Medical: Working from home

Was discharged yesterday (Monday) noonish from "The BI" and am back at Harvard Vanguard Kenmore (noonish too) for my Nulasta shot and blood tests.

It is nice to be back at HV:
- Neighborhood locations (2mi from home)
- more homey feel

Medical; Liver complaint

Thanks again for all your prayers.

Unfavorable liver function numbers have slowed my Ara-C infusion from every 12 hours (I shoulda been home by now after a 10pm, 10am, 10pm, 10am Fri-Sat-Sun course) to every 21 hrs: 10pm Fri, 7pm Sat, 4pm Sun.

I see now that 12hrs is pretty aggressive:
9pm - Hour of saline hydration & pre meds
10pm - Infusion start
1am - Infusion end
6am blood drawn for blood, White Blood & metabolic tests
Order breakfast
7am results & go/pause
Chemo bag ordered from pharmacy
Breakfast, bathroom, vein check
9am hour of saline
10am next chemo

Between Infusion end and pre hydration is only 8 hours, and mixed in there's usually twice daily meds, vitals checks every 4 hours, with opportunistic naps and meals

The delayed cycle has been stressful and boring but nut hectic as the planned cycle might have been.

Basically if they hit pause, it is at least for 4 hours awaiting for a next retest after an attempted fix (like " drink more water) (mines been 9 hours each time)

Infusion #3 is now underway from 4pm to 7pm. If the coffee and prayers have made my liver happy, a blood test at 11pm would show it (results by 12mid). If liver unhappy, I'd likely be discharged Monday AM (dropping #4 infusion and we'll see what 3 produce). If liver clears quickly & unexpectedly I will credit prayers and coffee and maybe get infusion #4.

Lyrical: On a scale of 0 to 10

I am feeling like I really missed my moment. This totally could have been the [Busiest Day] Scale for Pain Assessment:

Instead, Wong and Baker are sitting on a beach somewhere as the royalties roll in. Really? The first 11 integers below five crude emojis and you've got a bankable medical device? Sheesh.

So let me stake out some other corners of this land rush:

Appetite Scale
0 "Bleh"...to... 10 "Voracious"

The concept of Bleh will be depicted by an empty circle, depicting "nothing." Get it? When you have no appetite you eat nothing. This is a fresh medical insight that has not even occurred to even Wong or Baker themselves! The circle will have a secondary read as an empty dish or plate, and therefore hailed as a work of richly-layered metaphor.

I think the next four icons for increasing appetite should be something trans-cultural and universal like:

• One McDonald's Hamburger
• Two Hamburger Value Deal
• Big Mac
• Two Macs Meal

Of course since I am uninclined to split royalties, I will use the icons that the rip-off snack bar at the Airport uses, rather than licensed images.

"11" on the appetite scale will be "patient devours chart"

Constipation Scale (days since last BM)
0 "Zero"...to 10 "Ten"

The world that was rocked by the use of face icons may not be ready for counting days indexed from zero, but if I pull this off,  I will be so rich I will buy a Cadillac Escalade just to store my collection of condescending environmentalist bumper stickers (which I would otherwise be composting, ok?).

Bottom Line: Do not let my lawyers catch you using integer days to describe constipation duration. You have been warned.

Lyrical: BU Skyline from my window

From bottom to top and left to right:

Foreground: from left to right, that's the Winsor School's (fancy private high school) multi-sport center, and then Simmons College (foreground red brick). The buff-brick building, front right is the Bertha C. and Edward Rose Ambulatory Care Center of the Beth Israel Deaconness Medical Center, all fronting on the 300 block of Brookline Ave in Boston's "Longwood" neighborhood.

Just above Simmons is the horizontal treeline of the Riverway along the Muddy River (the "brook" whose line separated Boston from Brookline).  The Green Line's D branch to Newton pops out of its subway at right and runs along the base of the trees.

Just beyond the trees is the neighborhood that Mrs Blogger and I lived in as Newlyweds and in which apartment on Euston St, Bloggette #1 was born and which Blogette #2 enjoyed in-utero.

