Zen Radiology: What Is The Ultrasound of One Hand Clapping

I haven't had anything to report and things are still "normal."  But I recently had an experience that was worthy of blogging.  All of the events are true.  Some are slightly embellished to make a better story.

One of my friends warned me about this shortly after I started radiation and chemotherapy in the summer of 2009.  "When you've had cancer," she told me, "any slight abnormality in a test and they'll strip you, throw you on a cold table, and probe you like an alien abduction."

After Thanksgiving, I went in for one of my every-three-months routine follow-up with my oncologist.  I describe these checkups as a social visit with a blood draw because, after the phlebotomist has taken two or three tubes of vampire juice, I see the oncodoc and we spend more time talking about non-medical issues.  My oncodoc did his clinical fellowship at NIH, where I did my research fellowship, so we're fellow alumni - but without the booster club, Saturday tailgates, and phone solicitations for donations. 

Everything at this visit went well and, after we talked about my recent family vacation, I walked down the hall to the infusion room to say "Hello" to the wonderful nurses.  I'm always happy to see them as I have fond memories of my time in the recliner with an i.v. dripping poison into me - seriously.  Despite the reason I was there, it was a very tranquil place for me.  The nurses create a cozy, comfortable setting for patients.  I'm sure they're pleased to see me and other chemotherapy "graduates" too because we are the fruit of their labors.

So anyway, a few days after the appointment, I'm at Home Depot and I get a call from the onco-office.  Some people might answer the phone with trepidation, but I wasn't worried.  I didn't have a scan or a CEA test, so they couldn't tell me that I had a recurrence.  Well, it could have been their billing department, calling to tell me that the insurance company denied some claims and that I owed them $200,000.  So maybe I should have been afraid.

But it was the onconurse calling.  "The Doctor saw the results of your blood tests and the liver test can back a little above the normal range.  It's probably nothing, but he wants you to have an upper abdominal ultrasound."

Now, had I been a regular patient - well, I wouldn't have been in the oncologist's office if I were a regular patient, but just play along - but had I been a regular patient, the Dr would have said, "Come back in three months and we'll do another blood test.  If it's still high we'll do an ultrasound."  But, because I'm not a regular patient, oncodoc ordered an ultrasound immediately.

One of the blood tests detects levels of alkaline phosphatase (AP).  Yes, that alkaline phosphatase that is linked to antibodies and other molecules and is used in diagnostics and research assays.  Come to think of it, that's probably bacterial AP in those assays, not human.  Anyway,  in humans AP is made by the liver, specifically, the cells that line the bile ducts.  High levels of AP levels may indicate bile duct obstruction.  An image of the liver will let the radiologist and oncologist know whether anything is blocking the ducts.

If you've been pregnant, or have accompanied a pregnant woman to the OB-GYN's office for an ultrasound/sonogram, you know that the poor woman has to drink a lot of water and lie on a table while the pressure of the baby pushes down on her engorged bladder and she's holding back tears and other fluids to get a blurry black-and-white image of something that's going in the scrapbook that only she and her mother will ever look at.  I write that in order to say that my experience was not at all like that.

I could not eat or drink for six hours before the ultrasound.  Now the appointment was at 11AM.  That means nothing after 5AM. That practically means no food between dinner the night before and the end of the ultrasound.  If you know me, you know that 16 hours without eating is impossible.  So I was up before 5 AM to eat breakfast.  Actually, I finished breakfast at 5:30, half an hour after the no-eat deadline.

"Don't tell me the sex of the baby," I said to the ultrasoundologist, "I want to be surprised."  She gave me a muted giggle.  Either she had no sense of humor or she's heard that joke 10 times a day from men since she started her job.  I prefer to think it's the former.

"When was the last time you ate?" she asked.
"About 4:30 this morning," I lied.  I wasn't about to give the the chance to say that she couldn't do the test today and that I'd have to come back another time.

