Yesterday, after church at Grace Episcopal Church, I was walking down the sidewalk outside the church, having collected the signs that we put out by the street (W. Belfort Ave. just West of Stella Link) to encourage passing motorists to stop in for a visit, and I somehow managed to trip on the sidewalk and fell heavily (and gracelessly) on my left arm and shoulder on the grass. I'm lucky I wasn't impaled by one of the signs! An intense, sharp pain in my left shoulder let me know that this was a bad fall, indeed! I was sure that I'd dislocated my shoulder! Caroline drove me to the Emergency Room (ER) at M. D. Anderson Cancer Center (MDACC) because we were worried about my brand-new implanted Bard Power Port, even though it is installed just below my clavicle (collar bone) on my right side--we wanted to make sure the port wasn't damaged in the fall!
Fortunately, there weren't many people waiting to be seen at the MDACC ER and we were able to get right in! The x-rays revealed that I'd fractured my humerus (upper arm bone) at its "surgical neck" where the long cylindrical part of the upper arm bone joins its knobby "head" that sits in the shoulder socket. The surgical neck is the weakest portion of the humerus and is the place where most fractures occur. Sure enough, my x-rays clearly showed a lateral displacement in my humerus at its surgical neck!
The good news is that I probably won't have to have any surgery to fix it. As long as I keep my left arm completely immobilized in an uncomfortable (and marginally effective) sling, my bones should be able to knit themselves together again on their own and be almost as good as new (after excruciating rounds of physical therapy, no doubt)! The bad news is that the only thing they can give me to assist the healing process is some woefully inadequate pain medication! The 4 mg of morphine I got yesterday in the MDACC ER through my Power Port (which was working perfectly, by the way, completely unaffected by my fall!) barely registered at all--I wasn't even sure whether I'd gotten any morphine! Fractures of the humerus at the surgical neck are among the most painful, or so I was told today by a physicians assistant!
Although this is the first bone I've ever broken in over 52 years of life on Earth, I can certainly attest to the painfulness of it! I also lament the loss of use of my left arm! Sometimes you never appreciate what you have until you don't have it for a while! Farewell to arms (plural), indeed, for at least the next two weeks! Of course, the chemotherapy that I'll be starting this coming Friday morning (bright and early at 7:15AM!) may well prolong the bone healing process, but so far there appears to be no good reason to delay the start of the chemotherapy!
For those of you who are curious about the exact make-up of my "chemo cocktail," I'll be on the "FOLFOX" regimen supplemented (or complemented) by the non-chemo Avastin anti-angiogenesis treatment. The potential and possible side effects of these medications are truly awful, a veritable litany of horrors, so I intend not to have any of these side effects! I'll let you know how that works out for me!
Randy and Caroline
A lovely July in Seattle!
Monday, December 27, 2010
Still Very Much Alive and Kicking!
[I composed this post in the wee hours of Sunday morning, December 26, 2010, but went to sleep before actually posting this post, thinking that I'd get around to adding to it later that day. I'll go ahead and post it now "as is" and will update you in my next post about why I never got around to finishing this post yesterday! Here's a hint in the form of a slightly altered Zen koan--"What is the sound of one hand typing?"]
Hard to believe a whole week has flown by since my last post! Hope everyone had a very Merry Christmas, indeed! Technically, today is "Boxing Day" on the other side of the "pond" in Jolly Old England!
Today is also a "Doomsday" for 2010, as explained in John Conway's Doomsday Algorithm, where the "Doomsday" for a given year is simply the day of the week on which the last day of February falls (February 28, 2010 was a Sunday, and was the last day of February since 2010 is not a Leap Year, not being evenly divisible by 4), which just so happens to be the same day of the week on which 4/4, 6/6, 8/8, 10/10, and 12/12 fall, as well as 5/9, 9/5, 7/11, and 11/7 (which can easily be remembered by the mnemonic "I work 9 to 5 at the 7-11!"). Since the last day of February is the same as the "zeroth" day of March (3/0), 3/7, 3/14, 3/21, and 3/28 are also all Doomsdays. In non-Leap Years, January 31 ("February 0") is a Doomsday, as is January 3, whereas in Leap Years, February 1 ("January 32") is a Doomsday, as is January 4.
Using John Conway's Doomsday Algorithm, you can relatively easily calculate in your head the day of the week on which any given date (such as a birthday) in History fell (or on which any given date in the Future will fall!) and can, thus, emulate the uncanny mathematical prowess of an idiot savant! Amaze your friends! Be the life of the party!