At the left-center horizon, you see Harvard grad student housing on both sides of the Charles River (not seen).  Then Boston University's skyline starts with the Law Tower (Center) the tallest building in the photo, and goes rightward toward Kenmore Square.

Medical: Friday Check-in for first hospital Weekend

We finally got word at 2pm Friday that they'd freed a bed in the 7 Feldberg cancer ward at BIDMC. We got here at 4:20p or so, and getting here first means I got the window bed (775W) Instead of the one closer to the hallway (775 is semi private)

I chugged 1185 ml of water (5 8oz bottles) to ensure I'd ace my creatinine blood test (for kidney function). Then the RN had 3 false start stabs in my arm before calling the IV specialist. Mrs Blogger and I planned our schedules and ordered me my classic  comfort dinner: pizza, a scoop of tuna on Caesar salad, and apple juice.

That finished, I've dimmed my lights, enjoyed the night skyline of BU beyond the trees, and will try a nap.

Just after 10pm, the first of 4 injections of cytarabine began and will run for 3 hours, and set the cycle for my weekend (another 3hr infusion starting every 12 hours), 10a Sat, 10p Sat, with the last at 10a Sun (ending at 1p and discharge maybe maybe at 2 or 3pm 

All hopes of sneaking out to the Museum of Fine arts or the Isabella Stewart Gardener (about a 10 min walk, were I not in pajamas) have been dashed: can't get any farther than the "solarium" at the end of the hall, or the "family room."--this is the floor where I will spend 3 weeks solid starting around New year's.

Random thoughts from the chemo chair

This Beth Israel lady musta been rich. 😋

Chemo ward smells of new vinyl flooring.

I remembered to shave my arms to minimize the tape-rips-hair at the end of today's Rituxan.

The chemo chair seems to show the common heritage between the Barber and the Surgeon: so hiked up that even my long shanks can't reach the floor, and my feet dangle like a kid outside the principal's office. Fortunately there is a little slide-out shelf for use as a foot rest.

Medical: Bad news from a good image

My lump is "too big"

In an idealized course of treatment, each round of chemo would have delivered a 1000:1 reduction, going from, say

100 Billion cells  "before"
100 Million cells
100 Thousand cells
100 Cells

And in these cases, or in any similar "order of magnitude" reductions after each round the lump would have already been driven to undetectable size back in mid September. But that did not happen.

Mine's been more like 3:1 per round, which results in more like a 30:1 reduction:

Soup ladle
Serving Spoon
Table Spoon
Teaspoon

So we got a 30:1 reduction (in total) where 1,000,000,000 : 1 (or even 1,000,000:1) would have been more normal--or certainly more welcome.

And rather than have an "it happens sometimes" explanation, they have a stronger hypothesis: my lymphoma cells were found have extra mutations in early tests that we didn't have to think about until treatment is underway.

Now that treatment has run its first phase and my lump is still noticeable, it raises the possibility that  extra mutations could be (a) mutations that just happen to resist the exact chemo chose for the first rounds or, more ominously (b) my cells are particularly heedless of the self-destruction signals in general, which is bad because ALL rounds of chemo work on trying to get cancer cells to self-destruct.

There's a small chance, too, that the "immune boosting" diet that I've been eating has served mostly to boost my cancer-of-the-immune cells, just like early Luekemia patients died faster when given blood-boosting ( anti-anemia) vitamins. Or like the way a fetus gets priority on nutrition over the mother.  So my supplementation with spirulina ends today (but, hey here's a backhanded proof that spirulina is good for your  normal immune system)

IF the mutations have been decisive (or prove to be so), then the next option will be not an Autologous Stem Cell Transplant (from myself) but an Allogenic Stem Cell Transplant (from an unmutated family member).  To preserve the option of rapid action, we start today letting my siblings know that they will be asked to take a test to see if they are a match.

