Nuclear Family
It's flooded at Pere Marquette but this group has it under control.
Friday, May 22, 2009
Wednesday, May 20, 2009
Different Deal
And a better one. So here's the reason why you go the best hospital in town: they come up with better treatment.
Based on the same facts, the new doctor on the scene - his name is Bruce Haughey - has a different, and much less burdensome, treatment. The old plan was to (a) remove the cancerous nodes and surrounding tissue from the neck (b) do some "random biopsies" to try to find the primary cancer, and (c) follow up with radiation and, maybe, chemotherapy. The new guy will stick with (a), has a different approach to (b), and thereby will probably eliminate the need for (c).
Dr. Haughey is a self-confident New Zealander and the Director of Head and Neck Surgical Oncology at Barnes*. He said that what I have is quite common, and they have developed a process for it that has been very successful. His approach is to use a microscope to look for the primary cancer during the surgery and if he finds it, which he usually does, excise it with a laser. It is usually identified during that process and a followup biopsy of the removed tissue. Then, no need for radiation or chemo. Mrs. Strays asked the logical question why we hadn't heard about this procedure before. He said probably because he hadn't published it yet.
Well, yahoo. The surgery never bothered me. In fact I can't wait - it is strange to wake up every morning knowing you have cancer in your neck, and I'd like to get past it. But I was not looking forward to radiation, which was certain, or chemo, which was possible.
Dr. Haughey gave me the standard disclaimers, and can't guarantee no radiation. But it is a very different future. With this, I may well be back up and getting on with the rest of my life by mid-June. Yippee kai-yay.
* The name of the place is kind of a mess. So far I have about six: Barnes, Barnes-Jewish, BJC, Washington University School of Medicine, Center for Advanced Medicine, Siteman Cancer Center. I know there are some real distinctions between the hospital and the university; but the rest, I guess, is a mash of history and marketing.
And a better one. So here's the reason why you go the best hospital in town: they come up with better treatment.
Based on the same facts, the new doctor on the scene - his name is Bruce Haughey - has a different, and much less burdensome, treatment. The old plan was to (a) remove the cancerous nodes and surrounding tissue from the neck (b) do some "random biopsies" to try to find the primary cancer, and (c) follow up with radiation and, maybe, chemotherapy. The new guy will stick with (a), has a different approach to (b), and thereby will probably eliminate the need for (c).
Dr. Haughey is a self-confident New Zealander and the Director of Head and Neck Surgical Oncology at Barnes*. He said that what I have is quite common, and they have developed a process for it that has been very successful. His approach is to use a microscope to look for the primary cancer during the surgery and if he finds it, which he usually does, excise it with a laser. It is usually identified during that process and a followup biopsy of the removed tissue. Then, no need for radiation or chemo. Mrs. Strays asked the logical question why we hadn't heard about this procedure before. He said probably because he hadn't published it yet.
Well, yahoo. The surgery never bothered me. In fact I can't wait - it is strange to wake up every morning knowing you have cancer in your neck, and I'd like to get past it. But I was not looking forward to radiation, which was certain, or chemo, which was possible.
Dr. Haughey gave me the standard disclaimers, and can't guarantee no radiation. But it is a very different future. With this, I may well be back up and getting on with the rest of my life by mid-June. Yippee kai-yay.
* The name of the place is kind of a mess. So far I have about six: Barnes, Barnes-Jewish, BJC, Washington University School of Medicine, Center for Advanced Medicine, Siteman Cancer Center. I know there are some real distinctions between the hospital and the university; but the rest, I guess, is a mash of history and marketing.
Monday, May 18, 2009
Picking the Joint
So, here's where it comes out on the Teaching Hospital v. Other Good Hospital debate.
If you are dealing with something where you have a life expectancy statistic:
So, here's where it comes out on the Teaching Hospital v. Other Good Hospital debate.
If you are dealing with something where you have a life expectancy statistic:
- do the homework
- go with the best hospital for that area of disease
- to which you can have reasonable access.
On the other hand, if life expectancy isn't really an issue:
- do the homework
- go with the hospital that has an established practice in that area of disease
- to which you can have comfortable access.
Teaching v. non-teaching is not necessarily the driver. A very smart doctor I was with the other night had several examples where the teaching hospital was not necessarily the best in town.
