Twitching the Puffin Itch

An item long on my bucket list is to one day see a live penguin in the wild.  I’ve seen them in zoos but I’ve never been to the lands they inhabit, at least not during my birding days.  You see, penguins are a Southern Hemisphere-only species.  They evolved in the cold waters of South America and Antarctica, although they have ventured to the equator at the Galapagos Islands, where the cold Humboldt Current allows them to thrive.   The Inhospitably warm tropical waters have prevented them from migrating any farther north.

Years ago, I had a similar life goal: to see a live kangaroo in the wild.  I spent a couple of weeks down under cycling along the east coast, from Sydney to Brisbane in search of a live kangaroo.  I totally whiffed.  I saw several kangaroo carcasses – victims of  speeding Aussies, but never a live one.  The day before flying out from Brisbane, I visited the Brisbane zoo so at least I could say I saw a live one.  Those poor beasts were so fat they couldn’t even hop, although they did manage to drag themselves around in search of free handouts.  I am determined not to whiff on a penguin when I get the chance.  But wait!  There are no penguins in the Northern Hemisphere, but there are the even cuter puffins!

Puffins are not particularly rare, but they breed only on islands of the north Atlantic and live most of their lives out at sea. The remote distribution necessitates a fair bit of effort to see them, unless you’re a Canadian or a Scot.  While visiting my son in Manchester ,New Hampshire, I realized that I was probably closer to a puffin than I ever would be, at least in this lifetime.  So I negotiated a day of freedom from my wife and son, hopped in my son’s ancient Toyota Corolla, and drove the tollways 3 hours northeast to Boothbay Harbor, Maine. There I boarded a Cap’n Fish’s tour boat and cruised nearly 2 frigid hours east to Eastern Egg Rock, a low seven-acre hunk of schist and quartzite peeping out of the icy North Atlantic.  The boat cruised one loop around the island, allowing for about  20 minutes of frantic scanning and photography (made difficult by a 900 mm lens, a pitching boat, and frozen fingers).  I saw and shot my puffins, although not as close-up as I would have liked, and then reversed the five-hour journey back to Manchester.  Six hours of driving, four hours on a heaving boat, for 20 minutes of birding bliss.  Twitching is the act of traveling long distances specifically to see a rare or vagrant bird that has already been located by someone else, with the goal of adding it to a personal checklist.  Puffins may not be an endangered species, or rare where I saw them, but I think this qualifies as my most radical twitch to date!

Atlantic Puffins and their colorful Breeding Beaks swimming offshore of East Egg Rock

Eastern Egg Rock is both the prehistoric and present-day southern limit of breeding colonies of the Atlantic Puffin (Fratercula arctica).  By the end of the 19th century, puffins had been virtually extirpated from Maine coastal islands by hunting for feathers, food and eggs, as well as predation by aggressive gulls.  As it turns out, puffins prefer to nest among large colonies of terns.  The terns are bigger, are agile aviators, and very aggressively attack any gulls that threaten their territory. But they tolerate the puffins.  They are, in effect, the puffins’ bodyguards.  Over time, the puffins’ range receded along with the terns’ to only the more remote islands of the far north Atlantic.

Puffins, much like salmon, spend their adolescent years out at sea, never setting foot on dry land.  Also, like salmon, after 2-3 years at sea, they return to their birthplace to breed.  This behavior means that even with protective laws, they needed help to repopulate their former homes.  

In 1974, Dr. Stephen W. Kress of the National Audubon Society, kidnapped some baby puffins from their burrows off the coast of Newfoundland, and placed them in man-made burrows on Eastern Egg Rock.  Audubon biologists hand-raised the pufflings until they fledged and flew out to sea.  A small number returned a few years later, but they were reluctant to breed on a rock barren of other puffins.  To encourage them, scientists placed wooden decoy puffins around the islands, and blasted out recordings of puffin calls  (my wife Jane says they sound like water buffalo).  By 1981, four pairs of puffins were breeding on Eastern Egg Rock, and the population gradually grew.  Today there are over 175 breeding pairs using the small rock every spring.  Luckily for the puffins, their bodyguards also made a robust recovery.

The colorful beak most likely evolved as to attract mates.

Puffins provide a classic case study in convergent evolution.  They look similar to penguins.  They can “fly” underwater much like penguins do.  Their monochromatic outfit resembles the penguin’s tuxedo.  But they are not closely related; penguins and puffins occupy separate branches of the avian family tree.   Penguins and puffins independently evolved the same survival tools such as their black and white camouflage, torpedo shape, and the ability to use their wings to swim.  

Unlike penguins, puffins retained their ability to fly (although somewhat awkwardly) perhaps because the north Atlantic had more predators than the penguins’ Antarctic homeland.  Unlike penguins, puffins evolved a unique serrated beak that enables them to snag several small fish at one go.  The bright colors of their beaks during the breeding season likely aid in finding a mate.Puffins were a most worthy twitch.  Where should I go now to twitch a wild penguin?

