I Got Nuked

Yesterday I had the first of five radiation treatments for my cancer.

A bit over a week ago, I lay down in what I gathered was basically a CAT scanner.  I was lying on a couple of bags that they filled with, I guess, some kind of fluid that hardened, forming a kind of half cocoon which would keep me immobile during the treatments.  They then did a scan to generate data that would be used to program the machine that would actually administer the radiation (something like an industrial robot capable of precise movements).  Thursday was a “dry run” to make sure that the machine would perform as expected; then yesterday was the first actual treatment.

You don’t feel the radiation.  The radiologist explained to me that the beam would have about the same power as a dental X-ray, but would take longer to administer the required dose.  You just lie there relaxed and unmoving, except for normal breathing, for the fifteen or so minutes that it takes.

To mitigate the boredom, I mentally recited the lyrics to Gordon Lightfoot’s “Canadian Railroad Trilogy” and “The Wreck of the Edmund Fitzgerald”; and just as I was starting on “The Balad of the Yarmouth Castle”, they were done.  I made it home in plenty of time to catch DW News on the PBS World Channel. 😎

I’ll have four more treatments, Monday through Thursday; then I’ll start chemo on the 6th.

The radiation machine (I should probably ask what the correct term for it is) was interesting.  The radiation is generated by a roughly disk shaped thing with about an eighteen inch diameter, maybe a bit more, that looked something like this [from Wikipedia] although the rest of the machine was quite different.  Opposite that is a flat thing that, I guess, notes where the other side of the beam is to provide feedback for proper aiming.  The whole thing rotates around you, presumably to zap the cancer from different angles so that they don’t kill the tissues that you want to still be hanging around. 😎

Inside the disk were pairs of pointy things that were about 1mm or so apart.  I had guessed, probably incorrectly, that the “antenna” is actually the space between the points.  There were maybe ten or fifteen pairs, all in slightly different positions so that they would be slightly out of phase with each other, giving more precise control over the directionality of the beam.  This whole paragraph could be way off the mark, though, if the radiation’s wavelength is in the millimicron range, which is what I get from the Wikipedia article.  I’ll have to ask for a more detailed explanation of what’s going on next Monday, not because I have any desire to practice medicine without a license 😎 , but because I’m a geek who’d find it interesting.

Possible January Trip

I just found out that the ISO C committee will be meeting in Strasbourg, France in January.  I haven’t used good old C in ages, but I’m a member of the committee (actually INCITS PL22, an ANSI committee), and so I could attend; and it would give me an excuse to travel.

I could take Amtrak to Boston, fly Icelandair to Heathrow, then the Piccadilly Line to King’s Cross St. Pancras, Eurostar to Paris Gare du Nord, and a TGV from Gare de l’Est to Strasbourg.  I could mostly handle the 800m walk between the two Paris stations; but I see that there’s a stairway on the route that might be a bit of a challenge with two bags and a walker.  Does anybody know of a good way around that?

Motion on the Cancer Front

I had a bronchoscopy on Friday* looking for any movement of the cancer to my lymph nodes.  Everything looked normal, and although I haven’t seen the detailed results of the biopsy yet, I got a phone call from the radiologist’s nurse a while ago saying that there’s no evidence of additional cancer.  That’s good news because it means that the radiation treatment can concentrate on the one lump that we already know about.

I have an appointment with the radiologist tomorrow a bit after noon when we’ll work out the treatment schedule.  I’ll also have another CAT scan, I guess to make sure that the lump hasn’t moved; and I’ll get fitted for the cocoon that will keep me immobile during the radiation.  I’ll update this post tomorrow if there’s actually any more to say.

I’m glad to get moving on this.  I’ll have several radiation treatments (three IIRC); and the chemo, which will have to wait for the radiation to be done, will require four sets of three treatments on consecutive days, the four sets separated from each other by three (IIRC) weeks.  This already bumps into a trip that I’ll be taking in November by a couple of days; but the oncologist, who’ll be doing the chemo, said that he can work around that.  We’ll see…

Update 2023-08-16:  I now have a schedule for my radiation treatments starting a week from tomorrow:  six weekdays from Thursday the 24th through Thursday the 31st.  I’ll have about an hour and a half of driving (round trip) for fifteen-minute appointments. 8-(

I’m told that the first visit will be a dry run just to make sure that everything is working correctly; then I’ll have five actual treatments on Friday, then Monday through Thursday.

I also have some chemo appointments scheduled for later this month, but I think I remember the oncologist saying that we have to wait until after I’m done with the radiation before starting the chemo.  I’ve sent the oncologist a message asking whether we need to reschedule.

Today’s visit went pretty quickly.  They had me lie down in a CAT scanner on top of a couple of bags that, I guess, they filled with some kind of stuff that hardened around my torso.  They then did a CAT scan, I guess to make sure that they know where everything inside me is, and made some marks on my chest, I guess to make sure that they get me correctly positioned in my half-cocoon for the treatments.

