Have you had a CT scan before?

That was the question the tech asked me this morning as I skip-walked with her back to the scan prep area. I like to skip-walk because it makes me feel like a kid.

"Yes," I told the obviously-not-Vince tech, "I've had every kind of scan you've got," which is probably true unless they do some sort of trans-vaginal ultrasounds down in the former bomb shelter that is the Radiology department.

Next came a few words you never want to hear. "This is Heather, she's a nursing student who is observing today." Observing would be fine, but we all know what's coming, right?

"Heather, we need to draw labs, would you like to TRY it?". Uh-oh, this is going to leave a mark. "It's just the pin prick kind, Mr. Beskind, it won't hurt a bit." I agree it shouldn't hurt, but I extend my non-writing hand just in case.

Heather responds by grabbing my writing hand, and preparing my middle finger for pricking as if she were getting the last few drops out of the teet of her favorite bovine. She grabs one of the spring-loaded finger prick thingies and SNAP - misfires before it touches my finger.

Attempt # 2, finger contact along the edge of my engorged digit and SNAP. A glancing blow. The tiniest drop of blood ever tries to bubble its way out. "I don't know what's wrong with me today," says Heather with a slight quiver in her voice. Neither do I, Heather, but I'm beginning to care.

Third time's the charm. SNAP! A direct hit allows the release of a man-sized dollop of vein juice. Heather smears it on some sort of reader and hands it back to she-who-is-actually-getting-paid-to-be-here. They depart momentarily, then return with an IV kit.

Hell to the no, as the kids might say. Heather's not continuing her training on my arm, even if I do have  veins the size of small rivers.

Fortunately. the tech and I agree on this point, and the IV insertion goes without incident, as does the rest of the scan. I'll be at Dr. Z's tomorrow and will report any news right here. Stay tuned!

The Straight Poop About Colonoscopies

March is Colon Cancer Awareness Month, and what better way to celebrate than to read this vivid account of what actually happens before, during and after a colonoscopy?

Warning - there will be discussion about bowel movements in this posting. If you don't like to read about bowel movements, you probably want even less to talk about them, which is precisely the reason why more preventable colon cancers aren't prevented. So suck it up and read on!


A little background first. I have colon cancer. I was diagnosed in January 2005, at 38 years old, when one of two polyps found during a colonoscopy was determined to be malignant. Because the cancer was contained in the polyp, it was considered Stage 0. Had I not had the colonoscopy, it likely would have spread to other vital organs nearby. That's what happened to my mom at age 67. She fought cancer for two years before she died. I've had 5 colonoscopies, and have been the designated driver for a good 15 others between my wife and my dad.

So let's start with why one would even have a colonoscopy. Isn't that an "old-person's" test? Often it is. Doctors usually suggest having one around age 50.  But if you have a family history, it's usually a good idea to get checked at least a decade before your youngest relative was diagnosed. And if you have a significant change in bowel habits, bleeding, unexplained weight loss, or abdominal pain, your doctor might order a colonoscopy so they can see what's going on inside your large intestine (aka colon).

It's pretty common to be uncomfortable with the procedure. Anecdotally, it's right up there with the dreaded Digital Rectal Exam for prostate health on the least favorite procedures for men, and ladies, I'm sure there some stuff that goes on a the gynecologist's office that you detest or fear at least as much. Still, the problem with the colonoscopy is that the prep involves much more than dropping one's shorts/ hiking one's skirt while your doctor (hopefully) lubricates his/her (hopefully) gloved hand.

Colonoscopy prep involves being on a clear liquid diet for a day, and then topping it off with drinking a solution or downing a series of pills that will give you the worst case of diarrhea you've ever had - at least I hope it's the worst case for your sake. This is the rumbling, grumbling, "OMG how can there be anything left in me! Outta my way"explosive kind of diarrhea. And it's no fun. But it doesn't last that long. If you learn nothing else from this post, learn this: get some cream called Nupricanal from your local pharmacy. It's an over-the-counter med. You're going to wipe it on your very sore butt and find instant relief.