Wednesday, May 13, 2009
Tuesday, May 12, 2009
The Big C
Well, the Republic of Equity is going to have to wait a bit. The Dictators of Debt can continue their evil ways without my stuff, and I'm sure they're relieved. I have a bigger, more personal, and much easier-to-write-about thing going on.
I have cancer.
The road here:
A soft-spoken well-dressed guy I have known a little for years was taking over as my dentist. Our first visit was mid-March, and he does this macro head exam, taking casts, making models, shooting x-rays and photos and generally poking around. Plus he felt my neck, and, with his fingers on the left side, said "What's that?" I said, "Dunno." He said, "Get it checked out." He was quite insistent. "Get it checked out right away."
I had noticed it before, while shaving. I thought it was a sort of muscle, kind of buff. That's it.
So for the next six weeks I went through appointments broken and met, no big sense of urgency. First my regular doc, who sent me to an ENT, who did what's called a needle biopsy, and that didn't show him enough, so I went in for a real cut, under general anesthesia for the first time since I was five. (That was for a tonsillectomy.) He said the results would usually be - I like this term, it has a certain hauteur - "unimportant."
They put a drain, not a lot of fun, in the neck for the next couple of days, and upon my going in to have it dismantled and removed it fell to the nurse practitioner to reveal that the results were, well, important. Cancer in the lymph node.
I wish none of this were happening to me, obviously, but it's pretty interesting. The lymphatic system acts like a little storm sewer system in the body, separately from but in coordination with the blood circulatory system. Cancer cells travel to lymph nodes, and accumulate there. That's what they found. The cancer is metastatic, which means the cells are coming from a primary cancer somewhere else.
So the next step, of which I'm in the middle,* is to find the primary cancer. The first step was a PET scan.
PET scans are one of these jobs where you lie down on a tray and they move your body in and out of a tube. Fine, but they take a while and I was desperate for reading material. I resolved to memorize great speeches or great poetry so I can reel them out at future such times. As it was, I tried making lists, the first being a list of old girlfriends. I told this to the techies who run the machine and they loved it. (I wish their lives, by the way, on nobody.)
Yesterday we** met with a radiation oncologist, who tells you what to expect, generally, from the radiation treatments that are almost surely ahead. He gave us a first report on the PET scan and it sounded good. No evident cancer outside the head and neck. Something may going on with the right side, in an epiglottic fold***, but it may not be what they are looking for. All of this is pretty consistent with the better-case predictions I had heard.
Now on to the decision to move from the suburban hospital where all this has taken place so far, to a city teaching hospital, which is what practically everyone says to do. In particular, move to the Siteman Cancer Center at Barnes, which does indeed sound like a first-class place. I don't know the pros and cons. Why wouldn't everyone do this? Cost? Doubtful, I don't think the teaching hospitals are any more expensive for those of us who are insured. (And they are more likely to take on the uninsured.) Suburbitis? (You know, too many black folks in the waiting rooms at those big downtown hospitals...) Maybe, but that's not me. The doctors? My guy at Suburb Hospital, which itself has a terrific reputation, said it is comprised mainly of docs from Barnes (Washington University, actually) who don't want to teach. So they play more golf? OK, fine, but to me... unimportant.
********************************************************************************
* Up with this I will not put! - WC
** "We" ain't royal. We is me and Mrs. Strays.
*** The Epliglottic Fold sounds, to me, like a place where Jabba the Hutt might hang out.
Well, the Republic of Equity is going to have to wait a bit. The Dictators of Debt can continue their evil ways without my stuff, and I'm sure they're relieved. I have a bigger, more personal, and much easier-to-write-about thing going on.
I have cancer.
The road here:
A soft-spoken well-dressed guy I have known a little for years was taking over as my dentist. Our first visit was mid-March, and he does this macro head exam, taking casts, making models, shooting x-rays and photos and generally poking around. Plus he felt my neck, and, with his fingers on the left side, said "What's that?" I said, "Dunno." He said, "Get it checked out." He was quite insistent. "Get it checked out right away."
I had noticed it before, while shaving. I thought it was a sort of muscle, kind of buff. That's it.
So for the next six weeks I went through appointments broken and met, no big sense of urgency. First my regular doc, who sent me to an ENT, who did what's called a needle biopsy, and that didn't show him enough, so I went in for a real cut, under general anesthesia for the first time since I was five. (That was for a tonsillectomy.) He said the results would usually be - I like this term, it has a certain hauteur - "unimportant."
