Wednesday, August 13, 2003

Postscript Number Four: How I Spent My Summer Vacation

Dave’s Great Adventure
Postscript #4
August 19 2003
No News Is STILL Good News

Hello again, to friends, family, co-workers and those of you receiving my writings whom I may not even have met. I’ve been getting occasional inquiries from folks who wonder what’s going on here in Colorado (with me I mean ) since I haven’t written any updates in about three months now. Fair enough. Just so no one will worry that I’m not doing well, I’ll send a report on what’s been going on with me and the leukemia over the past months.

Not much.

The last major event in my treatment and plan for the future was to try to collect some stem cells from my circulation while I was in remission. You may remember that I had to go through several appeals to get my insurance company to even approve the collection of my stem cells and allow me to bank them away for future use, only to find out that my body wasn’t even making enough stem cells for us to be able to collect them! As of my last message in May, we were waiting for my marrow to recover enough from the abuse at the hands of the chemotherapy to be able to try again to collect the cells. We’re still waiting. My “transplanter” doc, Jeff Matous, wanted my white count to get up at least to 4,000 or so before trying again. So, we’ve been doing blood counts on me monthly but have been seeing my white blood cell counts just fluctuate in the mid-3,000 range since about last April or so. And so, we’ll keep doing these counts until the collection becomes possible, hopefully sometime before the leukemia returns.

What have I been doing with my time? Well, one major thing I did was go to Alaska with Kathy in June/July. I had been mentioning starting to do more traveling with her since last year, when I got the diagnosis of leukemia, since we now know that my life expectancy is likely less than we had planned (though, who really knows what their life expectancy will be, anyway?).

So, we scheduled a trip through a great travel agency called Rainbow Mountain Adventures, run by Collette Murray. Collette put together a wonderful, beautiful, relaxing and varied trip for us. We didn’t go on a cruise, didn’t go with a group, and weren’t on anyone else’s schedule. We were able to do things largely at our own pace and weren’t constrained by a tour director, a cruise liner schedule or by the speed of the slowest person on a bus trip. It was a great time. We went whale watching with two other folks in a small boat, we cruised up fjords to watch glaciers calve icebergs into the sea, we got up close to brown bears, we flew up to and landed on a glacier and walked around on it, we watched bald eagles all day, and much more. And we spent five nights in a very friendly B&B in Juneau, The Alaska Wolfhouse, run by Phil and Clovis Dennis, very nice folks whom I’m now also pestering with my “adventures,” after having discussed my condition, the meaning of life and much more while with them. If anyone out there is considering a trip to Alaska (and I think all of you should; it’s simply grand!) I have to recommend Collette Murray and her crew ( for your planning. They were wonderful. And if you’re going through Juneau, stop in at the Wolfhouse, but do it soon. Phil and Clovis are moving to Washington state next year to be close to their grandkids. Kathy and I have to appreciate that motivation!

I’m still working in the clinic four days a week, with a couple of day shifts on Labor and Delivery per month, on weekends. Work is going well, but as I mentioned a few months ago, I feel tired a lot. Perhaps I know now why, after having an adventure of another sort recently.

About two weeks ago, on a day off, I was doing chores around the house, but feeling extremely fatigued. I came in to sit with Kathy after a bit, and noticed that my pulse was very erratic. My heat was skipping about every other beat. I had Kathy feel my pulse, and she immediately wanted to take me in to the clinic to have a “real” doctor check me out. I told her I’d like to “wait” a while. For what, you ask? As I have told my family many times, “waiting” means I want to wait until the condition gets better or I die, whichever comes first. Well, Kathy wasn’t happy with that, so we ended up going in to see my doc. I figured that he’d listen to my heart, do an EKG and send me home.

But NO....!

As soon as he saw the EKG and listened to my heart, they got an oxygen mask on me, put an IV in my arm and sent me by ambulance to the hospital. There, they were to do a bunch of lab tests to see if I was having a heart attack. I was sure I wasn’t and was therefore confident that I’d soon be going home. Yeah, right. Well, all the lab tests came back normal, and my heart settled down into more of a normal rhythm so I prepared to leave, when the doc in the ER said I’d have to stay overnight for some prolonged monitoring and testing. Just great!

They put me in a back room in the ER and monitored my heart all might long. I didn’t get a lot of sleep. Intermittently they came in to check my blood pressure, pulse and so on, or to draw some more blood for tests. Then, in the morning, they set me up for a “stress test” where they hooked me up to an elaborate EKG machine and then put me on a treadmill for about ten minutes, with gradually increasing speeds, to see how well my heart was functioning. Well, hell, I was stressed even before we started after not having gotten enough sleep the night before, but I’m happy to say that my heart passed the test and I was finally allowed to go home after about eighteen hours in the hospital. Later this week I’m to do a 24-hour monitoring test to see how often my heart is doing these strange things. Then, we’ll see if I need medication to make it more normal.

