Stormin’ Out There OR I’ll Nap When I Want To!

Wed. Jan. 18, 2023 -8:50 AM

Sky is blue this morning and it’s calm with no wind, but last night I swore the sky was falling. Sure felt that way. We sleep on the south-east side of the house, that’s the direction of the prevailing wind. 

If there’s going to be a tree fall on the house during a storm, it will be from that direction, from the south-east. We seldom get strong winds at our home in Cumberland, but when they happen, they aren’t shy. 

Last night the weather had no shame, no sense of propriety. It came banging on the side of the house, undeterred by the fact that we might be sleeping (or trying to sleep) inside. The rain aimed to engrave the windows with incessant beatings. There would be no sleep, at least not until the weather lost its angry edge. 

One thing about sleeplessness is that my brain has plenty of time to speculate on things transpiring in the midlin’ parts of my body. Normally my brain is in denial, but storms put a wrench into that. The storms seem to amplify the ‘discomfort’ I feel in my back. Most of the time I don’t think about it. It may be that atmospheric pressure has something to do with the pain in my midsection, but that’s only speculation on my brain’s part. The pain is real, though. 

I was supposed to get a visit today from my palliative care doctor, but she was called away to an emergency so we’re putting that off until next week. 

Thursday, January 19, 2023 – 8:00 AM

0.0˚C. Jeez. That’s cold in my books. Looks like winter is carrying on. It’s going to hang around for some time yet, whether we like it or not. There’s no denying that. It may be that we escape more serious dumps of snow, but there’s no guarantee of that either. Ski patrollers would like to see lots of snow fall and we do need as big a snowpack as we can get, but I don’t welcome snow. I’m decidedly not a cold weather person. I like to sit by our politically incorrect woodstove, especially when I just get up in the morning and Carolyn has got a fire going in our new, very efficient Pacific Energy woodstove (rated at 1.8 parts per million). Ah, a nice wood fire, warm and welcoming, along with a nice cup of coffee. Life is good, isn’t it? Well, there is that other thing. 

My back has been a challenge lately with constant ‘stitches’. The pain isn’t horrible, but it is a pain in the butt (a little higher, actually) and pushes me to take more hydromorphone. If I take 4 mgs of breakthrough hydromorphone on top of the 18 mgs of the slow-release flavour, I can usually fall asleep and stay that way for a while. Lately, I’ve taken to sleeping in my recliner. It’s much more restrictive than my usual bed because it’s so much narrower, but also much more flexible in terms of position. Actually, I find my recliner quite comfortable to sleep in. Come to think of it, I may want to use it tonight.

Now, enter the game-changer. The Home Care team has arranged to have a hospital bed delivered to the house next week for my pleasure and sleeping enjoyment. This bed is kindly provided by the Canadian Red Cross and is available to me for as long as I need it. That has me a little unnerved, but I need to accept it in the same spirit it was offered. Thank you, Red Cross. 

The problem is that all the people I’ve ever known to get a hospital bed delivered to their homes have not come out alive. I guess that’s to be expected, but I don’t feel as though I’m that close to the final frontier. So, I’m of two minds about the hospital bed. On the one hand, yes, I want it because I think it would increase my level of sleepy time comfort and probably reduce my dependence on opioids. On the other hand, anything that reminds me of hospitals leaves me a little cold. 

I suppose the best thing for me to do is relax. Not sure I can do that. I’ll work on it. 

Friday, January 20, 2023 ~7:30 AM

The menagerie awakens to growling tummies. The cats, Princess and Sunshine, are prancing around wary of each other, but impatient for breakfast. Sunshine is a guest, Arianne’s cat who is here waiting for the renovations to their house in Vancouver to be finished allowing him to finally go home and relax on his favourite perch on the back porch. 

Tilly is impatient. She has that big tummy to fill up and she’s quite convinced that she will starve to death given that Carolyn hasn’t fed her yet and it’s getting late. Cooper, the neighbour’s dog sits at the deck doors waiting for something. He’s not sure what, but he’s convinced that it’s in here whatever it is. Food, maybe? A spot in front of the woodstove, maybe? Making decisions is tough. Every once in a while he lets out a bark, not one with great conviction, and just loud enough to ensure that the residents of this place know that he’s out there and needs something. What? Who knows?

Tilly is on guard making sure Cooper doesn’t exceed his privilege. She charges him from this side of the door. 

I had a good sleep last night. It was one of those rare ones. The pain in my back wasn’t present enough to wake me up and I didn’t have to pee. I slept a solid seven hours straight. Miraculous! 

My back is still twitching but that should attenuate shortly because I just took my meds, and they will take care of the twitching. After that, I’ll take a nap. I probably don’t need a nap, but it’s my right as an old man to nap whenever I feel like it. 

ActualIy, I nap out of a sense of duty. If I don’t nap, the government might feel justified in removing that privilege from me. Governments are like that, you know, according to the CPC. Liberals and Trudeau are always waiting to pounce to revoke our privileges. Bad government! Be scared of bad government! Be scared of everything! LOL! Ha Ha! He! He!

It’s my Birthday.

Yeah, it’s my birthday. No big deal.

I’m starting on my 77th year. That seems like a long time, but time is relative. I just finished a book by Steve Brusatte, The Rise and Fall of the Dinosaurs. Time in the context of dinosaurs is measured in millions of years. Even then, two million years is a relatively short period of time. Now, I’m reading another Brusatte book, The Rise and Reign of the Mammals: A New History, from the Shadow of the Dinosaurs to Us. It’s all very complicated stuff, and it’s certainly true that mammals got a leg up following the crash of the Cretaceous sixty-six million years ago thanks to an asteroid strike in what is now the Gulf of Mexico. In the next few weeks I’ll look for a good book on the differences between the prokaryotes and the eukaryotes and the evolution of the latter into us, eventually (after hundreds of millions of years).

