Last 4 days of eclipse travel was mostly cheat meals, where the most "anti-cancer diet" gesture would be throwing away the top bun of a Chick-fil-A sandwich (leaving a clean leaf of lettuce to hold onto while driving).

I also managed to only drink 2 of the Red Bull cans out of 4 that I'd allotted for a 1-per-day quota.

Our days were:

Saturday 5am to 2pm, drive Boston to Front Royal
Sunday 5am to 2pm, drive Front Royal to Pickens County, SC
Monday 4pm to 2am, drive in heavy traffic away from Eclipse
Tuesday 2pm to 12mid, drive home

Saturday evening was evening church and two unique experiences:
1) 2 Spelunkers Bacon Cavern Burger with Everythings.
2) Rolling thunder.  A storm with continuous lightening and therefore continuous thunder passed over us.  It really did sound like a motorcycle gang was passing by. The clouds also had an unusual stretched look

Sunday morning I realized that Southwest Virginia used to be hot stuff:
1) Lee is buried at Washington & Lee in Lexington Va
2) Jefferson owned Natural Bridge
3) Woodrow Wilson & Cyrus McCormick (of wheat-reaper fame) were born there

Sunday we stopped in Asheville NC, just to say we'd seen the Gustavino Vaulting on the Basilica of St Laurence

Monday was The Eclipse, which was:
1) Really amazing to see a dark circle hanging in the sky
2) A *tiny* bit disappointing, because the sky never got darker than twighlight blue (JUpiter and Venus appeared on the far left and right, respectively, but I still have never seen Mercury.
3) As the 1% sliver disappeared and later reappeared, there was a 100% change in what you saw.  The Cicadas started singing their twilight song and then stopped.

And then all along the path of the eclipse, people got in their car and left for home:

I *knew* we should have left immediately after totality, but there was much goodbye-ing and so the traffic had time to build. It was worst on I-85 back to Atlanta and Charlotte, but I-26 to Asheville was also awful, so we had to go circuitously via I-40 and I-77 to get to I-81, which then operated at what I'd call "super critical" volumes..moving fast but easily perturbed.  The rest areas were packed at 11pm the way they are in beach traffic on a summer weekend.

Anyway. Home safe and back to work.

Medical: From Half Lemon to Brazil Nut

In the eight or nine days since my chemo the lump in my neck has shrunk from approximately the size of a half lemon (the regular kind, not a runty organic sized one) to the size of a Brazil nut.

Lyrical: Feast of the Assumption

Today is the Feast of the Assumption of Mary into Heaven.

As a guy who has both got religion and got cancer, I went to the 12:10 midday mass at the little local church (decent crowd*) As Evelyn Ryan, the jingle-writing Prize Winner of Defiance Ohio wrote:

Every time I pass a church
I stop and make a visit
So when I'm carried in feet first
God won't say, "Who is it?”

Then I went for a diet-busting feast of 4 McDonald's Breakfast Burritos, which I consider a foretaste of heaven, particularly now that the Hot Picante sauce is back.

I think I also coined a new stop in the cycle of Season's Greetings:

Happy Thanksgiving
Merry Christmas
Blessed Easter
Safe Assumption

* The service had about 30 congregants. The 90%-geriatric assembly included several great Characters Not Appearing Elsewhere.

• Tiny Italian Woman Talking Too Loud About Chocolate (in Italian)
• Lou Ferrigno's Devout Son. 6'2", 20-something, cross-fit competitor huge, double hearing aids, skateboard attire, knows his Tantum Ergo and when to double-genuflect.
• Fresh-Faced Mexican Franciscan. Recently ordained, super earnest, discernible accent, looks like the doe-eyed, young, thin, black-haired version of the grey-eyed, older, thin, grey-haired architect we hired. Surprisingly bad rhythm (or good folk syncopation?) when leading Latin hymns.
• The Ingénue. Went to a top university. Probably Tufts. Did a year of mission work before law school. Ducks away from her public-defender job every Tuesday to read in clear, flawless, educated tones.
• Tone Deaf Haitian Lady. 40 years old. She loves Jesus and sings loud for him. We're talking I Love Lucy style off-key singing, sustained across entire hymns.
• Blogger with Cancer, the visitor doing his best to carry Tantum Ergo (his personal fave) and Holy God We Praise thy Name while positioned directly behind Haitian Lady, across from Hearing-Impaired Hulk, and a half beat ahead/behind Rhythmless Rector. Happy with his plight.

