Sorting Things Out

The gnawing fatigue and peripheral neuropathy I experience every day from myeloma, chemotherapy and B12 deficiency I can understand. Other symptoms are less understandable and less tractable. Some of them are ongoing, some temporary.

So, today I’m telling you a story of a particularly nasty experience I had this past weekend that defies classification and that has stumped my oncologists. That may be because it isn’t related to myeloma. I don’t know. That it turned out to be temporary I consider to be a good thing, but I have no real justification for feeling that way. I won’t describe in graphic detail everything I experienced. That’s not necessary, but I will give you the gist of what I experienced so that you understand the context, that is, what I think led up to this weirdness, and its aftermath, which is still with me.

Last Thursday I went to the hospital for my monthly infusion of Daratumumab. On that day I also took dexamethasone, Benadryl, lenalidomide, aspirin, and hydromorphone (HM), that is, my usual cocktail of meds. I also took some Senokot, to counteract the constipation that invariably accompanies taking HM. I’ll also take Dulcolax if I need it as things go on.

On Friday, the dex left me with the usual spurt of energy meaning that sleep does not come easily. I got up on Friday morning having had virtually no sleep after 2 AM, but the dex was still doing its thing. We had been invited by friends to their place for a get-together before dinner, around 5:30 PM. It was so good to be out visiting friends, but it was still fairly cold out and after a couple of hours I decided it was a good idea to get back home. I was chilled more than I thought. I climbed into bed almost immediately and covered myself with lots of blankets and quilts. My legs, however, were pretty sore. I’m used to my legs being sore, but this time they were inordinately so, and the soreness was accompanied by weakness, spasms, and tingling. The tingling is usually restricted to my feet and hands, but now my legs were also involved.

I took some extra HM shortly after going to bed (2 mg). It’s called breakthrough HM because it’s used as a supplement to the 3 mg slow release HM I take in the morning and the evening. The slow release just wasn’t doing it for me, and that’s expected to happen now and again; that’s why I was prescribed 2mg of HM to take if and when the pain gets too much. I still struggled with leg and back pain so a couple of hours later I took another breakthrough HM. At about 3 AM I took another HM. I tried to sleep without much luck.

Eventually, I tried to get up to pee. That’s when I realized that I had barely any control over my muscles, all of them! As I tried to get up I slowly slipped off my bed, which is pretty high off the ground, and found myself lying on the floor, essentially paralyzed. I didn’t fall off the bed, I slid off of it. My arms were useless and so were my legs. It’s not that I couldn’t feel them, I just couldn’t move them. Carolyn came to help me, but I’m a heavy guy and she’s light but strong. Finally, with the little help I could give her, she was able to pull me into the middle of the room. Then, she maneuvered an arm chair close to me and I was able, with a lot of her help, to pull myself into the chair. We were able, then, to get the chair close to the bed. I lurched back into bed and stayed there for virtually the whole day. I’m still feeling the effects of that episode of weird symptoms.

From my consultations with the docs, it doesn’t seem like my temporary ‘paralysis’ has anything to do with myeloma. They’re flummoxed. So, off I go to get a CT scan of my head to see if my brain is still in there. 😉

I’m posting this because I really want to know if I’m the only person who has ever experienced such a thing. That means that I’d very much appreciate it if you could let me know if you’ve ever had this experience or know of someone else who has. You can PM me on Facebook, or DM me on Twitter. Or, you can email me at rogalb@shaw.ca.

Damn, it’s dark, cold, and wet out there!

Sleepless Nights, Rain Showers and Owls

It’s 8:30 in the morning but I’ve been awake and up sporadically since 2 AM. That’s a typical scenario for me the day after my chemotherapy session at the hospital on Thursday mornings. It’s the dexamethasone (a corticosteroid) that keeps me awake. The other meds just make me feel ill generally.

Being awake at 2 AM until 7 or so when Carolyn gets up has its perks. The rain showers were amazing last night. The rain just pounds on the steel roof above the bedroom and the harder it rains the more intense the sound becomes. The first one started at around 3 AM but only lasted for twenty minutes or so. The one at 4 AM was much more intense and lasted much longer. The rain will be steady today, and probably tomorrow and the day after. The Weather Network predicts that we might just see the sun again by Tuesday. We’ll see about that.

At around 4:20, just before sunrise, I heard a great horned owl shouting its call at the back of the property. The owls like to perch in the tall conifers at the back of the property and in the forest behind our back fence. They usually sound off earlier in the year as the mating season gets into full swing. This owl may just have been a little late getting itself going, like many plants in the yard. The wisteria is just starting to sprout and the honey-locust is still yawning its opposition to getting up and at it. The ferns, though, are as happy as pigs in a wallow. They like the cooler, rainy weather and they show it.

So, at 2 AM, wide awake, what could I do? Well, I could just lay there and stew, or I could pick up my Kindle and start reading. Of course, as soon as I start reading, the cat decides it’s time for me to pay attention to her so she walks right in front of my face, sticks her tail up my nose and generally makes a pest of herself. Notwithstanding the feline interruptions I often read novels that are on the humorous side from authors like Thomas King, Kurt Vonnegut and Christopher Moore. But I also read a range of books on ‘more serious’ topics like sex, misogyny and patriarchy.

Last night I continued reading a book I picked up recently by David Friedman entitled A Mind of Its Own: A Cultural History of the Penis (2001) that had been referenced in another book I just finished on a related topic: Sex at Dawn: How We Mate, Why We Stray, and What It Means for Modern Relationships by Christopher Ryan, Cacilda Jetha (2013). Like Sex at Dawn, A Mind of Its Own: A Cultural History of the Penis is a must read if you want to understand how the social and cultural relations we’ve built around sex is so out of line with our biology. After outlining some of the most egregious sexual cultural practices in the Middle Ages in Europe around sex and later witchcraft along with a compendium of culturally weird sexual practices all over the world and since recorded history, Ryan and Jetha get into some very interesting musings on the United States and its perverse official political views and practices around sexuality, many driven by religion and the drive for power by mostly white, Protestant men of a certain age. After outlining the horrendous treatment of Black people by powerful white folk and their less wealthy followers, their base in current language, during pretty much the whole of American history starting with the arrival of slaves from Africa to work in Southern plantations, they get into some more current issues, including the appointment of Clarence Thomas to the Supreme Court. [He is a year younger than me] His appointment was very controversial for a number of reasons, the most important one being that he was (is) black. This is a long quotation, but it demonstrates clearly the issues at hand and the players that are still involved in government, including Joe Biden. It’s important to note here that Thomas had been accused by a fellow attorney Anita Hill of sexual harassment but he dodged that one. He had been nominated by George H.W. Bush. According to Wikipedia he’s widely considered the most conservative and ‘originalist’ of the Supreme Court justices. It appears that he hasn’t changed his tune at all since 1991. His views are anathema to me.