Another medical misadventure I experienced recently involved some dental work. About ten days before we were due to leave for Alaska one of my two remaining wisdom teeth cracked and was causing me a lot of pain. I didn’t want to be traversing Alaska with a sore tooth so I went to my dentist, who confirmed that the tooth was cracked and needed to come out. He then referred me to a local oral surgeon to get it taken out. Now, I had two of these teeth taken out years ago without any problems and I expected the same with this cracked tooth.

Say it altogether now, “But NO...”

Over the last few decades this particular tooth kinda fused with the surrounding jawbone. The oral surgeon tried to extract it intact, then he cut it in half to try to take out half at a time, then he broke off the top of the tooth and drilled and pried until he finally was able to get all the parts out of my jawbone, where the roots, in addition to fusing to the bone, had curved in towards each other. Thank God for great anesthetic injections.

But that wasn’t all. We went home, with a packing of gauze in the hole in my jaw, which I was to replace about every two hours. The first time I tried to replace it, blood began flowing, literally, from my mouth. I replaced the packing, bit down hard, and was able to stop the bleeding. But every time I tried to replace the gauze the same thing happened. I started wondering if my blood wasn’t clotting properly, as my platelets were a little low, but they should have been more than adequate, I thought, to stop most bleeding.

By nine o’clock at night I was still bleeding heavily every time I tried to take out a pack. So, we called, that is to say, Kathy called the oral surgeon (since I had to keep my mouth tightly shut on the packing) and told him of our problem. He told us to meet him at the office in about thirty minutes, which we did. I got back in the operating chair, opened my mouth so he could take a look, and he said, “Wow, that’s impressive!” Blood was still flowing heavily and rapidly.

What had happened, apparently, was that with all the digging he had to do in my jaw, he cut a small artery, but the artery had been tightly constricted by the epinephrine in the anesthetic, and so had not bled until later when the anesthetic wore off. He quickly packed the bleeding hole with some stuff we use in the OR called Surgicel, which helps make blood clot. Then he packed the hole with gauze again and I bit down hard, to see if the bleeding would stop. While I was biting down, we were discussing what our next step would be. The arteries are hard to stop; they come right out of the bone and can’t be tied off with sutures, etc. We thought maybe we’d have to go to the hospital and have a radiologist put a catheter in the arteries in my neck, then work it up to the jaw to inject stuff to block the bleeder from inside. I didn’t want to think about that possibility.

Thankfully, when I finally opened my mouth, after ten minutes of pressure on the Surgicel, the bleeding had stopped. We left the clinic and headed for Wendy’s for some food, since I hadn’t had anything to eat or drink all day. Kathy treated me to a Frosty, a milkshake dessert for those of you who may not patronize Wendy’s burger places. The food stayed down and the bleeding stayed stopped! It was a long day. The hole in my jaw hurt for weeks, but didn’t delay our Alaska adventure. I just took lots of Motrin.

You may remember that we are suffering quite a drought around here. I’ve mentioned the water use restrictions that have been imposed upon us. Well, the great blizzard of last March helped the situation a bit, and we had a relatively wet spring, but the restrictions remained, and people around here were very compliant with them. So compliant, in fact, that the water company was losing money! Think about that for a moment; what company can possibly stay in business by selling less and less of its product! So, even as they were telling us that the drought was NOT over, they began removing many or even most of the water use restrictions because they needed the income. Interesting local politics!

In other “local news,” our friendly squirrel, Stubby, the one who bit me last spring, has become a neighbor. She used to live in a large cottonwood tree about 200 yards away, but this spring, shortly after she bit me, she took over a magpie's nest in our back yard in which to raise her pups, or kits, or whatever baby squirrels are called. I hope that’s as close as she gets; we don’t want her family moving into our attic.

Going back to the leukemia, for a moment, I found a follow-up report from the M. D. Anderson Cancer Institute, in Houston, describing recent findings on the people they had used the Cytoxan/Fludarabine/Rituxan chemotherapy treatments on, the treatment protocol that my doc also used on me. Three years after the start of their study, they have found that 75% of their patients who went into remission are still in remission. That is extremely good news, as it would seem to indicate that there is a real good chance I’ll still be in remission a couple of more years from now (since I‘ve already been in remission almost a year now). Hey, that means I can plan a few more trips and spend some more money!

To close, I’ll mention the Veteran’s Administration again, as I did several months ago. They have decided that my disease may be Agent Orange related, based on my Vietnam exposure, and therefore I (and Kathy, on my demise) may be able to get a pension based on medical disability. So, I was invited to go to the local VA hospital for an evaluation recently. What they did was a complete, but fairly brief, physical examination and a few lab tests. It was done very efficiently and right on schedule but the whole process was incredibly impersonal. Most of the folks I interacted with hardly acknowledged my presence as they drew my blood, etc. But now it’s over and I’m just waiting for the paperwork to see what it all will mean to Kathy and me. I’ll pass on the news as it comes in.

And I think that's plenty of “update” for now. I’ll close this note and get in off into cyberspace.