So, to say that I’ve lived for 76 years is not saying much. The context is what’s important.

I think most people would agree that I’ve had a good life. Being a white male has given me substantial advantage to start with, and I was able to build on that foundation to create a decent life for myself and my family (albeit, one based on patriarchy).

This post will be very short because I’m not motivated to put out a regular length bit of writing but I’ll put out a couple of posts soon enough. I need to comment on oncology and the few other things. I don’t have an active relationship with myeloma at the moment. Obviously the disease is have a field day in my innards and I want to write about that. But that’s for another day.

I’m dying?

Funny, but I don’t feel like a dying man, nor am I eager to find out what that’s like. No matter what the medical experts think, I don’t feel as though I’m dying. 

All the indicators are there: I’m dying. I’m old and I have myeloma. Myeloma is incurable and I’ve probably had it for at least a decade, but I was only diagnosed with it in the fall of 2019. At that point I already had lytic lesions (caused by myeloma) in my femurs, especially my right femur. I suffered through chemotherapy for almost three years before abandoning that course of action in September, 2022. Now, I’m palliative. That means that I have a medical team that aims to reduce my pain to tolerable levels. As soon as they hear ‘palliative’ many people immediately assume end-of-life, but the two don’t necessarily equate. I’m still mobile. I just had my driver’s licence renewed (although I rarely drive), I’m getting back into drawing and watercolour. I’m writing, obviously. I’m not bedridden. 

We are all so different. Myeloma is especially idiosyncratic. In fact, there are several types of myeloma affecting individuals in various ways. One of the distinct problems with oncology today in an outback like British Columbia is that there are few resources that are dedicated to dealing with cancer. It can look like there are lots of resources, but there aren’t really when it comes to dealing with diseases like myeloma and its treatments. If you check out the BC Cancer Agency’s (BCCA) website, you’ll learn that almost 30,000 new cases of cancer were reported in 2019, the year I was diagnosed. It would take an inordinate amount of money and other resources to deal with that number of new cases, let alone the number of people already identified with cancer in the years before 2019. The numbers are staggering. The challenge daunting. 

When I was diagnosed in 2019 I was put on a standard chemotherapy protocol. That didn’t work. It caused a rash around my midsection that was incredibly itchy. Considering the failure of the first protocol, I was put on another protocol, this time with three drugs. Anyway, over the next few months, the protocol failures outnumbered the successes so that, eventually, just a couple of months ago I quit chemo altogether. There may have been another drug I could have potentially used, but it would have required very close, ongoing, and individualized care. An oncologist at BCCA told me that they just didn’t have the resources to deal with that kind of individualized need, that is, for me. So, here I am, palliative. 

I want to write about Jim Carr for a paragraph or two. He was a Canadian Federal Minister of International Trade Diversification elected in Winnipeg, Manitoba, first in 2015, then again in 2019 at which time he was diagnosed with multiple myeloma. He was in his late 60s at the time and received a stem cell transplant and dialysis along with chemotherapy. He died on December 12th, 2022. He gave his last speech to the House of Commons on December 6th. I can’t be certain about this, but it may be that Carr had a form of myeloma that specifically attacks the kidneys. His early treatment with dialysis indicates to me that his kidneys were failing, probably the thing that ultimately led to his death. So, was it myeloma or kidney failure that killed him? I have no information about any of his symptoms. I only have what was reported in the news. Still, a few things come to mind about his case. The news reports indicate that he was diagnosed in the fall of 2019, just as I was. It appears the chemo treatments didn’t work for him any more than they worked for me. In fact, I strongly suspect that had I not had any chemotherapy I’d be no worse off for it now. Chemotherapy must not have worked for Carr either otherwise he would have shown more positive results and lived longer. 

The fact that Carr was up and about giving a speech to the House of Commons on December 6th and died on the 12thindicates to me* that kidney failure ultimately precipitated his death. The oncologist we spoke with at the BC Cancer Agency after I had decided to quit chemotherapy insisted that I would not likely die precipitously but would experience a slow degeneration of my health over a period of months if not years. The fact is that people die of myeloma for a number of reasons and over various periods of time between diagnosis and death. As I’ve noted before, myeloma is notoriously difficult to diagnose so people like me might have myeloma for years before being officially diagnosed. That might have been the case for Jim Carr too. For all I know he might have been one of those people who doesn’t easily talk about how he feels and would want to ‘tough it out’. 

One observation around the news reports of Carr’s myeloma diagnosis is that Carr could fight this.  Of course, people want to say ‘the right thing’, at times like this. Commentators from Trudeau to Joly to any number of politicians, federal and provincial stated things like: Carr has been “a leader in many fights, and this one is another one [he] will win.”** Well, no, he could not win the fight, nor can any of us. Besides, it’s not a fight. Myeloma is incurable. It can be treated to some extent, but even in the face of all the positive talk from the oncology community, nobody walks away from myeloma alive, and ultimately, no one walks away from life alive. 

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*a rank medical outsider to be sure but a keen observer nonetheless of my own illness and that of others.

**https://www.ctvnews.ca/politics/trade-minister-jim-carr-diagnosed-with-cancer-says-spirits-are-high-1.4655348

This Blog

November 30, 2022 (8:35 AM)

If you’ve been following this blog since the Fall of 2019, you will know that I was diagnosed with cancer (multiple myeloma) at that time and that ever since I’ve dedicated the blog to exploring my relationship with ‘my’ cancer and its treatment. Lately, I’ve been compiling my blog posts into a Word file. Word tells me that I now have close to 150,000 words in that file. I’m sure I have double that in the blog since I started publishing it in 2012, the year I retired from teaching at North Island College. That’s a lot of verbal regurgitation. 

