Category Archives: Cancer

Malignant: Juggling

I Should Get Paid For This

Having cancer, it turns out, is a full-time job. And I haven’t even begun the real meat and potatoes treatment yet. Or, more accurately, the radiation and chemotherapy.

See, before my docs can zap me with sundry rays and flood me with powerful drugs, they have to make sure this old body is up to the onslaught. As the dermatologist, Dr. McTeague, described me about a year and a half ago, I’m an old battleship with a lot of barnacles on my hull.

I can still float but it remains to be seen if I can withstand both a torpedo hit and a poison gas attack.

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Anyway, now I have to undergo an accelerated series of deep cleaning treatments for my teeth, a process that normally takes a few weeks but in my case will be finished by a week from today since getting me zapped and doped needs to begin, as the medicos like to say, stat.

Periodontist Dr. Wittrig will do the sandblasting and chiseling herself because her hygienist is booked out too far in advance. The job on my choppers will require a lot of extra muscle power on her part because she can’t use her ultrasound jackhammer on me — the high-frequency sound waves might damage my implanted defibrillator or cause it to activate when it shouldn’t. So she’s going to have to knick her knuckles on my fangs, cleaning deep below the gum line to make sure there’s minimal chance of me coming down with a bone infection. That would be fairly disastrous after my mandible and maxilla are softened up by radiation.

Before she begins, though, I have to take an antibiotic before every session. I took one an hour before today’s appointment with her; it was prescribed by my primary care guy. So after leaving her office this morning I had to call my pharmacy to find out what the antibiotic he’d prescribed was as well as its dosage. Then I have to get that info over to Dr. Wittrig so she can call in her prescriptions of it.

Meanwhile, I have to call my radiation guy, Dr. Wu, to update him on where we are in all these preparatory ministrations. He’s getting antsy about now. Dr. Allerton, my chemotherapy guy, is as well. They want to get going before my olive pit grows into a full-blown olive. Wu wants to start the process of making my facial mask for radiation, a hockey mask type of thing on which he and his crew can paint crosshairs so as to aim their beams. It would also serve to hold my coconut steady while I’m being bombarded with millirems.

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Radiation Facial Mask

[Image: Mayo Foundation for Medical Education and Research]

Once finished with that update, I have to call Dr. Haddad’s office to find out if his crew has contacted the gastroenterologist so that the two of them can implant their hardware in me at the same time, the idea being I only get general anesthetic once.

Which would be a nice idea but Dr. Wittrig has to get back to Dr. Baker, my primary dentist, to okay me for tooth extraction. Wittrig says one of my molars, which has “mobility,” has to go. While we’re at it, she opines, we may as well yank my lower wisdom teeth. I’d guess that job’d call for general anesthetic too.

Another problem: I’ll have to get my mask fitted before the yanking is done because I’ll look like a chipmunk for about a week and my mask can’t reflect that.

Sheesh!

Honestly, the chemoradiation just might be a pleasant break from all this rigmarole. [Of course, it won’t be but let me dream a little, alright?]

The truth is I do indeed want to get this treatment going.  I’m getting a little antsy myself.

 

Malignant: Customer Service

Ownership

Y’know, customer service counts even in the medical rackets. Case in point: This AM, I was in good time for my first appointment with Dr. Haddad, the surgeon who’ll be installing the drug port in my upper chest. I was given a card with his address on it Friday at the office of Dr. Allerton, who referred me to him. It read 1000 West 1st St.

It’s not a terribly easy place to find. Suffice it to say I drove a circle around the greater Bloomington Hospital campus, accidentally pulled into 1000 West 2nd st. (which turned out to be a women’s health center), and then eventually found 1000 W. 1st.

Fair enough. Except I couldn’t see Dr. Haddad’s name displayed anywhere around the place. Hmm. I told the receptionist I was there for my appt. w/ the doc in Q. She looked at me as if I’d asked for a falafel sandwich and a coke (hmm again — that just might be the ticket for lunch at the Trojan Horse).

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I showed her the card and she said his office definitely wasn’t there. She pulled out a doctors directory. It became clear, though, she couldn’t find his name. Then, as if a lightbulb had flashed on over her head, she said, “You know where he is?” and then she proceeded to describe Dr. Allerton’s office building which is directly across 2nd st. from Bloomington Hospital.

“Huh,” I said, “they could have told me he was right there.”

“I’m sorry,” she said — and she meant it.

Now that’s customer service. It wasn’t her fault but she took ownership of the mixup and her action served to make me feel better. This, even though before I left, she told me it had just occurred to her Dr. Haddad had moved out of her office just a month ago. Which, BTW, I found less than credible.

Okay, so it was back out in the single-digit deep freeze. The inside of the car already had turned frosty despite the fact that I’d finally gotten it somewhat toasty by the time I’d pulled into the lot.

Now I was behind Bloomington Hospital. I could have gone left or right — east or west — to get around it to the north side of 2nd St. For a hot minute, I was torn. I actually sat in the car at the exit of the lot trying to decide which way to go. I suppose my brain has been overloaded with thoughts of pain and mortality, high-tech details, and countless appointment times and places. I shook my coconut and decided to go right, west.

I swung around to Allerton’s office building and could see no sign for Dr. Haddad. Somehow, I knew the receptionist was wrong.