Until later,


Tuesday, August 5, 2003

An Adventure of a Different Kind

It's amazing how sometimes things just snowball out of control and one leads to another. Soon you're somewhere you didn't want to be.

Yesterday was my day off. I got up, about 8:00 or so. I felt a little tired, but nothing too unusual. Since it was a day off, after having worked on Labor and Delivery over the weekend, I had a list of things to do. Most were yard things, so I started getting things done. Nothing too strenuous, just spreading some fertilizer, pulling weeds, replacing a couple of sprinkler heads. That kind of stuff. My new mower is not working, so I took it in to Sears for some work too. I was REALLY tired when I got back.

Kathy wanted to go out for breakfast, so we headed out to try a new place in Littleton, but it was closed. So we went to old reliable, El Tejado. Got the usual, huevos rancheros and chilequiles.

After we got back from breakfast, about noon ( a late breakfast, it turned out to be) I went out to do more yardwork. After about an hour I came back in and was exhausted. I sat next to Kathy and said "Feel my pulse." It was very erratic with a lot of skipped beats. She asked what we should do and I, characteristically said we should wait (which means, usually, wait until it gets better or I die, whichever comes first).

But it didn't get better, and I said that I guessed if I had a patient with this I'd send her to internal medicine to get checked out. So, Kathy loaded me up and off to the clinic we went. Without even an appointment! But I figured my doc could work me in, would do an EKG and tell me it was nothing to worry about and tell me to get out of there

I was right about doing the EKG, but I had the second part wrong. He looked at the EKG, asked a bunch of questions, and the next thing I knew they were loading me up in an ambulance and taking me to the ER. Uh, I hadn't planned on that part at all.

So, we got to the ER. There they did another EKG, drew some blood for lab tests, asked me all the same questions, poked on me for a little while and then left us alone, with me hooked up to a bunch of monitors and with oxygen tubes up my nose. Kathy had been able to ride in the ambulance with us, but had to leave the car at the clinic.

Nothing happened for a while, and I was feeling better, ready to go home, though my heartbeat was still a little irregular.

After about 30 minutes they said my labs looked okay and my EKG was showing nothing serious. But to be sure, they ran some medicine in my IV. It was magnesium sulfate. Epsom salts, to many of you. We use it a lot in OB to stop premature labor and to prevent seizures in women with toxemia in pregnancy. It's also a laxative, if taken orally. I didn't know they used it also for irregular heart beats! Made me feel crappy. Now I know what my patients feel like when I give it to them.

So, the medicine worked, my heart rate straightened out, and now I was even more ready to get out of there. Well, the resident, who had been taking care of me turned my care over to the staff doc, who came in to talk to me. She told me all my labs were normal and that my EKG has straightened out. But, I couldn't go home.

She wanted me to spend the night in the "Obs" (observation unit) area so they could watch me for the night, and to draw more blood. So off we went.

The Obs unit is actually in the ER, not on some quiet ward away from the crowds that appear all night long. I did have a room (fortunately) that had a door that closed. A lot of folks I saw were in open bays with just curtains. It was a scary place with a lot of strange looking folks there. Kathy stayed with me until about 10:30, but there really was no place for her to sleep, so we sent her home (with friends who were there also), and I tried to get to sleep. But it was not easy. They came in periodically to draw blood, to get vital signs (pulse, blood pressure, etc.) and to replace heart monitor leads that fell off as I tossed and turned. I finally fell asleep in the early morning hours, only to have them come back in at 5:30 to wake me up! They drew some more blood, did another EKG and took more vital signs. I decided to get up, put my contacts back in and see about breakfast, since I couldn't sleep anyway.

Breakfast!! Well, they wanted me to have stress test, done on a treadmill later in the morning, so, no breakfast for me. They did bring me a tray of "Clears," you know, the jello, chicken broth and juice tray.

Kathy appeared in the room again before seven. She must have really left home early! We turned on a TV they had brought in to me so we could get some news. But we kept falling asleep.
About 9:00 or so they came in to get me for the stress test. I was wheeled up to the fourth floor where the treadmills are and parked in the hallway. They wouldn't let me walk up there. Strange, I thought, since in a few moments they were going to put me on a treadmill and really give me a workout. But I waited, quietly.

Soon they took me into the room, made me sign a permit that said I might die during the testing process, and hooked me up for yet another EKG, which was still showing a number of irregular beats, but not quite as many as the day before. We started the treadmill, I walked, faster and faster. The doc wanted to get my heart rate up to at least 138, to get a good test. I was able to get it up to about 156 which gave her even more info, all of it good. No chest pain, no EKG abnormalities at all!

So I was finally cleared, after all that testing. Twenty four hours later, after I told Kathy my heart was acting funny, we were back home and competely tired out. My heart is still skipping beats, but not nearly as many as it was yesterday. I'll see my doc again and he'll probably do a 24 hour monitoring just to see what it shows.

And I've learned not to mention an irregular heartbeat unless I'm having chest pain with's just too much trouble!