A Trip to the Oncology Clinic

I had my first chemo treatment this morning.

You show up and sign in, and then you're encouraged to sit wherever you want. There is a large open room with about 25 black leather recliners arranged in it, each one with its own IV stand and portable cabinet of sharp stuff. You can bring in whatever you feel like - blanket, food, book, iPod - but this time I mostly read what they gave me, a set of extremely ominous articles about the drugs in question (one of them, did you know, is chemically related to mustard gas? Two of them were classed as "irritants" and the other two were classed as "vesicants", AKA "blister agents", and all were said to cause gross damage if they got out of the vein...

But not to worry, I guess; it's just more of the boilerplate. They hook up the IV to the port and flush it out with a snog of saline, then they run a little bag of some anti-nausea drug and some steroid that's apparently helpful in a general way. Then comes the first chemo drug, a large bag of toxicity that takes about an hour to run. After that comes another bag of saline, then they push two small syringes of two additional chemo drugs in. Then comes a large syringe of some red fluid; it's plenty toxic and they actually time how long they take to push it in; too fast and it can get nasty.

Then there's more saline, a final hosing-out of the port with heparin, and you're free to go. Total elapsed time, about two hours, not even enough to nibble my caramel popcorn.

I didn't feel a thing the whole time I was there. I didn't know what to expect. Immediate retching? Burning heat in my veins? A sudden desire to belt out songs from Oklahoma!? But really, I didn't feel anything at all. Side-effect-wise, the worst thing was having the tape ripped off my chest when the IV came out.

I went home and took a rather long nap, and when I awakened, I felt for all the world like someone was sitting on me. Someone fairly big and heavy too, Magnus ver Magnussen or someone of that sort. The sensation was very much like waking up and realizing that one has come down with something without knowing what it was. I felt heavy, slow, lethargic and drained, and since that's how I've felt for the last month, well, it's hard to say that I felt any worse.

Now, about 12 hours after the chemo, I detect the first leading edge of nausea. I was watching LSU destroy Georgia Tech in the Whatever-It-Was Bowl (I'm bad at remembering bowl names) when something somehow made me very queasy, and it was obvious that the TV was making it a lot worse. So I downed a nausea pill and got the hell away from the TV, and thus far my nausea is tolerable. I don't think I'll be eating anything for a while though...

Now here's the interesting observation. By far the most bothersome symptom I've had, far and away worse than just "feeling bad", was the agonizing pain my left lower back, left groin, left hip and left groin (left kidney to left knee, roughly). It was for this pain that I was taking Percocet about as fast as the instructions permitted, and it was this pain that made me think "Oh my God, how am I ever going to go back to work? This is impossible! This is going to require either a medical leave or unprecedented quantities of painkillers, and neither one is really good!"

But for whatever reason, that pain is gone. Not reduced, but gone. Did the steroid tamp down some inflammatory process associated with the tumors? Are the tumors themselves shrinking, or "debulking", as they apparently like to say? I don't know. All I do know is that if this is really a lasting consequence of chemotherapy, I'm going to have to put chemotherapy down in my book as a legitimate medical miracle no matter how fiddlesome the process is.

That's the news on this, the last day of the year.

Time to end this year and move on to a new one unfreighted by bad omens, bad luck and bad karma. And what more fitting way to do that than to have the year go out kicking and screaming in my first chemo treatment?

I don't know what to expect. I will be under the drip for roughly three hours. They suggested that I bring a blanket, a book and something to eat. Imagine that! A medical procedure so long you have to pack a lunch! I don't think they really intend for me to bring lunch, necessarily. A few crackers or something. But still, nobody said I couldn't bring a picnic basket with fried chicken and cole slaw, did they? They also said that when (not "if") the nausea started, they would supply me with drugs to control the vomiting. With that in mind, a fried chicken picnic basket maybe isn't the best idea in the world. Maybe just an apricot or something.

Anyway, it sounds like I'll be under the drip for three hours, and from roughly the halfway point on will start to "feel tired". I interpret this to mean that from the halfway point, the chemo drugs are going to work me like an Army mule. Is the blanket for warmth, or to dampen the sobbing and whimpering? :)

Actually, I think the blanket is mostly to mop off my corpus. These lymphoma sweats are truly impressive things and the odds are that if I'm there for three hours, I'm going to have one, and I'll need the blanket so I can exploit its large-scale absorbency and thus (hopefully) not look like I just crawled out of the pool.

Maybe I should take nothing but an apricot, a bucket, my iPod, and a Sham-Wow. Write down another use for that thing!

Portion Size

Dawg in her "I swear I heard potato chips around here somewhere" pose

I find that I eat a lot less these days. Not that I'm complaining - for person who historically could eat most of a medium-sized ham at one sitting, this new dietary restraint is welcome and overdue. It means that we waste a certain amount of food, though the word "waste" may not be entirely accurate, since what I can't eat generally finds its way onto the floor for Dawg to consume. The laws of dog karma say that I should divvy out the excess food evenly between Dawg and Elmo, but Elmo doesn't like most Man-Food and it takes him forever to make up his mind to eat things like dressing or hot dog chunks. Meantime, Dawg has eaten her entire share and is slavering for his, scrabbling and clawing in a desperate attempt to get to his spuds before he makes up his mind.

So the usual process is that I pass the plate to Dawg and say "Don't tell Elmo about this." Within seconds the food is gone, and other than the suspicious hint of brown gravy and Italian dressing on Dawg's breath, nobody is the wiser.