Here's my typical prep day:

6:30 Wake up, drink yellow Gatorade for breakfast. Nothing red or purple, as these colors can look like blood in the colon.
7:30 Go to work
9:30 Snack - lemon jello. Jello is liquid - don't ask.
12:00 Lunch - clear broth and a glass of yellow gatorade.
3:00 Snack - frozen lemonade
5:00 Go home
6:00 Start Prep by taking 4 horse-tranquilizer sized Osmo Prep (sodium phosphate) pills with 8 ounces of water
6:15 Repeat the pills and water every 15 minutes for an hour
7:00 Wonder what all the fuss is about
8:00 start a second round of Osmo Prep, this time 4 pills and 8 ounces of water every 15 minutes 3 times
8:17 realize what the fuss is about - Gotta Go!
Repeat trip to bathroom seven more times before 11:00. Apply Nupricanal each time. Wash hands thoroughly.
11:00 crawl into bed

Next day
5:00 Wake up
5:10 - One last time in the bathroom
5:40 - Nope, this is the last time
6:00  - Get driven to Dr's office
6:10 - Really? How can there be anything left?

And then we can start the procedure. But before we talk about that, let me just say a couple words about prep. There are easily a dozen methods of bowel prep used. The goal is the same, clean that 4 ft tube called a colon as thoroughly as possible so the GI doc can get a good look at it from the inside. The biggest challenge with the prep is the volume of liquid you have to drink. My prep uses pills and while it does require me to down a full gallon of water, at least it's water (or Gatorade if you prefer). There are other preps out there on the market that are all liquid and that will claim to have a refreshing fruit flavor. There's even one called GoLightly - I am not shitting you, if you'll pardon the pun. That's like calling a jack hammer the Tap-Tap Machine.

The point is you can ask your doc ahead of time what kind of prep they are going to require you to use. If you are easily nauseated and your doc says it's GoLightly and that's final - I'd strongly consider finding another doc. Not every patient can tolerate the pills, so it may not be an option for you, but ask up front. You can even call and ask the nurse before you schedule an appointment.

So, back to Day Two of colonoscopy fun. I hope you asked for an early appointment, because the sooner we get this over with the happier you'll be. The worst part is behind you. Your job now is pretty simple. They call your name, take you into a pre-op area, get your vitals, and before you can say "what's in that tank over there" you're in la-la land. It varies from practice to practice, but chances are you're in the kind of "twilight sleep" that they put moms in back when I was born so they'd forget the whole labor thing and want to have a baby again.

A nurse and a tech will roll you on your side, tuck your knees up and expose your ass to all the people in the office building next door. Then the doc will come on, blocking their view and will stick a thin, flexible tube in what some people prefer to think of as a one-way opening. The doc will also blow some air in there because that helps him round the corners and see all that freshly cleaned colon wall using the camera at the end of the tube. It also makes for a lively scene in the recovery room - more on that in a sec.

If he finds a polyp, he'll probably remove it by lassoing it with a little wire and snipping it off. That area will be sore for a couple days and may bleed a little. He'll send the tissue off to the lab and in a couple days you'll know whether it's cancer or not. "Not" is the better answer.

The whole process takes about 10 or 15 minutes. Then you go to a recovery area where somebody who must love you a whole lot will be called in to wait with you until you fart. That air the doc blew in there has to go somewhere, right? That's a sign that the plumbing is working. Once you're stable enough to dress yourself, you can go home.

You probably won't remember whatever the doctor or nurse told you about the procedure, which is OK, because the person who waited for you to fart listened to that while pretending not to listen to the other 4 patients farting. After you nap off the remaining anesthesia you'll fart some more, eat solid food, and text your co-worker to say it wasn't that bad.

Congratulations, you're no longer a colonoscopy virgin!

Live from the Chemo Room 19

I'm sitting next to a couple, around my age, and hearing the wife being told about the anti-nausea routine. Take this one starting tomorrow, take this one if you need it. She has throat cancer. Her chemo drug is similar to my "bad one" plus she has radiation treatment starting next week.

I gave them my 2 cents worth - stay ahead of the nausea. Take the "if you need it" one before you need it.

I'm one of the chemo vets now. I'm like Payton Manning, tutoring a young Andrew Luck, only I get paid about $20 million less. You don't want to be pushy, but when you see a couple heading into the unknown, you want to help where you can.

