Sunday, March 27, 2011

A Long, Strange Trip -- Checking the Map

What I'm doing in this posting is "pulling off to the side of the road and hauling out the Rand/McNally..."

Here's a capsule summary of the trip so far: Driving home from visiting my Dad in Baltimore two weeks ago, I felt a sharp, intermittent pain in the area of my heart. Given my issues with blood clotting, this could have been extremely serious -- possibly lethal.

On the advice of my family doc (who is absolutely terrific), I drove to the closest hospital and went to the Emergency Room. The hospital was in Jennersville, PA, and the staff there got me an X-Ray and CT scan remarkably quickly. Since J'ville is a small, regional hospital, they didn't have anyone on duty capable of reading the scans, and so sent them off to a facility in Michigan for analysis. When the results came back, the ER doc announced -- rather happily, I thought -- "Good news! It's pneumonia!" The consequences of which, when you think of it, are much less severe than having a blood clot lurking around your heart. So it certainly did qualify as "Good news."

The doc then told me he wanted me to stay at the hospital for a day or two for treatment and continued monitoring. While I thought this was excessive (I'd been treated for pneumonia before as an outpatient back home), I didn't feel qualified to argue with the doc, so I signed myself in as an inpatient and spent the next two days cooling my heels in J'ville.

The doc also mentioned that the CT scan showed a spot in one of my lungs that was somewhat worrisome: the formal report on the scan mentioned that this type of structure could have been caused by a tumor. And, quite frankly, I'd been concerned for some time about the possibility that my cancer from two years ago might have metastasized elsewhere in my body -- and I thought I recalled some doc mentioning that the lungs were a likely target. So "Good news" was really "Good news / Bad news."

When I (finally!) got home, I got a recommendation for a pulmonary (i.e., lung specialist) doc from my family doc, which was a group practice that other members of my medical "team" knew well and respected highly. And we made an appointment. And the appointment was last Friday.

And the doc was very good. He spent considerable time looking at the CT scans by himself, and then invited Deb and me to look at the CT scan along with him on an office computer while he explained where the spot was (actually, there's two of them...) and what it might mean.

He was nowhere near assuming that the spots represented cancer, and explained that spots like the ones on the scan had numerous possible sources, including bacteria (a number of which carry pneumonia-like names), viruses (which require a considerably different treatment regimen), and environmental causes (such as dust from the 50-year-old paper from my Dad's house that I had been shredding for days just before I got sick...). Or metastatic cancer.

And the way this was coming together for me, the likelihood of the spots being cancer seemed more and more remote: in addition to the paper shredding extravaganza I had recently completed, I had been performing at the Academy of Natural Sciences for two straight days, playing with a lot of germ-laden kids.  So the lung doc put me on (yet another) regimen of antibiotics -- and this one carries some pretty dire warnings, so it must be powerful stuff -- and told me to arrange a PET scan for several days after the antibiotics were all consumed. And then make an appointment to see him again.



The PET scan, I was told, "lights up" around a tumor -- although other conditions could also cause this "lighting up." So if the scan comes back negative, I'm in the clear -- just recovering from pneumonia. If the scan comes back positive, then a biopsy will be in order. And the doc says that, given the fairly small size of the spot, the biopsy might be able to remove it completely.


Oh, and the other good news is that a PET scan covers the entire body, so that if there were any other "hot spots," (i.e., potential metastatic tumors) they would also show up. Nose to toes.So Deb and I left the doc's office with a much clearer picture of things -- and a plan for the next couple of steps.


And with that, I will fold up the Rand/McNally and get back on the highway. Thanks for coming along!

Tuesday, March 22, 2011

A Long, Strange Trip -- with a Rest Stop

Well, well, well... things are starting to settle a bit:

My dry cough is pretty much gone -- replaced by an occasional "wet" cough, which is to be expected if one is recovering from pneumonia. (If that, in fact, was what was going on with me in Jennersville. I'm starting to wonder... Reading the X-Ray and CT scan reports, it surprises me that I don't see any mention of a pneumonia situation in either report. But maybe that's to be expected. How would I know? I'm just a passenger on this particular trip -- albeit a front-seat passenger. I'll ask the lung doc on Friday -- as described below.)

The antibiotics are a thing of the past and either:
(A) they worked and I feel much better or
(B) they had no effect on my illness but I feel better anyway.
But in either case, I feel much better. And the diarrhea that the antibiotics did cause is almost completely gone. At least now, I don't have to make sure I'm within sprinting distance of a bathroom at all times.