I suppose there's some actual scientific theory to explain this reduction in appetite, just like the theory that explains why Hodgkin's makes you itch like a naked man in a room full of mosquitoes. But I think it's merely that feeling bad as a consequence of overeating is now piled on top of feeling bad as a consequence of cancer, and my body is slowly learning to avoid things that make it feel bad. You'd think that by this age I'd have already figured that one out, but NO.


But we have to get this portion size thing figured out, because the real loser in all of this is Dawg. She's always had a certain tendency to run on the chunky side, but she's starting to show a certain plushness - good for those times when it's three in the morning and hugging the puzzled Dawg is the only thing left that I can do without waking Jean up, who needs sleep worse than I do, but not so good for Dawg's own health.

Holding Pattern

I continue to wait for my opportunity to start chemo, and in the meantime, I don't know what to say. I don't want to report that I'm getting worse, but I think I am. The pain in my left thigh, hip and left lower back have become chronic and intense. I think my foot and lower leg are actually starting to decompress a little, that is, to become a little less swollen, but it turns out that the lymphoma has slipped the bounds of the lymphatic system in my leg and it's infiltrating my left thigh and groin, which also accounts for its oddly swollen nature, perhaps, and its extremely painful nature, perhaps. I have occasional difficulty swallowing. I'm so doped up that most of the time I'm not entirely sure what I'm thinking.

I'm probably setting myself up for disappointment by hoping that the first chemo treatment on Wednesday will debulk the tumors in my groin and leg to the point that I'll regain reasonable use of my leg, but I have to believe in something. The alternative is to sit awake all night and reflect upon the fact that I haven't had any treatment at all yet and am, technically speaking, dying of this shit. Stage IV. Lovely.

I'd rather hold out hope for an unrealistically-rapid cure, if it's all the same to anyone else.

I have the strangest craving for canned peaches. What can it mean? When I get over this lymphoma stuff I'm going to publish a list of Immutable Laws and I suspect at least a third of them are going to involve canned peaches in some way.

Just Too Much

Here's a photograph of mild interest, at least to me. First off, it's a photograph of a model displayed on the hood of the truck and posed in a way that it causes a kind of unintentional confusion. Plane? Car? House? Sky? Runway? Or doofus with a camera?

Second, it's a picture taken with my cell phone and emailed to my computer, which for me is an act of almost frightening cybernetic sophistication. Why, next thing you know I'll be programming up artificial intelligences and making pivot tables. This is not normally the sort of thing I do. I still half-expect to have to look down into the tops of cameras, so that's how advanced I am.

Third, it's a picture of the Italeri re-release of the old and treasured AMT/Ertl XB-70 Valkyrie nuclear bomber, not to be confused with the Tom Cruise nuclear bomb of the same name (I'm sorry, Tom Cruise as a Junker aristocrat? I'm just not seeing it). The XB-70 was too much of everything. Too powerful, too big, too expensive, too fast, too radical, just too damn too everything, so obviously it's the sort of model airplane that's right up my alley. Six J-79 jet engines? I need me some of that! I thought after the demise of the AMT/Ertl issue that we'd never see this particular model ever again, but those charming lads at Italeri have stepped into the breach and rescued it from oblivion.

I probably won't start working on the XB-70 for a while, but at least I have it. It is far too big and cumbersome a model to work on in bed, and sitting up in a hard chair to work on a model isn't particularly pleasant yet. Though my lower left leg and foot seem to be improving a little, my left hip, thigh and lower back are still pretty bad, and I find that when I'm in a lot of pain, I lose patience for some of the finer aspects of model-building.

"Honey, you glued the cowboy to the horse's belly; was that on purpose?"

"No, I just lost patience."

Day After Christmas

Twas the day after Christmas,
and all through the house...
Not a creature was stirring,
and neither would I have been had I had the sense to have taken my Percocet on schedule.

The Marrow Of The Issue

I had my bone marrow biopsy this morning. The oncology clinic called and said "If you can get here in half an hour or so, we can do the procedure." So once again I found myself being subjected to a medium-painful procedure without so much fortification as a single cup of coffee!

Oh, it wasn't that bad. The doctor used a goodly quantity of anesthetic (Lidocaine?) so I didn't feel the various needles passing through my skin and flesh. But the big needle jamming into the crest of my hipbone was a pretty intense experience. Not painful, really, though it was quite painful. Mostly it was just really intense. I'm reasonably tough, or like to pretend that I am, but the biopsy left me drenched with sweat and and shaking. It didn't help that my bones proved to be very hard and dense. "You won't suffer from osteoporosis later in life," the doctor remarked as he leaned on the T-handle and tried to drive the needle into my bone. (The first biopsy needle bent and they had to get a new kit.)

Later I found that the copious quantity of anesthetic he used had partially shut down my right leg, so I had a bit of a Walter Brennan gimp going as I left the office. Dag-nabbit, Little Luke.

So now I have a new dressing, this one on my back, and once again I can't take a shower. Arrrgh! I'd give almost anything for a hot shower at this point. Twenty dollars, fifty, take my dawg, I don't care!

Chemo starts Wednesday, of a form he described as "medium-aggressive". It's one day of chemo followed by two weeks off, repeated as necessary but for at least six months. Interspersed will be a PET scan and possibly a bone marrow biopsy (whee) to see if the treatment is working.

Time for orange sherbet, which sounds incredibly soothing to me right now.