Lyrical: NY Upstate of Mind

First, somebody in Corning NY deserves a Nobel Prize in tourism promotion for the large share of visitors from China and the presentations in both English and Mandarin at the Corning Museum of Glass. Not quite a Michelin 3-star "worth a trip all for itself," but close, 2 stars: if you were doing an "all across America" vacation, definitely a rival to Niagara Falls or Frank Lloyd Wright's Fallingwater as something to see between New York and Detroit.

On Saturday 1pm ish, the hands-on "work your own glass" projects were also super cool (about 2000 degrees Fahrenheit).  Oldest daughter made a flower. Youngest daughter wrought a pendant. Youngest and I made a melt-and-fuse stained glass wind chime. All had to cool overnight (annealing), and we didn't make it back by 8pm Sunday for pickup, so they'll be cheerfully shipped to home for $19.

But the purpose of the trip was to retrieve daughter #2 at Chautauqua NY, which is also a pre-automobile Brigadoon worth seeing "in season" (June - August).  It's definitely a preserved slice of 1912 with a walkable, Victorian feel, such as The Music Man celebrates or such as Walt Disney referenced from his Kansas City boyhood. A set piece of Americana that Teddy Roosevelt described as "the most American thing in America" (speaking before Las Vegas assumed that role).

So, burying the lede, I saw my first Ballanchine-choreographed ballet, and it really was different and better. Think back to the first time that you (as perhaps a non-music person) could tell that Beethoven was different from anything that had gone before or since, and enjoyed by some fans as just better. Your heart said "wow" and your mind said "I can see what the fuss is about."

So there were two conflicting experiences I had in the amphitheater at Chautauqua

• The School Recital, and 
• The Direct Connection to Singular Art

The School Recital

If you have not been a parent at a School Recital, the Music Man's final scene does a loving/lampooning job of describing what it is like (see linked video), with parents standing and declaiming their internal thoughts: "That tuba is my Barney!  Linus! Play to me, son! Davey! That's my Davey!"

I think there's a universal experience of The School Recital as a parent: You sit down with the xeroxed program and look for your kids name, and hope it appears in at least 1/3 of scenes.

Blogger's tip: Pre-mark your kid's scenes with a Braille slash. Dig your finger nail into the program's margin at the left of any of your childen's names, and maybe the name of other kids (but only if they've actually been to your house).
.
Make two nail marks for your own kids and a single mark for anyone else.  These Braille slashes will allow you find the interesting parts even in a darkened auditorium, without being so obvious as using pen, nor so obtuse as waiting for the spousal elbow.

During any scene that your kid isn't in, you can think about scheduled auto maintenance, or upcoming vacation plans, or unanswered work emails as long you appear outwardly interested. Ideally, maintain an air of Patron of the Arts.  If you're lucky, there's a famous story or famous bit of music that you recognize.

When your finger feels a raised mark after a curtain or lighting change, be sure to look up, a child you know is on stage. Then it gets interesting, even good or really great. 

The Direct Connection to Singular Art

I knew that George Ballanchine was a big deal, the founder and majority owner of an entire genre of great art, as Beethoven is to Romantic style. I remember the story in the newspaper and the network news from when Ballanchine died-it makes a good Jeopardy question--but at age 50 I couldn't say I'd ever seen any Ballanchine ballet.  But, aspiring to be a Fancy Person, I am open to learning based on past revelatory experiences, like experiencing a first Monet exhibit, or Beatles song, or live-band Stars & Stripes Forever, or first Rogers and Hammerstein.

Try also to recall the first time you heard Moonlight Sonata. Remember that feeling? Savor that.

Now add the feeling if Moonlight Sonata was the first (and only) Beethoven you'd ever experienced.
Raise the stakes: imagine it at a school run by Beethoven's favorite piano soloist, for whom Beethoven wrote pieces specifically.

Then add that The Master's Student is now 74, but each summer she singles out a handful of soloists to dance pieces (The Raymonda variations, in this case) written originally for her. Finally, imagine that, at the end of the summer, in a genteel arts community, that summer student performs a work like Moonlight Sonata, just one degree removed from its creator and greatest performer and répétiteur

Repetiteur: In ballet, a répétiteur teaches the steps and interpretation of the roles to some or all of the company performing a dance.^[1] Several late 20th-century choreographers, such as George Balanchine, Jerome Robbins and Twyla Tharp, have established trusts and appointed conservators—hand-picked dancers who have intimate knowledge of particular ballets—as répétiteurs of their works.

Now Mash them Up

So now imagine that the first time you heard Moonlight Sonata, it was your daughter at the keyboard performing on stage, in a large summer festival amphitheater, communicating that direct connection to Beethoven and Beethoven's favorite soloist, yet radiating her own personal joy as your 16-year-old daughter.  That's what I saw.