It’s been a ride. 

Looking back over the years it’s obvious how much of a rollercoaster ride it’s been. The thing is the rollercoaster has two primary seats and a number of others that can also be involved. Of course, I’m in the lead seat. If I didn’t have myeloma there would be no rollercoaster, but since I do have myeloma, any rollercoaster rides I’m on also involve my family. Carolyn is my wife but also my primary caregiver. It has not been easy for her. My daughters who both live in Vancouver have made every effort to support Carolyn and I on our ride. They have come here which is highly disruptive of their lives, never a word of complaint. One of my brothers and one of my sisters who live on the Lower Mainland have come to visit and help out. I have a sister who lives in Nanaimo. She and her daughter, Janice, come as often as they can and bring meals for us to relieve some of the caregiving burden from Carolyn. We are very fortunate also in that we have fantastic, generous, kind, and supportive neighbours. 

I can only go by my own experience but living with myeloma for anyone (and its treatments) means that some days we feel fine (more or less) and other days we feel crappy. Not long ago, after my last disastrous treatment and hospital stay, I spoke with my oncologist at the BCCA in Victoria. I was determined to stop all treatment, chemotherapy, and radiation, which I did. It seemed that I would always get a high fever and some form of infection following treatment. Last month I wrote about how my last chemo treatment almost killed me. Of course, stopping all treatment has its consequences.

As I noted in a previous post, the upshot of ceasing treatments means that I now have to face myeloma head on without the help (or hindrance) of treatment. I am now considered palliative, meaning that any treatment I get now aims to deal with pain alone. So, tomorrow late afternoon I go to the hospital for a CT scan of my right femur. The palliative care doctors want to know what the state of that femur is to better decide on what to do about it. They may recommend surgery. When we know more, we’ll decide what to do. I’m not sure what to think at this point. 

December 1, 2022 (8:00 AM)

It’s probably the coldest day of the year here today at -5˚C. Snow is deep in the yard and we’re expecting more today and tonight. It’s quite bright out now but that can change quickly, just like how I feel. 

Yesterday I introduced the role of caregiver. Caregivers, family, volunteers, or paid members of palliative care organizations are essential for people who are sick or somehow disabled and who can’t always look after themselves, who can’t cook, feed themselves, do laundry, wash dishes, etcetera. Caregiving is tough, one of the toughest jobs around. Imagine going to work not knowing what will be expected of you when you get there. Never mind all the bum wiping and other physically related work that is expected of you. Some of us who need care are quite large and heavy. Caregivers risk injury to themselves as they care for their charges.

For some caregivers who provide in-home care the issue is mental illness or dementia. Imagine going to work and immediately getting verbally assaulted and insulted by the person you’ve come to help. It can be the same in the hospital. While I was there, I often heard caregivers, nurses, and aides, get yelled at and abused in a number of ways by patients. Or the issue can be that the patient may have had a stroke or are otherwise incapable of communicating verbally. Professional caregivers are normally prepared for all exigencies and requirements of the work, but there are certainly times when the work gets overwhelming and tiring.  There are several resources available through government and non-profit organizations that can help caregivers. I list some of the more obvious ones here along with their web links. This Island Health website contains a lot of links to other resources. I don’t feel the need to replicate all of them here. A principal non-profit is the Family Caregivers of British Columbia. It is funded by Island Health, United Way, and the Province of British Columbia. 

December 2, 2022 (12:20 PM)

There is a weather warning posted online by Environment Canada for our region indicating that there might be up to a 15 cm dump of snow today. So far, the snow has been light but it’s picking up now. I’m still expecting to go to the hospital for a CT scan at 5:15 PM, but we’ll see. We haven’t heard from the hospital yet. We’ll see. 

December 3, 2022 (10:00 AM)

Heavy snow out there. It snowed a lot last night. I did go to the hospital for a CT scan. It was snowing hard, but David did a stellar job driving the car, which is great in the snow. The hospital seemed deserted, but that’s an illusion, of course. The wards are full of people behind closed doors, and I’m sure the emerg was busy, but the reception was empty, suitable for bowling.  

December 4th, 2022 (9:22 AM)

So, I wrote on December 1st that it was the coldest day of the year. Well, today is even colder at -6˚C. It matters not to me, not in the slightest. I sit here in my recliner, nice and toasty. I can look out to the beautiful scene outside, but from the comfort of my living room. Works for me. I have good meds and it seems that I’ve been able to figure out how best to take them to minimize pain.

I’m still old and I’m still dying, but at least I have a lot of people supporting me. So many people die alone, violently, and/or in excruciating pain. I’m going to try very hard not to be one of those people. I aim to die peacefully with some good meds to deal with any pain issues I may have. When my ma was dying, the nurses came frequently to give her a shot of morphine. That seems like a good way to go although my mother wouldn’t have been able to tell you one way or another. From her bodily movements I don’t think that she was in a deep state of peace. She was agitated at times. It was almost like watching someone in REM sleep having involuntary limb movements. 

One of the generous neighbours I mentioned above gave me a book to read. Carolyn just finished reading it and found it delightful. Now, I’ll read it. It’s entitled: With the End in Mind: Dying, Death, and Wisdom in an Age of Denial. It was published in 2018. The author, Kathryn Mannix, is a British palliative care physician. As you can tell from the title, this book is right up my alley. It’s not an academic book, so no references. You won’t be reading any quotes from Ernest Becker* in its pages, but Becker is everywhere in the book as the scholarly backdrop to a book like this. 

I’ll leave this post for now. It’s long enough and I need to get on with reading Mannix so that I can discuss her book in my next post. If you are so inclined and you want to read a little scholarly background material for a book like Mannix’s, check out the first couple of dozen posts in this blog, the ones specifically about Becker and The Denial of Death

Bye for now.

