I shouldn't complain, but...

When I write "I shouldn't complain," it means that I'm going to complain, but I want you to think I'm a reasonable person who usually knows when to hold his tongue.  Anyway, the topics of my pique are in bold.

The side effects are increasingly annoying.  My sensitivity to cold objects now lasts the entirety of the two-week treatment cycle.  The effects modulate somewhat in the last seven days, but they do not subside completely.  Right now I'm typing this in a room that's probably at 70 degrees, but my fingers are tingling and I'm making more typos than usual.

Fatigue is also an issue.  It used to begin the day after my pump was disconnected., but it now starts earlier and lasts longer.  That's a bit of a problem when trying to run a Cub Scout den meeting, soccer practice, and the game.  Fortunately, those aren't all in one day and I can usually recruit other parents to help out.

My weight is beginning to drop - I lost a pound since my last weigh-in.  Even though I try to "eat as if it's a chore," the insensitive taste buds don't allow me to enjoy much.  I'll probably drop five to ten more pounds.  If you know me, you know that I can't afford to drop weight.

It would be nice if parents brought their kids to the soccer game on time.  I ask that they get there 15 minutes early to warm up and stretch, with the unreasonable hope that all 11 players will be there at game time.  At the last game, only six players were present for kickoff (the U8s play 6v6).  This completely screws up the line-up and substitutions that I plan. 

The referee lined the players up for an equipment check.  She did that last season too and is the only ref to do so.  One of the kids, despite everything I've told them and their parents, wore his shin guards over his socks.  At least I could blame the ref when I told tell dad that his son could not participate until he was properly in uniform.  This dad also yells "KICK IT!"  whenever the ball gets near his son.  I've asked the parents to refrain from coaching, because I don't want the kids to just boot the ball aimlessly, but that is also an unreasonable hope.

We lost the last match horribly. The mercy rule (add another player at -5 goal differential) was implemented in the middle of the first half.  Adding the player didn't help.  Part of the problem is that we took our team picture an hour before the game, and the boys ran around during the waiting time and may have tired themselves out.  So, rev up the "Fire Coach 270" bandwagon again.

I just put golvs on to tyoe.  Cqan you tell?>

FOLFOX Round 5: When It Absolutely, Positively, Has To Be There... Whenever

Nothing ever goes as planned.  I went to my infusion appointment last Tuesday, as I do every other Tuesday.  But I waited a little more time in the waiting room.  When I got to the infusion room, I noticed that one patient was getting extra attention from several nurses.  Not that I'm jealous, mind you.  It's going to happen in an oncology practice that someone has an emergency from time to time that takes a lot of attention.  So I sat in the recliner and waited until one of the nurses was free to hook me up and start my infusion.  In all, I was in the oncologist's office for five hours.

When I went back two days later, to have the pump disconnected, I was supposed to get a Neulasta shot.  Unfortunately, the shipment of refrigerated drugs was sitting on the ground in Memphis.  I'm sure that the Eyjafjallajökull is taking the blame for that.  Have you noticed how the English-language new services never mention the volcano's name?  It's always "the volcano in Iceland" or  "the volcano that has disrupted air travel in Europe."  C'mon, can't anyone pronounce Eyjafjallajökull?!

On the positive side, the "Fire Coach 270" bandwagon is idling.  The U8s are now 1-1, with a +6 goal differential.  We have more wins and more goals than DC United. The last game was fun for our team, but not so much for the other.  Most of them hadn't played soccer before and they were younger than our team.  Next time we outmatch a team (if there is a next time), I'll probably institute the 3-passes-before-you shoot rule or take a player off.  I informed the other coach that she could add a player at 5-0, but she said they "weren't keeping score."  Sorry lady, the kids do keep score.

Lies, Damn Lies, and Hit Counts

I started this blog last summer, but didn't install a hit counter until January.  It measures hits from individual computers and may overestimate the number of readers as some of you read this from your work and home computers. I'm not sure how or if it counts mobile devices.  If you're reading this from an iPhone or Droid, put the phone down and drive.

Anyway, now that we've crossed 1,000 individual computers, let's take a look at you. I should mention that it's a free hit counter, so the stat reports are limited - I don't know who you are.