Click here to read my Policy on the use of AI in this blog.

A Note about AI and this Blog

I am coming back to this blog after a years-long hiatus, with renewed enthusiasm, stoked by a re-reading of one of my all-time favorite books, A Journey Home by Edward Abbey, and by the onslaught of AI rubbish being foisted upon us at every turn.  I am far from anti-AI.  The technology is unfathomable, fun, time-saving and it beats the hell out of feeding Google a series of keywords, then wading through the results.  I am in the midst of a long, drawn-out fight with my medical insurance company.  I use AI to keep track of this battle, my denied and appealed claims, and to write many of the emails, chat messages, and letters (which I suspect are being read and answered by AIs).  It is the only way for me to come close to leveling the playing field.  It has saved me weeks of time, and has enabled me to successfully fight off their worst denials.  Frankly, without AI’s assistance, I would have thrown in the towel on this fight long ago. 

But we cannot let AI take away our creativity.  Content from a human brain, filtered through an AI’s writing, reeks of artificiality, and loses its humanity.  I prefer human writing, Oxford commas and all. I have set myself a policy, subject to future changes, on the use of Artificial Intelligence (sometimes also known as Artificial Stupidity).  Follow this link to read it.  I would love to hear your thoughts via the comment box at the bottom of this page.

Vegas!

I know they say that “what happens in Vegas stays in Vegas” but I’m going to leak some of the happenings during our visit there in late April.

Las Vegas has changed. I first went there sometime in the late 70’s during my wanderings around the west after attending geology field camp in Montana. I remember bright sun, lots of neon, the Sahara, Rio, the Sands, Caesars – all the classic casinos. High-rise hotels, low-rise casinos. No monstrosities. Cheap buffets (ideal for a starving student). Old fashioned slots with real arms you had to pull. Single deck Blackjack. I don’t remember any shows – but I probably wasn’t interested.

During my 30-year career in SoCal, I probably came to Vegas 10 times. I did some gambling, saw the new monstrosities being built (Treasure Island, Luxor, and the like), and saw a show or two (Cirque Du Soleil), and still enjoyed cheap buffets. I played the poker rooms downtown (Binion’s, 4 Queens). Rooms were around $20. Vegas was filled with retirees filling up the slots. Back then Vegas made its money from gambling – everything else was there to make you want to stay. Inside the casinos you could never tell night from day. Not many kids around – I remember my young son being kept well away from the casino floor.

Later, after retirement, I visited Las Vegas a couple more times with friends. The friends will remain nameless, and events during those visits will stay in Vegas…

That Vegas is gone. Try finding a room on the Strip under $300 – especially after the resort fees, parking, and numerous other unbundling fees. Impossible. Jane and I stayed downtown at the Golden Nugget. Nice room but $300 per night? Not that nice. We could walk to the Fremont Experience – what is left of Fremont Street. Now it is more amusement park/theme park than it is a street. Not much of interest for me. I read somewhere that during the 1980’s, 80% of Las Vegas revenue was from gambling; now gambling is only 20%, the rest comes from entertainment, fine dining, shows, resort fees, $20 drinks, and $40 Starbucks orders (it was for two and included a couple muffins, but still!).

See Jane’s video of Fremont Street

We did spend one evening down on the strip. We had a forgettable dinner and saw one of the new Cirque Du Soleil shows, KA, which is the only show that fit our brief stay. It had the usual acrobatics, but was designed to tell some mythical story involving a young brother and sister. I found the story absolutely indecipherable (there was no dialog, just action and music), and the human feats overwhelmed by pyrotechnics, a stage that resembled a raft being tossed about in a hurricane, and music loud enough for my Apple watch to send me several alerts! Jane said she enjoyed it though…

I did a bit of gambling. Blackjack is now multi-decks only, with very unfavorable rules and lots of very bad side bets. I played some poker – I managed a small profit that didn’t quite make up for my donation at the BJ table. I broke even (nearly) on a couple of bets on the Cavs – Raptors game (lost the game but won the over), but my gambling budget turned black when the Guardians beat the Blue Jays on the point spread.

By far the most memorable experience in Vegas was our dinner at Oscar’s Steak House. Oscar’s was opened in 2011 by notorious mob defender and former mayor Oscar Goodman as a throwback to the Rat-Pack days. Originally it was known as Oscar’s Beef, Booze, and Broads. Oscar was not much interested in being PC. They’ve dropped that tag, but its cuisine is still very much old Vegas. My steak was done to perfection as was Jane’s and all the fixings were excellent. I had two delicious Martinis (Bombay and olives, shaken not stirred) that left me spinning. Jane said her creme brûlée was the best she ever had (and that is saying a lot!). All that for just over $300 for two.