They put a drain, not a lot of fun, in the neck for the next couple of days, and upon my going in to have it dismantled and removed it fell to the nurse practitioner to reveal that the results were, well, important. Cancer in the lymph node.
I wish none of this were happening to me, obviously, but it's pretty interesting. The lymphatic system acts like a little storm sewer system in the body, separately from but in coordination with the blood circulatory system. Cancer cells travel to lymph nodes, and accumulate there. That's what they found. The cancer is metastatic, which means the cells are coming from a primary cancer somewhere else.
So the next step, of which I'm in the middle,* is to find the primary cancer. The first step was a PET scan.
PET scans are one of these jobs where you lie down on a tray and they move your body in and out of a tube. Fine, but they take a while and I was desperate for reading material. I resolved to memorize great speeches or great poetry so I can reel them out at future such times. As it was, I tried making lists, the first being a list of old girlfriends. I told this to the techies who run the machine and they loved it. (I wish their lives, by the way, on nobody.)
Yesterday we** met with a radiation oncologist, who tells you what to expect, generally, from the radiation treatments that are almost surely ahead. He gave us a first report on the PET scan and it sounded good. No evident cancer outside the head and neck. Something may going on with the right side, in an epiglottic fold***, but it may not be what they are looking for. All of this is pretty consistent with the better-case predictions I had heard.
Now on to the decision to move from the suburban hospital where all this has taken place so far, to a city teaching hospital, which is what practically everyone says to do. In particular, move to the Siteman Cancer Center at Barnes, which does indeed sound like a first-class place. I don't know the pros and cons. Why wouldn't everyone do this? Cost? Doubtful, I don't think the teaching hospitals are any more expensive for those of us who are insured. (And they are more likely to take on the uninsured.) Suburbitis? (You know, too many black folks in the waiting rooms at those big downtown hospitals...) Maybe, but that's not me. The doctors? My guy at Suburb Hospital, which itself has a terrific reputation, said it is comprised mainly of docs from Barnes (Washington University, actually) who don't want to teach. So they play more golf? OK, fine, but to me... unimportant.
********************************************************************************
* Up with this I will not put! - WC
** "We" ain't royal. We is me and Mrs. Strays.
*** The Epliglottic Fold sounds, to me, like a place where Jabba the Hutt might hang out.
Tuesday, March 10, 2009
Friday, March 06, 2009
I Am Starting to Get It
There was a book or a blog or something that was pushed at me for years called Empire of Debt. It predicted pretty much what is happening now.
They were obviously right but I think they got the metaphor wrong - at least if it's trying to describe the problem. The problem is not that it's an empire - it may be, but that's more of a descriptor than a critique - the problem is that it is a Dictatorship of Debt.
Hence AIG. Hence the US government, the ultimate debt junkie. Hence Goldman Sachs, which I am sure is well on its way to becoming the next Trilateral Commission in the eyes of the conspiracy theorists.
Their solutions are all based on the idea of reinflation through debt. Defer the problem to the next generation and the next and the next; stand at the arterial money flows and siphon off small percentages of huge torrents of cash; shrink the number of players at the top. (Bye-bye Lehman - too bad you didn't have enough friends on the way down.)
The answer for the revolutionaries: convert the Dictatorship of Debt into the Republic of Equity.
More later. Back to work. Keep the day job.
********************************************************
There was a book or a blog or something that was pushed at me for years called Empire of Debt. It predicted pretty much what is happening now.
They were obviously right but I think they got the metaphor wrong - at least if it's trying to describe the problem. The problem is not that it's an empire - it may be, but that's more of a descriptor than a critique - the problem is that it is a Dictatorship of Debt.
Hence AIG. Hence the US government, the ultimate debt junkie. Hence Goldman Sachs, which I am sure is well on its way to becoming the next Trilateral Commission in the eyes of the conspiracy theorists.
Their solutions are all based on the idea of reinflation through debt. Defer the problem to the next generation and the next and the next; stand at the arterial money flows and siphon off small percentages of huge torrents of cash; shrink the number of players at the top. (Bye-bye Lehman - too bad you didn't have enough friends on the way down.)
The answer for the revolutionaries: convert the Dictatorship of Debt into the Republic of Equity.
More later. Back to work. Keep the day job.
********************************************************
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