Where you at?
Most of you are in the United States.  You're probably looking for traffic reports or directions from Bethesda, MD to Hershey, PA and are wondering what I-270 has to do with colon cancer.  The highway and the colon are both routes with noxious, gaseous emissions.  Sometimes traffic moves quickly and sometimes not at all.  Fortunately, with the colon you get only one @$$h0le.

We have some repeat visitors from Spain (los amigos madrileños), Canada (cousins?), and the UK (other cousins?).

Among the one-time hits is someone from Denmark.  I don't know anyone in Denmark, or the rest of Scandinavia (including Finland and Iceland), but I do know Scandahoovian folks from Minnesota.

Other one-time hits have been from Australia and Slovakia, who may be former colleagues (G'day and dobre rano, respectively), and Poland.  I don't think I know anyone in Poland.

Your Gear
Most of you use PCs, probably because that's what you have at work (lots of XP users).  To those you you who have Macs supported by your IT department - luck-yyyyy.

Most of you use Internet Explorer.  Please run a virus scan immediately, then download Firefox.  For those using IE6, I have your credit card and social security numbers.

Anyway, all of you are welcome to post comments by clicking on "comments" at the bottom of each entry.. You may post as anonymous and make up a name.  Also, feel free to e-mail me.  If something is funny enough to be shared, I'll post it without your name.

Songs Of The Colon

Previously on The Local Lanes...

cowpasture said... Has this blog noted one songwriter's attempt to do for National Colorectal Cancer Awareness Month what he did for Chanukah?

The Colonscopy Song: Peter Yarrow

OK.. You asked for it.  Well, maybe all of you didn't but it's my damn blog.  Here are some clips about colons, rectums, and scopes.

Working Where the Sun Don't Shine: Bowser and Blue. I posted this one before my surgery.

The Colon is a Mighty Big River: Bowser and Blue. Schoolhouse Rock for adults.  Warning: contains actual colonoscopy images.

I Don't Like Getting Older: Robert Klein:

Bonus Comedy Track: WARNING: NOT SAFE FOR WORK OR KIDS.  Remember Billy Connolly?  Most Americans were introduced to him as Howard Hesseman's replacement in Head of the Class, you know, the savant sweathogs.  Here's his stand up routine about getting a colonoscopy.  He's Scottish, so he swears a lot and you may need a translator...

FOLFOX Round 4: Neulasta lasts an extra. extra. extra long time

My fourth round of treatment started with the usual routine: vitals, blood work, and a quick exam.  I managed to gain three pounds since my last visit, so eating all that garbage paid off.  I eat burgers, pizza, and, when the cold intolerance subsides, I scarf down a couple of Klondike bars (dark chocolate shell).  Of course it's bad for me, but I have to get my weight up so that I can lose it again.

Unlike last year's chemo, when my taste buds were very sensitive, the drugs in this round have really mucked up my taste buds.  Everything I eat tastes like the dry chicken breast that you have at corporate banquets.  Every meal I have is a disappointment because I can smell the food, just not taste it.  Mrs. 270 says that if everything tastes like cardboard, I might as well eat healthy stuff.  But then I play the weight loss card.

 

During the last treatment, when my white blood cell counts dropped, the nurse gave me a shot of Neupogen.  This time, my WBC counts are low again, so they're giving me Neulasta.  Neulasta contains the same cytokine as Neupogen, but it's mixed with polyethlyene glycol (a relative of antifreeze).  This acts as a slow-release depot for the drug, hence the "last" part of the name.  Those pharmaceutical nomenclaturists sure are clever.  The effects are supposed to last longer.  I suppose that's true for the side-effects too.

The cold intolerance is, to say the least, inconvenient.  At my house, school day breakfast for the kids usually consists of something processed and frozen (waffles or toaster strudel).  As the executive chef for breakfast, it is my duty to take these items from the freezer and put them in the toaster over.  This requires gloves and tongs.  So the next time you see someone using oven mittens to take something from the freezer, he or she may have peripheral neuropathy, not dementia.

