It worked

My new Hickman line worked - they were able to successfully draw blood out of all three of the lines, clearing away the last technical hurdle before the Second Transplant begins. I don't think it's going to be happening before Christmas though. They've only got four more days left to schedule the thing, and I just can't see it happening that fast.

My feelings are mixed. I'm glad to be home and relatively healthy (if somewhat weak) for Christmas. But on the other hand, the sooner the Second Transplant starts, the sooner it's over. I'd give up Christmas in return for a reasonable assurance that my lymphoma is going to be destroyed.

I'm starting to miss things. I'm starting to miss going out to dinner. I'm starting to miss going to lunch with the guys from work. I'm starting to miss lettuce and salad and spinach. I'm starting to miss going places like Harbor Freight or the hobby shop or the bookstore just for the hell of it. I think I'd just as soon have the second transplant now and get it out of the way to minimize how much longer I'll miss such things.

But the second transplant is going to be ugly. I just have that feeling. And I sometimes wonder just how much more I can cope with.

Catching Up

It's been a while since I wrote anything. As Inigo Montoya might say, "Let me 'splain. No, there is too much. Let me sum up."

I'm pretty well recovered from my first stem cell transplant. My blood cell counts are pretty much normal again, my blood chemistry is pretty much normal again, and I'm largely over the aftereffects of the massive dose of chemotherapy that killed my bone marrow in the first place. So what have I learned? First, I've never experienced any kind of fatigue that comes close to the fatigue you feel when your white blood cell count drops to zero. It's amazing. You can't do anything but sleep, and even sleeping wears you out. Even things as mundane as undressing and taking a shower have to be done in stages. You get undressed. You lie down for a while and rest. You take your shower. You lie down for a while and rest. You get dressed. You lie down and, spent, sleep for two hours.

It didn't help that I picked up an infection of clostridium dificile somewhere along the line, a rather unpleasant intestinal bug that requires special antibiotics to kill. The resulting diarrhea was profuse, and though I managed to drink enough fluid to stay ahead of the fluid loss, I lost so much potassium I verged into the "criticial deficiency" category - I think at its lowest, my potassium was 2.7, which is low enough that the doctors were starting to worry about cardiac problems.

The obvious solution? Hook a bag of potassium up to my central line and replenish, stat. As soon as the potassium started to go in I developed a most spectacular pain in the right side of my chest. It was as bad, and perhaps even worse, than heart attack pain. They thought I was having a heart attack; they wheeled in the portable EKG and ran some strips, and were puzzled when my EKG proved to be normal. But as soon as they stopped the drip, the pain went away. So that night I went home and tried to replace all my lost potassium by choking down potassium tablets the size of modest rodents, and the next day they tried to give me more IV potassium, this time through my old chemo port. Same result - devastating chest pain, and another night spent trying to choke down potassium tablets.

It turns out that both my central line and chemo port had failed - both had developed kinks that rendered them useless and triggered intense pain when the infusion pumps attempted to force potassium solution through them. They gave me potassium the old-fashioned way (that is, highly diluted with saline and mixed with lidocaine and infused through a vein in my arm) and eventually my potassium rose from "critical" to merely "low".

So what's the next step? I went back into the Special Procedures unit and had both of the failed lines removed and a new Hickman line installed in the right side of my chest. That was yesterday, and I still feel like I've been kicked in both sides of my chest by a large man wearing pointy-toed shoes.

But that brings us pretty much up to the present. My white blood cell count collapsed and came back up. My potassium level collapsed and came back up. My clostridium dificile infection came and (mostly) went. My old lines were ripped out and a new one installed. And as I write this, I don't feel too bad. My chest and neck are still extremely sore, and I don't have enough stamina to walk from the hospital entrance to the bone marrow transplant unit (lots of wheelchair rides for me lately). But I don't feel too bad, all things considered.

It certainly could have turned out a lot worse.

That Didn't Take Long

Last Wednesday I went into the hospital because my central venous line had stopped working. They concluded it had moved out of position and replaced it. Now today we discovered that my new central venous line has also stopped working! We don't know why yet, but I'd say it's a reasonable bet that it has shifted out of position again. There must be something fluky about my anatomy on my left side that just doesn't agree with central venous lines.