What I Saw

My daughter was dancing as taught by Patricia McBride, George Ballanchine's favorite principal dancer, and Kennedy Center Laureate in her own right (she danced 60 principal roles at the NYC Ballet, 30 created for her by the likes of Ballanchine or Jerome Robbins).

George Ballanchine was celebrated in his life and at his death as an inventor of a whole new kind of ballet and here I was only vaguely aware that ballet had genres, which I'd guess to be Russian, French, and neither-Russian-nor-French, and maybe Folkloric.

As I watched, I had conflicting self-conscious emotions, torn between "I can die happy" and the Music Man's "that's my [child's name here]!".

I let "I can die happy" win.

I saw my daughter truly radiating joy, as she danced a particularly, uniquely beautiful piece--maybe one of the most beautiful things made in the 20th Century--which I'd never seen the likes of before, and which almost seemed to have been invented expressly for her.

Experiencing her becoming joyfully One with Art, was overwhelming. I had a self-conscious mashup of naive audience member surprised by a first encounter with art, and knowing that my daughter was the one chosen to express it.

I was brought to tears and embraced them, even as my attention was torn between the transcending  beauty and my internal turmoil.

Am I this happy? Is this Joy? Is this that beautiful?
Yes, I am that happy. It is joy. Yes it is that beautiful 

Are you watching? Do you see her?
Yes. 

Don't get distracted by your own reaction.
Uh, thanks for the tip, Mr. Internal Monologue. 

Are other people seeing what I'm seeing?
I suppose they are. 

Can I die happy?
Yes, you can die happy.
Really?
Yes. 

Be sure to remember this.
I will. 

Joy.

Lyrical: The Inter-Chemo Normal (and Lull)

Things are going to get quiet around here, I think, because, we've got about 7 days coming up where not much is expected to happen, except:

• The neck lump is changing shape, which I take as proof that it is shrinking at a time when shrinking is otherwise hard to notice.  Day-to-day, spanning my lump with my fingers like I'm sizing up a half lime for Mexican/Margaritas, it is very hard to say "that's smaller" but pretty easy to say "it has never felt quite that shape before."
• The hip pain is less frequent but does pop up--unsurprising if the gut's tumor is shrinking at about the same rate as the neck's.
• Nagging nausea makes it tough to think about eating. We were gifted some glorious fresh-caught Striped Bass last night--enough for 8 entrees--which Mrs Blogger grilled. Fresh last night it was fabulous (everything from tongue to brain is in heaven eating it) .  Cold in a portion-controlled tupperware it still tastes great, but everything from neck to gut is saying "eat nothing"
• I have to eat like it is my job. Like a 2/3rds-scale Big 10 football player in training. Eating like a job means meals are portion-controlled and *must* be eaten, long after my body says "stop." My job is to maintain a healthy weight, no less than 175lbs (that's the "2/3rds scale" part), so that nausea-driven weight loss can be postponed until later or indefinitely.
• Exercising needs to be consistent with muscle-preservation My fear that I'd have to stop swimming was unfounded (it is more limiting that, in Boston, outdoor pool season is just June 20s to August 20s). I'd feared that needle-pocked arms, immune/infection vulnerability, or chemo side effects would keep me out of the pool. I needn't have: I did return to swimming 8 x 50m butterfly this morning. And note, that this is  harder than it sounds because there's no diving into a 4' deep municipal pool during lap swim. You gotta kick/push he whole way.
• We'll pull together all the medical records at some point, resolved to put "my case" in front of the second opinion team at Dana-Farber Cancer Center (just down the street from my first opinion doctor).

Beyond that, this weekend is a drive to Chautauqua NY, and exciting mix of the Perseid Meteor viewing (tonight, from along I-88), the Corning Museum of Glass (tomorrow), and seeing Daughter 2 dancing and fetch her home.

Lyrical: Nauseously Optimistic

This morning I am nauseously optimistic.

First, the Optimistic: the neck tumor is clearly in retreat: less pressure pain, fewer "need to clear throat" feelings, and I feel a gap opening between it and my jawbone.

However they warned that the stereotypical chemo nausea might wait a couple days and/or after the full dose was completed. It hinted its presence last night, and I treated it with ginger, Peppermint and rest.

Of course at chemo they give you anti-nausea Zofran, which constipates instead (and has).  And then will offer a laxitive whose side effect is diarrhea. Thanks, Science! (Is it only Liberal Arts majors who study sustained narratives?)

So I declined an additional Zofran yesterday and a prescription for it, choosing instead a fast acting anti nausea drug that I can carry with me but which has an even more hilarious set of side effects, that read like schoolyard taunts (like "spaz" and "space cadet" and worse) rewritten in Latin.