As I was returning from treatment, I noticed that my can accrued over 100,000 miles sometime in the last two weeks.  I knew it was coming up and had plans to pull over and phone the odometer (it's a guy thing).  But I forgot and now it sits at around 100,500.  What a lost opportunity.  They should really install an alarm for this.  This is the second car I've had to reach a century of millennia.  When I was in grad school, before Toyotas were spontaneously accelerating, my Celica reached 100,000 miles.  But, the speedometer cluster had broken somewhere around 90K.  Fixing it was not a priority (back then, our stipend was roughly $12K/year), so I had to gauge my speed by the gear and the tachometer (another guy thing).  Also back then, we did not have digital cameras on our cell phones because we did not have digital cameras and we did not have cell phones.  Next time I have a car that hits 100K miles, I'm sure the car will send you all tweets.

The Un-Special One

I'm no Jose Mourinho, but I've taken on the head coaching duty for our older son's U8 team this season.  I already told you about my playing experience.  As far as coaching experience, I ain't got none.  But I do watch a lot of soccer on TV and yell at the players to pass, shoot, and defend.  And I have managed teams on internet fantasy leagues.  It's the same thing, right?

As if my car trunk doesn't have enough stuff, it's now has a big bag of soccer balls, cones, and pinnies (for the uninitiated, these are brightly colored practice vests).  Because my trunk lid could still close, I got a couple of collapsible goals for practice.

I did buy a coaching book.  Picking one was really confusing because every person who has ever coached a youth team has also written a coaching book.  First, I eliminated the ones on Dutch methods because I don't know the difference between Holland and The Netherlands.  Sure, "total vootball" may be the way to go in the long term, but all those double vowel names (Ruud van Nistelrooy, Pierre van Hooijdonk, and Antonie van Leeuwenhoek) are hard to pronounce.  Second, I eliminated the books with a three-digit number in the title (101 Great Youth Soccer Drills, 300 Soccer Drills, The 101st Airborne at Normandy - I thought that one was about French heading drills).  By the time all the kids get to practice, we barely have time to run two of the four drills I planned and I can barely keep those four in my head.  What am I going to do with 97 more?  Finally, because Borders was about to close, I picked the cheapest one.

Six of the kids from last season are returning.  This is a relief, because it took me all of last season to learn their names.  Now I only have to learn four new names.  The returning kids are an enthusiastic bunch and know the rules and the positions.  Whether or not they stay in position is another thing.

U8 kids play 6 v 6, including the goalkeeper.  So I have to figure out whether to go with a 2-2-1, a 2-1-2, a 1-2-2 (for when we're behind), or a 3-1-1 (for keeping a lead), 1-3-1, or 1-1-3..  But it's U8 soccer.  Whatever formation they start with will end up as a 5-0-0, 0-5-0, or 0-0-5.  And then I have to hope that whoever plays goalkeeper doesn't get bored and start playing Spiderman with the net.  This is the leading cause of "goals against" in U8 soccer.  I'll have to appoint a parent as goalkeeping coach, whose sole duty will be to shout "You're doing a good job. Stay on your line. Way to go!"  Praise-correction-praise. (from the coaching book).

My proudest moment last season was when our son ran into the goalpost.  It wasn't the fact that he ran into the post, but why he did it.  He was on defense and the goalkeeper, channeling his inner Fabian Barthez, had gone off to the far extremes of the penalty area.  Our son, without instruction, sprinted across the end line to cover the goal, while keeping his eyes fixed on the ball and... thunk... ran into the post.  His chest absorbed most of the collision and he popped right back up (note to self: get a first aid kit with ice-packs).  Yeah, he ran into the post, but he was doing the right thing without being told.

Oh, the league gave all coaches a handout and a 10 minute talk on concussions.  Symptoms include inability to focus on a task, unresponsiveness to simple questions, and disorientation.  In other words, typical eight year old boy behavior.

So here I go, planning practices, running drills, and trying to organize eight year old boys.  This might be the longest eight-game season ever.  But, at the end, you'll be able to read all about it in my forthcoming book Water Breaks and Post-Game Snacks: The 101 Essentials of Yoouuth Soccer. Hey Joe Doc, can I get a cover endorsement from you?

