Last week, I received Cyberknife radiation treatment three times on Monday, Wednesday, and Friday. I was warned that I might experience side effects including fatigue, shortness of breath, and chest soreness.
I played 18 holes of golf on Tuesday, Thursday, and Saturday. No problem, no apparent side effects - lovely.
On Monday this week, I experienced shortness of breath, mild chest pains, and vertigo. I panicked, and the anxiety reawakened my GERD, which produced a sore throat and stomach pains from the acid reflux - RATS!
With a drastic change of diet and a conscious effort to chill, by Thursday I was five pounds lighter and able to go out to the range and hit a bucket of golf balls. Overestimating my capacity and underestimating the effects of the radiation and heat (82 degrees, 85% humidity), I went out this morning to play 18 holes with my regular Friday group.
Bad idea! I lasted 4 and 3/4 holes - one par, one bogey, and two doubles - until I accepted reality and hitched a ride with the ranger back to the clubhouse.
Friday, May 29, 2009
Wednesday, May 27, 2009
About Faith and the Unseen
While we lived in Redstone, Rabbi Harold Kuschner, author of When Bad Things Happen to Good People, spoke at least once every year at the Aspen Chapel. On one occasion, Rabbi Kuschner told of an encounter he had at the Johns Hopkins Medical Center several years ago. As I recall it the story went like this:
Rabbi Kuschner is asked by a patient there, a 32-year old Episcopal Priest dying of AIDS, to come see him. Kuschner agrees, goes down the hall with the medic and meets this young man, as Kuschner says, “pale, emaciated, lying in bed hooked up to several intravenous tubes.”
Kuschner asks, “How are you doing?”
The man replies, “Not too good. But I’m getting used to it.”
Kuschner then asks if the man "... somehow feels that he’s been brushed aside by God, locked out, diminished because of something in his character or behavior."
The young man replies, "No, just the opposite. The only good thing that has come out of this is that I found out something I always wanted to believe is really true. No matter how much I have messed up my life, God hasn’t given up on me. I’ve felt his presence here in the hospital room. God can love me even when I find it hard to love myself."
He pauses to gather his strength before continuing.
"When I was young, I thought I had to be perfect for people to love me.My parents gave me that message, threatening to withhold love every time I offended them. My teachers in school gave me that message. My Sunday school teachers reinforced that lesson. We didn’t go to one of those hellfire and brimstone churches, but we heard a lot about how much pain we were causing God every time we sinned, and I think that was just as bad, especially given the list of things we were told were sins." The young man continues, "I tried so hard to be perfect so that my parents, my teachers, and God would love me. I probably went into the ministry in part so that people would think that I was morally perfect and love me for it. But every time I did something that I knew was wrong and every time I told a lie to cover up for myself, I would hate myself for being such a phony, and I was sure that God was as contemptuous of me as I was of myself. But lying here in this hospital bed , knowing I’m going to die soon, I had this insight: God knows what I am like and God doesn’t hate me, so I don’t have to hate myself. God knows what I’ve done and he loves me anyway. I’ll be leaving the hospital soon, not because I’m getting better but because there’s nothing more they can do for me and they need the bed for someone they can help."
"I don’t know if my congregation will take me back now that they know I’m gay and I have AIDS and I am dying. I hope they will, because there is one last sermon I want to preach to them.I have to share the lesson my illness has taught me. You don’t have to be perfect. Just do your best and God will accept you as your are. Don’t expect your children to be perfect. Love them for their faults, for their trying and stumbling, even as our Father in Heaven loves us."
The Rabbi concludes, “Oh, young man, you’ve got it!You have made a claim, not on the seen, but on the unseen, the unfathomable and undying love of God reaching out for us, whoever we are, whatever our condition, indeed, however distant we may feel, eager to succor, to hold and to sustain us.
Part 4. "The heart and soul of our everyday living" (continued)
Now, I propose that the unseen and unseeable, these free creations of our minds, the products of inward sight, are important because they are the stuff which binds us together in relationships and interconnect us to create, in Christian verbiage, “the fellowship of the Holy Spirit.” to the secular mind, they are the connective tissue or energy which bind the parts of a system into a unified whole.
In Why God Won’t Go Away, Andrew Newberg et al state that “every religion relies on a form of interconnectedness. There is either a union of mankind with the rest of the world or a union of the individual with a greater individual. ” Andrew Newberg, Eugene G. D'Aquili, Vince Rause (2002) Why God Won't Go Away : Brain Science and the Biology of Belief.
In short,• Christianity posits a union of the individual with a greater individual (egoic duality)
• The concept of a union of mankind with the rest of the universe is found in Hinduism and Buddhism (wegoic non-duality)
As you might infer from my earlier remarks about the “egoic” perspective, I have a problem with the former view. My problem is that it implies that God (presumably the greater individual) is out there somewhere; furthermore, that each individual’s relationship is with God alone – that my relationship with you – whether we are linked by love or hate – is irrelevant. (When I was writing this, I initially used the word immaterial, but that’s the whole point of this discourse, relationships are not material objects, so I had to change the word to irrelevant).
