Risky Business

Below, in "Smokey Joe", I identify the first of three reasons I had (have?) cancer. This is number two.*

The second culprit is medication for another disease in my life, one I've posted on before, psoriasis. Psoriasis sucks. I've had cancer, and I've been obese, and I've had, and have, psoriasis. It's the worst of the three.

Not just skin psoriasis, which is a total drag, but psoriatic arthritis, which is scary. Eviller twin to rheumatoid arthritis. As to both skin and arthritis, there is a class of medications, called biologics, which have been approved for psoriasis. They are miracle drugs. I moved through two, Remicade and Embrel, and landed with Humira. (These are their commercial trade names. They have even weirder chemical names.)

Humira requires a self-administered injection. Kind of cool, in a junkieish sort of way. Shots twice a week. Insanely expensive, like three grand a month.

It worked like magic. All the symptoms cleared up completely. Except for the injections, I forgot I had the disease.

Then things got a little strange. Under stress, one evening at the office I gave myself the shot and the next morning I was in early, under a deadline, got the work done, and then fetched up with what was diagnosed later as vertigo. I had always equated vertigo with fear of heights and the Hitchcock movie, but it's a real bad thing - I wound up in the emergency room. Pretty clearly it was a side effect of the Humira. And at about the same time, my dentist noticed the lump, I saw the ENT doc, and I was off to my date with old man Mr. C.

As I careened through the medical establishment I asked lot about Humira and whether it played a role with the head and neck cancer, and nobody knew nada. It just seemed so probable. I plowed around the literature, and at this point what I know is this:

I'm not the first.

Humira's seller, Abbott, updates the risk factors, and I think theirs has evolved since I first looked at it, but the current version puts cancer right up there at the top of the list. It doesn't nail me, but it comes pretty close (again, closer than I think it used to) with language about "lymphoma and other cancers" (mine wasn't lymphoma, but it collected in the lymph nodes) and "squamous cell cancer of the skin" (mine was somewhere in my neck, we think, never did find the bugger).

What this gets me to is risk.

We all talk about risk. There is risk in everything, we all know that, but by definition the risk of bad consequences is something less than 100 percent. Otherwise it's not risk, it's the future. Most things, it's way less than 100 percent. But it's there, and the bad stuff does happen to some people.

I think you have to be one of those people to begin to understand risk. It's a little along the lines of the completely-true "shit happens" - a recognition that you will not sail through life without a scratch. Is all this obvious? It wasn't to me, not at 20, or 30, or even 40.

But now I've been there, in this medical context and others, and now I guess I understand that this is all pretty risky business. The best we can do is try to identify the risks, make intelligent choices, and move ahead.



*Could all three be true? What is number three? Stay tuned.