To answer EO's question from the comments: The stem cells are extracted from the donor's circulating blood...out one arm, through a collector, and back into the other arm.  I talked to a friend who'd donated (alongside his brother) to replace his mom's stem cells.  The HLA test is done for donor-compatibility. I don't know if there are risk markers on my cells that they can look for on my donors'

And...another reason why they might prefer a donor's immune cells is that the donor's immune system may recognize my cancer as alien even if my own system did not.  In fact, by definition, my Lymphoma has done as well as it has because my own immune system was good with it. But once you replace your immune system with somebody elses, there's no going back (one can never  re-make one's own)

Medical: Good image from PET/CT (despite bike ride)

The PET/CT technician confirmed that my images were good.  We (he and I both) had been a little bit worried that I'd biked too much. So much so that he (1) called a doctor and got "pre clearance" to believe that I would not be so glycogen depleted that my muscles would draw in the FDG intended for the cancer, and (2) we confirmed that the pictures were good before I left.

Five Footed Stool & large Sharps box.

The little room that they hold PET patients in is barely big enough for the "lounge chair" (the vantage from which this picture was taken--thats my arm-table in the lower left) and the 5-footed stool (that the tech sits on when inserting the IV line).  You can also see the sheet of lead --the dark line sandwiched in the middle of the door--that lines the whole room, door and walls. 

The whole room could be as small as 8'x8'

Just like when the Dental Hygenist steps out of the room while your dental x-rays are being taken, the PET technician steps out of the room during the pumped injection to avoid excess workplace exposure to radiation..and then the tech stays away for the hour thereafter as the injection circulates and the radioactive FDG sugar is drawn to the hungry cancer cells.

Medical: view from my lead-lined holding room

For a $750 co-pay, I totally should have shoplifted those two rolls of the stretchy-sticky 3M wrap that you see on my left elbow table.  Yes my feet are nearly out the door.  The room serves to keep me from irradiating (much) while the radioactive Fludeoxyglucose FDG circulates inside me.

Medical: E to BIDMC PET/CT

I sort-of forgot that some PET instructions include "no strenuous exercise" and biked my usual 6 miles from home to work this morning.

In my defense, (1) I find my bike ride "clarifying" not strenuous and (2) I suspect that instruction is actually "don't use sugary sports/recovery drinks.and don't put yourself in a context where you might accidentally do so out of habit."

[Update: actually it is that they don't want my muscle glycogen depleted, in which case the Radioactive sugar risks being drawn into my muscles--we will know soon if I messed it up and we get a muscle-gram instead of a cancer-gram.]

Other PET instructions (if you Google them) say "no caffeine." Boston's BIDMC does NOT ban caffeine, just ALL sugars, starches, and dairy. On my last visit, the technician speculated that other PET facilities ban caffeinated drinks only because too many patients don't think about the sugar in their sodas or unconsciously put sugar or milk in their coffee or tea.

BIDMC says coffee/tea are.fine as long as they are taken full black. If I pushed, I bet heavy cream would be OK too.

I am on the E train of the Green Line--going out Huntington Ave for the fist time in ages (12 years?). Partly it is so that I don't look all strenuous and sweaty when I arrive (I can still bike share back to the office at around 11a). Partly it is that when I am captive at BIDMC in upcoming chemo weekends, Huntington Ave is where I'd sneak out to go to the Museum of Fine Arts or Isabella Stewart Gardener.

[Update: I have had my needle, saline, radioactive FluroDeoxyGlucose, and saline rinse injection from the same machine that is a cross between a lead-lined floor buffer and Wall-E as last time. Now the sugar has to circulate for an hour to be taken up by sugar-hungry cells, from which it will then be decaying by positron emission.

A proton in the Fluorine decays into a neutron by emitting its charge as a positron (aka an anti-electron). That positron almost immediately crashes into an electron and the two disappear into a puff of gamma rays.

Wherever the gamma rays are detected, that's where either the cancer or other sugar-hungry cell is.  As I lie on that same table, they also do a CAT scan with x-rays to map "the regular me."

The map of sugar hot spots is then overlaid on the image of the regular me.  We are looking to see less cancer, particularly that lump near the ileocecal valve at my right hip, and in the not-easy-to-feel lymphs that neighbor the main lump in my neck.

Lyrical: Chemo Birds: Ivory Tainer and the Hornbills

Ivory Tainer

Like the Baltimore Oriole and the Whooping Crane, the native American Ivory Tainer has been driven from its habitat by waves of invasive species. Where the Ivory Tainer was common in both rural and urban settings for at least a century, in recent years it has been displaced by generations of invaders. 

