The Next Day (a medical update)

My doctor’s appointment this morning quickly turned into a classic Good News / Bad News situation.

The Good News:

• The chemo worked very well. Most of my swollen lymph nodes (tumors) that can be felt have disappeared entirely or shrunken so much they are probably not a factor in my health anymore.

• It appears Dr. A was right all along that a swollen node in my left groin was preventing my shin wound from healing because since the chemo the wound has begun to close at an amazing rate.

• As the nodes are metabolized by my body, I continue to lose weight. Fully clothed, I weighed in today at NYU at a trim 218.1 lbs. Our home scale said 211 balls naked, but it's on the payroll. I’ve just celebrated the fact that nothing fits anymore by binging on a pint of Cherry Garcia! That's a first for 2009. It made me sick. But it tasted sooo great it was worth it..

• I’ve been trying to take it easy and I feel pretty good considering ...

The Bad News:

• My blood numbers suck. Red cell count today was less than Monday’s numbers despite Tuesday’s transfusion of two units of red blood cells. I’ll get another two units of RBCs tomorrow at the hospital. White cell count is also down to "critical" levels. The working theory is it’s not caused by an auto-immune anemia reaction but rather the continued effects of the chemo. I've already beat AIA twice but it required a drug that will compromise my immune system even more than it is. Stay tuned for updates.

• Dr. A wants to strike while the iron is hot and doesn’t want to wait to resume chemo treatments. I’m now scheduled to get a second round Tuesday. But Treanda is now out of the mix – at least for now. We’ll go with a dose of Rituxin, the old standby monoclonal antibody that I know and trust. (We might even repeat the mega-doses I got in 2007 if it's needed down the road.) One step at a time.
  

Actually, it's not a bad trade-off . If all goes well – and it will – I’ll have successfully managed an incurable leukemia, cured my diabetes, left obesity in the dust and healed a seriously infected wound that was just hours from unnecessary surgery. All in just a few concentrated, crazy, weeks. All I have to do is to get my balking bone marrow in line so it starts manufacturing red and white blood cells again. Hell, I’ve done that before. (Maybe it needs some federal stimulus money.)

But I promise I’ll get by this even if it turns out to be AIA. It’s just a matter of time.

Keep those prayers and good wishes coming in. Let's get on with it!

Gratuitous advice: Before you criticize a man you should walk a mile in his shoes. That way you'll be a mile away from him -- and he won't have any shoes!

Dear Friends

The past few weeks have been a time that has tried my soul -- and, apparently the soul of my doctors. I admit I haven’t been the best patient, but patience is tough to come by when your life is concerned.

To get to the point, the main lesson I’ve learned so far this month has been that, when you’re fighting for your life, you cannot let down your guard for even a minute. I was so consumed with the battle with Dr. B to avoid surgery (see previous “My Birthday” blog post) that I let the dosing of my chemo slide. I didn’t ignore it, I was concerned enough to mention the issue to Dr. A, but I told him I would leave it to him and didn’t make an issue of it.

Historically, the problem with Treanda (bendamustine) has been dosing, too much and it’s very toxic and too little, it doesn’t do what it’s supposed to do. I got it in combination with Rituxan, the monoclonal antibody that I’ve responded to very well three times in the past. [See this website for an almost up-to-date article on chemos used in CLL by Dr. Terry Hamblin. It’s almost up-to-date because it doesn’t include a new, as yet unpublished, study where Treanda was combined with Rituxan for the first time. The first phase of the study was so successful that researchers skipped phase two and when directly to the third phase in hopes of securing a new market for the drug.]

I think history will show I got too much Treanda. A few hours after the second dose, it felt like a truck had hit me -- a big truck. It turned out the Treanda had worked too well too fast. It resulted in three outcomes:

• First, a condition called tumor lysis, where the drug breaks up the tumors so quickly it overwhelms the kidneys, the organ responsible with getting rid of the waste products of the cellular holocaust.