So I headed back toward 1st St. I passed the 1000 West address again and, a half block down, I caught sight of sign for a Dr. Fadi Haddad, Surgery. Hmm, a third time. I stopped the car just beyond the driveway and started to back up after checking to make sure no cars were behind me. At that very moment, a cop came up over the hill, driving in the opposite direction. He slowed down and locked eyes with me. I grinned sheepishly and pointed toward the doc’s office. He narrowed his eyes and drove on.

So, I entered Dr. Haddad’s office. As I signed in, I told the receptionist that I’d already been to two places and maybe the good doc ought have his card changed. She said, fairly defensively in my estimation, that his card definitely, absolutely does not say his office is at 1000 w. 1st St.

At which point I showed her the card. She looked at it skeptically and responded — again, defensively — “That’s not his card.”

It seemed she wanted to add some juicy addendum but I waved dismissively and told her, “I don’t care.”

The look on her face indicated that I had now cemented myself as her least favorite patient of the day and just might be the main topic of conversation at dinner tonight.

Keep in mind all she had to do was take ownership of the mixup. “Oh, I’m sorry, that not our card,” or “I’m sorry you had a tough time finding us,” or “I’m sorry…” for anything. Simple. I’m the customer. I had a problem. Her job is to chill me.

She was more interested, though, in proving me wrong.

BTW: I waited until 10:55 to be called in for my 9:45 appt. But that’s a customer service topic for another day.

The Upshot

As I was leaving Haddad’s office, I threw a couple of funny lines at the receptionist. She was happy to laugh at them. We’re good old pals now.

As for the medical man himself, Haddad showed me the type of port he’ll position just below my right collarbone. It’s a half-dollar-sized disc, about seven millimeters thick, with a tiny reservoir and a self-sealing lens-like cover. A wee bit of a nozzle to which a thin hose is attached projects from the reservoir. That hose will be inserted into a big, finger-width vein in my shoulder so that drugs and solutions can be injected into me, through the self-sealing lens. The idea is to get the stuff mixed up really well with the fast-flowing stream in that big blood vessel.

Here’s a typical port (the nozzle for the hose into my vein is on the lower right):

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This is what the fully-installed set-up looks like with skin involved:

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Dr. Haddad says he does three to five of these procedures a week. This both reassures and saddens me. Imagine that many people having to endure this stuff. Damn. Who knew?

Anyway, Haddad’s office is going to coordinate his procedure with a gastroenterology surgeon so I’ll get my port and an abdominal feeding tube done at the same time. That set-up’ll look like this:

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The feeding tube will come in handy when my charred throat precludes me from eating whole food. Fun times ahead, no?

Truth be told, I’m sort of looking forward to showing off my port and feeding tube after they’re installed. Hey, right now I’ll take my pleasures where I can get them.

Malignant: Overload

Finally, A Field General

Phew. I just came out of a three-hour session with my new medical oncologist, Dr. Allerton.

The best thing to come out of today’s huddle was learning that Allerton will now be the “quarterback” — his word — throughout the upcoming treatment program designed to rid my corpus of the olive pit(s) in my neck.

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Believe me, that’s progress. Big progress. I’ve been pinballed from doctor to doctor for two months now ever since it was suspected my main olive pit is a cancerous tumor. And it’s not that they didn’t like me, nor I them. We all get along famously. One big happy family. Then again, family is too teensy an aggregation term. I need a word that can accurately convey the sheer number of humans who’ve now been enlisted in this game of chess with carcinoma. Treating cancer takes…, well, a village.

Here, to the best of my recollection, is the trail of doctor bouncing I’ve been subjected to ever since my primary care physician felt up my neck, said Hmm, and furrowed his brow.

1) Dr. Behney, my primary care doc, referred me to the otolaryngologist, Dr. Pugh

2) I underwent a preliminary exam by Dr. Pugh’s Physician’s Assistant, Cheryl Pittsford

3) P.A. Pittsford referred me to a cytologist whose name I forget for a fine needle aspiration (FNA), a type of biopsy

4) Upon receiving the result of the FNA, I was granted an audience with Dr. Pugh

5) Dr. Pugh ordered a throat sonogram, a neck CAT scan and a thorax CAT scan, and surgical random biopsies of my throat and the base of my tongue

6) Dr. Pugh then referred me to the gastroenterologist, Dr. Selo, for an endoscopy

7) Upon receiving all these results, Dr. Pugh referred me to Dr. Wu, the radiation oncologist

8) Dr. Wu referred me to the dentist, Dr. Baker, for a pre-treatment exam

9) After examining, x-ray-ing, sensitivity testing, and otherwise digging around my mouth with a number of sharp instruments, Dr. Baker referred me to Dr. Wittrig, a periodontist

10) I’ve yet to convene with Dr. Wittrig; she likely will refer me to an oral surgeon

11) Upon receiving the result of a full body PET scan he’d ordered, Dr. Wu referred me to Dr. Allerton, the medical oncologist

I haven’t even mentioned my primary cardiologist, Dr. Shenoy, nor my electro-cardiologist, Dr. Strobel, both of whom must give their okays before my chemoradiation therapy begins.

All of which led me to ask Allerton today: Who’s the boss around here?

