Sunday, March 11th, 2018
​Richmond, Virginia

When we last left off, the plan was to:

• Wait for me to start bleeding again
• Inject radioactive material into my bloodstream
• Scan my body for radioactivity to see where the blood goes

That would identify the source of the bleeding. What to do about the source of the bleeding would depend on where it was located.

Since then, it's been decided that it doesn't matter much where I am bleeding because the next step would be the same regardless of the actual source (e.g. esophageal varices, gastropathy, anorectal varices): relieve my portal hypertension (high blood pressure in the veins leading into the liver). The current standard of care for my condition is the installation of a transjugular intrahepatic portosystemic shunt (TIPS). Despite the intimidating name, the procedure is simple in concept.

​Breaking down that mouthful (transjugular intrahepatic portosystemic shunt) explains how the procedure is performed:

• Transjugular — insert a catheter through the jugular vein, through which
• Intrahepatic — a hole is cut through the liver
  
• Portosystemic — connecting the portal circulation to the system circulation
• Shunt — and insert a tube to hold that hole open

All of that explains why I need the procedure. As for when and where, the procedure will be done this Wednesday (March 14th) by the Interventional Radiology staff at Johns Hopkins. I will be monitored for a day or two and then sent home, barring any complications from the procedure.

That all sounds easy enough, right?

My latest musical discovery is a group called Postmodern Jukebox (PMJ). They aren't so much a band as a rotating collection of entertainers: singers, musicians and tap dancers. The brainchild of pianist and arranger Scott Bradlee, PMJ has carved out a very entertaining niche for themselves performing modern pop music (e.g. Rihanna, Beyoncé) in the style of classic American genres (e.g. swing, jazz, soul, funk and such).

Below are the videos for three songs that represent their style:

• "All About That Bass" by Meghan Trainor
• "Umbrella" by Rihanna
• "Crazy" by Gnarls Barkley

On the left is PMJ's arrangement; on the right is the original. The first one, "All About that Bass," represents my initial discovery of PMJ and remains my very favorite. Your musical mileage may vary.

A slew of family birthdays have already been celebrated this year. Here are a few of them. Click any of them for more pictures.

​Here are some photos that we've either taken or collected recently.

Saturday, February 3rd, 2018
The Harry and Jeanette Weinberg Building, Room 5C-01
​Johns Hopkins Hospital, Baltimore, Maryland

I apologize for the long delay since my last post, but in this ongoing medical saga of mine, "no news is good news," as they say. Sadly, the delay comes to an end because I've spent the majority of the last 12 days as an inpatient here at Johns Hopkins Hospital. It's been a roller coaster of a time, with the inherent highs and lows of said coaster, so allow me to boil it down as best I can. It all started on Alison's birthday, the 21st of January:
​

• Sunday: Lots of gastrointestinal bleeding
• Monday: No bleeding
• Tuesday: More bleeding; hospitalized at Hopkins
• Wednesday: Bowel cleansing (Ug)
• Thursday: Capsule endoscopy performed
• Friday: No bleeding
• Saturday: No bleeding; discharged from hospital
• Sunday: Major bleeding
• Monday: No bleeding
• Tuesday: Moderate bleeding
• Wednesday: Hospitalized again
• Thursday: Bowel cleansing (Ug, ug)
• Friday: Endoscopy and colonoscopy both performed
• Saturday: Strategize

That brings us to this evening, as I sit here with an Ativan gently percolating through my bloodstream. The procedures performed yesterday indicated possible causes of the bleeding, but no smoking gun was identified. Going forward, the plan is to:
​

• Wait for me to start bleeding again
• Inject radioactive material into my bloodstream
• Scan my body for radioactivity to see where the blood goes

That should identify the source of the bleeding. Of course, what we do about the source of the bleeding will depend on where it is located. That exciting discussion will need to wait until next time.

Alison, my constant care companion — she sleeps here in my room each night, despite my (admittedly feeble) protestations — chose to record the beginning of my capsule endoscopy, i.e. swallowing the little camera.

Here are a few random photos collected since I've been here. We haven't taken too many, because between (A) my inability to shower (too many connected tubes) more often than every few days and (B) Alison sleeping on a fold-out chair, we don't make the most photogenic couple at the moment.

You might wonder to what the subject of this post refers. If so, that's an excellent question! I'll try to remember to explain that next time.

Sunday, December 3rd, 2017
Venice, Florida

When we last left off, Timmy was trapped in a well, Lassie had gone for help, I was officially in remission from my non-Hodgkin Lymphoma and the plan was to...

...monitor my blood work every two weeks and visit the oncologist every four weeks, in the hope of catching any relapse sooner rather than later.

​Since then, I have had my blood work checked as indicated and visited the oncologist twice, most recently on Thursday. When he came into the room and took a look at me, he said that (A) I was "radiating health," (B) my blood work agreed and (C) I didn't need to come back until mid-January. All in all, it was a Sabatino's day!

You might also recall that...

No matter how short or long the remission period might be, and what treatment we pursue once it does, one thing is clear: odds are strong that I will not be walking this planet at a ripe old age. To that end, Alison and I have chosen to slip into what I refer to as our early, temporary semi-retirement:

• Early, as I wasn't expecting retirement, semi- or otherwise, at 52
• Temporary, as we won't be riding this out until that ripe old age
• Semi, as we are each working a little bit each week, as health and interest permits

"A little bit" has turned out to be around 15 hours per week (a.k.a. three hours per day) for me and one day per week for Alison. That generates enough money for us to live our newly simplified life and gives us enough time to enjoy it as much as possible.