A Bottle of White, A Bottle of Red. Perhaps a Shot of Neupogen Instead

I had a shot of Neupogen to boost my low white blood cell counts.  Objecting to their declining status, a small percentage of the white cells on my right side, claiming to speak for all the white cells, formed a T (cell) Party and (1) asserted that the red blood cells did not come from my bone marrow, but from a transfusion, (2) that my therapy was determined by a cell death panel, and (3) that synapses between two cells with Y chromosomes is an abomination.

The Neupogen shot will keep my white cell, specifically neutrophil, counts up to fight obligate and opportunistic pathogens.and to stay on schedule for the next round of FOLFOX this Tuesday.  Here's a neat time lapse video * of a neutrophil ingesting Candida albicans (yeast.  No, not the beer making kind).

The Neupogen shot was administered by the English nurse.  So we talked about the upcoming World Cup and I mentioned that England would advance, but only after losing the the United States.  She gave me the evil eye and I said "I shouldn't have said that while you're holding a needle."  But she'd already given me the shot.  Next time I see her though, she might use an 8-gauge needle to inject me - in the eye.

I know the Neupogen is working because I have a backache - a common side effect.  Other, more adverse effects include splenic rupture, alveolar hemorrhage, acute respiratory distress syndrome (ARDS), and hemoptysis - Greek for "coughing up blood."  What's Greek for "Hey Angela, loan us a few billion Euros?"

*  Judith Behnsen, Priyanka Narang, Mike Hasenberg, Frank Gunzer, Ursula Bilitewski, Nina Klippel, Manfred Rohde, Matthias Brock, Axel A. Brakhage, Matthias Gunzer.  PLOS Pathogens

FOLFOX Round 3: We Are Experiencing Technical Problems

I have to undergo 12 rounds of FOLFOX in all.  If you're thinking "Hey, that sounds like a boxing match," you're right.  Boxing, for those most of you under 30, is how trained professionals beat each other senseless before there was mixed martial arts.  Unlike MMA, a boxing match does not happen in a cage.  I suspect MMA uses cages because all the fighters look like criminals.  Have you seen these guys?  A bunch of tattooed skinheads beating each other up. Sounds like English soccer fans.  Umm.... where was I?

Oh yeah, the hyper-extended boxing analogy.  In the first few rounds of this bout, you take a few punches, but it's not that bad and you recover quickly between rounds.  It's the stage where you're feeling out your opponent.  In the later rounds, your opponent learns your weaknesses and gets more aggressive.  You take more blows and take longer to recover.  In the final rounds, your opponent is going for the knockout.  You get knocked down each round and need a standing eight count.  In the end, you've endured 12 rounds against a tough opponent, you've taken all of his punches, but delivered none of your own.  You got knocked down but you get up again.  Somehow, beyond all reason, the judges declare you the winner on points.  See, like boxing, the match is fixed.

So the round started the usual way, three hours in the infusion room.  No problems with the port this time, the blood return was pretty good.  My blood cell counts were on the low end of normal last week.  This week they're beginning to drop out of the normal range.  So my oncologist wants to keep an eye on them, to see whether I need corrective action.  That means shots of Neupogen or Neulasta (G-CSF or pegylated G-CSF respectively).  Maybe, if my red cell counts drop too, I'll get erythropoietin (Epo) and compete in the Tour de France this summer.

Tingly fingers started pretty quickly and even a cold-ish room is enough to precipitate this side effect.  Although the weather warmed up, the ground is still cold and so are the water pipes.  So I need to remember to let the tap run for a while on warm before touching the water.  Or, I could stop washing my hands and showering.

This round came with technical problems.  The 5-FU continuous infusion pump is supposed to run about 48 hours.  So, when I left the doctor's office on Tuesday afternoon, I expected to return on Thursday afternoon for the pump to be disconnected.  Well, Wednesday night, at 11:30, the pump alarm signaled that the reservoir was empty.  So, I got up and took the batteries out of the pump (the nurses lock out the controls) to silence the thing.  I went to the office on Thursday morning to figure out whether (1) I didn't get enough volume to begin with or (2) the flow rate was faster than usual.  Either would account for the early empty signal.  Turns out that the reason was (3) a buggy pump.  The reservoir was not empty, but the silicon brain thought it was - it must be running Windows XP. So the nurse reset the pump to deliver the rest of the dose and I returned at 5 PM, when the reservoir was really empty, to have it disconnected. I suspect that the real reason for all of this is that the nurses wanted to see me twice in one day.