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*This is the first in a series of posts on Becker’s and related work. I published it in 2014: https://rogerjgalbert.com/2014/01/28/ernest-becker-1-of-mouths-digestive-tracts-and-anuses/.

Bits and pieces of this and that.

November 15th, 2022

Starring blankly out over the front yard a couple of days ago at our driveway that stretches about sixty metres (two hundred feet) to the road an image suddenly came to me of a road covered in red, yellow, and orange leaves much like our driveway is this morning. Unlike our driveway, however, it was clearly a one-way road and a dead-end to boot. I daydreamed about walking along this road, but as I walked, it became obvious that the end of the road was not clearly defined. It seemed to recede into a fog away from me with every step I took. 

So, my brain is being metaphorical on me, sending me covert messages about my future. 

We (Carolyn and I) had a meeting with a palliative care doctor a few days ago. I’ve been feeling abandoned by the oncologists that have overseen my case for the last many months. I guess I needed some assurance that I would get effective care from the palliative care team at the hospital here. I don’t mind going down a one-way, dead-end road, but I’d rather not go it alone if I don’t have to. 

It may be that abandoning radiation treatments has hastened my ultimate demise, but it couldn’t be for long. I remember vividly the spiking fevers I got after my last radiation treatment and the ridiculous stay in hospital while the ER doctors chased an infection that I don’t think was ever there. That doesn’t mean that it would happen again, but I’m loathed to take that chance. Myeloma is an infection, a growth of unwelcome protein in the blood that takes up space in my bone marrow and doesn’t prevent ‘good’ protein from doing its job. That’s what it is, an infection, and it will cause all kinds of effects including fevers. I just don’t need the treatment for myeloma to be worse than the disease itself. Now if I get a fever, I’ll know it’s because of the myeloma itself and not one of its treatments. 

And now we wait.

I’m not sure what we’re waiting for either. It may be a turn for the worse, meaning the reoccurrence of a nasty fever, which this time, won’t go away. Or it may be an attenuation of symptoms and a reprieve of sorts from the worse of the nastiness brought on by chemotherapy. Whatever. All I know for certain is that I don’t know. Well, there are things I do know for certain: I’m seventy-five, soon to be seventy-six. My maternal grandfather, Georges Leguerrier, died in 1975 at the age of seventy-eight. His wife, Julianna, my grandmother, died in 1989 at the age of 91. My father died at 95 years of age in 2007. My mother was 94 when she died in 2018. So, generally, my family is quite long-lived. It may be that I take after my maternal grandfather, Georges Leguerrier, who died at 78. I can’t imagine I’ll live as long as my other grandparents or my parents, for that matter. 

November 19th, 2022

It’s Saturday, 7:38 AM, and very cold, (-2˚C) at least for here. (Yesterday was even colder) But it’s crispy and dry too. The air is perfectly still. The house is warm and cozy. 

I’m feeling okay despite the increase in opioids I’m taking.* The pain in my legs seems to be attenuating. I walked to the bathroom without my cane this morning and it was not a problem. Now, I’m sitting in my recliner, and I don’t have any pain to speak of. It feels good for a change. I’ll walk down to the studio in a bit to put on some heat. I can’t let it get too cold or the paint freezes and becomes useless. Who knows, I may be able to use it sometime. 

It’s strange, but in my half-sleep this morning just before getting up, I flashed on me working on a painting that’s half finished in my studio. Twenty years ago, or even ten years ago, I wouldn’t have thought twice about going down to the studio to work on that painting and maybe a couple of others I have half finished. I may still be able to paint, maybe with watercolours for the most part, but only if I don’t have to stand at the easel. I think I can work that out. Still, I have to remember that what I was able to do without too much thinking involved ten years ago, I now have to seriously ponder. I may have the knowledge to do something, but I also need the stamina, and it’s the latter that is lacking in my life now. It’s simple really. For some time, I thought that knowledge was all that I needed. Then I realized through trial and error (much error) that no, I need to be able to sustain activity for some time if I want to get anything done. Getting older (and weaker), whether in good health or not will inevitably mean less energy and stamina. So, now, I don’t feel bad about napping in the afternoon, and maybe even in the morning if I’m feeling particularly sleepy. Napping is fine for people my age. Not all of us nap, but for those of us who do, we have to just accept it and relax about it. 

I could say the same thing about dying but dying and napping are obviously not the same. There is a certain finality in dying that is just not there in napping. 

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*Opioids contribute to pain relief, but they also can leave me sleepy, dizzy and cognitively dull. This morning I woke up without a lot of pain and fairly sharp (if I do say so myself). 

MAID and Aggressive Myeloma

So, things are moving along. To recap: I went into the hospital for my infusion of the chemo med Carfilzomib on September 15th. On the 15/16th during the night I didn’t sleep at all because I was in an altered state and shivering uncontrollably. In the morning, we called the Cancer Care Centre at the hospital, and they told Carolyn to take me to Emerg right away. It was a good thing she did because my kidney was shutting down. They kept me in the hospital for three days on an IV (lactated ringers) and a catheter, but you already know that. Fun and games. 

Now, I’ve decided no more chemo for me. It’s been three weeks. It will be some time before I know what the result of that decision will be, but I will not recover from myeloma. Last week I had a chat with a palliative care doctor. She just called me a few minutes ago to see how I was making out with a new prescription for dexamethasone. We also discussed some more imaging for my leg and side (for a plasmacytoma) in preparation for some radiation therapy in Victoria sometime in the future, who knows when. Just don’t wait too long. The palliative care team at the hospital has been so kind and helpful. 

The hospice staff has been wonderful too. They’ve laid out all the care possibilities to help as I get nearer to ‘the end’ as they put it. This afternoon Carolyn and I had a chat with a doctor that provides MAID services. I’m all set up for that. I don’t have a date or anything like that, but I do have all the paperwork done for when and if I decide it’s time. He was great. He’ll call me in six months to see how things are going if we don’t call him before that. At that point (April 2023) if I haven’t called for MAID, we will need to redo the forms. 

An aside: the weather has been sunny and dry. Warmish too. We really need rain, but this is quite pleasant. I’m sitting in the living room but with the door to the deck open. Such an agreeable late afternoon.

Saturday, October 8th, 2022

Before I forget, I want to note that I learned a new term yesterday talking to the MAID doctor: anticipatory grief: Anticipatory grief refers to the sorrow and other feelings you experience as you await an impending loss. It has some benefits: It may help you find closure, settle differences, or prepare yourself for the pain of letting go. This kind of grief can come with lots of other emotions, including anxiety, guilt, fear, and irritability.* There is no doubt that I am feeling anticipatory grief, and so is my family. Of course, my grief is for the end of my life. For my family, the grief will extend after my death but in a different form.

It’s disconcerting to be so unsure of the future. We have no idea what the estimated time of death is. We’ll discuss that with the oncologist this Wednesday. He may have some insights by looking at my bloodwork. The most concerning number, although there are a few, is the rise in my lambda Free Light Chains. Now that marker and its number won’t mean anything to you, but what it describes is the amount of myeloma protein in my blood. The reference (normal) range for this indicator is 5.7 mg/L – 26.3 mg/L. My blood as of three days ago is 589 mg/L. On December 13, 2021, it was 11.7. Then it went up to 174.2 on June 27, 2022. Since, it has gradually made it up to 589 mg/L. It can’t go much higher without damaging my kidney. 

In fact, my kidney is already compromised to some extent but it’s still hanging in there. I would speculate on my survivability now, but I think I’ll wait until we have a chat with my oncologist on Wednesday. I know that my type of myeloma is particularly aggressive, so we’ll see. 

Strange as it may seem, if you came for a visit today, you’d probably say: “Hey, you look good!” I would respond: “Looks can be deceiving!” The disease I carry is all on the inside. There isn’t a lot of evidence of it on my body. My insides are scary though. Good thing you haven’t got x-ray vision like Superman, otherwise you’d see the mess in there. 

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*From: https://www.verywellhealth.com/understanding-anticipatory-grief-and-symptoms-2248855

Myeloma: a Killer by Degree

[I wrote this post in May 2022, not that long ago. I reread it and I think it bears reposting. I keep getting bad news on the myeloma front. I had an MRI last Sunday and it showed a growth, a tumour if you like, growing on my lumbar spine and extending upwards to the left side of my thoracic area half way up my back. It’s a fairly new thing, and is ten centimetres long, five wide, and seven thick. So far I haven’t felt any ill effects from it except that my legs are beginning to feel slightly numb. That’s not good, and just adds to the peripheral neuropathy that already leaves my feet in a constant state of pain, pins and needles, and spasms. At least it looks like I’ll be continuing on my carfilzomib protocol into September.]

Yeah, well, myeloma. As I noted in my January post, the symptoms of myeloma and pernicious anemia overlap considerably. So, I have no idea what’s driving me nuts with peripheral neuropathy, numbness and tingling in my hands and feet, fuzzy brain, poor balance, weakness, especially in my legs, and bone pain, to name just a few of the symptoms I’m experiencing. It could be both the B12 issues and the myeloma that are teaming up to keep me in my place, and the chemotherapy is also no doubt contributing to my now radically re-assessed quality of life. 

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So, that’s it. I’m old, I have a severe B12 deficiency that could be the result of pernicious anemia, and I have multiple myeloma, with its attendant chemotherapy. 

As I lay in bed last night [again] I harkened back to times in my life when I was still able to do things easily and effortlessly, things like canoeing, woodworking, building decks, garden structures, and a number of other physical things. I can still paint and draw, but with some difficulty. Writing is even getting to be an issue because I can barely feel the tips of my fingers on my left hand, my dominant hand. 

It’s been difficult at times, not because of my physical abilities, but because of my attitude towards them. I’ve had challenges keeping the dark side away, the feeling that I can’t do things anymore like I used to, making me a lesser human being, somehow. 

Carolyn and I both read the news and despair at the state of the world, but Carolyn seems to have a greater capacity than I do for keeping the dark side away and for maintaining a sense of perspective about the world. It’s true that the world is in a mess, but it’s always been in a mess if the press is to be believed. I have to keep reminding myself that the press, all of it, has a vested interest in propagating the dark side. That’s where the money is. Outrage and fear sells the goods. The bright side doesn’t. 

That said, I don’t want to be captured by the dark side or the bright side. The world is a complex place. Life is finite and changes all the time. Mommy doesn’t have to change my diapers like she did seventy-three years ago, even if she were still alive. I don’t have to put a uniform on and go to elementary school. I never have to write a final exam or go on a job hunt ever again. Of course, I won’t experience the joy of the early days of fatherhood ever again either, of falling in love, nor of the thrill of discovering a wonderful, new camping spot. 

I guess my point with all this rambling is that life is full of variety, both at the individual as well as at the socio-political level. Some things we call bad, some good. Those are judgment calls, which for us are adjudicated with reference to capitalist morality which itself is expressed in possessive individualism based on wealth and health. We look down on the poor and the unhealthy. 

These judgments are not easy to counteract both at the individual and the political levels because they are so deeply rooted in our culture. They are so familiar to us that we consider them normal and reasonable. It’s easy to feel self-loathing for being poor or in ill-health. It’s almost expected of us. And those individual feelings are reinforced every day in a thousand ways by the vast majority of us as we compare ourselves to others, those with money or excellent health (mental and physical).