See, that’s a grand total of ten croakers (my father’s word — he acquired much of his colorful lexicon during his seven months in the US Army at the tail end of World War II). The total doesn’t include nurses, phlebotomists (I’ve been stuck more than an aging spinster’s pin cushion in the last couple of months), LPNs, radiologists, nuclear imaging technicians, surgical assistants, operating room technicians, medical records technicians, and all the other collaborators and adjuncts so necessary to the running of a modern medical outfit. I can safely estimate I’ve been poked, prodded, interrogated, and viewed semi- to fully-naked by no fewer than 75 people thus far. The next couple of weeks promise oral surgery as well as a pair of operations to insert a drug port in my upper chest and a feeding tube into my stomach.

Yeah, that’s a village. At least I know who the mayor is now.

It’s A Piece Of Cake

Another good thing to come out of my meeting with Dr. Allerton today? He says my brand of cancer is among the easiest to cure. Yay!

The War With Drugs

I learned a lot about chemotherapy today. I’ll be given three megadoses of cancer-cell-killing substances over the six week period during which I’ll undergo radiation therapy. The drug, a platinum-based substance, can cause sever nausea and even horking, either of which can be endured were I of the tough-guy ilk, but would be absolutely unbearable — even dangerous — once my throat becomes severely sunburned by the radiation.

The chemotherapy begins the day radiation does. I’ll go get beamed in Dr. Wu’s garage and then dash over to Doc Allerton’s place where I’ll be hooked up to a pump that’ll send copious amounts of drug-laden fluids into my bod through the drug port in my chest. The infusion process lasts four to six hours. Nice recliners and beds are provided, along with magazines, TVs, and WiFi. I’ll go for radiation Monday through Friday for the next six weeks and I’ll go back for more chemotherapy in three weeks. After each chemotherapy session, I can expect several days to a week of extreme nausea and possible horking although I’ll be provided very effective anti-nausea, anti-hork drugs. If I play my cards correctly and dose myself the nano-second I feel a bit of an upset stomach coming on, I shouldn’t have to bear much discomfort, if at all. Three weeks later, I’ll go for a final chemotherapy session.

I think I can do it. I hope. Okay, I promise I’ll give it a try at least.

Details, Details

A few more things. Dr. Allerton assures me Dr. Wu indeed has an IMRT machine in his garage. Cool. Intensity-Modulated Radiation Therapy, the latest in nuclear-zapping techniques, is said to reduce damage to healthy tissues by 70 percent. That makes me more than happy considering I’ve been worried I might never taste my own homemade spaghetti sauce again.

Also, surgery, Dr. Allerton explained, is now a last resort in cancer therapy. In the old days, he told The Loved One and me, doctors just hacked out huge divots of meat from cancer patients, leaving gaping caverns and terrifying scars behind, and after which the patients probably would have to undergo radiation and/or chemotherapy anyway. If chemoradiation doesn’t work in my case, Allerton sez (a long shot, BTW), only then would he and the gang consider applying the blade to my throat.

Finally, I learned the roadmap laid out for me so far is the standard recommended by both the Via Oncology Pathways program of the University of Pittsburgh Medical Center as well as that of the National Comprehensive Cancer Network, both of which have formulated the very latest treatment options and whose guidelines are followed by every accredited cancer treatment center in the nation. So, were I to seek a second opinion, the next oncologist would prescribe just what the Wu/Allerton team is calling for.

I guess this is it. Fingers crossed, babies.

Malignant: The Rebellious Patient

Sez Who?

As I mentioned Friday, a cancer patient’s latest news can only be described as such for a tantalizingly short period of time. Five minutes, say, or the length of time it takes to want to jam icepicks in your ears because you’re being forced to listen to Donald Trump speak.

No, wait — that’s five seconds. Sorry.

Anyway, today’s latest news is my fresh sense of rebellion. IDK how long this’ll be the latest; all I know is I want to ask all my doctors (and there are scads of them at this point) to step outside. I’m not promising this tête à tête will come down to the throwing of hands but some pointed questions will be asked.

Here are a couple:

● Why aren’t we doing IMRT (Intensity-Modulated Radiation Therapy)? This is the cutting edge technology that more finely directs the radiation beams at tumors, as opposed to the old machine that throw a wide vector of rad. at the general area, leading to nasty side effects like a charred throat, the destruction of salivary glands and taste buds, etc.

● What about surgery? I realize this isn’t as simple as slicing out my olive pit and then I’d be able to prance off and hike the Pacific Trail the next day but no one has yet explained the risks/rewards of the big knife to me.

Up until a couple of days ago, I’d been throwing my lot in with whatever the latest doctor had to recommend. After all, I haven’t studied cancer my entire adult life, as these oncology specialists have. I’ve mentioned before I’m not terribly interested in taking the advice of some semi-stranger I’d just met in the Bloomingfoods checkout line. (OTOH, I don’t shop at B-foods but you know what I’m getting at.)

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Big Mike’s Almost-Daily Cancer Journal

Of late, though, I’ve been feeling feisty. As in, Hey you guys, I want a say in what’s going on around here.

I suppose one of the biggest pains in the culo for a big shot cancer doc is dealing with all the patients who’ve spent a few hours on the Internet and suddenly consider themselves experts in the field.