And people that I know and love dearly have been so supportive -- and their wishes and prayers are almost palpable. I know people who, when they are ill, do what they can to keep their condition a secret rather than letting their friends and family know. And I feel sorry for them, that they've decided to isolate themselves from such a powerful source of healing and strength. Yes, it takes a village to raise a child, but when do we truly stop being children in this context? My hunch is never...

I had an MRI on my head (Including my brain! I'd like to say it tickled, but it didn't.) and neck areas late last week, and everything came back normal. Further proof that the cancer has not returned locally.

Deb and I visited my chemo doc yesterday, and we talked extensively about the CT scan from Jennersville. He's dubious that a CT lung scan of someone who is suffering from pneumonia can give a totally accurate picture of what's going on. He supports our upcoming visit to a lung doc on Friday, and expects that he/she might well have us wait another couple of weeks to let my lungs return to a condition as normal as possible before any further investigation takes place.

He also suggested (this is important! pay attention!) that the cancer I had has a reputation of recurring locally, but not so much metasticizing elsewhere. So he's looking askance at the notion that the thing in my lung is another tumor. (Pretty cool, yeah?)

I then got a phone call from my E/N/T doc -- who left a message on our home phone -- asking what was going on, and would I please call him on his cell phone? Oh yes! So we talked for 5 or 10 minutes, and he seems to share the scepticism of my chemo doc: there's no reason yet to assume that the inclusion in my lung is cancerous. And then, he all but implored me to call him on his cell phone whenever I wanted to talk something over. I mean, geez!!

You know how, when you've pulled the car over into a rest stop off of I-95 or other major thoroughfare, got out of the car, filled it with gas, visited the bathroom, picked up a snack and/or some coffee, walked around for a while -- you know how you can wind up feeling totally refreshed and ready to hit the highway again? And that you've decided that life is good and that you're one lucky person to be who you are and where you are?

Well, that's how I feel right now. Let's hit the highway!

Wednesday, March 16, 2011

A Long, Strange Trip -- Chapter 2

The story at the end of the previous chapter/posting looked like it was ready to close out: Randy gets sick, Randy goes to the hospital, Randy gets better and goes home. Geez, I wish...

The wheels started to fall off that story during a visit with my family physician on Friday morning. (That would be March 11, for those of you keeping score...) She looked at the reports of the X-Ray and CT scan and just shook her head and said: "I don't think pneumonia had anything to do with your chest pain." While that was a bit disturbing (missed diagnoses are never reassuring!), it sounded "right" somehow. I had pneumonia several years ago and what I was feeling on Tuesday during my drive home to West Chester was totally different from what I felt back then. But I guess I was so relieved that there was no sign of a blood clot that I wasn't really paying close attention to what the pain was (as opposed to what it wasn't).

But more important than the chest pain issue was the wording in the CT scan report. And I was hoping that she would be familiar with a couple of terms that I had never heard, but which didn't sound very encouraging. (And Google searches on the words in question were even more alarming.)

The report said my lung(s) might have "primary or metastatic neoplasm; [and that] bronchioalveolar carcinoma often contains [such structures as those identified in the scan]." I won't bother putting in links here for the puzzling terms -- you probably recognize the "hot button" words the report uses...

So, just in case you're losing track here (which would be perfectly understandable), allow me to summarize where we are: I go to an Emergency Room because of a pain in my chest. The pain is (quite possibly) misidentified as caused by pneumonia. But the lab tests to help diagnose the source of the pain show up the possiblility that my cancer has spread to my lungs.

So that was last Friday, and it's now late Wednesday. And I've been trying ever since I got home to get the attention of one of the doctors who treated me for cancer: What does this all mean? Has my cancer metastasized? Why haven't we ever scanned my lungs or liver or anywhere else to check to see if it's moved to somewhere else?

My family doc has been terrific, but she readily admits that the terms in the scan report are beyond her training and experience. (That's one of the things I like so much about her! She will readily admit that there's stuff she doesn't know and needs to find out about.) I've taken copies of the scan reports to my chemo doc and my E/N/T doc, but haven't heard back from either one of them. So she's put in a separate "professional" request to my chemo doc to try and get his attention. My specialist docs are busy people -- and I think they're pretty well convinced that I'm out of the woods on this cancer thing.

And I hope and pray they're right and my anxieties are baseless.

Oh yeah, one more thing: the treatment I got at the Jennersville hospital (which included up to three different types of antibiotic at the same time), seems to have wiped out all the "good" bacteria in my digestive tract, leaving me with a severe case of diarrhea. I kind of wish I had the time and energy to get annoyed at that...

