Thursday, July 12, 2018

Drip, Drip, Drip

OK, first of all, I have had writer's block. Somehow, a chronic nosebleed and the threat of stroke are as funny to me as impending doom from an exotic cancer that ends up being misdiagnosed. Why? I have no idea.

I have a long story to tell, but that will have to wait. I am already staying up too late, and I have to get up early tomorrow. On the other hand, there will be more news tomorrow, and I love a cliffhanger (although, it's really hard to beat 2005's "will he lose his right eye or not" moment)!

Briefly, the surgery did not entirely work. The story of what happened later is a laugh riot for another time, but I have been left with a slow ooze of blood in my nose that gradually builds up and then spills out after a few hours. This leads to such great moments as the other day, when I sneezed bloody snot on my shirt in front of a patient. (He had a story to tell when he got home.)

Meanwhile, I can only take half an aspirin a day if I don't want my nose to be a bloody spigot, and that leaves my vulnerable to another stroke. It might not be the fun kind like the first two. I could be driving or something.

So, tomorrow, for the first time since the surgery, I will see the surgeon again. Maybe he will have another suggestion as to what to do. He will probably want to repeat the procedure. That would mean another two stabs in the crotch followed by all the joys that followed them last time (to be described lovingly in another post). After that, I see the stroke guy and hear what he's got to say. That'll be a real hoot too.

Until later,

Tumoriffic Tom





My friend, Ollie the Gray Seal, says it's all going to be OK.

Tuesday, June 5, 2018

Best Angiogram Ever!

I have to admit, I was not looking forward to last week's angiogram. Some people are into that sort of thing, but not I. That said, last week's angiogram was the best I ever had. The first time was when I was 11 and getting worked up for the original tumor. I remember it as a distinctly unpleasant experience. This time was much better than I expected. The surgeon was really smooth with the arterial catheter. Other than the spike in an unpleasant place where they inserted the arterial catheter, it was kind of groovy. Or was it just the better drugs?

The results were interesting. First of all, there were the expected dense clumps of arterioles (tiny arteries) in each nostril. Those are why I have been getting nosebleeds since July, it means there is a solution to that. But, also, he did a general survey of arteries in the whole region.

Oddly, I have no atherosclerosis (harding/narrowing of the arteries). On the one hand, this is good news. Who, other than a pervert, would actually want to have atherosclerosis? On the other, it raises some annoying questions. I have always assumed that my two strokes were due to atherosclerosis of the arteries of my brain from my radiation therapy. That does not look to be the case.

The next most likely source of the strokes is the tiny hole between my atria (the top two chambers of my heart). This is a very common defect. 20% of everybody is born with it, and it is usually harmless. However, a large percentage of people who have unexplained strokes have this defect.* So then, we have to consider closing the defect, which can be done through yet another--wait for it--angiogram! I'm going to be a real pro at these things!

Anyway, last week's angiogram was just to get a map of my arteries--the appetizer, if you will. Tomorrow, I go for another angiogram, and this time, they mean business. They're going to release material (a combo of tiny beads or superglue) that will block off the extra arterioles that are the source of the nosebleeds. The downside is that there is a risk that too many arterioles will be blocked, and my nose will fall off. Well, actually, not fall off, but, still, badness. It's pretty unlikely, though. This interventional neuroradiologist / neurosurgeon does about 300 of these a year, and his record is excellent. But this is the sort of thing that keeps me up the night before a procedure.

On the bright side, if something bad happens, I'll be inspired to write more, and I like writing. On the brighter side, look at that adorable dog picture at the bottom of the post.





* It's called a patent foramen ovale (which sounds like the name of some sort of nobleman or other), aka PFO. The theory is that a tiny blood clot forms in venous (vein) system and makes its way to the heart. Then, somehow, it passes through the PFO into the arterial system and up into the brain, causing a stroke. This is weird, because the pressure is much greater on the arterial side, so you would expect stuff to go the other way, but there it is.




Wednesday, May 23, 2018

Artery Imitates Lifery

Get out the maracas, everybody! It's time for a nasal angiogram!

Why, you ask, would anyone want to a silly thing like that? What kind of nut would allow a doctor to stick a tiny tube into his femoral artery and thread it all the way through his major arteries and into his nose? This kind of nut, of course! Because I like it that way! Plus a real reason--bloody noses.