If I let myself I can easily be dragged onto the psychologically dark and barren landscape of blame and feelings of unworthiness. Enough of that now. I have a limited number of days, months, and years left to live. I cannot, I will not live them in fear and self-loathing. 

Death is like a destination, one we have no choice in travelling towards. But, you know, some of the best trips I’ve taken have been at their finest and most exciting just before reaching our intended destination. Maybe that’s a good metaphor for the last bit of my life.

Memory Works With A Little Effort

I’m not sure if you’ll be able to access this Atlantic article or not, so I’ll just summarize it a bit for you. It’s about memory or remembering and whether you remember events in the past from the first or third person perspective. I would expand the argument to include imagined events in the future.

When you remember a past event, say one that was particularly notable, do you remember it as you initially experienced it, or do you see yourself in it as a character, almost as an actor, in a play?

I’ll die soon. Soon is an indeterminate word, mind you. I’ve already commented in previous posts about the fact that I’ve not done all that well with chemotherapy. It seems that I’m probably a high-risk cancer patient in any case. I’ve been subjected to a number of different chemotherapy protocols. Now, according to the oncologist at the BC Cancer Centre in Victoria in charge of my case, I’m running out of options. At the moment I’m on a two-month trial with a drug called carfilzomib (trade name Kyprolis). So far, I’m entirely underwhelmed by its effectiveness. The next month will tell the tale. I’m not very hopeful given my recent bloodwork and my reactions to the chemo drugs. But, I haven’t completely abandoned hope. I may still get to live a few more months.

Recently I had a bit of a discussion with the family about MAID (Medical Assistance in Dying). It’s not something I need to consider immediately but eventually it will become an option, particularly when the levels of pain and immobility outweigh quality of life issues for me. I see no need to lie in bed in pain awaiting more or less imminent and sure death when there is the option of assisted suicide. I’ve tried to imagine my dying moments. I can do that from the third person perspective, but definitely not from the first person perspective although I know what it feels like to go under general anaesthetic. I imagine MAID as like going under general anaesthesia but never waking up again. I see myself lying on a gurney with a doctor setting up the meds and then injecting me first with morphine or something like that before administering the killer drug. I can imagine that. I can remember in the first person going into the Hospital to have my kidney removed in 2002. Now that I try, I can also see those events in the third person. Strange.

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It’s amazing how many incidents and events I can recall if I put a little effort into it. I have seventy-five years of them to capture. Lots of fodder for remembering. I could write a book, although there is a lot that I would not share with you or anybody, private things.

This post is about me as I age from 1949 or so until now. My life isn’t over yet, but I’m getting close to a complete lifetime. I can track my parents’ lives, at least as far as major events go. My father was born in New Brunswick (1911), my mother in Alberta in 1924. They both died at the Dufferin Lodge in Coquitlam, my father in April, 2007 and my mother in January, 2018. Noting their dates of birth and death means nothing, of course. They are merely life’s parentheses. It’s what transpired between those dates that makes a life. The same goes for me, and you. Photographs tell a bit of the story, but in a static kind of way.

In the first picture, I’m standing there with my sister Denise. She was born in 1943, four years before me, to a mother who subsequently died in 1945 giving birth to what would have been her first son. Denise died on December 13th, 2004 of cancer. I’m not sure where this picture was taken. It looks like it could be in Sapperton, not far from the Royal Columbian Hospital. I would welcome correction on this from anyone in the family. By the time this picture was taken the family lived at 634 Alderson Avenue in Maillardille (Coquitlam).

In this picture I look to be maybe two years old. Denise would have been six. I am endowed with a natural Mohawk hair do. I still have it. I don’t remember anything of what was happening when this picture was taken. I was way too young. The photograph does nothing to jog my memory.

Denise and I always had an interesting relationship. She was pretty tough and I was mouthy. She threw a knife at me at the dinner table when I was probably a pre-teen. She missed, but it was close. That was memorable and I see it in the third person. But during my late, listless, teenage years, after returning from College St-Jean and not knowing up from down, I lived with her and her then husband, Roy, for six months or so, and often looked after the kids (which they had adopted). They had a fairly large home in Vancouver, off of 41st. The basement was made out to look like a TiKi lounge. Strange now, but not so for the times.

I worked with my father at a couple of re-manufacturing plants in Surrey and Langley. But I also worked at a planer mill in Fort Langley. I got drunk on occasion with some of the guys from work. It’s amazing we didn’t kill ourselves on the way home from work. One of the guys drove a convertible and that’s what we came home in most of the time. Mom and Dad had to know but they never said anything.

From the time I left College St-Jean until I enrolled in courses at Douglas College in New Westminster in 1970 or so, I worked at a number of odd jobs, mostly in the lumber or related industries. For a few months I worked at a plywood plant on Braid Street in New Westminster. I remember the smells and sounds of that place the most, but I also remember (in the first person) the work I did, piling pieces of veneer in bins in preparation for pressing them into plywood. The last job I had before going to Douglas College was at a sawmill in Marpole. I worked there for maybe six hours total. I recall being required to ‘clean up the chain’ of massive timbers. I did that for a bit but then I slipped and had one of the timbers fall on me as I fell off the platform. I could barely walk after that so I dragged myself to the first aid shack. Nobody there. So I struggled to my car (an Austin Healey Sprite) and drove myself to the hospital. I had back surgery then. Dr. Hill (I recall his name to this day) removed a disc in my lower back. Worker’s Compensation (now Worksafe BC) paid for everything including my first year of studies at Douglas College. There was never an inquiry as to what happened at the mill and as to why there was nobody in the first aid shack when I went there for help. Workers Compensation just paid for everything, no questions asked.