And what, pray tell, caused the serious chest pain that started all this?

More later when things clarify.

A Long, Strange Trip -- the Beginning

(I get the feeling this is likely to be a long story, so I thought I'd better break it up into chapters.)

Okay, this story starts with a head cold. Nasty, but simple and straightforward. It's the cold I mentioned in the previous post about the Turks Head Jugglers practice session. Lots of coughing, bringing up that greenish yellow glop, sinus cleaning (for some details, see http://www.webmd.com/allergies/sinus-pain-pressure-9/neti-pots) and related activities. Tedious, but nothing worse.

On the Saturday described in the previous posting (that would be March 5th), I felt that I was coming out of the cold and should be fine in a couple more days. And on that basis, I scheduled a trip to Baltimore on the following Tuesday to be with my Dad and brother to finish some paperwork. (I had delayed this visit because of my cold, and was eager to get this paperwork stuff out of the way. You see, my Dad's in a retirement facility, and the staff there really doesn't want to see you if you're possibly contagious.)

So on the Tuesday, suffering from nothing other than a dry cough, I packed the paperwork into the car and headed south. After 20 minutes or so of driving, I felt a pain in my chest. Right over my heart. It came and went sporadically, and on a Pain Scale of 0 to 10, it was about a 3.

(Bit of explanation might be helpful here: You may recall that I've had some blood clot issues over the last several years. And the really dangerous part of these "Deep-Vein Thrombosis" episodes is that part or all of the clot might break loose and travel with the blood flow back to the heart and/or lungs. This can be fatal and, in fact, killed a nephew of mine just six months or so ago. So unexplained pain in the chest is something that calls for close attention. Especially if it's camped out right over the heart. And now back to the story.)

As I drove, I decided that the chest pain might simply be a muscle spasm caused by several weeks of inactivity. Because of the cold. And that spasm might be aggravated because the spot in question was right where my seat belt crossed my chest. Or it could be a blood clot broken loose. Not a nice set of choices.

I drove to my brother Warren's house in suburban Baltimore and found, after walking aroud for a while and having lunch, that the pain disappeared completely. So I decided to forget it. I mean, you can't live your life chasing down every little ache and pain and assuming the worst. You know? You'd wind up living in a sterilized plastic bubble, afraid to do anaything at all... But, come to think of it, I did tell Warren what to do in case I collapsed. Just in case. I mean, you can't just ignore the signs your body gives you that things aren't right. You know? There's a balance here.

So Warren and I drove to Dad's facility and got the necessary paperwork squared away. And all this time, my chest felt just fine -- much to Warren's relief. Oh, and mine too.

On my drive back to West Chester, the pain in my chest returned, but it was registering a 6. I called Deb on my cell phone and asked her to get in touch with our family doctor and ask for an opinion as to what to do. The answer came back quite quickly and was unambiguous: find the closest Emergency Room and sign in.

Mildred, my GPS system and close companion for occasions like this, told me that the closest hospital was in Jennersville, and so we left the road for home and started off towards J'ville.

Fortunately, the ER had little ongoing business when I showed up. So I got an X-Ray and a CT scan of the area around my heart in short order. Since J'ville is a rather smallish hospital and I had shown up after 5:00 PM, they had to send the CT scan to Michigan to have a radiologist there analyze what was going on. (They used to send such things to India, but had too much trouble with the accent...) But hey, isn't technology wonderful? Sometimes? Maybe most of the time? I mean I'm sitting in the ER of a small-town hospital in the late afternoon getting (what I hoped was) high-quality analysis of my scan in real time!

By this time, Deb had driven to J'ville -- God bless her! -- so the two of us waited for the 30 minutes or so it took to get the analysis done. And the ER doctor came back and said: "Good news! It's pneumonia!" Not something one hears often, I will grant you, but given the alternative (i.e., a life-threatening blood clot), pneumonia was, in fact, good news. He told us the scan showed no trace of blood clotting aroud the heart. Yay!!

The doc told us that they wanted me to stay overnight -- and possibly two nights -- just in case. This seemed excessive to me, I mean I walked in under my own steam and felt pretty much okay, except for this dry cough. But he rumbled on and on about "leaving against medical advice" and having to signing releases and so forth, so it seemed easier just to stay.