Pierce R. Butler commented on a previous post suggesting that I might want to take the half-cocoon, which he called a “mesh”, home with me after the treatments are done.  It doesn’t look like what they made is something I’d ever need for anything.

*The bronchoscopy required general anesthesia, so this extreme introvert, because he has nobody he can rely on to take care of him afterwards, had to spend Friday night in the hospital for “observation”.  I’ve never had any problem with general anesthesia, so as expected, nothing was observed. 😎

I didn’t really mind, aside from the boredom; but I thought that I was taking up a hospital bed for no good reason.  When I mentioned that to one of the doctors, he laughed and said that he’d had patients admitted for less reason than that, so I guess I’m not a bad guy after all.

My Story

I just watched a really interesting video that Abe Drayton posted on his blog, a lecture by Tim Wise that was mostly about white supremacy.  Two of his points jumped out at me:

– We have a systemic problem.  It’s not that ordinary folks like you and me are bad people (although there’s some of that), but that the system itself has been designed in a way to allow the majority of folks to avoid even noticing all the inequities in society because they’ve had the advantage of never having it affect their own lives in any serious way (and as a cis, het, white, male boomer, I’m one of ’em).

– Later in the talk, maybe during the Q&A, he reminded us that debunking goofy ideas with facts isn’t particularly effective because the people with the strange ideas just double down.  He suggested that what’s more effective is something that connects with individuals, basically storytelling.

So let me begin with a story from when I was about seven years old; and now that I’m seventy-seven (or will be tomorrow), I still remember it.

We were living in Delray Beach, Florida which, in the early 1950s, was still racially segregated.  I remember us driving home one night after visiting some of my parents’ friends; and at one point, we passed a pedestrian about whom my dad remarked, “He’s going to be in trouble.”  I asked why, and it wasn’t because the guy was obviously inebriated, but because he was Black; and there was a law back then that Black folks had to be in “colored town” after dark.  Even at age seven, I recognized the asymmetry (to put it mildly), although I wouldn’t have had the vocabulary back then to express that.

Tying that in to the first point I mentioned, I guess I’ve long been aware of the evils of racism because I learned something about it at an early age (even though I was in no danger myself); but I didn’t become aware of other systemic inequities until much later.  Just two examples:  I didn’t recognize the unfairness of sexism, and didn’t become a feminist, until I was in my thirties; and I had no clue about LGBTQIA+ issues until about a decade ago; in both cases because I simply had no need to notice.

There are some signs these days that maybe we’re starting to notice, and that gives me a little hope.  At least I hope I never stop learning.

Possible Movement on the Cancer Front

I got a second PET scan* on the 19th; and the results were basically the same as the one I’d had four months ago:  the cancerous lump hadn’t gotten any bigger, and there’s still no evidence of any spread to my lymph nodes.  It’s possible that I might have to get another biopsy of the lymph nodes just to make sure; but the last I heard, the biopsy guy didn’t think it would be necessary.  We’ll see how that goes.

Assuming that I don’t have to worry about the lymph nodes, which the oncologist I saw today said he thought was highly likely, I’ve decided on radiation and chemotherapy.

I’m told that the radiation will be something like a dental x-ray, except that it’ll take about fifteen minutes during which time I’ll be immobilized inside something that they’ll mold around my body.  IIRC, there will be three treatments on separate days, and I’ll be able to drive myself home after each one.

The chemo will be more complicated:  three treatments on consecutive days repeated three more times at 21-day intervals.  This would bump into my trip to Hawaiʻi in November by a day or two; but the oncologist said that he could work around that.  He also said that, although some folks do get nausious from the drugs that he’ll use for the chemo, very few do; and I should be able to drive myself home after those as well.  That’s important because the flip side of there being no one who depends on me for anything is that there’s nobody whom I can reasonably ask to drive me to and from the hospital and then take care of me after I get home.  (This will be an issue if I need another biopsy since that requires general anesthesia; and so I’d need to be admitted to the hospital overnight for observation.  I wouldn’t mind that except for the boredom, but it seems wasteful to me…like I was hoarding a hospital bed for what would likely be no good reason.)

If there are no lymph node issues, and if the radiation and chemo work as expected, both the radiologist and the oncologist assure me that I should retain sufficient independence and cognitive abilities to continue serving on the ISO C++ committee through next year at least.  That’s good news because next summer’s meeting in Stockholm has fallen through, and I’ve made an offer to host the committee next June or July.

I feel a whole lot better now that I have a plan.

*This was basically like a CAT scan except that they shot me up with radioactive sugar; and the cancer cells said, “OOO, FOOD!”  Unlike a CAT scan, I had to observe a low-carb diet the day before and not eat or drink anything except water after midnight the day of the test; and it took about 45 minutes of my just lying around to get the sugar distributed around my body.

New Subject

Katydid commented on my ethics post:

OT: Amtrak in upstate NY halted as tracks were washed out by “once-in-a-thousand-years” flood.

