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.