Which I did. And during the next two days, I received antibiotics via IV's and nebulizer treatments for the cough. And other than that, I just tried to figure out how to stay sane. Because as far as I was feeling, I was still just going home from Baltimore, and taking 48-plus hours to drive 80 miles seemed a bit much. But Deb had brought me books and sudoku puzzles, and that was a big help. And the food was actually pretty good.

So that might have been the end of it. The antibiotics clearing out the pneumonia bacteria and I leave J'ville on Thursday, feeling great.

It hasn't worked out that way. More in the next chapter. Stay tuned. (Geez, I wish I knew what to do about this dry cough!)

Saturday, March 5, 2011

Just another Saturday morning...

at West Chester Friends School Gymnasium: time and place for our regular Turks Head Jugglers practice session. And here's a report on that:

I'm battling a nasty head cold and probably wouldn't have gone to the gym at all this morning(too little energy to practice much and fear of infecting someone else), except that I hadn't arranged for someone else to unlock the door and monitor the group's activities. So I grabbed a sudoku puzzle and headed out. (I didn't take my prop bag, as it would only provide temptation to start practicing in earnest, and I didn't want to expend the energy.) Picked up a coffee on the way, and promised myself I would cruise back on home as soon as another member of the THJ Executive Committee (i.e., someone else with a key) showed up to run things.

So at 8:45 AM, I was sitting on a chair in the gym with the puzzle in my lap, sipping my coffee. And that's when the magic started.

Travis was first to show up. We exchanged a few pleasantries and he began unloading his prop bag. He's a long-term member of the Committee, and with the gym safely under his supervision, I could have left then and there. But I hadn't finished my coffee, so I decided to hang around for a while. At least until I finish my coffee.

Christian showed up next, and even though it wasn't the "official" 9:00 AM starting time, we already had 2.5 jugglers in the room. ("Hmmm," I thought, "at this rate, we're going to have a nice-sized crowd!") He smiled at Travis and me and started practicing. As is so often the case, Christian spent his time polishing juggling patterns that were already beautiful. And the beauty comes not from the patterns themselves, but the way in which Christian performs them. The elegance and (seeming) simplicity with which he juggles is unlike anything I've ever seen. He's a tall, slender young man who appears to be several centuries away from where he really belongs -- which is in a midaeval King's throne room dressed in jester's livery, accompanied by musicians on lutes and recorders. I could watch him all day...

Travis, in the mean time, was tossing his 4-ball shower pattern much higher than necessary -- a good practice for polishing a 5-ball shower. And preparation for tricks beyond. Unlike Christian's jewel-like juggling, Travis brings power and accuracy to his practice. A lovely study in contrasts.

David and his son Eli are the next to arrive and, after quick greetings all around, they too unpack and start to work. Eli (who's been a protege of mine on diabolo for several years now), decides to stand in front of me and demonstrate his ever-expanding repertoire of tricks. I feel honored and grateful. And amazed at what he's learning and how quickly he's progressing. When he and I started working together, I thought that, with enough practice, Eli would become competent. Silly me. He's now blossoming beautifully and developing his own style. I tell him that I am truly impressed with what he's doing, and he beams.

David's working with his (newly acquired) poi swings, making huge circles around his (very tall) body. His patterns are slow and deliberate. Carefully executed. It occurs to me that this controlled, mental approach to juggling is the way he gets to be so good at so many juggling props. Much to be admired -- and, perhaps imitated!

I make a suggestion to Eli (from a germ-proof 10 feet away) about stick positioning on several of his diabolo tricks. He listens politely and nods. David asks him if he understood what I told him and he answers, "Yeah, Randy told me that stuff a year ago." (But Eli is much too polite to have mentioned that fact to me!)

Travis begins working on a 4-club pattern, which is quite smooth and looks nice. But the pattern is only in preparation for his continued assault on a 5-club cascade. It's taken him roughly a year to get this far with the 4-to-5 club transition, and his efforts make you want to stand up and cheer him on. Yes, Travis, it's closer now than ever before!

Rich shows up with his two charming daughters. The oldest one (who's 12ish) has the "forward cross-follow" poi pattern absolutely nailed and is working hard on the "reverse" version of the same trick. When she gets both versions of this trick down cold, she will be able to dance across the gym floor freely with her poi swings surrounding her in big, colorful circles. I've told her several times that, if she slowed the pattern down, it would be easier to find and fix the problems she was having. Hard advice for a 12-year-old. But I think she's been watching David and his progress with large, slow, deliberate movements and taken a lesson from that. Once again, doing and showing prove more successful that telling and explaining.

Rich and his younger daughter are working on her 3-ball cascade pattern. And it's coming along just fine.