Symptomology

I can't sleep to save my life tonight. Or at least, not at this instant. I slept earlier, but once I awaken under these circumstances, sleep doesn't always return. One of the symptoms of Hodgkin's Lymphoma is what the books circumspectly call "night sweats". I call them "an absolutely disgusting torrent of sweat." Doesn't matter if you're awake or asleep either, apparently - I soaked the sheets and woke myself up, and now I'm soaking my shirt and shorts in front of the computer.

Another symptom is a sudden attack of nonspecific itching. Normally it's just the broad surfaces like my back, shoulders or chest, but sometimes (like right now) even the small, fiddly patches of skin get involved. Even that structure that lies between my nostrils itches. The skin behind my ears itches. The whole sweep of my back itches all at the same time. I have vivid fantasies of taking off my clothes and standing in a car wash so the industriously-whirling scrub brushes could itch every part of me simultaneously.

So here I sit, itching and scratching and sweating. Lovely image, isn't it? I feel filthy. Nobody can be this itchy and sweaty without needing a shower, right? And, truth be told, showers sometimes do help. I mean, at the very least you don't have to feel beads of sweat running down your legs and into your socks. But I can't take a shower yet - surgeon's orders. I sport a gay festoonery of dressings from my biopsy and Borg Implant, and the surgeon doesn't want them to get wet. Inasmuch as one of them could provide bacteria with access to my vena cava (superior or inferior? I wish I knew) I guess I should take orders seriously.

I guess the modern approach is to sponge betadine in huge quantity over the areas of interest and to let it dry afterwards. I have (well, had) dried betadine all over my chest and neck, and even had a good deal of it in my hair. Tonight's profuse night sweat has sort of mobilized the betadine, however. It's flowing down my chest in streaky rivulets of rust-colored sweat and betadine, as if I didn't need another reason to desperately crave a shower.

But oh God this itching it driving me mad. It isn't like a rash, where the same spot itches over and over. It's different. It's every spot itching at one time or another. You scratch your nose, then the small of your back, then behind one knee, then an eyebrow, it just goes on and on and on like a childhood game of Locate All Your Body Parts.

And now I'm starting to hurt again. I can feel my pain pills losing their edge.

So let me wish everyone a merry Christmas, and let me wish us all peace and prosperity.

That said, I'm going to go take some pain pills and see if I can convert a broom into a high-speed overall-body scratching apparatus. Yowzer.

It Has A Name

Well, it has a name. The surgeon who did the biopsy apparently kept prodding the pathologist, who said it was Hodgkin's. The official report hasn't worked its way through channels yet so I guess technically I still don't have a diagnosis, but the "telephone diagnosis" is Hodgkin's. And it's good to know.

But in a way, I was hoping for one of those other lymphomas that didn't have a name, just so I could call it "Earl's Lymphoma" or something. I didn't really want to name it after me. It's like Lou Gehrig's Disease; everyone shudders and thinks "Oh man, that poor bastard." I don't need a lot of poor bastard shudders associated with my name, so I was going to name it after Earl.

Another Step

The biopsy node has been taken out and the port, central line or whatever you choose to call it has been put in. I feel really no pain at all from those incisions, just some generic pulling and tugging from the patchwork of dressings I wear on the right side of my chest and neck. I'm supposed to be in bed and not up and "farting around", as they say, and soon enough I will be. The catheter from the port goes down into my vena cava and they really won't want it to come out. They don't? Me either!

The worst part was the weird bulge in their operating table. Maybe I was on it wrong or something - I routinely overflow hospital beds and operating tables - but it was pushing a bulge of something into the small of my back that was extremely painful. They tried for a few minutes to rearrange me with pillows, then the surgeon finally told them not to bother; I would be out within a few minutes anyway. And I was.

One step closer, though I'm festooned with dressings and can't really move my neck in any direction at all. It reminds me a tad of the grand old bypass days.

Man of Few Words

Biopsy tomorrow. Vicodin tonight. Comedy at some unspecified point in the future.

Holland Loader

Sometimes, when you feel bad, only a Holland Loader will suffice.

http://www.hollandloader.com/Default.htm

I first saw one of these many years ago somewhere near Las Vegas. Like the time I beheld one of those Petersen DD9G Quad-Tracs converted to a ripper, it was an experience that remained with me. This modern Holland Loader is yoked to what appears to me to be a pair of Cat D10s; the one I saw had a pair of Allis-Chalmers HD-41s. The D10s are better dozers by far, but back in the day the old HD-41s had a certain machismo.

And having ruminated thus, I feel better.

Bowls

I spent most of yesterday watching obscure college football bowl games. At least that's what it looked like from where I was sitting.

I think for the sake of efficiency I'll establish a rule that unless I say otherwise, each successive day should be assumed to be worse than the day before. Yesterday was very bad indeed, but there's no need to for me to say how bad because of this new rule. Today, however, is a little better than yesterday, so I'll mention it in passing.

But I spent most of yesterday remaining as stationary as possible and watching college football. It was the day of obscure bowl games, apparently, though I'm used to bowl games happening betwixt Christmas and New Years. I guess when you're a Division 9 team, you play when and as you can. The Chutney Bowl. The Hominy Bowl. The Affiliated Plastic Lunch Tray Bowl. But I'll say this much: most of the teams (according to the announcers) don't hand out athletic scholarships, so there was refreshing lack of ego. None of this T.O., Heisman candidate, hyping the self BS, just a bunch of guys out playing football in places I've never heard of and, generally, going a good job of it. Just the kind of soap required to get an oily Cowboys game off one's skin.