In the Ivory Tainer's case, the invaders were the Hornbills: The Creamy Pink Hornbill, the Foamy Hornbill, and Purell's Gelatinous Hornbill.

Known for its gritty, diffuse droppings, and circular (though flightless) wing motion, the Ivory Tainer is now common only isolated estuaries and eBays.

Once the dominant species in Hospital and Elementary School wetlands, a nesting pair was recently spotted in the church basement bathrooms of St. Camillus Parish, Arlington, Massachusetts, an isolated, pristine habitat untouched in the last 60 years.

Hornbills

All members of the Hornbill (Bucerotinae, literally "cow horn") family are cavity-nesting birds, and mostly occupy habitat originally dominated by Tainers.

When the female Bucerotinae is ready to lay her eggs, she enters the nest through a hole just barely just large enough for her. This opening is then walled up, primarily with her own dried droppings, leaving only a small hole, through which the incubating hen can receive the male’s regurgitated food deliveries and out of which, in turn, the female projectile-excretes her droppings.

All Hornbill nests also contain a small clear window through which the contents of the nest can be observed.


Creamy Pink Hornbill

The Pink Hornbill is known for the accumulation of dried pink droppings around its nest, both at the excretion hole, on vertical surfaces, and often in pools of pink excrement beneath the nest.

Conservationists targeted the Pink Hornbill for its wastefulness and habitat destruction.  Pink Hornbills would rapidly deplete a local area and then leave their nest empty and unusable by others. Soon every nest in a habitat would be empty.

A program of eradication in the early 2010s resulted in the Creamy Pink Hornbill being displaced by populations of Foamy and Purell's Hornbills, though the empty, unused Pink Hornbill nests often remain in place.



Foamy Hornbill

The Foamy Hornbill was introduced to the United States in 2011, hidden in a shipping crate arriving from China. It has proved to be fast-spreading.

Purell's Gelatinous Hornbill

Introduced by well-meaning scientists during the H5N2 Avian Flu outbreak of 2015, Purell's Gelatinous Hornbill quickly spread to habitats far beyond the traditional wetland habitat of the Pink Creamy and Foamy Hornbill.

Purell's Gelatinous Hornbill, while widely seen in medical settings is also seen in unexpected habitats like the vestibules of public libraries, grocery stores, and any place geriatric humans congregate.

Purell's Hornbill is identified by its white body, blue crest, and nearly-transparent excrement.

Medical: From Soup Ladle to Teaspoon

In the olden days, or in Cuba, where doctors actually touch patients, I'm sure that it would have sufficed to say that chemo is working if anybody would simply apply the "five-fingered caliper" to my neck mass and note that it has shrunk thusly:

• Pre Chemo: size of a Soup Ladle (late July)
• Early August Chemo 1
• After Chemo 1: size of a Serving Spoon (mid August)
• Early September Chemo 2
• After Chemo 2: roughly a Tablespoon (mid September)
• Early October Chemo 3
• After Chemo 2: roughly a Teaspoon (mid October (now))

For some patients, their lymphomas might have shrunk to un-feelable (which should be a word), but the Ocologist isn't worried: that you can still clearly feel the lump results some combination of:

1. natural variability
2. that mine started out bigger-than-normal (because we delayed hoping to prove it was limited to Stage 1)
3. Some of what I'm feeling is probably extra tissue that had been stretched out and is having trouble retracting
4. Some may be scar tissue from the biopsy

I have a PET scan at Beth Israel Deaconess Medical Center (BIDMC) tomorrow at 8:30am.  How anyone with cancer keeps a full-time job is beyond me (I'm 80% time).  I want to start a medical plan for working people that uses fancy machines "after hours" *and* would be cheaper because it was using hours when the expensive machines would sit idle.

Meanwhile, yes, this being 10 days since my Oct 4th/5th Chemo Days, I'm doing well.

The "blahs" cleared up around Tuesday last week (which meant the blahs lasted about 2 days longer than in the first two Rituxan/Bendamustine cycles).  The Oncologist did warn that as time goes on, the side effect may worsen as my white blood count gets "worn down" alongside the Mantle Cells (the whole Leukemia-Lymphoma family of cancers is a family precisely because the blood and immune systems are cousins/siblings descended from the same stem cells).