It all began last July, when I got an orbital cellulitis* under my right eye where I have no orbit. (See, Got the Stinkeye.) One of the major symptoms of that was nosebleeds.  While most of the infection went away, some remained in the back of my throat. From July until just a couple of months ago, I was on many different antibiotics, none of which worked for more than a week.** The infection finally cleared up a couple of months ago when I took my ENT consultant Hygeia's advice very literally and put gobs of antibiotic ointment up my nose every day. It was so much that it slipped down the back of my throat, directly attacking the site of the infection.

However, even after the infection got better, my nose kept on bleeding. And I'm not talking about a drop here and there. I'm talking about fairly exciting bleeds that sometimes might last for an hour until I had an emergency visit with a specialist to get it stopped. My nose would bleed at awkward times, like, for instance, when I was seeing a patient. I don't think I ever actually bled on a patient, but I was close a few times.***

This was made worse by the anti-platelet medication (kind of like a blood-thinner) that I take to prevent another stroke.**** This medication (Aggrenox) prevents strokes by making harder for blood to clot. Unfortunately, it also makes it easier to bleed. So, I have been going without Aggrenox for months. This is not a viable long term option. Strokes suck, even minor ones I like I have had, and the next one might not be so minor.

So, a few months ago, Hygeia suggested that I get this insane procedure to stop the bleeds. I procrastinated until I told Kathleen about it, which meant that it would actually get done.

The first part of this starts 6 hours from now. In the morning, this very specialized specialist will poke that a tube into my femoral artery, thread it through the major arteries all the way to the blood supply to my nose. He will then inject dye which will be visible by x-ray and allow him to make a map of the microscopic details of my blood vessels.

Some time in the next few weeks, after he has figured out the source of the bleeds, he'll do another angiogram (to me; unfortunately, I can't foist this on anyone else) and block the tiny blood vessels that are causing the nosebleeds with the equivalent of superglue. That has to be the hardest way anyone has every come up with just to sniff glue.












* which has nothing at all to do with planetary motion or unsightly lumps of fat around the thighs and buttocks. The orbit refers to the bone of the eye socket. Cellulitis is an infection just under the surface of the skin. An orbital cellulitis can be highly dangerous. The orbit is a relatively closed space, so drainage from the infection may get cut off, increasing pressure on the eye, potentially causing blindness, and so on. Lucky for me, my right orbit isn't a closed space anymore. They took the bottom of it out in 2005 when I had the osteosarcoma. See? Every cloud has a silver lining!

** Every time you use antibiotics, you are potentially breeding antibiotic resistant bacteria. Perhaps, if all of these antibiotics create an invincible superbug in my body, they can name it after me.

*** I'm fairly blase' about nosebleeds. I have had them fairly often since my childhood nasal cancer. I even carry a little clamp in my pocket that I can put on my nose to put pressure on it so I can still use my hands. I'm told it's very attractive.

****I've had two little strokes. For those stories, see Different Strokes for Different Folks in Tumoriffic, August 14, 2006, and I'll find the other link later.

Thursday, September 21, 2017

Got the Stinkeye

It's been quiet. Too quiet. Until right now.

It has been 10 months since I definitively learned that I did not, in fact, have an exotic, aggressive tumor that would kill me within 2 years. Life has settled down to the ho-hum existence of your average northeastern US primary care doctor living in the End Times. What was I to do for excitement?

So, this summer, I had been getting a runny nose, a cough, sneezing, and a bit of bloody nose. It didn't seem like anything special, but it went on for several weeks and did not respond to allergy treatments. So I stuck a culture swab up my nose, sent it to the lab, and prescribed myself some antibiotics. *

The culture grew 'normal skin flora.' Generally, when they find this in a culture, they throw it out, and that's just what they did. And I didn't get better. I went to see Hygieia. It indeed looked infected. She cultured it again, and I spoke to JD of infectious disease (ID). He put me on two antibiotics.

Those two antibiotics did seem to help some, but they made me ill, and, three days in, I woke up in the middle of the night with a fire alarm in my ear (tinnitus from hell). That was minocycline. Not doing that again. So JD switched out one of the drugs for another. But the new combo didn't seem to work, and the other drug, rifampin, turns all one's body fluid orange, which can be a real downer.

Meanwhile, about a week ago, whenever I coughed or sneezed, it felt like my right eye and cheek were about to blow off my face. On Sunday night, it crossed my mind that this was not actually normal, even for me.