Yes, I’ve been reading about that on an e-mail list, [email protected].  That’s Metro North’s Hudson Line to Croton-Harmon and Poughkeepsie, so it’s a big problem for commuters; but it also shut down Amtrak’s Empire Service and the Lake Shore Limited which use that track.

I’m not sure exactly where the flooding happened, but I’ve ridden on that line numerous times on the Lake Shore, and there are places where the track runs right along the eastern bank of the Hudson.

Update:  some photos

There’s also flooding on CSX’s River Line on the western bank.

Elementary Ethics

I watched the Podish-Sortacast today because I thought it would be interesting to hear other FtBloggers talk about how they became atheists.  The reason I bring that up is that, during the wrapup, PZ remarked that arguments for and against the supernatural really aren’t that interesting because they tend to be the same old arguments that have been made for centuries.  Far more important these days are various social issues like humanism, ethics and social justice, which I agree with; so I thought I’d jump in with my own admittedly abecedarian understanding of ethics.  Maybe commenters can help me get my thoughts more orderly.

Almost certainly because of the way that I was raised, there are a couple of points that I treat as if they were axiomatic:

  1.  People are more important than things.

  2.  It’s not all about me, and not all about my tribe.

Point 2 makes it easy for me to reject egoism and relativism as ethical principles; but between utilitarianism and a more Kantian approach, I confess to being very confused; and indeed I’m skeptical about both of them.  “The greatest good for the greatest number” doesn’t really have any meaning absent a calculus for it; and it has always seemed to me to be a pretty good general principle that the consequences of my behavior matter.

But point 1 means that I have an obligation to get through the day without being a jerk…without causing harm to others, and particularly without exhibiting the pridefullness and hatefullness that we see in the loudest of the far right; and so, as a practical matter, I need to pick one.  I tend to be more Kantian about big issues (things like hatred of folks not like me are just wrong); but I’m more utilitarian about smaller matters that are well understood.  (Should I get my flu shot?  Yeah, sure:  herd immunity.  That’s not the only reason, but it’s a sufficient reason.)

Have I gotten off on the right foot at least?  I hope so because, at age 76, I’m pretty set in my ways. 😎

More Cancer Thoughts

Introduction

I have a telephone appointment with a cancer surgeon on Tuesday, and I’ll probably be referred to an oncologist who can discuss various treatment options; and since I’m more comfortable with the written word than with the spoken word, principally because I can fix my mistakes before others know that I’ve made them 😎 , I want to write a short post to get my thoughts together in (I hope) some cogent way, and maybe to help the doctors be prepared with objections if they think I’m on the wrong track.

It’s possible that they’ll want me to communicate on-line using something called “MyChart”, but the messages that I can send are kind of like what I imagine tweets to be except for allowing more characters, so I’ve split this into four sections that will easily fit into four MyChart messages.  In any event, I’ll try to keep it short.

My goals

First of all, since I don’t believe in the supernatural, I’m not afraid of being dead:  it seems highly unlikely to me that there will be any me to be dead.

But I’m guessing that the process of dying won’t be any fun; so I think I’d like that to happen in some controlled way rather than, say, being surprised by a heart attack.  At present, I think I’d want to let the cancer take its normal course, eventually in some kind of hospice care where they keep me as comfortable as is legal in Missouri (most definitely a red state).

Also, since I’m a fairly extreme introvert, I don’t have anyone that I’d be selfishly leaving behind.

My questions

What I’m hoping for are guesses, for various treatment options, about how much time I have left 1) to be sufficiently independent that I can travel to meetings of an ISO standards committee that I serve on and 2) to retain sufficient cognitive abilities (e.g., not all hopped up on pain killers) that I can still use my computer.

– I’ve already made all the reservations for the trip to Hawaiʻi in November.

– I’ll probably just Zoom in to the Tokyo meeting in March in any event because I wouldn’t want to sit in an airplane long enough to get there.

– I’d like to make one or both of the Summer and Fall meetings in 2024 if I’m still around then.

Bottom line

I understand that surgery is the best option to let me die of something other than cancer; but like I said, that’s not my goal.

Can I make any reasonable guesses about how much longer I’d have a reasonable quality of life given other treatment options (including doing nothing at all)?  I’m not nearly as good at math as I’d like to be, but I understand some elementary statistics.  If I can get median, mean and standard deviation, I’d know what to do with that.  Alternatively, if I can get min and max along with probabilities that those numbers are close, I could deal with that as well.

With that information, I think I could make a rational decision about what I’d want to do and to make plans for it.

Update 2023-07-12:  as expected, the surgeon couldn’t really talk about anything except surgery; but he did refer me to a radiation guy with whom I have an appointment in a couple of days.

Since writing this post originally, I’ve made an offer to host a meeting of the C++ standards committee next summer (the plan for Stockholm has fallen through); so there’s now some urgency to decide on a course of treatment, possibly including doing nothing at all, that will give me a good likelihood of still being active enough for a year or so to do all the necessary administrivia.  We’ll see…