Anyway, I'm doing well, and this week has "non treatment" visits: the PET (Monday) and a Meet the Inpatient Doctor(Tuesday) in which I meet the doctor at BIDMC in whose care I will be for the next 3 rounds of Chemo, which require weekend hospitalization.

I'd like to figure out a way to have friends visit me during my weekend captivity, either by video con, or by smuggling me out to the Museum of Fine Arts or Isabella Stuart Gardener Museum.

The Early Nov*, Early Dec, and "New Years" in-patient hospitalizations are for BIDMC's convenience (not worrying about me missing appointments) and their billing (so they can officially bill me as an inpatient in a semi-private room). As a hospital they can only charge for inpatients, so I have to be an inpatient.

Which is to say, there's no medical necessity for me actually being at BIDMC in my room:

• Infusions every 12 hours.
• Sleep between each days "late" infusion and the next day's "early" one
• Waste 10 hours Sat & Sun between the early infusion and the late infusion

During those 10 daylight hours, I'd prefer to sneak out  rather than spend time in a semi-private room with "the other guy's" visitors, or listening to the other guy's choice of art/music/literature/news/nonsense

Email me if you're in Boston  Early Nov, Early Dec, and "New Years" and you'd like to be on the escape-mission team. It will probably not involve body doubles or laundry hampers.

*
Early Nov might actually be Oct 28/29 or Nov 4/5
Early Dec might actually be Thanksgiving Sat/Sun or Dec 2/3
New Years might actually be in the week between Xmas and New Years

Lyrical: Field Guide to Chemo Birds

Had chemo session 3.1 today, which was delayed (Rituxan slow in coming from the pharmacy), and sleepy (despite only 25mg of Benedryl instead of 50mg), so I amused myself by creating this Field Guide to Chemo Birds.

BLOGGER'S FIELD GUIDE TO CHEMO WARD BIRDS

Graduated Pill Swallow & Dixie Water Swallow

Alongside the Sharps and Monitors, the Swallows are extremely common in chemo habitats.

Graduated Pill Swallow

The small, translucent Graduated Pill Swallow has a near-symbiotic relationship with the larger Water Swallows, often coexisting in the same meager habitat, and cooperating in feeding tasks.

Photo: Graduated Pill Swallow, left, and Dixie Water Swallow, right

Pill Swallows are not picky eaters. The typical Pill Swallow in a chemo habitat thrives on a mixed diet of Benedryl, Tylenol, Pepcid, Zofran, and steroids.

Pill Swallows use their small size and unremarkable color to nest in crevices.

Dixie Water Swallow

The Dixie Water Swallow is recognized by its paper-white coloration, which is sometimes over-printed with forest camouflage, as shown here (above, right).

The Water Swallows are known to carry many times their bodyweight in water for long distances by filling their interior with spring water or filtered municipal water. Evolved to carry far more water than they themselves consume, they have become a critical source of water to drier areas.

As they approach the end of their short lifespan, Dixie Water Swallows typically migrate away to die alone in a nest built of litter.

Solo Water Swallow (not pictured)

The middle-sized and ironically-named Solo Water Swallow usually nests head-down in vertically-stacked colonies of up to 50 individuals, often in close proximity to the colony of young Dixie Water Swallows. The colony frequently locates near sources of abundant food and water.

American Skillet Footed Assayor

Photo: A Skillet Footed Assayor

This majestic, crane-like bird, with a nearly-square webbed foot is known to stand completely still on one leg for hours at a time.

Not easily aroused, it remains nearly motionless in the presence of larger predators, assessing their mass with its square, skillet-like foot whose subdermal sensors are sensitive to the tenth of a pound (the European Skillet Footed Assayor is half as sensitive--only to the tenth of a kilogram)

To intimidate and assess larger predators, it can also draw itself up to its full height, and strike them on the head using its extendible arm.

Halyard's Purple Nitrile

Photo: A male Halyard's Purple Nitrile, nesting.

A cavity-nesting bird first identified by Dr. Kimberly-Clark Halyard in Alpharetta, Georgia, the Halyard Purple Nitrile now holds leading market positions in 100 countries worldwide.