So what to do? Replace it again? Nah. They seem satisfied that they can do what they need to do using conventional IV access and my existing chemo port, though I do have to wonder why, if the port is adequate, we didn't just pull out the central venous line altogether last Wednesday and have done with it. They (meaning the bone marrow transplant unit) like the central venous line because you can access it without poking a hole in my skin. With conventional IV access or chemo port access, a needle must be pushed through my skin - the BMT unit regard this as an inferior approach from an infection suppression point of view. But I guess as a last resort, it'll do.

Besides, I don't mind. I'm all bruised up from having the new central venous line installed, but it makes me look tough.

My blood test results today were extremely positive. My white cell, red cell and platelet counts were really quite good, and despite all the vomiting my overall blood chemistry is still normal. Moreover, they hit me up with IV Aloxi and dexamethasone today because I started to get really sick right there in the BMT unit, and right now I feel right as rain. No nausea, no particular pain from my CVL installation, and immense relief that my stem cells seem to be finding their ways to my bone marrow and getting with the program.

I'll take that over a kick in the butt with a copper-toed boot any day.

First Flush

Do you ever take your car in to get the brakes fixed and find yourself testing the brakes gingerly the first few times you stop? I tend to fix the brakes on my cars myself - I apparently can't get enough of all that black dust, occasional hammering and random swearing. But still, even I test my brakes gingerly the first few times I stop afterwards. I don't know what I expect. Is the wheel going to fall off? Probably not. Is some vital brake component going to fly out? Unlikely. Will the car be gripped by that "uncontrollable acceleration" thing that was alleged to haunt Audis back in the 1980s? It would be fun, but it isn't likely.

I flushed my new central line for the first time tonight, and I confess I flushed it gingerly. I don't know what I expected to happen, but when you're pumping stuff straight into your heart, a gingerly approach seems justified. I am pleased to report that nothing went wrong. I'm even developing a dull headache, another sign of normal operations.

They say the fastest way to a man's heart is through his stomach. Well, let's time it. I just flushed my port, and I'm also getting ready to eat a small breakfast burrito. Let's see which one reaches my heart first.

Transplantitis

I had my first stem cell transplant Tuesday. Monday I was given the dose of Melphalan that kills the bone marrow (and, hopefully, the cancer) and on Tuesday I got two bags of my old stem cells back. It was... It seems that everything I write about is an unpleasant or uncomfortable experience, and I guess it shouldn't surprise anyone that the stem cell transplant was uncomfortable either. But I must sound like a broken record.

They thaw the cells but they still go in very cold, more of an icy slush than anything else. You're probably familiar with the idea of brain-freeze, the discomfort you get in your head when you eat ice cream too fast. Imagine the same thing happening to your heart and lungs. The icy fluid goes into your heart, which then pumps it straight on into your lungs. For the eleven minutes it took for the stem cells to be injected, I felt like I was having a heart attack and that my lungs had stopped working altogether. It's uncomfortable, and it's also terrifying; for a while I was pretty sure I dying.

Fortunately the discomfort doesn't last long and within a few minutes I was back to more or less normal. But boy was it an intense eleven minutes. The DMSO also gave me garlic breath. I myself couldn't smell it, but everyone around me kept saying "Wow, that DMSO really does smell!" Great. I have cancer, I've been chemoed, and now I'm physically repulsive too! Or maybe I always was and the DMSO just sealed the deal.

In the wake of the transplant, they discovered that my central line had stopped working, so they brought me back into the hospital Wednesday on a semi-emergency basis to see what had gone wrong. They shot one x-ray and said "Egads! It's hosed!" Somehow the central line had recoiled and gotten seriously out of position, probably during the frantic coughing I was doing during the actual stem cell transplant (that's my theory, not theirs; they didn't offer a theory as to why the thing would have moved).

So I had to have a new central line installed. They ran a wire up the old one, then pulled the old one out and snaked the new one in on the wire. It involved a great deal of pushing, jerking, yanking and general hubbub - I felt like the recipient of some strange and extremely violent Scandinavian massage technique. I couldn't see anything, however. They covered me completely with a sheet of light blue paper, and when they wanted to talk to me, they had to lift up a flap by my right shoulder, like a cook lifting the foil on a turkey to see how it's doing. The only part of the doctor I ever saw was a pair of eyes peering in at me under the flap.

So today my shoulder and neck are pretty sore. The chemo itself isn't as bad as ESHAP, at least thus far, but I've pretty much lost the ability to keep any kind of solid food in my stomach. I can still drink, though; that's an improvement over ESHAP.