John Conway is a fascinating character, an eminent mathematician (who has an "Official Princeton website") who dreamed up the cellular automaton The Game of Life. He also memorized the decimal expansion of the transcendental number pi (defined as the ratio of the circumference of a circle to its diameter) to 1000 decimal places and somehow managed to convince his first wife to also memorize it so that they could recite the decimal expansion of pi to each other, in chunks of 20 digits at a time, back and forth, while they were ambling along the path from Cambridge, England to nearby Grantchester when they would go there to a quaint little pub for lunch!
I strolled that very same path from Cambridge to Grantchester (for high tea) and back 31 years ago with David "Frank" Pearl when I attended Trinity College, Cambridge as the C. D. Broad Exchange Scholar from Weiss College at Rice University from 1979-1980 (the C. D. Broad Exchange Scholarship between Trinity College, Cambridge and Rice University was established by the wonderful Houston lawyer and philanthropist Frank Abraham who had cherished the opportunity he had been given as a soldier after World War II to study with and learn from the English philosopher C. D. Broad at Trinity College, Cambridge for six months before he returned to the States).
I didn't know more than a handful of the digits of pi back then, but now, in part inspired by the example of John Conway, I know more than 1300 digits of the decimal expansion of pi! Caroline, my wife, alas, has no interest in memorizing the digits of pi, but she will, on occasion, tolerate listening to me recite them to her as we are walking up and down along Belmont Street in our neighborhood in West University Place, as long as I don't speak in a voice loud enough for anyone else to overhear me!
In case you were wondering about an update on my medical condition, I now have my very own Bard PowerPort installed (implanted) just below my collar bone (clavicle), so I am all ready to start a round of chemotherapy this coming Friday afternoon, on New Year's Eve. What a way to bring in the New Year! The positron emission tomography (PET) scan I had on Monday, December 20, 2010, which shows metabolic "hot spots," such as metastasized tumors, using radioactively labeled glucose, didn't show any of the suspicious "nodules" that had shown up in the computerized tomography (CT) x-ray scan performed on Monday, December 13, 2010 at M.D. Anderson Cancer Center, but did show the metabollically "hot" tumor in the appendix. Since the nodules were fairly small, most no larger than about 1 cubic centimeter (1 cc or 1 milliliter, 1 ml) or so, they might not have been large enough to have produced a signal that was detectable above the "noise" of all the other metabolic processes going on. On the other hand, the absence of a signal could mean the absence of metabolic tumors, which would be great!
To be on the safe side, of course, one must assume that the nodules could still be metastases. I'm going in on this coming Tuesday to have one more test, a needle biopsy, that may help determine what these nodules really are. I'll go in as an out-patient and, while I'm under sedation, the interventional radiologist will use a long needle to collect cell samples from one of the nodules from the CT scan so that the pathologists can determine whether the cells are from an adenocarcinoma or not. If there are tumor cells in the nodule, then there has definitely been some metastasis. Even if the biopsy turns out negative and there are no tumor cells found, it still doesn't entirely rule out the possibility of metastasis. Either way, the conservative plan of action will be to proceed with the first round of chemotherapy, anyway.
Hard to believe a whole week has flown by since my last post! Hope everyone had a very Merry Christmas, indeed! Technically, today is "Boxing Day" on the other side of the "pond" in Jolly Old England!
Today is also a "Doomsday" for 2010, as explained in John Conway's Doomsday Algorithm, where the "Doomsday" for a given year is simply the day of the week on which the last day of February falls (February 28, 2010 was a Sunday, and was the last day of February since 2010 is not a Leap Year, not being evenly divisible by 4), which just so happens to be the same day of the week on which 4/4, 6/6, 8/8, 10/10, and 12/12 fall, as well as 5/9, 9/5, 7/11, and 11/7 (which can easily be remembered by the mnemonic "I work 9 to 5 at the 7-11!"). Since the last day of February is the same as the "zeroth" day of March (3/0), 3/7, 3/14, 3/21, and 3/28 are also all Doomsdays. In non-Leap Years, January 31 ("February 0") is a Doomsday, as is January 3, whereas in Leap Years, February 1 ("January 32") is a Doomsday, as is January 4.
Using John Conway's Doomsday Algorithm, you can relatively easily calculate in your head the day of the week on which any given date (such as a birthday) in History fell (or on which any given date in the Future will fall!) and can, thus, emulate the uncanny mathematical prowess of an idiot savant! Amaze your friends! Be the life of the party!