It is hard to say if today's gut tingle is nausea or constipation but as I said I am optimistic that both will subside.

Medical: Body Hacking with a Portacath

Before the next round of chemo I hope to have implanted one of these "ports" under the skin of either my chest or upper arm:

I'm totally psyched for the cyborg implants.  If only it came with a USB charger or an attachment for espresso.

If we go for the arm, I'd also like the chip from an MBTA Charlie Card implanted, because chest bumping the turnstile would be silly.

Between the chemo going in and the blood samples coming out, ones arm veins often just can't keep up, particularly in phases where the chemicals are harsher.  It is better to dump the chemo into a bigger vessel where dilution is maximized, and that's what these internal catheters do.

Then they can just tap through the skin into this port each time, instead of hunting around:

Medical: On a Benda

I am doing really well. The worst part of Bendamustine chemo today was the needle stick and leaving my USB charger there.* There was a little bit of irritation as the injection progressed, but not much, and I was able to bike there (21 minutes door to door, vs 13 minutes by car** and 30+ by subway) and bike back to the office, do some work, write this blog and be set for going home.  Actual time in the chair was near-exactly an hour

2:10 arrive late; binge on water in the waiting area
2:25 called in; weight 181, at least 2 of which was water
2:30 request chemo room with a window***
2:35 pulse, blood pressure, O2, and temp taken
2:45 today's vein: the right cephalic vein (yesterday it was the left basilic vein)
2:50 Text Mrs Blogger that it isn't worth her coming, since I'll be done by 3:30
3:00 Bendamustine arrives from pharmacy****
3:10 Pumping begins
3:20 Pumping reaches its goal, but bag is not empty; nurse restarts
3:25 Bag empty, pump shuts off when the inflow line air bubble reaches the pump

* I thought I was very clever, using a surplus patient ID sticker to mark my personal belongings, but feel very stupid for actually leaving it there.
** and when you consider that Lyft may take 3 to 8 minutes to arrive, or that, in one's own car, parking can take another 5 mins (hunting in the patient garage) the bike is practically the dominant mode for getting there.
*** there's chemo boredom and then there's windowless chemo boredom
**** all this stuff costs so much that the Pharmacy won't ship it up to Oncology until they know you're there.

Medical: PET Results Exactly Match What We Believed

For all a PET scan costs, they should at least give you an 8 x10 glossy and a couple of wallet size.

Me? Just text.

The radiologist describes a 4.8cm x 3.5cm mass (the neck tumor), with a nearby 1.1cm (reads as cancer) and 0.9cm masses on left side that reads as a "maybe"  So, interestingly, not in tonsils or tongue (which had been an early concern)

It also describes an ill-defined mass in the base/start of the colon (the cecum ) which we've seen as a 2cm to 3cm mass in the colonoscopy, and a nearby lymph that was probably glowing because it drains that general area (it was not glowing hard enough to seem cancer in its own right)

And that's it.

Just the neck cluster and the gut tumor and no place else (there was a tiny 2mm calcified nodule in my lung too small to classify)

It remains that I'm lucky that it was not cecum-only (which would have eluded detection until Jan 2018 scheduled  colonoscopy) and unlucky that it was not neck-only (for which radiation therapy would have replaced ASCT)

Lyrical: Chemophila Morning

"Chemo is my friend"

These words were spoken to the chemo nurse by her very first patient in 1980. That nurse is Mrs Blogger's Mother's Identical Cousin, now retired (whom Babtsia, the older two girls, and I stayed with when I went to Los Angeles as a Jeopardy contestant in 2009).

On Saturday, as we lingered in the Walgreen's parking lot, hesitating before claiming the first of many prescriptions, Mrs Blogger and I had a wonderful call from her. Mostly it persuaded me that God has already worked my miracle through modern science, which has turned MCL from 3-5yr death sentence to 10+ year (and more) survivable in just the last 15 years.

I've been using the "Chemo is my friend" sentiment to try to visualize the chemo working. If psychosomatic powers can cause illness, I believe they can also cure illness.

I've always been highly suggestible illness-wise. Ask me if I have nausea, and my stomach will start to knot. Tell me about your itchy contacts, and I will start to cry. Ask if I have any allergic reactions, and I will feel myself blush.

So I have been visualizing my Rituxan-activated immune system as t-Cell Pac-Men devouring the B cells in my tumor. I also picture the Bendamustine blistering and exploding my tumor cells at the moment they try to divide.

The working title of this interior movie is "Chemo is my friend" or Chemophilia.

The happy thing is I believe it is working.