Happy Jammie Day

These are your jammies on Melphalan. I'm smiling, so it must not suck too badly, right? Right. It feels about like ABVD, a general sense of illness, not the immediate body blow of ESHAP. But it's still early. I suspect I'll experience the worst side effects on Wednesday or Thursday, and they might well be enough to wipe the smile right off my face.

But for now, it's happy jammie city.

The Immediate Future

Here is the schedule of impending events. It will perhaps explain my sudden absence from cotillions, State dinners, ice cream socials and UN Security Council meetings.

Day Zero (Monday)

I receive a toxic dose of Melphalan. I've never been exposed to this particular drug before, but I've been exposed to drugs of its class. It is technically an alkylating agent, distantly related to mustard gas of World War One infame. It bonds alkyl groups across DNA base pairs, making it impossible for the cells thus affected to reproduce (many, in fact, commit a kind of cellular suicide upon the discovery that their DNA has been in effect glued shut). I've already done the ABVD protocol, and one of its drugs worked in this fashion. Nobody can really say how unpleasant the side effects will be. On the one hand, the side effects of ABVD weren't incapacitating. Unpleasant, sure, but I managed to keep working and as long as people didn't mind seeing me shuffle when I walked, I could generally get around. On the other hand, though, I'll be getting a monster dose of Melphalan - seven times the normal dose is the number that I remember. It could be bad, and it could be very bad. At the conclusion of this, I will be discharged and sent home.

I will also start daily courses of two antibiotics, an antiviral drug, and possibly an antifungal drug.

Day One (Tuesday)

I report back to the hospital for the reinfusion of half my stem cells. This is a precisely scheduled proceeding. My stem cells are currently frozen (not just frozen, but cryofrozen) and only remain viable for about ten minutes after they're thawed. The bone marrow team aims to have them infused within about three minutes of being thawed. Basically they get you all set up for the procedure with everything in place but the cells, then they rush the cells up from the vat of liquid nitrogen and put them in a special thawing device (kind of like trying to defrost a turkey in a sinkful of cold water on Thanksgiving morning, I imagine).

The greatest risk during this reinfusion is having a reaction to the DMSO that the cells were preserved in. Here's where having a good stem cell harvest pays off. I was able to produce over five million stem cells in two sessions of apheresis, so they only had to use two doses of DMSO to preserve my cells. People who have to go through many sessions of apheresis to get enough cells end up getting many doses of DMSO, and have a higher risk of having a reaction to all that DMSO. The doctors speculate that my main reaction will be to develop a garlicky taste in my mouth and garlicky DMSO breath. (Chemo almost always gives me a strange, unpleasant metallic taste in my mouth, so this might be refreshing for a change, though I do wish they could develop a class of chemo drugs that gives one a pecan pie taste in one's mouth.)

Day Three (Thursday)

My immune system finally fails. My white blood cell count will begin to decay immediately after the Melphalan, but it's on Day Three that the count basically bottoms out and the risk of infection becomes very serious. I'll go on full anti-infection measures Sunday night, before the Melphalan, but it'll be on this day that such measures will become seriously important. My red blood cell and platelet counts will also bottom out and I may need occasional transfusions of such cells, though that remains to be seen.

Day Five (Saturday, I think)

By now the stem cells have found their various ways to my bone marrow and have begun to colonize the area. On this day I start to receive daily injections of Neupogen, which stimulates the stem cells to divide even faster. They will also begin to differentiate. A stem cell is basically an undifferentiated cell that can turn into either a red blood cell, a white blood cell, or a platelet, and as they multiply and differentiate, my blood cell counts will slowly rise.

Neupogen is no picnic. While I thought Neulasta caused worse and more sustained bone pain, Neupogen isn't any fun either. Every part of your skeleton that contains marrow hurts. For me, it was concentrated mostly in my pelvis, the long bones of my legs, my spine, and my forehead ridge. Many people say that the worst discomfort is felt in the sternum, but HA! I fooled them; I had my sternum sawed in half and wired back together a few years ago and it has thus far not caused any pain from Neupogen. Maybe there's no marrow in my sternum any more.

Day Twelve

They expect my blood cell counts to return to more or less normal by Day Twelve. My immune system won't be normal by any means, but at least it'll be sufficiently rejuvenated that the greatest threat of infection will be over.

Meantime, if the President or the UN General Secretary want me, I'll be in bed maintaining a dutiful arm's distance between me and the rest of the world.