I doubt I’ll return to Las Vegas in this lifetime.

Oscar’s Steakhouse – looking down Fremont Street.

The OC and Sedona

We have been in the USA for 12 days—time enough to be over jet lag, and time enough to assess my reaction to coming back after an 8-year absence.

I expected more changes—the OC was pretty much how I remembered it. A few businesses are gone, but most are intact. The biggest change was all the new construction that has completely altered the campus of my former employer, Cal State Fullerton. I literally got lost on campus! One comforting, still-intact feature: the old escalators in McCarthy Hall—and fittingly, they weren’t working.

While there, I was reminded of SoCal’s greatest attraction: the friendly people. I had forgotten what it was like to wander around Albertsons at 7:30 am and have everyone I pass (customers and staff alike) wish me a good morning. Likewise, passing someone on the sidewalk often led to a short conversation. All that sunshine makes for a friendly population—that is something I do miss.

Sticker shock hit me fast. Dinner for two at my favorite old taco stand, Q-Tortas, was $50+! We’re talking a walk-up window here, not a sit-down, tablecloths place. Granted, I ordered like my 30-year-old self, and we had enough food for two meals, but still! And gas! The cheapest we saw was $4.99 per gallon; the most expensive was at a lonely gas station in the middle of the Mojave off I-40—nearly $11 per gallon, complete with a sign warning customers not to complain about the high prices! We left without making a purchase.

We had a great time catching up with friends and former students while in Fullerton/Placentia. It was good to see I am not the only one who has aged over the last eight years!

Oh yeah…the birding was pretty good at Bolsa Chica. Nearly every bird was a lifer! Pics will be posted on FB.

After a few days, we moved across the desert to Sedona (with a quick stop at Rainbow Basin to show Jane where I spent so many days). She was mildly impressed. On the other hand, we were both quite disappointed in Sedona. Yes, the scenery is nice (maybe I am a bit jaded, and Jane is not a huge fan of desert landscapes), but one of the biggest reasons I chose to stay in Sedona for a few days was the large number of fine restaurants to try. Ha! We ended up eating four out of five nights at our Airbnb with Safeway ready-to-eat food.

On night one, we arrived too late (too late in Sedona is 8 pm, when most restaurants close!). Night two, we had an early burger and beer at a nearby casual restaurant. Then, for the next three nights, I tried to make dinner reservations—EVERY restaurant was completely booked, many of them for the next week or even month! Sure, we could have gotten a table at 3 pm two days later…we chose Safeway.

On our last night, based on ChatGPT recommendations, we drove up to Airport Mesa to watch the sunset. Holy crap—so did 5,000 other people! Huge parking lot, no views without people in the way. Some had 10-foot-long selfie sticks to get above the crowd. The sunset was a dud—no clouds, just an orange ball dipping below a distant butte. We left early to beat the traffic and drove to 3–4 restaurants (ones that don’t take reservations). They either had huge lines or the kitchen was already closed (7:45 pm). Back to Safeway.

We have been in the USA for 12 days – time enough to be over jet lag, and time enough to assess my reaction to coming back after an 8 year absence.

I expected more changes – the OC was pretty much how I remembered it. A few businesses are gone, but most are intact. The biggest change was all the new construction that completely changed the campus of my former employer, Cal State Fullerton. I literally got lost on campus! One comforting still-intact feature: the old escalators in McCarthy Hall – and fittingly they weren’t working.

While there I was reminded about SoCal’s greatest attraction: the friendly people. I forgot what it was like to wander around Albertson’s at 7:30 am and have everyone one I pass (customer and staff alike) wish me a good morning. Likewise, passing someone on the sidewalk elicited a short conversation. All that sunshine makes for a friendly population – that is something I do miss.

Sticker shock hit me fast. Dinner for two at my favorite old taco stand, Q-Tortas was $50+!. We are talking a walk-up window here, not a sit-down table-cloths place. Granted, I ordered like my 30 year-old self, and we had enough food for 2 meals, but still! And gas! Cheapest we saw was $4.99 per gallon – most expensive was at a lonely gas station in the middle of the Mojave off I-40 – nearly $11 per gallon, and complete with a sign warning customers not to complain about the high prices! We left without making a purchase.

We had a great time catching up with friends and former students while in Fullerton/Placentia. It was good to see I am not the only one who has aged over the last 8 year!

Oh yea….the birding was pretty good at Bolsa Chica. Nearly every bird was a lifer! Pics will be posted on FB.