Christian has picked up another ball and has started polishing his 4-ball Mills Mess pattern -- something that maybe 3% of all active jugglers can do. I can't do it and I don't think anyone else in the club can either. Rich stops what he's doing and walks over to me to ask -- in a low voice, "It looks like he's doing Mills Mess, but with 4 balls rather than 3. Is that right? Can you do that?" (Ah! Time for some community building!) I call out, "Christian, could you please explain that last pattern to Rich?"

Christian (who seems quite shy) is quite pleased to be consulted (and now, thanks to me, he and Rich know each other by name). He comes over to Rich and me and begins an articulate and detailed explanation of the trick. As he begins this talk, half the gym stops what they're doing so they can listen in. As he talks, Christian's voice gets a little firmer and a little louder. He demonstrates the left-hand portion of the trick, then the right-hand portion, which is a mirror image of the left. When he puts the two halves of the trick together, the balls seem to resonate in the Harmony of the Spheres. You get the feeling that they would continue to perform the trick all by themselves -- even if Christian were to walk away from them. They would just stay suspended, moving through this elegant, weaving pattern with no human assistance or intervention.

Rich's younger daughter walks into the kitchen area adjoining the gym and returns with two books from our small "how-to-do-it" juggling library. I am impressed that someone so young would find value in researching juggling tricks in books rather than just flailing away with the props themselves. But I refrain from telling her this -- you never know but that she might stop reading immediately.

A little later, Rich and Eli fall into a very intense 2-person diabolo workshop. Each knows tricks and techniques that the other doesn't, and each is delighted to share. After 15 or 20 minutes of watching this, I walk over to them for a bit of a chat.

Eli asks me about a stalling problem he's encountered with the elevator trick. I assure the problem was not with him and not with his diabolo, but with his diabolo string. I explain that different types of diabolo string have different coefficients of friction, and that the elevator trick requires a unusually high coefficient. I promise to bring in some fresh string with more friction so he can try it out. This leads to a 10-minute, 3-person discussion of diabolo string and (as you probably guessed) diabolo sticks.

I look over to the other end of the gym and see that Rich's older daughter has found the school's (ground-level) balance beam and is walking it while doing the forward cross-follow, then spinning around and walking the other direction doing the reverse cross-follow. Wait! 20 minutes ago, she couldn't do that reverse pattern at all, and now she's transitioning smoothly from forward to reverse while walking a 4-inch wide beam! It looks great -- and I tell her so.

David and Eli begin working on their ball-passing skills. Eli drops a ball and, without interrupting the pattern in the least, picks up the ball and returns it to the pattern. I had no idea he could do that. Or anything like that.

It occurs to me that few if any of these delightful people would be practicing their juggling if it weren't for the Turks Head program. And that they wouldn't know each other. And therefore be unable to share and learn and grow.

Travis has picked up his 5th club and is patiently working with the complete set. One of the toughest parts of large-number juggling (that is, five and up) is just getting the pattern started and smoothly running. Travis is getting 8 to 10 throws per try, which means that the majority of his 5 clubs are getting two tosses apiece. It's dizzying to watch.

Rich and his youngest daughter are now playing catch with a diabolo -- tossing it from dad's string to daughter's string and back again. She's having a wonderful time, and certainly no one wants to spoil it by pointing out the terrific eye/hand co-ordination she's developing or the patience she's learning, or... you know, all that other stuff.

Paige and her son and her son's friend show up. And it's good to see them. Over the last several years, her son has made considerable efforts to find "his" juggling prop, but it just wasn't happening. But he recently discovered yo-yo's and is making formidable progress therewith. Like Eli, he wants me to see what he's doing and allow me to provide lavish "attaboy's" in response. Easy to do -- and an honor.

The Saturday sessions of the Turks Head Jugglers are scheduled to run from 9:00 to 11:00 AM. And my original plan was to be home and tucked up in bed by 9:45 at the latest. I look up at the clock and find that it's now 10:45 and the practice shows no sign of slowing down.

But if the practice is not slowing down, I certainly am. With a bit of reluctance, I bid everyone a good day, thank them for coming, and ask that they stay well.

As I put away my folding chair, pick up my coffee cup (which has been empty for well over an hour), and my (barely touched) sudoku puzzle, it occurs to me that everyone there -- with the exception of me -- would be leaving the gym as a significantly better juggler than when they showed up that morning.

And I had the deeply gratifying experience of watching it all happen -- and now, the pleasure of reporting it all to you.