John Conway is a fascinating character, an eminent mathematician (who has an "Official Princeton website") who dreamed up the cellular automaton The Game of Life. He also memorized the decimal expansion of the transcendental number pi (defined as the ratio of the circumference of a circle to its diameter) to 1000 decimal places and somehow managed to convince his first wife to also memorize it so that they could recite the decimal expansion of pi to each other, in chunks of 20 digits at a time, back and forth, while they were ambling along the path from Cambridge, England to nearby Grantchester when they would go there to a quaint little pub for lunch!
I strolled that very same path from Cambridge to Grantchester (for high tea) and back 31 years ago with David "Frank" Pearl when I attended Trinity College, Cambridge as the C. D. Broad Exchange Scholar from Weiss College at Rice University from 1979-1980 (the C. D. Broad Exchange Scholarship between Trinity College, Cambridge and Rice University was established by the wonderful Houston lawyer and philanthropist Frank Abraham who had cherished the opportunity he had been given as a soldier after World War II to study with and learn from the English philosopher C. D. Broad at Trinity College, Cambridge for six months before he returned to the States).
I didn't know more than a handful of the digits of pi back then, but now, in part inspired by the example of John Conway, I know more than 1300 digits of the decimal expansion of pi! Caroline, my wife, alas, has no interest in memorizing the digits of pi, but she will, on occasion, tolerate listening to me recite them to her as we are walking up and down along Belmont Street in our neighborhood in West University Place, as long as I don't speak in a voice loud enough for anyone else to overhear me!
In case you were wondering about an update on my medical condition, I now have my very own Bard PowerPort installed (implanted) just below my collar bone (clavicle), so I am all ready to start a round of chemotherapy this coming Friday afternoon, on New Year's Eve. What a way to bring in the New Year! The positron emission tomography (PET) scan I had on Monday, December 20, 2010, which shows metabolic "hot spots," such as metastasized tumors, using radioactively labeled glucose, didn't show any of the suspicious "nodules" that had shown up in the computerized tomography (CT) x-ray scan performed on Monday, December 13, 2010 at M.D. Anderson Cancer Center, but did show the metabollically "hot" tumor in the appendix. Since the nodules were fairly small, most no larger than about 1 cubic centimeter (1 cc or 1 milliliter, 1 ml) or so, they might not have been large enough to have produced a signal that was detectable above the "noise" of all the other metabolic processes going on. On the other hand, the absence of a signal could mean the absence of metabolic tumors, which would be great!
To be on the safe side, of course, one must assume that the nodules could still be metastases. I'm going in on this coming Tuesday to have one more test, a needle biopsy, that may help determine what these nodules really are. I'll go in as an out-patient and, while I'm under sedation, the interventional radiologist will use a long needle to collect cell samples from one of the nodules from the CT scan so that the pathologists can determine whether the cells are from an adenocarcinoma or not. If there are tumor cells in the nodule, then there has definitely been some metastasis. Even if the biopsy turns out negative and there are no tumor cells found, it still doesn't entirely rule out the possibility of metastasis. Either way, the conservative plan of action will be to proceed with the first round of chemotherapy, anyway.
Saturday, December 18, 2010
Thank God I'm Not Dead, Yet!
I am very grateful, indeed, that I'm not dead, yet! Lately, I have felt a little bit like the old hapless character in Monty Python and the Holy Grail who keeps crying out "I'm not dead, yet" when one of his relatives is trying to put him on the cart with the rest of the plague victims!
Just over two weeks ago, I received a diagnosis that I probably have an appendiceal adenocarcinoma with tumor cells that are "invasive and moderately differentiated." Appendix cancer! It's very rare (my GP, who has practiced for decades, has never had a patient before with an appendix cancer)! Fortunately, I was quickly able to get admitted to M.D. Anderson Cancer Center, one of the best cancer centers in the world, and even more fortunately, my wife Caroline and I live in West University Place, Texas, almost within easy walking distance of the Texas Medical Center and M.D. Anderson!
Further tests have revealed that my appendiceal adenocarcinoma has probably metastasized to some extent, so I'm scheduled to start an aggressive round of advanced chemotherapy right after Christmas. After about 8 weeks of chemo, I'll have another detailed, fine-grained Computerized Tomography (CT) x-ray scan and we'll be able to assess whether the chemotherapy is effective or not. When the tumors have been reduced in size, some kind of surgery may well be advisable. In the best of all possible worlds, the cancer would simply disappear under the onslaught of the chemotherapy and I won't end up with a "semicolon" after all!