In contrast, the latter conception, which Cynthia Bourgeault refers to as a “wegoic” perspective, is consistent with the tenets of Contemplative Christianity, as well as Buddhism and Hinduism -- this non-dual union of mankind with the rest of the universe, is more appealing to me, because it suggests that you and I are, willy-nilly, part of a web of relationships, individual figures on a shared ground. The ground is the contextual “glue’ that holds us together.
This figure-ground relationship forms a pattern, the significance of which each of us perceives and interprets in his or her own way. This emergent pattern for each individual is unique, but sufficiently similar to the perceptions of others to allow us to find kindred souls and gather ourselves into communities, called many things, Truth, Being, the Tao, the Void, and yes, indeed, even God.
What this pattern is called does not matter – square, triangle, Tao, or God. Recognition that there is a pattern is sufficient, what you label it is irrelevant. If it makes you happy and you feel the need, give it a name. This process of pattern recognition is called Gestalt formation.
Research on the brain has recently determined that the brain functions in precisely the same way when visualizing an object as it does when viewing the actual object – i.e. to the brain there is no difference between the image it creates and the object “out there”
The implication that “God" is a gestalt is not meant to trivialize our experience of God, but to suggest that one does not literally have to see God as a “thing out there” to be a believer. Our interconnectedness with and through “God” guides the way in which we choose to interact with each other. And the good news is that God doesn’t go away no matter how well or how poorly we interact with each other.
The concept of interconnectedness as "the heart and soul of our everyday living" transcends labels, political boundaries, and religious dogma.
The representation of interconnectedness found in the doctrine of the Jewel Net of Indra is one which I find particularly appealing.
The doctrine of The Jewel Net of Indra is an ancient view of the universe from Hua-Yen Buddhism. It teaches that the cosmos is like an infinite net of glittering jewels, all-different and each located at the connecting points in the net. In each one, we can see the images of all the others reflected. Each image contains an image of all the other jewels; and also the image of the images of the images, and so ad infinitum. The myriad reflections within each glistening jewel are the essence of the jewel itself, without which it does not exist. Every jewel is a Centre of the universe. Organizing in this image is not a machine. It is more like a hologram. Each part is the whole. Indra's Net is a web of relationships that sparkle, nourish, and amplify. It is an ancient image of oneness and diversity. And it is amazingly consonant with the new story of the universe emerging today at the frontiers of science. (Appreciative Inquiry Consulting: An Invitation to Connect With People Around the World for Creating a Positive Revolution In Change, http://www.aiconsulting.org/charter.htm)
Whatever. No-things matter! The ties that bind us together cannot be seen. they are not of this world, but they cab be made manifest simply by the way each of us chooses to act out our part in the web of relationships, named or nameless, in which we are grounded and made a part of a larger whole.
Think about your web of relationships while you listen to Ellen Stapenhorst's The Gift, Taking Our Lives in Our Hands, or Part of My Heart
Please note: Because the the limitations of Blogger to host audio files, it is necessary to use a third-party host. To avoid copyright infringement issues, please do not download these songs to your computer. You may listen to them by choosing the "Play" option. (First, turn off any music players in use). If you wish to download a song for your own use, please use iTunes or the music source of your choice. Thank you.
Part 3. Intermezzo: Seeing the Unseen
Time for a break from the metaphysical musings. When something is "unseen," you have no visual image of it, right? Well, sort of'Whilst part of what we perceive comes through our senses from the object before us, another part (and it may be the larger part) always comes out of our own mind."-- William James
Here are three "pictures." What do you see?
1.
Do you see a white square on top of 4 purple discs?
2.
Do you see the solid white triangle superimposed over the triangle bounded in red to form a "Star of David"?
3.
Do you see the outline of the white cube in front of the green circles?
What you have “seen” – the square, the triangle that completes the Star of David, and the cube, -- do not exist any place other than in your own mind.
What is there to seen are colored figures (shapes) on a white ground. It is your mind, and your mind alone, that creates and labels the white shapes. The white "shapes" are the result of the mental process of Gestalt formation - examples of how, without conscious effort, the egoic mind "thingifies" the unseen.
The image above has circulated in Britain since the late 1950s. It contains a face of Christ, but not everyone can see it straight away. The story that goes with it says it was taken by a Chinese photographer who was riding home one day through the snow. According to the story...
His soul was troubled. He had been witnessing a great movement towards Christianity among his friends since the Japanese invasion. He longed to know the truth of what he had been hearing from Christian missionaries.As he rode along he said, "Lord, if I could only see your face, I would believe." Instantly a voice spoke to his heart, "Take a picture. Take a picture."
He looked out at the melting snow forming pools of water and revealing here and there the black earth. It was an unattractive scene. Nevertheless, being thus strangely compelled, the man descended and focused his camera on the snowy roadway.Curious to know the outcome of the incident, he developed the film at once upon returning to his home. Out from the black and white areas of the snow scene a face looked at him, full of tenderness and love - the face of Christ. He became a Christian as a result of this experience.
Provocative thought - "God as Gestalt."Part 2. "The heart and soul of our everyday living" (continued)
In traditional Christian theology, there are two worlds – visible and invisible, the seen and the unseen. I have this on reasonably good authority:
(Pope John Paul II, Catechesis on God, Creator of the World, session 19)] [Nicene-Constantinopolitan Creed]:
(Edward de Bono, (1990) I Am Right, You Are Wrong)
(Pope John Paul II, Catechesis on God, Creator of the World, session 19)] [Nicene-Constantinopolitan Creed]:
"I believe in one God, the Father Almighty, Creator of heaven and earth, of all things (that is, entia or beings) seen and unseen".
