Apple Cider

Dear blog,

Obviously, I'm not writing very often these days. This is because I am very tired just about all the time. Earlier in the semester, I would experience, perhaps, four days each two weeks where I could not do very much. Now it is easily working in to the sixth day after chemo that I don't get much done and I never stop being tired. The only thing getting me through now is that the end is in sight.

I just got done getting my fourth to last infusion Thursday. I'm still just about incapacitated. In fact, the only reason this blog is being written is that Vivian has offered to take dictation. I have been exploring potential Ph.D. dissertation advisors at Ohio University and Kent State University. It is not ideal that I should be sick and studying while exploring this but there is no other option. I have narrowed down my possible fields of higher study to topologically driven dynamical systems and characters of finite group representations. The motivation for the latter is that characters of finite group representations have applications in chemistry, which I do not know enough about. The motivation for the former is that there is a large and active research group at the university on the subject.

If Joyce Stock is reading this, Vivian told me about a cake that you make made of layers of thin wafer with some sort of cream between the layers that softens the wafers. I would like this as a get well from cancer dessert. I plan to be in the Cleveland area in late December.

Regards,
Ian Hogan B.S. A.A. C.P.Lf.P.

Dear blog,

I am quite busy, so not blogging often. There is little to note. I do not feel well, with a cold, but no so unwell that I cannot get chemo tomorrow. I am due for chemo on Thanksgiving day. I must decide whether to go short or go long. Pros and cons to each. If I go long, the whole process will run longer as a result. If I go short, I miss the break. Same for finals week. That's the long and short of it.

"...has this experienced changed you perspective on how you want to live your life? Has it affected your feelings about death or changed your opinions about anything like health ins. or capital punishment or anything like that?"

In short, no. I feel like I was living a fairly full life before the risk of truncation became more solid before my eyes. I have been impelled to read a few books I was meaning to read, but nothing other than that. So while many find God or realize they have wasted so much time or whatever, I did not find or realize anything to that effect.

And in regards to health insurance, my opinion has not changed. My personal opinion is that in an era of such abundance: that there should be produced each year enough grain to feed the world; that individuals exist who pay in property tax the net income of entire villages over generations; that even one adult has the liberty to choose to purchase a large house between his other two houses so that he need not stop at a hotel driving from one to the other; in this world, it is unthinkably immoral and corrupt of anyone to believe I should be bankrupt because I rolled unlucky at the cancer craps table. I think it unfathomably disgusting now, now that I am facing the cruel reality of sitting near people whose surplus of wealth would handily end every financial woe I possess, knowing that if I even mentioned the disparity to them that they would merely cough uncomfortably and attempt to part company. I thought it unfathomably disgusting that such pairings existed before I was in one.

Frankly, it's enough to make any upright citizen sick if they think about it long enough. So now, as then, I try not to think about it.

Regards,
Ian Hogan.

$\ iff$ X is compact

Dear blog,

Naturally the title is referring to the fact that ultra-filters converge in compact spaces. (Makes sense right? They're compact. There's no infinity to go to.)

Ok, so most of you aren't mathies. Most of you are interested, perhaps nominally, in my state of existence viz. how many pieces of bad news am I from death; perhaps aesthetically in some sort of well-structured (insofar as none of you realize I'm practically illiterate) prose. Clarification: early one morning I grunted at an old man who had said hello. He asked me if I was 'even alive yet', prolly referring to a lack of coffee. I think I said no, a clever response requiring coffee, but then pondered the question more deeply (while waiting for the pot to fill with coffee). In said meditation, I decided it was possible metrize state of alive-ness by how many pieces of bad news I am from death. The most alive is 3 I think.
1) You have cancer;
2) The treatment isn't working;
3) There's nothing we can do.
Given that I have recently received (1) I rated myself as 2 on the metric.

This is all pretty silly and I'm sure any of you with some thought would come up with far more elegant metrics. I encourage you to do so as an ice-breaker at parties. Anywhat, I think I may be back up to 3 as of today, depending how one reads the metric.

I have received a negative PET scan. (Technical language follows, please skim this bit of wikipedia) What does this mean? Roughly it means that what cancer remains is insufficiently active to make the screen light up. There is certainly still some cancer, potentially alive and weak or too small to register on the scan. Thus I must continue treatment until December as planned.

That's really all the cancer news that's important. On to more frivolous matters. Comments. I got a bunch. Splendid. Better though was that one of them had several questions. Questions are good. Answering questions is fun and easy. I will endeavor to answer at least 1 with each post. If more questions are posed, the rate of answering will increase.