• But second, that meant the destruction of most of the tumors, including those, at least in theory, that were blocking the lymphatic system and preventing the healing of my leg.

• And last and least, all those swollen lymph nodes weighed something. So the silver lining in this cloud is that my weight is down. Officially, I weighed in at less than 100 kilos for the first time at Dr. A’s and my scale at home recorded 211.2 lbs yesterday. That’s down 121 lbs since my all-time heaviest and just 31 lbs away from my goal. The end of that project is in sight. I can now see the end, as well as my toes.

Last week, after a few days of living in a fog, I was taken by ambulance from the NYU Cancer Clinic to the NYU Tisch Medical Center a few blocks away. A blood test had revealed my blood levels had gotten way out of hand and Dr. A used the opportunity to get me in a confined situation to 1) see what was happening to my blood (2) get a infection expert to take a look at my leg wound and (3) get a complete workup on me.

I fought the idea as hard as I could but I knew it was necessary. As it turned out, my worst fears about hospitalization would be nothing compared to the actual experience. As I said, I wasn’t the best of patients. But despite the best efforts of many dedicated professionals, the hospital nearly claimed a victory.

I don’t want to dwell on the nightmare of hospitalization right now, but I do have to thank those who helped me escape as quickly as I did. First of all, my sister Joan, who was there every day. And the Tisch family, who came to my aid and got me a private room in their hospital. But most of all, I need to thank my beautiful, wonderful wife. Marcia made the call to Mrs. Tisch and she was at my side as much as was humanly possible, bringing me edible food and a touch of sanity. But mostly, she gave me her love, which was something, everything, I needed to live.

I also now realize how much I’ve come to depend on some of the medical professionals in my life. First, my NYUCCC nurse Tara, who cared enough to send her husband, an NYU doctor, to visit me the first night in the hospital and make sure I was alright. And Dr. K, who visited me in the hospital when she didn’t have to. And Dr. S, who called me everyday. And Dr. A’s nurse, the amazing Bridget, who visited me on her DAY OFF and ended up changing my dressing when the wound specialist didn’t show up. And Dr. A’s receptionist Ellen, who calmed me down so often (too often) and found him in minutes when I needed him. And Dr. A himself, who has learned to listen to me and who finally agreed with me that as a patient, I was “a pain in the ass.”

Well, I’m home now after the closest scrape I’ve ever had with the great beyond. My blood chemistry still screwed up and I’ve had to have two additional units of blood to replenish my red blood cells (in addition to two units of whole blood I got in the hospital) and find out tomorrow morning if I need more. But it’s obvious now that I’m going to be around for awhile longer and will have lots of opportunities to make a general pain in the ass of myself. But I’m a lot lighter and more maneuverable now, so watch your step.

One more thing, during my first chemo session, I got a phone call from Dr. B (see the same earlier “My Birthday” posting). He called to apologize for “what you had to go through.” He said because of my letter, he realized he had to “make a lot of changes” to his practice which, he said “has gotten away from me” and forced him “to take a look at how we operate from top to bottom.”

Amazing!

FUN WITH NUMBERS. (Really!)

The following is adapted from a website suggested by the remarkable Dr. Hamblin. Just go with it and enjoy the magic.

Arithmetic Relating to the Number 432

or

The Secret of Nine

The number 432 appears in various catagories and forms (432,000, etc.) in different cultures throughout history.The following is a composition of various aspects and forms the number 432 takes, and the effects it has in our everyday lives.

***

Some interesting arithmetic related to the number 432:

4+3+2=9

9x9=81

1/81 = 12345678

8/81= 98765432

98765432 x 9 = 888888888

12345678 x 9 = 111111111

432x432=186624 (close to the accepted universal constant speed of light)

186624 /9 /9 /9 /9 /9 = 3.16 (similar to the value of pi)

In the so-called "magic number" sequence of the periodic table of elements - 2,8,20,28,50,82,126 = sum = 316 (see immediately above).