SInce I flew back from Europe via New York, I did stop by MSK last week to see the Wizard. She agrees with the treatment plan, and thinks I'm doing well, despite the recent suspicious specks in my lung. I trust Dr. Z completely, but it still feels better to hear from another expert, particularly one who does nothing but colorectal cancer treatment, that you're on the right track.

Did you say you're a-peein?

A big ole jet airliner carried me far away to Europe this week. I needed to go to Czech Republic for work, and leaving a day early made the flights much cheaper, so I decided to reward myself with a stopover in Paris. Thanks to favorable winds, I had about 21 hours in the City of Lights. Luckily, the icy grip that had ensnared Europe for the last two weeks had just loosened, and I was greeted by a sunny day with temperatures around 45 F when I landed at Charles de Gaulle.

 

I got to my hotel around 2 PM, and quickly changed for my self-guided tour of the city. I decided to combine my need to do a longish run with my desire to see one of the world’s great cities for the first time. So following the advice of my boss’s wife, Marianna, I set out from towards the Sienne River. I saw all the big sights of Paris, the Louvre, the Eiffel Tower, Champs Elyse. I even stopped in a McDonald’s – not to eat of course, but to see if Pulp Fiction was right about the Big Mac. You decide…

It was nearly dinner time when I got back to the hotel, so I showered and ventured out. Speaking no French, I wanted to find a good, non-touristy restaurant, and to take my chances with the menu. I found a suitable place, and sat down at le table pour une. The first waiter said something in French, and picking up on my blank stare, called over another waiter who asked me in 3 different languages if I spoke each one. Fortunately, English was one of the choices.

He welcomed me and explained that “the specialty of the house is beef, we have many choices of only the finest French beef.” As impressive as it sounded, I don’t eat things that can’t fly, swim, or look like they should be able to. I told the waiter, “I’m sorry, but I don’t eat beef.” His reply was priceless.

“Then you must have the veal, it is simply the best!”

Unless “veal” is French for “fish” I was pretty sure that wouldn’t pass my swim or fly test, so I went for the duck leg. Good call – it was quite tasty.

From there, it was on to Prague, and then a two hour drive to our office in Zdar nad Sazavou, a quaint little town of 40,000 people on the Sazavou River (but you already knew that, didn’t you) in southeastern Czech.  The work went well, and I was able to do something I’d never done before in my life. No, drinking beer at lunch wasn’t it, as I had done that a few times already, and in Czech, everybody drinks beer at lunch. I think they even have little beer boxes they serve with lunch in “childergarten” but I could be wrong.

No, it was skiing. In 45 years, I’d never found the motivation to squeeze my size 12’s into some 6 foot long planks and attempt to slide across or down the frozen tundra. As graceful as I am (sorry for those who just did a spit-take), I’d never tried it.  Our European GM, Jarda, is an accomplished cross-country skier, probably about the same level in that sport as I am in running. He provided me with all the proper gear and drove me to the edge of town at lunchtime on Tuesday where some well groomed and reasonably flat trails awaited. It took a while, and while I was no (insert name of famous cross-country skier here), I held my own. 

For a farewell dinner Jarda and our head of engineering, Ales, took me to a restaurant about 10 km outside of town, where the snow was piled about a meter high alongside the one-lane road we drive down to get to the restaurant. Jarda told me the chef had trained in some famous Parisian bistros, so I was looking forward to the meal. I was not disappointed. The wild duck breast appetizer tasted like what I remembered an excellent steak tasting like. The fish on risotto was outstanding, and dessert, well, judge for yourself.

That’s blueberry mousse, folks. Mmmm…

I’m writing this from the plane on the way to New York, where I’m stopping by to see the Wizard at Memorial Sloan Kettering. Then it’s off to Savannah for Adam’s all-state chorus concert, before finally returning to my own bed Saturday night.

It’s been a good week so far. I hope you can say the same. 

Ear's the Update

If you read the title in a Cockney accent, you're my kind of reader!