I also suppose this newfound spunk is common among cancer folk. The whole notion of getting cancer is so crushing to the receiver of the bad news, making her/him feel helpless and trapped, that it’s only logical we’d react, eventually, with a certain degree of orneriness.

That’s me now. Ornery.

As in Fuck you, cancer.

Secondary to that, natch, is the impulse to say to the bearer(s) of unpleasant communiques, Oh yeah — sez who?

Saying Sez who? doesn’t necessarily have to be a call to battle. I really want to consider all my options. Lucky for me Dr. Wu’s prescribed old-style radiation-plus-chemotherapy treatment isn’t going to begin for at least a few weeks. One reason for the delay is the dental work I’ll have to undergo beforehand. I saw Dr. Baker, the dentist, yesterday and other than a scant few bacteria dots and a couple of loose gum pockets, my choppers are in remarkably good shape. I do have one big molar that, apparently, is cracked, for which I’m now scheduled to see a Dr. Wittrig next week. Sheesh, yet another doc to keep track of.

Big Mike tip: Don’t catch cancer — it’s a pain in the ass.

BTW: Dr. Baker offered me a more detailed reason for yanking any teeth now, before radiation begins. It seems a month and a half of bombardment by the x-rays, gamma rays, electron beams, or protons — whichever machine Dr. Wu has in his garage — turns the bones of the jaw into something akin to styrofoam. The bone becomes alarmingly brittle and loses its capacity to heal. Wrenching out a bicuspid, therefore, becomes awfully risky.

Another thing — before Dr. Wittrig, the periodontist, starts moving heavy equipment into my mouth, I’ll have to get dosed with powerful antibiotics since I’m a heart patient. Any sneaky little germs that are loosed by her oral jackhammers and excavators can slink their way to my weakened heart and, well…, give me a free ticket for a boat ride down the River Styx.

Luckily, I see Dr. Behney tomorrow so I can get the prescription then. My initial reason to visit him is to start on some sort of thyroid therapy, seeing as that gland has been squished by my olive pit(s) and consequently isn’t brewing up enough thyroid juice for my body’s liking.

Sp let’s see, how many doctors have I mentioned today? Four, by my count. I haven’t even touched upon the medical oncologist, my two cardiology specialists and, if my guess is right, an oral surgeon.

Again, stay away from cancer — unless you really dig spending countless hours with doctors.

Malignant: Looking For A Lottery Ticket

Trick Or Treatment?

My Soma Coffee pal Steve Llewellyn sent me a sweet message last night. He said he’d read of my adventures with the olive pit and suggested I look into getting treatment at another center. Here’s a clip of his communique to me:

Started researching your condition… and since you haven’t started treatment yet, thought I’d share this with you. You’re probably aware of the [University of Michigan] program, but if not, take a look. Apparently, they have better than average success in preserving the salivary glands with their approach to radiation treatment.

First off, how cool is it that people just start researching my disease when they hear I have it? People do care for each other in this often scary, sometimes lonely world. It’s shocking how many folks have promised to help, from offering a shoulder to cry on and a hand to hold to cooking and cleaning for The Loved One and me or driving me to radiation sessions. It almost makes me glad I caught cancer. Then again, let’s not get giddy, but you get the point.

I did indeed look into UM’s cancer treatment program and then, the Internet being what it is, I started going hither and yon looking at all sorts of treatment options. The Loved One has been doing that ever since this cancer first bullied its way into our lives. Me, not at all. I was too busy taking care of my emotions. I felt it was more important for me to concentrate on not getting beaten down by fear. I figured if TLO found some fabulous new treatment option, she’d tell me. And she did. Only I kept taking all her research messages, pdf-ing them, and sticking them into a desktop folder for later perusal. Frankly, I didn’t yet have the stomach or extra brain-power to juggle that info.

Anyway, I discovered a new technology called Intensity Modulated Radiation Therapy (IMRT). The way regular radiation therapy works, a beam is directed in the general area of my neck, destroying a lot of tissue and, in the process, knocking the bejesus out of the tumors. The loss of salivary glands, taste buds, localized healing properties, etc. is considered, shall we say, collateral damage.

As far as I can tell, IMRT minimizes that collateral damage. Narrow beams of differing levels of radiation energy are directed at the tumor(s) with a more pinpoint accuracy. This entails complicated three-dimensional computerized imaging of the target tumors plus directing the beams at the targets from a variety of angles.

The IU Health Goshen Center for Cancer Care describes IMRT as “a state of the art radiation delivery system, which has been called the most significant breakthrough in cancer treatments in the last 30 years.”

RadiologyInfo.org claims these advanced IMRT machines “safely and painlessly deliver precise radiation doses to a tumor….”

The National Cancer Institute says of this new technology “This type of radiation therapy reduces the damage to healthy tissue near the tumor.”

If all that is true, why in the world would I go through the living hell that chemotherapy and traditional radiation therapy would entail?

See what’s happening here? Now I understand why people have been conning and quacking cancer patients for time immemorial. Everything from apricot pits (laetrile) to antineoplastons to machines that lower the voltage of cancer cells to naturopathic herbal remedies like mistletoe extract have been hailed as spectacular healing agents.