I had to lie on my side, with my arm over my head (out of the ultrasoundologist's way).  She grabbed a bottle that looked like a white version of the cheap squeezable ketchup bottle you see at a hot-dog stand - you know, the red one with the conical nozzle - and squirted a bunch of room-temperature lube on my stomach.  She then had me inhale and exhale at various times while jamming the blunt probe into my abdomen as if she were trying to image my spine. "Take that for your stupid, unoriginal joke!"

Later, when I tell this story, I'll say that I spent the morning in a dimly lit room with a woman who rubbed lube all over me.

The prodding went on for about 10 minutes with the occasional replenishment of lube.  When she was finished, she kindly handed me one paper towel to clean up.  I put my shirt on, somehow managing to track the remaining lube all over my back and neck,  I had planned to go to work after the ultrasound, but I had to go home and shower.  Who wants to go to work smelling of K-Y?

A day later, the onconurse called to say that everything was normal.

Going to California

 Standin' on a hill in the mountain of dreams
Tellin' myself it's not as hard, hard, hard as it seems

This isn't a health update, but this is sort of cancer related.  I told you before about how the kids missed out on summer vacations the last two years because I was in chemotherapy and generally feeling awful.  Instead, we compensated by taking short trips to Seven Springs, PA and Williamsburg, VA.  However, this December I had a chance to make up for that when I attended a work-related conference in Los Cabos, Mexico, at the tippy tip tip of Baja California.  The family came along, getting their long overdue "summer vacation."


View Larger Map

Test Results

Medi-port/Port-a-cath

I neglected to tell you the results of the aforementioned scan.  Just to keep you in suspense, I'll mention something else first.

My port, the bionic vein, was removed last week because I don't need it anymore.  This was the device through which the chemotherapy was infused.  I call it "bionic," but it didn't give me any superhuman powers, except, maybe, the ability to easily take i.v. drugs: Higher than a bird, higher than a plane, shakier than the San Andreas fault, it's JunkieMan!

I also had a doctor's appointment, the first one in over six weeks.  I haven't gone that long without an appointment in a year.  He went over the results of my recent CT scan and blood tests.

Here's where I delay again, to build more suspense.  The U9 soccer team is doing well through three games.  We're 2-0-1 (14 GF, 7 GA).  That's 7 points, and if we were in the World Cup, we would have won our group and moved to the round of 16.

Where was I?  Oh yeah, test results.

CT scan?  Clear
CEA levels? Normal

El Oncologistador hasn't made an official proclamation or given me a certificate or anything, but I'll go ahead and say it:

Re-Mission Accomplished

Bari-yummm!

Barium (Ba, atomic number 56).  It is used as an insoluble heavy mud-like paste when drilling oil wells. Soluble barium compounds are poisonous due to release of the soluble barium ion, and have been used as rodenticides.  When heated with nitrogen and carbon, it forms the cyanide. (Source: Wikipedia)

What the f***?  We're supposed to drink this?

No.  I'm not Readi.

As you may have guessed, I have a CT scan coming up and have to drink barium sulfate (BaSO4) to provide contrast in my gastrointestinal tract. Some call it a "smoothie" while others call it a "shake."  It's not smooth and nothing like a milkshake, but one does have to shake it to suspend the gritty BaSO4.  I have to down one of these (450 mL) the night before the scan, another the morning of, and then some more at the radiology center right before the scan.

If you've ever had to drink this sludge, you know how awful it tastes (watch Becca).  Those clever makers of barium sludgies regularly come up with new flavors to make us think that this crap is palatable.  They've got a bunch of fruit flavors, like strawberry, citrus, and banana (that's why Dan does this).  The bottom line is, no amount of artificial flavoring will make you say "Bari-yummm!"  To .make a palatable, even delicious barium drink, we need the most creative culinary minds in America - a Top Chef Challenge!

Top Chef challenge: Create new flavors for barium drinks.

Barium Depth Charge

• Barium Depth Charge (Boilermaker): Drop a shot of BaSO4 into a glass of beer (a shot glass doesn't hold much, so you'll have to repeat this - a lot).
• Bari-Tini: Add gin and dry vermouth.  Shake and garnish with an olive.
• BariRum and Coke: Do I really have to describe this?
• Bari-shnikov: Add Russian vodka.  Stir by doing pirouettes.
• Bari-sta: Steam the BaSO4 and add a shot of expresso. Only comes in venti.
• Big Sandy: Add Kentucky bourbon.
• Strawbari Letter 23: Strawberry flavored with a funky base and served in a Johnson Brothers china cup to people over 40 (too obscure?).
• Bari Bonds: Add "nutritional supplements" from BALCO, then deny drinking it.
• Marion Barium: Add crushed marionberries, serve in a cracked glass set up by a bitch.

BariRum and Coke

Big Sandy

 

I Lampoon Our "European" Vacation

One of the things that frustrates me about these past 13 months is that the family didn't get a fun, summer getaway because I was undergoing treatment.  I realize that I can't do anything about that and that getting treatment trumps other considerations, but it was still annoying.  We did, however, manage to squeeze in a five-day trip before school started.  Anyway, I won't write an entry for each day, just a synopsis of our trip to Virginia and "Europe." No, not the Europe in Europe, nor the Europe in Orlando, FL.  We went to Busch Gardens Europe in Williamsburg, VA, where roller coasters and other rides are set amidst European scenes, like fake castles and fake marketplaces.

The first thing that made it feel like going to Europe was the long trip down I-95 in rush-hour Friday traffic.  A movie and free alcohol would have made the experience more authentic, but at least we avoided the security line at Dulles.  We were joined, for part of our stay, by brother-of-270 and his family.  Their flight from Florida was shorter than our drive.

The five flags of Europe

So, unencumbered by passports or Schengen visas, we headed to Europe.  To quote Donald Rumsfeld, this is Old Europe.  The only representatives were the United Kingdom, Ireland, Germany, France, and Italy; no Baltic states, former SSRs or former Yugoslav Republics.  Fortunately for los amigos madrileños, Spain was not represented.  I write "fortunately," because that's four amigos and 45 million others who won't be pissed off at Anheuser Busch for trivializing their country. Here's a brief look at selected "countries" and other notable items.

• United Kingdom (Lite):  This UK was missing Wales and Northern Ireland, but who, other than me, is counting.  Hooligan Chase would be a good, soccer-themed, thrill ride here.  We didn't do much in the UK, except get on a ride that takes you away to France.
• France:  The big thrill ride here, The Griffon,  was out of order when I tried to get on.  It really was out of service, not a usual French strike.  By the time I returned, it was in service but the wait was 45 minutes.  So I skipped it.  Our main attraction here was the all-you-can-eat buffet that featured traditional French dishes such as southern-fried chicken, hot dogs, and macaroni and cheese.  None of that coq au vin or escargot.  France was adjacent to another area of the park, titled "New France."  If you're wondering what "New France" is, it's Canada, complete with a trading post for north woods tschotkes.  France my derriere!
• Italy:.  Unlike the real Italy, no-one in BG's version smoked or rode scooters.  Now that would be a good ride, Bumper Vespas.  We did ride Escape from Pompeii, a water ride in which your boat floats past collapsing columns and statues, propane volcanoes, and finally, down a flume where you are splashed.  I told my kids that it's just like Indiana Jones, the world's worst archeologist.  Every time he enters an ancient temple, it crumbles to dust.  Anyway, Italy was the site of the only roller coaster that I went on (alone), Apollo's Chariot.  This was one of the few rides that made some sense.  If you remember your Roman mythology (which they plagiarized from the Greeks), you know the story of Apollo's son who took his dad's chariot without permission and went careening across the skies.  The roller coaster was sort of like that, in 45 seconds and with more screaming.
  
• Germany:  Here we took a ride through Dark Kastle, a house occupied by 3-D werewolves, which scared the kids.  Then we ate at Festhaus, where dancers danced to traditional German polka and oom-pah Musik.  What authentic German fare did we eat?  Pizza.
• Consistent (?!) with the European theme was a Jack Hanna exhibit with North American grey wolves and North American bald eagles.  This must be the NATO part of Europe.
• Gastarbeiters.  Translated as guest workers, this is the German term for foreign labor.  Except that they stayed in Germany, fought for citizenship, and their children now play for the German national soccer team.  BG (and the rest of Williamsburg) is filled with young people, mainly from Eastern Europe, with summer work permits.  This makes some sense.  If you're going to risk your life on a roller coaster, it's good to know that the people at the controls are good in physics and engineering.
  
• Shopping:  Who are these people who travel to a fake Europe and then spend thousands of dollars for a German cuckoo clock?  If they have that kind of cash, why not travel to the real Germany?  Seriously, "Germany" contains a cuckoo clock store.  Sadly, there is no German beer store, because this is BUSCH Gardens.

Donald or Douglas takes passengers around the Island of Sodor

Dum Dum.  You give me gum gum

Once you leave Busch Gardens and are back in American Williamsburg, you may visit President's Park.  A collection of giant busts of the 42 American Presidents, prior to Barack Obama, in one small park.  Obama is currently represented by a life-sized bust in the visitor center.  I don't know if this is because the sculptors are working on the giant Obama bust or if this is Virginia being Virginia.  Anyway, this place is America's Easter Island.  Presidential first name trivia:

• 6 named James (Madison, Monroe, Polk, Buchanan, Garfield, Carter).
• 5 named John (Adams, Q Adams, Tyler, Coolidge, Kennedy)
• 4 named William (H Harrison, McKinley, Taft, Clinton)
• 3 named George (Washington, HW Bush, W Bush)
• 2 named Andrew (Jackson, Johnson), Franklin (Pierce, Roosevelt), and Thomas (Jefferson, W Wilson)

Williamsburg Arsenal FC

Colonial Williamsburg:  OK, pretty much all of you know about this 18th century colonial village, one of several cradles of the American Revolution - at least the only one that charges you $36 to get in.  Williamsburg craftsmen use techniques of the period to make bricks, silver items, wool yarn, and ummm... funny hats.  Williamsburg actors portray revolutionary war-era events such as a protest of the new taxes in the Stamp Act, which is ironic because the food and beverage tax in Williamsburg is 10 FREAKIN' PERCENT!  With all that history around them, what did the boys enjoy most?  Guns from the gift shop.  My little Americans.

Water Country USA:  The last day of the trip turned out to be the most exciting.  The boys, who eschewed anything that looked like or was next to a roller coaster in BG, eagerly went down water slides.

After that, it was back on I-95 for the quick return trip home with the mandatory stop at Cracker Barrel.  Country fried steak, can't get that in any Europe.

Where Do We Go From Here?

These patient-written cancer blogs have two ways of ending  Too often, a sad entry is written by the patient's family member.  Otherwise the writer has moved on, trying to resume a somewhat normal life, and writes less frequently.  Maybe, someday, Mrs. 270 will write that I died celebrating my future grandson's goal in the 2046 World Cup, or future granddaughter's in 2047 (the other grandchildren will be a successful too, however, one must maintain some sense of decorum at the awards ceremonies in Stockholm and Oslo).

The alternative to ending this is to go on with mindless prattle about everyday things.

Today the boys got ready for school on time, without my yelling at them.  After I dropped them off, as I was driving to work, some idiot in a 7-series BMW cut me off. So I flipped him off.  Then he turned in to my office's parking lot.  I didn't know that our director drove a 7-series BMW.

But I'm not sure that I care to do that or that you would care to read it.  Rather than write for the sake of writing, I'll keep you up to date on scans, tests, etc.  So blog entries will decrease (as if they could possibly be fewer).