"We know that man enjoys a unique position within the sphere of creation: by his body he belongs to the visible world, while by his spiritual soul which vivifies the body, he is as it were on the boundary between the visible and invisible creation. To the latter, according to the Creed which the Church professes in the light of Revelation, belong other beings, purely spiritual, therefore not proper to the visible world, even though present and working therein. They constitute a world apart."
This viewpoint is uniquely Western. According to Cynthia Borgeault, it arises out of an “egoic” perspective based on a subject-object duality under which we implicitly accept the need for a viewer separated from the thing to be viewed. Cynthia then proposes an alternative, a “wegoic” non-dual perspective.
Things seen are tangible, verifiable by touch, sight, or smell. They are accepted as “scientific evidence.”“Contrariwise,” continued Tweedledee, "If it was so, it might be; and if it were so, it would be; but as it isn't, it ain't. That's logic."
Things unseen, intangible, and un-seeable cannot be verified from the “egoic” perspective;” the unseen cannot be touched, seen, or smelled. When we view the world from an “egoic” perspective, based on a subject-object duality, we are implicitly accepting the existence of a viewer separated from the thing to be viewed. We see only “things” out there; after all, "seeing is believing.”Hence, as John Paul II said, things unseen are not of this world. For me, this creates a cognitive dissonance – people of faith do not accept that God does not exist simply because God cannot be seen – which is driven by our innate urge to “thingify” our beliefs into objects that can be seen, through the use of familiar symbols, images, and metaphors. Pope John Paul II alludes to entities in the realm of the unseen as ”angels,” so, of course, we know angels must look just like Roma Downey.
The mind can only see what it is prepared to see.(Edward de Bono, (1990) I Am Right, You Are Wrong)
We see the world in terms of our cultural heritage and the capacity of our perceptual organs to deliver culturally predetermined messages to us.
(Jamake Highwater, Blackfeet/Cherokee, (1981): The Primal Mind: Vision and Reality in Indian America.)
How do you and I know this in the absence of verifiable scientific evidence?
Because we have experienced emotions – love, hate, sorrow. We have and hold insights, revelations, epiphanies, ideas, and concepts and, because we believe they are important, we struggle to communicate them to others. This struggle is at the heart of creativity as we seek to find a means to re-present our insights and feelings. But the best we can do in this “thingification” process is to create a “mind map” in the form of a painting, a poem, a piece of music, sermon or some other form of intellectualized experience.But my re-presentation is not the real thing --- Alford Korzybski's dictum, "the map is not the territory." Furthermore, because this re-presentation is grounded in my own unique cultural heritage and experiences, it is even more difficult for anyone else to see and to accept it as reality.
[View my self-description, "What Language Do You Speak," in the sidebar](To be continued)
Tuesday, May 26, 2009
Part 1. "The heart and soul of our everyday living"
[WARNING: You my find this "heavy" going - metaphysical musings on live and death, the seen and unseen, the "...spiritual and emotional dimensions of human existence – in other words the heart and soul of our everyday living." (Sabina Spencer (2004) Heart of Leadership. I plan to take this theme and push it along paths that I have been exploring for the past 40 years. Some of you may feel I’m pushing it right over the top. Take heart, I am not trying to sell you anything. No-thing ventured, No-thing gained.]
While we lived in Redstone, Colorado, my wife and I attended the Aspen Chapel, a non-denominational, and some would say, liberal, progressive congregation with spiritual leanings in more than one direction, tho' principally Lutheran/Methodist/Episcopalian and a soupçon of Buddhism. I occasionally served as a lay "message-sharer," no preachers here. What follows is a mash-up of ideas taken from some of my "messages."
----------------------------
Good Morning, rationalists, atheists, Christians, Jews, Buddhists, Hindus, Muslims, pagans, and miscellaneous others. Did I miss anybody?
No? OK, good. I will leave it to you to decide to which group I belong after hearing what I am going to say.
On becoming aware that I was recently diagnosed and am being treated for a particularly nasty form of cancer, several people have asked me, “Has this experience changed your attitude about life.”
The first time I was asked, I realized that I didn’t have a ready answer, so I responded with the first thing that popped into my head. “Well, “I said, “it’s a relief that I no longer have to worry about eating hamburgers anymore, as it is highly unlikely that I’ll die from heart disease.”
From the expression on the questioners’ faces, it was apparent that this was not the expected nor the desired answer.
Gray-haired folks may remember the 1983 Monte Python movie, "The Meaning of Life." On reflection, after seeing it, I thought, "Well that was a meaningless movie."
Over time, I came to the realization that, "Yes, "life" per se is meaningless, it simply is, an existential reality, a "vessel without content." It is the act of living that fills the vessel with substance and gives meaning to our lives. Life is no big deal. We are given the opportunity to live without having to ask for it.
Like "life," death simply is, an existential form without substance. Dying, on the other hand, seems to be a very big deal in people’s minds. Why is that?
Death is no big deal – given our fragile bodies, it’s easy to achieve and inevitable. Is death from disease any worse than death from aging? Sooner maybe, but no worse or better. The big deal is that, in our minds, death is a scary proposition – it is the fear of dying and its attendant trauma that is the big deal. Death, like life, is meaningless, the big deal is the way we give it form and meaning through action.
[Please note that although fear of death looms large among those of us of the Western, Christian persuasion, it is by no means universal among the groups I greeted this morning.]
Being able to overcome the fear of death by focusing on the quality of living is a very big step on the way to better living.
While we lived in Redstone, Colorado, my wife and I attended the Aspen Chapel, a non-denominational, and some would say, liberal, progressive congregation with spiritual leanings in more than one direction, tho' principally Lutheran/Methodist/Episcopalian and a soupçon of Buddhism. I occasionally served as a lay "message-sharer," no preachers here. What follows is a mash-up of ideas taken from some of my "messages."
----------------------------
Good Morning, rationalists, atheists, Christians, Jews, Buddhists, Hindus, Muslims, pagans, and miscellaneous others. Did I miss anybody?
No? OK, good. I will leave it to you to decide to which group I belong after hearing what I am going to say.
On becoming aware that I was recently diagnosed and am being treated for a particularly nasty form of cancer, several people have asked me, “Has this experience changed your attitude about life.”
The first time I was asked, I realized that I didn’t have a ready answer, so I responded with the first thing that popped into my head. “Well, “I said, “it’s a relief that I no longer have to worry about eating hamburgers anymore, as it is highly unlikely that I’ll die from heart disease.”
From the expression on the questioners’ faces, it was apparent that this was not the expected nor the desired answer.
Gray-haired folks may remember the 1983 Monte Python movie, "The Meaning of Life." On reflection, after seeing it, I thought, "Well that was a meaningless movie."
Over time, I came to the realization that, "Yes, "life" per se is meaningless, it simply is, an existential reality, a "vessel without content." It is the act of living that fills the vessel with substance and gives meaning to our lives. Life is no big deal. We are given the opportunity to live without having to ask for it.
Like "life," death simply is, an existential form without substance. Dying, on the other hand, seems to be a very big deal in people’s minds. Why is that?
Death is no big deal – given our fragile bodies, it’s easy to achieve and inevitable. Is death from disease any worse than death from aging? Sooner maybe, but no worse or better. The big deal is that, in our minds, death is a scary proposition – it is the fear of dying and its attendant trauma that is the big deal. Death, like life, is meaningless, the big deal is the way we give it form and meaning through action.
[Please note that although fear of death looms large among those of us of the Western, Christian persuasion, it is by no means universal among the groups I greeted this morning.]
Being able to overcome the fear of death by focusing on the quality of living is a very big step on the way to better living.
Must Reads ...
When I experienced my first metastatic melanoma four years ago, I struggled a bit over the choice of treatments (cf. "Evaluating Options,"May 21, 2009). While visiting our son in Arlington, VA, my wife bought me Jerome Groopman's, The Anatomy of Hope. Groopman is a Harvard Medical School professor and New Yorker staff writer; as you would expect, both knowledgeable and a gifted writer.
I highly recommend this book for anyone in need of help or wishing to help a friend suffering from cancer. It brightened my days and strengthened my resolve to live. I think you will find that it will do the same for you.
P.S. If you have not read it recently, add Vicktor E. Frankl's Man's Search for Meaning (1946) to your must read list. Although more philosophical and metaphysical in tone, it dovetails very effectively with Groopman's work and offers a more complete vision of the importance and power of a positive vision of the future.
I highly recommend this book for anyone in need of help or wishing to help a friend suffering from cancer. It brightened my days and strengthened my resolve to live. I think you will find that it will do the same for you.
P.S. If you have not read it recently, add Vicktor E. Frankl's Man's Search for Meaning (1946) to your must read list. Although more philosophical and metaphysical in tone, it dovetails very effectively with Groopman's work and offers a more complete vision of the importance and power of a positive vision of the future.
Saturday, May 23, 2009
Afterthought...
The images in my last post are kind of blobby and might not mean much unless you're a student of anatomy. So, in the interest of clarity I'm posting this graphic to show you the source of the problem.
(Sourced from Wikipedia)
(Sourced from Wikipedia)
Friday, May 22, 2009
Cyberknife Strikes Again
Today was my third and last Cyberknife treatment. Now, I' ll wait four weeks to see what's next - did it work? The only know prior instance of the use of Cyberknife for a heart lesion was for a sarcoma, so I am the only instance of treatment for melanoma. Here's what happened. The first image shows where the 270 radiation beams entered my body.
The second image shows the area of convergence. The oblong gray blob is my heart. The small bright orange spots indicate the area of maximum convergence (highest dosage); the larger orange boundaries indicates the areas where 72% convergence occurred (Since a lesion on the heart is a moving target it is necessary to set a larger perimeter for the target area to increase the probability of attaining a "hit").
The last image is a chart of the actual dosages received, color-coded to Image 2.