From Friedman:

“Six decades later, another black American faced a committee of white men agitated about his penis. For hours those white men listened, many of them visibly appalled, to complaints from a woman about the black man’s lewd behavior toward her, all of it, she said, unwelcome and unsolicited. They heard how he bragged about the size of his organ, comparing it to a supernaturally endowed porn star named Long Dong Silver. Now that same black man faced the same committee. Unlike Claude Neal, however, he was not dangling from a rope. Except, he said, metaphorically. “From my standpoint as a black American,” Judge Clarence Thomas told the senators considering his nomination to the United States Supreme Court, “[this] is a high-tech lynching for uppity blacks who … deign to think for themselves … and it is a message that unless you kow-tow to an old order, this is what will happen. You will be lynched, destroyed, caricatured by a committee of the U.S. Senate, rather than hung from a tree.” (from “A Mind of Its Own: A Cultural History of the Penis” by David M. Friedman, page 129 Kindle edition)

and

“The exchange between Senator Hatch and Judge Thomas about racial stereotyping ensured that no lynching would occur, high-tech or otherwise. If nothing else, the all-white members of the Senate Judiciary Committee were determined to show this was 1991, not 1891. At 10:34 P.M., on October 11, when Senator Biden recessed the hearings for the day, the verdict was clear. The nominee, so close to political extinction, had come roaring back to life. When Senator Hatch left the hearing room, he was stopped by Nina Totenberg of National Public Radio. “Senator, you just saved his ass,” she told Hatch. “No, Nina,” said the Utah Republican. “He just saved his own ass.” What both probably knew, but neither could say, was that it was another part of Thomas’s body that had really been at stake all along.” (page 139 kindle edition)

I’m about half way through Friedman’s book, but so far it’s making for compelling reading. It was clear to me back in 2010 before I retired that as I was teaching a course on Love and Sex, that women had been subject to an intense misogyny for as long as recorded history and probably for as long as our species started walking upright on the African savannah. Actually, I was aware of misogyny long before 2010 but that’s when I began a more intense focus on its deconstruction. The focus of Friedman’s book, the penis, is a literary means of shifting the conversation about sex and procreation from the biological to the cultural realm. So far, I think that he’s done an excellent job of it. His analysis of Freud’s penis envy as a metaphor for the way women have been disenfranchised and generally kept out of the highest positions of business and government is particularly good and one I hadn’t considered before, at least not in the kind of detail Friedman goes into.

More on this later…as I read the second part of Friedman’s book and tie it into other books I’ve been reading, including one by Christopher Moore.

What should I be thinking about now? How about death and dying, cultural discombobulation, misogyny, evolution, and pain management?

I told you last post that I would be giving up on my blog. That’s still the case. I’ll likely wrap it up by the end of this month at least in its current format, but that doesn’t mean that I’ve stopped thinking or wanting to write. When my readership fell below fifty views after a post, I decided that maybe it wasn’t worth the hassle of thinking about writing every week. Of course, some people might argue that if I have only one reader that should be enough for me. There’s an argument that can be made both ways. Who knows, things change. 

So, what should I be thinking and writing about now? As I get ever closer to death, it’s hard not to think about death and dying. My sister-in-law who was a couple of years younger than me, died recently. It seems like someone in my immediate circle of friends and family is dying every month. Such is life when one gets to a certain age. Of course, it’s not only older people who die. A forty-nine year old doctor in my Family Clinic died recently of heart failure. However, it’s certainly true that most Canadians, in any case, die at an advanced age. That will be me for sure because I’m already most of the way there.

Lately I’ve been trying to create a metaphor for the dying process. I think I’ve come up with one that makes sense. It’s probably not new to me, either. It’s the image of a wall, maybe a stone wall that can be seen in the distance just beyond a large, open field. In our younger days, the wall is low and hardly visible. We only pay attention to it fleetingly, maybe when we visit someone in the hospital, when we leave a funeral or witness a fatal car crash. Our physical vulnerability is only too obvious at these times. The truth is that we would have a hard time living our lives if we did not ignore the wall most of the time. Some people actually convince themselves that the wall doesn’t even exist and that even if it did, we could walk right through it. The thing is the wall is always there. As we get older the wall gets more visible. It gets bigger, thicker and broader and we begin to see individual stones in it. It begins to draw our attention more frequently. We seem to be getting closer to it and in fact we are.

My wall is clearly visible to me now. It’s so big, I can’t see much beyond it. Earlier in my life I could see mountains on the other side of it. Not anymore. Now, the wall demands my attention. It will not allow me to turn away from it. In a sense it’s a beautiful, solid wall. It’s obvious that much care was taken in its construction spanning the whole evolutionary time on this planet. Everyone has to come to the wall. No one is allowed to pass through it.

The denial of the existence of this wall is the essence of Ernest Becker’s work. My early posts on this blog consist of an exposition of Becker’s work and his contribution to understanding the denial of death. His last book, one that he had no hand in publishing because he was dead, was rightly entitled Escape From Evil. The evil that Becker writes about is death and disease. This book is a must read for anyone who wants to understand the power of denial in our lives because it’s a power that has determined so much of the death and destruction this planet has experienced with Homo sapiens at the centre of it.

Let’s now explore that denial a bit from a different perspective than I would have normally used. First up is how our social world seems to be coming apart at the seams with the war in the Ukraine, growing authoritarian at home and the pandemic that doesn’t seem to want to go away. I’m talking about the discombobulation of our social world and our reactions to it. Later I write about misogyny and evolution with a nod to Aristotle, the consummate misogynist and other philosophers of his time and ilk. But first, discombobulation.

Discombobulated  

This is my drawing of discombobulation. It’s my personal visual statement of my reaction to the Kurt Vonnegut world we live in today.