"Like, what all goes on in the chemo room?" Remarkably little, though I suppose answering will end up burning a lot of space. "...the chemo room" is a little incorrect. There is an "oncology and infusion" wing or department or flat, whatever you like. It is attached the the general hospital (ER, crap like that) by way of a hall. It consists of a front desk and waiting room (for when they are full or haven't finished whatever state-mandated prep they have to do in the morning) which is shared with cardiology, and a devoted piece of building with a central, partly open, partly walled room with desks and faxes and the like where nurses sit while they do paper work and scheduling and so forth, some halls around that central room with a few private inspection rooms (or whatever, they have the padded table and that's where the doc feels you up), two private infusion rooms and at least the doctors private office if not a few more offices that I cannot look at because they might be around a corner I have no access to...and a big room with a bunch of chemo chairs and televisions. Certainly more than a kiosk, certainly less than a Sears.

A chemo chair is a well padded chair that reclines quite a lot for comfort with an IV stand next to it. The main room has 6 chairs and two televisions which typically air soaps. A person sitting in one of those chairs is first given a nominal evaluation, blood pressure, temperature and heart rate and is asked if they're feeling alright. If all that is a go, they typically proceed to put some fluids in you by some means for some purpose. Those means are limited (a stick in the arm or a stick in a port), but the purposes and fluids are many and varied. Most of them are blood (supplements to those whose counts are low) and drugs (either to treat cancer to to mitigate the effects of the ones treating the cancer). The IV stand is on wheels because you will have to pee. Not might, will. They not only encourage you to show up as loaded as possible to make it easy to find veins and so forth, but most of the drugs come blended in water which your body decides it doesn't need immediately after sifting it from the drugs.

Anyway, like I said, once whatever treatment is a go you do whatever it is you do to avoid eye-contact with the other ill people with needles leading eerily to tubes and pouches of poison and strangers' blood and such for several hours until you feel like crap and they let you go home. I personally wear ear-plugs to blot out the damn TV and try to study until the chemo turns off my brain (at which point I will continue to be as studious as a gold-finch for 100 hours approx.). The IV machines (they don't drip, they force) beep quite often and nurses bustle out to see why they're beeping. Half the time the machine is claiming "air in line" when there isn't any and the other half they're claiming they're done with the pouch and to please hang up a new pouch. Maybe half of those times they're actually done, the other half the nurse tells it to keep going.

I think that's about it. Until next time,
-Ian Hogan.

"...brown gobbets up I throw."

Dear blog,

Another chemo session over, and I feel quite ill. My blood count is low again, so I will have to go get more Neulasta tomorrow. It's time for me to get a PET scan. The lymph nodes in my neck are fairly staunchly present, contrary to expected progress of the treatment. However, the other surface-accessible nodes under my arms could not be found by the doctor. Thus, there is hope that the nodes in my neck are necrotic and things are progressing normally or that treatment is simply progressing in an uneven fashion. I am fairly anxious about all this.

Given that everything is pretty routine and some other factors there may be fewer or less frequent updates in the future. One contributing factor to this is the lack of commenting of late. At least two people have indicated that they do read but this is always of short reassurance and comments would drive up post rate.

Respectfully submitted, your obedient, in the fullness of time,
-I.

Three or Two or One

Dear blog,

Today I got infused for the third time. By the way I had been counting, I am on my third cycle. However, this is technically incorrect. A cycle is two infusions, so I have just started my second cycle. Then again, there is a chance that this treatment will not be effective, and I will have to do a different treatment. By that counting, I am on my first treatment, hence the title.

Last blog, I mentioned that I would get a port consult the next day, which was about 2 weeks ago. The consultation went fine, and I was scheduled for port placement last Friday. After the consult, I got the Neulasta injection to boost my white blood cell count. My white blood cell count had been 1.7 on a 0 to 10 scale (I have met people with AIDS with higher blood cell counts). Neulasta burns, but it must be effective, because this time my count was 8.2.

The port placement went as planned. I was very sore afterwards. They prescribed Percocet. Since they could not be sure in which side of my chest they would place the port, they shaved my whole chest. So, I shaved the rest of my torso because it looked silly. Then I had my wife shave my back, because it still looked silly. Don't worry, there are pictures.