With a maximum dosage of 3740.33 cGy, the chart indicates the primary target area received a mean dosage of 3241.68 CGy (86.62%). With a maximum dosage of of 3439,69 cGy, the larger light orange secondary containing target area received a mean dosage of 3146.36 cGy (91.47%). Radiation exposure to the adjoining areas (lungs, heart, esophagus) was significantly lower, well below the threshold of damage danger.
What does this mean? First and most important, Cyberknife was able to deliver a therapeutic dosage to the target area without significant impact on the surrounding areas. Second, because the treatment dosage levels were based on 1985 experience for safe broad area radiation to the heart, the effect of focused multiple dosages is unknown. Thirdly, since I am the first melanoma patient to receive this treatment, nothing further can be inferred or verified about the result for 4 - 6 weeks, after follow-up studies are completed.
Sorry about that! Trust me, no one's more anxious to know than I am. In the meantime, I'm pushing for a resolution of the small, untreated mets in my right lung and enjoying the extra 20 yards I'm producing within my new Callaway FT-iQ driver.
The second image shows the area of convergence. The oblong gray blob is my heart. The small bright orange spots indicate the area of maximum convergence (highest dosage); the larger orange boundaries indicates the areas where 72% convergence occurred (Since a lesion on the heart is a moving target it is necessary to set a larger perimeter for the target area to increase the probability of attaining a "hit").
The last image is a chart of the actual dosages received, color-coded to Image 2.
With a maximum dosage of 3740.33 cGy, the chart indicates the primary target area received a mean dosage of 3241.68 CGy (86.62%). With a maximum dosage of of 3439,69 cGy, the larger light orange secondary containing target area received a mean dosage of 3146.36 cGy (91.47%). Radiation exposure to the adjoining areas (lungs, heart, esophagus) was significantly lower, well below the threshold of damage danger.What does this mean? First and most important, Cyberknife was able to deliver a therapeutic dosage to the target area without significant impact on the surrounding areas. Second, because the treatment dosage levels were based on 1985 experience for safe broad area radiation to the heart, the effect of focused multiple dosages is unknown. Thirdly, since I am the first melanoma patient to receive this treatment, nothing further can be inferred or verified about the result for 4 - 6 weeks, after follow-up studies are completed.
Sorry about that! Trust me, no one's more anxious to know than I am. In the meantime, I'm pushing for a resolution of the small, untreated mets in my right lung and enjoying the extra 20 yards I'm producing within my new Callaway FT-iQ driver.
When You Need a Friend...
When you have lived in the Washington, D.C. area, you are familiar with the saying, "If you're a politician and need a friend, get a dog!"
Everyone in need should have a dog (or a pet). Why? First, "Dog" is "God" spelled backward, so you got things covered coming and going, "Dog is my co-pilot."
Most importantly dogs offer unconditional love, are forgiving, and demand very little of their owners and soul mates - a little food and water, walks, hugs, and a measure of love returned. They also provide spontaneous moments of joy and reward.
I'm scheduled for my third Cyberknife radiation treatment today. Cookie, our 6-year old Cairn Terrier, came into the bedroom,
and did her best puppy bow with the obvious intention of inviting me to play. In this case, play consisted of me standing in the middle of the living room clapping my hands and yelling, "I'm going to get you!," while she races madly around the house, through my legs, under, and over the furniture, stopping only when she heard the toaster pop in the kitchen where my wife was making breakfast. "Toasties" are very high on Cookie's list of needs.
This was followed by some "training." This means she performs for treats. This morning with a chicken chip for motivation, I put her in a Sit-Stay and walked about 30' away and faced her. At this point, I'll usually use voice command and gesture for "Come," then "Stop" en route, followed by a final "Come" and reward. Today, I tried something new. She knows "Down" and "Stay", but I had never tried a Down-Stay from a distance. I was dubious about it working because the gestures for "Down" and "Come" are very similar, open palm toward dog moved vertically for "Down," horizontally for "Come."
So, starting her from a Sit-stay, I walked away, turned and gave the command for "Down." Sonnova gun, she dropped like a log and waited expectantly for the next command. Surviving cancer is a series of small victories - Cookie's my role model for success.
Everyone in need should have a dog (or a pet). Why? First, "Dog" is "God" spelled backward, so you got things covered coming and going, "Dog is my co-pilot."
Most importantly dogs offer unconditional love, are forgiving, and demand very little of their owners and soul mates - a little food and water, walks, hugs, and a measure of love returned. They also provide spontaneous moments of joy and reward.
I'm scheduled for my third Cyberknife radiation treatment today. Cookie, our 6-year old Cairn Terrier, came into the bedroom,
and did her best puppy bow with the obvious intention of inviting me to play. In this case, play consisted of me standing in the middle of the living room clapping my hands and yelling, "I'm going to get you!," while she races madly around the house, through my legs, under, and over the furniture, stopping only when she heard the toaster pop in the kitchen where my wife was making breakfast. "Toasties" are very high on Cookie's list of needs.
This was followed by some "training." This means she performs for treats. This morning with a chicken chip for motivation, I put her in a Sit-Stay and walked about 30' away and faced her. At this point, I'll usually use voice command and gesture for "Come," then "Stop" en route, followed by a final "Come" and reward. Today, I tried something new. She knows "Down" and "Stay", but I had never tried a Down-Stay from a distance. I was dubious about it working because the gestures for "Down" and "Come" are very similar, open palm toward dog moved vertically for "Down," horizontally for "Come."
