Absolutely Maybe

Dear blog,

I met with the O'bleness oncologist, Dr. Sarwar, today (the close one). He had received none of the staging information from Dr. Jain (the far one) which was supposed to be ready 'late last week'. But, regardless of all that information, the treatment is the same. ABVD, 6 months.

That's two months of warm up, two months sustained heat and two months cool down, for my fit readers. Some absolute maybes there. It may work. I will absolutely be able to tell if it is working. Around the time hair starts dropping out lymph nodes which I can feel are supposed to reduce in size. If that's not what happens, we absolutely know what kind of even more caustic drugs they will drip into me then. I'll let that go until we see how things are progressing in a few weeks.

I will certainly get a port. When my good insurance kicks in. That's 4-6 weeks from 1-2 weeks ago. Y'all are smart, you can figure that out.

I start Monday, 8:30 for five hours. My guess is about an hour for each of the A,B,V and D drugs they need to drip. Y'all have google. Go nuts. Poison is set for a biweekly schedule thereafter. I didn't ask if six months is generally 24 or 26 weeks. I guess I'll find out around Christmas.

Cordially,
Ian Hogan.

P.S. I got a call shortly after posting. There is no cancer in my bone marrow. Stage 3B.

Beyond Good and Evil

Dear blog,

This is not about updates. This is about emotional hippy dippy. Some folks have related concern.

There are some things in my worldview that need to be considered before one may understand how my emotional hippy dippy works with regards to cancer. I present a quote from a film, My Dinner with André:

WALLY: Yeah, but I mean, I would never give up my electric blanket, André. I mean, because New York is cold in the winter, I mean, our apartment is cold. It's a difficult environment! I mean, our lives are tough enough as it is, I'm not looking for ways to get rid of the few things that provide relief and comfort, I mean, on the contrary! I'm looking for more comfort, because the world is very abrasive, I mean, I'm trying to protect myself, because really there are these abrasive beatings to be avoided everywhere you look.

End quote. I recommend reading the entire transcript or watching the film for those who are not familiar. Here is another quote:

And the ocean itself turns out to be one enormous engine of decay. Seawater corrodes vessels with amazing speed-rusts them, exfoliates paint, strips varnish, dulls shine, coats ships' hulls with barnacles and kelp and a vague and ubiquitous nautical snot that seems like death incarnate.

End quote. That was from David Foster Wallace, the essay which title I used for the previous post. The astute reader may note a theme through the two quotes. This theme runs through my view of the world and how I deal with it.

The world is a cruel, cold, 'abrasive' 'engine of decay' if you will. This is the functional aspect of the world, anyway. You all should know that the world is also a glorious morass of hilarity and gorgeous landscape; taradiddles and forays and adventure; love &c. But that's not a functional view. Functionally, the world, with no particular consistent speed, annihilates absolutely everything. Set something down and sooner or later it will be gone. Animals will have sapped all of the nutrients, plants will have upended it with their roots and cracked it into many parts and solar radiation will chip at its chemical bonds until rain and wind and meteors ultimately render it to cosmic dust.

The world is also in no shape or form fair. I have had some great luck in my life. For instance, I was not born into an impoverished and disease ridden town with a life expectancy in the twenties. I was not consumed by fevers or pirates as a youth. Other such things all included. I have also been ejected from a program as a result of politics. I have been poorly advised before I knew to question the advice of advisers. I have been lied to to prevent me from getting jobs. I have had my car acquire more repair costs than its value at my poorest time at only 100k miles.

How did I deal with these things? The same way that one must, in my view, deal with the perpetual death machine that is the universe. By moving, thoughtfully, rapidly, and without rest. When an army is outmatched, its only option is to move, at all times, thoughtfully, rapidly. It must outmaneuver and be absolutely relentless to have even the barest chance. When I was ejected for unfair reasons without recourse, on a Friday, by Monday I was 100 miles away, signing up for a temporary position and contacting people for a room to rent in that area. It was the closest work, the most guaranteed work. I thought about it and I hustled on what I determined to be an effective plan. If I had waited a week to get my bearings, I would have missed that opportunity.

Cancer is just one of life's neatest tricks for me. It may be on a greater scale than ice followed by snow that is nigh impossible to chip from a walk, but it's the same style. The carelessness of the universe at the inconvenience of the human, best fought by well reasoned and relentless attack. It is this same mentality, I wish to add, which is very necessary to get by in a graduate program. Even with passion, if there is no ability to work without rest for hours, days, weeks, months, years, then failure is guaranteed.

This year I have studied. I have expanded and condensed. I derived, integrated, extrapolated and inferred. I supposed and concluded. I contradicted and implied, computed, researched and proved. I revised and edited and inquired. I reviewed, memorized, copied and regurgitated. I can prove the statement of any theorem in An Introduction to Analysis by Kirkwood. I can use a strange intuition to tackle any exercise in Algebra by Gallien. I can search JSTOR for an Arhangelskii essay which hints at the answer to a topology problem, just to know what I'm trying to prove. I have spent 60 hours on a single problem. I never solved it. Life isn't fair.

