out of Fluconazole, for some reason—thought I had half a dozen doses left. But, since with the anti-yeast biocides it’s always a toxicology race between your liver and your yeast, maybe it’s all for the best.
My weight was 187 this morning, and 192 before I took my evening meds (still via tube for those) last night. That’s not bad. I was up to 196 last weekend, so lost a little bit. Still, if I can get most of my calories by mouth, the last deep physiological impairment of the cancer will be overcome. Then it’s just working on my voice and getting some frickin’ exercise.
I’m on it. As best I can be. I slept most of today. Two days of hiking the Everglades was more than my shrunken musculature can handle. But I’m on it. Full report next week. Thanks for being here—you are still making my comeback possible. PS—my “singing” voice, such as it is, seems to be returning ahead of my speaking voice. I have half a dozen songs written that need production. If I can follow the Levon Helm model and get back to close-to-in-tune croaking (and I’m not sure why I should worry about being in tune NOW as opposed to the past), I’ll get ‘em recorded and up on the web for you. Thanks again. Love to all!!!
Note Florida pix and some travelogue up over at http://docviper.livejournal.com/ . Take a visit if you have a few moments. Some pretty pix. We packed a lot into two days!!!
Notes
[1] Scharrar, B. and M.S. Lochhead 1950. Tumors in invertebrates: a review. Cancer Research 10:403.
[2] Muttray, A.F., Schulte, P.M., Baldwin, S.A., Invertebrate p53-like mRNA isoforms are differentially expressed in mussel haemic neoplasia, Marine Environmental Research (2008), doi: 10.1016/ j.marenvres.2008.06.004