Before the blog entries get fewer and further between, I would like to thank all of you for your emotional and practical support. It has lifted our spirits to know that you care enough to read this and send us good wishes.

Your Vote Is Needed To Fulfill a Dream

In many countries, people are denied opportunities to fulfill their dreams because of war, poverty, malnutrition, or lack of education.  This is the story of Tim (his real name). Tim lives in Gainesville, Fl, in a hovel (by Beverly Hills standards).  His annual income is a tiny fraction of a Wall Street CEO's bonus.  Tim's dream, like that of so many men with a mid-life crisis, is to perform with his rock band in front of thousands of drunken, screaming chicks with full-sleeve tattoos and body piercings.  But Tim cannot fulfill this dream because his band does not have enough votes on an internet contest to open for KISS in Raleigh, NC.

Rodin's Kiss

Rockin KISS

Tim's band, The Sevilles, is known in North Florida for college-crowd pleasing songs such as "Mary Jane," "Riding the 8-Ball," and  "Highway 69."  As a good Catholic boy, Tim must be singing about a pious girl, a game of billiards, and  the unfinished rote from Michigan to Texas.  And "Highway 69" will one day form a triumvirate of road songs with "Route 66" and Highway 61 Revisited."

Tim and his Flying V

Tim sings and plays a Gibson flying V, which he slings low on his hip as if he's in his 20's.  He will soon develop carpal tunnel syndrome in his left hand from this.  If he had access to proper health care, an orthopedist would advise him to play the more ergonomic Les Paul and wear it higher.

Tim is getting older (much, much older - really, he's so much older than I am) and may not have more chances to reach his goal before he loses his hearing. Please help him and The Sevilles by voting at the website below. Just a minute of your time could help this aging rocker achieve his dream.  If they win, not only does get the opening gig, but Tim will wear make-up like Gene Simmons. That's on top of the lipstick and mascara that he puts on each morning.


How to Vote:
Go to this absurdly long URL
Select USA
Enter the Zip Code 27601
Fill out the fields: Gender, Birth year, e-mail address.
Enter the security code that's shown
Uncheck the "Receive Special Offers" box
Click Continue



(You're welcome, Tim)

FOLFOX Round 12: "I hold in my hand the last envelope."

Remember Johnny Carson's Karnac the Magnificent sketches and how the crowd would applaud in mock relief when Ed McMahon gave Johnny the last envelope with the corny set-up to the punchline?  Well, that's sort of what I feel like (relief, not corny).

So this is it.  The last FOLFOX treatment.  I may be done with chemo, but it's not done with me.  My fingers and toes are still numb and my taste buds are still not functioning properly.  The side effects will fade over the next four weeks and, I hope, none will become permanent.  Do I celebrate?  Not really, I'm too tired and no food tastes good to me. In a few weeks, when I have my energy and taste back, I may go out for a ribeye and a beer.  In the meantime, everyone else should have a drink and some cake to celebrate. - and strippers.  Everyone should have strippers in the kitchen.  What?  They're  good for getting the leaves off sprigs of rosemary and thyme.  Rosemary and Thyme aren't good stripper names, like Ginger and Cumin.

Where was I?  Oh yeah, If you recall, the whole thing started on July 22, 2009, when I was diagnosed with an adenocarcinoma of the rectum.  It's been a bumpy ride since then.

28 radiation treatments
12 FOLFOX treatments
two colonoscopies
two PET scans
two CT scans
too many digital rectal exams
one major surgery
one unnecessary trip to the ER
lots of percoset and oxycontin
one really sweet morphine drip
one episode of Ativan-induced hallucination

eight (at least) oncology nurses
four oncologists (primary, radiation, consulting, cousin-in-law)
four anesthesiologists
three primary care physicians (my regular doc is usually on vacation when I need an appointment)
three physician's assistants
three surgery residents
three radiologists (two for the scans, one is a college friend)
two radiation technologists
two gastroenterologists
too many phlebotomists
one surgeon (you really don't want more than one person knifing around down there)
one ER physician
A whole bunch of other medical personnel who have seen me naked from the waist down

Thousands of blog hits
Dozens of supporters
Several readers, co-workers, friends, and relatives who scheduled colonoscopies (and some who still need to do that)
A few new comrades also in the fight
One who succumbed

The number  I'm looking forward to now is zero, as in zero spots on the next CT scan.

