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Girl, you have no faith in medicine

Dear Big Pharma,

It’s time to talk. We’ve known each other for so long. Yes, I hang around with Supplements sometimes, and cruise the natural food store, and spend time eyeing better diets. I even exercise. But you are always there when I need a dependable helper.

Lately, though, you’ve been coming on strong, and I don’t like it. You’re pushing your way into every corner of my life. It’s embarrassing to see you lying around the house everywhere—with your gaudy orange outfits—whenever visitors come over.

You’re unreliable. You say you’ll do one thing, and you do another. You fix something over here, but make a mess of things over there. You follow me to work, in my car, on hikes, at every meal. I schedule my time around you. I wake up and go to sleep with you.

You need to back off and give me space—give us space. I don’t care what your friends say, let’s slow it down.

Your friend,

Michael

Pictured:
Zofran: Nausea
Compazine: Nausea
Edibles: Nausea
Lipitor: Cholesterol 
Chewable baby aspirin (yum!): So I don’t have a heart attack
Metoprolol: Blood pressure
Creon: Mealtime pancreatic enzymes
Oxy: For pancreatitis pain
Naloxone: For when I overdose on Oxy
Flagyl: Antibiotic
Cipro: Antibiotic
Lamictal: Epilepsy
Docusate: Constipation
MiraLax: Constipation
Imodium: Diarrhea (Make up your mind.)

Every day:
Creon: Pancreatic enzymes with every meal
Lamictal: For epilepsy
Metoprolol: For blood pressure (for the time being)

As needed during a chemo cycle:
Zofran: Nausea
Compazine: Nausea
Edibles: Nausea
Docusate: Constipation
MiraLax: Constipation
Imodium: Diarrhea
Tylenol/Ibuprofen

[Girl, you have no faith in medicine, White Stripes]

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Changes

Great Pumpkin, we hardly knew you. But we’re kicking you to the curb!

Because of the Heart Issues, The Oncologist is switching me to “non-cardiotoxic” drugs, even though my heart seems to be in tiptop shape. The concern, The Oncologist says, is that one of the former chemo drugs, 5-fluorouracil, was causing vasospasms, which can mimic a heart attack, and also cause a heart attack. She is solidly in the anti-heart attack camp.

So, the new chemo regimen switches from every other week to three weeks on-one week off. Downside: more chemo cycles, of course. Pluses: No Great Pumpkin and a regimen that is supposedly better tolerated.

In the meantime, cardiologist Dr. Brian is still convinced that something might be amiss with the heart-lung ecosystem, so we get yet another CT Scan tomorrow (I’ve lost track how many I’ve had) to check for a blood clot in the lung. I expect/hope/pray they find nothing.

Onward.

[Changes, by Charles Bradley (you were expecting Bowie, weren’t you?)]

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F*ck You

[Why I hate the pancreas and you should too.]

The pancreas is the crybaby of organs.

Take its neighbor the liver, for instance. You can beat the hell out of the liver (“Bottoms up!”), but if you ask for forgiveness early enough and pinky swear to be nice, it will sometimes give you a do-over and actually regenerate its own cells. How polite is that?

Colon cancer is bad, but you can detect it early, and it progresses slowly (good), and they can cut out a chunk of your six-foot long intestine and you’ll still be fine. Hodgkin lymphoma, prostate, testicular, melanoma, breast and thyroid cancer—I wouldn’t wish those diseases on anyone, but most people survive with the proper treatment.

But the pancreas is a little asshole of an organ. Most of us don’t know what it does and where it exists in our bodies. So it’s burdened with resentment that manifests as bad behavior. If you asked someone to tell you where the pancreas was, it would be like watching an American trying to find Ukraine on a map. If you asked someone to tell you what it does, it’d be like asking them to explain what this contraption is. The pancreas is not one of the popular kids, so it pouts in the corner of the schoolyard plotting its violent revenge. (“It was such a quiet organ. We never saw this coming.”)

The pancreas is very important. It secretes enzymes that allow the body to absorb nutrients. So technically, you could find pancreatic cancer very early. Losing weight unintentionally, especially muscle mass, could be a sign of pancreatic problems. In fact, the weight loss can sometimes emerge years before other symptoms. But who connects weight loss to emerging pancreatic cancer? No one. And the asshole pancreas hides its cancer cells so well that when you eventually find them, it’s already angrily shaking its fist at you. 

“Sorry, but I don’t see myself on your chart.”

The pancreas is such an asshole, when it gets angry, it can unleash a sudden torrent of pain that reaches an 11 on the hospital “how-would-you-rate-your-pain” scale. If you like morphine or Dilaudid, show up at an ER with pancreatitis and they will fix you right up. Three times my pancreas has swelled up, laying me low in a matter of minutes. Twice I went to the ER; the third time, I curled up on the floor of my office and waited an hour for the Tylenol to kick in. The thought of it returning haunts me.