A Message

And now, a message from the Sturgeon-General:

Warning! Eating caviar may be harmful to your health.

I met with the general surgeon today, who I quickly came to think of as the surgeon-general, and then the sturgeon-general. I have a node (not the node, because he didn't seem sure which one he most fancied yet) removed Monday, and this is a big step. It's where they finally arrive at a final diagnosis of what it is. Is it lymphoma? And if so, what sort? I confess there's a part of me that thinks that even at this late hour they'll reject the lymphoma diagnosis and say "Oh, it was just tuleremia or a bad cold or the funky chicken or something." But four out of four doctors think it's lymphoma; it's hard to argue with that kind of surety.

Time to get started. I'm losing leg function at a rate that in a week will probably cripple me. The weird thing is that I can walk and stand fairly normally, but I'm losing the ability to put on shoes, socks and pants, and I'm having trouble getting in and out of cars. The surgeon felt that once chemo started the nodes would just melt away and things would be better. That's a thought I believe I'll cling to.

The Dickens!

My leg hurts like the dickens today, and I've crossed a new boundary in my experience with illness: I've actually taken a Vicodin before coffee. This makes me feel like a lowly moral coward. A lowly moral coward without a deep stabbing pain in my leg, but a lowly moral coward anyway.

But what is a dickens? All my life I've enjoyed picking up odd non-standard words from people around me. One of my favorites was jag. My dad would say "Let's go get a jag of dirt," where jag was synonymous with truckload. Curiously, there didn't seem to be a half-jag or a quarter-jag. Nor could one have a jag of, say, lumber or scrap iron. Only dirt and gravel constituted a jag, and any quantity thereof was a full jag.

Another one that I like, simply because of the way it rolls off the tongue, came from my Uncle Bob in Iowa, when he would refer to a direction as caddywampus. "You head caddywampus across that field," meaning go across that field cross-wise at some arbitrary angle. He also once referred to a badly twisted barn as being caddywampus, which suggested that the word had more utility than you'd think and could be applied to something that had been cruelly twisted out of useful shape. (Stephen King uses the word widdershins to convey the same idea, but I contend that a widdershins sounds like some kind of gelatinous mollusc that lives in glorious but constrained majesty in some ghastly Maine tidepool before its cold, gooey life is snuffed out by something even nastier.)

My grampa was occasionally agin the idea. That's what he would say. "I'm agin the idea," though it was not always clear exactly what the idea was. He often said it to himself while scrawling a disorienting network of lines, dashes and squiggles on a piece of steel plate with a soapstone. If he was in a hurry, he was merely agin it.

But yeah. My leg's gone all caddywampus, as though I've been hauling jags of dirt, and I'm agin the idea.

Duct Tape

Tomorrow is my last workday for two weeks. It's also our highly mysterious Christmas party that they weren't going to have but decided to have anyway. It's all very hoosh-hoosh, as they say, but if it conflicts with my appointment with the general surgeon, well, I guess I'll have to miss it.

Because, yes, by cracky, tomorrow we decide which of my sullen nodes deserves to be gouged out of my flesh. The actual procedure isn't until next Monday; this is mostly a dry run designed to get me familiar with where the hospital is and stuff.

I'm a little put off by the idea of the shunt. What if it comes out? I don't think they're supposed to come out, but the Titanic wasn't supposed to sink either. I figure I'll cover it over with duct tape and JB Weld just in case.

The Irradiated Man

My PET scan today was interesting. It turns out that I have an inflamed schnauzer.

Mostly it involves a lot of lying around. Lay in a dark room and rest for an hour as the material works its way through your body. Lay on the PET scan table for a half an hour as the table moves back and forth in little jerks. This was a combined CT scan/PET scan, so the ring-shaped CT scanner was spinning around me, uncannily like the rings on the space portal machine in the movie Contact.

PET scans make you radioactive. When I had the nuclear stress test, the technetium-99m tracer caused me to emit gamma rays at about 105 keV (kilo-electron volts). But the fluorine isotope in the radioactive sugar for the PET scan causes one to emit gamma rays at 511 keV - five times the energy of the nuclear stress test, and hot enough that the technicians had no desire to be in the same room as I. Later I sat in my cubicle at work and realized that never once in my entire life did I ever imagine that I would end up intensely radioactive...

One more test out of the way. All that remains now are the two biopsies. I'm in something of a hurry to get started, because when I bend over I feel a strange sensation in my chest that I think is an enlarged lymph node pressing into my lung. It's deeply disturbing and I'd just as soon it was taken care of immediately. But there's a disconnect and the only hospital that the insurance company will authorize is heavily backed up...

That's what happens when you've got an inflamed schnauzer and a dawg that smells like Beef-a-roni.

Tomorrow's Test

Tomorrow I have a PET scan. I can already predict the results.

"Dear sir:

Most of your pets are spoiled, fat and ill-behaved. The exception is Max, who is merely spoiled and ill-behaved. Your dog smells like Beef-a-roni and the cats have fish-breath from eating canned salmon. Oh, and while you weren't looking, the other dog ate all your fig newtons."

That's the sort of PET scan I expect.