FOLFOX Round 11: I'm Running Out Of Subtitles

I just realized that I haven't posted anything about Round 11, which was two weeks ago.  There's nothing much to write about it.  I was taken of Emend (one of the anti-emetics).  The protocol is an infusion of Emend on day 1, followed by Emend tablets on days 2 and 3.  However, in about week four, I forgot to take the Emend tablets and, since I wasn't nauseous, I decided to stay off them.  The fewer drugs, the better is my creed - unless we're talking about narcotics.

In treatments 5-10, the nurses have asked if I had my Emend prescription.  I told them each time that I do, but I don't take it.  Finally, in week 11, one of the nurses figured that since I've been breaking protocol for months, she would take me off the d1 Emend infusion.  Fine with me, if that and the associated steroids are eliminated, it cuts an hour off the infusion time.  I really don't want to spend more time than necessary in the infusion room.

No new side effects to add.  I have the same old problems, they just last longer.  I had figured to lose my fine motor skills, but I didn't.  I'm still able to button my shirts, even those ridiculously tiny buttons on the collar,and I was able to build this:

LEGO Droid Trifighter

I haven't tried to tie my shoes lately, because I wear sandals to go out of the house.  It's 100 freakin' degrees out, I'm not wearing tennis shoes or Adidas Sambas, and I'm certainly not wearing these, not matter what Clint Dempsey says.

Yours for the low, low price of $339.99.

Whatever happened to black soccer boots anyway.  These days, the stars are wearing yellow, orange, and lime green ones.  If you're going to wear fancy-schmancy shoes, you'd better score lots of goals.  Hear that, Messrs. Rooney, Ronaldo, and Messi?

FOLFOX Round 10: Absolutely nothing to report.

Just the usual fatigue, numbness, lack of taste, and loss of appetite.

And now for something completely different.

Have you noticed that "Next Blog" link on the top of the page.  According to Blogspot,

The new and improved Next Blog link will now take you to a blog with similar content, in a language that you understand.

OK.  So I start on this blog and click Next Blog.  Of twenty attempts, here's what I get:

GREEN MAGAZINE: green lifestyle news.  If you want to "Go Green," turn off your freakin' computer.
Wednesday whining. To confuse you, none of the recent posts were done on a Wednesday.
Le Carnet d'Eledraël I don't know what the hell this is.
Mattye Lee's Raw Progression A "raw vegan" finds spiritual enlightenment in her journey through uncooked herbivorism.
Blogger: Blog not found and Blogger: Permission denied. Apparently there is a Bermuda Triangle for blogs.. 
Kathy - mom of many: A Christian mom of 10 children.  She makes sure to point out that she is neither Catholic nor Mormon.  I wonder if Kathy's last name is Koresh.
Radical. Rational. Juiceing [sic] and Feasting. Experiment.  Another health nut who "regularly detoxes."  If you call her, don't expect her to answer. She's in the bathroom.
Blog 324.  This is like Blog365 with 41 vacation days.

I also hit two family blogs , a few "what's on my mind at the moment" blogs (most of these folks should stick to twitter), two cancer blogs, and some weight-loss blogs.

Notice anything wrong here? Correct.  The "similar content" claim is, to quote Click (or is it Clack?) boh-oh-oh-oh-oh-oh-gus Only two cancer blogs, no soccer blogs, and no traffic reports.  As far as "a language you understand, I don't understand anything about Eldrael's car net. What's that about? Does the paint flake of into his food?

So either Blogspot is lying about this feature or I'm really a whining, tree-hugging Christian vegan with a très français vacation schedule.