After a few days, we moved across the desert to Sedona (with a quick stop at Rainbow Basin to show Jane where I spent so many days). She was mildly impressed. On the other hand we were both quite disappointed in Sedona. Yes, the scenery is nice (maybe I am a bit jaded, and Jane is not a huge fan of desert landscapes), but one of the biggest reasons I chose to stay in Sedona for a few days was the large number of fine restaurants to try. Ha! We ended up eating 4 out of 5 nights at our airBnB from Safeway ready-to-eat food. On night number 1, we arrived too late (too late in Sedona is 8 pm when most restaurants close!). Night two we had an early burger and beer at a nearby casual restaurant. Then for the next 3 nights, I tried to make reservations for dinner. EVERY restaurant was completely booked – many of them for the next week or even month! Ok, we could have gotten a table at 3 pm for 2 days in the future….we chose Safeway. On our last night, based on ChatGPT recommendations we drove up to Airport Mesa to watch the sunset. Holy crap! So did 5000 other people! Huge parking lot, no views without people in the way. People had 10 ft long selfie sticks to get up above the crowd. The sunset was a dud, no clouds, just an orange ball dipping below a distant butte. We left early to beat the traffic and drove to 3-4 restaurants (ones that do not take reservations), they were either huge long lines, or the kitchen was already closed (7:45 pm). Back to Safeway.

Sedona wasn’t all bad. We loved our big Airbnb house in a deathly quiet neighborhood—it had a nice yard and was well equipped. I did discover that one of their coffee mugs was decidedly not microwaveable—I have two large blisters on my fingers to prove it. The other nice surprise was the Sedona waste disposal site. Yes, you read that right. Its actual name is the Sedona Wetlands Preserve. The city of Sedona teamed up with the National Audubon Society to create a man-made series of marshes and ponds. Great birding locality with numerous waterfowl and passerine species. I spent two fun mornings there.

We also spent a day driving up to the South Rim. For me, the Grand Canyon from the rim is just a big hole. Jane was likewise only mildly impressed. It did bring back memories of the numerous backpacking trips I did there in my youth, and the raft trip I did with my son and 20 colleagues 20-odd years ago. It makes me think about doing another raft trip—anyone want to go?

We are off to Vegas today. I’ve heard about big changes there too (and high prices). I’ll tell you about it later!

Homecoming???

Today Jane, my wife, and I will fly to California and points beyond. It will be Jane’s first time in the United States, and essentially my first time back since the fall of 2018. (I did return briefly in 2020 for a medical procedure and barely escaped back to Thailand before the Covid shutdown.)

What will we find?

I lived in the United States for most of my first 59 years, but I no longer call it home. My home, my house, my friends, and most of the people I consider family are now here in Thailand. The country I was once so proud of—when we elected Obama—has changed into something I sometimes barely recognize, at least as far as the news and politics go.

During this visit we will spend time with friends in Southern California and with family in Cleveland and New Hampshire. We’ll also spend about ten days in Sedona and Las Vegas. I plan to do some birding; we’ll do some shopping and a little sightseeing. I long to see the desert again, to watch a ballgame in my hometown, and to taste real Mexican food.

Throughout the trip I suspect I’ll be acutely aware that I am a visitor now, not a resident. I worry about the prices. About driving on the right side of the road again. About stumbling into tense political conversations. About no longer quite belonging.

But more than anything, I’m curious.

How has the culture changed? Are Californians still as friendly as I remember? Are New Yorkers still as brusque? Will Cleveland still feel like my hometown?

I’m sure that while I’m there I’ll wonder what life might have been like if I had stayed, worked a few more years, and retired in the United States. My guess, though, is that before long I’ll start feeling homesick—for Thailand.

And of course, there are two weeks in Costa Rica still to come. Stay tuned!

Luck, Travel and the Virus

I am a lucky bastard. In mid-February I had cancer and traveled to the USA to be evaluated for surgery. I qualified and had surgery on March 3, just about a week before Covid-19 shut down most non-emergency procedures. Lucky. A week later, I was out of the hospital and recuperating at a friends house (thanks to the Kirby’s!). Early the following week I could see the coming lockdown in Thailand and bought a new ticket in an attempt to beat the lockout. I made it home with less than 24 hours to spare. Lucky again. I wasn’t even required to quarantine. Without my lucky timing I would likely be homelessly wandering the streets of LA…or worse.

The lockdown in Thailand was pretty soft. Restaurants could only sell take away, but many businesses stayed open, some with curbside service. Streets were empty for a week or two but then traffic picked up. Tourists mostly fled. By the middle of April, my life was back to normal, but the borders were shut tight and all domestic travel was prohibited. Even Thai citizens living abroad were prohibited from coming home. It worked; locally transmitted cases of Covid-19 plummeted. Gradually, restaurants and golf courses opened, followed by bars, although most places that rely on tourists remain shuttered. The number of Covid cases dwindled to none. The government began allowing Thais to return home, but kept them in fortress-like quarantine. Thailand’s (pending) victory over Covid adds to my lucky streak. There’s a big advantage having an authoritarian government and a fairly obedient citizenry. Finally, domestic tourism began to not only open up, but to be strongly encouraged with some very good “Thai Resident” discounts.