PET scans are actually fascinating. I don't know if anyone's all that interested in the mechanics of the thing, but suffice it to say that it involves anti-matter. Yes, anti-matter, that great hokum from Star Trek. The way it works is that imitation glucose molecules are tagged with radioactive isotopes of carbon, nitrogen, oxygen or fluorine (usually the latter because if its slightly longer half-life). Inside the body, the radioactive isotopes undergo what is called beta decay, and in the process emit positrons. A positron is the anti-particle of the electron - yes, Virginia, it's real anti-matter.

These positrons fly out into your tissues, where they quite by accident encounter normal electrons. The two particles completely destroy one another and produce a pair of gamma rays that are in the ballpark of 511 keV, moving in almost exactly opposite directions (the conservation of momentum isn't just a good idea, it's the dad-gummed law). The gamma rays are then received by the scanner, which exploits the paired nature of the gamma rays to selectively reject gamma rays that come from elsewhere.

The result is a three-dimensional model of the metabolic activity taking place in your body. The brain and heart are pretty active, but so are cancers, and by noting the prevalance of metabolically "hot" lymph nodes in one's scan, one can determine the extent of one's cancer.

And my dog really does smell like Beef-a-roni, by the way. I don't know why.

Sung to the tune of Huey Lewis

I need a new phone.

I think it's time. I've had the same old cell phone for a long time, and it's been of only marginal usefulness to me. For one thing, the battery appears to consist of paper clip electrodes submerged in an applesauce electrolyte; the point is that the battery literally lasts only about seven minutes. If you call me and I suddenly fall silent after seven minutes, it's not because I was suddenly laid low by The Grippe or struck by a meteorite; my battery just quit. This is no exaggeration. It fails to rapidly you can actually see the battery bars dwindle. I bought a new one a while back, but it's really no better. Maybe I shouldn't have purchased a phone with a toaster-oven attachment.

The next problem with my phone is that my number was recycled from some previous person. Whoever this Calvin fellow was, he must have been something of a man about town, because I get no end of calls from, shall we say, crisis debt management firms looking to have unholy congress with his checking account. The man's got some bad debts is what I'm saying, and they automatically assume that just because I answer the phone I must be the Calvin in question.

It might be different if it were some lovely contralto voice saying "Hey baby, tell me about your Krebs Cycle." But it's always a harsh, nasal voice that says "We're going to nuke you into next week if you don't call us back."

I stopped answering the phone, partially because I don't enjoy empty threats, and partially because by the time I convince them that I'm not Calvin and I never purchased a set of Harley-Davidson leather trousers, my seven minutes of battery time are up and I'm back in the Land that Time Forgot. So why bother? Better to not answer the phone at all than to have seven minutes of highly unsatisfactory parley with people who constitutionally mistrust me (you can hear it in their voices: "You say you aren't Calvin, but I know you're really Calvin, because you sound like Calvin, you bastard!").

What would life be like if my cell phone number had been used by someone more notable? Say, Judge Judy?

Rough Day

Today was a rough day. I don't know why it was so bad, necessarily. Perhaps a byproduct of the nuclear stress test, perhaps an insalubrious alignment of the planets, perhaps just bad luck, but I felt like crap all day, with the nadir occuring around noon. I'm always quick to attribute this sort of thing to eating the wrong kind of food, eating a bad piece of bologna, failing to take my medications at the right time. But what if it isn't really anything like that? What if I feel like crap just because I've got cancer and my body is starting to unwind and fail?

Brrr. Scary thought.

Time to get that chemo shit going! For those keeping score, Monday I go to my PCP, and Tuesday I go back to the oncology institute (the one "behind Albertson's", in their memorable phrase) for the PET scan. That leaves only the invasive biopsies to be done. I figure I'll take the first course of chemo just before Christmas, which means on Christmas eve at mom's house I'll be sitting in a corner, wearing a plastic poncho with a bucket between my legs. How festive! Maybe I can find a nice green bucket.

Wow

If anyone invites you to participate in a nuclear stress test, you may want to consider unlawful flight as an option.

Oh, come on, it isn't that bad, is it? Besides, who in their right mind would encourage people to avoid useful diagnostic tests?

The hard part of the stress test is getting your heart rate to the desired target, which in my case was about 150 beats per minute. To achieve that, they had to speed up the treadmill until I was walking literally as fast as I could. One tiny bit faster and I would have had to break into a run, which might actually have been more comfortable. And the angle! I felt like I was a Mexican speed-walker going up the Lhotse Face, for crying out loud. Never mind me, just on my way to the Geneva Spur...

But bear in mind that what started this whole medical extravaganza was the fact that my leg had ballooned up like something the Montgolfier Brothers would have been proud to claim, and over time had become increasingly painful and balky. My leg didn't enjoy that experience. Not at all. And it continued to let me know that it found that experience objectionable until I got myself propped up in bed and took a Percocet. In fact, it's still kind of pissed off at me, but at least it's stopped packing its little overnight bag.

The take-away from all this? If you have any kind of problem with your legs, skip the treadmill and go straight to the adenosine, a drug that chemically simulates exercise. I wish I had. Adenosine is pretty creepy, in my opinion, but it beats having your left leg suffer what NASCAR fans might well refer to as "the Big One."

And thus I offer my sorry experience as a service to mankind.

Griping

I don't necessarily mind all these tests. I don't mind having various radioactive and radio-opaque substances squirted into my veins, or having various forms of radiation sent sleeting through my tissues like hail through a sheet of newspaper.

What I mind is not being able to have coffee in the morning. These 24-hour fasting tests are a bummer.