12 x 360 = 4320 (link between the number 12 and 432, degrees in a circle, etc.)

Diameters Of The Sun And Moon

The diameter of the sun is 864,000 miles (2 x 432). The diameter of the moon is 2160 miles (432 / 2).

Comment - These ratios and numbers, combined with the cycle of the Precession of the Equinoxes of the Earth at 25,920 years (60x432), form an astounding coincidence, at the very least. Despite popular opinion that there may be billions and billions of worlds in the Universe, the odds are billions and billions to one that any such ratios prevail anywhere else.

Heart Beat

A healthy, athletic adult at rest has a heart rate of 60 beats to the minute. 60 X 60 minutes X 24 hours = 86,400 beats per day.

Comment - This may be one of the reasons why the number 60 is so common in metrology. It also gives humans a special relationship to the cosmos, in the sense that it links a fundamental physiological property of the human species to the cosmic geometry symbolized by the number 432.

Latitude of Stonehenge

Stonehenge is located at 51 degrees, 10 minutes, 42.35294118 seconds North latitude, and 51 x 10 x 42.3529 = 21,600, i.e. (432 / 2).

Comment - This is either an extraordinary coincidence; or the originators of Stonehenge knew a lot more about astronomy, geophysics, and geometry than they've been given credit for. It was the Greek astronomer Hipparchos (ca. 190 - 125 B.C.) who is credited with covering the sphere of the earth with meridians and parallels. Following the Babylonian method of dividing circles and angles according to the sexagesimal system he created a grid of 360 lines running from the North to the South Pole and 180 lines running parallel to the equator. All this was done, however, thousands of years after the building of Stonehenge.

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Precession of the Equinoxes

The Earth's axis is inclined at 23.5 degrees to the plane of its elliptical orbit around the sun. As the Earth rotates it experiences precession, like the wobbling of a top. This wobble causes the direction of the north celestial pole to change in a circular path over time. This motion is called precession of the equinoxes and occurs in a full cycle every 25,920 years (60 x 432).

Speed of Sound in Granite

The speed of sound through granite rock at room temperature (about 72 degrees) is 12,960 feet per second.

Comment - Sound waves need some type of matter as a carrier. Their speed is affected by the density and temperature of the substance through which they travel. At higher temperatures the speed of sound increases. This particular measurement (3 x 432), ties a primary property of stone to the cosmic geometry symbolized by the number 432. Coupled with the known power of acoustics to modify the physical properties of substances, this measurement suggests intriguing links between sound, stones, and the number 432. ,

Square Root of the Speed of Light

Einstein's famous equation of energy and matter - E=mc2 - leads to one of the most profound instances of the occurrence of the number 432. In the equation, E= energy, m = matter, and c = the universal constant speed of light. The speed of light is generally accepted to be 186,291 miles per second in a vacuum. However, the square of the number 432 is 186,624. If the universal constant speed of light were in fact 186,624, then the number 432 would be the square root of the speed of light. The deviation is small enough be be accounted for by several possibilities:
(1) Variation in our understanding of the length of the "mile", i.e. 5280 feet.

(2) Known anomalies in the theory of general relativity.

The Egyptian sacred pyramid inch is .0011 inches longer than our inch. 186,291 (accepted speed of light) x 1.0011 = 186496 or 99.931429 percent of 186,624. The speed of light, if calculated using the slightly longer sacred pyramid inch, is extraordinarily close to the square of 432.

Comment - Presume for a moment that you do not know the speed of light, but are aware of the equation E=mc2. An intuitive scientist who substituted the number 432 for "c" in the equation would be very close, if not precise, in the determination of this universal constant, that is, E=m(432)4. This illustrates the important concept of "reverse engineering" to find unknown quantities and constants by use of the cosmic number 432 and its multiples and divisors.

Got it?