For three years previous to graduate school I lost >100 pounds. I ran, walked, biked, swam, lifted, stretched, calisthenicized, yogaed, climbed, clamboured, pilatesed, fought and wrangled, all the time for years to accomplish the goal. I have been fighting the natural tendency towards decay for a while now and I'm damn good at it. So if I don't seem too put out about the cancer thing, that's why.

Wanna wrestle? We can wrestle.
Ian Hogan.

A Supposedly Fun Thing I'll Never Do Again

Dear blog,

The title is a rip-off from David Foster Wallace, an exposé on Cruises. It's not the best choice. Cancer isn't supposedly fun. However, I was reminded of the title by today's oncology experience.

I got a bone marrow biopsy today. Location: pelvis; right, rear entry. They numbed the skin and deep tissue with lidocaine, but there is no way to numb a bone. The doctor's description was that there would be pulling that would feel like pain for a minute that is not actually pain. A supposedly painless procedure. It's pain. Don't let them snow you. It felt like he was tapping a big part of my pelvis with a chisel. It was, however, a minute, and not more.

Bone marrow biopsy, while conscious, is on the list of things I never want to do again. It's a short list, getting longer with the new experiences I'm coming into with the cancer thing.

(1) I never want to do something I did, that hurt, and don't feel like sharing right now. It was a long time ago.

(2) I never want to be significantly overweight again. Ever. I'd become a drug addict before I ate to excess.

(3) I never want a doctor to stick 5 needles in my neck while conscious again. That was 1 lidocaine, 2 fine needle aspiration biopsy and 2 fine needle for flow test. The fact that none of them were diagnostic doesn't really add great positivity to my view here.

(3 1/2) (Cheers to Tychonov, I literally thought of this after writing (4)) I never want to get a bill that should be sent to insurance, call billing, call insurance, call billing, be told it's ok, get a second notice on the bill two weeks later and call billing, again. Tough luck on that, It'll probably be next month at the latest for that funzy game.

(4) I never want a bone marrow biopsy while conscious again. They said I wouldn't need one in conjunction with this cancer again. However, I know I'm at greater risk of getting this and other cancers later in life as a result of the ravages of treatment. I will probably ask to be put under if they start talking about needles in bones again.

The CT scan I got last Thursday is back. My spleen is enlarged and suspicious. The largest diameter of lymph nodes is 5.8 cm. Over 10 is what they call, if I'm not recalling incorrectly, "clumpy", and of different concern. So none of that. No nodes appeared in the pelvic scan. Some nodes in the chest were discovered, not surprising, and in the abdomen, also not very surprising. The easiest blood test in the world also came back; sedimentation rate. My rate is 97%. Bad is over 50%, some say 30%. This is not surprising given my fevers and night sweats-> indications of systemic involvement. This information taken into account, I am at least stage:
3B. If the marrow is infected (affected, I dunno), it'll be 4B, the latest and greatest.

I got straight A's though. If I pull that off on chemo this fall, I go to whatever PhD program I want. At least, I think I should be able to. I might get a port put in. That's a large vein temporary access port. That needs to be discussed more.

That's all for now. Bye bye,
Ian Hogan.

Tests Tests Tests

Dear blog,

Hurray, hurray, hurray, we got all kinds of tests. Not one blood sample but 4 blood samples! That's 20 ml (just 1 vein!). It's total madness. Two scans for the price of 2. We're checking marrow and heart and lungs. Does your body contain a specific organ or fluid of some kind? WE WILL EVALUATE!!!

Anyway, staging evidently involves many tests. I got CT, PET, blood work, ecg (simultaneous lung function test), bone marrow and semen analysis all scheduled or being scheduled for this and next week. Doc said this process should be fast. I asked him to define fast.

Fast is pretty quick, it seems.
-Ian Hogan.

(After Having Written: Nodes I thought I felt aren't worrisome. Nodes I couldn't find were found. I'll call it even.)

Medicine is Borke

Dear blog,

I have some updates, but you get the griping with them. Gripe:

So here's how medical doctors do most things, it seems to me. Well, perhaps we'll do the "not most" or "some things" part because that's the cool part. Not most of the time, they remove things from you what ought not be there and cure you. Yay medical doctors. Most of the time, they recognize that something ought not be there and prescribe a treatment. Exit medical doctor, enter nurse, nurses, pharmacist or combination thereof.

Logical conclusion: You see a doctor anywhere, and get treated anywhere. Right? Wrong. The hospital won't treat you until you see THEIR doctor.

"Oh, when is YOUR doctor available to prescribe the same textbook treatment as MY doctor?"

Answer: a month an a half. I'm shocked, and that does not happen often. Well, say I, I have a fast moving cancer. None of that non-Hodgkins watchful waiting, prostate cancer what takes more than 10 years to kill you. Nay, I got happening, shaking up the dance floor Hodgkin's Lymphoma. Now when is YOUR doctor available?