So I get out of bed. Already I can smell coffee on the air, because Jean's already had a cup. And I walk out to the kitchen and think "Yes, a hot cup of aromatic coffee would be splendid, wouldn't it?" And there stands the coffee maker, and there stands the supply of my preferred Sumatran Reserve coffee, and there's my cup, and I think "No, I think instead of this wonder of nature, I'll have a glass of cold water. Yeah! That's ever so much better than coffee!"

I've been known to cheat before medical tests before. What difference could it make to, say, a lipid test if I sneak a cuppa Sumatran Reserve or not? And if the numbers end up being way off, who cares, we'll just repeat the test. But these recent tests have a more overtly life-and-death aspect to them, and I think I'll resist the urge to cheat.

But not the urge to gripe about it.

Tomorrow's Test

Tomorrow's test? Nuclear stress test. Have to make sure the old ticker is up to the challenge of having a node taken out and a Borg implant put in. Oh, it's just a shunt, but I prefer to think of it as the first of many steps that will lead, ultimately, to Borg. Resistance is futile.

I'm considering taking a big jug of vodka with me tomorrow. What better to help one deal with a stress test than a big jug of cheap vodka, huh?

I am a little freaked out by the fact that the radioactive tracer used in the test is thallium. Hey, isn't that also the active ingredient in rat poison??

Diagnostic Update

I don't want to beat lymphoma to death because I've already vowed that I don't want to turn into a professional cancer patient. I want to remain me, and if I happen to write about lymphoma now and then, well, that's fine, but I don't want to make a career out of it.

We still don't know what exact form my lymphoma has taken. I have to go in and have a node surgically removed for microscopic examination, I need to have a bone marrow biopsy (ick) and I need to have a PET scan. That will allow them to determine the nature and extent of my disease, at which time they select the appropriate chemotherapy drugs from their amamentarium and let me have it with both barrels.

I'll likely have six months of chemo, with a five-days-on, 25-days-off schedule. I expect this to be a fairly unpleasant ordeal, but my oncologist seems reasonably certain that the results will be good. He believes I have an aggressive, fast-growing form that also succumbs to chemotherapy quite well, as opposed to slower-growing, almost-benign forms that can't be killed.

It can't start too soon. My leg is really becoming a problem and the nodes in my neck and head are starting to ache, though as Jean pointed out, maybe I just have a huge stress headache.

Diagnosis

Well, I've been given a diagnosis of lymphoma based on what the doctors saw in my CAT scan. The exact nature (Hodgkin's versus non-Hodgkin's) will require a biopsy to determine. I only found out today, so I have no idea of how I'll be treated, how advanced it is, and what my ultimate fate might be. I'll know more tomorrow, after I see the oncologist in the afternoon.

What a spectacular turn of events.

No, Really, That's Enough

TV has really gotten on my nerves today. It usually does, but this time, it's gotten in my nerves in two very specific ways.

The first is an ad for the TV show Brink, which strikes me as a sort of gosh-wow science show for the people who don't know much about science. Brink as a word is apparently a neologism intended to convey a sense of cutting-edge science-ness, or, for lack of a better set of words, gosh-wow-ness. And here's the bit that really gets under my skin. "A lunar rover? Not brink. A Mars rover built in someone's back yard? Brink!"

Wait a goddamned minute here. You design and build a lunar rover that not only meets certain critical weight and space requirements, but folds up so it can be stored in the descent stage of the LM and survive the vibration and gee forces of flight on a gol-durned Saturn V, but can be unfolded and deployed by only two men wearing highly restrictive spacesuits, and it works and allows the astronauts to travel a much farther across the moon's surface while providing excellent-quality TV pictures and telemetry, and that's not brink? But some guy builds an obvious clone of Spirit and Opportunity in his back yard and drives it across his lawn and it hasn't so much as been near a booster and that's somehow brink?

Oy. In other words, Brink isn't brink. No need for me to waste time with that clinker. I anticipate that watching it will only cause me to hemmorhage.

The second item is when Michio Kaku asks the plaintive question "What the heck is a parallel universe anyway?" Oh, I know what they're thinking, but I also know what I'm thinking, which is "A parallel universe is really a fanciful bit of fiction intended to buttress a particularly messianic interpretation of the superstring guess (it doesn't yet qualify as a theory) but since a parallel universe can't (as far I know) be measured or accessed in any way, it's just as much fun to imagine that my garage is occupied by invisble, massless blue Hungarians who dance and cavort and would be great fun to watch if we could figure out a way to actually see them or hear their multi-dimensional accordions."

He's better off asking "What the heck is a misleading question anyway?"

Back to my book. At least Brian Lumley hasn't yet employed the word "brink" or demanded an accounting of me about the nature of parallel universes.

The Tenth Album

Readers of my previous post will no doubt be acutely aware of my last-minute choke, namely, citing the Nine Crucial Albums because I couldn't make up my mind on the tenth one. Well, I think I may be ready to declare the tenth album, but not without (as is my wont) a great deal of needless palaver.

Let's list some of the contenders.

Shadows Fall, Threads of Life
Not popular amongst the death metal set because it is more or less overtly metalcore, this still isn't a bad album. Taint death metal or black metal, but taint straight Hatebreed-style metalcore either. I happen to like it, but I don't think I would thrive on a steady diet of it.