Before chemo, my neck had been tender particularly where the tumor has assumed a bullet shape as it forces itself down a lymphatic tube. As it stretched a coffee-stirrer-sized lymphatic tube into a finger sized lump, any place on the bullet tip was sore yesterday. Now it feels like the tumor has been driven back just enough to ease the worst of the tube-stretching pain.

I believe I am also experiencing the same thing with my mysterious hip pain, which I have recently connected to the ileo-cecal tumor found in the colonoscopy. Before yesterday, any walking or standing motion could trigger the little stab of pain. As I awoke this morning it has been hard to actually move enough to trigger that pain.

In both cases I picture that the tumor might have pulled back just 1%, but enough to be no longer pushing on the envelope of "regular me" around it. We actually are expecting the tumors to shrink 99.9% in the next 4 weeks (if the lump is a billion cells, that would leave me cosmetically cured but still in mortal danger with a million cells still there, and so still in need of many more rounds to drive it to zero, especially as the remaining cells are the mutants resistant to early rounds)

So depending on the shape of the remission curve, we could be expecting shrinkage of anywhere between 1% and 10% per day over the next 2 to 4 weeks. That is a happy thought indeed.

I will bike to work today, and think that the only thing that will keep me from biking home may be the Benadryl. We will install the bike rack on the back of the minivan against this contingency.

*From anatomy drawings it does appear that my gut tumor and my right hip pain are in basically the same location.  It ileocecal valve is in the groove of one's right hip, and my gut tumor was scoped right at the junction between the ileum (small intestine) and cecum (lowest part of the right ascending colon).

Lyrical: Chemophila

Chemo might not have gone well enough to say I loved it, but this fist phase mostly lived up to its Ghost of Christmas Past advance billing, so I couldn't resist the word play of Chemophilia.

The substitute Oncologist appreciates my jokes with audible laughter, so that is clear progress today.

But mostly it was boring. I would not be surprised if as much as 20% of the drear as one walks laps of the chemo ward (wheeling one's IV-on-pole) is actually just boredom dragging people's faces.

If you wanted to evangelize these people, offer free haircuts and a bit of conversation.

After an IV of Steroids, we began the big bag of Rituxan. As an immune therapy made in organisms, Ritxan has the potential for allergic reactions, and is dose-pumped in progressively faster flows, as they probe for a patient's limits. They found one (initially) on me.

At the 3rd or 4th step-up (while Benadryl-napping) I awoke with a small, new, unusual pen-poke sensation near my uvula. I reported it. Actually I was trying strange snorts and grunts to clear it, and asked Mrs Blogger to report it.  I earned myself a shut-off of the pump and an all-hands huddle like you might see on TV. (They don't want a throat reaction to mean my airways are closing.)

I was on drip-rate saline only until I could say I had been pain-free for 5 minutes solid. Took about 40 minutes for it to go away, and when Rituxan pumping resumed it was on the "baby steps" pace. But after several more step-ups, by the end of the bag they had reached today's target max.

The RN noticed that for the rest of the Ritxan, every time I saw her, I swallowed, testing my throat for the pain which never did return.

The Bendamustine went perfectly despite its mustard gas reputation for inflaming the veins. 

Tomorrow's Bendamustine-only session should be just 20 minutes of infusion sandwiched between 40 minutes of prep and pre-pills and 10 minutes of unhooking and au revoirs.

Written while downing a Vitamix slurry of coconut milk, veggie protein, greens, cilantro, wild blueberries, two eggs and plenty of hemp oil. Chased with a fresh ginger tea to ward off nausea.

Medical: At the all-you can eat Pharma Buffet

Via Pill in the minutes before Chemo Starts
Tylenol - to head off flu side effects today and the blood vessel inflammation*

Benadryl - as antihistamine (also anti-inflammation)
Fenadine - generic Allegra, also as antihistamine / anti-allergy

Zofran - Anti nausea

Via Intervenous Today
Steriods - a steroidal anti-inflammatory, also to fight the inflammation of either Ritxan or Benda.
Rituxan - the antibodies to turn my immune system on its own B-cells (today)
Bendamustine - (half dose) The(mild) poison that attacks fast-dividing cells

Later today via pill (and for the next year)

Acyclovir - an anti-viral, to prevent the suppression of my immune system from allowing old Chicken Pox to re-emerge as Shingles

Tomorrow
Bendamustine - Second half dose, injected into a different vein to limit irritation.

The idea is that my cancers is the only tissue that is attacked by both chemicals they are giving me.