Alison and I have never been the type to dress up for Halloween. Instead, we dutifully hand out candy and secretly hope that it will start to rain so that the crowds dwindle and we're left with a hoard of chocolate to gorge on by ourselves. This year, it didn't rain but the crowds dwindled nonetheless, leaving us with enough gorge-worthy chocolate to eat our selves sick. And that we did!

Our friends and family, however, do enjoy dressing up. Here are a few photos of them.

After I graduated from college, I spent the next two years in graduate school at the University of Wisconsin in Madison. During that time, and for another five years in Chicago after graduation, my closest and constant friend was Mike Engber, a fellow graduate student in computer science. Mike and I shared in various endeavors outside of school, some (in hindsight) more questionable than others. One of those endeavors (and this is not one of the questionable ones) involved the purchase of 200 music CDs from various artists at the rock-bottom price of 25¢ per disc. Mike had a friend that worked at a local radio station and was trying to get rid of the enormous heap of demo CDs that had been sent to them by aspiring artists. So, we each chipped in $25 and came away with 100 CDs for each of us.

Over the next few months, I listened to each one of them, or more accurately, as much of each one as I could tolerate before moving on to the next one. The vast majority of them were very bad; the remainder of them were just `regular` bad. The one shining exception to this was an album named Deliverance by a young Jonathan Butler. Fast forward 30 years and 25 albums later, and Butler remains in my regular musical rotation.

If you'll recall from my last post, this is where we left off:

The last vestiges of my non-Hodgkin lymphoma remain unchecked. The doctors at NIH outlined two general approaches to this situation:

• Do nothing (i.e. palliative care)
• Do something (e.g. a clinical trial or experimental therapy)

Assuming that we're not prepared to proceed quite yet with the first approach, we will be meeting with my oncologist at Johns Hopkins soon to discuss what the latter options might be. We'll keep you informed about what is discussed.

​Two weeks ago, we met with my oncologist at Johns Hopkins to discuss the options in question. Much to our surprise, he told us that my lymphoma is officially in remission (the "R" word) and so no treatment is needed at this time. Ignoring the question of why this hadn't been mentioned to us previously, the million dollar question is how long that remission will last. To quote the doctor: "It could last a month, or a year, or perhaps longer. We have no way at all to predict that." In the meantime, we will monitor my blood work every two weeks and visit the oncologist every four weeks, in the hope of catching any relapse sooner rather than later.

No matter how short or long the remission period might be, and what treatment we pursue once it does, one thing is clear: odds are strong that I will not be walking this planet at a ripe old age. To that end, Alison and I have chosen to slip into what I refer to as our early, temporary semi-retirement:
​

• Early, as I wasn't expecting retirement, semi- or otherwise, at 52
• Temporary, as we won't be riding this out until that ripe old age
• Semi, as we are each working a little bit each week, as health and interest permits

How will we passing the time in our semi-retirement? We'll tell you next time.

Sunday, October 1st, 2017
Richmond, Virginia

Here is the capsule summary of where we stand right now:

1. The disease in my bone marrow is gone
2. The disease in my spleen and elsewhere has been substantially eliminated
3. A stem cell transplant is needed to knock out the last vestiges of disease
4. A stem cell transplant will fail (i.e. death) with an unhealthy liver
5. Circumstantial evidence (i.e. portal hypertension) indicates an unhealthy liver
6. A liver biopsy is needed to confirm or deny that indication
7. I am not healthy enough for a liver biopsy (my platelet count is too low)
8. In light of (7) and (8), we must assume that the liver is unhealthy
9. A stem cell transplant is therefore not an option
10. The last vestiges of the disease remain unchecked

That last point is the real kicker, of course. The liver specialists outlined two general approaches to #10:

• Do nothing (i.e. palliative care)
• Do something (e.g. a clinical trial or experimental therapy)

Assuming that we're not prepared to proceed quite yet with the first approach, we will be meeting with my oncologist at Johns Hopkins soon to discuss what the latter options might be. We'll keep you informed about what is discussed.

On the positive side, I haven't felt better all year! Go figure.

All four of our kids are currently professionally displaced for one reason or another:

• Cameron was evacuated from St. Croix in advance of Hurricane Maria
• Nathan is in San Antonio, Texas at a Petco conference for senior dog trainers
• Ian continues his adventures in San Diego, now extended through Thanksgiving
• Eli is in Jacksonville, Florida to observe an occultation of Triton, one of Neptune's moons

Alison and I continue to live vicariously through their various adventures.

I've knocked off a few books in the intervening month. They were:

This past month has also been a busy one for crossword puzzles. In the past, I've always enjoyed doing them (for example, if I saw a half-finished puzzle lying on a coffee table) but it is only recently that I've switched into daily mode. Each day I do the puzzle from either The Wall Street Journal or The New York Times. On more ambitious days, I do both!

When doing these puzzles, you can't help but pick up new words, but not necessarily words that you will ever have the opportunity to use in everyday speech or even writing. Case in point: a recent clue was simply Stage direction and the answer was...

 Exeunt is borrowed from Latin, the third-person plural present indicative (yikes) of the verb exire, which translates as "to go out" or "to leave." When I run across words and explanations like these, my response is always the same: