Month: September 2021

The first week of chemotherapy has ended, and it wasn’t as dramatic as I expected. I can tell that there are likely challenges ahead, but the full impact remains to be seen. Still, it didn’t end as smoothly as I hoped. I really hate beeping.

Ending the Week

On Monday, they sat me in a chair all day, slowly filling me with stuff. The nurses said it may go faster on subsequent Mondays, as long as I adapt well. For the first time, it was all in mosy mode. They ended by hooking me to a pump to carry around the rest of the week.

The pump looked like a stylish, black fanny pack with thin tubes coming out to run under my shirt. Each day, I left work about 2:30, after my last class, and returned to the oncology clinic for a refill. The bag held about a half liter of strange, orange fluid. I also had to keep a hazardous material cleanup kit in case the bag leaked.

The hard part about the bag was getting into and out of the car. The bag sat easily in the passenger seat while I drove, but I had to restrap it around my waist every time I got out. Bit of a nuisance, but tolerable.

Finally, on Friday, they removed the pump. What a relief! I still had to sit for a while to get a couple of other medicines pumped in, but that used other pumps.

The last piece was a patch-type device stuck to the back of my arm, just a smaller pump. This little guy was to sit on my arm, held with adhesive, until about six-thirty Saturday night, flashing a little green light until it was done. At that time, it would pump in some medication to help my body build white blood cells. After about an hour, the flashing green light would become a solid light and I could pull the device off. That would be it; the end of this round of chemo.

Being the end of the day on Friday, the nurses gave me the leftover ham sandwiches that they keep around for patients, and sent me on my way.

Revenge of Prednisone

It should have been a good night. Probably would have, if I could have slept. When I got home, I took my evening pills, which included the last dose of prednisone. I hate that stuff.

For me, there are two bad side effects to prednisone. The first is that it gets me really wired up, making it hard for me to sleep. That meant I stayed up all night. It’s not a productive type of staying up, either; it is really hard to focus on anything.

The second side effect is that it increases my blood glucose. I’m on other medications to keep the glucose down, and they suck already. To have another drug undo all of that is a pain in the backside. This really becomes a problem with Jardiance.

Jardiance is a diabetes medication that removes excess blood sugar by encouraging it to go out through your kidneys and bladder. To do that, it has to send out a lot of liquid as well. If you find yourself in such a situation, know where your nearest restroom is located, because you are going to be there a lot.

The prednisone increases the blood sugar, by large amounts. The Jardiance redirects the sugar and any available fluids out through the kidneys. Before too long, dehydration sets in. So now, in addition to everything else out of whack, everything is running dry.

I finally got to sleep about Saturday at six o’clock Saturday morning. I weighed myself beforehand, as a way to check my fluid levels, and read 182.5 pounds. An hour later, I woke with an urgent need. After attending that, I had dropped to 181.0 pounds. That’s about a pound and a half of liquid in an hour.

Yep, dehydration was a definite issue.

Then the Beeping

My morning was somewhat productive, despite the lack of sleep. I kept up my fluid intake to try to get things settled. I figured the worst was past. I planned that by the middle of the evening, the last medical device would be gone and I could take a proper shower without worrying about keeping things dry.

It was around one o’clock in the afternoon when I heard the beeping. It was soft and a bit distant, so I assumed it came from something a neighbor was doing. Then I moved and it got louder.

The little pump on the back of my arm made the noise.

I went to a mirror to take a look. The flashing green light had become a flashing red light. Something was wrong.

The instructions for trouble were to call the doctor’s office. Obviously, the doctor’s office was closed on a Saturday, so I was directed to go to the emergency room. I grabbed all the related paperwork I had for the device and drove back to the hospital.

I made it through the ER processing easily, but with lots of people looking around and asking, “What’s that beeping?” I didn’t have to sit long before someone ushered me back to get things started.

That was probably a good thing. I’m usually a calm person and tend to adapt to things fairly well. The whole chemo experience has pushed the boundaries of my stress handling, using up quite a bit of my reserves. The beeping beasty on my arm pounced on that and really drove my stress levels high. Add the dehydration and the lack of sleep and I was really on the verge of freaking out.

Overall, it ended well. Once all the medical people were all on the same page, the action was simple. They removed the device, with plans to return it to the manufacturer and try to get reimbursed for it (i.e.: not charged). Then, time was close enough to when the device should deliver its medicine, so the nurse could just inject me directly.

All settled, I went home. It was still difficult to sit. My nerves still shook quite a bit. It still could have been partially the sleep and dehydration, but it was a bit rough.