Mr ear was better, but not 100%, so I called Dr. Z's office yesterday. I'm now taking Super Special Ear Drops which contain 2 more antibiotics and a steroid. So by Saturday, my left ear should be swollen to a size that suggests an otoplasty is in order.

Switching topics - here's an interesting tale from today's lunchtime outing to Jiffy Lube. There were two other customers ahead of me, one of whom was a 6' 8" guy with a buzz cut, who I'd just seen giving a copy of a book to the check-in person at the shop.

Tall guy, it turns out, used to play basketball at Auburn with Charles Barkley. He's an evangelist and author named Mark Cahill. Mark noticed the other customer's Livestrong bracelet and asked him if he had anyone in his family dealing with cancer.  The guy has lost his mom to cancer and his sister is currently battling. Mark offered some words about G-d's plan, and handed the guy a book. Here's where it gets interesting.

It was time for Customer 1 to check out. Mark stepped in fromt and said "I've got this." He paid for the man's oil change! Then he grabbed 4 more copies of his book, put $20 bills in each one, and gave them to the manager to pass on to the rest of the Jiffy Lube employees.

He gave me a pamphlet called "The Most Important Question of All Time" and told me I could have a free book too if I went to his website at www.oneheartbeataway.org The whole thing was strange, and I was left wondering what this guy's deal is. Why the $20 tips to all the employees? Why the free oil change for customer 1, but not for me (not that I needed it, but why?).

I never said a word about my own cancer, my book, etc. I'm debating sending him a copy.

Beckett anyone?

Waiting For Godot was one of those plays I never understood.* Waiting For Szabo is what happens when they work you in on an already busy Monday at Dr. Z's.

Nagging earache is the malady of the day, infection the Dx, Z-pack the cure.

Good thing, because the friendly skies are calling. Flying with an ear infection is no fun. Flying 8 hours with an ear infection would turn me into that toddler in 13-F, the one who sits right behind you cooing until they shut the front door and then begins to scream because mommy doesn't believe in the old adage "slip a little red wine in their apple juice before takeoff."

Drink up kid, and stop kicking my seat!

* - I didn't get Cat on a Hot Tin Roof either. Not a single feline, just a bunch of people. But Starlight Express... now that's greatness!

Live from the Chemo Room 18

Saw Dr. Z. All's good so far. We won't scan again for about 5 weeks, so I don't expect to have much news on my progress until then.

I don't think I mentioned the fun news I received from my insurance company when I went to restart my Xeloda prescription (oral chemo). The copay for a 14 day supply went from $35 in 2011 to, wait for it, two-hundred-and-fifty dollars and no sense! (neither the amount nor the word "sense" is a typo).  The logic, if you can call it that, is that there is an equivalent drug available that is delivered via a pump you wear for 3 days at a time. From what I've read, the pump is a pain in the butt, and there can be more side effects than you get from the oral drug.

The good news, and please share this with anyone taking expensive drugs, is that the manufacturer, Genentech, offers a program through which they will pay 80% of the co-pay amount, up to $1500 a year. Apparently, it's a fairly common thing for drug companies to do. The CFO in me admires the wisdom of this offer. Let's say you're the VP of Sales for the drug company. You've got this product that's worth $5,000 per prescription to you. You buy lunch for the staff of every oncology practice in the country, send the docs to boondoggles in Vegas, and your drug really takes off. A couple years goes by and the CEO says he needs you to generate another $100 million or else. The feedback from the satiated oncology practices is that some patients' insurance plans have really high co-pays for your drug, so they are using an alternative. "Hmmm," you think to yourself "if I make my drug cheaper, I lose revenue, and as I recall, that's bad. Man this VP stuff is hard!" You go home to your stay-at-home spouse, whom you under-appreciate and underestimate regularly. You tell him/her about the expensive drug and he/she responds with, "duh, send the patient a coupon." While that's the dumbest thing you ever heard, you do casually mention it to a coworker while waiting in the latte line the next morning.

A week later, a memo comes out announcing the co-worker's promotion to VP of Sales, the launch of the new co-pay drug card program, and wishing you well in your pursuit of new endeavors. You missed the point - picking up $1,500 a year for the patient allows you to generate $130,000 a year in top-line revenue. Duh.