This Just In

We got the Official List of Restrictions from the Bone Marrow Transplant team yesterday, and it's a doozy. Upon first reading, it was so long and comprehensive I didn't know whether to be shocked or depressed. Or maybe even angry, though raising my fists to the heavens generally results in me getting my fists thwapped by the ceiling fans. People who raise their fists to the heavens must apparently do so outdoors, or have higher ceilings than I do. Or perhaps they have shorter arms.

Let's start with the idea of arms. Nobody is allowed to sleep with me unless they remain one arm's length away at all times. We have a king-size bed, but my arm is sufficiently long that if I stretch it out, all that is left on the far side of the bed is a narrow strip about eight inches wide. Who do I know that is only eight inches wide? My scruffy dog, that's about it. Maybe Manute Bol.

Let's take a quick trip of some of the restrictions, shall we? No restaurant food. No take-out food. No fast food. No city water. No bottled water unless it is reverse-osmosis. No hot showers, only cold ones. No kissing. No canned food unless the rim of the can AND the can-opener have been sterilized. No fresh vegetables. No fresh fruit. Basically no melons. No microwave ovens. No leftovers. No towels - after showers, I am expected to find pleasure in vigorously rubbing myself with paper towels (I think I'll use Brawny paper towels, just out of cheekiness). No leaving the house without a mask. No exposure to cats at all, so no more playing with Baxter D. Cat in the mornings. Limited exposure to dogs, a hardship that the poor dogs just won't understand at all. Visits from friends and well-wishers cannot exceed 15 minutes in length. No brushing of the teeth (which perhaps explains the one-arm-length rule). No commercially-manufactured ice. Oh, here's a fun one, no activity that involves knives. It's okay if I juggle chain saws, I guess, but picking up a knife and working on a model airplane is a one-way express ticket to systemic infection. I guess that rules out any chance of me turning scrimshaw into a career. No walking around the house barefooted. No shorts. No short-sleeved shirts. (For centuries the Roman army kicked the crap out of its enemies while wearing little more than tunics and sandals, but I can't go from the bed to the refrigerator without donning heavy battle armor.) No licking of doorknobs (okay, I'm good with that one).

A hundred days of this. I have a theory that these transplants cure cancer not by chemical means, but by making your life so dreadfully boring that the cancer cells become restless and move on to more exciting pastures. Compared to me, mimes and origami artists will seem incredibly interesting and exciting.

Something Just For Me

I see the Food Network has a new competition show, something along the lines of The Worst Cook In America. I don't necessarily think I'm the worst cook in America. I'm pretty bad, but not that bad. But somehow I think this show might appeal to me.

When I was single, I was known for making dishes that basically amounted to boxes of macaroni and cheese with "other stuff" thrown in. Always stewed tomatoes, often ground beef, not infrequently diced green chilis. These things turn out surprisingly well - to this day I'm partial to the taste of commercial macaroni and cheese mixed with canned stewed tomatoes. But one day I started to make this substance and discovered that I didn't have stewed tomatoes. After a moment of agonized indecision, I grabbed what I had and threw it in the pot. It was a large can of Chunky split pea soup. The resulting substance looked and tasted just like wet concrete.

Another time (still while I was single) I conceived the idea of making Rice Krispy treats. I didn't have a recipe, but I was never one to let lack of instructional materials hold me back. I knew the basis of the thing was Rice Krispies, which I had, and some sort of melted something or the other. So I melted up a bunch of brown sugar and mixed in the Rice Krispies. When it cooled, it cooled into a brittle glass-like substance that shattered instead of cutting. I tried to cut off a hunk while it was still in the fridge and it exploded violently, more like safety glass than a foodstuff. Shards of Rice Krispy glass flew in every direction. I later found them in the refrigerator drawers, in the butter tray, on the floor... I'm surprised that some of them didn't embed themselves in the ceiling.

I don't know if that qualifies me for the show, but it's still pretty shameful. I can't even blame alcoholic beverage or heavy metal music for it.

It's On

It's official. I signed off the consent forms and the doctor signed off my treatment plan, so the transplant officially starts Monday morning. I won't get the actual transplant until Tuesday, because Monday we'll be destroying my bone marrow.

It's kind of ominous. The risk of complications and mortality are pretty low, but this isn't a flu vaccination. This is Serious Stuff and it kind of scares me. It doesn't scare me enough to back out, but it still has to be taken seriously. For one thing, it'll reset my immune system to Day Zero. I'll lose all my acquired immunity to everything, so I'll need to be vaccinated against even childhood diseases, and a lifetime spend accumulating antibodies against colds will be lost. Plus there's the simple observation that any chemo powerful enough to kill my bone marrow is likely to make me feel like crap for a while.

The next sixty days are liable to be fairly unpleasant, but the sooner I start, the sooner I can finish. That's the idea I'm trying to hang on to, not the idea of sixty days of feeling bad.

Scary. I'm at a loss for words. But won't it be nice to not have cancer any more?

All Bets Are Off

My medical gurus, in between bouts of levitation, chanting and incense-burning, have decided that I do not require a supplemental round of chemotherapy before the transplants begin. Some radiation, but not chemo. Instead, I go in Monday to discuss "transplant options" with the hospital staff. I wonder what that means. Does it mean I get a choice of what organs are transplanted? Can I have, say, George Clooney's face or Robert Irvine's arms? What would happen if I got LeBron James's right leg? It would be really hard to get around; with one really long leg and one normal leg, I'd constantly walk in circles and eventually wear a ring-shaped hole in the carpet.

No, I think they're just going to discuss timing, and the sooner the better, as far as I'm concerned. I wasn't honestly looking forward to a "placeholder" course of ESHAP anyway. If I'm going to have chemo, why not make it the scorched-earth chemo associated with the transplant and have done with it? It's like drinking Jaegermeifter (yes, I know it's Jaegermeister, but before the German alphabet was rationalized, gothic S characters looked like Fs) - the sooner you start, the sooner it's over with.

I guess I'll find out Monday. Further bulletins as events warrant.

601

This is my six hundred and first post. That's a lot of posts. What would Saint Inez think about that?

Curse of the Pharoahs

They say* that Howard Carter, the man who discovered Tutankhamun's tomb, died as a result of a curse placed on the tomb by ancient Egyptian priests. Or ancient Egyptian mummies. Or the Pharoahs themselves. Or maybe it was something Zahi Hawass, head of the Supreme Council of Antiquities, did himself. I don't know; the point is that someone put a curse on the tomb dooming its discoverer to some sort of gruesome demise.

Turns out that Howard Carter died of Hodgkin's Lymphoma, the same disease I have. So I wonder what my personal connection to Egypt and/or Tutankhamun might be that I came down with this. After all, I've never been to Egypt. I didn't see the King Tut traveling exhibition. My only real connection to Egypt and mummies is that I've seen practically every mummy movie ever made. Sue me already, I like Brendan Fraser and Imhotep the mummy, waddling around the countryside in lumbering search of tanna leaves, fresh Ace bandages, or princess Ankhesunamen, or whatever her name was (doubtless she was known to her friends as Top Ramen). Is that enough to qualify me for the Curse of the Pharoahs, or am I just a victim of collateral damage? I once made a model of a T-34/85 tank in Egyptian markings; could it have been that? Or was it that Revell 1/32nd scale MiG-21, which I also finished in Egyptian markings? A plastic tank and a plastic airplane don't seem nearly weighty enough to trigger a centuries-old curse, but maybe I underestimate the power of high-impact styrene plastic (much as I underestimate the power of the Dark Side of The Force).

Maybe I should ask John Carpenter. After all, he once made a movie (Prince of Darkness) whose main antagonist was a vat of mint-flavored Liquid Satan. If he can make Liquid Satan into a viable movie villain, surely he would have some sort of insight into how I got tagged by the Curse of the Pharoahs.

* They really do

Workday

I went to work today. I didn't manage to work a whole day - nine hours. But I didn't do too badly; I managed seven hours before I got so tired I was getting to the point that I wasn't entirely safe driving an automobile. And oh my, is work ever backed up! I don't know how long I'll be able to keep working - that depends on what the doctors decide to do to me. But I'll do it as long as I can; it's fun to get out of the house.

When I got home tonight I took a brief (and unintentional) nap and woke up in the middle of what I believe to be the worst movie ever made. Redline. It's awful. It's awful in every way. It's so awful I have a hard time looking away from it in all its crass, exploitative glory. I do, however, have to mute it immediately, inasmuch as I have absolutely no appetite for rap music at all. Not even a little. Kids today mock the music I listen to (that is, emotionally overwrought Scandinavian death metal) but on what basis?

Ach! Rap-musik! Jugend heute!

CVL

A view of my Borg implant. Every day I have to pump 3 ml of Heparin and saline into each of the three lines, and twice a week I have to replace the blue tips. The red and blue lines are easy but for some reason the white one always sticks. I have to get two pairs of pliers to break it loose, which makes me feel a bit like I'm a rusty old tractor. A little Liquid Wrench, some torch heat, and a pair of Vise-Grips and I'm good to go.

The central line enters my skin in the middle of the dressing, just under the white circle. Now and then it itches like the dickens, but at least it doesn't hurt. My port, on the other hand, is on the other side of my chest in almost exactly the same spot. It isn't visible except as a date-sized swelling under my skin (the skin over my port has been penetrated with those L-shaped chemo needles so many times it's taken on a permanent purplish hue, sort of like a hickey in a weird spot). Now that they've got tubes down both of my jugular veins, I don't think there's much more they can do to me tube-wise. Oh, I shouldn't tempt fate or pretty soon I'll have a catheter in my bladder too.

The hospital gave me a plastic urinal and a couple of plastic jugs. One of these days I'm supposed to collect a whole day's worth of urine for their analytical delectation. I'm strongly tempted to buy a case or two of the cheapest, nastiest beer I can find so when urine collection day comes, I can present them with two jugs of the nastiest, foamiest beer pee known to man.

Would I really present them with such offensive matter? They're only trying to help, after all. All I can say is that going through ESHAP chemo will make even a meek person vengeful, and the fact that I'm currently listening to black metal (Mayhem, De Mysteriis Dom Sathanas) isn't helping either. Maybe come urine collection day I should listen to an hour of Alan Parsons Project to anesthetize my instinct for revenge.

The Persener

I was watching a movie on AMC last night and noted that AMC is advertizing the hell out of the remake of The Prisoner. This'll probably blow my geek credentials to hell, but I have to come out of the closet and confess that I never liked The Prisoner.

Oh, I tried. I watched the show. I read the treatises on the symbolism of the bicycle-and-umbrella logo. I listened to the learned elders at science fiction conventions explain why The Prisoner was the most amazingly important TV show ever produced. But in the end, I had to admit that I had more fun watching re-runs of Daktari than The Prisoner. It made no sense, it seemed intentionally obtuse, and nothing ever seemed to happen. Compare this to Daktari, where stuff happened, animals were patched up, lions menaced the vets, and there was plenty of footage of specially-equipped Land Rovers driving across the Serengeti. Compare this to The Prisoner, where all you really get is a lot of formlessly portentious dialogue, enormous beach balls, and a sense of slowly-building ennui that eventually drives one to exclaim This is bullshit! This is overwrought bullshit!

Here's a thought. I never liked Doctor Who either, but I preferred it over The Prisoner.

Now that I'm out of the geek closet, I feel better.

Random Thoughts

Wouldn't it be amusing if all the people who obsessively use kosher salt because they think iodized salt has a funny aftertaste developed enormous goiters?

Do you think when Arnold Schwarzeneggar was oiled up and posing for a movie camera and uttering his famous line Get to de choppa that he had any inkling that he would in the fullness of time become the Governor of California? Or that as a budding young bodybuilder in Austria that he had any inkling that he would in time be oiled up and posing for a movie camera while uttering Get to de choppa? I can't decide if this represents some kind of deep circularity or if it's just stupid.

(The other day I was browsing the HobbyLink Japan website (www.hlj.com) and I saw they actually used the line Get to de choppa! You have a love a company that'll do that. HobbyLink Japan, by the way, is the source for weird, wild and wonderful hobby products from Japan. There's a link on their website ominously labeled "Japan Culture", but having sworn off anime and manga cold turkey, I fear to click on it.)

I would write more but, to your great relief, I'm going to stop because I have a splitting heache. Finally, an ailment I can't blame on chemo! This headache is mine, I tell you, MINE! It isn't the result of intercalated DNA or alkylated base-pairs or severely disturbed microtubule production; it's something I did to myself by drinking too much coffee this morning. For that reason, I'm kind of fond of it. Compared to the bilious retching nausea, endless diarrhea and aggravating neuropathy of chemo, it's like a visit from an old friend. An old friend with poor hygiene and annoying habits, but an old friend nevertheless.

Vents

I learned from the movie Big Trouble in Little China that the Chinese have a lot of hells. The Hell of the Upside-Down Swimmers, the Hell of Being Boiled Alive, and so forth. Maybe I shouldn't trust movies so much. The movie might not be such an authentic guide to Chinese culture, considering that at one point it has a Japanese guy, speaking Japanese, pretending to be a Chinese guy speaking Chinese. That's fair to moderately shameful, unless John Carpenter is trying to tell us something.