Now it has been well over 2 months since the last local transmission of Covid-19. The only new cases are among the returning Thais (I never realized how many Thais were living in places like Sudan, UAE, Egypt, and everywhere else on the planet). A small percent of those returning tested positive in state quarantine. Last month they began letting in a trickle of foreigners, such as those that had family here, or had work permits. A few of them also have tested positive, but so far the virus has not escaped the quarantines. Best of all, my first post-op MRI came back clean, and I am officially NED (no evidence of disease)! How much luck can I have? Now, with virtually no foreign tourists, and many hungry resorts, Jane and I have set out for a domestic adventure.

Booking a trip was a bit difficult, with resorts and airlines unsure or uncommitted to opening. It took two tries to book our airline tickets and two tries to book a resort. Our first stop was Khao Sok National Park.

Traveling by air within Thailand was easy and convenient. Masks required, and no food or drink on board – even the seat pockets were emptied. But all seats were used, and outside of temperature checks and logging in to the Thai Chana (translates as “Thailand Wins”) surveillance app, the travel was uneventful. With no security or check-in queues, air travel was easy and pleasant.

Masks up upon arrival at Surat Thani airport.

Our first stop for 2 nights was Khao Sok National Park. The Park’s main attraction is the large reservoir backed up behind Ratchaprapha Dam. The dam, completed in 1987, flooded towering karst topography and virgin rainforest. This area is the wettest in Thailand, with over 3500 mm (138 in) of annual accumulation. Long-tail boats service several floating hotels anchored to the wilderness shoreline. We stayed at the Panvaree the Greenery, a high-end option about 45 scenic minutes from the Dam.

The weather during our stay was drizzly and dreary, fitting for one of the wettest places in Thailand. On our first night, we had quite an overnight storm that left us a bit queasy, and blew away some cloths we had hung out to dry. The next morning, the resort staff couldn’t find their rescue boat. Finally they realized that it sunk in the storm!

The staff spent several hours refloating their “rescue” boat.

The highlights of our stay included kayaking the local waters, hiking to a jungle cave festooned with glittering stalagmites and stalactites, and enjoying delicious and abundant southern Thai food at our floating home. I highly recommend the Panvaree – very friendly and comfortable for a floating, wilderness resort. But I couldn’t help but feel melancholy about the entire experience.

On the way to the Cave.

The low water level of the reservoir exposed about 10 m of normally submerged shoreline and the exposed, drowned deadwood constantly reminded me of what a beautiful albeit inaccessible place this must have been before the engineers arrived. The building of the Dam necessitated moving several villages and displaced more than 300 households, but also generates 240 megawatts of hydroelectric power and fuels a small tourist industry surrounding and within the park. For anyone willing to swallow these contradictions, I would advise visiting the lake when the reservoir is full; that way at least you can pretend the lake is natural.

Our trip will continue on Koh Phangan.

Covid-19 in Thailand, a Mystery

Screenshot 2020-04-13 15.34.54

Something strange is  going on in Thailand.  By all measures, Thailand should have been devastated by the Covid-19 pandemic by now.  In January and early February over 1 million Chinese landed in Thailand.  As of mid-February, over 100,000 Chinese travelers were still in Thailand.  Just walking around Chiang Mai in early 2020 felt like walking around a Chinatown.  Most certainly, the SARS-CoV-2 virus landed in Thailand in late December, or early January.  In fact, the first confirmed case outside of China was found in Thailand on January 13.  

 

Thailand is a densely settled country.  The overall density is 354 people per mi2 but this actually understates the reality in the urban areas; Bangkok has a population density of 13,700/ mi2.   Thai’s love to hang out in large groups.  The more the merry here. 

140053697-chiang-mai-walking-street-chiang-mai-thailand-12-january-2020-a-local-handicraft-market-made-from-si
Chiang Mai’s walking street in mid-January 2020.  If I were a virus looking for a pandemic, this would be a good place to start.

Thailand would seem to have been fertile ground for a new virus that was seeded here early and often by traveling Chinese.  But it never really took off.  Why?

