I don't know how long I'll be at this, but I have a lot of material from more than 40 years of medical practice and a life with several twists and turns. I'd like to try to get those stories onto a form that is more permanent (say fire resistant because the way it is now, they will all jellify with my death or be incinerated at cremation.)
So each post will start with any medical updates that are applicable. If you are kind enough to want to know what is happening in my medical life and my attempts to squeeze quality time out what there is left, that information will be at the top of the material.
When the "daily briefing" is finished, I'll indicate that reveries will follow.
When the "daily briefing" is finished, I'll indicate that reveries will follow.
We returned from Stanford after bronchoscopy and biopsy on Wed afternoon.
Thursday was spent in gathering together legal papers for creation of a trust, getting tax records for our current home in Morro Bay and property in Las Vegas to our lawyer.
When Jasmine spoke with the surgical team at Stanford, they recommended that I consider returning to Stanford for chemotherapy, pointing out that they have a world class expert who does only pulmonary chemotherapy. The reason they spoke with her was that I was in the recovery room and would not have remembered.
On Thursday I called Dr. Palchak, the local Oncologist. Sometimes doctors have a hard time working together. I wanted to know if he would be comfortable with me meeting with the Stanford oncologist and getting the proposed treatment plan, which I would bring back locally and discuss with Palchak. He was fine with that approach and stated that there was a history of a very good working relationship between the Stanford and San Luis Obispo oncologists.
I thanked Dr. Palchak for putting me on steroids for a few days--that I felt 200% better and was ready to go back to NSAIDs, Motrin or Celebrex, now that there was no planned surgery and consequent risk of bleeding. He thought that was fine. I told him that I was ready to be given anything that might help and was willing to join any kind of chemo study available. I liked his rationale of obtaining better quality of life by attacking the tumor as aggressively as possible in the hopes of reducing symptoms those being caused by the tumor.
In my case, the gout in my ankle and left great toe seems to be an indicator of the metabolic activity of the tumor. The more active, the greater the turnover of DNA and RNA. Since uric acid is formed from the degradation products of DNA and RNA, the greater turnover means more uric acid. The more uric acid, the more likely I am to experience the hint of a flare. What I have just described is not a clearly linear set of relationships. I am taking Uloric to reduce production of uric acid and Colchicine to prevent gout symptoms in the presence of increased uric acid. When the pain increases, I take additional Colchicine. It's probably not as complicated as I have just made it.
Psychologically I am pretty strong. While waiting for the PET/CT scan I saw a man being wheeled on a gurney who looked terrible. There was emaciation and an unhealthy sallowness of skin color. I felt my stomach turn over and I realized I might be looking at my future. This was my lowest point of the past week. My greatest fear is not the final moment of departure, but the loss of body and ability to have and express concern for others.
Now I know my diagnosis and my long-shot chance of ever seeing the Skins in another Super Bowl. I'm going to do all that I can and not really think too much about what is happening. I'll be thankful for each good day that I get and I'll need to meet head-on the sequence of events that lie in my future. Since I can't really predict exactly what they are, I'll choose to deal with them when they occur and not waste much time thinking about what they might be.
One of the things I sometimes wish I had was an emergency, immediate self-destruct button. I worry about being terrified for a few minutes as the tumor possibly eats through a large pulmonary vessel and leaves me exsanguinating and being aware of it. It might be nice to have the bail-out option at that time. I think of Goering and his cyanide capsule sewn into his cheek, allowing him to bite through and kill himself rather than be hanged after Nuremberg. For me, I'd want it pretty deep so that I didn't set it off by biting my lips while eating Chevy's Chile Relleno (which are wonderful by the way, at least in California).
Jasmine is having a hard time. She complains about this awful feeling her stomach that won't go away. While my emotions have been bouncing around, she has been able to tell me things I needed to hear. Last weekend I posted information that was personal about a friend. I thought it was humorous, Jasmine thought it was hurtful.
"Eric, just because you are dying doesn't mean that you have the right to act badly." This was delivered in her usual, serene but firm way.
Of course she was right and I hope that my attempts to amend the harm were really successful.
In my case, the gout in my ankle and left great toe seems to be an indicator of the metabolic activity of the tumor. The more active, the greater the turnover of DNA and RNA. Since uric acid is formed from the degradation products of DNA and RNA, the greater turnover means more uric acid. The more uric acid, the more likely I am to experience the hint of a flare. What I have just described is not a clearly linear set of relationships. I am taking Uloric to reduce production of uric acid and Colchicine to prevent gout symptoms in the presence of increased uric acid. When the pain increases, I take additional Colchicine. It's probably not as complicated as I have just made it.
Psychologically I am pretty strong. While waiting for the PET/CT scan I saw a man being wheeled on a gurney who looked terrible. There was emaciation and an unhealthy sallowness of skin color. I felt my stomach turn over and I realized I might be looking at my future. This was my lowest point of the past week. My greatest fear is not the final moment of departure, but the loss of body and ability to have and express concern for others.
Now I know my diagnosis and my long-shot chance of ever seeing the Skins in another Super Bowl. I'm going to do all that I can and not really think too much about what is happening. I'll be thankful for each good day that I get and I'll need to meet head-on the sequence of events that lie in my future. Since I can't really predict exactly what they are, I'll choose to deal with them when they occur and not waste much time thinking about what they might be.
One of the things I sometimes wish I had was an emergency, immediate self-destruct button. I worry about being terrified for a few minutes as the tumor possibly eats through a large pulmonary vessel and leaves me exsanguinating and being aware of it. It might be nice to have the bail-out option at that time. I think of Goering and his cyanide capsule sewn into his cheek, allowing him to bite through and kill himself rather than be hanged after Nuremberg. For me, I'd want it pretty deep so that I didn't set it off by biting my lips while eating Chevy's Chile Relleno (which are wonderful by the way, at least in California).
Jasmine is having a hard time. She complains about this awful feeling her stomach that won't go away. While my emotions have been bouncing around, she has been able to tell me things I needed to hear. Last weekend I posted information that was personal about a friend. I thought it was humorous, Jasmine thought it was hurtful.
"Eric, just because you are dying doesn't mean that you have the right to act badly." This was delivered in her usual, serene but firm way.
Of course she was right and I hope that my attempts to amend the harm were really successful.
The steroids have magnified my appetite. As one of my cowboy patients once said, "I could eat a lamb and a fatted calf." Thursday was at least 2000 calories of Chevy's Tex Mex and a pint of Haagen Dazs.
I'm not sleeping well. Maybe four hours is all I can do at a time...then I'm up a while.
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No reveries at this moment. Will be working on some today. I know that awful feeling that Jasmine is having in her stomach. I remember it from early childhood. Those are the memories I'll be trying to pull together next, the time from about 2 until 7.
If you have read some of these notes, you know that I have a resentment about my early childhood brainwashing. It is the stuff of many religions. The fundamentalist Islamic madrassas that we see in places like Pakistan are all part and parcel of this abuse of children.
I'm not sleeping well. Maybe four hours is all I can do at a time...then I'm up a while.
------------------------------------
No reveries at this moment. Will be working on some today. I know that awful feeling that Jasmine is having in her stomach. I remember it from early childhood. Those are the memories I'll be trying to pull together next, the time from about 2 until 7.
If you have read some of these notes, you know that I have a resentment about my early childhood brainwashing. It is the stuff of many religions. The fundamentalist Islamic madrassas that we see in places like Pakistan are all part and parcel of this abuse of children.
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