All is Well: differential diagnosis

115journals.com/2018/10/06/all-is-well-another-contradiction-to-despair/

In the middle of October, I posted “All is Well”, another contradiction to despair. Events overtook me and I posted “Interval”, promising to post “All is Well: part 2”.

I will begin by explaining the difference between renal cell carcinoma and fat poor angiomyolipomas, so far as I understand it. The latter, also referred to as AMLs – not to be confused with Acute Myeloid Leukemia (that’s someone else’s nightmare) – are made up of blood, muscle and fat. Ours was spotted incidentally during an unrelated CT scan. It was a 4.1 cm. mass in the right kidney.

Did you know renal carcinomas can be diagnosed visually? So three weeks ago we got the bad news – kidney cancer. But wait a minute, the real target had been a 3.8 mass in the hip on the same side. Could be metastatic kidney cancer.

Honestly did not know I was capable of howling loud enough to alarm my neighbors.

But, stat, there was an MRI guided biopsy of the hip lump. Hip tumor not cancer. Rather a schwannoma, a tumor of the nerve sheath, in this case on the sciatic nerve and, in this case, benign.

Can there be kidney schwannomas ,we asked the Google gods. Possibly.

Let’s do another scan, stat of course, to see what is going on in adjacent organs – I imagine this one as High Def – and get a good look at the kidney interloper. Two days later, a voice mail message. Not cancer, but a fat-poor AML.

We had got used to the worst – every day terror, bleak future, all that good stuff. Hearing the no-cancer news, I had to put my head between my knees. One of us fell to cursing. The patient cried.

For three weeks, we had followed doctor’s instructions: prepare for the worst, maybe 17% survival in 5 years, gone in her early 60s. Then, when it was just kidney cancer, not metastatic we had a 96% chance. Now, we were back to 100%, or as close as you can be, given traffic on California freeways. We should have been happy, but we went around muttering, “It’s Tuesday, it must be cancer.” “It’s Thursday, it certainly isn’t.” “It’s Friday…”

We didn’t trust any doctor and certainly not a radiologist. The current one still wanted to call it cancer, despite a visible few fat cells. What we read, and we read everything, told us carcinomas had no fat. A radiologist in 2012 had reported that a tumor of 3.8 cm appeared on the left kidney. We ordered the CD record of it. Definitely, on the right. The radiologist had reverse-read the kidneys. If he had not, we would never have fallen for this funny little trick Nature sprang on us.

Lucky us. Lots of patients have discovered only after they’ve lost a kidney that they didn’t have cancer.

This morning, the urologist assured us that the offending growth will be biopsied when it is removed. When will that be? Well, first the main player, pain-wise, has to go. Simple to cut a schwannoma off a sciatic nerve, just don’t cut too close or -bingo- a different crisis here in Kern County. Recovery will take 2 days. When the patient feels better, she can call and get the kidney surgery date.

The issue of getting something to kill the pain is another whole drama. Governments make doctors’ lives hell when they prescribe opiate-type drugs. As far as I can see their draconian rules have not made a dint in the opioid crisis as yet. The neurosurgeon breezily suggested a pain clinic. Wait times for pain clinic appointments are at least 30 days. We live near an opioid addicted town, we might get lucky on a street corner. But, no, the urologist came through for the next 5 days. Not the same effective painkillers, not nearly as effective and rife with side effects. Weeping over the phone to the pain clinic got us an appointment in 5 days. And this is a temporary need, until surgery, for someone who can’t get up off the couch most days.

I am Canadian. We have the same struggles with diagnosis and waiting for surgery. I once waited for 7 weeks to have an intestinal carcinoid removed. I could eat only fluids or runny pureed veg. Great slimming diet. I was prescribed liquid morphine. But I absolutely never had to think about cost. Not true in California, even with Medicare.

This is a wonderful country, don’t get me wrong. Driving up the I-5 from the neurosurgeon’s, I remembered that, if California were a country, it would be the 5th largest economy in the world. But *#@! it, why doesn’t it take care of its people. My great nephew in Belgium had a 15 hour surgery on his brain, lived to tell the tale and got no bill.

Next up: insomnia of 10 months duration.

“All will be well and all will be well and all manner of things will be well”

 

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Writer Unblocked

wildanimalfightclub.com

wildanimalfightclub.com

https://115journals.com/2014/09/17/square-one-writers-block/

I wrote the blog above last summer after several people suggested I write a mystery. In it I lament my inability to get started. The post is about writer’s block. When I complained to those urging me that I couldn’t come up with an idea, they started brainstorming. Between us, we came up with a series of crimes, involving eco-terrorism, acts of protest or revenge against those who mistreat the environment. I brought the notes home with me when I returned home to Toronto in November. First, I had to catch up on a whole bunch of things after being away for six months – see the doctor and the dentist, that sort of thing. Then my brother visited from Brussels for several weeks and I was immersed in family. All the while I was thinking. By the beginning of January, I was ready to begin.