Rituxan 

• causes all CD20+ B cells to be attacked by other immune cells
• which is a good chunk of my immune system
• hence the side effects of allergic reactions and vulnerability to cold/flu/etc

Benda 

• a chemical attack all fast-dividing cells 
• like the lining of my throat and gut (but mostly spares hair follicles, somehow)
• hence the side effects of nausea (if the gut can't take it) and irritation anywhere it goes

Right now, I dread the Zofran because "anti-nausea" easily transforms into "pro-constipation"

* I was excited to learn that any chemo drug with "must" in its name, such as tomorrow's Bendamustine, is a derivative of WWI Mustard Gas, which, you'll recall Great Uncle Duffield Swan was hit with in the Great War.  Mustards are blistering agents, so yeah, inflammation, particularly of the blood vessels at the point of infusion, is a known side effect.

I've been calendared for a port in my chest, implanted under the skin, that will deliver September's chemo straight to a big vein (more dilute) so as to lessen inflammation.

Lyrical: Get a healthcare proxy on file

This marks the first deployment of the Medical Proxy I signed back in 2005 and am happy to not have needed to update. Mrs Blogger is primary, non-blogger older brother is secondary. Mass-resident brother in law is 3rd.

Medical: Today is Chemo Day 1: Immunotherapy

Arrival time 10:15a at Kenmore (the Fenway-proximate neighborhood, not the appliance brand). I did a lap swim this morning in what may be my last time swimming for 10 months.

Children are off at college visits (Barnard/Columbia), ballet school (8 hrs by car to Chautauqua NY), sailing (via MBTA subway), and cousins' in Melrose MA, respectively (the youngest may help drop me off).

Mrs. Blogger will join me because there are so many process and care questions that need answering, either by prototyping the process today or getting the question answered.

Medical: What a PET scan is like.

Somewhere in Woburn MA, there is a nuclear facility that ships radioactive Fluorodeoxyglucose (FDG) twice a day to Beth Israel Deaconess.  The amount is determined by the number, timing, and bodyweight of all PET scans each half day.

All things being equal, they will have to make twice as much FDG that morning for the 2pm scan than for the Noon scan simply because half of whatever was available at noon will have undergone decay by 2pm.  It is just algebra, but still pretty impressive.

Dissolved in saline, FDG is shipped in a 40-lb lead-encased vial like this:

Carried in a shipping box like this:

Upon receipt, it is  loaded into a cross between Wall-E and a lead-lined floor buffer, like this:

It gets wheeled very slowly into your tiny waiting room. After prepping an IV, the technologist enters your weight into the screen.  Knowing the current time and potency (determined by half-lives since creation), the machine automatically infuses the same dose of radiation (about 10 chest x-rays), even though more and more fluid has to be injected as the day goes on because the fluid is loosing its radiation-per-liter.

After injecting you with your dose Then they tell you that you will have to wait 1 hour as your glucose-deprived body draws the FDG out of your blood and into the busiest cells--your cancer.

During that hour you are free to sit quietly in a lead-lined room with a heavy door. If you close the door, you'll notice a sign on the back that says:

PLEASE DO NOT TALK WHILE YOU WAIT

no cellphone calls

But, since the technologists have had to flee your radioactive self, there's nobody around to explain or enforce this rule. And since the door is extremely thick and heavy (a sandwich of 1/8th of lead between two planks of 1" thick solid wood) who's ever going to hear?  And actually, reception is pretty good, considering you're a T-mobile customer in a lead lined room.

When it is time, they ensure that your bladder is empty, and usher you into yet another room with a giant donut with a bed that slides you in and out.  In this case, a combined CT xray (orbiting around the donut to map your outlines) and the 90% of the rest of the donut which hides a cylinder of gamma-ray detectors. The computer will overlay the gamma ray hot spots onto the xray image.

Then, it looks pretty much like this:

Then the challenge is to lie still for 20 minutes as you radiate your gamma rays into the detector.  It seems like they took 4 sectional images at 5 minutes each (shoulders, chest, gut, and groin).

The hardest part was suspending my arms "above" my head (had I been standing).  Other than that, I should have napped.

I will get my results tomorrow.

Medical: Take your school to PET day

Mrs Blogger and our 9yr-old son will be driving me to my 2 PM's PET scan. I hope he will find it home-school educational.

Once you get past the atomic physics of it PET scans are kind of the simplest scans to understand:

1) My body is made "restful", neither eating anything in the last 18 hours that would spike glucose (fats and protiens only; no sugars/starches), nor any strenuous exercise in the last 48 hours that would deplete stored glycogen, muscle's "local supply" of glucose.  

2) I will be injected with a glucose molecule with a radioactive tag

3) The tagged glucose will be drawn to places that are "busy" despite my restful state (as I lie on a table)

4) As the radioactive glucose sends out radiation* that says "Glucose was here" a big donut gamma-ray detector pinpoints where it is coming from as I'm threaded in and out of the donut.

5) The constructed picture shows glucose hot spots.  The brain and liver are usually hot, but it is the "elswhere" hot spots that are telling. This person (SAMPLE, NOT ME) has was looks like lymphoma in their shoulders, gut and groin:

* The part that is not easiest to understand but is still super cool: Fluoride 18 loses a positron (a bit of antimatter with the mass of an electron, but with proton's +1 charge), which quickly smashes into an electron and they cancel their charges to zero and their masses muturally-annihilate into a puff of two gamma rays. The gamma rays pass out of me to be detected. The Flouride 18 (made fresh today, given a half life of just 109 minutes), turns into harmless, stable (but rare) Oxygen 18 (which you might call "heavy oxygen")

Lyrical: This is MCL caught early

Here we pause to contemplate how lucky I am that my MCL manifested on my neck. My college roommate passed along the thought of a colleague: "that's really early to catch MCL"

Looking at the pictures on Friday, I'd been thinking:

• I'm so unlucky MCL is going to be confirmed in my gut, ruining my "neck only" hopes

When an equally plausible interpretation (which I've now adopted) is

• I'm so lucky MCL was in my neck, or my gut MCL would only have been caught too late

Without the neck lump, I'd be doing nothing about the gut lump and yet I'm coming to the conclusion that the gut lump is the cause of a small, mysterious pain in my front right hip.

For about a month, maybe more, I have had local pain, and maybe only noticed once or twice a day, usually during my first steps out of bed. It feels like it is the size of a child's marble, and have always manifested in the same place (plus or minus within a volume no larger than handball).

Sometimes it feels like it is on the bone (right in the "scoop" of the hip's anterior superior illiac crest), sometimes it feels like a "I jogged too hard" muscle strain, and sometimes it feels like a stomach cramp. But it has been there, repeatedly, very localized for at least a month.  Maybe two or even three.  It is the kind you say to yourself "there's my hip thing" and think no more of it (and for me, particularly, because I've been focused on my neck)

My hypothesis is that the hip pain is a direct, singular symptom of the gut tumor and I'd be ignoring it if it were not for my neck lump.

The neck is just about the best possible--most easily noticed and seen--concentration of lymph tissue any of us have.  Groin and armpits are second most obvious.  Non-obvious is the gut. I'm very blessed that it was not "gut alone" (Though my 5 year re-colonoscopy is due in January 2018..that'd have given the tumor way too much time before being found)

There's no way I'd be blogging about a hip cramp, or asking your prayers.

Or recommending that you check your

• scheduled colonoscopy
• long-term and short-term disability insurance
• life insurance policy

based on a hip cramp alone

Lyrical: It takes one good sleep

Looking inward, it seems I'm at peace with my situation. Bad news seems to take about 18 hours to digest (assuming 8 of them are spent sleeping).

And really, it is not that bad.  It just isn't as good.

I was really looking forward to radiation therapy; snuggling my neck right up against a gamma ray source and feeling the warm glow rip apart fast-dividing cells at a molecular level. This was a satisfying image for me. As satisfying as spritzing a yellow jacket with hornet spray.

Actually, it was going to be as satisfying as finding the hornets' nest and standing 20 feet away while streaming the spray right in that bottom hole.  As the hornets dropped out, still glistening with spray, smelling of poison, and twitching just a little, I'd have said "take that, cancer."

Autologous Stem Cell Transfer seems more like running a hornets nest over with a lawn mower. Perhaps 100% effective, yet more like an accident, with more collateral damage, and more like I'm going to run away screaming like a girl and flailing my arms wildly--uh, not that that's ever happened to me.

The nice thing about Mantle Cell Lymphoma is that treatment is no mystery and mostly works.

God willing, I'm pretty well set to outlive my Term Life Insurance, which is "up" in 2029 (They tell you the best deal is to sign up for a policy that gets your youngest child through college.)

Of course, had I known that outliving my term policy was going to be a central life goal, I really would have signed up for a policy extending to 2039, or heck, 2099.

Medical: I have Stage 3 MCL, will undergo stem cell in Jan.

Preliminary biopsy of the lump just below the ileocecal valve (ICV) was read as Mantle Cell Lymphoma (same as neck) and therefore I am Stage 3 (defined as cancer on both sides of one's diaphragm), and it is official that I have not, in fact, drawn the 4 (or 5) Aces required to avoid Autologous Stem Cell Transfer in early 2018. Mrs Bloggerj joined me for the appointment.  We were sad, though not surprised (since that picture I posted led naturally to pessimistic thoughts).