Then There’s Work

One of the questions at work is whether I would be returning to full-time teaching in the spring semester. My academic program, Computer Software Development (CSD) normally has three, full-time instructors and has seen almost no drop in enrollments. Our sister program, Web Technologies (Web) is much smaller, with one instructor. I can teach any of the courses in those programs, having not only the appropriate degrees but also the work history.

However, the plan by the department is to offer me no more than two courses to teach as an adjunct (part-time) instructor. To do this, the department must rearrange the other courses to accommodate:

• The two full-time CSD instructors will have an overload of six courses each, in addition to their other duties.
• Some non-core courses will not be offered. For example, students who took 2-D Game Programming in fall will not be offered 3-D Game Programming in spring.
• The one instructor for Web is also in the Army Reserve and will be going on deployment in February for seven months. The junior CSD instructor will take over the Web duties including being the acting program chair.
• The junior CSD instructor is still taking the required training program that all community college instructors must take during their probation, so he must devote time to that outside of the overloaded teaching assignment and new program chair duties.

There hasn’t been a clear explanation for all of these changes. Some of the faculty are completely confused by the whole process. So far, there are only rumors, some of which suggest that someone at the vice-president level really does not want me at Kirkwood, but I haven’t been able to find anything about those.

That’s how things seemed to be working out last Friday. It’s possible that I’ve misheard any of these things; I’m not involved in any of the discussions. It’s also possible that the whole plan, if that is the plan, could be tossed out on Monday and replaced with something else.

For the moment, I’ll just figure to be working somewhere else in spring. Basically, the semester ends in the middle of December. I turn in my grades and am then done. As of that time, I can take up whatever work I want. If I start now, I can be pretty sure of a smooth transition. I might even take that last half of December off and start in January instead. There’s lots of possibilities.

Two Weeks

So now, I need to wait two weeks until my next round of chemo. I’ll be watching for the various signs of side effects. I think I may already be seeing some of the dry mouth side effects, but that could also be dehydration and low humidity. There may be a call for gum chewing.

The two weeks will probably pass quickly. I’ll need to keep up my strength and eat well. Lowering stress will also be important, so I may need to slap people as a release. I wonder if I can use chemo-related stress as a defense in court.

If I know I’m not going back to Kirkwood, I can spend my “free” time working on other projects. There are some online courses I’ve been thinking about writing (UML Use Cases, anyone?) and some other things I could be doing.

Then the cycle will begin again.

As mentioned in a previous writing, my medical team found and removed a lymphoma tumor from my chest. As far as they can tell, they got the whole thing, despite me imagining the process as using an ice cream scoop. The scans showed that tumor to be the only one noticeable, and there were no other signs of trouble. Cancer, however, can hide as a single cell waiting to do its thing. That calls for get back to the ship and nuke it from orbit chemotherapy, just to be sure.

To the Heart

In preparation, the cardiologist ordered a new echocardiogram. This is like a sonogram but for looking at the heart. Last May’s echocardiogram took just the regular measurements to check for my cardiomyopathy (enlarged heart). Since chemo drugs can possibly damage some parts of the heart, they wanted to take base measurements before treatment so they have something to check later.

The echocardiogram really worried me. The tech holds the sonic transducer (the wand) tightly against my chest to assure good signal transfer to the heart and back. At the time of this test, I was just a few weeks out from my chest surgery, and things were still pretty tender around there.

The tech turned out to be really awesome and caused me no discomfort. I expressed my appreciation for her light touch. She said she often works with patients who have had mastectomies, and that has taught her to be gentle. I hadn’t thought about that, but it made perfect sense. As I go through treatment at the cancer center, I’m probably going to see or hear about a lot of people who are far worse off than I.

Indirectly to the Heart

The following Friday, September seventeenth, they installed a special port that makes it easier to do all the chemo activities. Special thanks to my friend of the last 25 years, Marli, for driving me to the appointment at way-too-dark in the morning.

The port item, called an Infusaport, includes a smallish, round thing with guide pins that sits under the skin below my right clavicle. It is connected to a tube that goes over the clavicle (under the skin) and then connects to a blood vessel that leads to the heart. The pump connector for chemo can easily align with the circle and its guides and puncture the skin to get a good line to my cardiovascular system. The goal is to minimize finding new veins to poke every time the team needs to stick something into me.

The installation went smoothly. They wanted me to be awake, but still slightly anesthetized. They underestimated my ability to nap whenever I want. The anesthesiologist had to wake me several times to ask if I was okay. I answered that I was and immediately nodded off again.

The surgery site is still sore, but is getting better. By next weekend, it will be healed well enough that I can shower like normal… when I don’t have the pump attached.

The Main Event

On Monday, September twentieth, I went for my first chemo treatment. I checked in, had blood drawn (through the new port), met with the oncologist, and then started the treatments.

The first drug is apparently a tough one. It must be administered slowly and in their presence. They started at a slow speed, checked my reaction in half an hour, and then started the next part at a slightly higher speed for another half hour. That continued for most of the morning until about one in the afternoon.

Fortunately, the chair they put me in was a very adjustable recliner. Between that and the heated blankets they kept offering, I was able to nap through most of the procedure.

During the second drug, they had me watch a couple of instructional videos. One was about the medicines and the second was about the pump I would wear for the rest of the week.

The pump video showed the interesting fact that the medicine being pumped into me needs to be treated like a very hazardous substance if it spills. The pump comes with an absorbent mat and a plastic bag for cleanup. They said to wear two layers of gloves. Any mess must be gathered up and sealed in plastic and taken back to the hospital for proper disposal. There are first aid steps for if you get the medicine on your skin or in your eyes. Though I know all chemicals react differently in their intended environment than they do in other environments, it was still a little unnerving to see all the warnings.

So I now have a bag full of pump and medicine strapped around my waist like some sort of overgrown fanny pack. It has the option to use shoulder straps, but around the waist seems like it is going to be easier to manage, not flailing around and such. At the moment, I could only use my left shoulder because of the recent port addition on the right, but the hoses are connected on the right. Having the pump around my waist means I can put it on the same side as the port.

On this coming Tuesday through Friday, I must go in to have the oncology folks inspect and refill my pump. On Friday, they remove the pump, temporarily, and give me other medicines to help counteract the side effects of the chemo.

I repeat this procedure every three weeks, for six times. The last one will start on January eighth. Some time after that, surgery will remove the Infusaport.

About that Work Thing

Being in the hospital all day meant that I could not go to work. I only teach one course section on Mondays, but class can’t really happen without the teacher. That is an issue. Since I will need to miss several Mondays during the semester, we needed a plan.

The course in question is an introductory programming course. The students are all beginners learning this stuff for the first time. It is a lot like learning a foreign language. They learn keywords (vocabulary), syntax (language rules), and the customs of programmers. To do this, they often follow along with a native speaker (me) as I write programs. This comes in handy when I can’t be there. For this course, the following along meets the requirements of the “instructor-led lab”.

When the college first went remote due to Covid, I recorded my labs and the students thoroughly loved them. They liked that I took the time to address things people usually messed up. They also liked that they could pause the video while catching up, or replay something they didn’t understand.

For this section, where I am missing some Mondays, I’ve scheduled their instructor-led lab for Mondays. The section meets in person, generally, but the students will receive a lab video for the days that I will miss. Normally, the lab is due the same day as class (to ensure that they show up for class and participate) but it is due a day later for the video version so the students have time to ask questions. The video went up last Wednesday.

By luck, it turns out we won’t have to do this very often. Remember, it’s only every third Monday where I will be out. One of those Mondays is Thanksgiving week, and there is no class that week. Another falls on the last day of class for this section when the students take their final exam. The exam is online, with open book and notes, so any staff or teacher can proctor. The students just can’t talk to other people while taking the test. They also must complete the exam in two hours or less, meaning that looking things up slows their progress.

The dean of the department and I discussed this ahead of time. She checked with the appropriate administrative types and got it all cleared. It should work out.

The unusual part is that, with the lump removed, my voice is much stronger and records better. I may have to take up singing again, much to the dismay of the Boy Scouts in my old Troop 504 in the 1980s. “All together now!”

Going Forward

For the week, I will get my refills each afternoon, about forty minutes after my last class. Then I will be without the pump for a couple of weeks. The pump will be inconvenient, but nothing more.

The bigger worry is the side effects of the medications. Despite having a large, extended family, I don’t know the stories of many who have undergone chemotherapy. Even if those histories were available, there is so much variety between the mixtures of medicines, the history of one may not mean much for the experience of another.

I typically hover just over anemic, and one of the possible side effects is anemia. That will require watching.

Prednisone, a steroid that is part of the treatment, can cause an increase in blood glucose, which is a problem for someone with Type II diabetes. Normally, I control my blood sugar with diet, exercise, and some pills. The oncologist suggested that those efforts may not fight what the prednisone does. On the other hand, prednisone can only increase blood sugar by converting body fat to glucose, which may mean I’ll lose more weight… in an incredibly unhealthy way. Still, my doctors want me to drop another ten pounds; 170 here I come!