The word discombobulation is an old word from the 19th Century that shouldn’t be forgotten because it so expresses the sense that not much makes much sense anymore. The world really hasn’t ever made much sense if one considers humanity’s millennia-old legacy of war and brutality combined with a huge dose of goodwill and caring underlying much of human history. It seems as though every generation has to learn this truth on its own never learning from history. I’ve spent my whole adult life in a quest to unravel this discombobulation. I think I have things more or less worked out (with the help of a lot of people now dead who were much smarter than me), but I can’t seem to communicate that to enough other people for my knowledge to make much sense. At least I feel that way sometimes. I may be like the proverbial falling tree in the forest with no one around to hear it fall. What does it matter? Well, it does matter to me. Sometimes I think of my writing as a drop in the bucket of cultural commentary, but it’s still a contribution.

That said, it’s a contribution that will leave many people behind. Admittedly, reading my blog posts requires a modicum of literacy. I don’t speak to a Grade 8 audience. That in itself will limit the influence of my work. My personal intellectual voyage can never be yours, but we must learn from each other otherwise the discombobulation wins. Patently, there are many people (No, I haven’t done a survey although others have) who are incapable of hearing what I have to say because they have been captured by an ideology that is inherently contradictory in itself but still seems to speak to their individual lives somehow. I’m talking about people who deny that we are inherently social and dependent on each other not only in our families and other intimate relationships, but in a collective sense with people we don’t know personally but who, combined, hugely affect the world we live in.*

I’m referring here to people who see taxes and government as an infringement on their freedom, whatever that means. They have no idea themselves what ‘freedom’ means, and it’s almost embarrassing if you dare ask them what they mean by it because their answers are naive to the extreme and essentially childish. In other aspects of their lives they may be competent enough, but when it comes to thinking about their place in the world and their responsibility to others, they just have no idea, except to spout platitudes they have absorbed by watching too much Fox News or have been absorbed by concentrating on their belly buttons for too long. I’m no big fan of much of what government does, but I’m not willing to chuck out the baby with the bathwater either. 

Recently, Carolyn and I listened to a CBC Ideas podcast on The Authoritarian Personality. The people who fit this profile are the people I’m talking about. The Authoritarian Personality is an idea popularized after the Second World War by Theodore Adorno and others to try to explain why people are attracted to fascist leaders. The book is available to be borrowed for free at the Internet Archive but it’s been revived and republished with an introduction by Peter Gordon of the Frankfurt School and is available on Amazon in various formats, including as an eBook, but it ain’t cheap. The book was first published in 1969 but was in writing for some time before that while the research for it was being conducted in California. The book itself and the blazing controversy surrounding it can be seen at the Internet Archive by simply typing in The Authoritarian Personality in the search function and looking around. Some of the reactions to the book are a full example of discombobulation. In fact, I would argue that the book is itself a treatise on cultural discombobulation as are reactions to it. We live in a discombobulated world but there’s nothing new about that.

So, I’m thinking that this post is long enough. I have probably another 5 or 6 thousand words I want to get out of my system at the moment but I think I need to break those up into manageable chunks. Therefore, I’ll leave this post as it is but I’ll carry on writing about the other topics in the title of this post and present them to you as soon as I get them fleshed out with good references, etcetera. Besides, it’s six o’clock in the morning and I’ve been writing since two thirty. Yesterday I went back to the hospital to get back on my chemo regime. The dexamethasone I took yesterday won’t let me sleep anyway, so instead of fretting that I can’t sleep, I might as well write, but enough for tonight…it’s getting light out and the coffee beckons.

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*This is a disparate group of people from grocery store clerks and managers, to cops, to delivery drivers, to municipal workers, librarians, veterinarians, road crews, mechanics, garbage (solid waste) collectors, baristas, Hydro crews, emergency personnel of all kinds, Hospital workers including medical doctors, nurses, technicians, etcetera. I mean anyone you come into contact with on a daily basis and who provides you with a service you depend on. Just think about it. You are massively dependent on others, even people in China and other Asian countries who make your T-shirts, jeans, phones and computers for you, and on the people who work on the planes and boats that get those products to you. How can anyone deny that? But they do because to recognize this fact they would have to accept that their individualism is contingent and not absolute. We are not free to do whatever we want. Let’s just get over that silly notion. I used to challenge my students to unplug their homes, and I mean in every way: cut off water, electricity, the internet, waste collection, everything. Do that for a few days and then let’s discuss how independent and ‘free’ you are.

February 18 Update

[I’ve written about some of the issues I’m having with myeloma before, many times. Because it’s such a presence in my life I can’t help but write about it often. Sometimes, I write about it to provide an update on my treatments and side effects. That’s what this post is about. It’s somewhat technical, but you don’t have to know everything about the drugs involved to understand the thread of my story.]

I sit here in my chair warmed by our new(ish) mini-split HVAC that lives on the wall up to my left with it’s companion outside, visible from the large window just behind me. It’s just after nine in the morning and it’s cold today but clear with the temperature hovering around the zero Celsius mark. We have the wood stove on too because the electric heat just doesn’t cut it when the temperature gets near or below zero. 

Myeloma is always at the forefront of my mind, but now pernicious anemia, and my opioid dependency are butting in and taking up some space of their own in my consciousness. So, in this post I’ll discuss the challenges posed by these issues for me every day. 

I’m so conflicted these days I’m almost completely immobilized. My myeloma saga is putting me in a space where I’m not sure what to think. I’m off my chemo meds for at least one cycle, approximately a month. My local oncology GP as well as my consulting oncologist in Victoria can’t detect much myeloma protein in my blood, if any at all, so it seems logical to give my body a break from the meds. Fair enough. However, for the last 7 cycles the combination of chemo meds (lenalidomide and dexamethasone) along with the monoclonal antibody Daratumumab have effectively erased most, if not all, traces of cancer in my blood. I’ve come to appreciate the protection I get from these meds even though they produce some nasty side effects, peripheral neuropathy** in particular. Still, I know that myeloma will always return. The last time I went off chemo meds was some time ago. I was taking a lenalidomide* based cocktail at 10 mgs per cycle but then I got a severe abdominal rash and had to shut that down. 