Today, there have been 2,579 document cases of Covid-19 in Thailand and 40 deaths.  By comparison, New York State with a population less than 1/3 of Thailand has 189,415 cases, and 9,385 deaths.  The disparity is getting larger by the day.  Yes, I know we are probably comparing apples to oranges.  There is a very large discrepancy in the testing rate.  As measured per capita, New York tests 23 times more people than Thailand.  But New York has 73 times more cases, so when corrected for the testing disparity, New York still has 3 times more cases as compared to Thailand.   I would argue that the testing disparity is not that large; both New York and Thailand (at least at the beginning) had similar criteria for doing the tests – basically you had to be sick enough to be at the hospital.  I think a significant part of this testing-disparity is because there were fewer people in Thailand sick with Covid-19. I would further argue that the number of deaths is not nearly as impacted by the testing disparity.  Both New York and Thailand have likely undercounted deaths by counting only hospital fatalities.  The reality is that if Thailand had a similar per capita death rate, there should be nearly 30,000 deaths here!  But there are only 40 deaths in Thailand as of this writing.  This huge difference cannot be caused by lack of testing or any effort at hiding the death toll in Thailand.  

Thailand did not go into lock down until around March 20, and even now, the lockdown is not nearly as complete as in New York or California.  Prior to mid-March that it was pretty much business as usual here.  There was no early and aggressive intervention by the Thai government that kept Covid-19 at bay.

What is it that makes Thailand such infertile ground for the SARS-CoV-2 virus?  Could it be climate?  Perhaps the universal inoculation of the Thai population with the BCG vaccine gave them a large degree of immunity to Cover-19?  Perhaps, it’s the Thai habit of “waiing” instead of shaking hands?  Could it be some quick of genetics?  Something in the food here?  Why is this not big news, and why isn’t this discrepancy being widely studied?  Sorry, I only have questions.

Out of the Tunnel

It has already been two weeks since the operation to remove a NET from my mesentery.  My ordeal began on Monday, March 2 at 5 pm when I checked into Cedars-Sinai Medical Center for an unusual early-evening combined colonoscopy and endoscopy.  I remember nothing of these procedures other than waking up about 30 minutes later with a blurry doctor telling me he found of nothing. My innards were perfectly clean as far as he could see, which is pretty amazing considering the abuse I have subjected them to over the years.   Since my surgery was scheduled for the next morning at 7 am, they kept me right there in the hospital.

IMG_1701
Five tiny incisions, and one slightly larger one.  I’m pretty sure I no longer have a belly button.

The next several hours were a blur.  I think they must have slipped me something.  The last thing I remember was looking at the red digital clock across the room and seeing 7:00 a.m.  I awoke amid a misty commotion all around me of doctors and nurses.  I squinted through the chaos and saw another red LED clock that read 10:00 PM……Holy shit!  10 PM???  I remember doing the math and thinking I was out 13 hours!!!! Later I figured out it was really 15 hours!  I was expecting 2-3 hours.  Early the next morning I was told the operation actually took 9 hours, but it took me another 6 hours to come out of the anesthesia.

According to my surgeon, who stopped by the morning after , the surgery took much longer than anticipated due to the positioning of my mesenteric tumor amidst a jungle of critical blood vessels.  If he were to nip one of them, I could lose half my bowels.  He made the decision to go 100% robotic knowing that this would triple or quadruple the time for the operation, but allow for very precise cuts.  As a bonus, they found the primary (e.g. “original”) tumor in my small intestine, which they resected. I have been assured that I won’t miss the 9 cm of removed bowel.  The primary tumor was not visible on any of the previous scans, and that they found it is of great significance.  There was no longer any mystery about the source of my mesenteric tumor, and by removing the primary tumor, my chances of a quick recurrence should be reduced.

IMG_1693
Day 3 in the hospital.  I look way better than I feel.

My doctor asked how I was feeling, and I told him I felt like someone punched 6 small to big holes in my belly, rummaged through my entire digestive tract, then yanked out a sizable section out through my belly button.  And then Mike Tyson used my belly for a punching bag for 5 minutes.  Actually, except for Mike, that is pretty much just what happened.

The next 6 days were a roller coaster of progress and setbacks, including an infection of unknown origin that left me feverish for 2 nights, getting dropped by a rushing X-ray tech (set me back at least 1 day), spasming at my first attempt to drink a clear liquid, and pained shuffles up and down the corridors.  But progress finally won out over the setbacks, and they released me almost exactly 1 week after I was admitted.

I made my final visit today to Cedars-Sinai for a last follow up with my surgeon.  He gave me the good news that I am officially NED (no evidence of disease)!  But Neuroendocrine tumors, even when you’ve had them removed, have a propensity to recur.  So I will be on a surveillance program, with scans every 3 months for at least the first year.  They are recommending that I can stop the monthly injections that I have been getting to slow down the cancers growth (a big relief to my digestive system).  This is all the best news I could have hoped for!

The care I received at Cedars-Sinai was amazing, from the orderlies, nurses, technicians (well, except for that one harried X-ray tech) and the dozen or more doctors that were involved in my care.  My main team consisted of my surgeon, a NET oncologist, gastroenterologist, and urologist.  All of them have been caring, funny, and exuding professional competence.  In spite of this being the most difficult medical journey of my life, I feel like I made the best choice!