While other dry habitat birds may groom by rolling in talcum powder, the Purple Nitrile is powder free

Easily recognized by the trademark purple color of its large five-fingered comb, the purple nitrile appears featherless but is actually covered by a silky purple coat of microscopic feathers.

Halyard's Silver Nitrile

Also migrating from Alpharetta, Georgia, but considerably more social, Halyard's Silver Nitrile is often seen in large colonies of birds of the Small, Medium, and Largelife-stages. 

The neutral color apparently appeals to hospital visitors, who are asked to sanitize their hands and then insert their hands directly into the Nitrile, similar to the process of stuffing a large Turkey.

Monitors and Surfbirds

Photo: Monitor (top) and Surfbird (bottom)

Another pair frequently nesting together are the Monitor and the Surfbird. 

While both shelter on vertical cliffs and small, shelf-like projections, the Monitor prefers the commanding views of the upper cliff, while the Surfbird builds its web-like nest in the sheltered recesses below the keybirds and mice.

Vinyl Exam Plover

Photo: Vinyl Exam Plover in its vertical habitat.

Related to the much-larger hip-waders found in deeper waters, the Vinyl Plovers are also known for their slick, water-proof coat.

Some Vinyl Plovers nest on near-vertical surfaces (as seen in photo, left), while other genera choose elevated horizontal surfaces.

Competes for habitat with the Purple Nitrile.

Pairs mate for life.

Lifespan: 15 minutes, tops, although the life cycle is currently the object of some dispute, as it appears that the Vinyl Exam Plovers' gender is only determined at their time of emergence. At the same time the pair determines their roles, they mate, fail to reproduce, and die.

While mostly flightless, the Vinyl Exam Plover is valued by unsophisticated peoples for its bladder-like skin which is frequently inflated, tied, and lofted in the air for comic effect.



White Tufted McKesson

Photo: White Tufted McKesson hatching from its nesting clutch.

The female White Tufted McKesson lays her entire brood of exactly 40 offspring in a single, box-like clutch.

Whether eggs in a single clutch will hatch simultaneously or sequentially over an extended period of time is largely determined by the onset of lachrymal-mucosal flow in nearby animals.  If the young are tightly packed, entire handfuls can emerge simultaneously, regardless of need.

In interactions with humans, McKesson populations can fluctuate drastically: reaching unsustainable lows when an entire breeding season's clutches are wiped out in the initial moments after coffee spills; followed by rapid overpopulation due to overzealous re-stocking by well-meaning caregivers.

Additional birds to be covered in future editions:

• Variably Billed Oncologist
• Infusion Pump
• Migratory Nurse
• Great White Commotion
• Five Footed Stool
• Chrome Plated Stand
• Tube Tailed Saline
• Foam Dispensing Hornbill
• Prothonotary Warbler
• Alcohol Swab

Lyrical: Chemo Birds: Distract Yourself from Needles while in Medical Offices

I continue to be impressed by the phlebotomists, the skilled job with the scary name.  They make being stabbed with a needle almost worth looking at. I still look away at the "just a pinch" moment, but they make it so "clean"  and I'm getting so accustomed that I'm resolved next time to peek.

My habit has been to look away whenever the needle goes in. Turning my head desperately to distract myself.  Usually this involves pretending that the doctor's office is actually an exotic aviary filled with rare birds, like this:

CHEMO BIRDS: HOW TO DISTRACT YOURSELF FROM NEEDLES:
PRETEND TO HAVE SPOTTED A RARE BIRD


Black Nosed Ear Looker

The Black Nosed Ear Looker is long-bodied bird with black and silver coloration and bright--even luminous--crest.

Its conical beak is known as the speculum.

The juvenile Black Nosed Ear Looker has a 2.75mm speculum, which is later shed, and the 4.25mm speculum emerges at adulthood.

Highly adapted to its ecological niche, the Black Nosed Ear Looker feeds entirely on a diet of mammalian ear wax.

Latin name: otoscope.

Photo: A Black Nosed Ear Looker and her nesting young.



Red Nested Sharp

Birds of the Sharp family are almost entirely translucent, except for their long, needlelike nose, and the black internal diaphragm that is visible through their graduated thorax.  Long bred for their use in the medical industry, Sharps are extinct in the wild.

Domesticated Sharps may develop internal bubbles. Trained handlers then coax the Sharps into regurgitating the air by rapping with a finger-flick at short intervals.

Sharps of widely-different varieties may be found sharing the same red, box-like nest.

Their plunger-like tail typically has an x-shaped cross section and a circular tip.

Some Sharps, like their distant cousins, the Vampire Bats, are known to draw blood. Others inject anesthetizing fluid which allows them to insert their proboscis and have it remain in place largely unnoticed by their animal hosts. 

Photo: a gloved ornithologist returns a Red Nested Sharp to its nesting box. 

Velcro Collared Constrictor (Dial Faced Constrictor)

Easily recognized from its round, clock-like face and pendulous, bulb-like beard, the Velcro-Collard Constrictor is an invasive species, now widely-spread in North America since its release in the 1960s.

First identified by German-Irish scientist, Sigmund O'Mometer, the Constrictor is highly prized for its ability to wrap itself around a human arm and cut of the blood supply and separately measure the pressure at which this occurs and the pressure at which flow resumes.

Typically a wall-nesting bird, it can often be found between the air and vacuum lines and the staff call button or cord.

Latin name: sphygmomanometer murata



Screen Faced Bower Bird

Caption: Screen Faced Bower Bird (or Screen-Faced Constrictor)  shown perched above its nest in which it has collected blue objects, similar to the Male Satin Bowerbird.

Also known as the Dial-Faced Bowerbird, it is a close cousin to the Satin Bowerbird.  As with the Satin Bowerbird, the male collects blue objects to decorate its basket-like nest.  The favored blue objects include latex gloves and Welch-Allyn instruction manuals.

Highly migratory, the Velcro Collard Constrictor is known to wheel its nest short distances up to 10 times a day







Rubber Crested Plessor / Red Mallet / Purple Mallet

The Rubber Crested Plessor was once widespread in North America, but is now rare.  Identifiable by its triangular head and swift, darting motion, it interacted easily with humans and initially thrived in urbanizing areas.  For reasons that are not entirely understood, it is no longer widely seen, but has been known to nest in drawers.

Latin: plessor rubris

Medical: Blood Test Tuesday before Chemo Wednesday

It is 10 days since I promised to report the insights of the lady "just like me" (same MCL, found in her colon (like my second lump was), same doctor, same hospital)

- Her highs and lows
- Her strategy for second opinions
- The stuff they don't tell you before you start

HIGHS & LOWS

Highs
- Private room during Stem Cell Transplant
- She'd returned to work after only 2 months out (1 month in hospital, 1 month at home)

Lows
- During the 2nd rounds of chemo (Nov, Dec, Jan) the hospital room is semi-private, so you're at the mercy of the other patient's TV & visitor habits.
- The lengths one must go to during ASCT for cleanliness (laundering, bagging, storing clothes, sterilizing ones inside (antibiotics) and out(antiseptic washes))
- Upon return home, there's still several weeks of vulnerability where you can't leave the house and should not share a bathroom

SECOND OPINION

- She went outside the "Harvard Bubble" (where I'm being cared for) and she at least went across town to the Tufts New England Medical Center (where Daughter 1 & Daughter 2 were born, as it happens).
- I'm inclined to see if I can go all the way to Houston (also a great cancer center) to see what they think.  In the Audiobook of Emperor of All Maladies, it appears that Houston was a refuge for many early chemo pioneers who didn't fit the "DC-NY-Bos" models of care, but often turned out to be right.

STUFF THEY DON"T TELL YOU (About ATSC)
- All that stuff about sanitizing and isolation listed under "lows"
- That for months I wont be  permitted to garden or eat salads due to the soil-borne germs risk.
- That for a month, my food will be exclusively heavily cooked, but later I can add fruits with peels
- That for 100 days my immune system will be like that of a newborn, and will have "forgotten" all the germs I've ever been exposed to and all the vaccinations I've ever had (and then, at 100 days, they'd start reintroducing childhood vaccinations)