Sunday, July 16th, 2017 Lexington, Virginia What's been happening?This past week, we tiptoed into the world of radiation oncology. On Monday, we met with Dr. Stephanie Terezakis, our radiation oncologist at Johns Hopkins. She explained to us some of the complexity of radiating my spleen. Specifically, my spleen is large enough that it has far outgrown its standard spot tucked under my left rib cage such that it now wraps around my kidney down below. We want to zap all of the little buggers hiding in my spleen but we want to absolutely minimize any radiation to my kidney (and elsewhere). The solution to this problem is something called intensity-modulated radiation therapy. To quote radiologyinfo.org: Intensity-modulated radiation therapy (IMRT) is an advanced mode of high-precision radiotherapy that uses computer-controlled linear accelerators to deliver precise radiation doses to a malignant tumor or specific areas within the tumor. IMRT allows for the radiation dose to conform more precisely to the three-dimensional (3-D) shape of the tumor by modulating—or controlling—the intensity of the radiation beam in multiple small volumes. IMRT also allows higher radiation doses to be focused to regions within the tumor while minimizing the dose to surrounding normal critical structures. On Wednesday, we returned for a radiation planning session. In this session, they place you on a ridiculously hard, flat surface (the back of the human body is far from flat) and slide you up and back through a CT scanner like a toasted baguette. This lasts for about 20 minutes. At this same time, a mold is hardening against your back, releasing heat as it hardens. The mold will be used to help guarantee accurate positioning of my body each time I get a dose of radiation. They even used a special belt to monitor my breathing pattern, since my spleen moves up and down with my belly as I lie on my back and breathe. I didn't bother to ask how they account for that movement. They are the experts and I trust that they know what they're doing. Looking aheadOnce the planning session was complete, we began a one-week hiatus from all things medical. We returned to Richmond, expecting to stay there for the week, but I've been feeling good enough lately (the calm before the storm) that we decided to sneak away to Lexington for the weekend. We haven't been here for two months and won't be back for two or three more, so it was the perfect time to squeeze in a visit. We will return to Richmond on Monday evening and then Baltimore on Thursday evening. On Friday, the radiation oncology team will perform a dry run of my "beams," as they call them, with me and my mold in place. Assuming it goes smoothly, the radiation therapy will begin the following Monday, July 24th. The therapy is twice a day, Monday through Friday, for two weeks. Once that is complete, all of the pre-transplant steps will begin, still targeting a transplant date of Friday, August 18th. Don't think twiceI've been trying to work as much as I can, but there are many hours during which I'm too tired to work but not tired enough to sleep. I continue to read a lot, but I've also added some YouTube exploration to the mix. I realize that much of the internet community uses YouTube simply to find the latest viral cat videos, but I use it to explore music: recordings of live performances of my favorite artists, which inevitably lead me to new artists of interest using YouTube's recommendation mechanism. With that in mind, here are two of my recent finds. Both are covers (audio only) of Bob Dylan's Don't Think Twice, I'm Alright. The first cover is by Chris Thile and Brad Mehldau. Chris is a virtuoso mandolin player and the new host of A Prairie Home Companion; Brad is an equally virtuosic jazz pianist. The second cover is by Susan Tedeschi, a Grammy-nominated singer and guitarist.
PicturesHere are some photos that we've either taken or collected in the last week. Keep an eye out for the world's first gluten-free stem cell cake!
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Wednesday, June 28th, 2017 Baltimore, Maryland Really
ICE
I think that my head is smaller
Bill Bryson's "One Summer: America, 1927"
PicturesTidbit
Thursday, June 15th, 2017 Baltimore, Maryland B-cellsRed blood cells nourish the body; white blood cells protect it. There are different types of white blood cells, each serving a slightly different purpose. One such type is the B-cell, pictured at right. Its surface is populated with antibodies (blue) that can bind to different kinds of foreign bodies (a.k.a. antigens). Once bound, the B-cell spawns many more copies of the matching antibody. I mention all of this because my official diagnosis is diffuse large B-cell lymphoma. Aside: Why are they called B-cells? I've wondered this for a while so I looked it up. In mammals, B-cells mature in the bone marrow; in birds, B-cells mature in the bursa of Fabricius, an obscure (at least to me) lymphoid organ. Somewhat surprisingly, it is bursa that lends the B to B-cells, not bone marrow. RituximabRituximab is the "R" in my chemotherapy cocktail (R-ICE). Strictly speaking, Rituximab provides immunotherapy, not chemotherapy. It leverages your own immune system to destroy malignant (as well as healthy, unfortunately) B-cells. Here's how it works. B-cells are special in that their surface is populated with both antibodies (blue in the picture from the previous section) and antigens (green). These antigens are obviously not foreign bodies but they act in the same way. (In fact, the word antigen is short for antibody generator -- anything that causes antibodies to be generated.) Rituximab is a synthetic antibody that has been engineered to bind to one of the antigens (CD20, if you are curious) that is present on most B-cells. Once the B-cells are bound, other parts of the immune system (a.k.a. natural killer cells) sweep in and destroy them (a.k.a. cell lysis). Pretty nifty, eh? This wonderful little antibody was created by researcher Nabil Hanna and his coworkers at IDEC Pharmaceuticals. Rituximab has proven so useful for a variety of conditions in which B-cells go awry that it is included on the World Health Organization's List of Essential Medicines, a list of the most important medications needed in a basic health system. Aside: I realize that Rituximab doesn't start with a "B" but it does end with one. Brady Coyne MysteriesI mentioned recently that I have been reading a lot this spring as my body slowed down, preventing more active pursuits. The bulk of that reading, 25 books in all, was the Brady Coyne Mysteries by William G. Tapply. Tapply was a high school teacher for 25 years before becoming a full-time writer. He was a lifelong New Englander, avid fly fisherman and dedicated smoker, three characteristics that he shared with the protagonist in his novels, Brady Coyne. The similarities stopped there, however. Coyne is a Boston lawyer that caters to wealthy clientele that seem to experience their unfair share of murder and mayhem. Since divorces, wills and estate planning isn't exactly thrilling work, Coyne spends a good deal of time investigating those murders personally. Clearly imperfect, Coyne is sufficiently complex to keep one reading almost to the 25th book. By the way, what's next?Tomorrow is the second day of this three-day chemotherapy cycle. That means another eight hours of chemotherapy (like today), along with a lumbar puncture throw in for kicks and grins. At some point, the brain fog for the cycle will settle over me and then these blog entries will either (A) stop for a while or (B) become incoherent. I'm hoping for (A).