But let's pretend that the Chinese have a lot of hells anyway. To them must be added a new one, the Hell of Really Early Morning Paid Programming. I woke up this morning well before dawn and ended up staring listlessly at the TV as spasms racked my esophagus (apparently another treat brought to me by chemotherapy, a conclusion I reach because the spasms started the same time chemo started). First it was a bunch of commercials for various forms of make-up, all of which made really quite remarkable claims. This stuff will do everything! It'll cover your acne! It'll cover your unsightly gunshot wound scars! It'll transform your life! It'll inhibit beta decay in the atomic nucleus! It'll reverse aging and raise the dead! It'll make you an even more vapid narcissist than you were before! Then it was a bunch of commercials for various weight loss programs, all of which made really quite remarkable claims. This program will do everything! It'll make (make, mind you; we're not fooling around here) you lose weight! It'll give you a better hairstyle! It'll make you taller! It'll give you better taste in clothing! It'll turn you into what Jesse The Body Ventura once called a sexual Tyrannosaurus! Then it was a food processor gadget, which made really quite remarkable claims. It'll make a hyooge salad in just 38 milliseconds! It'll solve Fermat's Last Theorem without recourse to the modularity conjecture! It'll convert some rubbery, nasty organism we found in a brackish tidepool into something you'd actually want to eat! It'll warm the hearts of crotchety old farts and make you into a culinary hero!

I don't really like olive oil. I live in mortal terror of a cooking show where they cook asparagus and some icky bivalve in a bunch of olive oil. Ugh. Why not put a few road apples and cow pies in there too while you're at it?

Subaru. Love. Yes, I do. I love the commercial where Action Executive picks up the cabbie and proceeds to turn some quiet residential street into his own private race track, startling the cabbie at first before pleasing him. I'd like to see the residents come out of their dwellings, shoot out the tires, and then beat Action Executive to death with rolling pins and hockey sticks. That'll teach you to endanger everyone by treating our quiet residential street as your own private test track, you pompous yuppie bastard. Maybe next time you'll slow down! There won't be a next time, of course, because they've beaten him to death, but you get my drift. (Maybe they should offer an Action Executive action figure. One hand could be specially molded to grip his Action Executive Blackberry; the other to grip his Action Executive Enormous Genitals. Then they could sell a cowboy action figure who could sit on a fence and roll his eyes at the stupendous self-absorption of Action Executive.)

Every now and then the Barefoot Contessa gets around to a show where she says something like "I know my friend is having a hard day, so I thought I'd make him dinner." His "hard day" happens to consist of having to deliver two orders for cut flowers, which doesn't seem all that hard to me. Why doesn't she have friends who have hard days on the order of working a twelve-hour shift in a steel mill? Because there aren't any steel mills in the Hamptons, I guess. The Hamptons must be wildly posh if delivering two batches of flowers counts as a hard day. Heaven forbid anyone should stub their toe; the whole fricking neighborhood would show up with hot dishes to console the poor bastard. How come Ina Garten doesn't cook for me when I'm having a hard day, such as Day Four of a brutal five-day chemotherapy course? Huh?? How about some home-made macaroni and cheese for me, huh? Oh, never mind; she'd just put arthropods in it and ruin it for me anyway.

Or the commercials that depict ordinary things as tasks of almost insuperable difficulty; I always like those. The woman who collapses in exhaustion after peeling three and a half potatoes. Nobody is saying that peeling potatoes is fun, but gee whiz, lady, if peeling three and a half potatoes pushes you to the breaking point, you may need to toughen up just a bit. Or the woman who has a conniption fit because the strain of taking one birth control pill a day crushes her soul and causes the sound track of her life to warble. The poor dear. What if she had to take two pills a day, or flush her central venous line once a day? Is brushing her teeth once a day too much for her too? If so, maybe they should invent a ring that goes in her mouth and bleaches her teeth.

I saw an infomercial for some make-up product called "Meaningful Beauty." What the hell does that mean? Does that mean that all this time we've been pursuing Meaningless Beauty? And what exactly does a "beauty consultant" do? Sit at a desk and look at photographs of things and decide if they're beautiful or not? "Landfill? Not beautiful. Snow-covered mountains? Beautiful. New Jersey? Iffy either way." How does one get that gig?

Last night I watched Good Eats and actually saw Alton Brown use an old-style oil can to squirt some olive oil into a pan. That's just a tad too precious, even for me. He always makes a tedious amateur thespian production out of his rants about uni-taskers, but there he is putting olive oil in a goddamned oil pump can, which is a uni-tasker if I've ever seen one (unless he puts a little thirty-weight in the same can to oil bike chains and the Tin Man when I'm not watching, which I doubt).