Amon Amarth, With Oden On Our Side
I like this album because of its workmanlike nature. There's nothing new or spectacular here, just a bunch of guys who like to eat and play death metal, and really, does everything have to be a damned artistic statement? Sometimes you just want to headbang in the company of guys who, like me, rarely skip dinner.

Entombed, Left Hand Path
This one gets in on the technicality vote, based more on its novelty and otherness than how much I like it. I have to be honest and say that I'd like the album a whole lot more if pinched harmonics were not present in such abundance. Here's what pinched harmonics do for me. They remind me of the Dr. Rockzo character in Metalocalypse, complete with that preternaturally squirming scrotum and the jubilant cry of "I do cocaine!" But other than that, there's certainly nothing wrong with the "death and roll" music. (Ironically enough, considering this album's status as a classic of metal, Entombed was once dismissed by no less than Hellhammer when he said "I was playing with the shit band Entombed...")

Enslaved, Eld
I don't know if this qualifies as Viking Metal or not, but I usually regard it as such, based mainly on the occasional outbreak of manly Viking-style choruses where one would normally expect black metal screeching. And musically it's quite striking - the guitarist and drummer both manage to sound different and novel without sounding weird (listen to the first minute or two of A Long Time Ago and you'll hear what I mean). You can generally listen to a mystery song and tell within a few seconds if it's by Enslaved because of the characteristic style. But it isn't perfect. At 16 minutes long, the first track is self-indulgent and useful mainly for killing the last 15 minutes of a workday.

But the winner is:

Insomnium, The Day It All Came Down.
It's just that good, at least for me. I particularly commend the song Daughter of the Moon. It isn't death metal except by the most narrow and technical of definitions (the vocalist gurgles) but whatever it is, it appears to sooth my Inner Finn, and who could argue with that?

Here is an item of Finland lore that I suspect most people don't know. The highest kill ratio established by any fighter aircraft in any war was established by the chunky Brewster Buffalo in Finnish hands, flying against the Soviets in the Winter War and the Continuation War. Put that in your sauna and sweat it out.

Compendium Metallicum

The Nine Crucial Metal Albums I Don't Leave Home Without*

Carcass Necroticism (Descanting the Insalubrious)
This is a classic of death metal that's kind of grindy and sloppy, and includes what is perhaps the
best kind of grindy, kind of sloppy death metal song ever performed, Corporeal Jigsore Quandry. Later Carcass (such as Swansong) is cleaner, tighter, more accessible and more commercial, but somehow it seems to lack the energy and warped sense of humor of this album. If you aren't ready for the full grindy-deathy immersion, you may want to consider Choice Cuts, a "greatest hits" album that mixes early and later stuff into a mess that might be more to the taste of newcomers.

Mayhem De Mysteriis Dom Sathanas
A classic in minimalist Norwegian black metal, and the only real album that ever came out of the
Count Grishnak/Euronymous pairing, a pairing more notable for murder than for music in that the former ended up stabbing the latter in the head (he claims it was self-defense, but still, he stabbed him in the HEAD, man). It's pretty good black metal, not as "abraded" as some early black metal, but well short of the florid nature of Emperor's In the Nightside Eclipse. The album has two main failings. One is that the vocalist sounds a trifle silly sometimes. Instead of sounding like an evil dwarf, the desired sound for a black metal vocalist, he sounds like he's trying to pass a navy bean through his nose. The other is that the album doesn't have much variety and if you listen to the whole thing, the last few tracks develop a strong "been there, done that" vibe.

Insomnium Above the Weeping World
This is a Finnish band that started out playing more or less conventional melodic death metal in
the Swedish fashion, but starting with their second album they began to move away from death metal and toward something that one is tempted to call melancholic metal. It's not really doom metal (or "doomdeath", as it is technically known) but it isn't death metal either. Indeed, by the third album (Above The Weeping World) the melodic death metal influence is difficult to detect, but the album is atmospheric, artistic and heavy all at the same time. Insomnium is often compared to Katatonia, and I can understand why, but I personally think they surpass Katatonia. There are three tracks of particular interest on this album, The Gale, Mortal Share, and In the Groves of Death.

Burzum Filosofem
This is one of the strangest and yet most evocative of black metal albums, minimalistic and spare, but at the same time almost hypnotic. Each of the six tracks are lengthy and could strike the pop-attuned listener as tedious, but each has a specific texture and feel that sets it apart from the others. It follows the usual black metal trope of having a fairly thin and "abraded" sound, especially the vocals, which even at high volume strike the listener as being at-best half-heard. This was the last album made by Varg Vikernes before starting his prison sentence for stabbing Euronymous in the head. Parts of the album hint at the dark ambient sound that he would later dabble with (dark ambient seems to be the curse of black metal - you make black metal, you experiment, and all of a sudden you're doing dark ambient, and nobody knows why).

Avenged Sevenfold Sounding the Seventh Trumpet
Normally I'm not a fan of metalcore. I leave the defense of metalcore to its fans; I for one don't
really enjoy all that hoarse shouting. And there's normally something poppy and juvenile about
Avenged Sevenfold - it, like Slipknot, is the Approved Metal of Summer Break, when fifteen year olds listen to metalcore and ride skateboards and experiment with cigarettes. But this album, Sounding the Seventh Trumpet, has a nice variety of songs and doesn't have that poppy teeny-bopper sound that we've come to know and hate. I quite like it, and I like the way that the album seems to knit itself together to form a seamless whole.