I do feel my spirits being buoyed up by all the prayers and positive thoughts and good vibes directed my way! It could definitely be worse--if my tumor hadn't caused mysterious and massive bleeding from my gastrointestinal tract right before Thanksgiving, which rendered me anemic enough to require a transfusion of 6 units of blood (my hemoglobin count got down to about 5.8 grams per deciliter, whereas a normal, healthy strapping lad of my size should have a hemoglobin count of at least 12 to 14 grams per deciliter or higher!), we might never have discovered my appendiceal adenocarcinoma at all!
I had had my first colonoscopy right before Thanksgiving in 2009 (when I was 51) and had had a 1 centimenter-sized pre-cancerous polyp removed from the left side of my colon. It was a good thing that I'd had that colonoscopy--I felt I'd really dodged a bullet then! However, colonoscopies are not able to peer into the interior of the appendix (the orifice where the appendix joins up with the colon all the way over on the left side of the colon in the secum is just too small to admit the scope) and my appendiceal adenocarcinoma could well have been lurking there inside my appendix even then!
Undoubtedly, I'm still in a state of shock and denial about my condition! And while I'm certainly much more conscious than I ever was before of the absolute reality of my own mortality, I'm convinced that my prognosis is actually very good. Lots of people have recovered from diseases that are far more debilitating than my appendix cancer and I intend to survive and thrive, God willing, for many years to come! And if I'm wrong, and the Grim Reaper means to harvest me despite everyone's best efforts to keep me alive, then at least I'm comforted by the knowledge that Caroline and I had the wisdom and the foresight to buy a lot of life insurance for me before I got my diagnosis!
Just over two weeks ago, I received a diagnosis that I probably have an appendiceal adenocarcinoma with tumor cells that are "invasive and moderately differentiated." Appendix cancer! It's very rare (my GP, who has practiced for decades, has never had a patient before with an appendix cancer)! Fortunately, I was quickly able to get admitted to M.D. Anderson Cancer Center, one of the best cancer centers in the world, and even more fortunately, my wife Caroline and I live in West University Place, Texas, almost within easy walking distance of the Texas Medical Center and M.D. Anderson!
Further tests have revealed that my appendiceal adenocarcinoma has probably metastasized to some extent, so I'm scheduled to start an aggressive round of advanced chemotherapy right after Christmas. After about 8 weeks of chemo, I'll have another detailed, fine-grained Computerized Tomography (CT) x-ray scan and we'll be able to assess whether the chemotherapy is effective or not. When the tumors have been reduced in size, some kind of surgery may well be advisable. In the best of all possible worlds, the cancer would simply disappear under the onslaught of the chemotherapy and I won't end up with a "semicolon" after all!
I do feel my spirits being buoyed up by all the prayers and positive thoughts and good vibes directed my way! It could definitely be worse--if my tumor hadn't caused mysterious and massive bleeding from my gastrointestinal tract right before Thanksgiving, which rendered me anemic enough to require a transfusion of 6 units of blood (my hemoglobin count got down to about 5.8 grams per deciliter, whereas a normal, healthy strapping lad of my size should have a hemoglobin count of at least 12 to 14 grams per deciliter or higher!), we might never have discovered my appendiceal adenocarcinoma at all!
I had had my first colonoscopy right before Thanksgiving in 2009 (when I was 51) and had had a 1 centimenter-sized pre-cancerous polyp removed from the left side of my colon. It was a good thing that I'd had that colonoscopy--I felt I'd really dodged a bullet then! However, colonoscopies are not able to peer into the interior of the appendix (the orifice where the appendix joins up with the colon all the way over on the left side of the colon in the secum is just too small to admit the scope) and my appendiceal adenocarcinoma could well have been lurking there inside my appendix even then!
Undoubtedly, I'm still in a state of shock and denial about my condition! And while I'm certainly much more conscious than I ever was before of the absolute reality of my own mortality, I'm convinced that my prognosis is actually very good. Lots of people have recovered from diseases that are far more debilitating than my appendix cancer and I intend to survive and thrive, God willing, for many years to come! And if I'm wrong, and the Grim Reaper means to harvest me despite everyone's best efforts to keep me alive, then at least I'm comforted by the knowledge that Caroline and I had the wisdom and the foresight to buy a lot of life insurance for me before I got my diagnosis!
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