I’m scared to death. I neither want to die, to loose portions of my throat, or to have to endure tortuous pain and other unpleasantness. So the first time I do a little digging, I come upon a panacea that promises not to destroy as many of my healthy body parts as chemotherapy and traditional radiation.

But is IMRT just a panacea? It seems those touting it are reputable, accredited medical providers. If IMRT won’t clobber me as badly as what Dr. Wu is planning for me, why hasn’t he mentioned it to me?

Some possible reasons:

  1. IMRT is too new and perhaps too unproven to be of use to me.
  2. My particular olive pit and its satellites are too big for it.
  3. Dr. Wu’s outfit, IU Health Cancer Radiology Center in Bloomington, doesn’t have an IMRT set-up.

Possibility No. 3 is disturbing. The American health care delivery system is not known as the world’s most efficient and comprehensive. It’s profit-based. The vast majority of IU Health operations are for-profit enterprises. If Dr. Wu’s location doesn’t have IMRT machines, it does his business no good for him to recommend the treatment for me. Would he be so craven as to withhold that information from me?

Who knows?

All I know is, I’m going to call him first thing Monday morning and ask him about it. I’m also going to make some calls to operations that do the treatment. As I told The Loved One, hell, if I have to, I’ll gladly travel to the Mayo Clinic in Minnesota or to the University of Pennsylvania to get IMRT if it’s doable for me. (She responded by looking at me through narrowed eyes and saying, “That’s why I sent you information about it weeks ago.” Hehe, sorry honey.)

The whole thing might turn out to be my mistletoe extract. Even if it is, you can’t blame a guy (and his Loved One) for hoping.

Malignant: Misdirection

Let’s Laugh

One of the things you learn about cancer is “the latest news” is perhaps the most fleeting descriptor in the English language. An item of info all too often can be described as “the latest” for, at the very most, only 24 hours or so.

For instance, yesterday I underwent a PET scan. My corpus was pried into from brow to shin by a multi-gazillion-dollar machine using rays and waves and computers and such. I was fed a juicy compound of the element fluorine and glucose via an IV. Then I was directed to sit in a darkened room for 45 minutes while the cocktail spread throughout my inner geography. Next, I was strapped onto a table and shoved into a claustrophobic ring for nearly an hour, where a rotating mechanism read the locales in my body where that tracer juice tended to accumulate.

A little science background, first. Don’t worry, there won’t be any math. The fluorine itself is radioactive. Not too much; just enough to show up on a readout produced by the rotating mechanism in the ring, itself emitting a penetrating wave and then sensing what happens to the positron-electrons it smashes into. The readout is a three-dimensional image of the body produced by a complicated computer algorithm showing the bounces and caroms and sub-atomic shrapnel caused by the waves. Follow me?

The radioactive compound tends to gather in masses that contain fast-reproducing cells — cancer. So, if the machine senses a pile of fluorine-flooded cells somewhere, the geek who reads the readout can say, Hey, that’s a tumor.

Dig the slideshow, below:

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Now, we know where my worrisome tumor is — that’d be the olive pit on the left side of my neck next to my thyroid gland, the one I discovered while enjoying a brisk shower last spring. The nature of my olive pit indicates there has to be another one somewhere, ergo the search via PET scan.

Dr. Wu called me first thing this AM to give me the old good news/bad news routine. The good news? No tumors were found in my lungs or belly or any other worrisome hiding places. The bad? There are a couple more malignant tumors around my thyroid. That means I’ll not only have to go through radiation therapy — the prospect of which over the last week I’ve become at least somewhat reconciled to — but I’ll also have to do chemotherapy. That’s lousy, mainly because I’ll have to get a feeding tube installed in my belly so that nourishment can be injected directly into my stomach. Whoopie.

Suffice it to say this latest news — and, fingers crossed, this will indeed be the latest news for the remainder of this siege — has put me in a bit of a funk. I’ve given myself a good 12 hours to moan Woe is me! and then I expect to be back to emotional stasis of a sort by dinner time tonight. Again, fingers crossed.

To help myself out of this pity party, I’ve decided to watch Laurel & Hardy’s Sons of the Desert. Soon as I finish this post, I’ll click it on. Hey, join me!

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Click On The Poster To Watch

Malignant: Blue Notes

Hard Work

So, it’s been almost two months since I learned the little black olive pit next to my thyroid gland is cancer. That’s almost two good months of taking the news in, digesting it, and adding it to the cesspool of knowledge that has accumulated inside my coconut.

There are, of course, stages of understanding, very similar to the stages of grief that Elizabeth Kübler-Ross laid out nearly a half century ago. They are:

  • Denial
  • Anger
  • Bargaining
  • Depression
  • Acceptance

Since EK-R published this little laundry list in 1969, grief researchers have tweaked and even pretzled the five stages. They don’t all come in that order. One or more of them may be absent. In some cases, people suffer very little grief over the death of a spouse or parent or sib — and not because the departee was a son of a bitch. There are models of behavior and reaction, but they’re not written in stone.

The enduring truth, though, is we take in and process bad news in stages. One — whatever it is — follows another — whatever that is.