I’ve now been staying with close friends just waiting to heal up sufficiently to fly back home to Thailand.  In the meantime, the world has imploded with the Covid-19 pandemic and it’s now a race against time through a dark tunnel to get back home before Thailand closes its gates.  If I can’t get back in time, I will be officially homeless…

Life Lesson #1: Believe the Labels

A quick update (as usual) regarding my upcoming tumor extraction.  My surgery has been delayed until Tuesday early morning March 3) due to a slow insurance approval.  I’ve been assured that everything is now is now a go.  The fun starts Monday with a double scope (endoscopy/colonoscopy, hopefully not at the same time) at 5 pm to be followed by an overnight in the hospital and surgery bright and early (7 am) on Tuesday.  Light is now slightly visible at the end of the long tunnel.  Now for the life lesson.

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Who reads this?

When my son, Chanon was around 8 years old, I wanted to expose him to winter sports.  I skied from a very young age, and I wanted the same for Chanon.  He decided that snowboarding was more fashionable.  OK, I said, then I will snowboard too.  How hard can it be?  I am an expert skier, and sliding on snow with one board or two can’t be that much different, can it?  So we travelled up to Mammoth Mountain, California for a weekend of snowboarding.  Saturday morning I marched into the rental center and rented a snowboard and boots, while Chanon had a snowboard lesson.  I waited while his lesson finished, then we both headed for the lift.  I confidently strapped on the board like I’d been doing it my whole life, and managed to get on the lift without incident, but I kept reaching for my non-existent ski poles.  Getting off the lift at the top (of the bunny slope) was another issue.  I immediately face planted and had to be quickly dragged out of the way by the lift attendants.  I then proceded to wipe out at least 10 times in the 30 m between the top of the lift and the start of the downhill.  By the time I was 100 m down the slope, I had fallen so hard on my ass that I was pretty certain I had broken by coccyx.  Chanon enjoyed this very much.

That “run” ended after 100 m, when I unceremoniously unstrapped my snowboard and post-holed my way to the bottom of the run and marched straight into the snowboard school.  One lesson and I was good to go, although I still fell a few times smack on that broken tail bone.  Unlike skis, it seems with snowboarding, you either fall on your ass, or you face plant, no other choices. However, snowboarding is actually easy once you get the non-intuitive hang of it.  But the damage to my bum was done.  From that day on, for the next several years, I lived with a sore ass.  It felt ok most of the time, until I sat for more than 10 minutes.   X-rays showed  that it was deeply bruised, but intact.  Apparently your coccyx has a limited blood supply and heals slowly.  For me, that was about 5 years.

I could deal with the pain by sitting on the edge of my seat, or getting up out of my chair every few minutes.  The hardest thing though was enduring the 20 hour flight back and forth from the USA  to Thailand, which in those days was a 2-3 times per year ordeal for me.   I bought one of those neck pillows, and sat on it with my coccyx in the hole, but that only slightly delayed the agony.  Vicodin to the rescue!  I was given a prescription of this opioid following a root canal, and dutifully filled it, but never needed it.   I quickly found out that a dose of Vicodin about an hour into the flight would easy my pain and allow me to sleep for several hours.  Mostly, I avoided any alcohol prior to taking the Vicodin….until one fateful trip.

I justified the pre-dinner scotch and soda by telling myself that I would wait a couple of hours before swallowing the Vicodin.  Yea, I know the label on Vicodin says “no alcohol”  but who reads those?  Everything felt fine, and I sat reading a novel waiting for the medication to kick in.  Suddenly, I felt something I’d never felt before, and it is very hard to describe.  It felt like my blood was quickly heating up and turning to steam.  The word began to swirl.  I thought to myself – is this what it feels like to have a stroke?  Or was this a heart attack?  Or was I about to explode because of an alien fired energy beam?  Somewhere in the inner, reptilian part of my brain, I decided that I was dying, and that since I was dying it would be a whole lot better to die in the toilet rather than in my seat.  I was seriously afraid that no one would notice for several hours if I died in my seat.  I’d probably stink by then. So I undid my seat belt, rose, and took 3 steps down the narrow aisle toward the aft of the plane. Boom!  Out cold in the aisle, at 40,000 feet, somewhere over the north Pacific Ocean.

I awoke a few seconds/minutes/hours later.  I was on my back looking up at three lovely Thai Airways flight attendants, their gorgeous faces swathed in ethereal auras, staring down on me.  I was certain that I was dead and this was heaven.  That notion was soon dispelled in a wave a nausea and dizziness.  The young women managed to haul me up to my feet and back into my seat, but I told them that I was about to pass-out again, or throw up, or both at once.  They quickly moved me up to one of the lay-flat business class seats, and I was comatose within seconds. Some unknown time later one of the male flight attendants rudely shook me awake and ordered back to my economy class seat. I guess my allotted time to be ill was finished.