The next day, Hygieia squeezed me into her schedule. (I guess she found the idea of my face bursting apart disturbing too.) The inside of my face was not looking better.** So she got another culture and ordered a CT scan (also because that spot hasn't had enough radiation lately). And the CT scan showed...another trophy for my catalogue of experiential medicine! I have orbital cellulitis.

What's orbital cellulitis, you ask? Sounds like something Chris Hadfield (http://chrishadfield.ca) might get. But no. It's an infection in the tissues surrounding the eye. Usually, it's quite painful, because the tissues around the eye usually form a closed space that can build up pressure. Luckily (Heh!), in my case, the orbit is not a closed space. It's wide open to what should be bone and sinus, but what has, for the last 10 years, been my facehole.

Know what's even more special? That culture seems to be growing Enterococcus faecalis! To put it delicately, that's a bug that one more often finds in the hole on the other end of things. This is so special, that only two patients in all of medical literature have ever had such an infection! *** And I bet neither of them had a facehole like mine! I win!

So, last night, after all of this, I called up my parents, and I asked, "are you bored? . . ."




_____________________
* Before you give me the a hard time about my treating myself, I am in frequent contact about these things with my primary care doc and my ENT doc, Hygieia, the Greek goddess of otolaryngology. Dr. Bug, head of infectious diseases at Ben and Jerry's Hospital, is impressed that I have been able to keep the inside of my face from turning into a foul sewer of infection for the last 10 years given what cancer, surgery, and radiation have done to it. (I guess that 10 year streak is over.)

** Meanwhile, her lab had tossed the second culture, because it too grew 'normal skin flora.' This made Hygieia very mad, since normal skin flora do not belong on the inside of my face.

*** https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5056554/




He's not bored.

Friday, April 28, 2017

No Window Into My Soul

Hi, Tumoriffic readers!

That whole thing about spitting out a piece of my skull thing fizzled out so quickly, I forgot to tell everyone what finally happened. Here goes:

1. Apparently, I am still alive.

2. When I got home from the British Virgin Islands, I went and saw Hygeia, Goddess of Otolaryngology. I had given her a heads up, so she had done her research. Apparently, in all of Pubmed, there were no useful articles about what to do when someone spits out a piece of their own skull. That made me feel very special.

Using her holy pharyngoscope, Hygeia could see where the piece had come from, and it was from the source of all of my recent adventures--my poor, tattered clivus.* What she could not see was what was left behind it. There was a scab, and she was disinclined to pick it off. She worried that doing so might rip my meninges** and spray cerebrospinal fluid in her face. I would have found it very embarrassing. 

So, she decided to get a CT scan of the area. After all that fuss, there was a still a layer of bone separating my meninges and brain from the back of my nose/throat. Yawn.

It was sort of anticlimactic, but at least I have a souvenir. Who else do you know who came back from a vacation with a dried out little cube of their own skull? I keep it in my bedside table in a little cardboard soap box from the resort. Everyone in Hygeia's office thought it was neat. I'll show it to you if you want.

Be well,

Tom



* Autocorrect wants to substitute 'cloves' for 'clivus.' Gimme a break, autocorrect! Are you telling me that you don't know basic skull anatomy? (On the other hand, cloves might do nicer things to my breath than rotting clivus.)

** The meninges are the membranes inside your skull that surround your brain like a Ziplock bag full of wet chicken. Meninges was also a minor Greek hero from the Iliad who was responsible for packing everyone's lunches.***

*** Homer left him out of the final draft. You can't prove that's not true, so it basically is.




This is what true love looks like.


Monday, February 20, 2017

Nearly A Piece of My Mind

Today started very strangely. Here's some background:

Ever since my surgery and radiation in 2005, I have been unable to blow my nose effectively. So, every morning and evening, without fail, I rinse out my nose with over half a gallon of salted distilled water using a sinus rinse bottles.* I call this process "nouching."

Anyway, as I was rinsing this morning, I felt something hard and sharp behind my nose. I rinsed some more, and spit out a piece of my skull.

Huh?

That's right. A piece of my skull. It's about a third of an inch to a side and more or less cubic. And holy plucking schmidt! It's a piece of my skull! And, it may surprise you, but it does not look healthy. It looks like peanut brittle (though less tasty) or pumice (though less useful for removing corns). I could probably crush it to powder between my finger and thumb. And did I say that it's from my skull?