In a sense, I’ve received two bits of bad news. First the cancer itself. As I’ve mentioned before herein, the nanosecond you hear the word cancer, you think death. It didn’t take long for me to disabuse myself of that notion. In fact, I knew long before I was told I had cancer that the disease wasn’t necessarily a high caliber bullet to the heart. I know many people who’ve survived cancer. The literature — both scientific and popular — is rife with news about modern treatments and the odds in this 21st Century that tumors can be quashed.

In fact, for a time I was even cavalier about the whole thing. I don’t feel any symptoms save the palpable presence of the olive pit. I’m feeling as healthy as an overweight old bear with a congenitally malformed heart can. Hell, I was conveying to the select few I’d told about my diagnosis my belief that this’d be a snap. Shoot some radioactive rays at me and away we go.

That brings us to the second bit of bad news. Radiation therapy is no snap. I’ve laid out the physiological horrors I’m likely to experience over the next couple of months already. When my radiation oncologist told me about them, my eyes grew so wide I was afraid they’d flop out of their sockets and roll on the floor. And should that have actually happened, it might be no worse a fate than what was to come.

That’s when the reality of this thing — coming in stages — hit. My stages are as follows:

● Friday night and Saturday: Numbing, zombie-fying, terrifying shock. It felt as though I’d been hit by a falling safe. I could not think of a single other thing. Steve the Dog would bark and I’d say to myself, “I wonder why he’s barking — and radiation will be hell.” I worked at the Book Corner on Saturday and when I’d greet a customer, I’d say, “Hi, how are you doing?” and then, to myself, “My throat’s gonna hurt so bad I won’t be able to eat.”

After a good 24 hours, I realized I’d lose what’s left of my mind if I continued along this path. My conclusion? I was living too much in the future. I wasn’t alive, psychologically, in the now. The solution? Reduce all my experience to one single minuscule thing: this moment. I’m thirsty? Drink some water. Enjoy it. Savor it. The Loved One’s sitting on the sofa, watching a movie? Look at her. She’s a hot tomato. Enjoy it. Savor it.

I pulled out my well-worn copy of P.G. Wodehouse’s compilation, Just Enough Jeeves. I’ve read all the stories time and again. They make me feel warm and comfortable and Wodehouse’s sneaky humor and creative use of the language is remarkable. Enjoy it. Savor it.

● Saturday Night and Sunday: I had concentrated so much on what was to come that I actually began to feel pain in my throat. Have you ever seen one of those sensory homunculi with the exaggerated features showing how strongly we feel in each distinct part of our bodies and how much of the brain is devoted to that area?

penfield-homunculus1

For a while my own homunculus was featuring a throat bigger than my entire head, my entire body even.

Now I decided every time I’d think about Dr. Wu’s words — “It’s gonna be hell.” — I’d immediately force myself to think of something else. The sun. The clouds. Steve the Dog. The Loved One. Bertie and Jeeves. The upcoming baseball season.

Then I read a Pencil comment from Linda Oblack. She told me of her own family’s experience with this cancer stuff. She wrote:

Every day was different, and we took it one day at a time. No looking ahead, no looking behind. We lived in the present time throughout the whole thing. It was all we could do to get through it…. One day at a time, Big Mike. One foot in front of another. It’s the best advice I can give. Don’t get ahead of yourself, and try not to worry about things you can’t predict.

See? I did the right thing! Wahoo! I’ll remember Linda Oblack and her imprimatur for the rest of my life. Thanks, kid.

I worked hard at controlling the flood of thoughts and fears. I’m pretty good at this stuff, having previously learned a lot of thinking techniques when I suffered through a 15-year bout with panic disorder, agoraphobia, and debilitating depression. All those lessons and practices came back to me, as if someone had handed me a third baseman’s mitt and told me to get out there and take some grounders. (Well, truth be told, I could be given a mitt as big as a Chevy Volt and I still wouldn’t be able reach 99.9 percent of the grounders hit in my direction anymore but you get the picture.)

● Sunday Night and Monday: Thanks to my previous training at filtering petrifying thoughts out of my consciousness I felt light and somewhat free. Yes, intellectually I still understood this radiation business would be a non-stop kick in the belly for weeks on end, but I wasn’t living in the pain and fear anymore. Whee!

● Tuesday: I got up, as usual, at 6 AM and let the dogs out. I started washing the dishes from the night before, my normal wake-up routine. Dishwashing first thing in the morning is great therapy at any time of life. It’s alone time, thinking time. And it satisfies the soul; when you’re finished, you look at the dishes and pots and silverware in the drainer and you can say, Aha, I’ve accomplished something already today. It’s a good start.

Oddly, though, merely stacking the dishes so I could wash them in good racking order (I know, I know, I’m OCD about some stuff) seemed so daunting that I had to stop. I was dead tired. I stood, leaning on the kitchen sink, wondering what the hell was wrong. Just the wondering seemed to sap me. So, rather than finish the dishes and then get ready to head out toward whatever coffeehouse would be my HQ for the day, I decided I had to stay home. I began grinding coffee and peanut-buttering some toast. Even these tasks seemed enormous.

Staying home was a bad decision. I was tired because I’d expended gigawatts of energy trying to grasp all this cancer and radiation rigmarole. Being tired made me depressed. Being depressed made me tired. Suddenly, I felt utterly alone. The world beyond the walls of my living room, where I retired to lay back for a while in the recliner, no longer existed. I jumped up and started to write. I drank my coffee. I read the New York Times. I didn’t even want to eat lunch. That’s a bad sign for a big lug like me.