One morning, I sat down at the computer and bought Microsoft Office. I had found that Pages wasn’t what I wanted, but I had had an older version of Microsoft Word on an earlier computer and knew I would like it. Having done so, I thought, “You can’t waste that money,” and just started writing. The upshot has been that I have neglected this blog. Fortunately, readers have not and the stats have remained what they were when I was posting at least once a week. I thank Eleanor Catton and her book The Luminaries for that in large measure. Readers have helpfully corrected and added to the time line I posted so long ago that they now are closer to the material than I am.

https://115journals.com/2014/04/05/deconstructing-the-luminaries-a-timeline/

I have over 70,000 words of the mystery written and probably 30,000 more to write. I set it in same sort of the mountain village I spent the summer in in Kern County, California as well as in Bakersfield and Los Angeles. So the setting is in part high desert in a time of drought, which gives scope for ecological angst. It is also home to a newly flourishing flock of giant birds, the reintroduced Californian condor. At the same time, the area is threatened by development, particularly on one of the biggest ranches in North America and ground zero for the endangered condor. Although much of the area is set aside as Los Padres National Forest, the Angeles National Forest and a privately owned wild wolf conservation area, where bears, cougars, deer and mountain lions roam, there is also hunting. A recent regulation prohibits the use of lead shot because the condors, scavengers, die after eating unclaimed creatures killed with lead shot. Since there has been almost no precipitation for over three years, the forest is tinder dry and yet bright sparks (pardon the pun) are still lighting campfires and starting wildfire.

We had come up with six possible crimes and, drawing on my personal history, I created a group of ecological activists, who seem to be responsible as one event succeeds another.

In the beginning, the narration is third person, but soon switches to first person, the narrator, Joanna, a woman of my age -78 – who is more or less stuck in the mountain village with not much to do, except speculate about the ‘crime wave’. She has a companion, who is even older and who has a gift for befriending everyone she meets and the curiosity to gather information.

(Excerpt:

Chapter One: Too Many Bears

The bear came down from the mountain in late afternoon. She wasn’t hungry. She had eaten well, but she was missing the cub.

 She turned at the bottom along the well-worn path, picking up the scent of honey in the distance, and closer up, traces of many other bears, including the cub. The cub was old enough to manage on her own now and there would be a new cub in late winter. She was almost there when another darker smell stopped her in her tracks. Blood. Bear blood. She took it in. Not just any bear blood, the cub’s blood.)

The first ‘crime’ is committed by a vengeful bear, a bear that shouldn’t be there and may have had a human accomplice.

I haven’t settled on a title. At first I saved it under the heading Bear Mountain Mystery. Now it’s Murder at the Center of the World, which is what the Chumash Indians called the place. Bear Mountain -not its real name- the center of the center and the highest point was where everything was in balance. The bear comes from there and seems intent on restoring balance on the lower slopes.

A good deal of the action, however, occurs in Bakersfield, or Bako, as it is fondly known. The Kern County Sheriff’s Dept is headquartered there and the nearest hospitals. The Bakersfield farmland is part of the Central Valley and produces an astonishing amount of food consumed by North Americans. It also produces Valley Fever spores, that live in desert soil and are released by development. In addition, farmers are draining the aquifers, as irrigation is being cutback by drought regulations. The land is actually sinking in places.

The most surprising thing about writing this is the interesting characters that emerge effortlessly. The main detective, Al Guevara, is not at all the good old boy I expected. His belly doesn’t hang over his belt, he has a sense of humor, he is unusually forthcoming, he is married to a defense lawyer, has five children and has trouble making ends meet. Another surprise was a romance novelist, Arta Dietzen, a best seller in your local drugstore, who is writing her way through the alphabet, beginning with Love at the Aswan Dam. Joanna can’t read these books, but finds herself admiring the writer.

This is not the first book I have written. My memoir Never Tell, an e-book, has a link on my blog’s home page or http://nevertell.ca/.

Here is another except. This part depicts Arta Dietzen at a public meeting which is about the proposed new Condor Ranch Village, which she supports, but which ecologists oppose.

Good evening,” said Arta and she was speaking directly to me, warmly, just short of taking me in her arms. Of course, everyone else was having the same intimate experience. “I’m soo glad you could take some time out of your busy lives to support me here. Thank God for PVR’s.” And we all laughed a little too long.

“Now first thing, I know I’m going to disappoint you. I promised y’all that Oliver my good friend Oliver Warren, the CEO of Condor Ranch, would be here. He isn’t. Just wait till I get my hands on that no-good, low-life critter.” She screwed up her face and hunched over so that she looked like the bad witch in The Wizard of Oz.

Whoops of laughter. Howls of laughter. Tears of laughter. The audience had been well and truly salted with supporters.

She straightened up, did a resigned face and said, “He has sent Roger, dear Roger in his stead, like Abraham sacrificing Isaac. I only hope God and this audience will appreciate his willingness and not demand his head. I give you Roger Smith, Public Relations Officer for Condor Mountain Village. I’m just a shill, a poster girl if you will.” She withdrew to the seat in front of the podium that had been reserved for her.