Metallica ...And Justice For All
America doesn't, in my mind, make good death metal, or good black metal. But it does make good thrash, and this is among the best thrash albums ever made. It isn't as aggressive and heavy as earlier Metallica albums, but it reveals a growing musical sophistication and confidence that the earlier albums didn't have. They were toothy, but unfinished. Justice isn't quite as toothy, but it's a more rounded listening experience, including as it does the seminal One and the slower, almost reflective To Live Is To Die. Some Metallica fans claim that one can detect in Justice the looming sell-out that the Black Album turned out to be, but I don't agree. I don't get much of a sell-out whiff from Justice, personally. But I do have a lot of fun spreading the rumor that Dyer's Eve is absolutely unplayable in concert even with fifty musicians.

Dark Tranquility The Mind's I
There are, as a general rule of thumb, three major Swedish melodic death metal bands. Not really three, but I simply for the sake of illustration. On the one hand is In Flames, which seems thrashy and commercial to me. On the other hand is At The Gates, a band that I'm frankly still trying to come to grips with. And on the gripping hand is Dark Tranquility, which is speedy and reasonably metallic but not really very heavy at all (where heavy means, basically, it sounds like Dismember). I like it, but sometimes I find myself wishing for just a bit more heavitude. The song Still Moving Sinews comes to mind: I love the beginning, with its strange stacked power chord descent, but then the bottom falls out and it turns into, I don't know, pablum. So I like Dark Tranquility, but I don't rely on them to deliver crushing riffs or mind-altering heavitude, because that's not their game. They're much more delicate than that.

Dissection Storm of the Light's Bane
Dissection did a form of music known to the inner circle as "blackened death metal", meaning it was musically related to death metal but employed black metal vocal techniques and lyrical content. And it's not a bad album. Better than hoary classics like Venom's Black Metal or Emperor's In The Nightside Eclipse. Where the album goes awry is its real-world trappings, what with the leader of the band committing suicide after penning an outrageous press release announcing that he'd accomplished Satan's work on earth. That so?

Dismember Like An Ever-Flowing Stream
This is pretty much the primal essence of grim death metal. Dismember reminds me of Carcass, but Carcass in a bad mood. The lyrical content of this album is pretty obnoxious and I wouldn't recommend anyone look up the lyrics, but the music is pure electric saw metal mayhem of a sort that I happen to like. Probably my favorite track on the whole album is Justifiable Homicide, which seems to invite one to engage in shoutery.

* It was supposed to be ten albums but I never could make up my mind on the tenth one.

Failout

Let's see. The economy is melting down. A key segment of the US industrial economy is on the verge of dying. India and Pakistan are edging closer and closer to war, each side polishing its nukes. The Taliban is coming back, smarter than ever if not actually stronger.

But we have news stories like "The top five movies that make Jennifer Aniston cry."

Do I care what moves make Jennifer Aniston cry? NO!
Do I care what Jennifer Aniston thinks? NO!
Do I even know who the hell she is? NOT REALLY!
Do I care? NO!

On a different subject:

I don't understand what's gotten into Congress. As as of the last time anyone fessed up to me, the US government has hosed in excess of $300 billion on various financial companies, and usually without requiring the financial companies to do anything at all. We (meaning the taxpayers) had to pay to bail AIG out twice, and that was *after* their swanky retreat. I heard a radio report (since quashed, I imagine) to the effect that the various financial "institutions" (I guess it makes them sound more noble than "financial companies") had spent about a third of the bailout money on things like stockholder dividends and executive compensation. Not, in other words, what we naively expected them to spend it on.

Then the automakers come to Washington to ask for between $25 billion and $34 billion in credit, loan guarantees and direct loans, and all of a sudden Congressmen turn into Scrooges. "What? A bailout? We can't just give you money! What do you think you are, an investment bank? Get real!" So to get the bailout, the Congress lays increasingly bizarre conditions on the automakers. "You have to fire your CEO. You have to stop using the letter 'X' in car models. You have to reduce by one third the number of restrooms in your factories. We want to see at least forty thousand retirees be killed, skinned and recycled into cat food to reduce pension costs. You have to alter the universal gravitational coefficient."

Why can the US government hose money all over the banks, who produce nothing tangible, and not all over the carmakers, who at least produce a product that can be seen and felt and, in principle, exported? Is this some kind of bizarre discrimination against blue-collar workers? Or, even better, another manifestation of the government's fairly widely perceived hostility toward unions? Are banker types seen as intrinsically more worthy than line workers at a GM transmission plant? Is Gordon Gekko combing his hair with a piece of warm bacon somehow more entitled to help than a guy that runs a CNC mill in a transmission factory? Is it because the Congressmen in question hope to score rich consulting positions for Wall Street firms once the electorate throws them out on their flaccid, ineffectual backsides?

This is really incredible. Congress has apparently decided that their hypcrisy doesn't stink. It makes me think that maybe there are too many lawyers and bankers in Washington, and not nearly enough engineers, doctors and machine tool operators.

Mind you, I do think it is appropriate for the carmakers to present a business plan that details what they're going to use the money for and what steps they're going to take to regain viability. And I further think it is entirely appropriate for the old guard corporate leadership to step down - as the consultants always say, you get the behavior that you reward, and rewarding failed executives doesn't seem wise to me.

But at the same time, the pretense that white collar Wall Street jobs are somehow deserving of bailout while blue-collar manufacturing jobs are not seriously pisses me off. Seriously. Full stop.