Oh, look, another cooking show with the "elite dinner party" theme, showing all these elite stylish people eating elite stylish food and drinking elite stylish wine while the host holds forth on the elite stylishness of the stuff he cooked. How come they never do cooking shows about a bunch of people eating chili dogs while watching a rodeo on TV? Because there aren't any rodeos in Beverly Hills, Napa Valley, or the Hamptons, I guess - let alone chili dogs. The elite food police have special equipment that can detect the characteristic sound of cans of chili being opened, and then they break down your door and send you to a food re-education camp until you admit that, yes, truffle oil really is next to Godliness.

I think my blood sugar must be low. Time to go get out the oil can, some arthropods, and the magical TV food processor and make breakfast, because delivering all these flowers is really going to hurt.

More Chemo

The results of my most recent PET scan are in, and they are mixed. I still have two active, cancerous nodes. One is less active than the last time; one is slightly more active than the last time. Not larger - they're all much smaller than they were. But active.

My doctors believe that it would be best to have more chemo before the transplant attempt; they want the cancerous nodes as dead as possible before swinging the Big Hammer at them. Fair enough, but it seems somehow predictable that just as I was starting to feel pretty good I'd have to go back under chemo. (Various people use various words to describe this. Some "take" chemo. Some are "on" chemo. Some "do" chemo. For me, "under" chemo seems the most accurate, capturing as it does the sense of having something heavy weighing one down.)

I don't know which sort of chemo yet. Surely not ABVD, since I already did that. I hope not ESHAP, which has proven in my case to be pretty effective but also pretty destructive. It takes me weeks to get over ESHAP in any meaningful way, and I'm not looking forward to losing all the strength I've gained back to another round of ESHAP. But I'm not a doctor, and if they think ESHAP is best, well, I guess that's what we'll do. But I don't have to be happy about it.

Last evening the neighbor's miniature dachshund ran away from home. As a small dog like that would be little more than a snack to the area coyotes, we turned out to help in the search. I wandered around out in the desert with a large flashlight for a meaningfully long time before I got tired, and even then, I didn't get mortally tired, I just sort of ran out of juice. It was nice to be able to do that, and to know that even though I could wear myself out, I wasn't pushing the edge of passing out. But now I'll have to do more ESHAP and I'll be right back in the same boat, bedbound and so weak that a walk to the water cooler is more work than I can manage.

Oh well. One does as one must.

PS: After everyone had given up the search, the little dog came home on his own, thirsty and dusty from his big adventure but unharmed.

Contrast Medium

I had my PET scan last week. It was actually a combined PET/CT scan, now my third. They want you to drink contrast medium to help visualize the intestines, and you actually have to drink quite a bit of it. They say "two cups" but the cups are the size of McDonalds milk shakes, so when you're trying to get the second one down, it feels more like two quarts.

My old oncology clinic made me drink this nasty white stuff that had about the consistency of 90 weight gear oil. At first the light blueberry flavor tastes pretty good, but the stuff is slimy and nasty and in the end the blueberry flavor becomes unpleasant. It takes some work to chug that stuff down, and it isn't always inclined to stay down, if you know what I mean.

The stuff at the hospital is different. It looks like, and for all the world tastes like, extremely weak strawberry-flavored Koolaid. It's easier to drink that the gooey stuff from the oncology clinic, but much messier on its way out of my system. Machs nichts, I guess - it's all ugly, just ugly in different ways.

My wife tells the story of when she and the kids were driving through South Dakota looking for the Badlands and they stopped to ask a highway department employee where the Badlands were. "Lady, it's all bad land," was his laconic reply. Quite. It's all bad land; the only question is whether it's going to be bad up front or later on.

Lately I've been having troubled dreams about an ugly brown Oldsmobile 98 with no visible driver trying to run me over. I don't think you have to be Freud to figure out what that dream means, but it does highlight the fact that my body has recovered from chemo sufficiently that I can at last actually achieve REM sleep. For several weeks I couldn't sleep for more than about ten minutes at a time, and that's not hyperbole, that's the actual fact. It's difficult to get much of a dream going on in ten minutes and the REM deprivation reaches the point that you'll do anything to knock yourself out for a while, including drinking half a bottle of Old Grand Dad. At least these days I'm not half-crazed by REM deprivation. I'm just half-crazed by dreams of ugly brown Oldsmobiles.

It's all bad land.