I find the series of photographs here helpful in some way in jogging my memory. The early ones don’t help at all but the later ones do. The one I posted of me doing my Knowledge Network tele course is still available to me as a video so I can go back and see myself over and over again if I so choose. I have many more photos too, but I’m not going to post all of them here.

All I wanted to do here is give the flavour of my life as I grew up, then grew down. We all have individual experiences of life. I often think of the many thousands of people who have died in conflict over the centuries, their lives often cut short by machetes, as in Rwanda in 1994. I suppose if a long life is a good thing, then I’ve had a good life.

Look at the forehead on that kid!
Me, maybe two years old
Me, five or six

Me in 1959 setting off for College St. Jean
Me at sixteen or so
Me doing television – late 1980s, early 90s.
Me not long ago

Carfilzomib and Buttle Lake

Wednesday, August 17th, 2022 – 2:30 PM

Just got back from the hospital for the first infusion of carfilzomib for the second cycle of this protocol. It went well, but as usual, I’m dexed out. Given this was my second cycle I didn’t have to stay after my infusion for an hour of observation. I had to go to the lab yesterday for bloodwork and the results were available today for us via MyHealth. Things seem to be going moderately well from the looks of my bloodwork. I have some reduction in my paraproteins (not that you should know what that means) which is good news but my kappa free light chains are going up. That’s not good.

However, we did a fair bit of reading about carfilzomib and one of the nasty side effects of that drug is renal toxicity. Given that I have only one kidney, that’s not great news. We just have to hope for the best.

As I said, I had to go to the lab yesterday for tests. What I didn’t say is that we spent the last three days at Buttle Lake in Strathcona Park for a bit of camping with the family. Yesterday, we had to race back to Courtenay to get on the lab waitlist. Around noon I started out at 29th on the list as we came into Campbell River but when we got to the hospital in Comox an hour later, I was down to 10th place which is quite acceptable. I didn’t have to wait too long to get my blood extracted.

Sunday, August 14th, 2022 –

We packed up yesterday and this morning. We were in four vehicles. I rode shotgun in the truck. It hauled most of the food, the banana boats and me. I won’t identify individual family members here. Suffice to say that there were enough of us to pilot four vehicles along with some passengers. We’ve been camping at Ralph River campground on Buttle Lake for upwards of thirty years. We’ve had some wonderful times on that lake, and particularly at that campground. It was such a pleasure getting back there. Frankly, I doubted that would ever happen.

From 2019 a few months before my diagnosis

I already posted this photo on this site, but I decided to post it again because it tells a story of how we had such great fun improvising and adapting the canoe with outriggers, a sail and electric motor. We’ve had the canoe for over forty years. We’ve had such great times with this canoe for decades! This boat didn’t come with us on this trip. I’m not ruling out the possibility that it will again feel the waters of this lake on its keel. Chances aren’t great, but we’ll see.

When the picture above was taken, so was the picture below.

Buttle Lake at Ralph River

You can see that these stumps are a predominant feature in the landscape. Who knows why the loggers left them (probably no need or profit in removing them) but they did and I took the opportunity to draw and paint them*. I can’t remember exactly when I drew them, maybe it was 2014, but that doesn’t matter.

You can see the water surrounding the stumps. They are maybe a half a kilometre from the campground and there are connecting pathways. Below is a photo of one of those pathways, the one they built for the movie See with Jason Momoa. That pathway and surrounding terrain used to be clear from the campground down to the stumps with a gravel base and not a lot of vegetation as you get closer to the lake. Now, as you can see, it’s flooded and there’s lots of vegetation, but the rocks that define it are still clearly visible.

The lake must be at least three metres above what it was when I took the above picture in 2019. The stumps are nowhere to be seen. They are all underwater. What a dramatic change! What a metaphor for life! Things can change so quickly and dramatically.

Main pathway from lake to campground.

Monday, August 15th, 2022 – 6:55 AM

I was awake for some time before 6:55, but that’s when I got up. The sky was pure blue. The previous evening it was overcast and spit a little rain. This morning was beautiful. Our campsite was open to the lake but the path to the lake was impassably muddy and crawling with Western toadlets to boot. We really had to go around to Jason’s pathway to get to the lake. I set up a chair in our campsite (called a gravity chair)facing the lake. For some time I watched the sun hit Mount Philips across the lake. Eventually, the shadow cast by the mountains behind us on Mount Philips reached the lake, but by then I was busy doing other things and I got distracted by this as I pushed myself vertical in my chair:

Cedar Boughs.

I actually took this picture later in the day after the sky had clouded over. I stared at this sight for a long time. There is an odd quasi-symmetry to the branches and needles. I contemplated drawing this, but I just couldn’t garner enough energy to do it. Instead, I took pictures and stared. I found looking at these boughs soothing. My pain dissolved. I relaxed completely. Such a great feeling…at least for a time!

I can’t thank my family enough for making it possible for me to get back to this lake and this campground. I’m an old man now. Many of the things we did for years like camping and messing around in boats are just not possible for me anymore. Maybe if it were only a question of age, but it’s not. Myeloma and chemo complicate matters immeasurably. Still, when I was at the lake I could much more easily recall so many pleasant experiences we had there. I love that place. It’s so much better to feel love for this place and for my family than to dwell on my health or lack of it.

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*See my art blog for images of the Buttle Lake stumps in ink and pencil: https://rogeralbert.blogspot.com/p/drawings.html

The habit of life and a new chemo protocol.