So, starting her from a Sit-stay, I walked away, turned and gave the command for "Down." Sonnova gun, she dropped like a log and waited expectantly for the next command. Surviving cancer is a series of small victories - Cookie's my role model for success.
Cultural Cancer - Stage 5
This morning, between walking this dog and my thrice-weekly trip to the Fitness Center, I was exposed to three news items: (1) the Obama-Cheney exchange on security policy (WSJ); (2) Lymphoma-afflicted Daniel Hanson's abduction by his mother (CNN); and (3) "Cougars," the sobriquet for 40+ women who frequent bars trolling for young men, on the way to becoming a reality TV show (CNN).
I was gobsmacked** by the moral and ethical issues represented and the seemingly irresolvable dilemmas they represent. In the first instance, we loudly descry, condemn, and eschew "torture" of terrorists, the consequence of which may be saving thousands, even, in the case of the use of nuclear or biological materials, hundreds of thousands if lives. In the second instance, by creating the illusion of free choice, we support and applaud the coercion of children and adults into being tortured by chemotherapy on the possibility of saving one life, even at the cost significantly reducing the person's quality of life, and to make matters worse, issuing an arrest warrant for a parent who undoubtedly believes she is doing the "right thing for her child.". (See my prior post, "Evaluating Options," May 21, 2009).
What a pickle! If nothing else, we have become a society that is consistent in it's inconsistency.
The third instance confirms this observation. Predatory women out for sex are called "cougers," derided and laughed at. Predatory men trolling for sex are called "studs," and admired by their wimpy peers.
Is there a Stage 5 for cultural "cancers?"
**"Gobsmacked" - English slang for "unexpectedly stupendously, stunned"
I was gobsmacked** by the moral and ethical issues represented and the seemingly irresolvable dilemmas they represent. In the first instance, we loudly descry, condemn, and eschew "torture" of terrorists, the consequence of which may be saving thousands, even, in the case of the use of nuclear or biological materials, hundreds of thousands if lives. In the second instance, by creating the illusion of free choice, we support and applaud the coercion of children and adults into being tortured by chemotherapy on the possibility of saving one life, even at the cost significantly reducing the person's quality of life, and to make matters worse, issuing an arrest warrant for a parent who undoubtedly believes she is doing the "right thing for her child.". (See my prior post, "Evaluating Options," May 21, 2009).
What a pickle! If nothing else, we have become a society that is consistent in it's inconsistency.
The third instance confirms this observation. Predatory women out for sex are called "cougers," derided and laughed at. Predatory men trolling for sex are called "studs," and admired by their wimpy peers.
Is there a Stage 5 for cultural "cancers?"
**"Gobsmacked" - English slang for "unexpectedly stupendously, stunned"
Thursday, May 21, 2009
Evaluating Options
In April 2005, two years after the initial diagnosis of melanoma in my right ear (Stage 1), I developed a tumor in a lymph gland on the right side of my neck (Stage 3). I was offered two options: (1) radical neck dissection to remove the tumor and all identifiable lymph glands in the vicinity; and (2) chemotherapy, followed by surgical removal of the tumor. The former was to be done at St. Mary's in Grand Junction , the latter at University of Colorado Medical Center in Denver.
I went down to Denver to learn more about the chemo option. During the pre-admission interview, I asked the nurse for a graph of survival rates. Apparently, no one had asked for one before and she had (a) to find it, then (b) get permission to show it to me. This struck me as slightly weird unless the people you deal with are in extreme denial or don't care how quickly they might die. The annotated chart below is an updated version similar, but more elaborate, to the one I saw.
The treatment consisted of a cocktail of 6 or 7 toxic chemicals, each of which had shown some positive effect on melanoma. The side effects, as I understod them, were pretty horrendous - total incapacitation for 6 - 8 weeks, with a potential 40% weight loss. With some more strenuous digging, I finally deduced the that a successful treatment might improve my survival rate by about 3%.
The capper was when the doctor returned after about 40 minutes, his first comment was to the nurse, "What, he's still here? What are you doing making him your life work?"
She was obviously embarassed, I was slighty stunned, "Well, I thought, "I certainly hope so."
In any event, my conclusion was the that risk-reward did not warrant the reduction in the quality of my life and this wasn't the place for me.
Lessons Learned: Gather as much hard data as you can before making any decisions and don't ignore the human factors.
These graphs compare the relative survival up to 15 years for patients with localized melanoma (stages II and I), regional metastases (stage III), and distant metastases (stage IV). The numbers in parentheses represent the number of patients from the AJCC melanoma staging database used to calculate the survival rates. The differences between the curves are significant (p <.0001). Data from: Balch, CM, Buziad, AC, Seng-Jaw, S, et al. Final version of the American Joint Committee on Cancer staging system for cutaneous melanoma. J Clin Oncol 2001; 19:3636.
I went down to Denver to learn more about the chemo option. During the pre-admission interview, I asked the nurse for a graph of survival rates. Apparently, no one had asked for one before and she had (a) to find it, then (b) get permission to show it to me. This struck me as slightly weird unless the people you deal with are in extreme denial or don't care how quickly they might die. The annotated chart below is an updated version similar, but more elaborate, to the one I saw.