This infusion, so far, has made me feel much sicker, much faster. Already today, I have taken a nap, which I did not on the same day of previous infusions. Also, I am between my third and fourth sittings attempting to eat some chicken ramen soup because I feel sick after only a few bites, which I did not experience on this day of previous infusions. I did, however, bike to and from the infusion.

The PET scan showed some areas of bone marrow disease. This means I am, in fact, stage 4B. This mostly just means that I am at higher risk of recurrence than otherwise.

Funny story: I'm a member of an online fitness tracking website called Fitocracy. I have been using it to advertise my cancer exercise tale. On that site, I am a member of a group called Bearded Barbell Club. One can imagine there are a wide variety of highly fit, burly men in this group, however, there are also some total wussies. Here is how I know: On the 17th, I joined a group challenge to see who in the group (who also joined the challenge (some 29 members)) could log the most points in the 2nd half of July. At the onset, I had anticipated coming in last given that I have fatigue-inducing cancer, fatigue- and nausea-inducing chemotherapy and a surgery scheduled during the challenge period. Yet, I am so far ranked 22 out of 29. I have a hefty margin over the member currently ranked 23rd, so I anticipate maintaining my rank through tomorrow (today being the 30th and second to last day of July).

Bwahahahahaha, wussies!! I tell you say, "Y'all losin' to a guy with cancer."

Full of fried chicken,
-Ian Hogan

Return of the Poison

Dear blog,

I biked to my second chemo session today. I had been feeling about 80-90% of normal for the last 5 days about of the first two week period. I could do sedentary activities without any symptoms, and walk without symptoms, but more serious exercise had a cap well below my usual ability.

My white blood count is low. I will have to take neulasta, an injection to stimulate production, tomorrow. I will get it after my port consultation at 2:15 PM. I decided to get a port after two of my veins failed to make a good IV site despite what appeared to be perfectly expert administration by the nurses. Let's be honest; setting IVs is their business, and if they had that much trouble after one cycle, I'll go ahead and do the surgery.

And I biked home. I'm pretty fatigued. The doctor said fatigue would tend to build. That makes sense. If I started the last treatment at 90 and I start this one at 80, then I'm bound to bottom out lower this cycle than last. I'm going to see if avoiding the anti-nausea at night helps me not lose sleep later in the cycle. I guess I didn't blog that bit. After the big sleeps died off, I actually had a lot of insomnia, which I blame on withdrawal from the drowsiness inducing anti-nausea.

So I have my protein shakes and iced-cream all ready, and turkey and mayo so I can make bland high protein sandwiches when I have limited appetite and potentially mouth pain later this week. If you're a turkey and mayo kind of person, I insist that you are bland. Bland bland bland.

With great piquance, if only in spirit,
Ian Hogan.

Chemo Days 4 and 5

Dear blog,

Day 4 (or third day after treatment) was the worst for me. I had mouth pain develop on day 3 that made me dread even taking a drink of water. It got worse on day 4 and is still present now. I treated it with the ten pound box o' packets' "salt water rinse" and "absurdly frequent tooth brushing". I mean, these guys were talking 'after every meal'! Anywhat, the salt water, while disgusting, had some soothing effect after eating or drinking, but that didn't change the fact that it was so hard to start. The worst pain is in the first few bites or sips, when salivation is activated. I found that this is common in forums online. For some folks, the symptoms only lasted days or a few cycles. I really hope the same is true for me.

I managed to get out of the apartment only once yesterday, to go to an arranged study session. I was able to think clearly, realize why the math made sense, but it wore me out extremely fast. In about 45 minutes I was feeling very sick and didn't get much done after that. I took a long nap and then watched TV for the rest of the day, until reading time.

Today I feel less fatigued and nauseous, though I actually took an anti-nausea early in the morning today, which might have been a good move yesterday. I was able to get down some Arby's chicken sandwiches which I had a coupon for and do normal stuff without great difficulty. I still took a 2 hour nap after getting some fun mail. 4 pieces of mail from the insurance.
The Good News: They processed my claims and they're not denying them!
The Bad News: I have copays and they are no longer an ethereal, in-the-future thing. 16 separate claims with 'student balances' running from 10 to 1500 dollars. That's after more than 80% was paid on each claim. I didn't manage to do a total before I decided sleep was a better idea, and now I'm writing this.

I would like to say, I don't feel better. I feel less bad. Something about a cold and feeling better, you expect a total cessation of symptoms in the near future when you feel better. I expect the symptoms to get slightly less until they get seriously worse again, and so on, for six months. Then, I will feel better.

5 down, 79 to go,
Ian Hogan.