But, once official, in quieter moments tears came easily (as Drs or Nurses stepped away to fetch papers or whatever).  Beyond that there's a enormous amount of busy-work involved in being a patient: scheduling, sequencing, signing waivers.  I will ask my employer to cut back to a 4-day/wk commitment. That will clear 2 days/month for chemo, and 2 more for, we hope, time with each child or a family trip or two before Christmas.

Dr is on vacation next 2wks, so she pulled the trigger on chemo start for next week before she goes.

PET scan on Monday will establish a pre-Chemo baseline, and will likely find what the colonoscopy found, and perhaps more (smaller) that had been below the threshold of the CAT. B
Chemo will consist of about 1.5 days every 4 weeks.  First two

Medical: Not what one is hoping to see

This is news, whose magnitude and direction we will learn Monday. Picture is not me with my tongue out, but a 3-4cm mass below my ileocecal valve.

Mostly normal from end to end, except the above noted (which is about the same size as neck lump) and a spot in my stomach which they also biopsied and which I will spare you the picture of.

PET for Monday

Offsetting the troubling news from my endoscopy is the news that I have a pet scan scheduled for Monday morning.

The timing seems a little odd since Monday morning is when we will be getting the results of today's biopsies but I guess the insurance company was optimistic enough to schedule the PET now

Medical: two polyps being biopsied

My colonoscopy looks generally clear but it did have to odd growths worth biopsy and we cannot say it was fully clear until the results of two biopsies come back--we are expecting the results Monday.

Of particular concern was A 3 to 4 cm mass (a firm friable ulcerated wide-based polyploid mass) found during the colonoscopy phase, adjacent to my ileocecal valve. This is not normal, was too big to be snipped out entirely, and may prove to be cancerous.

There was also a small bit in the lower stomach which they took a sample of and whose biopsy should be available Monday.

If it turns out my lucky streak has ended in my quest to prove I was stage 1, will be at peace.

Lyrical: my gut is clean and waiting to be looked at

My (pre-endoscopy) innards are as clean as:
A straw with the wrapper on
Shoes on the first day of school
Underwear at a doctor's visit
A bald mans comb
Trunk of a new car
Carpet under the floor mats

Medical: Prepping for Gut-scopy Thursday

Slotted for an upper endoscopy (mouth to midway) and lower endoscopy (bottom to midway...basically a colonoscopy that reaches slightly higher) tomorrow at 12:45p.  Diet of clear liquids* only 'til then, with two purges of Magnesium Citrate tonight and tomorrow.

*I asked if olive oil, coconut oil and hemp oil, which are all technically clear liquids were endoscopically-clear liquids. Medical Science was not expecting the old blog-meister to actually be chugging all 3 regularly.  They never saw me coming--I was the first to ever ask (had to catch the doc in the hallway). Answer was "No, those cling. They will gum up the sides of your gut."  At least they didn't try to maintain that they were not clear or not liquids.

Medical Good News: Aced Bone Marrow: Cytology is Clear

My Doctor writes:

GOOD NEWS!!! [Bone Marrow] normal (other than a small abnormality that is unrelated and NOT significant that I will discuss when I see you). Will work on the PET and GI referral ASAP. 

So I have officially cleared the Bone Marrow hurdle in my quest to demonstrate "only Stage 1"  Two scopes and a PET to go.

Now though, I'm distracted wondering what non-cancer exception they found in the marrow of my bones? "Awesomeness" seems a reasonable guess.

Lyrical: Through the Alimentary Canal with Gun Camera

In High School, my I favorite Algonquin Round Table author was Robert Benchley, for his sophomoric and digressive writing style. (I suppose you, like most people with better taste, chose Dorothy Parker, Noel Coward, or Harpo Marx)

Anyway, I always thought Benchley was the author of

Through the alimentary canal with gun and camera:
A fascinating trip to the interior, 
Hardcover – 1930

But it turns out Benchley only wrote the introduction.

Nevertheless, the book clearly anticipated the modern endoscopy and other-endoscopy.

Medical: Gut Check, literally, Wednesday 7am

I can tell my oncologist is back at work, and has called this an urgent appointment so they could book it for 7am, but can't tell if this is because the biopsies were clean, or if we're booking appointments assuming that they will be.

7am tomorrow "consultation" with a GI doc, which we hope will progress directly into an upper endoscopy (twixt mouth and stomach) to look for any imperfections in the lymphy lining of my gut.

Weeks ago now, the ENT threaded a camera and light atop a thin black cable up my nose and down my throat (after numbing).  I'm assuming this GI doc will do the same and just keep going to look at throat and stomach.