The treatment consisted of a cocktail of 6 or 7 toxic chemicals, each of which had shown some positive effect on melanoma. The side effects, as I understod them, were pretty horrendous - total incapacitation for 6 - 8 weeks, with a potential 40% weight loss. With some more strenuous digging, I finally deduced the that a successful treatment might improve my survival rate by about 3%.
The capper was when the doctor returned after about 40 minutes, his first comment was to the nurse, "What, he's still here? What are you doing making him your life work?"
She was obviously embarassed, I was slighty stunned, "Well, I thought, "I certainly hope so."
In any event, my conclusion was the that risk-reward did not warrant the reduction in the quality of my life and this wasn't the place for me.
Lessons Learned: Gather as much hard data as you can before making any decisions and don't ignore the human factors.
These graphs compare the relative survival up to 15 years for patients with localized melanoma (stages II and I), regional metastases (stage III), and distant metastases (stage IV). The numbers in parentheses represent the number of patients from the AJCC melanoma staging database used to calculate the survival rates. The differences between the curves are significant (p <.0001). Data from: Balch, CM, Buziad, AC, Seng-Jaw, S, et al. Final version of the American Joint Committee on Cancer staging system for cutaneous melanoma. J Clin Oncol 2001; 19:3636.
Music to Make You Smile
I had the privilege of meeting Mack Bailey when he played at an Aspen Chapel concert service several years ago. His Mom had succumbed to cancer in 2003. His song"Choose Your Attitude" and the album of the same name, were written and compiled at the time. According to Mack, "The saying was my mom's mantra during her last year."
I also included his "No Longer Afraid" from the same album. If you're feeling a bit down about life, I urge you to listen to both songs. When you do, I think you'll feel renewed, as I do.
Please note: Because the the limitations of Blogger to host audio files, it is necessary to use a third-party host. To avoid copyright infringement issues, please do not download these songs to your computer. You may listen to them by choosing the "Play" option. (First, turn off any music players in use). If you wish to download a song for your own use, please use iTunes or the music source of your choice. Thank you.
Choose Your Attitude, Mack Bailey/Chris Nole
No Longer Afraid, V. Buddy Renfro/Mack Bailey
Produced at The Parlor in Nashville, TN by Chris Nole
2006 Copyright Spa Creek Music, ASCAP All rights Reserved.
Recorded by an All-Star crew including Sam Bush playing fiddle on these cuts.
I also included his "No Longer Afraid" from the same album. If you're feeling a bit down about life, I urge you to listen to both songs. When you do, I think you'll feel renewed, as I do.
Please note: Because the the limitations of Blogger to host audio files, it is necessary to use a third-party host. To avoid copyright infringement issues, please do not download these songs to your computer. You may listen to them by choosing the "Play" option. (First, turn off any music players in use). If you wish to download a song for your own use, please use iTunes or the music source of your choice. Thank you.
Choose Your Attitude, Mack Bailey/Chris Nole
No Longer Afraid, V. Buddy Renfro/Mack Bailey
Produced at The Parlor in Nashville, TN by Chris Nole
2006 Copyright Spa Creek Music, ASCAP All rights Reserved.
Recorded by an All-Star crew including Sam Bush playing fiddle on these cuts.
Wednesday, May 20, 2009
My first Cyberknife Session
A day at the beach - After the predictable wait, I was given three small pills, two steroids to minimize swelling, and one sedative. After that I had a semi-nap for 90 minutes immobile on the Cyberknife table, while it did its robotic thing through three cycles of zapping me at the rate of about 1/minute from a multitude of different angles. I couldn't help thinking about it as a robotic laser welder on an auto assembly line. (I was assured no touch, no heat without having to ask).
There was a pause between cycles for the technician to change the collimator.** Apart from a slightly stiff neck when I got up, there were no detectable effects during or after the treatment, other than a slightly elevated blood pressure.
If it works, it's a great way to deal with an otherwise inaccessible location. It's shown to be highly effective with pancreatic, liver, lung, brain, and kidney tumors. I asked the technician if she had ever done one on the heart before. She said "...we've never done one here before, but I think there was one other, maybe in California." The Cyberknife Coordinator subsequently confirmed that mine was their first such treatment.
Hoo Haa - first on the block again!
**A device capable of collimating radiation, as a long narrow tube in which strongly absorbing or reflecting walls permit only radiation traveling parallel to the tube axis to traverse the entire length. For non-geeks, think of it as a hose nozzle or shotgun choke.
There was a pause between cycles for the technician to change the collimator.** Apart from a slightly stiff neck when I got up, there were no detectable effects during or after the treatment, other than a slightly elevated blood pressure.
If it works, it's a great way to deal with an otherwise inaccessible location. It's shown to be highly effective with pancreatic, liver, lung, brain, and kidney tumors. I asked the technician if she had ever done one on the heart before. She said "...we've never done one here before, but I think there was one other, maybe in California." The Cyberknife Coordinator subsequently confirmed that mine was their first such treatment.
Hoo Haa - first on the block again!