The pancreas is such an asshole that its pain will sometimes trick doctors into first thinking you have gallstones (I wish) or liver problems (I sort of wish). The pancreas is such an asshole that it will sometimes hide its tumor behind other organs—the harder to find you, my little dearie.

The pancreas is such an asshole, it even makes it hard for us to fix. Its head sits near critical blood vessels that can block the surgeon’s scalpel. And when you can do surgery on the pancreas, it’s so squishy and pudding-like that the surgical stitches sometimes slip apart. This was such a problem decades ago that one in five pancreas surgeries was unsuccessful. 

To be fair to the pancreas, when it works, it does its job quietly and efficiently. Without it, you’d have diabetes. But I’ve got nothing nice to say about my crybaby pancreas and its defective little bastard cells. Just the two words that title this post.

[Fuck you, by Lily Allen]

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Good Day Sunshine

I’ll be honest. I didn’t really want a steel wire threaded up from my wrist to the inside of my heart. Abundant anxiety as my brother and I tried to find our way through the maze of hallways at Kaiser Walnut Creek. No one seemed to know where I was supposed to be for my angiogram, which didn’t instill a lot of confidence in the whole Walnut Creek operation (as opposed to my Mother Ship, Kaiser Oakland, which is somehow chaotically functional and professional). We make a joke about Igor and a basement “operating room.”

But…after 90 minutes of prep and pep talks by wonderful nurses, it took no more than 10 minutes for them to feed the catheter up my arm and into my heart, inject some dye, look around, and call it a day—all of which I endured wide awake with just a smidge of fentanyl.

“OK, we’re done. Everything looks good,” says the doctor. Good as in no heart disease. Good as in no blood clots or other blockages. Good as in no stent required. And good as in “you can go home in a few hours.”

Good as in a good day.

PS: Nurse Nancy told me that I had to be very careful with the incision where they put in the catheter so that it doesn’t start bleeding. It’s an artery, and if it were to break open, I could “bleed out in two minutes.” I guess that would qualify as a bad day.

[Good Day Sunshine, The Beatles]

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Heart of Gold

Some merciful good news last night. I had an echocardiogram yesterday (that’s an ultrasound of the heart), and it showed no damage and my heart working normally. The aorta is slightly dilated (hmm, Dr. Google has a lot to say about that), but the cardiologist is not concerned, at least for now.

Big exhale.

Nonetheless, we had these shortness-of-breath episodes, so we will go ahead with an angioplasty tomorrow morning to see what’s what.

Fingers crossed and all that, and hopefully back to chemo next week.

[Heart of Gold, Neil Young]

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How Can You Mend a Broken Heart

In the battle to own control of my thoughts, ruminating about cancer is the strongman. It muscles its was into my consciousness past everything else. As my friend Lorena, who is waging her own battle, said last week: “I think about this fucking cancer every day. It’s always in the back of my mind. No matter what I’m doing.”

Last week, though, I got a reprieve. Because now it turns out I also appear to have a heart problem. So instead of chatting with my oncologist, or my helpful oncology nurses, much of last week, I spent time getting to know Brian the cardiologist.

Dr. Brian came into my life because I mentioned to my oncologist that I’d had two recent episodes of exertion the led to extreme shortness of breath and chest discomfort—one while on a moderate hike, the other on my exercise bike. I assumed it was because the chemo was frying my red blood cells, our body’s mighty little oxygen carriers, and I was maybe becoming anemic. But it turns out that my type of cancer, and my chemo drugs, and my chemo port in my chest, all can help create blood clots. So a day after sharing my anecdotes with her, I was having blood work done and getting an EKG, and two days after that, sharing my health history with Dr. Brian.

Dr. Brian is not happy. He has heard my story before, and coupled with my abnormal new EKG, he says it usually leads to the same conclusion: a (perhaps serious) blockage in the heart. But why now? Other, recent EKGs (including two in the last three months), and a stress test two years ago, had turned up nothing unusual. Chemo, Dr. Brian said, is probably the culprit. I probably have years of relatively unremarkable plaque build-up, but the chemo might have inflamed arteries, and led to a rupture and/or blood clot. All in the last few weeks.

Dr. Brian, wanting to convey the seriousness but trying hard not alarm me (do I sound scared or something?), prescribes me heart medicine (to start taking now), works to schedule an angioplasty as soon as possible, even if it means traveling to a different Kaiser facility, and tells me to take it real easy until then.

I like Dr. Brian. He makes time for two lengthy conversations—one after-hours—about this issue, and follows up with a Saturday morning email sympathizing with the fact that my “recent health issues have been very challenging in every way.” He promises to solve my heart issue as soon as possible.

My heart is my motor. Like my real car, it’s running a little rough. I like the idea of fixing it as soon as possible.

In the meantime, cancer, take a number. I don’t have time to think about you right now.

[How Can You Mend a Broken Heart, Al Green version.
Original lyrics by Barry and Robin Gibb, 1971.]

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sick, sick, sick