After that, I was moved to a drug called bortezomib, along with dexamethasone, and cyclophosphamide. The bortezomib (Velcade is its trade name) had some horrendous side effects for me, threatening to put me in a wheelchair or worse. I quit taking these meds out of desperation, but found that soon my paraproteins were increasing rapidly in my blood. That scared the poop out of me. Time to make another move. 

That’s when I was switched back to lenalidomide (Revlimid is the trade name) but at a minimal dose of 2.5 mgs along with 12 mgs of dexamethasone and an infusion of some 500 mls of Daratumumab per cycle.  That’s the cocktail I just stopped taking. Next month I see my local oncology GP for another assessment. It will be interesting to see what my bloodwork reveals. I’d be lying if I said I wasn’t worried about it. 

To complicate matters, I’m trying to wean myself off hydromorphone (an opioid) and gabapentin , both are widely prescribed pain relievers. Opioid dependency is no picnic. I was first prescribed hydromorphone when I was diagnosed with myeloma in the fall of 2019. Since then the goal has been to fine tune my doses to get the maximum effect while leaving me more or less sentient. It’s been difficult. For some time now I’ve been taking two types of hydromorphone, a slow-release 3 mg capsule and a 2 mg ‘breakthrough’ dose. I’ve taken one 3mg capsule in the morning and two in the evening. Now, as I try to get off this medication, I’m restricting myself to one 3mg in the evenings and none during the day. Last night I thought I’d be tough and not take any meds at bedtime. Well, I soon got schooled by hydromorphone for trying to back off too quickly. By 11 PM I was downstairs into the medicine shelf getting a 3mg capsule to take. The thing is I was not prepared yet for a full withdrawal. My body let me know very quickly. The pain in my back returned with a vengeance, and I couldn’t stand to have anything against my skin. I was completely distracted by itchiness all over my body. Thoroughly unpleasant. I expect that as I restrict my intake of hydromorphone more and more, that I will have fewer pain issues. Ironically, opioids can contribute to pain, especially during withdrawal. 

The reason I’m trying to get off hydromorphone is because of the success we’ve had in dealing with myeloma. I’m thinking that with my myeloma symptoms under control, I may not need as much pain relief as when it was in full bloom. 

As far as the pernicious anemia is concerned, I should have my B12 up to acceptable levels. I’ve injected B12 (cyanocobalamin) eleven times now in the last six weeks. That should do it. However, it will take up to six months before I experience any kind of improvement to my health. It would be nice if I only had one issue to deal with but I think I have things more or less under control for the time being. 

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•For a list of common side effects of lenalidomide check out this website: https://www.drugs.com/sfx/revlimid-side-effects.html

**I am a member of a myeloma support group. We had a Zoom meeting last Thursday. We are all at different levels of treatment and on various medications but we pretty much all have one thing in common: peripheral neuropathy. The neuropathy in my left hand is now starting to interfere with my ability to type. Given that I write a fair bit, that’s not at all welcome.

Sleepless in Cumberland

Yesterday was my day at the hospital for my monthly infusion of Daratumumab, the monoclonal antibody. It along with other flavours of monoclonal antibodies have changed a lot about how medicine thinks about and treats cancer, arthritis, and other nasty ailments of us fragile mortals. Along with my Dara, I also take some dexamethasone, only 12 mgs for the month, and a few other meds designed to protect me from viral infection. It’s the dex that keeps me awake as I’ve noted many times on this blog. 

So, instead of lying awake, allowing whatever thoughts I had rattle around in my brain causing no end of silly talk, I decided to read instead. Reading is a good way of filling in the night hours in what some people would call a ‘progressive’ way. However, I may need to revise the material that I choose to read at night. I haven’t read a lot of fiction in my life, focussing my reading time on sociology, anthropology, philosophy, and other sundry disciplines. I have read most of Kurt Vonnegut’s work, all of Emily St. John Mandel’s books and I did recently read several books by Kim Stanley Robinson, fictional accounts of the human colonization of Mars, New York under flood, and other similar topics. In his Mars trilogy one interesting commentary was on longevity. If people accepted a certain treatment, they could live hundreds of years instead of the paltry number of years generally allotted to our species. That fact, however, did not seem to mitigate the angst they felt about death and dying. In a book called Aurora, Robinson is at his most pessimistic about human excursions to other planets and their satellites in our solar system. His conclusions about the time it takes to travel from Earth to other planets are telling. Travelling to and back from a satellite of Venus, for example may take a hundred and seventy years or more with the need for cryogenic sleep. So, if you were one of the ‘lucky’ ones who won the lottery for space travel you would return to Earth after several decades of travel at a time when no one would know you, you would have no recognizable family and you would be relegated to the margins of society. I read Robinson at night. It was a bit hard to get to sleep after reading some of his stuff, but not impossible. Reading Barbara Ehrenreich and other non-fiction writers of her ilk is an entirely different story (no pun intended). Last night I finished reading her book Natural Causes: Life, Death, and the Illusion of Control. This book is firmly planted in reality. Problem is reality sucks sometimes. Ehrenreich is especially blunt when she writes about aging. Getting old is no cake walk. It’s not for the faint of heart although in our culture it’s not cool to ‘give in’ to the infirmities of age. Ehrenreich writes:

“But as even the most ebullient of the elderly eventually comes to realize aging is above all an accumulation of disabilities, often beginning well before Medicare eligibility or the arrival of the first Social Security check. Vision loss typically begins in one’s forties, bringing the need for reading glasses. Menopause strikes in a woman’s early fifties, along with the hollowing out of bones. Knee and lower back pain arise in the forties and fifties, compromising the mobility required for “successful aging.”” (from “Natural Causes: Life, Death and the Illusion of Control” by Barbara Ehrenreich)

And:

“Not doing anything is the same as aging; health and longevity must be earned through constant activity. Even the tremors of Parkinson’s disease can be seen, optimistically, as a form of health-giving exercise, since they do, after all, burn calories. The one thing you should not be doing is sitting around and, say, reading a book about healthy aging. There are bright sides to aging, such as declines in ambition, competitiveness, and lust.”*

So, we must always put a happy face on adversity, be positive about everything, and keep moving. I don’t think my nine hours a day sitting with my computer on my lap would be morally acceptable. But you know what? I’m finding it a wee bit difficult to feel positive about dying. A Cumberland friend, Howard Jones, who died recently spent his last few days in the hospital. He couldn’t breathe on his own much anymore. Months ago, over coffee he confided that he didn’t know how long he could continue on oxygen with a life very much reduced to sitting or lying in bed. He could no longer walk in his beloved forest. I meant to visit him in the hospital when I was there for my usual chemo treatment, but I was cautioned not to because of my compromised situation. I should have gone anyways. Now it’s too late. We did text each other, but that’s not the same as a face-to-face visit. One day, the day he died as far as I know, he was the one to make the decision to go off oxygen, thus ensuring his death. I think that Howard died a good death. 

The especially difficult decisions I know I will face in the near(ish) future will be whether I continue with the chemotherapy that has so far kept me alive. I will be thinking of Howard when the time comes. I expect that my (and my family’s) decision will hinge on the quality of life my treatments are now offering me and the intensity of their side effects. There is a question of how much benefit a few months of life can give in the face of much reduced quality of life. It will not be an easy decision. I love life, I love my family, my community and where I live. I am loathe to give that up, to know that the world will carry on without me. But it’s not like I or any of us have a choice in the matter. We all die. Some of us, however, are given the privilege of deciding when and how we die. 

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*I’m reading Ehrenreich as an ebook on a Kindle. The problem with that is that when I select a quotation to use on my post, it doesn’t give me a page number. I find that unacceptable and will see if I can find a work around. 

Dexamethasone, Tooth-aches, Pig Kidneys, and Life.

So, dexamethasone strikes again! I went to the hospital this past Thursday for my monthly infusion of the monoclonal antibody, Daratumumab. Along with the Dara, I get a number of other chemo meds among them dexamethasone. I only get fifteen milligrams of dex these days once a month and that’s probably a good thing because any steroid can be trouble in the long run. Of course my long run is getting palpably shorter, or to put it another way, dex can’t really hurt me in the long run if I don’t have much of a long run. What I can say, though, is that no matter how long my long run is, I’ll make the best of it. I’ve decided that that’s my goal. I’m thinking of my life now as a one mile marathon race. Getting closer to the finish line is no reason to slow up. In fact, it’s all the more reason to step up the effort. Of course, the closer to the finish line we get, the more tired we get so it’s a trade-off. Still, pushing to the end is my goal. But I digress.

What is interesting about dex is it’s effect on my tooth-ache. I mentioned before that I had a nasty tooth-ache that a dex shot in my neck attenuated rapidly and almost eliminated entirely. Well, that tooth-ache has persisted in a low rumble since it returned after a few days following my neck shot. Again, the dex that I took orally on Thursday killed the pain in my tooth right dead. It’s back now because as I’ve become well aware, the relief from dex is very short lived. Oh, I appreciate the pain relief whichever way I can get it, but dex has other side effects that aren’t as welcome as the pain relief. Check out this list of side effects. I’ve experienced many of them over the past couple of years.

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[As an aside, I’m writing this sitting in my new La-Z-Boy recliner (thanks to my very generous daughters) in my cozy, warm living room. Carolyn, my love of forty-eight years, while I sit warm and cozy in the living room, is out there walking on the trails in Cumberland in rain as thick as soup. She is accompanied by Tilly, our Bernese Mountain Dog/German Shepherd mix who loves her mom and also most other living things, and swimming too. I hope she gets home soon so we can have a cup of tea together. She did!]

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So, what about pig kidneys? Well, lots. This article explains what the experiment was all about. And it was an experiment, of course. Serious ethical issues aside, the experiment was a success. Researchers in New York attached a kidney from a specially raised pig, one that was genetically modified to not produce a certain sugar that caused immediate rejection in humans, to a cadaver. Yes, a cadaver. The objective was to see whether or not the pig kidney could reproduce the function of a normal human kidney, and apparently it did, and splendidly so. The cadaver was special too, of course. I suggest you read the article to get the story from a reputable source.

What’s the big deal, I ask? Researchers genetically modify pigs so that we humans can use their organs. How does that make you feel? The truth is that pig heart valves have been successfully implanted in humans for some time now and researchers have been experimenting with xenotransplantation since the 17th Century. We eat pigs all the time. They are one of our major sources of food. They are also intelligent, rivalling some humans I surmise.

The reason pigs are such a good fit for xenotransplantation is that they are so closely related to us genetically. In fact, we are related to all other living things, animal and plant but with varying degrees of fit in terms of the quantity of genes that we share with them. We are very closely related to chimpanzees sharing something like 99% of DNA with them. (I think that the reason we don’t raise chimps to eat is that they look too much like us.) We share DNA with ducks and cedar trees, snails, and puppy dogs.

From what I can gather from casual observation, we tend to think of all species as distinct from each other and, of course, that’s partially true. Sadly, we are generally ignorant of our place in the scheme of life on this planet. We have been convinced over millennia that we are special under the sun and that all life on the planet is there to serve us. That attitude will ultimately lead to our demise as we Bolsonaro the Amazon rain forest, empty the seas of fish and other life, and generally bulldoze our way through all life on the planet. We take up more and more of the biosphere every year. We, as a species, have no respect for life and from what I can see, have very few mechanisms that would allow us to gain respect for life. Our culture is designed to deny death and thus to ignore life.

Our political systems are geared to produce maximal growth and compete in absurd ways for greater and greater shares of planetary resources. It’s disconcerting to see China and the US embroiled in a chest-thumping match over Taiwan. How stupid. How short-sighted. How ignorant. What are they going to do, lob nuclear weapons at each other? It’s especially ridiculous knowing how closely tied manufacturing in the US is tied to production in China. It’s hard to see how Americans destroying American production in China will help anyone, anywhere. I suspect that the Chinese leadership is in need of a diversion to keep its population’s collective mind off of serious domestic problems. Focussing attention outward is a tried and true method of avoiding domestic conflict.

I could argue that the way we are increasingly economically interdependent through production of commodities in networks that span the globe is encouraging as a basis for concerted action. However, I’m not sure that we have the time to wait for economic interdependence to lead to political interdependence. Finally, I’m not convinced that as a species we are capable of doing what needs to be done to enable us to live in harmony with the rest of life on the planet. It may be that cockroaches will inherit the earth and if that’s the case, so be it.