I noticed, too, that my ears were ringing. This is a surefire tipoff that I’m tumbling into depression. Follow me here: Depression is the most selfish state of being imaginable. The sufferer cannot get beyond her or his own pain, loneliness, or existential pointlessness. The universe shrinks to a volume defined by the perimeters of your body. The birds, your friends, the rain — they all exist far away, somewhere else. Nothing else is part of you and you are part of nothing else. Consequently, all that exists are your thoughts and feelings and your physical sensations. At the worst of my decade-and-a-half descent into depression, I felt every sensation on my body as pain. My skin hurt. My bones throbbed. My head ached. My muscles were sore. The blood pulsing through my ears was torturous tinnitus.

Only when one emerges from deep depression does one’s universe expand beyond the self. Only then does physical sensation become distinguishable from pain.

Hey, I reminded myself, I’ve been through this kind of thing before (q.v. 15 years of it). Step No. 1: Don’t let it win. Get out in the world.

I wasn’t going to be trapped in the house — or, more accurately, in my mind and body. I dragged my corpus into the shower. It seemed to take hours to finish. My feet felt as though they were yards and yards away. Brushing my teeth was a crucible. I did it.

I cranked up the Prius and started driving. I went south on State Road 446, over the Lake Monroe causeway, through the S-curves and hills of the Hoosier Nat’l Forest. I turned west toward Hardin Ridge and the reservoir dam. I passed tiny ramshackle churches of indeterminate denomination. Double-wide trailer homes. Every dwelling with a big propane tank next to it. Farther west, the land flattened out to the Salt Creek flood plain. Farms. Fields lying fallow for the winter. Gangs of bovines, standing, lying, chewing. At one point, I saw a little calf — couldn’t have been more than a few months old — scampering to catch up to the adults. At another, a house cat timed my approach and dashed across the bumpy roadway in front of me. Hordes of starlings and crows erupted from this field and that copse.

Past the dam, I head south again on Old State Road 37, a barely-used stretch of two-lane blacktop. At Bedford, I joined the main SR 37 and headed back north. I pulled over several times to gaze at the striated walls of limestone where steep hills had been blasted and cut out to accommodate the road. Each layer of sediment represented — what? a century? a millennium? — some nearly incomprehensible stretch of the Earth’s history. The Earth was around long before I came here. It’ll be here long after I’m gone. I take comfort in that. My fears and pains are as nothing in comparison.

I’m glad I got out. I aired the depression out of my clothes, my skin, my entire self.

Apparently, this cancer stuff is going to be hard work.

 

Malignant: Random & Clumsy

Dumb Luck

When you catch cancer, suddenly you become something apart from the rest of the citizenry. First off, everybody showers you with love and affection. That’s cool. Really, really cool.

Most people don’t shovel hugs and kisses on you throughout the day unless you come down with something scary. Cancer, natch, is scary.

Which brings me to the second way you get separated from the populace. Right now I’ll bet everybody who knows me is thinking, “Thank holy Zeus (or Aten Ra or Ahura Mazda or even Jesus of Nazareth) I don’t have cancer.”

I know I would were I they. I know I have thought that when I learned a friend or acquaintance had cancer. I know I thought that when I learned my sister Fran had cancer. (Frances Ann Glab died in February, 2008. She was a tough bird.)

It’s not that I was glad they had cancer and I didn’t. I’m not a beast, for pity’s sake. But I recall stepping just a tad livelier after getting cancer news about someone else. Lucky me, I’d think, I’m free.

I’d mourn for the other person but I felt justified in celebrating my own dumb good luck.

I hope everyone out there who knows about my out-of-control squamous cells takes the time to celebrate their own dumb good luck. I’m happy to be of service. In this crazy, mixed-up world, you grab happiness wherever it pops up.

The vast majority of people who’ve commiserated with me about this thing have been caring and kind. No, wait — let me amend that: Everybody has been caring and kind.

There are those, though, whose advice or attempts to console me miss the mark. They mean well but I’m tempted to say, Thanks anyway, but, y’know, really, you don’t have to say anything more, okay?

Let’s call them the Clumsy Consolers.

● Clumsy Consoler #1: “Oh, my god, my brother-in-law had just what you had. Did he suffer! I have no idea how he did it. He said he would have gladly taken a drug that could have killed him if it would have just taken away the pain. He lost 92 percent of his body weight and he’ll never eat again except though a tube in his nose and….” Through all this, I’m listening and my anal sphincter is loosening from the terror and I have an urge to shriek like a schoolgirl and run off.

● Clumsy Consoler #2: “My sister’s ex-husband had just what you had. The doctors told him he’d have to go through all this torture but instead he read up on it and decided to just treat it himself. He eliminated all processed foods, white flours, and refined sugar from his diet. That was two years ago and he says he’s never felt better in his life.” At which point I’m tempted to say, Gee, thanks for the info. I’m gonna go right now to my oncologist’s office and tell him to take his MD and PhD and years and years of studying advanced intelligence about the most baffling disease to strike humans and shove it all. I’m gonna take the advice of some half-stranger I just met in a checkout line!

Only once thus far have I heard the line, “These doctors, they don’t know anything anyhow.” That’s once too many.