**A device capable of collimating radiation, as a long narrow tube in which strongly absorbing or reflecting walls permit only radiation traveling parallel to the tube axis to traverse the entire length. For non-geeks, think of it as a hose nozzle or shotgun choke.
On the Opaque Language of Medicine...
Talking with a doctor is akin to a calf crossing a meadow of succulent grasses - from the patient's point of view, the conversation tends to wander unpredictably, often into areas where the terminology is unfamiliar at best, totally opaque or misleading at worst.
In my initial discussion of treatment options, I heard my condition described as "unique" and that I was an "outlier." I understand the former and, as a statistician, the implications of the latter, so I pretty well knew the unvoiced meaning - the doctors didn't have any data or prior experience about how to approach my problem.
The CT surgeon, initially proposed open-heart surgery, promising to do more research, subsequently deciding it was too risky, leaving radiation as the only alternative. The radiation oncologist told me he had found "a very limited number of somewhat similar" situations in which radiation had been successful a very high percentage of the time, which in statistical terms means little, which he voluntarily admitted.
The remaining options, were euphemistically "watchful waiting," a clinical trial which might take months to find, if ever, and radiation using Cyberknife, which is non-invasive and offered at least the hope of an immediate successful treatment, even though they couldn't insert the markers used for accurate targetting -- Hookay, guess which one I chose.
In describing radiation treatment, the term "palliation" was used several times. I know what palliative care means (keep them comfortable until the pop off), but I'd never heard the term used as a noun. I didn't like the implication of this, so I used my Alt-Click to look it up on Answers.com:
Pal·li·a·tion
n.
In my initial discussion of treatment options, I heard my condition described as "unique" and that I was an "outlier." I understand the former and, as a statistician, the implications of the latter, so I pretty well knew the unvoiced meaning - the doctors didn't have any data or prior experience about how to approach my problem.
The CT surgeon, initially proposed open-heart surgery, promising to do more research, subsequently deciding it was too risky, leaving radiation as the only alternative. The radiation oncologist told me he had found "a very limited number of somewhat similar" situations in which radiation had been successful a very high percentage of the time, which in statistical terms means little, which he voluntarily admitted.
The remaining options, were euphemistically "watchful waiting," a clinical trial which might take months to find, if ever, and radiation using Cyberknife, which is non-invasive and offered at least the hope of an immediate successful treatment, even though they couldn't insert the markers used for accurate targetting -- Hookay, guess which one I chose.
In describing radiation treatment, the term "palliation" was used several times. I know what palliative care means (keep them comfortable until the pop off), but I'd never heard the term used as a noun. I didn't like the implication of this, so I used my Alt-Click to look it up on Answers.com:
Pal·li·a·tion
n.
[Cf. F. palliation.]
1. The act of palliating, or state of being palliated; extenuation; excuse; as, the palliation of faults, offenses, vices.
2. Mitigation; alleviation, as of a disease. Bacon.
3. That which cloaks or covers; disguise; also, the state of being covered or disguised. [Obs.]
Hmmm, not exactly what I hoped to see - elimination, cessation, eradication, gone bye-bye
Tuesday, May 19, 2009
What's It All About
Yesterday, I had my first Cyberknife* treatment at UNC Medical Center for a Melanoma met on, or immediately adjacent to my heart, with two more treatments to follow this week. (I'm telling people it's my week off to get a sun tan). Early this morning, really early this morning, I was lying awake thinking trivial thoughts about little things like, "what do I do next if this doesn't work," other unfinished business," and "how do I really feel about the prospect of dying."
This blog will, I hope, serve several useful purposes: A place to capture these musings for further analysis and reflection at a more appropriate hour; a place to share my learnings and experiences in the hope it will be of use to others; and a place for others to contribute their thoughts and resources that may be of value to me.
Sounds a bit self-serving, but I suspect those of you in similar circumstances will forgive me for my interest in seeking and finding help from any useful source.
In the sidebar you will find, lists of books, articles, and webs sites, Facebook, LinkedIn, and Twitter groups, and other social media sources. Feel free to contribute your own sources, suggestions, and thoughts. If there is enough interest and need to warrent a wiki or Ning social network site, I'll be glad to create one as a means of facilitating the exchange as a multilog.
In the meantime, "Live long and prosper." ( Sorry, I just saw the new Star Trek Sunday)
*If you are intersted in learning more about Cyberknife, please go to UNC Cyberknife.
This blog will, I hope, serve several useful purposes: A place to capture these musings for further analysis and reflection at a more appropriate hour; a place to share my learnings and experiences in the hope it will be of use to others; and a place for others to contribute their thoughts and resources that may be of value to me.
Sounds a bit self-serving, but I suspect those of you in similar circumstances will forgive me for my interest in seeking and finding help from any useful source.
In the sidebar you will find, lists of books, articles, and webs sites, Facebook, LinkedIn, and Twitter groups, and other social media sources. Feel free to contribute your own sources, suggestions, and thoughts. If there is enough interest and need to warrent a wiki or Ning social network site, I'll be glad to create one as a means of facilitating the exchange as a multilog.
In the meantime, "Live long and prosper." ( Sorry, I just saw the new Star Trek Sunday)
*If you are intersted in learning more about Cyberknife, please go to UNC Cyberknife.
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