The Well-Wishers

I appreciate all the people who expressed concern over the lymphoma and have wished me well. Thank you for your sentiments.

Please understand that I am a very fortunate person. For whatever reason, I have experienced very little major illness or damage in my life; still no broken bones, for example. The damage I have taken has been hard for doctors to find because I seem to be a bit robust. Those of you from the family know that robust-ness seems to be a family trait.

My cardiomyopathy (enlarged heart) had symptoms going back to the age of eleven but was not diagnosed until my early thirties, back in 2001. At that time, the doctors expected me to live a couple of years. The following year, my cardiologist was so excited to see the improvement.

By 2013, my new cardiologist showed me the Seattle Heart Failure Model, a statistical model used for determining the likelihood of success for various heart treatments. He pointed out that, for people with my symptoms, there was a 97% mortality rate in fifteen years. He asked if I knew what that meant. I said, “It means that if there were one hundred people with my same heart condition, in fifteen years ninety-seven of them would be dead, and that I could probably get the other two as well.” When I last met with him, he said my last echocardiogram required an expert to find the damage, and that my current state is no longer covered by the Heart Failure model because I am a statistical anomaly.

Type II diabetes showed up some years later. The main issue was lack of energy burning exercise. A bad heart will slow a person down a lot. Having a job that requires sitting does the same (welcome to a career in I. T.). So, I started the treatment with pills, but the big determinant in my diabetes is diet and exercise. If I exercise enough during the day, I can eat anything and have normal blood sugar. If I eat almost no carbs during the day, even with no exercise I will have low, possibly dangerously low, blood sugar in the evening. Unfortunately, there are Bavarian Cream filled pastries out there that must be destroyed.

Now we find the lump. The symptoms of the lump have been there for several years at least. That means it has been big enough to cause trouble for a while. During that time, the material did not spread enough to cause other tumors. This suggests that it is unlikely that there is any other material. I still must undergo chemotherapy to be on the safe side, but the side effects of that are my only real concern. The likelihood of more cancer is pretty low at this point. Just lucky, and a bit durable.

In Conclusion

Things are progressing and they will all be fine. It is, at this point, an expensive nuisance. It probably keeps me from spending money on something stupid. Life is like that sometimes.

I’ve often joked that when my treatment for enlarged heart started, “I am too big hearted, but the doctors are working on that.” When the diabetes started, the joke included, “…and I’m too sweet as well.” Now, with the tumor I must add, “Now they’ve started treatment because I experience too much inner growth.”

Many people worry when they hear about any sort of cancer, and though the worry may be well intended and appreciated, they should take some time to think about the fight as a noble effort. If I can stand in a blizzard and laugh at the North Wind, challenging it to do its worst, a little exhaustion and hair loss isn’t going to dampen my spirits. Even if something goes horribly wrong, and I lose the battle, I will go down fighting and making bad jokes. Not to worry, though; I have many more years and many more minds to corrupt before I return to the dirt.

The last thing I posted to this site was a while ago. Even that took an unusual amount of effort on my part. This reason is not that unusual in the world. My doctors found a lump.

Since about the age of eleven, I’ve had heart damage, probably caused by a flu-like virus. That’s how far back the symptoms go. Unfortunately, the heart issue was not properly diagnosed until my early thirties. At that time, I was nearly dead, but I’ve since improved quite a bit.

For years now, my main complaints were exhaustion and shortness of breath. Those can be symptoms of heart health and be easily dismissed. However, those are also the symptoms of other things.

I teach software development at my local community college. Some medical people suggested that staying up late to do grading and class prep was aggravating the exhaustion and breathing trouble (as well as preventing me from exercising regularly). It looked like I needed to give up teaching and go find a corporate job in information technology.

In spring of 2020, I told the dean of my department that I needed to leave teaching. We had been shorthanded and just hired a new guy. She asked if I could stick around for a year to help get the new guy all settled. Since I’m a sucker and I like working in education, I agreed.

The health issue did not improve, so in February of 2021, I told the new dean that I was leaving. I recommended a replacement for me. The school went through the hiring process and hired the person I recommended. That person was my replacement when I left my I.T. job at the same school to start teaching, so she seemed like a good candidate to replace me again.

The Twist

Then came May. While discussing a recent echocardiogram, the nurse practitioner and I talked in great detail about all my symptoms. She made it clear that my heart was not in bad enough shape to cause my breathing trouble. This was excellent news on the side of cardiac health. However, it meant there was something else. She referred me to the pulmonary people.