I slept quite good the rest of the flight, and my ass didn’t hurt.  I survived, albeit a bit shaken.  Life lesson:  Vicodin or alcohol.  Not both.  Read and believe the labels.  Since that time, I have chosen alcohol, and left the Vicodin at home.  And several years later, my coccyx finally healed.

Coming Out of the Closet

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Before I come out, just a quick update on my pending NET removal.  I’ve met with the surgeon, had my MRI, and had my pre-op testing completed.  Forward all engines!  My surgeon, Dr. Kosari at Cedars-Sinai Medical Center in LA was very upbeat.  He said the surgery should be buying me many years.  I may get my gall bladder out as a bonus; this is a preventative measure since the octreotide injections that will likely be a long-term part of my life tend to gum up your gall bladder.  Why do we have a gall bladder anyway since we can apparently survive quite nicely without one?  Maybe they should just remove it at birth along with your appendix. My surgery is scheduled for 7 am February 28.  Stay tuned.

At the risk of TMI, now for the closet.  Not the closet you’re all thinking of (sorry to disappoint).  It is an embarrassing medical closet.  It tuns out I am afflicted with another hard-to-treat disease. If you are at all squeamish about the details of men’s anatomy, now’s the time to close your browser………

I have Peyronie’s disease.  You can read all about it here.  I’ll give you the one sentence definition:  It is a condition whereby scar tissue builds up within your penis causing it to bend at a rather inconveniently acute angle (mine is about 70 degrees) that makes any kind of traditional bedroom fun geometrically impossible (not to mention extremely embarrassing).  The cause is thought to be either an acute injury or (as in my case) accumulated unnoticeable minor injuries during intercourse.  Woman-on-top is a big risk factor.  As my urologist at Cedars-Sinai said, it is perhaps just abnormal wear and tear.  Here’s what blows my mind:  According to my urologist, 9% of older men have this condition (and 3% of younger men)!! How could nearly 10% of men have this condition and I never heard of it until Dr. Google revealed it to me?  More likely than not, one or more readers of this blog also suffers this disease.   It’s time to bring this disease out of the closet. Sure, this is an embarrassing ailment, but really is it more embarrassing than hemorrhoids?  Worse than jock rot?  Worse than ED?  Worse than incontinence? We see all of these on tv ads everyday.  Hopefully more awareness will lead to more research and more treatments.  Hence my coming-out party.

I do understand why this malady is in the closet.  It takes a very heavy psychological toll.  Some men have been known to become suicidal.  To be sure, as ailments go, there are many worse diagnoses.  No one has died from Peyronie’s (not counting suicides).  For me, the realization that I had a condition that was not immediately treatable (at least in Thailand), and that would prevent sexual activity, was devastating.  Being otherwise healthy, but realizing sex was not going to be part of my life, hit hard.  With the help of a very understanding partner, I focused on other aspects of life.  In the end, I have to come to the realization that overall I’ve been pretty damn lucky, and there was still plenty to live for.  But not being able to be intimate with my partner is still quite painful.

It started about 18 month’s ago, so I have known about it for awhile.  Unfortunately, in Thailand, the only treatment they know about is radical surgery that sounded to me like partial castration.  I even travelled to a so called “specialist” at a top end hospital in Bangkok.  Surgical straightening, resulting in drastic shortening, was the only option he offered. Maybe I only imagined the sneer on his face.  

This week I found out the good news that there is minimally invasive treatment for Peyronie’s available in the USA. The treatment involves expensive injections of FDA approved, scar dissolving Xiaflex, and physical therapy (kinda sounds like rehabbing a shoulder injury).  My urologist said I am an ideal candidate – my condition has reached a “chronic” phase with no pain and no progression and my scar tissue is in the best location for this treatment.  So there is hope!  The treatment will necessitate anywhere from 1-4 sets of injections (each set done over a 5 day period) with each set of injections spaced 6 weeks apart.  This would necessitate returning to LA from 1-4 times this year (I can’t have an injection while rehabbing my cancer surgery).  Pending insurance approval, my first injection would be in August.  

The question now will be, is it worth it?  If I was 35 years old there would be no question, but at my age?  The cost of 4 trips to the USA will be substantial.  According to the doctor, the success rate is better than 50%, but I still risk spending money for nothing.  This is a decision that I will need to make over the next few months.  For now, I will concentrate on my upcoming surgery and the aftermath.  I will revisit this once I am fully recovered.  Who knows, by the end of the year I just might be once again an upstanding man (groan).

Thank you for allowing me to share this story.  Just getting it out here is a cathartic.  It will be nice not to have hide in the closet, and I’m ready for the inevitable banana jokes!