FOLFOX Round 2: I Am Such An Idiot

The second chemo treatment didn't start too well.  My port seemed to be clogged and the nurse couldn't get any blood return.  After three syringefuls of the anti-coagulant heparin and having me sit completely still and quiet, she worked it loose.  I suggested drano, but she didn't think it was a good idea.  I've never had trouble with the port before and hope it's a one-time thing.

I am such an idiot.
Before this set of treatments, my oncologist warned me about the cold sensitivity side effect of oxaliplatin, with which I would get a strong tingling sensation if i touch or eat something cold.  The next week, during a chemo-education session, the physician's assistant repeated the warning.  At the first chemo session, the nurse reinforced the lesson when she connected the iv bags and another nurse repeated it when she disconnected them.  By the third and fourth time, although I politely listened, i was thinking Yeah, yeah.  I know this stuff.  Well, Mr. I-know-this-stuff completely forgot the lesson two weeks later.  On the night of the second treatment, I took our younger son out for ice cream.

When I realized what a dope I was, I decided to experiment.  After all, I already paid for it (literally and figuratively with a frozen throat), so why not do some science.  It turns out that with the first spoonful, I felt nothing.  With the second, I felt a little tingling and the sides of my tongue were starting to freeze.  With the third spoonful, my tongue felt very frozen and I couldn't eat any more.  After waiting about two minutes, the sensitivity was gone and the three-spoon cycle reset.  So there you go: Effects of Cold Stone Creamery's Berry, Berry, Berry Good Flavor on a Patient with Oxaliplatin-Induced Peripheral Neuropathy is submitted for publication.  By the way, since when did going out for ice cream become an "experience," where the creamwright behind the counter kneads your ice cream and additions on a cold marble stone?  Whatever happened to just scooping the ice cream out, giving it to the customer, and charging a reasonable price?

Anyway, the cold sensitivity lasted longer this time.  As late as Friday I had trouble drinking cool water.  Then, on Saturday, the fatigue crept in on little cat feet.

Soccer note: Our older son is now playing FIFA 10 and proving that DC United can win with last year's roster.  Jaime, Gomez, and Emilio are scoring in bundles.  When he plays as the US National Team, even Jay DeMerit gets in on the scoring.

March Madness

Madness:Pronunciation: \ˈmad-nəs\.  Function: noun

1: the quality or state of being mad: as a : rage b : insanity c : extreme folly d : ecstasy, enthusiasm.
2: skipping your colonoscopy.

March is Colon Cancer Awareness month.  I will repeat my request for you to get your colonoscopy* over with.  If you are under 40, tell your parents to get the procedure.

Look.  This is not hard.  You have to "prep" the day before, meaning that you forgo solid food and drink a laxative that induces diarrhea.  If you've ever had food poisoning or an intestinal virus (a.k.a. the cruise ship trots), then you've had far worse diarrhea than you will with the prep.  The day of the procedure, you show up, have an i.v. inserted, make butt jokes with the nurses, make drug jokes with the anesthesiologist, fall asleep, and then wake up later.  That's all there is.  You don't see the camera going up your butt and you certainly don't feel anything.  You can reward yourself with a big lunch afterward.  Consider it a diet holiday and eat heartily.

Are you afraid of what they'll find?  In the overwhelming majority of cases they find nothing.  I know what you're thinking, "But they found something in you."  Truthfully, there's an extremely small chance that they'll find something.  But it's better to find out early, when you have no symptoms, than later, when you're in pain and bleeding.  Polyps in the early stage can be clipped right then and there.  Look, here are the survival rates at five years after diagnosis.  The numbers are from multiple sources, hence the range.

Stage 0: ~100% (pre-cancerous polyps)
Stage 1: up to 95%
Stage 2: ~80%
Stage 3: 40-65%
Stage 4: 8%

What are you waiting for? Get off your ass and have it looked at.


*  I know the guidelines recommend colonoscopies for those over 50, not 40, but I can't be impartial because I'm 43, younger than the recommended age.  Talk to your doctor as there are other screening options.