July 18th, 2022

So, we went to the Hospital this morning to the nuclear imaging department to get a baseline assessment of how well my heart is pumping blood. That’s in preparation for my initiation into a new chemotherapy regime starting tomorrow since the one I was just on including lenalidomide, dexamethasone, and Daratumumab wasn’t working anymore and it was producing some very interesting symptoms like temporary paralysis or what my GP considered seizures. These ‘seizures’ didn’t last for more than an hour or two, but had lasting effects like extreme fatigue and headaches. I thought I might be having a stroke or something of that nature, but that’s not likely. In any case, my GP ordered a CT scan of my head. It found nothing! ⁉️He also ordered an MRI of my lower back. That will happen at the end of August. That might be revealing. I’ve had issues with my lower back since I was twenty years old.

Also this morning I injected one milligram of vitamin B12 into my left thigh. I do this every Monday because I have an inability to absorb B12 from food. Sometimes I inject it into my right thigh, just for variety. If you’ve never been tested for B12 you might want to consider it if you have a lot of fatigue. That may not be easy if you don’t have a family doctor, but worth it, if for nothing else, to discount it.

Tomorrow afternoon I go back to the Hospital for my first infusion of carfilzomib (trade name is Kyprolis). It has some interesting side effects and reportedly is hard on the cardio-vascular system, but is touted as a solid replacement for Bortezomib (Velcade). It’s relatively new on the market.

All the things I note above are to give me a longer life. That’s the goal. I’m into that, but eventually I’ll have to kick the life habit. We are creatures of habit. (see my note below) Are we ever. And the biggest habit we have is life itself. No wonder we are so reluctant to give it up.

July 19th, 2022

Well, tomorrow is today. Went to the hospital’s Cancer Care Centre for a 1 PM appointment for an infusion of carfilzomib. I got a low dose infusion, forty-four milligrams. I experienced no adverse effects that I noticed. My next infusion, next Tuesday, will be one hundred and fifty-four milligrams. That will be the ongoing dose I get every week for three weeks, then I get a week off before going back for another round of three weeks. So, my life is pretty much tied to the hospital at the moment. I may be able to alter my regimen a bit, but I don’t want to mess with it. I think that consistency is a major part of chemotherapy and I want this protocol to work for me for the foreseeable future. My foreseeable future is shrinking every day. That’s fine. That’s life. It’s interesting as I watch myself go through what little is left of my life, the recognition that my energy levels are dropping fast and that I can’t do things I recently took for granted. I have no regrets. I understand evolution and the need for death. I’ve played my part and will continue to play my part until there is just nothing left of me.

July 20th, 2022

Yesterday was a day filled with anxiety and doubt for me. A new chemo regime is always stressful. Will it work? Will I experience nasty side effects? Is this my last kick at the can? So many questions.

Thankfully, the crew of nurses and support staff at the Cancer Care Centre are amazingly calm and systematic. They patiently answer all of my questions, and this time around I had lots of them.

My infusions of carfilzomib are just a half hour long compared to one and a half hours for Daratumumab in my last protocol. However, for the first three weeks this time around they have me stay for an hour after my infusion for observation. That’s a good move because anything new like this is cause for caution. We were out of there by three thirty. Still, It’s an afternoon a week, and I need to be close to the hospital. No travel abroad, that’s for sure. I’m fine with that. Not much interested in travel right now in any case.

One thing I’ve noticed since I’ve been off of Dara and lenalidomide is that some of the symptoms I’ve been experiencing around my face seem to be attenuating. I can now feel my lips coming back online and my eyes don’t feel as puffy and buggy-outy as they have been for some time now. Maybe, just maybe, I’ll feel a little more ‘normal’ now. I hope this trend continues. The sensation around my eyes is particularly disconcerting. Anything to relieve that is good news. I’m feeling optimistic about carfilzomib but there’s a ways to go yet before we have any sense of whether or not it’s working to keep me alive.

I sleep well these days. That’s great. Of course, dexamethasone will mess with my sleep. I expect that and adjust as needed. It means that I may just read a little longer after I go to bed or wake up later and need to read a bit again before I can get back to sleep. I’m reading Agatha Christie at the moment. She’s such a good writer. There’s lots of murder and mayhem in her books, but some great problem solving too. Poirot and Hastings are principle characters in many of her books. Their interactions create a wonderful backdrop for their crime solving endeavours. Hastings is a great foil for Poirot. He’s not too bright but he is willing, and enthusiastic. The books do a much better job that the television adaptations of Christie’s work in terms of the dynamics of the Poirot/Hastings relationship. Read on. I paid one dollar on Amazon for all of Christie’s work on Kindle. What a deal.

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Just a note to end this post thing:

The fact that we are creatures of habit will be our downfall as a species.* We can’t seem to kick habits we know are bad for us. We know that fossil fuels are in the process of polluting the planet to such a degree that we may very well not be able to reverse the process. The pollution is what is killing us, not the fossil fuels themselves. We keep driving our cars and trucks. That’s a habit hard to kick because we also have a habit of spending money, and we have to get that somehow. Working for others (employment) seems to be the main way we do that, but contract work is also quite common. Employment is a relatively recent way of organizing labour. I wonder how much longer it will last. What I can guarantee you is that it will go the way of the dodo bird just as everything else does.

One huge issue we face is the generational lag that dominates our lives. We tend to think that we can live the way our parents and grandparents lived. We buy big fishing boats and huge RVs to wander around the oceans and roads like the 20th Century had never passed. We all want to live in detached single family houses (around here at least). Well, our parents did it, why can’t we? Maybe it’s because fish are disappearing at an alarming rate and gas is so expensive and polluting. But we’ll carry on because that’s what we know. We do feel anxious about it. That anxiety sometimes gets squished out of our minds in strange ways such as in ‘freedom’ convoys and ridiculous conspiracy theories. Oh well, steady as she goes. We all get to the wall sooner or later.

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*All animals are essentially creatures of habit. We all develop habits of life, some learned, and some tropismatic. We cling to them as long as we can. So it goes. It works as much for bees, chickens, and elephants as much as it does for humans.