Dexamethasone for the Win!

Last post I more or less said that I would not write about pain anymore. Well, that’s not really practical if I want to write about my life so that idea is out the window. Lately pain has been my life. It’s dominated everything that I do and don’t do (because of it). So, away we go.

Along with the general pain in my legs and back from the chemo treatments I get, I have serious neck issues that are fairly common in older people, that is, vertebrae that collapse or the passages in the spine shrink (stenosis). For all of you young’uns out there, this is your future. However, most people don’t have pain to accompany these age-related changes. I just happen to be one of the lucky ones to get excruciating pain in my neck that includes cramps and a low-grade throbbing pain. Most of this I can handle. The cramps require immediate attention much like a charley-horse in the leg muscles. I often wear a neck brace to keep my neck from moving too much and inducing the cramps. In fact, I’ve just put one on because looking down on my keyboard is a sure way of bringing on a cramp.

I’ve been exasperated with my neck pain because it severely limits my mobility and I want to do some painting, drawing, and boat work. As soon as I look down for any length of time, I get a cramp and that really cramps my style, if you know what I mean. So, I called my GP. He, I’m sure being sick and tired of me complaining about pain referred me to the Pain Clinic at the hospital in Nanaimo. They called me from the clinic surprisingly quickly and we set up a telephone appointment with Dr. Pariser, one of the doctors who works at the clinic. We decided on a procedure. It would take place on October 6th, yesterday. All that was left was the waiting.

Carolyn drove me down to Nanaimo yesterday morning when I got to see Dr. Pariser. We decided on a treatment that’s been around for a long time and that works fifty percent of the time and only after a month following the procedure. It (the procedure) involves injecting a steroid in the spinal cord to deaden the pain. It’s clinically referred to as an epidural. Epidurals are sometimes given to women during labour but they are not uncommon for lower back pain.

In my case the steroid was dexamethasone. I’ve often mentioned dexamethasone (dex) in my previous posts because it’s a staple medication of my chemotherapy and it has interesting side effects. I was a bit surprised when Dr. Pariser told me that he would be injecting dex into my neck, but he assured me that there would be no adverse effects from adding this dosage of dex into my mix along with my monthly oral 12 milligrams taken in conjunction with my infusion of Daratumumab at the hospital. Frankly, I didn’t know what to expect in terms of side effects from the dex injection in my neck. It didn’t take long to find out.

Before I tell you about the effects of the dex injection in my neck I want to tell you about another source of pain I’ve had recently that prompted a visit to my dentist. It started innocently enough with a bit of sensitivity in an upper left molar. It has a large crown which has been there for some twenty-five years. X-rays showed a probable need for a root canal. Well, that was fine and dandy, but when could that be scheduled. I was in pain NOW. My dentist was very concerned and referred me to a group of dental specialists in the Valley that specializes in this kind of work. Great. Their office called me and cheerfully informed me that I was booked for an appointment on November 15th. Yahoo! That’s all I needed: a six week wait for a consultation, never mind the procedure. After whining for a bit I got the appointment moved up to October 15th. That was some improvement but still a long way off given the level of pain I was in. I mean, this pain trumped all other pain in my body. It was excruciating, it was relentless.

So, yesterday when we drove to Nanaimo I was still in a lot of pain, but it had attenuated some due to an onslaught of hydromorphone. I take hydromorphone daily in a small dose for pain associated with my multiple myeloma, its side effects and the side effects from the chemo. I take a slow-release dosage morning and night, but I also have a stock of what’s called breakthrough medication for times when the slow-release dosage just doesn’t cut it anymore. Over the last while I used a lot of breakthrough hydromorphone. It has a lot of side effects that I don’t particularly enjoy, like insomnia, but too bad about that. I needed pain relief and damn the torpedos! It’s a good thing I had my breakthrough hydromorphone.

This is where serendipity comes in. I love serendipity. Dex can relieve pain. I had pain in my mouth as well as my neck so what would dex do for my molar pain? Well, I’m pleased to report that the dex pretty much killed the pain in my mouth, at least for now. I don’t expect the pain relief to last a long time, but any relief is welcome. I have the hiccups, a common dex side effect so I know it’s working. Strangely enough, I slept very well last night. Insomnia is also a common side effect, but it’s also a side effect of other meds I’m taking so who knows what’s going on in my body.

As a bit of a side note, if there are scientists reading this, scientists interested in pain and its management, you might want to think about a way of letting others know how much pain we’re in. That wouldn’t have any pain relief effects, but it may increase positively the way most people react to people with chronic pain. I mean, it’s hard to know if someone is in pain or not. People can fake it. There are clues in bodily function and blood work, but not many that show physically. Arthritis can sometimes show clearly in the body. In the last decade of his life, my father’s hands became deformed with arthritis. He was unable to open them, and he kept them clutched against his chest. Maybe, if our pain wasn’t obvious, if our limbs glowed blue or green that would be a clear indication of pain. Whatever. Work on it.

So, in summary, dex was a clear winner for me yesterday and today. I still had a shake (liquid diet) for breakfast today like yesterday rather than my usual granola or toast, but I’ll carry on with that because I really like the shakes Carolyn makes! Besides, I expect my toothache to reappear as the dex wears off. So be it. Pain management is very complex because the pain never stays the same in terms of source or intensity. It’s like playing whack-a-mole, but with no fun involved.

Moments in my life #2: Withdrawing from opioids

It’s now 5:11 AM on Friday, August 27th, 2021. I just came downstairs to my recliner/writing station. I’ve been awake since 2 AM in a dexamethasone induced insomnia and decided that it was unproductive to just lie there thinking about nothing in particular (or a multiplication of musings about my life and career) when I could be downstairs at my computer where I could retain in writing some of the musings that had come to mind as I was lying in bed with my hands behind my head in a position not particularly inducive to bringing on sleep. So, if I had no possibility in my Dex determined insomnia to fall asleep, I might as well come downstairs. Princess Pretty Paws seemed to have no objection so here I am. She does expect that if I come downstairs, I will give her some “kitty crack”, marketed as cat treats or whatever. She’s addicted to her treats and will not be denied so I obliged and before sitting down I laid out a few bits of her favourite crack to munch on. She was appreciative if I can deduce that from her silence and aloofness. She’s now sitting in the kitchen awaiting another few bits of crack, but they’re not coming. She isn’t complaining so I won’t pay any more attention to her. If she meows a lot I may get up and indulge her. Oh wait, she’s just come over and is threatening to march all over my keyboard, so I’d better get up and give her a few treats. So, that’s that. Now I can get to the topic at hand, that is, withdrawing from opioids.