What does this mean? Is my head about to collapse into a mass of bone powder and goo? Probably not. Although the appearance of a piece of my skull in the bathroom sink was an unpleasant surprise, I know that the big part of my skull between my nose and brain is dead. I'm not sure how that leaves me alive and more-or-less healthy, but my doctors have assured me that I am alive and am in reasonable health. I'm not sure they entirely know why either. 

So, I left messages for my primary care doc, my local ENT doc, and my F'in Famous Cancer Hospital ENT doc. One nurse I spoke to said, "wow. That's different!" To say the least. I've heard back from Dr. Hygiea, Greco-Roman Goddess of otolaryngology, *** and she wants me to get a CT scan. That will have to wait.

See, I am currently spending the week in the British Virgin Islands. I called around. There is one ENT doc in the whole country. He might be able to see me in March. He will be in for emergencies tomorrow, but he'll be away for a week after that. So, if my brain lining rips and my CSF leaks onto my shoes, or if my head collapses onto my spine so that I am a human bobble-head, I'll have to get air-lifted to St. Thomas or San Juan.

I'm actually not really worried. This is just the sort of thing that happens when you have a large chunk of dead bone in the middle of your head. Really, the dangerous part is that dead bone, like a splinter, can fester and cause infections. So, all else being equal, the more of it that comes out, the better. It's like Mom always said, "better out than in." 

Tomorrow, I'll go snorkeling and look for whales.

Be well,

Tom




* By the way, I recommend this wholeheartedly to my patients. If you have a cold, sinusitis, or allergies, rinsing helps clear out the gunk. Do it as much as you can stand. The concept is disgusting, but, sometimes, it can help you avoid antibiotics, and involves no toxic products whatsoever. ENT docs love them. http://shop.neilmed.com/Products/Sinus-Rinse. The salt packets can be expensive, but pharmacies have started selling generic versions which are cheaper.

** I'm certainly not about to carry a giant jug of water on top of my head like some women in Africa. That could get ugly.

*** This is a pseudonym. 




Here's a baby gray whale checking us out in 2013. We're looking for humpbacks tomorrow. I hear there's a newborn nearby.

Sunday, February 5, 2017

Well, That Was Fun!

As of last update, I was in the emergency department at Ben and Jerry's Hospital getting worked up for an episode of double vision. After a normal CT scan and MRI, I had to wait overnight for a visit from the eye doctor and for an echocardiogram to make sure there wasn't a big, floppy blood clot throwing off bits and pieces into my brain.

That was the day before yesterday. They put me in a room in 'observation' (part of the emergency room where they keep you if you are there for more than a few hours, but they don't want to admit you). Surprisingly, if you have your own room and are hard of hearing like me, you can sleep pretty well in the ER. You take your hearing aids out, put in earplugs, and it's pretty quiet. There are pluses to bad hearing. K, on the other hand, slept terribly, worrying about me.

Yesterday, late in the morning, a technician wheeled in her ultrasound machine and got an echocardiogram of my heart. This involves the tech rubbing a microphone covered with KY Jelly on my chest. Those of you who have been pregnant may be familiar with a similar experience. It's a rather slimy. To everyone's relief, there is not a great big blood clot flopping around inside my heart waiting to fly off into my brain!

Finally, the ophthalmologist came by. He examined my eyes. I'm always jealous of ophthalmologists. They have all sorts of cool equipment to look into eyes. I only get to use the wimpy kind of ophthalmoscope primary care docs get. It makes me feel inferior. Thankfully, he did not rub it in.

The ophthalmologist agreed that the most likely explanation for my episode of double vision is that my extreme fatigue had amplified the inherent weakness of the muscles that move my right eye.* I had been really tired that day. Not only was there an early-morning meeting at my office, the night before, I had a migraine and had foolishly treated it with caffeine in addition to ibuprofen. I slept terribly that night.

Shortly after the ophthalmologist left, K showed up. I was ready to go home. Sadly, because someone had to put an official read on the echo and various notes had to be written, I had to wait until late afternoon to go home. Still, I had time to take the dog for a walk. It was a pretty short ordeal for a Tumoriffic episode.

That's all, folks!

T





* The muscles that move my right eye (extraocular muscles) are weak due the radiation and surgery I received in 2005. Generally doesn't bother me unless I look down or way to the right.

** I have been getting migraines lately, probably because I just got progressive lenses, and I'm not used to them.




Saying 'goodbye' to the ER and 'hello' to my new friend.