That line is pretty much the ultimate in anti-authoritarianism. That’s the weird thing about how the general public looks upon science these days. The greatest experts in whatever field you may choose —  evolutionary biology, cosmology, oncology, you name it — all acknowledge there’s tons more for them to learn. They readily admit the sum total of all they know doesn’t come near to explaining everything there is to know.

But people want scientists to be priests — all-knowing, never baffled. When science is demonstrated not to have every answer, far too many people say Aha! See? They don’t know anything.

We’re an odd species.

Malignant: Steve The Hellhound

Perspective

Remember how I told you my radiation oncologist, Dr. Wu, said my treatment was going to be “hell”?

Ever since he said that, I’ve been doing mental gymnastics trying to understand, foresee, and even conjure up a way of getting out of radiation therapy. Linda Oblack sent me a wonderful note regarding someone near and dear to her who’d also suffered cancer and who, too, went through hell. I was ripe to hear her suggestions of how I should approach this thing in my head. I’m hugely appreciative.

And yesterday, coincidentally, something happened to me that common sense tells me is far worse than facing a firing squad without a blindfold or even radiation. I was sitting back in the living room recliner, the oh-so-rare sunshine streaming in through the big picture window, napping at about 2:00pm. Steve the Dog was doing the same on the couch in the other corner and Sally the Dog was snoring on the sofa across from me. The Loved One at the time was conducting her own sleep symphony with the pussycats, Terra and Kofi, in her bedroom.

As happens often, the dogs and I came to consciousness as one. There was a lot of stretching and yawning, snorting and scratching. Then Sally did the dog thing, you know, the head and body shake. Both mutts have flop ears so when they do that in the very early AM, when it’s still a couple of hours from sunrise, the stereo rat-a-tat flumping sound could wake Pavlov himself.

Steve followed with his own head and body shake. Only this time — Satan only knows why — he had to throw up simultaneously. The floor, the coffee table and — aaarrrghh! — me were splattered with dog hork. If I had hair on the top of my head, it would have stood up.

The poor hound. I called him every name I could think of. If he had the capability, he would have shrugged his shoulders. He padded over toward the back door to be let out. “Jesus Christ, Steve,” I growled, “why couldn’tcha do that outside, ya knucklehead!”

So, okay, before you howl at me for verbally assaulting him, let’s just say I should have cursed his entire species for not having evolved enough to know not to upchuck on a pal.

Anyway, I had to clean the effluvium from all surfaces, including my own. Cleaning up dog hork is one of nature’s most foul tasks, especially when the curs are coprophages, which most domestic canines are. (BTW: Look up coprophage yourself. I hate even thinking about the word, much less attempting to define it here.)

To be sure, Steve had indeed dined al fresco immediately before settling in for his afternoon nap, so my task truly was Herculean in nature.

Every sense organ of my being was offended and when I was finished, I dumped all the paper towels in a plastic bag and, as if to remind me of the horrors, when I tied the bag up, out came a gust of aroma. I gagged for the eleventeenth and final time.

So, there it is. The “hell” of radiation therapy cannot be worse than that. Bring it on, Dr. Wu!

The oncology nurse whose job it was to hint at how nasty this radiation business would be, told The Loved One and me that extreme weight loss was a very strong possibility — even an inevitability. People who — shall we say — are less taken by the pleasures of the table than I am must worry about malnutrition during therapy.

“But I don’t think you have too much to worry about,” she said, smiling. “You look like you have plenty in reserve to get through this.”

Hah! Reserve. Keep this euphemism in mind in case your best friend asks you if she or he looks fat. Say, “Why no, darling, you merely have plenty in reserve!”

Should she or he still clunk you on the side of the head, why then, at least you’ll know you tried your best.

Malignant: Lumpy Humor

Laughter Is Life

Among scads of other people, jazz jock and All Things Considered local host David Brent Johnson came into the Book Corner to visit me today. He delivered what is so far the best gag regarding my lump and all the folderol surrounding it.

The set-up: DBJ’s employer, NPR affiliate WFIU, runs daily promos asking listeners to consult with their financial advisors to set up “a planned gift or a bequest.” The station’s website offers helpful suggestions of the forms this largesse may take. You may name the station in your will, designate it as your life insurance beneficiary, and even have your retirement plan assets turned over to WFIU after you’ve departed this coil.

I’ve written this once before in this space — basically, WFIU is making the euphemistic yet still unsavory request that more accurately can be posed: Say, I hate to bring this up, but once you’re dead, can we have some of your money?

Well, DBJ insisted on giving me a big lug-hug. It worked so well, we actually did it again. Under normal circs., two guys embracing within a period of three or so minutes might lead the more suspicious among the populace to begin to gossip. It’s a testament to both of our confident natures that we were able to clasp each other so readily and publicly. Although I must admit DBJ looked mighty dashing in his stocking cap and trench coat — but that’s another matter.

Anyway, as he was leaving, DBJ stopped, turned back toward me, and said: “Maybe this is too soon, but have you considered making a planned gift or bequest to the station?”

I roared. He did too. On the other hand, the eyes of Nick, the teenaged lad who works Saturday AMs w/ me, appeared about to pop out of his head.

Don’t worry, kid, laughter’s therapeutic.