Some readers of this post might consider this offering as a confession of failure. It may be viewed that way, I guess, but it’s more, in my mind, a reflection on the vagaries of life and responses to unintended outcomes and life-threatening events. I was first diagnosed with multiple myeloma (bone marrow cancer) in the fall of 2019. It was clear to Carolyn and me that I had been suffering from the effects of myeloma for many years and the resulting MRIs and CT scans confirmed that: for one thing, my femurs were being excavated by myeloma and my left femur had a ‘lytic lesion’ of 10 centimeters in length at the distal end closest to my knee and that the whole-body chronic pain I was dealing with which was clearly an effect of myeloma. That explained why I was in such constant pain all the time and increasingly unable to engage in the kinds of wonderful activities I had anticipated being able to engage in after my retirement in 2012. Of course, age plays a huge part in a body’s preparation for death, its entropy. We inevitably get weaker and have age-related physical symptoms that preclude strenuous activity. I don’t think that evolution had in mind (so to speak) that we would live so long. So now most of us over seventy have back and neck problems that tell us it’s time to slow down and forego the strenuous activities that were the hallmarks of earlier life. 

When I was finally diagnosed with myeloma, I was prescribed pain medications on top of the chemo meds I would be taking for the foreseeable future to deal specifically with my cancer. One of those meds was hydromorphone, a synthetic opioid much stronger than morphine. After some time, I was also prescribed other meds to deal with the neuropathic pain I was suffering brought on by myeloma. I was offered and take gabapentin. I was offered, took nortriptyline, then stopped taking it a few months back because I couldn’t stand the side effects it produced: unable to taste my food, enjoy eating, and I had dry mouth all the time. Enough of that. 

So, I’ve been taking a low dose of hydromorphone in two forms since late 2019. One form is a slow release 3 milligram tablet taken in the morning and 6 milligrams in the evening. It’s designed to produce ongoing relief from pain. I was also prescribed 2 milligram tablets of hydromorphone as a ‘breakthrough’ med if the pain got out of hand. I did take the breakthrough hydromorphone occasionally especially after I had indulged in some activity more strenuous than was good for me. It always worked if I took enough of it. The most I ever took was 18 milligrams, and that was only a couple of times. Taking the hydromorphone in that form eliminated some of the more egregious types of pain I endured, mostly in my thoracic area, lower back, neck, and legs, well in my whole body is what I’m saying.

Lately I’ve been feeling that I might be able to forgo some of my pain meds because I’ve been feeling pretty good. My neck pain is still nasty and prevents me from painting and drawing. Sculpting, especially with a chainsaw, is out of the question. I tried backing off gabapentin and soon realized that that was a mistake. My neuropathic pain returned with a vengeance. I’m now taking a bit more Gaba than I had been. The reality is that every med I take has side effects. None are purely capable of producing pain relief without negative consequences. Dexamethasone, for example, one of my chemo meds, is a powerful pain killer, but has huge negative consequences over time resulting in severe bone deterioration. It’s a glucocorticoid (Google it). It is not to be taken lightly although in my desperate state over the pain in my neck, I will go to the Pain Clinic at the Nanaimo Hospital in October and have some Dex injected into my neck. According to the doctor there, it may help, it may not. What have I got to lose at my age by giving it a try?

Anyway, getting back to hydromorphone. Of course, I knew that taking an opioid was fraught with issues, not the least of which is addiction. However, faced with severe chronic pain in most parts of my body, hydromorphone produced some relief and allowed me to resume some of my former activities. I can still write. Problem is that there is a balancing act when taking opioids for pain relief. Take too much and you become brain-addled and incapable of much in the way of coherent thought. Take too little and the pain relief objective is undermined.

In the face of the negative consequences of taking a powerful opioid like hydromorphone, I decided recently that I would try to withdraw from it. I knew that I shouldn’t try going cold turkey, so I decided to do the right thing and go cold turkey. Go figure! I stopped taking it last Sunday. I figured that since I was on such a low dose, how could I possibly be addicted? Well, I am addicted and the proof of that was how my body reacted to the withdrawal. I’ve never experienced in my life the effects of withdrawal. I didn’t experience some of the more horrific effects like vomiting and diarrhea, but after a while I just couldn’t stand the overall drastic body dysphoria that was the outcome of withdrawal. There’s no way I could sleep. I was agitated to the point of distraction. I could not relax or stay still. I paced. I sat down. I paced again. It was awful.

Consequently, Carolyn and I decided that I should probably resume taking hydromorphone in the usual way until my appointment at the pain clinic to see what my cortisone injections might produce in the way of pain relief. At that time, I will consult with my family doctor to develop a proper plan for withdrawal. I am prepared, though, for the possibility that I will not be able to live without some chemistry enabling a life with a modicum of relief from the grinding chronic pain that is my constant daily companion. My pain meds, so far, have proven effective. It may be that I’m suffering from some sort of moral panic. I’ve done some self-psychotherapy and have concluded that there is a distinct possibility that I may be in a moral existential crisis. How could a big, strong guy like me need opioids? The answer to that question is still blowing in my mind’s wind and may be the subject of another blog post. 

 

#86. ???????

I woke up this morning at seven twenty three and got out of bed at seven twenty eight. In that five minutes between seven twenty three and seven twenty eight I had a couple of thinks1. These were little thinks, nothing momentous or earth-shattering. They were thinks about what I would do today. I decided on a couple of things to work on, writing a blog post is one and the other is going down to my studio to continue a clean up I started some time ago in preparation for some work I want to do.

Today is the day after my Daratumumab infusion at the hospital. That’s a bi-monthly event for me. We get to the hospital for a nine o’clock appointment. I grab a coffee after being logged in at the Wellness Centre then make my way to the Cancer Care Centre. After getting settled in they hook me up to an IV drip and then call the pharmacy to tell them I’ve arrived and that they can prep the Dara. Yesterday it took over an hour for the pharmacy to get the Dara to the Cancer Care Centre. I waited patiently but with a little frustration, I must admit. After about ten fifteen they released the Dara starting the infusion. I read my book for a bit but soon fell asleep. I woke up at eleven forty five. Cool. The infusion was almost done. It generally takes about one and a half hours. At about twelve twenty, Carolyn picked me up and we came home.