A month and a week. They'll pull some strings to knock off a week. The actual update without gripe (maybe). I got an appointment for Monday (that I said last blues time, last blues hour), with an oncologist at Holzer. Holzer does not treat. Holzer's oncologist's patients get treated in Lancaster and Gallipolis. My home is roughly equidistant from each, 100 kilometers approximately. I would like to get treatment in Athens, at O'bleness Hospital (a mere 4.5 miles from my abode (a distance I hope to be able to bike even while being treated)), but they, as I griped, will not give me poison until their doctor sees fit that they do.

The plan: I will see the oncologist in Holzer on Monday. He will still be able to get the ball rolling on getting me staged, which since it is a brief process, I will be willing to go to Gallipolis to do it (I've been to Lancaster three times to try to get biopsies of my lymph nodes with no success before skipping one more out to Columbus. They say I'm young and should see the world. Hence, Gallipolis for the staging). I will see the Fancy Shmancy O'bleness oncologist three weeks later and bring diagnosis, staging and prescribed treatment from the Holzer oncologist and try to get him to say "Yea" so that I can be treated at O'bleness (the close one).

Constituent to the plan: (Does constituent mean what I think it means?...yes. Moving on.) I have scheduled an appointment to have my constituent part of any potential offspring analyzed up in Cleveland for the week after finals when I will be free to go up there. Cleveland clinic is the closest cryo facility to me, and the folks live there 'bouts and so on. Since Hodgkin's is a sterilizing disease, I need to get it analysed before paying my mother's hard earned dollars freezing it. No point freezing empty samples. Yeah?

Nigh identical constituent to the plan. I have made sure that Lakewood Hospital (near Cleveland) is on my insurance's preferred provider list so that I do some of the staging stuff up there. I know hospitals will take referred CT scans without pulling the "our doc first" line from experience. Hopefully I can get blood work done down in Athens or up in Lakewood and not have to make any trips to Gallipolis at all. But I've never been there. See the world, you know?

I don't know. I guess I'll find out.
-Ian Hogan.

Cancer

Dear blog,

Today is Wednesday. Last Wednesday I was diagnosed with Hodgkin's lymphoma. I have had it for over a year.

People are curious about the changes involved, and some want to be updated about future changes that will happen in the future. After-all, the future is where we will all spend the rest of our lives. Many folks think they know best about these things and have informed me that I should create a website through such and such and take this and do that and blah blah. I will do what the oncologist says, with the possible exception of skipping the anti-nausea drugs if they make me lose focus. Otherwise, why create a new device for relating change when life is change and I already have such a vessel?

I will post changes here, where change is the status quo and those interested may follow. I have an appointment with an oncologist next Monday, June 4 at 9 A.M. at Holzer Clinic, at the end of the bike path in Athens, Ohio. He will likely schedule me for CT scans of roughly everything to determine the spread of the disease. After that he will probably prescribe combination radiation and chemotherapy.

I will spend the summer sick and tired, practicing Algebra, guitar, piano and German, to help prepare for spending the fall semester sick and tired; teaching 1.5 times as much as a result of the quarters to semesters switch; and taking Algebra, Analysis and Coding, 6000 levels all.

Til Birnam Wood,
-Ian Hogan.

Leben Ist Pumpkin Pie

Dear blog,

Not long ago (perhaps a week) I noticed canned pumpkin and condensed milk in the lazy Susan of my landlord's shared kitchen and decided to make some good old pumpkin pie. It gave me an excuse to use the pastry crust recipe I had seen on the Food channel that very morning (mix butter, flour and water, roll out). I checked for all the other ingredients my old Betty Crocker New Cook Book listed; sugar, eggs, cinnamon, nutmeg, et al. There was no nutmeg, but there was ALLSPICE which said on it, "use in pumpkin pie..." so I used that instead of nutmeg.

The only thing missing; a pie pan. We own nary a pie tin, pan or even so much as an 8 in round baking tray, so I made 12 miniature pumpkin pies in the muffin pan we do have. I used a fairly large cup to cookie cutter the pastry dough into appropriate sized circles to line each muffin mcdivvit.

Et voila, I ate them all. Quite tasty, if only I had whipped cream. I took a picture, but as most of the pictures I take, it will sit lonely on my camera for a requisite aging period of some months.

I am proud of the experience. Because I google searched pumpkin pie muffins; and every single recipe I found, did not use pastry dough, but used paper muffin cups! LAZY SUSANS, THE LOT OF YE!!

Vivian described the pastries to her frat siblings, who all agreed that twice the quantity should be donated to their bake sale. I get brownie points for helping Vivian get "philanthropy hours" We discover the morning after that a total of 4 people had offered to bring baked goods. Perhaps we should have octupled the recipe.

I made a pumpkin pie loaf each time with extra filling. "At last, a luscious grape."
http://www.youtube.com/watch?v=aAFQ5kUHPkY

Sincerely,
-Ian Hogan