Before Summer Ends

Burying the Lede

I had always thought that the term "A-OK" was a NASA thing. I found a little support for this, in the following from NASA's history:

"The origin of the popular space term "A.OK" is a matter of widespread public interest. In reporting the Freedom 7 flight, the press attributed the term to Astronaut Shepard, and indeed NASA News Release 1-61-99, May 5, 1961, has Shepard report "A.OK" shortly after impact. A replay of the flight voice communications tape disclosed that Shepard himself did not use the term. It was Col. John A. "Shorty" Powers who reported Shepard's condition as "A.OK" in a description of the flight. Tecwyn Roberts of STG and Capt. Henry E. Clements of the Air Force had used "A.OK" frequently in reports written more than four months before the Shepard flight. Roberts attributed coinage of the term to Paul Lein, of the Western Electric Co., while the tracking network was being constructed. Lein, however, said that "A.OK" was a communal development among communications engineers while circuits were first being established downrange from Cape Canaveral. The voice circuits at first gave poor quality. The bands were narrow, and the systems operated on 1,500 cycles. There was much static and background noise. Words got lost in voice circuit systems checks. To make transmissions clearer, the communicators started using "A.OK" because the letter "A" has a brilliant sound. Other sources claim that oldtime railroad telegraphers used "A-OK" as one of several terms to report the status of their equipment. Be that as it may, Powers, "the voice of Mercury Control," by his public use of "A.OK," made those three letters a universal symbol meaning "in perfect working order." "

But Wikipedia makes no mention of this history, and for them (it?) it's just the verbal version of the well-known hand gesture. Among different cultures, the gesture has, uh, widely varying meaning. Suffice it that after reading the Wikipedia piece, outside the USA I wouldn't use it.

This is a long way round to the results of my latest PET scan, about 15 months after this Big C Odyssey began. From my radiation oncologist's nurse: "A-OK. No evidence of disease."

As I said once before, quoting from Die Hard, and this time with feeling: yippie ki-yay, motherfucker.

Strike Three

Below I identified two causes of my cancer, smoking in "Smokey Joe" and anti-psoriasis medication in "Risky Business." Today the third: human papillomavirus, or HPV.

I guess I have, or had, HPV. It may sound brave to reveal my connection to a sexually-transmitted disease; actually it's common. The statistics jump around, but it seems safe to say that a majority of American women, and lots of American men, have or had it. This "have or had" stuff comes from the fact that it seems to go away - your immune system can take care of it. My immune system is pretty funky - hence the psoriatic arthritis - and maybe that's why HPV caught up with me.

HPV has become well known as a cause of cervical cancer. Accordingly it's viewed as a women's issue, and a girls' issue, where the discussion has focused on the need to vaccinate girls before they become sexually active.

The same strain of HPV seems to be a principal cause of my type of cancer in men. The research is compelling. An article in the New England Journal of Medicine lays it all out in detail, and there appear to be plenty of others. Plus my doc identified it, without much qualification, in my case.

So, two things to say.

The first may be important. HPV may be killing as many men with head and neck cancer as it does women with cervical cancer. So the vaccine should be given to boys as well as girls. I haven't heard that said much; I am way past that stage of parenting, so maybe it's well known. It should be.

The second point is that if this cancer wins, I will have been felled by an STD. Or, more romantically, killed by a lady.

Like Sam Cooke. Not so bad, right?

The Big C

So now I'm a TV program. The name has been around for a while (see above, in my description of what Strays is about.) [True when posted - since changed - Ed.] I always associated it with John Wayne.

This show has Laura Linney, who is light years more terrific than JW or me, and I will be a watcher. But from the review I read this morning in the Times, although she's a cancer patient there are two big differences.

She isn't telling anyone. I, of course, have told everyone, puttin' it up on the Internet for chrissake.

And she, evidently, has a fairly near-term and terminal deadline. I haven't and don't.

The two are probably connected. I'm not sure how I would have reacted if the initial read was, you're cooked, but it may well not have been to go public. If it turns that way for me, how will I react? Don't know. I think the kimono, once open, stays open, but I don't really know. It's one of those things you have to experience first-hand, in real time, to genuinely understand.

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.

Good Dog

Smokey Joe

One thing about this cancer business that I've kind of avoided, until now:

What caused it.

Now, I'm a cause-and-effect skeptic. So many times things really don't cause things, or aren't the sole cause, or the principal cause, or even what we in the bar sometimes refer to as the legal cause. So many explanations are facile. Slavery caused the civil war; the clash of Islam and the West caused 9/11; man caused global warming. All have truth and a lot of untruth as well.

So, appropriately hedged, I have asked a passel of questions and read a lot, and now finger three causes of my head and neck cancer. In this post I light up the first: smoking.

My first cigarette was when I was 11 or 12, and I was smoking openly and regularly at 15. Unfiltered Camels. Compensating for something?

Whatever the underlying motivation, I sure loved cigarettes. Smoked about a pack a day. Opening the pack, striking a match, lighting the cigarette (and if she were there, my lady friend's) with a cupped hand. Playing with fire with slight of hand. Indoors or out, from breakfast until bed, and in bed until the lights went out. Surrounded by ashtrays and everything smelled like smoke, which means that to me everything smelled great.

The brand mattered. When my wife and I went on a drive south, I persuaded her to stop in Winston-Salem, so we could make a pilgrimage to the Camels plant. It was fine, redolent of smoke and machinery. And as you exited there was Old Joe, a Camel made of tobacco. The ancestor, I guess, of Joe Camel, the cartoonish mascot who came on about as I quit. Not sorry we missed each other; I always thought he trivialized a great product and institution. I took the stuff seriously.

I knew it was dangerous. We all did, and it was no problem at all. It was probably part of the allure.

Plus there is decent research indicating that smoking other substances was also unhealthy, and I sure did. Loved it. All the paraphernalia, the papers, the hookahs (later bongs), the roach clips. Pot was a pretty happy, peaceful world in the late 60's and early '70's. If you'd told me then it would still be illegal in 2010 I'd have called you crazy.

So things went until I was 33, when I stopped cold turkey.

So, some 25 years later, is it a credible cause of my cancer? The docs say yes. In fact I have a feeling they don't really know. But smoking today is so universally viewed as evil - well, it's a really safe answer.

If it was a cause of the cancer, was it worth it? You might as well ask if it was worth it being me, back in those days. If I'd had to identify who I was - you know, like lawyer/father/piano player/etc. - I certainly would have put smoker near the top of the list. Serious. Dangerous. Cool. Smoker.