Along with the Dara, as you well know, I take dexamethasone and lenalidomide. These are the chemo drugs. Dara is not a chemo drug, but a monoclonal antibody. Click on the word Daratumumab in the paragraph above for some good information about Dara. Dex and Lena are very different drugs that do different things in the blood. Dexamethasone is a steroid and has some annoying side effects like interfering with sleep. That it did last night. I slept in fits and starts and got maybe four hours of sleep total. I won’t get much sleep until Monday.

My life these days is organized around my chemotherapy. Of course, my Dara infusions predominate, but the dex has the most immediate and dramatic effects aside from the hydromorphone. I most often go to bed before nine o’clock in the evening. I rarely go to sleep right away, however. Yesterday, I did fall asleep after going to bed at eight thirty. I woke up about forty-five minutes later with a start. I had gone to sleep with the cat laying between my legs. I dreamt that the cat had been joined by my brother. I woke up with nobody on the bed with me. I was startled when I woke up but relieved too because I find it uncomfortable to have the cat sleep with me. I mean, I could easily get her off the bed, but I’m a sucker for the cat. She rules.

A preoccupation I have these days relates to the purpose of life and how to determine what to do with the time I have left to live. I have all kinds of time every day to think about things so off I go. Obviously there will be some physical restrictions that hamper the kinds of activities I can do; after all, I am seventy-four years old. One serious big think I’m having these days is coming to grips with the kinds of activities I am still capable of doing amongst the many I did during my younger years. I don’t want to simply lay back and avoid any activities that would require of me exertion that might tire me or leave me incapable of doing anything for a couple of days afterwards. I’m still strong enough, but I’m not as well coordinated as I used to be. I’m learning that I have to strike a balance between what I want to do and what I’m really capable of doing. There is a slew of activities I did when I was younger that are beyond me now. I have to be realistic about these things. I cranked up the chainsaw the other day and chopped a bit of wood. That was fine. I could do that. But what I want to do in terms of sculpture would require that I use saws and chisels for a sustained period of time. I don’t know if I have the sustainability to sculpt, but I know I can paint and draw. Whether I have the desire to do these things is another question.

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1 This is a verb being used as a noun, but it’s probably not original.

#84. One Day at a Time

Spring is a magical time for me. I never tire of looking out the windows at the many flowers, ferns, plants and trees as they come out in response to the warmth in the soil and other encouraging signs of Spring. On most days, the sun is there to warm my face. When it rains, the droplets glisten on the leaves as the hummingbirds dart back and forth between the feeder and their favourite perch. The wisteria is blossoming and will soon be in full flower, providing a shade canopy for the deck in anticipation of those lazy, hazy days of summer.

Wisteria

Occasionally I will take a slow stroll through the gardens aided by my cane and revel in the glorious, delicious scents that emanate from the many flowers that are now in full bloom. Right now the crab-apple tree with its ten or twelve foot canopy is showing off its clusters of blossoms and establishing its perfumed dominance as it spreads out next to the driveway. In the vegetable garden, without the benefit of a sweet scent, the rhubarb has already provided us with a delicious desert and promises more. The garlic is as hardy as ever this year and will supply us with all that we could possibly want for the coming year.

I seem to be feeling better as time goes by. Springtime has that effect on me. Of course, I’m 74 and I have the emperor of all maladies as well as various and sundry ailments related to my vertebrae competing to see which of them can make my life most miserable. All of them can and do contribute to the waves of pain that frequently sweep over me, and that inspire me to reach for the opiates and the acetaminophen. That said, I expect improvement in my situation in the coming weeks as I move into a new phase of chemotherapy having Daratumumab infusions once a month but staying the course with lenalidomide and dexamethasone. Of course, because of the nature of myeloma I can only think in the short term, five years tops. I have another handicap that makes my situation somewhat different than others and that’s the fact that I have only one kidney. I lost my left kidney to kidney cell cancer in 2002. The pain in my left side due to the nephrectomy (kidney removal) has not let me forget it either. My left side is a constant source of pain.

I should say that cancer has not been my only tormentor. In my youth I lost a lumbar disk to a sawmill accident leaving my lower back especially vulnerable to re-injury. Given all the physical ailments and challenges I’ve faced over my lifetime, I’ve managed to stay physically active running and cycling as well as working in my shop and studio. Now, the limitations I face are those of old age and cancer. I just have to be super vigilant and not do stupid things, things that could leave me physically incapacitated.

Back to my chemo life, I checked my numbers earlier this afternoon. That means that I consulted MyHealth, an online access to lab results, imaging, appointments, etc., to see what all the blood tests I get periodically can tell me about my state of health. I have results as of May 4th, 2021. Looking at the results you’d have to conclude that you were looking at the blood serum of a very healthy person of my age. It seems that the chemo meds that I’m on now are doing the trick, that is they are suppressing my myeloma down to levels seen in healthy individuals.

Too bad my blood serum won’t maintain that level of normality for any length of time. My myeloma is kept at bay as long as I keep taking my chemo meds. Stop taking my meds and the myeloma wants to kill, kill, kill. The amount of time between when I stop taking my meds and the resurgence of the disease can vary a lot. The last time I stopped taking my chemo meds it was only a matter of a couple of months before my myeloma was back and as active as ever.

With this new chemo regimen it looks like I may get a better result than I got last time. It also looks like I’ll have a long-term relationship with some of my chemo meds. I’m not sure which ones at the moment.

The way these things work, chemo meds only work for a certain length of time after which a new cocktail of chemo meds needs to replace the meds that are no longer working. It looks like the Daratumumab/lenalidomide/dexamethasone triumvirate is going to give me a longer period of remission than I had the last time I went off chemo meds. I’m hoping for years of remission but that’s yet to be determined. If I could get a modicum of mobility as well as ability to use shop tools and studio materials even for a few months I’d be happy. So far my Dara/Lena/Dex trio is doing the trick. I hope it continues that way and buys me some more time.

All I can do is take it one day at a time.