They did a breathing test and chest x-ray. The breathing test showed an obstruction. The x-ray showed a lump. A C-T scan confirmed there was a lump, but not much more. A PET scan filled in the details.

My internist explained that there was a lump on the backside of my sternum (breast bone) near the top. It was probably an enlarged thymus gland, and it needed to come out. The scan showed it was 3.8cm by 3.4cm by 2.4cm (about an inch and a half square and one inch thick).

A cardiothoracic surgeon arranged for a needle biopsy. That’s where they stick a needle into the lump and try to pull out enough stuff to look at. The results of this biopsy were inconclusive. The recommendation was for an excisional biopsy, i.e.: dig the whole thing out and look at it.

About three and a half weeks ago, I went to the hospital for surgery. The cardiothoracic surgeon went in and dug all of the lump out of me. From what I understand of his reputation, if he says he got all of it, then he got all of it. This surgery involved a partial sternotomy, where they cut through part of the sternum to open it like a barn door. When done, they wire the sternum pieces back together, like a farmer using tie-wire to wire shut a barn door.

By midday the following Saturday, they sent me home. By eight o’clock that night, I was headed back to the hospital with a fever of 103.6 degrees. I spent the next week hooked to intravenous feeds of strong antibiotics. They kicked me out again the following Saturday and gave me strong oral antibiotics for a week.

Since then, I’ve been gradually healing. I’m back to work, but only teaching part time.

The Effect

When writing all of this, the whole story doesn’t seem that long and should not have interfered with my writing or other activities. If you look carefully, though, you would see that the discovery of the lump was in May and the final release from the hospital was at the end of August. That’s the whole summer of doing some medical task and then waiting a week or two before the next activity. Such a long period with a mystery lump stops a lot of what your brain would otherwise do.

I am not prone to depression (as far as I know), but anyone can be messed up by a nebulous medical condition. During the summer, I found myself sitting for long periods of time simply blanked out. My mind was still there, still aware of what was going on around me, but I wasn’t being my usual, productive self. During these periods, I wasn’t actively thinking about anything; that part shut down.

Household chores got done. I met with friends as scheduled. Things that were on my to-do list that absolutely had to be completed were accomplished. For the rest of the time, there was only emptiness.

Oops, Unemployed!

This led to another very stressful situation. As noted above, in February I gave my notice that I was quitting my job. I planned on arranging a new job over summer while I was still receiving contract pay (and benefits) from the teaching gig. Early on, there were some interviews and such, but the information about the lump made job hunting harder. How do you tell a potential employer that you won’t be available as you start a job because of a serious medical issue? The sitting blank eventually stopped a lot of my job hunting.

There were other options. My replacement for the teaching position had to leave her position as the team lead. That was my old job before I went to teaching. They needed someone to replace her. I wanted to apply, but I also needed extra cash. To help with that, I contacted her direct boss and the vice president over her boss and explained all the reasons for some changes. I described why the pay needed to be higher. I explained why the job should be changed from team lead (an unofficial title) to manager (an official title). They were very good arguments.

The VP agreed and made the changes. Then he offered the improved position to the woman who was to replace me in the teaching job. She accepted. There was no longer a teacher to replace me and the start of the semester was coming fast. At least the direct boss sent me an email thanking me for the arguments in favor of the job changes.

That should mean that I would be able to go back to teaching because they would be in a dire position. It didn’t work out that way. The department arranged everything to deal with the missing teacher scenario. By the time I got there, they only had three courses available to teach, meaning that I would be teaching part-time as an adjunct instructor.

This isn’t all bad. I need the recovery time from the surgery. I will probably start chemotherapy before long; the lump turned out to be a large B-cell lymphoma. The teaching is enough to cover my basic bills. The government healthcare exchange website helped me hook up with insurance.

The big issue is the future. My dean and program chair want me back permanently full-time. I’ve heard rumors that there may be an administrator who does not. Even if they can bring me back full-time for spring, I would still be unemployed from mid-December to mid-January. I would also need to apply for the new full-time position for the following year, which would leave me unemployed for the summer.

Given that kind of instability, I might be better off finding a corporate I. T. job and leaving education. That would be sad because I am a pretty good teacher. Even the students who don’t do well in my classes generally like me. As much as I’m not a summer person, I have gotten a lot of writing done in summers. The uncertain future is a source of great stress.

Conclusion

So that’s what happened. Life threw a wrench in the works and it disrupted everything. I always tell my students, “If everything goes smoothly, you don’t get a good story out of it.” I just need to find where this story will take me next.