Tuesday, June 13th, 2017 Baltimore, Maryland HemoglobinHemoglobin is a wonderful little protein in your blood that binds to oxygen in your lungs and then delivers that oxygen to the rest of your body. If you have insufficient hemoglobin in your blood, then you've got insufficient oxygen in the rest of your body, including (eventually) your brain. Oxygen deprivation (hypoxia) in general is something best avoided. One common but unfortunate side effect of both cancer and its treatment (chemotherapy) is that they can drive down your hemoglobin. When that happens, your body slows down to a sluggish halt and the thought quickly surfaces that "something isn't right here." The remedy for low hemoglobin is easy enough: a blood transfusion -- fresh blood infused with normal volumes of hemoglobin. Thus I find myself back at JH today, with Alison by my side of course, to receive a couple of pints of new blood. AntibodiesBack in middle school, we all learned about blood typing and matching -- who can give to whom. I remember none of it except for the fact that there is some blood type known as the "Universal Donor" and another that is the "Universal Recipient." I'm drawing a blank on everything else and I haven't been ambitious enough to look it up. One thing that I have learned about is antibodies. If you think of "body" as meaning "foreign body", then the definition of an antibody makes sense: they seek out and bind to foreign bodies (a.k.a. antigens) so that other parts of your immune system can sweep them up and purge them from your body. As with anything in your body, sometimes things can go awry. In the case of antibodies, for example, they can mistakenly identify a native body as foreign which leads to good cells being purged. In my case, my blood contains antibodies that seek out native bodies that occur normally in the blood of most (but not all) people's blood. So, in order for me to receive a transfusion of blood without my own antibodies attacking the new blood, the blood bank needs to track down blood that does not contain the native bodies in question. That often takes a very long time (8-9 hours), yielding in turn a lot of thumb twiddling here at the infusion center. The Wright BrothersAs my body slowed down more and more earlier this year and before I knew why, I took the opportunity to read a couple of dozen books. Here's one of them. The Wright Brothers is a recent book by David McCullough, the winner of two Pulitzer Prizes for his books Truman and John Adams. Before I read this book, I knew only the very basics about the Wright brothers:
(1) "Widely considered to have invented..." does a disservice to the Wrights. Although various other people were trying to invent a flying machine at the same time, none of them was remotely close to success. The Wrights were clearly and unambiguously the thought leaders in the mechanics of avian flight and how they could be (and were) successfully applied to manned flight. (2) The Wrights did spend time in Kitty Hawk in order to take advantage of the plentiful winds and soft sand, but their base of operations and invention was definitely in their home town of Dayton. For the tourism bureaus, Dayton deserves the credit and Kitty Hawk should get honorable mention. (3) Their mother died young and father was a traveling preacher. Of the five surviving siblings (twins died in infancy) Wilbur, Orville and their sister Katharine became very close. When the brothers were away (which was often), Katherine managed both the household and the family bicycle business. (4) The Wrights offered their invention for sale to the United States government but received little more than a courtesy reply. That's because the Smithsonian was funding a similar machine of their own being developed by Samuel Langley (it never worked). So, they took their business overseas to the French, first and foremost, but also the Germans and Italians. They were warmly welcomed there. (5) Neither brother ever married. Wilbur died from typhoid fever at the age of 45. Orville lived until the age of 76. Although both brothers accumulated moderate wealth in their lifetimes (Orville in particular) from their invention and various patents, neither amassed anything close to the enormous fortunes of the railroad barons of the era. What's next?Summer 2009
Louise PennyLouise Penny lives in a small village outside of Montreal in the Province of Quebec. Her mystery novels are all set in and around Quebec and feature Chief Inspector Armand Gamache, the head of homicide for the famous Sûreté du Québec, their provincial police force. A thoughtful, erudite and compassionate man, Gamache continually crosses paths with the fictional village and villagers of Three Pines, a rural idyll that continues to elude mapmakers, cell coverage and Internet coverage.
We discovered these novels last spring when we started learning about Quebec in advance of our summer pilgrimage there. These are twelve wonderful books that follow a single, long story arc. If you have even a passing interest in them, definitely start at the beginning. I read two of the later books first and I therefore "knew a little too much" when I then returned to the first one to read them in order. |
Joshua GolubAn occasional blog about what's going on in our lives. Categories
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